Download Study of Some Epidemiological Factors in Teenage Pregnancy

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
CANDIDATE &
ADDRESS
Dr. SOUBHAGYA TALAWAR
POST GRADUATE STUDENT
DEPARTMENT OF OBSTETRICS &
GYNAECOLOGY,
KIMS, HUBLI-22.
2.
NAME OF THE
INSTITUTION
KARNATAKA INSTITUTE OF MEDICAL
SCIENCES, HUBLI-580 022.
3.
COURSE OF STUDY OF MS IN OBSTETRICS AND GYNAECOLOGY
STUDY AND SUBJECT
4.
DATE OF ADMISSION
TO THE COURSE
25th JUNE 2008
5.
TITLE OF TOPIC
STUDY OF MATERNAL AND FETAL OUTCOME
IN TEENAGE PREGNANCY
6.
BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for study:
Teenage pregnancy is coming up as one of the most important social and public
health problems all over the world with varying prevalence rates.
In recent years incidence is increasing due to early onset of puberty, early
sexual activity in girls and relative lack of education on contraceptive method.
It is well known that teenage faces greater risks of pregnancy than women in
their adulthood like pregnancy induced hypertension, eclampsia,
Premature onset of labour, fetal deaths and neonatal morbidities, jaundice, respiratory
distress syndrome & birth trauma.
Although adolescent marriage is congnizable offence in India, it is still a
common practice in many parts of the country. A high fertility rate, social customs,
poverty and ignorance make early marriage a common feature in this part of the world.
So this teenage group is most vulnerable and maximum attention should be diverted to
them.
6.2 REVIEW OF LITREATURE:
1. Study conducted by Bhalerao AR, Desai SV, Dastur NA, Daftary SN in 2008
They have taken 200 cases of teenage pregnancy.
Results are like this Anaemia was found in 25.5%, Pre-eclampsia 8.5%,
Eclampsia 1.5%, Spontaneous abortion 8%, 58.5% full term normal delivery,
6% Caesarean section, 2% fresh still birth, 2% macerated still birth, 46.2% low
birth weight babies.
2. Study was conducted in Institute of medical sciences, Banaras Hindu
university, varanasi, India by Ashok Kumar, Sriparna Basu, Sulekha Pandey,
V Bhargava and Tej singh in 2007 shows that restrospective case control study
was performed over 5 years for statistical purpose the sample was divided into
two groups < 17 years(GroupA) and 18-19 years (GroupB) (GroupA)
complications like pregnancy induced hypertension 11.4% versus 2.2%, pre
eclamptic toxemia 4.3% versus 0.6%, eclampsia 4.9% versus 0.6%, premature
onset of labours 26.1% versus 14.6%, low birth weight babies 50.4% versus
32.3%, Premature delivery 51.8% versus 17.5%, perinatal asphyxia 11.7/
versus 1.9%, jaundice 5.7% versus 1.2%, respiratory distress syndrome 1.9%
versus 0.3% & higher fetal 1.9% versus 0.3% and neonatal mortality 3.8%
versus 0.5%.
3. Study by Gordon C S Smith, Jill P Pell in 2001 in Queens mother’s hospital,
University of Glasgow, Glasgow, Scotland .
It was a population based retrospective cohort study. sample size of 110223
were selected out of which emergency caesarean section odds ratio 0.5, 95%
confidence interval 0.5 to 0.6. There is increased risk of moderate to extreme
prematurity and still birth.
4. Study done by Gortzak-UzanL Hallak, Press F, Katz M, Shoham Vardi in 2001
December shows that among a total of 11496 patients, rates of preterm delivery
were 14.2% is 16-17 years old, 9.8% in 18-19 years old age group. Rates of
small for gestational age, low birth weight and very low birth weight were
significantly higher in the youngest mothers.
5. Study was done by Ambedkar NN, DW Khandait, SP Zodpey, NB Kasturwar
and ND Vasudeo, in Government Medical college, Nagpur. Sample of 462
pregnant ladies less than 20 years in comparison to 500 primipara ladies,
( 20- 29 years). The results were preterm deliveries in the study group was
16% and in controls it was 2.8%, preeclampsia rate was 20.5% in study and in
controls it was 12.6%, eclampsia rate was 2.8% in study group and 0.6% in
controls, cpd was 9.1% in study group and 1.8% in controls. This study showed
that their was increase rate of preterm deliveries, preeclampsia, eclampsia, and
cpd in teenage pregnancies.
