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Human Chronic Gonadotrophin (HCG)
Human Chronic Gonadotrophin (HCG) is a peptide hormone which is produced during the pregnancy. This hormone is produced by placenta, which feeds the egg after its fertilization and attachment to the wall of uterine. The hormone is discharges into the urine of a pregnant woman. So it can be diagnosed through blood test as well as urine test. A blood test is used after 11 days of conception and urine test is used after about 12-14 days of conception to find out the levels of HCG. Generally the level of HCG gets doubled after every 72 hours and during 8 to 11 weeks of pregnancy it reaches to its peak and after that it starts declining and levels off and remains same for the rest of the pregnancy.
Functions of HCG
HCG performs the following functions during pregnancy:
- It helps corpus luteum to maintain progesterone production in early pregnancy
- It keeps the endometrium for the initial trimester;
- It stimulates the fetal gonad development and androgen synthesis by the fetal testes
- It is also helpful in the stimulation of the secretion of estrogen and the growth of the placenta.
Today pregnancy kits are easily available in drug stores; both doctors and public use these kits to assess the pregnancy occurrence. Latest kits which are available now in market are responsive and also have little chances of fake positive rates (Chard, 1992). Pregnancy kits are not quantitative and are unable to distinguish among various results of conception. Predicting effects after assisted conception cure is very important to patients and doctors. Studies reveal that the rise in plasma HCG is higher in possible pregnancies than biochemical or ectopic pregnancies. The concentrations of HCG are considerably high in numerous compared with singleton pregnancies. These observations recorded and used to foresee the possibility of various births. (Guth et al., 1995)
As discussed before Human Chorionic Ganadotropin (hCG) is produced by mother only during pregnancy period. This is produced by the mother's body when fertilized egg implants in the uterus. This hormone helps the patient at home as well as doctors by conducting to check its level in mother's body. Conducting hCG blood test at doctor will determine pregnancy at very early stages after fertilization. Any level which is more than 5 is considered as pregnant mother. This must be kept in mind that miscarriage at this time is still at high ratio approximately 30%. Tests conducted at home relatively require more time before conducting test and can be conducted after 14 days. hCG level at this time of pregnancy is in between 50 and 80. At this stage, the probability of miscarriage declines to only 10% because baby is implanted in mother's uterus.
hCG levels usually increase every 2-3 days and approximately doubles the value. To measure accurate values of hCG, it is advised to conduct the two tests about every three days. hCG values during the pregnancy are most likely to be as given below:
- 3 - Weeks: 5-50 mIU/ml (Reading below 5 means no pregnancy)
- 4 - Weeks: 5 - 426 mIU/ml
- 5 - Weeks: 19 - 7,340 mIU/ml
- 6 - Weeks: 1,080 - 56,500 mIU/ml
- 7 - 8 Weeks: 7,650 - 229,000 mIU/ml
- 9 - 12 Weeks: 25,700 - 288,000 mIU/ml
- 17 - 24 Weeks: 4,060 - 65,400 mIU/ml
- 25 - Term: 3,640 - 117,00 mIU/ml
Large range which is presented above which assume that one might be 7 days off on your ovulation, and this will present statistics for pregnancies with more than one baby. The above mentioned readings are approximate to give just idea how your pregnancy going on and its not 100 percent accurate. There are some cases in which it is observed that if patients levels are increasing, the failure to double every three days or so is not a good sign. Although this type of pregnancy can move for several months but this will most likely leads to death/miscarriage. A single set of diagnostics tests which do not show doubling might be just fine and another set of test s might be asked if ones level is at borderline.
Stillbirth can be defined as a fetus died in uterus during delivery and exits from mother's body. The other terms which are used in distinction to live birth and miscarriage? Stillbirths happen most of the time in full term pregnancies. Stillbirth rates vary widely between developed countries where the rate is 6-7/1000 births and the ratio i30/1000 births in developing countries. The etiologies differ by environment and resources; in developed countries fetal growth restriction, congenital or karyotypic anomalies, maternal medical diseases account for many still births whereas pre-eclampsia, obstructed labor and infection are more common causes in developing countries. Fetal death before the onset of labor is much more common than fetal death during labor or delivery.
