Urine Pregnancy Test Research Articles

Control materials for urine pregnancy test from collected know positive samples

Control materials for urine pregnancy test from collected know positive samples

Radiation protection of female patients of reproductive capacity: A survey of policy and practice in Norway

The implementation of various policies related to female patients of reproductive capacity was investigated using a structured telephone interview of radiological departments in Norway. The findings suggest that 60% (n=35/58) of radiological departments have written guidelines regarding female patients of reproductive capacity. The 10-day rule is implemented for a range of examinations in 12% (n=7/58) of the radiological departments questioned, and in another 9% (n=5/58) it is only implemented for hysterosalpingography. Forty percent (n=23/58) of departments are familiar with rapid urine pregnancy tests and use them in certain circumstances. In conclusion, a lack of standardisation of approaches to radiation protection is apparent, and this raises concerns as national and international recommendations are not being correctly implemented. This may lead to confusion amongst patients and staff, and may have adverse consequences such as the accidental irradiation of the unborn child.

Bleeding duodenal choriocarcinoma: An unusual cause of positive urine pregnancy test

Primary choriocarcinoma of the duodenum is exceedingly rare. Only a few cases have been reported previously. A case of extragenital choriocarcinoma of the duodenum in a 43‐year‐old Chinese woman is described. Her presenting symptoms were abdominal pain, anaemia and melaena. Her urine pregnancy test was positive, which made ectopic pregnancy one of the differential diagnoses. An urgent ultrasound scan and computed tomography scan of the abdomen showed no evidence of an ectopic pregnancy. Upper endoscopy found a bleeding ulcer at the second part of the duodenum. A duodenal ulcer biopsy showed choriocarcinoma. The positive urine pregnancy test represents a useful marker in early diagnosis.

Laboratory-measured Pregnancy Rates in a Thai Tertiary Hospital, Some Considerations on Marital Status

In Laboratory medicine, urine pregnancy test is an easily available diagnostic test in the present day. Only a few recent studies have estimated population pregnancy rates using objective, laboratory-based criteria. Here, the authors performed a study on laboratory-measured pregnancy rates and their correlation to marital status in a tertiary hospital in Thailand. This study can be not only good information in medical aspect but also in social aspect. The data from medical records of the female patients who got diagnostic urine pregnancy test at Division of Laboratory Medicine, King Chulalongkorn Memorial Hospital, Bangkok Thailand during August 2004 to December 2004 were reviewed. Descriptive statistic was used on the data where it was appropriate. There were 1005 medical records reviewed in this study. From total medical records, there was no subject who is younger than 10-years-old. The diagnostic test results were positive in 121 cases (12.0%) and negative in 884 cases (88.0%). Classified by marital status, we found that most were married. The laboratory-measured pregnancy rates in the single and married group are 15.1% and 9.7%, respectively. There is a significant higher rate among the single group. High percentage of pregnancy group can imply for unplanned and teenage pregnancy. On interest, those types of problematic pregnancy can bring both medical and social problems.

OC38.02: Screening for Down syndrome with a two‐step approach using first‐trimester combined screening followed by second‐trimester ultrasound examination: an interventional study

Objective: To identify ultrasound measurements which are the best predictors of the presence of retained products of conception (RPOC) within the uterine cavity in women with clinical suspicion of incomplete miscarriage. Methods: This was a prospective study of 200 women with a diagnosis of incomplete miscarriage who were referred for surgical evacuation. All women had a positive urine pregnancy test, and ultrasound findings suggestive of RPOC. The indication for intervention was heavy vaginal bleeding or continuous symptoms following ≥7 days of expectant management. The endometrial thickness and the volume of RPOC (D1 × D2 × D3 × 0.532) were measured preoperatively. The final diagnosis of incomplete miscarriage was based on histopathologic evidence of chorionic villi in the surgical specimen. Results: 189 (94.5%) women had evidence of chorionic villi on histology whilst decidua was only found in the remaining 11 (5.5%) women. On multiple logistic regression analysis the best discriminator between RPOC and decidua was endometrial volume, whilst the endometrial thickness was not statistically significant. Using a cut off level ≥1 ml the odds of tissue representing chorionic villi were 137 (95% CI 24 to 778). Conclusion: The measurement of endometrial volume on ultrasound scan is a better test to diagnose incomplete miscarriage than endometrial thickness.

