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1 2009 *!" ( ( ( ( ( :"$ %$& (C-Kinase CA125 - ") ( *"( (+ $(,-( ( ("$ (+ :"$ 2007/12/1,0 2006/12/1 / $ $ (" 534( $(" 60 ("$ (1 2( $& ( "$ "(/ $(/ 5(6 $ (7 8( 9"( :"+ 95 $ 30 ( (; ( 2( 5<" ($& ) ;,0 30 (1 ( $&( (; 5>( 1 $ 3= $" & 1 $ % & ' " (!" # * 29

2 ) & *" +,& - / 0" ) (" ( 2( ( ;( ( "$ ; >"( ( ( (3( 3;("695658) " " " (2946,; $& ; A$ (2>/>?241235) " 5 "( (&+ ( ( ( ( *0 $; :B ($ ( (/>D( 1075 ( (/C "( ( " ( ( %100 (; %83 ""( ( CA 125 ((; ((" %85 "(( (( (( %100 ((E ""( ( ( ( ( ($ / $ 419,;C (( (( %733 ((E (( (( %567 ((; %3667 %576 " ( =( (; (1,(;+ F; $! " > 1 ; A$ F; ( ( HI(& ( $; FG0 " :=4 ( (; ( ( (- (C-Kinase CA125 - "() > 1 30

3 2009 The Predictive Value of Measurement of Some Biochemical Factors in the Early Diagnosis of Ectopic Pregnancy Abstract Suzan Al- Tabarani * Objective: The study was designed to investigate the predictive value of some biochemical factors (Progesterone, CA-125 and creatine kinase) in the early diagnosis of ectopic pregnancy Methods: The study took place in the Maternity hospital of Damascus University, during the period between 1/12/2006 and 1/12/2007 Our study is a case control study60 pregnant women were included with pregnancy age between 5-9 weeks gestation according to LMP, women were divided into two groups equally, 30 women with normal Intrauterine gestation (controls) and 30 with ectopic pregnancy (EP) Age of the women ( ) years old, pregnancy age( ) weeks gestation, and the body mass index(bmi) ( kg/m2) for the case and control groups were nearly the same Results:In our study when using a progesterone concentration of less than 1075ng/m/ as a cut-point for the diagnosis of ectopic pregnancy sensitivity was 83% specificity was 100%, the positive predictive value was 100% and the negative predictive value was 85% When using CA-125 concentration of more than 4194/m/ as a cutpoint for the diagnosis of EP sensitivity was 3667%, specificity was 567%, the positive predictive value was 733%, and the negative predictive value was 5767% Creatine kinase levels were high in the EP group comparing with the normal IU pregnancy group Conclusion: The measurement of progesterone, CA-125 and creatine kinase levels is important in discriminating ectopic from normal IU gestations * Ass prof Matermity, Faculty of Medicine University Hospital Damascus 31

4 ) & *" +,& - / 0" 1 :$ -'+ %' # 4'# '# ') ' 6 $! ', '" ' ;' : (%10&'4) 89 1 " [4] " *" '+ Blastocyst ' ' '& >' ) 8 %'# '@ A' '9& '& B 3 ;? & [4] %+ Clinical Manifestations " &J E' %' D34' 8' C'1 1" " '# ' ' ' F!@ " / $# '; I'& - ' ' %50 H'+ E'! ; : / 'J /' ' $# )' ' ) 4" ( -K [2] ) : $+ :BhCG <$= = (1 ' /#' '& ' :' *" ) $ " L '&!B D'K '# # ') 34' &" 89 + BhCG /' ' ' N'+ *'" -'9O M3& ; $ " Human Chorionic '' " '','' '' ''9) /'& 6'"5 ') ' 3'& : AK# " " (Conadotopin 'P+ '1 Q ' '47 -N'" "' 1 $! D') ' 'J ' /' " - G [1] 1VF %O -1" " " - -5& 32

