Urine Pregnancy Test Research Articles

Successful Laparoscopically Assisted Transcervical Suction Evacuation of Interstitial Pregnancy following Failed Methotrexate Injection in a Community Hospital Setting

We report on a case of a patient with an early diagnosed cornual ectopic pregnancy following failed methotrexate treatment. The patient was subsequently taken to the operating room for a laparoscopic guided transcervical suction curettage of the cornual ectopic. The surgery was successful and the patient was followed up until her urine pregnancy test was negative. We conclude that in properly selected patients, cornual ectopic pregnancy may be treated with transcervical suction curettage.

Clinical Presentation and Diagnosis of Ectopic Pregnancy-A Dilemma?

Background: Present study was conducted with a background in mind to study various clinical presentations and diagnostic modalities for ectopic pregnancy to reduce ectopic pregnancy related morbidity and mortality. Objective: To study the clinical presentation and diagnosis of ectopic pregnancy. Material and Methods: This prospective study was conducted over a period of 1 year at the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital, Shimla, from March 2011 to February 2012. In this case-control study, all the diagnosed cases of ectopic pregnancy were taken as cases and controls were the age-matched women with normal intrauterine pregnancy of same gestation age. Total number of cases with ectopic pregnancy, who reported to our institute during the study period, was 110. Results: Overall incidence of ectopic pregnancy was 18.62 per 1000 deliveries in the present study, with mean age of 28.72 years. Maximum cases were multi-gravidae (80.90%). Most common symptoms were pain in the abdomen (90.90%), amenorrhoea (82.72%), bleeding per vaginum (75.45%), gastrointestinal symptoms (37.27%) and syncopal attacks (25.45%). Typical triad of ectopic pregnancy was present in 49.09% of the cases. Most common signs were cervical motion tenderness (67.27%), abdominal tenderness (70.90%) and pallor (56.36%). Shock was present in 10 cases. Signs and symptoms were more significantly present in cases when compared with controls. Urine pregnancy test was positive in 106 cases and negative in 4 cases. Ultrasonography diagnosed ectopic pregnancy in 101 cases. Conclusion: Ectopic pregnancy still remains a dreadful condition which has always challenged the clinical acumen of obstetricians and gynaecologists. Clinical findings associated with ectopic pregnancy have a wide spectrum, ranging from a completely asymptomatic status to hypovolemic shock. The classical pattern of period of amenorrhoea and abdominal pain may be lacking in most of the patients; however, a provisional diagnosis can be made in the light of clinical features along with the sonological findings. Delayed diagnosis may lead to disasters in the form of mortality or morbidity.

Molar Pregnancy Presenting as a Large Abdominal Mass and ‘Hook Effect’

A 20 year old woman presented in gynaecology department feeling generally unwell with vomiting and a large abdominal mass. The mass was of 28 weeks gravid uterus size. She reported a normal period 5 weeks earlier. A urine pregnancy test was weakly positive. She had a regular cycle with no other significant medical or surgical history. On examination she was pale and tachycardia, Pulse 104/min, BP 134/70 mmHg, Temp 36.4.

Study of outcome of pregnancy in patients with first-trimester bleeding per vaginum

Background: To assess pregnancy outcome in women with threatened miscarriage in the first trimester. To study various maternal complication and outcome of labor in pregnancy affected by first-trimester bleeding. Methods: This prospective study was carried out by institute from May 2013 to April 2014. 100 patients were included with a history of amenorrhea and urine pregnancy test positive with bleeding per vaginum in the first trimester. Results: In this case series, 100 cases of first-trimester bleeding were studied. Majority of patients were multigravida (66%). In the present study, 40 patient (40%) had a history of previous abortion out of these 16 (40%) had non-viable outcome and 24 (60%) continue with the pregnancy beyond 20 weeks. Majority of patients (68%) presented with spotting, among those 59 (86.7%) had a favorable outcome and only 9 (13.3%) out of 68 patients were aborted. All 10 patients of heavy bleeding category aborted. 5 out of 22 patients of bleeding of moderate category aborted. First-trimester bleeding associated with pain has a poor outcome. Conclusion: First-trimester bleeding is not only associated with miscarriage but also with a higher rate of pregnancy complications. First-trimester bleeding is associated with an increased risk of certain pregnancy-related complications namely placental abruption, preterm labor, delivery of low birth weight infants and preterm premature rupture of membrane.

