超声测量前置胎盘孕妇子宫颈管长度预测阴道出血与早产

应用超声测量前置胎盘孕妇子宫颈管长度,探讨其与阴道出血和早产的关系。方法 将2005年1月至2010年1月在本院产检并分娩的82例前置胎盘孕妇按孕周28～30周、31～33周、34 ～ 36周分为3组,采用超声测量各组孕妇子宫颈管长度,记录3组前置胎盘孕妇子宫颈管长度＞30 mm和≤30 mm例数,观察各组子宫颈管长度＞30 mm和≤30 mm孕妇出现的阴道出血、下腹痛、宫缩临床症状的例数并统计对比早产率、平均分娩孕周、新生儿出生体质量、新生儿窒息率。分别绘制子宫颈管长度预测阴道出血和早产的ROC曲线,计算曲线下面积和最佳临界点。结果 3组前置胎盘孕妇子宫颈管长度＞30 mm和≤30 mm的例数分别为28～30周组:20例、8例,31～33周组:19例、11例,34～36周组:11例、13例。子宫颈管长度≤30 mm的前置胎盘孕妇阴道出血率、早产率均明显高于子宫颈管长度＞30 mm者(28 ～ 30周组:阴道出血率87.50％比20％,早产率75％比15％;31～33周组:阴道出血率72.73％比26.32％,早产率63.64％比21.05％; 34 ～ 36周组:阴道出血率69.23％比27.27％,早产率38.46％比18.18％;均P＜0.05),3组出现下腹痛和官缩临床症状的比例也是子官颈管长度≤30 mm的前置胎盘孕妇高于子宫颈管长度＞30 mm者;3组子宫颈管长度≤30 mm的孕妇平均分娩孕周、新生儿出生体质量则低于子宫颈管长度＞30 mm者(均P＜0.05),新生儿窒息率在28 ～ 30周、31～ 33周组子宫颈管长度≤30 mm的孕妇高于子宫颈管长度＞30mm者(均P＜0.05),而34～36周组的孕妇均未出现新生儿窒息。子宫颈管长度预测阴道出血及早产的ROC曲线下面积分别为73.4％、65.3％,30.5 mm为预测的最佳临界点。结论 超声测量前置胎盘孕妇子宫颈管长度可作为预测阴道出血与早产的一种方法。     

Prediction of prolonged pregnancy in nulliparous women by transvaginal ultrasonographic measurement of cervical length at 20-24 weeks and 37 weeks

This study was done to evaluate transvaginal ultrasonographic measurement of cervical length at 20 to 24 weeks and 37 weeks as a predictor of prolonged pregnancy (defined as a pregnancy that extended beyond 41+2 weeks of gestation [289 days]) in nulliparous women. This prospective observational study enrolled 149 consecutive nulliparous women with singleton gestation at 37 weeks. Cervical length was measured by transvaginal ultrasonography at 20 to 24 weeks and 37 weeks. Cervical length at 37 weeks, but not at 20 to 24 weeks, was significantly longer in women delivered at >41+2 weeks than in those delivered at 相似文献   

Early transvaginal embryo aspiration: a safer method for selective reduction in high order multiple gestations.

