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?
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Yes, you are right. But any other problems, like thryoid disorder, can take them down to nearly zero level. The woman is obese. Perhaps she has PCOS or a thryoid disorder that would actually affect her hcg levels, if indeed, she were pregnant. I have a tough time trying to imagine a cervix so dilated (if indeed they are checking correctly) in a non-pregnant woman.
Molar pregnancy was ruled out in my mind as I understood that with molar pregnancy, hcg levels are actually so high, they are hard to quantify. That is why, to my thinking molar pregnancy would rule out. They would want to follow your hcg levels down to zero after a molar pregnancy, just to be sure all is clear.
Anyhow, thyroid comes to mind, so that is why I say, it can fall and read false-negative, esp with a urine test. But you are right; hcg is still present. I do believe I read, however, it differs in different women, so much so that they can have a "negative" pregnancy test after the 2nd trimester.
Anyhow, clearly, I am not the expert here. I am just taking a stab, in the dark.
When I worked L&D I had an obese woman screaming in pain brought in by ambulance. The ambulance personnel just timed her screams and decided she was in labor, as she screamed every 4 minutes and so brought her to us rather than to ER. She delivered a healthy 8lb baby about 15 minutes from arriving on the floor. Later she showed me pictures on her phone of the negative results of several pregnancy tests she had done. All urine.
I never did find out why they were all negative. She also insisted that she had continued to have her period regularly throughout the previous nine months.
Is it possible that she had a missed miscarriage late in the first trimester? Once the baby had died her levels would fall giving her the negative result. Her body was trying to deliver the baby therefore she was dilating.
Is it possible that she had a missed miscarriage late in the first trimester? Once the baby had died her levels would fall giving her the negative result. Her body was trying to deliver the baby therefore she was dilating.
I think its unlikely she would reach advanced dilation at that stage in the pregnancy. I have seen pre-termers deliver at 4-5 cm and that's considerably bigger than a first trimester fetus would be.
SmilingBluEyes
20,964 Posts
Yes, you are right. But any other problems, like thryoid disorder, can take them down to nearly zero level. The woman is obese. Perhaps she has PCOS or a thryoid disorder that would actually affect her hcg levels, if indeed, she were pregnant. I have a tough time trying to imagine a cervix so dilated (if indeed they are checking correctly) in a non-pregnant woman.
Molar pregnancy was ruled out in my mind as I understood that with molar pregnancy, hcg levels are actually so high, they are hard to quantify. That is why, to my thinking molar pregnancy would rule out. They would want to follow your hcg levels down to zero after a molar pregnancy, just to be sure all is clear.
Anyhow, thyroid comes to mind, so that is why I say, it can fall and read false-negative, esp with a urine test. But you are right; hcg is still present. I do believe I read, however, it differs in different women, so much so that they can have a "negative" pregnancy test after the 2nd trimester.
Anyhow, clearly, I am not the expert here. I am just taking a stab, in the dark.