Teenage pregnancy.

OBJECTIVE: To study the frequency of teenage pregnancy and its complications as compared to controls. METHODS: A retrospective case record analysis of 2522 pregnancies, aged below 25 years was carried out, in the Department of Obstetrics, Riyadh Armed Forces Hospital during the period 1 January 1999 to 31st December 1999. RESULTS: The incidence of teenage pregnancy for 1999 was 6%. Three hundred and eighty five (76%) were carrying their first pregnancy while 42 (8%) mothers had 2 or more previous pregnancies and deliveries. The birth weight was less than 2.5 kg in 109 (21.5%) adolescents, as compared to 187 (9%) of the controls. The rate of instrumental deliveries and cesarean section in adolescents was 9% and 6% as compared to 5% and 10% in the controls. Seventy nine (16%) of adolescents delivered prematurely as compared to 216 (11%) of the controls. Forty seven (9%) of adolescents were unbooked compared to 133 (7%) who were controlled. The incidence of pre-eclampsia and preterm delivery in adolescents was 2% and 16% as compared to 1% and 11% in the controls. CONCLUSION: Teenage pregnancy, which showed a steady decline from 18% in 1979 to 6% in 1999 was associated with a significantly higher risk of preterm delivery, pre-eclampsia, low birth weight and instrumental delivery.

Changing trends in perinatal deaths at the Armed Forces Hospital, Riyadh, Saudi Arabia.

A total of 104522 babies were delivered at the Riyadh Armed Forces Hospital between 1979 and 1998, including 807 stillbirths and 658 neonatal deaths. The 20-year period was divided into four 5-yearly intervals for comparative purposes. The overall Perinatal Mortality Rate (PMR) for infants weighing 500 grams or more ranged between 20.2 per 1000 in 1979 and 13 per 1000 in 1998. The lowest PMR of 10.3 per 1000 was recorded in 1985. Thirty-one per cent of the perinatal deaths were unbooked. The corrected neonatal death rate (excluding congenital anomalies) dropped from 10.1 per 1000 in 1979 to 1.7 per 1000 live births in 1998 - The corrected stillbirth rate dropped from 12.1 per 1000 births in 1979 to six per 1000 in 1998. Of the 807 stillbirths, 24.1% had lethal congenital anomalies while 29.5% were unexplained, 4% had hydrops fetalis, 2% died as a consequence of toxaemia of pregnancy, 7.5% were associated with antepartum haemorrhage, 7.9% were mechanical, related to cord accident and ruptured uterus, 9.8% died as a consequence of maternal disease, 5.4% of intrapartum asphyxia and 6.4% placental insufficiency. Of the 658 neonatal deaths, 47.5% had lethal congenital anomalies, 2% had hydrops fetalis, 7.6% died as a result of intrapartum asphyxia, 38% died as a result of prematurity with its complications of severe respiratory dysfunction and intraventricular and pulmonary haemorrhage, 4.1% died in NICU of secondary infection and 0.7% were unclassified. The overall PMR for infants weighing 500 grams or more was 14.1 per thousand. Congenital anomalies and low birth weight/prematurity accounted for 85.5% of the neonatal deaths. Congenital anomalies and unexplained deaths accounted for 53% of total stillbirths while maternal disease was responsible for 9.8% of total stillbirths. Reducing congenital anomalies and preventing prematurity and provision of good antenatal care will help in reducing PMR still further.

Can the rate of cesarean section be reduced?

OBJECTIVE: To look into all cases with previous one cesarean section who were cared for and delivered at Armed Forces Hospital, Riyadh, between January 1990 and December 1998, to determine its prevalence, final method of delivery, and outline measures of reducing its incidence. METHODS: Retrospective analysis of hospital records of all women with previous one cesarean section who had either a repeat cesarean section or delivered vaginally after cesarean section. RESULTS: Between 1990 and 1998, 61,060 mothers were delivered. Two thousand five hundred and seventy eight patients had one previous cesarean section. They represented 3.5% of the total number of deliveries. Nine hundred and sixty eight (37.5%) cases had repeat cesarean section. Of the 1610 (62.5%) mothers who achieved vaginal delivery, 102 (6%) had ventouse, 42 (3%) had forceps and 22 (1%) had an assisted breech delivery. Rupture of uterine scar was reported in 15 cases. There were no maternal or perinatal deaths. CONCLUSION: Patients with one previous cesarean section are three times more likely to have a cesarean section as compared to mothers with unscarred uterus. Reducing the overall cesarean section rate is possible through a closer look at the primary indication for the first cesarean section. A protocol is needed to allow more cases with one or more previous cesarean section to have trial of vaginal delivery under close monitoring and involve the senior staff more in the diagnosis and management of cases of dystocia and the use of Oxytocin when indicated.

Intrapartum rupture of the gravid uterus.

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