الفهرس 
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Abstract
Spontaneous abortion represents a common pregnancy adverse outcome and is a serious emotional burden for women. Loss of pregnancy is a distressing problem for both the patient and physician. The diagnosis of spontaneous abortion currently depends on a combination of ultrasonography and nine hormonal methods including serum human chorionic gonadotropin (hCG), estradiol (E2), estrone, estriol, progesterone, human placental lactogen, cortisol, urine hCG and urine estrogen. Another parameter that could be used as a predictive marker for a spontaneous abortion or subsequent outcome of pregnancy is Cancer Antigen-125 (CA-125).
In the present study it was thought of interest to evaluate the value of measurement of serum progesterone, β-hCG and CA-125 as possible parameters to predict the occurrence of miscarriage.
Automated Vitek Immuno Diagnostic Assay System (VIDAS) was used for the quantitative measurement of progesterone, β-hCG, and CA-125 in the serum of pregnant women, using the ELFA technique (Enzyme Linked Fluorescent Assay).
In the present study, ultrasound was carried out by the obstetrician to the pregnant women on their first visit at the obstetrics and gynaecology outpatient clinic at Misr University for Science and Technology Teaching Hospital. The following parameters were recorded: fetal pulsation and viability, the matching of the gestational sac measurments with the calculated gestational age, the presence of retro-placental hematoma, presence of inadequate chorio - decidual reaction, and screening of any congenital anomalies as Down’s syndrome. It was then repeated at 20 weeks gestation for follow-up.
The present study was conducted on eighty pregnant women, 39 of which were with previous history of single miscarriage (cases) and 41 primigravid women who served as control. A lower incidence of abortion was shown in pregnant primigravid women as compared with pregnant women with previous history of abortion. In the primigravid group only two out of 41 (4.9 %) pregnant women aborted. By comparison 7 out of 39 (17.9 %) pregnant women with history of miscarriage aborted (P<0.01). The relatively large size of the study sample in the present study may provide an advantage.
In the pregnant women with previous history of miscarriage, seven negative fetal pulsations were discovered. Three of these fetuses showed oligohydramnious with amniotic fluid index (AFI- 2) (normal: 10 – 20) and another 3 with normal appearance, while only one case showed congenital renal agenesis.
The pregnant women with previous history of single miscarriage showed significantly lower levels of beta-hCG when compared with control primigravid women. The serum level of Beta- hCG, was 105 x 103 ± 15.26 x 103 IU/ml in women who continued their pregnancy. On the other hand, the level in the aborted cases was 42 x 103 ± 21.32 x 103 IU/ml.
The pregnant women with previous history of single miscarriage showed significantly lower levels of progesterone when compared with control primigravid women. The serum level of progesterone, was 35.29 ± 2.16 ng /ml in women who continued their pregnancy. On the other hand, the level in the aborted cases was 19.51 ± 2.66 ng /ml (P<0.01).
The results indicated that serum progesterone measurement is an excellent predictor of the risk of miscarriage and can be a good alternative to CA-125 and other markers due its high availability and low cost.
Pregnant women with previous history of single miscarriage showed significantly higher levels of CA- 125 when compared with control primigravid women. A significantly higher level in CA-125 was also seen in aborted cases in pregnant women with previous history of miscarriage. The level of CA-125, was 19.37 ± 1.64 U/ml in women who continued their pregnancy. On the other hand, the level in the aborted cases was 41.04 ± 7.55 U/ml (P<0.01). It was concluded that CA-125 is an excellent predictive marker for the risk of spontaneous abortion.
A positive correlation was observed, in the present study, between serum β- hCG and progesterone; a decrease in serum β- hCG was parallelled by a decrease in serum progesterone in aborted cases. An increase in serum CA-125, however, occurred.
An advantage in the present study is the use of three different parameters simultaneously, to predict the risk of spontaneous abortion and so pregnancy outcome. Most other published work use either one or two parameters.
Other factors that might have contributed to miscarriage include a lower haemoglobin concentrations. Although the number of patients was small (5 pregnant women), yet haemoglobin concentration was less in the aborted women by approximately 1 %. This might have contributed to the development of hypoxia which could have shared in miscarriage. It’s known that anaemia could cause abortion (Frenkel et al., 2006).
Communications with the pregnant women for follow-up was performed and due analysis was made. Three patients with previous history of miscarriage exhibited abnormal hormonal levels, while 2 of them suffered threatened abortion. On the other hand, 2 primigravid control women suffered from threatened abortion, while only one woman had abnormal levels of the three markers in study: a decrease in serum beta- hCG and progesterone, and an increase in serum CA-125. The susceptible patients had been psychologically reassured that there was a great possibility to continue their pregnancy safely and they were directed to the importance of the four types of rest: psychological, mental, physiological, and sexual. Those who didn’t respond appropriately to the non- pharmacological intervention only were ordered to be on oral progesterone (Duphaston) with starting dose of 40 mg at once then a maintenance dose of 10 mg every 8 hours until symptoms remit. Eventually, throughout immediate and appropriate intervention, abortion had been prevented and the susceptible patients continued their pregnancy safely and gave birth of healthy well- being babies.
In conclusion, the results of the present study indicated that serum progesterone combined with quantitative serum β- hCG and CA-125 measurements are not only diagnostic but also have good predictive value for pregnancy outcome as combined triple markers.