Condous G, Kirk E, Van Calster B, Van Huffel S, Timmerman D, Bourne T
Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's University of London, London, UK.
BJOG. 2006 May;113(5):521-7. doi: 10.1111/j.1471-0528.2006.00924.x.
To assess the performance of the human chorionic gonadotrophin (hCG) ratio (hCG 48 hours/hCG 0 hour) to predict spontaneous resolution of pregnancies of unknown location (PUL).
Prospective cohort study.
Teaching Hospital Early Pregnancy Unit.
Women classified as having a PUL.
The optimal cutoff value for hCG ratio (serum hCG at 48 hours/serum hCG at 0 hours) was calculated from data on 189 consecutive PULs (the 'training set'). This cutoff was tested prospectively on a further 200 consecutive PULs (the 'test set'). The hCG ratio was also compared to absolute levels of serum hCG at 0 and 48 hour for the prediction of failing PULs.
hCG ratio in spontaneously resolving ('failing') PUL compared with those requiring intervention. Optimum cutoff determined and tested to predict spontaneously resolving PUL. Comparison of hCG ratio with absolute levels of serum hCG.
A total of 3996 consecutive women were scanned, of which 438 (11.0%) were classified as PULs. Complete data were available for 389 women: 189 in the training set and 200 in the test set. In the training set, there were 102 (54%) failing PUL, while 109 (55%) in the test set. hCG ratio of <0.87 predicted failing PUL, with a sensitivity of 93.1% (95% CI 85.9-97.0) and a specificity of 90.8% (95% CI 82.2-95.7) in the training set. In the test set, sensitivity was 92.7% (95% CI 85.6-96.5) and specificity was 96.7% (95% CI 90.0-99.1). The hCG ratio outperformed absolute serum hCG levels at 0 and 48 hours.
We have defined the optimal hCG ratio for the prediction of failing PUL. Using this cutoff, clinicians can safely adopt a noninterventional approach in women with PUL.
评估人绒毛膜促性腺激素（hCG）比值（hCG 48小时/hCG 0小时）预测不明部位妊娠（PUL）自然转归的效能。
前瞻性队列研究。
教学医院早期妊娠科。
被归类为PUL的女性。
根据189例连续PUL（“训练集”）的数据计算hCG比值（48小时血清hCG/0小时血清hCG）的最佳截断值。该截断值在另外200例连续PUL（“测试集”）上进行前瞻性测试。还比较了hCG比值与0小时和48小时血清hCG的绝对水平对失败的PUL进行预测。
自然转归（“失败”）的PUL与需要干预的PUL的hCG比值。确定并测试预测自然转归PUL的最佳截断值。hCG比值与血清hCG绝对水平的比较。
共对3996例连续女性进行了扫描，其中438例（11.0%）被归类为PUL。389例女性有完整数据：训练集189例，测试集200例。训练集中有102例（54%）PUL失败，测试集中有109例（55%）。hCG比值<0.87预测PUL失败，训练集中敏感性为93.1%（95%CI 85.9 - 97.0），特异性为90.8%（95%CI 82.2 - 95.7）。在测试集中，敏感性为92.7%（95%CI 85.6 - 96.5），特异性为96.7%（95%CI 90.0 - 99.1）。hCG比值在预测PUL失败方面优于0小时和48小时的血清hCG绝对水平。
我们确定了预测失败PUL的最佳hCG比值。使用该截断值，临床医生可对PUL女性安全地采取非干预方法。
