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Suggest medical tests to rule out pregnancy

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Posted on Wed, 18 May 2016
Question: After 1st kid age of around 3.5 years, we are trying to go for second child since last 3-4 months. but for unknow reason she is not able to conceive. Specially now her LMP was somewhere 3rd XXXXXXX 2016. We tried with PT kits find out. But it is negetive. Yesterday we consulted on OBG Doctor and she did scan also. But as per her no clear indications of Pregnancy. She suggested to repeat the Velocity PT kit (Dr.Reddy's), we tried in this morning but only one line was very clear and other line was appearing very light. We are not sure of the result now. As per Doctor, if this is again negetive today then should take some tablets to go for menustrual cycle. Now need your advice, since the scond line was showing very light should consider as positive or negetive? She has to start using those tablets for mensus? what do we do next to ensure positve result? also Doctor was referring bulky uterus- are there any issues because of this now and in future? please advise. thanks in advance
doctor
Answered by Dr. Nishikant Shrotri (43 minutes later)
Brief Answer:
Laparoscopy indicated to rule out ectopic pregnancy

Detailed Answer:
Dear XXXXXXX

In pregnancy, a hormone is secreted by the chorionic tissue (precursor of placenta) in high amounts for maintenance of pregnancy. This hormone is named as human chorionic gonadotropin hormone (hCG). In the pregnancy tests, this hormone is evaluated. When it is sufficiently increased, the second line of the pregnancy test becomes deep blue. However, of the levels of hCG are on lower side, it will be reflected by faint second line; i.e. weak positive test. It seems you have weak positive test.

Weak positive test with missed period can be attributed to:

1. Pregnancy with now non-viable baby. Hence the hCG levels are diminishing. Still the abortion has not taken place. So it is called as Missed abortion. However, in this condition, the uterine cavity would not be empty.

2. Pregnancy implanted not in the uterine cavity, but somewhere else. This condition is known as Ectopic pregnancy.

Moreover, your uterus has been reported to be bulky and empty. This goes more in favour of ectopic pregnancy. The most common site of ectopic pregnancy is tube; however, it can be anywhere in the abdominal cavity.

Please do not go for menstruation by hormonal pills before ruling out the possibility of ectopic pregnancy. If such pregnancy causes rupture of the tube, it is a very serious haemorrhagic emergency.

One has to be ectopic minded to diagnose an ectopic pregnancy.

To diagnose unruptured ectopic pregnancy, three criteria are required:

1. Pregnancy present somewhere as detected by week positive pregnancy test. You have got it so.
2. Uterine cavity empty with uterus rather bulkier. You have been reported to have it so.
3. Locating the site of the pregnancy outside the uterine cavity. This can be done by Laparoscopy. If the pregnancy is located in the tube, or anywhere else in unruptured state, it can be tackled by minimum invasion like injecting medicine like Methotrexate in the sac to kill the pregnancy. This prevents all the further threatening haemorrhagic complications.

Once the ectopic pregnancy ruptures, it is presented by sever agonising abdominal pain. There may be some vaginal bleeding. Most of the bleeding is in the abdomen. If so, emergency surgical intervention with blood transfusion is required.

Hence, I am requesting you to go for Laparoscopy to detect or rule out ectopic pregnancy. If there is no ectopic pregnancy anywhere, and the uterus is completely empty, it suggests that the abortion is complete. Then you may wait for some weeks for your menstruation.

Can you please upload the images of your pregnancy test strip showing weak positive results?

If you further want to have any clarification or explanation or information, I am always available for you, XXXXXXX

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Nishikant Shrotri (39 minutes later)
Dear Sir,

Thank you so much for the detailed note.

Have uploaded the photo of PT. Please check and advise. Ectopic pregnancy cant be ruled out thru scanning? Because yesterday Doctor did scanning for her and did not comment anything on these lines. Just add here, we could noitce slightly abdominal distension in her, we are not sure what it is exactly. Anything emergency here that we need to focus immdieatly and take care.
doctor
Answered by Dr. Nishikant Shrotri (15 minutes later)
Brief Answer:
Laparoscopy indicated to rule out ectopic pregnancy

Detailed Answer:
Dear XXXXXXX

I have seen your test strip picture. Yes, it is definitely weak positive test and you need to rule out ectopic pregnancy.

Ectopic pregnancy cannot be detected in ultrasonography scan at such early stage of pregnancy. Once it ruptures, the it can show blood in the pelvis and by puncturing posterior wall of vagina, we get blood through the needle. However, in this era, we should be in a position to diagnose it before rupture.

So please report to Obstetrician ASAP and demand for ruling out ectopic pregnancy. He/she will decide the ways to rule it out; however, I feel, Laparoscopy would be the option of choice.

I am awaiting for follow up, please.

For any further explanation of information, please feel free to ask me anytime, XXXXXXX You my post a good review with 5 star rating for me if you feel so.

Dr. Nishikant Shrotri
Above answer was peer-reviewed by : Dr. Deepak
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Dr. Nishikant Shrotri

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Suggest medical tests to rule out pregnancy

Brief Answer: Laparoscopy indicated to rule out ectopic pregnancy Detailed Answer: Dear XXXXXXX In pregnancy, a hormone is secreted by the chorionic tissue (precursor of placenta) in high amounts for maintenance of pregnancy. This hormone is named as human chorionic gonadotropin hormone (hCG). In the pregnancy tests, this hormone is evaluated. When it is sufficiently increased, the second line of the pregnancy test becomes deep blue. However, of the levels of hCG are on lower side, it will be reflected by faint second line; i.e. weak positive test. It seems you have weak positive test. Weak positive test with missed period can be attributed to: 1. Pregnancy with now non-viable baby. Hence the hCG levels are diminishing. Still the abortion has not taken place. So it is called as Missed abortion. However, in this condition, the uterine cavity would not be empty. 2. Pregnancy implanted not in the uterine cavity, but somewhere else. This condition is known as Ectopic pregnancy. Moreover, your uterus has been reported to be bulky and empty. This goes more in favour of ectopic pregnancy. The most common site of ectopic pregnancy is tube; however, it can be anywhere in the abdominal cavity. Please do not go for menstruation by hormonal pills before ruling out the possibility of ectopic pregnancy. If such pregnancy causes rupture of the tube, it is a very serious haemorrhagic emergency. One has to be ectopic minded to diagnose an ectopic pregnancy. To diagnose unruptured ectopic pregnancy, three criteria are required: 1. Pregnancy present somewhere as detected by week positive pregnancy test. You have got it so. 2. Uterine cavity empty with uterus rather bulkier. You have been reported to have it so. 3. Locating the site of the pregnancy outside the uterine cavity. This can be done by Laparoscopy. If the pregnancy is located in the tube, or anywhere else in unruptured state, it can be tackled by minimum invasion like injecting medicine like Methotrexate in the sac to kill the pregnancy. This prevents all the further threatening haemorrhagic complications. Once the ectopic pregnancy ruptures, it is presented by sever agonising abdominal pain. There may be some vaginal bleeding. Most of the bleeding is in the abdomen. If so, emergency surgical intervention with blood transfusion is required. Hence, I am requesting you to go for Laparoscopy to detect or rule out ectopic pregnancy. If there is no ectopic pregnancy anywhere, and the uterus is completely empty, it suggests that the abortion is complete. Then you may wait for some weeks for your menstruation. Can you please upload the images of your pregnancy test strip showing weak positive results? If you further want to have any clarification or explanation or information, I am always available for you, XXXXXXX Dr. Nishikant Shrotri