Symptomatic Patients With an Early Viable Intrauterine Pregnancy
- 1 July 2004
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 104 (1), 50-55
- https://doi.org/10.1097/01.aog.0000128174.48843.12
Abstract
To analyze the change in serial human chorionic gonadotropin (hCG) levels in women symptomatic with pain or bleeding who presented with nondiagnostic ultrasonography but were ultimately confirmed to have a viable intrauterine pregnancy. The rise in serial hCG measures were modeled over time, with the start point defined in 2 ways: by last menstrual period and by date of presentation for care. Both semiparametric (spline) curves and linear random-effects models were explored. The slope and projected increase of hCG were calculated to define 99% of viable intrauterine pregnancies. A total of 287 subjects met inclusion criteria and contributed 861 measurements of hCG. On average, these subjects contributed 3.00 observations and were followed up for 5.25 days. A linear increase in log hCG best described the pattern of rise. Curves derived from last menstrual period and day of presentation do not differ substantially. The median slope for a rise of hCG after 1 day was 1.50, (or a 50% increase); 2.24 after 2 days (or a 124% rise), and 5.00 after 4 days. The fastest rise was 1.81 at 1 day, 3.28 at 2 days, and 10.76 at 4 days. The slowest or minimal rise for a normal viable intrauterine pregnancy was 24% at 1 day and 53% at 2 days. These data define the slowest rise in serial hCG values for a potentially viable gestation and will aid in distinguishing a viable early pregnancy from a miscarriage or ectopic pregnancy. The minimal rise in serial hCG values for women with a viable intrauterine pregnancy is "slower" than previously reported, suggesting that intervention to diagnosis and treat an abnormal gestation should be more conservative.Keywords
This publication has 11 references indexed in Scilit:
- Smoothing Spline Models for the Analysis of Nested and Crossed Samples of CurvesJournal of the American Statistical Association, 1998
- Smoothing Spline Models with Correlated Random ErrorsJournal of the American Statistical Association, 1998
- Predictive value of human chorionic gonadotrophin in the outcome of early pregnancy after in-vitro fertilization and spontaneous conceptionHuman Reproduction, 1994
- Analysis of serum human chorionic gonadotrophin levels in normal singleton, multiple and abnormal pregnanciesHuman Reproduction, 1992
- Further observations on the doubling time of human chorionic gonadotropin in early asymptomatic pregnanciesFertility and Sterility, 1990
- Observations on the tog human chorionic gonadotropin-time relationship in early pregnancy and its practical implicationsAmerican Journal of Obstetrics and Gynecology, 1987
- Human chorionic gonadotropin increase in normal early pregnancyAmerican Journal of Obstetrics and Gynecology, 1987
- Evaluation of early pregnancy by serial chorionic gonadotropin determinations: a comparison of methods by receiver operating characteristic curve analysisFertility and Sterility, 1985
- Plasma concentrations of human chorionic gonadotropin from the time of implantation until the second week of pregnancyFertility and Sterility, 1982
- The Production of a Gonadotrophic Substance (Prolan) by Placental Cells in Tissue CultureScience, 1938