Acceptability and Feasibility of Phone Follow-up After Early Medical Abortion in Vietnam

To investigate phone follow-up with a semiquantitative urine pregnancy test and symptom checklist as a replacement for universal clinic follow-up after medical abortion. One thousand four hundred thirty-three women seeking early medical abortion at four hospitals in Vietnam were randomized to clinic or phone follow-up. Women allocated to clinic follow-up returned to the hospital for confirmation of abortion outcome 2 weeks after mifepristone administration. Women assigned to phone follow-up completed a semiquantitative pregnancy test at initial visit to determine baseline human chorionic gonadotropin range and again at home 2 weeks later. Clinic staff called women to review the pregnancy test results and symptom checklist. Women who screened positive were referred to the clinic. Effectiveness, feasibility, and acceptability of the follow-up methods were assessed. The rate of ongoing pregnancy was not significantly different between the two groups (clinic: 2.7% phone, 2.5%, relative risk 0.9, 95% confidence interval 0.99-1.02). Eighty-five percent of women in the phone group did not need an additional clinic visit. Phone follow-up was highly effective in screening for ongoing pregnancy with a sensitivity and specificity of 92.8% and 90.6%, respectively. Specificity of the pregnancy test alone (eg, without the symptom checklist) was higher (95.7%). Phone follow-up offers a feasible and effective approach to identify women with ongoing pregnancy after early medical abortion. When used with the semiquantitative pregnancy test, the symptom checklist offered no additional benefit and decreased the specificity of the screening. Given its effectiveness and ease of use, the semiquantitative pregnancy test alone could replace routine clinic follow-up after early medical abortion. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01150422. I.

Krukenberg tumor presenting as back pain and a positive urine pregnancy test: a case report and literature review

A Krukenberg tumor is a rare and potentially deadly cause of elevated serum β-hCG as part of a paraneoplastic syndrome. This study aims to describe the unusual case of a 36-year-old woman that presented to the Emergency Department (ED) with back pain and a positive urine pregnancy test. Assessment revealed no intrauterine pregnancy and a small left ovarian cyst. Further investigation showed moderately differentiated gastric adenocarcinoma with distant metastases to the spine. The patient died less than 3 months after her first presentation to the ED. Paraneoplastic syndrome, albeit rare, should be considered in the differential diagnosis of elevated β-hCG due to the high mortality associated with Krukenberg tumors.

Negative Pregnancy Test—Can It Confidently Rule out an Ectopic?

We have presented an unusual case of ectopic pregnancy with the negative urinary pregnancy test and a very low level of serum beta-hCG (11 IU/L). Ultrasound scan revealed right adnexal mass. Medical management and laparoscopic salpingectomy allowed for a favourable outcome.

