Testing is a mandatory procedure that every pregnant woman goes through. And of course, having received a sheet with the results, he always tries to understand - well, what is there, is everything in order? But alas, in addition to numbers, the results contain only incomprehensible abbreviations. HCG, MoM, RaRR-A, ACE - all this says little to an uninitiated person. Let's try to deal with some of them.
Churionic gonadotropin - what is it?
HCG stands for human chorionic gonadotropin, a hormone normally produced only by pregnant women. A fertilized egg begins to produce it, and later, after the trophoblast is formed, its tissues. By the way, it is his appearance in the urine that causes the pregnancy test to react.
The level of hCG can be an indicator of many pathologies of the mother and fetus, while it is either greatly reduced or significantly higher than normal. In the event that deviations from itinsignificant, it has practically no diagnostic value.
MoM – what is it
The abbreviation MoM comes from the English multiple of median, or, if translated into Russian, “a multiple of the median”. In gynecology, the median is the average value of one or another indicator at a certain gestational age. MoM is a coefficient that allows you to assess how much the results of the analyzes of a particular woman deviate from the average value. MoM is calculated by the formula: the value of the indicator is divided by the median (the average value for the gestational age). MoM does not have its own unit of measurement, since both the patient's indicators and the median are calculated in the same. Thus, MoM is an individual value for each woman. If it is about one, then the patient's performance is close to the average norm. If we consider the hCG indicator, MoM (norm) during pregnancy, it ranges from 0.5 to 2. This value is calculated by special programs that, in addition to arithmetic calculations, also take into account the individual characteristics of a woman (smoking, weight, race). That is why MoM values may vary in different laboratories. Deviations of HCG MoM from normal levels can signal serious violations in both the development of the fetus and the condition of the mother.
HCG functions
Horionic gonadotropin is the hormone of pregnancy. It starts the processes necessary for its normal development. Thanks to it, the regression of the corpus luteum is prevented andstimulates the synthesis of progesterone and estrogen, preserving pregnancy. In the future, this will be provided by the placenta. Another important function of hCG is to stimulate the Leydig cells that synthesize testosterone in the male fetus, which, in turn, contributes to the formation of male genital organs.
Chorionic gonadotropin consists of alpha and beta units, and if alpha-hCG in structure differs little from the structural units of hormones FSH, TSH, beta-hCG (MoM) is unique. That is why beta-hCG is of diagnostic value. In plasma, it is determined immediately after the fertilized egg is introduced into the endometrium, that is, approximately 9 days after ovulation. Normally, the concentration of hCG doubles every two days, reaching a maximum concentration (50,000–100,000 IU / L) by the 10th week of pregnancy. After that, for 8 weeks, it decreases by almost half, then remaining stable until the end of pregnancy. However, in the later stages, a new rise in hCG values \u200b\u200bmay be recorded. And although this was not previously considered a deviation from the norm, the modern approach requires the exclusion of placental insufficiency in Rh incompatibility, which can cause elevated HCG MoM. After childbirth or uncomplicated abortion in plasma and urine, hCG should not be determined after 7 days.
When analysis is scheduled
Analysis of hCG (MoM) can be prescribed in the following cases:
- for early pregnancy diagnosis;
- when monitoring the progress of pregnancy;
- forexclusion of ectopic pregnancy;
- to assess the completeness of induced abortion;
- if you suspect a miscarriage or threatened miscarriage;
- as part of a triple analysis (with ACE and estriol) for the early diagnosis of fetal malformations;
- with amenorrhea (absence of menstruation);
- in men, hCG analysis is done when diagnosing testicular tumors.
hCG to MoM by week
Different laboratories can set different norms for the indicators of this hormone, so the figures given are not a standard. However, in almost all laboratories, the hCG rate in MoM does not go beyond the range from 0.5 to 2. The table shows the hCG rates from conception, and not from the last menstruation.
| Term (weeks) | hcg honey/ml |
| 1 – 2 | 25 – 30 |
| 2 – 3 | 1500 – 5000 |
| 3 – 4 | 10,000 – 30,000 |
| 4 – 5 | 20,000 – 100,000 |
| 5 – 6 | 50,000 – 200,000 |
| 6 – 7 | 50,000 – 200,000 |
| 7 – 8 | 20,000 – 200,000 |
| 8 – 9 | 20,000 – 100,000 |
| 9 – 10 | 20,000 – 95,000 |
| 11 - 12 | 20,000 – 90000 |
| 13 – 14 | 15,000 – 60,000 |
| 15 – 25 | 10,000 – 35,000 |
| 26 – 37 | 10,000 – 60,000 |
When HCG is elevated
The following factors can cause an increase in hCG levels:
- multiple pregnancy;
- endocrine disorders including diabetes mellitus;
- fetal malformations (chromosomal abnormalities);
- trophoblastic tumors;
- taking hCG for therapeutic purposes.
