Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
Reprod Sci. 2023 Dec;30(12):3623-3628. doi: 10.1007/s43032-023-01308-7. Epub 2023 Aug 10.
Our primary objective is to verify or refute a 2013 study by Connolly et al. which showed that in early pregnancy, a gestational sac was visualized 99% of the time on transvaginal ultrasound when the HCG level reached 3510 mIU/mL. Our secondary objective was to make clinical correlations by assessing the relationship between human chorionic gonadotropin (HCG) level in early pregnancy when a gestational sac is not seen and pregnancy outcomes of live birth, spontaneous abortion, and ectopic pregnancy. This retrospective study includes 144 pregnancies with an outcome of live birth, 87 pregnancies with an outcome of spontaneous abortion, and 59 ectopic pregnancies. Logistic regression is used to determine the probability of visualizing a gestational sac and/or yolk sac based on the HCG level. A gestational sac is predicted to be visualized 50% of the time at an HCG level of 979 mIU/mL, 90% at 2421 mIU/mL, and 99% of the time at 3994 mIU/mL. A yolk sac was predicted to be visualized 50% of the time at an HCG level of 4626 mIU/mL, 90% at 12,892 mIU/mL, and 99% at 39,454 mIU/mL. A total of 90% of ectopic pregnancies presented with an HCG level below 3994 mIU/mL. These results are in agreement with the study by Connolly et al. Since most early ectopic pregnancies had an HCG value below the discriminatory level for gestational sac visualization, other methods for the evaluation of pregnancy of unknown location such as repeat HCG values are clinically important.
我们的主要目标是验证或反驳 Connolly 等人在 2013 年进行的一项研究，该研究表明在妊娠早期，当 hCG 水平达到 3510 mIU/mL 时，经阴道超声 99%的时间可观察到妊娠囊。我们的次要目标是通过评估未见妊娠囊时早期妊娠人绒毛膜促性腺激素（hCG）水平与活产、自然流产和异位妊娠的妊娠结局之间的关系进行临床相关性分析。这项回顾性研究包括 144 例活产结局、87 例自然流产结局和 59 例异位妊娠结局。使用逻辑回归来确定根据 hCG 水平观察到妊娠囊和/或卵黄囊的概率。预测 hCG 水平为 979 mIU/mL 时，妊娠囊有 50%的概率可见，2421 mIU/mL 时有 90%的概率可见，3994 mIU/mL 时有 99%的概率可见。预测 hCG 水平为 4626 mIU/mL 时，卵黄囊有 50%的概率可见，12892 mIU/mL 时有 90%的概率可见，39454 mIU/mL 时有 99%的概率可见。90%的异位妊娠 hCG 水平低于 3994 mIU/mL。这些结果与 Connolly 等人的研究结果一致。由于大多数早期异位妊娠的 hCG 值低于妊娠囊可见性的鉴别水平，因此评估不明位置妊娠的其他方法，如重复 hCG 值，在临床上很重要。
