Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Pregnancy of unknown location: outcome in a tertiary care teaching hospital

2017 ◽  
Vol 6 (7) ◽  
pp. 2787
Author(s):  
A. Shanti Sri ◽  
P. Kalpana
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Tertiary Care ◽  
Expectant Management ◽  
Transvaginal Sonography ◽  
Intrauterine Pregnancy ◽  
Care Teaching ◽  
Asymptomatic Patients ◽  
Pain Outcome ◽  
Pregnancy Of Unknown Location

Background: A pregnancy of unknown location (PUL) is a descriptive term used to classify a woman when she has a positive pregnancy test but no intra- or extra-uterine pregnancy is visualized on transvaginal sonography. The objective of present study was to find out the outcome of women with pregnancy of unknown location presenting to a tertiary care teaching hospital.Methods: The prospective study was conducted from from 1st October 2015 to 31st September 2016, to antenatal out-patient department, at Princess Esra Hospital, Deccan College of medical sciences, Hyderabad. Data was collected for women with early pregnancy or with history of amenorrhea, bleeding or pain. These women were investigated with serum beta-human chorionic gonadotrophin levels at interval of 48 hrs and transvaginal ultrasonography. Expectant management was done for failing pregnancy of unknown location while medical or surgical management was considered for persistent pregnancy of unknown location and ectopic pregnancy.Results: During study period, 9210 patients were admitted, and, of them, 960 (10.42%) were patients with early pregnancy. Meeting the inclusion criteria were 112 (11.6%) patients who formed the study sample. There were 104 (92.85%) patients presenting with amenorrhea, 98 (87.5%) had bleeding and 78 (69.64%) presented with pain. Outcome of 42 (48.83%) patients was failing pregnancy, 31 (36.04%) had intrauterine pregnancy, 8 (9.3%) converted to ectopic pregnancy, while 5 (5.81%) had persistent pregnancy of unknown location. All patients with persistent pregnancy of unknown location and 3 patients with ectopic pregnancy were medically treated. Three patients having an ectopic pregnancy were managed surgically.Conclusions: Management of choice for asymptomatic patients having pregnancy of unknown location is expectant management. Most of the patients suspected to have PUL resolved either into F-PUL or IUP with expectant management.

scholarly journals Role of Maternal Serum Glycodelin as Predictor of Ectopic Pregnancy in First Trimester

2018 ◽  
Vol 7 (4) ◽  
pp. 467-470
Author(s):  
Wasan Wajdi Ibrahim ◽  
Afraa Mahjoob Al-Naddawi ◽  
Hayder A. Fawzi
Keyword(s):  
Ectopic Pregnancy ◽  
Predictive Value ◽  
First Trimester ◽  
Maternal Serum ◽  
Intrauterine Pregnancy ◽  
Receiver Operator Curve Analysis ◽  
Medical City ◽  
First Trimester Of Pregnancy ◽  
Control Study

Objectives: Assessment of glycodelin (GD) as a marker for unruptured ectopic pregnancy (EP) in the first trimester of pregnancy. Materials and Methods: This case-control study was conducted during June 2016 to May 2017 in the Obstetrics and Gynecological Department of Baghdad University at Baghdad teaching hospital/medical city complex. In this study, 100 pregnant women in their first trimester of pregnancy were included after clinical and ultrasonic findings. Results: Based on the results, GD levels in EP were significantly lower than those with normal intrauterine pregnancy (1.58 ± 1.18 vs. 30.1 ± 11.9). In addition, using receiver operator curve analysis, the cut-off GD level of 9.5 and less had acceptable validity results (100% sensitivity, 100% specificity, 95% positive predictive value, 100% negative predictive value, and accuracy 100%) to predict EP. Conclusions: In general, serum GD is considered as an excellent predictor of unruptured EP.