Spontaneous Bilateral Tubal Ectopic Pregnancy

Background: Bilateral tubal pregnancy in absence of preceding induction of ovulation is a rare event, with an estimated incidence of 1/200,000 uterine pregnancies and 1/725–1/1580 ectopic pregnancies. These conditions are usually diagnosed at the time of surgery. This article reports a case of a spontaneous bilateral intact tubal multiple pregnancy associated with an ovarian cyst that was diagnosed intraoperatively and addressed with two different surgical techniques. Case: A 35-year-old woman, gravida 7, para 5+1, presented with a history of 8 weeks' amenorrhoea and intermittent vaginal bleeding; she also had mild lower abdominal pain of 1 week's duration. A urine pregnancy test taken on the day of her admission positive. This patient's abdomen was tender on palpation with a positive rebound and guarding. On pelvic examination, there was mild spotting and cervical motion tenderness were noted. A pelvic ultrasound reveled an echogenic mass lesion in the right adnexae with an ovarian cyst in the left side. A laparotomy reveled a bilateral ectopic tubal pregnancy with an ovarian cyst. Salpingectomy was performed in the unruptured right tube, and the unruptured ectopic pregnancy in the left tube was removed through salpingostomy. Results: This patient's postoperative follow-up was unevenful and histologic testing of the specimens that had been excised confirmed the diagnosis. Conclusions: Despite being rare, bilateral spontaneous ectopic pregnancy should be suspected regardless of the presence or absence of risk factors this condition, such as the use of assisted reproduction techniques. Because of its rarity, diagnosis of spontaneous ectopic pregnancy is difficult, but once the condition is diagnosed, it can be treated surgically. (J GYNECOL SURG 29:321)

Ectopic pregnancy implanted in the liver under the diaphragm

Abdominal pregnancy has been defined as an ectopic pregnancy implanted in the peritoneal cavity but excludes pregnancies that are tubal, ovarian, or intraligamentous [1]. Abdominal pregnancy is rarely seen and accounts for approximately 1% of all ectopic pregnancies [2]. Ordinarily, the location of an abdominal pregnancy is pelvic, but very rarely it may be implanted in the upper abdomen (especially on the liver) [3]. In most cases, the attachment site of the placenta is on the lower surface of the right lobe of the liver [2]. Here we report a case of ectopic pregnancy implanted on the upper surface of the right liver lobe. A 33-year-old Chinese woman (gravida 4, para 2) was admitted to our hospital’s emergency department with severe pain in the right upper quadrant of her abdomen and right shoulder pain radiation for a duration of 1 day. She had undergone two cesarean deliveries (the first in 2003 and the second 9 months prior to her presentation) and had not used any contraceptive method afterwards. On admission, she claimed to have amenorrhoea for 5 weeks and a urinary pregnancy test was weakly positive. Her serum hCG was elevated at 186.14 mIU/mL. On examination, her pulse was 82 beats/minute and blood pressure was 108/80 mmHg. Her physical examination was normal except for right upper quadrant tenderness. On vaginal examination, the uterus was normal in size with no definite adnexal mass. There was no vaginal bleeding. Transvaginal and transabdominal ultrasound examination showed a normal-sized uterus with an endometrial thickness of 8.4 mm, normal bilateral adnexae, and a moderate amount of free fluid in the abdomen. A mixed echogenic mass of 91 mm 37 mm in size was observed attached to the superior surface of the right liver lobe (Fig. 1). Because of this unusual finding, a computed tomography scan of the abdomen and pelvis was performed. A 90-mm-long mixed hypodense mass was evident on the upper surface of the right liver lobe (Fig. 2).

Clinical Utility of Screening Laboratory Tests in Pediatric Psychiatric Patients Presenting to the Emergency Department for Medical Clearance

We assess whether screening laboratory tests obtained to medically clear pediatric psychiatric patients altered management or disposition. This was a retrospective chart review of consecutive patients younger than 18 years and presenting to anacademic pediatric emergency department for medical clearance of an acute psychiatric emergency potentially requiring an involuntary hold (danger to self, danger to others, grave disability) from July 2009 to December 2010. Patients were identified by discharge diagnosis codes. History and physical examination and screening laboratory testswere reviewed for changes in management or disposition. Further analysis compared length of stay according to type of laboratory test performed. To avoid missing patients presenting with or for evaluation of an involuntary hold for whom an organic cause was diagnosed, charts with psychiatric chief complaints were reviewed for the same period. One thousand eighty-two visits resulting in 13,725 individual laboratory tests were analyzed. Of 871 visits withlaboratory tests performed, abnormal laboratory tests were associated with 7 disposition changes (0.8%) and 50management changes (5.7%) not associated with a disposition change. Twenty-five patients with noncontributory history and physical examination results had management changes, all non-urgent. One patient with a noncontributory history and physical examination result had a disposition-changing laboratory result, a positive urine pregnancy test. Patients who had any screening test performed had a longer length of stay than patients without testing (117 minutes longer; 95% confidence interval 109.7 to 124.4 minutes). In charts reviewed according to chief complaint, no patient was found to have an organic cause of their symptoms according to only screening tests. Screening laboratory tests resulted in few management and disposition changes in patients with noncontributory history and physical examination results but were associated with increased length of stay.

