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Utility of βh CG monitoring in the follow‐up of medical management of miscarriage
Author(s) -
Petersen Scott G.,
Perkins Anneliese R.,
Gibbons Kristen S.,
Bertolone Julia I.,
Mahomed Kassam
Publication year - 2017
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12607
Subject(s) - medicine , interquartile range , misoprostol , miscarriage , confidence interval , gestational sac , gynecology , pregnancy , surgery , obstetrics , abortion , gestation , biology , genetics
Objective To evaluate the percentage change in total βeta‐unit human chorionic gonadotropin (βhCG) levels (%Δβh CG ) in the prediction of treatment outcomes following intravaginal misoprostol for missed miscarriage before 13 weeks. Methods A secondary analysis of a randomised controlled study of medical management of miscarriage was performed. Total βh CG levels were collected before misoprostol (baseline) and after a planned seven day interval (follow‐up), when a transvaginal ultrasound ( TVUS ) reported a gestational sac as present or not. If no sac at TVUS , surgery was indicated on clinical criteria. %Δβh CG ((baseline βh CG – follow‐up βh CG )/baseline βh CG × 100) was evaluated in the prediction of a sac at TVUS and surgery on clinical criteria. Results %Δβh CG was calculated for cases with βh CG levels within two days of misoprostol and TVUS ; calculation interval determined case number. The median %Δβh CG for 24 cases with a persistent sac (6–9 day interval) was significantly lower than for 145 with no sac (58.75% (interquartile range (IQR): 37.59–76.69; maximum 86.54) vs 97.65% ( IQR : 95.44–98.43); P < 0.0001). The median %Δβh CG for eight cases needing surgery on clinical criteria (5–9 day interval) was significantly lower than for 140 cases with no sac not needing surgery (79.68% ( IQR : 64.63–91.15; maximum 94.06) vs 97.68% ( IQR : 95.61–98.50); P < 0.0001). The area under the receiver‐operator curve was 0.975 for prediction of a persistent sac and 0.944 for prediction of surgery on clinical criteria, respectively. %Δβh CG > 87% predicted no sac at TVUS . %Δβh CG > 94.5% predicted no surgery on clinical criteria. Conclusion %Δβh CG calculation over one week reliably predicted treatment outcomes after medical management of missed miscarriage.