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Note - This sub-heading shows an automated computer PubMed search using the listed sub-heading term. References appear in this list based upon the date of the actual page viewing. Therefore the list of references do not reflect any editorial selection of material based on content or relevance. In comparison, references listed on the content page and discussion page (under the publication year sub-headings) do include editorial selection based upon relevance and availability. (More? Pubmed Most Recent)
Urine Pregnancy Test
An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol
Emerg Med J. 2013 Oct 17. doi: 10.1136/emermed-2013-202887. [Epub ahead of print]
Wendt K, Crilly J, May C, Bates K, Saxena R. Source Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia.
BACKGROUND: Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011. METHODS: A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered. RESULTS: Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS-EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST). CONCLUSIONS: The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED. KEYWORDS: emergency care systems, admission avoidance, emergency care systems, emergency departments, obstetrics and gynaecology
Checking pregnancy status in adolescent girls before procedures under general anaesthesia
Arch Dis Child. 2012 Oct;97(10):895-9. doi: 10.1136/archdischild-2011-301229. Epub 2012 Mar 23.
Donaldson JF, Napier SJ, Ward-Jones M, Wheeler RA, Spargo PM. Source Wessex Regional Centre for Paediatric Surgery, Southampton, Hampshire, UK.
OBJECTIVE: 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. DESIGN: The authors conducted an observational study and a survey in their institution and a national survey of Association of Paediatric Anaesthetists (APA) linkmen. SETTING: Local: Southampton. National: UK. RESULTS: 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. CONCLUSIONS: This work illustrates the need for consistent national guidance. We propose that all girls who have reached menarche should be routinely offered a urine pregnancy test before any procedure under general anaesthesia. Comment in Developing guidance for checking pregnancy status in adolescent girls before surgical, radiological or other procedures. [Arch Dis Child. 2012]
Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: Revised Recommendations for the Use of Hormonal Contraception Among Women at High Risk for HIV Infection or Infected with HIV
June 22, 2012 / 61(24);449-452
Use of a checklist to rule out pregnancy: a systematic review
Contraception. 2012 Oct 4. pii: S0010-7824(12)00734-2. doi: 10.1016/j.contraception.2012.08.007. [Epub ahead of print]
Tepper NK, Marchbanks PA, Curtis KM. Source Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. Electronic address: firstname.lastname@example.org.
BACKGROUND: 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. STUDY DESIGN: The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning the performance of a pregnancy checklist compared to urine pregnancy tests. The quality of each study was assessed using the United States Preventive Services Task Force grading system. RESULTS: 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%. CONCLUSION: All four analyses demonstrated high (99-100%) negative predictive value for the pregnancy checklist. Published by Elsevier Inc.
False-positive urine pregnancy test due to leukocyte interference
Ann Lab Med. 2012 Mar;32(2):167-8. doi: 10.3343/alm.2012.32.2.167. Epub 2012 Feb 23.
Jao HF, Er TK, Hsiao JK, Chiang CH. Source Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. PMID 22389886
False-positive urine pregnancy tests--clinicians as detectives
Pan Afr Med J. 2011;8:41. Epub 2011 Apr 10.
Valenzuela R, Iserson KV, Punguyire D. Source Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
Reliably diagnosing pregnancy in women presenting with nonspecific abdominal pain can be lifesaving. If diagnostic tests are unreliable, however, valuable time and resources can be wasted pursuing unnecessary and potentially harmful interventions. After four false positive-urine pregnancy tests in one week, we began investigating the laboratory's entire process involving the UPreg tests. We discovered that, as is common in resource-poor settings, the laboratory repeatedly reused test tubes. We found that the false-positive tests resulted from performing the UPreg tests in test tubes that were improperly cleaned and, for the most part, had been used immediately beforehand to test women coming into the maternity ward. Sufficient residua from the pregnant women's high ß-HCG levels had remained in the test tubes to cause subsequent false-positive results in our emergency ward patients. Although pregnancy can now be reliably diagnosed with inexpensive, disposable and simple tests, these tests must not only be used properly, but also, when used in the laboratory, be accompanied by appropriate cleaning and quality-control procedures. This is particularly essential in resource-constrained environments.
Comparative analysis of the accuracy of urinary hCG tests in vitro
Rev Assoc Med Bras. 2011 Sep-Oct;57(5):516-22.
