P RMP ADOL GYNAE

Risk Management Pitfalls in the Management of Adolescent Patients With Gynecological Emergencies

1. “The patient said she had never had sex before, so I didn’t do a pregnancy test.”

Adolescents often do not disclose sexual activity, due to concerns about confidentiality. Emergency clinicians should have a low threshold for pregnancy and STI testing in adolescent girls, regardless of the history provided by the patient.

5. “The girl came in with vaginal discharge after intercourse with a partner reporting an STI, so I tested her for gonorrhea and chlamydia. I told her to call back in 2 days for results.”

Studies have shown that adolescents have poor follow-up and can be difficult to contact after presentation to the ED. If there is clinical concern for an STI, treat empirically for both gonorrhea and chlamydia in the ED; do not wait for test results.

9. “I found out the patient was pregnant, so I updated her mom about my plan to transfer her to a hospital with obstetric services.”

Clinicians are prohibited by law from disclosing pregnancy to parents/guardians without the patient’s consent, unless there is concern that the patient will harm herself or someone else. Adolescents aged > 12 years can seek sexual health services for contraception, pregnancy care, STI treatment, and sexual assault care, as well as mental health and substance use services without parental consent. Laws vary by state, so emergency clinicians should be familiar with confidentiality regulations where they practice