Diagnostic value of serum human chorionic gonadotropin and uterine artery Doppler indices in missed abortion

Abstract

OBJECTIVE To evaluate the combined diagnostic value of serum human chorionic gonadotropin (HCG) levels and uterine artery Doppler indices - including pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) - for identifying missed abortion. METHODS This retrospective cohort study included 160 patients diagnosed with missed abortion and 200 women with normal pregnancies between January 2019 and December 2023. Serum HCG levels were measured using electrochemical immunoassay, and uterine artery Doppler indices were obtained by transvaginal ultrasound. Statistical analyses included independent t-tests, Pearson correlation, receiver operating characteristic (ROC) curve analysis, and Akaike information criterion (AIC)-based model selection to assess diagnostic performance. RESULTS Compared to normal pregnancies, patients with missed abortion had significantly lower HCG levels and significantly higher PI, RI, and EDV values (all P < 0.001). Serum HCG levels were negatively correlated with PI (r = -0.33), RI (r = -0.24), PDV (r = -0.25), and EDV (r = -0.26). The combined diagnostic model incorporating HCG, PI, RI, PSV, and EDV demonstrated the highest diagnostic accuracy, with an area under the curve (AUC) of 0.941 (95% CI: 0.918-0.964), sensitivity of 86.25%, and specificity of 87.00%. CONCLUSION Combining serum HCG levels with uterine artery Doppler indices markedly enhanced the diagnostic accuracy for missed abortion compared to single biomarkers. This multimodal approach offers high sensitivity and specificity, and may be useful in clinical practice.