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ESSAY 200 - Teenage pregnancy

Posted by Balakrishnan V.
Teenage pregnancy is considered high risk pregnancy due to its association with maternal psychological, social and health problems as well as fetal complications.

In her first booking visit I will ask how she is feeling and coping with her pregnancy and would like to stress upon importance of compliance with her antenatal checkups.
I will confirm her gestation by LMP and scan, enquire about early pregnancy problems like hyperemesis, any medical history of asthama or insulin dependent diabetes. Problems with weight, like anorexia, bluminia or obesity are common in this age group. I will advice on healthy eating to meet increased pregnancy caloric requirement, moderate exersice like walking. An appointment with the dietician may be helpful.
Smoking, drinking, unstable sexual relationships and use of recreational drugs is commom among teenagers, but it will not be helpful to enquire about them in the presence of her mother. I will try to get few minutes with the patient alone, or arrange another appointment, to ask about these problems and give relevent advice or even to arrange appointment with smoking sessation counsellor, drug specialist or genitourinary clinic as appropriate.
I will ask about partner support and financial stability. I will appriciate her mother\'s support and encourage her to continue it.

Her further antenatal care should be shared by hospital, G.P and midwivery. As her antanatal attandance may be poor community midwife and social worker should give her home visits.
Medical problems of anaemia, pre eclampsia , urinary tract infections and preterm labour are common among teenage girls. In every antenatal visit bloodpressure and urine dipstix should be done and oral iron prescribed if needed.
Fetal risks include congenital abnormalities,IUGR,prematurity, and later negligence and sudden infant death syndrome. Detailed anomally scan will be done at 20 weeks. In third trimester if IUGR suspected clinically serial growth scan and Doppler may need to be done .
She should be encouraged to attend antenatal classes, so she will have an idea about pregnancy, labour and delivery.
Epidural analgesia in labour is preferred due to high analgesia requirement. The chances of operative vaginal delivery or caesarean are high due to immature small pelvis.
Before discharge from hospital she should be given proper contraception and advice on emergency contraception to decrease
future chances of unplanned pregnancy. She should be encouraged to breast feed. She should have continuouse support at home either by family of social worker as she is more susceptible to postnatal depression. A review at 6 weeks should be arranged to see her GP.


Posted by Sarwat F.

