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Human Chorionic Gonadotropin

Human Chorionic Gonadotropin. Photo of average 14 y.o. patient at the Children’s ED. 6 Questions. How Early is it detectable? Causes of false +ve urine HCG? Causes of false -ve urine HCG? U/S findings at different hCG levels? Does dilution really matter? Is doubling time accurate?.

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Human Chorionic Gonadotropin

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  1. Human Chorionic Gonadotropin

  2. Photo of average 14 y.o. patient at the Children’s ED

  3. 6 Questions How Early is it detectable? Causes of false +ve urine HCG? Causes of false -ve urine HCG? U/S findings at different hCG levels? Does dilution really matter? Is doubling time accurate?

  4. How long does it take to get back? Urine: 3 minutes Serum: 1 hour Ascheim-Zondek test: 100 hours

  5. What is HCG? Alpha Subunit • Glycoprotein • First measurable placental product • Supports the corpus luteum - Beta Subunit

  6. How does the test work? Tracer Antibody Capture Antibody

  7. Antibody Sandwhich Tracer Antibody Alpha Subunit Beta Subunit Capture Antibody

  8. How early will it be positive? Depends…

  9. Detection Level: Urine: Above 25 HCG Trends

  10. Ddx (+) hCG • Physiologic artifact • Exogenous hCG • Gestational Trophoblastic Disease • HAAA • Non-gestational malignancy

  11. False Negative Ddx • Early Pregnancy • Hook Effect • Expired test • Sensory deficit • Inadequate test time

  12. What should I see and when should I see it

  13. Is Dilution really a problem? • Standard of 1.010 - 1.015 • QuickVue: “1.007” • Need more data to be 100% sure

  14. Is doubling-time accurate?

  15. “Doubling Time” 66% 53%

  16. Summary • Ab Sandwhich • As early as 28 days post LMP • Remember false + and false - • Minimum 53% rise in 2 days

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