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Peris M, Crompton K, Shepherd DA, Amor DJ. The association between human chorionic gonadotropin and adverse pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:118-184. [PMID: 37572838 DOI: 10.1016/j.ajog.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the association between human chorionic gonadotropin and adverse pregnancy outcomes. DATA SOURCES Medline, Embase, PubMed, and Cochrane were searched in November 2021 using Medical Subject Headings (MeSH) and relevant key words. STUDY ELIGIBILITY CRITERIA This analysis included published full-text studies of pregnant women with serum human chorionic gonadotropin testing between 8 and 28 weeks of gestation, investigating fetal outcomes (fetal death in utero, small for gestational age, preterm birth) or maternal factors (hypertension in pregnancy: preeclampsia, pregnancy-induced hypertension, placental abruption, HELLP syndrome, gestational diabetes mellitus). METHODS Studies were extracted using REDCap software. The Newcastle-Ottawa scale was used to assess for risk of bias. Final meta-analyses underwent further quality assessment using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method. RESULTS A total of 185 studies were included in the final review, including the outcomes of fetal death in utero (45), small for gestational age (79), preterm delivery (62), hypertension in pregnancy (107), gestational diabetes mellitus (29), placental abruption (17), and HELLP syndrome (2). Data were analyzed separately on the basis of categorical measurement of human chorionic gonadotropin and human chorionic gonadotropin measured on a continuous scale. Eligible studies underwent meta-analysis to generate a pooled odds ratio (categorical human chorionic gonadotropin level) or difference in medians (human chorionic gonadotropin continuous scale) between outcome groups. First-trimester low human chorionic gonadotropin levels were associated with preeclampsia and fetal death in utero, whereas high human chorionic gonadotropin levels were associated with preeclampsia. Second-trimester high human chorionic gonadotropin levels were associated with fetal death in utero and preeclampsia. CONCLUSION Human chorionic gonadotropin levels are associated with placenta-mediated adverse pregnancy outcomes. Both high and low human chorionic gonadotropin levels in the first trimester of pregnancy can be early warning signs of adverse outcomes. Further analysis of human chorionic gonadotropin subtypes and pregnancy outcomes is required to determine the diagnostic utility of these findings in reference to specific cutoff values.
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Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Kylie Crompton
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David J Amor
- Neurodisability and Rehabilitation Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Australia.
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Keikkala E, Ranta JK, Vuorela P, Leinonen R, Laivuori H, Väisänen S, Marttala J, Romppanen J, Pulkki K, Stenman UH, Heinonen S. Serum hyperglycosylated human chorionic gonadotrophin at 14-17 weeks of gestation does not predict preeclampsia. Prenat Diagn 2014; 34:699-705. [DOI: 10.1002/pd.4335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 12/29/2022]
Affiliation(s)
- Elina Keikkala
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
- University of Helsinki; Helsinki Finland
| | - Jenni K. Ranta
- Department of Clinical Chemistry; University of Eastern Finland; Kuopio Finland
- Eastern Finland Laboratory Centre; Kuopio Finland
| | - Piia Vuorela
- Department of Obstetrics and Gynecology; Porvoo Hospital; Porvoo Finland
| | | | - Hannele Laivuori
- Department of Obstetrics and Gynecology; Helsinki University Central Hospital; Helsinki Finland
- Department of Medical Genetics; Haartman Institute, University of Helsinki; Helsinki Finland
| | - Sari Väisänen
- Department of Clinical Chemistry; University of Eastern Finland; Kuopio Finland
- Eastern Finland Laboratory Centre; Kuopio Finland
| | - Jaana Marttala
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | | | - Kari Pulkki
- Department of Clinical Chemistry; University of Eastern Finland; Kuopio Finland
- Eastern Finland Laboratory Centre; Kuopio Finland
| | - Ulf-Håkan Stenman
- Department of Clinical Chemistry; University of Helsinki; Helsinki Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology; Kuopio University Hospital and University of Eastern Finland; Kuopio Finland
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Abstract
BACKGROUND Biochemical tests of placental or feto-placental function were widely used in the 1960s and 1970s in high-risk pregnancies to try to predict, and thus try to avoid, adverse fetal outcome. OBJECTIVES To assess the effects of performing biochemical tests of placental function in high-risk, low-risk, or unselected pregnancies. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 May 2012). SELECTION CRITERIA Controlled trials (randomized or 'quasi-randomized') that compare the use of biochemical tests of placental function in pregnancy with non-use. DATA COLLECTION AND ANALYSIS Trial quality was assessed and data were extracted by the review author. MAIN RESULTS A single eligible trial of poor quality was identified. It involved 622 women with high-risk pregnancies who had had plasma (o)estriol estimations. Women were allocated to have their (o)estriol results revealed or concealed on the basis of hospital record number (with attendant risk of selection bias). There were no obvious differences in perinatal mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.36 to 2.13) or planned delivery (RR 0.97, 95% CI 0.81 to 1.15) between the two groups. AUTHORS' CONCLUSIONS The available trial data do not support the use of (o)estriol estimation in high-risk pregnancies. The single small trial available does not have the power to exclude a beneficial effect but this is probably of historical interest since biochemical testing has been superseded by biophysical testing in antepartum fetal assessment.
