title: Serum angiopoietin-2 and β-hCG as predictors of prolonged uterine bleeding after medical abortion in the first trimester.
abstract: OBJECTIVE
  The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We evaluate serum Angiopoietin-2 (Ang-2) and β human chorionic gonadotropin (β-hCG) in women who had undergone a medical abortion as markers of prolonged uterine bleeding (PUB).
  
  
  METHODS
  Prospective trial involving 2843 women attending an gynecology outpatient clinic who following a medical abortion with mifepristone and misoprostol, the study cohort was divided into women with duration of uterine bleeding >14 days (PUB) and women with duration of uterine bleeding ≤14 days (normal uterine bleeding, NUB). Serum determinations of Ang-2 levels by ELISA and β-hCG levels by electrochemiluminiscence immunoassay. Receiver Operating Characteristics (ROC) analyses were calculated and plotted for the diagnostic accuracy of serum β-hCG and Ang-2 concentration to discriminate PUB and NUB.
  
  
  RESULTS
  Baseline characteristics for both groups were similar, Only duration of bleeding showed a significant difference between the PUB group and NUB group. Ang-2 serum levels moderately correlated with serum β-hCG levels with statistically significant correlation coefficients of 0.536. Serum β-hCG and Ang-2 levels on day 7 and on day 14 after medical abortion were signifcantly higher in PUB group than in NUB group. Plotted as ROC curves, β-hCG area under curve (AUC) was 0.65 (95% CI, 0.53-0.76) on day 7, rising to AUC = 0.83 (95% CI, 0.75-0.92) on day 14. Using Ang-2 on day 7 and day 14 as predictive parameter resulted in an analogous AUC (AUC = 0.61 on day 7, AUC = 0.78 on day 14).
  
  
  CONCLUSIONS
  Both parameters are clinically useful as a diagnostic test in predicting PUB after medical abortion, and can be helpful in uncertain clinical situations, but should be considered as supplementary to a general clinical evaluation.
authors.affiliation: Department of Clinical Laboratory Medicine, Affiliated Dongyang Hospital of Wenzhou Medical College, Dongyang, Zhejiang, People's Republic of China.
authors.forename: Maofeng
authors.initials: M
authors.lastname: Wang
authors.forename: Junqing
authors.initials: J
authors.lastname: Chen
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.forename: Jiong
authors.initials: J
authors.lastname: Yu
authors.forename: Bifei
authors.initials: B
authors.lastname: Huang
authors.forename: Zhaoxiang
authors.initials: Z
authors.lastname: Ren
authors.forename: Xianyu
authors.initials: X
authors.lastname: Wang
authors.forename: Qiaoqiao
authors.initials: Q
authors.lastname: Guo
authors.forename: Yunlai
authors.initials: Y
authors.lastname: Wang
authors.forename: Liuyi
authors.initials: L
authors.lastname: Qiu
authors.forename: Hongsheng
authors.initials: H
authors.lastname: Yu
authors.forename: Rugen
authors.initials: R
authors.lastname: Wan
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects*; D000328:Adult; D042702:Angiopoietin-2 / Q000097:blood*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D006801:Humans; D015735:Mifepristone / Q000627:therapeutic use; D016595:Misoprostol / Q000627:therapeutic use; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D014592:Uterine Hemorrhage / Q000097:blood*; D055815:Young Adult
chemical_list: D042702:Angiopoietin-2; D018997:Chorionic Gonadotropin, beta Subunit, Human; D016595:Misoprostol; D015735:Mifepristone