5 2009 ') $' '" "' H+ # : -5' ' %90 '+ /' '&" '@ " " R'+ ' 'B ' 'S" T -1 K "& 8 '" -' '9&# '"& F!'@ L' " D'@ ' ' 0%844 ' 0%963 'O '0" 1) A [1] () %948 0" 1 0%986 ' T' ') $' '" " K %; B /6-5/ ' ' '" //' ' 2000 &' 1500 BhCG ' [6] T # : " 2 ' -5' ' ' ' ' '+ :# " 4&" B (/'795) '/A';25 ' :' 4&" +" 8 ) [8] K > T -5 %99'98 T B 3'(" ' '@ ' ' " ' '"" /' '1 '; " + " 0" 1 '( " ' ' ' 3"" AN9+ DK % ' # A'S ' '&!B '+ /' 1 ; T(" + 14 [5] ' IUI ' 'K 3' 1 # IVF V4 + %O :' W' D') '; ) S" # & " " '" $!' *'" '&0" # )X' ' " ' /' H+ E! [5] ) $ " BhCG / 6 :A+ 3 CK 4'& "'& Ca125 ' ' /' H+ G# ) 33

6 ) & *" +,& - / 0" 1 ''( Fetal Fibronectin '' "&''S Inhibin A # '') [8] '1 ' ' ' '& D ') ' *" -" Ca125 D" ' /' '@ - ' # " " CK 4& "& ' :' ','O ' ' - F!@ - ( /',S G' '" ' 'O '0" '1 'S& [3] -"N Interpretation of Investigations *="K "- # ' ' *'" ' # " $# G,O ' ' A,'B / " % / B ' /',S ' /' M' -! ' " F!'@ L " 8 S& *'" '1" ' '+ D/' -W1" 5 # -"N ' ' T' ')"(N Y,'" &" N W1" N Q :Sensitivity "" ' '!' E',# ' Q' %' : S& " O 11 O =!& + 11 O D'!& ' -5' ' S " "5 /4 H+!&@ '; 'O # :' '" ' " # Q" G " )# $# / [3] 34

7 2009 :Specificity ; ' 5!' E',# ' Q % : S& " O 11 =!& O + 11!& O -5 S " "5 /4 H+!&@ Sufficiency - ' /'4 H'+!'&@ Q' %' -W1" 5 " 3& "!&!& O -5 S " "5 S& O = S& -"5 +& Predictive Values > -'"N '0" '1 '" %' ' ' ' ANK '+ [3] -"5 F!@ Y," S" / " '" 6' $!' ' '& # '" O 0" 1 9" &# & A B 11 O = O 0" 1!& O + 11 O ' '& '" '9" 0" 1 H+ E! 1 : &# &!) O A " 6 $! 11 = 0" 1!&

8 ) & *" +,& - / 0" 1 :"$ %$& - ' ' /' '0" '1 '+ ' F!'@ - '& *'" '+ (CK CA125 " ') ' ',& ' *'" '&B :' /'1 /'4 3') D) -5 *'" X'" ' '9 -SK' $'S" '&# ' A& ) # '& 'O /#' 1" ' '+ 90'" # & 6"SK I# I 5 -'1 :'B W' ' '# Q 'S ) & *" 6," A5 : PS &O ( P+ N :F 2 $ /' '+ ' ' W ' # " :S + -# '1 ' -' " 2007/12/1 :'B 2006/12/1 ' ' ( 4 /' 60 ' '!'# '" 8' Case Control ' '9 / '? \'" % ' T # 9&'5 ) AN / ',' '# $'S & -9 ( F!@ X A DLMP :" :B 1" KJ " # /' ' "' - ' ' /' 30 '" :@' '1 *' "' ' ' W ' # " :S + $ " &0 & IUP K ) :S' '+ 3 ' O ' '+ 1 K 30 " : '2 '@ ' ' ') *' "' ' W # " -' /'&" BhCG '' '( :' W' EP (Ectopic Pregney) T' '/ /' ' 2000 ' 1500 ' BhCG) ) $ " () $ " K 36

9 2009 &' " ') '"] '" W'O -K' - - ' ' '&X" ' K' & /" W " & (CK CA125 $ ')" # '" '" '+ 90' # 6'&H $# K -' %' :' '&X" " E!& D- 7 # & W ' '" 5# :' *' T + % " 1 /' -'# -' 'S9" ' ' + - / -" ( '" 4') "' ' '& '1 '1 " -'" D ' W ' '# '" :S + +" Mini Vidase X' A' (4'B) '4 ' X'" 1 1 CA 125 / /' -'" ' '+ D/ / 35&'0 ^"" + 1 '@ ' '+ CK '' 1 X A &, 1 + CK A'1+ W ' ' '//'170&'24 ' // 195&'24 :Y,'" ' W ' '# " :S + " : "! 3 N! 1 P (n=30) > $ < %K+" (n=30) & < %K+" ± ± ± ± 08 " ± ± 25 BMI (kg/m2) $& ; ; (1) >/ $ >" ( " ( " -'7" ' ' ")'" "'1 "' # Y"",'B '+ ' 5 ' '"& 37

