title: Diagnostic accuracy of serum activin A in detection of ectopic pregnancy.
abstract: BACKGROUND
  Ectopic pregnancy (EP) still remains a main cause of maternal mortalities. This study is designed to evaluate the accuracy of serum Activin A in detection of ectopic pregnancy.
  
  
  METHODS
  This prospective observational study was conducted from 2009 to 2010 at two main referral university hospitals, Isfahan University of Medical Sciences, Isfahan, Iran. Two hundred subjects who were under 10 week's pregnancy with clinical presentations of abdominal pain and vaginal bleeding were enrolled. After sampling serum Activin A, patients underwent ultrasonography, titer of B-HCG and surgery (if indicated) and were divided into two groups: EP (n = 100) and intrauterine pregnancy (IUP) (n = 100). The mean of Activin A was compared between groups and by ROC curve, the optimal cut off with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined.
  
  
  RESULTS
  The mean age of women with IUP was 25.4 ± 4.3 years (15-40 years) compared with 25.9 ± 4.1 years in women in EP group (P = 0.448). Statistical difference was not found between EP versus IUP groups in gestational age (6.32 ± 1.03 vs. 6.85 ± 1.82 weeks, P = 0.124). The mean of serum Activin A in EP group was 0.264 ± 0.0703 ng/ml versus 0.949 ± 0.5283 ng/ml in IUP group (P < 0.05). According to ROC curve (area under the curve = 0.981, P < 0.05, confidence interval: 0.961-1.000), the optimal cut off was estimated as 0.504 ng/ml with sensitivity of 97% and specificity of 93.5%.
  
  
  CONCLUSIONS
  This study indicated that the mean of serum Activin A is lower in EP compared with IUP. The serum Activin A has a fair accuracy in detecting EP.
authors.affiliation: Department of Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Roghaei
authors.forename: Fahimeh
authors.initials: F
authors.lastname: Sabet
authors.forename: Keivan
authors.initials: K
authors.lastname: Mohamadi