Checklist for ruling out pregnancy among family-planning clients in primary care

Use of a checklist to rule out pregnancy: a systematic review

“…The PubMed search strategy for articles assessing a pregnancy checklist identified 453 articles, of which 4 analyses from 3 studies met inclusion criteria for this review (Table 1) [5][6][7][8]. All were diagnostic accuracy studies, comparing a pregnancy checklist to urine pregnancy testing, which was considered to be the reference standard.…”

“…One study, conducted in Kenya, used a convenience sample of seven family-planning clinics [7]. From these clinics, 1852 non-menstruating women seeking contraception were enrolled in the study; 59% were postpartum and lactating, 37% were between menses, and 4% had recent abortions.…”

Does free pregnancy testing reduce service denial in family planning clinics? A cluster-randomized experiment in Zambia and Ghana

“…Neither histories nor pregnancy tests are perfect screening tools; “false negatives” can occur when pregnancy tests miss early pregnancies, and, more commonly, “false positives” occur (with published frequency ranging from 12% 3 to 39% 4 ) when the pregnancy checklist fails to exclude pregnancy in non-pregnant women 1 . But since no known risk occurs to either a mother or an undetected fetus from exposure to contraceptive hormones, the benefits of increased client contraceptive access should take precedence over excessive caution in excluding pregnancy, particularly in countries with high maternal mortality and morbidity rates.…”

“… 3 Although this job aid—essentially a client history-taking tool—has been shown to improve access to services when used correctly, 6 its introduction has not been a cure-all. Even when providers do take full advantage of the pregnancy checklist, it cannot exclude pregnancy for a sizable minority of new family planning clients who do not meet any one of its 6 criteria—such as sexual abstinence since last menstrual period—that rule out pregnancy.…”

“…Such clients are sent away, either home to await menses or forced to go to a pharmacy to buy a pregnancy test. Resources are wasted as clients—very few of whom are pregnant 3 , 4 —pay for expensive, often unnecessary tests and make multiple clinic visits. Clients sent home to await menses also run the risk of becoming pregnant in the interim.…”