The prediction of outcome at early pregnancy are very important to obstetrician and pregnant woman, especially in the pregnancies of infertility patients. To the present, most of obstetric investigators have predicted the outcome of pregnancy at
early
first trimester via ultrasonography and serum β-hCG levels. But these mothods were spent much time and were showed relatively high incidence of false positive.
The CA-125 that disocovered by using monoclonal antibodies derived from the ovarian cancer cell line OVCA 433, is present high in human amniotic fluid throughtout gestation. Extract of human decidua and chorion have been found to contain
significant
quantities of CA-125. In contrast, the serum CA-125 level is low in either maternal or fetal blood, and very little is found in extracts of amnion and trophoblast.
The large CA-125 molecules from the cystic fluid or the amniotic fluid gain access to the serum compartment only as the epithelial basement membrane is disrupted via peritoneal lymphatics. The impending abortion may be associated with disruption
of
the
epithelial basement membrane of either the fetal membrane or the decidua, leading to an increase in maternal serum CA-125 level. This increase may be a predictor of subsequent spontaneous abortion of the fetus.
This study was initiated to investigate whether a sudden rise in the serum CA-125 level might predict spontaneous first-trimester abortion, and concomittant check with serum β-hCG and fetal growth on sonographic findings might predict subsequent
abortion more early than other parameters without-serum CA-125. And comparing with other parameters without serum CA-125, confirm to predictional value of subsequent spontaneous abortions.
This study was undergone from October 1992 to May 1993 retrospectively for whom were treated by controlled ovarian hyperstimulation for IVF(In Vitro Fertilization) and ET (Embryo Transfer) program, visited to infertility clinic, the department of
Obstetics and Gynecology, the medical college, Chung-Ang university. The CA-125 levels of 30 cycles of IVF early pregnancy were evaluated on ET 12 days and followed up weekly to 11 weeks to determine wether there is a sudden increase immediately
before
or at the time of abortion.
The results were as followed. The nine of 13 cycles with serum CA 125 level of 150 U/mL or greater were aborted and their positive predictive ratio was 69.2% (p<0.01), compared with one of 17 cycles with serum CA-125 level less than 150 U/mL was
aborted
and it's negative predictive value was 94.1% (p<0.01). And the nine of 10 cycles which had been aborted,had greater than 150 U/mL of serum CA-125.
The level of CA-125, (six of 10 abortions) did not increase until much later, after fetal viability was established.
As a conclusion indicated that there was a definite correlation between high level or sudden increased serum CA-125 levels and subsequent spontaneous abortion. On prediction of early pregnancy outcome, the check of serum β-hCG and fetal size
engrowing
on ultrasonography with serum CA-125 level are more precise and decrease false positive.
|