Following declining human chorionic gonadotropin values in pregnancies of unknown location: When is it safe to stop?

Katherine E. Cameron, Suneeta Senapati, Mary D. Sammel, Karine Chung, Peter Takacs, Thomas Molinaro, Kurt T. Barnhart

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To determine if the pattern of decline in hCG curves can discriminate spontaneous abortion (SAB) from ectopic pregnancy (EP). Design Retrospective cohort study. Setting University hospitals. Patient(s) A total of 1,551 women with symptomatic pregnancy of unknown location (PUL) and decreasing hCG values. Intervention(S) None. Main Outcome Measure(s) Percentage change in hCG; days and visits to final diagnosis. Result(s) Of the 1,551 women with a PUL and declining hCG, 146 were ultimately diagnosed with EP and 1,405 with SAB. An 85% hCG drop within 4 days or a 95% hCG drop within 7 days both ruled out an EP 100% of the time. Applying the 4-day cutoff to this population would have saved 16% of the SAB population (229/1,405) a total of 2,841 person-days and 277 clinical visits. Applying the 7-day cutoff would have saved 9% of the SAB population (126/1,405) a total of 1,294 person-days and 182 clinical visits. These cutoffs were separately validated on a group of 179 EPs collected from three university clinical centers. In that population, each cutoff separately ruled out EP 100% of the time. Conclusion(s) The decline in serum hCG is slower in EPs than in SAB and can be used to aid clinicians in the frequency and duration of follow-up. Costs and patient time may be saved by allowing women who meet one of these criteria to be followed less frequently.

Original languageEnglish (US)
Pages (from-to)953-957
Number of pages5
JournalFertility and sterility
Volume105
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • ectopic pregnancy
  • hCG curves
  • pregnancy of unknown location

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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