Teenage pregnancy is a high risk pregnancy. Proper antenatal care will be planned to minimize risks. At the time of booking visits various issues that need to be evaluated include social history and personal history of smoking drugs, alcohol.
Sympathetic approach is important as she may be under lot of stress if there is unplanned pregnancy. She will be asked if she wants to be interviewed alone or in the presence of any family member.
Teenage pregnancy is high risk as patient may not have adequate support from family or partner and this leads to increased stress and subsequent complications like hyperemesis gravidarum, so issue of social support should be particularly evaluated at this visit so that appropriate steps can be taken for management.
Personal history like smoking, intake of any drugs, intake of alcohol are asked as these are quite common in teenage pregnant woman.
Her attitude towards this pregnancy is explored and birthing preferences, analgesia for labour and delivery will be asked.
Her last menstrual period is asked as this will help in accurate dating of pregnancy.
Nutritional deficiencies are also quite common in teenagers so this is also evaluated.
Her capacity to consent is assessed as she is below the age of consent so gillicks or fraser competence is assessed.
Any history of sexual abuse is elicited in a careful and tactful manner respecting patients confidentiality.
Regarding subsequent antenatal and postnatal care, teenage pregnancy is associated with a number of complications which include social problems, drug and alcohol abuse, nutritional deficiencies, anemia, urinary tract infection, hypertension, preterm labour and low birth weight.
If social problems are identified social worker help will be arranged, regular visits will be arranged with a community midwife.
Counseling regarding smoking, drugs and alcohol abuse will be done. Appointments with drug detoxification centre will be arranged if drug abuse is identified to help stopping or changing to less harmful like methadone in case of opiate abuse.
She will be counseled regarding need of proper diet intake during pregnancy to prevent development of any nutritional deficiencies. Hospital based care will be preferred in her case.
As UTI is common so her urine will be checked at each visit.
She will be educated about signs and symptoms of preterm labour to identify early and take appropriate steps.
Teenage pregnancy can be associated with intrapartum problems like difficult pelvic examination, vaginismus higher analgesia requirement during labour, obstructed labour, and increased risk of operative delivery.
An antenatal appointment with anaesthetist can be offered to disuss issues regarding pain relief in labour. Help with a psychologist may be sought in case there are problems like vaginismus.
There are risks in the postnatal period as well which include increased risks of sudden infant death syndrome, short interval to next pregnancy, increased risk of sexual health risk behaviour and STDs. Social support is arranged if needed to help the mother cope with managing newborn. It is ensured that patient receives proper contraception advice as well as information regarding safe sexual practices, use of condoms. A postnatal visit to discuss these isues is arranged and written information provided.
Posted by Freha Z.
Adolescent pregnancy is associated with both social and medial problems. I would confirm her LMP, any problems related to pregnancy and her attitude towards pregnancy. I will insist on the importance of antenatal visits because of adverse social circumstances compliance with antenatal visits tends to be poor. I will take history of smoking and ilicit drugs use and counsel the patient that both have adverse effect on pregnancy. She is also at high risk of nutritional deficiency, anaemia and therefore advised healthy diet. Her care should be based on multidisciplinary approach including midwife, GP, and social worker should be involved. I will give her information on pregnancy, delivery and child rearing which should be backed up by leaflets and advise her to join for antenatal classes.
I will advise complete blood count to rule out anaemia and ultrasonography to confirm pregnancy.
Regarding further management special emphasis should be on prevention and treatment of complications of preterm labour, pre eclampsia as well as risk of sexually transmitted disease. Fetal monitering should be done by regular growth scans.
She needs continuous emotional support during pregnancy and labour. Hospitalized delivery is indicated because of risk of obstructed labour due to immature pelvis.
Postnatal visits are important to moniter infant feeding practices, infant growth and safety. Effective contraception should be implemented. She should receive continuous support from social worker during pregnancy and postnatal period.
Posted by SANGEETA P.
Teenage pregnancy is a high risk pregnancy which has social and psychological risks involved apart from the obstetrics risk.Multidisciplinary care should be offered involving social servises, community mid wife, obstetricians, GPs and other support groups as required.At her first visit she should be dealt with great empathy.Detailed history shoould be taken to get her view regarding the pregnancy weather it is planned or if she is happy to carry on the pregnancy as at this gestation she can be councelled carefully for termination if she wishes with detailed councelling related to the risks involved.Her social, financial and family circumstances should be find out as most of the teenage pregnancies have social, financial and psychological concers and in that case she may be reffered to the support groups involving social support.Coming to the antenatal clinic with mother does indicate that her family is supporting her but still her mother should be given a chance if she has any concerns.Considering her young age she is at risk of HIV, STIs, smoking, alcohol and use of illicit drugs, history related to this should be sought and importance of safe sex practice and avidance of the substances should be emphasised, she should be advised to use barrier methods for safe sex during pregnancy.If she uses illicit drugs , approprate measure e.g methadone programme can be discussed with her.She has documented high risks of growth retardation, sudden infant death syndrome.Nutritional defeciencies is also major concern and she should be councelled for the importance of taking healthy diet in pregnancy.At this visit she should have routine bloods including HIV, Hep B, and blood levels for iron, folic acid, vit b and other vitamins levels.