[Article in English, Portuguese] Moraes GS, Amaral Cristovam Rd, Savaris RF. Source Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
OBJECTIVE: To identify whether cutoff for sensitivity advertised by three pregnancy tests in urine are compatible to those reported by the manufacturer and to describe their diagnostic performance. METHODS: The urine of a male volunteer was used to dilute recombinant β-hCG at defined concentrations of 0, 6.25, 12.5, 25, 50, and 100 mIU/mL. The tubes containing each of the concentrations were coded and blindly assessed for positivity in three different lots of hCG tests: Strip Test Plus®, BioEasy®, and Visitect Pregnancy®. The sample size was calculated for an alpha error of 5%, with a power of 99%. RESULTS: All three brands, in their three lots analyzed, had 100% of sensitivity for detecting β-hCG, with 100% negative predictive value, using only negative controls and samples with concentrations equal or higher than the test cutoff (n = 180/brand). The accuracy of the tests was 83% (BioEasy®), 84%(Visitect®) and 91% (Strip Test Plus®). Strip Test Plus® had the best positive likelihood ratio (52.5), while Visitect® had the best negative likelihood ratio (zero). CONCLUSION: The three brands have adequate sensitivity for the advertised cutoffs. The Strip Test Plus® test had the best performance to identify urinary concentrations of β-hCG > 12.5 mIU/mL, and consequently, to confirm pregnancy, while Visitect® had the best performance to exclude β-hCG in urine (negative post-test probability: zero).
False-negative results in point-of-care qualitative human chorionic gonadotropin (hCG) devices due to excess hCGbeta core fragment
Clin Chem. 2009 Jul;55(7):1389-94. Epub 2009 Apr 24.
Gronowski AM, Cervinski M, Stenman UH, Woodworth A, Ashby L, Scott MG.
Source Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA. email@example.com Abstract BACKGROUND: During pregnancy, human chorionic gonadotropin (hCG) immunoreactivity in urine consists of intact hCG as well as a number of hCG variants including the core fragment of hCGbeta (hCGbeta cf). We identified 3 urine specimens with apparent false-negative results using the OSOM(R) hCG Combo Test (Genzyme Diagnostics) qualitative hCG device and sought to determine whether an excess of 1 of the fragments or variants might be the cause of the interference. METHODS: We measured concentrations of hCG variants in the urine from 3 patients with apparent false-negative hCG results. Purified hCG variants were added to urines positive for hCG and tested using the OSOM, ICON(R) 25 hCG (Beckman Coulter), and hCG Combo SP(R) Brand (Cardinal Health) devices. RESULTS: Dilution of these 3 urine samples resulted in positive results on the OSOM device. Quantification of hCG variants in each of the 3 patient urine specimens demonstrated that hCGbeta cf occurred in molar excess of intact hCG. Addition of purified hCGbeta cf to hCG-positive urines caused false-negative hCG results using the OSOM and ICON qualitative urine hCG devices. CONCLUSIONS: Increased concentrations of hCGbeta cf can cause false-negative results on the OSOM and ICON qualitative urine hCG devices.
Production of human chorionic gonadotropin during the normal menstrual cycle
J Reprod Med. 2009 Apr;54(4):245-50.
Cole LA, Gutierrez JM. Source USA hCG Reference Service, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA. firstname.lastname@example.org
OBJECTIVE: To present a comprehensive study of pituitary human chorionic gonadotropin (hCG) production during the menstrual cycle, investigating its occurrence, timing and the possibility of a separate biologic role for pituitary hCG during the normal menstrual cycle. STUDY DESIGN: Daily urine samples were tested from 185 women during 405 normal menstrual cycles. Levels of hCG and luteinizing hormone (LH) were measured daily. RESULTS: hCG levels were detected at LH peak in 84% of menstrual cycles. At this time, hCG levels paralleled LH values. The remaining menstrual cycles (16%) had significantly lower LH levels, suggesting lack of detection of hCG as a result of low concentration of LH or very dilute urines. We infer that hCG is produced in all menstrual cycles. CONCLUSION: hCG is seemingly produced alongside LH in all menstrual cycles. hCG has a much greater circulating half-life compared to LH. It may function to extend the short, sharp LH peak in promoting ovulation or in promoting initial progesterone production by the corpus luteal cells.
New discoveries on the biology and detection of human chorionic gonadotropin
Reprod Biol Endocrinol. 2009 Jan 26;7:8.
