Serum Levels Of Chorionic Gonadotropin Research Articles

How to Optimize Laparoscopic Management of Cornual Pregnancy

We report a case of a 32-year-old woman, gravida 6 para 3, with a history of 2 previous miscarriages. She presented with a pelvic pain to our emergency department. She was hemodynamically stable with a β-human chorionic gonadotropin serum level of 26 342 IU/L. Ultrasound was suspicious for an interstitial pregnancy (Fig. 1). After patient consent, surgical management was decided considering her obstetric history. She underwent an explorative laparoscopy; a nonruptured left cornual pregnancy was found (Fig.

Malignant postpartal gestational trophoblastic neoplasm: A rare appearance of equal ultrasonography and operative finding in uterine placental site trophoblastic tumor and choriocarcinoma

Introducton. Frequency of malignant gestational trophoblastic neoplasms (GTN) is estimated at 1.03 cases in 1,000 deliveries with 5 fold greater risk in patients younger than 20 and older than 40 years. Serum value of human chorionic gonadotropin is the most relevant parameter in diagnosis of GTN. In placental site trophoblastic tumor (PSTT), serum levels of chorionic gonadotropin do not have the same significance as they do in other malignant GTN. Definite diagnosis of PSTT is almost always confirmed by immunohistochemistry. Case report. In the course of just a few months (August 2016 to January 2017) in the Clinic for Obstetrics and Gynecology ?Narodni front? in Belgrade, two GTN patients were admitted and treated, with almost equal ultrasonography (pictures), operative findings and postoperative outcome. Due to histopathological and immunohistochemical examinations two different types of malignant GTN were confirmed. The first patient (admitted in August 2016), 26 years old, was admitted for uterine bleeding 11 months after vaginal delivery and histopathological examination confirmed PSTT. The second patient (admitted in January 2017), 27 years old, was admitted 4 months after vaginal delivery because of uterine bleeding. Histopathological examination confirmed choriocarcinoma. Conclusion. Considering the fact that malignant GTN can appear in different types, with different ultrasonography pictures, this report is significant because two distinctly different malignant GTN entities could appear with equal clinical manifestations and equal ultrasound pictures even when they may have very different course of the disease treatment and outcome. Such cases need correct diagnosis which may be reached only after immunohistochemical analysis. The ultrasound patterns, both in gray scale, color flow, and Doppler values, were almost equal in both cases and guided the diagnostic procedures to the final treatment, even regardless of their very different histopathology.

Total Hysteroscopic Treatment of Cervical Pregnancy: The 2-step Technique

To evaluate the efficacy of total surgical treatment of ectopic cervical pregnancy [1] with a minimally invasive approach performed by hysteroscopy [2]. Step-by-step video demonstration of the surgical technique using 5 mm hysteroscopy followed by 10 mm resectoscopy. A research and university hospital (IRCCS Burlo Garofolo, Trieste, Italy). A 41-year-old woman with an ultrasound diagnosis of ectopic cervical pregnancy at 6 + 6 weeks of gestation with a beta human chorionic gonadotropin serum level of 55.951 mUI/mL. We performed a 2-step technique using 5- and 10-mm hysteroscopy (Video 1). During the first step, a 5-mm Bettocchi hysteroscope (Karl Storz, Tuttlingen, Germany) with a 5F bipolar electrode Versapoint Twizzle (Gynecare, Menlo Park, CA) was used. In this phase, the gestational sac was identified in order to confirm the diagnosis and its site of implantation. Later, the gestational sac was opened, and the pregnancy was terminated by cord section under an embryoscopic view (Fig. 1). Finally, a partial vessel coagulation was performed. Afterward, the cervix was dilated, and a resectoscopy was performed. During the second step, a 10-mm Gynecare resectoscope with the bipolar Gynecare Versapoint was used and the gestational sac with the embryo was removed; subsequently, a complete chorial villi resection was achieved. At last, a coagulation of bleeding vessels on the implantation site in order to control the hemostasis was performed (Fig. 2). The study was approved by the institutional review board. The patient was discharged 24 hours after the procedure with an uneventful postoperative course, and the beta human chorionic gonadotropin serum level became negative in 20 days. After 40 days, the ultrasound cervical findings were regular, whereas office hysteroscopy showed the implantation site scar. After 5 months, the patient was pregnant with regular intrauterine implantation (Fig. 3). The total hysteroscopic approach with a 2-step technique offers an effective, safe, and minimally invasive surgical treatment to ectopic cervical pregnancy. Considering that our method, in contrast with the recent literature [3-5], is performed without any medical treatment, we reported for the first time an approach, that deserve more clinical data to confirm its effectiveness.

