TY - JOUR
T1 - Following declining human chorionic gonadotropin values in pregnancies of unknown location
T2 - When is it safe to stop?
AU - Cameron, Katherine E.
AU - Senapati, Suneeta
AU - Sammel, Mary D.
AU - Chung, Karine
AU - Takacs, Peter
AU - Molinaro, Thomas
AU - Barnhart, Kurt T.
N1 - Funding Information:
Supported by grants R01-HD036455 (K.T.B., M.D.S.) and R01-HD076279 (K.T.B.).
Publisher Copyright:
© 2016 American Society for Reproductive Medicine.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Objective To determine if the pattern of decline in hCG curves can discriminate spontaneous abortion (SAB) from ectopic pregnancy (EP). Design Retrospective cohort study. Setting University hospitals. Patient(s) A total of 1,551 women with symptomatic pregnancy of unknown location (PUL) and decreasing hCG values. Intervention(S) None. Main Outcome Measure(s) Percentage change in hCG; days and visits to final diagnosis. Result(s) Of the 1,551 women with a PUL and declining hCG, 146 were ultimately diagnosed with EP and 1,405 with SAB. An 85% hCG drop within 4 days or a 95% hCG drop within 7 days both ruled out an EP 100% of the time. Applying the 4-day cutoff to this population would have saved 16% of the SAB population (229/1,405) a total of 2,841 person-days and 277 clinical visits. Applying the 7-day cutoff would have saved 9% of the SAB population (126/1,405) a total of 1,294 person-days and 182 clinical visits. These cutoffs were separately validated on a group of 179 EPs collected from three university clinical centers. In that population, each cutoff separately ruled out EP 100% of the time. Conclusion(s) The decline in serum hCG is slower in EPs than in SAB and can be used to aid clinicians in the frequency and duration of follow-up. Costs and patient time may be saved by allowing women who meet one of these criteria to be followed less frequently.
AB - Objective To determine if the pattern of decline in hCG curves can discriminate spontaneous abortion (SAB) from ectopic pregnancy (EP). Design Retrospective cohort study. Setting University hospitals. Patient(s) A total of 1,551 women with symptomatic pregnancy of unknown location (PUL) and decreasing hCG values. Intervention(S) None. Main Outcome Measure(s) Percentage change in hCG; days and visits to final diagnosis. Result(s) Of the 1,551 women with a PUL and declining hCG, 146 were ultimately diagnosed with EP and 1,405 with SAB. An 85% hCG drop within 4 days or a 95% hCG drop within 7 days both ruled out an EP 100% of the time. Applying the 4-day cutoff to this population would have saved 16% of the SAB population (229/1,405) a total of 2,841 person-days and 277 clinical visits. Applying the 7-day cutoff would have saved 9% of the SAB population (126/1,405) a total of 1,294 person-days and 182 clinical visits. These cutoffs were separately validated on a group of 179 EPs collected from three university clinical centers. In that population, each cutoff separately ruled out EP 100% of the time. Conclusion(s) The decline in serum hCG is slower in EPs than in SAB and can be used to aid clinicians in the frequency and duration of follow-up. Costs and patient time may be saved by allowing women who meet one of these criteria to be followed less frequently.
KW - ectopic pregnancy
KW - hCG curves
KW - pregnancy of unknown location
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U2 - 10.1016/j.fertnstert.2015.11.050
DO - 10.1016/j.fertnstert.2015.11.050
M3 - Article
C2 - 26698678
AN - SCOPUS:84951944278
SN - 0015-0282
VL - 105
SP - 953
EP - 957
JO - Fertility and sterility
JF - Fertility and sterility
IS - 4
ER -