Relation between single serum progesterone assay and viability of the first trimester pregnancy

Abstract

This study was designed to detect the relation between serum progesterone and viability of pregnancy during the first trimester. Prospective study carried out in Al-Rashid Maternity and Ahmadi Kuwait oil company hospitals, over three years from February 2009 to February 2012. Two hundred and Sixty (260) pregnant women were hospitalized due to vaginal bleeding and/or abdominal pain during the first trimester of their pregnancies and were included in this study. Women included in this study were; sure of dates, conceived spontaneously with no history of infertility and had a positive serum pregnancy test. 2 ml blood samples were taken for women included in this study for serum progesterone assay. Women included in this study were followed by ultrasound for the viability of the pregnancy till the end of first trimester and the outcome of their pregnancy were recorded, while women with exogenous progesterone support or multiple pregnancies or suspected ectopic pregnancy or Hydatiform mole were excluded from this study. Data were collected and statistically analyzed to detect the relationship between serum progesterone level and viability of pregnancy during the first trimester. The mean age of the studied population was 32.7 ± 5.1 years, the mean gestational age at progesterone assay was 9.7 ± 0.5 week and by the end of the first trimester, women included in this study were classified according to the viability of their pregnancies into; viable pregnancy group 178 (68.5%) cases and non-viable pregnancy group (ended by miscarriage) 82 (31.5%) cases. The mean serum progesterone of the studied population was significantly high in viable pregnancy group (46.5 ± 7.4 ng/ml) compared to non-viable pregnancy group (9.9 ± 4.8 ng/ml), (p <0.05). In this study; 6.7% of viable pregnancies had serum progesterone level <10 ng/ ml, while 20.7% of non-viable pregnancies had serum progesterone level >10 ng/ml, the serum progesterone at cut off level 10 ng/ml was 79.3% sensitive to diagnose non-viable pregnancy and was 93.3% specific to diagnose viable pregnancy. Also, in this study; 1.1% of viable pregnancies had serum progesterone level <20 ng/ ml, while 4.8% of non-viable pregnancies had serum progesterone level >20 ng/ml, the serum progesterone at cut off level 20 ng/ml was 95.1% sensitive to diagnose non-viable pregnancy and was 98.9% specific to diagnose viable pregnancy. Serum progesterone is a reliable marker for early pregnancy failure and single assay of its serum level can differentiate between viable and non-viable pregnancies.

Luteal phase serum progesterone level as a predictor of vaginal bleeding or adverse pregnancy outcome in patients undergoing assisted reproductive techniques

“…The combined cut-off value of progesterone >25.2 ng/mL and β-hCG >126.5 mIU/mL may suggest a good prognosis. 19 Similar findings were seen in studies conducted by Abdelazim IA et al 20…”

The Ability of a Single Serum Progesterone Measurement to Predict the Prognosis of First Trimester Pregnancy

“…The Royal College of Obstetricians and Gynaecologists' guideline stated that the value of single serum progesterone in early pregnancy is useful for predicting the outcome of pregnancy, and when serum progesterone threshold is 20 nmol/L (about 6.2 ng/mL), it can be predicted non-viable pregnancies with 93% sensitivity, 94% specificity in symptomatic pregnant (22). In the study of Abdelazim et al when the serum progesterone cut-off level was 10 ng/ml, it was 79.3% sensitive for non-viable pregnancy diagnosis, 93.3% specific for viable pregnancy diagnosis; when serum progesterone cut-off level was 20 ng/ml, it was 95.1% sensitive for non-viable pregnancy diagnosis and 98.9% specific for viable pregnancy diagnosis (23). Elson et al reported that the 25 ng/mL serum progesterone cut-off value obtained by ROC curve statistical analysis predicts viable pregnancies with 100% sensitivity and 43% specificity (5).…”

Does maternal serum progesterone level in early pregnancy predict placental dysfunction in third trimester?

“…The importance of first trimester value of progesterone, which is necessary for preparation of the endometrium for implantation, support of decidualization required for a healthy maintenance of pregnancy, and development of immune tolerance against the fetus, has been shown in several studies on both single and multiple pregnancies. [1][2][3] In some studies emphasizing the role of progesterone in predicting gestational prognosis in early pregnancy, maternal progesterone level below 35 nmol/L (11 ng/mL equivalent) has been found to be associated with vaginal bleeding and miscarriage. [4,5] However, there are also studies stating different progesterone threshold values for healthy maintenance of pregnancy in the first trimester.…”