Do we need to follow up complete miscarriages with serum human chorionic gonadotrophin levels?

  title={Do we need to follow up complete miscarriages with serum human chorionic gonadotrophin levels?},
  author={George Condous and Emeka Okaro and Asma Khalid and Tom Bourne},
  journal={BJOG: An International Journal of Obstetrics \& Gynaecology},
Despite a history of heavy vaginal bleeding with clots, a proportion of women diagnosed with complete miscarriage, using transvaginal sonography (TVS), have an underlying ectopic pregnancy (EP). We evaluated the need for hormonal follow up in women with history and scan findings suggestive of complete miscarriage. One hundred and fifty‐two consecutive women with findings suggesting complete miscarriage at presentation based on their history and TVS were presented to the Early Pregnancy Unit… 

Ectopic pregnancy: Challenging accepted management strategies

  • G. Condous
  • Medicine
    The Australian & New Zealand journal of obstetrics & gynaecology
  • 2009
The diagnostic capabilities of transvaginal ultrasound to confirm an EP are well founded, but there are no randomised data to support the use of MTX over expectant management.

Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location.

Current tools for the diagnosis of EP are appraised, the diagnostic criteria for non-tubal EP is described, the literature on the clinical management of PUL is reviewed and the current diagnostic challenges are outlined.

Pregnancy of unknown location: an evidence-based approach to management

The incidence of pregnancy of unknown location (PUL) is increasing, and conservative management of PUL results in lower rates of unnecessary intervention, as the condition often resolves spontaneously; the difficulty is in determining which ones will not.

Pregnancies of unknown location: diagnostic dilemmas and management

New mathematical models have been developed to predict the outcome of pregnancies of unknown location; however, prospective studies are needed to assess the reproducibility of these models in different centres on different populations.

A missed opportunity for excellence: the NICE guideline on the diagnosis and initial management of ectopic pregnancy and miscarriage

  • T. Bourne
  • Medicine
    Journal of Family Planning and Reproductive Health Care
  • 2014
The quality indicators used by NICE are however a concern, and difficulties may arise if evidence is considered to be of poor quality as this leads to the opinions of NICE panels being perhaps too influential in what is or is not included in final guidance.

The optimal timing of an ultrasound scan to assess the location and viability of an early pregnancy.

In asymptomatic women with no previous ectopic pregnancy TVS should be delayed until 49 days, to reduce the number of inconclusive scans, without an associated increase in morbidity from missed ectopic pregnancies.

There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location.

Established criteria for the use of uterine curettage in the management of PULs, including those advocated by the American Society for Reproductive Medicine (ASRM), can theoretically result in an inadvertent TOPs.

The management of miscarriage.

First trimester complications.



Human chorionic gonadotrophin and progesterone levels in pregnancies of unknown location

Suspected ectopic pregnancy: expectant management in patients with negative sonographic findings and low serum hCG concentrations.

Test results of the diagnostic strategy, that integrated the results of serial transvaginal sonography, serum hCG monitoring and expectant management, were good and enabled us to avoid untimely invasive interventions in patients with an early intrauterine pregnancy or with trophoblast in regression.

The use of a new logistic regression model for predicting the outcome of pregnancies of unknown location

The logistic regression model M1, can predict which PULs will become failing Puls, IUPs and, most importantly, EPs based on the patient’s HCG ratio alone.

The conservative management of early pregnancy complications: a review of the literature

  • G. CondousE. OkaroT. Bourne
  • Medicine
    Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
  • 2003
The role of conservative management in early pregnancy complications is evaluated and the role of transvaginal sonography for diagnosis, treatment and follow up is evaluated.

The expectant management of women with early pregnancy of unknown location

To assess the results of expectant management in women with pregnancy of unknown location and to identify diagnostic parameters that are predictive of spontaneous pregnancy resolution.

Transvaginal sonography in the detection of retained products of conception after first‐trimester spontaneous abortion

The aim of this study was to assess the use of transvaginal sonography to detect retained products of conception after first‐trimester spontaneous abortion.

Suspected ectopic pregnancy: expectant management inpatients with negative sonographic findings and low serum hCG concentrations. Early Pregnancy 1995;1:258–262

  • 1995

The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom

  • 2000