ORIGINAL SCIENTIFIC ARTICLE ORGINALNI NAUČNI RAD ORIGINAL SCIENTIFIC ARTICLE THE INCIDENCE OF ADOLESCENT PREGNANCY AT CLINIC OF GYNECOLOGY AND OBSTETRICS OF CLINICAL CENTER KRAGUJEVAC Marija Bicanin Ilic1 and Aleksandra Dimitrijevic1 Clinic of Gynecology and Obstetrics, Clinical Centre Kragujevac, Kragujevac, Serbia INCIDENCA ADOLESCENTNIH TRUDNOĆA NA KLINICI ZA GINEKOLOGIJU I AKUŠERSTVO KLINIČKOG CENTRA KRAGUJEVAC Marija Bićanin Ilić1 i Aleksandra Dimitrijević1 Klinika za Ginekologiju i akušerstvo, Klinički centar Kragujevac, Kragujevac, Srbija Received/Primljen: 26.04.2019. Accepted/Prihvaćen: 03.05.2019. ABSTRACT SAŽETAK Adolescent pregnancy belongs to a group of high-risk preg- Adolescentna trudnoća spada u grupu visokorizičnih trud- nancies with high maternal and fetal mortality and morbidity rate noća sa visokom maternalnom i fetalnom smrtnošću i stopom with high prevalence globally (11%). The aim of this observa- morbiditeta sa visokom prevalencijom na svetskom nivou (11%). tional study is to show the incidence of adolescent deliveries in Cilj ove opservacione studije je da prikaže učestalost porođaja a- relation to the total number of births in the twelve-year period dolescenata u odnosu na ukupan broj rođenih u dvanaestogodiš- from 2007 to 2019 at the Department of Gynecology and Obstet- njem periodu od 2007. do 2019. godine na Klinici za ginekologiju rics of Clinical Center in Kragujevac from medical protocols and i akušerstvo Kliničkog centra Kragujevac prema podacima dobi- patients’ medical records. By evaluating the data of our research, jenim iz porođajnog protokola kao i medicinskih istorija. Sagle- we noticed a continuing decrease in the percentage of adolescents davajući rezultate našeg istraživanja, primetili smo kontinuirano that give births each year. The total number of births in our clinic smanjenje procenta adolescentkinja koje rađaju iz godine u go- in this twelve-year period was 26544, and the number of teenage dinu. Ukupan broj porođaja u našoj klinici u ovom dvanaestogo- deliveries was 390 (1.74%), which is in accordance with the re- dišnjem periodu bio je 26544, a broj tinejdžerskih porođaja 390 sults of a similar research which was conducted in our clinic in (1.74%), što je u skladu sa rezultatima sličnog istraživanja koje je the period from 2002 to 2007 (16.1%). However, despite the in- sprovedeno na našoj klinici u periodu od 2002. do 2007. (16,1%). crease in the number of caesarean sections, Apgar score of new- Međutim, uprkos povećanju broja carskih rezova, Apgar skor no- born babies was similar to the results of previous tests - 8.31 vorođenčadi bio je sličan rezultatima prethodnih studija - 8,31 which proves that the increase in caesarean sections is not corre- što dokazuje da povećanje procenta carskih rezova nije u korela- lated with growth of Apgar score. The average pregnancy dura- ciji sa rastom Apgar skora. Procečno trajanje trudnoće adole- tion of adolescents is similar as in the previous five-year period scentkinja je slično kao u prethodnom petogodišnjem periodu (37.5 w.g.), while in the general population of pregnant women it (37,5 n.g), dok u opštoj populaciji trudnica iznosi 39,2 n.g što is 39.2 w.g which represents a statistically significant difference. predstavlja statistički značajnu razliku. Glavni uzroci loših ishoda The main causes of poor outcomes of adolescent pregnancies are adolescentne trudnoće su biološka nezrelost majki, loša zdrav- biological immaturity of mothers, poor health care, that comes stvena zaštita koja proizilazi iz loših socio-demografskih uslova, from poor socio-demographic conditions, as well as emotional kao i emocionalni stres. Neophodno je promeniti odnos društva stress. It is necessary to change the attitude of society towards prema ovim mladim ljudima, dati im podršku u okruženju u kojem these young people, give them support in the environment they live žive i pružiti im bolju zdravstvenu zaštitu i socijalni tretman. and provide them with better health care and social treatment. Ključne reči: adolescentska trudnoća, trudnoća u tinejdžerskoj Keywords: Adolescent pregnancy, teenage pregnancy, young dobi, porođaj u mladom dobu. age childbirth. UDK: 612.1.015 UDK: 000.00-000.0/.0-000; 000.000/ Corresponding author: Ser J Exp Clin Res 2019; 20 (1): 3-13 Marija Bicanin Ilic, MD; DOI: 10.2478/sjecr-2019-0028 Clinic of Gynecology and Obstetrics, Clinical Centre Kragujevac, 30 Zmaj Jovina Street, Kragujevac, Serbia; Phone: 0642210218 e-mail: [email protected] INTRODUCTION income countries, and about 3 million have an abortion. Complications during pregnancy and childbirth are the sec- According to the World Health Organization (WHO) def- ond cause of death of girls in this age group. Young mothers, inition, adolescence presents forming