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Value of Trasvaginal Ultrasonography in Diagnosing Early Ectopic Pregnancy and Value of Serum β-hCG Level on Day 14 and 16 in Predicting Pregnant Outcomes after IVF-ET

Author: OuYangZuo
Tutor: LuGuang
School: Central South University
Course: Reproductive Engineering
Keywords: in vitro fertilization-embryo transfer serumβ-hCG transvaginal ultrasonography ectopic pregnancy pregnant outcome increased multiple
CLC: R714.22
Type: Master's thesis
Year: 2011
Downloads: 55
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Abstract

In recent years,the rapid development of reproductive technology has brought the hope of fertility for the infertile.The maturing IVF-ET technology is increasingly widely used in clinic.However,the propotion of multiple pregnancy and kinds of adverse pregnant outcomes by IVF-ET,such as ectopic pregnancy and miscarriage, is higher than that of natural conception.How to accurately predict and efficiently diagnose the pregnant outcomes,as well as prevent and treat the adverse consequences early is a problem receiving widespread concern in clinic.In this study,the value of transvaginal ultrasonography in diagnosing early ectopic pregnancy and the value of serum (3-hCG on Day 14 and 16 combined the multiple of 16d/14d serumβ-hCG in predicting pregnant outcomes after IVF-ET were analysed,which will help take proper measures ahead of time to avoid further injuries.This study is demonstrated from two parts as follows:Part oneObjective:To assess the clinical value of TVS in the diagnosis of early ectopic pregnancy after IVF-ET.Materials and methods:154 IVF cycles, including conventional IVF 106 cycles, ICSI 27 cycles and FET 21 cycles, committed in our hospital (2008.1-2011.2) were analyzed retrospectively, who were examined by TVS after IVF-ET and then confirmed by operation and pathological results. By comparing the diagnostic results of TVS with surgical and pathological results, as well as analyzing the diagnostic time distribution and related diagnosis of TVS, assess the clinical value of TVS in the diagnosis of early ectopic pregnancy after IVF-ET.Results:1. The diagnostic accordance rate of ectopic pregnancies was 94.22%.The sensitivity of diagnosing ectopic pregnancy by TVS was 97.96%, and 74.03% by the first TVS examination.2. Three grey-scale appearances of tubal pregnancy were revealed by TVS:hyper-echoic ring, typical gestational sac and inhomogeneous mass.Typical gestational sac type was the most one, accounting for 46.98% of the total tubal pregnancies, and inhomogeneous mass type was of the second place.3. There was no significant difference of the serum (3-hCG level on Day 14 after transplantation among these three types of tubal pregnancy, but the general tendency was hyper-echoic ring type< inhomogeneous mass type< typical gestational sac type.And intrauterine pregnancy was significantly higher than ectopic pregnancy of the serumβ-hCG level on the 14th day after transplantation.4. The average diagnostic time of ectopic pregnancies by TVS was Day 26.67±6.63 after transplantation,89.57% of which were directly diagnosed before Day 32.Conclusion:1. TVS has high accuracy and sensitivity in diagnosing ectopic pregnancy after IVF-ET and most patients can get right diagnosis by the first TVS examination. TVS has great value for the diagnosis of early ectopic pregnancy after IVF-ET.2. Most ectopic pregnancies can be diagnosed directly by TVS in the early stage after transplantation. Combining TVS with serumβ-hCG can further improve the diagnostic efficiency. Part twoObjective:To evaluate the value of serumβ-hCG level on Day 14 and 16 combined the multiple of 16d/14d serumβ-hCG in predicting pregnant outcomes after IVF-ET.Materials and methods:234 IVF/ICSI cycles (2008.1-2010.7) committed in our hospital, who were confirmed as clinical pregnancies afterwards, were analyzed retrospectively. Serumβ-hCG level of the 234 patients were detected on Day14 and Day16 at 8 to 9 o’clock after IVF-ET.The patients were divided into two groups according to ultrasonic diagnosis and surgical and pathological results:A.adverse pregnancy; B.ongoing pregnancy. A group can be divided into ectopic pregnancy group (A1) and early miscarriage group (A2); B group can be divided into single pregnancy group (B1) and multiple pregnancy group (B2). The predict value of serumβ-hCG on Day 14 and 16 combined the multiple of 16d/14d serumβ-hCG as well as the relationship between them and pregnant outcomes after IVF-ET were analysed by comparing the absolute level of serumβ-hCG and the multiple of 16d/14d serumβ-hCG of different groups.Results:1. Serumβ-hCG level on Day 14 and 16 after transplantation and the multiple of 16d/14d serumβ-hCG in group A, A1,A2 were significantly lower than that in group B.2.Excluding serumβ-hCG level on Day 16 between group A1 and A2,each two groups from A1,A2,B1,B2 showed significant difference of serum P-hCG level on Day 14 and Day 16.The general tendency was A1<A2<B1<B2.3.Both Day 14 and Day 16 serumβ-hCG level had high accuracy in predicting normal and abnormal pregnancy,and the Day 16 one was better; diagnostic effectiveness of the two ones were similar to each other in predicting single pregnancy and multiple pregnancy.4.Set 16d/14d serumβ-hCG≥2,0.87-2,<0.87 as the threshold in diagnosing ongoing pregnancy, ectopic pregnancy and early miscarriage respectively, all diagnosis obtained high diagnostic accuracy.Conclusion:1. The absolute serumβ-hCG level on Day 14 and 16 after transplantation can predict pregnant outcomes effectively.2. There is close relationship between the multiple of 16d/14d serumβ-hCG and pregnanct outcomes after IVF-ET, and these values are of great clinical significance.3. The absolute level of serumβ-hCG on Day 14 and 16 combined the multiple of 16d/14d serum P-hCG can predict pregnant outcomes more efficiently and accurately.

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CLC: > Medicine, health > Obstetrics and Gynaecology > Obstetrics > Pathological pregnancy ( abnormal pregnancy ) > Ectopic pregnancy ( ectopic pregnancy )
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