Perception and knowledge of early pregnancy assessment unitsamong perinatal practitioners in Europe.

To investigate perceptions of early pregnancy assessment units (EPAUs) among perinatal practitioners working in Belgium, France, and Switzerland. A prospective multinational survey was conducted between September 1, 2015, and May 21, 2016. Obstetricians, gynecologists, medical doctors, radiologists, and midwives were recruited during meetings, via e-mail invitations, or through the websites of regional obstetrics and gynecology scientific societies. The survey comprised 17 questions that assessed the participants' knowledge, interest, and management of early pregnancy. Of the 871 individuals invited to participate in the survey, 306 (35.1%) responded. Most of the participants were gynecologists and/or obstetricians (225 [73.5%]). A total of 258 (84.3%) participants had no or limited knowledge about EPAUs. Furthermore, 211 (69.0%) participants reported incorrect management when they visualized a gestational sac without embryo and 265 (86.6%) misinterpreted changes in serum levels of chorionic gonadotropin during early pregnancy. In all, 201 (65.7%) participants were interested in collaboration with an EPAU; however, only 125 (40.8%) had sufficient time and resources available to support a patient's psychological distress after early pregnancy loss or salpingectomy. Knowledge about early management of pregnancy was limited among the perinatal practitioners surveyed; however, the concept of EPAUs was welcomed bymany.

Human chorionic gonadotropin serum levels following ovulation triggering and IVF cycle outcome.

The clinical significance of serum hCG levels after ovulation triggering was studied previously with conflicting results. Our aim was to study the correlation of hCG levels on the day after ovulation triggering using recombinant hCG (r-hCG) with treatment outcome. A prospective observational study of all fresh IVF/ICSI cycles in a single medical center, between January 2015 and June 2016, was performed. hCG serum levels were obtained 10-12h following ovulation triggering with 250mcg r-hCG. Clinical and laboratory outcome parameters were compared between cycles with serum hCG above and below median level. A multivariate regression analysis was performed in order to study the association between hCG levels and live birth rate, after controlling for confounders. Overall, 326 cycles were included. Median serum hCG level was 91.35IU/L. hCG levels were lower as age and BMI were higher (p = 0.004, p < 0.001, respectively). The study groups did not differ with regard to clinical pregnancy rate (p = 0.14), live birth rate (p = 0.09), fertilization rate (p = 0.45), or metaphase II oocyte rate (p = 0.68). On multivariate regression analysis, hCG level was not associated with live birth (aOR 0.99, 95% CI 0.98-1.005), after controlling for patient's age and BMI. hCG levels on the day after ovulation triggering with 250mcg r-hCG are inversely correlated with patient age and BMI. However, they are not correlated with any clinical or laboratory outcome parameter. Therefore, testing for hCG levels after ovulation induction seems futile and cannot be recommended.

Follow-up of gestational trophoblastic disease/neoplasia via quantification of circulating nucleic acids of placental origin using C19MC microRNAs, hypermethylated RASSF1A, and SRY sequences.

