What is the best use of serum markers in the evaluation of threatened miscarriage?
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Ultrasound is the most definitive test to determine pregnancy location and viability. (SOR: C, based on expert opinion.) Serial human chorionic gonadotropin (hCG) levels are useful when ultrasound is nondiagnostic or initial hCG levels are less than 1,500-2,000 IU/L; failure to attain at least a 53% increase in 2 days indicates abnormal gestation. (SOR: B, based on a cohort study.) A low progesterone level can signify nonviability, but cannot locate a pregnancy. A combination of hCG and progesterone may be more useful than either serum marker alone. (SOR: B, based on a cohort study.)
Evidence Based Practice 14(7): 08.