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Alan S Penzias - One of the best experts on this subject based on the ideXlab platform.
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luteal phase support
Fertility and Sterility, 2002Co-Authors: Alan S PenziasAbstract:Abstract Objective: To develop a consensus regarding the need for luteal phase support during assisted reproductive technology (ART), and to establish the optimal compound and route of administration for this purpose. Design: Review of the published literature on luteal phase support. Patient(s): Women undergoing assisted reproductive technologies. Intervention(s): Progesterone was administered orally, vaginally, or by intramuscular (i.m.) injection to supplement the luteal phase after assisted reproductive technology (ART). Main Outcome Measure(s): Pregnancy following ART. Result(s): Gonadotropin releasing hormone (GnRH)-agonist protocols necessitate the use of luteal phase support. Progesterone and human chorionic gonadotrophin (hCG) have both been used for this purpose, with comparable outcomes. Progesterone is the product of choice, however, as it is associated with a lower incidence of ovarian hyperstimulation syndrome (OHSS). Its use is indicated up to the serum Pregnancy Test. Oral, i.m., and vaginal progesterone preparations are available. Intramuscular and vaginal preparations lead to comparable rates of implantation and clinical Pregnancy, despite higher serum progesterone levels after i.m. injection. Oral formulations are inferior products for luteal support. Although widely used, i.m. progesterone is uncomfortable and inconvenient for patients. By contrast, the vaginal progesterone gel (Crinone 8%) is more convenient and easier to use. Conclusion(s): Progesterone support of the luteal phase in in vitro fertilization (IVF) cycles is indicated, though support beyond the serum Pregnancy Test may not be needed. The Pregnancy rates after vaginal and i.m. progesterone support are comparable, despite higher serum levels after i.m. injection. Patients prefer the vaginal progesterone gel.
Liyu Tsai - One of the best experts on this subject based on the ideXlab platform.
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Urine Pregnancy Testing in Two Women with Cancer
Laboratory Medicine, 2007Co-Authors: Yuhjyh Jong, Liyu Tsai, Hung-jung Cheng, Bai-hsiun ChenAbstract:Questions1. What are the most striking clinical and laboratory findingsin these patients?2. Why is it important to assess Pregnancy status?3. What are some of the causes of false-positive serum andurine Pregnancy Tests?4. How would you rule out human or technical error as a possiblecause of a false-positive or -negative urine Pregnancy Test?5. What can cause discordances between urine and serum hCGTest results?6. What is the most likely diagnosis for these patients?7. What is the clinical significance of a false-positive urinePregnancy Test?8. Are serum hCG Tests unaffected by factors that can causefalse-positive Test results?Possible Answers1. The most striking laboratory findings in both of thesepatients was a positive urine Pregnancy Test in patients who,based on their medical history (data not shown), were not ex-pected to have a positive urine hCG Pregnancy Test.2. Determination of Pregnancy status is important in thework-up of a woman presenting with vaginal bleeding or lowerabdominal pain. Women with these symptoms should bescreened for Pregnancy using a urine Pregnancy Test, especiallyprior to undergoing an x-ray procedure. Clinical decisions re-garding additional diagnostic Testing should be based on the re-sults of the urine Pregnancy Test and knowledge of thoseconditions that can cause false-positive screening Tests for humanchorionic gonadotropin (hCG) in urine and serum, includingthe presence of serum human anti-mouse antibodies (HAMA)and diseases (eg, colon or cervical cancer) associated with excre-tion of hCG into the urine.3. A number of preanalytical conditions, other than preg-nancy, including trophoblastic disease and certain non-trophoblastic neoplasms (eg, Testicular tumors, prostate cancer,breast cancer, and lung cancer), can cause elevated serum levelsof hCG that are then excreted into the urine.
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false negative Pregnancy Test in hydatidiform mole
Clinical Chemistry, 2006Co-Authors: Yuhjyh Jong, Eingmei Tsai, Chilin Huang, Huiwen Chou, Binghong Zheng, Liyu TsaiAbstract:A 16-year-old girl (gravida 0, para 0) presented to the emergency department with a 2-week history of nausea, vomiting, vaginal spotting, and lower leg edema. On examination we found a palpable lower abdominal mass. The patient acknowledged recent sexual activity but denied having any sexually transmitted diseases. Molar Pregnancy was suspected because of the typical “snowstorm” appearance observed with ultrasound examination. The quantitative serum β-subunit of human chorionic gonadotropin (β-hCG) concentration was 746.20 IU/L (reference interval, <0.5 to 2.90 IU/L; reportable interval, 0.5–1000 IU/L). The result of a qualitative urine hCG Test, however, was negative. Human error was initially suspected as the cause of the negative result in the first qualitative urine hCG Test. Two experienced and well-trained senior medical technologists repeated the urine hCG Test twice, but the results were still negative. The patient’s nurse also indicated that she did not think there had been mislabeling of the urine sample. Because of this discrepancy, we …
David G Grenache - One of the best experts on this subject based on the ideXlab platform.
