Rationale Recent studies have suggested that teenage pregnancies are not as hazardous as thought to be earlier.Objective To compare the sociodemographic data, obstetric complications and attitudes towards family planning in teenagers and older women.Design and Setting A prospective cohort study at the University Obstetrics Unit, Teaching Hospital, Galle. Subjects and MethodSociodemographic data, details of antenatal care and family support, antenatal complications, gestation at delivery, mode of delivery, the proportion of unplanned pregnancies, and the possible effects of contraceptive counselling, in two groups of pregnant teenagers (13-16 years, n = 95 and 17-19 years, n = 250) were compared with a control group of pregnant women (20-24 years, n = 275).Results The teenagers were from lower socioeconomic strata and the younger teenagers were significantly less educated than the controls. Teenagers had a significantly higher risk of anaemia (Odds Ratio (OR) = 2.3, 95%CI = 1.7-3.3, p < 0.001). The younger teenagers had a significantly higher risk of gestational hypertension (OR = 4.8, 95%CI = 1.8-13.0, p < 0.001) and pre-eclampsia (OR = 5.0, 95%CI = 1-27, p = 0.03). The older teenagers had a significantly higher risk of delivery before 34 weeks of gestation (OR = 13.6, 95%CI = 1.8-287, p = 0.001). There were no significant differences in the mode of delivery. The younger teenagers had a much higher proportion (54%) of unplanned pregnancies compared to the controls (16 %). A significantly higher proportion of younger teenagers (48%) and older teenagers (25 %), if counselled, would have delayed their pregnancies compared to the controls (10 %).Conclusion Teenage pregnancies, especially those below 17 years of age have a significantly higher risk of adverse outcomes. A large proportion of these pregnancies is unplanned and could be prevented by counselling.
Introduction: Preconception Care (PCC) is an important component of reproductive health care. Objectives: To study the level of preconception preparedness of pregnant women, and factors influencing it, in order to identify possible strategies to improve PCC.
Sustained release ISMN administered vaginally is effective for preinduction cervical ripening.
Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial M Withanathantrige 1 , I M R Goonewardene 1 IntroductionDelayed cord clamping (DCC), an inexpensive method which allows physiological placental transfusion has been described since the 1950s [1,2]. DCC is associated with increased birth weight, (mean difference 101g; 95% CI 45-157), increased new born haemoglobin (mean difference 2.2 g/dl; 95% CI 0.3-4.0 g/dl), increased new born haematocrit >45% (RR 16.2; 95% CI 2-127.4) persisting up to 48 hours, and a reduction of the risk of iron deficiency at three to six months of age (RR 2.7; 95% CI 1.0-6.7) [3]. The requirement of phototherapy for neonatal jaundice is reduced by early cord clamping (RR 0. 62; 95% CI 0.41-0.96) compared to DCC [3]. However DCC is not associated with lower Apgar Scores at 5 minutes, increased admission to special care baby units, respiratory distress, severe jaundice or long term adverse effects [3][4][5][6][7]. DCC is also not associated with increased risk of postpartum haemorrhage, blood transfusion, manual removal of placenta or increased duration of third stage of labour [3,[6][7][8]. DCC improves blood pressure, reduces the need for blood transfusions and the risk of intra-ventricular haemorrhage and necrotizing enterocolitis in preterm infants [9]. Furthermore, DCC maintains oxygenation by sustained placental circulation and is beneficial if spontaneous pulmonary respiration is delayed or impaired [10][11][12][13]. Recently the use of the term 'deferred' cord clamping has been recommended as this suggests a planned policy in contrast to the term 'delayed' cord clamping which may imply that the cord is clamped later than the ideal time [14].Although evidence based guidelines have recommended that DCC should be practiced for all births, in
Objective Nitric oxide donors have been shown to cause cervical ripening. The aim of this study was to evaluate the effects on the mother and the fetus when isosorbide mononitrate (ISMN) 40 mg or the sustained release ISMN (ISMN -SR) 60 mg was administered vaginally for preinduction cervical ripening.Methods A double blind randomised controlled trial. Consecutive women (n=156) with uncomplicated singleton pregnancies between 40 weeks +5 days and 41 weeks' gestation with modified Bishop Scores (MBS) <5 were allocated by stratified (primp / multip) block randomisation to receive ISMN 40 mg, ISMN -SR 60 mg or the placebo vitamin C 100 mg vaginally.Results At the commencement of the study the parity and mean age, MBS, pulse rate (PR), systolic and diastolic blood pressure (SBP and DBP), umbilical artery resistance index (RI) and pulsatility index (PI) were similar among the three treatment groups. There was significant increase (p<0.001) of mean MBS by 1.3 (95% CI 0.8, 1.7) in primips and by 1.7 (95% CI 1.3, 2.0) in multips at 6 hours and by 2.4 (95% CI 1.9, 2.7 ) in primips and by 2.3 (95% CI 2.0, 2.6) in multips at 48 hours. Greater proportions of primips (42% with ISMN -SR 60 mg and 31% with ISMN 40 mg, p<0.05) were favourable for induction of labour (IOL) after 48 hours in comparison with the controls (7.6%). Greater proportions of multips (46% with ISMN -SR 60 mg and 40% with ISMN 40 mg, p<0.05) were favourable for IOL after 48 hours in comparison with the controls (16%). A mean increase of PR by 6.7-10.2 bpm (95% CI 5.0 -12.5, p<0.001) in both ISMN groups at 180 minutes persisted up to 360 minutes. A mean reduction of SBP by 7.3 -10 mmHg (95% CI = 8.0-11.5, p<0.001) in both ISMN groups at 180 minutes persisted up to 360 mins. No significant change was seen in DBP, RI or PI. Frequency of maternal side effects (mainly headache) were higher in ISMN groups. Conclusions
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