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.

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.

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.

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 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.

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.

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 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.

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.