Pregnancy Test

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Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.

Introduction

File:Pregnancy test

The first of prenatal diagnostic tests. Through history there were a number of supposedly diagnostic tests to determine early pregnancy, the most obvious was the absence of an ongoing menstrual cycle in women of reproductive age. It was not until the early 20th century that the first clinical maternal urine test was developed.[1] A complicated test requiring analysis of changes induced in the immature mouse genital system by hormones present in the maternal urine. The test was replaced by a urine test with either the rabbit (Friedman modification[2]) showing similar changes or frog (Xenopus), that could be induced to lay eggs by similar urine effects. In the 1960's an immunological test for human chorionic gonadotropin (hCG) in either maternal urine or blood led to development in the late 1970's of home pregnancy kits that became simple one step tests in the late 1980's.

See the external link to 2003 online NIH summary, "The Thin Blue Line" and the 2004 review[3] on the history of the home pregnancy test.

Note that there are a number of pathological conditions, such as endocrine tumours and hydatidiform moles, that can also mimic the detected hormonal changes.


Links: Menstrual Cycle | Week 2 | Implantation | Placenta Development | Pregnancy Test | Hydatidiform Mole | Human Chorionic Gonadotropin
Diagnosis Links: Prenatal Diagnosis | Pregnancy Test | Amniocentesis | Chorionic villus sampling | Ultrasound | Alpha-Fetoprotein | Pregnancy-associated plasma protein-A | Fetal Blood Sampling | Magnetic Resonance Imaging | Computed Tomography | Non-Invasive Prenatal Testing | Fetal Cells in Maternal Blood | Preimplantation Genetic Screening | Comparative Genomic Hybridization | Genome Sequencing | Neonatal Diagnosis | Category:Prenatal Diagnosis | Fetal Surgery | Classification of Diseases | Category:Neonatal Diagnosis

Some Recent Findings

  • Use of a checklist to rule out pregnancy: a systematic review[4] "Safe initiation of contraceptive methods requires that pregnancy be excluded. The World Health Organization has developed a list of criteria to assess pregnancy status. This review was conducted to evaluate the evidence regarding these criteria in excluding pregnancy. Four analyses of data from three studies met inclusion criteria as direct evidence. All were diagnostic accuracy studies of fair quality that evaluated the performance of a pregnancy checklist compared with urine pregnancy test to rule out pregnancy. The performance of the checklist varied, with sensitivity ranging from 55-100% and specificity ranging from 39-89%. The negative predictive value was consistent across studies at 99-100%."
  • Checking pregnancy status in adolescent girls before procedures under general anaesthesia[5] "Surgery, ionising radiation and anaesthesia in the presence of an undetected pregnancy could be harmful. British guidelines state that female patients of 'childbearing age' should have their pregnancy status established before surgery. Approaching this topic with an adolescent girl can be challenging. The authors conducted an observational study and a survey in their institution and a national survey of Association of Paediatric Anaesthetists (APA) linkmen. Both surveys demonstrate widespread concerns about inconsistent and informal practices. Only 45% of respondents in the authors' institution stated they ask adolescent girls if they could be pregnant. 40% of APA linkmen were unaware of national guidelines."
More recent papers
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Search term: Pregnancy Test

Linda Farahani, Anjita Sinha, Jilly Lloyd, Melissa Islam, Jackie A Ross Negative histology with surgically treated tubal ectopic pregnancies - A retrospective cohort study. Eur. J. Obstet. Gynecol. Reprod. Biol.: 2017, 213;98-101 PubMed 28441571

Beatriz Escobar-Padilla, Carlos A Perez-López, Horacio Martínez-Puon [Risk factors and clinical features of ectopic pregnancy]. [Factores de riesgo y características clínicas del embarazo ectópico.] Rev Med Inst Mex Seguro Soc: 2017, 55(3);278-285 PubMed 28440980

Rebecca Armstrong, James G Scott, Andrew J O Whitehouse, David A Copland, Katie L Mcmahon, Wendy Arnott Late talkers and later language outcomes: Predicting the different language trajectories. Int J Speech Lang Pathol: 2017;1-14 PubMed 28440674

Dorah Chorongo, Fredrick Majiwa Okinda, Eric Jimmy Kariuki, Emily Mulewa, Fredrick Ibinda, Samuel Muhula, George Kimathi, Richard Muga Factors influencing the utilization of focused antenatal care services in Malindi and Magarini sub-counties of Kilifi county, Kenya. Pan Afr Med J: 2016, 25(Suppl 2);14 PubMed 28439338

Bryn King, Melissa Van Wert Predictors of Early Childbirth Among Female Adolescents in Foster Care. J Adolesc Health: 2017; PubMed 28438523

