When/how might a doctor determine someone is pregnant when they're unaware of it?

[u/blu3heron]

Basic idea is MC is pregnant and finds out basically during Their Worst Day Ever which kicks off the rest of the story. They're not morning sick and they don't have periods so they don't have anything unusual to tip them off that they need to take a pregnancy test on their own.

I thought it could be a natural thing that happens because they have to go to the doctor for emergency treatment (they get in a fight), but I don't actually know what might make a doctor find out? Or suspect?

The best idea I have right now is that maybe they need an x-ray, but I don't know if they would require a pregnancy test if it's 1) not in the torso region and 2) an emergency situation.

I guess the other option would be needing to check before prescribing any medication, but I also don't know if that would come into play in an emergency situation again.

I am a woman, but because I'm asexual I always answer "no" when doctors ask me if I might be pregnant, and obviously they just take me at my word. If you're sexually active (with someone with the required parts), regardless of birth control, do you always say "yes" and then the doctor might ask you to take a test if it's necessary?

I dunno, I would appreciate any suggestions!

[u/randymysteries]

I congratulated a coworker for being pregnant once, and she didn't know. I was right. It seemed obvious to me.

[u/BoysenberryMelody]

It’s common to take urine test whenever going for regular lab work.

[u/ElfjeTinkerBell → u/BoysenberryMelody]

Depends on the country though. I'm chronically ill but never had a pregnancy test

[u/magic_snail1888 → u/ElfjeTinkerBell]

Have you had a urinalysis? Because thats just part of it and they won't mention it if there's nothing to mention. It's part of every urinalysis that is run.

[u/ElfjeTinkerBell → u/magic_snail1888]

It's part of every urinalysis that is run.

As a nurse - no. At least not in my country, from what I read it's different in the US. They only analyse the things that have to be analyzed. I've never seen a pregnancy test done when it wasn't necessary.

Also I can see all my lab results, regardless of outcome, and they don't have a pregnancy test.

[u/Steelcitysuccubus]

If you're afab you will be forced to take a urine pregnancy test before many medical procedures, some tests,and before getting certain meds. Some docs in certain states moght allow a waiver. But even ace, celibate, sterilized people like me get tested.

In a true emergency they might slap a blood preg test onto the many they're getting otherwise particularly in red states.

If she goes to the doc feeling sick and can't remember her last period they'll do a urine pregnancy test, maybe hormonal testing if the FMC has been trying to get pregnant.

Usually have to fight to get any hormone screening for chronic symptoms but anything can happen in fiction.

[u/ElfjeTinkerBell → u/Steelcitysuccubus]

If you're afab you will be forced to take a urine pregnancy test before many medical procedures, some tests,and before getting certain meds. Some docs in certain states moght allow a waiver. But even ace, celibate, sterilized people like me get tested.

This may be true for the US (can't confirm, that's an 8 hour flight), it's definitely not true everywhere.

I'm chronically ill and never had a pregnancy test

[u/AutomaticPiccolo9554]

morning sickness, peeing too much, extreme un-explained sleepiness.

[u/AutomaticPiccolo9554 → u/AutomaticPiccolo9554]

also a pap test, looking at the cervix is a giveaway. plump I think, google it.

[u/vindecisiveanon]

yes they’d ask you to take a pregnancy test right away if there’s any chance you’re pregnant before scans/surgery, also would show in blood work

[u/Steelcitysuccubus → u/vindecisiveanon]

Just being female is cause now. I'm sterilized and haven't had a period since I was 24. Been 20 years and they still make me pee in a cup even tho there's LITERALLY ZERO chance i could be pregnant as a person who doesn't have sex with men

[u/ReaperReader]

There's symptoms before morning sickness - tender breasts, tiredness, etc. She can suffer from one or more of those and ask a medical person about it.

[u/guesswho502]

They pretty much always run a blood test, partially because pregnancy causes weird and sometimes unpredictable symptoms, and partially because they want to double-check any meds they prescribe are safe. Look up some of the early pregnancy symptoms, there are a lot that don't involve the stereotypical morning sickness. I'm sure you can find some reasons within those symptoms that could get her to the doctor. From there, it would be routine to do a test.

[u/deadthreaddesigns]

A friend of mine went into the hospital because she got hurt at work. They did a blood test on her and she found out she was 4 months pregnant, never had any symptoms. She had an irregular period and wasn’t in a relationship anymore so she didn’t think anything of not having her period for so long.

