Novel placental and nonplacental serum markers in ectopic versus normal intrauterine pregnancy

Abstract

Objective: To evaluate whether the serum concentrations of novel placental markers and nonplacental markers differ in ectopic pregnancy when compared with normal intrauterine pregnancy.

Design: Prospective clinical study.

Setting: University hospital.

Patient(s): Patients with confirmed ectopic pregnancy (EP) and control population with normal intrauterine pregnancy (IUP).

Intervention(s): Laparoscopy.

Main outcome measure(s): Serum concentrations of placental markers: pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta(1)-glycoprotein (SP1), human placental lactogen (HPL), and HCG; and nonplacental markers: glycodelin, vascular endothelial growth factor (VEGF), and P.

Result(s): The multiples of median of all markers (except VEGF) were decreased in EP when compared with the control group. Conversely, the serum values of VEGF were significantly increased in EP. VEGF showed a negative correlation with HCG and SP1, but not with PAPP-A, P, or the nonplacental markers. HCG, PAPP-A, SP1, and HPL strongly correlated with each other. But, in contrast to the above, P only correlated with HCG and, in contrast to the controls, with glycodelin. The combination of three independent markers in the formula VEGF/(PAPP-A x P) was found to be largely superior to the measure of any single marker.

Conclusion(s): The "triple marker analysis" [VEGF/(PAPP-A x P] allows a clear discrimination between normal IUP and EP.