Childbirth in Teenagers at the Centre Hospitalier Universitaire Communautaire de Bangui ()
1. Introduction
The teenager is the one whose chronological age is between 10 and 19 years old according to the World Organization Health (WHO) [1]. In 2012, the WHO [2] estimated that almost 16 millions of teenage girls whose ages are from 15 to 19 years old and 2 millions of teenage girls under the age of 15 give birth every year in the world. The global teenage birth rate declined from 60 per 1000 in 1990 to 48 per 1000 in 2007, with rates ranging from 5 per 1000 in East Asia to 121 per 1000 in Sub-Saharan Africa in 2007 [3].
Pregnancy during teenage age, whether desired or not, presents serious obstetric risks. Several studies have shown that the socio-economic situation of the parents, the educational level of the teenager as well as the one of the partners are risk factors for teenage pregnancy [3] [4] [5]. The teenager’s vulnerability is linked to her physical aspect (pelvic immaturity) and the psychological aspect because pregnancy is difficult to accept at this age [5] [6]. In the Central African Republic (CAR), 20% to 30% of young girls have a baby before the age of 18 [7]. The purpose of this study was to assess the risk factors associated with childbirth in teenage girls in our maternity ward because the early pregnancy is frequent in our country.
2. Patients and Methods
This was an analytical cross-sectional study (witness case) conducted over the period from April 1st to September 30th, 2019 (6 months) in the maternity ward of the Centre Hospitalier Universitaire Communautaire. The study population consisted of parturients who delivered during the study period. The sample’s size is consisted of all of the parturients who come to give birth during the study period.
They were included in the study all parturients who presented regardless of the place of pregnancy follow-up, whose pregnancy age was greater than or equal to 22 amenorrhea weeks. The pregnancy was mono-fetal and she voluntarily agreed to submit to the study requirements. These women were divided into two groups, according to their age: a group comprising parturients under the age of 20 (teenage girls) and a second group bringing together parturients aged 20 and over (Witnesses). The following parameters were collected: age of the parturient, age of pregnancy, age of first sexual intercourse, pregnancy desired or not, parity, abnormalities during labor, route of delivery, condition of the mother and the newborn.
We collected the data using a pre-designed questionnaire. The analysis was carried out on the SPSS12, EPI-INFOversion2011. The results were considered statistically significant from the P < 0.05 threshold.
3. Results
A total of 510 childbirths were recorded during the study period, we identified 157 childbirth aged less than 20 years (adolescent), and 353 witnesses. The frequency of childbirth for teenage girls was 30.7%. The average age of adolescent girls was 15 with the extremes of 13 - 19. The average for the first sexual intercourse was 14 years old. 80.2% of teenage girls were first-time mothers. The pauciparous were the most found in witnesses 32.5%. The big multiparous represented 9.8% of witnesses (Table 1). The frequency of preterm birth was 14% in teenage girls (Table 2).
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Table 1. Distribution of teenagers and witnesses according to the parity.
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Table 2. Distribution of teenagers and witnesses according to the term of the pregnancy.
Statistically significant associations were found between teenage age and the onset of preeclampsia (p < 0.03), preterm birth (p < 0.001), delivery after an episiotomy (p < 0.001), and complications of postpartum (p < 0.001) (Table 3). Newborns of low weight were more found among teenagers with a statistically significant difference (p < 0.001). Perinatal asphyxia and perinatal death were not a risk factor of childbirth in teenagers. The evacuation of the newborn in the neonatology department was found in the 2 groups (teenagers and witnesses) without a statistically significant difference (Table 4).
4. Discussion
We have realized a study in the Hospital that cannot be generalized in our Country. This is our study’s limit. The frequency of teenage deliveries was 30.7%. This result is almost identical to that of other authors [4] [7]. On the other hand, it is clearly higher than that of Adama who in his study carried out in Mali in 2015 found a frequency of 13.31% [8]. This difference between the observed frequencies could be explained by poverty, the low level of education and the precocity of sexual activity as in the study by Prosper Kakudji Luhete [9].
The average age of teenage girls was 15 years old. This average age was less than that found by Sépou (17.8) [7]. On the other hand, a study carried out by ILOKI in CONGO found the average age of teenage mothers at 14 years [10]. The average age is very low, is also probably due to poverty. The majority of teenage mothers were first-time mothers. This is explained by the fact that the CAR is among the countries where the literacy rate of young girls is low, and early marriages are frequent [7]. This result is similar to that found in Mali in 2015 by Adama reporting the proportion of first-time mothers at 82.4% [8]. The
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Table 3. Distribution of teenagers and witnesses according to the occurrence of maternal complications.
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Table 4. Distribution of teenagers and witnesses according to the occurrence of neonatal complications.
first sexual intercourse was at age 14 in 73% of adolescent girls. Sepou had already made this observation [7].
Episiotomy was performed in 110 childbirths, i.e. 70% (Table 3) in the teenager group against 88% or 24.9% in the control group, with a statistically significant difference (p < 0.001), Yattasaye in 1998 in Mali had found 57% and Treffers had found 62.7% [6] [11]. The lack of control over the pain of childbirth would be at the origin of the episiotomy to protect the perineum. Preeclampsia was also found in predominantly adolescent girls (p < 0.001). Our results confirm the hypothesis that there is an association between young age and the onset of maternal complications [3] [12] [13] [14] [15]. According to several authors; teenage pregnancy, primiparity, celibacy, low socioeconomic status, constitute risk factors for the prognosis of childbirth (prematurity, low birth weight and intrauterine growth retardation) [5] [14] [15]. Low birth weight (Table 4) was more found in adolescent girls, 11.46%, against 4.53% of controls with a difference being statistically significant (p < 0.001). This rate is higher than that found by Adama 2.3% [8] Diallo in Mali had found a similar rate of 11.8% [16]. The physical immaturity of the uterus (still hypoplastic) is often implicated in the birth of a premature baby and even that of a low birth weight. In addition to this physical immaturity, some authors blame the diet of teenage girls, which is generally more problematic than that of adults, by its poverty, and by its dietary habits. Teenage pregnancy generates specific nutritional and dietary needs, different from those of adult women’s pregnancy, because the teenage body has not yet reached maturity, and continues to grow; hence the needs of pregnancy are added to those of growth [17] [18] [19].
5. Conclusion
This study has allowed us to observe that the evolution of pregnancy and childbirth in teenagers is marked by great morbidity. In view of our results, special attention should be paid to teenagers with regard to the quality of obstetrical and neonatal care provided in our hospitals. Pregnancy in teenagers is a real public health problem.