hCG in ectopic pregnancy

Detecting defects: low initial serum human chorionic gonadotropin (hCG) level may predict future fetal anomalies following frozen embryo transfer (FET)

PURPOSE

To investigate the relationship between early serum hCG levels after frozen embryo transfer and fetal anomalies.

METHODS

This was a case-control study at a single academic fertility center between 1/2010 and 12/2021, including all patients who underwent euploid frozen embryo transfers resulting in any fetal anomaly confirmed at the time of induced abortion > 10 weeks or any anomaly reported at delivery. Controls included patients with healthy live births matched for age and day/grade of embryo after euploid FET. The primary outcome was fetal anomaly, with comparisons made using serum hCG levels from cycle day 28 to cycle day 35 and percent change between days 28 and 35.

RESULTS

Both cycle day 28 serum hCG levels and day 35 serum hCG levels were significantly lower in the anomalous group (day 28: 152 vs 177.5 mIU/mL, p < 0.04; day 35: 3033 vs 3744 mIU/mL, p < 0.05). Patients with anomalous outcomes had a significantly lower hCG to start with 5/78 (6.4%) < 50 mIU/mL, 16/78 (20.5%) 51-100 mIU/mL, and 57/78 (73.1%) > 101 mIU/mL, compared to controls 3/78 (3.8%) < 50 mIU/mL, 8/77 (10.3%) 51-100 mIU/mL, and 66/77 (85.7%) > 101 mIU/mL (p < 0.02). However, the rate of rise between day 28 and day 35 was not statistically different (1758.0% vs 2097.0%, p = 0.23).

CONCLUSION

Patients with anomalous fetal outcomes following frozen embryo transfer had lower early serum hCG levels than controls with healthy live births, highlighting the potential utility of this serum marker to identify high-risk pregnancies in the first trimester and expedite treatment as appropriate for this rare but devastating outcome.

Diagnostic utility of clinicodemographic, biochemical and metabolite variables to identify viable pregnancies in a symptomatic cohort during early gestation

A significant number of pregnancies are lost in the first trimester and 1-2% are ectopic pregnancies (EPs). Early pregnancy loss in general can cause significant morbidity with bleeding or infection, while EPs are the leading cause of maternal mortality in the first trimester. Symptoms of pregnancy loss and EP are very similar (including pain and bleeding); however, these symptoms are also common in live normally sited pregnancies (LNSP). To date, no biomarkers have been identified to differentiate LNSP from pregnancies that will not progress beyond early gestation (non-viable or EPs), defined together as combined adverse outcomes (CAO). In this study, we present a novel machine learning pipeline to create prediction models that identify a composite biomarker to differentiate LNSP from CAO in symptomatic women. This prospective cohort study included 370 participants. A single blood sample was prospectively collected from participants on first emergency presentation prior to final clinical diagnosis of pregnancy outcome: LNSP, miscarriage, pregnancy of unknown location (PUL) or tubal EP (tEP). Miscarriage, PUL and tEP were grouped together into a CAO group. Human chorionic gonadotrophin β (β-hCG) and progesterone concentrations were measured in plasma. Serum samples were subjected to untargeted metabolomic profiling. The cohort was randomly split into train and validation data sets, with the train data set subjected to variable selection. Nine metabolite signals were identified as key discriminators of LNSP versus CAO. Random forest models were constructed using stable metabolite signals alone, or in combination with plasma hormone concentrations and demographic data. When comparing LNSP with CAO, a model with stable metabolite signals only demonstrated a modest predictive accuracy (0.68), which was comparable to a model of β-hCG and progesterone (0.71). The best model for LNSP prediction comprised stable metabolite signals and hormone concentrations (accuracy = 0.79). In conclusion, serum metabolite levels and biochemical markers from a single blood sample possess modest predictive utility in differentiating LNSP from CAO pregnancies upon first presentation, which is improved by variable selection and combination using machine learning. A diagnostic test to confirm LNSP and thus exclude pregnancies affecting maternal morbidity and potentially life-threatening outcomes would be invaluable in emergency situations.

