流產病患HCG下降較快
子宮外孕HCG下降較慢或略上升
由HCG下降幅度可評估子宮外孕風險

Fertil Steril. 2015 Dec 14. pii: S0015-0282(15)02173-1. doi: 10.1016/j.fertnstert.2015.11.050. [Epub ahead of print]

Following declining human chorionic gonadotropin values in pregnancies of unknown location: when is it safe to stop?

Cameron KE1, Senapati S2, Sammel MD3, Chung K4, Takacs P5, Molinaro T6, Barnhart KT7.

Author information

Abstract

OBJECTIVE:

To determine if the pattern of decline in hCG curves can discriminate spontaneous abortion (SAB) from ectopic pregnancy (EP).

DESIGN:

Retrospective cohort study.

SETTING:

University hospitals.

PATIENT(S):

A total of 1,551 women with symptomatic pregnancy of unknown location (PUL) and decreasing hCG values.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Percentage change in hCG; days and visits to final diagnosis.

RESULT(S):

Of the 1,551 women with a PUL and declining hCG, 146 were ultimately diagnosed with EP and 1,405 with SAB. An 85% hCG drop within 4 days or a 95% hCG drop within 7 days both ruled out an EP 100% of the time. Applying the 4-day cutoff to this population would have saved 16% of the SAB population (229/1,405) a total of 2,841 person-days and 277 clinical visits. Applying the 7-day cutoff would have saved 9% of the SAB population (126/1,405) a total of 1,294 person-days and 182 clinical visits. These cutoffs were separately validated on a group of 179 EPs collected from three university clinical centers. In that population, each cutoff separately ruled out EP 100% of the time.

CONCLUSION(S):

The decline in serum hCG is slower in EPs than in SAB and can be used to aid clinicians in the frequency and duration of follow-up. Costs and patient time may be saved by allowing women who meet one of these criteria to be followed less frequently.