Correlation between fetal sex and human chorionic gonadotropin in peripheral maternal blood and amniotic fluid in second and third trimester normal pregnancies.

BACKGROUND: To study the correlation between fetal sex and human chorionic gonadotropin (hCG) in maternal blood and amniotic fluid. METHOD AND MATERIAL: One hundred and thirty uncomplicated pregnancies, 82 of whom were at sixteen and 48 at thirty-five weeks of gestation. RESULTS: The hCG levels were significantly higher in maternal serum than in amniotic fluid. At 16 weeks there were no sex-related differences in the hCG levels, either in maternal blood or in amniotic fluid. At 35 weeks the hCG levels in maternal blood were significantly higher in pregnancies with female fetuses than in those carrying male fetuses (p<0.004), while in amniotic fluid the hCG levels tended to be slightly higher in the female group than in the male. In pregnancies with female fetuses the hCG levels in maternal blood were significantly higher at 35 than at 16 weeks (p<0.02), while in pregnancies with male fetuses the levels were highest at 16 weeks. For both sexes the hCG levels in amniotic fluid were significantly higher at 16 than at 35 weeks of pregnancy (p<0.001). Whereas a significant correlation between hCG levels in maternal blood and amniotic fluid was seen at 16 weeks of gestation for both sexes (p<0.01 and R value 0.45 for males and 0.41 for females), no correlation was observed at 35 weeks. CONCLUSION: This study shows a significant correlation between hCG and fetal sex at third trimester of gestation only, possibly caused by a gender factor and a shift in synthesis and/or in metabolism of hCG from the second to the third trimester.

[To conceive a child is not a human right]. / A få barn er ingen menneskerett.

PIP: In recent decades, with the help of in vitro fertilization and freezing of pre-embryos, the reproductive limits have been extended for infertile couples. Such techniques also confirm severe genetic diseases in advance and help decide on abortion. In Norway it is still a paradox that, even though so much knowledge has been acquired about reproduction and the means of regulating it, annually about 15,000 healthy fetuses are aborted when there are couples who would do anything to have children. Women have different reasons why they never became pregnant, and when they come to the end of their reproductive age they find it important to have a child. The reproduction of women differs from that of men because the latter still can produce sperm in old age, while the optimal age for women to become pregnant is in the mid-20s. 80% of them become pregnant within 1 year at this age, but starting at age 30 there is a gradual reduction in the ability to conceive. At age 40 only 30-40% of women become pregnant within 1 year. The risk of having a genetic defect also increases with age. At an older age the risks of infections, hormonal disorders, and the development of malignancies also increase. Other factors that influence reproduction include stress, physical exertion over time producing amenorrhea, carrier goals with physical and psychological demands, and sexually active life leading to infections. Women should realize that their biological age for conception is preordained and should use the best time to have a child. In this area of problem resolution, doctors can be instrumental by providing advice and counseling, especially when the couple has a functional defect which hinders spontaneous pregnancy.^ieng

Human chorionic gonadotropin in cord blood and peripheral maternal blood in singleton and twin pregnancies at delivery.

The influence of fetal sex on human chorionic gonadotropin (hCG) in cord and peripheral maternal blood was studied at delivery in 57 twin and 66 singleton uncomplicated pregnancies. In twin pregnancies the hCG levels were about twice as high in female-female and in female-male vis-à-vis male-male combinations in both maternal and cord blood. In singleton pregnancies the hCG levels were significantly higher in maternal and in cord blood in cases of female vis-à-vis male infants. The ratio of maternal hCG/placental weight was also highest in the twin pregnancies when one or both infants were female. This suggests a "female effect", possibly genetically based.

Ovarian pregnancy associated with the intra-uterine contraceptive device. A survey of two decades.

Records of 25 cases of ovarian pregnancy in the period 1965 to 1984 were reviewed. Seventeen cases (68%), had an IUCD in situ, and 15 of these had occurred during the last decade. The ratio of ovarian pregnancy to all ectopic pregnancies was 1:13 in the IUCD group versus 1:78 in the non-IUCD group (p less than 0.025). In contrast to patients with tubal pregnancies, those with ovarian pregnancy very seldom have a history of pelvic inflammatory disease (PID), infertility, or earlier pelvic operations. Subsequent fertility is good compared with patients with tubal pregnancies, for patients both with and without IUCD.

Human chorionic gonadotropin in uterine and peripheral blood tested with an enzyme-linked immunosorbent assay and a radio-immuno assay in cases of spontaneous abortion.

Human chorionic gonadotropin (hCG) was analysed by a hCG-beta-subunit radio-immunoassay (hCG-beta-Ria) and a rapid serum test in uterine and peripheral blood in 29 cases of spontaneous abortion. The levels of hCG were significantly higher in uterine than in peripheral blood. The rapid serum test was correctly positive in all 29 samples of uterine and in 28 of peripheral blood.

Fetal heart block, anti-SSA and anti-SSB antibodies. Association with intra-uterine growth retardation, fetal death and lupus anticoagulant.

A case of complete fetal heart block associated with intra-uterine growth retardation, SSA- and SSB-antibodies is presented. The fetus died in utero. Autopsy revealed damage to the fetal cardiac conducting system together with severe placental fibrosis and recent infarctions. These findings and a slightly prolonged activated partial thromboplastin time indicated also the presence of the lupus anticoagulant.

Disappearance of human chorionic gonadotropin following removal of the fetus and placenta left in situ in a case of advanced abdominal pregnancy.

In a case of abdominal pregnancy, human chorionic gonadotropin (hCG) was determined twice during the first trimester and serially after removal of the fetus and placenta left in situ. From the 5th to the 7th week of gestation, the hCG values increased, from 5980 to 10000 U/l. After operation the hCG level decreased to 197 U/l after 51 days and hCG was not detectable 72 days postoperatively.

