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Introduction ⬇

This test measures ovarian and placental function. Specifically, it measures a part of the hormone progesterone and its principal excreted metabolite, pregnanediol. Progesterone exerts its main effect on the endometrium by causing the endometrium to enter the secretory phase and to become ready for the implantation of the blastocyte should fertilization take place.

Pregnanediol levels in women with normal menstrual cycles are constant during the follicular phase. Levels increase sharply during the luteal phase. During pregnancy, levels gradually increase, falling sharply before the onset of labor and delivery.

Pregnanediol excretion is elevated in pregnancy and decreased in luteal deficiency or placental failure.

Normal Findings ⬆ ⬇

This test is difficult to standardize; it varies with age, sex, and length of existing pregnancy.

Child: <0.1 mg/24 hr or <0.312 μmol/d

Men: 0–1.9 mg/24 hr or 0–5.9 μmol/d

Women: follicular phase, 0–2.6 mg/24 hr or 0–8.1 μmol/d

Luteal, 2.6–10.6 mg/24 hr or 8.1–33.1 μmol/d

Pregnancy: First trimester, 10–35 mg/24 hr or 31–109 μmol/d

Second trimester, 35–70 mg/24 hr or 109–218 μmol/d

Third trimester, 70–100 mg/24 hr or 218–312 μmol/d

Procedure ⬆ ⬇

  1. Properly label a 24-hour urine container with the patient’s name, date and time of collection, and test(s) ordered.

  2. Refrigerate the specimen or use a boric acid preservative. Check laboratory policy. Protect the specimen from light.

  3. Follow general instructions for 24-hour urine collection (see Long-Term, Timed Urine Specimen [2-Hour, 24-Hour]).

  4. Record exact starting and ending times on the specimen container and in the patient’s healthcare record.

  5. Send the completed specimen to the laboratory.

Clinical Implications ⬆ ⬇

  1. Increased urine pregnanediol is associated with:

    1. Luteal cysts of ovary

    2. Arrhenoblastoma of the ovary

    3. Congenital hyperplasia of adrenal gland

    4. Granulosa theca cell tumor of ovary

  2. Decreased urine pregnanediol is associated with:

    1. Amenorrhea (ovarian hypofunction)

    2. Threatened miscarriage (if <5.0 mg/24 hr or <15.6 μmol/d, miscarriage is imminent)

    3. Fetal death, intrauterine death, placental insufficiency

    4. Toxemia, eclampsia

    5. Ovarian failure

    6. Chronic nephritis in pregnancy

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose of test, procedure for 24-hour urine collection, and interfering factors. Written instructions can be helpful.

  2. Allow food and fluids.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient regarding abnormal findings.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆

Decreased values occur with estrogen or progesterone therapy and with the use of oral contraceptives.