Risk of ionizing radiation in women of childbearing age undergoing radiofrequency ablation

Background

The International Commission of Radiology recommends a pregnancy screening test to all female patients of childbearing age who will undergo a radiological study. Radiation is known to be teratogenic and its effect is cumulative. The teratogenic potential starts at doses close to those used during these procedures. The prevalence of positive pregnancy tests in patients undergoing electrophysiological studies and/or catheter ablation in our midst is unknown.

Objective

To evaluate the prevalence of positive pregnancy tests in female patients referred for electrophysiological study and/or radiofrequency ablation.

Methods

Cross-sectional study analyzing 2,966 patients undergoing electrophysiological study and/or catheter ablation, from June 1997 to February 2013, in the Institute of Cardiology of Rio Grande do Sul. A total of 1490 procedures were performed in women, of whom 769 were of childbearing age. All patients were screened with a pregnancy test on the day before the procedure.

Results

Three patients tested positive, and were therefore unable to undergo the procedure. The prevalence observed was 3.9 cases per 1,000 women of childbearing age.

Conclusion

Because of their safety and low cost, pregnancy screening tests are indicated for all women of childbearing age undergoing radiological studies, since the degree of ionizing radiation needed for these procedures is very close to the threshold for teratogenicity, especially in the first trimester, when the signs of pregnancy are not evident.

Enhancing the emergency department approach to pediatric sexual assault care: implementation of a pediatric sexual assault response team program

OBJECTIVES

The objectives of this study were to describe the experience of a novel pediatric sexual assault response team (SART) program in the first 3 years of implementation and compare patient characteristics, evaluation, and treatment among subpopulations of patients.

METHODS

This was a retrospective chart review of a consecutive sample of patients evaluated at a pediatric emergency department (ED) who met institutional criteria for a SART evaluation. Associations of evaluation and treatment with sex, menarchal status, and presence of injuries were measured using logistic regression.

RESULTS

One hundred eighty-four patients met criteria for SART evaluation, of whom 87.5% were female; mean age was 10.1 (SD, 4.6) years. The majority of patients underwent forensic evidence collection (89.1%), which varied by menarchal status among girls (P < 0.01), but not by sex. Evidence of acute anogenital injury on physical examination was found in 20.6% of patients. As per the Centers for Disease Control and Prevention guidelines for acute sexual assault evaluations in pediatric patients, menarchal girls were more likely to undergo testing for sexually transmitted infections and pregnancy (P < 0.01) and to be offered pregnancy, sexually transmitted infection, and HIV prophylaxis (P < 0.01).

CONCLUSIONS

In an effort to improve quality and consistency of acute sexual assault examinations in a pediatric ED, development of a SART program supported the majority of eligible patients undergoing forensic evidence collection. Furthermore, a substantial number of patients had evidence of injury on examination. These findings underscore the importance of having properly trained personnel to support ED care for pediatric victims of acute sexual assault.

Double sac sign and intradecidual sign in early pregnancy: interobserver reliability and frequency of occurrence

OBJECTIVES

To assess the interobserver agreement, frequency of occurrence, and prognostic importance of the double sac sign (DSS), intradecidual sign (IDS), and other sonographic findings in early intrauterine pregnancies.

METHODS

We retrospectively identified all sonograms obtained between January 1, 2006, and December 31, 2011, in which: (1) the scan demonstrated an intrauterine fluid collection without a yolk sac or embryo; (2) a follow-up scan confirmed an intrauterine pregnancy; and (3) the first-trimester outcome was known. Each coinvestigator characterized the 199 study sonograms as demonstrating or not demonstrating a DSS or an IDS, based on judgment about whether the scan met published criteria defining these signs.

RESULTS

Interobserver agreement was poor for the DSS (κ= 0.24) and IDS (κ= 0.23). Scans frequently demonstrated neither sign: 150 cases (75.4%) if we considered a sign to be present when both investigators graded it as present and 69 cases (34.7%) using the looser criterion that either graded it as present. The presence of a DSS or an IDS was unrelated to the β-human chorionic gonadotropin (β-hCG) value (P > .05, t test, all comparisons). An inner echogenic ring was present in 158 cases (79.4%), and the decidua was brighter peripherally than centrally in 102 (51.3%). The first-trimester outcome was unrelated to the presence of a DSS or an IDS, presence of an inner echogenic ring, or decidual appearance (P > .05, χ(2), all comparisons).

