Pediatric emergency medicine trisk 2113 2113
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Consideration of pregnancy and pregnancy-related complications on the
differential diagnosis for adolescent females
Rapid stabilization of unstable patients
Identification of appropriate resources to ensure adequate treatment and followup
Attention to consent and confidentiality issues
CLINICAL PEARLS AND PITFALLS
The symptoms of pregnancy in teenagers are highly variable. It should
be considered in the differential diagnosis for almost every chief
complaint among postpubertal adolescent girls. This is true even if using
contraception since adolescents are more likely to use short-acting
methods (daily pills, weekly patches, monthly vaginal ring, or quarterly
shot) that require frequent dosing; they are also more likely than adult
women to use these methods incorrectly and inconsistently. Physicians
should remember to include the possibility of pregnancy in teens with
chronic illness and disability. One study of sexual behaviors in teenagers
with chronic conditions demonstrated that they are as sexually active as
their otherwise healthy counterparts.
Confidentiality and Legal Issues
Confidentiality should be maintained throughout the visit to encourage autonomy,
protect privacy, promote necessary medical follow-up, and guard the teen from
any physical harm or humiliation that may result from disclosing pregnancy
status to family members. The results of a pregnancy test are best shared with the
adolescent alone initially. This allows the practitioner to assess the adolescent’s
attitudes towards the pregnancy privately and counsel around options as needed.
It also allows the provider to encourage the teen to share the information with a
trusted adult and to engage in a shared decision-making process to determine
which trusted adult—parent, family member, or friend—the adolescent deems
acceptable to offering support and assistance during subsequent follow-up. The
teen may choose to share this information with those that have accompanied her
to the ED or her partner, or may want to contact another adult. A nonjudgmental
and compassionate approach will assist the teen in choosing the option that suits
her life situation best because she is the one who will be most affected by that
choice. However, there are certain situations in which disclosure is required,
regardless of the teen’s wishes. It is important to be cognizant of state laws
