Alpha-fetoprotein in vaginal blood: a promising novel marker for early pregnancy failure that needs further validation - Fertility and Sterility

Early pregnancy loss is a common obstetric complication and is often preceded by vaginal bleeding. It is estimated that as many as 12% to 15% of all clinically recognizable pregnancies and up to 22% of all pregnancies end in miscarriage (1x1Zinaman, M.J., Clegg, E.D., Brown, C.C., O'Connor, J., and Selevan, S.G. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996; 65: 503–509 Abstract | Full Text PDF | PubMed | Google ScholarSee all References)(1). In women of advanced reproductive age, the miscarriage rate may approach 75%. Bleeding in early pregnancy is a common reason for women to seek acute care through the emergency department or in early pregnancy units. The assessment of these women has been standardized. Transvaginal ultrasound combined with the measurement of serum human chorionic gonadotropin (hCG) levels are routinely performed, but they allow for the immediate diagnosis of only a portion of patients. For women in whom a previously seen intrauterine gestational sac is no longer present or a fetus without further cardiac activity is observed, the diagnosis of pregnancy failure or spontaneous abortion is certain. However, when the state of the pregnancy cannot be definitively determined with ultrasonography, repetitive testing over the course of several days to weeks is often required until a definitive diagnosis can be made. This protracted diagnostic process not only delays potential treatment but can be physically and emotionally difficult for the patient. Repeated absences due to frequent medical visits within a short time may pose difficulties for the patient at work or at home. As discussed by Robinson (2x2Robinson, G.E. Pregnancy loss. Best Pract Res Clin Obstet Gynaecol. 2013; 28: 169–178 Crossref | PubMed | Scopus (23) | Google ScholarSee all References)(2), as women begin to develop cramping or bleeding, they may experience anxiety, fear, helplessness, and feelings of loss of control. The uncertainty of the outcome, especially for the women who highly desire their pregnancies, likely adds an additional burden of stress and anxiety to an already difficult situation. In fact, the anxiety experienced during and after a miscarriage has been reported by women to be worse than the depressive symptoms that often follow in the early weeks after a loss (2x2Robinson, G.E. Pregnancy loss. Best Pract Res Clin Obstet Gynaecol. 2013; 28: 169–178 Crossref | PubMed | Scopus (23) | Google ScholarSee all References)(2). Previous studies have not been successful at delineating the risk factors in symptomatic early pregnancies that could