Thread: Complications of Teenage Pregnancy

Complications of Teenage Pregnancy

Patient Presentation
A 16-year-old female came to the emergency room with dysuria for 2 days. She had increased urinary frequency and urgency, and complained of strong smelling urine. She had no fevers, chills, constipation, or other abdominal pain. She had minimal vaginal discharge that was unchanged.

The past medical history was non-contributory. The social history was obtained without her mother present and showed that she was sexually active with her second lifetime male partner. She denied sexual activity with female partners. She said they used condoms inconsistently and did not use a spermicide. Her last intercourse was 3 days prior and her last menstrual period was about 8-9 weeks ago. She denied previous pregnancies or sexually transmitted infections.

The review of systems also revealed general fatigue and breast tenderness for 6 weeks. The pertinent physical exam had normal vital signs with a height of 75% and weight of 50% for age. HEENT was negative. Breasts showed no masses or skin changes. Abdomen had normal bowel sounds without hepatosplenomegaly or masses. There was no costovertebral angle tenderness, but there was mild suprapubic tenderness. External genitourinary examination showed no vaginal discharge, with minor erythema of the skin around the urethral opening.

The laboratory evaluation showed a urinalysis with a specific gravity of 1.015, 1+ blood, 4+ white blood cells with + leukocyte esterase and nitrates. She had 1-2 red blood cells and too numerous to count white blood cells. A urine pregnancy test was positive but she refused any testing for sexually transmitted infections.

The diagnosis of urinary tract infection in a pregnant adolescent was made. She was treated amoxicillin for the urinary tract infection. The physician discussed the pregnacy and all the potential options with the patient and also offered to be with the patient when she told her mother or to tell her mother for her. She agreed to this and after her mother calmed down from hearing the news, her mother was very supportive. Her mother said she would contact her own obstetrician for an appointment for her daughter.

As the patient's primary care provider was a family physician, the emergency room physician recommended contacting the family physician who may provide pregnancy counseling and obstetrical care. Additionally, the emergency room physician also gave them other pregnancy-related community services for pregnancy counseling and obstetrical care. The patient was also given a prescription for daily prenatal vitamins and given basic information on nutrition and avoiding alcohol and drugs.

Discussion

Adolescent sexual activity and pregnancy continues to be significant health problems.

Common pregnancy clinical presentations include overdue menses (most common), abdominal pain, breast tenderness, fatigue, nausea and urinary frequency. Gestation age can be estimated by last menstrual period and fundal height. At 8 weeks gestation the uterus can be palpated, at 12 weeks gestation the uterus is at the pubic symphysis, and at 20 weeks gestation, itshould be at the umbilicus. Non-judgemental pregnancy counseling should be offered including giving birth and raising the child, adoption and/or abortion. Referral for prompt prenatal care should be given to help prevent complications, but health care providers can also give prescriptions for prenatal vitamins and offer information on nutrition and avoiding alcohol/drugs.

Learning Point

Teenage pregnancy complications include:

For the infant

• Low birth weight
• Preterm birth
• Higher peri- and post-neonatal mortality including sudden infant death syndrome and congenital malformations
• Poverty

For the mother

• Anemia
• Delayed prenatal care
• Depression
• Inadequate weight gain
• Poverty - partly due to inadequate education (only 50% of adolescent mothers complete high school by age 18 and by 35-39 years only 70% have a high school degree)
• Pregnancy induced hypertension and eclampsia
• Second birth as a teen

Some of these problems may be more related to poor prenatal care, nutrition and poverty than the mother's age. In general, first pregnancies have more complications than subsequent pregnacies, including teenager pregnancies.

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