regarding age of legal consent for sexual activity, criteria for emancipated minor status, and the health provider’s status as mandated reporter in the case of suspected physical or sexual abuse and suicidal or homicidal ideation; some states include pregnancy in women younger than 13 years old in the definition of abuse Current Evidence According to the Youth Risk Behavior Survey, approximately 40% of high school students have been sexually active; of those who are currently sexually active, 54% report condom use and 21% report birth control use during their last sexual encounter In 2017, there were 194,377 teen births which was 7% down from the year prior Despite this decrease, the United States still has one of the highest teen birth rates in the world Clinical Considerations Clinical Recognition A recent study found that only 20% of adolescent females seen in an ED underwent pregnancy testing Among those patients with a chief complaint potentially related to pregnancy, the proportion who underwent pregnancy testing was higher (44.5%) but still represented the minority of cases The most common presenting complaint associated with early pregnancy is a missed or abnormal menstrual period However, the menstrual history is particularly unreliable in teenage women secondary to high rates of anovulatory cycles Other symptoms commonly associated with pregnancy include fatigue, dizziness, breast tenderness, weight gain, nausea, and morning sickness Many adolescents report nonspecific complaints related to the gastrointestinal or genitourinary tracts Less commonly, the presenting symptom is associated with complications of early pregnancy, including vaginal bleeding, hyperemesis, hypertension, headache, hyperglycemia, vaginal discharge, or dysuria Clinical Assessment It is important to consider offering a pregnancy test to all teenage women seeking care Even if a pregnancy test is unrelated to the presenting symptoms, there are several advantages to the patient in identifying pregnancy as early as possible: earlier initiation of prenatal care if childbirth is desired, earlier detection of lifethreatening complications such as ectopic pregnancy, opportunity for consideration of options such as therapeutic abortion or adoption, and increased time for counseling, regardless of the patient’s ultimate choice If the pregnancy test is negative and pregnancy is suspected, repeat testing should be done in weeks