Dr J Roy Assistant Professor Department of Obstetrics & Gynaecology

We take one step back from the topic of teenage sepsis to that of Teenage pregnancy.

Here we need to know

why teenage pregnancy is an important factor what is the problem related to sepsis and pregnancy what is the rate .. and how we can reduce teen pregnancy and therefore sepsis

World status
South Korea has the least number of teenage

pregnancy of 3 per 1000 women aged 15 to 19 years, closely followed by Japan and China. The highest rate of teenage pregnancy in the world 143 per 1,000 girls aged 1519 years is in sub-Saharan Africa.

The South Asian chapter

Fertility rates in South Asia range from 71 to 119 births per 1000 women aged 1519.
In the Indian subcontinent, 30% of all induced

abortions are performed on women who are under 20. Unlike developed countries premarital sex is not a common cause of teen pregnancy as is early marriage. The rate of early marriage is higher in rural regions than it is in urbanized areas.

Causes of teenage pregnancy

The causes leading to teenage pregnancy can be

broadly divided into two groups that in the developed world and in the developing world. In the developed world causes are young age at first intercourse inconsistent and/or incorrect use of contraceptive methods with high failure rate use of drugs, alcohol and aberrant lifestyle

Contd..Causes of teenage pregnancy

In the developing world causes are

early marriage family pressure for early conception but the the women not mentally ready to carry the pregnancy poor socio-economic status poor nutrition ..and.. lack of education, especially sex education lack of knowledge of contraception lack of awareness that medical termination of pregnancy is legal after 18years of age

The Indian chapter

Though India is a developing country..it has

got a mixed picture i.e.

In the metropolis like developed countries
In the rural areas like developing countries

The Vicious Cycle

Teenage pregnancy

Teenage abortion

Sepsis

Objective Study at COMJNMH

Prospective study carried out at COMJNMH, Kalyani Study duration 1/12/2010 to 30/11/2011 for a period of

one year.
To know the demographic pattern of Kalyani and its

suburbs that resort to means that leads to sepsis. To know the status of abortion service providers

Information obtained:
Age Marital Nature

status Education status, Socioeconomic status Occupation Parity

of abortion Place of abortion Contraceptive awareness Management

Total patients (60) admissions due to sepsis (of which 50 case notes were available for analysis) Retrieval rate 83.3% approx 42 Induced abortion leading to sepsis(84%)

(1) Type of abortion

8 Spontaneous abortion leading to sepsis(16%)

Results & Analysis of Septic Abortion in Kalyani & its suburbs..

2) Age distribution
<16 years 16-19 years 2 18

(36%)

20-24 years
25-29 years >30 years

5
4 3

Results & Analysis cont

3) ParityNullipara Multipara 48 (80%) 12

4)Educational profile
Primary Secondary Higher secondary &above 10 31 9 20% 62% 18%

Results & Analysis

5)Method of abortion used
Suction&Evacuation 35 /Dilatation & curettage Medicines/Abortificie nts 15 70%

30%

6)Antibiotic usage In 40 out of 50 antibiotics were used (80%)

Results & Analysis

7)Mortality 3 (5%)
8)Causes of death
Acute renal failure Gross sepsis with DIC Hepatic encephalopathy

Results & Analysis.

Service provider
Trained Untrained 28 22 56% 44%

Contraceptive use
None Rhythm method Postcoital contraception 30 10 10 60% 20% 20%

Discussion
Important highlights: Majority of the patients of sepsis had secondary education Contraceptive usage was poor Maximum sepsis was in the 16-20 years of age group Sepsis was most common in primipara Trained doctors provided abortion services in 56% of the cases presenting with sepsis In 80% antibiotics were used. Death rate due to sepsis was 3.3% in the teenage mothers compared to the 1.6% maternal deaths in the older age group.

Take home messages

Stringent laws needed to enforce the Indian marriage

act that it is a punishable offence to marry below the age of 18years. Supplying and ensuring that all teenaged girls have iron and folic acid tablets daily, especially in the rural/tribal set up. Contraceptive awareness needed amongst teens which can be given in schools and colleges or by field workers. Self induced abortion, i.e. postcoital contraception, should be discouraged and not be taken as a substitute for regular contraception.

 Awareness should be spread amongst women that

medical termination of pregnancy is legal. There is a need to ensure strict autoclaving and maintenance of sterile environment in the OT. This can be followed up by being vigilant and taking regular swab culture that can be done at monthly or atleast three monthly intervals. The above would ensure the optimum use of antibiotics and thus prevent resistant strains of organism from developing. Hence MRSA strains can be prevented from popping their heads and creating a havoc.

Lets join our hands together to save our mothers who are innocent and unaware of the sorry plight that awaits them at the cost of their ignorance.