Maternal serum markers in predicting successful outcome in expectant management of missed miscarriage

Memtsa, Maria; Jauniaux, Eric; Gulbis, Béatrice; Nyrhinen, Netta N.C.

doi:10.1016/j.rbmo.2016.09.004

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…11 Another study also concluded that Hs-CRP did not contribute as a predictor of complications in the early phases of pregnancy. 12 However, the role of CRP in pregnancy has not shown consistent results. The study reported concluded that an abnormal CRP response in the fi rst trimester of pregnancy indicates a disruption in fetomaternal relationships and is associated with the incidence of abortion.…”

Section: Discussionmentioning

confidence: 97%

Role of C-Reactive Protein, Erythrocyte Sedimentation Rate, Progesterone and Estradiol Hormone Levels in First Trimester Threatened Abortion

Rajuddin¹,

Rizia²,

Nainggolan³

2021

Indones J Obstet Gynecol

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Objective: To assess correlation of High sensitivity C-Reactive Protein (Hs-CRP), erythrocyte sedimentation rate (ESR), progesterone and estradiol levels in the first trimester threatened abortion incidence in Dr. Zainoel Abidin Hospital, Banda Aceh.Methods: Case control design used in this study divided threatened abortion into a case group and normal pregnancy into a control group with a total of 20 subjects for each group. This research was conducted in the Emergency Room and Obstetric Ward of Dr. Zainoel Abidin hospital Banda Aceh in 2019. Eta correlation test was conducted to find out the link between variables towards threatened abortion with 95% confidence level followed by the Receiver Operating Curve (ROC) analysis to find out the cut off points.Results: Progesterone levels (14.76 ng/mL), estradiol (427.61 pg/mL), Hs-CRP (2.57 mg/L) and ESR (28.75 mm/hour) case group were lower compared to the control group. Incidence of threatened abortion correlates to progesterone and estradiol with the correlation strength respectively -0.838 and -0.416.Conclusion: Progesterone and estradiol correlate negatively with first-trimester abortion incidence. Evaluation of these two hormones levels is useful for diagnostic purposes and screening of threatened abortion with a cut point of progesterone 23.03 ng/mL and estradiol 468.8 pg/mL.Keywords: C-Reactive Protein, erythrocyte sedimentation rate, estradiol, progesterone, threatened abortion Abstrak Tujuan: Penelitian ini bertujuan untuk menilai korelasi antara kadar High sensitivity C-Reactive Protein (Hs-CRP), Laju Endap Darah (LED), progesteron dan estradiol terhadap kejadian abortus imminens pada trimester pertama di RSUD Dr. Zainoel Abidin Banda Aceh. Metode: Desain kasus kontrol digunakan dalam penelitian ini dimana kejadian abortus imminens menjadi kelompok kasus dan kehamilan normal menjadi kelompok kontrol dengan jumlah masing-masing kelompok sebanyak 20 sampel. Penelitian ini dilakukan di Instalasi Gawat Darurat dan ruang rawat Obstetri Rumah Sakit Umum Dr. Zainoel Abidin (RSUDZA) Banda Aceh pada tahun 2019. Uji korelasi Eta digunakan untuk mengetahui korelasi antar variabel terhadap abortus imminens dengan tingkat kepercayaan 95% dilanjutkan dengan analisis Receive Operating Curve (ROC) untuk menentukan titik potong. Hasil: Kadar progesteron (14,76 ng/mL), estradiol (427,61 pg/mL), Hs-CRP (2,57 mg/L) dan LED (28,75 mm/jam) kelompok kasus lebih rendah dibandingkan kelompok kontrol. Kejadian abortus imminens berkorelasi terhadap progesteron dan estradiol dengan kekuatan korelasi (R) secara berurutan -0,838 dan -0,416. Kesimpulan: Progesteron dan estradiol berkorelasi negatif terhadap kejadian abortus imminens pada trimester pertama kehamilan. Evaluasi kadar kedua hormon tersebut bermanfaat untuk kepentingan diagnostik dan penapisan abortus imminens dengan titik potong progesteron 23,03 ng/mL dan estradiol 468,8 pg/mL. Kata kunci: abortus imminent, C-Reactive Protein, estradiol, laju endap darah, progesteron

