Abstract:
BACKGROUND:Threatened miscarriage affects one in five women and is associated with significant emotional distress. The uncertainty around the prognosis of threatened miscarriage makes it equally challenging to the healthcare professionals. Various biochemical markers have been investigated in the past to predict the outcome of threatened miscarriage; however, the results have been conflicting. Therefore, we have conducted a systematic review and meta-analysis to determine the diagnostic accuracy of biochemical markers in predicting the outcome in women presenting with threatened miscarriage. METHODS:This is a systematic review and meta-analysis of prospective studies that investigated biochemical markers to determine outcomes for women with threatened miscarriage at 5-23 weeks gestational age. Electronic databases were searched up to June 2015 and study quality assessment was performed using QUADAS-2 (Quality Assessment for Diagnostic Accuracy Studies-2: A Revised Tool) for evaluating the diagnostic accuracy studies. Statistical analysis was performed using the Cochrane systematic review software. RESULTS:A total of 19 studies were included in the qualitative data synthesis of which 15 (including 1263 women) were eligible for the meta-analysis. The review highlights the role of biochemical markers serum progesterone, hCG, pregnancy associated plasma protein A, estradiol and cancer antigen 125 (CA 125) in the prediction of outcome in women with threatened miscarriage. Interestingly, serum CA 125 appears to be the most promising marker (n = 648 women in seven studies), whereas serum progesterone and hCG are less useful once fetal viability is established. The summary receiver operating characteristics for CA 125 showed a sensitivity of 90% (95% confidence interval (CI) 83-94%), specificity of 88% (95% CI 79-93%), positive likelihood ratio of 7.86 (95% CI 4.23-14.60) and negative likelihood ratio of 0.10 (95% CI 0.06-0.20). The inverse of negative likelihood ratio was 9.31 (95% CI 5-17.1) indicating that a negative test is likely to identify those who are likely to continue with the pregnancy. Serum estradiol was the next best marker with a sensitivity of 45% (95% CI 6-90%), a specificity of 87% (95% CI 81-92%), a positive likelihood ratio of 3.72 (95% CI 1.01-13.71) and a negative likelihood ratio of 0.62 (95% CI 0.20-1.84). CONCLUSIONS:In women with threatened miscarriage, serum CA 125 has high predictive value in identifying pregnancies that are 'likely to continue', whereas the most commonly used biomarkers of serum hCG and progesterone are not useful in predicting outcome of a pregnancy with a viable fetus. Other markers such as inhibin A and a combination of markers need to be investigated to hopefully improve the prediction of outcome in women with threatened miscarriage.
journal_name
Hum Reprod Updatejournal_title
Human reproduction updateauthors
Pillai RN,Konje JC,Tincello DG,Potdar Ndoi
10.1093/humupd/dmv054subject
Has Abstractpub_date
2016-03-01 00:00:00pages
228-39issue
2eissn
1355-4786issn
1460-2369pii
dmv054journal_volume
22pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Monoamines play important roles in decidualization, implantation, immune modulation and inflammation. Furthermore, monoamines are potent vasoactive mediators that regulate blood flow and capillary permeability. Regulation of the uterine blood flow is important both during menstruation and pregnancy. Adequate...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmn048
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Infertility is estimated to affect as many as 186 million people worldwide. Although male infertility contributes to more than half of all cases of global childlessness, infertility remains a woman's social burden. Unfortunately, areas of the world with the highest rates of infertility are often those with p...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv016
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:IUI for unexplained infertility can be performed in a natural cycle or in combination with ovarian stimulation. A disadvantage of ovarian stimulation is an increased risk of multiple pregnancies with its inherent maternal and neonatal complication risks. Stimulation agents for ovarian stimulation are clomiph...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmz035
更新日期:2020-01-01 00:00:00
abstract::BACKGROUND Endometriosis associated with pain symptoms in adolescents has been extensively reported, but the exact prevalence is unclear because pain symptoms may be atypical and endometriosis can only be diagnosed by laparoscopy. The aim of this paper is to provide a systematic review of the prevalence of endometrios...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmt016
