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PC Ado > Teen Pregnancy > Flashcards

Teen Pregnancy Flashcards

1
Q

Important info when trying to determine risk of pregnancy

A
  • Social: development and family (social is very important for teens - what are they getting from friends?)
  • Menstrual: LMP, length, type of flow, regularity, age of menarche, last period normal? perceived symptoms
  • history of sexual activity: unprotected sex, contraception, condoms, including emergency contraception, STIs
  • Hx of pregnancy: when? What happened?
  • PMH/Meds
  • Stressors
  • ROS
    • Pregnancy / STI sx
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2
Q

Strategies to help teens remember dates (LMP, sexual encounter, etc)

A
  • A calendar with holidays and school vacations
  • Recording dates on telephone (some already do)
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3
Q

Pregnancy symptoms

A
  • Missed period
  • Tender swollen breasts
  • Nausea/vomiting
  • Increased urination
  • Fatigue
  • Food aversions or cravings
  • Spotting and cramping – they may think it’s their period
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4
Q

STI symptoms

A

vaginal discharge, pruritis, lesions, dysuria, lower abdominal pain, dyspareunia)

risk: past history of STIs

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5
Q

How to establish gestational age

A

Ultrasound, fundal height or bimanual clinical examination

OR by calculating the number of weeks and days from the first day of the last menstrual period (LMP) or by the teen’s sexual history.

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6
Q

How has the rate of adolescent pregnancy in the US changed over the last 10 years?

A

Historic lows in all racial and socioeconomic statuses - since the 1950s

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7
Q

What are some of the factors that have contributed to decline in ado pregnancy?

A
  • Primarily due to improvements in contraception use
  • Increased use of highly effective and dual contraception methods
  • Comprehensive sex education programs
  • Access to contraception
  • Changes in childbearing norms – used to be cool
  • Little of the change due to delaying sex – age of first sexual experience has not changed
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8
Q

What are some of the factors that place teens at greater risk for adolescent pregnancy?

A
  • Age of first sex before 15years
  • No contraception use at 1st sexual encounter
  • Older partners (3 years)
  • Greater number of sexual partners (3 or more)
  • Poverty – missed results
  • Inconsistent contraception
  • Previous pregnancy – biggest red flag.
    • 25% have a 2nd child within 24 months
  • Poor school performance
  • Pregnancy wantedness/ambivalence
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9
Q

Pregnancy and contraceptive outcomes for teens who desire pregnancy vs those who are ambivalent

A

similar. Ambivalent are

  • Less likely to use contraception
  • More likely to be pregnant within 6 months
  • Higher risk of STIs because of inconsistent condom use
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10
Q

Why do teens want to use home UPTs

A
  • Privacy, confidentiality, immediate results
  • Cost of test vs cost of clinic or office visit
  • Access to care and insurance coverage or lack of insurance privacy for teen
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11
Q

What does use of a HPT indicate about a teen?

A
  • red flag for pregnancy ambivalence - high risk of getting pregnant later. Ask if they’ve ever done.
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12
Q

Why is teen use of HPTs problematic?

A
  • Less likely to perform tests accurately and at optimal time
  • False negative tests related to delay in seeking care
  • Missing a large number of teens who are in need of care for contraception, STI screening, etc
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13
Q

When are HPTs most accurate?

A

1 week after first day of missed menses

(Early tests” can pick up 25-50 mIU/ml of HCG [first day of missed menses] )

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14
Q

What factors contribute to false negatives on an HPT?

A
  • may be more prevalent with adolescents
  • too early & HCG levels not high enough to be detected
  • dilute urine (best to use first morning void)
  • timing of color change; directions not followed
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15
Q

Consequences of a false negative in ados

A
  • delay seeking care or repeating test
  • limits pregnancy options or behavior changes
  • ectopic pregnancy or threatened /missed abortion
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16
Q

False negative rate in ado HPTs

A

24-48 % or greater rates

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17
Q

Why might an HPT be a false positive?

A

(rare); tumors, LH surge with ovulation

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18
Q

What should you do if an ado is using HPTs?

A
  • Discuss how they work and when will be most accurate; follow directions exactly
  • Arranging a follow-up visit to validate results - insurance and privacy may be a concern
  • Arrange visit for plan of care regarding results and STI screening
  • Contraceptive counseling, including emergency contraception
  • Work with manufacturers’ help-lines and written package directions to make teen-friendly
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19
Q

Why would you do a UPT in the office?

A
  • Had unprotected sex and “want to be sure”
  • Confirm home pregnancy test
  • Offer test for late, missed, or undetermined period or last period was different from the others
  • Hidden agenda visit
  • Mother of teen request test
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20
Q

Signs of pregnancy on exam

A
  • Enlarged uterus
  • Breast changes/tenderness
  • Softening and enlargement of cervix (Hegar sign)
  • Bluish discoloration of cervix (Chadwick sign)
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21
Q

What to discuss with ado before UPT

A
  • Determine need for test
  • What she hopes the result will be
  • Who knows she is getting a pregnancy test
  • Will she share the results with parent/guardian and partner why or why not
  • What does her partner hope the result will be
  • Assess knowledge about options for positive and negative test
  • Discuss contraception options
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22
Q

What do you as a clinician need to do if the result of the ado’s UPT is negative?

