title: Progesterone as a predictor of ectopic pregnancy when the ultrasound is indeterminate.
abstract: The objective of this study was to evaluate a progesterone cutpoint of 5.0 ng/mL ability to identify abnormal pregnancy (abnormal intrauterine pregnancy and ectopic pregnancy) as well as ectopic pregnancy alone in 2 subclasses of indeterminate ultrasounds. This was a prospective observational study of emergency department patients with abdominal pain or vaginal bleeding and an indeterminate transvaginal ultrasound. Two subclasses of indeterminate ultrasounds were eligible: those with an empty uterus and a beta-human chorionic gonadotropin value <3,000 mIU/mL and those with a nonspecific fluid collection. Patients were enrolled if a progesterone assay was collected the day of the emergency department visit. Patients were excluded if lost to follow-up. One hundred sixty patients were enrolled. Of these, 24 were diagnosed with ectopic pregnancy. The sensitivity and specificity of progesterone identifying abnormal pregnancy were 84% and 97%, respectively. The sensitivity and specificity of progesterone identifying ectopic pregnancy were 88% and 40%, respectively. In the 2 subclasses, the progesterone cutpoint was both sensitive and specific in identifying abnormal pregnancy and was sensitive but only moderately specific for identifying ectopic pregnancy.
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston, MA 02118-2393, USA. rdart@bu.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Dart
authors.forename: Prasanthi
authors.initials: P
authors.lastname: Ramanujam
authors.forename: Linda
authors.initials: L
authors.lastname: Dart
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage / Q000209:etiology
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D011374:Progesterone