Unwanted pregnancy and termination

Specialties > General practice

Differential Diagnosis Schema 🧠

Pregnancy Diagnosis

Pregnancy confirmed by urinary or serum beta-hCG: Typically presents with a positive test after a missed period.
Ectopic pregnancy: Consider if the patient presents with abdominal pain and vaginal bleeding; diagnosed via ultrasound and beta-hCG levels.
Molar pregnancy: Suspected if the patient presents with exaggerated pregnancy symptoms and an unusually high beta-hCG level; confirmed by ultrasound.
Miscarriage: May present with vaginal bleeding and abdominal pain; confirmed by ultrasound showing an empty gestational sac or non-viable fetus.
False-positive pregnancy test: Can occur due to certain medications or conditions; confirmed with repeat testing and clinical evaluation.
Non-pregnancy-related conditions: Consider other causes of amenorrhea or pelvic pain, such as polycystic ovary syndrome (PCOS) or pelvic inflammatory disease (PID).
Functional hypothalamic amenorrhea: Stress, weight loss, or excessive exercise leading to amenorrhea and a negative pregnancy test.
Ovarian cyst: Can cause abdominal pain and menstrual irregularities; diagnosed via ultrasound.

Key Points in History 🥼

Pregnancy History

Last menstrual period (LMP): Helps determine the gestational age and whether there is a delay in menstruation suggestive of pregnancy.
Previous pregnancies: Number of pregnancies, including live births, miscarriages, and terminations, which may influence decision-making.
Contraceptive use: Assess if and what contraceptive methods were used, which may provide insight into the reasons for unintended pregnancy.
Symptoms of pregnancy: Nausea, vomiting, breast tenderness, and fatigue, which can help confirm the diagnosis of pregnancy.
Symptoms of ectopic pregnancy: Pain, bleeding, and dizziness, which may suggest a potentially life-threatening condition.
Personal views on pregnancy: Understand the patient’s thoughts on continuing or terminating the pregnancy to provide appropriate support.
Cultural or religious factors: May influence decision-making regarding termination and should be approached sensitively.

Social History and Support Systems

Support networks: Assess the availability of emotional and practical support from partners, family, or friends.
Living situation: Stability of housing and the ability to care for a child if the pregnancy is continued.
Financial status: Consideration of financial stability, which may influence the decision regarding pregnancy continuation.
Domestic violence: Screening for intimate partner violence is essential, as this may impact the decision and safety.
Educational or occupational factors: Impact of pregnancy on education or employment, and whether adjustments can be made.
Access to healthcare: Availability and accessibility of healthcare services, including antenatal care or termination services.

Possible Investigations 🌡️

Initial Investigations

Urinary beta-hCG: Initial test to confirm pregnancy.
Serum beta-hCG: Quantitative test to confirm pregnancy and assess gestational age, especially if there is a suspicion of ectopic pregnancy.
Pelvic ultrasound: To confirm intrauterine pregnancy, estimate gestational age, and exclude ectopic pregnancy or molar pregnancy.
Blood group and antibody screen: Important for RhD-negative women to determine the need for anti-D immunoglobulin.
Full blood count (FBC): To assess baseline hemoglobin and rule out anemia.
Sexually transmitted infection (STI) screen: Especially if the patient is at risk or requests it; to ensure comprehensive care.
HIV and hepatitis screening: Routine in antenatal care, and important for guiding management in case of continuation or termination.

Pre-Termination Assessments

Counseling: Ensure the patient has access to counseling services to discuss options, including continuation, adoption, and termination.
Informed consent: Confirm that the patient fully understands the procedure, risks, and alternatives before proceeding.
Medical history review: Including any contraindications to medical or surgical termination.
Psychological assessment: Particularly if there is a history of mental health conditions that might be exacerbated by the termination process.
Physical examination: To assess the patient’s general health and any conditions that might affect the termination procedure.
Discussion of contraception: Post-termination contraceptive planning to prevent future unintended pregnancies.

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