| Abstract|| |
Aim : To evaluate complications of teenage pregnancy by Ultrasonography, Repeated ultrasonography is necessary in high risk teenagers because of the complications they face during pregnancy and labour such as IUFD, Anemia, Preeclampsia, congenital anomalies and abnormal presentations. They also face more psychological and physical stress in relation to older women. Material and Methods : One hundred and twenty Patients attending the antenatal clinic of age group of 13-20 years were taken for ultrasonography. 50 percent of patients attending the antenatal clinic are of age group of 13-20 years. Results : Abnormal presentations were seen in 10 (8.33 percent) patients and anemia was seen in 10 (8.33 percent) patients and IUFD in 6(5 percent) patients. As there are underdevelopments of pelvis and CPD In teenagers the number of caeserean sections were high. Around 43.91 percent of patients delivered by caeserean section, remaining 17.3 percent underwent assisted (Low forceps) delivery and the remaining normal deliveries (38.79 percent) Conclusions : Since the bulk of deliveries in India especially in rural areas take place at home, the risk to mother's life is high. This is compounded by early pregnancy, malnutrition and inadequate antenatal care. More than 60 percent deliveries in rural India are attended by untrained persons. This affects both infant and Maternal mortality rates. Better antenatal care, health education and awareness can reduce these complications.
Keywords: Ultrasonography, Teenage Pregnancy
|How to cite this article:|
Tripathy S, Das C. Ultrasonography in teen age pregnancy. Indian J Radiol Imaging 2003;13:169-72
| Introduction|| |
In the course of revolving years, it has been observed that the incidence of pregnancy in teenagers has perceptibly increased. This increase in incidence of pregnancy in teen agers are due to early marriage, social changes, and relative sexual freedom or emancipation of women in our society. A pregnant teen agers is subjected to greater psychological and physical stress in relation to older women. As a result pregnancy in teenagers puts her in a high risk group because there is increase in incidence of abortion, intrauterine death, anemia, preeclampsia and congenital anomalies of offspring.
Some of the fascinating mysteries of modern medicine are hidden in the statistics that report pregnancies in both married and unmarried teen age girls. The changes in the attitude of general population towards sex, the impact of media, television and literature which are sex oriented are responsible for present adolescent behaviour.
A number of studies have hinted at the possibility of poor reproductive health and higher incidence of secondary sterility due to early initiation of child bearing. Early marriages are associated with a number of health problems for the girls; early sexual activity leads to early pregnancy at a time when she is not biologically mature to rear the foetus. As such a pregnant women in her teens runs a high risk of abortion. Most adolescent girls, being illiterate are not aware of family planning methods and even if they are, they do not have easy access to family planning services or fail to utilize them due to inhibitions or pressure to attain motherhood to satisfy their mother-in-laws or husbands. Since the bulk of the deliveries in India especially rural areas takes place at home, the risk to mother's life is high. This is compounded by early pregnancy, malnutrition and inadequate antenatal care - Pathak and Ram et al 1993.
| Aim|| |
It was decided to study abnormalities and complications in pregnancy in teen agers, in the patients coming to Kamineni Institute of Medical Sciences Hospital, Narketpally, Andhra Pradesh from December 2001 to November 2002.
| Methods|| |
One hundred and twenty patients of teen age pregnancy between age group of 13-20 years were subjected to ultrasonographic examination as regards the biophysical profile, congenital anomalies, placental maturity, Amniotic fluid index and complications of pregnancy if an. Real time ultrasonography (Wipro Logiq a 100 CL 3.5 MHz was used for this study.
| Discussion|| |
The incidence of teen age pregnancy is high (50%) in the present study. In may states the mean age at marriage has already moved to 19.3 years in girls in 1991. In the present group 66 (55%) cases belong to age group of 20 years. There are over 13 million married women under the age of 18. There are over 13 million married women under the age of 18. There has been decline in the number of child marriages but adolescents are still marrying at a almost higher rate.
In 1988, 8.8% women were observed to have attained motherhood by the age group of 15-19 years. Out of 100 married women aged 15-19, 26 had attained motherhood in 1988 - Pathak. K.B, Ram. F et al 1993.
In absolute terms there were 3.3 million adolescent mothers in 1988. This means that the number of adolescent mothers has increased by 50% during the last 27 years and is likely to increase further due to the population momentum. Surprisingly the share of births occurring to adolescents among all births has also increased to 13% in 1981. The highest rates of adolescent motherhood in 1981 (i.e., above national level) have been observed in Andhra Pradesh besides other states. It is seen that highest contribution of births occurring to adolescent to total births is from Andhra Pradesh followed by Maharashtra.
