Urine Pregnancy Test Result Research Articles

Evaluation of telemedicine medical abortion using a no-test protocol in the Eastern Europe and Central Asian region: Evidence from Ukraine, Uzbekistan, and Azerbaijan.

To evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre-treatment in-person tests in Ukraine, Uzbekistan, and Azerbaijan. We conducted an open-label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at-home, high-sensitivity, urine pregnancy test. Participants were referred to in-person visit based on symptoms, urine pregnancy test results, or initiative by the participant. In all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in-person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred. Telemedicine medical abortion using the no-test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan.

Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception.

To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days. This was a secondary analysis of a randomized trial that compared the copper T380A IUD and levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, participants had a negative urine pregnancy test result and reported the frequency and timing of any unprotected intercourse in the preceding 14 days. We assessed pregnancies 1 month after IUD placement and compared pregnancy risk by single or multiple unprotected intercourse episodes and by timing (5 or fewer days before IUD placement or 6 or more days before). Among the 655 participants, one pregnancy occurred in a patient who reported intercourse once 48 hours before IUD placement. Multiple unprotected intercourse episodes were reported by 286 participants (43.7%), and 95 participants (14.4%) reported at least one unprotected intercourse episode 6 or more days before IUD placement. No pregnancies occurred among those with multiple unprotected intercourse episodes (0%, 97.5% CI 0-1.3%) or with any unprotected intercourse episode 6-14 days before IUD placement (0.0%, 97.5% CI 0.0-3.8%). Pregnancy risk difference did not significantly differ by single compared with multiple unprotected intercourse episodes (0.3%, 95% CI -0.3% to 0.8%), nor by unprotected intercourse 5 or fewer days before IUD placement or 6 or more days before (0.2%, 95% CI -0.2% to 0.5%). With a negative urine pregnancy test result at IUD placement, 1-month pregnancy risk remains low, regardless of frequency or timing of unprotected intercourse in the prior 14 days. ClinicalTrials.gov, NCT02175030.

UTAH: Using Telemedicine to improve early medical Abortion at Home: a protocol for a randomised controlled trial comparing face-to-face with telephone consultations for women seeking early medical abortion

IntroductionEarly medical abortion (EMA) is a two-stage process of terminating pregnancy using oral mifepristone (a progesterone-receptor antagonist) followed usually 1–2 days later by sublingual, vaginal or buccal misoprostol (a prostaglandin...

Young Female With Lower Abdominal Pain

A 17-year-old female patient without systemic disease presented to the emergency department because of lower abdominal pain for 1 day. Intermittent vaginal spotting was noted for 2 months. On physical examination, she was afebrile, with a pulse rate of 86 beats/min and blood pressure of 118/72 mm Hg. Whitish vaginal discharge without active bleeding was found on pelvic examination. Laboratory tests showed a positive urine pregnancy test result and an elevated serum β-human chorionic gonadotropin (HCG) 225,000 mIU/mL.

Sixteen-Year-Old Female Adolescent With Fever and Altered Mental Status

A female adolescent presented to the emergency department with altered level of consciousness, fever, and hypotension. Initial management was focused on acute resuscitation. Shortly after arrival, the search for the cause of the patient's shock became acutely focused due to the finding of a positive urine pregnancy test result, but the ultimate etiology of her decompensation was not fully determined until days later in the intensive care unit.

P3.265 Discordant Couples in HIV/AIDS Cycle

ObjectivesA large proportion of new HIV infections in sub-Saharan Africa occur in stable HIV-discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour...

Hirsutism in a Female Adolescent Induced by Long-Acting Injectable Risperidone

Hirsutism in a Female Adolescent Induced by Long-Acting Injectable Risperidone

Rate of Detection of Unsuspected Pregnancies After Implementation of Mandatory Point-of-Care Urine Pregnancy Testing Prior to Hysterosalpingography

