SAQ 259 – Obstetrics and Adolescent Health – early pregnancy bleeding and confidentiality
Model Answer
Question 3. early pregnancy bleeding and confidentiality.
a. Urine pregnancy test
| Result | Significance |
|---|---|
| Positive | Likely true positive with a low false-positive rate; obtain quantitative beta-hCG for gestation assessment and follow-up. |
| Negative | Excludes pregnancy in approximately 97%, but false negatives may occur with dilute urine, poor technique, expired strips, or test error. At six weeks, a positive result would usually be expected. |
b. Speculum indications
- Bleeding heavier than a normal menstrual period, suggesting cervical products.
- Trauma.
- Sexual assault requiring forensic examination.
- Known vaginal pathology.
- No local obstetric or gynaecology service.
c. Relevant history
- Competence and understanding.
- Reasoning and voluntariness.
- Social supports and dependence.
- Previous pregnancy or termination.
- Significant medical or psychiatric comorbidity.
- Possibility of sexual assault or coercion.
d. Response to parents
- Reassure the parents without disclosing confidential information.
- Assess the patient's competence.
- Respect confidentiality if competent.
- Explain and encourage the benefits of involving her parents.
- Disclose appropriately if she is not competent.
- Consider safeguarding and possible sexual assault.
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