| Objective: Abnormal pregnancy is the most common event in early pregnancy, only the spontaneous abortion accounting for 10-15 percent in normal intrauterine pregnancy. The majority of abortion in pregnancy occur within 8 weeks gestation, meanwhile a single ultrasound examination is often difficult to determine whether the normal embryonic development. However, both normal intrauterine pregnancy, abnormal intrauterine pregnancy and ectopic pregnancy are usually accompanied by changes of various hormones levels. We often moniter the levels of serum progesterone, estradiol and beta-human chorionic gonadotropin(β-HCG) for directing therapy. Now excessive tocolytic therapy as result of misunderstanding not only increases the economic burden but also causes psychological pressure on patients. But a single hormone measurement is difficult to accurately predict pregnancy outcome, so combination measurement of multiple hormones levels with sonography in early pregnancy may be helpful to solve the puzzles in practice.Methods: A total of 504 patients with a gestational age 5-9 weeks were included in the study. Blood samples were collected for measurement levels of serum β-HCG, progesterone and thyroid hormones at first presentation. β-HCG levels were measured again apart 2-3 days and thyroid hormones levels four weeks later. The embryonic development was examined at > 6 weeks gestation by sonography. All patients were followed up until 12 weeks gestation. Patients with abnormal thyroid hormones levels were excluded. The objects were divided into two groups by the percentage change in the first two β-HCG measurements taken 48-72 hrs apart: ‘normally rising’β-HCG group(≥66%) and ‘abnormally rising’β-HCG group. The ‘abnormally rising’β-HCG group included ‘slowly rising’(increase of <66% but >10%), ‘static’(increase or decrease ≤10%) or ‘falling’(≥10%). Accord- ing to the level of serum progesterone, patients were divided into A, B, C subgroups, namely the subgroup A: the progesterone level was less than 10ng/ml, the subgroup B: the progesterone level was between 10-20ng/ml and the subgroup C: the progesterone level was more than 20ng/ml. The patients who were in ‘normally rising’β-HCG group with symptoms of threatened abortion were randomly divided into the observation group and progesterone therapy group.Results:1 In the‘normally rising’β-HCG group, there were 430 cases where the incidence of the good pregnancy outcome was 89.53%. Meanwhile, in the‘abnormally rising’β-HCG group, there were 74 cases where the incidence of the good pregnancy outcome was 6.76%. There was statistically significant difference between the two groups(P<0.05).2 175 cases with the progesterone level < 10ng/ml(subgroup A) had 64% of good pregnancy outcome. 184 cases with progesterone level between 10-20ng/ml(subgroup B) had 84.23% of good pregnancy outcome meanwhile 145 cases with progesterone level > 20ng/ml(subgroup C) had 77.93%of good pregnancy outcome. When the subgroup A was compared with the subgroup B or C, there was significant difference(P<0.05).3 In the‘normally rising’β-HCG group, the good pregnancy outcome in the subgroup A was 65.61% while they were 93.48% and 92.44% respectively in the subgroup B and C. When the subgroup A was compared with the subgroup B or C, there was significant difference(P<0.05). In the ‘abnormally rising’β-HCG group, the good pregnancy outcome were 5.41%, 7.41% and 10% respectively in the subgroup A, B and C. The difference among the three groups had no statistical significance(P>0.05).4 For patients in the ‘ normally rising ’ β-HCG group with the progesterone level <10ng/ml, the good pregnancy outcome was 73.33% after administered progesterone therapy while it was 25.93% for expected observation. There was statistically significant difference between the two groups(P<0.05).Conclusions:1 The pregnancy outcome of patients with ‘normally rising’β-HCG and the progesterone level >10ng/ml in early pregnancy was likely better whether or not administered progesterone therapy.2 For the patients with ‘normally rising’β-HCG and the progesterone level <10ng/ml, the pregnancy outcome was significantly improved after progesterone therapy.3 The pregnancy outcome of patients with ‘abnormally rising’β-HCG was likely poor regardless of the level of serum progesterone. |
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