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. 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.