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:High-density lipoprotein (HDL) appears to be the dominant lipoprotein particle in human follicular fluid (FF). The reported anti-atherogenic properties of HDL have been attributed in part to reverse cholesterol transport. The discoveries of the scavenger receptor class B type I (SR-BI) and the ATP-binding ca...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp029
更新日期:2010-01-01 00:00:00
abstract::Cryopreservation of testicular tissue might benefit prepubertal boys who must undergo chemotherapy or radiotherapy. Cryopreservation of testicular tissue and testicular cells for intracytoplasmic sperm injection (ICSI) is feasible and widely applied. Testicular tissue from prepubertal boys can also be frozen, by apply...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.4.378
更新日期:2001-07-01 00:00:00
abstract::Maternal use of marijuana, in which the exocannabinoid Delta(9)-tetrahydrocannabinol is the most active psychoactive ingredient, is known to have adverse effects on various aspects of reproduction including ovulation, spermatogenesis, implantation and pregnancy duration. Endogenous cannabinoids of which Anandamide is ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmm018
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:The cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-activated Cl(-) and HCO(3)(-) conducting channel, mutations of which are known to be associated with male infertility. However, the underlying mechanisms remain elusive. METHODS:Literature databases were searched for papers on the topi...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dms027
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:The effect of postmenopausal hormone therapy (HT) on cardiovascular disease (CVD) risk remains controversial. OBJECTIVE AND RATIONALE:We aimed to systematically review the evidence regarding the role of dose, route of hormone administration, timing of initiation and duration of HT on cardiovascular risk amo...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmy039
更新日期:2019-03-01 00:00:00
abstract::This paper investigates the relationship of features of in-vitro fertilization (IVF) embryos and the associated oocyte and follicle to the outcome of transfer. It differs from previous studies in including a range of features (n = 53) and in using class probability tree analysis. This is a non-parametric multivariate ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.2.121
更新日期:1998-03-01 00:00:00
abstract::The effects on reproductive tract development in male rats, of neonatal exposure to potent (reference) oestrogens, diethylstilboestrol (DES) and ethinyl oestradiol (EE), with those of two environmental oestrogens, octylphenol and hisphenol A were systematically compared. Other treatments, such as administration of a g...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.3.236
更新日期:2001-05-01 00:00:00
abstract::The use of laparoscopic techniques for the treatment of polycystic ovarian syndrome (PCOS) has included many different approaches in the 1980s and 90s. Broadly similiar results have been obtained using biopsy, cauterization, multi-electrocoagulation and laser surgery; i.e. > 50% ovulation and a mean pregnancy rate of ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/2.4.337
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:Transfer of more than a single embryo in an IVF cycle comes with the finite possibility of a multiple gestation. Even a twin pregnancy confers significant risk to both mother and babies. The move to single-embryo transfer for all patients will be greatly facilitated by the ability to quantify embryo viabilit...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmu064
更新日期:2015-11-01 00:00:00
abstract:UNLABELLED:BACKGROUND; Combined oral contraceptives (COCs) reduce levels of androgen, especially testosterone (T), by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Although this suppressive effect has been investigated by numerous studies over many ye...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmt038
更新日期:2014-01-01 00:00:00
abstract::Contraception is one of the keystones of reproductive health. The availability of effective contraception has helped to change dramatically the structure of the world's population during the last 50 years, through a demographic transition involving lower fertility rates and longer survival. As the transition evolves m...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmi019
更新日期:2005-09-01 00:00:00
abstract::Nitric oxide (NO) is an important mediator of paracrine interactions, especially within the vascular system. It is a powerful inhibitor of platelet aggregation and a potent vasodilator. NO is also a neurotransmitter and it plays a role in cell-mediated cytotoxicity. NO-generating enzymes (nitric oxide synthases, NOS) ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.5.565
更新日期:1998-09-01 00:00:00
abstract::The wide use of assisted conception methods has risen dramatically. The greater proportion of singletons, twins and high order of multiplicity conceived by those methods have already focused the medical community to various obstetric complications. Recently, there have been suggestions that the levels of mid-gestation...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.5.530