The aim of the study was to evaluate the effectiveness of placental-specific markers, extracellular fetal DNA (sex-determining region Y and hypermethylated RASSF1A sequences) and circulating C19MC microRNAs (miR-516-5p, miR-517-5p, miR-518b, miR-520a-5p, miR-520h, miR-525, and miR-526a) for the diagnosis and consecutive follow-up of gestational trophoblastic disease/neoplasia. Increased levels of extracellular fetal DNA and C19MC microRNAs were detected in patients with active disease when compared with the period when the patients reached remission of the disease. The positive correlation between plasma levels of hypermethylated RASSF1A sequence, C19MC microRNAs, and human chorionic gonadotropin serum levels was found. MiR-520a-5p had the best performance to detect patients with active disease (a positive predictive value of 100% at a null false positive ratio (FPR)). MiR-516-5p and miR-525 were able to diagnose 100% of women with active disease at the FPR 3.9%/7.7%. The overall predictive capacity of single miR-526a (81.8% at null FPR), miR-517-5p (90.9% at 15.4% FPR), miR-518b (100% at 38.5% FPR), and miR-520h (90.9% at 26.9% FPR) biomarkers to detect active disease cases was slightly lower. Transient increase in C19MC microRNA plasma levels after the first cycle of chemotherapy indicated the decay of placental trophoblast residual tissue. The increased levels of extracellular fetal DNA and placental-specific C19MC microRNAs are associated with gestational trophoblastic disease/neoplasia. Screening of extracellular placental-specific biomarkers may represent an additional option to identify a significant proportion of women with active disease and to monitor the therapy response. Non-invasive follow-up of the decomposing residual tissue in the form of extracellular nucleic acids of placental origin packed into apoptotic bodies derived from placental trophoblasts is available.

Is chemotherapy necessary for patients with molar pregnancy and human chorionic gonadotropin serum levels raised but falling at 6 months after uterine evacuation?

ObjectiveTo compare the outcomes of Brazilian patients with molar pregnancy who continue human chorionic gonadotropin (hCG) surveillance with those treated with chemotherapy when hCG was still positive, but falling at 6months after uterine evacuation. MethodsRetrospective chart review of 12,526 patients with hydatidiform mole treated at one of nine Brazilian reference centers from January 1990 to May 2016. ResultsAt 6months from uterine evacuation, 96 (0.8%) patients had hCG levels raised but falling. In 15/96 (15.6%) patients, chemotherapy was initiated immediately per FIGO 2000 criteria, while 81/96 (84.4%) patients were managed expectantly. Among the latter, 65/81 (80.2%) achieved spontaneous remission and 16 (19.8%) developed postmolar gestational trophoblastic neoplasia (GTN). Patients who received chemotherapy following expectant management required more time for remission (11 versus 8months; p=0.001), had a greater interval between uterine evacuation and initiating chemotherapy (8 versus 6months; p<0.001), and presented with a median WHO/FIGO risk score higher than women treated according to FIGO 2000 criteria (4 versus 2, p=0.04), but there were no significant differences in the need for multiagent treatment regimens (1/15 versus 3/16 patients, p=0.60). None of the women relapsed, and no deaths occurred in either group. ConclusionIn order to avoid unnecessary exposure of women to chemotherapy, we no longer follow the FIGO 2000 recommendation to treat all patients with molar pregnancy and hCG raised but falling at 6months after evacuation. Instead, we pursue close hormonal and radiological surveillance as the best strategy for these patients.

Growth trend of small uterine fibroids and human chorionic gonadotropin serum levels in early pregnancy: an observational study

To analyze the growth trend of small uterine fibroids during early pregnancy, evaluating the potential factors involved, with particular interest in hCG levels. Observational study. Tertiary care university hospital. Women who had an ultrasound diagnosis of small myomas (diameter, ≥10mm and ≤50mm) from January 2007 to December 2013, and who subsequently became pregnant within 1year. None. Three additional ultrasound examinations were performed during early pregnancy (7-8, 10-13, and 20-22 complete gestational weeks, respectively) and the modifications in diameter and volume of each uterine fibroid were recorded. A serial evaluation of hCG serum levels from 5-12weeks was performed. From the 109 women who fulfilled the study inclusion/exclusion criteria, a significant increase emerged, both for volume and diameter of the detected fibroids. Specifically, a median growth rate (GR) of 122% was observed during the interval of the first to the second ultrasound, whereas a median GR of 108% was detected during the interval between the second and the third ultrasound, and a median GR of 25% between the third and the fourth ultrasound. A significant positive correlation between hCG levels and diameter (R = 0.69) of myomas between 5 and 12weeks emerged. A remarkable nonlinear growth of small fibroids during initial pregnancy was observed, with a faster rate in the first trimester and a slowdown by midpregnancy. Those changes seem to be related to the similar increase of hCG levels until 12weeks.

