The role and poor pregnancy outcome relations of human chorionic gonadotropin, progesterone and adam 12 in threatened miscarriage

Aim: The aim of the study is to investigate the maternal serum β-hCG , progesterone and A Disintegrin and Metalloprotease 12 (ADAM 12) levels in threatened miscarriage, to examine the usability of these markers in threatened miscarriage in defining the possible abortions and to evaluate these three maternal serum markers in the view of poor pregnancy outcomes in delivery resulted gestations. Materials and Method: Our study was prospectively planed between November 2012 and Jıne 2013 after receiving the permission of Dokuz Eylül Unıversity ethical commician. Total 200 spontaneous single pregnant (100 threatened miscarriage and 100 control group), in their 7th and 14th weeks are included in our study. At first application β-hCG and progesterone levels were wanted from the whole pregnants. We called all the pregnants, included in the study, at their 20th gestation week and received information about their pregnancy and later all these groups and cases are followed until delivery. The members of this case were all called by phone and the informations of preterm delivery (<37th week), early membrane rupture, preeclampsia, small for gestational age. gestational diabetus mellitus, fetal or neonatal deaths were recorded. When the study finished some of the pregnancies in control group were excluded in the evulation of poor obstetrics outcomes due to not reaching the delivery term. Results: Abortion occured 14 (%14) in threatened miscarriage, 4 (%4) in control group pregnants (p> 0.05). In threatened miscarriage maternal serum β-hCG and progesterone levels were found significantly statistical low in control groups (respectively p<0.001 and p=0.013). We found that, according to the ROC analyze the true forseeingof abortion for β- hCG the cut off value must be at the level of ≤ 56000 IU/L for progesterone, the cut off value must be at the level of ≤ 27.86 ng/ml (respectively p<0.001 and p =0.002). No statistical significant difference were found at the value of ADAM 12 between control groups and threatened miscarriage groups (p=0.335). In all cases and also threatened miscarriage group, ADAM 12 levels were found significantly lower in the ones who underwent abortion than the ones who didn't undergo abortion (respectively p=0.001 and p= 0.010) . When all the case group examined ADAM 12 levels were found significantly low in the preeclampsia and SGA patients than the ones who didn't develop preeclampsia and SGA (respectively p< 0.001 and p= 0.041). Conclusion: Our study showed that maternal serum β-hCG and progesterone levels can be used to identify the abortion in threatened miscarriage group (respectively p<0.001 and p= 0.002). It is found that true forseeing of abortion for maternal serum β-hCG the spesivity %62 and sensitivity %60 , for progesterone spesivity %52 and sensitivity %65 . Additionally, in first trimester pregnancy with vaginal bleeding if ADAM 12 levels are low spontaneous abortion risk is on the increase and if the pregnancy is countinuing with ADAM 12 levels are low reeclampsia and SGA occurance risk can be more. As a result closely following these patients maybe crucial for pregnancy outcomes. Key Words: Threatened miscarriage, progesterone , human chorıonıc gonadotropin, A Disintegrin and Metalloprotease 12