CONCLUSIONS

The sonographic appearance of early gestational sacs, before visualization of a yolk sac or embryo, is highly variable. The DSS and IDS are often absent; there is poor interobserver agreement regarding these signs; and the prognosis is unrelated to their presence or absence. A round or oval intrauterine fluid collection in a woman with positive β-hCG should be treated as a gestational sac until proven otherwise, regardless of whether it demonstrates a DSS or an IDS.

[Trends in the incidence of positive pregnancy tests in adolescents seen in an emergency department]

INTRODUCTION

The current debate on induced abortion and the age when a young woman is considered mature to have this without parental consent, shows the need to know the real importance of adolescent pregnancy in the Emergency Department.

OBJECTIVES

a) To determine the adolescent pregnancy rate variation in the Emergency Department during last 12 years; b) to determine the characteristics of the pregnant adolescent and the outcome of their pregnancies.

MATERIAL AND METHODS

Retrospective study of pregnant adolescents diagnosed in the Emergency Department between July 1, 1997 and June 30, 2009. Pregnancy rates were calculated per 1000 annual female adolescent consultations. Two periods were considered: 1/from July 1, 1997 to June 30, 2003 and 2/from July 1, 2003 to June 30, 2009.

RESULTS

Eighty-three pregnancies were diagnosed in adolescents. Pregnancy rates varied from 0.5 to 2.0 per 1000 females; an increased trend in adolescent pregnancy rate was observed in the second period. Metrorrhagia, abdominal pain and vomiting were the most frequent complaints. There were 62 on-going pregnancies, 20 abortions and one ectopic pregnancy. Only 35 of the outcomes of the 62 on-going pregnancies were known: 19 ended in live birth, 11 in induced abortion and 4 in stillbirth.

CONCLUSIONS

The adolescent pregnancy rate is low; nevertheless an increased trend is being observed in the last few years. Many adolescents diagnosed with pregnancy had nonspecific complaints, so it is important to ask about sexual habits in all adolescents. A high percentage of diagnosed pregnancies end in abortion.

Home pregnancy test compared to standard-of-care ultrasound dating in the assessment of pregnancy duration

OBJECTIVE

To determine the level of agreement between the Clearblue Digital Pregnancy Test with Conception Indicator home pregnancy test and standard-of-care ultrasound in assessing pregnancy duration in a real-life, observational setting encompassing routine, clinical care.

RESEARCH DESIGN AND METHODS

This was a prospective observational study of non-pregnant women seeking conception. Women collected daily urine samples from day 1 of their next menstrual cycle. If any volunteer became pregnant, daily urine samples continued to be collected for 43 days after the LH surge. Samples from day -7 to day +28 relative to the expected period (LH surge + 15 days) were tested using the home pregnancy test. This categorised any resulting pregnancies into one of three groups: 1-2 weeks, 2-3 weeks, and 3+ weeks since conception. Information from the standard UK ultrasound dating scan was also recorded by the midwife, including the expected delivery date according to ultrasound and the expected delivery date according to LMP.

MAIN OUTCOME MEASURES

Full data were available from 52 pregnant women who had conceived naturally. During the study analysis, 4786 urine samples were cross-compared with 52 routine 12-week NHS ultrasound assessments and the level of agreement between home pregnancy testing and standard-of-care ultrasound in determining pregnancy duration was calculated.

RESULTS

The agreement between the gestational age as calculated by the home pregnancy test result and the exact midwife-recorded gestational age using ultrasound was 82.3%. However, when a ± 5-day range was applied to the ultrasound reading (as per routine UK clinical practice), the level of agreement was 98%.

CONCLUSIONS

The home pregnancy test provides a significantly high (98%) level of agreement with standard-of-care ultrasound when assessing pregnancy duration in a real-life, observational setting which closely mirrors daily clinical practice.

Number of oral contraceptive pill packages dispensed, method continuation, and costs

OBJECTIVE

To estimate the effect of the number of cycles of oral contraceptive pills (OCPs) dispensed per visit on method continuation, pill wastage, use of services, and health care costs.

