Temporal refinement does not affect predicted human chorionic gonadotropin rise in early pregnancy

Although improved temporal precision suggests steeper human chorionic gonadotropin increases in early intrauterine gestation, current estimation of human chorionic gonadotropin rise is appropriately conservative for determination of a nonviable gestation.

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Authors

Andrew R. Fisher, M.D., Mary D. Sammel, Sc.D., Suneeta Senapati, M.D., Ashley Singer, B.Sc., Kurt T. Barnhart, M.D., M.S.C.E

Abstract

Objective

To examine the impact of validation and temporal resolution of estimation of hCG increase, because patients’ hCG values are not obtained at precise daily increments or always in the same laboratory.

Design

Retrospective cohort study of women presenting with nondiagnosed symptomatic first-trimester pregnancies who had serial hCG level measurements over time.

Setting

Not applicable.

Patient(s)

A total of 171 women presenting from September 2007 to February 2010 with first-trimester pregnancy pain and/or bleeding for whom a normal intrauterine pregnancy was ultimately confirmed.

Interventions

None.

Main Outcome Measure(s)

Serial hCG values, time period between hCG measurements, hCG rise.

Result(s)

After data verification, 118 subjects contributing 327 values met inclusion criteria and passed data verification for analysis with improved temporal precision. The more precise data showed a steeper hCG rise, and the predicted 2-day hCG increase at the 1st percentile was slightly faster (1.68-fold vs. 1.56-fold) than the “raw” clinical data and previous models.

Conclusion(s)

Data verification and improved temporal precision suggested a faster hCG increase in early intrauterine gestation than previously demonstrated. Because laboratory variation and temporal imprecision are common, these data demonstrate that current modeling of the expected rise of hCG in a normal gestation is valid and appropriately conservative in the determination of a nonviable gestation. No change in the minimal threshold for potential viability is recommended.

Read the full text at: http://www.fertstert.org/article/S0015-0282(16)610...

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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