Urine Pregnancy Test Research Articles

An early return to fertility resulting in ectopic pregnancy 10 weeks post vaginal birth: A case report

Background: There exists an unmet need for timely initiation of reliable postpartum contraception among mothers. This could result in unplanned and closely spaced pregnancies that may endanger the lives of the mother and the unborn baby.
 Case presentation: A 22-year-old para 1+0 presented to the emergency department with gradual onset of lower abdominal pains, per vaginal spotting, and bloating 10 weeks after childbirth. She reported full-time breastfeeding and regular and consistent use of male condoms for contraception. A diagnosis of ectopic pregnancy was established following a positive urine pregnancy test and a transabdominal ultrasound that revealed features of right tubal pregnancy. Exploratory laparotomy and partial salpingectomy were performed. The patient was stable and was discharged on the second postoperative day.
 Conclusion: Early return of fertility in exclusively breastfeeding mothers is possible; hence, an effective family planning method is needed during the postpartum period to minimize the complications of short interpregnancy intervals.

Medical abortion via telemedicine for women and adolescents: Experience from Moldova

AbstractIntroductionTo pilot and evaluate the safety and participant satisfaction of the first‐ever telemedicine medical abortion service provided in Moldova, a lower‐income country located in Eastern Europe.MethodsBefore enrolment, each participant confirmed their pregnancy with a urine pregnancy test, ultrasound and/or blood test and calculated the gestational age based on the last menstrual period. After study consent was obtained, the study clinician confirmed eligibility for medical abortion and the study and provided counselling via videoconference or telephone. Eligible participants received medications by mail or prescription. A follow‐up call to assess abortion outcome, adverse events and other medical history was conducted 1 week after participants took mifepristone. A pregnancy test was taken 4 weeks after taking mifepristone for a final evaluation of the abortion outcome. The analysis was descriptive.ResultsBetween March 2020 and March 2021, 549 eligibility screenings were conducted, and 531 study packages containing medications or prescriptions were sent to pregnant women and adolescents with gestations ≤9 weeks since the last menstrual period. The majority of procedures (n = 477, 89.8%) were completed without an in‐person visit. Final abortion outcome was available for 499/531 (94.0%) medical abortion procedures: 484/499 (97.0%) were complete abortions, 11 (2.2%) were surgical completions (seven incomplete abortions and four continuing pregnancies), and four participants (0.8%) decided to keep their pregnancy. One serious adverse event occurred. Acceptability of the service was high (99.0% very satisfied or satisfied) and 86.5% of participants reported a future preference for telemedicine. The most commonly reported reasons for choosing the telemedicine service were convenience (n = 286, 56.2%) and confidentiality (n = 202, 39.7%).ConclusionThe medical abortion via telemedicine service has proven to be a safe and acceptable option for women and adolescents in Moldova. This model has the potential to increase access to abortion, including during emergencies like the COVID‐19 pandemic.

Levonorgestrel 52 mg intrauterine system efficacy and safety through 8 years of use

Extending hormonal intrauterine system duration will allow users to have less need for procedures to provide long-term contraception. This study aimed to evaluate the efficacy and safety of the levonorgestrel 52 mg intrauterine system during years 7 and 8 of use. A total of 1751 nulliparous and multiparous participants aged 16 to 45 years enrolled in a phase 3, multicenter trial to evaluate the efficacy and safety of the use of the Liletta levonorgestrel 52 mg intrauterine system for up to 10 years. Participants aged 36 to 45 years at enrollment underwent safety evaluation only. After the first year, we evaluated participants every 6 months for intrauterine system location confirmation and urine pregnancy testing at each visit. We assessed the Pearl Indices in years 7 and 8 and the life-table analysis for cumulative pregnancy rates through 8 years of use. For the primary efficacy analyses, all participants aged 16 to 35 years at enrollment were included through year 6; years 7 and 8 included only users aged ≤39 years at the start of each use year. Safety outcomes were assessed in all participants regardless of duration of use. We assessed amenorrhea rates, defined as no bleeding or spotting in the 90 days before the end of the year. After intrauterine system placement, we followed 1568 participants aged 16 to 35 years and 146 participants aged 36 to 45 years. The 16- to 35-year-old participants included 986 (57.5%) nulliparous and 433 (25.3%) obese users. Overall, 569 participants started year 7, 478 completed year 7 (380 aged ≤39 years at beginning of year) and 343 completed year 8 (257 aged ≤39 years at beginning of year); 77 completed 10 years of use. Eleven pregnancies occurred over 8 years, 7 (64%) of which were ectopic. Two pregnancies occurred in year 7 (Pearl Index, 0.49; 95% confidence interval, 0.06-1.78), 1 in a participant with implantation 4 days after a desired removal; no pregnancies occurred in year 8. The cumulative life-table pregnancy rate in the primary efficacy population through year 8 was 1.32 (95% confidence interval, 0.69-2.51); without the postremoval pregnancy, the rate was 1.09 (95% confidence interval, 0.56-2.13). Two perforations (0.1%) occurred, none noted after year 1. Expulsion occurred in 71 (4.1%) participants overall, with 3 in year 7 and 2 in year 8. Pelvic infection was diagnosed in 16 (0.9%) participants during intrauterine system use, 1 each in years 7 and 8. Only 44 (2.6%) participants overall discontinued because of bleeding complaints (4 total in years 7 and 8) with rates per year of 0.1% to 0.5% for years 3 to 8. Amenorrhea rates were 39% at both years 7 and8. The levonorgestrel 52 mg intrauterine system is highly effective over 8 years of use and has an excellent extended safety profile. This report details the longest period of efficacy and safety data for continuous use of a levonorgestrel 52 mg intrauterine system for contraception.

