Serum Progesterone and 17-Hydroxyprogesterone in the Diagnosis of Ectopic Pregnancies and the Value of Progesterone Replacement in Intrauterine Pregnancies when Serum Progesterone Levels Are Low

Choe, Jonggeun; Check, Jerome H.; Nowroozi, Kosrow; Benveniste, Robert; Barnea, Eytan R.

doi:10.1159/000292745

Cited by 13 publications

(6 citation statements)

References 6 publications

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“…Overall, 26 studies were eligible for inclusion, with a total of 9436 participants. Nineteen studies included women with pain or bleeding alone,16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 and seven studies included women with pain or bleeding and inconclusive ultrasound diagnosis 3435 36 37 38 39 40 The supplementary (web extra) table shows the characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…The table shows the pooled diagnostic accuracy estimates for identifying women with non-viable pregnancies with the most commonly reported thresholds, and figure 5 shows the estimates separately for each study according to available cut-off values. For women with symptoms alone, the progesterone test had a higher specificity using a threshold of 10 ng/mL (nine studies with 4689 participants18 20 21 24 26 29 30 31 32), rather than higher thresholds at 15 and 20 ng/mL, 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 median prevalence of a non-viable pregnancy in the studies included in this analysis was 62.9%; this was raised to 96.8% if the progesterone was lower than 10 ng/mL compared with a 37.2% probability if the progesterone was higher.…”

Section: Resultsmentioning

confidence: 99%

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Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

Verhaegen

Gallos

Mello

et al. 2012

BMJ

117

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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%. ConclusionA single progesterone measurement for women in early pregnancy presenting with bleeding or pain and inconclusive ultrasound assessments can rule out a viable pregnancy. IntroductionVaginal bleeding and abdominal pain are the most common causes of consultation in early pregnancy; 30% of women will experience pain or bleeding in their first trimester.1 These symptoms lead to anxiety and can be the first signs of a possible miscarriage or an ectopic pregnancy. Miscarriage occurs in 10-20% of all recognised pregnancies, and the prevalence of ectopic pregnancies in the United Kingdom is 1.6%, which is raised to 3% in women with symptoms.2-4 Most women seeking medical advice have a transvaginal ultrasound scan to confirm a viable pregnancy, a miscarriage, or an ectopic pregnancy. However, even with expert use of transvaginal ultrasound, confirming if a pregnancy is intrauterine or extrauterine may not be possible in 8-31% of cases at the ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

Verhaegen

Gallos

Mello

et al. 2012

BMJ

117

View full text Add to dashboard Cite

show abstract

“…Indeed, the authors found that if aggressive progesterone therapy was initiated in the first trimester when the progesterone was <15 ng/ml 70% did not have a miscarriage [110]. The authors even found that 60% could be salvaged with aggressive progesterone therapy with a serum progesterone level <8 pg/ ml [111]. Thus, the authors are under the impression that at least some miscarriages may be caused by a corpus luteum of pregnancy not making enough progesterone and intervention with supplemental progesterone can allow a majority to have successful pregnancies.…”

Section: Progesterone To Prevent Miscarriagementioning

confidence: 99%

The role of progesterone and the progesterone receptor in human reproduction and cancer

Check

Cohen

2013

Expert Review of Endocrinology & Metabolism

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Insufficient progesterone, effect possibly more on immune factors rather than adequate endometrial development, can be an easy remedial cause of infertility by simply supplementing the luteal phase with either vaginal or intramuscular or oral (dydrogesterone) progesterone. Progesterone will also help to reduce miscarriage rates when follicle maturing drugs are used for those with regular menses but follicular maturation defects, or women with recurrent miscarriages. One mechanism of action seems to be related to production of an immunomodulatory protein, the progesterone-induced blocking factor either in the cytoplasm or in the circulation. PIBF inhibits cytotoxicity of natural killer cells. Cancer cells may 'borrow' the same mechanism to escape NK cell immunosurveillance. KEYWORDS: cancer • growth factors • immunosuppression • infertility • miscarriage • preterm delivery • progesterone• progesterone receptor • progesterone receptor antagonist • progesterone-induced blocking factor

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“…However, we demonstrated a miscarriage rate of only 30% when pregnant women were aggressively treated with a combination of IM and vaginal P [26]. In fact even with serum P level < 8 ng/mL, aggressive P therapy reduced the miscarriage rate to 40% [27].…”

Section: Introductionmentioning

confidence: 99%

Pros and cons of the use of progesterone to reduce miscarriage rates

Check¹

2018

Clin. Exp. Obstet. Gynecol.

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To present flaws in the experimental design of a recent randomized controlled trial (RCT) published in the prestigious journal The New England Journal of Medicine (NEJM) concerning the lack of benefit of using progesterone (P) to prevent miscarriage. Materials and Methods: The RCT started vaginal P not until confirmation of pregnancy up to six weeks gestation. Results: Evidence is provided why a properly designed RCT should initiate P therapy in the early luteal phase to maximally inhibit the increase in cytotoxic leukocytes [especially natural killer (NK) cells] that are in the area of the site of implantation that are needed for uterine remodeling. The cytotoxicity of these cellular immune cells need to be suppressed or they may attack the fetal semi-allograft. Evidence is provided to support the hypothesis that the main effect of P is to stimulate the rise of an immunosuppressive protein called the P-induced blocking factor (PIBF). Conclusions: The RCT published in a late 2015 edition of the NEJM should not be regarded as a conclusive study showing no benefit of P in reducing risk of miscarriage. This is not only because of not starting the P in the early luteal phase, but also the type of P used. Some studies have found that vaginal P does not raise the PIBF levels nearly as well as intramuscular P.

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Serum Progesterone and 17-Hydroxyprogesterone in the Diagnosis of Ectopic Pregnancies and the Value of Progesterone Replacement in Intrauterine Pregnancies when Serum Progesterone Levels Are Low

Cited by 13 publications

References 6 publications

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

The role of progesterone and the progesterone receptor in human reproduction and cancer

Pros and cons of the use of progesterone to reduce miscarriage rates

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