Return to Scenario ListShow Learning Points most relevant to Phase 1:

Pregnancy diagnosis

Clinical Discipline(s)/Organ System(s)
General Practice, Obstetrics & Gynaecology, Reproduction & Development
Progress Test Topic(s)
Women's health
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.
Progress Test-Type Questions:   Question 1
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 intimate partner violence and mental health
   - Undertake a booking pregnancy examination, including measurement of blood pressure, height and weight, bimanual exam.
   - Calculate the estimated date of delivery based on Last Menstrual Period (LMP). Use communication skills to counsel for pregnancy options (continuation of pregnancy, adoption, abortion). 
   - Routine early pregnancy investigations (full blood count, blood group and antibody screen, rubella/ syphilis/HIV/hepatitis B and C serology, vulvovaginal swabs for chlamydia and gonorrhoea, urine culture; and if indicatied haemoglobin electrophoresis, smear
   - Role of obstetric ultrasound in early pregnancy
   - Routine Screening for Down syndrome and other chromosomal abnormalities
   - Routine counselling: potential teratogens, lifestyle advice, vitamin and mineral supplementation, antenatal education options, booking early with a Lead Maternity Carer (LMC). 
   - Nausea and vomiting of pregnancy: severity and indications for hospital admission, consider other diagnoses
   - Surgical and medical methods of first trimester abortion; risks, benefits and common complications of each method. 
Personal and Professional Skills 
   - Confidentiality and privacy
   - Ascertaining woman's feelings towards pregnancy
   - Understand the socio-economic factors that contribute to teenage pregnancy
   - Supporting patient choice of pregnancy options. 
   - 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
   - Understand the role of community midwife and suporting patient choice of lead maternity carer (LMC)
   - Contraception and sexually transmitted infection (STI) prevention counselling after abortion or birth
   - Awareness of the possibility of intimate partner violence in teenage pregnancy.
   - Understand women’s reasons for requesting abortion with regard to physical and mental health and overall well-being
   - Legal and professional responsibilities regarding providing abortion, and providing care in an abortion-related medical emergency
   - Psychological impact of abortion and necessary support.
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, reviewing medcations, cessation of smoking, alcohol and illicit drugs, diet and exercise, and optimal gestational weight gain.
   - Screening for intimate partner violence and mental health problems during pregnancy
   - Legal criteria for abortion in New Zealand.
   - Epidemiology of teenage pregnancy
   - Epidemiology of abortion 
   - Referral process and investigations required prior to abortion
Conditions to be considered relating to this scenario
pregnancy, unplanned pregnancy, teenage pregnancy, abortion, termination of 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