There are many causes of stillbirth. Aetiology is never identified in at least 25% of stillbirths in spite of complete evaluation. Fetal causes for stillbirth include chromosomal and genetic abnormalities and congenital malformations. Placental causes include premature separation before delivery, hemorrhage and umbilical cord complications. Other causes such as intrauterine infection and fetal growth restriction are multifactoral, often involving the mother and either placenta or fetus. (Linda Heffner, Danny J. Schust, 2010)
There are many causes of stillbirths which are unknown even in the cases where all the tests have been conducted like HCG, autopsy and ultrasounds. Death due to stillbirth is never identified 100 %. However, the possible known causes of stillbirth can be summarized below:
- Placental Problems: Placenta is a place where baby gets nourishment in mother's body. In some cases, uterus loose placenta before birth, which creates problems for baby survival as oxygen and nutrients are only available in placenta for baby. This situation is responsible for stillbirth upto 16% and is known as placental abruption.
- Birth Defects: In some cases baby is created with faulty chromosomes, which leads to genetics problems. This situation leads to serious defects in baby which also makes impossible for baby to survive. It is observed that approximately 5% to 10% of stillbirths are due to genetic problems. Another source for birth defects can be due to environmental toxins, smoking, use of alcohol and drugs.
- Infection: It has been observed that in some mothers, infections develop which results damage to the fetus. Toxoplasmosis, listeria and rubella are some of the bacterial infections which can create serious problems in baby. STD's are also known as responsible for death of baby.
- Maternal Illness: Maternal health issues can also create problems for fetus for intrauterine and intra-patrum death. Women with diabetes and live problems have increased risk for giving birth to stillbirth baby. 5% of death of babies can be contributed due to these problems.
- Birth Trauma: Stillborn baby sometime have trauma during labor pains and this also leads to death of the baby. Babies suffer from shoulder dystocia while giving birth to the babies, which also sometimes leads to death.
Diagnosis of Stillbirth
When the mother feels no movement of the baby, the doctors can use different technique to diagnose the reason. Firstly, the doctor can use stethoscope to listen the heartbeat of the baby. Secondly, a Doppler ultrasound can also be used to diagnose the heartbeat of the baby. Lastly, an electric non fetal stress can be given to the mother. In this test, the mother is laid on her back and electric monitors are attached to her abdomen. The monitors capture the movement, heartbeat of the baby and contraction of the uterus.
In case of intrauterine death of baby, the mother is taken into the labor with two weeks of the baby death. If the patient doesn't go into labor, then doctor uses the induce labor to avoid the danger of hemorrhage. Labor is normally induced in the body of the female by a drug known as oxytocin. This drug helps the uterus to contract.
The risk of stillbirth can be minimized through good parental care and taking care of the mother from the exposure to the infectious diseases such as smoking, alcohol abuse or drugs. Ultrasound, the alpha fetoprotein blood test and the electronic fetal non-stress test must be taken before the delivery to evaluate the situation of pregnancy and health before the baby dies.
Molar pregnancy is a type of trophoblastic disease. In mole pregnancy a partial or complete mole becomes when egg and sperm combine at fertilization. But unfortunately the cell does not grow in the way that supports the pregnancy. In a normal pregnancy the fertilized eggs get 23 chromosomes from the mother side and 23 chromosomes from the father side and total make the 46. But in molar pregnancy the wrong number of chromosomes combine and abnormalities are created in the pregnancy.
Molar pregnancy is uncommon so it is rare. Chances of molar pregnancy increase when the female has following:
- Age is more then 40
- Previous experience of molar pregnancy
- A history of miscarriage
- Deficiency of Vitamin-A known as betacarotene
Types of Molar Pregnancy
Molar pregnancy can be classified into 2 categories:
- Complete Molar Pregnancy
- Partial Molar Pregnancy
In Complete molar pregnancy, the fertilized egg contains no genetic information. In this type, fertilized egg does not have any information from mother side and the chromosomes from the side of father are duplicated. Two copies or set of chromosomes are received from father's side. In this scenario, there is no fertilized egg, placenta, amniotic sac etc. Rather placenta makes the cluster of sac which looks like the bunch of grapes. These clusters can be seen through sonography.
In Partial Molar Pregnancy, the placenta starts growing, which shows that the fertilized egg / embryo is developing. Fetus, some fetal tissues or amniotic sac form, but ultimately the pregnancy has some biological issues because of missed genetic information. Actually two sperms fertilize an egg, as a result of which a partial mole is formed. Instead of making twins, some goes wrong and abnormal placenta and fetus are formed. The baby gets too many chromosomes from the father side and no one form the mother side. The baby always dies in the uterus with an unhappy pregnancy for the couple.
Symptoms of Molar Pregnancy
Following are the signs of molar pregnancy:
- Severe nausea and vomiting
- High level of HCG
- Bleeding from vagina in the forms of grape like vessels
- No fatal movement
- No heart beat of baby
- Enlarged soft ovaries
- Uterus grows rapidly
Diagnosis of Molar Pregnancy
An ultrasound as well as high beta HCG helps to detect the molar pregnancy.
