Multiple Marker Screening in Multifetal Gestations: Failure to Predict Adverse Pregnancy Outcomes

Drugan, Arie; O’Brien, Justin; Dvorin, Elena; Krivchenia, Eric L.; Johnson, Mark P.; Sokol, Robert J.; Evans, Mark I.

doi:10.1159/000264273

Cited by 14 publications

(9 citation statements)

References 9 publications

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“…Plasma levels are maintained at this lower level for the remainder of pregnancy [11] . There are many reports regarding hCG in twin gestations, and most have found that the concentration of hCG is almost 2 MoM [12,13] . In the present study, the preoperative concentration of hCG in TTTS was 6.34 MoM (interquartile range 3.52-9.86), which is significantly higher than that of normal twin gestations.…”

Section: Discussionmentioning

confidence: 99%

Decrease in High Human Chorionic Gonadotropin in Twin-Twin Transfusion Syndrome following Fetoscopic Laser Surgery

Hanaoka

Hayashi²,

Saito³

et al. 2011

Fetal Diagn Ther

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Introduction: The purpose of this study was to investigate the concentration of maternal serum human chorionic gonadotropin (hCG) in twin-twin transfusion syndrome (TTTS) before and after fetoscopic laser surgery and to clarify the association between TTTS and hCG. Material and Methods: The concentration of maternal serum hCG was measured before fetoscopic laser surgery and 2 and 4 weeks after laser surgery in 120 patients diagnosed with TTTS. Results: The preoperative serum concentration of hCG was 6.34 multiples of the median (MoM; interquartile range 3.52–9.86). The concentration of hCG was higher in TTTS of Quintero stage III or IV (7.17 MoM, range 4.21–11.0) compared to stage I or II (3.37 MoM, range 2.35–7.74). When laser surgery for TTTS was effective, hCG gradually decreased to less than half the preoperative concentration 2 weeks after laser surgery, and the concentration was further reduced to within the normal range at 4 weeks. However, the concentration of hCG in 3 cases with TTTS recurrence did not decrease. Discussion: A close association was observed between the concentration of hCG and the condition of TTTS. A change in the concentration of hCG after laser surgery could be a useful marker to judge the effectiveness of laser surgery in TTTS.

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Section: Discussionmentioning

confidence: 99%

Decrease in High Human Chorionic Gonadotropin in Twin-Twin Transfusion Syndrome following Fetoscopic Laser Surgery

Hanaoka

Hayashi²,

Saito³

et al. 2011

Fetal Diagn Ther

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“…This value converted to 5.39 multiples of the median (MoM) (IQR, 2.83 -8.64 MoM) based on the median hCG value (18,000 mIU/mL=1 MoM) of singleton pregnancies in our institution examined at the same gestational age, significantly higher than in normal twin pregnancies, which have been reported to be almost 2 MoM (Fig. 1-A) [16,17].…”

Section: Resultsmentioning

confidence: 99%

“…In singleton pregnancies, by the beginning of the 2 nd trimester, as hCG secretion declines, serum fT4 and fT3 concentrations decline, and serum TSH concentrations rise slightly (within the normal range). Some reports have demonstrated that compared to singleton gestations, the concentration of hCG in twin gestations is almost 2 MoM [16,17]. Because of higher hCG concentrations in women with multiple pregnancies, hyperthyroidism may be experienced more frequently in these women than in those with normal singleton pregnancies.…”