METHODS

We used paid claims data for 82,319 women dispensed OCPs through the California Family PACT (Planning, Access, Care, and Treatment) Program in January 2003 to examine contraceptive continuation and service use.

RESULTS

Women who received 13 cycles at their first visit in January 2003 received 14.5 cycles over the course of 2003 compared with 9.0 cycles among women receiving three cycles at first visit. When client characteristics are controlled, women who received 13 cycles were 28% more likely to have OCPs on hand and twice as likely to have sufficient OCP cycles for 15 months of continuous use compared with women who received three cycles. Oral contraceptive pill wastage was higher among women initially dispensed 13 cycles (6.5% of the cycles dispensed) than among women who received three cycles (2% of cycles). Despite having one fewer clinician visit, women dispensed 13 cycles were more likely to receive Pap and Chlamydia tests and less likely to have a pregnancy test than women initially dispensed fewer cycles. Over the course of the year, Family PACT paid 99 US dollars more for women who received three cycles and 44 US dollars more for women who received only one cycle than it did for women who received 13 cycles at their first visits of 2003.

CONCLUSION

Dispensing a year's supply of OCP cycles to women is associated with higher method continuation and lower costs than dispensing fewer cycles per visit.

LEVEL OF EVIDENCE

II-2.

Negative pregnancy tests in urban adolescents: an important and often missed opportunity for clinicians

This study describes a project to determine the incidence of negative pregnancy tests performed in an urban community for teens 18-years old and younger. Pregnancy test logs were kept at a variety of clinical agencies for a three-month period. Five hundred and fifty urine pregnancy tests were performed; 77% were negative. In our community a large number of teens are accessing health care services for pregnancy tests, the vast majority of which are negative and represent an important opportunity to prevent unintended pregnancies in a population of adolescent girls.

Clinicians' views on reproductive needs and services for teens with negative pregnancy tests

ISSUES AND PURPOSE

To explore services available to adolescent girls at the time of the negative pregnancy test (NPT) in an urban community.

DESIGN AND METHODS

Clinician focus groups were conducted to identify the needs of adolescents at the time of a NPT result.

RESULTS

Teens access care in a variety of ways, services provided at the time of a NPT were agency and clinician dependent, and strategies for follow-up care often were unstructured. Few services were available for parents or partners. Barriers included difficulty communicating with agencies, lack of staff trained to work with adolescents, and time/financial constraints.

CONCLUSION

Adolescents need comprehensive, teen-friendly reproductive care at the time of a NPT result.

Emergency department management of sexually transmitted infections in US adolescents

STUDY OBJECTIVE

Adolescents are at risk for developing a variety of sexually transmitted infections for many reasons. Many of these adolescents present to the emergency department (ED) for their care. We describe the management of adolescent sexually transmitted infections in US EDs.

METHODS

Data were obtained from the 1992 to 1998 National Hospital Ambulatory Medical Care Survey. All visits by adolescents aged 12 to 19 years were identified by any International Classification of Diseases, Ninth Revision code related to sexually transmitted infections. Treatment was reviewed and compared with existing guidelines from the US Centers for Disease Control and Prevention (CDC). Multivariate logistic regression was used to determine the independent association of each of the following variables on antibiotic prescribing rates: sex, race and ethnicity, hospital location, age, and insurance.

RESULTS

Eighteen thousand nine hundred ninety-nine records that represented 70,693,603 adolescent visits to US EDs were identified during the 7-year study period, of which 351 records representing 1.2 million visits were for a sexually transmitted infection. Mean age was 17.1 years, and 92% were female patients. Overall, 80% of patients diagnosed with a sexually transmitted infection were treated (received antibiotics or were admitted to the hospital); 91% of patients had pelvic inflammatory disease and 71% of patients had other sexually transmitted infections. Eight percent of patients diagnosed with pelvic inflammatory disease were admitted to the hospital. However, treatment for female patients with pelvic inflammatory disease was fully compliant with CDC recommendations in only 35% of cases (95% confidence interval [CI] 19% to 45%) and partially compliant in another 45%; 20% (95% CI 12% to 31%) of patients received either no treatment or treatment not in accordance with guidelines. Male patients were more likely to be treated for sexually transmitted infection (adjusted odds ratio [OR] 6.3; 95% CI 1.0 to 38.7), and Hispanic patients were less likely (adjusted OR 0.3; 95% CI 0.1 to 0.9) to be treated. Age, insurance type, and hospital location were not a factor in receiving antibiotics. For female patients who had a sexually transmitted infection, only 43% had a pregnancy test done, and of all adolescents diagnosed with a sexually transmitted infection, only 1 (0.3%) had an HIV test performed.

