Stories from the RSA Line Room
Conversation of Dr. Alter, Dr. Beta, Dr. Kelvin, Dr. Eric, and Dr. Fairy (pseudonyms)
When is the best time to do a urine test after termination?
Dr. Alter: Seeking advice from all senior doctors.
Dr. Beta: What’s up? Go ahead and tell us…
Dr. Alter: I would like to consult on the guidelines for advising patients to do a urine pregnancy test after termination. Personally, I don’t recommend patients to test immediately, but if they are worried, I suggest testing after 4 weeks. Many places recommend patients to test after 2 weeks, but I think that if tested during this period, it will still show two lines, so I don’t recommend it as it will unnecessarily increase the patient’s anxiety.
I encountered a new case this morning… A patient messaged at around 4 AM, shocked because the test showed two lines.
I would like to consult with all senior doctors to reach a consensus so that we can provide consistent advice nationwide.
Dr. Beta: I recommend testing after 4 weeks. If it still shows two lines, the patient should come for an additional ultrasound. This is purely my personal opinion and experience.
Dr. Kelvin: From what I’ve seen, patients test and it shows faint two lines, which is very rare. They need to test and follow up with a urine pregnancy test in another 2 weeks. If it’s an ultrasound, nothing will be found. Generally, after 4 weeks post-termination, it should show only one line.
But if the service recipient does a urine pregnancy test themselves 2 weeks after termination and it shows two lines or faint two lines, they need to see a doctor.
Dr. Kelvin: I agree that it should be 4 weeks.
Dr. Delta: I remember that beta HCG has a half-life of 3 weeks, and current urine pregnancy tests are more sensitive to hormones than before. If pregnancy tests are developed to be even more sensitive to hormones, we will be confused about the appropriate time for testing after termination, possibly changing from 2 to 4 to 6 weeks.
Dr. Eric: I use 30 days, it’s the most certain.
Dr. Delta: I’ve seen some places schedule a repeat ultrasound 1 week after a safe termination. I think it’s reliable and convenient to ensure complete termination. If it’s not complete, further action can be taken because the gestational age hasn’t progressed too far.
Dr. Fairy: I agree. It’s often found that the pregnancy continues, and if left too long, the gestational age becomes too advanced. After a safe termination, if after 1 week the ultrasound shows nothing, then check the urine test results for another 1-2 weeks.
Dr. Delta: If listening to symptoms, simply put, if breast tenderness or morning sickness doesn’t decrease within 1 week, it might be suspected that the miscarriage is not complete.
After termination, things to know are as follows…
A complete miscarriage means the body has expelled all parts of the pregnancy, including blood, tissue, and the embryo, and no further instrumentation (such as suction) is needed. After the tissue and blood clots are expelled, abdominal pain and all side effects will disappear. There will be vaginal bleeding for 7-14 days, gradually decreasing. Use sanitary pads during this time.
Normally, after a miscarriage, symptoms that occurred during pregnancy will gradually disappear. The HCG hormone levels that occurred during pregnancy will also decrease, but it may take several weeks to decrease to normal levels and become undetectable in urine. It may take about 3-4 weeks, so sometimes testing before this period may yield a positive result because the hormone is still present in the urine even though the person is no longer pregnant. It depends on each person’s initial HCG hormone level. The only way to know if a miscarriage is complete is through a pregnancy test.
For pregnancy testing after a miscarriage, it should be done from 3-4 weeks onwards. If two lines are found, return to see a doctor for further urine or ultrasound testing.
The following cases may indicate an incomplete miscarriage, and a doctor should be consulted:
- No tissue is expelled, or there is only slight bleeding for more than 6 hours.
- There are still pregnancy-like symptoms, such as breast tenderness, frequent urination, or nausea.
- Bleeding lasts more than 14 days, and an examination is needed to see if there is retained placenta.
Source: From the RSA Volunteer Network Line Group