Abstract
ObjectiveThe combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We evaluate serum Angiopoietin-2(Ang-2) and β human chorionic gonadotropin (β-hCG) in women who had undergone a medical abortion as markers of prolonged uterine bleeding (PUB).MethodsProspective trial involving 2843 women attending an gynecology outpatient clinic who following a medical abortion with mifepristone and misoprostol, the study cohort was divided into women with duration of uterine bleeding >14 days (PUB) and women with duration of uterine bleeding ≤14 days (normal uterine bleeding, NUB). Serum determinations of Ang-2 levels by ELISA and β-hCG levels by electrochemiluminiscence immunoassay. Receiver Operating Characteristics (ROC) analyses were calculated and plotted for the diagnostic accuracy of serum β-hCG and Ang-2 concentration to discriminate PUB and NUB.ResultsBaseline characteristics for both groups were similar, Only duration of bleeding showed a significant difference between the PUB group and NUB group. Ang-2 serum levels moderately correlated with serum β-hCG levels with statistically significant correlation coefficients of 0.536. Serum β-hCG and Ang-2 levels on day 7 and on day 14 after medical abortion were signifcantly higher in PUB group than in NUB group. Plotted as ROC curves, β-hCG area under curve (AUC) was 0.65 (95% CI, 0.53–0.76) on day 7, rising to AUC = 0.83 (95% CI, 0.75–0.92) on day 14. Using Ang-2 on day 7 and day 14 as predictive parameter resulted in an analogous AUC (AUC = 0.61 on day 7, AUC = 0.78 on day 14).ConclusionsBoth parameters are clinically useful as a diagnostic test in predicting PUB after medical abortion, and can be helpful in uncertain clinical situations, but should be considered as supplementary to a general clinical evaluation.
Highlights
The World Health Organization (WHO) reported that there were 43.8 million induced abortions in 2008 globally [1],there are about 9 million induced abortions in China every year and the figure is increasing annually [2]
According to the results of the examination, an individual follow-up plan was formed. 44 women with duration of bleeding.14 days after a medical abortion were enrolled in the prolonged uterine bleeding (PUB) group. 1:1 sample size will achieve the highest statistical power, so a cohort of 44 women with total duration of bleeding #14 days after a medical abortion would be adequate for statistically significant comparisons with PUB group
Correlation between b human chorionic gonadotropin (b-hCG) and Ang-2 Baseline levels of women underwent a medical abortion, Ang-2 serum levels moderately correlated with serum b-hCG levels with statistically significant correlation coefficients of 0.536
Summary
The World Health Organization (WHO) reported that there were 43.8 million induced abortions in 2008 globally [1],there are about 9 million induced abortions in China every year and the figure is increasing annually [2]. First trimester abortion with medications rather than surgery is widely used throughout the world, Medical abortion has the potential to expand abortion services, where surgical services are limited, and to expand women’s choice of abortion method and experience [3] Drugs such as mifepristone and misoprostol for medical abortion are widespread throughout the world [4]. The most common significant adverse event or outcome reported was ongoing intrauterine pregnancy, occurring in 0.5% of all medical abortion procedures. This regimen usually has a significantly longer bleeding time and a greater amount of hemorrhage than surgical abortion [4]. It is a concern for the attending doctor, as prolonged bleeding can be a sign of an incomplete abortion
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