alexa Prognostic Factors of Pregnancy and Childbirth in Adolescents at the Borgou Regional University Teaching Hospital in Parakou (Benin) | Open Access Journals
ISSN: 2161-0932
Gynecology & Obstetrics
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Prognostic Factors of Pregnancy and Childbirth in Adolescents at the Borgou Regional University Teaching Hospital in Parakou (Benin)

Obossou AAA1*, Salifou K1, Sidi IR1, Hounkponou AF1, Hounkpatin BIB2, Tshabu Aguemon C2, Houndeffo T2, Vodouhe M1, Mere Gode WST1 and Perrin RX2

1Department of Mother & Child, Faculty of Medicine; University of Parakou, Republic of Benin

2Faculty of Health Sciences, University of Abomey-Calavi, Republic of Benin

*Corresponding Author:
Awadé Afoukou Achille OBOSSOU
Obstetrician- Gynecologist, Assistant Professor
Faculty of Medicine / University of Parakou
03 P.O.Box 18, Republic of Benin
Tel: (229) 95 85 32 79/97 06 78 52
E-mail: [email protected]

Received Date: September 22, 2015; Accepted Date: October 05, 2015; Published Date: November 05, 2015

Citation: Obossou AAA, Salifou K, Sidi IR, Hounkponou AF, Hounkpatin BIB, et al. (2015) Prognostic Factors of Pregnancy and Childbirth in Adolescents at the Borgou Regional University Teaching Hospital in Parakou (Benin). Gynecol Obstet (Sunnyvale) 5:332. doi: 10.4172/2161-0932.1000332

Copyright: © 2015 Obossou AAA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objective: Identify the prognostic factors of pregnancyand childbirth in adolescents at Regional University Teaching Hospital (CHDU) Borgou.
Method: We conducted a cross-sectional study with descriptive and analytical purpose which make a prospective comparison of 110 adolescent primiparous (14-19 years) with 220 control primiparous (20-34 years). The study was carried out from March 1 to August 31, 2014 at the Borgou Regional University Teaching Hospital.
Results: Childbirth prevalence in adolescents was 11.2%. After comparative analysis, pregnancy prognostic factors in the adolescent were poor pregnancy monitoring, hospitalization during pregnancy for malaria and anemia. During childbirth, the prognostic factors were fever, episiotomy, perineal lacerations, artificial labor and long postpartum hospitalization. As regards newborns, low birth weight, transfer to neonatal care unit and perinatal deaths were the prognostic factors associated with childbirth in adolescents at CHUD-B/A in Parakou in 2014.
Conclusion: In the adolescent living in Parakou pregnancy is common and seems to occur with high risk. It is therefore necessary to promote efficient antenatal follow-up and good quality childbirth for pregnant adolescents.

Keywords

Pregnancy; Childbirth; Adolescents; Risk factors; Reproductive health

Introduction

Adolescence is a period of psychological instability and immaturity of organs which may lead to risk abortions and dystocia during childbirth [1]. Early pregnancy is still an issue of concern considering its adverse effects on adolescents’ health, education and rights as well as the precarious prognostic of unborn children. In Benin, adolescents account for 21% of total fertility [2]. However, few studies had been dedicated to the issue. This study aims to identify the prognostic factors of pregnancy and childbirth in adolescents at CHDU-B in Parakou.

Patients and Method

The study had been carried out in the gynecology and obstetrics unit of the Borgou Regional University Teaching Hospital located in the town of Parakou (Republic of BENIN).

It was a comparative cross-sectional study with descriptive and analytical purpose which covered a 6-month period ranging from March 1 to August 31, 2014. As target, it focused on all the pregnant nulliparous adolescents under 35 years of age who were attended during the study period in the unit. We divided them into two (02) groups:

-the group of «adolescents » under 20 years of ages considered as a « risk group »;

-the group of « adults » aged 20 to 34 years, considered as the « reference group » used for comparisons in the analytical study. We selected this age group for it is the optimal age group for reproduction [3].

This research work involved the nulliparous pregnant subjects bearing a single pregnancy and under 20 years of age as regards adolescents and those aged 20 to 34 years as regards adults and who accepted to participate to the study. The population study did not involve nulliparous women whose pregnancy did not result in childbirth during the study period, women who gave birth before admission to the unit, pregnancy and multiple birth and women who refused to participate to the study. We selected nulliparous patients because we were concerned with eliminating the effects of obstetrical history of mothers who had already given birth before the study period.