[Table - 1] shows complications of pregnancy in 19-20 years of age group. Abnormal presentations were seen in 10 (8.33%) patients and anemia in 10 (8.33%) patients and anemia in 10 (8.33%) patients. IUFD seen in 06 (5%) patients and IUGR 06 (5%) vide [Figure - 1][Figure - 2][Figure - 3] patients. The patients seeking abortion are due to blighted ovum and spontaneous abortion and some are out of wedlock pregnancy and desertion by husbands and parents etc. (Allahabad et al 1990). Abortions seen in 04 (3.33%) patients. Besides PIH seen in (1.66%) vide [Figure - 4],[Figure - 5],[Figure - 6] patients. APH (placenta previa) in 02 (1.66%) patients and TWIN 02 (1.66%) patients and Cervical incompetence in 02 (1.66%) patients.
Under the economic conditions prevailing in rural India and the poor utilization of health services, the problem of adolescent motherhood is linked with child survival and material mortality. More than 60% of deliveries in rural India are attended by untrained persons. This affect both infant and maternal mortality rates.
A number of studies have shown comparatively higher infant mortality rates ( IMR) for children born to adolescent mothers. It appears then that over 3,00,000 children of adolescent mothers (15-19 years) die in infancy and further that their survival beyond infancy is comparatively lower. In fact the IMR of Children born to mothers in 15-19 group varies from 31 in Kerala to 143 in Madhya Pradesh-Pathak K.B. and Ram F et al 1993.
The Maternal Mortality Rate (MMR) in 15-19 age group is one of highest in India. MMR is declined to 28 in 1998. In the present study there is no maternal death as found by Das et al (1994). However Damania et al 1989 in retrospective analysis of maternal death found teenagers in the 15-19 years at higher risk when compared to 20-25 years age group. It is felt that IMR (especially its neonatal component) and MMR can be reduced to a great extent by educating women to utilize the services of trained dais and nurse at the time to delivery.
The phenomenon of early marriage is related to the girls schooling especially when they are in 10-14 years age group. This suggests that education of girls upto 10th Standard should be made compulsory to bring about a substantial change in the pattern of adolescent marriage. This would directly reduce the extent of adolescent motherhood which is still every high in India. It has been observed that adolescent mothers suffer a higher child loss than mothers aged 20-24 or 25-29 years. Maternal mortality among mothers aged 15-19 years is also very high as compared to that among the mothers in 20-24 years age group Pathak-K.B, Ram. F et al 1993. Due to frequent pregnancy the health of the mother is badly affected. She becomes anemic and gives birth to an underweight child who faces a higher risk of death each age.
In order to avoid these deaths we need to take steps to educate adolescent married girls about the health hazard of successive child bearing to both mother and child. There is also a need to provide them with suitable culturally sensitive opportunities for education and economic activities to delay marriage (beyond the age of 20 years). If married adolescent girls can be better educated about family planning methods and can be motivated to adopt the small family norm by postponing the birth of the first child and properly spacing births both IMR and MMR can be significantly reduced.
[Table - 2] shows literate are 10 (8.33%) patients and illiterate are 110 (91.6%) patients and socioeconomic status shows poor in 100 (83.3%) patients, married women pregnant were 118 (98.33%) patients and unmarried were 2 (1.66%) patients. Primi were 117 (97.8%) patients and multi were 0.3 (2.5%) patients and all cases were rural girls (100%) patients. Quershi (1981) observed that women from lower socio-economic group married earlier than those in middle and higher income group.
Since these patients belong to a high risk group, repeated ultrasonography is suggested to detect complications, like APH etc. Abnormal presentations and caeserean sections (43.91%) are high, presumably due to an under development of pelvis and CPD in teenagers.
| Conclusions|| |
The incidence of teen age pregnancy is high in this country, and the corresponding complications are also high. Most of the girls are undernourished. Most of the girls marry at an earlier age in this part of India inspite of legislation which has made the legal age of marriage of 21 years.
In order to make the complications less, better antenatal care, health education and awareness is mandatory. The present teen ager is a major social and economic problem. She comes from a poor socio-economic background. All of them belong to rural background. Hence health education is mandatory for these teen agers and their parents and husbands.
| References|| |
|1.||Pathak.K.B, Ram F: Adolescent Motherhood: problems and consequences. The Journal of Family Welfare, March 1993; 39 (1) : 17-23 |
|2.||Das C.R., Patnaik P.L. et al, Teen age Pregnancy, Orissa Medical Journal, 1994; 13 (1): 34-37 |
|3.||Quereshi S.M, Family Formation Pattern and Health, further studies E.D. Omran A.D, standley C.C, WHO Geneva 1981; 122. |
|4.||Park.J and Park. K. Text Book of Social and Preventive Medicine 2001, 16th Edition 386. |
|5.||Recent Advances in obstetrics and Gynaecology, S.Das Gupta 1993; 1:1. |
|6.||Ghulam. I.J. Early Teen age Child Birth, consequences for Mother and Child. WHO Regional Office for Eastern Mediterranean, H. Sharaf I et al 1982; 2:125 |
Kamineni Institute of Medical Sciences, Sreepuram, Karketpally, Nalgonda District, Andhra Pradesh-508254
Source of Support: None, Conflict of Interest: None
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
[Table - 1], [Table - 2]