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

Tepper, Naomi K.; Marchbanks, Polly A.; Curtis, Kathryn M.

doi:10.1016/j.contraception.2012.08.007

Cited by 23 publications

(11 citation statements)

References 14 publications

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“…Our results are generally consistent with previous international studies, which reported some variation in the performance of the checklist with sensitivity ranging from 55% to 100% and specificity ranging from 39% to 89% but consistently high NPV of 99–100%. 3 Our estimated NPV was slightly lower; some characteristics of our study population may explain this difference. The prevalence of pregnancy in our study population was considerably higher than the prevalence in previous studies, which ranged from 1% 5,6 to 4%.…”

Section: Discussionmentioning

confidence: 52%

“…1,2 Although urine pregnancy tests are available in most U.S. settings, they are not able to detect pregnancies resulting from recent intercourse, their detection rates can vary based on the sensitivity of the test and timing with respect to missed menses, and they may remain positive weeks after a pregnancy ends. 1,3 Uncertainty about pregnancy status may result in unnecessary delays in contraceptive initiation to rule out pregnancy. Immediate initiation of contraception may reduce time at risk for pregnancy and improve short-term method continuation.…”

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confidence: 99%

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Using a Checklist to Assess Pregnancy in Teenagers and Young Women

Whiteman

Tepper²,

Kottke³

et al. 2014

Obstetrics & Gynecology

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OBJECTIVE Health care providers should assess pregnancy in women seeking contraceptive services. Although urine pregnancy tests are available in most U.S. settings, their accuracy varies based on timing relative to missed menses, recent intercourse, or recent pregnancy. We examined the performance of a checklist based on criteria recommended in family planning guidance documents to assist health care providers in assessing pregnancy in a sample of U.S. teenagers and young women. METHODS Study participants were a convenience sample of sexually active black females aged 14–19 years seeking care in an urban family planning clinic. Each participant provided a urine sample for pregnancy testing and was then administered the checklist in two formats, audio computer-assisted self-interview and in-person interview. We estimated measures of the checklist performance compared with urine pregnancy test as the reference standard, including negative predictive value, sensitivity, specificity, and positive predictive value. RESULTS Of 350 participants, 31 (8.9%) had a positive urine pregnancy test. The audio computer-assisted self-interview checklist indicated pregnancy was unlikely for 250 participants, of whom 241 had a negative urine pregnancy test (negative predictive value=96.4%). The sensitivity of the audio computer-assisted self-interview checklist was 71%, the specificity was 75.6%, and the positive predictive value was 22%. The in-person checklist yielded similar results. CONCLUSION The checklist may be a valuable tool to assist in assessing pregnancy in teenagers and young women. Appropriate use of the checklist by family planning providers in combination with discussion and clinically indicated use of urine pregnancy tests may reduce unnecessary barriers to contraception in this population.

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Section: Discussionmentioning

confidence: 52%

mentioning

confidence: 99%

Using a Checklist to Assess Pregnancy in Teenagers and Young Women

Whiteman

Tepper²,

Kottke³

et al. 2014

Obstetrics & Gynecology

Self Cite

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“…The World Health Organisation’s Selected Practice Recommendations for Contraceptive Use can be used to assess pregnancy status [6] and has been shown in a systematic review to have a negative predictive value between 99 and 100% [7]. Nevertheless, relying on this method when better alternatives are readily available is not advisable.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy testing in patients undergoing radiation therapy

Kharod

Greenwalt

Dessaigne

et al. 2017

ecancer

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Radiation therapy (RT) can be lethal to a developing fetus; therefore, determining pregnancy status before RT is essential. We here sought to determine how many women treated with RT at our institution for over one year were at risk for pregnancy when starting RT. We retrospectively reviewed the medical records of all female patients 12–55 years old treated with radiation, i.e. 1 October 2012 to 31 September 2013. Patients were categorised as ‘at risk’ if they had a uterus and ‘no risk’ if they had a hysterectomy. Documented birth control, pregnancy test status, and timing of the pregnancy test in relation to the radiation start date were recorded.We included 131 female patients with a median age of 48 years (range 14–55 years). Breast cancer was the most prevalent disease site (18%) followed by head/neck and central nervous system (both 11%). Of the 131 patients, 35 were deemed ‘no risk’ and 95 (72%) were ‘at risk’. Pregnancy testing of the ‘at risk’ population was done in 47%, but only 17% of the pregnancy testing was performed accurately, which we defined as a test performed within 14 days before starting RT. Over one year, 66% (63/95) of ‘at risk’ women were not tested appropriately before starting RT. Most (66%) women of child-bearing age with an intact uterus receiving RT at our institution were not appropriately tested for pregnancy before the initiation of RT. These data laid the foundation for our formal pregnancy testing policies for women undergoing RT.

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“…A systematic review published in 2013 reported on the accuracy of pregnancy checklists to rule out pregnancy (19). The checklists were based on criteria defined by the World Health Organization's Selected Practice Recommendations for Contraceptive Use (20,21).…”

Section: Pregnancy Testingmentioning

confidence: 99%