The biochemical diagnosis of pregnancy may be made very early with the use of qualitative serum bhCG tests of blood and urine. Modern tests can detect serum bhCG levels of 20 mIU/mL or lower in urine and can diagnose pregnancy within 7 to 10 days after conception, at 3 weeks of gestational age. Gestational age is measured from the first day of the last menstrual period. Quantitative serum bhCG levels correlate with the gestational age of the normal pregnancy. At any given gestational age, serum bhCG titers are markedly higher when twins (or multiple gestations) are present. Table.109-1 indicates the approximate gestational age at which different sonographic and serum markers appear in early pregnancy.7 The standards shown in the table are those of the International Reference Preparation (IRP). Some institutions may use an older standard called the Second International Standard, with values approximately one-half of the IRP values.
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