Maternal serum markers in predicting successful outcome in expectant management of missed miscarriage.
The aim of this study was to evaluate the use of biological serum markers, available routinely in most hospital clinical laboratories, in predicting successful outcomes of expectant management in women presenting with a missed miscarriage. This is a single centre observational prospective study over a 16-month period. Among the 490 women who consented to the study protocol, 83 presented with missed miscarriage during the first trimester of pregnancy and opted for expectant management. The mean gestation sac diameter and volume of the gestation sac were recorded during ultrasound examination. Maternal serum samples were obtained in each case and assayed for human chorionic gonadotrophin, progesterone, pregnancy associated plasma protein A (PAPP-A) and high-sensitivity C-reactive protein using commercial assays. When examined individually, maternal age (P = 0.01), progesterone (P = 0.03) and PAPP-A (P = 0.02) were all significantly associated with successful expectant management. Increased maternal age was associated with an increased chance of success with the odds of success increased by around 75% for a 5-year increase in age. Higher values of progesterone and PAPP-A were associated with a reduced chance of successful management. Low maternal serum progesterone concentration was the strongest parameter associated with a successful spontaneous completion of miscarriage.
Early Pregnancy Assessment Unit (EPAU), Department of Obstetrics and Gynaecology, University College London Hospital (UCLH), London, UK.
Maria
M
Memtsa
Early Pregnancy Assessment Unit (EPAU), Department of Obstetrics and Gynaecology, University College London Hospital (UCLH), London, UK; Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London (UCL), London, UK. Electronic address: e.jauniaux@ucl.ac.uk.
Eric
E
Jauniaux
Department of Clinical Chemistry, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
Béatrice
B
Gulbis
Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London (UCL), London, UK.
Netta C
NC
Nyrhinen
Academic Department of Obstetrics and Gynaecology, UCL Institute for Women's Health, University College London (UCL), London, UK.
Davor
D
Jurkovic
D000030:Abortion, Missed / Q000097:blood* / Q000628:therapy*; D000328:Adult; D001681:Biological Assay; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D015415:Biomarkers; D011374:Progesterone; D002097:C-Reactive Protein; D011266:Pregnancy-Associated Plasma Protein-A
C-reactive protein; first-trimester; maternal serum; miscarriage; pregnancy