Reassessing the role of the human chorionic gonadotropin (hCG) discriminatory zone in the evaluation of patients with a pregnancy of unknown location
| Autor: | Jenny Sim, Miriam Scadeng, Karen Wallis, Sophie Peryman |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
endocrine system
Pregnancy medicine.medical_specialty Acoustics and Ultrasonics Radiological and Ultrasound Technology Ectopic pregnancy Obstetrics business.industry Gestational sac Ultrasound Biophysics medicine.disease Human chorionic gonadotropin Miscarriage medicine.anatomical_structure medicine Positive Pregnancy Test Radiology Nuclear Medicine and imaging Vaginal bleeding medicine.symptom business hormones hormone substitutes and hormone antagonists |
| Zdroj: | Ultrasound in Medicine & Biology. 45:S113-S114 |
| ISSN: | 0301-5629 |
| DOI: | 10.1016/j.ultrasmedbio.2019.07.373 |
| Popis: | Objective This study aimed to determine the usefulness of the Human Chorionic Gonadotropin (hCG) Discriminatory Zone (DZ) (defined as the serum hCG value above which an intrauterine gestational sac is consistently seen on ultrasound in normal pregnancies1) as a diagnostic tool in the evaluation of patients presenting symptomatically (lower abdominal pain and/or vaginal bleeding) with a pregnancy of unknown location (PUL). A PUL is defined as a clinical scenario where a woman has a positive pregnancy test and no evidence of either intrauterine pregnancy or ectopic pregnancy on transvaginal ultrasound2. This objective will be achieved in this study by asking three questions: Firstly, how useful is the DZ in identifying an ectopic pregnancy? Secondly, how useful is the DZ in identifying a failed intrauterine pregnancy? And third, can a patient with an hCG level above DZ levels and a PUL following the initial scan can progress to a live, intra uterine pregnancy? Methods A retrospective chart review of ultrasound records at one, large urban hospital in Auckland, New Zealand identified 97 patients with lower abdominal pain and/or vaginal bleeding, who had serum hCG testing and transvaginal ultrasound performed within 12 hours of initial hospital presentation. The following information was recorded: hCG level, initial ultrasound findings, follow up outcomes, age, gravida and parity. Statistical analysis using Kruskal-Wallis and Wilcoxon were then performed. Results In total, 97 women met the criteria and were included in the study. Twenty-seven women had an hCG level of 1000 IU/L or higher, with true PUL on ultrasound. Of these, three went on to develop a normal intrauterine pregnancy, three were ectopic and 20 were miscarriages. The highest hCG value with a true PUL that progressed to a live intrauterine pregnancy was 2767 IU/L. The hCG discriminatory zone showed wide variability in hCG values and no statistically significant difference between median hCG values in the initial transvaginal ultrasound groups. The difference in median hCG values were found to be statistically significant between the final outcome groups of IUP, miscarriage and ectopic. However, the large overlap in values across the groups shows that hCG has low specificity. Conclusion This study recommends limited reliance on the hCG DZ and raises awareness of the high variability of hCG values. The hCG DZ was not shown to be useful in this study in the evaluation of women with a pregnancy of unknown location. |
| Databáze: | OpenAIRE |
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