MP11-03 FALSE POSITIVE PREGNANCY TESTS AMONG PEDIATRIC PATIENTS WITH AUGMENTATION ENTEROCYSTOPLASTIES

You have accessJournal of UrologyCME1 May 2022MP11-03 FALSE POSITIVE PREGNANCY TESTS AMONG PEDIATRIC PATIENTS WITH AUGMENTATION ENTEROCYSTOPLASTIES Zoë Baker, Arthi Hannallah, Hannah Dillon, Yuding Wang, and Evalynn Vasquez Zoë BakerZoë Baker More articles by this author , Arthi HannallahArthi Hannallah More articles by this author , Hannah DillonHannah Dillon More articles by this author , Yuding WangYuding Wang More articles by this author , and Evalynn VasquezEvalynn Vasquez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A high number of false positive pregnancy test results have been self-reported among patients with augmentation enterocystoplasties using over-the-counter (OTC) urine pregnancy tests. We sought to determine the accuracy of OTC pregnancy tests among pediatric patients who had previously undergone augmentation enterocystoplasties. METHODS: Patients at a tertiary care pediatric hospital who had previously undergone augmentation enterocystoplasties or Mitrofanoff appendicovesicostomies only were prospectively recruited. Urine samples were obtained and two OTC pregnancy tests, one point of care testing (POCT) urine pregnancy test, and urinalysis (UA) were completed. All pregnancy tests qualitatively assessed human chorionic gonadotropin (hCG). OTC Test A was a sandwich immunoassay employing monoclonal anti-β-hCG, goat anti-rabbit, anti-α-hCG, and rabbit Immunoglobulin G (IgG) antibodies and using chromatography to separate bound and free colored label. OTC Test B was a lateral flow immunoassay dipstick containing mouse monoclonal anti-β-hCG antibody colloidal gold conjugate pre-dried on a pad, mouse monocolonal anti-α-hCG antibodies, and goat anti-mouse IgG. The POCT test employed mouse monoclonal anti-hCG antibodies and goat polyclonal anti-hCG antibodies. RESULTS: Among 14 pediatric patients who had undergone augmentation cystoplasty, 12 (85.7%) had positive pregnancy test results on OTC Test A, including all 9 females and 60% of males (n = 3/5; Table 1). No patients had positive pregnancy test results on OTC Test B or the POCT pregnancy test (Table 1). No false positive OTC pregnancy test results occurred among 4 patients with Mitrofanoff appendicovesicostomies only. Among patients with enterocystoplasties, UA results indicated that the majority had at least trace levels of protein, blood, and leukocytes, most tested positive for nitrite, and mean urine pH was 6.7 (±0.5; Table 1). CONCLUSIONS: Preliminary findings indicate that certain OTC pregnancy tests qualitatively assessing hCG in urine may be inaccurate among patients who have previously undergone augmentation enterocystoplasties. Female patients of reproductive age should be counseled regarding appropriate pregnancy testing options to avoid unplanned pregnancy scares or concerns about ectopic pregnancies. Source of Funding: The Long Road Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e157 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zoë Baker More articles by this author Arthi Hannallah More articles by this author Hannah Dillon More articles by this author Yuding Wang More articles by this author Evalynn Vasquez More articles by this author Expand All Advertisement PDF DownloadLoading ...