Assisted reproduction technologies and ovulation induction for treatment of infertility continue to cause high order multiple gestations. Increased perinatal morbidity and mortality, as well as maternal morbidity, may complicate these pregnancies. Selective fetal reduction, an acceptable therapeutic approach in these cases, is usually performed at or after the ninth week of gestation, with KCl injected in the vicinity of the fetal heart, and is associated with a total pregnancy loss rate of 11.7%. We report our experience with 90 women who underwent early (mean 7.5 weeks gestation, range 7. 0-8.0 weeks) transvaginal selective embryo aspiration. The mean number of viable embryos before and after reduction was 3.5 and 2.1 respectively. Six (6.7%) pregnancies were lost before 24 gestational weeks. One miscarriage occurred at the tenth gestational week. The other five pregnancies were aborted at 17.3-21.6 weeks gestation. Additional interventions were performed in three of these pregnancies: genetic amniocentesis in two cases and cervical suture in one case. In the subset of 39 patients with>/=4 embryos, only one (2.6%) pregnancy loss was recorded. This loss rate is significantly lower (P < 0.05) than the 15.3% loss rate in patients with >/=4 fetuses calculated from other work. Four (4.4%) other pregnancies were complicated by premature delivery (25-28 weeks gestation). Mean gestational age of delivered pregnancies in our series was 35.7 weeks. In conclusion, early transvaginal embryo aspiration is a simple and relatively safe method for multiple pregnancy reduction. The overall pregnancy loss rate associated with early embryo aspiration is similar to that of procedures performed at later gestational age, but is significantly lower when the initial number of embryos is four or greater.     

Clinical Efficacy of Cervical Length and Volume for Prediction of Labor Onset in VBAC Candidates

Background: The purpose of this research is to discover whether measurement of cervical length and cervical volume at term is helpful in predicting the onset of labor in VBAC candidates.Methods: Transvaginal sonographic evaluations of the cervixes of pregnant women who desired to undergo VBAC were performed between 36 - 40 weeks gestation. Clinical information such as labor onset time, gestational age at delivery and delivery mode was gathered from medical records.Results: A total of 514 pregnant women participated in this study. Cervical length was significantly longer in the group that delivered 7 days or more after measurement than in the group that delivered within 7 days of measurement (43±0.77 cm vs. 2.99±0.72 cm, p< 0.001). Cervical volume was significantly larger in the group that delivered at and after 7 days than in the group that delivered within 7 days (29.21±11.62 cm³ vs. 34.07±13.41 cm³, p=0.014). The cervical length ROC curve was significantly more predictive than the cervical volume ROC curve (AUC: 0.711 vs 0.594, p= 0.001). There were no significant differences between the combined cervical length/volume ROC curve and the cervical length ROC curve alone (p= 0.565). The AUC of the cervical length ROC curve to predict postterm pregnancy was 0.729.Conclusion: Measuring cervical length is helpful in predicting the onset of spontaneous labor within 7 days and posterm delivery in VBAC candidates.     

Triplet gestation: clinical outcome of 14 cases

BACKGROUND/OBJECTIVE: To determine maternal complications and fetal outcome of triplet gestations. METHOD: Retrospective study of pregnant women with triplet gestation managed in 10 years. RESULTS: Fourteen women were managed with triplet gestation, of these, (71.4%) were booked for antenatal care and four (28.6%) were unbooked. The mean age of the women was 31.3 years. The age range was between twenty seven years and thirty nine years. The mean gestational age at diagnosis for the booked women was 18.6 weeks. Of the fourteen patients, ten (71.4%) had spontaneous conception, three (21.4%) followed ovulation induction and one (7.2%) resulted from invitro fertilization and embryo transfer. Two (14.3%) patients had cervical cerclage based on their past obstetric history and assessment of the cervix. Six (42.9%) patients were hospitalized and treated for preeclampsia 3 patients, spontaneous abortion 1 patient and cervical incompetence 2 patients. Eleven (78.6%) patients had preterm birth. The mean gestational age at delivery was 33.4 weeks. Of the thirteen deliveries, nine (69.2%) had caesarean section and four (30.8%) delivered per vaginam. A total of thirty nine babies were delivered, thirty four (87.2%) babies survived and five (12.8%) died. Perinatal mortality was 11.9% and the "take home" baby rate was 81%. CONCLUSION: Antenatal care with initiation of specialized prenatal care and planned delivery in triplet gestation improves fetal outcome.     

Use of time to event analysis to estimate the normal duration of human pregnancy.

