![]() The possible advantages of a point-of-care (POC) test over the existing technology are that:ġ) It would provide a rapid result, helping to aid prompt and effective clinical decision making.Ģ) It is likely to improve patient satisfaction by reducing waiting time for results and clinical decisions and enabling immediate feedback of the results to the patient.ģ) It may be more cost effective than current laboratory methods.Ĥ) It may help diagnoses to be made in primary care especially in the context of increasing availability of ultrasound scanning in the community setting.ĥ) It may allow follow-up in primary care rather than in secondary care.Īlthough there are several qualitative point-of-care hCG devices on the market, we identified only two quantitative POC hCG tests: Abbott Point of Care iSTAT and Radiometer AQT90 FLEX. However most women undergoing serial hCG testing are not admitted to hospital but managed in the community until a definitive diagnosis is made. This not only causes a delay in determining the management plan, it may also result in unnecessary hospital admission (in women deemed to be at high risk of ectopic pregnancy) and almost certainly increases patient anxiety. In most cases patients are asked to wait until the following day for the result of the hCG test. In cases where there is a change in serum hCG between these values, clinical review is essential to determine the likelihood of an ectopic pregnancy (6). Point-of-care testing for human chorionic gonadotrophin (hCG) Horizon Scan Report 0043 November 2015 NICE have concluded that a rise of more than 63% in 48 hours is likely to be an ongoing pregnancy and a decline of more than 50% is likely to be a failing pregnancy. Serial hCG measurements are therefore used, not to determine the location of the pregnancy, but to predict viability of the pregnancy. The current clinical pathway involves patients being seen in secondary care and having a blood sample sent to the laboratory. The change in hCG over 48 hours gives an indication as to whether the pregnancy is likely to be ongoing (intrauterine or ectopic), or whether it is more likely to be a failing pregnancy (either intrauterine or ectopic). The use of serial quantitative human chorionic gonadotropin (hCG) measurements is a mainstay of practice in Early Pregnancy Assessment Units (EPAUs) to aid in the management of these patients. Its incidence varies between 11 and live births in developed countries (3-5). The main clinical concern in cases where the pregnancy location has not been determined is whether there is an ectopic pregnancy, a potentially life threatening condition. ![]() The aim of subsequent investigations is to distinguish between these outcomes. ![]() ![]() The possible clinical outcomes of a PUL are: In up to 42% of cases no intrauterine pregnancy is seen on scan (and no ectopic pregnancy is identified) and this is known as a ‘pregnancy of unknown location’ (PUL) (2). The first line of investigation for these women is an ultrasound scan to determine the location and the viability of the pregnancy (1). In pregnant patients presenting to Primary Care or to an Early Pregnancy Assessment Unit with bleeding and pain, what is the accuracy and utility of a point-of-care quantitative hCG test compared to standard laboratory measurement?īackground, Current Practice and Advantages over Existing Technology:īleeding and pain in early pregnancy are very common presentations to Primary Care, Emergency Departments and to specialist Early Pregnancy Assessment Units. ![]()
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