Value Of Transvaginal Ultrasound Combined With Detection Of Serum β-HCG On Early Differentiating Missed Abortion And Hydatidiform

Objective:To investigate the value of transvaginal ultrasound combined with serum β-HCG to diagnose missed abortion and atypical hydatidiform mole in early and provide the basis for timely and correct clinical diagnosis and treatment.Methods:120 cases of early pregnancy women whose transvaginal ultrasound images is not typical, suspected hydatidiform mole and missed abortion, during the period of eight to ten weeks were collected from February 2014 to February 2016 in Shanxi Academy of Medical Sciences shanxi dayi hospital obstetrics and gynecology outpatient and the inpatient. Dynamically monitoring serum β- HCG, transvaginal ultrasound, and complete curettages of uterine cavity in our hospital were done. According to the result of pathology they were divided into 80 cases of missed abortion group and 40 cases of hydatidiform mole group. 35 cases of normal pregnancy women whose ultrasonic diagnosis was intrauterine pregnancy were selected during the period of six to ten weeks at the same time as control group, asking for the treatment of artificial abortion.Analysing three groups of characteristics and differences of ultrasonic images, observing serum β-HCG level change, comparing serum β-HCG whether there were statistically significant in the three groups, we calculated the diagnose accordance rate of serumβ-HCG level and ultrasound detection of missed abortion and atypical hydatidiform mole respectively and jointly.Results:There were 35 cases of the yolk sacs and embryos that were observed clearly by transvaginal ultrasound examination, and tracked to 8 weeks of pregnancy, original heart beats tubes were detected in all. In ultrasonic images of Missed abortion, there were 46 cases of wither pregnant bursa and intrauterine clutter echo, 3 cases of intrauterine clutter echo and liquid dark area, and 31 cases of similar bullate mole type. 2 cases misdiagnosed as part of the partial hydatidiform mole, and 8 cases misdiagnosed as atypical hydatidiform mole. The ultrasound diagnosis and pathologic results were the same in 70 patients. Diagnostic coincidence rate was 87.50%. 13 cases of intrauterine clutter echo and liquid dark area in hydatidiform mole group. 27 cases of irregular bullate mole inside pregnant bursa According to ultrasonographic features. 7 cases were misdiagnosed as missed abortion. As ultrasound diagnosis and pathological results corresponded in 33 cases of hydatidiform mole group, ultrasound diagnosis coincidence rate was 82.50%. The accuracy of ultrasonography in the differential diagnosis of these two diseases was 85.83%.Serum β-HCG had a statistically significant difference among the three groups(P <0.05), 8 weeks < gestational age < 9 weeks, serum β-HCG in the hydatidiform mole group(152260.86±8103.04 m IU/ml) significantly higher than normal pregnancy group(51106.94±3101.91 m IU/ml) and the missed abortion group(18032.85±3466.40ml), and serum β-HCG in normal pregnancy group was higher than that of missed abortion. 9weeks < or less gestational age < or less 10 weeks serum β-HCG in the hydatidiform mole group(159018.07±7959.62 m IU/ml) significantly higher than normal pregnancy group(55601.98±3202.81 m IU/ml) and the missed abortion group(18405.31±3422.67 m IU/ml), and serum β-HCG in normal pregnancy group was higher than that of missed abortion The diagnostic accordance rate of serum β-HCG on missed abortion was 77.50%. The diagnostic accordance rate of β-HCG serum on hydatidiform mole was 70.00%. The accuracy of serum β-HCG in the differential diagnosis of these two diseases was 75.00%.Diagnosis coincidence rate of ultrasound combined with serum β-HCG on early missed abortion and hydatidiform mole w as respectively 98.75% and 100%. The differential diagnostic accuracy of the two indicators combination of these two diseases was 99.17%, higher than that of single test results, and the difference has statistically significant(P<0.0125).Conclusion:1. The serum β-HCG levels can be used as a important auxiliary examination in the diagnosis of missed abortion and hydatidiform mole, contributing to the differential diagnosis in both.2. Images are clear in Transvaginal ultrasound with little interference factors, and the accuracy of early diagnosis of missed abortion and hydatidiform mole is high, but early two diseases are not typical ultrasonography is easy to confuse.3. With two-dimensional image cross in missed abortion and early hydatidiform mole, transvaginal ultrasonography combined serum β-HCG can make up for a lack of a single test, which has important value in early diagnosis and differentiation of the two diseases, guiding physicians to choose clinical diagnosis and treatment plan timely and do a good job of follow-up.