During ultrasound the molar pregnancy gives the effect of snow storm. On the other hand, high HCG level shows that pregnancy is abnormal and further study or diagnosis is required.
Treatment of Molar pregnancy
A minor operation known as D≈C (Dilation and Curettage) is used to terminate a molar pregnancy. In this method the patient goes through a general anesthesia. During the anesthesia, the surgeon widens the cervix of the female and tissues are removed through gentle suction from uterus of the female. Equipment known as curette is used to remove the further tissue if left in the uterus walls. Sometimes all the tissues are not removed in one sitting of the D≈C so a second sitting is also required.
The other treatment to remove the molar pregnancy is medicine. The medicines are given to the patient so the body shed all the tissues by it. The medicine can be given as tablets to swallow or as gel or peccary that is inserted into the vagina.
The ongoing treatment includes the regular check up of the HCG level several times in a week. After that a weekly test of HCG is taken till three weeks until the the levels doesn't get normal. Up to one year, the test of HCG level is taken on monthly basis and then after every six months. A pelvic examination is also compulsory. An increased level of HCG and an enlarged uterus shows the choriocarcinoma. The couple gone through this situation should avoid the next pregnancy till one year. (Stephanie A. Eisenstat, Karen J. Carlson, Terra Diane Ziporyn, 2004s)
Ectopic means out of the place. It is the type of pregnancy that occurs outside the uterus or womb of the woman. Out of 100, about 02 pregnancies are ectopic in nature. In Ectopic pregnancy, there is no chance left for the normal delivery.
In general, when an egg and sperm meets or fertilize, both make an embryo. This embryo implants itself inside the uterus of female and starts growing and developing there. The unusual sites or locations of the embryo where it accidentally gets attached and grow can be Fallopian tubes, Cervix, Ovary and abdominal cavity. Most of the abnormal pregnancies occur in fallopian tubes. It has been studied that about 95% of the ectopic pregnancies take place in fallopian tubes.
Normally, fertilization of sperm and egg take place in the fallopian tubes. Fallopian tubes link the ovaries to uterus. The fertilized egg or embryo travels from ovaries to the uterus and implants itself in the womb and start growing into baby.
But in Ectopic pregnancy, the embryo gets attached itself elsewhere while travelling from ovaries to the uterus and start growing at abnormal location where it does not get the favorable environment to grow.
Ectopic pregnancy can never lead towards a normal delivery because there is no space or favorable condition for the embryo to grow outside the womb or uterus. When the embryo starts growing, which has been attached at improper location, it results to the rupture of the fallopian tubes. This type of pregnancy can be diagnosed today during the first six weeks of the pregnancy, before the dangerous stage of rupture of fallopian tubes is approached.
The burst of the fallopian tubes causes the bleeding, sever pain, and to the extreme the death of the mother. Although today, it can be diagnosed before it becomes dangerous but still mother has to go to the stage of termination of her pregnancy. Women who have pelvic infection of pelvic inflammatory disease are more prone to the ectopic pregnancy and the chances of this pregnancy are highest for women above age of 35. The females, who have gone through ectopic pregnancy before, are more likely to have it again. (Isabel Stabile, 1996)
Diagnosis of Ectopic Pregnancy
In start, an ectopic pregnancy is similar to the normal pregnancy. It can be started with a skipped menstrual cycle and other indications like nausea and sore breasts. There is sometimes irregular vaginal flow of blood which might happen little later than expected time. Most often this flow of blood is misunderstood as periods. Ectopic pain occurs usually and linked with the light-headedness. If there is rupture of tube, this will result in severe abdominal pain, fainting and shock feelings. This is very difficult to diagnose through clinical examination and only results might be a pain. A tubal pregnancy is a disaster. It was diagnosed only after the tube rupture and than doctor must do an emergency surgery to stop the flow of blood and also save the life of mother. Most of the time doctors have to completely remove the tube as it was completely damaged. Also on the same time, patient's ability to conceive become difficult after tube rupturing.
Following type of tests can be used to diagnose the ectopic pregnancy.
