Can someone help me with a summary? I need to write a summary this articlle. Tha

Question

Can someone help me with a summary? I need to write a summary this articlle. Thank you so much!

ADOLESCENT PREGANNCY AND ITS CONSEQUENCES

INTRODUCTION

Teenage pregnancy is a parameter related to adolescent sexuality. Different customs, moral or ethical codes and behavioral manners have influenced its expression during the course of human evolution. Over the last century, puberty and sexual activity have begun at earlier ages. Delaying initial sexual intercourse would, of course, reduce the rate of teenage pregnancies, but this is not easily achieved1.

While there is general agreement about the magnitude of the problem, there is considerable dis- agreement with respect to possible solutions. Most experts concur that there is no single solution or a simple answer2. It is also a multiform problem with long-term medical, social, educational, economic and political implications. Literature reviews and statistical reports claim that adolescent mothers are at increased risk for several prenatal and obstetric complications3,4. In general, adolescent pregnancy is associated with higher rates of preterm birth and low birth weight. These outcomes seem to be related to socioeconomic factors and lack of adequate prenatal care rather than to adolescence. The social consequences of childbearing, for adolescents of any age, can be substantial. It has also been found that adolescent mothers tend to have lower cognitive scores, more difficulty in schooling and poorer health5–7.

Teenage pregnancy became a problem in the 1960s and 1970s, largely because of the increased sexual freedom of adolescents, the availability of contraceptives and the legalization of abortion in the industrialized countries8. The first multi centric report on adolescent sexuality and its consequences was published in 1976 by the Alan Guttmacher Institute in the USA. It was reported that more than 1 million teen- agers in the USA became pregnant each year9. Unfortunately, this number remained stable for more than a decade. Since then the birth rate has been found to be steadily decreasing.

Although the birth rate decreased, the teenage pregnancy rate continued to increase with the difference that a higher percentage of pregnancies were terminated in an elective abortion10. Also, adolescent sexual activity in the USA is not significantly higher than in other industrialized countries and the adolescent pregnancy rate is significantly higher. For example, it has been estimated that 101.1 per 1000 adolescents, between 15 and 19 years old became pregnant in the year 1995. Later it was reported that the birth rate in the USA in 1996 was 54.4 per 1000 adolescents. Overall, adolescent pregnancies, in 53% of cases, resulted in birth, 35% requested abortions and 12% miscarried. The decrease in adolescent pregnancy rates is most probably the result of sexual education programs and increasing rates of contraception use as well as the popularity of condom use among teenagers11,12. European data are more con- fused since recent multi centric studies do not exist. The International Federation of Pediatric and Adolescent Gynecology (FIGIJ) has published a multinational study on the rate of adolescent pregnancy in Europe13. The potential risk factors for a teenage girl to become pregnant are shown in Table 1. In the present study we were interested to determine the incidence and various other aspects related to adolescent pregnancies that were well attended, following a specific protocol.

MATERIAL AND METHODS

The medical records of two institutions of the University of Athens Medical School (1st and 2nd Departments of Obstetrics and Gynecology at Alexandra and Aretaieion University Hospitals, respectively) were reviewed. The number of adolescent pregnancies as well as the complications seen, method of delivery and abortion and miscarriage rates were recorded during a 14-year period between the years 1985 and 1998. The ages of the young women included in the study were between 14 and 19 years old.

A special protocol for the evaluation and follow-up of teenage pregnancies is a sine qua non policy in our institution3. The protocol includes a monthly clinical examination, biochemical and hormonal tests (triple test) or amniocentesis and an interview with a social worker and/or a psychologist. All pregnancies were treated following the above protocol (Table 2).

RESULTS

Among 71 680 births, 5398 occurred during adolescence and correspond to 75.3 cases per 1000 pregnancies during this period. The teenage birth rate has decreased from 9.0% in 1985 to 5.6% in 1998 (Table 3). Among the teenage pregnancies, 34% resulted in birth, 57% in abortion and 9% in mis- carriage. The mean gestational age at delivery was 38 weeks and 3 days and the mean birth weight was 2880 g. The mode of delivery was normal delivery in 84% of the cases, while 9.6% delivered by Cesarean section and 6.4% by forceps (mainly vacuum extraction). Seventy eight per cent of the cases were primagravidas. Toxemia and anemia were seen in 1.2% and 0.23% of cases, respectively. Complications such as premature separation of the placenta and placenta previa were seen in 1.08% and 1.29% of the cases, respectively.