International action day on women's health

International action day on women's health

Young Female with Lower Abdominal Pain

A 19-year-old woman with a prior induced abortion presented to the emergency department with a 3-day history of vaginal bleeding and lower abdominal pain. Her last menstrual period was 6 weeks ago. Her blood pressure was 115/67 mm Hg and pulse rate was 108 beats/min; furthermore, she had obvious rebound tenderness. A urine pregnancy test yielded a positive result, and therefore, the emergency physician performed transvaginal ultrasonography (Figures 1 and 2).

Efficacy of a low-sensitivity urine pregnancy test for identifying ongoing pregnancy after medication abortion at 64 to 70 days of gestation

ObjectivesWe assessed whether a low-sensitivity pregnancy test is effective at identifying ongoing pregnancy after medication abortion at 64 to 70 days of gestation. Study designFrom October 2018 to March 2020, we performed a prospective observational study of participants in England and Wales undergoing medication abortion. Participants were scheduled to return to the clinic 14 ± 3 days after mifepristone administration to perform a low-sensitivity pregnancy test (human chorionic gonadotropin threshold of 1000 mIU/mL) and symptom checklist, and state whether they thought the abortion was complete. Clinicians also assessed the low-sensitivity pregnancy test and performed an ultrasound to determine abortion status. We calculated the sensitivity, specificity, negative and positive predictive value of the low-sensitivity pregnancy test (with and without a symptom checklist) for detecting ongoing pregnancy. ResultsWe enrolled 757 participants. Thirty-one did not progress to abortion and 558 (76.9%) completed follow-up. Most (79.6%) attended per-protocol; 22 (3.9%) attended earlier than 11 days and 92 (16.5%) later than 17 days. Thirteen participants (2.3%) had an ongoing pregnancy. The low-sensitivity pregnancy test correctly identified all the ongoing pregnancies (sensitivity = 100%; specificity = 84.8%; negative predictive value = 100%; positive predictive value = 13.5%). The symptom checklist alone had a sensitivity of 76.9% and a negative predictive value of 99.4% for identifying ongoing pregnancies. Participants and clinicians agreed on the interpretation of the low-sensitivity pregnancy test 94.6% of the time. ConclusionsPatient self-assessment of a low-sensitivity pregnancy test after medication abortion between 64- and 70 days’ gestation has high sensitivity and negative predictive value for identification of ongoing pregnancy. ImplicationsPatients can be offered a low-sensitivity pregnancy test to assess for ongoing pregnancy after medication abortion up to 70 days of gestation thereby reducing the need for in-person visits. Services should be prepared to provide in-person assessments after positive or inconclusive results to ensure early identification of abortion complications.

False Negative Urine Pregnancy Test: Hook Effect Revealed

The urine pregnancy kit tests are commonly used in women of childbearing age to detect pregnancy. However, these tests may fail to detect pregnancy, rarely leading to inadvertent lab and radiation exposure. The hook-effect is a rare but important phenomenon, rendering the kit tests false negative due to an improper antigen-antibody ratio.

Contraceptive effectiveness, pharmacokinetics, and safety of Sayana® Press when injected every four months: a multicenter phase 3 trial.

