Teen pregnancy in the United States is disproportionately more frequent than it is in other industrialized nations, and although there has been a recent decline, the epidemiology of adolescent pregnancy still warrants careful observation for postmenarchal teenage girls who present with abdominal pain. Pediatricians should be aware of pregnancy as a potential cause for abdominal pain.

The symptoms associated with adolescent pregnancy include morning sickness, swollen tender breasts, weight gain, and amenorrhea. The presentation of these symptoms is often vague and presents like a flulike syndrome, including headache, fatigue, and pain in the abdominal region. Doctors should be aware that denial of sexual activity as a result of embarrassment or fear of negative parental reactions does not sufficiently exclude pregnancy. A complete examination and appropriate diagnostic testing may be necessary to identify pregnancy. On physical examination, an enlarged uterus, cervical cyanosis, a soft uterus, or a soft cervix are strong indicators of intrauterine pregnancy. Pregnancy testing is recommended to complement the physical exam. The most sensitive pregnancy test, a quantitative beta-human chorionic gonadotropin (β-hCG) radioimmunoassay, is less commonly used because of its expense, but it is useful in diagnosing an ectopic pregnancy, a retained placenta, or a molar pregnancy. Urine pregnancy tests have sufficient sensitivity to be used as a screening tool.