Adolescent pregnancy and parenting — formative SAQs

SAQ 1 — Pregnant 15-year-old presenting to clinic (10 marks)

A 15-year-old presents with eight weeks of amenorrhoea and nausea. She has not told her mother and is frightened. She is sexually active with a 16-year-old partner and used condoms inconsistently. She is well, with normal vital signs and no pain or bleeding. [1] [2]

Questions

1. Outline your immediate clinical actions and how you confirm and date the pregnancy while excluding an emergency. (4 marks) [1]
2. Describe your approach to options counselling and safeguarding, including who you involve and how you frame confidentiality. (3 marks) [2]
3. Outline the antenatal care plan, naming the adolescent-specific obstetric risks you will screen for. (3 marks) [3] [8]

Model answer

Immediate actions (4). Greet the young person first; establish time alone and state conditional confidentiality with lawful limits. Confirm pregnancy with urine β-hCG (serum β-hCG if equivocal), establish gestational age from LMP, and arrange a dating pelvic ultrasound to confirm a viable intrauterine pregnancy and exclude ectopic. Absence of pain or bleeding makes ectopic less likely but does not remove the need to confirm location; ask explicitly about abdominal pain and bleeding at every contact. [1] [2]

Options and safeguarding (3). Present continuing with parenting, continuing with adoption, and termination (where legally available) in a non-directive, balanced way within the relevant time window; do not steer. Complete a safeguarding review: clarify the partner and consent context; a 15-year-old with a same-age partner in a consensual relationship is different from coercion. Assess capacity (decision-specific) and agree who is involved; where local age-of-consent or mandatory-reporting thresholds are met, follow local statute, telling the young person what you must share and why. [2] [1]

Antenatal plan (3). Multidisciplinary care — midwifery, obstetrics, paediatrics, social work, mental health, education liaison. Routine antenatal screening (blood group and antibodies, full blood count, ferritin, blood pressure, urinalysis, syphilis/HIV/hepatitis B) plus STI screening (chlamydia/gonorrhoea) given sexual activity. Name the adolescent-specific risks: anaemia, pre-eclampsia, preterm birth, low birthweight, STI. Supplementation with folic acid, iron and iodine per local guidance. Plan mental-health screening, nutrition, and education re-entry from the outset. [3] [8]

SAQ 2 — Postpartum adolescent mother at the six-week visit (10 marks)

A 17-year-old mother attends six weeks after an uncomplicated vaginal birth. She is formula-feeding, reports low mood, broken sleep and little support, and is not using contraception. The baby is growing well. [6] [5]

Questions

1. Describe your assessment of her mood and the actions you take if a depression screen is positive. (4 marks) [6]
2. Outline your contraception counselling and why timing matters. (3 marks) [4] [5]
3. Explain the broader parenting-support plan, including breastfeeding, education and follow-up. (3 marks) [7] [2]

Model answer

Mood assessment (4). Screen with a validated instrument (e.g. EPDS principles) and take a focused history: duration, anhedonia, sleep (beyond the baby's wakes), appetite, guilt, bonding, and any thoughts of self-harm or harming the baby. If positive, perform a same-visit suicide and safety assessment — ideation, plan, intent, means, prior attempts, protective factors, ability to keep safe. Decide between early outpatient review with a safety plan and urgent crisis pathway; do not defer to delayed psychology alone if risk is high. Postpartum psychosis, if suspected (new hallucinations, delusions, confusion), is a psychiatric emergency. [6]

Contraception (3). This is the highest-yield postpartum act for preventing rapid repeat pregnancy, which is strongly predicted by absent or delayed contraception. Offer the most effective acceptable method — long-acting reversible contraception (intrauterine device or implant) where available and chosen — emphasising that it must be offered, never imposed. Where LARC is declined, support her chosen method and arrange prompt follow-up; post-placental IUD insertion (where available) is high-yield because the postpartum visit is often missed. [4] [5]

Parenting support (3). Offer adolescent-specific breastfeeding support (interventions improve initiation and duration even if she has stopped, support a restart if desired); she should not be made to feel guilty for formula feeding. Plan school re-entry with education liaison, link to financial and housing supports, and arrange close follow-up that addresses both the parent's health and the child's developmental surveillance — two patients at every visit. [7] [2]