Prospective Study Of Dynamic Monitoring Of Serum ?-hCG And Progesterone To Predict Early Pregnancy Outcome

Objective Dynamically monitor the changes of serum ?-hCG and progesterone in early pregnant women,and prospectively analyze its clinical value in predicting the outcome of early pregnancy.Method Choose 6 to 11-week-old pregnant women who were in the outpatient clinic of the Qingdao Women and Children's Hospital Affiliated with Qingdao University from December 2018 to July 2019.According to the inclusion and exclusion criteria,314 patients were included in the study.According to the different pregnancy outcomes,the above patients were divided into 232 cases of normal pregnancy group and 82 cases of missed abortion group.(1)Collect and record the clinical data of the two groups of patients,including the patient's name,age,the date of the pregnancy test,menstrual marriage and childbirth history,related clinical symptoms and signs,etc.,and dynamically monitor the changes of serum ?-hCG and progesterone values at 6 to 11 weeks of pregnancy.(2)Perform correlation analysis of basic clinical features and pregnancy outcomes.(3)Analyze the levels and differences of serum ?-hCG values of the two groups during each gestational week,especially the changes of serum ?-hCG peak levels,and calculate the best diagnostic value for predicting the outcome of missed abortion by ROC curve.(4)Dynamically analyze the change level of serum progesterone value in each gestational week,compare the difference in serum progesterone value between two pregnancy outcomes,and calculate the best diagnostic value for predicting adverse pregnancy outcomes.Results(1)The incidence of missed abortion in advanced age pregnant women(age>35years)(46.67%)was significantly higher than that of younger pregnant women(23.94%),and the difference was statistically significant(P<0.01).(2)The incidence of missed abortion was 38.60% in patients with previous history of adverse pregnancy and birth;it was higher than that of patients with no previous history of adverse pregnancy(23.54%),and the difference between the two was statistically significant(P<0.05).(3)The serum?-hCG value of the normal pregnancy group at each gestational week was significantly higher than that of the missed abortion group,and the differences were significantly statistically significant(all P<0.01).In the normal pregnancy group,the serum ?-hCG value gradually increased from 6 to 8 weeks of pregnancy.During 8 to 10 weeks of pregnancy,the serum ?-h CG value showed a “peak” change.After 11 weeks of pregnancy,the serum ?-hCG decreased to the level of the 7th week of pregnancy.In the missed abortion group,serum ?-hCG increased from 6 to 8 weeks of pregnancy,but the growth rate and speed were less than those of the normal pregnancy group.After maintaining peak levels during 8 to 9 weeks of pregnancy,serum ?-hCG showed a downward trend after 10 weeks of pregnancy.The ROC curve shows that the best diagnostic value ofserum ?-hCG at each gestational week is predictive of pregnancy outcome.(4)Compared with the missed abortion group,the peak serum ?-hCG level in the normal pregnancy group lasted longer,and the peak average value was significantly higher than that of the missed abortion group.The difference was statistically significant(P<0.05).According to the relationship between serum ?-hCG peak value and pregnancy outcome,a ROC curve was made.The area under the ROC curve of serum ?-hCG value was 0.970(P<0.01).The best diagnostic value of serum ?-hCG is 83327mIU/mL,and the sensitivity and specificity are 95.97% and 85.06%,respectively.It has good predictive value for pregnancy outcome.(5)In the normal pregnancy group,the serum progesterone value increased slowly from 6 to 11 weeks,but compared with the previous gestational week,the increase in progesterone value was not statistically significant(all P<0.01).The serum progesterone value of the missed abortion group at each gestational week was significantly lower than that of the normal pregnancy group,and the differences were significantly statistically significant(all P<0.01).By drawing the ROC curve,the best diagnostic value of serum progesterone in each gestational week is predictive of pregnancy outcome.Conclusions(1)Advanced age pregnant women with a history of poor pregnancy and birth history have a higher incidence of early pregnancy missed abortion.(2)Dynamic monitoring of serum ?-hCG is meaningful for predicting pregnancy outcome.(3)The slow increase in serum ?-hCG value,small amplitude,short peak duration and peak serum ?-hCG?83327mIU/mL all indicate the possibility of early missed abortion.(3)The change of serum progesterone value during 6 to 11 weeks of pregnancy is relatively stable.Dynamic monitoring of its value can help predict pregnancy outcomes.If the serum progesterone value continues to be below 55 nmol/L,it indicates the possibility of early missed abortion.