[u/an0n0myis_I_guess]

There's a lot of ways they can find out. The thing is, that a lot of scans can damage a fetus in the womb. Xray, CT scan, MRI (in some cases) and more. Even Anesthesia can be very damaging to a fetus, especially one in the first trimester. So, before a test like this, they will usually ask the person if they may be pregnant (as you've seen) and given that she's... well, obviously sexually active, they would run a test before a scan like that or if they had to do any surgery on her.

But, bottom line, they always ask, and unless you tell them that you don't consent, in some cases they'll run a test just to be safe. (This was my experience, anyway).

So, unless she says that she doesn't consent, or unless she's not conscious and therefor unable to consent, then they will likely run a test. It would be pretty routine especially if she said something like "I'm not sure" when they ask if she could be pregnant.

[u/elizabethcb]

They always do a pregnancy test. If they take blood, pregnancy test. Pee test, pregnancy test. Had a hysterectomy, pregnancy test.

They always do a pregnancy test.

[u/Kylynara]

It would not be out of place for them to do a pregnancy test before an x-ray on a woman of childbearing age. CT scan or MRI works for this too, and they might do those to check for internal bleeding.

Lots of things they might check your blood or urine for where they could also discover you're pregnant.

[u/Kaurifish → u/Kylynara]

It doesn’t matter if you’re strictly celibate, lesbian, in a committed relationship with a sterile man or whatever. They will ask you when your last period was, if you might be pregnant and then go ahead and test you anyway.

Not doing anything to imperil a pregnancy is one of the top priorities of the American medical system.

[u/fae-tality]

Blood work! Which could be taken for a million different reasons. Hormone level in your blood can determine pregnancy.

My doctor did check my blood before prescribing me medication. For this exact reason. If I’d have been pregnant, that medication would have been unsafe for me to take.

[u/csl512]

Just to confirm they're already going to the hospital for plot reasons? The fight is part of the story and not a way to solve the problem of getting them to a doctor?

Morning sickness in pregnancy in fiction is nearly a guarantee, but in reality it's variable by person and by pregnancy.

Edit: If you go the medication route and need to name a specific one on page, drugs are classified into pregnancy categories. In the US it's A, B, C, D, and X. Basically something off of X, D, or C would be believable.

[u/blu3heron → u/csl512]

Yeah, the fight is also important bc it's part of the worst day ever.

[u/MillieBirdie]

Practically every time I'd go to urgent care for anything they'd have me pee in a cup and while sometimes they were testing for other things too they were also testing for pregnancy. They don't exactly come out and tell you that's what they're doing, it's not like 'we need to see if you're pregnant so go pee in this cup'. It's just 'here's your cup to pee in'. Sometimes it will say in the detailed breakdown of results from your tests that you're not pregnant and that's the only way you'd know they test.

Doesn't matter if I say there's no way I'm pregnant or even I'm actively on my period they still test it. I'm pretty sure they'll do it even if you say you're not sexually active cause they expect people to lie.

You also have to do a pregnancy test (again by peeing in a cup) before getting an X-ray. I don't think it matters where.

[u/MillieBirdie]

Practically every time I'd go to urgent care for anything they'd have me pee in a cup and while sometimes they were testing for other things too they were also testing for pregnancy. They don't exactly come out and tell you that's what they're doing, it's not like 'we need to see if your pregnant so go pee in this cup'. It's just 'here's your cup to pee in'.

You also have to do a pregnancy test (again by peeing in a cup) before getting an X-ray.

[u/Snoo-88741]

Blood test. Part of the standard blood test protocol for a reproductive age woman would be to test for pregnancy. 

[u/Genseeker1972]

At least in the US, any woman of child bearing age is routinely given a pregnancy test when they go to the emergency room. Exceptions are only made when the woman has had a hysterectomy. It's standard because women can get pregnant on birth control and some medicines are more dangerous than others to a developing fetus.

With my first child, I found out when I had a bad cough and trouble breathing. Left with a diagnosis of bronchitis and pregnant. Hadn't even missed a period yet.

[u/OuiMarieSi]

It’s pretty standard that when labs are taken, blood or urine, a pregnancy test is done. Regardless of the situation.

Things that could possibly work:

She has a UTI or Yeast Infection, making the worst day ever TRUELY the worst day, and goes to an urgent care.