Diagnostic challenges in cornual epithelioid trophoblastic tumor

ObjectiveWe present a case of primary cornual epithelioid trophoblastic tumor (ETT) because of its rarity and diagnostic and therapeutic challenge. Case reportA 28-year-old woman, gravida 1, para 1, who missed menstruation for 3 months, had an elevated β-human chorionic gonadotropin serum level of 2764 mIU/mL, an absence of intrauterine pregnancy, and the presence of an adnexal mass detected by transvaginal ultrasound. As an ectopic pregnancy was suspected, laparoscopic surgery was performed and showed a right corneal mass. Complete excision of the tumor was done through exploratory laparotomy. Frozen pathology favored the diagnosis of squamous cell carcinoma. Since there was no apparent tumor at other sites, no additional surgery was done. The final pathology showed ETT. Primary ETT is often misdiagnosed as an ectopic pregnancy, leading to delayed treatment, and poses a diagnostic challenge in distinguishing it from squamous cell carcinoma during pathological examination. ConclusionCareful evaluation and avoidance of overtreatment are emphasized.

Relationship between human chorionic gonadotropin serum levels and the risk of ovarian hyperstimulation syndrome

The object of this retrospective cohort study was to determine if hCG levels correlate with ovarian hyperstimulation syndrome (OHSS) risk after adjustment for other risk factors during in vitro fertilization (IVF). We measured serum hCG approximately 12 h after hCG trigger in women undergoing 406 cycles of controlled ovarian hyperstimulation for IVF between June 2006 and December 2009. Serum hCG levels were measured 12 h after trigger. Bivariate logistic regression was used to assess the association between patient and cycle characteristics and OHSS. In our series, mild to moderate OHSS occurred in 9% (38/406), and severe OHSS diagnosed in 1.5% (6/406) of IVF cycles. OHSS risk was increased in younger women (<30 years old: adjusted odds ratio: aOR 2.46, 95% confidence interval: CI 1.14–5.34), increased number of oocytes (11–20: aOR 6.79, 95% CI 1.97–23.40; >20: aOR 17.55, 95% CI 4.84–63.70), and increase E2 levels (≥3,000 pg/mL: aOR 2.59, 95% CI 1.33–5.05), but was unrelated to hCG level (100–200 IU/L: aOR 1.53, 95% CI 0.60–3.91; ≥200 IU/L: aOR 1.42 95% CI 0.48–4.20). These results indicate that OHSS risk during IVF is unrelated to serum hCG level measured approximately 12 h after trigger.

Sonographic Detection and Follow-up of a Persistent Ectopic Pregnancy

Ectopic pregnancy is a life-threatening condition if not detected early, prior to it rupturing. This case study presents a situation where an ectopic pregnancy is sonographically detected prerupture and treated with methotrexate. Based on serial sonograms, a salpingectomy was performed several weeks later when the pregnancy had not resolved. Sonographic findings indicative of an ectopic pregnancy are presented, along with the importance of correlating findings between serial sonograms and β–human chorionic gonadotropin serum levels.

