Author

Alla Smith

Date of Award

January 2012

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Lei Chen

Second Advisor

Howard Pearson

Subject Area(s)

Medicine, Health care management, Health education

Abstract

HIGH INCIDENCE OF SUBSEQUENT PREGNANCY IN TEENS TESTED FOR STDs IN THE EMERGENCY DEPARTMENT. Alla L. Smith and Lei Chen. Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University, School of Medicine, New Haven, CT.

Teen pregnancy continues to be an important public health issue in the United States and elsewhere. Teens at risk for unplanned pregnancies often seek care in emergency departments (EDs). The ED therefore represents a potentially important arena for interventions to prevent subsequent unwanted pregnancies. Establishing the risk of subsequent pregnancy and the time interval from ED visit to conception (Time to Conception) is a necessary prelude to effective interventions. However, no data to date documents incidence of pregnancy or the average Time to Conception in this population. This study set out to measure the incidence of pregnancy and the Time to Conception in at-risk teenage women following an ED visit.

A review of medical records was conducted in an urban general and pediatric ED. Subjects were included if they were 13-19 years of age and were tested for Gonorrhea and Chlamydia in the ED from 2004-2006. Subjects were excluded if they were not patients in the Primary Clinics at the affiliated academic institution. Subsequent pregnancies were determined from the Primary Clinic charts. The duration of follow-up was 4 years.

Three hundred and ninety eight subjects were included in the study. The mean age at inclusion was 17.3 +/- 1.5 years. A majority, 279 of the 398 patients (70.1%) had a subsequent documented pregnancy (SP). For those patients who had a SP the mean Time to Conception was 15.8 months (481.5 days +/- 364 days.) 80 out of the total 398 patients (20.1%) tested positive for Chlamydia and 23 out of 398 (5.8%) tested positive for Gonorrhea at their ED visit. Patients who had a SP were significantly more likely to be an ethnic minority, were more likely to have tested positive for Gonorrhea and were more likely to have visited the adult ED.

In this population of at-risk teens the majority became pregnant within two years. Demographic distinctions between patients who had a SP and those who did not may assist clinicians in identifying high-risk patients. The test for Gonorrhea and Chlamydia is an excellent marker of future risk for SP in this ED population. Health care providers should consider offering a wide spectrum of reproductive health services to these high-risk patients. Future study is needed to establish attitudes of providers and subjects regarding prescription of contraception to teens during an ED visit.

Comments

This is an Open Access Thesis.

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