When I was pregnant, the only first trimester symptom was that my hips were in CONSTANT pain. I know it was weird, and not super common.

Or she gets rhabdo from over-exercise. (She would have to have done the work out about 36ish hours before going to an urgent care or ER.)

[u/Snoo-88741 → u/OuiMarieSi]

the only first trimester symptom was that my hips were in CONSTANT pain.

I had that in the third trimester. 

[u/sspif]

...obviously they just take me at my word...

Let me stop you right there. No competent doctor will ever take you at your word on this one. If you were in the hospital for something not relevant to pregnancy, they probably wouldn't press you on it. But if it matters, they are going to test you on it before they do any procedure that would put a pregnancy at risk. It would be one of the tests that the lab runs when they draw blood.

This is one of the first things they teach you when you go into a medical field - "Don't take their word for it unless they don't have a uterus."

[u/blu3heron → u/sspif]

That's interesting to me! This thread in general has been.

I have ended up in the ER on multiple occasions and had a CT scan and x-rays before and they never asked me to pee in a cup. The time I had a CT scan they did take blood (they thought something was wrong with my kidneys, checked a bunch of stuff, and told me I was vitamin deficient), so they could have conceivably checked for pregnancy and just not told me they did.

[u/Bubblesnaily]

Some hospitals and doctor's offices don't care what you say, they always test, either urine or blood, sometimes both if the treatment/medicine is severe enough.

I broke a leg. Prior to that, I'd had a hysterectomy. The hospital I was at was where the hysterectomy had been performed. They still did a blood draw to check for pregnancy. 🙄 And, this was in California. So I'd imagine if your book is set post-dismantling of Roe v. Wade in a red state, the pregnancy test nonsense and distrust in women would be even greater.

[u/BoleynRose]

In some pregnancies fainting can be a side effect. One of my friends passed out and was still really woozy even after coming round so they took her to A&E, she was pregnant!

[u/Traditional_Hat_6929]

Med student (F) graduating in 4 months here. Any woman who gets periods automatically gets a pregnancy test in the emergency room. We don’t care if they’re 13 or 52. It’s protocol because it’s important for the docs to know if you’re at extra risk for things that pregnancy can cause (fetus in the wrong spot which can kill a woman, blood clots, dangerously low iron, etc.), and it’s important to let the patients know so they are aware of what’s going on with their body. I had a 42 yo woman come in for stomach pain a few months ago. I threw an ultrasound on her stomach to see if there was any internal bleeding or cysts on some organs, and I found a 35week along pregnancy she had no idea about. Get your character into an emergency room for any reason, and she’ll find out she’s pregnant.

[u/Traditional_Hat_6929 → u/Traditional_Hat_6929]

Oh, and I say any reason because, depending on the region, 80-90% of ER visits on any given day are often what we call “urgent care” complaints like coughing, small cuts that need one or two stitches, a lowgrade fever, etc. Your character could even get back pain and just go to the emergency room because it’s closer than an urgent care or smth. Don’t feel pressured to make it an actual emergency if you want something mild-moderate to happen to her before the pregnancy reveal.

[u/mrsalderaan → u/Traditional_Hat_6929]

I've had to go to the ER simply due to lack of 24 hour urgent cares in my area before, so there's plenty of leeway for it being something urgent care worthy

[u/Steelcitysuccubus]

Any time you go to the doc they grill you and would do a pee test

[u/Terrible-Ad7017]

I am not currently sexually active and doctors often still do pregnancy tests regardless of me telling them it’s not humanly possible.

I would say that, especially in an emergency situation, doctors are probably more likely to include a blood/urine test for that in their work up. They have to ensure there’s no risk for any treatment necessary to any possible fetus.

In my experience, this is also true for most outpatient procedures. It’s a very quick test, and hCG will be apparent in urine/blood if a person is pregnant, because hCG does not appear at all in someone who is not pregnant.

[u/_notkvothe → u/Terrible-Ad7017]

I went to the ER 8 days after giving birth to my first child for postpartum preeclampsia and because I had chest tightness they also did a chest X-ray. I had literally given birth 8 days prior and they still had me do a pregnancy test before the X-ray.

[u/Dyliah]

If she goes to the ER and she's menstruating age, she's getting that pregnancy test, it is routine.

