The role of Quantitative ELABELA, βHCG, and Fibrinogen in Distinguishing Missed Miscarriage from Viable Pregnancy in Iraq

Abstract

Missed miscarriage (MM) is a prevalent obstetric complication in the first trimester of pregnancy. ELABELA (ELA), a G protein-coupled receptor that is expressed in the reproductive, cardiovascular, and renal tissues. Researches show the deletion of ELABELA in animal models has been demonstrated to produce preeclampsia like symptoms, underlining its importance in normal placental development. External administration of ELA has been demonstrated to enhance the invasiveness of extravillous trophoblasts and effect the morphological pattern of placental outgrowth, suggesting it plays a significant regulatory role in trophoblast differentiation and placentation. β-HCG is a glycoprotein hormone secreted by the syncytiotrophoblast cells of the placental tissue after implantation of a fertilized ovum and Fibrinogen (coagulation factor I) serving as the key structural protein responsible for blood clot formation and hemostatic integrity. The present study was carried out to evaluate and compare maternal serum concentrations of (ELA), β-HCG, and Fibrinogen between women with ultrasound confirmed missed miscarriage and gestational aged matched women with viable first trimester pregnancies (6 – 14 weeks), and using the ROC curve to investigate their ability to differentiate between the studied groups. We established that the mean serum levels of ELA, βHCG, and Fibrinogen were significantly lower in the Missed Miscarriage compared to viable pregnancy. Also, In the missed miscarriage arm it is the only primary peptide ELA that tracks plasma fibrinogen. We conclude that that combined panel (ELA, βHCG, and Fibrinogen) may have the potential to be used as an indicator of trophoblast health and placental function (ELA), failing pregnancy (Fibrinogen), and monitoring early pregnancy viability (βHCG) in missed miscarriage.