Help with a Brain Teaser

Published

i am currently taking my a&pii classes for my nursing pre-reqs. we have weekly discussion questions and this one has me completely stumped. i have researched and also asked my own gyn - he did not know either. please help!!!

an obese woman reports to the er with complaints of gas pains. after carefully examination, the er physician calls for a pregnancy test which came back negative. the woman insisted it was a waste of time as she performed the same test earlier that same morning. further observation caused the physician to check for dilation of the cervix which measured 8 cm. briefly describe a physiological explanation for this occurance.

now i am assuming that the pregnancy test at the hospital would have been a blood test. can the blood test be false? is she really pregnant and ready to deliver the baby and not know she was pregnant or is there another medical reason the cervix could dilate without pregnancy?

any help would be appreciated.

frantic nursing student :uhoh3:

danielle

Up Vote Up Vote ×

could be an ectopic pregancy (rare)

could be a full term multiple gestation pregnancy which can cause HCG levels so high that they're unable to be analyzed and must be diluted before they give a positive result (more likely)

I dunno! Sounds like fun stuff though!

Up Vote Up Vote ×
Specializes in OB, lactation.

In my neck of the woods, she would be sent up to OB where we would do an exam and find her cervix to be, in fact, closed. Some of our ER docs are famously bad at cervical checks! LOL

I am trying to think of a real answer to your question. I assumed the test was urine, since the patient said she had done the same test that morning. HCG levels should still be high enough to make the test positive. Can her urine be too dilute to register HCG for some reason? There probably is something that I'm totally not thinking of...

Up Vote Up Vote ×

perhaps she is diabetic, with dilute urine....and later in the day less likely to be positive....i have known of neg testing and actually being preg, but i had thought testing had improved some in 35 years!!

Up Vote Up Vote ×

Could it be a molar pregnancy? That's a great brain teaser...Make sure you post the answer once you find out for sure. Thanks.

Up Vote Up Vote ×
Specializes in Med/Surge, Psych, LTC, Home Health.

I'm thinking that the test was a urine test, was a false negative due to the concentration of the patient's urine, and that the patient is in fact pregnant.

Up Vote Up Vote ×
Specializes in 2 years as CNA.

I saw this post and was very curious as well. I did some searches and came across this article.

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijgo/vol6n2/test.xml

This woman had many factors contribute to why she was having a negative test.

For the most part I found that the only reason could be that the test was stored in the wrong temperature or some how the test was not done correctly. The only other thing, like others mentioned, was that the urine was diluted. I read that after 12 weeks the HCG goes down but should still register on an OTC test. Interesting post.

Up Vote Up Vote ×
Specializes in student; help!.

I know mine registered at +6m. It's embarrassing, but there ARE laws about poas if you find one, you know. So I found one when I was cleaning out the pantry, and I had to pee on it to avoid prosecution. lol

Still +. *whew*

Up Vote Up Vote ×
Specializes in OB, lactation.

Danielle,

Did you find out the answer? I'm curious!! :)

Up Vote Up Vote ×

No answer yet - it will be a few weeks before he goes over that chapter - as soon as I know I will post. I really appreciate all the good answers and I am researching each of them.

Up Vote Up Vote ×
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Well, actually hcg falls off as pregnancy proceeds, not goes up. down to the point where an hcg test would read negative at term......pregnancy should be ruled in our out by u/s at this point, not a urine or blood test.

You see, hcg is present in early pregnancy, in order to preserve the pregnancy in early gestation. Once the placenta is fully functioning and "takes over" maintaining the the pregnancy (over the corpus luteum) hcg falls off gradually.

Add to that any thyroid issues, and you can really have a big drop in hcg, fast.......

This is my understanding of how it works, anyhow.

Up Vote Up Vote ×

Here is a link detailing HCG levels in pregnancy. It looks like that although they level off they are still incredibly high at the end of pregnancy.

http://www.americanpregnancy.org/duringpregnancy/hcglevels.html

Up Vote Up Vote ×
+ Join the Discussion