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmn049
更新日期:2009-03-01 00:00:00
abstract::Ovarian follicular development occurs in a hierarchical manner with each follicle having a unique biochemical composition at any moment in time. It has long been understood that a precise coordination between the growth and maturation of the oocyte and adjacent follicular cells (i.e. somatic cells) is essential in ord...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh061
更新日期:2005-03-01 00:00:00
abstract::Following its benchmark discovery, nitric oxide (NO) is now known to play important functional roles in a variety of physiological systems. Within the vasculature, NO induces vasodilation, inhibits platelet aggregation, prevents neutrophil/platelet adhesion to endothelial cells, inhibits smooth muscle cell proliferati...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.1.3
更新日期:1998-01-01 00:00:00
abstract::In 1987, Nigel Harris cautioned against over-diagnosing the antiphospholipid syndrome (APS). In what was a rather prophetic editorial titled 'The Syndrome of the Black Swan', he suggested that while patients with APS do indeed exist, they are probably much more unusual than many medical professionals might like to bel...
journal_title:Human reproduction update
pub_type: 社论
doi:10.1093/humupd/dms020
更新日期:2012-09-01 00:00:00
abstract::Cancer treatment modalities are increasingly more effective in achieving complete remission and cure. Aggressive chemotherapy and radiotherapy, as well as bone marrow transplantation, results in >90% cure in many cancers of children and young women. As a result of this success however, a new problem has arisen. Many y...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.6.526
更新日期:2001-11-01 00:00:00
abstract::Prior to the development of high-throughput methods for the analysis of differential gene expression, genes required for proper ovarian function were identified on a case-by-case basis. Recently, however, several techniques have been developed that enable investigators to study large-scale changes in gene expression u...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh017
更新日期:2004-05-01 00:00:00
abstract::In those clinical situations in which an immediate and profound suppression of gonadotrophins is desired, LHRH agonists have the disadvantage of producing an initial stimulatory effect on hormone secretion. Therefore, the use of GnRH antagonists which cause an immediate and dose-related inhibition of LH and FSH by com...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/6.4.322
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmx009
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Recurrent pregnancy loss (RPL) occurs in 1-3% of all couples trying to conceive. No consensus exists regarding when to perform testing for risk factors in couples with RPL. Some guidelines recommend testing if a patient has had two pregnancy losses whereas others advise to test after three losses. OBJECTIVE...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmz048
更新日期:2020-04-15 00:00:00
abstract::This review presents detailed risk estimates from relevant epidemiological and other studies on the comparative safety of second and third generation oral contraceptives (OC). Written with the intention of presenting a repository of the available information, it also discourses briefly into the symptomatology and diag...
journal_title:Human reproduction update
pub_type: 历史文章,杂志文章,评审
doi:10.1093/humupd/5.6.565
更新日期:1999-11-01 00:00:00
abstract::BACKGROUND To review the accuracy of multivariate models for the prediction of ovarian reserve and pregnancy in women undergoing IVF compared with the antral follicle count (AFC) as single test. METHODS We performed a computerized MEDLINE and EMBASE search to identify articles published on multivariate models for ovar...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmn001
更新日期:2008-03-01 00:00:00
abstract:BACKGROUND:Anti-Müllerian hormone (AMH) is an established marker of ovarian reserve and a good predictor of poor or excessive ovarian response after controlled hyperstimulation. However, it is unclear whether it can predict the ultimate outcome of assisted conception, live birth. We undertook a systematic review and me...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmu003
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Induced abortion is a common procedure. However, there is marked variation in accessibility of services across England. Accessing abortion services may be difficult, particularly for women who live in remote areas, are in the second trimester of pregnancy, have complex pre-existing conditions or have difficu...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmaa026
更新日期:2020-11-01 00:00:00