A multiple marker model to predict pregnancy viability when progesterone is indeterminate.
OBJECTIVE
To develop a model to differentiate viable from nonviable pregnancies at a single first-trimester visit.


METHODS
This prospective cohort study included 256 symptomatic women in the first trimester who presented to our urgent care unit in Providence, Rhode Island, between 2002 and 2004. Predictors of pregnancy viability were collected, including clinical information and serum samples for several biomarkers. Each predictor was evaluated alone and in conjunction with other variables using receiver operator characteristic curves. The cohort was separated into 2 subgroups based on whether the progesterone value was at the "extremes" (<5 ng/mL or >25 ng/mL) or in the "grey zone" (5-25 ng/mL).


RESULTS
Among single biomarkers, progesterone had the greatest diagnostic accuracy in predicting viability. Progesterone was highly accurate at the extremes (area under the curve [AUC] = 0.99) but less accurate in the grey zone (AUC = 0.71). A multiple marker model was developed to include progesterone for all patients, and human chorionic gonadotropin, ultrasound findings and symptoms for participants in the grey zone (AUC = 0.90).


CONCLUSIONS
A multiple marker model predicted pregnancy viability in symptomatic women with overall accuracy of 90%.
Plante
Beth J
BJ
Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown Medical School, USA. bethplante@gmail.com
Blume
Jeffrey D
JD
Lambert-Messerlian
Geralyn
G
Shackelton
Rebecca
R
Canick
Jacob
J
Phipps
Maureen G
MG
D000328:Adult; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D005328:Fetal Viability; D006801:Humans; D007265:Inhibins / Q000097:blood; D015233:Models, Statistical; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal
D015415:Biomarkers; D006063:Chorionic Gonadotropin; C422362:inhibin A; D011374:Progesterone; D007265:Inhibins