Postpartum monitoring of retained placenta.Two cases of abnormally adherent placenta

To save fertility, hysterectomy may be avoided with abnormal placental adherence by leaving the placenta in situ. Several reports support this strategy, but no reports are available on optimal follow-up strategies. We present two women with conservative treatment of placenta accreta and describe the prospective monitoring of the clinical course, placental regression, and recovery of the uterine anatomy using serial sonography, hysteroscopy and magnetic resonance imaging. There was no postpartum hemorrhage. Menstrual cyclicity resumed within 18 weeks. The human chorionic gonadotropin serum levels normalized within 10 weeks, whereas regression of placenta tissue was slow and continued up to nine months after delivery. In both cases placental remnants persisted; in one woman they were removed and uterine anatomy restored. She had a subsequent uneventful pregnancy afterwards. The presented systematic follow-up provides tools to monitor and treat other women in similar ways.

Endometrial Thickness and Serum β-hCG as Predictors of the Effectiveness of Oral Misoprostol in Early Pregnancy Failure

ObjectiveTo evaluate ultrasonographic measurement of endometrial thickness and serum levels of chorionic gonadotropin (β-hCG) as predictors of failure to abort completely in patients designated for uterine evacuation using oral misoprostol. MethodsWomen attending an obstetric outpatient clinic who complained of residual vaginal bleeding 15 days or more after taking oral misoprostol for medical induction of abortion for early pregnancy failure were evaluated by transvaginal ultrasound scan and assay of serum β-hCG. They subsequently underwent dilatation and curettage under general anaesthesia. According to the results of histopathological examination of uterine contents, the study cohort was divided into women with incomplete abortion (19 cases, 19.6%) and cases with complete abortion (78 cases, 80.4%). The results of the ultrasound scan and the assay of serum β-hCG were correlated with the histopathological results to determine the accuracy of these markers in predicting complete abortion. ResultsBaseline characteristics for both groups were similar. The endometrial thickness in the two groups ranged from 11.2 ± 3.9mm in the complete abortion group to 14.6 ± 6.1mm in the incomplete abortion group, a statistically significant difference (P = 0.003). Serum β-hCG levels were statistically different in the two groups (complete abortion 73.9 ± 23.9 IU/L vs. incomplete abortion 109.4 ± 68.4 IU/L, P < 0.001). Measured endometrial thickness ≥ 12mm predicted incomplete abortion with a sensitivity of 88.5%, a specificity of 73.7%, a positive predictive value (PPV) of 93.2%, and a positive likelihood ratio (LR+ve) of 85.6. A serum β-hCG ≥-100 IU/L predicted incomplete abortion with a sensitivity of 87.2%, a specificity of 78.9%, a PPV of 94.4%, and a LR+ve of 85.6. ConclusionQuantitative assay of serum β-hCG and ultrasound measurement of endometrial thickness are clinically useful measures for predicting late failure of medical abortion, but should be used as supplements to clinical assessments.

SERUM PROTEOMIC PROFILING BY SURFACE-ENHANCED LASER DESORPTION/IONIZATION TIME-OF-FLIGHT MASS SPECTROMETRY IN TESTICULAR GERM CELL CANCER PATIENTS

Objectives: Surface-enhanced laser desorption ionization mass spectrometry (sELDI-TOF MS) incorporates time-of-flight protein mass spectrometry and chip-based chromatographic protein selection and allows rapid protein profiling of complex biological samples. In this study, serum protein profiles were examined in testicular germ cell cancer patients and healthy controls with the aim of predicting cancer patients by a molecular test combining on-chip chromatography and mass spectrometry. Methods: Serum samples were taken from 49 patients with histologically proven seminomas. Forty-nine healthy subjects served as controls. Mass-spectrometry-based SELDI-TOF ProteinChip technology was used for serum proteomic analysis. The samples were fractionated and bound to the IMAC-Cu+ and CM10 ProteinChip. Proteomic spectra were generated by the ProteinChip system and analyzed by the proteomic platform ?proteomic.net?. Serum samples were also examined for beta-human chorionic gonadotropin levels. An artificial intelligence learning algorithm was used to differentiate between cancer and control subjects. Results The classification algorithm correctly identified the pattern in 90.4% of the samples (95% confidence interval of 82.6%-95.5%). Decision trees predicted seminomas with 91.5% sensitivity and 89.4% specificity. Seminoma patients with normal beta-human chorionic gonadotropin serum levels (n=38 of 49) were correctly predicted with 80% sensitivity and 70% specificity. Conclusion Our study is the first to demonstrate that SELDI-TOF MS protein profiles of cancer and control subjects differ to a highly significant degree in testicular germ cell cancer patients. Validation of these findings may enable proteomic profiling to become a valuable tool, especially for aftercare.

