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Semin Reprod Med 2008; 26(5): 383-390
DOI: 10.1055/s-0028-1087104
© Thieme Medical Publishers

The Use of Serial Human Chorionic Gonadotropin Levels to Establish a Viable or a Nonviable Pregnancy

Karine Chung1 , 3 , Rene Allen2 , 3
  • 1Assistant Professor of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, Keck School of Medicine, Los Angeles, California
  • 2Fellow, Division of Reproductive Endocrinology and Infertility, University of Southern California, Keck School of Medicine, Los Angeles, California
  • 3Division of Reproductive Endocrinology and Infertility, University of Southern California, Keck School of Medicine, Los Angeles, California
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Publikationsverlauf

Publikationsdatum:
29. September 2008 (online)

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ABSTRACT

Measurement of serial human chorionic gonadotropin (hCG) concentrations facilitates the diagnosis of normal or abnormal early gestation, as deviations from expected rates of rise or decline prompt intervention and/or treatment of abnormal pregnancies. Recently, the expected rise in hCG levels for normal intrauterine pregnancies (IUPs) was well characterized, and based on a 95% confidence interval, it was determined that the slowest rise in a normal IUP was 53% in 2 days. When the hCG level is decreasing, it is clear that the pregnancy is not viable. The management of such cases consists of observation or intervention. The rate of decline associated with nonviable pregnancies that resolved with expectant management has been described, with a faster decline observed with higher hCG levels at presentation. A rate of decline that is slower than 21 to 35% in 48 hours suggests the presence of retained trophoblastic tissue or an ectopic pregnancy and indicates the need for intervention to achieve a definitive diagnosis. While there is no consistent pattern of serial hCG levels characterizing ectopic pregnancies, the majority of patients ultimately diagnosed with ectopic pregnancy will exhibit rates of rise or decline that are outside the “normal” range as defined by the established curves.

KEYWORDS

Human chorionic gonadotropin - ectopic pregnancy - spontaneous abortion - multiple gestation - intrauterine pregnancy

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Karine ChungM.D. 

Assistant Professor of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Southern California, Keck School of Medicine

1240 North Mission Road, Room 8K9, Los Angeles, CA 90033

eMail: karinech@usc.edu

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