Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 11 , ISSUE 6 ( November-December, 2019 ) > List of Articles

Original Article

Serum Progesterone Measurement in Diagnosis of Ectopic Pregnancy

Sathya Selvarajan, Jothimalar Ramalingam, Zachariah Bobby

Keywords : β-Human chorionic gonadotropin, Ectopic pregnancy, Gestational age, Pregnancy, Progesterone, Serial measurement, Serum biomarker, Ultrasonography

Citation Information : Selvarajan S, Ramalingam J, Bobby Z. Serum Progesterone Measurement in Diagnosis of Ectopic Pregnancy. J South Asian Feder Obs Gynae 2019; 11 (6):353-355.

DOI: 10.5005/jp-journals-10006-1732

License: CC BY-NC 4.0

Published Online: 25-02-2013

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The implantation of the fertilized ovum outside the normal uterine cavity is termed an ectopic pregnancy (EP). Progesterone an important hormone in the regulation and maintenance of pregnancy has been studied with limited validation as a biomarker of this condition. The aim of this study was to determine whether a measurement of progesterone could discriminate an EP from a normal pregnancy. Materials and methods: Serum levels of progesterone were measured by direct chemiluminescence in 140 women with EP and 140 women with normal pregnancy at Sri Ramachandra Medical College and Research Institute, Chennai, India. Statistical analyses were performed using SPSS software version 16.0, and a p value of less than 0.05 was considered significant. Results: The mean progesterone level in EP was 6.4 ng/mL. This was significantly lower than the value of 24.6 ng/mL in normal pregnancy. Receiver operating characteristic (ROC) curve analysis revealed that at a cutoff of 16.22 ng/mL, progesterone was able to distinguish an EP from a normal pregnancy with a sensitivity of 98.6% and specificity of 87.1%. Conclusion and clinical significance: Progesterone measurement in women in early pregnancy can be used to rule out an EP. Especially in the time window of 4–6 weeks of gestation where ultrasonography is inconclusive, we have to rely on biomarkers like progesterone to resolve the treatment modalities at the earliest.

  1. Milwidsky A, Adoni A, Segal S, et al. Chorionic gonadotropin and progesterone levels in ectopic pregnancy. Obstet Gynecol 1977;50(2):145–147.
  2. Matthews CP, Coulson PB, Wild RA. Serum progesterone levels as an aid in the diagnosis of ectopic pregnancy. Obstetrics and Gynecology 1986;68(3):390–394. DOI: 10.1097/00006250-198609000-00021.
  3. Arafat ES, Hargrove JT, Maxson WS, et al. Sedative and hypnotic effects of oral administration of micronized progesterone may be mediated through its metabolites. Am J Obstet Gynecol 1988;159(5):1203–1209. DOI: 10.1016/0002-9378(88)90448-6.
  4. Pisarska MD, Carson SA, Buster JE. Ectopic pregnancy. Lancet 1998;351(9109):1115–1120. DOI: 10.1016/S0140-6736(97)11476-3.
  5. Buck RH, Joubert SM, Norman RJ. Serum progesterone in the diagnosis of ectopic pregnancy: a valuable diagnostic test? Fertil Steril 1988;50(5):752–755. DOI: 10.1016/s0015-0282(16)60310-2.
  6. Li C, Zhao WH, Zhu Q, et al. Risk factors for ectopic pregnancy: a multicenter case-control study. BMC Pregnancy Childbirth 2015;15(1):187. DOI: 10.1186/s12884-015-0613-1.
  7. Shaw JL, Diamandis EP, Horne AW, et al. Ectopic pregnancy. Clin Chem 2012;58(9):1278–1285. DOI: 10.1373/clinchem.2012.184168.
  8. National Center for Biotechnology Information. PubChem Compound Database; CID=5994, https://pubchem.ncbi.nlm.nih. gov/compound/5994 (accessed Feb. 5, 2018).
  9. Graziosi GCM, Mol BW, Ankum WM, et al. Management of early pregnancy loss. Int J Gynaecol Obstet 2004;86(3):337–346. DOI: 10.1016/j.ijgo.2004.04.038.
  10. Sivalingam VN, Duncan WC, Kirk E, et al. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011;37(4): 231–240. DOI: 10.1136/jfprhc-2011-0073.
  11. Carson SA, Buster JE. Ectopic pregnancy. N Engl J Med 1993;329(16):1174–1181. DOI: 10.1056/NEJM199310143291608.
  12. Yeko TR, Gorrill MJ, Hughes LH, et al. Timely diagnosis of early ectopic pregnancy using a single blood progesterone measurement. Fertil Steril 1987;8(6):1048–1050. DOI: 10.1016/s0015-0282(16)59607-1.
  13. Verhaegen J, Gallos ID, van Mello NM, et al. Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies. BMJ 2012;345(sep 27 4):e6077. DOI: 10.1136/bmj.e6077.
  14. Mol BW, Lijmer JG, Ankum WM, et al. The accuracy of single serum progesterone measurement in the diagnosis of ectopic pregnancy: a meta-analysis. Hum Reprod 1998;13(11):3220–3227. DOI: 10.1093/ humrep/13.11.3220.
  15. Al-Bayati MM, Qader MM, Salma JH. Serum Progesterone & CA125 levels as an aid in the prediction of ectopic & intrauterine pregnancy. Iraqi Acad Sci J 2015;14(1):7–13.
  16. National Institute for Health and Clinical Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. (Clinical guideline 126.) 2019.
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