CONCLUSION

Significant numbers of adolescents sought care for sexually transmitted infections in US EDs. Evaluation and treatment of these adolescents is not optimal. Male patients are more likely to be treated for a sexually transmitted infection. Hispanic patients are less likely to be treated for a sexually transmitted infection. Pelvic inflammatory disease is not always treated with antibiotics, and few patients with pelvic inflammatory disease are admitted to the hospital. HIV testing was almost never done. Further study is necessary to explain these disparities and optimize care.

Hospital referrals with possible ectopic pregnancy: prospective observational study

Women of reproductive age with abdominal pain represent a diagnostic challenge, especially in primary care where the decision whether to refer to hospital needs to be taken. The diagnosis of an ectopic pregnancy hinges on a combination of clinical findings and a positive urinary pregnancy test (UPT). We investigated whether non-pregnant patients with abdominal pain were being referred inappropriately to hospital to exclude ectopic pregnancy because a UPT had not been performed or had been interpreted incorrectly. In this study, of the 81 patients referred by their general practitioners (GPs) on suspicion of ectopic, 38 were not pregnant on admission and only 46% of the UPT results in hospital agreed with those reported to the GP by the patient prior to referral. Given the high sensitivity and specificity of correctly interpreted UPTs, our findings suggest that pregnancy should be confirmed before hospital referral.

'Condom club': an interface between teenage sex and genitourinary medicine

In response to demand from young teenagers, a nurse-led 'condom club' was established in 1996. This paper reports the use of the service from 1996 to 1999 by retrospective case note review. Two hundred and eighty-six individual males and 327 individual females made 655 and 824 visits, respectively. Condoms were accessed by 495 individuals, but girls also requested emergency contraception and pregnancy testing. Young teenagers were reluctant to have screening for sexually transmitted infections (STIs), but in those that did, 50% were found to have an STI. It is concluded that young teenagers will access a nurse-led sexual health advice service. The use of nursing staff allows greater flexibility of access. Geographical accessibility was also shown to be important.

Prevalence of home pregnancy testing among adolescents

OBJECTIVES

This study estimated the prevalence of home pregnancy testing among adolescents.

METHODS

A survey was administered in 11 urban clinics to 600 females aged 13 to 19 years.

RESULTS

The prevalence of home pregnancy test use was 34% among 474 sexually experienced youths; 77% of the users had received at least 1 negative pregnancy test result, and 48% took no further action for confirmation. Compared with those who had never used such tests, users were older, younger at sexual debut, less likely to consistently use effective birth control, and more likely to have ever been pregnant.

CONCLUSIONS

Health care clinics are important sources for pregnancy prevention, but clinics may have limited opportunity to intervene with some youths who use home pregnancy tests.

Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997

CONTEXT

If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives.

METHODS

A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race.

RESULTS

In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues.

CONCLUSION

Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.

The impact of a pregnancy confirmation clinic on the commencement of antenatal care

OBJECTIVE

To introduce a pregnancy confirmation clinic as part of antenatal care and to determine whether this would alter the gestational age at which patients commence antenatal care.

SETTING

Three municipal antenatal clinics in Atteridgeville and Central Pretoria.

METHOD

A pregnancy confirmation clinic was set up at three sites. At the clinic any woman wishing to confirm whether she was pregnant was offered a urine beta-HCG test. If this test was positive, on-site testing for syphilis, anaemia and rhesus status, dipstick testing of the urine, clinical examination and ultrasound examination were performed. Women with abnormal test results were commenced on appropriate treatment immediately and women requiring further medical care or investigation were referred appropriately.