Uterine artery pseudoaneurysm hidden behind septic abortion: Pseudoaneurysm without preceding procedure

Uterine artery pseudoaneurysm (UAP) can occur after cesarean section or traumatic delivery, usually manifesting as postpartum hemorrhage. Here we report a patient with UAP possibly caused by septic abortion. She had high fever and bleeding with positive urine pregnancy test. We diagnosed this condition as septic abortion. Ultrasound revealed an intrauterine echogenic mass and color Doppler revealed swirling blood flow within the mass. Contrast-enhanced computed tomography showed a heterogeneously enhanced intrauterine mass. Selective internal iliac artery angiography revealed contrast medium within the mass immediately after medium injection. Bilateral uterine artery embolization was performed, after which medium no longer accumulated in the uterus, and hemostasis was achieved, confirming the diagnosis as UAP. Antibiotic treatment ameliorated the infection and the uterine content was expelled and absorbed. UAP can occur even without preceding procedures and may manifest abortive, and not postpartum, hemorrhage. UAP may be hidden behind septic abortion.

Early pregnancy detection by female community health volunteers in Nepal facilitated referral for appropriate reproductive health services.

Female community health volunteers (FCHVs) are a possible entry point for Nepali women to access timely reproductive health services at the village level. This evaluation assessed the success of a pilot program that trained FCHVs in early pregnancy detection using urine pregnancy tests (UPTs), counseling, and referral to appropriate antenatal, safe abortion, or family planning services. Between July 2008 and June 2009, the program trained 1,683 FCHVs from 6 districts on how to provide UPTs and appropriate counseling and referral; 1,492 FCHVs (89%) provided follow-up data on the number of clients served and the type of services provided. In addition, the program conducted in-depth interviews with selected FCHVs and other reproductive health service providers on their perceptions of the program. Of the FCHVs with follow-up data, 80% reported providing UPTs to women in the 8-month follow-up period. In total, they conducted 4,598 UPTs, with a mean number of 3.1 tests per FCHV. Among the women with a negative pregnancy test (47%), FCHVs provided 24% of them with oral contraceptive pills and 20% with condoms; referred 10% for other contraceptive services; and provided contraceptive counseling only to 46%. Among the women with positive pregnancy tests (53%), FCHVs referred 68% for antenatal care and 32% for safe abortion services. Providing FCHVs with the skills and supplies required for early pregnancy detection allowed them to make referrals for appropriate reproductive health services. Results of this evaluation suggest that community health workers such as FCHVs are a promising channel for early pregnancy detection and referral. As the intervention is scaled up, the focus should be on ensuring service availability and awareness of available services, UPT supply, and creating viable options for record keeping.

