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Following declining human chorionic gonadotropin values in pregnancies of unknown location: when is it safe to stop?
Katherine E Cameron1, Suneeta Senapati1, Mary D Sammel2
1Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Objective:
To determine if the pattern of decline in hCG curves can discriminate spontaneous abortion (SAB) from ectopic pregnancy (EP).
Design:
Retrospective cohort study.
Setting:
University hospitals.
Patient(S):
A total of 1,551 women with symptomatic pregnancy of unknown location (PUL) and decreasing hCG values.
Intervention(S):
None.
Main Outcome Measure(S):
Percentage change in hCG; days and visits to final diagnosis.
Result(S):
Of the 1,551 women with a PUL and declining hCG, 146 were ultimately diagnosed with EP and 1,405 with SAB. An 85% hCG drop within 4 days or a 95% hCG drop within 7 days both ruled out an EP 100% of the time. Applying the 4-day cutoff to this population would have saved 16% of the SAB population (229/1,405) a total of 2,841 person-days and 277 clinical visits. Applying the 7-day cutoff would have saved 9% of the SAB population (126/1,405) a total of 1,294 person-days and 182 clinical visits. These cutoffs were separately validated on a group of 179 EPs collected from three university clinical centers. In that population, each cutoff separately ruled out EP 100% of the time.
Conclusion(S):
The decline in serum hCG is slower in EPs than in SAB and can be used to aid clinicians in the frequency and duration of follow-up. Costs and patient time may be saved by allowing women who meet one of these criteria to be followed less frequently.
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