Ovarian Choriocarcinoma in a Rhesus Monkey Associated with Elevated Serum Chorionic Gonadotropin Levels

A clinically normal, 3-year-old female rhesus monkey (Macaca mulatta), which was part of a routine toxicology study, had a mass in the right ovary with metastases to the adjacent mesentery and lungs. The histologic features and immunohistochemistry results were consistent with the diagnosis of choriocarcinoma. Neoplastic cell types included cytotrophoblast (positive for cytokeratin), syncytiotrophoblast (positive for human chorionic gonadotropin), and extravillous trophoblast (positive for human placental lactogen). Because the neoplasm was present in the ovary, the uterus was normal, and the animal was not currently pregnant, this was considered a primary ovarian neoplasm of germ cell origin. The monkey had elevated serum levels of chorionic gonadotropin at the beginning of the study, indicating that, as in women, choriocarcinomas in monkeys can be associated with increased gonadotropin levels and that the tumor was preexisting at the start of the toxicology study.

LUTEINIZED CYSTIC OVARIAN HYPERPLASIA ASSOCIATED WITH PLACENTOMEGALY DUE TO CHORANGIOMATOSIS

Luteinized cystic ovarian hyperplasia (LCOH) is a rare benign condition characterized by bilateral ovarian enlargement during pregnancy secondary to high maternal human chorionic gonadotropin serum levels referred to occur under several conditions. We report the case of a 29-year-old obese woman with LCOH incidentally discovered during cesarean section of a single pregnancy at 35 weeks of gestation for fetal intrauterine demise. The fetus showed external ambiguous genitalia, imperforate anus, bilateral dysplastic kidneys, and hydrometrocolpos secondary to atresia of the vagina. The placental weight was 1,450 g (normal for gestational age: 415 g). The placenta showed diffuse chorangiomatosis (CM) characterized by multifocal stem villi enlargement containing increased number of small vessels with alpha-smooth muscle actin positive cells in the walls in a dense reticulin fibers-rich stroma. The combination of LCOH and placentomegaly due to CM appears to be unique.

Monitoring serum chorionic gonadotropin levels after mifepristone abortion

Monitoring serum chorionic gonadotropin levels after mifepristone abortion

Predictors of Success of Methotrexate Treatment in Women With Tubal Ectopic Pregnancies

Presently, methotrexate is a common treatment for tubal ectopic pregnancy. In this trial, the investigators examined the role of several pretreatment factors on the outcome of intramuscular methotrexate therapy in 350 women with tubal ectopic pregnancies. They included the baseline serum chorionic gonadotropin (CG) and progesterone levels, the size and volume of the conceptus, blood in the peritoneal cavity, and fetal cardiac activity. The criterion for success was resolution of the pregnancy without the need for surgery. Methotrexate was given in single doses of 50 mg/m2. With one exception, surgery was performed if the serum CG did not respond after three doses or if fetal cardiac activity remained evident. At baseline, about three-fourths of women had an ectopic tubal mass on transvaginal ultrasonography, and one-third had free peritoneal fluid, presumably blood, limited to the pelvis. Methotrexate therapy succeeded in 91 percent of cases. Age, parity, and the size or volume of the ectopic mass did not predict the outcome, nor was the presence of peritoneal fluid a factor. Successfully treated women did, however, have lower serum CG and progesterone levels and less frequent fetal cardiac activity. Average serum CG levels were 4019 and 13,420 mIU/ml in the successful and failed cases, respectively, and the progesterone levels averaged 6.9 and 10.2 ng/ml. Fetal cardiac activity was present in 12 percent of successfully treated cases and 30 percent of failed cases. On regression analysis, a high baseline serum CG level was the only factor significantly predictive of treatment failure. Just more than 80 percent of women in the study and 82 percent of those who responded received a single dose of methotrexate. Serum progesterone (but not CG) was higher in women given more than one dose, as was the frequency of fetal cardiac activity. In this series, the baseline serum CG concentration was the most powerful predictor of success in women given intramuscular methotrexate on a single-dose protocol for ectopic pregnancy. Relatively high levels mean a greater risk of treatment failure. N Engl J Med 1999;341:1974–1978

