Pregnancy outcome following suboptimal rise in beta HCG in early pregnancy

1. Pregnancy outcome following suboptimal rise in beta HCG in early pregnancy Dr Maheswari Srinivasan, ST6 trainee Heart Of England NHStrust. Mrs Pratibha Arya,Consultant Obstetrician and Gynaecologist.Worcestershire Acute hospital NHS trust.UK. OPTIONALLOGO HERE OPTIONALLOGO HERE Methods Results Objectives Conclusions • 33 persons had sub optimal rises in beta HCG’s • 17 patients had ectopic pregnancy (50%) • 10 patients had medical management • 3 had repeat dose of methotrexate(30%) • 6 patients had salpingectomy (35%) • Anti D is given appropriately. • Too many Beta HCGS are requested. • Involvement of consultant in decision making was appropriate. • Back ground- • Miscarriage - 10–20% of clinical pregnancies. • Management of these women in the outpatient EPAU service is very cost effective. • Suboptimal rise in beta HCG in early pregnancy poses a clinical dilemma of either an ectopic pregnancy or miscarriage. • RCOG has given us guidelines regarding this management. • Ectopic Pregnancy is a Common, Treatable Problem • Sensitive BHCG Assays Allow Early Detection • Surgical and Medical Options Exist • Ruptured Ectopic Should be Unusual with Compliant Patients and Appropriate Medical Care • Aim :- • To audit our management of early pregnancy loss in accordance with RCOG green top guidelines. • To look at the pregnancy outcome of the women with suboptimal rise in B HCG. • RCOG Auditable standards • The proportion of women who are haemodynamically stable with ectopic pregnancy treated laparoscopically. • The proportion of women managed expectantly with ‘pregnancy of unknown location’ who required surgical intervention • Materials and methods- • Beta HCG’S requested from biochemistry analysed in a 6 months period ( june-nov 2009) and women who had suboptimal rises were isolated and case notes analysed. • 1600 requests • 33 isolated . • Conclusion- • Sub optimal rise in beta HCG’s could also occur with intra uterine pregnancy.(6%) • More than 50% cases with suboptimal rise in beta HCG was ectopic pregnancy. • Around • Methotrexate is used in 59% of cases in the management of ectopic. • 30% needed second dose of methotrexate. • Ectopic pregnancy could also occur with higher Beta HCG values. References • Pregnancy of unknown location: an evidence-based approach to management • The Obstetrician & Gynaecologist 2008;10:4:224-230 • RCOG –green top guidelines –Management of early pregnancy loss and management of ectopic pregnancy • …