10 ) & *" +,& - / 0" 1 : 2$,; " $ "$ -2 :"]& Y," -& " " 1 -" " ; P ; ng/m1 (< % + ") 636 ± 292 P < ± 715 $& $& ; " ; (2) >/ $ ' ' ' A') A,'B A'(+ E'@ H+ " A1+ E! D" ' ' ' ' ' K ) ' ' '+ Q'K &' 'S# " ' & 8 (P < 00001) K T 1 ) ' & '/;'1075 ' '( " ' ' " :# ) *" %83 = (%96 - % 70) % 95 = CI 19 G" %100 = %100 = O 0" 1 (%99'72) %85 = 0" 1 '( C4'" ' Cross tabs ' ' '+ - TK "' A'1+ '/ ;' 1075 ' S : " : 38

11 P < "" Sensitivity = 83% A" CI= 95% (70-96%) E Positive predictive Value = 100% = $ 1075 H 1075 < X 2 = 429 " " ; Specificity = 100% " Negative Predictive Value = 85% (72-992%) -C,;C " >/ Crosstabs = $ (3) >/ $ "$ ; A$ / >D 1075 n= " =/ 1075=//+ " 1075=/+ / >D 1075 H " ; $; K N! (1) >/ "$ ; A$ "' ' "' ' '),B + E@ " A1+ E! ' *'" ' & '/;' 1075 ( " '" ' '0" '( D%100 :'B '" B 0" ( T ) %85:B : 2$,; CA125 $ "$ 3 Y,'" -'& D' ' '+# G CA125 ( b-a_ ` & 39

12 ) & *" +,& - / 0" 1 P CA125 ; IU/m1 (< % + ") ; P < ± ± 109 "$ ; A$ CA 125 ; (4) >/ $ $& ' ' ' ' '+ :# CA125 # " ' T' D' 'K ' ' ) P < " G47 $!,B + *'" ' & '//' 419 ' :' CA 125 " ' Cross tabs ' ' '+ -' TK T ) A'1+ '/ ' /' 419 ' 'S :' CA125 '( C4" :"X " " P < 0038 "" Sensitivity = 3667% 4 26 E Positive predictive Value = 732% (51-957%) $ $ A" CI= 49% ( %) = $ 419 < CA > CA125 X2 = 436 ; Specificity = 567% (745% - 988%) " Negative Predictive Value = 576% (33-83%) -C,;C CA125 >/ Crosstabs = $ (5) >/ $ $& ; / 40

13 2009 n= CA< CA< CA CA>419 >419 "!!!"! 419 IU/m1< CA125 ; $; K N! (2) >/ "$ ; A$ '' :'' CA125 '' "'' '' '' '' ''" '),'B '+ ' ') ' *" & // 419 '0" '( %733 :'B '" B 0" ( T " %576 :B " : 2$,; CK! $ "$ 4 Y,'" -'& ' "' '+# G CK 4& "& ( b-a_ ` :"] & CK ; P ; IU/m1 (< % + ") 702 ±186 P < ± $& ; A$ CK ; (6) >/ $ ' ' 'K :'# '& 4'& "& " # $# 'K ' ' -! ' G' 6' " ' ) )"' '& '+ '( '" 5 [7] ' ' - A1+ 41

14 ) & *" +,& - / 0" 1 F CK ' : "5 ) *" & :/ '+ 6' ') ' '+ " ' '( S " + P ' ') ' 4'" " ' -& ( D '/;' 1075 " ' '" " %83 K -5' '+ " ' *'1 + % B D%100 :B " T '+ *'1 :'B $0' / ) /' H'+ E!' D' S' ( Y" " &' ' '; ' *'" ' S" # )X " [5] Katsikis (2005) ' ' '" '& - " 1 [5] ' - ' & ' / ; ' 1075 " ' '" " ' '' ''+ D%85 '' '' D %85 6"'' ''+ '' ' ' 0%71 ' ' -& 1+ Guillaume et al (1990) /; 10 " " %100 )"' '" " ' ' 1 -" 1+ G# - + & Darai ' 'S+ ') ' 4" " & [5] -'& ' / A'; 25 " ' '" "' et al (2002) Buck et al ' '+ '# 0%57 ' ' %97 ' [5] %87 ' ' -'&+ '/ A; 25 " " (2000) ') ' 'S" # '& '" " %71 " ' G" ' 'S Q'K ' & D) ; :' '"5 ' ' ' T )"1 /) + 42