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Affiliation(s)
- James P Neilson
- Department of Women's and Children's Health, The University of Liverpool, First Floor, Liverpool, UK.
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Ozkaya E, Cakır E, Cınar M, Altay M, Gelişen O, Kara F. Second trimester serum alpha-fetoprotein level is a significant positive predictor for intrauterine growth restriction in pregnant women with hyperemesis gravidarum. J Turk Ger Gynecol Assoc 2011; 12:220-4. [PMID: 24591998 DOI: 10.5152/jtgga.2011.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/07/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the association between three parameters of second trimester serum secreening and preterm labor and intrauterine growth restriction (IUGR) in patients with hyperemesis gravidarum (HG). MATERIAL AND METHODS A prospective study on 429 pregnancies with HG was designed to determine the association between alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotropin (HCG) and pregnancy prognosis in terms of preterm labor, IUGR and birth weight. RESULTS In our study group the mean age of patients was 25.4±3.8 years. Mean birth weight was 3180±555 g. Mean AFP, uE3, hCG levels in the study group were 1.44±0.65 MoM, 0.91±0.38 MoM, 1.09±0.64 MoM, respectively. Twenty nine (6.8%) patients delivered before 37 weeks of gestation and 52 (12.1%) patients developed IUGR. Mean MoM values of AFP among patients with preterm labor, IUGR and normal delivery were 1.35±0.45, 1.97±0.81, 1.34±0.58 MoM, respectively (p<0.001). Mean MoM values of hCG among patients with preterm labor, IUGR and normal delivery were 1.46±0.90, 1.35±0.89, 1±0.5 MoM respectively (p<0.001). Mean MoM values of uE3 among patients with preterm labor, IUGR and normal delivery were 0.75±0.25, 0.80±0.30, 0.95±0.40 MoM, respectively (p=0.003). Odds ratio of AFP>1.55 was 3.73 (95% CI, 1.99-6.98, p<0.001) for IUGR after adjustment for HCG. CONCLUSION Our study suggests that AFP levels of the second trimester screening test higher than 1.55 MoM is significantly associated with IUGR in hyperemesis gravidarum. The second trimester screening test can predict poor outcome in HG.
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Affiliation(s)
- Enis Ozkaya
- Department of Obstetrics and Gynecology, Dr. Sami Ulus Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Evrim Cakır
- Department of Endocrinology and Metabolism, Dışkapı Yıldırım Beyazıd Teaching and Research Hospital, Ankara, Turkey
| | - Mehmet Cınar
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Metin Altay
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Orhan Gelişen
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Fadıl Kara
- Department of Obstetrics and Gynecology, Dr. Sami Ulus Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
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Heikkilä A, Makkonen N, Heinonen S, Kirkinen P. Elevated Maternal Serum hCG in the Second Trimester Increases Prematurity Rate and Need for Neonatal Intensive Care in Primiparous Preeclamptic Pregnancies. Hypertens Pregnancy 2009. [DOI: 10.3109/10641950109152646] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sayin NC, Canda MT, Ahmet N, Arda S, Süt N, Varol FG. The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet 2007; 277:47-53. [PMID: 17653738 DOI: 10.1007/s00404-007-0421-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Accepted: 07/05/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study was designed to investigate the relationship between the second trimester maternal serum markers and adverse pregnancy outcomes in healthy newborns. MATERIALS AND METHODS A total of 749 women who delivered in our institution with complete follow up and second-trimester triple marker test data available were included in the study. Women with multiple pregnancies, chronic diseases, diabetes mellitus, obesity, smokers and infants with chromosomal and congenital abnormalities were excluded. Maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and unconjugated estriol (uE(3)) values were investigated in our cohort who developed preeclampsia (n = 28), gestational diabetes (GM) (n = 69), preterm