Authors:
Banerjee S. Aslam N. Woelfer B. Lawrence A. Elson J. Jurkovic D.
Institution:
D. Jurkovic, Early Pregnancy/Gynaecol. Assess. U., Dept. of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London SE5 8RX; United Kingdom.
Title:
Expectant management of early pregnancies of unknown location: A prospective evaluation of methods to predict spontaneous resolution of pregnancy (2001-3335).
Source:
British Journal of Obstetrics and Gynaecology. Vol 108(2) (pp58-163), 2001.
Abstract:
Objectives:
To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan.
Design:
Prospective observational study.
Setting:
Dedicated early pregnancy unit in an inner city teaching hospital.
Population:
Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications.
Methods:
A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta-human chorionic gonadotrophin (beta-hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non-declining beta-hCG levels.
Settings, Design and Main Outcome Measures:
Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum beta-hCG level to< 20 iu/L) without need for any active intervention.
Results:
Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values >= 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L.
Conclusion:
Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.
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- Q 12.11 Recurrent Miscarriage I have miscarried again. Why does this keep happening?
- 12 What congenital problems might be associated with recurrent miscarriage and how could they be treated?
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- 14 Can infection cause recurrent miscarriage and would treatment help?
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- 20 After every miscarriage I become more depressed. Could this account for the problem?
- 21 Is it always possible to explain recurrent miscarriage?
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- 23 What is an ectopic pregnancy?
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