A
  • Give results and observe reaction
  • Assess pregnancy wantedness and readiness to use contraception – avoid telling them directly it’s a bad idea if they want it. Meet at their level to lead to understand consequences
  • Match readiness
  • Frequent follow-up
  • Does she need another test in two weeks? Return in 2 weeks.
  • STI testing
  • Return in 2 weeks
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23
Q

Significance of negative pregnancy test for teen’s future pregnany risk

A

Significant risk of pregnancy in next 18 months

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24
Q

What to do if teen’s UPT is positive

A

“Your pregnancy test is positive that means that you are pregnant”
Accurate and unbiased discussion about her options

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25
Q

Key components of pregnancy options counseling

A
  • Determination of pregnancy risk and gestational age
  • Discussion of the accuracy of a pregnancy test today
  • Meaning of a positive and negative test
  • Assessment of the teen’s knowledge of available options
  • Discussion of all available options: motherhood, abortion, adoption
  • Identification of a supportive adult to discuss options
  • Discussion of her readiness for motherhood, ability to complete school, support of family and partner Assessment of the safety of adolescent related to a positive result
  • Contraceptive options if not pregnant or following delivery/termination
  • STI screening and condom use for prevention
  • Follow-up plan to further discuss decision about pregnancy and provide timely referral for prenatal care or abortion
  • Once the adolescent has made her decision, referral to appropriate services in the community
  • follow-up plan RTC in 1 week
26
Q

What do you need to consider when preparing a teen for abortion

A
  • Determine gestational age and counsel regarding options (medical vs. surgical)
  • Explain procedure and how you may feel physically and emotionally
  • STI testing and treat before appointment
  • Prepare for protestors
  • Help determine who will accompany her
  • Assist with making appointments and determining costs
  • Increased risk of denied care due to presenting further along in pregnancy
27
Q

Are adolescents at increased psychological risk from obtaining an abortion?

A

Adolescents are not at increased psychological risk – higher for having baby than abortion

28
Q

What are the abortion options?

A
  • Medical Abortion (up to 63 days)
    • Mifepristone + Misoprostol
  • Surgical Procedures (6-14+ weeks)
    • Manual vacuum extraction
    • Dilatation & curettage
    • Dilation & evacuation
29
Q

Who is eligible for a medical abortion?

A

Up to 63 days-9 weeks- (49 in some states) after 1st day of last missed period

30
Q

Medical abortion regimen

A
  • 1) Mifepristone (blocks progesterone) and doxycycline given in office
  • 2) Take Misoprostol (prostaglandin) 24 to 48 hours later: causes cramps and heavy bleeding
  • Number of office visits vary from state to state
31
Q

How long may bleeding and spotting last after a medical abortion?

A

up to 4 weeks

32
Q

C/Is to medical abortion

A
  • Allergy to med
  • Ectopic pregnancy
33
Q

Advantages of a medical abortion (vs surgical)

A

Private, early in pregnancy, no anesthesia

34
Q

Why are medical abortions not often accessed by teens?

A

Need to be done early in pregnancy and their recognition of pregnancy or care seeking is often delayed

35
Q

Possible Complications of Medical Abortion

A
  • Hemorrhage
  • Incomplete abortion
  • Uterine or pelvic infection
  • Ongoing intrauterine pregnancy requiring surgical abortion
  • Misdiagnosed/unrecognized ectopic pregnancy
36
Q

When can aspiration abortion (vacuum or suction curettage) be performed?

A

1st trimester - up to 10 weeks

37
Q

How does aspiration abortion (vacuum or suction curettage) work?

A

Vacuum or suction aspiration empties the uterus

38
Q

safety of aspiration abortion (vacuum or suction curettage)

A

10x safer than childbirth

39
Q

bleeding associated with aspiration abortion (vacuum or suction curettage)

A

normal-like heavy bleeding

make sure they don’t use tampons!

40
Q

How long does aspiration abortion (vacuum or suction curettage) take?

A

5-10 minutes

wait in office after for at least one hour

41
Q

When can dilatation and curettage be performed?

A

6 to 14 weeks after LMP

42
Q

How does a D&C abortion work?

A

Vacuum aspiration empties the uterus and curette used to clean walls of uterus

43
Q

When can dilation and evacuation be performed?

A

After 14 weeks

44
Q

How does a D&E abortion work?

