Author:

Keywords:

SISTA, Science & Technology, Life Sciences & Biomedicine, Obstetrics & Gynecology, Reproductive Biology, activin A, inhibin A, pregnancy of unknown location, human chorionic gonadotrophin, ectopic pregnancy, HUMAN CHORIONIC-GONADOTROPIN, ECTOPIC PREGNANCY, EXPECTANT MANAGEMENT, FAILING PREGNANCIES, WOMEN, MISCARRIAGE, VALIDATION, DIAGNOSIS, CURVES, MODEL, Activins, Chorionic Gonadotropin, Diagnosis, Differential, Female, Humans, Inhibins, Predictive Value of Tests, Pregnancy, Pregnancy Outcome, Pregnancy, Ectopic, Prospective Studies, Ultrasonography, 11 Medical and Health Sciences, 16 Studies in Human Society, Obstetrics & Reproductive Medicine, 3215 Reproductive medicine

Abstract:

BACKGROUND: The aim was to evaluate the role of serum inhibin A and activin A in the prediction of the outcome of women with 'pregnancies of unknown location' (PULs). METHODS: Serum human chorionic gonadotrophin (hCG), progesterone, inhibin A and activin A levels were measured at 0 and 48 h. Differences in the mean levels and the change in levels over 48 h expressed as a ratio (48/0 h) were examined between the three outcome groups--failing PUL, intrauterine pregnancy (IUP) or ectopic pregnancy. Variables were incorporated into logistic regression models to predict the pregnancy outcomes, which were evaluated using receiver operator characteristic curves. RESULTS: One hundred and forty-one women were classified as PULs: 67 failing PULs (47.5%), 58 IUPs (41.1%) and 16 ectopic pregnancies (11.4%). Activin A levels were not significantly different between the three outcome groups. Inhibin A levels were significantly lower in failing PULs. The logistic regression model based on serum inhibin levels gave an area under the curve (AUC) of 0.88 for failing PUL, 0.87 for IUP and 0.60 for ectopic pregnancy. The model based on serum activin levels gave an AUC of 0.61 for failing PUL, 0.64 for IUP and 0.51 for ectopic pregnancy, and the model based on serum hCG levels gave an AUC of 0.95 for failing PUL, 0.97 for IUP and 0.67 for ectopic pregnancy. CONCLUSIONS: Serum activin A levels at 0 and 48 h are not helpful in predicting the outcome of PULs. Although serum inhibin A levels may be of use in the prediction of failing PULs and IUPs in the PUL populations, they do not perform as well as serum hCG levels.