A pregnancy test is used to determine whether a woman is pregnant or not. The two primary methods are testing for the pregnancy hormone (human chorionic gonadotropin (hCG)) in blood or urine using a pregnancy test kit, and scanning with ultrasonography. Testing blood for hCG results in the earliest detection of pregnancy. Almost all pregnant women will have a positive urine pregnancy test one week after the first day of a missed menstrual period.
Types
Human chorionic gonadotropin (hCG)
Identified in the early 20th century, human chorionic gonadotropin (hCG) is a glycoprotein hormone that rises quickly in the first few weeks of pregnancy, typically reaching a peak at 8- to 10-weeks gestational age. hCG is produced by what will become the placenta. hCG testing can be performed with a blood (serum) sample (typically done in a medical facility) or with urine (which can be performed in a medical facility or at home). The assays used to detect the presence of hCG in blood or urine are generally reliable and inexpensive. Secretion of hCG can occur as soon as 6 days following ovulation and on average 8–10 days following ovulation; this is the earliest hCG can be detected in a blood sample. The hCG concentration in blood is higher than in urine. Therefore, a blood test can be positive while the urine test is still negative. Qualitative tests (yes/no or positive/negative results) look for the presence of the beta subunit of human chorionic gonadotropin in blood or urine. For a qualitative test the thresholds for a positive test are generally determined by an hCG cut-off where at least 95% of pregnant women would get a positive result on the day of their first missed period. Qualitative urine pregnancy tests vary in sensitivity. High-sensitivity tests are more common and typically detect hCG levels between 20 and 50 milli-international units/mL (mIU/mL). Low-sensitivity tests detect hCG levels between 1500 and 2000 mIU/mL and have unique clinical applications, including confirmation of medication abortion success. Qualitative urine tests available for home use are typically designed as lateral flow tests. Quantitative tests measure the exact amount of hCG in the sample. Blood tests can detect hCG levels as low as 1 mIU/mL, and typically clinicians will diagnose a positive pregnancy test at 5mIU/mL.
There is a multilevel urine pregnancy test (MLPT) that measures hCG levels semiquantitatively. The hCG levels are measured at <25, 25 to 99, 100 to 499, 500 to 1999, 2000 to 9999, and >10,000 mIU/mL. This test has utility for determining the success of medication abortion.
Ultrasound Obstetric ultrasonography may also be used to detect and diagnose pregnancy. It is very common to have a positive at-home urine pregnancy test before an ultrasound. Both abdominal and vaginal ultrasound may be used, but vaginal ultrasound allows for earlier visualization of the pregnancy. With obstetric ultrasonography the gestational sac (intrauterine fluid collection) can be visualized at 4.5 to 5 weeks gestation, the yolk sac at 5 to 6 weeks gestation, and fetal pole at 5.5 to 6 weeks gestation. Ultrasound is used to diagnose multiple gestation, which cannot be diagnosed based on the presence of hCG in urine or blood. Determination of the gestational age of the embryo/fetus is an additional benefit of ultrasound compared to hCG tests.
Accuracy
A systematic review published in 1998 showed that home pregnancy test kits, when used by experienced technicians, are almost as accurate as professional laboratory testing (97.4%). When used by consumers, however, the accuracy fell to 75%: the review authors noted that many users misunderstood or failed to follow the instructions included in the kits.
False positive False positive pregnancy test results are rare and may occur for several reasons, including:
user error in performing and interpreting the test, biochemical pregnancy (loss of pregnancy before signs of pregnancy are apparent on ultrasound, likely very soon after implantation), non-pregnant production of the hCG molecule (i.e. secretion due to a tumor or the pituitary gland, some diseases of the liver, cancers, including choriocarcinoma and other germ cell tumors, IgA deficiencies, heterophile antibodies, enterocystoplasties, gestational trophoblastic diseases (GTD), and gestational trophoblastic neoplasms). bacterial contamination and blood in urine Spurious evaporation lines may appear on many home pregnancy tests if read after the suggested 3–5 minute window or reaction time, independent of an actual pregnancy. False positives may also appear on tests used past their expiration date.
Due to use of medication Urine tests can be falsely positive in those that are taking the medications: chlorpromazine, promethazine, phenothiazines, methadone, aspirin, carbamazepine and drugs that cause high urinary pH.
False negative False negative readings can occur when testing is done too early. hCG levels rise rapidly in early pregnancy and the chances of false negative test results diminish with time (increasing gestational age). Less sensitive urine tests and qualitative blood tests may not detect pregnancy until three or four days after implantation. Menstruation occurs on average 14 days after ovulation, so the likelihood of a false negative is low once a menstrual period is late. Ovulation may not occur at a predictable time in the menstrual cycle. A number of factors may cause an unexpectedly early or late ovulation, even for people with a history of regular menstrual cycles. Medical providers often struggle to 'rule out' pregnancy for medical testing or treatment that cannot be conducted during pregnancy before they can do an accurate urine pregnancy test. More rare, false negative results can also occur due to a "hook effect", where a sample with a very high level of hCG is tested without dilution, causing an invalid result.
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