Gonadotropin versus steroid regulation of the corpus luteum of the rhesus monkey during simulated early pregnancy.

During the nonconceptive cycle in primates, progesterone is a likely intermediary for several LH-dependent events in the ovary including ovulation, luteinization of the follicle wall, and maintenance of the developed corpus luteum. To determine whether progesterone is an important local factor in the ability of chorionic gonadotropin (CG) to enhance luteal structure and function in early pregnancy, rhesus monkeys received hCG in a dose-escalating regimen (15-2880 IU twice daily) beginning on Day 9 of the luteal phase of the natural menstrual cycle to simulate the rapid rise in serum CG levels associated with early pregnancy. Some animals were concomitantly treated with the 3beta-hydroxysteroid dehydrogenase (3beta-HSD) inhibitor trilostane (500 mg twice daily) to suppress progesterone production during gonadotropin stimulation. Corpora lutea were removed after 1, 3, 6, and 9 days of treatment (n = 3-4 per group); time-matched control tissues were obtained from untreated animals (n = 3 per group). Treatment with hCG prevented both the decrease in luteal wet weight (p < 0.05) and the histologic indices of luteal regression seen in controls during the menstrual cycle. However, coadministration of the progesterone synthesis inhibitor led to early declines in luteal wet weight (p < 0.05) and luteal cell size compared to treatment with hCG alone. Luteal progesterone receptor (PR) mRNA content increased (p < 0.05), but the percentage of cells staining positive for immunoreactive PR declined (p < 0.05) over the treatment interval in all groups. CG administration alone and in combination with trilostane increased PR staining intensity in some luteal cells within 1 day of treatment; intensely staining cells persisted around vascular elements after 9 days of treatment with hCG+trilostane but not with hCG alone. These data suggest that some, but not all, actions of CG to maintain the primate corpus luteum in early pregnancy are mediated by progesterone via a receptor-mediated pathway.

High maternal serum chorionic gonadotropin level in Downs' syndrome pregnancies is caused by elevation of both subunits messenger ribonucleic acid level in trophoblasts.

A unique product of human placenta is CG. Its concentration in maternal blood rises exponentially until 9-10 weeks' gestation, thereafter, it decreases to about 20% of the maximum, remaining constant from 16-17 until 40 weeks. High second-trimester maternal blood level indicates an increased risk for Downs' Syndrome (DS). This study's aim was to determine whether changes occur in the genetic expression of CG subunits in cultured trisomy-21 trophoblasts compared with various gestational age controls. Second-trimester trisomy-21 trophoblasts secrete 10 times more CG than gestational age-matched controls during the first day in culture: 878 (range, 235-2230) IU/g vs. 87 (range, 20-150) IU/g (P < 0.05). This high secretion closely resembles quantities secreted by first-trimester normal trophoblasts: 7500 (range, 3,850-10,000) IU/g. Both subunits' messenger RNA content are substantially increased, CG beta much more than CG alpha, although these genes are not located on chromosome 21. We conclude that at least one cause of high second-trimester maternal blood CG in DS pregnancies is a rise in alpha and beta CG messenger RNA levels in the trophoblast. We propose that at 12-14 weeks, when rapid decrease in maternal blood CG levels can be found, higher than normal values may indicate an increased risk for DS.