[u/DreamingofRlyeh]

Blood test. If the doctor orders a blood panel for whatever reason, and if they are looking at the right things in the blood, it would reveal the pregnancy.

https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-testing

https://my.clevelandclinic.org/health/diagnostics/9703-pregnancy-tests

https://womenshealth.gov/pregnancy/you-get-pregnant/knowing-if-you-are-pregnant

[u/Steelcitysuccubus → u/DreamingofRlyeh]

You'd have to order a blood pregnancy test which they dont do when you can pee in a cup

[u/DreamingofRlyeh → u/Steelcitysuccubus]

I'm saying that if they are testing for something else in the blood but come across the evidence of a pregnancy, it would work. And there are plenty of situations which could cause a doctor to order a general blood panel.

[u/Steelcitysuccubus → u/DreamingofRlyeh]

General blood panel doesn't include a pregnancy test. It's a pee test or a whole extra test ordered with cause.

Source: I'm a nurse in a trauma center.

[u/Snoo-88741 → u/Steelcitysuccubus]

They do if there's medical indication for a blood test anyway.

[u/Steelcitysuccubus → u/Snoo-88741]

We don't slap on a blood hgc test when urine is available because insurance isn't going to cover it without direct diagnosis of pregnancy. If patient comes into the ER you get a rainbow panel. If there's suspicion sure they can add it on but it's not automatic.

[u/HoneyedVinegar42]

In an emergent situation, they are likely to just go ahead and test any female (most likely urine) as part of the standard panel that they're running, unless she is outside menstruating age. I know a CBC (complete blood count) is typical, too.

Real life example: when she was 14, my daughter had appendicitis and I brought her into the ER with presenting symptoms of extreme abdominal pain and vomiting (in the 1.5 mile distance between the house and the hospital, she puked 3 times--yes, I was driving her in my own car because it is a myth that you'll be seen faster in the ER if you arrive by ambulance. I will say that if you arrive with uncontrollable frequent vomiting, you'll be heading back right fast, as they don't want other patients puking in sympathy and they can start getting some anti-nausea drugs on board). I remember the white count was sky high, and when she went into imaging, they found it was the appendix, but fortunately while it was close, it had not burst and she was able to get the less complicated surgery). They still ran a pregnancy test, the CBC and I'm not recalling what else because it's been a few years now.

So if your MC's injuries are ER-worthy, it definitely would be something they test just as part of the standard work up.

[u/Expert-Firefighter48]

Ace here, too. ♠️

Some women can go through an entire pregnancy without knowing it even periods can continue very rarely but there are blood results that can determine pregnancy or skipping periods and the woman feeling it's just down to stress and the doc seeing other signs and matching it all up. Many docs aren't good enough to know instantly and will often send a woman for a basic pee test.

[u/Snoo-88741 → u/Expert-Firefighter48]

Periods can't continue during pregnancy. A period is defined as shedding the uterine lining, and if that happens during pregnancy, the baby is coming with.

However, some people experience vaginal bleeding during pregnancy, which could be confused with menstrual blood. But the biological mechanism is completely different, unless they're miscarrying.

[u/Expert-Firefighter48 → u/Snoo-88741]

You are correct here. It is called a cryptic pregnancy with bleeding when women still bleed while pregnant, but it is not the uterine lining shedding as you say unless they're miscarrying. Sorry I didn't word my answer better.

It does seem like irregular or even regular periods for those who go through cryptic pregnancy and any kind of bleeding.

[u/the_king_lobo]

I’ve seen a lot of women say that, regardless of the original complaint they go in for, many doctors will insist on a pregnancy test regardless of whether or not you’re sexually active.

If rude/annoying bedside manner is not your preference, like everyone else said, the risk of fetal abnormalities caused by x-ray, medications, etc. is equally as plausible.

You can also always go the route of “I didn’t know I was pregnant” in which the cryptic pregnancy goes completely undetected until the pregnant person is in active labor.

[u/Steelcitysuccubus → u/the_king_lobo]

It's policy now to pregancy test every woman between 9 and 70 for procedures even xrays. This can cause dangerous delays in care. Even if its in the chart that you had ovaries and uterus removed they still test you. They even test trans men who have had bottom surgery depending on what's listed in the chart. It's bonkers!

[u/ThemisChosen]

My friend found out she was 5 months pregnant when she went to the doctor because she was so exhausted for so long there had to be something wrong. (This was after two different doctors told her she would never have kids.)

