Adolescent pregnancy and parenting — branching viva

Stem

The examiner will test whether you can run a non-judgemental, safeguarding-aware adolescent pregnancy pathway under pressure. [1] [2]

Branch 1 — Confirmation and engagement

Examiner: A 16-year-old has a positive home pregnancy test. What do you do first? [1]

Strong answer: Confirm with urine β-hCG (serum if equivocal), date with a pelvic ultrasound, and exclude ectopic — ask specifically about pain and bleeding. Engage the young person alone, state conditional confidentiality with lawful limits, and assess capacity and who to involve. [1] [2]

Branch 2 — Options counselling

Examiner: She doesn't know what she wants to do. Talk me through your counselling. [2]

Strong answer: Present parenting, adoption and termination (where legal) in a balanced, non-directive way within the relevant time window; do not steer. Complete a safeguarding review of the partner and consent context. Give her time and a follow-up, and document the conversation. [2] [1]

Branch 3 — Antenatal coordination

Examiner: She decides to continue. What does good antenatal care look like for her? [3]

Strong answer: Multidisciplinary care — midwifery, obstetrics, paediatrics, social work, mental health, education liaison. Routine screening plus STI and anaemia screening given adolescent risk; supplementation with folic acid, iron and iodine per local guidance. Name the elevated risks: anaemia, pre-eclampsia, preterm birth, low birthweight, STI. Plan mental-health screening, nutrition and education re-entry from the outset. [3]

Branch 4 — Safeguarding disclosure

Examiner: She now tells you the father is 28 and she was frightened to refuse. [2]

Strong answer: This is a safeguarding concern: age/power asymmetry and likely coercion, possibly meeting mandatory-reporting thresholds. Follow local child-protection pathways, share the minimum necessary, tell her what you must do and why, and support her through it — do not punish her for the disclosure. Consider sexual-assault pathways per local statute. [2]

Branch 5 — Postpartum and contraception

Examiner: She has delivered and is about to be discharged. What must happen before she goes home? [4] [5]

Strong answer: A contraception plan must be agreed before discharge — this is the single highest-yield act to prevent rapid repeat pregnancy. Offer the most effective acceptable method; long-acting reversible contraception where available and chosen, offered not imposed. Also confirm breastfeeding support, mood screen, postpartum anaemia check, and a follow-up that covers both her and the baby. [4] [8] [5]

Branch 6 — Mental health

Examiner: At six weeks she scores above threshold on a depression screen. [6]

Strong answer: Same-visit suicide and safety assessment — ideation, plan, intent, means, prior attempts, protective factors. Decide early outpatient review with a safety plan versus urgent crisis pathway. Treat depression actively. Rule out postpartum psychosis (new confusion, delusions, hallucinations), which is an emergency. [6]

Examiner extras

• Two patients: the parent is your patient as much as the infant. [7]
• Breastfeeding support is adolescent-specific and improves outcomes. [7]
• Do not invent jurisdiction-specific consent ages or abortion law — name the principle and local statute. [2]
• Late or unbooked presentation is a red flag for concealed abuse or barriers to access. [1]