Her age has significant antenatal and post natal effects which should be addressed carefully, usually teenage girls are poor attenders, could be due to social, might have a fear of being embarrased or disclosing the scerets if they are involved with drinking or illicit drugs.She should be encouraged to attend the antenatal clinic, or her mid wife should be involved for home visits to make sure regular ante natal check up is done.She will need regular growth scans+/_ doppler if there is any concers regarding baby;s growth.During labour, she should have support from the family and the mid wife nad medical staff in a empathetic manner.Continuous CTG may be justified if there is any concern.She should be offered good pain relief in labour preferably epidural.Contrary to the belief teenage pregnancy does not have high risk og instrumental delivery but may have high c/section rate if small pelvis.
Post natally she is more prne to develop post natal depression so she should be watched out for that.If she is planning to breast feed the baby,involve the breast feeding grpoup to help her estabilishing the breast feeding.Its been well documented that teenage pregnancies are followed bu another quick pregnancy so should be advised for the contaceptives preferably barrier method..Her social and pychological support should continue after the preganncy and she should be emphasised on the importance of continuing her education.
Posted by Aroosha B.
Teenage pregnancy is associated mainly with social problems rather than physical or medical problems..Issues to be addressed at initial visit are exclusion of any medical problems by a thorough history . Encouragement regarding regular antenatal visits as the are prone to default . Other social problems for example financial problems which is less likely in this case as she seems to be supported by her parents. Illicit drug use , smoking , and alcohol consumption are common in this age group therefore , they have to be managed and advise given accordingly . Help of social workers and drug counsellors may be needed. Screening and management of STD?s is done with the help of GUM clinic as STD?s are more likely in teenagers . Advice for safe sex practice use barrier methods should be given . Lifestyle modification regarding proper eating habits , stopping smoking and alcohol should be advised . Booking ultrasound and baseline investigations for e.g. FBC , RBS and serology to rule out anemia and hepatitis B,C,HIV, syphilis and rubella status is done . Communication with family doctor , midwife and social services may be needed to ensure adequate care in case of default from A/N checkup. Information leaflets on pregnancy , delivery and infant care is given.
During subsequent A/N includes identification and management of anemia , UTI by regular screening by FBC and MSU C/S in every trimester . BP monitoring at each visit and plus urine for protein as they are at increased risk of PET. Ensure adequate weight gain if underweight and give proper dietary advice and nutritional supplement . Regular growth scans are done as increased risk of low birth rate babies . Explanation of signs and symptoms of pre-term labour as this is most common in this age group. Drug substitution may be needed which is done with the help of drug addiction units . Continous education and support is ensured.
During labour increased anaelgesia requirements should be met with adequate anaelgesia . Continous support with a family member is preferable. Operative assistance may be needed so senior staff should be present . Continous fetal monitoring if any associated medical problem . Neonatologist if there is pre term delivery or a low birth weight baby. In a 14 yr old risk of obstructed labour due to a small pelvis needs confinement in specialist unit . Postnatally advice and support for infant feeding and care encourage secondary education reliable contraception for example injustibles , implants , IUCD with barrier method is advised. She should be advised to continue iron and folic acid for atleast 3 months if anemia during pregnancy.
Posted by adnan S.
Teenage pregnancy is linked to social deprivation ,they are associated increased risk of neutritional defeciancies,sexually transmited infections,and abnormal behaviours like smoking ,alcohol consumption and illicit drug abuse.During her first visit the issues to be discussed are there are increase risk of mother developing complications like anaemia,urinary tract infection and pregnancy induced hypertension,the fetus is at the risk of preterm delivery ,low birth weight hence she needs to have regular antenatal care ,good neutrition .She might be at risk of sexually transmited infections depending upon her lifestyle should be screened for HIV.Hepatitis B infections if positive there is risk of vertical transmission.If she is using illicit drugs ,alcohol consumption and smoking they have adverse effects on fetus.Social factors like there is increased risk of drop out of school ,and fail to achieve their full educational potential .Contact numbers of local authorities which have special education units which allow young mothers to continue their education after the birth of the baby,and provide child care while mother is in class.