The aim of this study was to determine the rate of detection of unsuspected pregnancies after the implementation of mandatory point-of-care urine pregnancy testing before hysterosalpingography (HSG). At the authors' institution, HSGs are scheduled to occur during days 8 to 12 of the menstrual cycle. Upon arrival in the radiology department, all women undergo point-of-care urine pregnancy testing before HSG (at a cost of $1.25 per test). Urine pregnancy test results were retrospectively reviewed. Four hundred ten women (mean age, 25.9 years; range, 22-50 years) underwent point-of-care urine pregnancy testing before HSG between October 2010 and July 2012. Study indications were infertility evaluation (90.7% [372 of 410]) and tubal patency assessment after placement of tubal occlusive devices (9.3% [38 of 410]). Two positive urine pregnancy test results (0.5%) were recorded. One positive result was deemed a false-positive because the patient had received an intramuscular injection of β-human chorionic gonadotropin before the scheduled HSG, and follow-up laboratory testing showed declining β-human chorionic gonadotropin levels. The second positive result was a true-positive, and the patient was determined to be 4.5 weeks pregnant on the date of the scheduled HSG. One of 410 women presenting for HSG was found to have an unsuspected early pregnancy, which was detected with a point-of-care urine pregnancy test. Consideration should be given to routine pregnancy testing of women before HSG because scheduling on the basis of menstrual cycle dates can be unreliable.

Is Routine Pregnancy Testing Necessary in Women with Suspected UTI?

Objective: To determine if women of reproductive age who present to the Emergency Department (ED) with urinary tract infection (UTI) symptoms can accurately predict their pregnancy status. Methods: We performed a retrospective study of women who presented to the ED with UTI symptoms (dysuria, fre- quency, or urgency). Consecutive females aged 18-49 years were referred from triage to a computer kiosk in the waiting room. The kiosk asked all patients in oral and written format: Are you pregnant, worried you might be pregnant or have you missed your last period? Patient responses about pregnancy risk were compared to urine pregnancy test results. Test characteristics and post-test probabilities were calculated. Results: From a total of 300 eligible subjects, 216 received a pregnancy test, of which 10 were positive, giving a preg- nancy prevalence of 5%. Of 196 patients who reported no pregnancy risk, 4 were found to be pregnant, yielding a nega- tive posttest probability of pregnancy = 2.0% (95%CI 0.8-5.1). Among the 155 women diagnosed with a UTI, 6 were pregnant, giving a prevalence of 4%. Of the 144 patients who reported no pregnancy risk, 2 were found to be pregnant, yielding a negative posttest probability of 1.4% (95% CI 0.4-4.9). Conclusions: Adult women presenting to the ED with UTI symptoms who report no pregnancy risk have a 2% or lower probability of actually being pregnant. We believe this level of accuracy to be sufficient for routine clinical practice, and consider it is reasonable to initiate empiric antibiotic therapy without diagnostic pregnancy testing in such patients.

Pregnancy and HIV transmission among HIV-discordant couples in a clinical trial in Kisumu, Kenya

A large proportion of new HIV infections in sub-Saharan Africa occur in stable HIV-discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour despite knowledge of discordant serostatus. Our objective was to compare HIV transmission between discordant couples who did and did not conceive during participation in a clinical trial. Five hundred and thirty-two HIV-discordant couples were followed for up to 2 years in Kisumu, Kenya as part of the Partners in Prevention HSV/HIV Transmission Study. Quarterly HIV-1 antibody and urine pregnancy test results were analysed. Forty-one HIV-1 seroconversions occurred over 888 person-years of follow-up, resulting in an annual incidence of 4.6/100 person-years. Twenty seroconversions occurred among 186 HIV-1-uninfected individuals in partnerships in which pregnancy occurred (10.8% of HIV-1-negative partners in this group seroconverted), in comparison to 21 seroconversions among 353 uninfected individuals in partnerships in which pregnancy did not occur (5.9% of HIV-1-negative partners seroconverted), resulting in a relative risk of 1.8 [95% confidence interval (CI) 1.01-3.26; P<0.05]. Pregnancy was associated with an increased risk of HIV seroconversion in discordant couples. These data suggest that the intention to conceive among HIV discordant couples may be contributing to the epidemic.

Recurrent Ectopic Pregnancy in the Ipsilateral Oviduct After Prior Laparoscopic Partial Salpingectomy

