不明妊娠或可能宫内妊娠的早期药物流产后hCG水平的变化。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-04-10 DOI:10.1016/j.contraception.2025.110902

Tagrid Jar-Allah , Karin Brandell , Frida Gyllenberg , Janina Kaislasuo , Helena Kopp-Kallner , Kristina Cederblad , Oskari Heikinheimo , Kristina Gemzell-Danielsson , Helena Hognert , On behalf of the VEMA (Very Early Medication Abortion) Study Group

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引用次数: 0

摘要

目的：评价不明位置妊娠（PUL）和可能的宫内妊娠（IUP）的极早期药物流产（VEMA）患者血清/血浆人绒毛膜促性腺激素（hCG）从基线水平的变化，以确认治疗成功。研究设计：从VEMA随机对照试验中选择一个前瞻性队列，该试验在9个国家的26个地点进行。孕龄≤42天超声未确认宫内升压的患者（n = 741）按照WHO指南进行药物流产，在服用米非司酮时测定hCG，并于第7天重复（+/-2）。分析hCG的变化，以区分与完全流产、异位妊娠、持续妊娠和不完全流产相关的趋势。结果：533例完全流产患者中，96.8例患者在流产后7（+/-2）天hCG水平下降≥80%。完全流产的平均hCG下降为94% （CI: 93.2-94.9）。异位妊娠8例（1.7%）和正在妊娠21例（2.9%）均未出现下降≥80%的情况。结论：早期药物流产7（+/-2）天内hCG下降≥80%，可有效确认完全流产，排除异位妊娠和持续妊娠。这些结果强调了hCG监测作为一种可靠的随访工具来管理未确诊IUP的VEMA的有效性。

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Change in hCG levels after very early medication abortion for pregnancy of unknown location or probable intrauterine pregnancy

Objective(s)

To evaluate changes in serum/plasma human chorionic gonadotropin (hCG) from baseline levels in very early medication abortion (VEMA) in pregnancies of unknown location (PUL) and probable intrauterine pregnancy (IUP) to confirm treatment success.

Study design

A prospective cohort was selected from the VEMA randomized controlled trial conducted at 26 sites across nine countries. Patients with a gestational age ≤42 days without confirmed IUP on ultrasound (n = 741) received medication abortion according to WHO guidelines, hCG was measured at mifepristone intake and repeated on day 7 (+/-2). Changes in hCG were analyzed to distinguish the trends associated with complete abortion versus ectopic pregnancy, ongoing pregnancy, and incomplete abortion.

Results

Among 533 cases with complete abortion, a decline in hCG level of ≥80% was observed in 96.8 of cases 7 (+/-2) days post-abortion. The mean hCG decline for complete abortions was 94% (CI: 93.2–94.9). None of the ectopic pregnancies 8 (1.7%) or ongoing pregnancies 21 (2.9%), showed a decline of ≥80%. Rising or insufficient decline (<80%) indicated ectopic and ongoing pregnancy. The hCG trend following complete abortion was significantly different from all other outcomes (p < 0.001), but trends did not distinguish between ectopic, ongoing pregnancy, or incomplete abortion.

Conclusion(s)

A hCG decline of ≥80% within 7 (+/-2) days can effectively confirm complete abortion and rule out ectopic and ongoing pregnancies in early medication abortion. These results highlight the effectiveness of hCG monitoring as a reliable follow-up tool for managing VEMA without confirmed IUP.

Implications

This study highlights the value of hCG monitoring in early medication abortions in pregnancy of unknown location to differentiate between complete or incomplete abortion, ectopic, or ongoing pregnancy. An hCG decline of ≥80% within 7 (+/-2) days post-mifepristone can confirm complete abortion and help exclude ectopic and ongoing pregnancy.

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.