Progesterone to Rule out an Ectopic Pregnancy
Date First Published:
June 28, 2005
Last Updated:
July 22, 2005
Report by:
Emma Shawkat, 4th Year Medical Student (Manchester Royal Infirmary)
Three-Part Question:
In [women presenting with vaginal bleeding] can a [single measurement of Progesterone] [rule out/diagnose an ectopic pregnancy]?
Clinical Scenario:
A 31 year old women presents to accident and emergency with vaginal bleeding. You wonder if a single measurement of serum progesterone can be used to diagnose or rule out an ectopic pregnancy?
Search Strategy:
Medline 1966-06/05 using the OVID interface
Embase 1980-06/05
CINAHL 1982-06/05
The Cochrane Library Issue 2, 2005
Embase 1980-06/05
CINAHL 1982-06/05
The Cochrane Library Issue 2, 2005
Search Details:
{([ectopic pregnancy.mp. or exp Pregnancy, Ectopic or tubal pregnancy.mp. or exp Pregnancy, Tubal or abdominal pregnancy.mp. or exp Pregnancy, Abdominal or extrauterine pregnancy.mp] AND [exp PROGESTERONE or progesterone.mp]) LIMIT to humans and enlgish language}
Cochrane 'ectopic pregnancy' AND 'progesterone'
Cochrane 'ectopic pregnancy' AND 'progesterone'
Outcome:
118 papers were found using Medline, there was 1 meta-analysis. The search was repeated but limited between 2005 and 1998 giving 35 papers, of which 1 was relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis Mol BW. Lijmer JG. Ankum WM. van der Veen F. Bossuyt PM 1998 ENGLAND | 26 studies evaluating the performance of a single serum prgesterone measurement in the diagnosis of ectopic pregnancy | Meta-analysis | Pregnancy failure from viable IUP | Almost perfect specificity with a sensitivity of 60%, or 95% sensitive with a specificity of 40% | No threshold values are given for the above specificities and sensitivities for distinction between pregnancy failure and viable IUP and ectopic pregnancy from non-ectopic pregnancy |
| Ectopic pregnancy from non-ectopic | Specificity >90% with a sensitivity of 15% or 95% sensitive with a specificity of <40% | ||||
| Ruling out pregnancy failure | Threshold value of 20ng/ml: Sensitivity 95% with a specificity of 40% | ||||
| Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients Buckley RG. King KJ. Disney JD. Riffenburgh RH. Gorman JD. Klausen JH 2000 UNITED STATES | 716 symptomatic first-trimester emergency department patients with abdominal pain or vaginal bleeding at a tertiary care military teaching hospital had progesterone levels measured by radioimmunoassay with results unavailable to the treating physician. All patients were monitored until a criterion standard diagnosis of intrauterine pregnancy or ectopic pregnancy was confirmed | Derviation study | Ectopic pregnancy | Progesterone level <22ng/ml`: Sensitivity 100%, Specificity 24%, PPV 9% and NPV 100% |
Author Commentary:
The two studies both had different cutoff values. The meta-analysis reported a lower sensitivity to the other study, which reported 100%.
Bottom Line:
A single measurement of serum progesterone is insufficiently sensitive and specific to allow a definite diagnosis of ectopic pregnancy. However, it can help determine the risk.
References:
- Mol BW. Lijmer JG. Ankum WM. van der Veen F. Bossuyt PM. The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis
- Buckley RG. King KJ. Disney JD. Riffenburgh RH. Gorman JD. Klausen JH. Serum progesterone testing to predict ectopic pregnancy in symptomatic first-trimester patients