, Esra Nur Çiçek 2
, Gökhan Demirayak 3
, Simten Genç 4
, Orhan Şahin 5
, Yağmur Özkan 4
, Veli Mihmanlı 4
2Private Balkan Hospital, Kırklareli, Turkey
3İstanbul Memorial Şişli Private Hospital, Clinic of Obstetrics and Gynecology, Division of Gynecologic Oncology, İstanbul, Turkey
4University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
5University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
Abstract
Objective: To evaluate the doubling rate of maternal serum serial beta human chorionic gonadotropin (β-hCG) and a single initial serum progesterone level to predict fetal viability before ultrasonography in women diagnosed with intrauterine pregnancy (IUP) of undetectable viability.
Methods: Three hundred thirty six pregnant women who applied to the outpatient Clinic at Okmeydanı Hospital between March and December 2018 were evaluated on a “prospective observational” basis. The study was completed with 100 pregnant women diagnosed with IUP involving suspected fetal viability by transvaginal ultrasonography only, who met the inclusion criteria. Serum β-hCG and progesterone levels were measured at the first admission. After 48 h, control serum β-hCG was taken and the increase rates were calculated. Early pregnancy loss was diagnosed by (transvaginal) TV-USG. Patients were divided into two groups as fetal heartbeat (FHB) positive and FHB negative. Pregnancy results were compared with β-hCG increase rates and progesterone levels.
Results: No statistically significant result was obtained between FHB +/- groups in terms of maternal age, previous pregnancy anamnesis, nationality, presenting symptoms, or ultrasound findings. The study, which was conducted with a confidence interval of 95%, found the viability rate to be 70% with a β-hCG increase rate of 31% and 100% in the case of an increase of 181%. For progesterone, when the value was 5.9 ng/mL, the viability rate was 49% and 100% at 37.5 ng/mL and above. The efficacy values of β-hCG increase and first progesterone level in predicting viability were found to be ROC AUC: [0.748 (0.621-0.874)] and ROC AUC: [0.796 (0.685-0.907)], respectively.
Conclusion: Either Serial β-hCG ratio or serum progesterone level can be used alone to predict the pregnancy outcome in early pregnancy. With the dissemination of similar studies, estimation modalities can be improved, and TV-USG examinations can help shorten the waiting time for results to reduce the anxiety of families, hospital admissions and health expenses.