Background
Methods
Statistical analyses
Ethical considerations
Results
Socio-demographic characteristics and referral status of study participants
Variable | Adolescent parturients (10–19 years) | Non-adolescent parturients (≥20 years) | Sig. (p-value) | OR (95% CI) | Entire study sample | |
---|---|---|---|---|---|---|
n (%) | n (%) | N (%) | ||||
Study sample
| 560 (9.3) | 5437 (90.7) | 5997 (100.0) | |||
Age (years) |
Mean ± SD
| 17.78 ± 1.31 | 28.32 ± 5.44 | <0.001 | 27.34 ± 6.03 | |
Range
| 13-19 | 20-49 | 13-49 | |||
Marital status
|
Single
| 432 (79.4) | 2654 (50.1) | <0.001 | 3.85 (3.10-4.77) | 2759 (47.2) |
Married
| 112 (20.6) | 2647 (49.9) | 3086 (52.8) | |||
Occupation
|
Student
| 290 (52.6) | 1097 (20.5) | <0.001 | 4.36 (3.63-5.24) | 1387 (23.5) |
Unemployed
| 15 (2.7) | 197 (3.7) | 1.26 (0.73-2.16) | 212 (3.6) | ||
Employed
| 246 (44.6) | 4059 (75.8) | 1.00 | 4305 (72.9) | ||
Referral status
|
Referred
| 36 (6.4) | 233 (4.3) | 0.020 | 1.53 (1.07-2.20) | 269 (4.5) |
Non-referred
| 524 (93.6) | 5204 (95.7) | 5728 (95.5) |
Parity and gestational age of study participants
Variable | Adolescent parturients (10–19 years) | Non-adolescent parturients (≥20 years) | Sig. (p-value) | OR (95% CI) | Entire study sample | |
---|---|---|---|---|---|---|
n (%) | n (%) | N (%) | ||||
Gravida
|
Mean ± SD
| 1.29 ± 0.63 | 3.13 ± 2.01 | <0.001 | 27.34 ± 6.03 | |
Range
| 1-5 | 1-21 | 1-21 | |||
Primigravida
| 390 (76.5) | 1085 (23.4) | <0.001 | 7.81 (6.28-9.72) | 1475 (28.7) | |
2-4
| 118 (23.1) | 2565 (55.4) | 1.00 | 2683 (52.2) | ||
≥5
| 2 (0.4) | 977 (21.1) | 0.04 (0.01-0.18) | 979 (19.1) | ||
Parity
|
Mean ± SD
| 1.90 ± 0.30 | 2.08 ± 0.37 | <0.001 | 2.28 ± 1.64 | |
Range
| 1-7 | 0-12 | 0-12 | |||
0 (primip) | 50(9.8) | 148 (3.2) | <0.001 | 2.91 (2.09-4.07) | 198 (3.9) | |
1-4
| 459 (90.0) | 3959 (85.7) | 1.00 | 4418 (86.1) | ||
≥ 5
| 1 (0.2) | 515 (11.1) | 0.02 (0.002-0.12) | 516 (10.1) | ||
Pregnancy gestation (weeks) |
Mean ± SD
| 38.13 ± 3.19 | 38.46 ± 2.72 | 0.050 | 38.43 ± 2.77 | |
Range
| 28-44 | 28-46 | 1.31 (1.04-1.66) | 28-46 | ||
28-36
| 110 (29.3) | 897 (24.5) | 0.007 | 1.00 | 1007 (25.0) | |
37-41
| 252 (67.2) | 2694 (73.7) | 2.11 (1.15-3.87) | 2946 (73.1) | ||
≥42
| 13 (3.5) | 66 (1.8) | 79 (2.0) | |||
Referral status
|
Referred
| 36 (6.4) | 233 (4.3) | 0.020 | 1.53 (1.07-2.20) | 269 (4.5) |
Non-referred
| 524 (93.6) | 5204 (95.7) | 5728 (95.5) | |||
Preterm delivery
|
Yes
| 110 (29.3) | 897 (24.5) | 0.041 | 1.28 (1.01-1.62) | 1007 (25.0) |
No
| 265 (70.3) | 2760 (75.5) | 3025 (75.0) | |||