We performed an exhaustive continuous sampling of pregnant adolescents. For each case of adolescent admitted for care, two « control » adults were sélected. They were nulliparous patients bearing a single pregnancy, attended for first childbirth and aged between 20 and 34 years, the one admitted just before the adolescent case and the other just after her. In the event where this last condition was not fulfilled, the two control-cases selected were either the two adult patients who met the same criteria and admitted just before the adolescent case, or the two who were admitted just after the adolescent case. This permitted us to get almost the same care team for each adolescent case and each control case. In fact, as each team has its cares habits we wanted that our patients receive care in the same conditions.

The study variables were related to:

- Course of pregnancy,

- Characteristics of childbirth and newborn.

The data collected were captured in a mask developed in Epi-INFO software version 7.1.1.14 dated July 2, 2013. The results are shown in the form of text with Word 2007 software and figures were made by means ofl Excel 2007. The statistical descriptive analysis consisted in calculating the different frequencies and averages of study variables. The qualitative variables were compared with Pearson’s chi2 test followed by p-value. When p ≤ 0.05, the difference is statistically significant. To study the association meaning Odds-Ratio (OR) was calculated.

Results

During the study period, CHDU-Parakou’s maternity registered 978 childbirths, including 110 occurred in primiparous adolescents i.e. an 11.2% frequency.

Pregnancy prognostic factors in adolescents

Poor pregnancy follow-up, hospitalization during pregnancy and diseases such as malaria and anemia are pregnancy risk factors in the adolescent (Table 1).

Course of  Pregnancy Adolescents Adults  
n % n % p
Number of ANCduringpregnancy         0,0000
None 16 14.55 5 2.27  
< 4 50 45.45 86 39.09  
≥ 4 44 40.00 129 58.64  
Places of ANC         0.0000
Public healthcenter 82 87.23 161 74.88  
Privatehealth center 12 12.77 54 25.12  
Hospitalizationduringpregnancy         0.0013
Yes 25 22.73 22 10.00  
No 85 77.27 198 90.00  
Reasons for hospitalization          
Malaria 17 54.84 12 48.00 0.0020
Urinary infection 1 3.23 1 4.00 0.3333
PeripheralArterialDisease (PAD) 4 12.90 3 12.00 0.1072
Vaso-occlusive crisis (VOC) 1 3.23 2 8.00 0.4818
Hypertension 3 9.68 5 20.00 0.0979
Anemia 5 16.12 2 8.00 0.0249

Table 1: Pregnancy prognostic factors in adolescents at CHDU-B in 2014.

Childbirth prognostic factors in adolescents

Fever during labor was significantly found out in adolescents (OR=5.26; p=0.0004); episiotomy and artificial labor with pelvic examination were significantly performed in adolescents (Table 2).

Characteristics of childbirth Adolescent mothers Adult mothers    
n % n  % p OR/CI (95%)
Type of delivery         0.3359 1.11 [0.69-1.78]
vaginal delivery 67 60.9 128 58.2    
natural delivery 12 17.7 67 52.3 0.0007  
directed labor 10 14.9 11 8.6 0.0340  
artificial delivery 45 67.2 50 39.1 0.0004  
cesarean delivery 43 39.1 92 41.8    
Maternal fever at admission         0.0004 5.26 [1.96-14.29]
Yes 14 12.7 6 2.7    
No 96 87.3 214 97.3    
Vaginal delivery procedures            
Episiotomy 45 67.2 50 39.1 0.0004 2.32 [1.42- 3.85]
Artificial labor and pelvic examination 22 32.8 17 13.3 0.0096 2.44 [1.15-5.00]

Table 2: Prognostic factors of childbirth in adolescents at CHDU-B in 2014.

Childbirth complications and length of stay in CHDU-B among adolescents in 2014

During childbirth, adolescents are more at risk of experiencing perineal lacerations and significant length of stay in hospital than adult mothers (Table 3).

Childbirth complications and length of stay in hospital Adolescent mothers Adultmothers  
n % N  % p
Complications of vaginal delivery         0.0399
Perineal lacerations 7 10.5 5 3.9  
Cervical lacerations 1 1.5 0 0.0  
Postpartum complications          
Postpartum hemorrhage 2 1.8 1 0.5  
Postpartum eclampsia 1 0.9 0 0.0  
Disseminated Intravascular Coagulation (DIC) 2 1.8 0 0.0  
Length of stay in hospital         0.0019
1 day 43 39.1 100 45.5  
1 à 5 days 58 52.7 118 53.6  
>5 days 9 8.2 2 0.9  

Table 3: Childbirth complications and length of stay in CHDU-B hospital among adolescents in 2014.

