Document Detail


Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients.
MedLine Citation:
PMID:  10918099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: This study was conducted to prospectively measure the accuracy of serum progesterone levels to detect ectopic pregnancy. METHODS: Seven hundred sixteen symptomatic first-trimester emergency department patients with abdominal pain or vaginal bleeding at a tertiary care military teaching hospital had progesterone levels measured by radioimmunoassay with results unavailable to the treating physician. All patients were monitored until a criterion standard diagnosis of intrauterine pregnancy or ectopic pregnancy was confirmed. RESULTS: A 14-month derivation phase (n=399) used receiver operating characteristic curve testing to select a cutoff value of progesterone less than 22 ng/mL. A 12-month validation phase (n=317) then retested this cutoff value. Combining both phases, there were 434 (61%) viable intrauterine pregnancies, 229 (32%) nonviable intrauterine pregnancies, and 52 (7. 3%) ectopic pregnancies, of which 17 were ruptured. Sensitivity, specificity, positive predictive values, and negative predictive values (95% confidence intervals) for progesterone levels less than 22 ng/mL to detect ectopic pregnancy were 100% (94% to 100%), 27% (23% to 30%), 10% (7% to 12%), and 100% (98% to 100%), respectively. CONCLUSION: Given similar disease prevalence, roughly one fourth (178/716) of symptomatic patients can be classified as low risk (0%, 95% confidence interval 0 to 2%) for having an ectopic pregnancy using a progesterone cutoff of 22 ng/mL. Whether implementation of rapid progesterone testing can safely expedite care and reduce the need for urgent diagnostic evaluation or admission remains to be determined.
Authors:
R G Buckley; K J King; J D Disney; R H Riffenburgh; J D Gorman; J H Klausen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  36     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2000 Aug 
Date Detail:
Created Date:  2000-09-08     Completed Date:  2000-09-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  95-100     Citation Subset:  AIM; IM    
Affiliation:
Departments of Emergency Medicine, Clinical Investigations, Radiology, and Obstetrics and Gynecology, Naval Medical Center San Diego, CA, USA. rgbuckley@rota.med.navy.mil
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / diagnosis,  etiology
Adult
Biological Markers / blood
Confidence Intervals
Emergency Service, Hospital
Female
Humans
Predictive Value of Tests
Pregnancy
Pregnancy Trimester, First
Pregnancy, Ectopic / blood,  diagnosis*
Progesterone / blood*
Prospective Studies
ROC Curve
Radioimmunoassay
Registries
Sensitivity and Specificity
Uterine Hemorrhage / diagnosis,  etiology
Chemical
Reg. No./Substance:
0/Biological Markers; 57-83-0/Progesterone

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


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