Outcome of teenage pregnancy.
AR Bhalerao, SV Desai, NA Dastur, SN Daftary
Nowrosjee Wadia Maternity Hospital, Parel, Bombay, Maharashtra.
A R Bhalerao
Nowrosjee Wadia Maternity Hospital, Parel, Bombay, Maharashtra.
Two hundred consecutive cases up to 19 years of age admitted for confinement at The Nowrosjee Wadia Maternity Hospital, Bombay, were studied. Out of these 200 girls, 6 were unmarried, 51 were anaemic, 20 had toxaemia of pregnancy. Six girls (43%) in the age group 15-17 years delivered prematurely as compared to only 26 girls (14%) in the age group of 17-19 years. This difference is statistically significant. Also, only, 4 girls (29%) in the age group of 15-17 years had full term normal delivery as compared to 113 girls (61%) in the age group of 17-19 years signifying that the outcome of pregnancy becomes worst in girls below the age of 17 years. Ten babies (71%) of mothers in the age group of 15-17 years were LBW as compared to 75 babies (44%) of mothers in the age group of 17-19 years signifying that the incidence of LBW babies is inversely proportional to maternal age. Teenage pregnant girls needed more attention for prevention and treatment of preeclampsia eclampsia, anaemia, prematurity and LBW.
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Bhalerao A R, Desai S V, Dastur N A, Daftary S N. Outcome of teenage pregnancy. J Postgrad Med 1990;36:136-9
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Bhalerao A R, Desai S V, Dastur N A, Daftary S N. Outcome of teenage pregnancy. J Postgrad Med [serial online] 1990 [cited 2020 Jun 4 ];36:136-9
Available from: http://www.jpgmonline.com/text.asp?1990/36/3/136/846
Teenage pregnancy is a fairly common occurrence in India, due to many factors such as early marriages, girls reaching puberty at younger ages and high specific fertility rate in the adolescent age group. In India, teenage pregnancy rate varies from 8 to 14%,,. The pregnant teenager may not be quite fit to bear the burden of pregnancy and labour at a tender age, as efficiently as a woman in her twenties. The obstetric outcome of teenage pregnancy is influenced by many socio-medical factors. Maternal and perinatal morbiditymortality in teenagers is influenced by medical complications like toxaemia, anaemia, cephalopelvic disproportion (CPD) and social problems viz. out of wedlock pregnancy, unwanted pregnancy etc. In view of this, it was decided to collect the data about the pregnant teenagers and to compare the incidences of various complications and outcomes of pregnancy with those reported in literature.
Two hundred consecutive cases upto 19 years of age, admitted for confinement at the N. W. Maternity Hopital, Mumbai, from July 1988 to October 1988, were reviewed. Medical, obsteric and socio- econmic aspects of these pregnant girls were studied and results were analyzed. During the period under review i.e. from July 1988 to October 1988, there had been 3150 confinements, of which 200 girls were aged 19 year or younger, giving an incidence of teenage pregnacy as 6.3%. A vast majority of teenage pregnant girls belonged to poor or lower middle class families and were housewives.
Fourteen girls (7%) were in the age group of 15-17 years and the rest (93%) were between 17 and 19 years. As expected, 173 girls (86.5%) were nullipara, 26 (13%) were para 1 and only one girl was para II. Six girls were unmarried, giving an incidence of 3%. It was interesting to know that 3.1% got married as early as the age of 11-13 years. Only 24.7% got married when their age was between 17 and 19 years. As the legal of marriage for girls in India is 18 years and above, only these marriages were legal.
Antenatal complications are listed in [Table:1]. Anaemia was found in 25.5% girls, 8.5% had pre-eclampsia and 1.5% suffered from eclampsia. Thus, overall 10% girls had toxaemia of pregnancy.
The outcome of teenage pregnancy is shown in [Table:2]. In the 1st or 2nd trimester 8% had spontaneous abortions. During labour, no increased incidence of abnormal presentation, lie and prolonged, complicated or difficult labour compared to normal was observed. Sixteen percent had premature vaginal delivery. The overall incidence in our hospital was 10%. Only 58.5% teenagers had full term normal delivery. Six percent underwent Caesarean section. Out of 12 sections, 3 were done for CPD, 2 for primi with breech presentation, 1 for transvers lie and remaining 6 for foetal distress. The incidence of CPD was 1.5%. Vaginal assisted breech delivery was carried out in 1.5%. Two percent had fresh still birth, 2% had macerated still birth, whereas the overall hospital incidence was half of this.
