Teenage pregnancy is a condition of bearing a developing embryo and fetus by a teenage girl. It is clinically manifested by the same signs as gestation in adults: the absence of regular menstruation, causeless nausea and vomiting, a change in taste habits, engorgement of the mammary glands, hyperpigmentation of the areoles and nipples, weight gain, and an increase in the circumference of the abdomen. When making a diagnosis, data from a gynecological examination, results of a pregnancy test and ultrasound of the uterus are used. When the patient decides to save the child, management tactics are aimed at the timely identification and correction of complications, the selection of an appropriate delivery method.
General information
Teenage pregnancy is not only a medical problem, but also a social one. In developed countries, its prevalence reaches 12 cases per 1,000 adolescents. According to the WHO, about 16 million girls aged 15-19 years old give birth to children each year, which makes up 11% of all births in the world. 95% of such cases are detected in low- and middle-income countries. National and religious traditions largely influence the level of teenage pregnancy - it is much less common in Islamic states. According to statistics, up to 30% of pregnancies in girls end with artificial interruption, 14% with miscarriage, and 56% with childbirth. Two thirds of minors give birth out of wedlock. By social status, 72% of patients attend school, vocational schools, or are housewives.
Causes of Teenage Pregnancy
Physiological opportunities for fertilization of the egg arise in the girl after the onset of the first menstruation (menarche). However, the real causes of early pregnancy are associated not with the biological, but with the social aspect. The provocative factors in different countries differ, in many respects they are determined by the level of economic development, organization of education and medical care, local norms and traditions. According to experts in the field of obstetrics and gynecology, the onset of pregnancy in adolescence is facilitated by:
-> Inadequate sexual education and enlightenment. Teenagers are not always fully aware of the consequences of unprotected sex, the need for and the rules of contraception. This is due to the lack of targeted programs for the sexual education of schoolchildren, the hypocritical attitude of adults, and examples of the antisocial lifestyle that parents lead. In fact, we hear a lot of True Stories where we see teenagers get pregnant due to lack of adequate sex education.
-> Sexual emancipation. 9 out of 10 girls receive their first sexual experience before the age of 20 years. This is facilitated by the availability of low-alcohol drinks, narcotic substances, and pornographic materials. According to research, adolescents who watch television shows and films with sex scenes, the risk of early pregnancy doubles.
-> Prejudice to contraception. There is still a persistent stereotype in society that the use of male barrier contraceptives reduces the severity of pleasure and affects the romanticism of relationships. As a result, some girls and girls, in fear of losing partners, are embarrassed to turn to them for protection with condoms.
-> Sexual violence. About 10% of pregnant teens under the age of 15 report a forced nature of their first sexual relationship. Often coercion to sex is caused by the girl's presence in an unfavorable social environment; much less often it is an element of blackmail by a partner who threatens to end a romantic relationship.
-> Poor socio-economic situation. This reason is one of the most significant for low-income countries. For some adolescents, financial benefits at birth and social assistance allocated before they reach a certain age become a significant argument in favor of early motherhood, and sometimes the only source of income.
Some of these reasons are relevant for poor countries with high unemployment, unavailability of educational and medical services, and low incomes. However, an increase in the frequency of early pregnancy in developed countries indicates the shortcomings of the implemented public policy and the absence of targeted efforts to solve this problem.
Pathogenesis
Although in general the development of teenage pregnancy is based on the same mechanisms as normal, it has a number of features that affect the course of the gestational period and childbirth. First of all, these features are associated with functional immaturity of the genitals and endocrine regulation systems. In the adolescent period, pregnancy complications are more often noted, the likelihood of injuries in childbirth increases. The onset of gestation in a teenager leads to an acceleration of puberty and somatic maturation processes - the size of the bone pelvis increases to typical for 16-18 year old girls, which, combined with sufficient hydrophilicity and elasticity of the ligamentous apparatus, makes the bone ring more supple.
Classification
To predict the development and selection of the optimal tactics of accompaniment, teenage pregnancy should be systematized, taking into account a number of medical, physiological and social factors. Such a classification allows you to pre-identify the risks of the gestational period, prevent possible complications and determine the optimal delivery option. The main criteria for systematizing teenage pregnancy are:
-> Menstrual age. Given the time of onset of menarche, groups of pregnant adolescents with a menstrual age of up to 1 year, 2 years, 3 years or more are distinguished. The lower the CF, the more likely the pathological course of pregnancy, childbirth and the postpartum period is.
-> The age of the pregnant. Girls under 9 years of age with accelerated sexual development are called “supernatural nulliparous”, at the age of 9-15 years with incomplete puberty - “young nulliparous”, at 15-18 years old - adolescents who are ready to realize the genital function.
-> Health condition. Depending on the presence of concomitant pathology, categories of completely healthy pregnant teenagers, young pregnant women suffering from extragenital diseases and teenage girls with gestational complications are distinguished.
-> Circumstances of the onset of pregnancy. There are primiparous girls with a desired pregnancy from prosperous and complete families, young pregnant women with an unwanted pregnancy from disadvantaged and single-parent families, adolescents who become pregnant due to rape.
Symptoms of Teenage Pregnancy
A key sign of gestation is the absence of regular periods, although girls with an unsteady monthly cycle may underestimate the significance of this symptom. A possible pregnancy is indicated by the appearance of causeless nausea and vomiting, a change in taste and food preferences, breast engorgement, and soreness in the nipple-areolar zone. As the uterus grows, urination increases, weight gain and an increase in the circumference of the abdomen are observed. For teenage pregnancies, sudden abrupt mood swings with emotional lability, tearfulness, and tantrums are characteristic. Often girls complain of unusual drowsiness, general weakness and fatigue.
