Beta hCG (Quantitative), pregnancy test
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Human chorionic gonadotropin (hCG) is a hormone produced by the placenta of a pregnant woman. Early in pregnancy, the level of hCG increases in the blood and is eliminated in the urine. A pregnancy test detects hCG in the blood or urine and confirms or rules out pregnancy.
During the early weeks of pregnancy, hCG is important in maintaining function of the corpus luteum. Production of hCG increases steadily during the first trimester (8-10 weeks) of a normal pregnancy, peaking around the 10th week after the last menstrual cycle. Levels then fall slowly during the remainder of the pregnancy. hCG is no longer detectable within a few weeks after delivery. When a pregnancy occurs outside of the uterus (ectopic), the level of hCG in the blood increases at a slower rate.
When an ectopic pregnancy is suspected, measuring the level of hCG in the blood (quantitative test) over time may be useful in helping to make a diagnosis of ectopic pregnancy.
Similarly, the hCG blood level may be abnormal when the developing baby (fetus) has a chromosome defect such as Down syndrome. An hCG test is used routinely in conjunction with a few other tests as part of screening for fetal abnormalities between 11 and 20 weeks of pregnancy.
Human chorionic gonadotropin (hCG) is a glycoprotein hormone that consists of 2 subunits (alpha and beta chains), which are associated to comprise the intact hormone. The alpha subunit is similar to those of luteinizing hormone, follicle-stimulating hormone, and thyroid-stimulating hormone. The beta subunit of hCG differs from other pituitary glycoprotein hormones, which results in its unique biochemical and immunological properties. This method quantitates the sum of intact hCG plus the beta subunit.
hCG is produced in the placenta during pregnancy. In nonpregnant individuals, it can also be produced by tumours of the trophoblast, germ cell tumours with trophoblastic components, and some nontrophoblastic tumours. The biological action of hCG serves to maintain the corpus luteum during pregnancy. It also influences steroid production. The serum in pregnant individuals contains mainly intact hCG. Measurement of the hCG concentration permits the diagnosis of pregnancy as early as 1 week after conception.
For confirming pregnancy, the timing of testing depends on how accurate a woman is about the day she expects her menstrual period as well as the method used for testing. In general, blood tests are more sensitive than urine tests and can be done two days before a woman would expect her period to start. A urine or blood hCG test can be done reliably by 10 days after a missed menstrual period. Even using a urine test, a woman may be able to determine whether she is pregnant the day she misses her period, but the result could be falsely negative. Testing may be repeated at a later date if the first test is negative but pregnancy is still suspected.
Quantitative blood hCG tests may be ordered repeatedly over several days when a healthcare practitioner wants to identify or rule out an ectopic pregnancy or to monitor a woman after a miscarriage. In these cases, a woman may experience the normal signs and symptoms of pregnancy at first but then may develop others that indicate that the pregnancy is not progressing as expected.
Some signs and symptoms of ectopic pregnancy include:
- Abnormal vaginal bleeding—because a woman is pregnant, she may not have a regular period but then may have light bleeding or spotting with an ectopic pregnancy
- Low back pain
- Pain or cramping in the lower abdomen or on one side of the pelvis
- Dizziness, weakness
- Feeling faint or fainting
- Low blood pressure
- Pain in the shoulder area
- Sudden, sharp pain in the pelvic area
- Fever, flu-like symptoms
An hCG test may be ordered prior to a medical procedure or treatment that might be harmful during pregnancy.
Values in pregnancy should double every 2 to 3 days for the first 6 weeks.
Elevated concentrations of human chorionic gonadotropin (hCG) measured in the first trimester of pregnancy are observed in a normal pregnancy but may serve as an indication of chorionic carcinoma, hydatiform mole, or multiple pregnancies.
Decreasing hCG concentrations indicate threatened or missed abortion, recent termination of pregnancy, ectopic pregnancy, gestosis or intrauterine death.
Both normal and ectopic pregnancies generally yield positive results of pregnancy tests. The comparison of quantitative hCG measurements with the results of transvaginal ultrasonography (TVUS) may aid in the diagnosis of ectopic pregnancy. When an embryo is first large enough for the gestation sac to be visible on TVUS, the patient generally will have hCG concentrations between 1,000 and 2,000 IU/L. (These are literature values. Definitive values for this method have not been established at this time.) If the hCG value is this high and no sac is visible in the uterus, an ectopic pregnancy is suggested. Elevated values will also be seen with choriocarcinoma and hydatiform mole.
Peri- and postmenopausal females may have detectable hCG concentrations (< or = to 14 IU/L) due to pituitary production of hCG. Serum follicle-stimulating hormone measurement may aid in ruling-out pregnancy in this population. Cutoffs of greater than 20 to 45 IU/L have been suggested and are method dependent.
False-elevations (called phantom human chorionic gonadotropin: hCG) may occur with patients who have human antianimal or heterophilic antibodies.
Some specimens may not dilute linearly due to abnormal forms of hCG.
Elevated hCG concentrations not associated with pregnancy are found in patients with other diseases such as tumours of the germ cells, ovaries, bladder, pancreas, stomach, lungs, and liver. This test is not intended to detect or monitor tumours or gestational trophoblastic disease.
The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.
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