Analysis of Urine and Body Fluids
Lec 2: Pregnancy Tests
Siti C. Malubay BMLS 3-A
PREGNANCY TESTS
PREGNANCY
Detection of human chorionic gonadotropin (hCG)
Produced primarily by syncytiotrophoblastic cells of the placenta
during pregnancy
Stimulates the corpus luteum to produce progesterone to maintain
the pregnancy
FALSE POSITIVE
o Increased levels of hCG
o Ectopic pregnancy
HUMAN CHORIONIC GONADOTROPIN (HCG) o Germ cell tumors – hCG can be used as a tumor marker
o Other tumors (bladder, lung, breast, etc)
o Gestational trophoblastic disease
• α subunit
o Treatment with selective serotonin reuptake inhibitor
o Identical to the α-subunit of other hormones in the
(SSRI) antidepressants and other drugs (ex. aspirin,
glycoprotein family, including luteinizing hormone
carbamazepine, methadone)
(LH), follicle-stimulating hormone (FSH), and
o Nephrotic syndrome – blood or protein in the urine
thyroid-stimulating hormone (TSH)
o Following blood transfusions
• β subunit
o Perimenopausal and postmenopausal states
• Intact hCG is the predominant form present throughout FALSE NEGATIVE
pregnancy
o Free β subunit is present in the first trimester o Early measurement after conception
o Free α subunit appears in the second trimester and o Dilute urine specimen
steadily increases in the last trimester o Hook effect - when hCG levels are about 500,000 mIU/mL
o Too much hCG saturates the antibodies
• Serum hCG increases dramatically during the first trimester,
o Perform dilution first
reaching a peak at about 16 weeks’ gestation
• Elevated hCG in maternal serum and urine is a reliable
indicator of pregnancy QUANTITATIVE MEASUREMENTS
• When a patient presents with early gestational vaginal bleeding
TYPES OF hCG or abdominal pain
1. Serum hCG o May suggest the presence of ectopic pregnancy or
2. Urine hCG spontaneous abortion
• Allows more accurate diagnosis and sound management than are
SERUM hCG obtained by clinical judgment alone
Reference interval: typically 4–6 mIU/mL • Can be used to check for intrauterine implantation
Increases above the reference interval by implantation, 6 to 12 o Doubling of hCG in 2 days provides a greater than
days after ovulation 80% probability of intrauterine implantation of the
fertilized ovum
URINE hCG o Increases in serum hCG of less than 53% in 2 days
Commonly measured by qualitative immunoassay test kits indicate abnormal pregnancy with 99% sensitivity
with detection limits of approximately 20 mIU/mL o Failure to double the serum hCG may suggest an
ectopic pregnancy
Urine methods can detect elevated urine hCG 2 to 3 days later
than serum methods
❑ Current immunoassays use monoclonal antibodies to measure
either the β subunit of hCG or the intact hCG α-β dimer
❑ Can quantify hCG as low as 1 to 2 mIU/mL
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