# Situation: A 30-year-old primigravida at 30 weeks' gestation attends a prenatal check-up at a lying-in clinic. Her pregnancy has been uncomplicated so far. She complains of heartburn after meals and low back pain at the end of the day. She takes the iron–folic acid tablet from the health center each morning. She recalls, "My home pregnancy test was positive early on, but the midwife said that result alone did not prove I was pregnant." Which explanation should the nurse give?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629370  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 30-year-old primigravida at 30 weeks' gestation attends a prenatal check-up at a lying-in clinic. Her pregnancy has been uncomplicated so far. She complains of heartburn after meals and low back pain at the end of the day. She takes the iron–folic acid tablet from the health center each morning.

She recalls, "My home pregnancy test was positive early on, but the midwife said that result alone did not prove I was pregnant." Which explanation should the nurse give?

## 보기

1. A blood test for the hormone would count as a positive sign.
2. Urine tests measure progesterone, which also rises before each period.
3. The hormone it detects can come from conditions other than a fetus. **✔ 정답**
4. Urine is too dilute early in pregnancy to give a trustworthy result.

**정답: 3**

## 해설

Pregnancy tests detect human chorionic gonadotropin (hCG), which can also be produced by a molar pregnancy and some tumors. For that reason a positive test, whether urine or serum, is a probable sign. Only findings that come from the fetus itself (fetal heartbeat, fetus seen on ultrasound, fetal movement felt by the examiner) are positive signs.

## 심화 해설

Why a positive pregnancy test is not a positive sign

Pregnancy tests, whether performed on urine or blood, detect human chorionic gonadotropin (hCG). The reason a positive result is classified as only a probable sign of pregnancy is that hCG is not exclusively produced by a normal intrauterine fetus. Other tissues can secrete this hormone, so the test result alone cannot prove that a viable pregnancy exists.

A positive hCG test is a probable sign because the hormone can be elevated in conditions unrelated to a normal pregnancy. The most clinically important examples are gestational trophoblastic disease and certain tumors. A molar pregnancy (hydatidiform mole) produces large amounts of hCG from abnormal trophoblastic tissue, and choriocarcinoma—a highly malignant trophoblastic tumor—also secretes β-hCG [3]. In addition, rare non-trophoblastic neoplasms can cause elevated β-hCG. A case report describes a woman with a malignant phyllodes tumor of the breast who had a positive urine pregnancy test and a serum β-hCG level of 1,152.7 mIU/mL [2]. These examples illustrate why a positive test cannot stand alone as proof of pregnancy.

Watch out! A positive hCG result does not tell you where the hormone is coming from. It could be a normal pregnancy, a molar pregnancy, choriocarcinoma, or even a rare non-gestational tumor.

The distinction between probable and positive signs follows a clear principle. Positive signs of pregnancy are only those findings that originate directly from the fetus itself. These include hearing the fetal heartbeat, visualizing the fetus on ultrasound, and palpating fetal movement by the examiner. Everything else—amenorrhea, nausea, breast changes, uterine enlargement, and positive hCG tests—remains a probable sign because each can have a non-pregnancy cause.

| Sign type | Examples | Why it is classified this way |
| --- | --- | --- |
| Probable sign | Positive urine or serum hCG, uterine enlargement, Hegar sign, Chadwick sign | Can be produced by conditions other than a viable fetus (e.g., molar pregnancy, tumors) |
| Positive sign | Fetal heartbeat heard, fetus seen on ultrasound, fetal movement felt by examiner | Originates directly from the fetus; cannot be simulated by other conditions |

A related point concerns false-positive urine tests. One case report describes a woman with adenomyosis and persistent vaginal bleeding who had a positive qualitative urine hCG but a negative quantitative serum hCG [1]. This suggests that the false-positive urine result was not caused by elevated circulating hCG, but rather by interference in the urine specimen itself. The report notes that hemoglobin at 40 mg/dL in the urine was present, while 1 mg/dL of hemoglobin was not expected to interfere with the test device [1]. This is a separate issue from the main concept, but it reinforces that urine hCG results can be misleading for reasons beyond actual hormone elevation.

Key point! The nurse should explain that the hormone detected by pregnancy tests can come from conditions other than a fetus, which is why a positive test is a probable sign, not a positive sign.

The other answer choices are incorrect. A blood test for hCG would still be a probable sign, not a positive sign, because the hormone source remains uncertain. Urine pregnancy tests measure hCG, not progesterone, and progesterone elevation before a period is a different hormonal pattern. Urine dilution is not the primary reason a positive test fails to prove pregnancy; the biological source of hCG is the central issue.References (research sources)

- [1]False-positive urine pregnancy test in a woman with adenomysosis.Research articleEr TK, Chiang CH, Cheng BH, Hong FJ, Lee CP, Ginés MA (2009) · DOI: 10.1016/j.ajem.2008.12.023

- [2]Phyllodes Tumor: A Rare Cause of False-Positive Pregnancy Test Result.Research articleKracaw RA, Cotter S, Bastian IN, Zhang Y, Grenvik J, Blazek K (2025) · DOI: 10.7759/cureus.77071

- [3]A Rare Case of Multimetastatic Choriocarcinoma.Research articleSzymaniuk D, Szymaniuk P, Janica M, Świenc E, Muszyński P. (2026) · DOI: 10.3390/diagnostics16162539

## 임상 시나리오

Positive hCG Is Still a Probable SignWhy a positive pregnancy test cannot prove pregnancy
Pregnancy tests detect hCG, which is not exclusive to a normal fetus. A molar pregnancy, choriocarcinoma, or rare non-gestational tumors can also secrete beta-hCG, so a positive result is only a probable sign.

Only findings that come directly from the fetus count as positive signs: fetal heartbeat, fetal movement felt by the examiner, or fetus seen on ultrasound.

CautionA positive hCG test—urine or serum—does not tell you where the hormone is coming from. Rule out gestational trophoblastic disease when the clinical picture is inconsistent with a normal pregnancy.

## 핵심 개념

- **hCG** — Human chorionic gonadotropin; the hormone detected by pregnancy tests, produced by trophoblastic tissue and some tumors.
- **Probable sign** — A finding strongly suggesting pregnancy but not conclusive, such as a positive hCG test or uterine enlargement.
- **Positive sign** — A finding that directly originates from the fetus, such as fetal heartbeat, fetal movement felt by examiner, or ultrasound visualization of the fetus.
- **Molar pregnancy** — Gestational trophoblastic disease where abnormal trophoblastic tissue produces large amounts of hCG.
- **Choriocarcinoma** — A malignant trophoblastic tumor that secretes beta-hCG, causing a positive pregnancy test without a normal pregnancy.

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