Teenage pregnancy is the state of gestation of a developing embryo and fetus by an underage teenage girl. It is clinically manifested by the same signs as gestation in adults: the absence of regular menstruation, causeless nausea and vomiting, changes in taste habits, breast enlargement, hyperpigmentation of the areoles and nipples, weight gain, an increase in the circumference of the abdomen. When making a diagnosis, gynecological examination data, pregnancy test results and ultrasound of the uterus are used. When the patient decides to save the child, the management tactics are aimed at timely detection and correction of complications, the choice of a suitable method of delivery.
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 WHO, about 16 million girls aged 15-19 give birth to children every year, which is up to 11% of all births in the world. 95% of such cases are detected in low- and middle-income countries. The level of teenage pregnancy is largely influenced by national and religious traditions – in Islamic states it is much less common. According to statistics, up to 30% of pregnancies in girls end with artificial termination, 14% — miscarriage, 56% — childbirth. Two thirds of minors give birth out of wedlock. By social status, 72% of the patients study at school or are housewives.
Physiological possibilities for fertilization of an egg arise in a girl after the onset of the first menstruation (menarche). However, the real reasons for early pregnancy are not related to the biological, but to the social aspect. The provoking factors differ in different countries, largely determined by the level of economic development, the 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 promoted by:
- Insufficient sexual education. Teenagers are not always fully aware of the consequences of unprotected sex, the need and rules of contraception. This is caused by the lack of targeted programs for sexual education of schoolchildren, the sanctimonious attitude of adults, examples of an antisocial lifestyle that parents lead.
- Sexual liberation. 9 out of 10 girls get their first sexual experience before the age of 20. This is facilitated by the availability of low-alcohol beverages, narcotic substances, pornographic materials. According to research, adolescents who watch TV shows and movies with sex scenes have a doubling risk of early pregnancy.
- Prejudice against 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 their partners, hesitate to ask them for protection with the help of condoms.
- Sexual violence. About 10% of pregnant teenagers under the age of 15 report the forced nature of their first sexual relations. Often, coercion to sex is caused by the girl’s stay in an unfavorable social environment, much less often it is an element of blackmail on the part of 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 teenagers, financial benefits at the birth of a child and social assistance allocated until 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, the increase in the frequency of early pregnancy in developed countries indicates the shortcomings of the implemented state policy and the lack of targeted efforts aimed at solving this problem.
Although, in general, the development of teenage pregnancy is based on the same mechanisms as usual, it has a number of features that affect the course of the gestational period and childbirth. First of all, these features are associated with the functional immaturity of the genitals and endocrine regulation systems. In the teenage period, pregnancy complications are more often noted, the likelihood of injury in childbirth increases. The onset of gestation in a teenager leads to an acceleration of the processes of sexual and somatic maturation – 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 malleable.
In order to predict the development and choose the optimal tactics for accompanying teenage pregnancy, it is advisable to systematize, taking into account a number of medical, physiological and social factors. This classification allows you to identify the risks of the gestational period in advance, prevent possible complications and determine the optimal delivery option. The main criteria for the systematization of teenage pregnancy are:
- Menstrual age (MA). Taking into account the time of onset of menarche, groups of pregnant adolescents with menstrual age up to 1 year, 2 years, 3 years or more are distinguished. The lower the MA, the greater the probability of a pathological course of pregnancy, childbirth and the postpartum period.
- The age of the pregnant woman. Girls under 9 years of age with accelerated sexual development are called “super—young primiparous”, at the age of 9-15 years with incomplete puberty — “young primiparous”, at 15-18 years of age – teenagers ready to realize the childbearing function.
- State of health. Depending on the presence of concomitant pathology, there are categories of completely healthy pregnant adolescents, young pregnant women suffering from extragenital diseases, and adolescent girls with complications of the gestational period.
- Circumstances of pregnancy. There are primiparous girls with the desired pregnancy from prosperous and full families, young pregnant women with unwanted pregnancies from dysfunctional and incomplete families, teenagers who became pregnant as a result of rape.
Symptoms of teenage pregnancy
The key sign of gestation is the absence of regular menstruation, 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, changes in taste and food preferences, breast swelling, soreness in the nipple-areolar zone. As the uterus grows, the urge to urinate becomes more frequent, weight gain and an increase in the circumference of the abdomen are observed. Teenage pregnancies are characterized by sudden sharp mood swings with emotional lability, tearfulness, tantrums. Girls often complain of unusual drowsiness, general weakness and fatigue.
Fetal gestation and childbirth have an increased burden on the immature adolescent 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 pathology affecting fertility. As a result, teenage pregnancy often has a complicated course. Underage pregnant women are three times more likely to suffer from therapeutically resistant anemia. Every second girl has gestosis, which manifests on average 12-14 days earlier, mainly has a moderate or severe course. Due to the presence of concomitant genital infections in the adolescent age group, the likelihood of developing an ectopic pregnancy increases.
