What are the steps to take after a positive urine pregnancy test (UPT)?

Steps After a Positive Urine Pregnancy Test

After a positive urine pregnancy test, the clinical visit should include estimation of gestational age, appropriate counseling, and referrals to follow-up care based on the patient's needs and preferences. 1

Initial Assessment

• Perform a medical history including discussion about the patient's reproductive life plan and any coexisting conditions (chronic medical illnesses, physical disability, psychiatric illness) 1
• Determine the date of last normal menstrual period to estimate gestational age 1
• If the woman is uncertain about her last menstrual period date, a pelvic examination may be needed to help assess gestational age 1
• Assess the patient's social support system and identify any need for additional supportive services 1

Counseling and Education

• Provide information about normal signs and symptoms of early pregnancy 1
• Instruct the patient to report any concerning symptoms that may suggest complications (e.g., severe pain, heavy bleeding) 1
• Discuss options available to the patient (continuing pregnancy, adoption, termination) in accordance with recommendations from professional medical associations 1
• Respect patient confidentiality - if a client chooses not to involve her partner, confidentiality must be assured 1

For Patients Continuing the Pregnancy

• Provide initial prenatal counseling including:
  • Review of current medications that might be contraindicated in pregnancy 1
  • Recommendation to take daily prenatal vitamins with folic acid 1
  • Advice to avoid smoking, alcohol, and other drugs 1
  • Guidance to avoid fish that might have high levels of mercury 1
• Screen for asymptomatic bacteriuria with a urine culture at 12-16 weeks' gestation or at the first prenatal visit if later 1
• Discuss the timing for prenatal care appointments and what to expect 1

Referrals and Follow-up

• Make appropriate referrals for prenatal care (e.g., obstetrician or midwife) 1
• Expedite and follow through on all referrals - this may include providing a resource listing or directory of providers 1
• For adolescents, consider referral to home visiting and other support programs that have been shown to reduce rates of repeat teen pregnancy 1
• If ectopic pregnancy or other pregnancy abnormalities are suspected, either manage the condition or refer for immediate diagnosis and management 1

Special Considerations

• For adolescents, provide services in a "youth-friendly" manner that is accessible, equitable, acceptable, and appropriate 1
• Encourage adolescents who come alone to talk to their parents or guardians, but maintain confidentiality 1
• For sexual assault victims, provide comprehensive care including emergency contraception if appropriate, STI testing and prophylaxis, and mental health support 1
• Be aware that false positive results with home pregnancy tests are extremely rare with current generation test kits 2, 3

Common Pitfalls to Avoid

• Failing to confirm pregnancy with appropriate testing - qualitative urine tests can detect hCG at 20-25 mIU/mL but may not detect very early pregnancies 4
• Not recognizing that most qualitative pregnancy tests require an additional 11 days past expected menses to detect 100% of pregnancies 4, 3
• Overlooking the possibility of ectopic pregnancy when symptoms suggest it 1
• Delaying referral for prenatal care, which can impact maternal and fetal outcomes 1
• Not providing adequate information about all available options to the patient 1

By following these steps, healthcare providers can ensure appropriate care after a positive urine pregnancy test, optimizing outcomes for both mother and baby while respecting patient autonomy and preferences.