Positive Urine Pregnancy Test Research Articles

Should patients who are suspected of having an ectopic pregnancy undergo physical examination?

Objective: To determine whether physical examination is useful for patients with suspected ectopic pregnancy (EP) for whom transvaginal sonography is performed and serum hCG levels are measured. Design: Prospective study. Setting: Two large teaching hospitals. Patient(s): Three hundred eighty-two patients with suspected EP, based on a positive urine pregnancy test and the presence of abdominal pain, vaginal bleeding, or risk indicators. Intervention(s): Abdominal examination, speculum inspection, and digital vaginal examination. Main Outcome Measure: A final diagnosis made by transvaginal sonography, serum hCG measurement, and, if necessary, confirmatory laparoscopy. Result(s): One hundred sixteen (30%) of the 382 patients had an EP. At external abdominal examination, rebound tenderness and muscular rigidity had likelihood ratios of 3.7 and 8.0, respectively. Findings at speculum inspection and digital vaginal examination had likelihood ratios between 0.33 and 2.4. Logistic regression analysis showed that the additional information provided by physical examination for the diagnosis of EP is limited compared with the information provided by transvaginal sonography and serum hCG measurement alone. Conclusion: On the basis of our results, we believe that vaginal digital examination for patients with suspected EP is unnecessary.

Laparoscopic management of early primary abdominal pregnancy

Abdominal pregnancy is a very rare condition with a high mortality rate. A 29-year-old woman with a history of primary infertility was admitted because of lower abdominal pain, bloody vaginal discharge, and positive urine pregnancy test. Transvaginal ultrasonography revealed a 27 x 25-mm mass containing a gestational sac-like structure located outside the uterus. At laparoscopy, a clot was revealed including chorionic villi, adherent to the peritoneum in the right vesicouterine pouch. This was removed along with the adherent peritoneum. Postoperative histology revealed invasion of chorionic tissues into peritoneum. Early diagnosis of an ectopic pregnancy by transvaginal ultrasonography enabled the laparoscopic management of early abdominal pregnancy.

Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies)

Objective: To determine whether treatment with low dose aspirin and heparin leads to a higher rate of live births than that achieved with low dose aspirin alone in women with...

The introduction of a serum β-hCG threshold for suspected ectopic pregnancy, in a district general hospital, is safe and cost effective

SummaryWe assessed the effect of introducing a rapid, serum /?-hCG assay as part of a routine ‘early pregnancy assessment’ service in a District General Hospital on treatment costs and the negative laparoscopy rate.Eighty-five consecutive women presenting who had an empty uterus on transvaginal scan and a positive urinary pregnancy test had a serum β-hCG measured. They were managed according to a simple algorithm. Laparoscopy was performed when a serum β-hCG was above a threshold level of 1000 iu/1.he algorithm had a sensitivity of 100 per cent and the negative laparoscopy rate was reduced from 61 to 9 per cent. There were no false negative diagnoses and no emergency admissions in those patients discharged home.This simple addition to an already established early pregnancy assessment service, in our unselected population, has provided a safe and cost effective method which can reduce unnecessary admissions and operative morbidity in the management of suspected ectopic pregnancy.

Emergency department diagnosis of ectopic pregnancy

To assess the accuracy of the history and physical examination as compared to the addition of serum progesterone screening for ectopic pregnancy in women presenting to the emergency department. Prospective, consecutive case series, N = 2,157. ED of the Regional Medical Center at Memphis, a publicly subsidized, 450-bed acute care hospital staffed by residents and faculty of the University of Tennessee, Memphis. All ED patients with a positive urine pregnancy test treated between January 1 and December 31, 1988. Screening history, physical examination, and serum progesterone (P) and quantitative human chorionic gonadotropin (hCG) titer. All discharged patients were given follow-up appointments within two weeks; those found to have a P less than 25 ng/mL were called to return for repeat hCG and transvaginal ultrasound. One hundred sixty-one of 2,157 patients (7.5%) with a positive urine pregnancy test were found to have an ectopic pregnancy. All but five had a P of less than 25 ng/mL (sensitivity, 97%); four of these were admitted for immediate surgery because of symptoms. Overall, the ED physician detected 89 of 161 ectopics (55.3%) on initial presentation, 53 (60%) of which were ruptured at the time of surgery. Seventy-two patients (44.7%) who were discharged but later found to have an ectopic pregnancy had benign clinical presentations, including 41 with vaginal bleeding. There were no statistically significant differences in the presenting symptoms of patients with unruptured ectopics compared with normal intrauterine pregnancies. All but one of the 72 discharged patients were noted the following day to have a progesterone of less than 25 ng/mL and contacted to return. Eight of these were found to have a ruptured ectopic at the time of surgery. Only 91 of 161 patients (56.5%) with ectopic pregnancy acknowledged one or more clinical risk factors on follow-up questioning. The standard history and physical examination, including those performed by gynecologic specialists, are insufficiently sensitive for early detection of unruptured ectopic pregnancy. EDs with a high incidence of ectopic pregnancy should strongly consider implementation of a universal progesterone screening program to decrease unnecessary patient morbidity and the risk of mortality from undiagnosed ectopic pregnancy.

