PLAB 2 Guide: Managing a teenage Girl with Vomiting and Suspected Pregnancy
- Ann Augustin
- Jul 22
- 3 min read
Updated: Jul 23
This station tests your ability to provide sensitive, confidential, and structured care in an A&E setting for a teenage patient. Below is a step-by-step guide tailored for exam-style performance.
1. Initial Assessment & Investigations
Take a comprehensive history: vomiting (onset, frequency, triggers), LMP, pregnancy symptoms, red-flag checks (pain, dehydration, weight loss).
Ask about current medications and allergies:
“Are you taking any regular medications? Do you have any known allergies?”
Order investigations: UPT, urinalysis, relevant bloods, and consider point-of-care pelvic ultrasound if indicated.
2. Maintaining Confidentiality
Start with parents present to build rapport, then ask to speak privately.
“May I speak with you alone for a few minutes?”
Explain confidentiality:
“What we discuss is confidential unless I’m concerned for your safety, in which case we’ll discuss that together.”
3. Sexual History & Safeguarding
Use open, non-judgmental questions:
Partners:
“How many sexual partners have you had?”
Coercion/unwanted pressure:
“Do you feel comfortable in your relationship? Have you ever felt pressured?”
Explore details like partner's age, safety at home, and possible safeguarding concerns. Document and escalate if needed.
4. Explaining a Positive Urine Test
🧾 Explaining the Diagnosis
“Based on your history and the urine test today, it indicates you are pregnant.”
💬 Acknowledging Feelings
“This might be unexpected. How are you feeling about this?”
5. Reassurance, Support & Parental Involvement
“You’re not alone, and there’s support for any decision you choose. If you’re comfortable, we can involve your parents or someone you trust—but only if you’d like. We’re here for you either way.”
6. Symptomatic Relief for Vomiting
The vomiting is likely pregnancy-related due to hCG hormone changes. Mild-moderate cases should be treated with:
Dietary changes (small frequent meals)
Oral anti-emetics such as cyclizine or prochlorperazine
Hydration: encourage sips or oral rehydration; escalate to IV fluids if signs of dehydration or ketonuria
For severe nausea and vomiting of pregnancy (hyperemesis gravidarum), initiate antiemetics and consider IV fluids and thiamine
7. Referral & Next Steps
“With your permission, I can refer you to your GP, who can arrange antenatal care if you wish to continue the pregnancy, or help signpost to specialist services like NUPAS if you'd like further support or are considering termination. If you'd prefer, I can help you contact NUPAS directly now.”
NUPAS is an NHS-funded service providing confidential, non-judgmental advice and care
🏥 What Is NUPAS?
NUPAS is a government-commissioned, CQC-registered provider offering:
Pregnancy counselling (non-directive)
Medical and surgical abortion services
Contraception advice
Emergency contraception
STI screening (sometimes)
🟢 Services are free, confidential, and do not require parental consent — even for under-18s, as long as they have capacity.
✅ When to make a referral to NUPAS?
Refer to NUPAS (or another provider like BPAS or MSI Choices) if:
She has a confirmed pregnancy AND
She is:
Unsure about what to do OR
Considering a termination OR
Wants someone to talk to outside her family/GP
8. Safety Netting & Follow-Up
“If at any time you're feeling unwell, have worsening symptoms, or feel distressed, please seek help immediately—through A&E, your GP, or any of the services you’ve been given information about.”
9. Leaflet & Information Provision
Provide a leaflet detailing:
Pregnancy options (continuation, adoption, termination)
Contact info for NUPAS, BPAS, Brook, NHS 111
Guidance on where to go if symptoms worsen or she needs urgent care
10. Documentation
Document clearly:
History and presenting problem
Capacity assessment
Investigations and results
Discussion points, decisions, and understanding
Any safeguarding concerns and referrals
Management plan, safety-netting, and follow-up arrangements
Comments