Pregnancy in early adolescence: are there obstetric risks?

The purpose of this study was to determine if early adolescence imparts a significant obstetric risk in young primiparas relative to adult primiparas. The records of 239 young primiparas (< 16 years) and 148 older primiparas (18-29 years) were reviewed for demographic information, antepartum complications, mode of delivery, length of labor, episiotomy, lacerations, birthweight, and length of gestation. The young adolescents were shorter, had an earlier age at menarche, a lower pregravid body mass index, and a higher gestational weight gain. The young teens were less likely to smoke cigarettes but were more likely to be Medicaid recipients. The incidence of most antenatal complications (chronic hypertension, pregnancy-induced hypertension, placental abruption, placenta previa, premature rupture of the membranes, urinary tract infections, and anemia) were similar between the two groups. Preterm labor and contracted pelvis were more common among the young adolescent, while gestational diabetes was less common. The young primiparas were significantly (P < .05) less likely to have a Cesarean delivery and to lacerate with vaginal delivery. The length of labor and its stages were similar, as were overall birthweight and length of gestation. Thus, obstetric concerns regarding pregnancy in early adolescence may be unfounded. With the exception of an increased risk for preterm labor, it appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara.

Planning effectiveness may grow on fault trees.

The first step of a strategic planning process--identifying and analyzing threats and opportunities--requires subjective judgments. By using an analytical tool known as a fault tree, healthcare administrators can reduce the unreliability of subjective decision making by creating a logical structure for problem solving and decision making. A case study of 11 healthcare administrators showed that an analysis technique called prospective hindsight can add to a fault tree's ability to improve a strategic planning process.