BACKGROUND: Current estimates of the average duration of human pregnancy are flawed by inaccurate estimation of the time of conception and by failure to account adequately for the effect of routine elective delivery post-term. METHODS: In this study, 1514 healthy pregnant women were studied in whom the discrepancy between the menstrual history and first trimester crown-rump length estimated gestational age was within -1 to +1 day difference. The duration of gestation was estimated using time to event analysis: non-elective delivery was taken to be the event, and elective delivery was taken to be censoring. RESULTS: The median time to non-elective delivery using the Kaplan-Meier product limit estimate was 283 days after last menstrual period (LMP) and there was no difference comparing male and female fetuses. The median was significantly greater for nulliparous women compared with multiparous women (284 versus 282 days, P < 0.0001). Multivariate analysis using Cox's proportional hazards model confirmed the independent effect of nulliparity on duration of pregnancy [hazard ratio, 0.75; 95% confidence interval (CI) 0.67-0.85] and demonstrated no effect of maternal age, previous abortions, fetal sex, high parity, or bleeding before 24 completed weeks of gestation. Bleeding in the third trimester of pregnancy was, however, associated with an earlier onset of spontaneous labour (hazard ratio, 1.38; 95% CI 1.03-1.84). CONCLUSION: This study provides a basis for predicting the probability of labour at a given gestational age at term.     

Birth weight in pre-eclamptic and normotensive twin pregnancies: an analysis of discordance and growth restriction

The aim of this study was to verify whether twin pregnancies complicated by pre-eclampsia were associated with a higher rate of inter-twin weight discordance or an increased prevalence of small for gestational age (SGA) neonates than in normotensive twin pregnancies. A 17 year retrospective study was undertaken by examining 76 twin pregnancies complicated by pre-eclampsia and comparing them with 400 normotensive twin pregnancies. The case notes were reviewed in reference to birth weight differences, birth order, pregnancy outcome and inter-twin birth weight discordance. Statistical analyses were performed with t-test, contingency tables, regression curves, rank sum test and non-parametric survival plots. Power analysis was also carried out. Pre-eclamptic twin pregnancies were delivered at similar weeks of gestation to normotensive. They resulted in a smaller size for the second twin the earlier the delivery week, while in normotensive twin pregnancies no significant difference occurred at any week. Twin pregnancies complicated by pre-eclampsia showed higher rates of SGA neonates among second twins than those with normal pressure. The >25% discordance was associated with lower gestational age at delivery in each group [mean (range) 33 weeks (27-38) versus 37 (29-41), P < 0.005 pre-eclampsia and 35 weeks (25-41) versus 38 (25-42), P < 0.001 normotensive]. In pre-eclampsia the concomitant occurrence of SGA second twin and the discordance >25% was associated with shorter gestation while the presence of SGA second twin alone was not.     

The cost effectiveness of stopping preterm labor with beta-adrenergic treatment

We retrospectively compared the costs of maternal and neonatal medical care after beta-adrenergic drug treatment, given to arrest preterm labor, with expected costs associated with no gestational delay. The treatment arrested labor for at least three days in 61 per cent of patients; gestation was extended by 14.1 +/- 1.1 weeks (mean +/- S.E.M.) in infants with the earliest gestational age at treatment (20 to 25 weeks) and by 2.3 +/- 0.7 weeks in those with the latest gestational age (36 to 37 weeks). Costs were based on hospital charges and physicians' fees, including high-risk obstetric outpatient charges, obstetric prenatal and delivery inpatient charges, and pediatric inpatient charges. Treatment provided between 26 and 33 weeks of gestation was clearly cost effective, resulting in expected savings of $11,240 (1981 dollars) per birth. After 33 weeks there was no substantial difference in expected costs with or without treatment. Between 20 and 25 weeks of gestation, the expected costs per surviving infant were $39,000 lower with treatment; however, the number of mothers who were not treated at this early stage of gestation (three patients) was too small to permit statistical significance. When the improved survival of infants after prenatal treatment was taken into account, treatment before 25 weeks was also cost effective. Thus, the increased costs of prenatal medical care were offset by decreased costs of neonatal medical care when treatment was given before 34 weeks of gestation.     