The most common symptoms of pregnancy were missed menses, breast tenderness and vaginal bleeding (Table 4). Usually more than one symptom was reported. Ectopic pregnancies were not seen. Most adolescents were found to have an ambivalent attitude toward pregnancy; more than 60% of the pregnancies menstrual irregularities especially when a secondary amenorrhea is present. This does not imply that every adolescent, who misses a period is pregnant, as anovulatory cycles during this period of life are common. As ovulation may occasionally be seen before the first menstrual period, young women who have not yet menstruated but are sexually active are also at risk for pregnancy. In addition, in early pregnancy, bleed- ing can occur around the time of the missed menses as a result of invasion of the trophoblast into the decidua (implantation bleeding). This bleeding can be mis- taken by some adolescents as menses, leading to a delay in the diagnosis of pregnancy20. As usual during adulthood, the most frequent signs and symptoms of adolescent pregnancy include breast tenderness, fatigue, nausea and frequent urination. The above were also confirmed in the present study as shown in Table 4. With advancing gestational age the physical diagnosis of pregnancy is much more reliable. Unfortunately, these symptoms and findings are invariably present in early pregnancy and have been found to be non-specific and unreliable in predicting pregnancy21. Finally, diagnosis is confirmed by the measurement of maternal serum b-human chorionic gonadotropin (b-hCG) levels and ultrasound findings beginning at the 4th or 5th week of gestation.

In order to evaluate teenage pregnancy special attention should be given to the sexual, contraceptive and menstrual history as well as to the abdominal and pelvic examination. This evaluation is to determine the gestational age and identify potential pregnancy complications that may require emergency referral. Attention must be given to chronic medical conditions that can have consequences for pregnancy and maternal outcome. All pregnant adolescents should be referred for follow-up to special units of adolescent gynecology that provide ideal services for their needs. Adolescents experiencing abdominal pain or vaginal bleeding should be referred for more specific tests. The necessary referrals for abortion, prenatal care or adoption should also be arranged22,23.

Early and adequate prenatal care, preferably through a program that specializes in teenage pregnancies, ensures a healthier baby. Smoking, alcohol use and drug abuse should be strongly discouraged and methods of support should be offered to assist the pregnant teenager in terminating such behavior. Adequate were unplanned and in only 34% of cases was occasional contraception used.

DISCUSSION

Several studies including personal experience mention that adolescent pregnancy outcome has improved following a specific follow-up program during the gestation. It is emphasized that adequate prenatal care is the crucial variable in these follow-up programs3,14. The success of these programs is their ability to recruit pregnant adolescents early and to achieve compliance with subsequent prenatal visits. Early and continuous prenatal care is associated with improved perinatal outcomes. However, it does not explain the markedly higher low-birth-weight rates reported in adolescent deliveries15. On the other hand, the social and economic consequences of adolescent childbearing received more attention than medical complications. About 80% of teenagers who become pregnant never complete their high school education. Furthermore, normal, healthy infants born to teenage mothers were found to be more likely to die in their first year of life than those of older mothers16. The higher post- neonatal mortality rates are usually the result of infections, violence or accidents and may also be related to the young mother’s social, economic or educational limitations17,18.

Missed menses is the most common symptom lead- ing adolescents or parents to suspect pregnancy. About 68% of pregnant adolescents report having missed a menstrual period19. The menstrual history should be carefully evaluated at the first consultation. Nonetheless, pregnancy testing is important in case of nutrition must be assured through both education and the availability of community resources. Finally, follow-up by a social worker or psychologist is usually necessary.

In addition to the screening and diffusion of accurate information, the goals of counselling must also encompass primary prevention of high-risk sexual behavior and the risk factors therein. The counsellor should be seen as a knowledgeable and safe resource, who has the ability to advise the adolescent’s family on how to face sexual matters. Following the above, the pediatrician liaises between parent and adolescent. Unfortunately, multicentric studies measuring the effectiveness of primary-care clinicians and their influence on high-risk sexual behavior are limited. More- over, consistent evidence exists that some teenagers have changed their behavior in response to consultation on pregnancy, abortion and sexually transmitted diseases. Finally, instructions should be given to teenagers and the family on the use of condoms and other contraceptive methods24–26.

To prevent teenage pregnancy adolescents should be properly informed prior to their sexual debut. Primary efforts should be directed towards delaying the onset of sexual activity and on introducing contraceptive use prior to first sexual intercourse. Young people must learn that they are responsible for their own sexual behavior. The ideal learning environment is school itself and sex education should be part of the curriculum as early as primary school. However, teen- agers prefer their peers and the media as important sources of sexual information. For teenagers, visual media are usually a source of misinformation. In a study performed in our institution we found that the media and peers accounted for 11% and 35%, respectively, of sources of information received by adolescents and related to sexual activity1,3,25. Although parents would like to play this role, they may feel inadequate owing to lack of information and annoyance in discussing matters of a sexual nature, confusing their own sexual attitudes and feelings. Thus, conflict arises between parents and teenagers over these issues.

