Change in serum beta-human chorionic gonadotropin after abortion with methotrexate and misoprostol.
OBJECTIVE
The purpose of this study was to determine the normal beta-human chorionic gonadotropin change within 24 hours after a medical abortion. Because a medical abortion creates a "miscarriage," these data can represent the serum beta-human chorionic gonadotropin changes that would occur with a complete spontaneous abortion. Knowledge of normal beta-human chorionic gonadotropin changes after a spontaneous abortion may help to differentiate within a 24-hour period a complete from an incomplete spontaneous abortion or an ectopic pregnancy.


METHODS
Data from recent trials that used methotrexate and misoprostol for abortion at < or = 56 day's gestation were reviewed. Patients from each of four trials were included in this analysis if (1) they received both methotrexate intramuscularly and misoprostol vaginally and (2) they had serum beta-human chorionic gonadotropin levels drawn on both the day of misoprostol administration and the next day.


RESULTS
The change in serum beta-human chorionic gonadotropin was evaluated in 86 patients. Subjects who had a complete abortion after receiving methotrexate and a single dose of misoprostol had a decline in serum beta- human chorionic gonadotropin of 66% +/- 8%. All other subjects had a decline of 25% +/- 19% (p=0.0001).


CONCLUSIONS
An aborting pregnancy, if the abortion has occurred, should have a beta-human chorionic gonadotropin decrease of at least 48% within approximately 24 hours. This decline, however, does not guarantee that the abortion is complete. A patient with a serum beta-human chorionic gonadotropin level that has not declined by a minimum of approximately 50% over 24 hours is unlikely to have a complete abortion.
Creinin
M D
MD
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, PA, USA.
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced; D000282:Administration, Intravaginal; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy
D000020:Abortifacient Agents, Nonsteroidal; D018997:Chorionic Gonadotropin, beta Subunit, Human; D016595:Misoprostol; D008727:Methotrexate