A
  • Cervix is slowly dilated (may be over 24 hrs) then suction and instruments used to empty uterus - can take multiple office visits
45
Q

Possible complications of surgical abortion

A
  • Hemorrhage
  • Incomplete abortion
  • Uterine or pelvic infection
  • Ongoing uterine pregnancy requiring second procedure
  • Hematometra (blood clots in uterus)
  • Uterine preformation
  • Cervical laceration
46
Q

Warning S/S of surgical abortion

A
  • Severe pain
  • Chills
  • Temp > 100.4
  • Bleeding heavier than menses (1 pad/hr)
  • Clots > quarter
  • Foul-smelling d/c
  • Continuing symptoms of pregnancy
47
Q

After care for surgical abortion

A
  • Phone call follow-up to assess medical and emotional recovery and reinforce postabortion care
  • Return 2 to 4 weeks
  • Assessment of
    • Well-being (physical and emotional)
    • Urine pregnancy test to confirm resolution of pregnancy
  • Pelvic exam
    • Cervical os for closure
    • Infection: discharge, uterine size, shape, tenderness
  • Provide contraception: depending on procedure OCPs or DMPA can be started right after procedure, or with 2nd trimester procedure can start OCPs 3-6 weeks after
  • Regular contraception follow-up q 3 months and prn
48
Q

Prenatal care for adolescents should be:

A

early and continuous

adolescent friendly: e.g., privacy, everything in one place, can get appts at short notice, etc

49
Q

What should you screen for/educate about in teen prenatal care?

A
  • Careful dietary assessment – ados don’t tend to eat a balanced diet
  • Ongoing screening for drug and alcohol use
  • Intimate partner violence screening: more common in teen pregnancy
  • Prenatal vitamins
  • Avoid alcohol, tobacco, illicit/prescription drugs, unpasteurized foods, fish high in mercury
  • Review medications taken for safety during pregnancy
  • Discuss common symptoms of pregnancy
50
Q

Teen pregnancy: Indications for immediate medical care

A 
Lower abdominal pain
Heavy bleeding (2 pads/hour for 2 or more hours)
51
Q

What percentage of teen moms place children in adoption?

A

2-3%

52
Q

In how many states can minor child can place child for adoption without parental involvement?

A

40 states and in DC

53
Q

Important considerations when a teen is considering adoption?

A
  • Adoption can be:
    • Open or closed
    • Private or public
  • Teens need - Emotional support, support with their ambivalence
  • Terms (placing not giving up) - “placing” active choice
54
Q

When do teen parents have better outcomes?

A
  • Live with mother for at least 2 years after birth
  • Maternal age greater than 15 years
  • Ability to delay second birth
  • Completion of school
  • Stable housing
  • Economic resources
  • Confidence in caregiving skills and tasks
55
Q

Teen parenting: risks to mother

A
  • Less likely to receive prenatal care or enter care later in pregnancy
  • Medical: Ectopic pregnancy, preeclampsia, anemia, placenta previa, and preterm labor
  • Dropping out of school
  • Feeling isolated
  • Difficulty gaining employment
  • Lower income, living in poverty
  • More likely to be a single parent
  • More likely to abuse or neglect child without social support
56
Q

Teen parenting: risks to father

A
  • Less likely to finish high school
  • More likely to be employed
  • Earlier marriage and cohabitation
  • State laws vary on legal age for people to have sexual intercourse
    • May be required to register as sex offender
    • May be considered statutory rape
57
Q

Teen parenting: risks to infant

A
  • More likely to be preterm or low birth weight
  • Increased neonatal mortality
  • Lower APGAR scores
  • Higher SIDS, accidents, hospitalizations, abuse, neglect
  • Delayed early development
  • Increased behavioral and social problems persist into adolescent
  • Less likely to graduate from high school
  • More likely to be a teen parent
58
Q

1 reason teen girls drop out of school?

A

pregnancy

59
Q

Title IX: how does it protect pregnant teens?

A

School must allow a pregnant student to

  • Continue to participate in classes and extracurricular activities
  • Allow you to choose if you want to participate in special programs or classes for pregnancy students
  • Do not have to supply a doctors note to participate in school activities unless it is required from all students with a physical or emotional condition requiring treatment by a doctor
  • Provide reasonable accommodations
  • e.g., bathroom access, larger desks
  • Excuse absences due to pregnancy or childbirth that your doctor says is medically necessary
  • Must return with same academic and extracurricular status as before medical leave with time to make up work
  • Provide same services as given other ill or homebound students
  • Protection from harassment
60
Q

How can schools prevent teen moms dropping out?

A
  • Small school settings dedicated to teen mothers
  • Collaboration with outside community organizations
  • On-site childcare and healthcare
  • Individual counseling and mentoring
  • Group therapy
  • Academic support services and career preparation
  • Case management
61
Q

Interventions that contribute to successful parenting for teen parents

A
  • Comprehensive program
    • Develop sense of herself as competent parent and caregiver
  • Rally emotional and tangible resources
  • Mother and baby clinics
  • Centering pregnancy models
  • Advocate mentor model – can help find community resources
  • Home visitation models
  • School-based supportive programs
62
Q

Important considerations for well-baby visit with a teen mom - what should you focus on?

A
  • Focus on mother before focusing on baby. They are egocentric teens.
  • Support system
  • School situation
  • School attendance
  • Childcare
  • Helpers
  • Father’s involvement

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