Ectopic pregnancy and failed oocyte retrieval during in vitro fertilization stimulation: Two case reports

BACKGROUND

Due to a slight rise in beta-human chorionic (β-hCG) levels that are undetectable, and vaginal bleeding that is similar to regular menstruation, ectopic pregnancy (EP) that occurs during the expected menstrual cycle prior to ovulation induction as part of in vitro fertilization (IVF) is likely to be undiagnosed. We present two cases of unexpected EP and emphasize the importance of the β-hCG assay when an unexplained increase in progesterone is present prior to the triggering of ovulation during controlled ovarian stimulation (COS).

CASE SUMMARY

A 26-year-old woman with primary infertility and a 31-year-old woman with secondary infertility. Both patients sought IVF treatment due to fallopian tube obstruction and underwent COS using the gonadotropin-releasing-hormone (GnRH)-antagonist protocol. In the late stage of COS, progesterone levels in both patients significantly increased, and luteinizing hormone levels decreased, followed by oocyte retrieval failure. A right salpingectomy was performed and tubal ectopic pregnancy was diagnosed by pathology in the first patient, and the second patients was diagnosed with a suspected EP abortion because her β-hCG levels declined to 12.5 mIU/mL. After full recovery for 2 mo, the first patient entered a new IVF treatment cycle with a GnRH-antagonist regimen and successfully achieved eight oocytes and three viable embryos. After 6 mo, the second patient received another COS treatment with a progestin-primed ovarian stimulation protocol and successfully achieved nine oocytes and five viable embryos.

CONCLUSION

β-hCG levels in the initial and midterm phases of COS must be considered in patients with unusual hormone dynamics.

Rapid β-human chorionic gonadotropin detection in urine with electric-double-layer gated field-effect transistor biosensors and a handheld device

In this experimental study, a portable biosensor was developed to detect β-human chorionic gonadotropin (β-hCG), which is extensively used in pregnancy tests and serves as a biomarker for ectopic pregnancy. The sensor used is an electric-double-layer field-effect transistor biosensor with the extended-gate design. Bias voltage is applied on the sensor to measure the resulting drain current signals. Gold electrode surface is functionally activated with an anti-β-hCG antibody to capture β-hCG protein. Fluorescence imaging technique is utilized to confirm the surface functionalization. The biosensor demonstrates a dynamically wide range of molecules as detection targets at very low sample concentrations, which shows the potential to detect ectopic pregnancy in very early stages and easily keep track of its periodic changes. It can be produced en masse and does not use additional labels/reagents or pre-processing techniques for the sample. This biosensor can significantly reduce the manufacturing costs and is comparable with the currently available commercial ß-hCG assays. It is suitable for early diagnosis of ectopic pregnancy with low cost and easy operation at home with urine samples.

Ultrasound of the First Trimester

Ultrasound is the imaging study of choice for detection and full characterization of early pregnancies based on its accuracy, low cost, safety profile, and abundant availability. This article reviews the goals and utility of first-trimester ultrasound in gestation localization, viability determination, and abnormal pregnancies, including ectopic implantation, retained products, and molar pregnancy.

Ectopic pregnancy: exploration of its global research architecture using density-equalising mapping and socioeconomic benchmarks

OBJECTIVE

About 2% of all pregnancies are complicated by the implantation of the zygote outside the uterine cavity and termed ectopic pregnancy. Whereas a multitude of guidelines exists and related research is constantly growing, no thorough assessment of the global research architecture has been performed yet. Hence, we aim to assess the associated scientific activities in relation to geographical and chronological developments, existing research networks and socioeconomic parameters.

DESIGN

Retrospective, descriptive study.

SETTING

On the basis of the NewQIS platform, scientometric methods were combined with novel visualising techniques such as density-equalising mapping to assess the scientific output on ectopic pregnancy. Using the Web of Science, we identified all related entries from 1900 to 2012.