A Case of Hickam's Dictum: Concurrent Appendicitis and Ectopic Pregnancy

BackgroundBoth ectopic pregnancy and appendicitis are surgical emergencies that should be considered in female patients who present with right lower-quadrant pain. Deciding on the appropriate imaging modality in the pregnant patient can be difficult. The challenge of diagnosis is compounded when one considers that both pathologies may be present simultaneously. ObjectivesWe present a case demonstrating co-occurrence of ectopic pregnancy and appendicitis and suggest an algorithm for evaluation and management of cases with this presentation. Case ReportA 25-year-old woman presented to the Emergency Department complaining of 3 days of abdominal pain and a positive urine pregnancy test. After consultation with Obstetrics/Gynecology (OB/GYN) and General Surgery, a nondiagnostic pelvic ultrasound (US), and a magnetic resonance imaging (MRI) study consistent with appendiceal inflammation, the patient was taken to the operating room for a laparoscopic appendectomy. While removing the inflamed appendix, the general surgeon noted the right fallopian tube was enlarged, suggestive of an ectopic pregnancy. OB/GYN was consulted again intraoperatively and noted a right ectopic pregnancy. The surgical intervention was completed with a right salpingectomy. ConclusionIn a pregnant patient with right lower-quadrant pain, the differential diagnosis includes ectopic pregnancy, acute appendicitis, or in rare cases, both.

Copper T380 intrauterine device for emergency contraception: highly effective at any time in the menstrual cycle

Does the efficacy of placing a copper intrauterine device (IUD) for emergency contraception (EC) to prevent pregnancy depend on menstrual cycle timing and timing of unprotected intercourse (UPI)? If the urine pregnancy test is negative prior to IUD placement, the copper IUD is highly effective for EC at any point in the menstrual cycle. The use of the Copper T380A for EC has been encouraged by the failure of oral EC methods to decrease rates of unintended pregnancy and the documented success of the IUD in reducing unintended pregnancies. However scant data exist regarding the efficacy and safety of IUD insertion for EC when accounting for menstrual cycle timing and time since UPI. This is a secondary analysis of data obtained from a previously published prospective cohort study of women who received the Copper T380A IUD for EC between July 1997 and January 2000. We included 1840 participants according to the study inclusion criteria of a known last menstrual period (LMP) and cycle lengths of 25-35 days. The original study included women aged between 18 and 44 years who presented for EC at 18 sites throughout China and who had regular menstrual cycles between 24 and 42 days, a known LMP, UPI within 120 h (5 days) and a negative urine pregnancy test (cutoff <25 IU/ml). Women with uncertain LMP dates were excluded. This study included only participants with cycle lengths of 25-35 days. Among the 1840 participants with usual cycle lengths of 25-35 days, 850 (46.2%) had their IUD inserted following UPI in the expected fertile window and 84 (4.6%) had the insertion >5 days after the predicted ovulation day and 52 (2.8%) had the insertion >5 days after UPI. There were no pregnancies in the first month among the 1771 women who had information available regarding their 1-month follow-up pregnancy test. This was a secondary analysis of an observational study, and thus participants were not randomized to an alternative postcoital method. There were a small number of women who had UPI >5 days after their predicted ovulation day thus limiting the confidence of assuring a low risk of pregnancy in this situation. The ovulation day was calculated based on the LMP prior to IUD insertion and not on the subsequent first day of menses following IUD insertion. If the urine pregnancy test is negative prior to IUD placement, the copper IUD is likely to be effective for EC at almost any point in the menstrual cycle. The original study was funded by the UNDP/UNPFA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The donors and sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the paper for publication.

The role of a semi-quantitative urine pregnancy test after uterine evacuation for very early, undesired pregnancy: a pilot randomized controlled trial

To investigate if a self-administered semi-quantitative urine pregnancy test (SQ-UPT) reduces the number of patients who require an in-person visit to confirm complete abortion after surgical termination of very early pregnancy.