Repeat ectopic pregnancy. A twenty-year hospital survey.

Seventy-two patients with repeat ectopic pregnancy including 3 women with three ectopic pregnancies each during the period 1965 to 1984 were studied. In the same period there was a total of 842 ectopic pregnancies, giving a repeat ectopic pregnancy incidence of 9.4%. In the last decade the incidence of repeat ectopic pregnancy was 10.4%, and in the first decade it was 7.0% (p less than 0.025). None of the women used an intra-uterine contraceptive device, among those with repeat ectopic pregnancy in the first decade, vis-à-vis 17 (30.4%) in the last decade. A history of infertility was common among the patients with repeat ectopic pregnancy. Between the two events there was a total of 17 deliveries in 13 patients. Four out of 24 potentially fertile women completed full-term pregnancies following their second ectopic pregnancy.

Human chorionic gonadotropin in early normal and pathologic pregnancy. Discordant levels in peripheral maternal blood and blood from the uterine and abdominal cavities.

Human chorionic gonadotropin was assayed in 25 cases after first-trimester induced abortion, in 45 cases of spontaneous abortion in the first trimester, and in 27 cases of ectopic pregnancy. Blood was obtained from an antecubital vein and from the uterine cavity. In the cases of ectopic pregnancy blood was also obtained from the abdominal cavity. In the group of induced abortion the human chorionic gonadotropin levels in peripheral maternal blood did not differ significantly from the levels in the uterine cavity. In the groups of spontaneous abortion and ectopic pregnancy the human chorionic gonadotropin levels were significantly higher in blood from the uterine cavity and the abdominal cavity, respectively. In four cases (three with spontaneous abortion and one with an ectopic pregnancy) human chorionic gonadotropin was not detectable in peripheral maternal blood, while it was found in blood from the uterine and abdominal cavities.

Evaluation of new serum and urine tests in cases of suspected pathologic early pregnancy.

Two pregnancy tests, ModEL serum hCG Assay and ModEL Urine hCG Assay, were evaluated using sera and urine from 46 patients suspected of pathologic early pregnancy, of whom 22 patients had spontaneous abortion and 9 an ectopic pregnancy. ModEL Serum hCG Assay had a 100% sensitivity and specificity, thus demonstrating its value in these cases. With a sensitivity of 94% and a specificity of 87%, ModEL Urine hCG Assay gave poorer results. Both tests have a relative high "detection limit" of 25 U/l (serum) and 50 U/l (urine) which may impair their ability to distinguish between presence and absence of pregnancy by very low levels of hCG.

Morphological changes in tubal mucosa associated with the use of intrauterine contraceptive devices.

We examined the endosalpinx of 28 healthy non-pregnant women, 12 of whom had an intrauterine contraceptive device (IUCD) and 16 of whom had neither an IUCD nor used oral contraceptives. Measurements made on light- and scanning electron micrographs showed that the percentage area covered by ciliated cells was approximately 40% in non-IUCD users and only 20% in IUCD users.

PIP: Given that IUD users have a high risk of ecotopic pregnancy and since most of these pregnancies are tubal, a study was undertaken in Norway to determine if there were any differences in the tubal epithelium of IUD users and women who never used IUDs. The proportion of the epithelium surface covered by ciliated cells was the major focus of the investigation. 1 cm segments from the isthmic section of the oviduct were removed from 12 IUD users and 16 nonusers while they were undergoing sterilization procedures. The women were all healthy and nonpregnant. Both groups of women were similar in terms of average age and parity. The IUDs used by the women included 5 copper Ts, 4 Multiloads, 1 Lippes Loop, and 2 IUDs of unknown type. All of the users had worn the devices for at least 6 months. The specimens of epithelium were immersed in a fixative and stained. The proportion of the epithetial surface covered by ciliated cells was measured using both light and scanning electron micrographs. The results obtained from the 2 methods of measuring differed somewhat for individual specimens; however, the overall results obtained from both methods were similar. Light microscropy measurements indicated that the proportion of epithetial surface covered by ciliated cells was 39.9% for nonuser and 21.2% for IUD users. Respective results obtained by scanning electron microscopy were 38.8% and 20.0%. The results were obtained from women in different menstrual cycle phases. A comparison of specimens by menstrual cycle phase revealed that the proportion of surface covered by ciliated cells was not affected by hormonal changes during the menstrual cycle. IUD users had a slightly higher intraepithelial leucocyte count than the control group. Whether or not reduced ciliation in IUD users plays a role in tubal pregnancy is not known; however, egg transport might be slowed down when there are fewer ciliated cells. Reduced ciliation might also affect sperm migration which in turn might enhance the risk of abnormal embryos. Most tubal pregnancies are characterized by abnormal embryos.

Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy.

Human chorionic gonadotropin (hCG) in maternal serum was analyzed by a hCG-beta-subunit, radioimmunoassay (hCG-beta-RIA) in 36 cases after induced first-trimester abortion, 35 cases of spontaneous abortion in the first trimester, and in 35 cases of ectopic pregnancy to determine the time between the apparent removal of all trophoblastic tissue by surgical intervention and the disappearance of hCG from the blood. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy d. In the cases with induced abortion, hCG was detectable from 16 to 60 days, with a median of 30 days after uterine evacuation, in those with spontaneous abortion from nine to 35 days with a median of 19 days, and in the cases of ectopic pregnancy from one to 31 days with a median of eight, five days after laparotomy and removal of the affected tube. There was a significant correlation between the initial hCG levels and the disappearance time in each series. The demonstrated disappearance times are longer than previously recognized, which should be appreciated when hCG is analyzed after termination of early pregnancy.