Correlation between Hormonal Levels and Ultrasound in Patients with Threatened Abortion

Abstract

96 women with threatened abortion were monitored by repeated ultrasonic examinations. Simultaneously plasma HCG, progesterone, estradiol and estriol levels were measured. 12 patients with blighted ovum had hormonal levels in the low normal range before the 8th week and abnormal values after the 10th week. 31 patients had abnormal ultrasonic morphology and absence of fetal heart movements. In half of these patients, estradiol was low even before vaginal bleeding. When vaginal bleeding occurred, all subjects who aborted later, except 1, had at least one abnormal hormonal value. In 4 cases, fetal life signs were detected only after the 10th week; hormonal levels remained normal, confirming the presence of a viable fetus. 31 patients had normal ultrasounds despite vaginal bleeding and arrived to term. Hormonal profiles were also normal. 18 patients had normal ultrasounds and aborted in the second trimester of pregnancy. Some of them had low normal hormonal levels. Others had a secondary decrease in hormonal levels (most often estrogen levels) which, in some cases, preceded the abnormality of the ultrasounds. It is concluded that ultrasounds and hormonal measurements are complementary. Ultrasounds alone gave a correct prognosis in 78% of the cases after a single examination. Caution is advised when fetal life signs are absent and termination of pregnancy is contemplated. Hormonal measurements may then confirm or refute the unfavorable prognosis. Also, hormonal measurements may provide some insight as to the subsequent evolution of a threatened pregnancy, even in the presence of normal ultrasounds. The therapeutic prospect of this knowledge is, however, still to be defined.

Dydrogesterone in threatened abortion: Pregnancy outcome

“…With ultrasound, a correct diagnosis of the in-utero situation was reported to be made on admission in 93% of cases and this increased further after one week to 99% of cases [19]. In another study, a single examination with ultrasound alone provided a correct prognosis of the pregnancy in 78% of cases with threatened abortion [20]. Hormonal measurement is a complementary method that may confirm or refute the un-favorable prognosis.…”

Higher ꞵ-human chorionic gonadotropin and estrogen levels during the first 6 weeks of pregnancy are associated with threatened abortion

“…A reduction in the rate of spontaneous miscarriage with the use of dydrogesterone was also observed (14). Lower estrogen level was found in women with threatened abortion and historically estrogen was also commonly used to save threatened pregnancies in these women (16,17). However, evidence from randomised controlled trials to assess the use of estrogen and/or progesterone for preventing miscarriages is insufficient (6,13,17,18).…”

Estriol review: Clinical applications and potential biomedical importance

“…Mothers who carry growth-restricted fetuses have serum E3 levels that are about half the normal level [28][29][30]. In addition, association studies have correlated low early 2 nd trimester E3 levels with fetal demise [31], and low 1 st trimester levels of uE3 are associated with pregnancy loss [32,33].…”