Maternal Inhibin A and Activin A Levels as Markers of a Viable Trophoblast in Incomplete and Complete Miscarriage

Background: From early gestation the human trophoblast secretes large amounts of inhibin A and activin A, and their measurement provides a value for predicting the outcome in women who become pregnant after assisted reproductive techniques. Objective: The aim of this study was to look at the potential function of maternal serum inhibin A and activin A as markers of viable trophoblast in women who miscarry, and to compare their value to β-hCG. Materials and Methods: A case‐control study that was conducted in the Department of Obstetrics and Gynecology over a period from February 1 till October 1, 2019. It included 91 women with singleton pregnancy proved by a positive pregnancy test, serum β-hCG measurement, and ultrasound examination. They were divided into three groups: complete group included 23 pregnant women diagnosed as complete miscarriage, incomplete group included 23 pregnant women diagnosed as incomplete miscarriage, and control group included 45 pregnant women with viable pregnancy, no history vaginal bleeding. Test for inhibin A level, for activin A level, for β-hCG level, and transvaginal and/transabdominal ultrasound were done. Results: Means of β-hCG, activin A, and inhibin A levels were significantly lower in patients of complete group than that in incomplete and control groups. β-hCG < 8750 mIU/mL, activin A < 822 pg/mL, and inhibin A < 104.81 pg/mL were found to be predictive for the occurrence of complete miscarriage. Mean of β-hCG, activin A, and inhibin A levels were significantly lower ( P < 0.05) in complete group than that other groups both in early and late 1st trimester miscarriage. Conclusion: There is a possible role of inhibin A in signaling early pregnancy problems especially if combined with β-hCG. Activin A level is considered as promising biomarker in combination with inhibin A in determining the reminisce of viable from non-viable trophoblastic tissue.