SummaryBackgroundSayana Press® is a 3-monthly contraceptive injection approved by regulatory agencies in more than 40 countries worldwide. Existing effectiveness and pharmacokinetics (PK) data suggest that high contraceptive efficacy may be maintained if the reinjection interval of Sayana Press is extended from 3 to 4 months.MethodsWe conducted a phase 3 trial at three sites in the Dominican Republic, Brazil, and Chile from September 2017 through April 2020. We enrolled 750 women at risk of pregnancy who agreed to use Sayana Press off-label every 4 months (3 treatment cycles) for 12 months. The effectiveness cohort included 710 participants randomized equally to receive injections in the abdomen or thigh. Forty additional participants received injections in the back of the upper arm for comparative PK analyses. The primary outcome was pregnancy, defined by a positive urine pregnancy test confirmed by ultrasound and/or serum human chorionic gonadotropin. Secondary outcomes included PK, safety, and acceptability. Laboratory and trial Sponsor staff were blind to injection site. This study is registered with ClinicalTrials.gov, number NCT03154125.FindingsThere were no pregnancies during follow-up; the Pearl Index during 629.3 woman-years (WY) of follow-up in the primary effectiveness analysis was 0.00 (95% CI 0.00, 0.59). Pharmacokinetic profiles differed by injection site, with higher geometric mean (GM) medroxyprogesterone acetate concentrations for the abdomen than the thigh and arm. At month 8, significantly higher GM concentrations were observed in the abdomen and the thigh as compared to the arm, as well as at month 12 in the abdomen as compared to the arm. Injection site reactions were reported by 10.7% of participants.InterpretationBoth pregnancy and PK results confirm that Sayana Press is a highly effective contraceptive method when administered every 4 months. These findings may inform modification of the dosing schedule, or duration of the grace period for reinjection, or both, to reduce overall drug exposure while maintaining contraceptive efficacy.FundingThis work is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), provided to FHI 360 through Cooperative Agreement AID-OAA-A-15–00,045, and a grant from the Gates Foundation. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID, the United States Government, or the Gates Foundation, nor does any mention of trade names, commercial products, or organizations imply endorsement by FHI 360, USAID, the United States Government, or the Gates Foundation.

Pregnancy Status Is Associated with Lower Hemoglobin A1c among Nondiabetes Women in the United States from NHANES 2005-2016.

Background It has been verified that the incidence rate of diabetes mellitus (DM) is sharply increased in pregnant female adults. However, the relationship between pregnant status and hemoglobin A1c (HbA1c) in nondiabetes women remains unclear. Methods We conducted a cross-sectional study of 7762 participants in the National Health and Nutrition Examination Survey (NHANES) 2005–2016. Multivariable linear regression models were performed to evaluate the associations between pregnant status with HbA1c and serum glucose in nondiabetes women. Results HbA1c was significantly lower in the pregnant group than in the nonpregnant group. There was a negative association between urine pregnancy test and HbA1c in all three models (model 1: β = −0.23, 95% CI: (−0.18 to −0.27); model 2: β = −0.20, 95% CI: (−0.15 to −0.24); model 3: β = −0.24, 95% CI: (−0.20 to −0.29)). In the subgroup analysis stratified by age, this negative association existed in all age subgroups (age <20: β = −0.20, 95% CI: (−0.04 to −0.27); age ≥20, <35: β = −0.24, 95% CI: (−0.20 to −0.29); age ≥35: β = −0.28, 95% CI: (−0.17, −0.39)). In the subgroup analysis stratified by race, the negative associations steadily existed in different subgroups (Mexican American:β = −0.20, 95% CI:(-0.11 to -0.29); Other Hispanic:β = -0.31, 95% CI: (-0.16 to -0.46); Non-Hispanic White: β = −0.24, 95% CI: (−0.17 to −0.31); Non-Hispanic Black: β = −0.21, 95% CI: (−0.12 to −0.31); Other races:β = −0.22, 95% CI: (−0.08 to −0.35)). On the other hand, a negative association between self-reported pregnant status and HbA1c was also found (model 1: β = −0.22, 95% CI: (−0.18 to −0.27); model 2: β = −0.19, 95% CI: (−0.15 to −0.2); model 3: β = −0.23, 95% CI: (−0.19 to −0.28)). In the subgroup analysis stratified by age, this negative association also existed in all age subgroups. Conclusions The study indicated that nondiabetes women with pregnant status had significantly lower HbA1c compared with those nonpregnant. Moreover, the negative associations between pregnant status and HbA1c steadily existed in subgroups stratified by age and gender.

Differential-diagnostic and therapeutic challenges in the management of ruptured corpus luteum cyst with undiagnosed intrauterine pregnancy in the early first trimester and ruptured ovarian pregnancy