OC37.02: Ultrasound and histological findings in women with suspected incomplete miscarriage

Objective: To identify ultrasound measurements which are the best predictors of the presence of retained products of conception (RPOC) within the uterine cavity in women with clinical suspicion of incomplete miscarriage. Methods: This was a prospective study of 200 women with a diagnosis of incomplete miscarriage who were referred for surgical evacuation. All women had a positive urine pregnancy test, and ultrasound findings suggestive of RPOC. The indication for intervention was heavy vaginal bleeding or continuous symptoms following ≥7 days of expectant management. The endometrial thickness and the volume of RPOC (D1 × D2 × D3 × 0.532) were measured preoperatively. The final diagnosis of incomplete miscarriage was based on histopathologic evidence of chorionic villi in the surgical specimen. Results: 189 (94.5%) women had evidence of chorionic villi on histology whilst decidua was only found in the remaining 11 (5.5%) women. On multiple logistic regression analysis the best discriminator between RPOC and decidua was endometrial volume, whilst the endometrial thickness was not statistically significant. Using a cut off level ≥1 ml the odds of tissue representing chorionic villi were 137 (95% CI 24 to 778). Conclusion: The measurement of endometrial volume on ultrasound scan is a better test to diagnose incomplete miscarriage than endometrial thickness.

Utility of low-sensitivity and high-sensitivity urine pregnancy tests as indicators of gestational sac expulsion after medical abortion

Introduction: We performed this trial to ascertain the accuracy of low-sensitivity (LS) and high-sensitivity (HS) urine pregnancy tests in determining gestational sac expulsion following treatment with mifepristone and misoprostol for medical abortion.Materials and Methods: This planned substudy was part of a multicenter medical abortion trial in women up to 63 days of gestation. One thousand eighty subjects received 200 mg of mifepristone po and were randomly assigned to take 800 ��g of misoprostol vaginally either 6���8 or 23���25 h later. Subjects returned 7 (��1) and 14 (��2) days after initiating treatment. A transvaginal ultrasound to determine the presence of a persistent gestational sac as well as HS and LS urine pregnancy tests were performed at each visit. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each urine pregnancy test.Results: The sensitivities, specificities, PPVs and NPVs with 95% CIs are as follows:First follow-up visit���LS test: sensitivity, 95.7 (87.3���100); specificity, 13.1 (10.8���15.5); PPV, 3.1 (1.8���4.3); NPV, 99.1 (97.2���100). HS test: sensitivity, 90.5 (77.9���100); specificity, 6.4 (4.7���8.1); PPV, 2.5 (1.4���3.6); NPV, 96.2 (91.1���100).Second follow-up visit���LS test: sensitivity, 78.9 (60.6���97.3); specificity, 38.5 (34.6���42.4); PPV, 4.0 (2���5.9); NPV, 98.3 (96.6���100). HS test: sensitivity, 83.3 (66.1���100); specificity, 33.7 (29.9���37.5); PPV, 3.7 (1.9���5.5); NPV, 98.5 (96.8���100).Discussion: The LS and HS urine pregnancy tests showed inconsistent sensitivities and specificities. The PPV was too low to accurately identify women who required additional treatment. The high NPV of both tests indicates the accuracy of a negative test result in detecting expulsion of the gestational sac after medical abortion. Introduction: We performed this trial to ascertain the accuracy of low-sensitivity (LS) and high-sensitivity (HS) urine pregnancy tests in determining gestational sac expulsion following treatment with mifepristone and misoprostol for medical abortion. Materials and Methods: This planned substudy was part of a multicenter medical abortion trial in women up to 63 days of gestation. One thousand eighty subjects received 200 mg of mifepristone po and were randomly assigned to take 800 ��g of misoprostol vaginally either 6���8 or 23���25 h later. Subjects returned 7 (��1) and 14 (��2) days after initiating treatment. A transvaginal ultrasound to determine the presence of a persistent gestational sac as well as HS and LS urine pregnancy tests were performed at each visit. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each urine pregnancy test. Results: The sensitivities, specificities, PPVs and NPVs with 95% CIs are as follows:First follow-up visit���LS test: sensitivity, 95.7 (87.3���100); specificity, 13.1 (10.8���15.5); PPV, 3.1 (1.8���4.3); NPV, 99.1 (97.2���100). HS test: sensitivity, 90.5 (77.9���100); specificity, 6.4 (4.7���8.1); PPV, 2.5 (1.4���3.6); NPV, 96.2 (91.1���100).Second follow-up visit���LS test: sensitivity, 78.9 (60.6���97.3); specificity, 38.5 (34.6���42.4); PPV, 4.0 (2���5.9); NPV, 98.3 (96.6���100). HS test: sensitivity, 83.3 (66.1���100); specificity, 33.7 (29.9���37.5); PPV, 3.7 (1.9���5.5); NPV, 98.5 (96.8���100). Discussion: The LS and HS urine pregnancy tests showed inconsistent sensitivities and specificities. The PPV was too low to accurately identify women who required additional treatment. The high NPV of both tests indicates the accuracy of a negative test result in detecting expulsion of the gestational sac after medical abortion.

