Serum Progesterone and Serial Beta-hcG Levels in Predicting the Outcome of Early Pregnancies With Doubtful Viability: A Prospective Observational Research
Authors: YILDIZ Mustafa , CICEK Esra Nur , DEMIRAYAK Gokhan , SAHIN Orhan , OLMEZ Yagmur , MIHMANLI Veli 
Published: September 2021

Abstract
BACKGROUND: To evaluate the doubling rate of maternal serum serial β-hCG and a single initial serum progesterone level to predict fetal viability before ultrasonography in women diagnosed with intrauterine pregnancy of undetectable viability. METHODS: 336 pregnant women who applied to the outpatient clinic at Istanbul Okmeydanı City Hospital between March and December 2018 were evaluated on a “Prospective observational” basis. 236 women were excluded from the study for various reasons. The study was completed with 100 pregnant women diagnosed with intrauterine pregnancy (IUP) involving suspected fetal viability by transvaginal ultrasonography only, who met the inclusion criteria with CRL: < 7mm and mean gestational sac diameter: < 25mm. Serum β-hCG and progesterone were taken at the first admission. After 48 hours, control serum β-hCG was taken and the increase rates were calculated. Early pregnancy loss was diagnosed by (transvaginal) TV-USG performed after the days 7, 11 and 14. Patients were divided into two groups as fetal heart rate (FHR) positive (viable) and FHR negative (early pregnancy loss). Pregnancy results were compared with β-hCG increase rates and progesterone value. SPSS 22.0 software was used for statistical analysis and P<0.05 was accepted as statistically significant.RESULTS: No statistically significant result was obtained between the viable and early pregnancy loss (FHR +/-) groups in terms of maternal age, previous pregnancy anamnesis, nationality, presenting symptoms, or ultrasound findings. According to the last menstrual period, the mean gestational age was 45.1±14 days in the viable (FHR+) group and 51.3±14 days in the Early pregnancy loss (FHR-) group, and this difference was found to be statistically significant. Estimation modality was developed in terms of viability with the serum progesterone values and increase rates of β-hCG. The study, which was conducted with a confidence interval of 95%, found the viability rate to be 70% with a β-hCG increase rate of 31%, 80% in the case of an increase by 49%, 90% in the case of an increase by 73%, 95% in the case of an increase by 97%, and 100% in the case of an increase by 181%. For progesterone, when the value was 5.9 ng/ml, the viability rate was 49%, and it was 69% at 10.5 ng/ml, 80% at 13.4 ng/ml, 90% at 18.0 ng/ml, 95% at 21.7 ng/ml, 99% at 29.3 ng/ml, and 100% at 37.5 ng/ml and above. In conclusion, the significant efficacy values of β-hCG increase and first progesterone level in predicting viability were found to be ROC AUC: [0.748 (0.621-0.874)] and ROC AUC: [0.796 (0.685-0.907)], respectively.CONCLUSION: Either Serial β-hCG ratio or serum progesterone level can be used alone to predict pregnancy outcome in early pregnancy. With dissemination of similar studies, estimation modalities can be improved and TV-USG examinations can help shortening the waiting time for results to reduce anxiety of families, hospital admissions and health expenses.