[Pregnancy in the adolescent. I. Primigravidas of 9 to 15 years old]. / Gravidez na adolescencia. I. Primigestas de 9 a 15 anos.

PIP: From January 1975 to June 1980, 13,951 births took place at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil. Of these births, 105 (0.7%) were 1st births to adolescents between the ages of 9 and 15. 92.3% of the adolescents were unmarried, indicating that they failed to use adequate methods of birth control. 89.5% of the adolescents did not receive adequate prenatal care, contributing to the high incidence of complications during the pregnancy-puerperal cycle. Among complications occurring during pregnancy, the most common were toxemia (29.5%), urinary infection (16.1%), and anemia (8.5%). Premature birth took place in 30.5% of the adolescent pregnancies, a rate a prematurity greater than in the general population. Analgesia at birth was necessary in 20.9% of the cases. This tendency was more a consequence of nulliparity and emotional factors than of age of patient. Contrary to expectations, cesarean sections were required with no greater frequency than in the general population. Complications in birth and puerperium did not differ from patients in general. No cases of fetal death occurred; neonatal deaths occurred in 5.5% of the cases, the consequence of prematurity. Jaundice occurred as the most frequent complication in newborns (70.0%); no cases of serious malformations were observed.^ieng

[Pregnancy in the adolescent. II. Comparative study between primigravida from 9 to 15, 16 and 17 years old]. / Gravidez na adolescencia. II. Estudo comparativo entre gestantes de 9 a 15 anos, 16 e 17 anos.

PIP: This paper presents a study of adolescent pregnancy in which different age groups were compared to establish which age group had the greatest incidence of risk factors. Primiparous adolescents who delivered at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, between January 1975 and June 1980 were studied. During this period, 13,961 births occurred, of which 105 were to 9-15 year olds (0.7%), 137 were to 16 year olds (0.9%) and 106 were to 17 year olds (0.7%). A large majority of the adolescents in each age group were unmarried; similarly, a lack of adequate prenatal care was observed in all 3 groups. A gestational age of less than 38 weeks was encountered in 30.5% (30 cases), and 16.9% (18 cases), respectively, in the 9-15, 16, and 17 year age groups. Among pregnancy complications, there was an elevated incidence of arterial hypertension in all 3 groups, as well as an increased occurrence of eclampsia among the 9-15 year olds. Urinary infections and anemia were also evident during pregnancy. Analgesia was required in 22 cases (20.9%) of the 9-15 year old age group, in 3 cases (2.2%) of the 16 year age group, and in 2 cases (1.9%) of the 17 year age group. Fetal presentation, duration of labor, type of birth (normal, forceps, or cesarean), puerperal morbidity, birth weight, and perinatal mortality for each of the 3 groups are presented in tables. Neonatal deaths were determined to be the consequence of prematurity and its complications except in 1 case of congenital heart disease which occurred in the 17 year old group. Neonatal jaundice was the most frequent cause of morbidity in the newborns. The results of this study agree with those of similar studies appearing in the literature. The authors attribute the greater frequency of premature births among 9-16 year olds to immaturtity of uterine muscle fiber, deficient prenatal care, and the emotional tensions to which the adolescents were subjected, as well as to medical complications of pregnancy and general maternal physical immaturity. The 17 year olds presented behavior closer to that of the adult population.^ieng

[Pregnancy in the adolescent. III. Comparative study between primipara from 18 to 19 years old]. / Gravidez na adolescencia. III. Estudo comparativo entre primiparas de 18 a 19 anos.

PIP: Not all pregnancies are subject to the same risks. Many factors are considered risks, some inherent in the individual, others dependent on the environment (e.g., social maladjustment, socioeconomic level, nutritional deficiency). These factors can act alone or synergistically. Physicians agree that pregnancy in adolescence runs a very high level of risk. They do not agree, however, on the upper age limit of this high risk group. To explore this area, the authors studied 209 primiparous adolescents who gave birth at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, between January 1975 and June 1980. Patients were divided into 2 groups: Group 1 consisted of 105 women 18 years old, and Group 2 was composed of 104 women 19 years old. 68 patients (64.8%) in Group 1 were unmarried while 14 patients (13.4%) were unmarried in Group 2. Prenatal care was considered inadequate (less than 5 visits) in 70.5% of Group 1 and 54.8% of Group 2. Pregnancy complications in both groups were recorded, with arterial hypertension occurring in 49% of Group 1 and 30.4% of Group 2. Urinary infections (14.3% in Group 1, 17.3% in Group 2) and anemia (14.3% of Group 1, 15.5% of Group 2) were the 2nd and 3rd most frequent complications observed. Fetal presentation, length of labor, use of forceps, and cesarean deliveries were also recorded for both groups. Birth weight, Apgar scores, and perinatal mortality showed no significant differences between the 2 groups. Results of the study indicate that there are no important differences between the pregnancies of 18 and 19 year old adolescents, although the 18 year olds more frequently received inadequate prenatal care. Clinical complications were similar to those of all adolescents in general, with a much higher rate of urinary infection than in adult pregnancies. The authors conclude that 18 and 19 year old parturients present a maturity similar to that of adults despite maintaining some of the same characteristics as adolescents.^ieng

[Pregnancy in the adolescent. IV. Borderline reproductive age risk among adolescents]. / Gravidez na adolescencia. IV. Idade limite de risco reprodutivo entre adolescentes.

PIP: This study examined the cases of 557 primiparous adolescents, between the ages of 9 and 19, who gave birth at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, from January 1975 to June 1980. During this period 13,961 deliveries took place, producing an adolescent pregnancy incidence of 3.9%. Based on previous work, 2 groups were established: Group I, composed of 242 women aged 9 to 16, and Group II, composed of 315 women aged 17 to 19. The greatest number of unwed mothers occurred in Group I, the younger age group (98.4%), compared to 54.3% in Group II. An important characteristic in the younger age group was lack of adequate prenatal care. In Group I only 12% received adequate prenatal care, while in Group II, 28.6% received adequate care. Clearly the greatest frequency of prematurity was in the younger group (28.1% of Group I vs. 12.4% of Group II), along with a higher rate of perinatal mortality (4.9% in Group I vs. 2.5% in Group II). Cases of eclampsia occurred more frequently in the younger adolescents (3.3% of Group I vs 1.6% of Group II), but hypertension was more prevalent among the older adolescents (35.9% in Group II vs. 22.7% in Group I). The authors conclude that during pregnancy all adolescents reach similar biologic and endocrine maturity and display similar obstetric performance. The less satisfactory performance among patients in Group I is primarily due to socioeconomic conditions, inadequate resolution of problems related to acceptance of pregnancy, lack of family support, and inadquate prenatal care. The authors believe that the risks associated with adolescent pregnancy could be substantially reduced if adolescents were better informed and received psychological support and adequate prenatal care.^ieng

Gestacão e mal formacão genital / Pregnancy and genital anomalies

Sao estuados 18 casos de malformacoes genitais e gravidez ocorridas na Clinica Obstetrica da FMUSP no periodo de 1977 a 1982. Analisaram varios parametros, como antecedentes obstetricos incidencia de abortamento e prematuridade, tipo de parto mobiletalidade-perinatal. Os antecedentes obstetricos revelaram 23,0% de prematuridade e 46,1% de abortamento; na gestacao atual 27,7% de prematuridade e 16,6% de abortamento. Ressaltam o alto indice de operacao cesarea (80,0%).Concluem pela importancia do diagnostico previo e tratamento adequado no pre-natal na diminuicao dos elevados indices de patologia materno-fetal