Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study
Threatened miscarriage is a common gynaecological emergency, with up to 25% of women eventually progressing to spontaneous miscarriage. The uncertainty of pregnancy outcomes results in significant anxiety. However, there is currently no acceptable framework for triaging patients presenting with thre...
| Main Authors: | , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2021
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| Online Access: | https://hdl.handle.net/10356/146101 |
| _version_ | 1826123490966634496 |
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| author | Tan, Thiam Chye Ku, Chee Wai Kwek, Lee Koon Lee, Kai Wei Zhang, Xiaoxuan Allen, John C., Jr. Zhang, Valencia Ru-Yan Tan, Nguan Soon |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) Tan, Thiam Chye Ku, Chee Wai Kwek, Lee Koon Lee, Kai Wei Zhang, Xiaoxuan Allen, John C., Jr. Zhang, Valencia Ru-Yan Tan, Nguan Soon |
| author_sort | Tan, Thiam Chye |
| collection | NTU |
| description | Threatened miscarriage is a common gynaecological emergency, with up to 25% of women eventually progressing to spontaneous miscarriage. The uncertainty of pregnancy outcomes results in significant anxiety. However, there is currently no acceptable framework for triaging patients presenting with threatened miscarriage. We aim to evaluate the efficacy and safety of a novel clinical protocol using a single serum progesterone level to prognosticate and guide management of patients with threatened miscarriage. 1087 women presenting with threatened miscarriage were enrolled in the study. The primary outcome was spontaneous miscarriage by 16 weeks' gestation. Among the 77.9% (847/1087) of study participants with serum progesterone ≥ 35 nmol/L who were not treated with oral dydrogesterone, the miscarriage rate was 9.6% (81/847). This did not differ significantly from the 8.5% (31/364) miscarriage rate observed in our prior studies; p = 0.566. Among women with serum progesterone < 35 nmol/L who were treated with dydrogesterone, the miscarriage rate was 70.8% (170/240). Our novel clinical triage protocol using a single serum progesterone level allowed both effective risk stratification and a reduction in progestogen use with no significant adverse pregnancy outcomes. This protocol, based on a single serum progesterone cutoff, can be readily adapted for use in other healthcare institutions. |
| first_indexed | 2024-10-01T06:05:31Z |
| format | Journal Article |
| id | ntu-10356/146101 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T06:05:31Z |
| publishDate | 2021 |
| record_format | dspace |
| spelling | ntu-10356/1461012023-03-05T16:47:54Z Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study Tan, Thiam Chye Ku, Chee Wai Kwek, Lee Koon Lee, Kai Wei Zhang, Xiaoxuan Allen, John C., Jr. Zhang, Valencia Ru-Yan Tan, Nguan Soon Lee Kong Chian School of Medicine (LKCMedicine) School of Biological Sciences Science::Medicine Biomarkers Chemical Biology Threatened miscarriage is a common gynaecological emergency, with up to 25% of women eventually progressing to spontaneous miscarriage. The uncertainty of pregnancy outcomes results in significant anxiety. However, there is currently no acceptable framework for triaging patients presenting with threatened miscarriage. We aim to evaluate the efficacy and safety of a novel clinical protocol using a single serum progesterone level to prognosticate and guide management of patients with threatened miscarriage. 1087 women presenting with threatened miscarriage were enrolled in the study. The primary outcome was spontaneous miscarriage by 16 weeks' gestation. Among the 77.9% (847/1087) of study participants with serum progesterone ≥ 35 nmol/L who were not treated with oral dydrogesterone, the miscarriage rate was 9.6% (81/847). This did not differ significantly from the 8.5% (31/364) miscarriage rate observed in our prior studies; p = 0.566. Among women with serum progesterone < 35 nmol/L who were treated with dydrogesterone, the miscarriage rate was 70.8% (170/240). Our novel clinical triage protocol using a single serum progesterone level allowed both effective risk stratification and a reduction in progestogen use with no significant adverse pregnancy outcomes. This protocol, based on a single serum progesterone cutoff, can be readily adapted for use in other healthcare institutions. Ministry of Health (MOH) National Medical Research Council (NMRC) Published version The authors would like to thank Ms. Trish Koon, Ms. Doris Ong and Ms. Erica Nuriyah Fadziulah for their assistance in patient recruitment. We wish to thank all the families who participated in our research and all the dedicated staff from all participating departments. This study was funded by the NMRC (National Medical Research Council) Singapore Ministry of Health Industry Alignment Fund Category 1 (MOHIAFCat1-11010). There has been no significant financial support that could have influenced the study outcome 2021-01-26T08:08:03Z 2021-01-26T08:08:03Z 2020 Journal Article Tan, T. C., Ku, C. W., Kwek, L. K., Lee, K. W., Zhang, X., Allen, J. C., Jr., . . . Tan, N. S. (2020). Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study. Scientific Reports, 10(1), 9153-. doi:10.1038/s41598-020-66155-x 2045-2322 https://hdl.handle.net/10356/146101 10.1038/s41598-020-66155-x 32499581 2-s2.0-85085966266 1 10 en MOHIAFCat1-11010 Scientific Reports © 2020 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. application/pdf |
| spellingShingle | Science::Medicine Biomarkers Chemical Biology Tan, Thiam Chye Ku, Chee Wai Kwek, Lee Koon Lee, Kai Wei Zhang, Xiaoxuan Allen, John C., Jr. Zhang, Valencia Ru-Yan Tan, Nguan Soon Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study |
| title | Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study |
| title_full | Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study |
| title_fullStr | Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study |
| title_full_unstemmed | Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study |
| title_short | Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage : a prospective cohort study |
| title_sort | novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage a prospective cohort study |
| topic | Science::Medicine Biomarkers Chemical Biology |
| url | https://hdl.handle.net/10356/146101 |
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