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Grand Rounds

A New Biomarker for the Detection of Miscarriage?

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BACKGROUND AND PURPOSE:  

  • Mor et al. (Fertility and Sterility, 2021) sought to determine if a high AFP level in vaginal blood collected on pads could serve as a reliable marker for incomplete or missed miscarriage with first trimester bleeding  

METHODS: 

  • Prospective cohort study 
  • Participants 
    • Pregnant women with vaginal bleeding  
    • Women undergoing elective D&C as a positive control 
  • Exposure groups 
    • Active miscarriage (missed or incomplete) 
    • Pregnancy of unknown location (PUL) 
    • Completed miscarriage or extrauterine pregnancy (EUP) 
    • Ongoing pregnancy 
  • Study design 
    • AFP levels calculated  
    • Sensitivity & specificity, and receiver operating characteristic (ROC) were calculated  
  • Primary outcome 
    • Performance of AFP for detection of miscarriage  

RESULTS: 

  • Women with vaginal bleeding: 76 | Women undergoing D&C: 24 
    • Ongoing pregnancy: 35 women 
    • Pregnancy failures: 38 women 
      • Active miscarriages: 16 
      • Pregnancy of unknown location (PUL): 12 
      • Completed miscarriage/Extrauterine pregnancy (EUP): 10 
  • Median (range) vaginal blood AFP levels 
    • Active miscarriage: 3.7 IU/mL (0.5 to 739.2) 
    • D&C: 4,542 IU/mL (15.6 to 100,000) 
  • AFP was detected in all elective D&C and active miscarriage cases (except in 1 case) 
  • No APF was detected in the PUL or completed miscarriage/EUP groups 
  • The detection of an active miscarriage with AFP had 
    • Sensitivity: 93.7% 
    • Specificity: 97.8% 
    • Cutoff 0.61 IU/mL; area under the curve 0.96 

CONCLUSION: 

  • AFP can be used to detect an active miscarriage (incomplete, or missed) with high specificity and sensitivity 
  • Vaginal blood collected from sanitary pads can be used for AFP detection, providing an easy method of same-day detection of active miscarriage 

Learn More – Primary Sources: 

Miscarriage determination in first trimester based on alpha-fetoprotein extracted from sanitary pads 

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Related ObG Topics:

MifeMiso RCT results: Mifepristone Plus Misoprostol or Misoprostol Alone for Miscarriage Treatment?
2021 Cochrane Review: Intervention vs Expectant Management for Miscarriage

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