Objective

To determine if high alpha-fetoprotein (AFP) level in vaginal blood collected on a sanitary pad can assist with detecting an active miscarriage.

Design

A prospective cohort study.

Setting

Academic medical center.

Patient(s)

Five groups were evaluated: women with active miscarriage, pregnancy of unknown location, completed miscarriage or extrauterine pregnancy (EUP), ongoing pregnancy, and undergoing elective dilation and curettage (D&C).

Intervention(s)

None.

Main Outcome Measure(s)

For each patient, AFP level in the vaginal blood collected on a sanitary pad was quantified.

Result(s)

The vaginal blood AFP median levels (and their ranges) were 3.7 IU/mL (0.5–739.2) and 4,542 IU/mL (15.6–100,000) in the active miscarriage (n = 16) and the elective D&C (n = 24) groups, respectively. Alpha-fetoprotein was detected in all elective D&C and active miscarriage cases except in 1 case. In the ongoing pregnancy group (n = 35), only 2 of 35 specimens showed detectable AFP levels. In the pregnancy of unknown location (n = 12) and the completed miscarriage or EUP (n = 10) groups, no AFP was detected. Receiver operating characteristic analysis demonstrated 93.7% sensitivity and 97.8% specificity for the detection of an active miscarriage (cutoff 0.61 IU/mL; area under the curve 0.96).

Conclusion(s)

Alpha-fetoprotein can be extracted from vaginal blood collected on sanitary pads. A high level of vaginal AFP can assist with the same-day detection of an active miscarriage. This novel test is useful in differentiating active miscarriages from ongoing pregnancies, completed miscarriages, and EUPs and, therefore, it reduces uncertainty, anxiety level, and number of repeat office visits.

中文翻译：

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基于从卫生巾中提取的甲胎蛋白确定孕早期流产

客观的

确定在卫生巾上收集的阴道血液中的高甲胎蛋白 (AFP) 水平是否有助于检测活动性流产。

设计

一项前瞻性队列研究。

设置

学术医疗中心。

患者

评估了五组：活动性流产、位置不明的妊娠、完全流产或宫外孕 (EUP)、持续妊娠和接受选择性扩张和刮宫 (D&C) 的妇女。

干预措施

没有任何。

主要结果测量

对于每个患者，在卫生巾上收集的阴道血液中的 AFP 水平被量化。

结果

主动流产 (n = 16) 和选择性 D&C (n = 24) 组的阴道血 AFP 中位数水平（及其范围）分别为 3.7 IU/mL (0.5–739.2) 和 4,542 IU/mL (15.6–100,000) ， 分别。除 1 例外，所有择期 D&C 和活动性流产病例均检测到甲胎蛋白。在持续妊娠组（n = 35）中，35 个样本中只有 2 个显示可检测到的 AFP 水平。在位置不明的妊娠（n = 12）和完全流产或EUP（n = 10）组中，未检测到AFP。接受者操作特征分析表明检测活动性流产的灵敏度为 93.7%，特异性为 97.8%（截止值为 0.61 IU/mL；曲线下面积为 0.96）。

结论

可以从收集在卫生巾上的阴道血液中提取甲胎蛋白。高水平的阴道 AFP 有助于当天检测到活动性流产。这种新颖的测试有助于区分主动流产与持续妊娠、完全流产和 EUP，因此，它减少了不确定性、焦虑水平和重复就诊的次数。