How and when human chorionic gonadotropin curves in women with an ectopic pregnancy mimic other outcomes: differences by race and ethnicity.
OBJECTIVE
To investigate the hCG profiles in a diverse patient group with ectopic pregnancy (EP) and to understand when they may mimic the curves of an intrauterine pregnancy (IUP) or spontaneous abortion (SAB).


METHODS
Retrospective cohort study.


METHODS
Three university hospitals.


METHODS
One hundred seventy-nine women with symptomatic pregnancy of unknown location.


METHODS
None.


METHODS
Slope of log hCG; days and visits to final diagnosis.


RESULTS
Of women with an EP, 60% initially exhibited an increase in hCG values, with a median slope of 32% increase in 2 days; 40% of subjects initially had an hCG decrease, with the median slope calculated as a 15% decline in 2 days. In total, the hCG curves in 27% of women diagnosed with EP resembled that of a growing IUP or SAB. Of the EP hCG curves, 16% demonstrated a change in the direction of the slope of the curve. This was more common in African Americans and less evident in Hispanics. Furthermore, it was associated with more clinical visits and days until final diagnosis.


CONCLUSIONS
The rate of change in serial hCG values can be used to distinguish EP from an IUP or SAB in only 73% of cases. The number of women who had a change in direction of serial hCG values was associated with race and ethnicity.
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Katherine E
KE
Dillon
Vasileios D
VD
Sioulas
Mary D
MD
Sammel
Karine
K
Chung
Peter
P
Takacs
Alka
A
Shaunik
Kurt T
KT
Barnhart
D000022:Abortion, Spontaneous / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D016208:Databases, Factual / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D009017:Morbidity; D017699:Pelvic Pain / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood; D011271:Pregnancy, Ectopic / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology*; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data
D018997:Chorionic Gonadotropin, beta Subunit, Human