Pregnant adolescents in the emergency department: diagnosed and not diagnosed

A study was conducted to compare the presenting complaints and historical information of adolescents diagnosed as pregnant (DP) in the emergency department (ED) with adolescents seen in the ED who were pregnant and not diagnosed (MP). Medical records for the period 1980-94 were retrospectively analyzed to identify patients 16 years of age or younger who were diagnosed as pregnant in the ED or who had a live birth and had an ED visit during pregnancy. This analysis was done in a university-affiliated tertiary referral hospital with approximately 65,000 ED visits and 3,500 deliveries each year. The DP patients had complaints referable to the abdomen or genitourinary system more commonly than the MP patients (91% v 22%). Less than 10% of the DP patients mentioned the possibility of pregnancy at initial triage, 10.5% denied being sexually active, and 5% had a pelvic examination and sexually transmitted disease screening; 68% of MP patients did not have sexual or menstrual history documented, and 5% had a pelvic examination. The diagnosis of pregnancy can be a challenge in patients who present to a busy ED with complaints that are not necessarily suggestive of pregnancy. Historical information regarding menses and sexual activity is either not obtained or is incomplete or inaccurate. We recommend a low threshold for the consideration of pregnancy in adolescents irrespective of the presenting complaint.