Questionhttp://experts.about.com/q/1007/3643443.htm
Dear Dr. Rappaport,
Though I am not a medical professional, I beg to differ with you, with all due and utmost respect, regarding the response you gave the woman who asked the question referenced in the URL above. You assured the woman that her 13 week hCG lab value was within normal range with respect to gestational age. However, you also stated that "Down's syndrome is a genetic problem and is not related to HCG."
First, and least importantly, the correct common name for Trisomy 21 is "Down Syndrome" (not the possessive "Down's"). Secondly, while it is true that DS is a chromosomal abnormality, and that it is not *caused* by elevated hCG by gestational age, elevated hCG in the late 1st trimester and early 2nd trimester, after the serum level should have dropped to roughly 0.2 of the peak, is an *indicator* for DS, particularly when, in the context of the triple screen [that should be] done at this time, MSAFP and estriol levels are lower than average. However, many professionals consider elevated hCG level alone at 12-14 weeks (the woman who asked the question above was at 13 weeks) to be a possible indicator of DS.
I am sure that you know all of this, but perhaps misunderstood the woman's question. (Maybe you thought that she was inquiring whether elevated hCG can cause DS?) The only reason I felt compelled to write to you was that I would like to see the response revised for the benefit of other women who have the same question (myself included - I ran across your response while searching for more info on what I feel is my very early gestation elevated hCG).
Regarding another part of your response, with which I do not disagree, highly elevated hCG is indeed a red flag for trophoblastic overproliferation; however, typical hCG lab values, or a range thereof, for molar pregnancy are difficult for laypeople such as myself to find. Perhaps it is just my Internet search skill that needs honing, but I have been unable, in nearly a week of searching, to find these numbers. If you could point readers to them, or give the number ranges yourself, it would be most helpful.
Finally, it may deserve mention in a revised response that preeclampsia-like symptoms before the third trimester are practically a diagnosis for molar pregnancy since a mother should not present with preeclampsia until 3rd trimester (except in extremely rare cases such as molar pregnancy).
Thank you for your consideration. I hope that my suggestions were not offensive to you, especially since I plan to post some questions for you in the near future and hope that you will provide detailed responses!
AnswerI am sorry that you disagree with my response. I have reviewed the question to which you are referring. An HCG value of 10,000-100,000 can be completely normal at 2-3 months gestational age. Even a value of 15,000-200,000 can be normal at 6-8 weeks gestation. However, a high value of HCG always gives us an index of suspicion for trophoblastic disease. Nowadays, trophoblastic disease is usually dagnosed using imaging techniques when there is no FH when there should be an FH. I was not aware that I used an apostrphy when mentioning Down Syndrome. I'm sorry and I apologize for the spelling error. I do not like to use "soft" signs and symptoms to diagnose trophoblastic disease. Pregnancy induced hypertension or chronic hypertension appearing in early pregnancy cannot be labeled as "preeclampsia". I would not diagnose a molar pregnancy based on preeclampsia-like symptoms, but rather from sonographic studies, lack of FH, and the complete clinical picture. I offer quad screen of triple screen to screen patients for Down Syndrome or Neural Tube defects. If the the entire screen shows an indication of any abnormality, I recommend an amniocentesis to give a diagnosis. This includes a low AFP and an evaluation of HCG and estriol as well. Thank you for your interest.
