|Year : 2018 | Volume
| Issue : 1 | Page : 32-36
The presentation and pregnancy outcome among teenage parturients in state specialist hospital, Asubiaro, Osogbo, Southwestern, Nigeria
Olalekan Olugbenga Awolola
Department of Obstetrics and Gynaecology, State Specialist Hospital, Asubiaro, Osogbo, Osun State, Nigeria
|Date of Web Publication||3-Apr-2018|
Dr. Olalekan Olugbenga Awolola
Department of Obstetrics and Gynaecology, State Specialist Hospital, Asubiaro, Osogbo, Osun State
Source of Support: None, Conflict of Interest: None
Background: Teenage pregnancies are pregnancies between the age group of 13 and 19 years. Such pregnancies are categorized as high-risk pregnancies worldwide. This makes monitoring during the antenatal, intrapartum, and puerperal periods highly important. Objectives: The aim of this study is to determine the incidence, the mode of presentation, and the materno-fetal outcome in teenage parturients and compare with a control group. Materials and Methods: this prospective case–control study, recruited 63 teenage parturients who presented in labor ward in active phase labour between February 2013 and January 2015. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1 cm), but are of age, 22–30 years. Thus, a total number of 126 parturients were studied. The mothers and their babies were followed up until the first 7th day postpartum. Results: In this study, 39 (61.90%) and 24 (38.10%) were married and unmarried, respectively, among the teenage parturients, whereas 60 (95.24%) and 3 (4.7%) were married and unmarried among the control group. Majority of the teenage parturients, 57 (90.47%) had only primary and secondary education, while 59 (93.47%) among the controls had secondary and tertiary levels of education. There were statistically significant differences in the incidences of genital lacerations (9 [14.28%] and 2 [3.18%]: P < 0.05), and the incidences of anemia in pregnancy (9 [14.28%] vs. 2 [3.18%]: P < 0.05) in the teenage and the older parturients. The other outcome measures in the two groups were similar. Conclusion: This study showed that teenage pregnancies with good antenatal, intrapartum, and neonatal care, gives almost the same materno-fetal outcomes as the control group. The determining factors for poor maternal and fetal outcomes are poor socioeconomic status and lack or poor quality of antenatal, intrapartum, and puerperal care.
Keywords: Anemia in pregnancy, birth asphyxia, low birthweight, perineal injury, preterm labor, teenage pregnancy
|How to cite this article:|
Awolola OO. The presentation and pregnancy outcome among teenage parturients in state specialist hospital, Asubiaro, Osogbo, Southwestern, Nigeria. J Mahatma Gandhi Inst Med Sci 2018;23:32-6
|How to cite this URL:|
Awolola OO. The presentation and pregnancy outcome among teenage parturients in state specialist hospital, Asubiaro, Osogbo, Southwestern, Nigeria. J Mahatma Gandhi Inst Med Sci [serial online] 2018 [cited 2019 Nov 20];23:32-6. Available from: http://www.jmgims.co.in/text.asp?2018/23/1/32/229152
| Introduction|| |
Teenage pregnancy is pregnancy between the ages of 13 and 19 years or pregnancy under the age of 20 at the time that the pregnancy ends. This is the period of transition from childhood to fully grown adulthood biologically, psychologically, socially, and emotionally. Thus, full maturation has not been achieved during this period.
Teenage pregnancies occur in all races and cut across all socio-economic classes and religions. It is more common in some races and more frequent in people of low socio-economic classes. It is categorized as a high-risk pregnancy and has been reported to be associated with medical, physical, psychological, and social consequences, especially where the patients involved are not or poorly educated, single or from a poor socioeconomic family background.
The incidences of teenage pregnancy vary from the region-to-region and determined by cultural, religion, political, economic status of the area, availability and acceptability of contraception, cultural and religion attitudes toward sex. In Nigeria, the reported incidences varies from as low as 1.6% in an urban city such as Enugu to as high as 45.4% in a rural community in Abia, Southeast, Nigeria.,,,,,,,,, Although the incidences may be higher than these, because some pregnancies might have been terminated. Other incidences quoted in other countries are; 9% in Thailand, 4% in India, 6.85% in Bharatpur Nepal, and 2.9% in South Korea.,,,
Unfortunately, most cases of teenage pregnancies occur in Sub-Saharan Africa., Teenage mothers are associated with poor socioeconomic status, unemployed, little or no education, unmarried and atimes in forced marriages. The age for optimum obstetric performance of women is in their twenties, thus pregnancies before and after twenties are likely to results in adverse maternal and fetal outcomes.,,,,,,, However, many authors reported divergent views on the obstetric outcomes. Some authors reported similar outcomes for the teenage pregnancies and their older counterparts. While some reported better outcomes in teenage pregnancies, as compared with their older peers.
