Pregnancy Outcomes, A Comparative Study Between Adolescents and Vicenarians In Akatsi District Hospital

Abstract

Adolescent pregnancy is a burning global issue and a public health concern. It is defined as pregnancy in a girl aged 10 to 19 years. These pregnancies tend to have adverse health, economic, social and psychological effects on the adolescents. This study was done to compare obstetric and perinatal outcomes between adolescents and vicenarians and the factors associated with these outcomes at the Akatsi District Hospital. Method A retrospective chart review of case records of 245 adolescents and 245 vicenarians who delivered in Akatsi District Hospital from January 2015 to December 2016 was performed. A structured data abstraction form was used to gather information on socio-demographic characteristics, obstetric and perinatal outcomes. The obstetric outcomes compared in this study were preeclampsia/eclampsia, episiotomy and perineal tear while the perinatal outcomes compared were preterm delivery, low birth weight delivery and birth asphyxia. Data was analyzed using Stata version 14.1. Categorical data was characterized by frequencies and proportion while continuous data was characterized by means (SD). Bivariate analysis of categorical variables was done with Pearson chi2 test of independence. Multivariable analysis of factors affecting adverse pregnancy outcomes was done using multiple logistic regression analysis at a confidence interval of 95%. P ≤0.05 was deemed statistically significant. Results The mean age of the adolescents was 17.45 (SD =1.26) with an age range of 13-19 years whilst that of the vicenarians was 23.64 (SD=2.85) with an age range of 20-29 years. The unadjusted analysis demonstrated an association between age and perinatal and obstetric outcomes. Compared to adolescents, vicenarians were found to have a 55% less likelihood of having episiotomy performed (uOR=0.45; 95% CI 0.31-0.64). The association between age and episiotomy remained significant after adjusting for some confounders in the model (aOR=0.35; 95% CI 0.21-0.60). With regards to mode of delivery, vicenarians were found to have a 92% more likelihood of having caesarean sections performed compared to adolescents (uOR=1.92; 95% CI 1.22-3.03) although not significant after controlling for confounders. Vicenarians had significantly lower unadjusted odds of preterm delivery (uOR=0.16; 95% CI 0.11-0.22), low birth weight (uOR=0.24; 95% CI 0.18-0.33) and birth asphyxia (uOR=0.08; 95% CI 0.05-0.13) but these became non-significant after controlling for confounders. Mothers who had four or more antenatal visits had significantly lower odds of preterm delivery (aOR=0.29 95% CI (0.17-0.51) and birth asphyxia (aOR=0.46 95% CI; (0.20-0.99) and significantly higher caesarean section delivery rate (aOR 2.47; 95% CI (1.15-5.32). Mothers with tertiary education were found have significantly higher rate of caesarean deliveries (aOR=9.72 95% CI 1.06-88.71) Conclusion The adolescents in this study tend to have more successful spontaneous vaginal deliveries and had significantly higher rates of episiotomy. Adolescents in this study had higher likelihood of having preterm delivery, low birth weight delivery and birth asphyxia. Four or more antenatal visits have been observed in this study to be protective factors against birth asphyxia, preterm delivery and low birth weight delivery. Mothers with tertiary education had higher caesarean section rates.