FERTILITY AND STERILITY
Vol. 57, No.2, February 1992
Copyright © 1992 The American Fertility Society
Printed on acid-free paper in U.S.A.
Serum progesterone and uterine curettage in differential diagnosis of ectopic pregnancy
Thomas G. Stovall, M.D.*t Frank W. Ling, M.D.t Sandra A. Carson, M.D.:j: John E. Buster, M.D.:j: Department of Obstetrics and Gynecology, University of Tennessee-Memphis, Memphis, Tennessee
Medical management of ectopic pregnancy (EP) is an attractive alternative to surgery when diagnosis is accomplished without laparoscopy.l Definitive nonsurgical diagnosis of EP is aided by the use of curettage, which effectively differentiates intrauterine pregnancy (IUP) from EP.l Pregnancy nonviability, however, must be confirmed before curettage. Because a single low serum progesterone (P) can help differentiate IUP from Ep 2,3 and may also serve as an effective screening tool for EP,5 we reasoned that it might serve also to identify pregnancies that are nonviable if a cutoff value below which there are no viable pregnancies could be identified. To this end, we reviewed serum P in 1,028 consecutive first trimester pregnant patients seen in an emergency department population. After retrospectively arriving at a P concentration below which no pregnancy progressed to viability, we prospectively tested the utility of this value by using it to select candidates for uterine curettage. MATERIALS AND METHODS
The clinical outcome of 1,028 consecutive first trimester pregnant patients seen in the Emergency Department of the Regional Medical Center, Memphis, was reviewed. All patients in this retrospective
Received November 7, 1990; revised and accepted October 9, 1991. * Reprint requests: Thomas G. Stovall, M.D., Department of Obstetrics and Gynecology, 853 Jefferson Avenue, Room E-102, Memphis, Tennessee 38163. t Division of Gynecology. :j: Division of Reproductive Endocrinology and Infertility. 456
Stovall et al.
Communications-in-brief
review had ultrasound (US)-documented viable IUPs. Serum P and human chorionic gonadotropin (hCG), drawn at the time of presentation, had been measured by a direct radioimmunoassay (RIA) using commercial kits (Progesterone: ICN Biomedicals, Inc., Costa Mesa, CA; hCG: First International Reference Standard; Tandem-R-HCG, Hybritech, Inc., San Diego, CA). The serum RIA has not been evaluated for specificity in pregnancy serum and may overestimate or underestimate the actual serum P concentrations. Laboratories using this technique need to set their own cutoff values for the method they use or use the test described herein. At a value of 5.0 ng/mL, the P assay has an intraassay variation of 3.6%, with an interassay variation of 6.7%. The cross-reactivity at 50% displacement as compared with the P curve for this assay is
Vol. 57, No.2, February 1992
Copyright © 1992 The American Fertility Society
Printed on acid-free paper in U.S.A.
Serum progesterone and uterine curettage in differential diagnosis of ectopic pregnancy
Thomas G. Stovall, M.D.*t Frank W. Ling, M.D.t Sandra A. Carson, M.D.:j: John E. Buster, M.D.:j: Department of Obstetrics and Gynecology, University of Tennessee-Memphis, Memphis, Tennessee
Medical management of ectopic pregnancy (EP) is an attractive alternative to surgery when diagnosis is accomplished without laparoscopy.l Definitive nonsurgical diagnosis of EP is aided by the use of curettage, which effectively differentiates intrauterine pregnancy (IUP) from EP.l Pregnancy nonviability, however, must be confirmed before curettage. Because a single low serum progesterone (P) can help differentiate IUP from Ep 2,3 and may also serve as an effective screening tool for EP,5 we reasoned that it might serve also to identify pregnancies that are nonviable if a cutoff value below which there are no viable pregnancies could be identified. To this end, we reviewed serum P in 1,028 consecutive first trimester pregnant patients seen in an emergency department population. After retrospectively arriving at a P concentration below which no pregnancy progressed to viability, we prospectively tested the utility of this value by using it to select candidates for uterine curettage. MATERIALS AND METHODS
The clinical outcome of 1,028 consecutive first trimester pregnant patients seen in the Emergency Department of the Regional Medical Center, Memphis, was reviewed. All patients in this retrospective
Received November 7, 1990; revised and accepted October 9, 1991. * Reprint requests: Thomas G. Stovall, M.D., Department of Obstetrics and Gynecology, 853 Jefferson Avenue, Room E-102, Memphis, Tennessee 38163. t Division of Gynecology. :j: Division of Reproductive Endocrinology and Infertility. 456
Stovall et al.
Communications-in-brief
review had ultrasound (US)-documented viable IUPs. Serum P and human chorionic gonadotropin (hCG), drawn at the time of presentation, had been measured by a direct radioimmunoassay (RIA) using commercial kits (Progesterone: ICN Biomedicals, Inc., Costa Mesa, CA; hCG: First International Reference Standard; Tandem-R-HCG, Hybritech, Inc., San Diego, CA). The serum RIA has not been evaluated for specificity in pregnancy serum and may overestimate or underestimate the actual serum P concentrations. Laboratories using this technique need to set their own cutoff values for the method they use or use the test described herein. At a value of 5.0 ng/mL, the P assay has an intraassay variation of 3.6%, with an interassay variation of 6.7%. The cross-reactivity at 50% displacement as compared with the P curve for this assay is
