DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212157

Comparison of maternal serum CA-125 and ultrasonography findings as a prognostic marker in threatened abortion

Kamlesh Yadav, Pragya Ojha, Anant Chopra

Abstract


Background: WHO defines abortion as pregnancy termination before 20 week gestation or with fetus born weighing <500 gms. Early pregnancy markers in patients with threatened abortion including biochemical marker like raised maternal serum CA-125 (cancer antigen-125, carcinoma antigen 125 or carbohydrate antigen 125) and USG parameters that is, fetal crown-rump length (CRL), the presence/absence of sub-chorionic hematoma and fetal heart rate (FHR) are good predictors of outcome.

Methods: The study was conducted in the department of obstetrics and gynaecology, S.P. medical college and associated group of hospital, Bikaner, Rajasthan. This was a hospital based prospective comparative study. The study group comprise of pregnant females attending obstetrics and gynaecology OPD. A total of 200 pregnant women were examined in this study. We divided these patients into 2 groups, group A and group B. Group A consists of 100 pregnant females with threatened abortion and group B with 100 normal pregnant female.

Results: Maternal serum CA-125 at cut off level 61.64 U/ml is 84.21% sensitive, 96.77% specific in predicting abortion with 94.12% positive predictive value and 90.91% negative predictive value while FHR at 115 bpm is 76.32% sensitive, 90.32% specific in predicting abortion with 82.86% PPV and 86.15% negative predictive value.

Conclusions: Single raised value of maternal serum CA-125 has best predictive value followed by USG parameters (FHR, sub-chorionic hematoma and CRL ) in threatened abortion which results in loss of pregnancy.


Keywords


Pregnancy, Abortion, Threatened, CA-125, USG

Full Text:

PDF

References


National Institute of Health. Fact sheet: Pregnancy: Condition Information, 2015. Available at: https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo. Accessed on 8 March 2021.

Rubio C, Simón C, Vidal F, Rodrigo L, Pehlivan T, Remohí J, et al. Chromosomal abnormalities and embryo development in recurrent miscarriage couples. Hum Reprod. 2003;18(1):182-8.

Redinger A, Nguyen H. Incomplete Abortions. Stat Pearls. 2021.

Saraswat L, Bhattacharya S, Maheshwari A. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG. 2010;117(3):245-57.

Arafa M, Abdel-Fattah M, Zeid HA. Outcomes of pregnancies complicated by early vaginal bleeding. East Mediterr Health J. 2000;6(2-3):457-64.

Yang J, Hartmann KE, Savitz DA, Herring AH, Dole N, Olshan AF, et al. Vaginal bleeding during pregnancy and preterm birth. Am J Epidemiol. 2004;160(2):118-25.

Elson J, Salim R, Tailor A, Banerjee S, Zosmer N, Jurkovic D. Prediction of early pregnancy viability in the absence of an ultrasonically detectable embryo. Ultrasound Obstet Gynecol. 2003;21(1):57-61.

Nyberg DA, Mack LA, Harvey D, Wang K. Value of the yolk sac in evaluating early pregnancies. J Ultrasound Med. 1988;7(3):129-35.

Altay MM, Yaz H, Haberal A. The assessment of the gestational sac diameter, crown-rump length, progesterone and fetal heart rate measurements at the 10th gestational week to predict the spontaneous abortion risk. J Obstet Gynecol Res. 2009;35(2):287-92

Tan S, Tangal NG, Kanat-Pektas M, Özcan AŞ, Keskin HL, Akgündüz G, et al. Abnormal sonographic appearances of the yolk sac: which can be associated with adverse perinatal outcome? Med Ultrason. 2014;16(1):15-20.

Felder M, Kapur A, Gonzalez-Bosquet J. MUC16 (CA125): tumor biomarker to cancer therapy, a work in progress. Mol Cancer. 2014;13:219-29.

Oun AEM, Ibrahem EM, Elaziz MRA. Role of both serum ca125 and ultrasound in prediction of pregnancy outcome in first trimester threatened miscarriage. Int J Life Sci. 2018;7(2):79-84.

Maged AM, Mostafa WA. Biochemical and ultrasonographic predictors of outcome in threatened abortion. Middle East Fertil Soc J. 2013;18(3):177-81.

Mohamady MA, Fattah GA, Elkattan E, Byoumy R, Hamed DA. Correlation of serum CA-125 and progesterone levels with ultrasound markers in the prediction of pregnancy outcome in threatened miscarriage. Int J Fertil Steril. 2016;9(4):506-11.

Doubilet PM, Benson CB. Outcome of first-trimester pregnancies with slow embryonic heart rate at 6-7 weeks gestation and normal heart rate by 8 weeks at US. Radiology. 2011;236(2):643-6.

Tannirandorn Y, Sangsawang S, Manotaya S, Uerpairojkit B , Samritpradit P, Charoenvidhya D. Fetal loss in threatened abortion after embryonic/fetal heart activity. Int J Gynaecol Obstet. 2003;81:263-6.

Eid M, Abdallah AK. Cancer antigen 125 (CA-125) and serum progesterone as predictors of fate of threatened abortion: case control study. Int J Fertil Steril 2017;7(4).

Sweed MS, Sammour HM, Bakr AA. Serum CA-125 for early prediction of miscarriage. Med J Obstet Gynecol. 2016;4(1):1077.

Fiegler P, Katz M, Kaminski K, Rudol G. Clinical value of a single serum CA-125 level in women with symptoms of imminent abortion during the first trimester of pregnancy. J Reprod Med. 2003;48(12):982-8.

Schmidt T, Rein DT, Foth D, Eibach HW. Prognostic value of repeated serum CA125 measurement in the first trimester of pregnancy. Eur J Obstet Gynaecol Reprod Biol. 2001;97:168-73.