15 2009 '; ' ') ' S" " /S / " ) :'# '& CA125 ' # "' -'K# 1+ CA125 / ' ' ' ') + "' ' G4'7 $!,'B + T D K *'" ' & '/ /' 419 ' : CA125 " ' ' %3667 -'& ' ' # '" ') T' %' " ' ' '+ CA125 ' + CS"5!@ %567 ' %80 ' '+ ' -& 8 [7] SAha1999 ' %'" # '@ E'! S ) S " " %867 'N ' CA125 '' ' ' 4 ( ) S :B 8' [8] Vitoratos N,Papadias C ' T' "' -K'" '& ') ' '+ CA125 '( + S 6 F!@ -)P# ' 8' %K' '" # E'! S ( D + 6 -' *'1 :'B $0' (' Y ' )!7 N CA125 ' ' '+ "' '+ F " & 1+ 4& "& # ' '+ F' ' " ' :# "/ / (702) ) ' T' :'" ' "/ / 3373 K -" '' ''+ A''S" '' 8'' [7] Ganguly NK Saha,Pk2005 ' *' 6' :' ] )K # 5B 4& "& 4'& "'& -" ' C'S" "' '&B -S [8] Vitoratos N 43

16 ) & *" +,& - / 0" 1 ' '( '" 5 ] :'" ') *" & # ') ' *'" '&X" $ & )" & ) S" 6S " ' G" ' 'S ' "' 6" ( X * ' -' 6'"&# '( ' + 6 ) + ' T'+ '+ 'S 4'& "'& CA125 " B 1 :'K '1" '+ S' " ' ' (Specificity) ' "' ' '; K'S -5 + A ) ) -' F!'@ "' BhCG '' -' ') $ " ) *" &X",& = ') -5' '+ '1+ CK CA125 D" ' /' WB &'1 BhCG '' '@ '( :' W' '@ ' ' ')+ E " TVU ) $ " ') I' 5 :S' 'K ') " TK : &'2 :N E! P", VN " 24 ' : BhCG / WB "B - CA125 " ') ' ',& - ' / ' W 'B - ' '&! '& ' -5 + *" 3) CK 4& "& M3'& '; ') $' '" $ $ *" & '&B ' D'" ' S" ' 'S& AP ) 4 /'& ' '" ' TK # D) -5 & ),B ) 4" -SK +N" 44

17 2009 ;' :' 6' '15 1" - WB 5-3 ' *'" ' '+ - ' F!'@ /&0 Y," /' '" '" 5 ] :'" /' -' 1 6# 5B ) T' Y,'" -K'" '& D') & " C-Kinase ' CA 125 ' "

18 ) & *" +,& - / 0" 1 References 1-Condous G, Okaro E, Khalid A, et al The Accuracy of Transvaginal Ultrasonography For The Diagnosis of Ectopic Pregnancy Prior to Surgery Hum Reprod 2005 ; 20: Dart RG, Kaplan B, Varaklis K Predicitive Value of History and Physical Examination In Patients With Suspected Ectopic Pregnancy Ann Emerg Med 1999 ; Dawson Saunders B, Trapp RG Basic Clinical Biostatistics, 2 nd ed, Appleton Lange, Connecticut Fylstra DL Tubal Pregnancy, A Review Of Current Diagnosis And Treatment Obstet Gynecol Surv Mol BW, Lijmer JG, Ankum WM et al The Accuracy Of Single Serum Progesterone Measurement In The Diagnosis Of Ectopic Pregnancy A Meta Analysis Hum reprod 2005; Paul M, Schaff E, Nichols M, The Roles Of Clinical Assessment Human Chorionic Gonadotropin Assays and Ultrasonography In Medical Abortion Practice Am J Obset Gynecol 2000 ; 183:S34 7-Saha PK, Gupta I, Ganguly NK Evaluation Of Serum CA125 & Creatine Kinase As A Diagnostic Marker For Tubal Pregnancy Aust N Z J Obstet Cynaecol 2005 ; 39, Vitoratos N, Gregoriou O, Papadias C, et al Clinical Value of CA125 and Creatinine Kinase In The Diagnosis Of Ectopic Pregnancy Gynecol Obstet Invest 2003 ; 46: /3/24 : :B 8 \" 2008/5/8 : 6( \" 46