#HOW TO FIND YOUR SERUM SERIAL NUMBER SERIAL#

The combination of mifepristone and methotrexate was effective in 58.3% of cases in comparison to 49.2% resolution rate with methotrexate alone. The odds ratio of failure of treatment with initial hCG >5,000 mIU/ml is 5.45 (95% CI, 3.04-9.78) compared with values 4,000 and >5,000 mIU/ml respectively.

#HOW TO FIND YOUR SERUM SERIAL NUMBER SERIAL#

Morse et al., demonstrated that the likelihood for misclassifying a pregnancy as abnormal based on serial hCG estimations was greater in the initial weeks of pregnancy when hCG titres were 5,000 mIU/ml as well as presence of haemoperitoneum, rapidly increasing hCG (>50% / 48 hours) before methotrexate and continued rapid rise in hCG concentrations during methotrexate therapy are all predictors of treatment failure. Silva et al., observed that 60% of women with EPs had an initial rise in hCG, 40% had an initial fall, 20.8% had a rise similar to viable IUP (similar to our findings) and 8% had a fall similar to complete miscarriage, and concluded that there is no single way to characterize the pattern of hCG for EPs.

In our series, 23.9% of women with EP presented with a rise (в‰Ґ53%) similar to viable IUP and 3.0% had more than doubling of hCG levels only 4.2% had a fall 35%. A rapid decline in hCG levels is usually indicative of miscarriage, the minimum fall being 21-35% in 48 hours and if the fall is slower, the presence of an EP should be suspected. In fact, a rise in hCG as low as 35% can also indicate an IUP and it is prudent to repeat the test for the third time, particularly when the initial hCG levels are low. However, 15% of normal IUPs show a suboptimal increase and the minimum rise to predict normal viable IUP is 53%. Traditionally, a doubling or rise in hCG level >66% has been regarded as indicative of a viable IUP and a suboptimal rise or static levels indicate possible EP. A considerable number of EPs can resolve spontaneously and treatment is not always necessary. However, EPs can be identified at lower hCG titres as was the case in 31 (9.2%) surgically confirmed EPs in our study, the lowest level being 122 mIU/ml.

EP is suspected if transvaginal sonography does not show an IUP and the hCG level is >1,500 mIU/ml. DZ is the level of hCG above which an imaging scan should reliably visualize a gestational sac within the uterus in a normal IUP. With the advent of high resolution transvaginal sonography and sensitive hCG assays, many EPs are diagnosed early. Women receiving expectant or medical management who developed severe persistent abdominal pain or haemoperitoneum or showed no decline in hCG levels were also advised surgical intervention. Surgical intervention was advised to those women with features suggestive of ruptured EP or those who did not meet the aforementioned criteria for medical management. Subsequently, serum hCG titres were assayed every week until negative. ДЄsymptomatic women with serum hCG 15% after 48 hours.

Of all the predictors of failure of medical management, hCG is the most important contributor. The treatment modalities include expectant, medical and surgical options once commenced the decision to persist with expectant/medical management or resort to surgery subsequently is governed mainly by the patientвЂ™s symptoms and the serum hCG levels during the treatment phase. Once diagnosed, the therapeutic approach to EP is dictated by several factors such as clinical condition, sonographic features, serum hCG, parity, desire for future fertility and willingness to return for regular follow-up. However, there are exceptions to the rules and this has been our experience too in our day-to-day clinical practice. In more than two-third of EPs, serial hCG levels done 48 hours apart demonstrate either a suboptimal rise than in normal Intrauterine Pregnancy (IUP) or a fall in titres less than in a spontaneous miscarriage. Ultrasonography and serial estimations of serum Beta Human Chorionic Gonadotropin (hCG) are used to detect or exclude an Ectopic Pregnancy (EP) in women presenting with vaginal bleeding or abdominal pain in the first trimester.

How to find your serum serial number