Teen Pregnancy and Situation of the Clinics Hospital of Montevideo Uruguay: Observational Study

Florencia Feldman , Juan Recouso , Leonardo Paller , Grazzia Rey . Resident of Gynecological “B” Clinic. School of Medicine, University of the Republic. MontevideoUruguay. Assistant Professor of Gynecological “B” Clinic. School of Medicine, University of the Republic Montevideo-Uruguay. Resident of Gynecological “B” Clinic. School of Medicine, University of the Republic. Montevideo-Uruguay. Associente Professor of Gynecological “B” Clinic. School of Medicine, University of the Republic. Montevideo-Uruguay. *Corresponding Author: Florencia Feldman. Resident of Gynecological “B” Clinic. School of Medicine, University of the Republic. Pedro Francisco Berro 1115 apto 601. Montevideo, Uruguay. Received date: December 22, 2019; Accepted date: January 29, 2020; Published date: January 20, 2020 Citation: Feldman F, Recouso J, Paller L, Rey G. (2020) Teen pregnancy and situation of the Clinics Hospital of Montevideo Uruguay: Observational study. Obstetrics Genecology and Reproductive Sciences, 4(1); DOI:10.31579/2578-8965/034


Introduction
The World Health Organization defines adolescence as the stage of life in which the individual acquires reproductive capacity, transiting the psychological patterns from childhood to adulthood; considering that it runs between 10 and 19 years. It also classifies it in early or early adolescence, from 10 to 13 years old, middle adolescence, between 14 to 16 years old; and late adolescence of 17 to 19 years, each one being exposed to different risks against a teenage pregnancy [1]. Adolescence constitutes one of the most important transition stages in the life of the human being. Beyond physical and sexual maturation, there are other changes that include the development of identity, the evolution towards social and economic independence; in addition to acquiring the skills necessary to establish adult relationships and functions, highlighting the ability of abstract reasoning. Although adolescence is synonymous with exceptional growth and great potential, it is also a stage of considerable risks, during which the social context can have a determining influence [1].
In turn, it is a period of life with specific health and right's needs. In the same way, it is a time to develop knowledge and skills, learn to manage emotions and relationships, and acquire the attributes that will be essential to enjoy the teenage years and in the very near future assume adult roles [2]. Sexuality, sexual health and reproductive health occupy a central place in the health and life of teenagers. Sexual rights are universal human rights based on inherent freedom, dignity and equality for all human beings [3].
For all the above, this period is characterized by biological, psychological and social changes representing a stage of vulnerability [4], therefore not being the ideal time for pregnancy.
Teen pregnancy is one of the most important medical dilemmas, the result of early sexual intercourse and the inappropriate use of contraceptive methods, which greatly increases its number. It is a worrisome reality worldwide, linked to the increase in maternal and perinatal morbidity and mortality and being a factor of social vulnerability [5]. In this context, Uruguay has high levels of adolescent fertility in relation to the world average, close to the average for Latin America and the Caribbean [6].
Teen pregnancy is also a clear expression and consequence of inequality and social segmentation; perpetuating the violation of women's rights. In most cases these were not planned, seriously affecting future performance in terms of autonomy, self-support capacity, continuity or educational reintegration and participation in other dimensions and areas. On the other hand, and not least, we highlight the close link with situations of sexual violence in children under 15, realizing the existence of unequal gender relations [4].
Therefore, Uruguay considered reducing unintended pregnancy in adolescents within the framework of the "National Health Objectives 2020" [6] planting multiple protocols by the Ministry of Public Health to achieve this goal [7].
The objective of this study was to describe the incidence of births, repetition of pregnancy and Voluntary Interruption of Pregnancy in the adolescent population that uses the service of the Gynecological Clinic "B" of the Clinics Hospital Montevideo-Uruguay, in the period 2009-2017.

Material and methods.
An observational, descriptive, retrospective study was conducted. Data were extracted from the Perinatal Computer System (SIP) of the births of patients with maternal age between 10 and 19 years. From these, obstetric history data were obtained assessing the repetition of adolescent pregnancy taking into account the history of abortion, ectopic pregnancy and delivery or cesarean section prior to the current pregnancy. The SIP is a system created by the Latin American Center for Perinatology, Women's Health and Reproductive Health in 1983, used as a strategy to improve the quality of care for mothers and newborns. Currently, the Ministry of Public Health of Uruguay requires its use by all the maternity hospitals in the country, and is responsible for collecting and validating the data entered in order to obtain reliable statistics at the institutional, local and national levels 8 . In addition, data were collected from the registry of voluntary termination of pregnancy of the Clinics Hospital for the period from 2012 to 2017, in adolescent patients, being from the year 2012 when the law number 18.987 of voluntary termination of pregnancy was established in Uruguay .
The results were expressed as percentages with respect to total births using the OpenEpi program available at: https://www.openepi.com/Proportion/Proportion.htm

Results.
In the analyzed period of time there were 6,552 births of which 4,978 (75.98%) were in women older than 19 years and 1,574 (24.02%) were in women with 19 years or less. Among the total adolescent pregnant women, 469 (29.8%) had at least one previous pregnancy, of which 90 (19.1%) had at least one child alive. Regarding the voluntary interruptions of pregnancy, a total of 381 were performed in our center, of which 318 (80.82%) were in women over 19 and 63 (19.18%) were in adolescent women.
In Figures and Tables 1, 2 and 3, the percentage per year of adolescent pregnancy, adolescent pregnant women with at least one previous pregnancy and voluntary termination of pregnancy in adolescents, respectively, in the Clinics Hospital in the mentioned period of time can be assessed.

