A very late reply - I was waiting for the outcome of a meeting yesterday with
the lead consultant in Obs & Gynae.
Last year I performed an audit of the use of progesterone testing in
PUL/EP/miscarriage at Kingston Hospital - we use the Roche E170 too. It was
found to be used (and abused) in all sorts of ways. We have now discussed
the outcome with the consultant, who has thought long and hard and decided
that the only time it helps to affect management is when there is a PUL (which
she has also checked for), with an HCG level that is not declining, or not
declining at the expected rate. In this situation a single progesterone level can
then help guide her as to how often to check the HCG, ie whether she needs
to perform 48hrly monitoring, or can leave the woman 1-2 weeks before
checking the HCG (therefore reducing hospital visits, anxiety etc).
In terms of interpretation, the table (XL file - attached) is the guideline given
to me by the consultant, which follows the levels given by the RCOG guidelines
She also sent me this from an internet article:
Predicting Outcomes in Pregnancies of Unknown Location: Serum Progesterone
Emma Kirk 1 and Tom Bourne 1,2
1Early Pregnancy & Gynaecology Ultrasound Unit, St George's, University of
London, Cranmer Terrace, London, SW170RE, UK.
2Department of Obstetrics & Gynaecology, University Hospital Gasthuisberg,
KU Leuven, Belgium
Single serum progesterone levels have been used to predict the outcome of
PULs. A serum progesterone level below 20 nmol/l has been shown to have a
positive predictive value greater than 95% of predicting pregnancy failure.
Levels above 25 nmol/l are 'likely to indicate' and levels above 60 nmol/l
are 'strongly associated' with pregnancies subsequently demonstrated to be
viable. However, viable IUPs have been reported with initial levels below 16
nmol/l. Serum progesterone measurements have also been advocated as a
diagnostic tool in the noninvasive diagnosis of ectopic pregnancy. However, a
meta-analysis of 26 studies has demonstrated that, whilst a single serum
progesterone measurement has a good discriminative capacity to distinguish
between pregnancy failure and a viable IUP, a single measurement cannot
discriminate between ectopic pregnancy and nonectopic pregnancy. This
review concluded that serum progesterone measurement can identify women
at risk for ectopic pregnancy who need further evaluation, but its
discriminative capacity is insufficient to diagnose ectopic pregnancy with
certainty. Therefore, it would appear that a serum progesterone level is good
at predicting viability, but not the location of pregnancy.
1 Banerjee S, Aslam N, Woelfer B, Lawrence A, Elson J, Jurkovic D: Expectant
management of early pregnancies of unknown location: a prospective
evaluation of methods to predict spontaneous resolution of pregnancy. BJOG
108, 158-163 (2001).
9 Royal College of Obstetricians and Gynaecologists (RCOG), Green-top
Guideline No. 25: The management of early pregnancy loss. RCOG Press,
London, UK (2006).
10 Mol BW, Lijmer JG, Ankum W, van der Veen F, Bossuyt PMM: The accuracy
of single serum progesterone measurement in the diagnosis of ectopic
pregnancy: a meta-analysis. Hum. Reprod. 13, 3220-3227 (1998).
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