Performance of a checklist to exclude pregnancy at the time of contraceptive initiation among women with a negative urine pregnancy test

Abstract

Objective Our objective was to measure the sensitivity and specificity of a six-item “pregnancy checklist” at excluding early or luteal-phase pregnancy among women with a negative urine pregnancy test who were initiating contraception. Study design This was a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort study of 9,256 women in the St. Louis region. Women who had a negative urine pregnancy test on the day of enrollment were included in this analysis. Women with a positive urine pregnancy test or without urine pregnancy testing were excluded. We identified all luteal-phase pregnancies that occurred among women with a negative urine pregnancy test. We calculated the sensitivity, specificity, positive and negative predictive value, and likelihood ratios of the pregnancy checklist for excluding luteal-phase pregnancies. Results There were 6,929 women included in this analysis; 69% of these women met at least one checklist criterion to exclude pregnancy (“negative screen”). There were 36 luteal-phase pregnancies (0.5%) subsequently diagnosed among women with a negative urine pregnancy test. The sensitivity and specificity of the checklist were 77.7% and 69.1%, respectively. The negative predictive value of the checklist was 99.8% and the positive predictive value was 1.3%. Conclusion Among women with a negative urine pregnancy test, the pregnancy checklist can be used to safely exclude more than 99% of early pregnancies at the time of contraceptive initiation.

Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar

“…In contrast, pregnancy tests are easy to administer and false-positive results are extremely unlikely [16]. Because uring pregnancy tests are ineffective between fertilization and menses, these tests should be used in combination with the checklist, shown to have a false-negative rate of 22% during this period [17]. The tests have long been unaffordable in low-resource settings, but their cost has fallen significantly in recent years.…”

Point-of-Care Diagnostics for Improving Maternal Health in South Africa

“…Early detection of pregnancy in HIV infected women can allow prompt enrolment in care within the PMTCT program [ 35 ]. The urine pregnancy test is also important for family planning [ 36 ]. The WHO recommends that health workers confirm that a woman is not pregnant before offering her hormonal contraceptives [ 37 ].…”

Case report: successful open resection of a symptomatic giant liver haemangioma during the second trimester of pregnancy

“…Despite a negative urine Beta HCG test at the time of CT scanning, she was subsequently found to be pregnant. False negative results such as this are reported to occur, especially in the early luteal phase [4] when the urine HCG may not have reached the diagnostic threshold. Approximately 1 year prior, she had ceased the combined oral contraceptive after taking it for 10 years and was planning to conceive.…”