Post-term delivery
|
Yes
| 13 (4.9) | 66 (2.4) | 0.014 | 2.11 (1.46-3.87) | 79 (2.6) |
No
| 252 (95.5) | 2694 (97.6) | 2946 (97.4) |
Mode of delivery
Variable | Adolescent parturients (10–19 years) | Non-adolescent parturients (≥20 years) | Sig. (p-value) | OR (95% CI) | Entire study sample | |
---|---|---|---|---|---|---|
n (%) | n (%) | N (%) | ||||
Mode of delivery
|
Vaginal
| 462 (83.4) | 4583 (85.4) | 0.207 | 1.16 (0.92-1.47) | 5045 (85.2) |
Cesarean
| 92 (16.6) | 784 (14.6) | 876 (14.8) | |||
Instrumental vagina delivery
|
Yes
| 7 (1.5) | 50 (1.1) | 0.411 | 1.40 (0.63-3.09) | 57 (1.1) |
No
| 455 (98.5) | 4533 (98.9) | 4988 (98.9) | |||
Instrumental delivery types
|
Forceps
| 7 (100.0) | 47 (94.0) | 1.000 | n.a | 54 (94.7) |
Vacuum extractor
| 0 (0.0) | 3 (6.0) | 3 (5.3) | |||
Perineum after delivery
|
Intact
| 280 (69.5) | 2865 (76.7) | <0.001 | 1.00 | 3145 (76.0) |
Episiotomy
| 60 (14.9) | 281 (7.5) | 2.19 (1.61-2.96) | 341 (8.2) | ||
Tear
| 63 (15.6) | 587 (15.7) | 1.10 (0.82-1.46) | 650 (15.7) | ||
Episiotomy done
|
Yes
| 60 (14.9) | 281 (7.5) | <0.001 | 2.15 (1.59-2.90) | 341 (8.2) |
No
| 343 (85.1) | 3452 (92.5) | 3795 (91.8) | |||
Perineal tears
|
Yes
| 63 (15.6) | 587 (15.7) | 0.962 | 0.99 (0.75-1.32) | 650 (15.7) |
No
| 340 (84.4) | 3146 (84.3) | 3486 (84.3) | |||
Tear degree
|
1st degree
| 59 (93.7) | 567 (96.6) | 0.278 | n.a | 626 (96.3) |
2nd degree
| 4 (6.3) | 19 (9.2) | 23 (3.5) | |||
3rd degree
| 0 (0.0) | 1 (0.2) | 1 (0.2) | |||
Blood loss (cc) |
Mean ± SD
| 494.29 ± 70.48 | 499.07 ± 102.06 | 0.391 | 498.53 ± 99.34 | |
≤ 500
| 344 (98.6) | 3310 (98.0) | 0.437 | 0.70 (0.28-1.74) | 3654 (98.0) | |
> 500
| 5 (1.4) | 69 (2.0) | 74 (2.0) |
State of perineum after delivery
Maternal blood loss during delivery
Fetal vitality
Variable | Adolescent parturients (10–19 years) | Non-adolescent parturients (≥20 years) | Sig. (2p-value) | OR (95% CI) | Entire study sample | |
---|---|---|---|---|---|---|
n (%) | n (%) | N (%) | ||||
Apgar score at 1st minute
|
Mean ± SD
| 7.09 ± 2.77 | 7.69 ± 2.38 | <0.001 | n.a | 7.63 ± 2.43 |
Apgar score at 5th minute
|
Mean ± SD
| 8.45 ± 3.06 | 8.94 ± 2.50 | <0.001 | n.a | 8.89 ± 2.56 |
Apparent fetal death
a
|
Yes
| 63 (12.4) | 352 (7.6) | <0.001 | 1.75* (1.25-2.47) | 415 (8.1) |
No
| 445 (87.6) | 4251 (92.4) | 4696 (91.9) | |||
Perinatal fetal death
b
|
Yes
| 53 (10.4) | 292 (6.3) | 0.001 | 1.69* (1.17-2.45) | 345 (6.7) |
No
| 456 (89.6) | 4312 (93.7) | 4768 (93.3) | |||
Maternal mortality
|
Deaths
| 2 | 43 | 0.45 (0.11-1.86) | 45 | |
Maternal mortality rate
c
