Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2011
Further evidence against the reliability of the human chorionic gonadotropin discriminatory level.
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Doubilet Peter M, Benson Carol B
Аннотация
OBJECTIVES: The human chorionic gonadotropin (hCG) discriminatory level-the maternal serum β-hCG level above which a gestational sac should be consistently visible on sonography in a normal pregnancy--has been reported to be 1000 to 2000 mIU/mL for transvaginal sonography. We assessed whether a woman with a β-hCG above 2000 mIU/mL and no intrauterine fluid collection on transvaginal sonography can subsequently be found to have a live intrauterine gestation and, if so, what the prognosis is for the pregnancy.
METHODS: We identified all women scanned between January 1, 2000, and December 31, 2010, who met the following criteria: serum β-hCG testing and transvaginal sonography were performed on the same day; β-hCG was positive and sonography showed no intrauterine fluid collection; and a live intrauterine pregnancy was subsequently documented. We tabulated the β-hCG levels in these cases and assessed pregnancy outcome.
RESULTS: A total of 202 patients met the inclusion criteria, including 162 (80.2%) who had β-hCG levels below 1000 mIU/mL on the day of the initial scan showing no intrauterine fluid collection, 19 (9.4%) with levels of 1000 to 1499, 12 (5.9%) 1500 to 1999, and 9 (4.5%) above 2000 mIU/mL. There was no significant relationship between initial β-hCG level and either first-trimester outcome or final pregnancy outcome (P > .05, logistic regression analysis and Fisher exact test). The highest β-hCG was 6567 mIU/mL, and the highest value that preceded a liveborn term baby was 4336 mIU/mL.
CONCLUSIONS: The hCG discriminatory level should not be used to determine the management of a hemodynamically stable patient with suspected ectopic pregnancy, if sonography demonstrates no findings of intrauterine or ectopic pregnancy.
METHODS: We identified all women scanned between January 1, 2000, and December 31, 2010, who met the following criteria: serum β-hCG testing and transvaginal sonography were performed on the same day; β-hCG was positive and sonography showed no intrauterine fluid collection; and a live intrauterine pregnancy was subsequently documented. We tabulated the β-hCG levels in these cases and assessed pregnancy outcome.
RESULTS: A total of 202 patients met the inclusion criteria, including 162 (80.2%) who had β-hCG levels below 1000 mIU/mL on the day of the initial scan showing no intrauterine fluid collection, 19 (9.4%) with levels of 1000 to 1499, 12 (5.9%) 1500 to 1999, and 9 (4.5%) above 2000 mIU/mL. There was no significant relationship between initial β-hCG level and either first-trimester outcome or final pregnancy outcome (P > .05, logistic regression analysis and Fisher exact test). The highest β-hCG was 6567 mIU/mL, and the highest value that preceded a liveborn term baby was 4336 mIU/mL.
CONCLUSIONS: The hCG discriminatory level should not be used to determine the management of a hemodynamically stable patient with suspected ectopic pregnancy, if sonography demonstrates no findings of intrauterine or ectopic pregnancy.