THE ROLE OF ACTIVIN A AND FOLLISTATIN IN THE DIFFERENTIATION BETWEEN VIABLE INTRAUTERINE PREGNANCY FROM MISSED MISCARRIAGE AND ECTOPIC PREGNANCY

2019 ◽  
pp. 197-202
Author(s):  
ESRAA HAMEED HUMADI AL-MAINI ◽  
ISRAA TAILB ABD AL-KADIR ◽  
RAWNAQ ALI AL-SAADI
Keyword(s):  
Ectopic Pregnancy ◽  
First Trimester ◽  
Activin A ◽  
Intrauterine Pregnancy ◽  
Good Ability ◽  
Lower Accuracy ◽  
Significant Difference ◽  
Group B ◽  
Age Range

Objective: The objective of the study was to investigate the role of activin A and follistatin (FS) in the differentiation between viable intrauterine pregnancy from missed miscarriage and ectopic pregnancy (EP). Study Design: This was a case–control study. Setting: This study was conducted at the Department of Obstetrics and Gynecology at Al-Yarmouk Teaching Hospital, from February 2017 to October 2017. Patients and Methods: The study included 90 pregnant women, aged from 21 to 40 years old in their the first trimester attending the outpatient and inpatient clinic with single fetal pregnancy with a gestational age range between 6th and 8th weeks, they were divided into three groups; Group A: Includes 30 cases with uncomplicated pregnancies in their first trimester, Group B: Includes 30 cases diagnosed as missed miscarriages, and Group C: Includes 30 cases diagnosed as EPs. Results: There was no significant difference in the maternal age and body mass index between the three groups, β-human chorionic gonadotropin, activin A, FS, and their ratio were significantly higher in the healthy intrauterine pregnancy compared to missed miscarriage and EP. Activin A and activin A/FS ratio had an excellent ability to discriminate EP from healthy intrauterine pregnancy, while FS alone had good ability to discriminate between EP and intrauterine pregnancy. Activin A had fair ability to discriminate missed miscarriage from intra healthy uterine pregnancy, while both FS and activin A/FS ratio had poor ability to differentiate missed miscarriage and intrauterine pregnancy. Conclusion: Activin A can be used with high accuracy as a biomarker for EP and missed miscarriage, FS alone, and activin A/FS ratio is a possible biomarker, but it offers lower accuracy compared to activin A alone.

Echocardiography in Early Pregnancy

2013 ◽  
Vol 7 (2) ◽  
pp. 168-181 ◽  
Author(s):  
Carmen Comas ◽  
Pilar Prats RodrRguez
Keyword(s):  
High Risk ◽  
Early Pregnancy ◽  
Fetal Heart ◽  
Early Stage ◽  
Fetal Echocardiography ◽  
Heart Defects ◽  
Transvaginal Ultrasound ◽  
First Trimester ◽  
Slight Reduction

ABSTRACT Within the last decade, two significant events have contributed to the increasing interest in early fetal echocardiography. First, the introduction of high frequency vaginal ultrasound probes allows detailed visualization of cardiac structures at early stage of gestation, making early detection of fetal malformations possible. Second, the close relationship observed between some first trimester sonographic and Doppler markers and congenital heart defects allows an early identification of a high-risk group at 11 to 14 weeks of gestation. In this context, from the early 1990s, many authors have examined the potential role of the transvaginal approach to obtain earlier diagnosis of fetal cardiac malformations. Further studies have appeared in the literature showing that early transvaginal echocardiography in experienced hand is a fairly sensitive investigative tool. Although some malformations are detected as early as 11 weeks’ gestation, the optimal gestational age to perform the early scan is at least 13 weeks’ gestation. Transvaginal ultrasound is the preferred approach, although most of the authors agree that results can be improved if transabdominal ultrasound is also incorporated. The further application of color Doppler enhances visualization. The sensitivity and specificity of early fetal echocardiography for the detection of heart anomalies is acceptable compared to the ones obtained by mid-gestational echocardiography, showing a slight reduction in detection rates and an increase in false positive and negative rates. The cardiac anomalies detected at this early stage of pregnancy are mainly defects involving the four-chamber view, indicating that defects solely affecting the outflow tracts are difficult to diagnose in the first trimester of pregnancy. Heart defects diagnosed early in pregnancy tend to be more complex than those detected later, with a higher incidence of associated structural malformations, chromosomal abnormalities and spontaneous abortions. The neonate follow-up or postmortem examination in case of termination of pregnancy (TOP) is essential to assess the actual role of early fetal echocardiography. At present, early fetal echocardiography is a promising technique, which can be of considerable value for patients at high-risk. This technique is, however, currently limited to a few specialized centers. The aim of this review is to explore the possibilities of examining the fetal heart at this early stage of pregnancy. This article also present our experience in the first multicenter trial in early fetal echocardiography performed in Spain. In accordance with other studies, this experience stresses the usefulness of early echocardiography when performed by expert operators on fetus specifically at risk for cardiac defects. Our review of these additional 48 cases contributes to the expanding literature on the ability of transvaginal ultrasonography to detect fetal heart defects in early pregnancy. How to cite this article Gabriel CC, Rodriguez PP. Echocardiography in Early Pregnancy. Donald School J Ultrasound Obstet Gynecol 2013;7(2):168-181.