Though the number of younger teenagers upto 17 years of age was small i.e. only 14, the trend in them is worth noting. When the outcome of pregnancy in the teenage girls in the age group of 15- 17 years was compared with that of girls in the age of 17-19 years, it was interesting to know that 42.9% girls in the age group 15-17 years delivered prematurely as compared to only 14% girls in the age group of 17-19 years. This difference was statistically significant (p < 0.05). Also, only 28.6% girls in the age group of 15-17 years had full term normal delivery as compared to 60.8% girls in the age group of 17-19 years. This difference also was statistically highly significant (p < 0.05). These findings signify that the outcome of pregnancy becomes worst in girls below the age of 17 years.
Gestational age at the time of delivery and birth-weight of babies are presented in [Table:3]. The gestational age was less than 37 weeks for 20.1% babies. The overall hospital incidence was 10%. Only 53.8% babies of these teenagers had 2.5 kg and above birth weight. This means that the rest, 46.2% were low birth-weight (LBW) babies. The overall hospital incidence of LBW babies was 30%.
The difference in birth-weight with respect to mother's age is shown in Table 4-71.5% babies of mothers in the age group of 15-17 years were LBW as compared to 44.1% babies, of mothers in the age group of 17-19 years. This signifies that the incidence of LBW babies is inversely proportional to maternal age. It increases as maternal age decreases. Poverty, undernutrition, anaemia, toxamia may be the operating factors.
Perinatal mortality rate was 65.2 per 1000 total births; there were fresh still births (n = 4), macerated still births (n = 4) and nconatal deaths due to prematurity and birth asphyxia (n = 4). The hospital incidence of perinatal mortality was 45 per 1000 total births. There was no maternal mortality.
Israel and Woutersze in 1963, estimated the incidence of teenage pregnancy as 9.8%. Ghose and Ghosh in 1976, estimated it to be as high as 14.9%. In our study it was 6.3%. Sen has reported incidences of anaemia amongst teenagers to be 19.5% Ghose and Ghosh recorded anaemia in 24% cases. In our study 25.5% girls were anaemic and 10% had toxaemia of pregnancy. The reported incidence for the latter are 7.8% (Israel and Woutersz) and 8% (Ghose and Ghosh).
In our study group, 16% had premature vaginal delivery; the overall hospital incidence being 10%. Israel and Woutersz have reported it to be 14.7% and according to Ghose and Ghosh it is 14.9%. At the age of 14 or 15 years, the precise estimation of pelvic adequacy can be made! The incidence of CPD in our series was 1.5%. Philips and Sivakamasundari have recorded the incidence of CPD in their series as 2.6%. In our study group, the incidence of LBW babies was 46.2%. Philips and Sivakarnasundari estimated the incidence of LBW babies in their series as 30.8%.
According to Ballard and Gold, the adolescent above the age of 15, who escapes toxaemia, anaemia and premature labour seems to enjoy a relatively benign obstetric course. In conclusion, pregnant teenagers are definitely at greater risk, requiring additional efforts and resources to serve and protect their total health. They need more attention for prevention and treatment of preeclampsia, eclampsia, anaemia and last but not the least, prematurity and low birth-weight.
Ballard WM, Gold EM. Medical and Health Aspects of Reproduction in the Adolescent. Clinical Obst & Gynecol 1971; 14: 338-366.|
|2||Ghose N, Ghosh B. Obstetric behaviour in Teenagers (A study of 1138 consecutive cases). J Obst Gynecol India 1976; 26:722-726.|
|3||Israel SL, Woutersz TB. Teenage Obstetrics, A Co- operative Study. Amer J Obst and Gynaecol 1963; 85:659-668.|
|4||Philips FS, Sivakarna-Sundari S. Teenage pregnancy. J Obst & Gynecol India 1978; 28:576-581.|
|5||Sen SP. Pregnancy in Adolescence. J Obst & Gynecol India 1974; 24:93-96.