Background: The similarities in clinical features between ruptured corpus luteum cyst (RCLC) with undiagnosed intrauterine pregnancy in the early first trimester (RCLC-P) and ruptured ovarian pregnancy are well established. However, the identification of differences between these two morbid conditions is important to determine the causes and manage the hemoperitoneum without devastation of pregnancy in RCLC-P. Furthermore, the pregnancy outcomes after laparoscopic surgery in women with RCLC-P are not recognized. Methods: Retrospective observational study of six women with RCLC-P and seven women with ruptured ovarian pregnancy. Results: All cases were referred under strong suspicion of ruptured ectopic pregnancy due to lower abdominal pain and positive urinary pregnancy test after spontaneous conception. The estimated median number of gestational weeks in RCLC-P (5 weeks) was significantly lower than that for ruptured ovarian pregnancy (7 weeks). At triage, the median serum levels of beta-human chorionic gonadotropin (β-hCG) were significantly lower in RCLC-P (592 IU/L) than ruptured ovarian pregnancy (3723 IU/L) (p = 0.01). In all six cases with RCLC-P, laparoscopic ovary-sparing surgery was performed. Among the four women who received postoperative supplementation of progesterone, uneventful vaginal delivery occurred at term in three cases. Conclusions: Early gestational age and lower serum β-hCG levels at triage, as well as non-declining levels of serum β-hCG on the day after surgery, were significant predictors of RCLC-P rather than ruptured ovarian pregnancy. Laparoscopic surgery was a feasible option for the management of RCLC-P with appropriate postoperative luteal support to achieve successful obstetric outcomes.

Medical management of ectopic pregnancy in a family planning clinic: A case series

ObjectiveTo evaluate safety of medical management of ectopic pregnancy in a free-standing family planning clinic setting. Study designWe retrospectively reviewed cases of ectopic pregnancy between January 2014 and December 2018 which were identified using a “Beta Board” tracking system. Planned Parenthood of Orange and San Bernardino Counties staff added patients the “Beta Board” if they had a positive urine pregnancy test without definitive ultrasound diagnosis of intrauterine pregnancy and/or symptoms suggestive of ectopic pregnancy, such as vaginal bleeding, and cramping. Patients were included in the study if they had received a final diagnosis of ectopic pregnancy. ResultsOf 5083 patients tracked via the Beta Board, 260 patients presented to a Planned Parenthood free-standing, family planning clinic with ectopic pregnancy. Ninety-five patients were treated with methotrexate entirely at the clinic. There were no deaths. Four ectopic pregnancies ruptured and 8 required surgery. ConclusionTreatment of ectopic pregnancy with methotrexate in the family planning clinic setting can be safe and effective with reassuring outcomes that are similar to the hospital setting.

Syncope Due to a Ruptured Ectopic Pregnancy.

This simulation is intended for all levels of emergency medicine residents. Syncope and near-syncope are very common presenting complaints to the emergency department.1 There are several causes of syncope ranging from benign to life threatening. It is imperative that the emergency physician is able to evaluate and treat patients with undifferentiated syncope even with limited information. Approximately half of syncope cases can be differentiated by the presentation and clinical context.1 In addition to a thorough history, an electrocardiogram (ECG) should be obtained on all patients presenting with syncope or near-syncope since it is non-invasive and cost effective in assessing cardiac causes of syncope. In this particular simulation, the cause of syncope is due to a hemorrhagic shock from a ruptured ectopic pregnancy. At the conclusion of this simulation, the learner will be able to:Review the initial management of syncopeUtilize laboratory and imaging techniques to diagnose a ruptured ectopic pregnancy.Demonstrate the ability to resuscitate and disposition an unstable ruptured ectopic pregnancy. This simulation case was designed as a medium-to-high fidelity simulation scenario. It could also be altered and utilized as a practice oral board exam case. The quality of the simulation and educational content was evaluated by debriefing and verbal feedback that was obtained immediately after the case. Additionally, a survey was emailed to participants and observers of the case to provide qualitative feedback. Post-simulation feedback from learners and observers was positive. Everyone present for the simulation felt that it was realistic and provided a unique opportunity to practice resuscitation skills. Syncope and near-syncope are common presentations to the emergency department with multiple etiologies that range from cardiac, neurologic, neurocardiogenic, and orthostatic to unknown. It is crucial that we diagnose and treat life-threatening causes of syncope rapidly and with limited information. In this case, the cause of syncope due to a ruptured ectopic pregnancy should be rapidly diagnosed with a thorough history and exam, urine pregnancy test, and a bedside abdominal ultrasound. Once the urine pregnancy test was resulted, ectopic pregnancy was the top differential diagnosis for each learner that participated. Initially, most learners only performed a transabdominal pelvic ultrasound of the pelvis, which is normal in the case. One learner performed a rapid ultrasound for shock and hypotension (RUSH) exam and was able to find free fluid in the right upper quadrant. Overall, this case and the debriefing topics were effective for learners at all levels. Ectopic pregnancy, obstetrical emergencies, ultrasound, resuscitation.