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should the qualitative serum Pregnancy Test be considered obsolete
American Journal of Clinical Pathology, 2012Co-Authors: Larissa V Furtado, Christopher M Lehman, Catherine D Thompson, David G GrenacheAbstract:Qualitative and quantitative serum human chorionic gonadotropin (hCG) Tests are used to diagnose Pregnancy. We assessed physicians’ perceptions and compared turnaround times (TATs) and performance characteristics of both Tests. We surveyed 1,058 physicians about their perceptions of hCG Tests. Seven months of TAT data were analyzed. hCG was measured in all qualitative samples. Pregnancy status was determined by chart review. Of the physicians surveyed, 183 responded. Fortynine percent preferred qualitative over quantitative serum Tests for determining Pregnancy status. Physicians were willing to wait 45 minutes for results from either Test. Qualitative Tests are performed faster than quantitative Tests, but TATs were not significantly different when sample transport time was considered. The negative predictive value of both Tests was 99.9%. Qualitative serum hCG Testing could be replaced by quantitative hCG Tests, but there is no clear advantage to doing so. Rapid Testing for the qualitative detection of human chorionic gonadotropin (hCG) in urine or serum using point-ofcare (POC) Test devices is frequently performed in health care settings to identify a possible Pregnancy. Qualitative urine hCG Tests are attractive because the urine sample requires no special processing and the Tests are granted waived status by the Clinical Laboratory Improvement Amendments (CLIA). As such, Testing can truly be performed at the POC by any health care provider. In contrast, qualitative serum hCG Tests are categorized by CLIA as moderately complex because they require the collection of a whole blood specimen that must be centrifuged before Testing to obtain the serum sample. The need to perform qualitative hCG Testing in serum
Tessa Madden - One of the best experts on this subject based on the ideXlab platform.
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performance of a checklist to exclude Pregnancy at the time of contraceptive initiation among women with a negative urine Pregnancy Test
Contraception, 2015Co-Authors: Jaspur Min, Christina Buckel, Gina M Secura, Jeffrey F Peipert, Tessa MaddenAbstract:Abstract Objective Our objective was to measure the sensitivity and specificity of a six-item “Pregnancy checklist” at excluding early- or luteal-phase Pregnancy among women with a negative urine Pregnancy Test who were initiating contraception. Study design This was a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9256 women in the St. Louis region. Women who had a negative urine Pregnancy Test on the day of enrollment were included in this analysis. Women with a positive urine Pregnancy Test or without urine Pregnancy Testing were excluded. We identified all luteal-phase pregnancies that occurred among women with a negative urine Pregnancy Test. We calculated the sensitivity, specificity, positive predictive value and negative predictive value (NPV) and likelihood ratios of the Pregnancy checklist for excluding luteal-phase pregnancies. Results There were 6929 women included in this analysis; 69% of these women met at least one checklist criterion to exclude Pregnancy (“negative screen”). There were 36 luteal-phase pregnancies (0.5%) subsequently diagnosed among women with a negative urine Pregnancy Test. The sensitivity and specificity of the checklist were 77.7% and 69.1%, respectively. The NPV of the checklist was 99.8% and the positive predictive value was 1.3%. Conclusion Among women with a negative urine Pregnancy Test, the Pregnancy checklist can be used to safely exclude more than 99% of early pregnancies at the time of contraceptive initiation. Implications In patients with a negative urine Pregnancy Test, a Pregnancy checklist using six criteria based on patient history has high NPV in excluding early Pregnancy. This checklist can be used to facilitate same-day initiation of contraceptive methods, including long-acting reversible contraception. Although the checklist had a high false positive rate, initiation of contraception should not be delayed in women with a “positive screen.” Rather women who desire an intrauterine device or implant can be “bridged” with a shorter-acting method until Pregnancy can be excluded.
Marie Klingbergallvin - One of the best experts on this subject based on the ideXlab platform.
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simplified follow up after medical abortion using a low sensitivity urinary Pregnancy Test and a pictorial instruction sheet in rajasthan india study protocol and intervention adaptation of a randomised control trial
BMC Women's Health, 2014Co-Authors: Mandira Paul, Kirti Iyengar, Sharad D Iyengar, Kristina Gemzelldanielsson, Birgitta Essen, Marie KlingbergallvinAbstract:Background: The World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic. Methods/Design: This study protocol describes a study that is a randomised, controlled, non-superiority trial. Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. The randomisation list will be generated using a computerized random number generator and opaque sealed envelopes with group allocation will be prepared. Randomization of the study participants will occur after the first clinical encounter with the doctor. Eligible women randomised to the home-based assessment group will use a low-sensitivity Pregnancy Test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study this study protocol describes is to evaluate the efficacy of home-based assessment using a low-sensitivity Pregnancy Test and a pictorial instruction sheet 10–14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This resulted in an optimized, tailor-made intervention and in the development of the pictorial instruction sheet with a guide on how to use the low-sensitivity Pregnancy Test and the danger signs after a medical abortion. Discussion: In this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10–14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor. Trial registration: Clinicaltrials.gov NCT01827995. Registered 04 May 2013.