Serum progesterone and human chorionic gonadotropin in very early pregnancy: implications for clinical management

We studied beta-human chorionic gonadotropin (beta-HCG) and progesterone (P) in maternal serum in 71 patients with a positive urine pregnancy test with a threshold of 50 U HCG/liter urine and an ultrasound examination without demonstrable fetal heart beat. Patients were divided into three groups: ongoing intra-uterine pregnancy of more than 12 weeks duration (n = 23), ectopic pregnancy (n = 14), and abnormal intra-uterine pregnancy (blighted ovum, early spontaneous abortion) resulting in dilatation and curettage (n = 34). We found that both beta-HCG and progesterone levels were significantly lower in abnormal pregnancies but that there was less overlap between the progesterone values in normal, ectopic and abnormal pregnancy as compared to beta-HCG levels. There was a positive correlation between beta-HCG levels < 5000 mU/ml and serum progesterone in ectopic pregnancies but not in normal or abnormal intrauterine pregnancies. The size of the gestational sac correlated with serum beta-HCG levels but not with serum progesterone levels in normal intra-uterine pregnancies. We conclude that serum progesterone levels (cut-off point 15 ng/ml) in very early pregnancy can be helpful to differentiate between normal intra-uterine pregnancy and abnormal intra-uterine or ectopic pregnancy.

Trial with an antiprogestin for the termination of early pregnancy and its biochemical effects

A clinical study was carried out on an antiprogestin, a synthetic steroid, 17 Hyroxy-11 β-(4-dimethyl amino-phenyl-1)—17 (Prop-1-ynyl-estra—4, 9, dien-3-one) for the termination of pregnancies in female subjects within 14 days of missed menstrual period and with positive urine pregnancy test (Gravindex Test). The compound was tested for its efficacy as an abortifacient and its acceptance by human subjects was assessed by measuring various biochemical parameters before and after introduction of the drug. The parameters measured in the subjects included, fasting blood sugar, blood urea, SGOT, SGPT, serum alkaline phosphatase, serum bilirubin, serum creatinine, serum proteins, A/G ratio and serum Na+, K+. Statistically insignificant variation was noted in all the parameters studied. This clearly shows that the drug is very well accepted by human subjects. 70% of the subjects tested in the pilot study aborted within 4 days of introduction of the drug. Overall, 90% of the subjects tested aborted as a result of introduction of the drug.

Detection of ectopic pregnancy in an outpatient population: The role of the beta-HCG level

A retrospective analysis was made of 265 female outpatients who initially presented to an emergency department with a complaint of amenorrhea, vaginal bleeding, or abdominal/pelvic pain. The patients were discharged from the emergency department pending results of a serum pregnancy test. Forty-five of the patients were subsequently found to have an elevated (>5 mIU/mL) beta human chorionic gonadotropin (HCG) level. Six of the patients had an ectopic pregnancy; their beta HCG levels ranged from 19 to 265 mIU/mL. A detectable beta HCG level less than 500 mIU/mL had a 33076 probability of an ectopic pregnancy in the study group. Historical features, physical examination, and laboratory parameters were of limited value for identification of minimally symptomatic outpatients at risk for an ectopic pregnancy. No study patient had a systolic blood pressure of less than 86 mm Hg on presentation. A comparison group of 29 patients admitted to the hospital directly from the emergency department with a diagnosis of “rule out ectopic pregnancy” during the same time interval was identified. Nine of the directly admitted patients were found to have ectopic pregnancies. A statistically greater proportion of the directly admitted patients had a hematocrit less than 35% and a positive urine (tube) pregnancy test than that found for the study group. Five of the comparison group patients were noted to have a systolic blood pressure of less than or equal to 80 mm Hg. The beta HCG was found to be an essential tool in the evaluation of potential ectopic pregnancy in patients with minimal symptomatology.