Pediatric emergency medicine trisk 2114 2114
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regarding age of legal consent for sexual activity, criteria for emancipated minor
status, and the health provider’s status as mandated reporter in the case of
suspected physical or sexual abuse and suicidal or homicidal ideation; some states
include pregnancy in women younger than 13 years old in the definition of abuse.
Current Evidence
According to the Youth Risk Behavior Survey, approximately 40% of high school
students have been sexually active; of those who are currently sexually active,
54% report condom use and 21% report birth control use during their last sexual
encounter. In 2017, there were 194,377 teen births which was 7% down from the
year prior. Despite this decrease, the United States still has one of the highest teen
birth rates in the world.
Clinical Considerations
Clinical Recognition
A recent study found that only 20% of adolescent females seen in an ED
underwent pregnancy testing. Among those patients with a chief complaint
potentially related to pregnancy, the proportion who underwent pregnancy testing
was higher (44.5%) but still represented the minority of cases. The most common
presenting complaint associated with early pregnancy is a missed or abnormal
menstrual period. However, the menstrual history is particularly unreliable in
teenage women secondary to high rates of anovulatory cycles. Other symptoms
commonly associated with pregnancy include fatigue, dizziness, breast
tenderness, weight gain, nausea, and morning sickness. Many adolescents report
nonspecific complaints related to the gastrointestinal or genitourinary tracts. Less
commonly, the presenting symptom is associated with complications of early
pregnancy, including vaginal bleeding, hyperemesis, hypertension, headache,
hyperglycemia, vaginal discharge, or dysuria.
Clinical Assessment
It is important to consider offering a pregnancy test to all teenage women seeking
care. Even if a pregnancy test is unrelated to the presenting symptoms, there are
several advantages to the patient in identifying pregnancy as early as possible:
earlier initiation of prenatal care if childbirth is desired, earlier detection of lifethreatening complications such as ectopic pregnancy, opportunity for
consideration of options such as therapeutic abortion or adoption, and increased
time for counseling, regardless of the patient’s ultimate choice. If the pregnancy
test is negative and pregnancy is suspected, repeat testing should be done in 2
weeks.
