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Case study . Dr Iram Yasin. Miss LB. 15 year old girl No remarkable PMH Attends on 30/11/2011 with mum & sister Pregnant with 17 year old boyfriend Quiet Withdrawn Little eye contact Mum says …’ well tell her then..’ Miss LB says ‘..erm.. I’m pregnant…’.

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case study

Case study

Dr Iram Yasin

miss lb
Miss LB
  • 15 year old girl
  • No remarkable PMH
  • Attends on 30/11/2011 with mum & sister
  • Pregnant with 17 year old boyfriend
    • Quiet
    • Withdrawn
    • Little eye contact
  • Mum says …’ well tell her then..’
  • Miss LB says ‘..erm.. I’m pregnant…’
slide3
What thoughts are going through your mind as the Dr?
  • What would be your next step ?
  • How does the consultation feel ..
slide4
Then…
  • Mum and sister are most talkative during the consultation..
  • …sister had similar accident at the same age and had an abortion and both feel that LB should have the same
  • …LB states ….’they don’t know how I feel its my body and my baby…’
  • Mum tells ‘ boyfriend is not going to stick around, I cant afford to have her and another mouth to feed, and she only wants this baby cos’ all her friends have babies..’
  • Sister …’ she doesn’t understand this is going to ruin her life…’
any thoughts
Any thoughts?
  • What would you do next?
  • Thoughts about the structure of the consultation?
and then
And then…
  • Tried to engage eye contact with Miss LB
  • Boyfriend aged 17, consensual sex, not forced or aggressive.
  • Arranged follow up later that day with boyfriend and Miss LB alone
  • Mum booked next appointment for herself ..to talk about LB!!
alternative options
? Other management ideas

Thoughts about Fraser competence

Mums appointment?!?!

Alternative options
appoinment with couple
Appoinment with couple
  • Miss LB more talkative, expresses that she understands she is young but would like to consider keeping the baby
  • Boyfriend feels he is too young and cant cope with responsibility
  • Refer to – teenage pregnancy specialist midwife! For balanced options counselling

at Keighley Sexual health clinic

what happened next
What happened next?
  • Phone call from mum at AGH – Miss LB admitted for ? Ectopic, currently in theatre ..’Could you ask them to get rid of baby at the same time!..’
  • d/w Obs SHO – made aware of situation
  • TOP 7/12/2011 at AGH
post top
Post TOP
  • Multiple attendances for UTI, abdo pain
  • Two further admissions to AGH for ? Appendicitis
  • Split with boyfriend, low mood, Marie Stopes post TOP counselling arranged
what did i learn
What did I learn?
  • Complexities of consultations with imposing relatives.
  • To try to maintain structure of consultation to allow focus on patient
  • Fraser – Gillick competence and how to apply this
  • Use of MDT
  • To be able to be truly non-judgemental (personal beliefs)
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