6.3 Objectives of study:
1. To evaluate the effect of pregnancy in teenage girls (13-19 years)
2. To evaluate maternal outcomes in teenage pregnancy (13-19 years)
3. To know the fetal outcomes in teenage pregnancies(13-19 years)
7.
MATERIAL AND METHODS
7.1 Source of data
Cases of teenage pregnancies admitted in ANC ward & labour room, KIMS,
Hubli, during the study period of January 2009 to December 2009.
7.2 Methods of collection of data
A performa is designed for each patients all teenage pregnancies (13-19 years)
attending KIMS hospital in a study period of January 2009 – to December 2009
Inclusion Criteria:
All teenage pregnancies in primigravida with singletone pregnancies without
any medical disorders.
Exclusion Criteria
- Teenage multigravida
- Twin gestation
- Associated medical disorders like
- Cardivascular disorders
- Hypertensive disorders
- Respiratory disorders
- Endocrinologic disorders
- Previous history and investigations suggestive of medical disorders.
7.3 Does the study require any investigations to be conducted on patients on
animals specify.
Yes, patients needs
Routine- Hemoglobin percentage, blood group & urine routine
Screening-HIV test, HbsAg test and VDRL TEST
Ultrasonography
7.4 Has ethical clearances been obtained from ethical committee of your
institution In case of 7.3?
Yes, ethical clearance has been obtained from ethical committee of KIMS,
HUBLI.
8.
LIST OF REFERENCES
1. Bhalerao AR, Desai SV, Dastur NA, Daftary SN, Outcome of teenage
pregnancy. Journal of post graduate Medicine. 2008;36:136
2. Ashok kumar, Tej singh, Sriparna Basu, Sulekha Pandey and V. Bhargava.
Outcome in teenage pregnancy. Indian journal of Pediatrics 2007;74(10):927948
3. Gordan C S Smith and Jill P Pill. Teenage pregnancy and risk of adverse
perinatal outcomes associated with first and second births: population based
retrospective cohort study. British Medical Journal 2001; September ; 323:476
4. Gortzak, Hallak M, Press F, Katz M, Shoham. Teenage pregnancy: risk factors
for adverse perinatal outcome. Journal of Maternal- Fetal Medicine,2001
Dec;10(6):393-397.
5. Ambedkar NN, DW Khandait, SP Zodpey, NB Kasturwar
and
ND Vasudeo. Teenage pregnancy outcome. Indian Journal of Medical Sciences
1999; 53(1): 19-23.
9
SIGNATURE OF
CANDIDATE
10
REMARKS OF THE
GUIDE
11
NAME &
DESIGNATION
11.1 GUIDE
Dr. SEETA GARAG
MD,DGO
PROFESSOR,
DEPARTMENT OF OBSTETRICS &
GYNAECOLOGY, KIMS, HUBLI
11.2 SIGNATURE
11.3 HEAD OF THE
DEPARTMENT
11.4 SIGNATURE
12
12.1 REMARKS OF
CHAIRMAN &
PRINCIPAL
Dr. U.S.HANGARGA
MD
PROFESSOR & HEAD OF DEPARTMENT OF
OBSTETRICS & GYNAECOLOGY, KIMS, HUBLI
12.2 SIGNATURE
Indian Journal of Community Medicine
All Medical Journals Issues Contents Editorial Board
& Information
Study of Some Epidemiological Factors in Teenage
Pregnancy - Hospital Based Case Comparison Study
Author(s): M.S. Chahande, A.R. Jadhao, S.K. Wadhva, Suresh Ughade
Vol. 27, No. 3 (2002-07 - 2002-09)
Government Medical College and Hospital, Nagpur
Abstract:
Research questions: 1. What are epidemiological factors related with teenage
pregnancy? 2. What are outcomes and complications associated with teenage pregnancy?
Objectives: To study epidemiological factors related with teenage pregnancy and its
outcome and complications.? Study design: Hospital based cross-sectional study with
comparison group.?
Setting: Government Medical College and Hospital, Nagpur.?
Participants: Of all the women who delivered in labour wards of Govt. Medical College
and Hospital, Nagpur from 1st October 1999 to 30th June 2000, 462 women <20 years
constituted the cases and 500 primiparous women in the age group of 20-29 years formed
the comparison group.?
Study variables: Socio-demographic factors, pregnancy outcome and complications.?
Statistical analysis: Chi-square and Z test, Odds Ratio, 95% C.I.?
Results: Mean age of cases was 18.5 years and that of comparison group was 22.4 years.