Adolescent sexual behavior is often associated with casual sexual partners and a failure to use contraception. Today, contraceptives are more widely available than ever before. However, a considerable gap still exists between the initiation of sexual intercourse and the consistent use of a reliable contraceptive method. Adolescent females do not usually think about using a contraceptive method until after they have been sexually active for up to 1 year. More than 50% of all adolescents use no form of contraception during first sexual intercourse26. High pregnancy and infection rates during adolescence are indicative of an inconsistent use of barrier methods. Among 33–50% of teenagers, who practice contraception at first inter- course, 30–40% use condoms, 20–30% use withdrawal and only 10–20% use the contraceptive pill27. In order to lower teenage pregnancy and abortion rates, as well as to prevent sexually transmitted diseases, strategic plans should be directed toward increased contraceptive availability, if possible, through family planning centers for adolescents.

Faced with unintended pregnancy many adolescents turn to abortion. Abortion is a significant health risk for a sexually active teenager. Legal and safe abortion is not always available. Thus, abortion complications are reported to be disproportionately high for adolescent women. In many countries the right to have an abortion requires all minors to obtain either parental or judicial consent. The psychological aspect is also very important and a psychologist must be avail- able if necessary.

In conclusion, adolescent pregnancy still remains both a medical and social problem. This is mainly due to the incomplete information provided to young individuals. Most adolescent pregnancies are un- wanted pregnancies. It is for this reason that abortion rates are also high during adolescence. The present study supports our previous findings3 that adequate medical follow-up of adolescent pregnancies prevents complications such as toxemia and anemia, and in most cases adolescents deliver normally. Adolescence is a critical emotional, physical and social period. Appropriate counselling by family planning centers or family is not only a stepping stone in preventing teenage pregnancy, but can also assist in healthy sexual development and safe motherhood.

Explanation / Answer

Over the last few years there has been an increase in teenage pregnancy. Teenage pregnancy is directly related to activeness of adolescent sexuality. This is seen as the fault of sexual freedom, abuse of contraceptives and the legalization of abortion. It is difficult to reduce the rate of teenage pregnancies and the ways to do it is not easily achieved. There is no simple answer or single solution to this problem making this a difficult problem to tackle.

Implications and problems of adolescent mothers

Reports and statistics claim that adolescent mothers are at increased risk for several prenatal and obstetric complications. These outcomes seem to be related to socioeconomic factors and lack of adequate prenatal care. These include:

About 80% of teenagers who become pregnant are unable to complete their high school education. Furthermore, normal, healthy infants born to teenage mothers were found to most likely die in their first year of life due to infections, violence, accidents, inadequate nutrition or care, and/or due to young mother’s social, economic or educational limitations. Abortion also poses a significant health risk for a sexually active teenager. Legal and safe abortion is not always available thus, abortion complications are reported to be disproportionately high for adolescent women.

Statistics of pregnancy in USA

In 1976 according to Alan Guttmacher Institute, USA "more than 1 million teenagers in the USA became pregnant each year." During the year 1995 it was estimated that 101.1 per 1000 adolescents, between 15 and 19 years old became pregnant and in 1996, estimate was 54.4 per 1000 adolescents in USA. Of most of the cases, 53% of cases, resulted in birth, 35% requested abortions and 12% miscarried. The teenage birth rate has decreased from 9.0% in 1985 to 5.6% in 1998 in which 34% of cases resulted in birth, 57% in abortion and 9% in miscarriage. Since then there has been steady decline in the rates of teenage pregnancy. The decrease in adolescent pregnancy rates has been accounted to sexual education programs and increased rates of contraception use among teenagers.

Symptoms of Pregnancy

The most common symptoms of pregnancy are:

During early pregnancy, bleeding can occur around the time of the missed menses which is mistaken by some adolescents as menses, leading to a delay in the diagnosis of pregnancy. Young women who have not yet menstruated but are sexually active are also at risk for pregnancy.

Evaluation and care of pregnant teenagers

To evaluate teenage pregnancy special attention needs be given to the sexual, contraceptive and menstrual history as well as to the abdominal and pelvic examinations. This evaluation also helps to determine the gestational age and identify potential pregnancy complications that may require emergency referral. Attention must be given to chronic medical conditions that may have consequences for pregnancy and maternal outcome.

All pregnant adolescents should be referred for follow-up to special units of adolescent gynecology that provide ideal services for their needs. Adolescents experiencing abdominal pain or vaginal bleeding should be referred for more specific tests. Smoking, alcohol use and drug abuse should be strongly discouraged and methods of support should be offered to assist the pregnant teenager in terminating such behavior. Finally, follow-up by a social worker or psychologist is usually necessary to help hem face the challenge of motherhood.

Prevention of Pregnancy

There are many ways to prevent teenage pregnancy. These include:

CONCLUSION

In conclusion, adolescent pregnancy still remains both a medical and social problem. This is mainly due to the incomplete information provided to young individuals. Most adolescent pregnancies are unwanted pregnancies. It is for this reason that abortion rates are high during adolescence. Adolescence is a critical emotional, physical and social period. Appropriate counselling by family planning centers or family is not only a stepping stone in preventing teenage pregnancy, but can also assist in healthy sexual development and safe motherhood.

Related Questions

Navigate

• Browse (All)
• Browse C
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.