The commonly associated materno-fetal complications are anemia in pregnancies, preterm labor and deliveries, low birth weight, pregnancy-induced hypertension, preeclampsia, eclampsia, increased cesarean section rate, birth asphyxia, interventions in labor such as augmentation in labor and instrumental vaginal deliveries.,,,,,
A similar study has not been carried out in this center, hence the need to determine the incidence, the mode of presentation and obstetric outcomes to review our antenatal care program and the management of these patients in labor to improve on their obstetric performance.
| Materials and Methods|| |
This prospective case–control study was carried out in the Department of Obstetrics and Gynaecology, State Specialist Hospital, Asubiaro, Osogbo, Osun State, Nigeria, between February 2013 and January 2015. All the 63 teenage parturients, admitted into the Labour Ward in active phase labor during this period were recruited into the study. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1), but are of age group of 22–30 years. Thus, a total number of 126 parturients were studied. All patients in the two groups had their packed cell volume, and Hemoglobin concentration assessed on admission to identify those with anemia in pregnancy. The mothers and their babies were followed up until the first 7th day postpartum.
The State Specialist Hospital, Asubiaro, Osogbo, is a multicenter facility located in Osogbo the capital of Osun State, Nigeria. It serves as one of the major referral centers in the state, receiving patients from all the local government areas in the state. Patients are referred from private, mission, and government-owned hospitals. The hospital delivery rate in the past few years has been about 1980 per year with an average monthly delivery of 165.
Patients with clearly defined factors that will affect the outcome of pregnancies were excluded from the study. These includes; Antepartum hemorrhage secondary to either abruptio placentae or placenta praevia, severe preeclampsia or eclampsia, fibroids coexisting with pregnancy (of diameter >5 cm), maternal height <1.5 m, known sickler (Hbss), previous uterine scar such as myomectomy or cesarean section, abnormal lie, abnormal presentation such as breech presentation and multiple gestations.
The social classes of the parents of the parturients were determined, using the Social Class Scoring System by Olusanya et al., because the majority of the teenage parturients were unmarried, and using their educational level alone to determine the socioeconomic background may not be appropriate.
The outcome measures considered were preterm labor and deliveries, low birthweight, birth asphyxia, neonatal jaundice, neonatal sepsis, early neonatal deaths, anemia in pregnancy, intrapartum preeclampsia and eclampsia, cesarean section rate, primary postpartum hemorrhage, puerperal sepsis, and maternal mortality.
The patients were adequately counseled and an informed verbal consent obtained from them before recruitment into the study.
The data were collected from the two groups in structured obstetric data sheets. The sociodemographic characteristics and pregnancy outcome measures were analyzed with a personal computer using SPSS version 20.0 (SPSS IBM Corp. Armonk, NY, USA). Chi-square test was used to determine the associations between the two groups and P < 0.05 was considered statistically significant.
| Results|| |
In this study, the incidence of teenage deliveries in our center was 1.6%. The mean maternal ages for the study and the control groups were 18.38 + 0.86 years and 25.62 + 1.80 years, respectively. The mean gestational ages at booking were 27.84 + 2.50 weeks and 28.29 weeks for the teenage parturients and the control group, respectively. When the two groups were compared in terms of mean maternal age and gestational ages at bookings, there was no statistically significant difference between them.
[Table 1] shows the sociodemographic characteristic of the two groups, 39 (61.90%) and 24 (38.10%) were married and unmarried, respectively, among the teenage parturients, while 60 (95.24%) and 3 (4.7%) were married and unmarried among the control group. Majority of the teenage parturients 57 (90.47%) had only primary and secondary education, whereas 59 (93.66%) among the controls had a secondary and tertiary education. When the two groups were compared, there were statistically significant differences in terms of marital status and level of education (P< 0.05). The booking status in the two groups was almost similar, with 54 (85.71%) and 9 (14.29%) were booked and unbooked among the teenage parturients while 58 (92.06%) and 5 (7.94%) were booked and unbooked among the control group. There was no statistically significant difference in between the two groups when they were compared in terms of booking status (P > 0.05).
The mean gestational age at delivery in the two groups were; (38.86 + 1.18 vs. 39.46 + 0.99: P <0.05). Thus, there was the statistically significant difference between the two groups in terms of the gestations at delivery.
Analysis of the parents' social class was carried out to assert the actual socio-economic background of their parents. It showed that 51 (80.96%) of the teenage parturients were from lower and middle socioeconomic background while 23 (36.51%) and 40 (63.49%) of the parturients in the control group were from middle and high social classes. None of the parturients in the control group came from low social class [Figure 1]. There was the statistically significant difference when the two groups when compared in terms of the social classes of their parents.
[Table 2] compares the obstetrics outcomes in the two groups. The routes of deliveries in the 2 groups were similar; Cesarean sections (6 [9.52%] vs. 9 [14.29%]: P > 0.20), vaginal deliveries (55 [87.31%] vs. 59 [85.71%]: P > 0.20). Two (3.17%) among the teenage parturients had instrumental vaginal deliveries (Vacuum extractions) for poor maternal efforts in the second stage of labor. The mean fetal birth weights were 2.86 + 0.32 Kg and 3.12 + 0.33 Kg for the teenage parturients and the control group, respectively.
|Table 2: compared the adverse pregnancy outcomes among the cases and the controls|
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[Table 3], compared the adverse pregnancy outcomes only between the married and the unmarried teenage parturients. This is to observe whether those unmarried teenagers with unwanted pregnancies had more adverse outcomes as compared with the married teenage parturients.
|Table 3: Comparison the adverse pregnancy outcomes between the married and unmarried teenage parturients|
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Interestingly, we observed that, 24 (38.10%) of the teenage parturients were unmarried with unwanted pregnancies, compared with 3 (4.74%) of the control group [P value <0.0001]. We later observed that there was a statistically significant difference between the married and the unmarried parturients in terms of anaemia in pregnancy. Nine cases of anaemia in pregnancy were recorded among the teenage parturients. Seven (77.78%) of these teenage parturients were unmarried or single ladies. [P value <0.05].