Antenatal care of this girl should be supportive ,at booking weight should be checked if low BMI adequate neutrition is adviced Baseline BP is checked .Routine blood tests done like FBC to check HB , Rh status should be checked if negative prophylactic anti D is given at 28 &34weeks ,rubell antibodies,syphilis ,HIV Hepatitis screening is done ,dating USS is done.Iron and folic acid supplementation is given.If the girl is reluctant to attend antenatal clinic home based care should be provided,parenting skills should be taught and support should be provided.Routine downs screening is done .at 20weeks anomaly scan is done and regular monitorin of weight ,BP and urine analysis is done at each antenatal visit.Fetal monitoring is done as ther is risk of low birth weight &pre-term labour.C-section is done for obstetric indications.During labour continues support should be provided by her mother or family members,adequate analgesia is provided,and careful watch on progress of labour is done as there is risk of dystocia.
Postnataly she should be provide with adequate contraception ,parenting skills should be taught and social support to complete education
Posted by neera  B.
My 1st essay pl check.
The level of understanding of this young girl should be assessed, extra time given, confidentiality ensured. some time should be spent alone with the patient without mother to take sexual history, risk assesment for STI, history of alcohol, smoking and drug abuse.
She should be asked about problems in current pregnancy such as vomiting. Ascertain if pregnancy is wanted or not, termination should be discussed in case of unwanted pregnancy. Social history about income, family and partner support should be asked. Need for social and community support now and after child birth shold be assessed and documented.
She should be reassured that most teenage pregnancies have a favorible outcome. But preterm labour, PIH, low birth weight, anaemia and urinary tract infections are more common. So importance of regular antenatal visits and good nutrition are emphasised. She should be advised to avoid contact with children who have flu like symptoms and rash.
Rubella screen and usual booking investigations are dispatched, endocervical swab is sent for chlamydia, dating scan arranged.
Antenatal management involves booking under a consultant. Patient listning to her complaints, need to repeat things to enable her to understand and provision of pamphlets is essential. Anaemia should be treated by diet and iron supplements. Smokers should be offered smoking cessation programme. If high risk of STI, enrollment to GUM clinic is done. Alcoholics should be counselled about adverse effects and safe limit.Safe sex is advised using condoms.
BP should be checked at each antinatal visit. Social support and family support are important in antenatal period. Careful watch for progress of labur is needed due to risk of CPD. Pelvimetry does not help in predicting normal delivery.
After delivery help with breast feeding and home visits by community midwife are arranged. If needed, child suport is offered. Letter to GP is written. contraceptive advice rendered. Follow up visit should be arranged.
Posted by Ismatara B.
Adolescent pregnancy is a high risk pregnancy. There are various issues to be addressed at this visit. Teenage pregnancy is associated with social, physical and medical problems.
She should be dealt with great sympathy. She should be asked weather this is her planned pregnancy and is happy to carry on this pregnancy or wants termination of pregnancy. She will be asked about this carefully weather alone or in the presence of any family member, whichever she wants. Her capacity about consent should be assessed as she is under the age of consent so Gillicks or Fraser competence is assessed.
A thorough history about her LMP, smoking, illicit drug abuse, alcohol consumption should be taken, as this is common in pregnancy.
She is at risk of nutritional deficiency and sexually transmitted disease. So should be evaluated.
Regarding her antenatal and postnatal care a multidisciplinary approach including community midwife, GP, obstetrician, social services and other support groups should be involved, as she is at risk of anemia, nutritional deficiency, urinary tract infection, hypertension, preterm labour, IUGR, higher need for analgesia during labour, sudden infant death syndrome.
She should be encouraged to attend antenatal clinic regularly, or midwife may be involved for home visit, if she is a poor attender. She may not have adequate support from her partner or family, if so social support by an empathetic midwife and a social worker should be ensured during ante, intra and postnatal period. Lifestyle modification regarding proper eating habits with haematinics, stopping smoking and alcohol should be advised.
At this visit, FBC, urine for MSU and C/S, dating scan should be arranged if not done earlier. She should be screened for HIV, Hep B and other STDs. Help of GUM clinic may have to be involved if needed. Counseling about safer sex by using barrier method. Supply of disposable syringe should be ensured if needed.
FBC and urine for MSU and C/S should be checked at each trimester to identify anemia and UTI. BP should be monitored, as she is susceptible to PET. Ensure weight gain if she is underweight. Growth scans, CTG, Doppler from 28weeks may be needed, if there is any concern of IUGR.
She should be given information on pregnancy, delivery and childrearing, backed up by information leaflet and antenatal classes.
She will be educated about signs and symptoms of preterm labour to identify earlier and take appropriate measure.
An antenatal appointment with anaesthetist can be offered to discuss about pain relief in labour as there is increased need for analgesia.
Continuous support during labour by family member and empathetic midwife is needed. Senior obstetrician should be involved and confinement to a specialist unit is advisable as there is chance of obstructed labour due to small pelvis and there is chance of caesarean section. Continous fetal monitoring if any associated problem. Neonatologist should present if there is preterm labour or IUGR.
Postnatally, she may develop postnatal depression, so psychiatrist involvement may be needed and advice and social support regarding infant feeding and care should be encouraged. Effective contraception should be implemented, as there is chance of short interval to next pregnancy. A postnatal follow up after 6 weeks should be arranged and importance of continuing her education should be emphasized.




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Posted by OJO AJIBADE  .
Teenage pregnancy is associated with more social problems rather than physical problems.After an initial introduction;booking history will include her last menstrual period to give a rough estimate of her date of delivery.Type of contraception she was using and whether the prgnancy was planned or not. Enquiry about preconceptual folate intake will be documented and other social activities eg smoking;alcohol consumption;other illicit drug will be noted. The effect of these on maternal eg loss of apetite and fetal effects eg fetal growth resriction will be discussed.
Past history of urinary tract infection;sexually transmitted infections and treatment offered will be noted.Attempt will be made to see her alone to discuss any suspicion of sexual abuse and this will be done sympathetically after assuring her of confidentiality.Any social support from partner and family members will be noted.
General examination will note her BMI(if <19 or >30) will need dietician involvement.Booking blood including full blood count(if Hb is low will need iron supplement);group and save to determine her rhesus status.She will be screened for STI (eg chlamydia;gonorrhoea and appropriate treatment offered if necessary) ;blood borne infections eg HIV:Hepatitis B and C.
Dating scan will be arranged to confirm viability and number of pregnancy.Other issues are increased risk of miscarriage;preterm labour;gestational hypertnsion and preeclampsia;anemia;fetal growth resriction and postpartum sudden infant death syndrome.

