Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive

Mol, Ben Willem J.; Hajenius, Petra J.; Engelsbel, Simone; Ankum, Willem M.; Veen, Fulco van der; Hemrika, D. J.; Bossuyt, Patrick M.

doi:10.1016/s0015-0282(98)00278-7

Cited by 119 publications

(79 citation statements)

References 17 publications

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“…1,16,27 The b-hCG level is mainly helpful to stratify risk in women whose initial ultrasound is indeterminate-diagnostic of neither intrauterine pregnancy nor ectopic pregnancy. 28 Nevertheless, at some hospitals, protocols persist that defer ultrasound for below-threshold b-hCG levels, and at other hospitals, endovaginal ultrasound may not be routinely available. In these hospitals, emergency physicians must still use the single b-hCG level to stratify risk for ectopic pregnancy without the benefit of a transvaginal ultrasound result.…”

Section: Discussionmentioning

confidence: 99%

Beta‐Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding

Kohn

2003

Academic Emergency Medicine

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Strategies for diagnosing ectopic pregnancy that defer endovaginal ultrasound in women with suggestive symptoms and serum beta-human chorionic gonadotropin (bhCG) levels less than 1,500 mIU/mL ignore the increased risk of ectopic pregnancy in these patients. Objective: To quantify this increased risk by establishing and comparing the b-hCG distributions of symptomatic women with ectopic pregnancies, abnormal intrauterine pregnancies, and normal intrauterine pregnancies. Methods: The authors reviewed the records of a cohort of women who visited an urban emergency department (ED) during a 34-month period with abdominal pain or vaginal bleeding and nonzero quantitative b-hCG levels. Explicit criteria were used to determine whether the pregnancy ultimately turned out to be intrauterine and normal, intrauterine and abnormal, or ectopic. Probability distributions were compared using frequency distributions, receiver operating characteristic (ROC) curves, and likelihood ratios. Results: Of 730 ED patients included in the analysis, 96 (13%) had ectopic pregnancies, 253 (35%) had abnormal intrauterine pregnancies, and 381 (52%) had normal intrauterine pregnancies. The b-hCG distributions of patients with ectopic pregnancies and abnormal intrauterine pregnancies were similar and much lower than the b-hCG distribution of patients with normal intrauterine pregnancies. A b-hCG level less than 1,500 mIU/mL more than doubled the odds of ectopic pregnancy (likelihood ratio ¼ 2.24). Of the 158 patients with b-hCG below 1,500 mIU/mL, 40 (25%; 95% confidence interval [CI] ¼ 19% to 32%) had ectopic pregnancies, and only 25 (16%; CI ¼ 11% to 22%) had normal intrauterine pregnancies. Conclusions: In women with pain or bleeding and serum b-hCG levels less than 1,500 mIU/mL, the risk of ectopic pregnancy is substantially increased, while the likelihood of normal intrauterine pregnancy is low.

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Section: Discussionmentioning

confidence: 99%

Beta‐Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding

Kohn

2003

Academic Emergency Medicine

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“…However, others have noted lower success rates in that population (13). Several studies have attempted to ascertain indicators of success after medical treatment of EP (2,14,15). Different markers and features of EP have been studied to predict the outcome of treatment approaches (6,16,17).…”

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confidence: 99%

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Çelik¹,

Türkçüoğlu²,

Karaer³

et al. 2013

J Turkish German Gynecol Assoc

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Objective: To evaluate percentage changes in serum beta-human chorionic gonadotropin (β-hCG) values between days 0-1, 0-4 and 0-7 as an indicator of methotrexate therapy success in extra-uterine pregnancies. Material and Methods:Women with ectopic pregnancy treated with single-dose methotrexate therapy between January 2011 and August 2012 were assessed. Recorded data were reviewed electronically from patient files. All women (n=93) with an ectopic pregnancy treated medically with intramuscular methotrexate (50 mg/m 2 ) were included. The percentage changes in serum β-hCG levels from day 0 to 1, day 0 to 4 and day 0 to 7 were calculated for each case. Results:The median β-hCG values decreased between days 0 and 4 by 55.8%, and 89.6% of these cases were treatment successes. The median initial serum β-hCG values were lower in women with successful treatment, but this was not statistically significant (p=0.11). Conclusion:A decline in serum β-hCG values between days 0 and 4 appears to be the best predictor. It would be beneficial to determine whether a woman with an ectopic pregnancy treated with singledose methotrexate administration will be treated successfully. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Key words: Ectopic pregnancy, human chorionic gonadotrophin, methotrexate.Received: 8 April, 2013 Accepted: 26 May, 2013 Amaç: Ektopik gebeliklerin tedavisinde methotraksat tedavisinin başarısını belirlemede beta-human koryonik gonadotropin (β-hCG) değerlerinin 0-1, 0-4 ve 0-7 günleri arasında yüzde değişimlerini değerlendirmek. Gereç ve Yöntemler:Ocak 2011 ile Agustos 2012 tarihleri arasında ektopik gebelik nedeniyle tanı alan ve tek doz metotreksat tedavisi alan 93 olgu çalışmaya dahil edildi. Elektronik ortamda kaydelilen hastaların dosyalarında bulunan tüm bilgiler incelendi. 0-1, 0-4 ve 0-7 günler arasındaki serum β-hCG seviyelerindeki değişim yüzdeleri her olgu için hesaplandı. Bulgular:Metotreksat tedavisinin başarılı olan olguların %55.8 ve %89.6'da ortanca β-hCG değerleri 0 ve 4. günler arasında azalmış olarak bulundu. Tedavi öncesindeki ortanca β-hCG seviyesi tedavinin başarılı olduğu olgularda daha düşük saptanmasına rağmen iki grup arasında istatistiksel olarak bir fark saptanmadı (p=0.11).Sonuç: Serum β-hCG değerlerindeki 0 ile 4. günler arasındaki düşme olması metoteksat tedavisinin başarısını tahmininde en iyi gösterge olarak ortaya çıkmaktadır, ve tek doz metotreksat ile tedavi edilen ektopik gebeliklerin nihai tedavinin başarısını belirlemek yararlı olacaktır. (J Turkish-German Gynecol Assoc 2013; 14: 125-9) Abstract Özet tion of MTX treatment success. The serum β-hCG level before MTX administration has been reported as a particular factor contributing significantly to treatment failure (8). Previously, it has been found that at least a 15% reduction in the β-hCG concentration on the seventh day compared to the fourth day after MTX administration is the best predictor of treatment success, with a positive predictive value of approximately 93.0% (9). A rise in the β-hCG titer on t...

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“…Nel caso in cui l'ecografia TV non mostri segni certi di GE e la beta HCG risulti inferiore a 1500 UI/l sarà il riscontro o meno di un incremento della beta HCG superiore al 66% dopo 48 h di osservazione a confermare o escludere la diagnosi [19][20][21][22] .…”

Section: Sospetta Gravidanza Extrauterinaunclassified

Acute abdominal pain: emergency diagnosis and treatment (Part II)

Cristoni¹,

Palmonari²,

Iannone³

et al. 2008

Emerg Care J

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Serum human chorionic gonadotropin measurement in the diagnosis of ectopic pregnancy when transvaginal sonography is inconclusive

Cited by 119 publications

References 17 publications

Beta‐Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding

Beta‐Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding

Assessment of early decline in percentage of β-hCG values between days 0 and 4 after methotrexate therapy in ectopic pregnancy for prediction of treatment success

Acute abdominal pain: emergency diagnosis and treatment (Part II)

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