| 400 | 800 | 0.435 | n.a | 800 | |
Maternal mortality ratio
d
| 415 | 940 | n.a | 890 |
Maternal mortality
Pregnancy outcomes amongst adolescent parturients
Variable | Adolescent sub-group (years) |
X
2
| Sig. (p-value) | |||
---|---|---|---|---|---|---|
10-14 | 15-17 | 18-19 | ||||
n (%) | n (%) | n (%) | ||||
14 ( 2.5%) |
177 ( 31.6%) |
369( 65.9) | ||||
Referral status (referred case) | 0 (0.0) | 11 (6.2) | 25 (6.8) | 1.05 | 0.887 | |
Pregnancy gestation (weeks) |
Mean ± SD
| 35.88 ± 3.90 | 38.21 ± 3.29 | 38.16 ± 2.10 | n.a | 0.128 |
28-36
| 5 (62.5) | 33 (28.9) | 72 (28.5) | 4.84 | 0.353 | |
37-41
| 3 (37.5) | 78 (68.4) | 171 (67.6) | |||
≥42
| 0 (0.0) | 3 (2.6) | 10 (4.0) | |||
Preterm delivery
| 5 (62.5) | 33 (28.9) | 72 (28.5) | 4.35 | 0.135 | |
Post-term delivery
| 0 (0.0) | 3 (3.7) | 10 (5.5) | 0.55 | 0.794 | |
Mode of delivery
|
Vaginal
| 12 (85.7) | 144 (81.8) | 306 (84.1) | 0.49 | 0.845 |
Cesarean
| 2 (14.3) | 32 (18.2) | 58 (15.9) | |||
Instrumental vaginal delivery
| 0 (0.0) | 0 (0.0) | 7 (2.3) | 3.62 | 0.255 | |
Baby’s weight at delivery (grams) |
Mean ± SD
| 2680.0 ± 637.95 | 2937.16 ± 655.66 | 3019.21 ± 641.61 | n.a | 0.078 |
<2500
| 5 (37.5) | 29 (16.4) | 61 (16.5) | 4.02 | 0.420 | |
2500-3999
| 9 (64.3) | 143 (80.8) | 300 (81.3) | |||
≥4000
| 0 (0.0) | 5 (2.8) | 8 (2.2) | |||
Perineum after delivery
|
Intact
| 6 (60.0) | 73 (61.3) | 201 (73.4) | 6.41 | 0.110 |
Episiotomy
| 2 (20.0) | 21 (17.6) | 37 (13.5) | |||
Tear
| 2 (20.0) | 25 (21.0) | 36 (13.1) | |||
Perineal tear degree
|
1st degree
| 2 (100.0) | 25 (100.0) | 32 (88.9) | 3.20 | 0.244 |
2nd degree or worse
| 0 (0.0) | 0 (0.0) | 4 (11.1) | |||
Postpartum blood loss (cc) |
Mean ± SD
| 457.14 ± 113.39 | 501.36 ± 52.66 | 492.06 ± 75.94 | n.a | 0.194 |
>500
| 0 (0.0) | 2 (1.8) | 4 (1.7) | 0.13 | 1.00 | |
Apgar score at 1st minute
|
Mean ± SD
| 7.58 ± 2.39 | 7.05 ± 2.89 | 7.10 ± 2.72 | n.a | 0.811 |
Apgar score at 5th minute
|
Mean ± SD
| 8.66 ± 3.08 | 8.35 ± 3.31 | 8.49 ± 2.93 | n.a | 0.869 |
Apparent fetal death
a
| 1 (8.3) | 22 (13.2) | 40 (12.2) | 0.29 | 0.921 | |
Perinatal fetal death
b
| 1 (8.3) | 21 (12.6) | 31 (9.4) | 1.26 | 0.500 | |
Maternal mortality
|
Deaths
| 0 (0.0) | 1 (0.6) | 1 (0.3) | 0.34 | 0.566 |
Maternal mortality rate
c
| 0.0 | 0.6 | 0.3 | 0.34 | 0.566 | |
Maternal mortality ratio
d
| 0.0 | 667 | 313 | n.a | 0.455 |
Predictors of maternal and of perinatal mortality
Variables | N | AOR | 95% CI | Sig. (2 sided) |
---|---|---|---|---|
Age
(years)
| 0.137 | |||
Adolescent: 10-19
| 300 | 0.00 | 0.00- | 0.994 |
