[Obstetric decisions concerning adolescents vs. adults]. / La resolución obstétrica de las adolescentes en comparación con la de las adultas.

Information relative to the frequency of vaginal delivery and cesarean section in adolescent population is limited and contradictory. Some publications refer that cesarean section is practiced more frequently in adolescents than in adults, because teenagers have a biological immaturity and a less medical control during pregnancy; but others show that frequency of cesarean section and vaginal delivery is very similar in adolescents as in adults. The reason of this contradiction is the fact that all studies compare general populations, with or without sistemic pathologies, and with or without obstetric antecedents. Therefore, the authors of this paper consider that if they compare adolescent and adult populations in their first pregnancy and without sistemic pathologies, the frequency of cesarean section and vaginal delivery should be the same in the two groups of women. To confirm their hypothesis, the authors collected original data from 121 adolescent women in their first pregnancy, seventeen years old or younger, without sistemic pathology, attended in the Instituto Nacional de Perinatología, and they compared them with original data collected from 121 adult women also in their first pregnancy, between 20 to 27 years old, without sistemic pathology, attended in the same institution and during the same period. The authors concluded that there were not statistical differences between the two groups in relation to the number of prenatal care visits; the weeks of pregnancy at the time of delivery; the indications of the different obstetric procedures to resolve the delivery; and in the perinatal mortality. Nevertheless, there were differences with high statistical significance between the number of vaginal deliveries and the number of cesarean sections; in fact, the cesarean section was performed more frequently in adult women. The authors considered that in the population of adolescents they studied, the age by itself was not a risk factor; furthermore, it is necessary to perform other studies to confirm and to explain why the cesarean section was performed more frequently in the adult population.

The effectiveness of antenatal care in preventing intrauterine growth retardation and low birth weight due to preterm delivery.

A case-control study was conducted to assess the effectiveness of antenatal care in preventing intrauterine growth retardation (IUGR) and low birth weight due to preterm delivery (PD), using data from 1837 births which took place in 25 hospitals in Mexico City during 1984. Women with an inadequate number of visits for gestational age had 63% greater odds of IUGR (95% CI: 1.01, 2.65) and 51% greater odds of PD (95% CI: 1.02, 2.23) than women with an adequate number. The content of antenatal visits showed no independent effect on the prevention of IUGR. Women having had poor content showed a PD OR of 1.76 (95% IC: 1.33, 2.34). An important reduction in the incidence of births with IUGR and PD could be expected if women could attend an adequate number of antenatal visits (11 and 9% reductions, respectively). Eighteen per cent of the PD births would probably be prevented if antenatal care could include at least six procedures: blood pressure, height and weight, urine and blood samples, and pelvic examination.