title: How can we better predict the risk of spontaneous miscarriage among women experiencing threatened miscarriage?
abstract: 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.
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .|b Department of Obstetrics and Gynecology , KK Women's and Children's Hospital , Singapore .
authors.forename: Chee Wai
authors.initials: CW
authors.lastname: Ku
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .
authors.forename: John C
authors.initials: JC
authors.lastname: Allen
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .
authors.forename: Rahul
authors.initials: R
authors.lastname: Malhotra
authors.affiliation: c School of Biological Sciences, Nanyang Technological University , Singapore , and.
authors.forename: Han Chung
authors.initials: HC
authors.lastname: Chong
authors.affiliation: c School of Biological Sciences, Nanyang Technological University , Singapore , and.|d Institute of Molecular and Cell Biology, A*STAR , Singapore.
authors.forename: Nguan Soon
authors.initials: NS
authors.lastname: Tan
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .
authors.forename: Sze Min
authors.initials: SM
authors.lastname: Lek
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .
authors.forename: Desiree
authors.initials: D
authors.lastname: Lie
authors.affiliation: a Duke-National University of Singapore Graduate Medical School , Singapore .|b Department of Obstetrics and Gynecology , KK Women's and Children's Hospital , Singapore .
authors.forename: Thiam Chye
authors.initials: TC
authors.lastname: Tan
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D000033:Abortion, Threatened / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011261:Pregnancy Trimester, First; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment; D013491:Suppressor Factors, Immunologic / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C110058:PIBF1 protein, human; D011257:Pregnancy Proteins; D013491:Suppressor Factors, Immunologic; D011374:Progesterone
keywords: Miscarriage; predictive; progesterone; progesterone-induced blocking factor