Several tests are required by law or medical standards for every pregnant
woman. It is important that any physician who cares for a pregnant woman know
the results of these tests and act upon them if necessary.
The first and most important test is for pregnancy. Any woman of childbearing
age should be considered pregnant unless there is evidence to the contrary if
any medical treatment might affect the pregnancy or the fetus. Most radiology
departments are covered in signs that ask women if they might be pregnant. Many
internists, however, do not ask a woman about pregnancy and contraception
before prescribing a drug that is not accepted for use in pregnancy. The risks,
both medical and legal, are much greater for some drugs than they are for a
chest X ray.
On the other hand, there is no laboratory test that can establish pregnancy
beyond doubt in the first trimester. A physician should never tell a woman that
she is or is not pregnant on the basis of a laboratory test alone. A history
and physical examination are as necessary to making this diagnosis as any
other. A patient who is assured that she is not pregnant may expose herself to
agents that can harm her fetus. Even if there are no expected problems, failure
to diagnose the pregnancy can interfere with the patient's receiving proper
prenatal care and will reduce her options about abortion or prenatal diagnosis.
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