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Section: Discussionmentioning

confidence: 97%

Role of C-Reactive Protein, Erythrocyte Sedimentation Rate, Progesterone and Estradiol Hormone Levels in First Trimester Threatened Abortion

Rajuddin¹,

Rizia²,

Nainggolan³

2021

Indones J Obstet Gynecol

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“…There are only a few studies that have evaluated the relationship between hsCRP and first or second trimester pregnancy loss 34,36 . We have also evaluated its role in predicting successful outcome of expectant management in women presenting with missed miscarriage 37 . Similarly to the present study, we found no significant difference in the mean serum hsCRP levels between women with failed and successful conservative management of TEP.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of maternal serum biomarkers in predicting outcome of successful expectant management of tubal ectopic pregnancies

Memtsa

Jauniaux

Gulbis

2020

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: To assess the value of multiple serum biomarkers for the prediction of successful outcome of expectant management in women with tubal ectopic pregnancy (TEP). Study design:Women with a conclusive ultrasound diagnosis of TEP had a blood test to measure β-human chorionic gonadotropin (β-hCG), progesterone, inhibin A, activin A and high sensitivity C-reactive protein (hsCRP) at the initial visit. Women presenting with pain, serum b-hCG ≥ 1,500 IU, evidence of a live ectopic pregnancy or a significant haemoperitoneum were advised to have emergency surgery. Women eligible for expectant management were followed-up prospectively until serum β-hCG declined to non-pregnant level or surgical treatment was required.Results: A total of 93 women with a TEP were included in the final cohort.Emergency surgery was carried out in 42/93 (45%) of women whilst 51/93 (55%) were managed expectantly. Of the latter group, 42/51 (82%) had successful expectant management and 9/51(18%) required surgical procedure after a period of follow up. On multi-variable analysis, only higher values of serum b-hCG and progesterone at the initial visit were associated with a lower chance of successful expectant management of TEP. A one-unit increase in either variable on the log-scale was associated with an approximate 20-fold reduction in the odds of a successful outcome. Conclusion(s):Serum β-hCG and progesterone were significantly lower in women who had successful expectant management of TEP. Other biomarkers under consideration were not significantly different in women with successful and failed expectant management.

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“…Therefore, it is unlikely to be useful in busy emergency departments or early pregnancy units. Memtsa et al reported that the older the patient and the lower the s-progesterone level the higher the likelihood of complete miscarriage < 7 days [18]. We did not test patient age as a predictor, because we found it unlikely to be related to the time to complete evacuation of the uterine cavity.…”

Section: Commentsmentioning

confidence: 94%

“…This is probably explained by differences in study populations (types of miscarriage, symptomatology), definitions of complete miscarriage and treatment success, and variables tested as predictors. However, more than one study reported that the lower the s-β-hCG and s-progesterone values the higher the likelihood of success of expectant management [ 16 , 18 , 19 , 21 ] and that success rate is higher in incomplete miscarriages than in embryonic or anembryonic miscarriages [ 15 – 17 ]. Only two studies are reasonably similar to ours with regard to inclusion criteria and definition of treatment success [ 18 , 21 ].…”

Section: Commentsmentioning

confidence: 99%

“…Expectant management of miscarriages with a retained gestational sac is less likely to be successful within a few weeks, especially in women with no vaginal bleeding [13]. Most studies investigating possible predictors of treatment success of medical treatment or expectant management include both incomplete miscarriages and embryonic or anembryonic miscarriages and/or both patients with and without vaginal bleeding [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. This makes results difficult to generalize.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

Fernlund

Jokubkiene

Sladkevicius

et al. 2020

Arch Gynecol Obstet

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Purpose To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding. Methods This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables—serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space—were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior–posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression. Results Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment. Conclusions Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.

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Maternal serum markers in predicting successful outcome in expectant management of missed miscarriage

Cited by 9 publications

References 30 publications

Role of C-Reactive Protein, Erythrocyte Sedimentation Rate, Progesterone and Estradiol Hormone Levels in First Trimester Threatened Abortion

Role of C-Reactive Protein, Erythrocyte Sedimentation Rate, Progesterone and Estradiol Hormone Levels in First Trimester Threatened Abortion

Evaluation of maternal serum biomarkers in predicting outcome of successful expectant management of tubal ectopic pregnancies

Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding

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