RESULTS

The study recruited 382 women, 145 of whom were defaulters from contraception. Half of the women (191) had a positive pregnancy test. The mean presenting gestational age was 12 weeks 4 days (standard deviation 5 weeks, range 5 weeks-25 weeks 2 days). Treatable conditions with the potential to influence pregnancy outcome were identified in 37 of the pregnant women (19.4%) Forty-three of the pregnant women intended to terminate the pregnancy.

CONCLUSION

It is possible to shift the commencement of antenatal care to an earlier gestational age.

Pregnancy wantedness in adolescents presenting for pregnancy testing

PURPOSE

To explore and describe dimensions of pregnancy wantedness in adolescents who present for pregnancy testing.

DESIGN

Descriptive survey.

METHODS

Adolescents presenting for pregnancy testing at a multiservice teen center were invited to participate by completing the Pregnancy Importance Questionnaire while awaiting the results of their pregnancy test. Eighty-nine adolescents responded to questions concerning their desire for pregnancy, knowledge and access to birth control information and supplies, and expectations of how a pregnancy would change their lives.

RESULTS

Approximately 7% wanted the pregnancy test to be positive, 60% wanted it to be negative, and 33% were not sure. There was a moderately low (1.97 out of 5) desire for pregnancy, a moderately high (3.11 out of 5) knowledge of and access to birth control, and moderately low (2.08 out of 5) expected changes with a pregnancy. There were no differences in these dimensions by age group (early, middle, and late adolescence).

CLINICAL IMPLICATIONS

All clinicians working with adolescents should explore sexual risk-taking and pregnancy prevention measures among these clients. Appropriate counseling and follow-up is necessary for adolescents who present for pregnancy testing, whether the pregnancy test is positive or negative.

Diagnostic efficiency of home pregnancy test kits. A meta-analysis

OBJECTIVE

To assess the diagnostic efficiency of home pregnancy test (HPT) kits.

DATA SOURCES

A literature search of English-language studies was performed with MEDLINE and a review of bibliographies.

STUDY SELECTION

Studies were included if HPT kits were compared with a criterion standard (laboratory testing), if they used appropriate controls, and if data were available to determine sensitivity and specificity.

DATA EXTRACTION

Two investigators independently extracted data, and disagreement was resolved by consensus. Sensitivity, specificity, and an effectiveness score (a measure of the discriminatory power of the test, with higher scores implying greater effectiveness) were calculated.

DATA SYNTHESIS

Five studies evaluating 16 HPT kits met the inclusion criteria. The range of sensitivities for HPT kits was 0.52 to 1.0. In studies where urine samples obtained by the investigators were tested by volunteers, sensitivity was 0.91 (95% confidence interval [CI], 0.84-0.96). However, the sensitivity was less in studies where subjects were actual patients who performed the test on their own urine samples (sensitivity, 0.75 [95% CI, 0.64-0.85]). The test effectiveness score was 2.75 (95% CI, 2.3-3.2) for studies where subjects were volunteers but deteriorated to 0.82 (95% CI, 0.4-1.2) for studies with actual patients.

CONCLUSIONS

The diagnostic efficiency of HPT kits is greatly affected by characteristics of the users. Despite the popularity of these kits, the relatively low effectiveness scores of these kits when used by actual patients are of concern. We suggest that manufacturers of HPT kits publish results of trials in actual patients before marketing them to the general public.

Evaluating effects of exposures on embryo viability and uterine receptivity in in vitro fertilization

We consider models for the occurrence of pregnancy following in vitro fertilization. In this clinical protocol, implantation depends on two factors: the receptivity of the uterus and the viability of at least one of the embryos transferred to the uterus. This work is motivated by the need to identify reliable bio-markers for these two factors, in order to enhance the success rate for couples undergoing this procedure. We present a general latent variable structure model for outcomes that take either one of two possible forms: as summed Bernoullis, based on an ultrasound count of gestational sacs, or as aggregated Bernoullis, based only on the outcome of a biochemical pregnancy test. We allow both uterine receptivity and embryo viability to be influenced by covariates. The proposed latent variable structure allows us to utilize the existing statistical packages to maximize an otherwise intractable likelihood function. The method is sufficiently flexible to permit any valid choice of link function. We illustrate by applying the method to a recent study of in vitro fertilization carried out in North Carolina. The number of cells at transfer is evidently a marker for embryo viability.