full sexual maturity, and particularly teenage mothers, are a vulnerable group at maturing of person from the psyche of the child to the psyche high risk of poor mental health outcomes compared to moth- of an adult and transition from full social and economic de- ers aged 25 and above (6). pendence to the relative independence (1). This life period of a woman is followed by turbulent psychosocial events and About 11% of all pregnancies globally belong to adoles- often complicated by dyscoordination of mental and physical cent pregnancies (7). Since 1990 there has been a downward maturation. Modern hygiene and dietary conditions have led trend in adolescent pregnancies which is associated with to the occurrence of girl’s menarche earlier , that together, more massive educating youth about the risks and conse- followed by the customs and attitudes of the surroundings, quences of unprotected sexual relation and massive use of results in sexual relations at the early age. Adolescents are condoms. usually not aware of the risks and dangers of unprotected sex- ual behavior and they are not mentally mature to face the con- The aim of this study is to determine the incidence of ad- sequences of the act. Adolescent pregnancy is usually the olescent deliveries in relation to the total number of births in product of the mentioned factors. It belongs to a group of the twelve-year period from 2007 to 2019 at the Department high-risk pregnancies with high maternal and fetal mortality of Gynecology and Obstetrics of Clinical Center in Kraguje- and morbidity rate. Pregnancy at this age has been reported vac by collecting the data about the maternal age, body as the leading cause of death in adolescent girls in low- and weight and Apgar score of newborns, indications for instru- middle-income countries (2). mental delivery and frequency of caesarean section. Insufficient biological maturity of pregnant girls, poor socio epidemiological living conditions and inadequate med- ical care are key factors of pregnancy complications among- METHODOLOGY which the most common are: premature birth, intrauterine growth restriction, pregnancy induced hypertension (PIH), anemia, infections and fetal anomaly (1). Partial progester- Ethical concerns one resistance that persists into adolescent years may com- This observational study was performed in accordance promise the physiological transformation of the spiral arter- with all relevant ethical principles. ies and predispose for defective placentation in the case of pregnancy. The major obstetric syndromes caused by im- Design of the study paired placental bed spiral artery remodeling are prevalent in teenage pregnancies, including preeclampsia, fetal growth re- This study was designed as retrospective cross-sectional striction, and spontaneous preterm labor (3). Some studies re- observational clinical study which evaluated the incidence of port that the adverse outcomes are due to physiological and adolescent pregnancy during twelve-year period from 2007 anatomical factors associated with young maternal age, while to 2019 at the Department of Gynecology and Obstetrics of others report that they are due to external factors such as so- Clinical Center in Kragujevac from medical protocols and cioeconomic status, social support, inadequate antenatal care patients’ medical records. and other behavioural determinants associated with adoles- cence (4). Almost all assessments of adolescent pregnancies Population of the study are based on chronological age. Gynecologic age is defined as age in years at conception minus age at menarche and it is The study included all medical data regarding adolescent an indicator of physiological maturity. Low Gynecologic age pregnancy from birth protocols and caesarean sections proto- is associated with an increased rate of obstetric and perinatal cols and patients’ medical records during past twelve years. complications in adolescent pregnancies. Although the main The main inclusion criteria were adolescent age (12-18 years aim is the prevention of adolescent pregnancies, a detailed old) and confirmed pregnancy. evaluation of such pregnancies including determination of Data processing and analysis the gynecological age together with a multidisciplinary ap- proach may decrease potential complications (5). All data were processed in Excel, presented in tables and charts, statistically expressed by mean and by percentile. According to WHO statistics, about 16 million girls aged 15 to 19 give birth each year, mostly in low- and middle- RESULTS In percent, from all pregnancies over past twelve years, the highest incidence was in 2009, then in 2007 and 2008. On Prevalence of adolescent births the other hand, 2017 and 2018 were years with the lowest incidence (Figure 1).