Accurate diagnosis or exclusion of pregnancy is essential in emergency medicine. Standard analytical techniques screen blood or urine for human chorionic gonadotropin (HCG), a glycoprotein produced by the trophoblast after implantation. Since implantation occurs about 1 week after conception, these screening tests are particularly helpful in establishing or excluding early pregnancy. At 4 to 5 weeks' gestation and beyond, definitive diagnosis can be made by sonographic visualization of the embryo or fetus (see Chap 109, "Pelvic Ultrasonagraphy"). Alternatively, in later stages detection (by fetal stethoscope or sonogram) of fetal heart activity distinct from maternal heart activity or detection of palpable fetal movement may confirm pregnancy.
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