Pregnancy testing and counseling: a university health center's 5-year experience

Profiles and related sexual histories of 2,029 women who sought pregnancy tests at a university health center over a 5-year period were examined. Rates of pregnancy (30%) were consistent over the 5 years. The highest rates of testing were among seniors and juniors, with graduate students reporting the highest levels of unintended pregnancy. More than 37% of the women indicated they had not used any method of contraception at the time of risk; 29% of the women who had used condoms reported that the device had either torn or slipped off. The women with previous pregnancies were more likely to test positive and to terminate the pregnancy than were the women who had never been pregnant. The findings are discussed with reference to sexually education programs and pregnancy counseling.

Adolescents with negative pregnancy test results. An accessible at-risk group

OBJECTIVE

To estimate nationally what percentage of young women receive negative pregnancy test results before becoming pregnant, to explore their fertility and test histories, and to estimate the potential for intervention at the time of a negative test result.

DESIGN

A cross-sectional study in which young women presenting to clinics for pregnancy tests were asked to complete a self-administered questionnaire before test results were known that explored prior pregnancy tests, pregnancies, sexual and contraceptive histories, and childbearing attitudes.

SETTING

Fifty-two clinics including hospital, health department, Planned Parenthood, and independent facilities.

PARTICIPANTS

A total of 2926 patients aged 17 years or younger requesting pregnancy tests at presentation.

RESULTS

Among young women who had ever conceived, 34.2% had a prior negative pregnancy test result and 24.4% had a prior negative test result at a clinic. Almost three of five of the adolescent girls, including both those who had and those who had not conceived, received a negative test result at a clinic before they ever became pregnant. By the age of 14 years, the probability of a negative test result was substantially greater than the chance of a positive test. Many presented for tests even though they were quite certain that they were not pregnant.

CONCLUSIONS

Adolescent girls with a negative pregnancy test result may be an appropriate target group for intervention. One fourth of adolescent girls who have a negative pregnancy test may be identified by the health care system on that occasion in time to prevent early childbearing.

Detection of pregnancy by radioimmunoassay of a pregnancy serum protein (PSP60) in cattle

The accuracy and efficiency of pregnancy diagnoses in cattle by pregnancy serum protein (PSP60) radioimmunoassay, a progesterone radioimmunoassay or oestrus detection were compared. Blood samples were taken from 349 suckling heifers and cows (1,191 inseminations) at 28, 35, 50 and 90 d post-insemination for PSP60 determination and at 22-23 d for progesterone. Females were declared nonpregnant when plasma PSP60 concentration was lower than 0.2 ng/ml at 28, 35 and 50 d and 0.5 ng/ml at 90 d. When compared with rectal palpation at 90 d, the accuracy of positive (negative) diagnoses by progesterone assay was 80% (100%) in heifers and 75% (99%) in cows. The accuracy of positive diagnoses by PSP60 assay increased with gestation stage from 90% on d 28 in heifers (74% in cows) to 100% (99% in cows) at the time of rectal palpation. This accuracy was 84% on d 28 in cows when the interval from calving to blood sampling was higher than 115 d. Whatever the stage, the accuracy of negative diagnoses was higher than 90%. Efficiency in detecting pregnant or nonpregnant females on d 28 was equivalent to the progesterone assay. The method for detecting oestrus applied in this experiment was as efficient as the PSP60 or progesterone test at any stage of gestation. The PSP60 test is very flexible, which makes its use particularly interesting in naturally mated suckling herds because of the uncertainty regarding the date of fertilization.

The usage of pregnancy tests in one health district

OBJECTIVE

To investigate the total number of pregnancy tests performed and the proportion that are repeated in one health district. To relate these results to the number of conceptions.

DESIGN

Collection of data related to the numbers of pregnancy tests performed from all sources. Surveys of women booking for antenatal care or undergoing nonroutine obstetric ultrasound examination.

SETTING

One health district in the south of England.

RESULTS

About five pregnancy tests were performed for each proven pregnancy. Nearly two-thirds of tests were purchased over the counter, the remainder being carried out by hospital laboratories and pregnancy advisory services. Very few women had their pregnancy diagnosed on clinical grounds alone and a small number of ultrasound examinations were apparently performed in lieu of chemical tests. Repeated testing was more likely in primiparous women (P < 0.005).

