Progesterone, inhibin, and hCG multiple marker strategy to differentiate viable from nonviable pregnancies

Objective: To determine whether a combination of serum and urine biomarkers drawn from symptomatic pregnant women will help early differentiation of v iable from nonviable pregnancies. Methods: We conducted a prospective cohort study of 220 women who presented in the first trimester of pregnancy with complaints of pain, cramping, ble eding, or spotting. Serum samples for progesterone, inhibin A, and hCG, and urine beta-core hCG, were collected at presentation. To evaluate whether t hose biomarkers could predict viable and nonviable outcomes in pregnancy, w e used likelihood ratios to compare operating characteristics of single and multiple biomarker strategies. Results: Of 220 Pregnancies studied, 98 were viable and 122 nonviable. Amon g single biomarkers, progesterone alone appears to have the greatest utilit y (area under the receiver operator characteristic curve = 0.923). Among du al-biomarker strategies, progesterone plus hCG and progesterone plus inhibi n A improved specificity but not sensitivity. At 95% sensitivity, the combi nation of progesterone and hCG improved specificity from 0.29 to 0.66 (impr ovement 0.37 [95% confidence interval 0.23, 0.52]). A triple-biomarker comb ination did not show substantial improvement over the dual-biomarker strate gy. Also, combinations that used urine beta-core hCG did not improve diagno stic accuracy. Conclusion: Serum progesterone appeared to be the single most specific biom arker for distinguishing viable from nonviable pregnancies. When a dual-bio marker strategy was applied, combining serum progesterone with hCG, specifi city improved significantly, which suggests that a multiple biomarker strat egy might help distinguish viable from nonviable pregnancies in early gesta tion. (C) 2000 by The American College of Obstetricians and Gynecologists.