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Pregnancy diagnosis

Clinical Discipline(s)/Organ System(s)
General Practice, Obstetrics & Gynaecology, Reproduction & Development
Progress Test Topic(s)
Women's health
Description
Whilst on attachment in a GP clinic you see a NZ European 15 year old who has not had a menstrual period for 2 months. She feels unwell, particularly first thing in the morning. She is healthy and has a regular 30 day menstrual cycle. She has never visited the GP without her parents before.
Applied Science for Medicine 
   - Anatomy and function of the female reproductive tract
   - Endocrine regulation of the normal menstrual cycle
   - Physiology and endocrinology of early pregnancy
   - Normal and abnormal embryo and trophoblast development
   - Medication use in early pregnancy
Clinical and Communication Skills 
   - Differential diagnosis of secondary amenorrhea
   - Consider the possibility of pregnancy in all women of reproductive age and perform a pregnancy test
   - Undertake a booking pregnancy history including screening for domestic violence and maternal mental health
   - Undertake a booking pregnancy examination, including measurement of blood pressure, height and weight
   - Calculate the estimated date of delivery
   - Routine early pregnancy investigations (full blood count, blood group and antibody screen, rubella/ syphilis/HIV/hepatitis B and C serology, cervical smear if appropriate, chlamydia nucleic acid amplification test [NAAT], urine dipstick and culture) and if indicated, varicella/cytomegalovirus serology, haemoglobin electrophoresis
   - Role of obstetric ultrasound in early pregnancy
   - Screening for Down syndrome and other chromosomal abnormalities
   - Routine counselling of all women in early pregnancy: potential teratogens, lifestyle advice, vitamin and mineral supplementation, antenatal education options
   - Use communication skills to counsel for pregnancy options
   - Surgical and medical methods of first trimester termination of pregnancy: relative risks and benefits
   - Nausea and vomiting of pregnancy: severity and indications for hospital admission, initial therapeutic options, consider other diagnoses
Personal and Professional Skills 
   - Confidentiality and privacy
   - Ascertaining patient's feelings towards pregnancy
   - Understand the socio-economic factors that contribute to teenage pregnancy
   - Supporting patient choice (continuation of pregnancy, termination, adoption)
   - Counselling and treating a pregnant woman who is under the age of consent
   - Legal ramifications of underage pregnancy and role of the police and social worker
   - Ethical opinions and the legality surrounding abortion
   - Psychological impact of abortion and necessary support
   - Understand the role of community midwife and patient choice of lead maternity carer (LMC)
   - Awareness of the possibility of intimate partner abuse in teenage pregnancy
   - Contraception and sexually transmitted infection (STI) prevention counselling after termination, miscarriage or birth
Hauora Māori 
   - Consideration of access to cultural/spiritual support for patient/whānau (including appropriate antenatal support programmes)
   - Ensuring a culturally safe environment given the potentially life changing event (child birth)
Population Health 
   - Models of maternity care in New Zealand
   - Optimising maternal health for pregnancy, including folate and iodine supplementation, cessation of smoking, alcohol and illicit drugs, and optimal gestational weight gain through diet and exercise
   - Epidemiology of teenage pregnancy and abortion
   - Screening for intimate partner violence and mental health problems during pregnancy
   - Termination services in New Zealand and legal requirement to refer
Conditions to be considered relating to this scenario
Common
pregnancy, unplanned pregnancy, teenage pregnancy, miscarriage (threatened, recurrent, spontaneous, complete or incomplete), ectopic pregnancy, polycystic ovarian syndrome, prolactinaemia, thyroid dysfunction, hyperemesis gravidarum, multiple pregnancy
Less common but 'important not to miss'
molar pregnancy
Resources

www.nsu.govt.nz