Transvaginal ultrasonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women

The aim of this study was to evaluate the value of transvaginal sonographic cervical measurement in predicting failed labor induction and cesarean delivery for failure to progress in nulliparous women. One hundred and sixty-one women scheduled for labor induction underwent transvaginal ultrasonography and digital cervical examinations. Logistic regression demonstrated that cervical length and gestational age at induction, but not the Bishop score, significantly and independently predicted failed labor induction. According to the receiver operating characteristic curves analysis, the best cut-off value of cervical length for predicting failed labor induction was 28 mm, with a sensitivity of 62% and a specificity of 60%. In terms of the likelihood of a cesarean delivery for failure to progress as the outcome variable, logistic regression indicated that maternal height and birth weight, but not cervical length or Bishop score, were significantly and independently associated with an increased risk of cesarean delivery for failure to progress. Transvaginal sonographic measurements of cervical length thus independently predicted failed labor induction in nulliparous women. However, the relatively poor predictive performance of this test undermines its clinical usefulness as a predictor of failed labor induction. Moreover, cervical length appears to have a poor predictive value for the likelihood of a cesarean delivery for failure to progress.     

Ultrasonographic estimation of fetal gestational age by fetal kidney length

Introduction: Fetal kidney length vs biparietal diameter (BPD) and femur length (FL) were comparatively evaluated and the role of fetal kidney length in estimating gestational age was determined in the second and third trimesters. Materials and methods: The study was carried out on 199 women with singleton uncomplicated pregnancies attending the outdoor patient department (OPD) for routine ultrasound fetal biometry. Fetal kidney length was measured biweekly, between 18 weeks and 38 weeks of gestation. Linear regression models for estimation of gestational age were derived from biometric indices (BPD and FL) and kidney length. Result: The earliest age at which fetal kidney could be seen sonographically was the 18th week of gestation with the mean kidney length of 12 ± 1.31 mm. The mean sonographic kidney length at the 38th week of gestation was 40.4 ± 1.71 mm, indicating that the mean fetal kidney length increases as pregnancy progresses from 18 weeks to 38 weeks of gestation. Conclusion: The best linear regression model for estimating fetal gestational age is femur length, kidney length, and biparietal diameter in that order, with standard error of ±3.85 days, ±8.04 days, and ±8.75 days, respectively.     

Obstetrical results after embryonic reductions performed on 34 multiple pregnancies

Thirty-four women with multiple pregnancies (three or more fetuses) underwent embryonic reduction in order to reduce abortions, premature births or fetal growth-retardation by obtention of twins. Four early abortions occurred. Thirty pregnancies reached term and out of 60 fetuses, 58 infants were born alive. Fetal death in utero of one twin occurred in two pregnancies. The mean term until delivery was 36 +/- 2.8 weeks gestation and the prematurity rate was 51.7%. Of 55 neonates, 25 were underweight within the 10th percentile and 10 out of 55 neonates were underweight below the 3rd percentile. There were three deaths in the early neonatal period. The rate of perinatal mortality was 8.3%. Fifty-four children are currently healthy and one child has a mild axial hypotonia. A reduction in prematurity was observed with a gain of 2 weeks on reported data concerning triplet pregnancies. The rate of low-birth-weight infants was high, 63.5% being underweight at birth.     