Subsequetly; she will be advised on normal routine clinic attendance and social worker ;community midwife and her GP will be notified in case of poor and infrequent attendance which they are prone to.At each visit; weight;BP ;Urinalysis will be checked.This detect early abnormality eg hypertension ;preclampsia;asymptomatic bacteriuria;diabetes so that approprite treatment will be offered early with the involvement of appropriate specialists. Anomaly scan will be arranged for 22-24 weeks.If she indulges in smoking; heavy alcohol consumption; and other drugs ;drug liason team will be invoved.She will need social support ;hence the involvement of social worker .
Intrapartum ; I will enviasage vaginal delivery with low threshhold for operative vaginal delivery and CS for obstetric reason only eg obsructed labour due to Cephalopelvic disproportion..Ccontinuous support from family members will be encouraged; adequate analgesia especially epidural will be offered if she wishes;labour dystocia will be managed appropritely with syntocinon augmentation if not contraindicated .Social support is essential postpatum if family support is lacking.
Risk assessment for VTE will be done and given heparin thromboprophylasis if necessary in addition to early mobilisation adequate hydration and TED socks.
The baby will be given vitamin K and watched for sudden infant death syndrome .Effective conraception will be offered after counselling to prevent unplanned pregnancy
Posted by Surekha R.
Majority of times teenage pregnancy is an unplanned pregnancy and so is associated with social,medical and fetal problems.A detailed history about her social,financial,and educational status should be taken and any concerns regarding pregnancy should be addressed.She should be stressed upon the importance of having regular antenatal checkups.The girl should be advised about taking nutritious diet and modifying certain life style factors like smoking and drug abuse if present.To relieve her anxiety or fears of pregnancy social support with family physician,midwife or socialworker should be offered.Emotional support of family members should be emphasised.She should be given full information about pregnancy , delivery and baby care.The girl should be assured that the likelihood of having a operative delivery will not be increased becos of her biological immaturity.At the same time her competence in understanding things should be assessed and in case of immaturity in understanding termination of pregnancy should be offered as a choice.Mother is prefarably involved in the whole discussion.
Careful antenatal and postnatal care is required to achieve good maternal and fetal outcomes as psychiatric disorders especially in this age group are an important indirect cause of maternal mortality.Compliance with regular antenatal checkups should be maintained with the help of midwives or social support groups.Early ultrasonography should be done to check the gestational age as these fetusws are more prone for fetal growth restriction and prematurity.She should be looked for nutritional deficiences like anemia and vitamin deficiencies and put on iron , folicacid and calcium supplementation accordingly.Careful B.P checkups should be done as she at risk of developing pregnancy induced hypertension. Fetal growth should be monitored regularly and if signs of growth restriction serial growth scans are done.Throughout antenatalcare pshycosocial factors should be kept in mind and support should be offered , if necessary services of a psychiatrist should be taken.if dystocia is suspected due to immaturity delivery should be scheduled in a specialised unit.
Postnatal period is the most important period as they are more prone to developing depression &psychiatric problems durig this time. Careful vigilance by midwives and public health nurses should be arranged. The girl should be taught about infant feeding practices and infant safety as sudden infant death syndrome is common in this group.Contaception should be discussed.
Posted by Samir A.
Teenage pregnancy has more social rather than physical impact.It is usually unplanned.I\'ll ask the girl if she wants to terminates pregnancy or continue it+/-adoption.I\'ll assess thegirl competence for giving the consent.I\'ll find the chance to talk to her without her mother.I\'ll ask her for history suggestive of STDs,smoking,alcohol and drug abuse.I\'ll arrange multidiscepliary managment accordingly.I\'ll inform the girl and her mother the importance of attending antenatal care classes.I\'ll arrange midwife home visits since hospital visits might disturb school attendance as well as results in poor compliance.Teenage pregnancy needs support by obstetrician,midwife,social worker as well as I\'ll encourage the partener and the family,especially the mother to give full psychological and social suuport.
In addition to the usual antenatal care I\'ll take hitory of LMP,do dating scan, pay more attention to the possible risks of hypertensin, anaemia,IUGR and UTI in teenage pregnancy.I\'ll do anmaly scan at 20 weeks, doppler sscan if IUGR suspected as well as regular check of MSU, BP and CBC in each ANC visit.I\'ll give the girl information leaflet for ANC and parent teaching.
Postnatally, she has the risk of post natal depression, I\'ll give follow up appt after 6 weeks.I\'ll give contraception after counselling .I\'ll counsell the girl, partener and family regarding the risk of sudden neonatal/infant death syndrome and give parent teaching.I\'ll give also the the contacts of Support group e.g Young Parents Club.