ArticleActa obstetricia et gynecologica Scandinavica2022
Evaluating cut-off levels for progesterone, β human chorionic gonadotropin and β human chorionic gonadotropin ratio to exclude pregnancy viability in women with a pregnancy of unknown location: A prospective multicenter cohort study.
Article in Acta obstetricia et gynecologica Scandinavica, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.
- Predictors of successful expectant and medical management of miscarriage: A systematic review.Acta obstetricia et gynecologica Scandinavica · 2024Pooled it
- Managing Pregnancies of Unknown Location With the M4 Prediction Model or the NICE Algorithm: A Randomised Controlled Trial With Cross-Sectional Diagnostic Accuracy Data.BJOG : an international journal of obstetrics and gynaecology · 2025Trial
- High diagnostic accuracy and early prediction of ectopic pregnancy in patients with pregnancy of unknown location: a multicenter cohort study.AJOG global reports · 2026Article
- The diagnosis and management of extrauterine and uterine ectopic pregnancy.Human reproduction update · 2026Review
- Development of machine learning models for predicting early pregnancy outcomes based on β-hCG, progesterone, and estradiol.PloS one · 2026Article
- Maternal plasma microRNAs as potential biomarkers for triaging pregnancies of unknown location and ectopic pregnancy diagnosis.Non-coding RNA research · 2025Article
- Progesterone decline threshold in predicting early pregnancy loss: a retrospective study.Frontiers in endocrinology · 2025Article
- Development of a single-visit protocol for the management of pregnancy of unknown location following in vitro fertilization: a retrospective study.Human reproduction (Oxford, England) · 2024Article
- Progesterone and β-hCG Determination Using an Electrochemical Combo-Strip for Pregnancy Monitoring.International journal of molecular sciences · 2023Article
- Evaluating cut-off levels for progesterone, β human chorionic gonadotropin and β human chorionic gonadotropin ratio to exclude pregnancy viability in women with a pregnancy of unknown location: A prospective multicenter cohort study.Acta obstetricia et gynecologica Scandinavica · 2022Article
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Authors and funding
18 authors at 9 institutions in 3 countries.
Funding
Abstract
introductionThere is no global agreement on how to best determine pregnancy of unknown location viability and location using biomarkers. Measurements of progesterone and β human chorionic gonadotropin (βhCG) are still used in clinical practice to exclude the possibility of a viable intrauterine pregnancy (VIUP). We evaluate the predictive value of progesterone, βhCG, and βhCG ratio cut-off levels to exclude a VIUP in women with a pregnancy of unknown location. MATERIAL AND
methodsThis was a secondary analysis of prospective multicenter study data of consecutive women with a pregnancy of unknown location between January 2015 and 2017 collected from dedicated early pregnancy assessment units of eight hospitals. Single progesterone and serial βhCG measurements were taken. Women were followed up until final pregnancy outcome between 11 and 14 weeks of gestation was confirmed using transvaginal ultrasonography: (1) VIUP, (2) non-viable intrauterine pregnancy or failed pregnancy of unknown location, and (3) ectopic pregnancy or persisting pregnancy of unknown location. The predictive value of cut-off levels for ruling out VIUP were evaluated across a range of values likely to be encountered clinically for progesterone, βhCG, and βhCG ratio.
resultsData from 2507 of 3272 (76.6%) women were suitable for analysis. All had data for βhCG levels, 2248 (89.7%) had progesterone levels, and 1809 (72.2%) had βhCG ratio. The likelihood of viability falls with the progesterone level. Although the median progesterone level associated with viability was 59 nmol/L, VIUP were identified with levels as low as 5 nmol/L. No single βhCG cut-off reliably ruled out the presence of viability with certainty, even when the level was more than 3000 IU/L, there were 39/358 (11%) women who had a VIUP. The probability of viability decreases with the βhCG ratio. Although the median βhCG ratio associated with viability was 2.26, VIUP were identified with ratios as low as 1.02. A progesterone level below 2 nmol/L and βhCG ratio below 0.87 were unlikely to be associated with viability but were not definitive when considering multiple imputation.
conclusionsCut-off levels for βhCG, βhCG ratio, and progesterone are not safe to be used clinically to exclude viability in early pregnancy. Although βhCG ratio and progesterone have slightly better performance in comparison, single βhCG used in this manner is highly unreliable.
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