Cole LA. Source USA hCG Reference Service, Obstetrics and Gynecology, and Biochemistry and Molecular Biology, University of New Mexico, Albuquerque, NM, USA. larry@hCGlab.com
Human chorionic gonadotropin (hCG) is a glycoprotein hormone comprising 2 subunits, alpha and beta joined non covalently. While similar in structure to luteinizing hormone (LH), hCG exists in multiple hormonal and non-endocrine agents, rather than as a single molecule like LH and the other glycoprotein hormones. These are regular hCG, hyperglycosylated hCG and the free beta-subunit of hyperglycosylated hCG. For 88 years regular hCG has been known as a promoter of corpus luteal progesterone production, even though this function only explains 3 weeks of a full gestations production of regular hCG. Research in recent years has explained the full gestational production by demonstration of critical functions in trophoblast differentiation and in fetal nutrition through myometrial spiral artery angiogenesis. While regular hCG is made by fused villous syncytiotrophoblast cells, extravillous invasive cytotrophoblast cells make the variant hyperglycosylated hCG. This variant is an autocrine factor, acting on extravillous invasive cytotrophoblast cells to initiate and control invasion as occurs at implantation of pregnancy and the establishment of hemochorial placentation, and malignancy as occurs in invasive hydatidiform mole and choriocarcinoma. Hyperglycosylated hCG inhibits apoptosis in extravillous invasive cytotrophoblast cells promoting cell invasion, growth and malignancy. Other non-trophoblastic malignancies retro-differentiate and produce a hyperglycosylated free beta-subunit of hCG (hCG free beta). This has been shown to be an autocrine factor antagonizing apoptosis furthering cancer cell growth and malignancy. New applications have been demonstrated for total hCG measurements and detection of the 3 hCG variants in pregnancy detection, monitoring pregnancy outcome, determining risk for Down syndrome fetus, predicting preeclampsia, detecting pituitary hCG, detecting and managing gestational trophoblastic diseases, diagnosing quiescent gestational trophoblastic disease, diagnosing placental site trophoblastic tumor, managing testicular germ cell malignancies, and monitoring other human malignancies. There are very few molecules with such wide and varying functions as regular hCG and its variants, and very few tests with such a wide spectrum of clinical applications as total hCG.
Natural limits of pregnancy testing in relation to the expected menstrual period
JAMA. 2001 Oct 10;286(14):1759-61.
Wilcox AJ, Baird DD, Dunson D, McChesney R, Weinberg CR. Source Epidemiology Branch, MD A3-05, National Institute of Environmental Health Sciences, Durham, NC 27709, USA. email@example.com Erratum in JAMA 2002 Jan 9;287(2):192.
CONTEXT: Pregnancy test kits routinely recommend testing "as early as the first day of the missed period." However, a pregnancy cannot be detected before the blastocyst implants. Due to natural variability in the timing of ovulation, implantation does not necessarily occur before the expected onset of next menses. OBJECTIVE: To estimate the maximum screening sensitivity of pregnancy tests when used on the first day of the expected period, taking into account the natural variability of ovulation and implantation. DESIGN AND SETTING: Community-based prospective cohort study conducted in North Carolina between 1982 and 1986. PARTICIPANTS: Two hundred twenty-one healthy women 21 to 42 years of age who were planning to conceive. MAIN OUTCOME MEASURES: Day of implantation, defined by the serial assay of first morning urine samples using an extremely sensitive immunoradiometric assay for human chorionic gonadotropin (hCG), relative to the first day of the missed period, defined as the day on which women expected their next menses to begin, based on self-reported usual cycle length. RESULTS: Data were available for 136 clinical pregnancies conceived during the study, 14 (10%) of which had not yet implanted by the first day of the missed period. The highest possible screening sensitivity for an hCG-based pregnancy test therefore is estimated to be 90% (95% confidence interval [CI], 84%-94%) on the first day of the missed period. By 1 week after the first day of the missed period, the highest possible screening sensitivity is estimated to be 97% (95% CI, 94%-99%). CONCLUSIONS: In this study, using an extremely sensitive assay for hCG, 10% of clinical pregnancies were undetectable on the first day of missed menses. In practice, an even larger percentage of clinical pregnancies may be undetected by current test kits on this day, given their reported assay properties and other practical limitations.
THE DIAGNOSIS OF PREGNANCY WITH THE ASCHHEIM-ZONDEK TEST
Can Med Assoc J. 1931 Apr;24(4):491-5.
Ettinger GH, Smith GL, McHenry EW. Source Department of Physiology, Queen's University, Kingston.
THE ASCHHEIM-ZONDEK HORMONE TEST FOR PREGNANCY
Cal West Med. 1929 Dec;31(6):412-3.
Kaplan HE. PMID 18741243
MECHANISM OF OVULATION IN THE RABBIT: II. OVULATION PRODUCED BY THE INJECTION OF URINE FROM PREGNANT WOMEN
Mechanism of ovulation in the rabbit: II. Ovulation produced by the injection of urine from pregnant women.
Maurice H. Friedman
Am J Physiol November 1, 1929 90:617-622