Ectopic pregnancy in Sokoto, Northern Nigeria.

Ectopic pregnancy is an important cause of maternal mortality and morbidity in the first trimester of pregnancy. We report a descriptive, cross-sectional study of ectopic pregnancy presenting to the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, between 1990 and 1997. There were 140 cases of ectopic pregnancy with incidence of 18.1 per 1,000 deliveries. The mean age of patients was 26.7 years and the median parity of cases of ectopic gestation was 1; 32% were nulliparae. Abdominal pain and tenderness were the most frequent symptom and sign respectively. Diagnosis was usually based on clinical findings augmented by procedures including paracentesis abdominis, abdominal ultrasound scan and urine pregnancy test. The ectopic pregnancy was sited in the Fallopian tube in 92% of cases. In 56 cases (41%), there was macroscopic evidence of previous pelvic infection at surgery. 66 % of ectopic pregnancies had ruptured at presentation. Treatment was surgical in all but one case, and unilateral salpingectomy was the procedure most frequently performed. The case fatality rate was 1.5%.

Three-dimensional sonographic diagnosis of ovarian pregnancy

Three-dimensional sonographic diagnosis of ovarian pregnancy

Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea

Recurrent C difficile -associated diarrhea (CDAD) is associated with a lack of protective immunity to C difficile toxins. A parenteral C difficile vaccine containing toxoid A and toxoid B was reported previously to be safe and immunogenic in healthy volunteers. Our aim was to examine whether the vaccine is also well tolerated and immunogenic in patients with recurrent CDAD. Subjects received 4, 50-microg intramuscular inoculations of the C difficile vaccine over an 8-week period. Serum antitoxin antibodies were measured by ELISA, and toxin neutralizing activity was evaluated using the tissue culture cytotoxin assay. Three patients with multiple episodes of recurrent CDAD were vaccinated. Two of the 3 showed an increase in serum IgG antitoxin A antibodies (3-fold and 4-fold increases, respectively) and in serum IgG antitoxin B antibodies (52-fold and 20-fold, respectively). Both also developed cytotoxin neutralizing activity against toxin A and toxin B. Prior to vaccination, the subjects had required nearly continuous treatment with oral vancomycin for 7, 9, and 22 months, respectively, to treat recurrent episodes of CDAD. After vaccination, all 3 subjects discontinued treatment with oral vancomycin without any further recurrence. A C difficile toxoid vaccine induced immune responses to toxins A and B in patients with CDAD and was associated with resolution of recurrent diarrhea. The results of this study support the feasibility of active vaccination against C difficile and its toxins in high-risk individuals but must be validated in larger, randomized, controlled trials.

Case 2: An unusual cause of syncope

An 11-year-old girl presented to the emergency department with three brief episodes of syncope that day. Before each episode, the patient was standing and then felt weak and dizzy. Subsequently, she vomited once and experienced lower abdominal pain. She had no fever, diarrhea or dysuria. She denied visual or gait disturbances, weakness, paresthesia, chest pain or shortness of breath. There was a remote history of trauma one month previous when she fell approximately four feet off an unloading ski chairlift onto her abdomen. She was examined and medically cleared at the time. Her past medical history was unremarkable. Her menarche was one month earlier, and she denied being sexually active. She was on no medications. On physical examination in the emergency department, she appeared pale with slightly dry mucus membranes. She was alert with a supple neck. Her heart rate was 120 beats/min and her respiratory rate was 20 breaths/min. Her blood pressure was 110/60 mmHg and she was saturating 98% in room air. When she sat up, she felt dizzy and presyncopal. Her head and neck examination was normal. Her cardiorespiratory examination revealed a clear chest with no murmurs and normal peripheral pulses and perfusion. Her abdomen was soft with diffuse tenderness in the lower quadrants bilaterally. Her neurological examination was normal. Initial investigations revealed a white blood cell count of 14.3 × 109/L, hemoglobin of 101 g/L, and platelets of 274 × 109/L. The urine pregnancy test was negative. Liver function tests, renal function tests and amylase were normal. The chest x-ray and electrocardiogram were within normal limits. The patient was given a bolus of 20 mL/kg of normal saline and sent for an abdominal CT (computed tomography) scan where the diagnosis was made. When the hemoglobin was repeated 4 h later because of the CT scan findings, it had dropped to 81 g/L.

