KnE Medicine

ISSN: 2519-125X

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The Accuracy of Single Progesterone, Single β-hCG, and Their Combination Measurement in Predicting Early Miscarriage: A Prospective Study in Outpatient Setting

Published date: Oct 04 2016

Journal Title: KnE Medicine

Issue title: The 6th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2016)

Pages: 99-106

DOI: 10.18502/kme.v1i1.543

Authors:
Abstract:

Introduction: Most of miscarriage events occurred during the first trimester of pregnancy. Recent studies found the beneficial effects of maternal serum markers to predict pregnancy outcomes. However, study in Indonesian setting was still limited, especially in outpatient setting. The aim of this study was to evaluate serum progesterone and β-hCG measurement  as a beneficial predictor of miscarriage.

Materials & Methods: This was a prospective study recruiting outpatients pregnant women in Aceh who seek first medical attention for their pregnancy during January 2013 to January 2015. Serum progesterone and β-hCG level were measured beside routine obstetric procedure. The discrimination attained between miscarriage and non-miscarriage groups of pregnant women at the end of first trimester was evaluated using logistic regression and receiver operating curve analysis.

Results: Among 70 pregnant recruited in this study, nineteen of them (27.1%) experienced miscarriage. Serum progesterone level of women in miscarriage group was lower than non-miscarriage group (17.85 (IQR 13.26-21.15) ng/dl vs 33.67 (IQR 21.83-44.14), p<0.001). Serum β-hCG level was also lower in miscarriage group (10 681 (IQR 5 787.5-26 577.5) mIU/ml vs 48 109 (IQR 17 137-93 915) mIU/ml, p=0.001). Single progesterone measurement gave a good predictor ability for miscarriage with 82.2% accuracy, 86.3% sensitivity and 73.7% specificity if 19.5 ng/dl was used as a cut-off point.

Conclusion: Maternal serum progesterone level could be a good predictor for miscarriage during the first trimester of pregnancy. Single β-hCG serum in combination with progesterone serum measurement only had little added value for predicting miscarriage.
References:

[1] D. Miller, Assessment and management of miscarriage, New Zealand Family Physician, 35, no. 3, (2008).


[2] I.-C. Chi, T. Agoestina, and J. Harbin, Maternal mortality at twelve teaching hospitals in Indonesia - an epidemiologic analysis, International Journal of Gynecology and Obstetrics, 19, no. 4, 259–266, (1981).


[3] R. Hasan, D. D. Baird, A. H. Herring, A. F. Olshan, M. L. Jonsson Funk, and K. E. Hartmann, Association between first-trimester vaginal bleeding and miscarriage, Obstetrics and Gynecology, 114, no. 4, 860–867, (2009).


[4] O. Hanita and A. H. Hanisah, Potential use of single measurement of serum progesterone in detecting early pregnancy failure, Malaysian Journal of Pathology, 34, no. 1, 41–46, (2012).


[5] I. A. Abdelazim, A. A. Elezz, and M. Elsherbiny, Relation between single serum progesterone assay and viability of the first trimester pregnancy, Springer Plus, 1, no. 1, 1–5, (2012).


[6] J. Elson, R. Salim, A. Tailor, S. Banerjee, N. Zosmer, and D. Jurkovic, Prediction of early pregnancy viability in the absence of an ultrasonically detectable embryo, Ultrasound in Obstetrics and Gynecology, 21, no. 1, 57–61, (2003).


[7] J. Verhaegen, I. D. Gallos, N. M. Van Mello, M. Abdel-Aziz, Y. Takwoingi, H. Harb, J. J. Deeks, B. W. J. Mol, and A. Coomarasamy, Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: Meta-analysis of cohort studies, BMJ (Online), 345, no. 7879, Article ID e6077, (2012).


[8] L. Duan, D. Yan, W. Zeng, X. Yang, and Q. Wei, Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage, Archives of Gynecology and Obstetrics, 283, no. 3, 431–435,(2011).


[9] N. Kadar, B. V. Caldwell, and R. Romero, A method of screening for ectopic pregnancy and its indications, Obstetrics and Gynecology, 58, no. 2, 162–166, (1981).


[10] Z. A. A. Al Jufairi, The value of serum progesterone measurement in early pregnancy, Bahrain Medical Bulletin, 22, no. 1, 18–20, (2000).


[11] MM. Al-Jeborry, Predictive Power of Serial Serum Beta Human Chorionic Gonadotropin Measurements in the Outcome of Pregnancy, Medical Journal of Babylon, p. 11, (2014).


[12] G. Konrad, First-trimester bleeding with falling HCG: Don’t assume miscarriage, Canadian Family Physician, 53, no. 5, 831–832, (2007).


[13] C. R. Gracia, M. D. Sammel, J. Chittams, A. C. Hummel, A. Shaunik, and K. T. Barnhart, Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies, Obstetrics and Gynecology, 106, no. 5 I, 993–999, (2005).


[14] E. De La Rochebrochard and P. Thonneau, Paternal age and maternal age are risk factors for miscarriage; Results of a multicentre European study, Human Reproduction, 17, no. 6, 1649–1656, (2002).


[15] J. Johns, S. Muttukrishna, M. Lygnos, N. Groome, and E. Jauniaux, Maternal serum hormone concentrations for prediction of adverse outcome in threatened miscarriage, Reproductive BioMedicine Online, 15, no. 4, article no. 2969, 413–421, (2007).tona, F. M. Severi, F. Sanseverino, S. Danero, and F. Petraglia, Maternal serum inhibin A levels are a marker of a viable trophoblast in incomplete and complete miscarriage, European Journal of Endocrinology, 148, no. 2, 233–236, (2003).


[17] G. C. Di Renzo, A. Mattei, M. Gojnic, and S. Gerli, Progesterone and pregnancy, Current Opinion in Obstetrics and Gynecology, 17, no. 6, 598–600, (2005).


[18] R. Mackenzie, M. Walker, A. Armson, and M. E. Hannah, Progesterone for the prevention of preterm birth among women at increased risk: A systematic review and meta-analysis of randomized controlled trials, American Journal of Obstetrics and Gynecology, 194, no. 5, 1234–1242, (2006).


[19] A. Sotiriadis, S. Papatheodorou, and G. Makrydimas, Threatened miscarriage: Evaluation and management, British Medical Journal, 329, no. 7458, 152–155, (2004).


[20] N. S. Qureshi, E. C. Edi-Osagie, V. Ogbo, S. Ray, and R. E. Hopkins, First trimester threatened miscarriage treatment with human chorionic gonadotrophins: A randomised controlled trial, BJOG: An International Journal of Obstetrics and Gynaecology, 112, no. 11, 1536–1541, (2005).


[21] A. García-Enguídanos, M. E. Calle, J. Valero, S. Luna, and V. Domínguez-Rojas, Risk factors in miscarriage: A review, European Journal of Obstetrics Gynecology and Reproductive Biology, 102, no. 2, 111–119, (2002).


[22] X. Weng, R. Odouli, and D.-K. Li, Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study, American Journal of Obstetrics and Gynecology, 198, no. 3, 279–e1, (2008).

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