Banerjee S, Aslam N, Woelfer B, Lawrence A, Elson J, Jurkovic D
Department of Obstetrics and Gynaecology, King's College Hospital, Denmark Hill, London, UK.
BJOG. 2001 Feb;108(2):158-63. doi: 10.1111/j.1471-0528.2001.00031.x.
To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan.
Prospective observational study.
Dedicated early pregnancy unit in an inner city teaching hospital.
Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications.
A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta-human chorionic gonadotrophin (beta-hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non-declining beta-hCG levels.
Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum beta-hCG level to < 20 iu/L) without need for any active intervention.
Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values > or = 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L.
Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.
前瞻性评估两种多参数诊断模型及其各个组成部分预测经阴道超声检查无法确定的早期妊娠结局的能力。
前瞻性观察性研究。
市中心教学医院的专门早期妊娠单元。
尿妊娠试验阳性且临床怀疑有早期妊娠并发症的女性。
初次就诊时进行完整的病史采集、临床检查和经阴道超声检查。当超声无法确定妊娠位置时，测量血清β-人绒毛膜促性腺激素（β-hCG）和孕酮水平。所有女性均进行期待治疗，直至超声显示正常妊娠；妊娠自然消退或因临床症状恶化或β-hCG水平未下降而需要干预。
妊娠自然消退（即症状消失且血清β-hCG水平降至<20 iu/L），无需任何积极干预。
在招募的104名女性中，72例（69%）妊娠自然消退。两种多参数诊断模型识别出自然消退妊娠的阳性预测值均≥95%。与单独使用孕酮水平相比，它们的表现并无显著更好，孕酮水平以20 nmol/L为临界值时阳性预测值达到97%。
对于预测未知位置妊娠期待治疗成功与否，仅测量血清孕酮与更复杂的诊断模型一样准确。