Successful laparoscopic management of ectopic pregnancy in a districtgeneral hospital

SummaryA retrospective analysis of the management of ectopic pregnancy was undertaken at Billinge Hospital, Wigan from June 1999 to June 2002. A total of 114 cases of ectopic pregnancy were identified. Diagnosis was usually confirmed by laparoscopy (89.4%) and 102 cases (82.4%) were managed by laparoscopic salpingectomy. A total of 7.08% of patients needed a laparotomy after the initial laparoscopy and two (1.75%) had laparotomy performed as the primary approach. Medical treatment was given to eight women (7.0%). All the consultants were competent in performing laparoscopic surgery and 71.3% of cases were performed laparoscopically by a consultant. The diagnostic accuracy was high using a combination of urine pregnancy tests, serum beta-hCG and transvaginal scan.

Placental-site trophoblastic tumour: an unusual presentation with bilateral ovarian involvement

A 33-year-old woman presented in August, 2000, with a 7-week history of amenorrhoea and a positive urine pregnancy test. She had had an early-pregnancy failure 3 years previously and a subsequent pregnancy 15 months later, which resulted in the delivery of a healthy baby girl by emergency caesarean section. Transvaginal ultrasonography showed no evidence of an intrauterine gestation sac and was otherwise unremarkable. At this time, measurement of serum human chorionic gonadotropin (hCG) was 104 IU/L. Subsequent transvaginal ultrasonography 1 month later showed a heterogeneous 21-mm mass adjacent to the right ovary and repeat hCG was 140 IU/L. She was given 50 mg/m methotrexate intramuscularly for a presumed failed ovarian ectopic pregnancy. However, subsequent serial serum hCG concentrations did not show the expected decline. A further dose of intramuscular methotrexate was therefore given in September, 2000; however, serum hCG continued to rise reaching a maximum of 214 IU/L in October, 2000. Repeat transvaginal ultrasonography at this time showed an abnormally vascular right ovary, which measured 50 29 34 mm. Laparoscopy showed a grossly abnormal right ovary and a right salpingo-oophorectomy was done. Histopathological examination showed an ovary infiltrated by a poorly circumscribed tumour that consisted of sheets and nests of mononuclear cells, with vacuolated or eosinophilic cytoplasm. Focal hyperchromatic nuclei and multinucleate cells were present. There were focal regions of necrosis and stromal hyalinisation (figure 1). On immunostaining, tumour cells were strongly positive for human placental lactogen with weak focal staining for hCG and placental alkaline phosphatase (figure 1). The features were strongly Lancet Oncol 2005; 6: 59–61

Mysterious Pregnancy: A Diagnostic Dilemma

We present an interesting case in early pregnancy who reported to us with pain abdomen. Initial management was based on the clinical picture, serum beta hCG, and ultrasound findings. Few days later as there was a disparity between the three, surgical intervention was carried out. Despite all interventions we could not find the origin of high beta hCG levels in our case in the absence of a proven pregnancy .even after an extensive literature search we were unable to dissolve the mystery of our case. CASE REPORT A 28 year old lady at six weeks of amenorrhoea and positive urine pregnancy test was referred to our early pregnancy unit with lower abdominal pain. This was a spontaneous first pregnancy. She had no history of per vaginal bleeding, discharge, gastrointestinal or urinary symptoms. There was no history of pelvic inflammatory disease and she had never used an intrauterine contraceptive device. Her past medical and surgical history was not significant. Clinical observations were stable. Examination revealed left lower abdominal tenderness with mild cervical excitation. Routine bloods were normal and serum beta HCG was 16,600 IU. An ultrasound was requested to confirm an intrauterine viable pregnancy. Ultrasound showed an intrauterine sac with a small yolk sac and a heterogeneous left adnexal mass of 6x6 cm. The probable differential diagnoses put forward were a hemorrhagic corpus luteal cyst and heterotrophic pregnancy. Considering the rarity of a heterotrophic pregnancy in this case and serum beta HCG being consistent with 6 weeks of pregnancy she was managed conservatively. Her serum beta HCG levels were sequentially monitored to rule out exponential rise. Ten days later a repeat scan performed showed the same size of intra uterine sac and yolk sac with slight increase in adnexal mass with 100ml of free fluid in pouch of Douglas. Her beta HCG levels were above 100,000 IU/ml. Though clinically she was stable, with such high serum beta HCG levels and an adnexal mass an operative laparoscopy and suction curettage were carried out after informed consent. Intra operatively both tubes were apparently normal looking, left ovary had a cyst of 8x8 cms septate with clear fluid. Pouch of Douglas had clear straw coloured fluid. Uterine curettings were suspicious of molar tissue. Histology of the cyst showed only fibrous component in a luteinised cyst with no evidence of dysplasia or malignancy. The uterine curettings showed decidualised endometrium with focal Arias Stella reaction, with no evidence of chorionic or fetal tissue and could not confirm an intrauterine pregnancy. Post operative recovery was uneventful. Beta HCG levels began to fall and reached normal levels in four weeks time at which she had a normal