Successful triplet pregnancy in a patient with a unicornuate uterus with a cavitary communicating rudimentary horn

In a patient with primary infertility, ovulation was inducedby monitored stimulation with human menopausal gonadotrophins(HMG) because of polycystic ovarian disease. Infertility work-uphad shown a unicornuate uterus with a cavitary communicatingrudimentary horn. The husband showed a varicocele-related moderateoligoasthenoterato-zoospermia. A triplet pregnancy occurredin a third HMG ovulation induction cycle combined with intra-uterineinsemination of the husband's washed semen. The pregnancy wascarefully monitored, and measures to prevent premature deliverywere taken. Because of the patient's obvious discomfort in thepresence of premature labour, Caesarean section was performedat 33 weeks gestation and three healthy infants were delivered.This is the first report of a successful triplet pregnancy ina women with a unicornuate uterus. The reproductive and obstetricoutcome of this condition in general, and in the case of multiplepregnancy, is discussed.     

Pregnancy: Reduced circulating placental protein concentrations during the first trimester are associated with preterm labour and low birth weight

Serum concentrations of human chorionic gonadotrophin (HCG),Schwangerschaftsprotein 1 (SP-1), pregnancy-associated plasmaprotein A (PAPP-A), progesterone and oestradiol were measuredat weekly intervals between the fifth (embryo transfer plus3 weeks) and 13th week of gestation during the first trimesterof pregnancies achieved following in-vitro fertilization (IVF)and embryo transfer in a group of women who delivered before(n = 8) or at term (n = 52). Those women who had a preterm deliveryhad significantly lower concentrations of PAPP-A (weeks 7–13;P = 0.0001–0.028) and SP-1 (weeks 6–8 and 10–12;P = 0.004–0.04). After correction of birth weight forsex and gestational age at delivery, preterm delivery was foundnot to be associated with growth retardation. However, comparisonof the circulating concentrations of the substances analysedin mothers who delivered babies of < 85% of the 50th centileof the normal range of birth weight for a given gestationalage and sex, with those who delivered babies of >85% revealedthat the concentrations of HCG (P = 0.012–0.04 on weeks6–9) and SP-1 (P = 0.003–0.03 on weeks 7, 9–13)were significantly lower in the former group. Weak, inconsistentassociations were found between the circulating concentrationsof HCG, SP-1 and PAPP-A and both corrected birth weight andgestational age at delivery. Thus, both the gestational ageat delivery and low birth weight may be related to impairedplacental development/function during the first trimester.     

未足月胎膜早破母婴结局的临床资料分析

目的探讨未足月胎膜早破（PPROM）的母婴预后。方法回顾性分析我院2004年1月-2008年12月收治的PPROM单胎妊娠的537例孕产妇的临床资料。结果孕23-32＋6周PPROM患者的死产率为83.3%,新生儿死亡率为63.3%,围产存活新生儿发病率与孕33-36＋6周的PPROM患者相比,两组差异具有统计学意义（均为P〈0.01）。PPROM患者的围产儿结局与破膜孕周密切相关。结论孕23-32＋6周PPROM的早产儿预后较差,在保守治疗期间应根据具体情况适时终止妊娠,而孕33-36＋6周PPROM患者建议在积极期待治疗期间及时分娩,以减少早产儿并发症。     

Relationship between cervical mucus interleukin-8 concentrations and vaginal bacteria in pregnancy

PROBLEM: High interleukin (IL)-8 concentration in cervical mucus in the second trimester is a risk factor for premature birth. We investigated the relationship between vaginal pathogens and IL-8 in cervical mucus. METHOD OF STUDY: In 501 women with single pregnancy, vaginal secretions were cultured for bacteria and cervical mucus IL-8 concentrations were measured between 20 and 24 gestational weeks. RESULTS: Lactobacillus species were detected in 56.0% of 84 subjects with high IL-8 (> or =377 ng/mL), significantly less often than in 417 subjects with IL-8 below 377 ng/mL (84.7%; P < 0.0001). Anaerobic pathogens were detected in 83.3% of high IL-8 subjects, significantly more often than in normal IL-8 subjects (43.9%; P < 0.0001). By multivariate analysis, cervical IL-8 was significantly high only in subjects without Lactobacillus species; they showed a significantly higher prematurity rate than Lactobacillus-positive subjects. CONCLUSIONS: Absence of vaginal Lactobacilli was associated with increased cervical IL-8 and increased risk of premature delivery.     

