الفهرس 
MiscarriageOnly 14 pages are availabe for public view
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Abstract
T
hreatened miscarriage is a clinically descriptive term applied to women who are less than 20 weeks of gestation having vaginal bleeding, closed cervical os and possibly mild uterine cramps. It may progress to a term viable pregnancy or miscarriage. Ultrasound is an accurate method for evaluating threatened miscarriage because it can establish the presence of a normal viable intrauterine pregnancy accurately and to distinguish this from either pregnancy failure or ectopic pregnancy. In cases of threatened miscarriage fetal bradycardia, discrepancy between gestational age and crown to rump length and abnormal yolk sac size are all adverse prognostic factors regarding fetal outcome.
Progesterone is produced by the corpus luteum until about the 10th week of gestation. After about 8 weeks of gestation, the placenta replaces the ovary as the source of the progesterone. Before this time, surgical removal of corpus luteum will result in miscarriage unless exogenous progestin is given. According to Witt et al. (1990) Progesterone, due to its constancy in maternal serum during early normal gestation and due to its rapid metabolic clearance (<10 min), could potentially be an excellent marker for early pregnancy failure.
CA-125 (cancer antigen-125) is a cell-surface antigen with high molecular weight. It increases in the first trimester as it is produced from the decidua and passes to the maternal compartment via tubal reflux and rises in the circulation after the absorption by peritoneal lymphatics.
In a study done by Ayaty et al. (2007) the mean CA-125 level in the threatened miscarriage group who miscarried was higher than those who continued their pregnancy with the same gestational weeks. Such situation can be explained with the disruption of decidual tissue, resulting from an inevitable miscarriage. In a meta-analysis done by Pillia et al. (2015); they found that serum CA125 is the most reliable marker for predicting the outcome of threatened miscarriage.
This prospective controlled clinical trial was conducted to evaluate the accuracy of ultrasound findings in comparison to serum CA125 and progesterone in predicting fetal demise in cases of first trimester threatened miscarriage. A total of 42 pregnant women who are sure of their dates and have an established intrauterine Singleton Pregnancy between 6- and 8-weeks’ gestation with threatened miscarriage symptoms were included in the study. Patients with irregular menstrual cycle, recurrent miscarriage, ovulation induction medications, progesterone treatment or a history of any disease causes an increase in CA-125 level were excluded from the study.
All eligible women were subjected to thorough history taking, general and abdominal examination, vaginal ultrasound which was done three times: the first one was done at the first time the patient presented to us between six to eight weeks of pregnancy to make sure that the cardiac pulsations are present and measure FHR,CRL,GSD and YSD, the second ultra sound was done after two weeks from the first one to follow up the patient for pregnancy survival, the third one was done at the end of first trimester to ensure fetal life. Serum progesterone and Serum CA 125 were measured once to all patients fulfilling the inclusion criteria at the first time, they presented to us.
In our study the incidence of miscarriage was 31%. Women who miscarried and those who continued their pregnancy were not significantly different as regards demographic data, GSD, YSD and CRL. On the other hand, there was association between fetal bradycardia, increased serum CA125 or decreased serum progesterone and fetal loss.
Finally, estimation of CA125 , progesterone serum level with the ultrasonographic findings in patients with threatened miscarriage are attempts to develop rapid, cheap and sensitive method for anticipating the pregnancy outcome and detecting which of them is the most accurate. According to our study, CA125 is the most accurate method.
Conclusion
CA125 is more accurate than progesterone and ultrasound findings in predicting fetal demise in cases of first trimester threatened miscarriage.