A study on outcome of controlled ovarian hyperstimulation and intrauterine insemination (husband) in a medical college in Kolkata

Background: A combination of controlled ovarian hyperstimulation and intrauterine insemination (IUI) remains an important treatment option for couple having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors. Aims and Objectives: To assess the factors affecting the success rate of IUI and to evaluate the success of ovulation Induction by different methods of controlled stimulation protocol. Materials and Methods: It is a duration-based prospective cross-sectional study where total of 67 couples were included by inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having a maximum of three cycles. Ovulation induction was done by clomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The outcomewas measured by positive urine pregnancy test. Range, percentage, confidence interval, mean with standard deviation, median, range, and P-value were calculated. P&lt;0.05 was taken as statistically significant. Results: Out of 90 IUI cycles 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors that had a positive impact were follicle size &gt;21 sqmm, endometrial thickness &gt;9 mm, post wash count &gt;15 million/ml, &gt;2 cycles of IUI and on the number of follicles 2 or more on the day of trigger. Conclusion: The study concluded that IUI after ovulation induction can be a simple and safe cost-effective procedure in selected group of infertile couple. Clinical significance IUI following ovulation induction can be a successful approach for specific indications in a low-resource setting where options for other ART interventions are absent or limited.

Can I Be Pregnant? – Diagnostic Challenges in Ruptured Chronic Ectopic Pregnancy

Ectopic pregnancy is an obstetric emergency which accounts for 4% of all pregnancy-related deaths. All women of child bearing age with abdominal pain or vaginal bleeding presenting to the Emergency Department should be evaluated for ectopic pregnancy. However, there have been many reported cases of diagnostic challenges of ectopic pregnancy. One rare variant of ectopic pregnancy that can be easily overlooked is chronic ectopic pregnancy. We present this case of a 39-yearold female, who presented with acute abdomen and free fluid in her abdomen. Urine pregnancy test indicated she was not pregnant. However, intraoperative findings confirmed left tubular pregnancy. We would like to highlight three major diagnostic challenges we faced in this case i.e.; (i) women of child bearing age with abdominal pain should always be evaluated for ectopic pregnancy; (ii) diagnosis of ectopic pregnancy should not be dismissed even though the pregnancy test is negative; and (iii) the role of computed tomography (CT) scan in acute abdomen of unclear aetiology. As a rule, all haemodynamically unstable acute abdomen should be sent to the operation theatre. Haemodynamically stable patients should be carefully evaluated to facilitate surgical management.

Medical abortion in primary care.

SUMMARYEarly medical abortion is a safe, cost effective and acceptable alternative to surgical abortion. It offers privacy and autonomy and can be provided by general practitioners who have completed an online training module.Abortion can be induced with mifepristone and misoprostol up to nine weeks of gestation. Apart from anticoagulation and severe anaemia, there are few contraindications and precautions for medical abortion.Obtaining informed consent requires the provision of information on expected effects, adverse effects and complications. The woman must know when to present to an emergency department.Follow-up must be arranged to ensure the abortion is complete. A serum human chorionic gonadotropin concentration or a low-sensitivity urine pregnancy test is used to confirm completion.Most contraceptive methods can be started immediately following medical abortion. If an intrauterine device is preferred, it should be inserted after confirming the abortion is complete.

World’s Oddest Toads: Xenopus Pregnancy Tests and Animal Commodities in “Capitalist Ruins”

ABSTRACT In the 1930s it was discovered that the Xenopus toad was a useful instrument in urine pregnancy tests. An injection of a woman’s urine into a toad that resulted in the production of ova was proof of pregnancy. Extracted from its native South Africa and imported to the United States, the Xenopus was a popular tool, used to this day for high school dissection and in professional labs. But once replaced by chemical pregnancy tests, labs no longer needed large Xenopus populations and began to release them or give them to pet dealers. Because of its long life, pet owners often tired of the toad and released it into the wild. Today the Xenopus is an invasive amphibian present on four continents feeding on endangered amphibians, creating resilient populations, and becoming a pest. With a warming climate, scientists predict that the carnivorous toad will continue to expand its habitat threatening other species. The medical and pet supply industries led to a large-scale extraction and trade in the Xenopus which has made the toad one of the most widespread amphibian species globally. The Xenopus’s resilience has allowed it to make a home within the destructive environment created by capitalism.

