Biochemical and ultrasonographic predictors of outcome in threatened abortion

ObjectivesTo evaluate different biochemical and ultrasonographic markers as predictors of outcome in cases with threatened abortion.Study designA prospective observational study involving 250 women in their 1st trimester was divided into three groups: group I (65 women) in whom threatened abortion ended in abortion, group II (85 women) with threatened abortion who completed their pregnancy and group III (100 women) with normal pregnancy. Biochemical markers studied included CA 125, beta human chorionic gonadotropin (β HCG), progesterone, Estradiol (E2), Lactate dehydrogenase (LDH), and Total leucocytic count (TLC) and ultrasonographic markers included Embryonic/Fetal heart rate (E/FHR), Gestational sac diameter (GSD), Crownrump length (CRL) and Yolk sac diameter (YSD). Comparison between markers was done using sensitivity, specificity, PPV and NPV.ResultsThere was a statistically significant difference between GI and the other two groups regarding CA 125 β HCG, progesterone, FHR and CRL.There was no significant difference between the three study groups regarding E2 level, LDH, TLC, GSD or yolk sac diameter.The sensitivity, specificity, PPV and NPV of CA 125 at 80 IU/ml were 80.2, 78.3, 69.6 and 82.4, respectively, for β HCG at 19887 mIU/ml were 88.6, 81.1, 45,6 and 96.8, respectively, for Progesterone at 25 ng/ml were 90.1, 87.2, 51,2 and 97, respectively, for FHR at 110 bpm were 98.1, 99.1, 89,2 and 91.4, respectively and for CRL at 21 mm were 46.4, 40.1, 35,5 and 33.7, respectively.ConclusionCA125, β HCG and progesterone are good biochemical markers and FHR and CRL are good ultrasonographic markers for the prediction of outcome in women with threatened abortion. FHR at 110 bpm gives the best predictivity followed by serum P at 25 ng/ml, β HCG at 19887 mIU/ml, CA 125 at 80 IU/ml and CRL at 21 mm with the least predictive accuracy among studied markers. Adding serum progesterone to FHR gave a sensitivity and specificity of 100%.