Section: Methodsmentioning

confidence: 99%

Change of maternal thyroid function in twin-twin transfusion syndrome

2015

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HUMAN CHORIONIC GONADOTROPIN (hCG) is part of the family of glycoprotein hormones, which have a common alpha-subunit and a unique beta-subunit. This family includes thyroid stimulating hormone (TSH). As a result, hCG has weak thyroid-stimulating activity [1]. In normal pregnancy, serum hCG concentrations rise soon after implantation and peak at 10 to 12 weeks of gestation, after which they decline. During the period of highest serum hCG concentrations, serum free triiodothyronine (fT3) and free thyroxine (fT4) concentrations increase, usually within the normal range, and serum TSH concentrations are correspondingly reduced. Transient subclinical hyperthyroidism occurs in 10% to 20% of normal pregnant women during the period of highest serum hCG concentrations; these women do not require treatment [2].Change of maternal thyroid function in twin-twin transfusion syndrome Masachi Hanaoka 1), 2) , Naoko Arata 2) and Haruhiko Sago Abstract. Human chorionic gonadotropin (hCG) has weak thyroid-stimulating activity because of its homology with thyroid stimulating hormone (TSH). In twin-twin transfusion syndrome (TTTS), which is a severe complication of monochorionic twin pregnancies, a close association between maternal serum hCG concentration and TTTS has been reported. And, TTTS can be treated by fetoscopic laser coagulation of the communicating vessels. To clarify the relationship between maternal serum hCG and maternal thyroid function in TTTS, the present study investigated the change in thyroid hormone and hCG levels after laser therapy. The protocol included collection of serial maternal blood samples in TTTS before laser therapy, and at two and four weeks after laser therapy. For 131 cases of TTTS, the following parameters were determined at each point: hCG, TSH, free triiodothyronine (fT3), and free thyroxine (fT4). The multiple of the median (MoM) of pre-operative hCG concentration in TTTS was 5.39 MoM (interquartile range, 2.83 -8.64). There was a moderate positive correlation between hCG and fT3 in TTTS pre-operatively (R = 0.22, P = 0.030). fT4 was also positively correlated with hCG (R = 0.33, P < 0.001). Some cases showed very high concentration in fT3. When laser therapy for TTTS was effective, the hCG concentration significantly decreased, and fT3 and fT4 decreased progressively in concert with the decrease in hCG. The relationship between hCG and thyroid function in TTTS supports the finding of TTTS as a novel etiology of hCG-mediated hyperthyroidism during pregnancy.Key words: Pregnancy, Human chorionic gonadotropin (hCG), Twin-twin transfusion syndrome (TTTS), Hyperthyroidism, Laser thearpyTwin-twin transfusion syndrome (TTTS) accounts for approximately 10% of monochorionic twin pregnancies. If left untreated, TTTS is associated with a high fetal morbidity and mortality rate [3]. A net transfusion of blood flow from one fetus (donor twin) to the other (recipient twin) via placental vascular anastomoses has been proposed as the major etiology of TTTS [4,5]. The donor twin becomes hypovolemic and oli...

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“…If laboratory sample size did not permit, then combining whites with Hispanics, and African Americans with Asians would be the next best approach. The same concept has now been expanded to hCG and uE3 with the same conclusions [15,41].…”

Section: Race Adjustmentsmentioning

confidence: 97%

Variability of Adjustments to Indices in Determining Patient Risk in Biochemical Screening

Brooks

Chik²,

O’Brien³

et al. 1999

Fetal Diagn Ther

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It has long been appreciated that the measurement of biochemical parameters for prenatal screening for neural tube defects, and later aneuploidy, is not as simple as measuring hemoglobin or hematocrit. Early in the game, it was recognized that there are gestational age curves, and that since α-fetoprotein (AFP), for example, is a fetal product, its distribution varies as a function of maternal plasma volume, and therefore the weight of the mother. A number of different adjustment factors have been used for AFP and other parameters for years, with varying degrees of consistency and reliability. Here we review a number of adjustments that have been used, and try to give priority to those that have been most effective. Furthermore, laboratories and programs need to be cognizant that with newer parameters being added, the specifics of requirements will vary on a case-by-case parameter basis, and optimal screening can only be achieved with the appropriate adjustments.

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Multiple Marker Screening in Multifetal Gestations: Failure to Predict Adverse Pregnancy Outcomes

Cited by 14 publications

References 9 publications

Decrease in High Human Chorionic Gonadotropin in Twin-Twin Transfusion Syndrome following Fetoscopic Laser Surgery

Decrease in High Human Chorionic Gonadotropin in Twin-Twin Transfusion Syndrome following Fetoscopic Laser Surgery

Change of maternal thyroid function in twin-twin transfusion syndrome

Variability of Adjustments to Indices in Determining Patient Risk in Biochemical Screening

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