scholarly journals the Forecast of Weekly β-HCG and Progesterone for Early Pregnancy

2020 ◽  
Author(s):  
Yan Yang ◽  
Jie Duan ◽  
Yan Wang ◽  
Xin Du ◽  
Wei wu ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Sensitivity And Specificity ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Intrauterine Pregnancy ◽  
The Status ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Sensitivity Specificity

Abstract Background: Serum beta human chorionic gonadotropin (β-HCG) and progesterone levels are both monitored to assess the status of early pregnancy. Deviations from the expected levels of these hormones may indicate abnormal pregnancy. However; the relationship between progesterone levels and the magnitude of weekly β-HCG increases, as well as their combined predictive value for pregnancy outcome, is still debated. This study evaluated the predictive value of weekly serum β-HCG multiplication and progesterone levels on early pregnancy outcomes. Methods: This retrospective study reviewed patients with pregnancy confirmed by β-HCG in our hospital. Weekly β-HCG and progesterone levels were analyzed and ultrasonography was performed as necessary to determine outcomes at 13 weeks gestation. Results: There were 277 viable intrauterine pregnancies, 102 spontaneous abortions, and 59 ectopic pregnancies. At weeks 5-8, β-HCG was multiplied by 6.76, 6.21, 2.11, and 0.68 respectively. Logit models were established with the logarithm of HCG (LHCG) and progesterone as independent variables to predict viable intrauterine pregnancy. The sensitivity, specificity, and overall accuracy for the models were 85.9% and 90.25%, 44.72% and 72.04%, and 70.77% and 83.6%, respectively. When progesterone was ≥10 ng/ml, the sensitivity and specificity for predicting viable pregnancy were 90.25% and 72.04%, respectively. When progesterone was <10 ng/ml, the sensitivity and specificity for predicting ectopic pregnancy and complete abortion were 94.2% and 81.57%78.86%, respectively. Progesterone values were significantly different for viable pregnancy, abortion, and ectopic pregnancy (p<0.0001). A joint progesterone and LHCG model to predict viable pregnancy had 88.8% sensitivity, 75.2% specificity, and 83.8% overall prediction accuracy.Conclusion: Weekly β-HCG multiplication and progesterone levels can predict early pregnancy outcomes individually or jointly.

scholarly journals Association Of Serial Beta HCG And Progesterone Level With Outcome In Pregnancy Of Unknown Location

2017 ◽  
Vol 08 (01) ◽  
pp. 21-25
Author(s):  
Ayesha Ajmi
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Clinical Signs ◽  
Final Diagnosis ◽  
Progesterone Level ◽  
P Value ◽  
Intrauterine Pregnancy ◽  
Beta Hcg ◽  
Assessment Unit ◽  
Pregnancy Of Unknown Location

Objective: To study the association of change in serial beta HCG level over 48 hours and serum progesterone with final diagnosis i.e. viable intrauterine pregnancy, ectopic pregnancy or failing pregnancy in cases initially labelled as pregnancy of unknown location. Study Design: prospective population based study Place and duration of study: Early Pregnancy Assessment unit of Homerton University Hospital London from December 2013 to February 2014 Methodology: Fifty patients were recruited in the study who presented to early pregnancy assessment unit and had positive urine for pregnancy test but no evidence of pregnancy on transvaginal scan. Initial beta HCG, progesterone and transvaginal scan were done in all cases. Patients were followed up with repeat HCG at 48 hour interval and repeat TVS until final diagnosis was established. Results: Final diagnosis was miscarriage 58%, viable intrauterine pregnancy 24% and ectopic pregnancy 12%. 67% of patients with rise in HCG >60% had viable intrauterine pregnancy whereas all patients with >50% fall in HCG had a miscarriage. A highly significant association of >60% rise of HCG with viable intrauterine pregnancy and of >50% fall in HCG with miscarriage was observed with p-value<0.0001. 58% of patients with progesterone >30 had viable intrauterine pregnancy whereas 83% of patients with progesterone <10 were miscarriage and 17% had ectopic pregnancy. A highly significant association of final diagnosis of viable intrauterine pregnancy and progesterone level >30 was observed with p-value<0.0001. Conclusion: Although there is high association of >60% rise in 48 hour repeat HCG and progesterone >30 with viable intrauterine pregnancy, ectopic pregnancy cannot be ruled out on the basis of biochemical test. Therefore a high index of suspicion is required to diagnose cases of ectopic pregnancy using clinical signs and symptoms, transvaginal scan as well as biochemical tests such as serial beta HCG and progesterone levels.