Traumatic Intracranial Injury in Intoxicated Patients With Minor Head Trauma

Studies focusing on minor head injury in intoxicated patients report disparate prevalences of intracranial injury. It is unclear if the typical factors associated with intracranial injury in published clinical decision rules for computerized tomography (CT) acquisition are helpful in differentiating patients with and without intracranial injuries, as intoxication may obscure particular features of intracranial injury such as headache and mimic other signs of head injury such as altered mental status. This study aimed to estimate the prevalence of intracranial injury following minor head injury (Glasgow Coma Scale [GCS] score ≥14) in intoxicated patients and to assess the performance of established clinical decision rules in this population. This was a prospective cohort study of consecutive intoxicated adults presenting to the emergency department (ED) following minor head injury. Historical and physical examination features included those from the Canadian CT Head Rule, National Emergency X-Radiography Utilization Study (NEXUS), and New Orleans Criteria. All patients underwent head CT. A total of 283 patients were enrolled, with a median age of 40 years (interquartile range [IQR] = 28 to 48 years) and median alcohol concentration of 195 mmol/L (IQR = 154 to 256 mmol/L). A total of 238 of 283 (84%) were male, and 225 (80%) had GCS scores of 15. Clinically important injuries (injuries requiring admission to the hospital or neurosurgical follow-up) were identified in 23 patients (8%; 95% confidence interval [CI] = 5% to 12%); one required neurosurgical intervention (0.4%, 95% CI = 0% to 2%). Loss of consciousness and headache were associated with clinically important intracranial injury on CT. The Canadian CT Head Rule had a sensitivity of 70% (95% CI = 47% to 87%) and NEXUS criteria had a sensitivity of 83% (95% CI = 61% to 95%) for clinically important injury in intoxicated patients. In this study, the prevalence of clinically important injury in intoxicated patients with minor head injury was significant. While the presence of the common features associated with intracranial injury in nonintoxicated patients should raise clinical suspicion for intracranial injury in intoxicated patients, the Canadian CT Head Rule and NEXUS criteria do not have adequate sensitivity to be applied in intoxicated patients with minor head injury.

Use of a checklist to rule out pregnancy in teens

Family planning guidelines recommend that providers assess pregnancy status for women seeking contraceptive services. Urine pregnancy tests are readily available in most US settings. However, cost, time and lower accuracy with early pregnancy may be barriers to their use. We examined the performance of a pregnancy checklist based on World Health Organization-recommended criteria that providers may use to be reasonably sure a woman is not pregnant versus a urine pregnancy test in a sample of US teens.

O04.1 The Influence of Hormonal Contraception and Pregnancy on the Vaginal Microbiome, Sexually Transmitted Infections, and Cytokine Responses in a Cohort of Rwandan Sex Workers

BackgroundThe effects of hormonal contraception and pregnancy on the vaginal microbiome (by molecular methods), acquisition and persistence of sexually transmitted infections (STIs), and genitourinary mucosal immunology are still largely unknown.MethodsHIV-negative,...

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...

Characteristics, medical management and outcomes of survivors of sexual gender-based violence, Nairobi, Kenya.

Médecins Sans Frontières Clinic for sexual gender-based violence (SGBV), Nairobi, Kenya. Among survivors of SGBV in 2011, to describe demographic characteristics and episodes of sexual violence, medical management, pregnancy and human immunodeficiency virus (HIV) related outcomes. Retrospective review of clinical records and SGBV register. Survivors attending the clinic increased from seven in 2007 to 866 in 2011. Of the 866 survivors included, 92% were female, 34% were children and 54% knew the aggressor; 73% of the assaults occurred inside a home and most commonly in the evening or at night. Post-exposure prophylaxis for HIV was given to 536 (94%), prophylaxis for sexually transmitted infections to 731 (96%) and emergency contraception to 358 (83%) eligible patients. Hepatitis B and tetanus toxoid vaccinations were given to 774 survivors, but respectively only 46% and 14% received a second injection. Eight (4.5%) of 174 women who underwent urine pregnancy testing were positive at 1 month. Of 851 survivors HIV-tested at baseline, 96 (11%) were HIV-positive. None of the 220 (29%) HIV-negative individuals who returned for repeat HIV testing after 3 months was positive. Acceptable, good quality SGBV medical care can be provided in large cities of sub-Saharan Africa, although further work is needed to improve follow-up interventions.