title: Predicting the decline in human chorionic gonadotropin in a resolving pregnancy of unknown location.
abstract: OBJECTIVE
  To characterize the curve derived from serial human chorionic gonadotropin (hCG) values in women with spontaneous resolution of pregnancy of unknown location and to assess factors that modify the decline.
  
  
  METHODS
  Data from three sites were extracted from a clinical database of women with a symptomatic pregnancy of unknown location that required follow-up with serial hCG levels. A nonlinear mixed-effects regression model was used to generate hCG elimination curves.
  
  
  RESULTS
  Four hundred forty-three women presenting with a pregnancy of unknown location that resolved without intervention were studied between September 2007 and May 2009. Women older than 35 years had a slower hCG decline (P=.001) and those with pain had a steeper decline (P=.006), but these changes did not alter the curve in a clinically meaningful way. The decline in hCG is faster for those with a higher level at presentation. The average decline of hCG in women with spontaneous resolution is slower than previously reported. However, the minimal decline in hCG for women with spontaneous resolution of a pregnancy of unknown location ranged from 35% to 50% at 2 days of follow-up and from 66% to 87% at 7 days, which is more rapid than previously reported.
  
  
  CONCLUSIONS
  In a diverse population, using updated statistical methods, it was observed that the minimal decline in hCG for women with spontaneous resolution is more rapid than previously reported. A decline slower than these thresholds may indicate the presence of retained trophoblastic tissue or ectopic pregnancy.
  
  
  METHODS
  III.
authors: Department of Obstetrics and Gynecology and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; the University of Southern California, Keck School of Medicine, Department of Obstetrics and Gynecology, Los Angeles, California; and the Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, Florida.
authors: Samantha F
authors: SF
authors: Butts
authors: Wensheng
authors: W
authors: Guo
authors: Mark S
authors: MS
authors: Cary
authors: Karine
authors: K
authors: Chung
authors: Peter
authors: P
authors: Takacs
authors: Mary D
authors: MD
authors: Sammel
authors: Kurt T
authors: KT
authors: Barnhart
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin
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