scholarly journals the Forecast of Weekly β-HCG and Progesterone for Early Pregnancy

2019 ◽  
Author(s):  
Yan Yang ◽  
Jie Duan ◽  
Yan Wang ◽  
Xin Du
Keyword(s):  
Ectopic Pregnancy ◽  
Sensitivity And Specificity ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Intrauterine Pregnancy ◽  
The Status ◽  
Β Hcg ◽  
Ectopic Pregnancies ◽  
Sensitivity Specificity

Abstract Background: Serum beta human chorionic gonadotropin (β-HCG) and progesterone levels are both monitored to assess the status of early pregnancy. Deviations from the expected levels of these hormones may indicate abnormal pregnancy. However; the relationship between progesterone levels and the magnitude of weekly β-HCG increases, as well as their combined predictive value for pregnancy outcome, is still debated. This study evaluated the predictive value of weekly serum β-HCG multiplication and progesterone levels on early pregnancy outcomes. Methods: This retrospective study reviewed patients with pregnancy confirmed by β-HCG in our hospital. Weekly β-HCG and progesterone levels were analyzed and ultrasonography was performed as necessary to determine outcomes at 13 weeks gestation. Results: There were 277 viable intrauterine pregnancies, 102 spontaneous abortions, and 59 ectopic pregnancies. At weeks 5-8, β-HCG was multiplied by 6.76, 6.21, 2.11, and 0.68 respectively. Logit models were established with the logarithm of HCG (LHCG) and progesterone as independent variables to predict viable intrauterine pregnancy. The sensitivity, specificity, and overall accuracy for the models were 85.9% and 90.3%, 44.72% and 72%, and 70.77% and 83.6%, respectively. When progesterone was ≥10 ng/ml, the sensitivity and specificity for predicting viable pregnancy were 90.25% and 72.04%, respectively. When progesterone was <10 ng/ml, the sensitivity and specificity for predicting ectopic pregnancy and complete abortion were 94.2% and 81.57%, respectively. Progesterone values were significantly different for viable pregnancy, abortion, and ectopic pregnancy (p<0.0001). A joint progesterone and LHCG model to predict viable pregnancy had 88.8% sensitivity, 75.2% specificity, and 83.8% overall prediction accuracy. Conclusion: Weekly β-HCG multiplication and progesterone levels can predict early pregnancy outcomes individually or jointly.

scholarly journals Unruptured unilateral twin ectopic pregnancy: a rare case report

2020 ◽  
Vol 9 (5) ◽  
pp. 2151
Author(s):  
Nayanika Gaur ◽  
Piyush K. Goyal ◽  
Manish Jha
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Complete Recovery ◽  
Intrauterine Pregnancy ◽  
Serum Progesterone ◽  
Post Surgery ◽  
Β Hcg ◽  
The Right

Unilateral twin ectopic pregnancy is a rare entity with an incidence of 1 in 125,000 pregnancies. This is a case of a 26-year-old primigravida with a spontaneous unilateral twin ectopic gestation, diagnosed on transvaginal ultrasound, treated laparoscopically by doing unilateral salpingectomy and confirmed with histopathology. The doubt for ectopic pregnancy was raised when the serum β-HCG level was constantly >1500 mIU/ml and serum progesterone level was <5 pg/ml and no intrauterine pregnancy was seen. On a follow-up scan, twin gestational sac was noted in right adnexa along with a large haemorrhagic cyst in the right ovary. On post-surgery follow-up, patient was found to have had complete recovery. This case report discusses the incidence and rarity, yet possibility of twin ectopic gestations, the need for early diagnosis and its management.

scholarly journals The diagnostic role of the β-hCG discriminatory zone combined with the endometrial pattern for ectopic pregnancy in Chinese women

