Different Diagnostic Tests for Pregnancy

The Confirmation of Pregnancy

A medical diagnosis of pregnancy serves to date when the birth will occur and also helps predict the
existence of a high-risk status

Before there were sonograms and maternal serum pregnancy tests, pregnancy was diagnosed on
symptoms reported by the woman and the signs elicited by a healthcare provider.

3 classifications:

a. Presumptive (subjective symptoms)

b. Probable (objective signs)
c. Positive (documented signs)

Presumptive (Subjective) Symptoms

- Experienced by the woman but cannot be documented by an examiner.

Probable signs

Laboratory Tests – Commonly used are based on the use of a venipuncture or a urine specimen to
detect the presence of human chorionic gonadotropin (hCG), a hormone created by the chorionic villi of
the placenta, in the urine or blood serum of the pregnant woman.

Home Pregnancy Tests – takes only 2-3 minutes to complete with high degree of accuracy (97% to 99%)
if the instructions are followed exactly because they can detect as little as 35 milli-International Unit/ml
of hCG.

Tips:

- Check the expiration date

- Read the instruction pamphlet and follow carefully
- A concentrated urine sample (first urine in the morning) is best
- Some prescription medicines, like methadone or chlordiazepoxide, may cause false-positive
results.

It is suggested to wait until at least the day of the missed menstrual period to test. If a woman think
she is pregnant but gets a negative result, repeat test 1 week later if she still has not had a
menstrual flow. If symptoms of pregnancy persists after two tests, she needs to see her healthcare
provider as might have another condition causing the amenorrhea; she would need proper diagnosis
and therapy for this.

Positive signs

1. Demonstration of a fetal heart separate from the mother’s

2. Fetal movements felt by an examiner
3. Visualization of the fetus by ultrasound
PHYSICAL EXAMINATION

Pelvic Examination

- A pelvic examination reveals information on the health of both a woman’s internal and external
reproductive organs

Papanicolaou Smear

- A Pap smear is taken from the endocervix at a first prenatal visit to be certain a precancerous or
cancerous condition of the uterine cervix, vulva, or vagina is not present.
- A photograph of the cervix may be taken to document the appearance of a suspicious lesion on
the cervix or confirm that a previous lesion from an infection has healed.
- Bethesda system – most commonly used classification system to interpret Pap smears.

Findings Interpretation
Negative No precancerous or cancerous cells are found
Squamous Cells
Atypical squamous cells (ASC) Some cells appear different than normal but
cannot be classified as precancerous.
Low-grade squamous intraepithelial lesion Mild precancerous changes may have been
(LSIL) found in some cells.
High-grade squamous intraepithelial lesion Moderate to severe precancerous changes may
(HSIL) have been found in some cells.
Squamous cell carcinoma Cancerous cells are present.
Glandular Cells
Atypical glandular cells There is an increased risk of pre-cancer or
cancerous cells.
Adenocarcinoma Cancerous cells are present.

Vaginal Inspection

- With speculum, a culture for trichomoniasis (microscope slide wet mount sample) or group B
Streptococcus (done at 35 to 37 weeks gestation) may be taken.
- Some Pap test specimen can be analyzed for gonorrhea, chlamydia, and HPV, so a separate
swab for these infections is not required.
- Treatment to eliminate all of these infections during early pregnancy helps guard maternal,
fetal, and newborn health.
- If pregnant, vaginal walls turn dark blue to purple. Any areas of inflammation, ulceration, lesions
or discharge should be noted.

Examination of Pelvic Organs

- After speculum examination, a bimanual (two-handed) examination is perform to assess the

position, contour, consistency, and tenderness of pelvic organs.
- Abnormalities may include ovarian cysts, enlarged fallopian tubes (perhaps from pelvic
inflammatory disease), and an enlarged uterus. An early sign of pregnancy (Hegar;s sign) is
elicited as well.
Rectovaginal Examination

- The hand is withdrawn from the vagina. The index finger is reinserted into the vagina and the
middle finger into the rectum.
- By palpating the tissue between the examining fingers in this way, it is possible to assess the
strength and irregularity of the posterior vaginal wall.