- Quantitative Human Chronic Ganadotrophin Test
- Pelvic Examination and Ultrasound
- Laparoscopic Surgery
Ectopic pregnancy can be detected at early stages by having blood tests of HCG and conducting ultrasound of vagina. At one time both tests can be done. Ectopic pregnancy is confirmed when ßhCG levels reach at 1500 mIU/ml and fetus is not apparent during the vaginalultrasound. HCG test confirms the pregnancy but do not tell about the site of the embryo, it can be located through a vaginal ultrasound. Infrequently, the sacs are visible from the exterior of the uterus, making a positive diagnosis of ectopic through sonography. In early pregnancy, the embryo can not be seen obviously. When the HCG level is higher than 2000 mIU/ml and the doctor is unable to see a gestational sac , it means that the finding is an ectopic pregnancy. If the doctor thinks that the pregnancy is ectopic or having another problem, then he checks the HCG level after every few days.
In pelvic examination the doctor insert the gloved finger into the vagina and feels the abdomen with other hand. Pelvic examination is conducted to test the figure out the painful areas of the abdomen, to check an enlarged uterus which might have pregnancy and other masses present in the abdomen. If the ectopic pregnancy is diagnosed then the female also has an ultrasound. An ultrasound shows the picture of the location of the embryo but it is not helpful when the pregnancy is of or less then six weeks.
It is another test which is used to detect the ectopic pregnancy. Laparascope is the device which is inserted into the abdomen by the path of belly button. This device has camera attached so the doctor can see the internal organs without making the large abdominal cut. This is the easy way and the patient can be released on the same day from hospital if she is having ectopic pregnancy and it has to be terminated. All this process can be done through laparoscopically.
This test is used to check the internal bleeding because if the ectopic pregnancy. This method is not commonly used. A needle is inserted into the space at the top of the vagina in front of the rectum and behind the uterus. If blood or fluid comes out by the insertion of the needle, it indicates that the pregnancy is ectopic.
Treatment of Ectopic Pregnancy
It is sure that an ectopic pregnancy can never lead towards a normal baby. But there is remedy to save the patient's fallopian tubes to be ruptured. The tube can be saved if the ectopic pregnancy is diagnosed at its early stage. The early diagnosis helps to increase the chances of future fertility and normal delivery in the future. The early pregnancy can be terminated with an injection known as methotrexate. It is the successful method in early stage of the pregnancy. When the HCG level is decreased, it forecasts that the body is absorbing the pregnancy and no treatment is required to terminate the ectopic pregnancy. Although, there is possibility of treatment. This injection helps to dissolve the fertilized egg and then it is absorbed by the body. Nothing can be done doctor if the ectopic pregnancy is at its early stages and HCG level is low. It is an intramuscular injection and when it is given then there is the need to monitor the beta HCG regularly to make sure that it is declining to zero. The zero beta HCG confirms that pregnancy has successfully terminated. (Gerard Doherty, 2006)
The other possibility is the Ultrasound when tubes are not ruptured. It also includes the toxical chemical and potassium chloride, into the fetus in the tube while having sonography. This chemical helps to kill the tissues of the pregnancy and body automatically absorbs the pregnancy.
One more solution is surgery depending upon the time length of the pregnancy. Surgery is required when the tubes are ruptured and blood is collected in the abdomen. In this situation, the tubes are badly damages and they are required to be removed immediately. It involves two methods. One is laparoscopy which is a small incision in the belly button. The other method of surgery is the laparotomy, which involves the much larger incision in the lower abdomen. The damage and removal of tubes guide towards the low chances of fertility. (Joanne Stone, Keith Eddleman, Mary Duenwald, 2009)
- Chard, T., 1992. Pregnancy tests: a review.Hum. Reprod.,7, 701-710. Available at:[http://humrep.oxfordjournals.org/cgi/content/abstract/7/5/701]
- Guth, B., Hudelson, J., Higbie, J.et al.,1995. Predictive value of HCG concentration 14 days after embryo transfer.J. Assist. Reprod. Genet.,12, 13-14. Available at: [http://cel.isiknowledge.com/InboundService.do?product=CEL&action=retrieve&SrcApp=Highwire&UT=A1995RC74300004&SID=V1DBhHHFkf3hFL6nD2C&Init=Yes&SrcAuth=Highwire&mode=FullRecorD≈CustomersID=Highwire]
- Gerard Doherty, 2010. Current diagnosis & treatment surgery. McGrawHill Companies, Inc.
- Isabel Stabile, 1996. Ectopic pregnancy: diagnosis and management. University of Cambridge, USA.
- Joanne Stone, Keith Eddleman, Mary Duenwald, 2009. Pregnancies for Dummies. Wiley Publishing Inc.
- Karen J. Carlson, Stephanie A. Eisenstat, Terra Diane Ziporyn, 2004. Harvard University Press.
- Linda Heffner, Danny J. Schust, 2010. The Reproductive System at a Glance. Blackwell Publishing.