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Factors Influencing Pregnancy Screening in the Pediatric Intensive Care Unit
Caroline Perkowski1, Derika Schlueter2, Shouhao Zhou3
1Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania.
Insights
Incidental pregnancies are rare in female adolescents admitted to the pediatric intensive care unit (PICU). However, inconsistent pregnancy screening may risk maternal and fetal health, necessitating routine screening considerations.
Area of Science:
- Pediatric Critical Care Medicine
- Adolescent Gynecology
- Healthcare Quality Improvement
Background:
- Female adolescents admitted to the pediatric intensive care unit (PICU) may have undiagnosed pregnancies.
- Pregnancy screening practices in this population are not well-established.
- Early identification of pregnancy is crucial for appropriate medical management and maternal-fetal health.
Purpose of the Study:
- To determine the incidence of incidental pregnancy in female adolescents admitted to the PICU.
- To assess the frequency of pregnancy screening in this demographic.
- To identify factors associated with pregnancy screening in the PICU setting.
Main Methods:
- A cross-sectional, descriptive study was conducted at a children's hospital.
- Data were collected from the electronic health records of female adolescents (14-21 years) admitted to the PICU between 2011 and 2019.
- Patients were categorized based on the presence or absence of pregnancy screening.
Main Results:
- Of 431 female adolescents, 63.8% received a pregnancy screen; no incidental pregnancies were identified.
- Pregnancy screening showed significant associations with patient age, admission type, and transfer origin.
- Lower screening rates were observed in patients with developmental delay, cerebral palsy, mental retardation, and chromosomal abnormalities.
Conclusions:
- Incidental pregnancy is uncommon among female adolescents in the PICU, but incomplete screening poses a risk to care.
- Routine pregnancy screening should be considered for all female patients of childbearing age admitted to the PICU.
- Clinicians must be aware of patient-specific factors that may influence screening decisions.
Study Objective:
The objective of this study was to determine the rate of incidental pregnancy, pregnancy screening frequency, and factors associated with pregnancy screening in the pediatric intensive care unit (PICU).
Design:
A cross-sectional, descriptive study.
Setting:
The research was conducted at Penn State Health Children's Hospital evaluating PICU admissions between January 1, 2011, and January 31, 2019.
Participants:
Female adolescents 14-21 years of age who were admitted to the PICU.
Interventions:
The study population was divided into 2 groups (Presence and Non-Presence of Pregnancy Screening), and data were collected from the electronic health record.
Main Outcome Measures:
We evaluated for patient characteristics and for presence and results of urine pregnancy screening.
Results:
A total of 431 patients were included in the study. Of these, 275 patients (63.8%) had a pregnancy screen performed. No patients with incidental pregnancy were found. There was a statistically significant relationship between pregnancy screening and patient age, type of admission, and origin of transfer (P < .01). Analysis of secondary diagnoses (co-morbidities) indicated lower screening rates in patients with developmental delay, cerebral palsy, and/or mental retardation (15, 5.5%) [p < 0.0001] and chromosomal abnormalities (9, 3.3%) [p =0.021].
Conclusion:
Incidental pregnancy is uncommon in female adolescents of childbearing age who are admitted to the PICU, but not all patients were screened, thus potentially jeopardizing maternal and fetal care. Clinicians should consider routine pregnancy screening of female patients of childbearing age admitted to the PICU and should be cognizant of individual factors that could preclude screening prior to or during their presentation.
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