There were more cases of anemia in pregnancy 9 (14.28%) among the teenage parturients than 2 (3.18%) among the controls (P< 0.05), genital injuries were also higher among the teenage parturients than the controls; (9 [14.28%] vs. 2 [3%–18%]: P < 0.05). The teenage parturients also had more interventions (mainly augmentation of labor) for poor progress in labor; (11 [17.46%] vs. 5 [7.94%]: P > 0.10). There were statistically significant differences when the 2 groups were compared in terms of anemia in pregnancy and genital injuries, but not in terms of interventions in labor. Other parameters, such as low birthweight, preterm deliveries and birth asphyxia, showed similar outcomes.
| Discussion|| |
In this study, the incidence of teenage deliveries was 1.6%, this is similar to the value of 1.7% reported by Ebeigbe and Gharoro in Benin-city, but much lower than 2.25% and 2.65% reported in Abakaliki and U. S. A.,,
The teenage parturients were mostly unmarried as compared to the controls. This was due to the fact that, they were not ready for the pregnancies. This is similar to reports from other centers.,, Although a different pattern was reported in northern part of Nigeria where early marriage is practiced due to religion and cultural influences.
In this study, most of the teenage parturients were from low social class, and the parturients themselves had only primary and secondary school education, some were even secondary school dropout., The social classes of their parents were taken into consideration to determine their actual socioeconomic background since they were mostly unmarried. Conversely, parturients in the control group were more educated; mostly with the secondary and tertiary level of education and from the middle and high socioclasses background.
The parity in the two groups were similar since the groups were matched in parity and were mostly nullipara; 62 (98.41%) and 62 (98.41%) in the two groups. The booking pattern and frequencies of antenatal clinic visits were similar in the two groups. This may be due to the free Obstetric Care Services in the state by the state government. A similar result was reported in Kano possibly because most of the teenage parturients in Kano were married. Thus, the pregnancy was prepared for and not accidental or unwanted. This was however different from results from Bharatpur in Nepal and Abakaliki where the teenage parturients were mostly unmarried and unbooked.,
In this study, the routes and modes of deliveries were similar in both groups. Although similar studies in Benin-city and Bayelsa state in Nigeria reported higher incidences of Caesarean section rates among the teenage parturients than the older group., Surprisingly, reports from other centers showed lower caesarean section rates among the teenage parturients compared to the older age group.,,,
Anemia in pregnancy, genital injuries and interventions in labor (namely augmentation of labor) were higher among the teenage parturients than the control parturients, although, statistically significant differences were only seen when the two groups were compared in terms of anemia in pregnancy and genital injuries. The higher incidence of anemia in pregnancy was similar to findings in previous studies.,,,, Most of the cases of anemia in pregnancy in the 2 groups were mostly unbooked while those among the booked cases were those with antenatal clinic attendance of <3 visits. Interestingly, when the married and unmarried teenage parturients were compared in terms of anemia in pregnancy, there was a statistically significant difference between the two groups. This was possibly due to the lack of care and supports during pregnancy. Although most of the previous studies did not consider genital injuries as one of the outcome measures as considered in this study, Ebeigbe and Gharoro reported similar findings in terms of augmentation of labor in Benin-City, in Nigeria.
The fetal outcomes among the teenage parturients and the older parturients were similar in this study. Fortunately, we did not record any case of maternal mortality in this study.
It is suggested that a similar prospective case–control study involving a larger number of teenage parturients, over a longer period such as 5 years be carried out to further highlight the maternal and fetal outcomes of teenage pregnancies.
| Conclusion|| |
This study showed that teenage pregnancies with good antenatal care and follow-up, quality intrapartum monitoring and good neonatal care gives almost the same materno-fetal outcomes as their counterpart of older age group. The reasons for the poor maternal and fetal outcomes are poor antenatal clinic visits and care, socioeconomic status and lack of the desire to be a mother because they are not psychologically, socially, financially, and educationally matured for childbearing.
The solution to this problem is to prevent teenage pregnancies by; making education up to secondary school level compulsory and free for the girl child, health education, provision of affordable, available, safe, and acceptable contraceptive services for our teenagers where necessary and the provision of free and qualitative obstetric care services in both the rural and urban areas.
I am very grateful to the Medical officers, House officers and the Nurses in the Antenatal Clinic and Labour Ward, who helped in identifying these patients and comanaged the patients with me. I also admire the patient's compliance with the follow-up management.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]