Ectopic pregnancy occurs in approximately 2% of all pregnancies, and over 95% of ectopic pregnancies involve the oviduct. Ectopic pregnancy remains the major cause of first-trimester maternal death [1]. Tubal surgery is reported to be the greatest risk factor for ectopic pregnancy. Other important risk factors include a previous ectopic pregnancy, in utero diethylstilbestrol exposure, pregnancy with an intrauterine device in situ, documented tubal pathology, infertility, previous genital tract infection, and a history of multiple sexual partners [2]. Transvaginal ultrasonography has proven to be indispensable in the early diagnosis and localization of ectopic pregnancies [3]. Even in the absence of abnormal symptoms, patients with a history of prior ectopic pregnancies should undergo thorough transvaginal ultrasonography examinations when the confirmed pregnancies are detected. Here, we report a rare case of a patient with a recurrent ectopic pregnancy in the ipsilateral oviduct after prior laparoscopic partial salpingectomy. A 28-year-old, gravida 1, para 0, woman using no contraception presented to the emergency department, complaining of severe lower abdominal pain and vaginal bleeding that had lasted 5 hours. Five years earlier, the patient had undergone laparoscopic left partial salpingectomy for an ectopic gestation. The patient’s blood pressure was 97/55 mmHg and her pulse was 97 beats/min. Her abdomen was diffusely tender with rebound. A urine pregnancy test result was positive and her hemoglobin was 10.0 g/dL. A transvaginal sonogram demonstrated a 2 × 3 cm heterogeneous left adnexal

Urine Pregnancy Test: Interesting Bio-social Cases

In Laboratory medicine, urine pregnancy test is an easily available diagnostic test in the present day. Urine pregnancy is a monitoring of human chorionic gonadotropin (hCG), which is secreted by the trophoblastic cells of the placenta. The most common indication for urine pregnancy test is secondary amenorrhea. The social impact of urine pregnancy test result is of concern. Since the result can be legal aspect and relate to the family folder, the test is considered an important test in laboratory medicine. Here, the author presented three interesting case reports of urine pregnancy test in bio-social aspect.

Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result

Ectopic pregnancy has been increasing in frequency over the past 2 decades. The sudden rupture of a fallopian tube caused by ectopic pregnancy can lead to hemorrhagic shock and death if not diagnosed and treated in a timely fashion. The emergency physician is often the health professional that is called on to make the diagnosis and coordinate timely and effective intervention. The first step in the diagnosis of ectopic pregnancy is demonstration of pregnancy by means of a rapidly performed and sensitive qualitative urine test for the β-subunit of human chorionic gonadotropin (β-hCG). A negative urine pregnancy test result will generally be used to exclude ectopic pregnancy from further consideration. The following is a report of a patient presenting to an emergency department with hypovolemic shock in conjunction with 2 negative urine β-hCG analysis results and a quantitative serum β-hCG level of 7 mIU/mL, a value less than the lower limit of detection for the highly sensitive qualitative urine and serum tests. This case report demonstrates the importance of further consideration of the diagnosis of ectopic pregnancy in the setting of a negative urine pregnancy test result. [Kalinski MA, Guss DA. Hemorrhagic shock from a ruptured ectopic pregnancy in a patient with a negative urine pregnancy test result. Ann Emerg Med. July 2002;40:102-105.]

The effect of physiological urine dilution on pregnancy test results in complicated early pregnancies.

This study addresses the likelihood of false negative urine pregnancy test results, due to physiological urine dilution as described in some anecdotal reports. In this prospective study 320 pregnancy tests were performed on urine samples of varying concentrations obtained from 40 women, with suspected complications of early pregnancy, who had presented for ultrasound scans. Four different pregnancy tests were used and serum betahCG levels were measured quantitatively. Despite a mean fivefold increase in urine dilution, the pregnancy tests with low betahCG detection limits maintained maximal sensitivity. The detection of betahCG in dilute urine was adversely affected by using pregnancy tests with higher betahCG detection limits and these tests should be used with caution when assessing gynaecological emergencies.

Analytical versus clinical sensitivity and specificity in pregnancy testing

A typical urine pregnancy test with the enzyme-linked immunoassay for human chorionic gonadotropin (Tandem Icon human chorionic gonadotropin) was performed as was a qualitative serum radioimmunoassay for human chorionic gonadotropin when the positive cutoff for the latter was set at 30 IU/L. There was 99.5% concordance between the two methods when performed on 871 simultaneous urine and serum specimens. Although the serum radioimmunoassay can detect levels of human chorionic gonadotropin as low as 10 IU/L, in this study the majority of patients with serum levels between 10 and 30 IU/L were not pregnant on clinical follow-up. Of nine patients with adequate clinical follow-up, a negative urine pregnancy test result, and a serum human chorionic gonadotropin level between 10 and 30 IU/L, only one proved to be pregnant. The Tandem Icon human chorionic gonadotropin urine test is sufficient for routine pregnancy testing and to rule out the need for immediate intervention in cases of ectopic pregnancy