Newborns’ prognostic factors

The children born of adolescent mothers are more at risk of having low birth weight, being transferred to the neonatal care unit and of dying in that unit than adult mothers (Table 4).

Newborn’scharacteristics Adolescent mothers Adult mothers    
n % n % p OR/CI
Newborn’s condition atbirth         0.2751 1.30 [0.52-3.12]
Alive 101 91.8 206 93.6    
Stillborn 9 8.2 14 6.4    
Average APGAR Score            
First minute 7.38 ±1.49 7.53 ± 1.52 0.3976  
Fifth minute 8.91 ±1.46 9.09 ±1.20 0.2596  
Resuscitationatbirth         0.1014 1.51 [0.79-2.94]
Yes 19 18.8 27 13.1    
No 82 81.9 179 86.9    
Birthweight         0.0000  
< 2500g 36 32.7 26 11.8    
2500-4000g 74 67.3 192 87.3    
>4000g 0 0.0 2 0.9    
Newborn ‘s transfer to neonatal care unit         0,0001 2.5 [1.56-4.16]
Yes 65 64.4 85 41.3    
Non 36 35.6 121 58.7    
Reason for transfer to neonatal care unit            
Lowbirthweight (LBW) 30 46.2 22 25.9    
Idiopathic Nephrotic Syndrome (INS) 21 32.3 20 23.5    
Pregnancy-related diseases/ Fetal malformation 14 21.5 41 48.2    
Macrosomia 0 0.0 2 2.4    
Condition on discharge from neonatal care unit         0.0024 4.91 [1.58-18.32]
Dead 13 20.0     4 4.7    
Alive 52 80.0 81 95.3    

Table 4: Prognostic factors of adolescent mothers’ newborns at CHD-U in 2014.

Discussion

We made comparative cross-sectional study both descriptive and analytical. This work took into account only the pregnancies ended in childbirth, cases of spontaneous abortion, ectopic pregnancy and molar pregnancies were not considered. This is a bias because it would allow a better comparison of birth outcomes in the two groups studied.

The first prognostic factor encountered was lack of pregnancy follow up or poor pregnancy monitoring. This observation accords with the findings of Iloki et al. [4] and Gandzien et al. [5] in Congo; Dedeckeret [6] in the Reunion Island, Kaka et al. [7] in DRC. Most often, those adolescents are single or they bear unintended pregnancies or are in unstable relationships, thus they lack financial resources to attend hospitals. As well, that age group is associated with ignorance of complications of pregnancy-induced diseases. The type of childbirth is not significantly different in both groups. Vaginal delivery was not associated with childbirth in adolescents in our cohort. There is a discrepancy between this remark and the results of the research works conducted by Foumsou et al. [8] in Chad, Gandzien et al. [5] in Congo and Traore et al. in Mali [9]. However, episiotomy is significantly more performed among adolescents in our investigative work and is in favor of artificial vaginal delivery rate which is significantly associated with childbirth in adolescents. This conclusion is consistent with the findings of other authors [9,10].

Maternal fever on admission, artificial labor and pelvic examination are associated with childbirth in adolescents. Dedecker et al. [6] in the Reunion Island had identified a non-significant difference between adolescents and case controls in their cohort as regards maternal fever. Besides, according to our research work, childbirth in the adolescent is significantly associated with perineal laceration risk. This result had been confirmed by Kaka et al. [7] in DRC and NGEMBI [1] in the Central African Republic.

As far as newborns’ characteristics are concerned, low birth weight was associated with adolescents’ childbirth in our study. This result is not found out during research works performed by Hamada et al. [10] in Morocco but it is consistent with the one encountered by Kaka et al. [7] in DRC.

Moreover, newborns’ transfer to neonatal care unit and perinatal deaths were also associated with those childbirths in adolescents. Our result is not shared by other cohorts investigated: Dedecker et al. [6] in the Reunion Island, Hamada et al. [10] in Morocco. In contrast, the findings of Iloki et al. [4] in Congo and Ngembi et al. [1] in the Central African Republic are similar to our conclusion about transfer to neonatal care unit and perinatal mortality.

Conclusion

We can conclude that childbirth in adolescent involves risks. The reduction of those complications depends on medical care for pregnant subjects and on high quality assisted delivery.

References

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