Using a Checklist to Assess Pregnancy in Teenagers and Young Women

OBJECTIVE

Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women.

RESULTS

Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted self-interview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results.

CONCLUSION

The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population

Table 1

Criteria and Related Questions Used in the Checklist to Assess Pregnancy Among Female Teenagers and Young Women Seeking Care in a Family Planning Clinic

WHO and CDC Criteria to Be Reasonably Certain a Woman Is Not Pregnant	Question in Study Checklist and Determination of Pregnancy Status*
Is 7 d or less after the start of normal menses Has not had sexual intercourse since the start of last normal menses Has been correctly and consistently using a reliable method of contraception Is 7 d or less after spontaneous or induced abortion Is within 4 wk postpartum Is fully or nearly breastfeeding, amenorrheic, and 6 mo or less postpartum	Did your last menstrual period start within the last 7 d? Have you had sex since your last menstrual period started? Have you been using a reliable birth control method consistently and correctly since your last menstrual period started? Did you have a miscarriage or abortion in the last 7 d? Did you have a baby in the last 4 wk? Did you have a baby in the last 6 mo? Are you breastfeeding now? Are your periods still gone since you had the baby?	Yes: Pregnancy unlikely No: Pregnancy unlikely Yes: Pregnancy unlikely Yes: Pregnancy unlikely Yes: Pregnancy unlikely Yes to all: pregnancy unlikely

WHO, World Health Organization; CDC, Centers for Disease Control and Prevention.

*Pregnancy was considered to be unlikely if the participant fulfilled any of these criteria: answered “yes” to questions 1, 3, 4, or 5; answered “no” to question 2; or answered “yes” to questions 6, 6A, and 6B.

Via:  http://ht.ly/RUk8x

By: Maura K. Whiteman, PhD, Naomi K. Tepper, MD, MPH, Melissa Kottke, MD, MPH, MBA, Kathryn M. Curtis, PhD,Peggy Goedken, MPH, Michele G. Mandel, and Polly A. Marchbanks, PhD

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia