The ‘Saving Mothers’ Lives’ report found that between 2006–8 ectopic pregnancies accounted for over 1% of pregnancies in the UK, and 6% of maternal deaths. The accident and emergency (A&E) department is the first port of call for many women with symptoms of abdominal pain, collapse or vaginal bleeding. NICE recommends assessment of any women of a reproductive age must include consideration into whether symptoms are due to an ectopic pregnancy. We performed a six-month retrospective review of adolescents attending the A&E department with abdominal pain and examined factors influencing sexual history taking and urine pregnancy testing.
From April to September 2014, A&E notes of all female patients aged 13–16 years old presenting with abdominal pain were collated and screened using the computer system Symphony. Fifty patients fitted the selection criteria. The assessing doctor’s department and grade was noted and information collected on presence of urine pregnancy test, sexual history taking, patient ethnicity and who, if anyone, accompanied the patient.
Of the fifty patients, half had a urine pregnancy test documented. Of the patients with documented urine pregnancy tests, A&E doctors performed this 73% of the time and paediatric team 25% of the time. Only 21% of Indian adolescents had a urine pregnancy test performed. Black patients had the highest rate of documentation of urine pregnancy test (83%). There did not appear to be a correlation between the percentage of urine pregnancy tests performed and person accompanying the patient. The surgical team documented the patient’s last menstrual period in 78% of cases, which was higher than the A&E department (62%) and paediatrics (53%). Only 11% of 16 year-old patients and 27% of 15 year old patients had sexual history taking documented.
There appears to be ethnic bias when performing a urine pregnancy test, but there is no correlation between rate of pregnancy tests, patient age and presence of an accompanying adult. These results highlight the need for improvement in sexual history taking and pregnancy testing in this patient group.
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