History

  • 1928 - Bernhard Zondek and Selman Aschheim procedure that measured the increase in gonadotrophic substance in the urine of a pregnant woman.[1][6]
    • Immature mice injection with urine led to ovarian changes after a few days.
    • Xenopus clawed frog replaced mice, injection with urine stimulated the females to lay eggs that were easily seen the next day.
  • 1960s - immunological tests for chorionic gonadotropin.
  • 1972 - Research on hCG at NIH by Judith Vaitukaitis and Griff Ross.
  • 1978 - USA first home pregnancy test kits available.
  • 1988 - first “one step” test, Clearblue Easy, a blue stripe appeared to indicate pregnancy.
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Aschheim-Zondek Test (1928)

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Rabbit

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Xenopus clawed frogs

Judith Vaitukaitis-Griff Ross-c1971.jpg

Judith Vaitukaitis and Griff Ross (c1971)

Pregnancy Testing in Medicine

The urine test can be an indicator of an existing pregnancy, but does not exclude a pregnancy that has not reached the implantation stage, or even a very early adplantation stage (GA week 3). This test is often used in consultation with information on sexual history and the menstrual cycle, the last menstrual period (LMP).

There are a number of medical procedures and medications that are contraindicated for pregnant women. This can form part of a discussion or screening process prior to the procedure or prescription. This is also an issue in some medical procedures on women of reproductive age that require anaesthesia,[7] see also UK NICE Guideline - section 5.18). A second issue relates to the preoperative pregnancy testing of minors, regulations for this circumstance may differ between countries.


A immunoradiometric assay for human chorionic gonadotropin (hCG) in urine identified that 10% of clinical pregnancies were undetectable on the first day of missed menses. The same test 1 week after the first day of the missed period, the test identified 97% of clinical pregnancies.[8]


Links: Menstrual Cycle | Abnormal Development - Drugs | Australian Drug Categories | USA Drug Categories

References

  1. 1.0 1.1 Aschheim, S., and Zondek, B., Klin. Wschr., 7 8, 1401 (1928).
  2. Friedman, M.H. Mechanism of ovulation in the rabbit: II. Ovulation produced by the injection of urine from pregnant women. Am J Physiol. 1929 90:617-622. PDF
  3. Judith L Vaitukaitis Development of the home pregnancy test. Ann. N. Y. Acad. Sci.: 2004, 1038;220-2 PubMed 15838116
  4. Naomi K Tepper, Polly A Marchbanks, Kathryn M Curtis Use of a checklist to rule out pregnancy: a systematic review. Contraception: 2013, 87(5);661-5 PubMed 23040127
  5. J F Donaldson, S J Napier, M Ward-Jones, R A Wheeler, P M Spargo Checking pregnancy status in adolescent girls before procedures under general anaesthesia. Arch. Dis. Child.: 2012, 97(10);895-9 PubMed 22447994
  6. H E Kaplan THE ASCHHEIM-ZONDEK HORMONE TEST FOR PREGNANCY. Cal West Med: 1929, 31(6);412-3 PubMed 18741243
  7. Committee on Standards and Practice Parameters, Jeffrey L Apfelbaum, Richard T Connis, David G Nickinovich, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, L Reuven Pasternak, James F Arens, Robert A Caplan, Richard T Connis, Lee A Fleisher, Richard Flowerdew, Barbara S Gold, James F Mayhew, David G Nickinovich, Linda Jo Rice, Michael F Roizen, Rebecca S Twersky Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology: 2012, 116(3);522-38 PubMed 22273990
  8. A J Wilcox, D D Baird, D Dunson, R McChesney, C R Weinberg Natural limits of pregnancy testing in relation to the expected menstrual period. JAMA: 2001, 286(14);1759-61 PubMed 11594902

Reviews

Laurence A Cole The hCG assay or pregnancy test. Clin. Chem. Lab. Med.: 2012, 50(4);617-30 PubMed 22149742


Articles

Ann M Gronowski, Mark Cervinski, Ulf-Håkan Stenman, Alison Woodworth, Lori Ashby, Mitchell G Scott False-negative results in point-of-care qualitative human chorionic gonadotropin (hCG) devices due to excess hCGbeta core fragment. Clin. Chem.: 2009, 55(7);1389-94 PubMed 19395437

Brenda G Fahy, Valerie A Gouzd, Joseph N Atallah Pregnancy tests with end-stage renal disease. J Clin Anesth: 2008, 20(8);609-13 PubMed 19100935

K J Catt, M L Dufau, J L Vaitukaitis Appearance of hCG in pregnancy plasma following the initiation of implantation of the blastocyst. J. Clin. Endocrinol. Metab.: 1975, 40(3);537-40 PubMed 1117063

J L Vaitukaitis Changing placental concentrations of human chorionic gonadotropin and its subunits during gestation. J. Clin. Endocrinol. Metab.: 1974, 38(5);755-60 PubMed 4823920


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Cite this page: Hill, M.A. 2017 Embryology Pregnancy Test. Retrieved April 26, 2017, from https://embryology.med.unsw.edu.au/embryology/index.php/Pregnancy_Test

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© Dr Mark Hill 2017, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G