Document Detail

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies.
MedLine Citation:
PMID:  23045257     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the accuracy with which a single progesterone measurement in early pregnancy discriminates between viable and non-viable pregnancy.
DESIGN: Systematic review and meta-analysis of diagnostic accuracy studies.
DATA SOURCES: Medline, Embase, CINAHL, Web of Science, ProQuest, Conference Proceedings Citation Index, and the Cochrane Library from inception until April 2012, plus reference lists of relevant studies.
STUDY SELECTION: Studies were selected on the basis of participants (women with spontaneous pregnancy of less than 14 weeks of gestation); test (single serum progesterone measurement); outcome (viable intrauterine pregnancy, miscarriage, or ectopic pregnancy) diagnosed on the basis of combinations of pregnancy test, ultrasound scan, laparoscopy, and histological examination; design (cohort studies of test accuracy); and sufficient data being reported.
RESULTS: 26 cohort studies, including 9436 pregnant women, were included, consisting of 7 studies in women with symptoms and inconclusive ultrasound assessment and 19 studies in women with symptoms alone. Among women with symptoms and inconclusive ultrasound assessments, the progesterone test (5 studies with 1998 participants and cut-off values from 3.2 to 6 ng/mL) predicted a non-viable pregnancy with pooled sensitivity of 74.6% (95% confidence interval 50.6% to 89.4%), specificity of 98.4% (90.9% to 99.7%), positive likelihood ratio of 45 (7.1 to 289), and negative likelihood ratio of 0.26 (0.12 to 0.57). The median prevalence of a non-viable pregnancy was 73.2%, and the probability of a non-viable pregnancy was raised to 99.2% if the progesterone was low. For women with symptoms alone, the progesterone test had a higher specificity when a threshold of 10 ng/mL was used (9 studies with 4689 participants) and predicted a non-viable pregnancy with pooled sensitivity of 66.5% (53.6% to 77.4%), specificity of 96.3% (91.1% to 98.5%), positive likelihood ratio of 18 (7.2 to 45), and negative likelihood ratio of 0.35 (0.24 to 0.50). The probability of a non-viable pregnancy was raised from 62.9% to 96.8%.
CONCLUSION: A single progesterone measurement for women in early pregnancy presenting with bleeding or pain and inconclusive ultrasound assessments can rule out a viable pregnancy.
Jorine Verhaegen; Ioannis D Gallos; Norah M van Mello; Mohamed Abdel-Aziz; Yemisi Takwoingi; Hoda Harb; Jonathan J Deeks; Ben W J Mol; Arri Coomarasamy
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2012-09-27
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  345     ISSN:  1756-1833     ISO Abbreviation:  BMJ     Publication Date:  2012  
Date Detail:
Created Date:  2012-10-09     Completed Date:  2012-12-11     Revised Date:  2013-08-28    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  England    
Other Details:
Languages:  eng     Pagination:  e6077     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynaecology, Academic Medical Centre University of Amsterdam, Amsterdam, Netherlands.
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MeSH Terms
Abdominal Pain / etiology*
Abortion, Spontaneous / blood,  diagnosis
Biological Markers / blood
Cohort Studies
Obstetric Labor, Premature / diagnosis*
Predictive Value of Tests
Progesterone / blood*
Sensitivity and Specificity
Uterine Hemorrhage / etiology*
Reg. No./Substance:
0/Biological Markers; 57-83-0/Progesterone
Comment In:
J Fam Pract. 2013 Jun;62(6):305-16   [PMID:  23828803 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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