Complications
Fetal gestation and childbirth have an increased burden on the immature teenage body. In addition, in recent years, there has been a significant deterioration in the somatic and reproductive health of girls - up to 75-86% of adolescents suffer from chronic somatic diseases, from 10 to 15% have genital pathologies that affect fertility. As a result, teenage pregnancy often has a complicated course. Pregnant minors are three times more likely to suffer from therapeutically resistant anemia. Every second girl develops gestosis, which manifests on average 12-14 days earlier; mainly have a moderate to severe course. Due to the presence of concomitant genital infections in the teenage age group, the likelihood of developing an ectopic pregnancy increases.
Pregnant girls of menstrual age 1-2 years more often develop fetoplacental insufficiency with hypoxia, antenatal distress and fetal growth retardation. Insufficient secretion of steroids by the fetoplacental system leads to anomalies of the birth forces. With a teenage pregnancy, the risk of spontaneous abortion, premature birth increases. Hypoglobulinemia and insufficient reserve potential of phagocytes provoke immune failure, which is manifested by an increase in infectious and inflammatory processes at the gestational and postpartum stages.
The course of childbirth directly depends on the menstrual age of the minor. With menstrual age up to 1-2 years, anatomical or functional contraction of the pelvis is observed in 50-66% of primiparous, more often pelvic presentation occurs; labor is complicated by spastic irregular contractions in the preliminary period, violent labor, and primary weakness of the labor force, soft tissue trauma, and hypotonic postpartum hemorrhage arising from pathological attachment of the placenta. Girls with 3-year menstrual age often give birth quickly or swiftly; they show signs of primary weakness or discoordination of labor, tears of the birth canal, especially the perineum and cervix, are observed. After childbirth, underage mothers are twice as likely to have postpartum endometritis, uterine subinvolution, hypogalactia, and agalactia.
Diagnostics
A feature of adolescent pregnancy is its late diagnosis, due to the fact that up to 35-55% of girls do not suspect that they have a baby, or hide it. Often, adolescents turn to an obstetrician-gynecologist only in the later stages, and 8-11% of underage pregnant women do not register at all. The “gold” standard for diagnosing the condition is based on identifying the same presumptive, probable and reliable signs as in the adult reproductive group. To finally confirm pregnancy in a girl with a delay in menstruation, spend:
-> Inspection on the armchair. With bimanual palpation, an increase in the uterus to a probable gestational period, softening of its isthmus, increased neck mobility is determined. Examination in the mirrors reveals possible signs of genital infection (inflammation of the vaginal mucosa, discharge from the cervical canal).
-> Pregnancy test. Laboratory diagnosis is based on the determination in the urine of chorionic gonadotropin, a specific hormone that begins to secrete from the time of implantation of a fertilized egg in the uterus. Modern inkjet tests are highly sensitive, and their reliability reaches 99%.
-> Ultrasound of the uterus. Sonographic examination is the most popular and affordable method that reliably confirms the fact of pregnancy in a teenager. With the help of ultrasound in the uterine cavity, the fetus, placenta, membranes are revealed. Regular screening allows you to dynamically monitor gestation, and fetometry - to evaluate the development of the fetus.
Teenage Pregnancy
After identifying gestation, a teenage girl, her relatives and employees of a medical institution must determine the feasibility of bearing a child, patient management tactics and the optimal method of delivery. Possible solutions to the problem, taking into account all the possible factors and opinions of the pregnant woman, may be:
-> Artificial abortion. It is necessary to explain to the girl and her relatives that medical or surgical abortion performed in adolescence is more often complicated by traumatic injuries of the uterus, inflammation of the reproductive organs and violation of the ovarian cycle. In the future, such patients increase the likelihood of miscarriage, infertility. If the girl insists on terminating the pregnancy, it is important to perform the intervention at an earlier date.
-> Carrying a pregnancy with natural delivery. The tactics of maintaining young primiparous does not significantly differ from standard protocols and involves timely correction of emerging complications. In more than 90% of cases, a teenage girl is able to give birth to a baby on her own. Even with an anatomically narrow pelvis, a clinical mismatch between the size of the fetal head and the pelvis of the mother is observed only in 10% of patients, which is associated with the frequent onset of premature birth.
-> Pregnancy and cesarean section. The decision on the operation in each case is taken individually, and the young age of the patient should not be taken as an obstacle to timely surgical intervention. Indications for surgical delivery in adolescent women are the same as in adult women. Caesarean section is performed to identify abnormalities of labor, clinically narrow pelvis, signs of intrapartum hypoxia resistant to conservative therapy.
In the management of a girl carrying a child, the obstetrician-gynecologist pays attention to both the medical aspects of pregnancy and the correction of the patient’s lifestyle. Since the representatives of the teenage age group often eat irregularly and unbalanced, explanatory work is carried out on the importance of a rational diet and adherence to a meal regimen. Particular attention is paid to the discussion of smoking, the use of alcohol and drugs, the prevention of sexually transmitted infections, and the psycho-prophylactic preparation for the upcoming birth. Given the increased risk of complications during childbirth, adolescent pregnant women are shown hospitalization in highly qualified obstetric hospitals at 37-39 weeks of gestational age.
Forecast and Prevention
The prognosis for the proper management of teenage pregnancy and the selection of the optimal method of delivery is favorable. The average gestational duration in the adolescent group is shorter than in adults, and averages 37.9 weeks. Providing adequate medical support can significantly reduce the risks of possible complications. Preventive measures should be aimed at preventing the early onset of sexual activity, the use of contraceptives, targeted educational work with schoolchildren and especially girls from risk groups (living in antisocial families who use alcohol and drugs).