Incidence of still birth, preterm delivery, low birth weight and complications during
pregnancy and labour like toxaemia of pregnancy, eclampsia, cephalopelvic
disproportion were more in teenagers. However, caesarean section rate was not
significantly different in two groups. Relation of antenatal care services and favourable
outcome did not show any statistical significance.?
Keywords:Teenage pregnancy, Pregnancy outcome, Complications
Introduction:
Teenage pregnancy is on the rise, emerging as a serious problem today all over the world
and more so in the developing countries like India, as early marriages and early
pregnancy are the accepted cultural norms of our society1. Pregnancy in very young
women is generally considered to be a very high risk event, because teenage girls are
physically and psychologically immature for reproduction. In addition, there are some
extrinsic factors such as inadequate prenatal care, illiteracy, poor socio-economic
conditions which affect the outcome of pregnancy in teenage girls2,3. While there is a
growing recognition of the need for action to promote adolescent reproductive health,
work done in this field is often piecemeal4.
Material and Methods:
Present hospital based cross-sectional study with a comparison group was carried out on
inpatients of department of Obstetric and Gynaecology at Government Medical College
and Hospital, Nagpur.
462 women <20 years who delivered at Government Medical College and Hospital,
Nagpur over a period of 9 months from 1st October 1999 to 30th June, 2000 constituted
the cases. The comparison group included 500 primiparous women in the age group of
20-29 years who delivered at Government Medical College and Hospital, Nagpur during
the same period.
The data was collected using a predesigned and pretested schedule, using interview
technique. Data was analysed and appropriate statistical tests were applied wherever
required.
Results:
Majority of the cases (97.8%) were in the age group of 18-19 years. Mean age of the
cases was 18.5 years. In the comparison group majority (81.0%) were in the age group of
20-22 years. 302(65.3%) cases and 313(62.6%) females from comparison group belonged
to Hindu community, rest of them belonged to Budh, Muslim and Christian community.
40(8.6%) cases and 35(7.0%) women from comparison group were illiterate. Husbands of
18(3.9%) cases and 25(5.0%) from comparison group were illiterate.
246(53.2%) cases and 376(75.2%) women from comparison group were house-wives.
Husbands of 283(61.3%) cases and 310(62.0%) from comparison group were labourers.
Of the total 462 cases, 246(53.2%) were from urban area and 216(46.8%) were from rural
area. Out of 500 women from comparison group 283(56.6%) were from urban area and
217(43.4%) were from rural area. 188(76.5%) cases belonged to middle socio-economic
status and rest belonged to lower and upper socio-economic status in urban area, whereas,
in rural area 183(84.7%) belonged to middle socio-economic status and rest belonged to
lower and upper socio-economic status.
Mean age of marriage in cases was 16.7 years and in comparison group 18.6 years.
137(29.6%) cases and 8(1.6%) from comparison group got married due to their parents
wish. Other reasons were custom in village (24.4% in cases, 11.1% in comparison group),
custom in religion (22.0% in cases, 25.1% in comparison group). In 3(0.6%) unmarried
girls reasons for pregnancy was rape.
Essential antenatal care was received by 418(91.2%) cases and 452(90.4%) females from
comparison group. 418(91.1%) cases and 452(90.4%) from comparison group were
registered before 16 weeks. 421(91.7%) cases and 456(91.2%) women from comparison
group consumed iron and folic acid tablets for three months. 446(97.2%) cases and
485(97.0%) from comparison group received tetanus immunisation.
Table I: Pregnancy outcome in study subjects and comparison group.
Pregnancy outcome
Study subjects Comparison group
No.
(%)
No.
(%)
Live birth
439
(94.6)
490
(97.6)
Still birth
25
(5.4)
12
(2.4)
Total
464
(100)*
502
(100)
*2 twin deliveries in study subjects and comparison group.
x2 = 5.88, df = 1, OR = 2.32, 95%CI = 1.11-5.14, p=0.0153
Table I clearly shows the high incidence of still birth in teenagers as compared to
comparison group. This difference was found to be statistically significant.
Relation of antenatal care services and unfavourable outcome did not show any statistical
significance. Preterm deliveries occurred in 74(16.0%) cases and 14(2.8%) from
comparison group. Incidence of preterm deliveries was 5 times more in teenage mothers
and the difference was found to be statistically significantfont face="Arial" size="2">(x2
= 19.38, df = 1, p<0.0001).
Caesarean section rate (27.3%) in teenage mothers and (26.4%) in comparison group did
not show statistically significant difference.
Table II: Birth weight of babies in study subjects and comparison group.
Birth weight
<2 Kg.
Study subjects Comparison group
No.
