Course of the Pregnancy and Delivery

A teenage pregnancy, and even more so when the girl is very young, is often discovered late for many reasons: ignorance, fear of talking about it, absence of an interlocutor, anxiety concerning the medical follow-up, fear of being forced to abort and, for some, denial of an initially desired reality that is subsequently dreaded once it is fulfilled. All coincide to delay the official declaration to the national health insurance program and thus the monitoring of the pregnancy. Indeed, certain extreme cases can go to term without being noticed or even suspected by the girl's entourage and therefore end in an unexpected delivery at home or, even worse, in a public site or school. This clandestinity is a major problem because it prevents all medical surveillance, thereby rendering the pregnancy more vulnerable, and puts the future mother in a state of isolation that is detrimental from all points of view.

The diagnosis of this pregnancy is also made difficult by the high number of long and irregular menstrual cycles during this period and the reported dates of the last menstruation are pure fantasy. Indeed, such a date, when vague, should never a fortiori be considered as being etched in stone.

Very often, the adolescent will consult her doctor without causal relationship with her condition and, when unclear symptoms are described, the question of a possible pregnancy must simply be asked. At the time of the first medical visit, the chief complaint (or presenting problems) may vary from vague and nonspecific symptoms, such as a sore throat, abdominal pain or urinary tract symptoms, to more specific signs and symptoms characteristic of pregnancy.

Ultrasonography remains the best examination to determine the time of gestation during the first trimester with the aim of leaving enough time to allow the choice of termination. After this legal time limit, all the obligatory examinations will be performed to complete the physical examination and interview, so as to determine the specific risk factors of each adolescent.

In our study, only 13% of the pregnancies were seen during the first trimester, respectively 31 and 41% consulted as of the second and third trimesters, and 17% were first seen at the time of delivery. Analysis of the teenager's family situation showed that 42% were married or living with their partner and 58% were single but two-thirds knew who the father of their child was.

Teenage pregnancy is reputed to be at-risk, primarily because of the higher number of low-birth-weight infants. The rate of premature deliveries, around 10% in all studies, is probably more responsible for these low birth weights because true intrauterine growth retardation at the 10th percentile is approximately 13%, barely more common than in the general population.

Nutritional disorders are often the most common risk factor, as the protein needs are not always met because of the more frequent vomiting early during pregnancy and later because of the low socioeconomic level. In contrast, for 1 out of 5 cases, too much weight is gained because of the too high intake of glucides and it can result in definitive obesity.