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.
BECKMAN COULTER PREGNANCY TEST SERIAL
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). Since BNP is a point of service test, the primary outpatient site of service expected to perform a serum BNP is the emergency room or a physician’s office.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. Monitoring the efficiency of treatment for CHF Serum BNP will be considered noncovered in the following: Since this situation is an inpatient service, it is not addressed in this LCD. Predicting the long term risk of cardiac events or death across the spectrum of acute coronary syndromes when measured in the first few days after an acute coronary event. Serum BNP, when used in conjunction with other clinical information, will be considered reasonable and necessary for the following:Įstablishing the diagnosis of CHF in acutely ill patients presenting with dyspnea. Serum BNP, for the purposes of coverage, is considered a ‘point-of-service test (performed and immediately used in the disposition of patient care).
Used in conjunction with other clinical information, serum BNP concentrations parallel dyspnea in heart failure suggesting its usefulness as a neurohormonal index of progressive heart failure. B-type natriuretic peptide (BNP) is synthesized, stored, and released primarily by the ventricular myocardium in response to volume expansion and pressure overload, which are hemodynamic parameters in CHF.
This list omits certain waived tests that are typically not performed in physician office settings.Ĭongestive Heart Failure (CHF) is a complex clinical syndrome characterized by dysfunction of the left, right, or both ventricles, which results in the impairment of the heart’s ability to circulate blood at the rate sufficient to maintain the metabolic needs of the peripheral tissues and various organs.