The risks associated with pregnancy in women aged 35 years or older

The obstetric risks of adverse outcome during pregnancy in women aged > or =35 years were quantified using a retrospective analysis of data from 385 120 singleton pregnancies in the North West Thames Region, UK, between 1988 and 1997. A comparison of pregnancy outcome was made on the basis of maternal age at delivery: 18-34 years (n = 336 462), 35-40 years (n = 41 327) and women aged > 40 years (n = 7331). Women aged <18 years (n = 5246) were excluded from the study. Data are presented as percentages of 18-34 year old women, 35-40 year old and > 40 year old women, with adjusted odds ratios (OR) according to age group. Pregnant women aged 35-40 years were at increased risk of: gestational diabetes, OR = 2.63 [99% confidence interval (CI) 2.40-2.89]; placenta praevia = 1.93 (1.58-2.35); breech presentation = 1.37 (1.28-1.47); operative vaginal delivery = 1.5 (1.43-1.57); elective Caesarean section = 1.77 (1.68-1.87); emergency Caesarean section = 1.59 (1.52-1.67); postpartum haemorrhage = 1.14 (1.09-1.19); delivery before 32 weeks gestation = 1.41 (1.24-1.61); birthweight below the 5th centile = 1.28 (1.20-1. 36); and stillbirth = 1.41 (1.17-1.70). Women aged >40 years had higher OR for the same risks. Pregnant women aged >/=35 years are at increased risk of complications in pregnancy compared with younger women.     

Pregnancy: Intrauterine sonographic assessments of embryonal liver length

Our purpose was to evaluate embryonal liver length measurementusing intrauterine sonography with a specially developed 20MHz flexible catheter-based high-resolution real-time miniature(2.4 mm outer diameter) ultrasound transducer in early first-trimesterpregnancy. A total of 36 women about to undergo therapeuticabortion at 7–9.9 weeks gestational age and one abnormalpregnancy with fetal hydrops at 9 weeks were studied. The normalrange of embryonal liver length for each day of pregnancy wasdetermined. A relationship between embryonal liver length andcrown-rump length measurements is described. A linear relationshipwas found between the menstrual age and embryonal liver length(R² = 93.3%), and a normal range of embryonal liver length forestimating the growth of the embryonal liver during early firsttrimester pregnancy was generated. A nonnogram of menstrualage as predicted by embryonal liver length was also generated.Embryonal liver length was curvilinearly correlated with crown-rumplength (R² = 92.3%). Embryonal liver length value (6.4 mm) ina case of fetal hydrops at 9 weeks was above the normal range.These results may provide an additional measurement for theestimation of gestational age in the early first trimester ofpregnancy. In this limited series one embryonal liver enlargementwas demonstrated and, thus, there is a potential for its usein the detection of embryonal congestive heart failure. Thevalue and potential applications of this new embryonal parameterare discussed.     

Impaired glucose tolerance and pregnancy outcome in Chinese women with high body mass index

To determine if impaired glucose tolerance (IGT) impacts on the outcome of singleton pregnancies in Chinese women with a high (>26 kg/m(2)) body mass index (BMI), a retrospective case-control study was performed on 128 women with IGT and 128 controls with normal oral glucose tolerance test results, who were matched for pre-pregnancy BMI (within 0.1 kg/m(2)) and delivered within the same 3 year period. The IGT group was older, with more multiparae, a higher incidence of previous gestational diabetes mellitus, higher booking haemoglobin and fasting glucose concentrations, but no difference in the pre-pregnancy weight, gestational weight gain, or weight or BMI at delivery. There was no difference in the obstetric complications, mode of delivery, or the gestational age or mean infant birthweight. However, the birthweight ratio (relative to mean birthweight for gestation), incidence of large-for-gestational-age (birthweight >90th percentile) and macrosomic (birthweight > or =4000 g) infants, and treatment for neonatal jaundice, were significantly higher in the IGT group. The results suggest that some of the complications attributed to gestational diabetes mellitus are probably related to maternal weight excess/obesity in the affected subjects, but IGT could still affect infant birthweight outcome despite diet treatment which has normalized gestational weight gain.     

