THE ABILITY OF A SINGLE SERUM PROGESTERONE VALUE TO IDENTIFY ABNORMALPREGNANCIES IN PATIENTS WITH BETA-HUMAN CHORIONIC-GONADOTROPIN VALUESLESS-THAN 1,000 MIU ML/

Objective: To determine the test performance of a single serum progest erone value <5.0 ng/mL for detecting ectopic pregnancy or other abnorm al pregnancies in symptomatic ED patients with beta-hCG levels <1,000 mIU/mL. Methods: A prospective study of progesterone levels was perfor med in consecutive ED patients presenting to an urban teaching hospita l Born December 1995 to March 1997 with abdominal pain and/or vaginal bleeding, a positive qualitative beta-hCG, and a quantitative beta-hCG value <1,000 mIU/mL. Patients were excluded if they were status-past a dilatation and evacuation procedure, had insufficient serum to run t he progesterone assays, or were lost to follow-up, Progesterone values were measured from the original P-I ICG sample, Final patient diagnos is was abstracted from hospital records. Results: 127 patients mel eli gibility criteria. 39 patients were excluded, leaving a total of gs en rolled patients, 76 patients with abnormal pregnancies were identified [9 ectopic pregnancies, 62 abnormal intrauterine pregnancies IUPs), 5 abnormal IUPs vs ectopic pregnancies], 71 of whom had progesterone va lues <5.0 ng/mL [sensitivity 71/76 (94%), 95% CI 86-98%]. 12 patients with normal pregnancies were identified, all of whom had progesterone values greater than or equal to 5.0 ng/mL [specificity 12/12 (100%), 9 5% CI 78-100%]. Conclusion: A single progesterone value <5.0 ng/mL has high sensitivity and specificity in detecting abnormal pregnancy in s ymptomatic ED patients with beta-hCG values <1,000 mIU/mL.