Use of single serum progesterone level measurement as a predictor of the fetal viability during the first trimester

* Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq. Introduction Pain with vaginal bleeding is the most common causes of women seeking medical advice in early pregnancy. These symptoms are a source of anxiety for both the health care providers as well as the pregnant woman due to the fact that these symptoms often lead to miscarriage or ectopic pregnancy in about (15-20%). Transvaginal ultrasound has been used for detection of fetal viability as a first tool, however situations may differ in cases for the following reasons: when the pregnancy is at an early stage and detecting a fetal heart may be difficult, another issue may arise if the gestational sac is less than 20mm with no yolk sac or embryo ,and finally if the embryo is less than 8mm with negative fetal heart at that time of pregnancy. If uncertain viability is diagnosed, an ultrasound scan may be repeated within 7-10 days. Biochemical tests aids in predicting the viability is BhCG, is sensitive in distinguishing viable from nonviable during pregnancy however for the test to be accurate serial quantitative readings must take place within 48-72 hours as well as the increment Background and objective: Approximately one in third of pregnant women experience discomfort, pain and or vaginal bleeding during the first trimester of pregnancy. Ultrasound is known to be a useful tool in detecting and diagnosing the viability of the fetus but it is sometimes inconclusive. In cases in which pregnant women experience symptoms of discomfort, serum progesterone may be admitted to the patient for counseling and prediction of the continuity of pregnancy. This study aimed to estimate the relation between single serum progesterone level and the viability of the fetus during the first trimester. Method: A prospective study was carried out in Maternity teaching hospital-Erbil city to estimate the accuracy of single serum progesterone measurement for the prediction of fetal viability at the end of the first trimester. All the cases have been detected by ultrasound device that has been for women who attended the hospital and reported the feeling of discomfort, pain and bleeding early in the first trimester of pregnancy, serum progesterone level of the patients were compared between viable and nonviable fetuses. Results: A total of 97 participants were involved in this study; 57 participants had a viable pregnancy at the end of the first trimester, and 40 participants had un-viable pregnancy that has been terminated either by spontaneous abortion or termination performed for missed abortion. The mean of serum progesterone level in viable pregnancies was (19.358 ng\ml) when compared with the non-viable pregnancies which were (11.082 ng\ml). The differences were statistically significant (P <0.001). The cut-off value (13.68ng\ml) provides the highest sensitivity and specificity. Conclusion: A single serum progesterone measurement was regarded as a reliable test for the prediction of viable and non-viable pregnancy in women who reported to be experiencing pain and bleeding in the early trimester of pregnancy with or with inconclusive ultrasound.