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Hum. Reprod. Advance Access published online on April 28, 2005
Human Reproduction, doi:10.1093/humrep/dei038
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received November 25, 2004
Revised March 19, 2005
Accepted March 23, 2005

Article

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

J. Elson 1, A. Tailor 1, R. Salim 1, K. Hillaby 1, T. Dew 2, and D. Jurkovic 1*

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

* To whom correspondence should be addressed.
D. Jurkovic, E-mail: davor.jurkovic{at}kcl.ac.uk


  Abstract

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 {alpha}-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 {alpha}-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.

Keywords: expectant management; IGFBP-1; inhibin A; inhibin pro {alpha}-C RI; miscarriage.
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