Managing pregnancy of unknown location based on initial serum progesterone and serial serum hCG levels: development and validation of a two-step triage protocol

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
B Van CalsterT Bourne

Abstract

A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two-step triage protocol to select PUL at high risk of ectopic pregnancy (EP), based on serum progesterone level at presentation (step 1) and the serum human chorionic gonadotropin (hCG) ratio, defined as the ratio of hCG at 48 h to hCG at presentation (step 2). This was a cohort study of 2753 PUL (301 EP), involving a secondary analysis of prospectively and consecutively collected PUL data from two London-based university teaching hospitals. Using a chronological split we used 1449 PUL for development and 1304 for validation. We aimed to assign PUL as low risk with high confidence (high negative predictive value (NPV)) while classifying most EP as high risk (high sensitivity). The first triage step assigned PUL as low risk using a threshold of serum progesterone at presentation. The remaining PUL were triaged using a novel logistic regression risk model based on hCG ratio and initial serum progesterone (second step), defining low risk as an estimated EP risk of < 5%. On validation, initial serum progesterone ≤ 2 nmol/L (step 1) classified 16.1% PUL as low risk. Second-step classification with the risk model selected ...Continue Reading

Associated Clinical Trials

References

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Citations

Jul 1, 2017·Women's Health·Shabnam BobdiwalaTom Bourne
Aug 22, 2018·BJOG : an International Journal of Obstetrics and Gynaecology·S BobdiwalaT Bourne
Sep 6, 2018·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Frédéric BlavierLeonardo Gucciardo
Aug 7, 2019·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·S BobdiwalaT Bourne
Oct 17, 2019·Clinics·Pedro Paulo PereiraRossana Pulcineli Vieira Francisco
Jun 17, 2020·Human Fertility : Journal of the British Fertility Society·Shabnam BobdiwalaTom Bourne
Sep 29, 2020·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Sara OoiJoanne Ludlow
Jun 17, 2020·The Australian & New Zealand Journal of Obstetrics & Gynaecology·Batool NadimGeorge Condous
Mar 20, 2018·Archives of Toxicology·Jeremy GingrichAlmudena Veiga-Lopez
Aug 23, 2018·Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
Jan 27, 2021·European Journal of Obstetrics, Gynecology, and Reproductive Biology·A UcyigitJ A Ross
Feb 2, 2021·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Frederic BlavierLeonardo Gucciardo
Sep 16, 2020·BJOG : an International Journal of Obstetrics and Gynaecology·E ChristodoulouB Van Calster
Mar 28, 2021·Fertility and Sterility·Jessica A LentscherGregory E Chow
Mar 1, 2020·Journal of Gynecology Obstetrics and Human Reproduction·Frederic BlavierLeonardo Gucciardo
Mar 4, 2021·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·C J Valdera SimbrónM Albi González
Oct 27, 2021·Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology·Safiyah HoseinElizabeth P Gurney
Nov 21, 2021·Gynécologie, Obstétrique, Fertilité & Sénologie·M DapO Morel

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