labor-birth (n = 100), oligohydramnios (n = 37) and macrosomia (n = 59) by using receiver operating characteristic (ROC) curve analysis, with chi-square and Pearson's correlation tests. RESULTS Women with uE(3) < or = 1.26 MoM (P = 0.001, AUC = 0.666), HCG > 1.04 MoM (P = 0.032, AUC = 0.599) or AFP < or = 0.69 MoM (P = 0.049, AUC = 0.600) values significantly developed oligohydramnios. Also, macrosomic infants were observed in women who had HCG values > 0.86 MoM (P = 0.047, AUC = 0.578). Patients with HCG > 1.04 MoM (P = 0.04, AUC = 0.565) and uE(3) < or =0.88 MoM (P = 0.049, AUC = 0.571) developed GDM. HCG levels > or =2.5 or > or =3 MoM were significantly associated with the development of oligohydramnios [P = 0.005; OR = 4 (95% CI: 1.7-9.7)], [P = 0.008; OR = 4.9 (95% CI: 1.7-13.7)], respectively. When women with adverse (n = 237) and normal (n = 512) outcomes were compared there were significant differences in maternal serum AFP (1.40 +/- 0.84 vs. 1.23 +/- 0.75 MoM, P = 0.006) and uE(3) values (1.38 +/- 1.42 vs. 1.45 +/- 0.98 MoM, P = 0.001). CONCLUSIONS Serum estriol, AFP or HCG values in triple test results may be associated with development of oligohydramnios, gestational diabetes and macrosomia in women with healthy and normal appearing fetuses.
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Affiliation(s)
- N Cenk Sayin
- Department of Obstetrics and Gynecology, Trakya University, Edirne, Turkey.
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Ganapathy R, Lamont RF, Bassett P. Unexplained elevated maternal serum β-HCG concentration and adverse pregnancy outcome. Prenat Diagn 2007; 27:995-9. [PMID: 17621365 DOI: 10.1002/pd.1813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association between unexplained elevated maternal serum beta-Human chorionic gonadotrophin (HCG) in the second trimester of pregnancy and adverse pregnancy outcome. METHODS In a case-controlled study of 3463 women who opted for second-trimester serum screening for Down syndrome, 142 were found to have a serum beta-HCG of > or =3.5 multiples of the median (MoM), 56 of whom had a serum beta-HCG of > or =5.0 MoM. These women were compared with a control group of women with serum beta-HCG within the 95% confidence interval around the median. RESULTS In the elevated beta-HCG group (> or =5 MoM) significantly more babies required admission to the special care baby unit (p = 0.02) and were small for gestational age (SGA) (p = 0.03). The mean birth weight was also significantly lower in the group with elevated beta-HCG. Women with a serum beta-HCG of > or =5, > or =6, > or =7 or > or =8 MoM were associated with SGA babies in 40, 44, 64 and 86% respectively. All babies born to the six women with beta-HCG of 8.75-24.1 MoM were SGA. CONCLUSION Increased surveillance is necessary in pregnancies where the maternal serum beta-HCG in the second trimester is inexplicably elevated to > or =5 MoM.
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Affiliation(s)
- Ramesh Ganapathy
- Department of Obstetrics and Gynaecology, Northwick Park Hospital, North-West London, NHS Trust, London, UK
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Proust S, Philippe HJ, Paumier A, Joubert M, Boog G, Winer N. [Mirror pre-eclampsia: Ballantyne's syndrome. Two cases]. ACTA ACUST UNITED AC 2006; 35:270-4. [PMID: 16645561 DOI: 10.1016/s0368-2315(06)78312-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report two cases of Ballantyne's syndrome which was first described in association with foeto-placental hydrops caused by rhesus isoimmunization. Our two cases occurred in association with materno-fetal parvovirus infection. Although the pathogenic mechanism remains to be fully elucidated, fluid retention and hyperplacentation are the main features. Together with these two case reports, a literature review confirmed the diverse nonimmunological etiologies associated with Ballantyne's syndrome. Clinicians should be aware of this particular presentation of hydrops fetalis resulting from a mechanism different from hypotrophic placentation because specific etiological treatment can avoid unnecessary pregnancy termination. Pre-conception counselling is also different.
