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Hcg Quantitative Levels

Hcg Quantitative Levels

Why the Test is Performed

HCG appears in the blood and urine of pregnant women as early as 10 days after conception. Quantitative HCG measurement helps determine the exact age of the fetus. It can also diagnose abnormal pregnancies, such as ectopic pregnancies, molar pregnancies, and possible miscarriages. It is also used as part of a screening test for Down syndrome.

This test is also done to diagnose abnormal conditions not related to pregnancy that can raise HCG level.

Risks

Risks of having blood drawn are slight, but may include:

  • Excessive bleeding
  • Fainting or feeling lightheaded
  • Blood accumulating under the skin (hematoma)
  • Infection (a slight risk any time the skin is broken)
  • Human chorionic gonadotropin

Human chorionic gonadotropin (hCG) is a 40kDa glycoprotein hormone secreted by the developing placenta shortly after fertilization. It is composed of two subunits α and β. The α subunit is common for hCG, follicle stimulating hormone (FSH), luteinizing (LH), and thyroid stimulating hormone (TSH). The β subunit is distinguishing for hCG, hence the nomenclature “βhCG” test, which implies reduced cross-reactivity with the other hormones mentioned above.

In normal pregnancy, hCG can be detected in serum as early as six to seven days following conception. Recent studies suggest that urine hCG concentrations are approximately one-half of, or less than one-half of, corresponding serum hCG concentrations. Thus, hCG can likely be reliably detected in urine as early as 14 days after conception (approximately 28 days since the last menstrual cycle). hCG approximately doubles in concentration about every two days until it peaks at approximately 8 to 10 weeks after the last menstrual period.1 The appearance of hCG soon after conception and its subsequent rise in concentration during early gestational growth make it an excellent marker for the early detection of pregnancy.

Hormone levels ≥25 mIU/mL are usually reported as a positive qualitative indication of pregnancy. Urine samples containing ″5 mIU/mL usually indicate a negative result for pregnancy. A borderline result is generated by some assays when the hCG level is between 5 and 25 mIU/mL. Samples reported as borderline are considered indeterminate, and clinicians should request a repeat test within 48 to 72 hours or obtain a quantitative serum hCG. However, some assays report values in the 5 to 25 mIU/mL range as positive for pregnancy. This sometimes can cause confusion for the patient when she is tested later on and the result is negative. 

Verifying hCG levels

The discussion above leads one to conclude that hCG testing for pregnancy is not as simple as it appears on the surface. hCG itself is not a simple molecule, nor does it exist in one form. Furthermore, a single test may lead one to a wrong conclusion diagnostically. That is why when a test presents with low levels of hCG it is better to verify the diagnostic conclusion than to just call the result positive, as some assays would have you do. In fact, Snyder states:

“Because hCG measurements have two clinical applications, false-positive hCG results not only cause clinical confusion, but in several instances have led to harmful therapeutic interventions.”

Test usage

Human chorionic gonadotropin (hCG) is a glycoprotein secreted by the placenta during pregnancy that consists of an alpha and beta subunit. The alpha subunit is structurally similar to the alpha subunits of FSH, LH and TSH. The beta subunit is distinct for hCG. The release of hCG into maternal circulation begins with embryo implantation 5 to 7 days after fertilization.

Several forms of hCG are present in serum and urine (Clinical Chemistry 1997; 43:2233 – 43). In early pregnancy, trophoblast cells of the placenta secrete predominantly intact hCG. This molecule is broken down into several degradation products. The normal degradation pathway is: non-nicked hCG → nicked hCG → nicked free →β → β core fragment.

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