86
(%)
(18.5)
No.
>19
(%)
(3.8)
2-2.5 Kg
251
(54.1)
278
(55.4)
>2.5 Kg.
127
(27.4)
205
(40.8)
Total
464
(100)
502
x2 = 19.38, df = 1, OR = 1.83, 95%CI = 1.35-2.42, p=0.0001
It is obvious from Table II that the incidence of low birth weight babies is higher in
teenage group, `p' value being significant. Low socio-economic status, inadequate
antenatal care and mother's nutrition are the common causes predisposing to delivery of
low birth weight babies.
Table III: Complications during pregnancy and labour in study subjects and
comparison group.
Complications during pregnancy and labour l
Study
subjects
(n=462)
No.(%)
Complications
Toxaemia of
pregnancy
95
Eclampsia
13
APH
Comparison
group
(n=500)
No.(%)
OR
95% CI
x2
df
p
63
(12.6)
2.88
1.944.28
31.55 1
<0.0001
(2.8)
3
(0.6)
8.28
2.2245.79
14.71 1
<0.0001
4
(0.8)
5
(1)
1.53
0.307.21
0.4
1
>0.5287
Preterm labour
75
(16.2)
14
(2.8)
10.24
5.4820.00
74.81 1
<0.0001
Foetal distress
82
(17.7)
105
(21)
1.49
1.032.15
5.01
1
<0.0252
Cephalopelvic
disproportion
42
(9.1)
9
(1.8)
8.92
4.1221.33
43.9
1
<0.0001
Retained
placenta
3
(0.6)
4
(0.8)
1.43
0.218.59
0.22
1
>0.6387
ike toxaemia of pregnancy, eclampsia, preterm labour, cephalopelvic disproportion were
more in teenagers as compared to comparison group. The difference was found to be
statistically significant. Whereas, complications like antepartum haemorrhage and
retained placenta showed no statistically significant difference. The risk of toxaemia of
pregnancy is almost three times more in study group as compared to comparison group.
Main indication for caesarean section in teenagers was cephalopelvic disproportion
(33.3%), whereas, in comparison group it was only in 6.8%. This difference was found to
be statistically significant (x2 = 36.56, df = 2, p<0.001).
Discussion:
There is substantial evidence to suggest that early child bearing is on the increase every
where and it presents a serious problem in many countries1. The minimum legal age of
marriage for girls as envisaged in the national policy by Government of India is 18 years,
even then the problem of teenage pregnancy is widespread, as early marriages are still
prevalent in Indian community3. There is evidence that teen age may constitute "high risk
group" in reproductive terms because of assumed double burden of reproduction and
growth, reports on the subject are inconsistent5.
The purpose of this investigation, therefore, was to evaluate the characteristics and the
outcome of the pregnancy in teenage girls and compare them with other women of the
age group 20-29 years5. The results of this study confirm the findings of other studies in
showing that pregnant teenagers experience higher risk of adverse perinatal outcome and
various complications during pregnancy and labour1-3,5-8.
Though caesarean section rate was not high in the present study the main indication was
cephalopelvic disproportion. The pelvic architecture is not yet completely formed and
mature enough for term delivery. Therefore, cephalopelvic disproportion is the
commonest problem encountered during labour, the p value being significant1.
Emphasis on delaying the onset of child bearing beyond 20 years of age should be an
important element of population control programme1.
References:
1. Nitwe MT et al. Teenage Pregnancy, A Health Hazard. J Obst and Gyn of India,
1989; 39: 303-6.
2. Bhaduria S et al. Teenage pregnancy: A retrospective study. J Obst and Gyn of
India, 1991; 41(4): 454-6.
3. Kale KM et al. Socio-medical correlates of teenage pregnancy. J Obst and Gyn of
India, 1996; 46(2): 180-4.
4. Pandit SN, Rao S. Teenage pregnancy - Unmet needs for counselling. J Obst and
Gyn of India, 1999; 49(5): 140-4.
5. A detoro OO, Agah A. The implication of child bearing in post pubertal girls in
Sokoto, Nigeria. International J Obst and Gyn, 1988; 27: 73-7.
6. Ambadekar NN et al. Teenage pregnancy outcome. Indian J of Medical Sciences
1999; 53(1): 19-23.
7. Bacci A et al. Outcome of teenage pregnancy in Maputo, Mozambique.
International J Obst and Gyn, 1993; 40: 19-23.
8. Ventura S, Green ES. Risk in pregnant teenagers. International J Obst and Gyn,
1990; 32: 7-13.
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