title: Predictive value of serum human chorionic gonadotropin ratio, progesterone and inhibin A for expectant management of early pregnancies of unknown location.
abstract: OBJECTIVE
  To evaluate serum human chorionic gonadotropin (hCG) ratio, progesterone and inhibin A as single parameters and in combination for the prediction of spontaneous resolution of pregnancies of unknown location (PUL).
  
  
  METHODS
  Prospective observational study of 105 consecutive patients with a diagnosis of PUL. Serum levels of hCG, progesterone and inhibin A were determined at the first visit and after 2 days. Patients were followed clinically until a final diagnosis of spontaneously resolving PUL, viable or non-viable intrauterine pregnancy, or ectopic pregnancy with need of laparoscopic intervention had been reached. Different combinations of hCG ratio (hCG at 48 h/hCG at 0 h), s-progesterone and s-inhibin A were investigated to find the best predictor for successful expectant management.
  
  
  RESULTS
  The final pregnancy outcomes were: 52 spontaneously resolving PUL (49.5%), 37 viable intrauterine pregnancies (35.2%), 8 non-viable intrauterine pregnancies (7.6%), 7 ectopic pregnancies (6.7%), and one molar pregnancy (1.0%). An hCG ratio<0.80 predicted spontaneously resolving PUL with positive and negative predictive values (PPV and NPV), sensitivity, and specificity of 0.98, 0.78, 0.72, and 0.99, respectively. In patients with hCG ratio ≥ 0.80, a combination of s-progesterone < 20 nmol/l and s-inhibin A < 30 pg/ml predicted spontaneously resolving PUL with PPV, NPV, sensitivity and specificity of 0.92, 0.96, 0.85, and 0.98 respectively.
  
  
  CONCLUSIONS
  Our results suggest that patients with PUL and hCG ratio < 0.80 display a high probability of spontaneously resolving PUL with minimum need of follow-up. In cases of hCG ratio ≥ 0.80, a combination of s-progesterone < 20 nmol/l and s-inhibin A < 30 pg/ml, may be a reliable predictor of spontaneously resolving PUL. The safety of this approach should be tested in large prospective studies.
authors.affiliation: Department of Obstetrics and Gynecology, Randers Regional Hospital, Randers, Denmark. hudamaje@rm.dk
authors.forename: Huda
authors.initials: H
authors.lastname: Majeed
authors.forename: Astrid
authors.initials: A
authors.lastname: Højgaard
authors.forename: Peter
authors.initials: P
authors.lastname: Johannesen
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Ladefoged
authors.forename: Axel
authors.initials: A
authors.lastname: Forman
authors.forename: Pinar
authors.initials: P
authors.lastname: Bor
mesh_terms: D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D003718:Denmark / Q000453:epidemiology; D020964:Embryo Loss / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D007265:Inhibins / Q000097:blood*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D012075:Remission, Spontaneous; D012306:Risk; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; C422362:inhibin A; D011374:Progesterone; D007265:Inhibins