CONCLUSIONS

Chemical pregnancy tests appear to be trusted more than clinical examination for the diagnosis of pregnancy by women and doctors. When there is no medical urgency, women who want formal confirmation of pregnancy should be advised that home testing kits will provide the quickest results.

Measuring dairy herd fertility

The use of the calving index as a measure of herd fertility ignores the proportion of the herd that is culled, generally for failing to conceive. It is more important to consider the total cost of long calving intervals, high culling rate and even low pregnancy rates in an integrated index that reflects inefficient management, than to have to cope with balancing a number of separate physical indicators. In a study of 91 herds containing 14,524 cows a full range of physical indices was examined. The average herd calving interval was 380.3 days, with a culling rate of 23.1 per cent. Of the cows calving, 76.9 per cent recalved, a figure which when adjusted for the calving interval (CIA calving rate) became 73.8 per cent. In quartiles split on the basis of CIA calving rate, the top quartile achieved 82 per cent with a calving index of 375.2, and a culling rate of 16.7 per cent. These standards were achieved by serving 91.9 per cent of the cows after calving, at an interval to first service of 67.2 days. The submission rate for artificial insemination in the first 24 days after the earliest service date was 57.5 per cent and the overall pregnancy rate was 51.2 per cent. As a result 92.1 per cent of the cows served, and 85.3 per cent of those which calved, conceived again, with an average of 1.9 services per conception. Assessing fertility on a financial basis, with costs attributed to calving interval, culling rate and pregnancy rate to give a fertility index, the average herd was losing pounds 62/cow/year, compared with target levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethnic differences in patient requests for pregnancy testing

This study identifies a black-white difference in pregnancy test requests and in factors predicting such requests among 324 women tested at an academic family practice in 1986. Data were obtained from encounter sheets filled out by clinicians at the time tests were ordered. Analysis of variance revealed that blacks requested fewer pregnancy tests than whites, and that this finding remained significant (P less than .01) after controlling for the effects of gestational status and other clinical and sociodemographic factors. Blacks were less likely to be married or possess health insurance, but more likely to have been pregnant before. Logistic regressions indicated that factors predicting test requests differed by ethnicity, with symptoms and age predicting test requests among whites, and pregnancy the only significant predictor among blacks. Explanations consistent with these findings include possible ethnic differences in reactions to symptoms and economic factors. Further refinement of these hypotheses and consideration of other alternatives will advance understanding of ethnicity as a factor in test-requesting behavior, and enable clinicians to communicate with and care for black women more effectively.

Monoclonal antibodies to beta subunit of choriogonadotropin: development and use in a sandwich ELISA pregnancy test

Balb/c mice were immunized with beta subunit isolated and purified from crude human chorionic gonadotropin preparations. Spleen cells from the higher titered mouse were fused with Sp 2/0 myeloma cells. Four specific secreting hybridomas were obtained. Specificity, affinity, and suitability of secreted antibodies for use in enzyme immunoassays were studied. Ascites of the selected hybridoma was raised; the antibody was purified by protein A-affinity chromatography and coupled to horseradish peroxidase. This conjugate was employed in a simultaneous sandwich enzyme immunoassay on microtiter plates sensitized with goat polyclonal antibody to measure the hormone. The test has a sensitivity of 10 mlU/ml either on urine, serum, or plasma samples when read in a microplate reader. The results can also be evaluated by the naked eye, with a sensitivity of 20 mlU/ml. No cross reactivity was detected with other human gonadotropins.

How frequently are home pregnancy tests used? Results from the 1988 National Maternal and Infant Health Survey

Many women use commercially available home pregnancy tests to determine their pregnancy status before seeking professional health care. Despite the increasing popularity of these products, no national estimates have been reported to date on their frequency of use. We analyzed available data from the 1988 National Maternal and Infant Health Survey to determine the frequency of use of home pregnancy tests during recent pregnancies of women of varying sociodemographic backgrounds. Approximately 33 percent (N = 4700) of the women surveyed used such a device. Use was most frequent among women who were white, married, over age 39 years, highly educated, or had a high family income. We conclude that home pregnancy testing appears to be a frequent procedure, especially among women of high socioeconomic background.