Doe rats, dame rabbits, female frogs and femme!!!

Doe rats, dame rabbits, female frogs and femme!!!

‘What is this test supposed to test doctor?’  

A portly, middle aged, mother of my teenaged patient, was almost irate. Her daughter lay on the examination table, curled up with her hands clutching her tummy.  

‘It tests for pregnancy!’ I answered in a calm voice.  

Her mouth gaped and just wouldn’t close; her uvula dangling mockingly. Finally she did manage her jaw and blurted, ‘she is mmmy daughter doc; she’s unwed, you know it, and why do you still order a pregnancy test? That’s outrageous!’

I am used to such diatribe. The scene repeats once or twice a year.  Usually I get the test done without the patient’s knowledge. She’s just told to ‘go and get the urine examined’, the words ‘for pregnancy’ are omitted. If I were to say it all, people such as this lady would never agree to the test. I just scribble UPT on the paper. This lady was smart enough to decipher the meaning and was incensed. With due sympathies for her moralistic indignation, as a doctor I am forced to play such tricks. Not testing can boomerang and spell doom. Everyone does this and each hospital has its own code word. One of my friend writes, CISC, meaning ‘check if she is carrying!’  

‘Do you really need that test?’ Mama.  

‘Unless otherwise proved, every ‘pregnantable’ woman is considered pregnant! That’s the dictum my teachers have taught me and my textbooks concur. I simply following that. Regardless of marital status or cohabitation, whether a divorcee or an abandoned woman, sterilized or otherwise, hubby vasectomized or otherwise, with copper T in situ or otherwise, everyone goes for the test at the slightest provocation. Many an accident is diagnosed and many a disaster averted due to timely testing and instant intervention.  

The lady calmed down, agreed to the test and left.  

Magically quick diagnosis is the power of the urine pregnancy test. Now a days patients don’t wait for me to prescribe the test, they come flaunting the strip. This is indeed recent. Just a few decades ago the diagnosis of pregnancy wasn’t all this simple. Diagnosing pregnancy in early months was even more challenging. Except for some honorable exceptions from the filmdom, no physician has ever been able to diagnose a pregnancy just by feeling the pulse!  

A certain diagnosis meant a wait for at least two to five months.  A visit to the doctor was mandatory. An embarrassing and uncomfortable internal examination would follow. Doctors often had a tough time coming to a diagnosis. Texts succinctly listed the causes of a bloated abdomen as, fat, flatus, fluid, faeces and foetus. But without a rotund enough belly, misdiagnosis was common.  

Amenorrhoea, morning sickness, milky discharge from the nipple, a bluish congested cervix and a soft bulky uterus were the earliest indicators of pregnancy. All of these were presumptive signs. The definitive signs were, perceptible foetal movements, foetal heart beat and of course birth!!!

You will find this rather amusing but this is how things stood for generations.  

In the eighties and nineties, home based pregnancy test became available in India and a silent revolution followed. The kit is now available in every drug store and ASHA and Anganwadi workers provide it for the asking. A few drops of urine at one end of the strip and lo behold, within minutes the strip lights up with one or two lines. A lone line means no pregnancy, two means a pregnancy and none means that the test isn’t working, you need to repeat it.

Early diagnosis of pregnancy has been an issue since ancient times. Had the test been was available to some of the leading

ladies of our epics; our cultural history would have been very different! Egyptian women would pee on wheat and barley. Sprouting wheat meant a girl, barley sprouts meant a boy and none meant no pregnancy. Such lore pervaded all cultures and now is the stuff of ‘Believe It Or Not’ columns.  

The line appears indicating the presence of HCG, a hormone, in the urine tested. HCG is formed by the baby’s placenta. It’s a chemical signal to the mother stimulating lots of metabolic changes favouring the baby’s nourishment. A woman, when pregnant, excretes plenty of this hormone through urine. The early tests to detect this hormone were too time consuming and complicated. Just a few decades ago such tests required animal sacrifice!  

Urine from the supposedly pregnant women was injected in doe rats (female rats) and a few days later they were dissected to check for ovarian stimulation, caused by HCG (Aschheim-Zondek test).   Friedman used female rabbits and devised a similar test. But the tests were costly, inefficient and therefore were used only under pressing circumstances. If there was a probable pregnancy, and the diagnosis was a must, and a turnaround time of two weeks was acceptable; it was then that the test was ordered. The greatest hurdle was keeping an animal house and the messy sacrifice. But there was no alternative. Later female frogs replaced rats and rabbits. The frogs laid eggs obviating the need for killing them and making the test a little cheap.  

India never saw these tests in common use. A senior colleague could vaguely recollect such a test being conducted at Haffkine Institute, Mumbai.  The cost and the infrastructure involved was prohibitive. We jumped from clinical examination to the simple urine test. Simple though it was it involved ten steps and a visit to the laboratory was needed.  Soon the home pregnancy kits were developed and these made a sea change.  

Pregnancy can’t be kept a secret. Sooner or later the diagnosis becomes obvious! But the DIY tests made early diagnosis easy, reliable and private. In fact in the privacy of the loo. Women now can decide whom to reveal the news to. They can decide upon the fate of the gestation. A positive test isn’t always a good news. It can be life shattering. Some eagerly await a positive result while some dread it.  

Considering the polar response to the result, the exact nature of the indicator on the strip was given a good long thought. Icons such as a sperm, a pregnant woman, and a smiling baby were all discarded. To some the angelic neonatal smile could appear sardonic. A plain, simple line was chosen.  It was left to the client to attach meaning to the result. Some suggested that flowery, bright packaging but it was thought that this will seem frivolous and rob the kit of its sober, reliable and clinical looks. The advertisements too focus on the secrecy, reliability and rapidity of diagnosis rather than smelly, unpleasant urine drops! Rapid, early and reliable diagnosis is indeed a boon. An unwanted pregnancy can be safely aborted, a wanted one can be nurtured. Certain drugs can be avoided, certain complications can be averted and doctors can guard against some.  

Take the case of this school girl for instance.

The test was done. It showed a positive result. The mother was left gaping.  

Ultrasound showed a pregnancy outside the uterus, in the Fallopian tube. The mother kept gaping.  

The tube had ruptured, and was spouting blood inside the abdomen.  

By the time we wheeled her in for an emergency surgery, the girl was already sinking. After a hasty surgery and five bags of blood she stabilised and survived.  

But for the pregnancy test, she would have died!!