Synopsis
Use consented pregnancy testing according to pregnancy potential and clinical consequence, interpret early or persistent hCG safely, and escalate pain, bleeding or instability without false reassurance from a single result.
- Base testing on whether pregnancy is biologically possible and clinically relevant, not on age, gender identity, relationship status, reported contraception or assumptions about sexual activity.
- Explain why the result affects diagnosis, medicines, anaesthesia or imaging, seek consent and agree confidential communication; do not perform a hidden test simply because urine is available.
- Home and clinical urine tests are most reliable from the first day of a missed period; if cycle timing is unknown, NHS advice is to test at least 21 days after the last unprotected sex.
Key red flags
Pain, bleeding or haemodynamic change can precede a clearly positive urine result, so an early negative test does not close ectopic pregnancy when timing is uncertain.
Amenorrhoea or an atypical period plus unilateral pain, bleeding, syncope or shoulder-tip pain warrants ectopic assessment even when reported contraception lowers probability.
Investigation priorities
Rapidly identify pregnancy in acute or routine presentations where the result changes care.
Management branches
Pregnancy could change the differential diagnosis, medicine, imaging or procedure.
- Ask privately about pregnancy potential, last normal period, cycle, contraception, sperm exposure, fertility treatment and recent pregnancy, then explain why testing matters.
- With consent, perform a correctly timed urine test; use serum hCG when urgent sensitivity or quantified follow-up is needed.