| Predictive value of serum human chorionic gonadotropin ratio, progesterone and inhibin A for expectant management of early pregnancies of unknown location. | |
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MedLine Citation:
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PMID: 22921576 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate serum human chorionic gonadotropin (hCG) ratio, progesterone and inhibin A as single parameters and in combination for the prediction of spontaneous resolution of pregnancies of unknown location (PUL). STUDY DESIGN: Prospective observational study of 105 consecutive patients with a diagnosis of PUL. Serum levels of hCG, progesterone and inhibin A were determined at the first visit and after 2 days. Patients were followed clinically until a final diagnosis of spontaneously resolving PUL, viable or non-viable intrauterine pregnancy, or ectopic pregnancy with need of laparoscopic intervention had been reached. Different combinations of hCG ratio (hCG at 48h/hCG at 0h), s-progesterone and s-inhibin A were investigated to find the best predictor for successful expectant management. RESULTS: The final pregnancy outcomes were: 52 spontaneously resolving PUL (49.5%), 37 viable intrauterine pregnancies (35.2%), 8 non-viable intrauterine pregnancies (7.6%), 7 ectopic pregnancies (6.7%), and one molar pregnancy (1.0%). An hCG ratio<0.80 predicted spontaneously resolving PUL with positive and negative predictive values (PPV and NPV), sensitivity, and specificity of 0.98, 0.78, 0.72, and 0.99, respectively. In patients with hCG ratio≥0.80, a combination of s-progesterone<20nmol/l and s-inhibin A<30pg/ml predicted spontaneously resolving PUL with PPV, NPV, sensitivity and specificity of 0.92, 0.96, 0.85, and 0.98 respectively. CONCLUSION: Our results suggest that patients with PUL and hCG ratio<0.80 display a high probability of spontaneously resolving PUL with minimum need of follow-up. In cases of hCG ratio≥0.80, a combination of s-progesterone<20nmol/l and s-inhibin A<30pg/ml, may be a reliable predictor of spontaneously resolving PUL. The safety of this approach should be tested in large prospective studies. |
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Authors:
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Huda Majeed; Astrid Højgaard; Peter Johannesen; Marie Louise Ladefoged; Axel Forman; Pinar Bor |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-8-24 |
Journal Detail:
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Title: European journal of obstetrics, gynecology, and reproductive biology Volume: - ISSN: 1872-7654 ISO Abbreviation: Eur. J. Obstet. Gynecol. Reprod. Biol. Publication Date: 2012 Aug |
Date Detail:
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Created Date: 2012-8-27 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375672 Medline TA: Eur J Obstet Gynecol Reprod Biol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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