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000177603 0247_ $$2ISSN$$a1600-0412
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000177603 037__ $$aDKFZ-2021-02662
000177603 041__ $$aEnglish
000177603 082__ $$a610
000177603 1001_ $$00000-0003-0540-2191$$aBobdiwala, Shabnam$$b0
000177603 245__ $$aEvaluating cut-off levels for progesterone, β human chorionic gonadotropin and β human chorionic gonadotropin ratio to exclude pregnancy viability in women with a pregnancy of unknown location: A prospective multicenter cohort study.
000177603 260__ $$aMalden, MA$$bWiley-Blackwell$$c2022
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000177603 500__ $$a2022 Jan;101(1):46-55
000177603 520__ $$aThere is no global agreement on how to best determine pregnancy of unknown location viability and location using biomarkers. Measurements of progesterone and β human chorionic gonadotropin (βhCG) are still used in clinical practice to exclude the possibility of a viable intrauterine pregnancy (VIUP). We evaluate the predictive value of progesterone, βhCG, and βhCG ratio cut-off levels to exclude a VIUP in women with a pregnancy of unknown location.This was a secondary analysis of prospective multicenter study data of consecutive women with a pregnancy of unknown location between January 2015 and 2017 collected from dedicated early pregnancy assessment units of eight hospitals. Single progesterone and serial βhCG measurements were taken. Women were followed up until final pregnancy outcome between 11 and 14 weeks of gestation was confirmed using transvaginal ultrasonography: (1) VIUP, (2) non-viable intrauterine pregnancy or failed pregnancy of unknown location, and (3) ectopic pregnancy or persisting pregnancy of unknown location. The predictive value of cut-off levels for ruling out VIUP were evaluated across a range of values likely to be encountered clinically for progesterone, βhCG, and βhCG ratio.Data from 2507 of 3272 (76.6%) women were suitable for analysis. All had data for βhCG levels, 2248 (89.7%) had progesterone levels, and 1809 (72.2%) had βhCG ratio. The likelihood of viability falls with the progesterone level. Although the median progesterone level associated with viability was 59 nmol/L, VIUP were identified with levels as low as 5 nmol/L. No single βhCG cut-off reliably ruled out the presence of viability with certainty, even when the level was more than 3000 IU/L, there were 39/358 (11%) women who had a VIUP. The probability of viability decreases with the βhCG ratio. Although the median βhCG ratio associated with viability was 2.26, VIUP were identified with ratios as low as 1.02. A progesterone level below 2 nmol/L and βhCG ratio below 0.87 were unlikely to be associated with viability but were not definitive when considering multiple imputation.Cut-off levels for βhCG, βhCG ratio, and progesterone are not safe to be used clinically to exclude viability in early pregnancy. Although βhCG ratio and progesterone have slightly better performance in comparison, single βhCG used in this manner is highly unreliable.
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000177603 650_7 $$2Other$$aearly pregnancy complications
000177603 650_7 $$2Other$$aectopic pregnancy
000177603 650_7 $$2Other$$apregnancy
000177603 650_7 $$2Other$$apregnancy of unknown location
000177603 650_7 $$2Other$$areproductive endocrinology
000177603 650_7 $$2Other$$aultrasound
000177603 7001_ $$00000-0001-9001-5545$$aKyriacou, Christopher$$b1
000177603 7001_ $$0P:(DE-He78)8da2eca0bc6341c8681c317fe2b8e27b$$aChristodoulou, Evangelia$$b2$$udkfz
000177603 7001_ $$00000-0002-8082-6499$$aFarren, Jessica$$b3
000177603 7001_ $$00000-0003-0299-9586$$aMitchell-Jones, Nicola$$b4
000177603 7001_ $$aAl-Memar, Maya$$b5
000177603 7001_ $$aAyim, Francis$$b6
000177603 7001_ $$aChohan, Baljinder$$b7
000177603 7001_ $$aKirk, Emma$$b8
000177603 7001_ $$aAbughazza, Osama$$b9
000177603 7001_ $$aGuruwadahyarhalli, Bramara$$b10
000177603 7001_ $$aGuha, Sharmistha$$b11
000177603 7001_ $$aVathanan, Veluppillai$$b12
000177603 7001_ $$aGould, Debbie$$b13
000177603 7001_ $$aStalder, Catriona$$b14
000177603 7001_ $$00000-0002-3707-6645$$aTimmerman, Dirk$$b15
000177603 7001_ $$00000-0003-1613-7450$$aVan Calster, Ben$$b16
000177603 7001_ $$00000-0003-1421-6059$$aBourne, Tom$$b17
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