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Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies

Methodology Score: 4/5                
Usefulness Score: 2/5

Verhaegen J, Gallos ID, van Mello NM, Abdel-Aziz M, Takwoingi Y, Harb H, Deeks JJ, Mol BW, Coomarasamy A
BMJ. 2012 Sep 27;345:e6077


This thorough and well performed systematic literature review found that a single progesterone test before 14 weeks gestational age in women with pain or bleeding and an inconclusive ultrasound could predict a viable vs. non-viable (spontaneous abortion or ectopic) pregnancy with a specificity of 98.4% and sensitivity of 74.6%. JC attendees felt that the results of this review did not support the routine use of a single progesterone for predicting non-viability given the poor sensitivity of this test and the risk of potential ectopic pregnancy in this group. Continued use of serial beta-hcgs and clinical follow-up were strongly favoured. 
By: Dr. Laura Francis
(Presented April 2014)


Epi lesson: Goals of Systematic Literature Reviews

We often consider systematic literature reviews (SLR) and meta-analyses as tools to help us better understand the effectiveness of a given therapy when there are multiple conflicting studies in the literature. Another reasonable goal, however, is to advance the science in a given domain. On occasion, there lack rigorous study definitions to allow for effective research to answer a given clinical question or perhaps studies have been published looking repetitively at the same issue without any advancement on the clinically relevant question. Researchers can use SLRs to highlight gaps in the current literature and the need for a specific study design. This can focus researchers towards answering the question rather than multiple haphazard approaches. 
By: Lisa Calder

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