Expectant management of early pregnancies of unknown location: A prospective evaluation of methods to predict spontaneous resolution of pregnancy

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Abstract

Objective: To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan. Design: Prospective observational study. Setting: Dedicated early pregnancy unit in an inner city teaching hospital. Population: Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications. Methods: A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta-human chorionic gonadotrophin (β-hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non-declining β-hCG levels. Main outcome measures: Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum β-hCG level to < 20 iu/L) without need for any active intervention. Results: Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values ≥ 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L. Conclusion: Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.

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APA

Banerjee, S., Aslam, N., Woelfer, B., Lawrence, A., Elson, J., & Jurkovic, D. (2001). Expectant management of early pregnancies of unknown location: A prospective evaluation of methods to predict spontaneous resolution of pregnancy. British Journal of Obstetrics and Gynaecology, 108(2), 158–163. https://doi.org/10.1016/S0306-5456(00)00031-0

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