Ob/Gyn Reacts: Negative Pregnancy Test?! | Didn't Know I Was Pregnant

Hey guys, welcome back. I'm a Dr. Jones, OB-GYN and mom to four. Today we're going through another episode of I Didn't Know I Was Pregnant. We seem to learn a ton from these. They're super fun to film and you guys seem to enjoy watching them. If you're not subscribed, hit that little subscribe button. That means you're a crockpot. We like crockpots. It's a long story. Have a lot of fun here. We learn a lot of things here. We like science and sarcasm here and I think you're going to like it here. So come back here if you want. But only if you want. This episode is season four, episode 14 and we're going to jump right into it after this. We've been married for eight wonderful years. We had two boys. Jarek is eight and Jacek is five. We didn't want any more kids. We were done with just our two boys. Janetsi works as a medical assistant in a clinic. The doctor had a weight loss clinic. I decided to go on the prescription diet pills. My doctor did say you might have abnormal periods but that's normal. Around March of 09, I was missing my period and I was on the pill. So I was like, you know what, it's just the diet pills. Okay, so a few things to say about this. I don't know what diet pill they have her on. Sometimes when you have gained a significant amount of weight your body is not ovulating regularly and losing some of that weight will spark you back into ovulating normally. It is interesting to me that they're talking about the diet pill making your periods irregular because I wouldn't typically expect that unless somebody lost weight and was below a normal weight. Importantly, she also mentions that she was on a birth control pill. And sometimes people don't have periods while they're on a birth control pill. But all of this is a little bit unusual and I don't know, you know, it's always hard to get the full story from this but I would say in general, weight loss that is getting from a too high weight to a lower weight should not make your periods go away. That would be a reason to call or come in and see your OBGYN or your advanced practice provider. What I have seen happen myself in clinic is somebody will have gone on an exercise plan or a diet routine and have been having irregular periods and then lose some weight and go back to ovulating normally and not realize that they have done that and get pregnant and then not put the pieces together that they're not just going back to having irregular periods again. So I can see how if you were having irregular periods and then they went away, I don't know, it's a little bit hard to get all the information but your weight dropping a lot and being too low or your weight being too high can definitely contribute to abnormal periods. But again, like we said in one of the other videos, this should always be a conversation with your doctor and should always prompt a pregnancy test. I feel like that should be the name of the series. Just take a pregnancy test. If your periods change, just take a pregnancy test. I'm gonna put that on a shirt. Just take a pregnancy test. I said, you know what? Let's throw in a pregnancy test in there. Cause the fact that I'm been off here and there every other month. Okay, we'll do. About a week later, the blood work comes all back. My pregnancy test came back negative. I'm like, you know what? Blood doesn't really lie. So basically I thought, you know what? I'm fine. A serum pregnancy test, a blood pregnancy test. Siri thinks I'm talking to her. I couldn't find blood pregnancy test in your music. Yeah, Siri. That's because blood pregnancy test is not in my music. I said serum, not Siri. Anyway, the serum pregnancy test being negative would be unusual if she is pregnant unless she got pregnant just in the past couple of weeks and it wasn't there yet. Is HCG, human chorionic gonadotropin is the hormone that we're testing for. And that is made by the placenta. So anytime the placenta is there, there should be HCG. It goes up and down in pregnancies and it certainly can be higher or lower. So what may have happened is that it was low enough that it wasn't picking up on what is called a qualitative serum pregnancy test. It was below like 25 and she was just super early pregnant or she wasn't pregnant yet or it was a false negative which would be incredibly rare. I don't know what the percentage is but it would be very, very unusual. As summer begins, Janetsi feels like she's losing steam. I would come home and just sleep. For about two years now, I have been known as a chronic anemic. Got it, got it, got it. In September, she felt like she was kind of passing out. I'm out in the heat, exhausted. I really wanted Janetsi to stop taking those pills and kind of saw that they were not good for her. From mid-September on, I wasn't on no diet pills. On December 4th, she clocks in for another 12-hour shift at the clinic. My cramps were extremely heavy to the point that I'm walking my patients to the room and I'm having to stop and hunch over. I called Eric and let him know that I was coming home. The boys went ahead and got the jacuzzi ready for me so that mommy could come home and relax. After my ride home, I just went straight into the tub. My cramps were unbearable. Okay, so we figured out she's in labor. This is how it always happens. They think they have a kidney stone or they're dying, which is what we would all think. This is really interesting to me because if she had the lab work done in the summer and it was negative, that is really, really rare. So she had to be at least 12 or so weeks pregnant depending on the gestational age that she's likely about to deliver at, I don't know. A false negative is possible anytime, but is very, very rare, particularly on a blood test after the first three to five weeks of pregnancy. Now, importantly, the level of HCG in the blood has to be above