Ratios of biochemical markers in peritoneal fluid to those in venous blood for the diagnosis of ruptured tubal pregnancy: A prospective study.
OBJECTIVE
Ectopic pregnancies are among the leading causes of maternal morbidity and mortality in both developed and emerging nations, but tests for early, accurate, and convenient detection are lacking.


METHODS
Between January 2013 and February 2015, 504 women with tubal pregnancy were prospectively recruited, and their clinical characteristics were recorded. Samples of peritoneal fluid were collected by culdocentesis, and venous blood was drawn from the antecubital vein. In samples from each source, levels of the following biochemical markers were measured: cancer antigen 125 (CA125), human chorionic gonadotropin (hCG), progesterone, vascular endothelial growth factor, and creatine kinase.


RESULTS
The ratios of biochemical markers in the peritoneal fluid and in the blood (Rp/v) were calculated. The median of Rp/v-CA125 and Rp/v-hCG were significantly lower in the ruptured ectopic pregnancy group than in the unruptured group. The optimal cutoff value to detect ectopic pregnancy rupture was 401.5U/mL as the upper limit for peritoneal CA125, with a sensitivity of 93.5% and specificity of 74.2%. The optimal cutoff value was 18.7 as the upper limit in the peritoneal fluid/blood ratio (Rp/v) of CA125, with a sensitivity of 77.5% and specificity of 68.4%.


CONCLUSIONS
In countries with poor access to laparoscopy, culdocentesis is useful. In this study, culdocentesis provided additional information for management of abdominal pain when laparoscopy is not available. The authors propose Rp/vcutoff values that can be used conveniently and quickly to diagnose ruptured ectopic pregnancies and bleeding, enabling rapid and appropriate therapeutic responses.
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
Xiao-Lu
XL
Zhu
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
Zhuo-Wei
ZW
Xue
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
Yan-Li
YL
Xu
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
Juan
J
Wang
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China.
Zhi-Hong
ZH
Ai
Department of Obstetrics and Gynecology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China. Electronic address: yc_teng@126.com.
Yin-Cheng
YC
Teng
D000328:Adult; D001202:Ascitic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D008565:Membrane Proteins / Q000097:blood; D019152:Paracentesis; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood* / Q000175:diagnosis; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D012422:Rupture, Spontaneous / Q000097:blood; D042461:Vascular Endothelial Growth Factor A / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D018394:CA-125 Antigen; D006063:Chorionic Gonadotropin; C451759:MUC16 protein, human; D008565:Membrane Proteins; D042461:Vascular Endothelial Growth Factor A; D011374:Progesterone; D003402:Creatine Kinase
Cancer antigen 125; Creatine kinase; Diagnosis; Ectopic pregnancy; Human chorionic gonadotropin; Monitoring; Progesterone; Vascular endothelial growth factor