Expectant management of miscarriage—prediction of outcome using ultrasound and novel biochemical markers

Elson, J.
Tailor, A.
Salim, R.
Hillaby, K.
Dew, T.
Jurkovic, D.

¹Early Pregnancy and Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, London, UK
²Department of Biochemistry, King's College Hospital, London, UK

³To whom correspondence should be addressed at: Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, Denmark Hill, London SE5 8RX, UK. Email: [email protected]

Submitted on November 25, 2004; resubmitted on March 19, 2005; accepted on March 23, 2005

Human Reproduction 20(8):p 2330-2333, August 2005.

BACKGROUND

The aim of this study was to examine the value of various ultrasound and biochemical parameters for the prediction of successful expectant management of miscarriage.

METHODS

This was a prospective observational study. Clinically stable women with an ultrasound diagnosis of miscarriage were offered expectant management. In all cases, gestational age, size of retained products of conception, serum HCG, progesterone, 17-hydroxyprogesterone, insulin growth factor-binding protein 1 (IGFBP-1), inhibin A and inhibin pro α-C RI levels were recorded. Follow-up continued until resolution of the pregnancy. Clinical data, ultrasound findings and biochemical markers were analysed using univariate analysis and decision tree analysis.

RESULTS

Fify-four women underwent expectant management of miscarriage. Thirty-seven (69%) had successful expectant management and 17 (31%) required surgery. The size of retained products, serum HCG, progesterone, inhibin A and inhibin pro α-C RI were all significantly different in those pregnancies that resolved spontaneously (P<0.05). Serum inhibin A was the best predictor of a complete miscarriage.

CONCLUSION

This study shows that novel biochemical markers may be used to predict the likelihood of successful expectant management of miscarriage.