about 25 for one type of serum pregnancy test to pick up and come back as positive. But there's another one that will pick up over five. So it kind of depends which one they ordered. Either way though, if she delivers in December and I'm going out on a limb because all of these shows seem to have a happy ending and guessing that this baby is at or close to term, then a pregnancy test in the summer should have been well over 25. The number of HCG, like the level of HCG in the blood does go down as you get further along in the pregnancy after a certain point, but it shouldn't go down below 25. I don't know what the exact rate of a false negative at that gestational age would be, but it's very low. So let me see if I can find that. Causes of a false negative. So testing too soon. Okay, so it's saying that rarely there can be something called a hook effect where the level is so high that the assay that they're testing it with comes back as negative because it's not dilute enough to even calculate the number. That's my guess. That's my guess as to what happened with this is that she was far enough along that the level of HCG was very, very high and that the serum pregnancy test that they did had what is called a hook effect where it came back negative. I would say the chances of this happening is really, really, really low. A urine pregnancy test, the false negative rate is slightly higher, but still all of these, any false negative after about the first three or four weeks of pregnancy is gonna be less than 1%, extremely rare. I don't know. That's all I have to say about that. We learned something new. Hook effect where the levels of HCG are so high that the test fails to recognize it as being different from the surrounding environment that it's looking at and a lab error. They mixed up a sample or something like that. I think those are the only two things that potentially could make a pregnancy test negative at that point in pregnancy. I can't think of any other way that that would have happened but I completely understand why she would think she wasn't pregnant. She said she was on the diet pills until about September, October, November, December, that would be about 12 weeks. So until the middle of the second trimester. And I know she didn't know she was pregnant. I generally don't recommend my patients continue on diet pills if they are pregnant. And the reason is because although it's okay if you lose weight in pregnancy and we're monitoring it and it's not intentional, we generally don't like to purposefully have patients losing weight during pregnancy. It does occasionally happen from hyperemesis or somebody who just starts changing their eating habits drastically. They were having a really unhealthy diet. They get pregnant and they're eating a lot more healthy, things like that. And if you're losing weight because of that, as long as the baby's growing, it's probably okay. But in general, my preference is to have patients gain a reasonable amount of weight, which we decide based on the IOM guidelines. And that's around 25 to 40 pounds, even as low as maybe 10, depending on your starting weight, or to maintain a weight if we've talked about it and decided that that's a safe thing for that patient to do. So that recommended weight gain in a pregnancy would depend on each person individually. And I would recommend that people talk to their doctor or midwife about that and how it pertains to them. Everybody, I hope, would say, don't keep taking diet pills if you find out you are pregnant. So I'm glad to hear that she stopped those. It would just potentially cause growth restriction, the baby not growing well because of how they work. I'm not super familiar with all the diet pill types, but that's my guess. What's wrong? I feel like something's coming out of me really big. Let me look, let me look. And he looks down. And then he got quiet. And that's when he said it's a baby's head. I said, Jeannette, do you know you're having a baby? And she goes, no, I didn't know. I said, Jeannette, how can you not know you're having a baby? I'm only laughing because the music is so intense, but also it's funny he's re-enacting this and describing it and he's so calm. I would love to see how he was in the actual moment if he really looked at her and said, Jeannette, did you know you're having a baby on the toilet? It's coming out right now because he's so calm right now. And if he did remain that calm, props to him. I mean, I would want you at my delivery if I was unexpectedly having a baby. If you're going to unexpectedly have a baby somewhere, you need someone who can call for help and someone who can remain calm, that is all. I mean, it would be nice if you also had a midwife or a doctor accidentally living next door, but in general, it would be okay as long as the person around can stay calm and help you out. Eric lays me down on the bathroom floor. I was just hysterical. I didn't know what to think. I kind of helped Jeannette push the baby out, like all the way to his shoulders. And once I saw that, I had to tell her, you have to hold this because I have to go get you some blankets. Within two seconds of moving. He is so calm. He helped her off the toilet, laid her down, coached her through pushing, and then waited for the shoulders to come out and said, wait, don't push, I'm going to get blankets. He did that with only the best of intentions, I am sure. But anybody who has had a baby or watched somebody have a baby knows that what she's about to say, I'm guessing, is there was no way at that point I could stop pushing and not let the baby come out. But let's see. Me laying there, I didn't have to push. She naturally, I guess, just came out. I came back and Jeannette had the baby already on her arms. For a minute, I kind of didn't hear her cry, so I was getting scared. So I kind of did what they used to do in the hospitals, you