Kadam Vijay K, Agrawal Shivani, Saxena Pinkee, Laul Poonam
Department of Obstetrics and Gynaecology, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi, 110064 India.
J Obstet Gynaecol India. 2019 Oct;69(5):431-435. doi: 10.1007/s13224-019-01228-0. Epub 2019 May 9.
Bleeding is commonly seen during early pregnancy, and predicting the outcome of pregnancy in such cases is a difficult task. The aim of our study was to evaluate the predictive value of single serum progesterone level for finding the viability in threatened miscarriage and to determine the cut-off value for a viable ongoing pregnancy.
This was a prospective study in which patients attending the OPD with early pregnancy and bleeding were recruited. Inclusion criteria were period of amenorrhoea less than 12 weeks, complaints of bleeding per vaginum with or without lower abdominal pain and positive urine pregnancy test or serum beta HCG. Multiple pregnancies, inevitable miscarriage, ectopic pregnancy, molar pregnancy and pregnancy achieved by artificial reproductive techniques were excluded from this study. A detailed clinical examination was done, and routine investigations along with serum progesterone were done. Patients were followed up by serial ultrasound for viability, and their outcome was recorded.
A total of 150 patients with early pregnancy threatened miscarriage were enrolled for this study. Of the patients studied, 105 (70%) had a viable pregnancy and 45 (30%) had non-viable pregnancies. The mean serum progesterone was higher in the viable pregnancy, 17.97 ± 7.75 ng/ml, compared to non-viable group, 6.21 ± 2.86 ng/ml. The area under curve was calculated, and a cut-off value of 10.08 ng/ml was obtained. 83.8% of viable pregnancies had serum progesterone more than or equal to 10.08 ng/ml which was statistically significant.
A single value of progesterone is useful in predicting the viability of the ongoing threatened pregnancy. Serum progesterone with a cut-off value of 10.8 ng/ml was found to have a positive predictive value of 95.7% and negative predictive value of 70.7% with an accuracy of 86%.
早期妊娠期间出血较为常见，预测此类情况下的妊娠结局是一项艰巨的任务。我们研究的目的是评估单次血清孕酮水平对判断先兆流产中妊娠是否存活的预测价值，并确定持续妊娠存活的临界值。
这是一项前瞻性研究，招募在门诊出现早期妊娠并伴有出血的患者。纳入标准为闭经时间少于12周、有或无下腹痛的阴道出血主诉以及尿妊娠试验阳性或血清β-HCG阳性。本研究排除多胎妊娠、难免流产、异位妊娠、葡萄胎妊娠以及通过人工生殖技术实现的妊娠。进行了详细的临床检查，并进行了包括血清孕酮在内的常规检查。通过连续超声检查对患者进行随访以确定妊娠是否存活，并记录其结局。
本研究共纳入150例早期妊娠先兆流产患者。在研究的患者中，105例（70%）妊娠存活，45例（30%）妊娠未存活。存活妊娠组的平均血清孕酮水平较高，为17.97±7.75 ng/ml，而非存活组为6.21±2.86 ng/ml。计算曲线下面积，得出临界值为10.08 ng/ml。83.8%的存活妊娠血清孕酮水平大于或等于10.08 ng/ml，具有统计学意义。
单次孕酮值有助于预测持续先兆妊娠的存活情况。发现临界值为10.8 ng/ml的血清孕酮阳性预测值为95.7%，阴性预测值为70.7%，准确率为86%。