Adult: >19 (ref.) | 2817 | 1.00 | ||
Workstatus
| ||||
Student
| 747 | 0.23 | 0.02-2.84 | 0.251 |
Unemployed
| 98 | 0.35 | 0.07-1.75 | 0.201 |
Employed (ref.) | 2272 | 1.00 | ||
Matrimonial status
| ||||
Married (ref.) | 1460 | 1.00 | ||
Single
| 1657 | 0.83 | 0.31-2.23 | 0.707 |
Referral status
| ||||
Referred case* |
150
|
4.60
|
1.37-15.48
|
0.014
|
Not-referred case (ref.) | 2967 | 1.00 | ||
Gravida
| 0.879 | |||
1st pregnancy
| 910 | 0.00 | 0.00- | 0.990 |
2-4th pregnancy (ref.) | 1636 | 1.00 | ||
≥5th pregnancy
| 571 | 0.58 | 0.70-4.70 | 0.611 |
Parity
| 0.133 | |||
1st delivery
| 118 | 0.01 | 0.00- | 0.996 |
2-4th delivery (ref.) | 2698 | 1.00 | ||
≥5th delivery* |
301
|
8.64
|
1.05-70.79
|
0.045
|
Gestational age (weeks) | 0.094 | |||
<37* |
884
|
2.91
|
1.11-7.61
|
0.030
|
37- < 42 (ref.) | 2178 | 1.00 | ||
≥42
| 55 | 0.00 | 0.00 | 0.997 |
Delivery mode
| ||||
Vaginal
| 3061 | 1.00 | ||
Cesarean
| 56 | 0.00 | 0.00 | 0.998 |
Number of fetuses
| ||||
Singleton (ref.) | 2948 | 1.00 | ||
Multiple
| 169 | 0.00 | 0.00- | 0.995 |
Perineal state
| 0.818 | |||
Intact (ref.) | 2378 | 1.00 | ||
Episiotomy
| 258 | 1.73 | 0.21-14.13 | 0.607 |
Tear
| 481 | 0.79 | 0.17-3.63 | 0.757 |
Variables | N | AOR | 95% CI | Sig. (2 sided) |
---|---|---|---|---|
Age (
years)
| 0.137 | |||
Adolescent: 10-19
| 298 | 1.43 | 0.89-2.30 | 0.141 |
Adult: >19 (ref.) | 2797 | 1.00 | ||
Work status
| 0.674 | |||
Student
| 743 | 0.73 | 0.30-1.79 | 0.491 |
Unemployed
| 97 | 0.85 | 0.37-1.97 | 0.711 |
Employed (ref.) | 2255 | 1.00 | ||
Matrimonial status
| ||||
Married (ref.) | 1453 | 1.00 | ||
Single* |
1642
|
1.61
|
1.16-2.23
|
0.005
|
Referral status
| ||||
Referred case* |
150
|
3.08
|
1.91-4.98
| <0.001
|
Not-referred case (ref.) | 2945 | 1.00 | ||
Gravida
| 0.590 | |||
1st pregnancy
| 902 | 1.04 | 0.71-1.53 | 0.846 |
2-4th pregnancy (ref.) | 1626 | 1.00 | ||
≥5th pregnancy
| 568 | 1.33 | 0.77-2.30 | 0.304 |
Parity
| 0.002 | |||
1st delivery* |
116
|
1.90
|
1.11-3.42
|
0.019
|
2-4th delivery (ref.) | 2681 | 1.00 | ||
≥5th delivery* |
298
|
1.33
|
0.77-2.30
|
0.008
|
Gestational age (weeks) | ||||
<37* |
880
|
4.37
|
3.16-6.04
| <0.001
|
37- < 42 (ref.) | 2160 | 1.00 | ||
≥42* |
55
|
3.94
|
1.81-8.55
|
0.001
|
Delivery mode
| ||||
Vaginal (ref.) | 3039 | 1.00 | ||
Cesarean
| 56 | 0.44 | 0.10-1.87 | 0.265 |
Number of fetuses
| ||||
Singleton (ref.) | 2927 | |||
Multiple* |
168
|
0.08
|
0.02-0.32
| <0.001
|
Perineal state
| 0.479 | |||
Intact (ref.) | 2358 | 1.00 | ||
Episiotomy
| 258 | 1.08 | 0.59-1.95 | 0.806 |
Tear
| 479 | 1.31 | 0.85-2.03 | 0.226 |