LABORATORY ASSESSMENT

Urinalysis

- Urine is tested for proteinuria (protein in urine), glycosuria (glucose in urine), nitrites (bacteria in
urine), and pyuria (white blood cells in urine suggesting an infection)

Blood Serum Studies

1. Complete Blood Count, including hemoglobin or hematocrit and red cell index to determine the
presence of anemia, a white blood cell count to determine infection, and a platelet count to
estimate clotting ability.
2. A genetic screen for common ethnically inherited diseases.
e.g. African American women – screen for sickle-cell trait or disease and glucose-6-phosphate
dehydrogenase (G6PD)
Asian and Mediterranean women – β-thalassemia
Jewish – Tay-Sachs disease
Caucasian women – cystic fibrosis
3. Serologic Test – for syphilis (venereal disease research laboratory (VDRL) or rapid plasma reagin
test). If Syphilis is present, it must be treated early in pregnancy before fetal damage occurs.
4. Blood typing (including Rh factor) – documented because blood may have to be made available
if a woman has bleeding during pregnancy and to detect the possibility of ABO and Rh
isoimmunization.
5. Cultures for chlamydia and gonorrhea should be collected at the initial pelvic examination. By
identifying these asymptomatic infections, the patient can be appropriately treated with
antibiotics and the risk of neonatal morbidity reduced.
6. Maternal serum α-fetoprotein (MSAFP) and pregnancy-associated plasma protein A – most
accurate if scheduled between 16 and 18 weeks of pregnancy. Both of these levels will be
elevated if a neural tube or abdominal defect is present in the fetus; they may be decreased if a
chromosomal anomaly is present. If levels are elevated or decreased, a sonogram or
amniocentesis will be prescribed to clarify fetal health.
7. Indirect Coombs test – determination of whether Rh antibodies are present in an Rh-negative
woman). This test is generally repeated at 28 weeks of pregnancy.
8. Serum antibody titers for rubella, hepatitis B (HBsAg), hepatitis C, varicella (chickenpox) may be
assessed. The tests determine whether a woman is protected against these diseased if exposure
should occur during pregnancy. Vaccines can then be offered in the postpartum period. HBsAg
testing may be repeated at about 36 weeks.
 9. HIV screening – the CDC recommends that all women be tested in early pregnancy for HIV, and
those at high risk should be retested in the third trimester (CDC, 2016a)
10. 50-g oral 1-hour glucose loading or tolerance test (glucose challenge test) – this test is for
woman who has history of previously unexplained fetal loss, has a family history of diabetes, has
had babies who were large for gestational age (9 lb or more at term), has a BMI over 30, or has
glycosuria. Done toward the end of the first trimester (12 weeks) to rule out gestational
diabetes. The addition of a serum (HgA1C) has the best predictive value for identifying diabetes
(Hughes, Moore, Gullam, et al., 2015).

Tuberculosis Screening (Mantoux test)

- For this test, a small amount (0.1ml) of tuberculin units are injected by a needle and syringe
intradermally. In 48 to 72 hours, the area is inspected.
- Reddened, raised, hardened area (induration) – if woman has tuberculosis, has been exposed to
tuberculosis, or has received the bacilli Calmette-Guérin (BCG) vaccine for tuberculosis
- If induration is at least 10 cm in diameter – POSITIVE
- In a person with a lowered immune response, 5 cm can be considered a positive result.
- Chest X-ray will be prescribed (if Positive) to assess her current disease status. Lead apron is
given to cover her abdomen to protect the fetus.
- Interferon-gamma release assay (IGRA) – for women who had BCG vaccine because PPD test can
cause extreme reaction. Or for women who will have difficulty to return for a follow up.
- Screening is important early in pregnancy because it is a chronic and debilitating disease that
increases the risk of miscarriage.

Ultrasonography

- If LMP is unknown, a woman will be scheduled for a sonogram to confirm the pregnancy length
and document healthy fetal growth at 7 to 11 weeks of pregnancy.
- Ultrasound – 11 and 13 weeks of pregnancy to assess for increased risk of Down syndrome.
- Sonogram – 16 and 20 weeks gestation to verify healthy fetal structures and gender.