know, put the finger through the mouth in case she had some kind of mucus or whatever was going through the throat. And once he did that, the baby started crying. I've never seen so much blood. Even though she was saying she's okay, but I saw that blood and I was like, I got to call 911. It can be very jarring if you've never seen a delivery, exactly how much blood can be there. And sometimes that's normal. Sometimes it's something like a hemorrhage or an abruption. She labored, it sounds like in a normal timeframe, she was at work, she started having pain, and then it kind of progressed, and then she came home and she got in the bath, and then she had the baby. So it doesn't sound like she labored and delivered really quickly, but sometimes a problem called placental abruption can cause a very rapid labor and quite a bit of bleeding at the same time. That can be life-threatening for both mom and baby. I don't think that's what she had here. That's where the placenta separates and comes off. But I'm guessing that the amount of bleeding that she had seemed like a lot because it is a lot when you're not used to having a baby born in your bathroom floor. Vaginal delivery, a normal amount of blood loss is up to 500 milliliters. And for a C-section, a normal amount of blood loss is up to 1,000 milliliters or one liter. Anything over 1,000 milliliters is a postpartum hemorrhage. In a vaginal delivery, 500 to 1,000 is more than normal, more than average, but we don't generally call it postpartum hemorrhage until it hits that one liter mark. But again, he's super calm and I am very impressed. Oh, also, priority is calling for help if this is an unintentional delivery in somebody's house, probably if this were me, and I hope to never be in that situation, delivering a baby somewhere outside of my normal places that I deliver babies. If baby's crying and mom is okay and communicating, then you want them skin-to-skin to keep baby warm. That's also good for helping mom produce oxytocin so the uterus will contract down and decrease bleeding. If there's a baby coming somewhere unexpectedly, my first thought is, is the baby crying? If the answer's yes, skin-to-skin with mom. If the answer's no, probably still skin-to-skin with mom, stimulating, turning baby over, trying to get baby to wake up. As paramedics tend to Janetsi, her frightened boys look on. They're like, can you get up to walk to the stretcher? I'm like, yeah, sure, not a problem. I got up, I took one step. She just went straight to the floor. I was really scared. I was afraid of losing Janetsi and the baby. Her poor kids. Can you imagine how terrifying that would be? I just feel so bad for them. She stood up and passed out. It's hard to know, did she stand up and pass out because she actually did have a hemorrhage and now she's anemic? And she said she kind of hangs out at an anemic blood count so it wouldn't take a lot of blood loss potentially to make her feel bad from anemia. I don't know, and maybe they'll talk about it in a minute, if she had a hemorrhage and it was so much blood that now she's anemic and she may need a blood transfusion or at least some fluids to help get her blood pressure up. Or if maybe she just was overwhelmed by the pain and the shock of it all and passed out from that. So maybe we'll find out a little bit more about the medical stuff in just a second. At the hospital, doctors quickly examined Janetzi and her baby. She needed a blood transfusion. Wait. I love that they, in the reenactment, they didn't bother to get anything to help move her over. They just picked up a sheet and moved her over. It's like when you're a kid and your parents swing you around in a blanket that just like, whoosh, whoosh. That doesn't usually happen like that in a hospital. I was panicking and the back of my head was just going, I just hope I don't lose my wife. Janetzi slowly stabilizes. Doctors are still examining her newborn, a daughter. I didn't want to look at the baby because I was on these diet pills. I was basically starving myself sometimes because I wasn't eating. Someone who's losing significant amounts of weight is at risk for having limited amounts of nutrients or elements that the baby needs to develop. It's a bad idea to take diet pills during pregnancy. At the same time, I would say here, it's a bad idea to take diet pills if you know you are pregnant. She had a negative pregnancy test. There should be no guilt from her. It just sounds like she feels guilt about this. If I could talk to her, I would say, you did the best you could with the information you had. And the information you had was a pregnancy test that was done in a serum pregnancy test that was negative. My guess is that the baby is going to be just fine. It could cause a life-threatening growth restriction, but that doesn't sound like what's going on here. But she was fine. Doctor says everything was okay. Six pounds, 12 ounces. Congratulations. The doctors told me that the baby was almost full term. I was ecstatic. I was so happy. Her name is Jocelyn Elizabeth. Somebody whose blood test for pregnancy is negative can feel very confident that they are not pregnant. However, there's always a potential for human error. If it's labeled wrong or incorrectly run, you could come up with a falsely negative result. I would say the takeaway from this should not be you can't trust a serum pregnancy test. It is extraordinarily unusual for that to come back with a false negative. So, I just need to put that out there. I love this episode because he was so super calm. It sounds like she did just fine and she stabilized quickly and that the baby did just fine also, which we always love. Thank you guys for being here. I hope you liked this. If you did, please give it a thumbs up. That helps me out a lot. Be kind to yourself, to each other, to me. In the comments, be kind, and I will see you next time.