a clinical question

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I've a pt 27 y/o w/o any significant medical problems(incl gyn-no abortion/prior preg), came to the clinic for anxiety d/o and currently undergoing psychotx. She was also trying to get a baby(in a monogamous rel) for the past 3/4 months, so meds were not an option. Now she has nausea/brest tenderness/ dizziness/browninsh discharges and few clots for 1-2 days instead of regular menses-but they are happening at the due date of the menses(for the past 2 cycles-confirmed by collateral info). However the urine preg was -ve. I would love to start her on some meds, and she understands that-the only thing which is in between is this pregnancy. Her Ob did the lab-work and I am still waiting for the fax for the past 2 wks. 🙁
My question is how sensitive is the urine hcg as compared to blood hcg and is there anything else(e.g. US) that can r/o pregnancy? I know of resistance in therapy, but this is rather extreme 😀 I hope this is not pseudocyesis-it will make my job much difficult. 🙂
Any help would be appreciated.

 

[endodoc]

I've a pt 27 y/o w/o any significant medical problems(incl gyn-no abortion/prior preg), came to the clinic for anxiety d/o and currently undergoing psychotx. She was also trying to get a baby(in a monogamous rel) for the past 3/4 months, so meds were not an option. Now she has nausea/brest tenderness/ dizziness/browninsh discharges and few clots for 1-2 days instead of regular menses-but they are happening at the due date of the menses(for the past 2 cycles-confirmed by collateral info). However the urine preg was -ve. I would love to start her on some meds, and she understands that-the only thing which is in between is this pregnancy. Her Ob did the lab-work and I am still waiting for the fax for the past 2 wks. 🙁
My question is how sensitive is the urine hcg as compared to blood hcg and is there anything else(e.g. US) that can r/o pregnancy? I know of resistance in therapy, but this is rather extreme 😀 I hope this is not pseudocyesis-it will make my job much difficult. 🙂
Any help would be appreciated.

Have you done a follow up with the OB? It seems as though the OB just stick his/her ugly attending head in this case.

 

[Seaglass]

Serum will get it maybe a couple of days before urine. Urine will get it if it's there. If she missed a period then Urine should have gotten it. Serum is mostly good for following bHCG in tubals the OB decides to treat chemically, or if you're not sure if it's a tubal or not (in which case the urine would be + anyway).

 

[mdblue]

thanks a lot endodoc and seaglass 🙂
I talked w/ Ob and it seems that she might be one of the rare cases where they don't secrete hcg in urine-so she is not sure about the pregnancy yet. And US is not going to help right now. So the plan is to wait and repeat testing in another couple of weeks.

 

[DrQuinn]

Sometimes if a woman is under a lot of stress/anxiety, their menstrual cycle may get thrown off, I've even seen a week and a half late. Scared the crap out of me back in college.