Trends in Survival and Incidence of Bronchopulmonary Dysplasia in Extremely Preterm Infants at 23–26 Weeks Gestation

The aim of this study was to investigate the relationship between survival and incidence of bronchopulmonary dysplasia (BPD) in extremely premature infants, and identify clinical factors responsible for this association. Medical records of 350 infants at 23–26 weeks gestation from 2000 to 2005 (period I, n = 137) and 2006 to 2010 (period II, n = 213) were retrospectively reviewed. The infants were stratified into 23–24 and 25–26 weeks gestation, and the survival, BPD incidence, and clinical characteristics were analyzed. BPD was defined as oxygen dependency at 36 weeks postmenstrual age. The overall survival rate was significantly improved in period II compared to period I (80.3% vs. 70.0%, respectively; P = 0.028), especially in infants at 23–24 weeks gestation (73.9% vs. 47.4%, respectively; P = 0.001). The BPD incidence in survivors during period II (55.0%) was significantly decreased compared to period I (67.7%; P = 0.042), especially at 25–26 weeks gestation (41.7% vs. 62.3%, respectively; P = 0.008). Significantly improved survival at 23–24 weeks gestation was associated with a higher antenatal steroid use and an improved 5-minute Apgar score. A significant decrease in BPD incidence at 25–26 weeks gestation was associated with early extubation, prolonged use of less invasive continuous positive airway pressure, and reduced supplemental oxygen. Improved perinatal and neonatal care can simultaneously lead to improved survival and decreased BPD incidence in extremely premature infants.     

Day 14 maternal serum progesterone levels predict pregnancy outcome in IVF/ICSI treatment cycles: a prospective study

BACKGROUND: Serum progesterone has been advocated as a tool in the diagnosis of early pregnancy failure. We conducted this prospective study in order to investigate the potential value of early (14 days after oocyte recovery) serum progesterone measurement, in women undergoing IVF/ICSI and receiving rectal progesterone supplements, in relation to pregnancy outcome. METHODS: 442 women consecutively treated by IVF or ICSI had serum progesterone and bhCG levels prospectively measured 14 days after oocyte retrieval (day 0). All women received natural progesterone 400 mg rectally until the pregnancy test on day 14. Pregnant women were followed up by serial transvaginal ultrasound scans to 8 weeks gestation. RESULTS: 115 women (26%) had a viable intra-uterine pregnancy at 8 weeks gestation, 80 (18.1%) had an abnormal pregnancy (biochemical, ectopic, miscarriage) and 247 (55.9%) failed to conceive. Women with on-going pregnancies had significantly higher serum progesterone levels (median: 430, 95%CI: 390-500 nmol/l) compared to those who had either an abnormal pregnancy (72, 48-96 nmol/l; P < 0.001) or failed to conceive (33, 28-37 nmol/l; P < 0.001). Receiver-operator curve analysis demonstrated that a single serum progesterone on day 14 post-oocyte retrieval, could highly differentiate between normal and abnormal pregnancies (area under the curve = 0.927, 95%CI = 0.89-0.96; P < 0.0001). CONCLUSIONS: In spite of exogenous progesterone supplementation, serum progesterone levels, from as early as 4 weeks gestation (day 14 post-oocyte retrieval) were significantly elevated and predicted women destined to have viable intra-uterine pregnancies. These high levels are suggestive that endogenous progesterone is already sufficient in viable pregnancies and that exogenous progesterone administration will not rescue a pregnancy destined to result in a miscarriage. Single serum progesterone measurement could be a useful indicator of pregnancy outcome in women undergoing IVF or ICSI treatment.