Effect of pregnancy tests on demand for family planning: evidence from a randomized controlled trial in Uganda

BackgroundUnmet need for family planning and unintended pregnancies are high in developing countries. Home pregnancy tests help women determine their pregnancy status earlier and the confirmation of a negative pregnancy status can facilitate the adoption of family planning. This study provides the first experimental evidence of the effect of access to pregnancy tests on women’s demand for modern family planning.MethodsA randomized controlled trial was conducted among 810 women of reproductive age in northern Uganda. During a baseline survey, women were randomly allocated to either: (1) an offer to take a hCG urine pregnancy test during the survey (on-the-spot pregnancy test) (N = 170), (2) an offer of a home pregnancy test kit to be used at any time in the future (future-use pregnancy test) (N = 163), (3) offers of both on-the-spot and future-use pregnancy tests (N = 153), or (4) a control group (N = 324). Future-use pregnancy tests were offered either for free, or randomly assigned prices. Approximately 4 weeks after the baseline survey, a follow-up survey was conducted; modern contraception methods were made available at no charge at local community outreach centers.ResultsWhen offered a free, on-the-spot pregnancy test, 62 percent of women accepted (N = 200). Almost all, 97 percent (N = 69), of women offered a free future-use pregnancy test strip, accepted it. Purchases of future-use pregnancy tests declined with price. The offer of either on-the-spot, future-use tests, or both, have no overall large or statistically significant effects on the take-up of modern family planning.ConclusionDemand for pregnancy tests is high and access to pregnancy tests has the potential to facilitate the demand for family planning. At the same time, more research is needed to understand underlying beliefs about pregnancy status and risk that guide behaviors ultimately important for maternal and neonatal health.Trial registration The study was pre-registered in July 2018 for AEA RCT registry (AEARCTR-0003187) and clinicaltrials.gov (NCT03975933). Registered 05 June 2019, https://clinicaltrials.gov/ct2/show/record/NCT03975933

Complete Molar Pregnancy in Postmenopausal Woman: A Rare Case Report

BACKGROUND: Molar pregnancy, the form of the gestational trophoblastic disease (GTD), generally occurs in women of the reproductive age group, and rarely occurs in postmenopausal women. To present a rare case of molar pregnancy in a postmenopausal woman. CASE REPORT: A multiparous woman aged 54 years was referred to the outpatient department at Raja Ahmad Tabib General Hospital of Riau Island, Indonesia with the main symptoms of nausea and vomiting profusely with 1 month before, lower abdominal pain, lump in the abdomen, abnormal vaginal bleeding, and a positive urine pregnancy test. Her last menstrual bleeding was 14 months ago. Physical examination found stable hemodynamic within blood pressure 150/95 mmHg. Laboratory results showed Hb 11.7 g/dL, positive urine pregnancy test, and serum β-HCG 292,876.1 mIU/mL. Ultrasound examination showed a vesicular pattern in the uterine cavity without fetal tissue. The patient was managed by elective total abdominal bilateral hysterectomy salpingo-oophorectomy. The intraoperative finding was softened, enlarged uterus size of 14–16 weeks of pregnancy, and no local spreading of disease. The patient was discharged on the 3 day after surgery. CONCLUSION: Even though molar pregnancy is rare, it can occur in the postmenopausal woman. Therefore, GTD has remained in the differential diagnosis of postmenopausal bleeding which can prevent delay in diagnosis and management. Definitive treatment with total abdominal hysterectomy has been chosen in menopausal women who do not wish to preserve their fertility and prevent any malignant sequelae.

Cohort Profile: The Birhan Health and Demographic Surveillance System.

Abstract The Birhan health and demographic surveillance system (HDSS) was established to determine the magnitude and causes of morbidity and mortality in Ethiopia among pregnant and postpartum women and children. Located in the North Shewa Zone of the Amhara Region, the site includes 16 kebeles (villages) and spans two woredas (districts), Angolela Tera and Kewet/Shewa Robit. The initial census was conducted in May 2018, and core demographic and health events are updated every three months. The site has 18,933 households and a population of 77,766. Over 82.6% of the population is rural. During the baseline census, all households were geocoded; household members were enumerated; and data were collected on sociodemographic status, housing construction material, economics and asset ownership, care seeking behaviors, and water and sanitation access. During each subsequent round, data on key demographic events such as births, deaths, marital status changes, in-migration, or out-migration were collected for all enumerated household members. Pregnancy surveillance was conducted among married women of reproductive age 15-49 using a pregnancy screening questionnaire and confirmed by urine pregnancy tests. Morbidity and immunization status data for children aged under two years were collected during each round.