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Affiliation(s)
- S Proust
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, quai Moncousu, 44093 Nantes Cedex 1
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Towner D, Gandhi S, El Kady D. Obstetric outcomes in women with elevated maternal serum human chorionic gonadotropin. Am J Obstet Gynecol 2006; 194:1676-81; discussion 1681-2. [PMID: 16643816 DOI: 10.1016/j.ajog.2006.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 12/29/2005] [Accepted: 03/04/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study was undertaken to assess outcomes in unselected women with maternal serum human chorionic gonadotropin (MShCG) 2.0 MoM or greater. STUDY DESIGN This is an observational cohort study of 309 women with MShCG 2 MoM or greater and 309 women of the same age and ethnicity with MShCG less than 2.0 MoM who were evaluated for preterm delivery (PTD), preeclampsia, stillbirth, birth weight 10% or less, and birth weight 90% or greater (larger for gestational age [LGA]). Confounding variables evaluated were nulliparity, prior PTD, chronic hypertension, diabetes, and maternal serum alpha-fetoprotein and estriol. RESULTS There was no overall increase in adverse outcomes despite associations found with PTD for preeclampsia with MShCG 3.0 MoM or greater (odds ratio [OR] 5.9, CI 1.5-23.2) and PTD for fetal indications with MShCG 4.0 MoM or greater (OR 45.5, CI 4.1-509). There was an increase of LGA infants with MShCG 3.0-3.9 MoM (OR 2.5, CI 1.0-5.8). CONCLUSION Adverse pregnancy outcome is associated with MShCG 3.0 MoM or greater, thus increased surveillance is not warranted with lower values.
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Affiliation(s)
- Dena Towner
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California at Davis, Sacramento, CA, USA
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Hershkovitz R, Bar G, Erez O, Smolin A, Sheiner E, Mishori-Dery A, Mazor M. Increased maternal serum human chorionic gonadotropin concentrations are an independent risk factor for SGA in dichorionic twin gestations. J Matern Fetal Neonatal Med 2005; 18:117-22. [PMID: 16203597 DOI: 10.1080/14767050500199228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine maternal and neonatal complications among dichorionic and monochorionic twins with isolated midtrimester elevated maternal serum human chorionic gonadotropin (MShCG). MATERIAL AND METHODS MShCG was determined in 247 women with dichorionic twins and 32 women with monochorionic twins between 16-18 weeks gestation. Among the dichorionic twins 219 patients had MShCG < 2.5 MoM, 14 between 2.5-3.0 MoM and 14 above 3.0 MoM. Of the patients with monochorionic twins 15 had MShCG < 2.5 MoM, nine between 2.5-3.0 MoM and 8 above 3.0 MoM. All patients had maternal serum alpha fetoprotein < 2.5 MoM. Karyotype was normal among all neonates. Statistical analysis was performed with SPSS package. RESULTS Patients with monochorionic twins had higher rates of cesarean section when MShCG was > 3.0 MoM (100% vs. 44%; p = 0.03) and of preterm delivery when MShCG was > 2.5 MoM (87.5% vs. 46.7%; p = 0.04). A non significant higher rate of small for gestational age (SGA) neonates was found when MShCG was > 2.5 MoM among first twin (37.5% vs. 13.3%; p = 0.08). In contrast, patients with dichorionic twins had higher rates of SGA neonates and low 1 minute Apgar scores in the second twin when MShCG was > 2.5 MoM (23.1% vs. 10%; p = 0.04, 15.4% vs. 11.9%; p < 0.01). A multivariate logistic regression model with forward stepwise selection was performed with SGA as outcome variable. The model included the following variables: MShCG, hypertensive disorders, gestational age at delivery, chorionicity, twin order, cesarean section (CS) and preterm delivery. MShCG levels were the only significant factor predicting SGA among bichorionic twins (OR 1.76, 95% CI 1.2-2.5). CONCLUSIONS (1) Increased concentrations of MShCG are an independent risk factor for SGA among dichorionic twins. (2) MShCG > 2.5 MoM are associated with adverse maternal outcome among monochorionic twins.