RESULTS

8040 publications were analysed. The USA and the UK were dominating the field in regard to overall research activity (2612 and 723 publications), overall citation numbers and country-specific H-Indices (US: 80, UK: 42). Comparison to economic power of the most productive countries demonstrated that Israel invested more resources in ectopic pregnancy-related research than other nations (853.41 ectopic pregnancy-specific publications per 1000 billlion US$ gross domestic product (GDP)), followed by the UK (269.97). Relation to the GDP per capita index revealed 49.3 ectopic pregnancy-specific publications per US$1000 GDP per capita for the USA in contrast to 17.31 for the UK. Semiqualitative indices such as country-specific citation rates ranked Switzerland first (24.7 citations per ectopic pregnancy-specific publication), followed by the Scandinavian countries Finland and Sweden. Low-income countries did not exhibit significant research activities.

CONCLUSIONS

This is the first in-depth analysis of global ectopic pregnancy research since 1900. It offers unique insights into the global scientific landscape. Besides the USA and the UK, Scandinavian countries and Switzerland can also be regarded as leading nations with regard to their relative socioeconomic input.

Optimising the diagnosis of ectopic pregnancy

This retrospective cohort study reviewed the diagnosis of all ectopic pregnancies within a district general hospital over a 5-year period after the establishment of a dedicated Early Pregnancy Assessment Unit (EPAU). Of 215 ectopic pregnancies identified, notes were available for 208 (97%). Two-hundred and two cases were determined to have been diagnosed and managed as ectopic pregnancies. Six cases were excluded as they were pregnancies of unknown location managed as such. Overall, 91% were diagnosed by ultrasound scan, 5% were diagnosed clinically and 3% were diagnosed on serial human chorionic gonadotrophin (hCG) levels. This study found that the introduction of a dedicated, multi-professional, EPAU with a stable workforce improved ultrasound visualisation of ectopic pregnancies at first ultrasound scan from 22% prior to its commencement, to 61% over this period. The improvement in positive scan diagnosis of ectopic pregnancy was associated with a reduction in negative laparoscopy rate from 13% to 6%.

Quantitative analysis of total β-subunit of human chorionic gonadotropin concentration in urine by immunomagnetic reduction to assist in the diagnosis of ectopic pregnancy

BACKGROUND

The initial diagnosis of ectopic pregnancy depends on physical examination, ultrasound, and serial measurements of total β-subunit of human chorionic gonadotropin (hCGβ) concentrations in serum. The aim of this study was to explore the possibility of using quantitative analysis of total hCGβ in urine rather than in serum by immunomagnetic reduction (IMR) assay as an alternative method to diagnose an ectopic pregnancy.

METHODS

We established a standard calibration curve of IMR intensity against total hCGβ concentration based on standard hCGβ samples, and used an IMR assay to detect total hCGβ concentrations in the urine of pregnant women with lower abdominal pain and/or vaginal bleeding. The final diagnosis of ectopic pregnancy was based on ultrasound scans, operative findings, and pathology reports. In this prospective study, ten clinical samples were used to analyze the relationship of total hCGβ IMR signals between urine and serum. Furthermore, 20 clinical samples were used to analyze the relationship between urine IMR signals and serum levels of total hCGβ.

RESULTS

The calibration curve extended from 0.01 ng/mL to 10,000 ng/mL with an excellent correlation (R(2)=0.999). In addition, an excellent correlation of total hCGβ IMR signals between urine and serum was noted (R(2)=0.994). Furthermore, a high correlation between urine IMR signals and serum levels of total hCGβ was noted (R(2)=0.862).

CONCLUSION

An IMR assay can quantitatively analyze total hCGβ concentrations in urine, and is a potential candidate for point-of-care testing to assist in the diagnosis of ectopic pregnancy.

Ectopic pregnancy: a red flag diagnosis

: Ectopic pregnancy (EP) is a leading cause of maternal morbidity and mortality. Rates of EP have declined, yet ethnic, socioeconomic, and age-related disparities persist. Improved ultrasound resolution, the use of emergency transvaginal ultrasounds, and improved lab sensitivity have enabled earlier diagnosis, which could further improve outcomes for patients with EP.

A highly sensitive gold nanoparticle bioprobe based electrochemical immunosensor using screen printed graphene biochip

This study describes a highly sensitive electrochemical immunosensor for the detection of human chorionic gonadotropin (hCG) that uses gold nanoparticles (AuNP) as the electrochemical label and graphene as electrode material.