Fetoplacental insufficiency with hypoxia, antenatal distress and fetal development delay is more often formed in pregnant girls of menstrual age 1-2 years. Insufficient secretion of steroids by the fetoplacental system leads to anomalies of labor forces. With the teenage version of pregnancy, the risk of spontaneous abortions and 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 labor directly depends on the menstrual age of the minor. With MA up to 1-2 years of age, anatomical or functional narrowing of the pelvis is observed in 50-66% of primiparous women, pelvic presentation occurs more often, childbirth is complicated by spastic irregular contractions in the preliminary period, violent labor activity, primary weakness of labor forces, soft tissue traumatization, hypotonic postpartum bleeding that arose due to pathological attachment of the placenta. Girls with 3-year-old MA often give birth quickly or rapidly, they have signs of primary weakness or discoordination of labor activity, ruptures of the birth canal are observed, especially the perineum and cervix. After childbirth, postpartum endometritis, uterine subinvolution, hypogalactia and agalactia are detected twice as often in underage women in labor.
A feature of teenage pregnancy is its late diagnosis, due to the fact that up to 35-55% of girls do not suspect that they are carrying a child, or hide it. Teenagers often turn to an obstetrician-gynecologist only at late stages, and 8-11% of underage pregnant women do not register at all. The “golden” standard for the diagnosis of the condition is based on the identification of the same presumptive, probable and reliable signs as in the adult reproductive group. To finally confirm the pregnancy of a girl with delayed menstruation,:
- Examination on the chair. With bimanual palpation, an increase in the uterus to the probable gestational age, softening of its isthmus, increased mobility of the cervix is determined. Examination in mirrors allows you to identify possible signs of genital infection (inflammation of the vaginal mucosa, discharge from the cervical canal).
- Pregnancy test. Laboratory diagnostics is based on the determination of chorionic gonadotropin in urine — a specific hormone that begins to be secreted 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, the fetus, placenta, and membranes are detected in the uterine cavity. Regular screening allows you to dynamically monitor gestation, and fetometry allows you to evaluate fetal development.
To exclude possible infectious and inflammatory pathology of the genitals, vaginal smear microscopy, bacteriological culture on nutrient media, TORCH complex, ELISA, PCR diagnostics are performed. Subsequently, CTG is recommended for early detection of signs of fetoplacental insufficiency. Differential diagnosis is carried out with neoplasms of the abdominal cavity and pelvis, malformations of the uterus, hypothalamic-pituitary disorders, primary ovarian insufficiency, metabolic and endocrine disorders in diabetes mellitus, hypofunction and hyperfunction of the thyroid gland, other diseases accompanied by amenorrhea. According to the indications, the patient is consulted by a teenage pediatrician, an endocrinologist, an infectious disease specialist, a dermatologist, a neurologist, a neurosurgeon, a psychologist, a psychiatrist.
Management of teenage pregnancy
After the detection of gestation, a teenage girl, her relatives and employees of a medical institution need to decide on the expediency of carrying a child, the tactics of patient management and the optimal method of delivery. Possible solutions to the problem, taking into account all possible factors and the opinion of the pregnant woman, may be:
- Artificial termination of pregnancy. The girl and her family need to be explained that a medical or surgical abortion performed at a transitional age is more often complicated by traumatic damage to 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 management of young primiparous does not differ significantly from standard protocols and assumes timely correction of emerging complications. In more than 90% of cases, a teenage girl is able to give birth to a child on her own. Even with an anatomically narrow pelvis, a clinical discrepancy 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 occurrence of premature birth.
- Gestation and cesarean section. The decision on the operation in each case is made individually, and the young age of the patient should not be perceived as an obstacle to timely surgical intervention. Indications for operative delivery in adolescent women in labor are the same as in adult women. Caesarean section is performed when abnormalities of labor activity resistant to conservative therapy, clinically narrow pelvis, signs of intranatal fetal hypoxia are detected.
When managing a girl carrying a child, an obstetrician-gynecologist pays attention to both the medical aspects of pregnancy and the correction of the patient’s lifestyle. Since representatives of the adolescent age group often eat irregularly and unbalanced, explanatory work is carried out on the importance of a rational diet and compliance with the eating regime. Particular attention is paid to the discussion of smoking, alcohol and narcotic substances, prevention of sexually transmitted infections, psychoprophylactic preparation for the upcoming childbirth. Taking into account the increased risk of complications in childbirth, pregnant adolescents are shown hospitalization in highly qualified obstetric hospitals at 37-39 weeks of gestational age.
Prognosis and prevention
The prognosis with proper management of teenage pregnancy and the choice of the optimal method of delivery is favorable. The average duration of gestation 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).