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Affiliation(s)
- Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Human Chorionic Gonadotropin and Vascular Endothelial Growth Factor in Normal and Complicated Pregnancies. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200311000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Hershkovitz R, Erez O, Sheiner E, Landau D, Mankuta D, Mazor M. Elevated maternal mid-trimester chorionic gonadotropin ≥4 MoM is associated with fetal cerebral blood flow redistribution. Acta Obstet Gynecol Scand 2003. [DOI: 10.1034/j.1600-0412.2003.820104.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND Biochemical tests of placental or feto-placental function were widely used in the 1960s and 1970s in high-risk pregnancies to try to predict, and thus try to avoid, adverse fetal outcome. OBJECTIVES To assess the effects of performing biochemical tests of placental function in high-risk, low-risk, or unselected pregnancies. SEARCH STRATEGY Comprehensive electronic search of the Cochrane Pregnancy and Childbirth Group trials register (February 2003). SELECTION CRITERIA Controlled trials (randomized or 'quasi-randomized') that compare the use of biochemical tests of placental function in pregnancy with non-use. DATA COLLECTION AND ANALYSIS Trial quality was assessed and data were extracted by the reviewer. MAIN RESULTS A single eligible trial of poor quality was identified. It involved 622 women with high-risk pregnancies who had had plasma (o)estriol estimations. Women were allocated to have their (o)estriol results revealed or concealed on the basis of hospital record number (with attendant risk of selection bias). There were no obvious differences in perinatal mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.36 to 2.13) or planned delivery (RR 0.97, 95% CI 0.81 to 1.15) between the two groups. REVIEWER'S CONCLUSIONS The available trial data do not support the use of (o)estriol estimation in high-risk pregnancies. The single small trial available does not have the power to exclude a beneficial effect but this is probably of historical interest since biochemical testing has been superseded by biophysical testing in antepartum fetal assessment.
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Affiliation(s)
- J P Neilson
- Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool, UK, L69 3BX.
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Reis FM, D'Antona D, Petraglia F. Predictive value of hormone measurements in maternal and fetal complications of pregnancy. Endocr Rev 2002; 23:230-57. [PMID: 11943744 DOI: 10.1210/edrv.23.2.0459] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intrauterine tissues (placenta, amnion, chorion, decidua) express hormones and cytokines that play a decisive role in maternal-fetal physiological interactions. The excessive or deficient release of some placental hormones in association with gestational diseases may reflect an abnormal differentiation of the placenta, an impaired fetal metabolism, or an adaptive response of the feto-placental unit to adverse conditions. This review is focused on the applicability of hormone measurements in the risk assessment, early diagnosis, and management of pregnancies complicated by Down's syndrome, fetal growth restriction, preeclampsia, preterm delivery, and diabetes mellitus. Combined hormonal tests or the combination of hormones and ultrasound may achieve reasonable sensitivity, but research continues to simplify the screening programs without sacrificing their accuracy. Only in a few instances is there sufficient evidence to firmly recommend the routine use of hormone tests to predict maternal and fetal complications, but the judicious use of selected tests may enhance the sensitivity of the risk assessment based solely on clinical and ultrasound examination.
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Affiliation(s)
- Fernando M Reis
- Department of Obstetrics and Gynecology, University of Minas Gerais, Belo Horizonte 30130-100, Brazil
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15
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Merviel P, Müller F, Guibourdenche J, Berkane N, Gaudet R, Bréart G, Uzan S. Correlations between serum assays of human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) and pre-eclampsia or intrauterine growth restriction (IUGR) among nulliparas younger than 38 years. Eur J Obstet Gynecol Reprod Biol 2001; 95:59-67. [PMID: 11267722 DOI: 10.1016/s0301-2115(00)00370-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To study the relation between serum human chorionic gonadotrophin (hCG) levels measured at 15-18 weeks and gestational disorders, assess their correlation with the artery uteroplacental Doppler (AUD) at 24 weeks among nulliparas, and assess the predictivity of the hCG/hPL (human placental lactogen) ratio for pre-eclampsia. STUDY DESIGN Retrospective study of two groups of women younger than 38 years old: one with an elevated serum hCG level (2 MoM (multiples of the median) or more) and a normal fetal karyotype (group A), and the other with a lower hCG level (group B). Within each group, we studied the nulliparas separately (respectively groups AO and BO). We analyzed the double screening, elevated hCG levels with abnormal AUD, for the predicting of hypertensive disorders. RESULTS Elevated hCG levels were significantly (p<0.05) more prevalent among women who developed gestational diabetes (groups A and AO) and among nulliparas with pregnancy-induced hypertension and pre-eclampsia (AO). Among nulliparas, the combination of the hCG assay and a subsequent Doppler increased the positive predictive value (PPV) of the assay from 19 to 75%, without reducing its negative predictive value (NPV) for gestational vascular disorders. The hCG/hPL ratio did not improve the predictivity of the hCG assay alone for pre-eclampsia. CONCLUSIONS An hCG level of 2 MoM or more at 15-18 weeks identifies a group of women at risk of gestational vascular disorders; it therefore ought to lead to an AUD at 24 weeks. This double screening should be able to define a population of women at risk of developing a hypertensive disorder, who could thus benefit from a preventive treatment, as aspirin.
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Affiliation(s)
- P Merviel
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
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