If pregnancy is suspected in a client who has been using any contraceptive method, please first confirm this by a urinary pregnancy test at presentation. Perform the pregnancy test according to the manufacturer’s instructions.

Please remember that this unplanned pregnancy may or may not be unwanted and the client’s emotions may range from happy to deeply upset. It is important to discuss the implications of a positive result with the client and discuss all pregnancy options with her. The following support and follow-up should be instigated in all cases. Please offer to call a partner, relative or friend for the client if she wishes further support.

In cases where the pregnancy has occurred whilst the client continues to use a contraceptive method e.g. implant or intrauterine device, please see the appropriate guideline for further management advice:

Please arrange an urgent ultrasound to determine gestation if this cannot be
determined clinically. If at all possible, this should be arranged for the same day
as the result may affect the client’s ongoing decisions. If it is apparent from the
scan that the client has conceived after an implant has been inserted, please
retain the implant if it is removed and contact the manufacturer for further
advice. Complete a DATIX/incident reporting form.

If client decides to continue with the pregnancy: 

Give literature and information on health in pregnancy. Discuss the effect of the
contraception on the ongoing pregnancy. Inadvertent exposure to hormonal
contraception has not been shown to be associated with specific fetal
abnormalities. Similarly pregnancies conceived with an intrauterine device in
situ do not appear to be associated with congenital abnormalities but may be
associated with an increased risk of miscarriage. Discuss and offer information
on folic acid, vitamin D, smoking, alcohol consumption, drugs, toxoplasmosis,
listeria and HIV. Provide written confirmation of the test for the client to take to
her GP. Follow local pathways for referral to antenatal care. If the pregnancy is
over 12 weeks gestation, please refer directly to the appropriate antenatal
service.

If client opts for termination of the pregnancy:

Give information on options. Give client information on Termination of
Pregnancy either by leaflet or SMS link and refer onward as per local procedure
if appropriate.
Some clients may wish to see their GP to discuss the options further.

For clients who are uncertain:

More extensive counselling and support can be offered at TOP services.
Further counselling and support is also available through the voluntary sector
(ask a senior colleague).
In all cases where the client has given permission, please notify the GP of the
consultation.