ELEVATED MIDTRIMESTER MATERNAL SERUM HCG IN CHROMOSOMALLY NORMAL PREGNANCIES IS ASSOCIATED WITH PREECLAMPSIA AND VELAMENTOUS UMBILICAL-CORDINSERTION

This study was undertaken to determine whether patients with unexplain ed, elevated second-trimester maternal serum human chorionic gonadotro pin (hCG) concentrations are at increased risk of adverse pregnancy ou tcome. In a retrospective study, perinatal outcomes of 355 patients sh owing elevated second-trimester maternal serum hCG concentrations (gre ater than or equal to 2.0 multiples of median) were compared with thos e of patients from the same clinic showing normal values (N = 4935), u sing multiple regression analysis. The effects of variables such as so cioeconomic status on pregnancy outcome were taken into account.Betwee n the study subjects and controls, statistically significant differenc es were observed as regards low birthweight (odds ratio [OR] 1.56, 95% confidence interval [CI]: 1.00-2.44) and intrauterine growth retardat ion (OR 1.46, 95% CI: 1.03-2.06). Differences in the frequencies of pr eterm delivery, fetal/perinatal death, fetal distress, or admission to a specific infant care unit were not statistically significant. Preec lampsia (OR 1.76, 95% CI: 1.16-2.70) and velamentous umbilical cord in sertion (OR 2.62, 95% CI: 1.47-4.69) were particularly involved in the pathophysiology. Elevated maternal serum hCG concentrations were asso ciated with an increased risk of adverse pregnancy outcome. This resul ted mainly from preeclampsia and velamentous umbilical cord insertion. The optimal perinatal management strategy for patients with unexplain ed elevated hCG levels is not yet resolved. In view of our results, th e possibility of preeclampsia and abnormal insertion should be taken i nto account. In future studies, increased surveillance should be offer ed in cases showing abnormal uterine artery velocimetric results or ab normal umbilical cord insertion in color Doppler examination to evalua te whether and to what extent intensive monitoring decreases perinatal morbidity in high-risk pregnancies followed because of unexplained, e levated hCG. Until further data are available, no specific recommendat ions can be made.