OBJECTIVE: To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan. DESIGN: Prospective observational study. SETTING: Dedicated early pregnancy unit in an inner city teaching hospital. POPULATION: Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications. METHODS: A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta-human chorionic gonadotrophin (beta-hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non-declining beta-hCG levels. MAIN OUTCOME MEASURES: Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum beta-hCG level to < 20 iu/L) without need for any active intervention. RESULTS: Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values > or = 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L. CONCLUSION: Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.
OBJECTIVE: To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan. DESIGN: Prospective observational study. SETTING: Dedicated early pregnancy unit in an inner city teaching hospital. POPULATION: Women with a positive urine pregnancy test and clinical suspicion of early pregnancy complications. METHODS: A full medical history, clinical examination and transvaginal ultrasound scan were carried out at the initial visit. When the location of the pregnancy could not be ascertained by ultrasound, serum beta-human chorionic gonadotrophin (beta-hCG) and progesterone levels were measured. All women were managed expectantly until either a normal pregnancy was visualised on scan; the pregnancy resolved spontaneously or intervention was required due to a worsening of clinical symptoms or non-declining beta-hCG levels. MAIN OUTCOME MEASURES: Spontaneous resolution of pregnancy (i.e. cessation of symptoms and decline in serum beta-hCG level to < 20 iu/L) without need for any active intervention. RESULTS: Of the 104 women recruited, 72 (69%) pregnancies resolved spontaneously. Both multiparameter diagnostic models identified resolving pregnancies with positive predictive values > or = 95%. Their performances were not significantly better compared with individual progesterone levels which achieved a positive predictive value of 97% using a cutoff level of 20 nmol/L. CONCLUSION: Serum progesterone measurement alone is as accurate as more complex diagnostic models for the prediction of successful expectant management in pregnancies of unknown location.
Authors: S Bobdiwala; S Guha; B Van Calster; F Ayim; N Mitchell-Jones; M Al-Memar; H Mitchell; C Stalder; C Bottomley; A Kothari; D Timmerman; T Bourne Journal: Hum Reprod Date: 2016-05-10 Impact factor: 6.918
Authors: Christopher B Morse; Mary D Sammel; Alka Shaunik; Lynne Allen-Taylor; Nicole L Oberfoell; Peter Takacs; Karine Chung; Kurt T Barnhart Journal: Fertil Steril Date: 2012-01 Impact factor: 7.329
Authors: Kurt Barnhart; Norah M van Mello; Tom Bourne; Emma Kirk; Ben Van Calster; Cecilia Bottomley; Karine Chung; George Condous; Steven Goldstein; Petra J Hajenius; Ben Willem Mol; Thomas Molinaro; Katherine L O'Flynn O'Brien; Richard Husicka; Mary Sammel; Dirk Timmerman Journal: Fertil Steril Date: 2010-10-14 Impact factor: 7.329
Authors: Kurt T Barnhart; Mary D Sammel; Mary Stephenson; Jared Robins; Karl R Hansen; Wahid A Youssef; Nanette Santoro; Esther Eisenberg; Heping Zhang Journal: Contemp Clin Trials Date: 2018-09-20 Impact factor: 2.226