The nurse said “your baby is fine”

“What baby?!?!”

[u/TapeBadger → u/ThemisChosen]

I found out I was 7 months along when I finally went to the doctor about the 'weird stomach issues' I'd been having for months (sensitive stomach and minor bloating). 

When she palpated my belly she was like "any chance you could be pregnant?" and I was all "naahhhh. I've been on the pill for years". She had me take a test 'just in case', which was positive and blew my mind. She said she'd estimate I'm out of the first trimester and sent me to the local hospital for a scan where it was determined I was 32-34 weeks along. Baby was born 6 weeks later. 

[u/comradejiang]

My hospital runs a piss test on basically every woman of age if they come in for any sort of “not feeling well” type shit.

[u/JKmelda]

Could the character have injured her back in the fight? I pulled a muscle in my lower back as a teenager and they made me sign a “definitely not pregnant” waiver before getting an x-ray.

I was at an infusion clinic today for a routine medicine. As I was literally filling out a waiver saying I wasn’t pregnant, I heard a nurse from the hallway call out, “has anyone seen any pregnancy tests?” I thought, “ geez people! I’ve already said there’s a 0% chance I’m pregnant!” (Not sexually active.) Turns out it was for another patient who just wanted to be sure before she got her medication. It’s just funny to me to have all that happen today and then see this post. I don’t know what medications would need a waiver/test in an emergency situation as my infusions are for chronic migraines.

[u/hackingdreams]

I second the "make them require a CT scan." They run the pregnancy blood test as a routine pre-screen procedure for CTs regardless of whether you answered you could be pregnant or not due to the radiation dose, specifically for the "they're pregnant and don't know it" circumstances.

Have your character take a blow to the chest and mention chest pains afterwards - they'll probably do the CT because it's extremely easy to justify in such a circumstance and bills better than a plain flat film X-ray. (Along with all of the other tests they'll certainly run. Chest pains = cha-ching for the hospital, even if it eventually turns out to be gas or a bruised rib.)

[u/Steelcitysuccubus → u/hackingdreams]

Er docs love to run CTs. She can sat she's having vision changes and a severe headache and bam CT! Fell and may have bonked head? CT! Car accident with deployed airbag? CT for you!

[u/csl512 → u/Steelcitysuccubus]

What about driving too fast or slow, or selling glasses or sweaters at too high a price?

[u/Steelcitysuccubus → u/csl512]

None of those are reasons to go to the ER.

[u/HidaTetsuko]

This is how the movie Sliding Doors ends

[u/miparasito]

There are a few medications where they aren’t fucking around because birth defects are so severe. One is accutane — I believe you now have to get tested monthly before they can legally renew the prescription. It’s a quick pee in a cup put it in the little cabinet, but you could have the pharmacy send a message saying there is a problem with your order before she gets her lab results. 

CT scans are also going to require either absolute certainty or a quick test. 

Having an IUD implanted is another one where they need to make sure you’re not pregnant before. 

[u/Technical-Camera-291]

They don't require a pregnancy test for an X-ray, but they will ask if you could be. (and as someone who is sexually active, I always answer yes.) However, for a CT scan, they most certainly will do a pregnancy test (unless life or death) because the high radiation levels can cause birth deformities. The alternative would be an ultrasound to check on internal injuries without the risk from a CT or x-ray. I speak from experience of 15+ years of chronic illness and multiple pregnancy tests (all which were negative. lol)

[u/Writing_Bookworm]

It might be most reasonable for them to have some sort of abdominal injury from the fight you mentioned. Maybe they got kicked several times or something? That could trigger the doctor to perform a quick ultrasound to make sure there's no signs of internal bleeding and they could discover a pregnancy that way

[u/Steelcitysuccubus → u/Writing_Bookworm]

Abdominal ultrasound to look for internal bleeding from a hit to the abdomen is usually a quick first choice. Particularly if MC was kicked hard or say fell onto something. They want to look fast for bleeding and they can do that quicker than a CT. If mc has a lot of bruising on her stomach or groins they'd ultrasound for a hematoma or aneurism too.

Source: vascular surgery nurse. We be preg testing everybody since can't be on blood thinners (shouldn't but people do it).

[u/blu3heron → u/Writing_Bookworm]

Not a bad idea at all! Thank you. I'll see if I can maybe work with that.