Serum hCG levels in the prediction of molar pregnancy below 11 weeks of gestational age

Carvalho, Lucas Ribeiro Borges de; Assis, Rafaela Tessaro de; Braga, Antônio; Bonetti, Tatiana Carvalho de Souza; Araujo Júnior, Edward; Mattar, Rosiane; Sun, Sue Yazaki

doi:10.1590/1806-9282.20240659

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Original Article • Rev. Assoc. Med. Bras. 70 (12) • 2024 • https://doi.org/10.1590/1806-9282.20240659 linkcopy

Serum hCG levels in the prediction of molar pregnancy below 11 weeks of gestational age

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE: The aim of this study was to evaluate the serum hCG level in the differential diagnosis between non-molar miscarriage and complete hydatidiform mole in<11 weeks gestation.

METHODS: This was a retrospective collaborative cohort study. This study included women with gestational age<11 weeks, with ultrasound evidence of failed pregnancy and available serum hCG pre-uterine evacuation, divided into two groups: the non-molar miscarriage group and the complete hydatidiform mole group. Serum hCG levels were compared according to gestational age. Statistical analysis used a nonparametric test with a 5% significance level (p<0.05).

RESULTS: In total, 416 patients were included, out of which 79 were included in the non-molar miscarriage group and 337 in the complete hydatidiform mole group. The calculated power of the sample was more than 80%. Data analysis showed that the 75th quartile of the median in the non-molar miscarriage group was always lower than the 25th quartile of the median in the complete hydatidiform mole group [9,721 mUI/mL/16,435 mUI/mL (6–7 weeks), 20,229 mUI/mL/64,911 mUI/mL (8–9 weeks), and 29,633 mUI/mL/126,278 mUI/mL (10–11 weeks), respectively; p<0.001].

CONCLUSION: Facing failed pregnancies, hCG>16,435 mUI/mL at 6–7 weeks, hCG>64,911 mUI/mL at 8–9 weeks, and hCG >126,278 mUI/mL at 10–11 weeks were most prevalent on complete hydatidiform mole diagnosis. On the contrary, hCG<30,000 mUI/mL at 10–11 weeks was most prevalent in non-molar miscarriage diagnosis.

KEYWORDS:
Miscarriage; Complete hydatidiform mole; Chorionic gonadotropin; First trimester pregnancy

Characteristics	NMM				CHM				p-value
Characteristics	n	Minimum–maximum	Median (IQR 25–75)	Mean±SD	N	Minimum–maximum	Median (IQR 25–75)	Mean±SD	p-value
Age	79	15–43	29 (23.5–34)	28.6±6.9	337	13–52	27 (22–34)	28.4±8.6	0.488
Pregnancies	79	1–6	2 (1–3)	2.3±1.2	337	1–10	2 (1–3)	2.2±1.6	0.105
Parity	79	0–4	1 (0–1.5)	1.0±1.0	337	0–8	0 (0–1)	0.8±1.2	0.047
Ethnicity	n		Percentage		n		Percentage		p
White	12		36.40%		173		55.30%		0.182
Black	6		18.20%		32		10.20%
Mixed	14		42.40%		103		32.90%
Other	1		3.00%		5		1.60%
Not informed	46		–		24		–		–

GA	NMM group (mUI/mL)				CHM group (mUI/mL)				Mann-Whitney and Shapiro-Wilk test
GA	n	Mean±SD	Median (IQR 25–75)	Min–Max	N	Mean±SD	Median (IQR 25–75)	Min–Max	p-value
6–7 weeks	19	11,002±16,678	3,738 (531–9,721)	51–57,075	47	198,866±245,453	100,150 (16,435–236,965)	924–982,174	<0.001
8–9 weeks	29	16,075±18,904	8,669 (4,684–20,229)	737–73,489	120	209,270±222,869	136,213 (64,911–282,009)	8,573–999,000	<0.001
10–11 weeks	31	20,620±27,986	8,554 (3,340–29,633)	171–123,941	170	292,585±255,171	207,806 (126,278–395,340)	3,422–999,000	<0.001

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[TFN1] NMM: non-molar miscarriages; CHM: complete hydatidiform mole; IQR: interquartile range; SD: standard deviation. Categorical variables were compared by chi-square and numerical variables by Mann-Whitney test. Statistical analysis of ethnicity was performed differently due to small sample sizes.