Prognostic Value of Biochemical Markers- Ca 125, Serum Beta HCG And Serum Progesterone in Cases of Recurrent Pregnancy Loss In The First Trimester of Pregnancy
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 4
Abstract
Introduction: Recurrent pregnancy loss is defined as the sequence of two or more spontaneous abortions as documented by either sonography or on histopathology, before 20 weeks (American Society Of Reproductive Medicine guidelines 2013). It affects nearly 1% of women in reproductive age group & the risk of recurrence increases with each successive abortion. It becomes nearly 30% after three consecutive losses. Various biochemical markers have been identified as predictors of miscarriage in the first trimester of pregnancy. Cancer Antigen- 125 (CA 125) is a high molecular weight glycoprotein, expressed by foetal chorionic membrane, amniotic fluid & maternal decidua. Therefore, in cases of disruption of decidua or foetal membranes, its levels in maternal serum would rise. Similarly, beta HCG is a glycoprotein synthesized by syncytiotrophoblasts, which sustains the corpus luteum & hence early pregnancy. Progesterone, is a C-21 steroid hormone, required in maintenance of pregnancy & its main source is the corpus luteum, until the 10th week of gestation. After a transition period from the 7th -10th week, this function is taken over by the placenta. Hence, these markers at different gestational ages in the first trimester can be used as prognostic tools for predicting the risk of abortion in cases of habitual aborters & threatened pregnancies. Aim: To evaluate the prognostic efficacy of serum beta HCG, CA-125 & serum progesterone as biochemical predictors of pregnancy loss at different gestational ages in the first trimester of pregnancy Methodology: A prospective study was conducted on 125 women in the age group of 20-35 years, with history of recurrent pregnancy loss, in the Department of Obstetrics & Gynaecology, MGM MCH. The cases were divided into three groups. Group A is the control group consisting of 45 normal pregnant women with no history of miscarriage. Group B consisted of 40 subjects with history of two or more 1st trimester pregnancy loss. Group C comprised of 40 subjects who failed to complete the pregnancy till the first trimester, aborting for the first time during the study. These three groups were subdivided into three subgroups on the basis of weeks of gestation. Group I with 6-7 weeks, group II with 8-9 weeks & group III with 10-11 weeks of gestation. The subdivision was done in order to increase the comparability of the results. The study was carried out for a period of one year from June 2017. The cases in which the pregnancy continued were followed upto 22 weeks of gestation. The levels of the three biomarkers were evaluated & correlated with the pregnancy outcomes. The groups & subgroups were comparable in demographic features. The results were statistically analysed. Results: Serum beta HCG showed a sensitivity of 100%, a specificity of 55.9%, a PPV of 52.7%, a NPV of 100%. Serum progesterone showed a sensitivity of 37.42%, a specificity of 82.34%, a PPV of 54.91%, a NPV of 80.53% Serum CA 125 showed a sensitivity of 88.97%, a specificity of 74.89%, a PPV of 68.93%, a NPV of 82.58% The combined sensitivity & specificity of the three serum biomarkers is 98.9% & 83.4%, with area under ROC curve estimated to be 0.982. Conclusion:Serum beta HCG & CA 125, as independent variables, have shown statistically significant sensitivities in predicting pregnancy outcome in cases of recurrent pregnancy loss & threatened abortion. However, combined estimation of all the three serum biomarkers further improves the chances of identifying high risk pregnancies & their management can be planned accordingly.
Authors and Affiliations
Dr. Ela Jha, Dr Arun Kumar Jha, Dr. Annie Samuel
Keywords
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- EP ID EP573183
- DOI 10.9790/0853-1804090107.
- Views 35
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