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ACEP: Urine hCG Tests May Miss Early Pregnancy By W. A. Thomasson Special to DG News CHICAGO, IL -- October 17, 2001 -- As many as 5.9 percent of negative urine human chronic gonadotropin (hCG) tests occur in the presence of serum hCG levels indicating pregnancy, according to Kelli Fritz, DO, and Steven Kristal, MD, of Henry Ford Hospital in Dearborn, MI. Their study was presented yesterday at the Scientific Assembly of the American College of Emergency Physicians. "We expected to find the urine test was just as accurate as the blood," Dr. Kristal told DG News, "but that wasn't the case. So it's a little disturbing." The study included the 662 patients who received simultaneous urine and serum hCG tests at Henry Ford Hospital during 1999. One hundred and two urine tests were reported as negative, of which six were in women whose serum hCG levels indicated pregnancy. By contrast, just two of 556 positive urine tests (and one of three reported as "weakly positive") were in a woman with non-pregnant serum hCG levels. Five of the six women with false negative tests had serum hCG levels in the range 11-97 mU/ml, which is typically associated with the first month of pregnancy. In some cases, examination of the medical records suggested that the discrepant test results may have followed a recent miscarriage, with the urine rest returning to normal while the serum test had not yet done so. As Dr. Kristal pointed out, retrospective analysis of the small proportion of patients in whom both tests were ordered may have introduced selection bias. That is, the serum test may in some cases have been ordered because of clinical suspicion that the urine test was incorrect or because the patient stated the urine test had failed to detect previous pregnancies. "The actual percentage of falsely negative urines may be much, much smaller than this number," he said. Nevertheless, Henry Ford Hospital now uses serum hCG measurement as the standard pregnancy test for patients less than four weeks past the expected date for their initial missed period. E-mail this page to a friend or colleague! To print, use this version