Clinical utility of serum reproductive hormones for the early diagnosis of ectopic pregnancy in the first trimester

Abstract

Aim: A tubal ectopic pregnancy (EP) in the first trimester remains a major life-threatening complication for the mother. We aim to determine whether serum reproductive hormones may be clinically useful in the early identification of a tubal EP. Methods: A total of 109 age-matched patients with a serum b-human chorionic gonadotropin (b-hCG) concentration <2000 IU/L were enrolled, including 68 patients with a tubal EP, 22 with a viable intrauterine pregnancy (vIUP) and 19 with a non-viable intrauterine pregnancy (nIUP). Serum was collected during the first trimester of pregnancy and assayed for b-hCG, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (TE), progesterone (P), estradiol (E2) and prolactin (PRL) by using automated electrochemiluminescence immunoassays. Results: Patients with an EP had significantly lower levels of daily b-hCG variation (Db-hCG/day), P and E2, and significantly higher levels of LH and FSH than IUP patients (P < 0.05). As an EP diagnostic marker, progesterone demonstrated a sensitivity of 100% at the cutoff of 86.01 nmol/L. The combination of E2 with Db-hCG/day reached a specificity of 100% for EP evaluation. To identify non-viable pregnancies (including EPs and nIUPs), progesterone demonstrated a sensitivity of 95.40% and a specificity of 90.91% at the cutoff of 63.2 nmol/L; the diagnostic power of the receiver operating curve was 0.9702. Conclusions: A combination of Db-hCG/day, P and E2 may help distinguish EPs and nIUPs from vIUPs, facilitating earlier diagnosis and the timely implementation of medical treatment to prevent tubal rupture.

Deregulation of miR-324/KISS1/kisspeptin in early ectopic pregnancy: mechanistic findings with clinical and diagnostic implications

“…Accordingly, different biomarkers have been proposed in order to increase accuracy of EP diagnosis, which would allow a rapid triage of pregnancies at risk of extra-uterine location. These putative markers may include circulating levels of progesterone, estradiol, vascular-endothelial Kisspeptin and miR-324-3p in Ectopic Pregnancy growth factor-A (VEGF-A), inhibin-A and activin-A (6)(7)(8)(9)(10)(11). Yet, despite promising results (11), there is little pathogenic information emerging from these studies, and no diagnostic test based on these markers is currently available in clinical practice for accurate biochemical identification of EP.…”

Hemoperitoneum in a Peritoneal Dialysis Patient: Ruptured Ectopic Pregnancy

“…In non-dialysis patients, the diagnosis of ectopic pregnancy is made based upon a combination of measurement of the serum quantitative hCG and a transvaginal ultrasound. There may be a lower likelihood of early pregnancy symptoms with ectopic pregnancies as progesterone, estradiol, and hGC may be lower in ectopic pregnancy than in normal pregnancy in general (9)(10)(11). In a review of over 700 admitted patients with ectopic pregnancy, nearly 30% of those with beta hCG of less than 100 iu/L were found to have tubal rupture at laparoscopy (12).…”

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“…These associated symptoms are also not consistent with stage of the disease progression at time of presentation for evaluation. Patients may present in the early phase of ectopic pregnancy with minimal symptoms due to levels of progesterone, estradiol, and beta-HCG being lower than in normal pregnancy [8][9][10]. Such cases may be treated with either observation or methotrexate administration without invasive procedures.…”