DXA and Pregnancy Issues in Research Involving Minors

0478 Dual-energy x-ray absorptiometry (DXA) exposes subjects to a small radiation dose and raises procedural issues regarding pregnancy testing and confidentiality, especially with minors. Although DXA has become a widely used technique in exercise science for body composition analysis with youths, researchers rarely report in detail on procedures related to pregnancy issues. PURPOSE: To determine current practice among U.S. researchers regarding DXA use and pregnancy-related issues with minors. METHODS: A search of the PubMed database was made to identify studies meeting the following criteria: original research published in English with a PubMed entry date between June 30, 2002 and June 30, 2003; DXA measurement of female subjects 18 years-of-age or younger; and U.S. mailing address for the author of correspondence. Twenty-three authors were identified with this process. A 16-item questionnaire dealing with DXA and pregnancy issues was sent to each of the 23 authors along with a cover letter and self-addressed, stamped return envelope. RESULTS: Fourteen of the 23 questionnaires (61%) were returned. All reported having conducted research using DXA with females 18 years-of-age or younger. Eleven of 14 (79%) respondents said an attempt was made to determine pregnancy prior to DXA scanning, with 8 of the 11 (73%) using a urine pregnancy test. Reasons for not determining pregnancy included pre-pubertal status of the subjects, minimal radiation dose associated with DXA, and lack of exposure of the abdominal region during DXA scanning. Of those who determined pregnancy status, 8 of 11 (73%) indicated that the parental consent form contained information about determining the pregnancy status of the daughter, while only 5/11 (45%) said the child assent form contained such information. Ten of 11 (91%) responded that in the event that evidence of pregnancy had been identified the child would have been informed, whereas only 4/11 (36%) said the parent would have been informed. None of the respondents reported ever seeking an attorney's opinion regarding DXA and pregnancy issues with minors. CONCLUSIONS: Current practice among U.S. researchers utilizing DXA with minors usually includes an attempt to determine pregnancy status prior to scanning. Most respondents indicated that minors would have been informed of positive pregnancy results, but fewer than half indicated that parents would have been informed.

Ectopic Pregnancy Months after Laparoscopic Supracervical Hysterectomy

Although it is an easy diagnosis to eliminate, pregnancy is rarely considered in a woman with acute abdominopelvic pain and history of hysterectomy. A 37-year-old woman was seen because of acute onset of pelvic pain. Her history was significant for laparoscopic supracervical hysterectomy performed 4 months previously. A urine pregnancy test was positive. At diagnostic laparoscopy, an area in the right tube was consistent with ectopic pregnancy. Bilateral salpingectomy was performed, and pathology confirmed an ectopic pregnancy in the right tube. A diagnosis of ectopic pregnancy should be entertained in any woman with pain and intact ovaries.

Charge variants in serum and urine hCG

Background: All serum and urine pregnancy tests sold in the United States are calibrated against the WHO 3rd and 4th International Standards (3rd and 4th I.S.) of Human Chorionic Gonadotropin (hCG). These standards have been isolated from pregnancy urine; however, they are used to calibrate, and generate antibodies used in both urine and serum hCG tests. hCG molecules may vary in sialic acid content; this changes the acidity of the molecule. Published studies have shown that these carbohydrate elements may alter recognition of hCG in different serum and urine hCG tests. We investigated the charge variants of hCG in serum and urine samples, and in hCG standards. Methods: Samples were analyzed by preparative isoelectric focusing. Charge variants of hCG were quantitated using the DPC Immulite hCG assay. Results: A difference was observed in the proportion of charge variants in urine and serum samples. There was a significantly higher proportion of more-acidic variants in the urine samples. Conclusions: Urine-derived standards may not be representative of serum hCG and therefore may not be appropriate for calibrating serum assays. Variation among hCG test results when using different immunoassays has been a persistent problem for years. Additional studies are needed to focus on the molecular dissimilarity of urine and serum hCG, as well as other factors, to determine their significance and contribution to the problem of interassay variation when comparing hCG results.

Urine pregnancy test and intrauterine inseminations

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Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

Familial recurrent molar pregnancy: a case report

Familial recurrent molar pregnancy: a case report