Role of Serum β-HCG Doubling in Diagnosis of Early Pregnancy and its Management Strategy

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends of β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected of early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and -HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among the 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found that the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their HCG. Those who had an IUP, 11% had a suboptimal increase in HCG. Conclusion: PUL rate in our unit was 6%. The majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial HCG values, clinical assessments and upon the consent of the patient.