Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage.

摘要

PURPOSE: To investigate the predictive power of progesterone combined with beta human chorionic gonadotropin (beta-HCG) measurements in the outcome of threatened miscarriage. METHODS: This retrospective study was conducted on 245 intrauterine pregnant women from January 2006 to October 2008. 175 women with threatened miscarriages who consulted for vaginal bleeding received exogenous progesterone supplements. There were 108 patients with ongoing pregnancies until delivery and 67 patients with inevitable miscarriages. Control group included 70 pregnant women. Serum concentrations of progesterone and beta-HCG were measured by Microparticle enzyme immunoassay between the fourth and fifth gestational weeks. The discrimination attained between the two study groups (ongoing pregnancies and inevitable miscarriages) was evaluated by logistic regression and receiver operating characteristic curve analysis. RESULTS: The mean serum levels of progesterone and beta-HCG in patients with inevitable miscarriages (13.76 +/- 5.52 ng/ml, 3,647.00 +/- 2,123.00 mIU/ml, respectively) were significantly lower than these levels in normal intrauterine pregnancies (31.67 +/- 5.86 ng/ml, 13,437.00 +/- 6,256.00 mIU/ml, respectively) and ongoing pregnancies (25.47 +/- 6.18 ng/ml, 8,492.00 +/- 2,389.00 mIU/ml, respectively) (P < 0.001). Serum progesterone combined with beta-HCG measurements, with a diagnostic accuracy of 85.7% (sensitivity 88.1%, specificity 84.3%), had the best prognostic reliability and significant differences were found when this parameter was compared with the predictive value of a single progesterone (diagnostic accuracy 72.5%, sensitivity 76.1%, specificity 70.4%) or beta-HCG (diagnostic accuracy 74.8%, sensitivity 64.1%, specificity 81.4%) determinations. A combination of two biochemical parameters shows substantial improvement over a single-marker strategy. CONCLUSIONS: Progesterone combined with beta-HCG measurements may be useful for predicting the outcome of threatened miscarriage.