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Close to 800,000 adolescents between 15 and 19 years old in the United States experience a pregnancy each year, with approximately 30% of these pregnancies terminated by therapeutic abortion, 14% resulting in spontaneous abortion, and the balance resulting in a live birth. Although these data reflect a significant issue impacting adolescent health and well-being, trends in pregnancy, abortion, and birth among US adolescents continues on a downward trend over the past 25 years.1 Of those who maintain the pregnancy to term, about 95% of adolescents decide to parent the child, and 79% of teen mothers are unmarried.2 The factors that place young women at risk for an unintended pregnancy and the interactions among these factors are complex. Lack of appropriate knowledge regarding sexual intercourse and contraception plays a role in the perpetuation of myths regarding risk for pregnancy, especially among younger teenagers. Cognitive immaturity results in adolescents’ difficulty in linking the act of sexual intercourse with the possible outcome of pregnancy and therefore assessing their true personal risk for pregnancy as well as difficulty in applying information that they may have to their own decision-making related to sexual behavior and pregnancy prevention. Environmental factors including poverty, community norms, and cultural expectations make teenage parenthood an attractive alternative role for many young women. Also, society’s ambivalence regarding adolescent sexual activity, contraception, pregnancy, and teenage parenthood acts as a barrier to the development and maintenance of effective interventions.

During any assessment of a female adolescent, it is advisable to record the date and normality of the last menstrual period. A history of unprotected intercourse since the last menses with or without amenorrhea or unusual vaginal bleeding should alert the physician to the possibility of pregnancy. The absence of historical information does not preclude pregnancy because often the adolescent is unwilling to communicate sexual information to the clinician. In addition to amenorrhea or a “missed period,” the typical symptoms associated with pregnancy (nausea, vomiting, intermenstrual spotting, breast tenderness, unexplained weight gain, urinary frequency, and fatigue, among others) may be present in any combination or may be absent early in pregnancy.

Evaluation for Pregnancy

A physical assessment, including a pelvic examination, is critical to the evaluation of a possible pregnancy. The pregnancy test confirms the presence of an early pregnancy, using detection of β-human chorionic gonadotropin (β-HCG) in the urine. Within 24 hours of implantation, the placenta initiates production of HCG (⩽ 5 mIU/mL), and concentrations double every 48 to 72 hours in a normal pregnancy. By 2 weeks, the level rises to more than 200 mIU/mL in a normal pregnancy, and concentration peaks at approximately 100,000 mIU/mL at 6 to 8 weeks. Thereafter, the level drops to below 10,000 mIU/mL by 14 weeks. Currently, urine testing using monoclonal antibodies to β-HCG provides an accurate, sensitive, easy, and inexpensive screening tool to detect early pregnancy with sensitivities to levels of 5 to 50 mIU/mL. Thus, testing performed ...

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