Expectant management of miscarriage--prediction of outcome using ultrasound and novel biochemical markers.
BACKGROUND
The aim of this study was to examine the value of various ultrasound and biochemical parameters for the prediction of successful expectant management of miscarriage.


METHODS
This was a prospective observational study. Clinically stable women with an ultrasound diagnosis of miscarriage were offered expectant management. In all cases, gestational age, size of retained products of conception, serum HCG, progesterone, 17-hydroxyprogesterone, insulin growth factor-binding protein 1 (IGFBP-1), inhibin A and inhibin pro alpha-C RI levels were recorded. Follow-up continued until resolution of the pregnancy. Clinical data, ultrasound findings and biochemical markers were analysed using univariate analysis and decision tree analysis.


RESULTS
Fifty-four women underwent expectant management of miscarriage. Thirty-seven (69%) had successful expectant management and 17 (31%) required surgery. The size of retained products, serum HCG, progesterone, inhibin A and inhibin pro alpha-C RI were all significantly different in those pregnancies that resolved spontaneously (P<0.05). Serum inhibin A was the best predictor of a complete miscarriage.


CONCLUSIONS
This study shows that novel biochemical markers may be used to predict the likelihood of successful expectant management of miscarriage.
Elson
J
J
Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, London, UK.
Tailor
A
A
Salim
R
R
Hillaby
K
K
Dew
T
T
Jurkovic
D
D
D000022:Abortion, Spontaneous / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy*; D000328:Adult; D015415:Biomarkers; D003663:Decision Trees; D005260:Female; D006801:Humans; D007265:Inhibins / Q000097:blood; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
D015415:Biomarkers; D018970:Insulin-Like Growth Factor Binding Protein 1; C422362:inhibin A; D007265:Inhibins