Causes of low hCG
Decrease in hCG can cause:
- ectopic pregnancy;
- threatened abortion or miscarriage;
- antenatal fetal death;
- chromosomal abnormalities.
hCG in the diagnosis of fetal anomalies
The modern level of medicine allows you to identify abnormalities in the development of the fetus at a fairly early stage. An important role in this is played by the study of the level of hCG (MoM). To date, optimal terms of research have been developed that every woman who is expecting a child must undergo in order to identify pathological changes during pregnancy in time. They include several indicators. In the first trimester of pregnancy (10-14 weeks), these are ultrasound and laboratory studies of the level of hCG hormones, PAPP-A. At a later date, in the second trimester (16-18 weeks), in addition to ultrasound, a triple test is performed (AFP, hCG,estriol). The data of these studies with a high degree of probability allow us to assess the possibility of developing fetal pathologies and the risk of chromosomal abnormalities. All forecasts are made taking into account individual characteristics - the age of the mother, her weight, the risks caused by bad habits, pathologies in children born in past pregnancies.
Interpretation of screening results
Unfortunately, in some cases, the results are far from the indicators that are considered normal hCG, MoM during pregnancy. If the deviations are insignificant, then this may not be taken into account as a sign of pathology. However, if the results of the study, against the background of a low level of other markers, show values \u200b\u200bthat greatly exceed hCG 2 MoM, then this may mean that the fetus has such a chromosomal pathology as Down syndrome. Genetic abnormalities such as Edwards or Patau syndromes can be indicated by a reduced level of hCG and other markers. It is possible to suspect Turner's syndrome with even hCG levels against the background of a decrease in other markers. In addition, significant abnormalities in screening results may indicate neural tube and heart defects.
When such abnormalities are detected, invasive diagnostics are carried out to clarify the diagnosis. Depending on the term, the following examinations may be prescribed:
- chorionic biopsy;
- amniocentesis;
- cordocentesis.
In addition, in all disputed cases, a genetic consultation is necessary.
hcg in ectopic pregnancy
In addition to fetal abnormalities, β-hCG (free), MoM are also indicators that illustrate the he alth of the mother. One of the dangerous emergency conditions that can be diagnosed in time and therefore acted upon is an ectopic pregnancy. This happens when a fertilized egg attaches not to the inner layer of the uterus (endometrium), but in the cavity of the fallopian tubes, ovaries, and intestines. The danger of this pathology lies in the fact that an ectopic pregnancy is inevitably interrupted, and this process is accompanied by severe internal bleeding, which can be very difficult to stop. An ectopic pregnancy can be detected if an ultrasound scan is performed in a timely manner and its results are compared with the hCG levels in the blood serum. The fact is that a fertilized egg, occupying a place not intended for it by nature, experiences significant difficulties and, as a result, much less gonadotropin is produced by the trophoblast. In the event that the test results show an extremely slow increase in hCG that does not correspond to the gestational age, an ultrasound scan is prescribed using a vaginal sensor. As a rule, this procedure allows you to find a fetal egg outside the uterus, which will confirm an ectopic pregnancy and allow you to terminate it in time, without waiting for complications.
Missed Pregnancy
It happens that after a pregnancy test gives a positive result, its symptoms do not occur or end abruptly. In this case, the death of the embryo occurs, but there is no miscarriage for some reason. This point can be identified if, in the analysis made, the hCG indicators not only stop growing, but also begin to decline. By conducting an ultrasound examination, you can make sure that the embryo does not have a heartbeat. Sometimes ultrasound shows only an empty ovum. These changes are called missed pregnancy. Most of them develop for up to ten weeks. The following conditions may be the reasons:
- chromosomal pathologies;
- infection of the mother's body (most often endometritis);
- malformations associated with the maternal blood coagulation system (thrombophilia);
- anatomical defects in the structure of the uterus.
If a missed pregnancy is detected for medical reasons, a medical abortion or curettage of the uterus will be performed. In the event that a missed pregnancy is diagnosed in a woman more than twice, the couple is recommended to be examined to identify the objective reasons for this.
Bubble skid
Sometimes, after fertilization, a “loss” of the female part of the genome can occur, that is, instead of an equal number of chromosomes from the mother and father, only the male genome remains in the fetal egg. In this case, a condition similar to pregnancy can be observed, but only the father's chromosomes are present in the zygote (fertilized egg). This condition is called complete hydatidiform mole. In the case of a partial egg, the egg retains its genetic information, but the father's chromosome number is doubled. Since they are responsible for the trophoblast, the levels of the hCG hormone are growing rapidly. Bubble drift is dangerous not only spontaneousmiscarriage, since the development of a normal pregnancy with it is impossible. The main danger lies in the fact that such a “stimulated” trophoblast invades the wall of the uterus, growing beyond it, and over time it can degenerate into a malignant tumor.
You can suspect a hydatidiform mole with the following symptoms:
- uterine bleeding early;
- excruciating vomiting;
- womb size is out of date (much larger);
- sometimes weight loss, palpitations, finger tremors.
The appearance of such signs requires a visit to a doctor, an ultrasound scan and monitoring the level of hCG in the blood serum. Exceeding several times the indicator of 500,000 IU / l, which is the maximum in a normal pregnancy, requires a more careful examination.
Thus, an attentive attitude to the level of hCG, MoM allows you to diagnose many pathological changes in the body of a woman and fetus at an early stage. And therefore, take the necessary measures in time.
