Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance

McCord, Marian L.; Muram, David; Buster, John E.; Arheart, Kristopher L.; Stovall, Thomas G.; Carson, Sandra Ann

doi:10.1016/s0015-0282(16)58560-4

Cited by 119 publications

(60 citation statements)

References 8 publications

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“…Of a cohort of symptomatic first-trimester patients with progesterone values <5.0 ng/mL, only two of 1,279 (0.16%) had a final diagnosis of normal IUP. 12 In patients for whom the diagnosis of normal IUP has been excluded, a DϩE procedure is useful because it excludes the diagnosis of ectopic pregnancy in more than half of these cases.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Endometrial Stripe Thickness in Patients with Suspected Ectopic Pregnancy Who Have an Empty Uterus at Ultrasonography

Dart

Mitchell

et al. 1999

Academic Emergency Medicine

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Abstract. Prior research suggests that, in patients with empty uteri at ultrasonography, endometrial stripe thickness may be predictive of ectopic pregnancy or the likelihood of obtaining chorionic villi after a dilatation and evacuation procedure (DϩE). However, it is unclear whether the predictive value of endometrial stripe thickness is confined to patients with low beta-human chorionic gonadotropin (␤-hCG) values. Objective: To determine whether endometrial stripe thickness is predictive of the risk of ectopic pregnancy or the likelihood of obtaining chorionic villi after DϩE in patients with ␤-hCG values >1,000 mIU/mL or Յ1,000 mIU/mL. Methods: In an urban academic ED, the authors conducted a retrospective chart review of consecutive ED patients from August 1991 to August 1997 with abdominal pain or vaginal bleeding, a positive ␤-hCG value, and an empty uterus by transvaginal ultrasound examination. Patients were divided into four groups-group 1: endometrium thin, ␤-hCG value Յ1,000 mIU/mL; group 2: endometrium thick, ␤-hCG value Յ1,000 mIU/mL; group 3: endometrium thin, ␤-hCG value >1,000 mIU/ mL; and group 4: endometrium thick, ␤-hCG value >1,000 mIU/mL. The secondary analysis was limited to patients who had a DϩE performed within 48 hours of the ED visit. The risks of ectopic pregnancy and the likelihoods of obtaining chorionic villi after DϩE were compared using chi-square or Fishers' exact test where appropriate, with a p-value of 0.05 being significant. Results: 224 patients were enrolled in the initial analysis. Intergroup differences in the frequency of ectopic pregnancy were of borderline significance (p = 0.08). However, when the comparison was limited to the groups with ␤-hCG values Յ1,000 mIU/mL, the predictive value of endometrial stripe thickness reached statistical significance (group 1: 27/99 [27%], group 2: 2/28 [7%], p = 0.05). 79 patients had a DϩE performed. Intergroup differences in the rate of obtaining chorionic villi were significant (p = 0.002). Group 1 had the lowest frequency of having chorionic villi identified (4/26 [15%]) and was the only group in which villi were obtained in fewer than 50% of cases. Conclusion: Endometrial stripe thickness may be predictive of the risk of ectopic pregnancy and the likelihood of obtaining chorionic villi at DϩE. However, its predictive value appears to be confined to patients with ␤-hCG values Յ1,000 mIU/mL.

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Section: Discussionmentioning

confidence: 99%

The Predictive Value of Endometrial Stripe Thickness in Patients with Suspected Ectopic Pregnancy Who Have an Empty Uterus at Ultrasonography

Dart

Mitchell

et al. 1999

Academic Emergency Medicine

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“…Many subsequent studies into the utility of progesterone as a biomarker for tubal ectopic pregnancy had similar results. Serum progesterone levels are significantly lower in tubal ectopic pregnancy but that they are not discriminative enough to be diagnostic in isolation (Mantzavinos et al 1991, Grosskinsky et al 1993, Kuscu et al 1993, Daily et al 1994, Ledger et al 1994, McCord et al 1996, O'Leary et al 1996, Mol et al 1998b, Buckley et al 2000, Condous et al 2004, Mueller et al 2004. However, the concept that progesterone can be a marker of serial hCG dynamics …”

Section: Progesteronementioning

confidence: 99%

Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities

Cartwright¹,

Duncan²,

Critchley³

et al. 2009

Reproduction

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Ectopic pregnancy remains a considerable cause of maternal morbidity and mortality worldwide. Currently, it is diagnosed using a combination of transvaginal ultrasound and serial serum b-human chorionic gonadotrophin levels. Diagnosis is often delayed and these tests are time-consuming and costly, both psychologically to the patient and financially to health services. The development of a biomarker that can differentiate a tubal ectopic from an intrauterine implantation is therefore important. In the pre-genomic era, a one-by-one scientific approach has revealed over 20 candidate biomarkers that could be used as a test to diagnose ectopic pregnancy although at present their clinical utility is very limited. These biomarkers cluster into themes: markers of abnormal embryo/trophoblast growth, markers of abnormal corpus luteum function, markers of a growing pregnancy in the Fallopian tube, markers of inflammation and peritoneal irritation, and uterine markers of normal implantation. It is likely that this thematic approach will facilitate the identification of newer biomarkers using microarray technology and inform the development of investigative paradigms using multiple markers at the time of presentation.

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“…In the past, EP was diagnosed on clinical symptoms such as vaginal bleeding and lower abdominal pain, but it imposed constraints on early detection [53]. It is worthy to mention that the initial diagnosis of first-trimester hemorrhage presents a crucial challenge.…”

Section: Diagnosis Of Ectopic Pregnancymentioning

confidence: 99%

Ectopic Pregnancy: Diagnosis, Prevention and Management

Abdulkareem¹,

Eidan²

2017

Obstetrics

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An ectopic pregnancy (EP) falls within the area of the gynecological emergency and/or reproductive management of women, which is the implantation of fertilized ovum outside the endometrial cavity. The etiology of EP concentrated mainly on factor causes delayed transport of the fertilized ovum through the fallopian tube (favors implantation in tubal mucosa), thus giving rise to EP. This chapter describes the causes, diagnosis, prevention and the guidelines to improve the management of women who may have an EP, a major gynecological emergency that is a cause of morbidity or even mortality of women in first trimester. Three types of EP are diagnosed: tubal, cervical and ovarian; tubal is the main type. Identification of the signs and symptoms of acute and chronic EP in women, involving classical clinical trials or other symptoms common to early pregnancy, as well as evaluating the most important congenital and acquired factors related with EP, were discussed. Explanation of the most accurate methods used to diagnose the pregnancy including serum beta hCG and progesterone levels, medical history, ultrasonography, pregnancy tests and laparoscopy was also clarified. The evaluation of the most effective management tools of EP, including methotrexate administration and surgery (laparotomy and laparoscopy), was obviously explained.

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Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance

Cited by 119 publications

References 8 publications

The Predictive Value of Endometrial Stripe Thickness in Patients with Suspected Ectopic Pregnancy Who Have an Empty Uterus at Ultrasonography

The Predictive Value of Endometrial Stripe Thickness in Patients with Suspected Ectopic Pregnancy Who Have an Empty Uterus at Ultrasonography

Serum biomarkers of tubal ectopic pregnancy: current candidates and future possibilities

Ectopic Pregnancy: Diagnosis, Prevention and Management

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