PUID 49:: Unplanned Teenage Pregnancy Presenting with Nausea:: A PLAB 2 Mock:: 1st Attempt

Practice a case with the AI patient 🤖

Summary

A 15-year-old girl presents to A&E with morning sickness (vomiting). Despite her age, suspicion for pregnancy must be addressed with a urine test. Key aspects include confidentiality, safeguarding, gentle history taking, breaking sensitive news, symptom management, and appropriate referral pathways.

🔍 Key Points

Patient Demographics & Legal Context

• Patient is 15 years old, below legal age for sexual activity.

• Any signs suggestive of pregnancy warrant prompt urine pregnancy testing.

Confidentiality & Environment

• Offer strict confidentiality early in the consultation ("what you say stays between us—unless safety is at risk").

• Ask parents to step out before personal questioning (menstrual, sexual history).

History-Taking: <u>Systematic & Sensitive</u>

• Presenting complaint: onset, frequency, red flags (blood, headache, vision changes, fever, abdominal pain, travel).

• Past medical, meds/allergy, travel history to exclude common causes.

• After pregnancy test-positive:

  • Menstrual history: LMP, cycle regularity.

  • Sexual history: activity, contraception, partner’s age, consent — including safeguarding and coercion questions.

  • Psychosocial/social history: school, mood, smoking, alcohol.

Safeguarding

• In teens, particularly under 16, always ask about consent and coercion.

• If partner is in position of trust or older, escalate to child safeguarding services.

• Explain limitations of confidentiality: information may be shared if safety is at risk.

📋 Important Considerations

• Never rush—explore both exclusion and sensitive lines of questioning thoroughly.

• Always verbalize intended exams and tests to trigger findings in the simulation.

• Explain your role in A&E vs ongoing care in primary care.

🩺 Diagnostic Approach

1. History: Vet GI symptoms, red flags, conduct pregnancy test early.

2. Physical Exam: Dehydration status, full vitals, focus abdomen exam.

3. Bedside Investigations: Urine pregnancy test, urinalysis, dehydration markers.

4. Blood tests: Basic labs as needed.

🛠️ Management

• Communicate results sensitively using EVE: Explore emotion, validate feelings, empathize.

• Explain pathology: early pregnancy hormones (HCG) cause vomiting.

• Provide symptom relief:

  • Encourage small frequent meals, hydration (ORS), avoid trigger foods.

  • Offer pregnancy-safe antiemetics (e.g., prochlorperazine).

• Continued care referral:

  • Give options based on her preference—refer to GP or National Unplanned Pregnancy Advisory Service (NUPAS).

  • Discuss termination options, continuation of pregnancy, GP follow-up or Early Pregnancy Assessment Unit.

• Provide printed information and emergency advice.

🗣️ Communication Skills

• Show calm, empathic, non-judgmental tone.

• Use simple, clear language—avoid jargon.

• Gain consent before sharing info: “With your agreement, I’d like to involve your parents/support.”

• Allow silence after delivering heavy news—let her process.

• Reassure ongoing support: “You’re not alone—we’ll help you explore your choices.”

⚖️ Ethical & Legal Considerations

• Provide full confidentiality, while mentioning safety exceptions.

• Be mindful around safeguarding obligations regarding coerced sex or partner abuse.

• Informed, non-directive counseling required for unplanned pregnancies in minors.

📚 Additional Resources

• National Unplanned Pregnancy Advisory Service (NUPAS)

• Early Pregnancy Assessment Unit referral guidance

• GMC/RCGP confidentiality, safeguarding, and consent modules