The potential use of urinary hCG measurements in the management of pregnancies of unknown location

Abstract

Multiple measurements of serum human chorionic gonadotropin (hCG) are used to predict the final pregnancy outcome for women with a pregnancy of unknown location (PUL) and monitor the management of ectopic pregnancy (EP). Urine-based testing would be more convenient and economical. This prospective cohort study involving 80 women assessed the degree of correlation between serum and urine hCG levels and whether urine hCG levels have the potential to impact clinical decision making in the management of women with a PUL. Paired urine and serum hCG measurements differed quite widely but were well correlated and the degree of correlation improved after creatinine correction. Although serial serum hCG measurements appear to be better for the overall prediction of pregnancy outcome in PUL (AUC 0.77–0.94 compared to corrected urine AUC 0.69–0.84), serial urine hCG measurements may have a role in identifying subtypes of low-risk PUL (AUC 0.83–0.84).

Keywords:

• Urine
• serum
• chorionic gonadotrophin
• chorionic gonadotrophin
• beta subunit
• human
• pregnancy
• ectopic
• pregnancy complications
• pregnancy
• high-risk
• pregnancy trimester
• first

Author’s roles

YA, RH, RF and TB participated in the conception and design of the study. SB, MAM and CS acquired patient samples and data. SB and RH processed the samples in the laboratory. RH performed the statistical analysis. SB, RH, DT and TB interpreted the results. SB, YA, RH, and TB wrote the initial version of the manuscript. All authors critically revised the manuscript and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

TB is supported by the NIHR Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. SB is supported by NIHR CLAHRC NWL (Collaboration for Leadership in Applied Health Research & Care, NorthWest London). Tissue samples were provided by the Imperial College Healthcare NHS Trust Tissue Bank. Other investigators may have received samples from these same tissues. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. DT is Fundamental Clinical Researcher of FWO (Research Foundation – Flanders).