|March 2013 · Vol. 25, No. 3
EXAMINING THE EVIDENCE
Can a single progesterone testYes, according to this meta-analysis of 26 cohort studies involving
distinguish viable and nonviable
pregnancies accurately in women
with pain or bleeding?
9,436 pregnant women.
Among women who had pain or bleeding or both, as well as inconclusive ultrasonographic assessment (five studies of 1,998 women and progesterone cutoff values from 3.2 to 6.0 ng/mL), the progesterone test predicted a nonviable pregnancy with pooled sensitivity of 74.6% (95% confidence interval [CI], 50.6–89.4), specificity of 98.4% (95% CI, 90.9–99.7), a positive likelihood ratio of 45 (95% CI, 7.1–289.0), and negative likelihood ratio of 0.26 (0.12–0.57). The median prevalence of a nonviable pregnancy was 73.2%, and the probability of a nonviable pregnancy was raised to 99.2% if the progesterone value was low.
Among women who had pain and/or bleeding but no ultrasound assessment, the progesterone test had higher specificity when a threshold of 10 ng/mL was used (9 studies of 4,689 participants) and predicted nonviable pregnancy with pooled sensitivity of 66.5% (95% CI, 53.6–77.4), specificity of 96.3% (95% CI, 91.1–98.5), positive likelihood ratio of 18 (95% CI, 7.2–45.0), and negative likelihood ratio of 0.35 (95% CI, 0.24–0.50). The probability of nonviable pregnancy was raised from 62.9% to 96.8% when the progesterone value was low.
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Is the hCG discriminatory zone a reliable indicator of intrauterine or ectopic pregnancy?
Andrew M. Kaunitz, MD (Examining the Evidence, February 2012)
A few outliers don’t justify dismissing the hCG
(Comment & Controversy, April 2012)
Linda R. Chambliss, MD, MPH
Chief of Obstetrics and Director of Maternal-Fetal Medicine, St. Joseph’s Hospital and Medical Center, and Professor of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, Nebraska.
It is not uncommon to see a patient in her first trimester who is experiencing abdominal pain or vaginal bleeding or both. At my institution, we use the beta human chorionic gonadotropin (ß-hCG) value in conjunction with transvaginal ultrasonography to determine whether the pregnancy is a viable intrauterine pregnancy, a missed spontaneous abortion, or an ectopic gestation. However, even a combination of modalities can be inconclusive, necessitating repeated ß-hCG measurements and several ultrasound images. For the patient, it can provoke considerable anxiety to be told to wait and see if the pregnancy will continue.CLICK HERE to read more