Maternal serum CA 125 levels in first trimester abortion

Prognostic value of repeated serum CA 125 measurements in first trimester pregnancy

OBJECTIVE

To assess the diagnostic value of maternal CA 125 in patients with symptomatic first trimester pregnancy and to evaluate the prognostic significance of CA 125 versus beta-hCG in early pregnancies with intact fetal heartbeat, complicated by vaginal bleeding.

STUDY DESIGN

Two prospective open-label studies with longitudinal follow-up in the second trial.

SETTING

Academic Department of Obstetrics and Gynecology, University of Cologne.

PATIENTS

Study 1: 168 patients presenting between gestational weeks 6 and 12 with: extrauterine pregnancy, 29; missed abortion, 50; incomplete spontaneous abortion, 38; imminent abortion, 33; and normal pregnancy (no history of endometriosis or ovarian mass), 18. Study 2: Fifty consecutive patients with vaginal bleeding during gestational weeks 6-12 all of whom having demostrable fetal heartbeat. Eighteen patients finally aborted whereas the remainder had normally continuing pregnancy until term.

MAIN OUTCOME MEASURE

Study 1: Single serum determinations of CA 125 and beta-hCG were correlated with the different disorders observed. Study 2: Two sequential measurements of serum CA 125 and beta-hCG performed within a 5-7 days interval were related to the outcome of pregnancy as indicated by changes of the ultrasound presentation, miscarriage, future hospitalization, or delivery.

RESULTS

Study 1: Patients with vaginal bleeding generally had higher median CA 125 values (38 IU/ml; range 1.3-540) compared to non-bleeding patients (17.8 IU/ml; range 1.0-157). No statistically significant differences in regard to median serum CA 125 levels between symptomatic and normal pregnancies occurred: normal pregnancy, 25.5 IU/ml (range 3.2-97); ectopic pregnancy, 26 IU/ml (range 1.3-157); missed abortion, 19.1IU/ml (range 1-242); threatened abortion, 48 IU/ml (range 5.2-540); spontaneous abortion, 40 IU/ml (range 5.4-442). Study 2: Initial CA 125 levels did not differ significantly between both groups of patients with 27/32 non-aborters and 13/18 aborters showing concentrations below 65 IU/ml. After 5-7 days, CA 125 in all patients who eventually aborted remained high or increased whereas non-aborters all had constantly low or steeply declining CA 125 measures. beta-hCG increased in all non-aborters but also in 13/18 aborters during the 5-7 day interval.

CONCLUSION

Single serum measurements of CA 125 in symptomatic first trimester pregnant patients failed to discriminate spontaneous abortion, ectopic or normal pregnancies. However, sequential determinations of maternal CA 125 measurements appear to be a highly sensitive prognostic marker in patients with viable pregnancy at risk for abortion.

Differentiating tubal abortion from viable ectopic pregnancy with serum CA-125 and beta-human chorionic gonadotropin determinations

OBJECTIVE

To determine whether serum CA-125 and serial beta-hCG levels can be used to distinguish between tubal abortion and viable ectopic pregnancy (EP).

DESIGN

Retrospective cohort study.

SETTING

A tertiary care institution.

PATIENT(S)

Twenty-six women with EPs of 7-12 weeks' duration were studied retrospectively. Five had laparoscopically proved tubal abortions and 21 had active, viable EPs at the time of entry into the study. All but 3 of the latter group were managed surgically; the others were given a single dose of methotrexate.

INTERVENTION(S)

Surgical removal of EPs by means of laparoscopy or laparotomy, or medical treatment of the disease.

MAIN OUTCOME MEASURE(S)

Serum CA-125 and beta-hCG determinations were used to differentiate tubal abortion and viable EP. The results were compared with the findings at surgery.

RESULT(S)

The mean (+/-SD) CA-125 level was 112.2 +/- 11.9 IU/mL for the patients with tubal abortion and 30.1 +/- 15.3 IU/mL for the patients with viable EP. The mean (+/-SD) beta-hCG level was 3,643 +/- 3,718 IU/L for the patients with tubal abortion and 10,755 +/- 11,465 IU/L for the patients with viable EP. Linear regression analysis showed a statistically insignificant inverse relation between serum CA-125 and beta-hCG levels.

CONCLUSION(S)

The use of CA-125 levels as an adjunct to serial beta-hCG levels shows promise as a means for differentiating tubal abortion from viable EP.

Serum CA-125 values on the day of oocyte retrieval are not predictive of subsequent pregnancy with in-vitro fertilization

In the clinical management of in-vitro fertilization (IVF) patients it would be very useful to know, before the embryo transfer, whether or not there is a significant chance of pregnancy in that cycle. If low, it would be better to freeze the embryos and postpone the embryo transfer to a subsequent cycle. For this reason, a retrospective study was carried out to investigate the correlations between the serum CA-125 values before embryo transfer and the clinical outcome of that IVF cycle. Women aged <40 years undergoing a complete infertility evaluation including laparoscopy and receiving gonadotrophin-releasing hormone analogue (GnRHa) suppression followed by purified follicle stimulating hormone (FSH) for IVF-embryo transfer were entered into the study. Ninety-seven cycles qualified for evaluation (26 pregnant and 71 non-pregnant cycles). CA-125 concentrations on the day of oocyte retrieval were significantly lower in the pregnant versus non-pregnant cycles in both non-endometriosis and endometriosis patients. To evaluate the existence of a cut-off value of CA-125 which would allow the prediction of a possible pregnancy with sufficient specificity and sensitivity, a receiver operating characteristic curve analysis was performed. This analysis demonstrated the absence of any predictive value of the subsequent pregnancy for CA-125 concentrations. For this reason, and in contrast with previous findings, CA-125 determinations before the embryo transfer in IVF patients do not appear to be a useful tool for clinicians to use in predicting the outcome of IVF in any given cycle.