Ku Chee Wai, Allen John C, Malhotra Rahul, Chong Han Chung, Tan Nguan Soon, Østbye Truls, Lek Sze Min, Lie Desiree, Tan Thiam Chye
a Duke-National University of Singapore Graduate Medical School , Singapore .
b Department of Obstetrics and Gynecology , KK Women's and Children's Hospital , Singapore .
Gynecol Endocrinol. 2015;31(8):647-51. doi: 10.3109/09513590.2015.1031103. Epub 2015 Jun 2.
This study seeks to establish progesterone and progesterone-induced blocking factor (PIBF) levels as predictors of subsequent completed miscarriage among women presenting with threatened miscarriage between 6 and 10 weeks of gestation. Our secondary objective was to assess the known maternal risk factors, toward development of a parsimonious and clinician-friendly risk assessment model for predicting completed miscarriage. In this article, we present a prospective cohort study of 119 patients presenting with threatened miscarriage from gestation weeks 6 to 10 at a tertiary women's hospital emergency unit in Singapore. Thirty (25.2%) women had a spontaneous miscarriage. Low progesterone and PIBF levels are similarly predictive of subsequent completed miscarriage. Study results (OR, 95% CI) showed that higher levels of progesterone (0.91, 95% CI 0.88-0.94) and PIBF (0.99, 95% CI 0.98-0.99) were associated with lower risk of miscarriage. Low progesterone level was a very strong predictor of miscarriage risk in our study despite previous concerns about its pulsatile secretion. Low serum progesterone and PIBF levels predicted spontaneous miscarriage among women presenting with threatened miscarriage between gestation weeks 6 to 10. Predictive models to calculate probability of spontaneous miscarriage based on serum progesterone, together with maternal BMI and fetal heart are proposed.
本研究旨在确定妊娠6至10周出现先兆流产的女性体内孕酮及孕酮诱导封闭因子（PIBF）水平，以预测随后是否会发生难免流产。我们的次要目标是评估已知的母亲风险因素，从而开发一种简洁且便于临床医生使用的风险评估模型，用于预测难免流产。在本文中，我们对新加坡一家三级妇产医院急诊科119例妊娠6至10周出现先兆流产的患者进行了一项前瞻性队列研究。30例（25.2%）女性发生了自然流产。低孕酮和PIBF水平同样可预测随后的难免流产。研究结果（OR，95%CI）显示，较高水平的孕酮（0.91，95%CI 0.88 - 0.94）和PIBF（0.99，95%CI 0.98 - 0.99）与较低的流产风险相关。尽管之前有人担心孕酮的脉冲式分泌，但在我们的研究中，低孕酮水平是流产风险的一个非常强的预测指标。低血清孕酮和PIBF水平可预测妊娠6至10周出现先兆流产的女性发生自然流产。我们提出了基于血清孕酮、母亲BMI和胎儿心率来计算自然流产概率的预测模型。