Discussion
In the total period of time analyzed, it is observed that approximately one quarter (24.02%) of the pregnancies produced in the maternity of Clinics Hospital correspond to adolescent mothers. This represents a higher percentage than the one reported at the national level where it is observed that in the last five years 17% of the total births have been in adolescent women 6 National data show that the level of adolescent fertility in Uruguay is very high and resistant to decline: the country has high figures (60 per thousand women aged 15 to 19 in 2014) in relation to the world average (45 per thousand) and the region (65 per thousand) 6 . On the other hand, the percentage of births in children under 20 has remained between 15% and 16% in the last two decades 6 . This differs from our motherhood where there has been a significant decline from 2009 (26.47%) to 2017 (19.85%), as already mentioned.
In our maternity center there is a repetition of adolescent pregnancy of 32.07% in 2009 with a decrease in 2013 (23.15%) and a subsequent rise in 2017 with 30.3%. These figures are higher than those recorded at the national data level with 21.4% in 2010 and a rise in 2017 with 24.5% 10 . Knowing that teenage pregnancy is often the user's first contact with a health center, it is an unamicable opportunity to conduct education and counseling in an appropriate contraceptive method in order to prevent a second unintended teenage pregnancy; as well as the formation of social networks to promote socio-economic self-development.
In this line, the promotion of post-obstetric contraception stands out, with individualized contraceptive counseling at this stage being mandatory. Post-obstetric contraception is understood as the advice and implementation of a contraceptive method within the first 48 hours after an abortion, childbirth or caesarean section and prior to hospital discharge 11 . The American College of Obstetricians and Gynecologists supports the placement of a long-term contraceptive method (Long-Acting Reversible Contraception, LARC) in the immediate postpartum period, for its role in preventing the rapid recurrence of unwanted pregnancy. Adolescent girls are at greater risk of a brief intragenic period, with the risks that this entails 12 . LARCs in general have shown greater efficacy, rate of continuity in use and higher satisfaction rates compared to short contraceptive methods duration, among the teenagers who choose them [13,14].
Finally, we observe that of the total voluntary interruptions of pregnancy performed in the Clinics Hospital, about 20% are in adolescents. This also differs from official figures of the Ministry of Health, which report 15% [6]. Again, it is an important moment for sexual and reproductive health education in adolescents.
Both regionally and nationally, but also in Latin America, access to adolescent sexual reproductive health services remains a challenge [15]. That is why, with the regional context, that the Montevideo Consensus [16] on population and development was a fundamental regional commitment made at the first meeting of the Regional Conference on Population and Development in Latin America and the Caribbean, held in August 2013. This document agreed to invest in youth, through public policies specific and enunciated the regional commitment to: 1. Ensure the effective implementation of comprehensive education programs for sexuality. Recognizing the affectivity, from early childhood, respecting the progressive autonomy of the child and the informed decisions of adolescents and young people about their sexuality, with a participatory, intercultural, gender and human rights approach; 2. Implement friendly health services. These must guarantee the decision making in a free, informed and responsible manner in relation to their sexual and reproductive life and the exercise of their sexual orientation; 3. Access to modern, safe and effective contraceptive methods. Respecting the principle of confidentiality and privacy; 4. Prevent the transmission of HIV and other sexually transmitted infections; 5. Prioritize teenage pregnancy prevention and elimination of unsafe abortion. Through comprehensive education for sexuality, and timely and confidential access to quality information, advice, technologies and services, including non-prescription emergency oral contraception and female and male condoms; 6. Design intersect oral strategies. Aimed at helping women prevent subsequent teenage pregnancy, including prenatal, childbirth and postpartum care, access to effective contraceptive methods in the post -vent period, and protection and access to justice.

Conclusions
As we have seen, adolescence is far from being the optimal time for pregnancy; affecting participation in multiple aspects of women's lives and perpetuating, in some cases, the circuits of poverty.
Unintentional adolescent pregnancy and its repetition constitute a clear failure of health policies in sex education and in the Auctores Publishing -Volume 4(1)-034 www.auctoresonline.org ISSN: 2578-8868 implementation of correct contraceptive counseling; being recommended in these patients long-term and reversible contraceptive methods such as the sub dermal implant and the intrauterine device. Works like this, allow us to assess a relevant situation in the user population of the Clinics Hospital, making us reflect on the efforts to prevent this reality.