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  • Title: Pregnancy testing and counseling.
    Author: Stephenson JN.
    Journal: Pediatr Clin North Am; 1989 Jun; 36(3):681-96. PubMed ID: 2660091.
    Abstract:
    Pregnancy testing and counseling are increasingly accepted as necessary services for adolescents within the primary care setting. For teenagers in need of a pregnancy test, the easy-to-perform, highly sensitive and specific enzyme immunoassay analysis for measuring beta-human chorionic gonadotropin (beta-HCG) is ideal. However, no single beta-HCG analysis should be taken as absolute evidence for the presence or absence of pregnancy. Instead, an integrated approach using all of the health care professional's skills in adolescent health care should be taken. In some cases a careful history and physical examination will confirm the pregnancy. At other times serial quantitative serum HCG titers, pelvic ultrasonography, and culdocentesis may be necessary to rule out the possibility of ectopic pregnancy or threatened abortion. For more than three quarters of pregnant adolescents the pregnancy is unplanned and may represent a major conflict for themselves, their partner, and their families. When such an event occurs the health care professional will frequently be sought as a resource. Successful pregnancy counseling has many components. The adolescent will need to visualize the counselor as an available, sensitive, nonjudgmental individual who believes in the right of the pregnant teenager ultimately to progress to her own decision. The counseling process should be firmly based on an understanding of adolescent psychosocial and biologic development, crises intervention techniques, and family dynamics. The counselor needs to be a reliable information source. If the adolescent decides to go to term, programs offering comprehensive prenatal services to teenagers should be identified. Information concerning high-quality, low-cost abortion services also will need to be available for those who wish to terminate. It is important to monitor the quality of care given in prenatal and abortion service referrals. Few adolescents currently choose to place their babies for adoption. Counseling in this area is especially needed. Several types of adoption procedures are available and at appropriate times during a teenager's neonatal care adoption should be presented as a reasonable alternative to parenthood. Throughout this process, the health care professional will have opportunities to discuss a wide variety of health related topics with the adolescent and often her partner and their respective families. Ideally, whatever her final decision, it is the goal of the counselor to make the experience a positive and maturing influence on her life and the lives of other persons involved. A review of pregnancy diagnosis, testing and counseling for adolescents includes both professional and home tests, and issues to consider when counseling a pregnant adolescent, especially legal implications of her decision. Presumptive signs and symptoms of pregnancy are considered with results of pregnancy tests, all of which are assays for human chorionic gonadotropin (hCG). The beta chain of hCG can be radioimmunoassayed quantitatively as early as 9 days after the LH peak: quantitative information is useful to define a healthy pregnancy, when hCG doubles every 48 hours. Professional slide, tube, dipstick and ELISA tests are discussed and tabulated. Home pregnancy tests are more reliable if the woman uses one with 2 tests per packet, and utilizes the 800 toll call number is she has questions. Pregnancy counseling for adolescents is a process, usually done in crisis. It should be done expeditiously, yet the girl should be allowed to come to her own conclusion. Since currently few teens consider adoption, all options should be described, including agency adoption, open agency adoption where she helps decide on the newborn's placement, and independent adoption, done privately with an attorney. Legal issues that need to be considered within the context of teen pregnancy counseling include: legal consent for abortion, especially if parental consent is not obtained, access to a lawyer for those intending to keep the baby, to define issues of paternity, custody and support, referral to an attorney for adoption, and mandatory reports of pregnancies resulting from rape or incest, without which civil penalties may be incurred. It is important to use nondirective language, such as "fetus" rather than "baby," and to refer the pregnant adolescent to all needed services, such as prenatal care or postabortion follow-up.
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