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Qi Lu ◽  
Yiwei Wang ◽  
Xiao Sun ◽  
Yuhong Li ◽  
Jing Wang ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Chinese Women ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Diagnostic Value ◽  
Wide Range ◽  
Endometrial Pattern ◽  
Diagnostic Role ◽  
Β Hcg

Abstract Previous studies have regarded the discriminatory serum β-hCG zone (DSZ) as a valuable tool for the diagnosis of ectopic pregnancy (EP). However, the wide range of the DSZ makes achieving a clinical diagnosis of EP difficult, and these reports do not indicate whether the DSZ is suitable for an EP diagnosis in Chinese women. Several studies have indicated that the endometrial pattern in patients with EPs is different from that in patients with intrauterine pregnancies (IUPs). The aims of this study were to define the DSZ cutoff value for Chinese women, test whether the endometrial pattern is a suitable predictor for EP, and assess the diagnostic value of these indicators. We enrolled participants with IUPs or EPs with abdominal pain and/or vaginal bleeding, and serum β-hCG level measurements and transvaginal ultrasound (TVS) were performed to assess the diagnostic value of the indicators for EP. The sensitivity and specificity for identifying an EP were improved by combining the DSZ, endometrial thickness and trilaminar pattern indexes. The results of this study might be helpful toward providing further options for the diagnosis of EP, especially for patients without hemoperitoneum or colporrhagia.

scholarly journals P070: Excluding ectopic pregnancy in patients presenting to a community emergency department with first trimester bleeding

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S81-S82
Author(s):  
E. Hoe ◽  
C. Varner ◽  
M. Ivankovic
Keyword(s):  
Emergency Department ◽  
Ectopic Pregnancy ◽  
Community Hospital ◽  
Transvaginal Ultrasound ◽  
Retrospective Chart Review ◽  
First Trimester ◽  
Point Of Care Ultrasound ◽  
Intrauterine Pregnancy ◽  
Missed Abortion ◽  
Diagnostic Modality

Introduction: Current guidelines recommend patients with first trimester bleeding without previously documented intrauterine pregnancy undergo urgent transvaginal ultrasound (TVUS) to exclude ectopic pregnancy. However, in Canadian practice to receive urgent TVUS, particularly out of daytime hours is difficult, if not impossible. Thus, when TVUS is not available to exclude ectopic pregnancy, providers use point of care ultrasound (POCUS) or their best clinical judgment to determine if the patient can be safely discharged home while awaiting outpatient follow-up. The objective of this study was to determine what proportion of first trimester patients presenting to a community hospital emergency department (ED) with vaginal bleeding undergo either TVUS or POCUS to exclude ectopic pregnancy. Methods: This is an ongoing retrospective chart review of pregnant women gestational age (GA) less than 20 weeks presenting to a community hospital ED (103,000 visits/year) with a discharge diagnosis of vaginal bleed, first trimester bleed, threatened abortion, spontaneous abortion, missed abortion, rule out ectopic pregnancy, and ectopic pregnancy from January 2016 - January 2017. Patients are excluded if they are diagnosed with a ruptured ectopic pregnancy during their index ED visit. To date, 98 patient charts have been reviewed. Results: Of the 98 included patients, 13 (13.3%) had a viable pregnancy, 37 (37.8%) had a spontaneous or missed abortion, 4 (4.1%) had an ectopic pregnancy, and 45 (45.9%) had unknown outcomes. Of included patients, 4 (4.1%) only had POCUS, 66 (67.4%) only had a radiologist-interpreted TVUS, and 3 (3.1%) had both POCUS and radiologist-interpreted TVUS during their ED index visits. Thus, 73 (74.5%) had either a radiologist-interpreted TVUS or ED provider-performed POCUS during their index ED visit. After their index ED visits, 2 (2.0%) patients returned with ruptured ectopic pregnancies, 1 of whom had not undergone initial US investigations. Conclusion: Although TVUS is standard of care to exclude ectopic pregnancy in patients presenting with first trimester bleeding or abdominal pain, our preliminary results show some patients are not receiving this diagnostic modality nor POCUS during their index ED visit. Particularly in a setting, such as this ED, without rapid access to an early pregnancy clinic, patients should be counselled about their risk of ectopic pregnancy at the time of ED discharge.

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