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Caesarean delivery rates in Turkish adolescents

Adolescent pregnancies are often associated with unfavourable obstetric outcomes, including low birth weight infants (LBWI) and pre-term delivery (Scholl et al. 1994). Additionally, outcomes of adolescent pregnancies directly affect forthcoming adult population obstetric outcomes. In Turkey, the prevalence of pregnancy among women aged 15–19 years was 8% according to a population study (Ministry of Health 2004). The aim of our study was to compare caesarean rates, indications for caesarean sections and obstetric outcomes in 17 year-old adolescents’ pregnancies, with the results of 20-year-old adults’ in a maternity hospital. Medical records of 14,135 pregnant women who delivered in 2007 were reviewed. Cases of 17-year-old adolescents were accepted as the study group (n1⁄4 137). Cases of 20-year-old young adults were selected as the control group (n1⁄4 732). The outcomes of the deliveries were accurately compared for mentioned risks. In the adolescent group, the mean age was 16.8+0.45 years (range 14–17). The rate of caesarean section was significantly higher in the reference group (21.7% vs 13.1%; p1⁄4 0.02). If cases with previous caesarean delivery as operation indication were excluded from the analysis, the rates were similar between the groups (p1⁄4 0.07). Also, nulliparous pregnant women within the groups were compared with the type of delivery. The caesarean delivery rate was 13.7% in the study group and 20.9% in the control group (study group, n1⁄4 131; control group, n1⁄4 597; p1⁄4 0.06). Indications of caesarean section were significantly different between the groups (p1⁄4 0.01). The most common cause was cephalopelvic disproportion (38.9%) in the adolescent group, and fetal distress (34.4%) in the control group (Table I). No statistically significant difference was found for birth weight and gestational age between the two groups (Table I). Two important conclusions can be derived from this study. First, in the adolescent period, biological immaturity may cause an increase in the rate of cephalopelvic disproportion. Second, an increase in the rate of caesarean delivery in adolescence, results in a corresponding increase in adults. Three studies revealed that the caesarean section rate was significantly higher in adults compared with the adolescents (Adam et al. 2009; Kara et al. 2003; Keskinoglu et al. 2007), but in our study, it was found to be less in adolescents. Although, in most studies, the rate of LBWI (52,500 g) in the adolescent group was found to be higher (Briggs et al. 2007; Jolly et al. 2000; Zeck et al. 2008), in our study no difference was observed. Our results seem to be consistent with results of studies that compare the adolescent cases by grouping them as younger and older adolescents (Berenson et al. 1997; Usta et al. 2008). In conclusion, the rate of caesarean delivery in cases of 17-year-olds, who are defined as biologically immature, is significantly less and the risk of LBWI is not different from that of adults. In our hospital, as in many other clinics, previous caesarean delivery is commonly accepted as a factor determining the proposed type of delivery. Therefore, high caesarean section rates in adults may be considered as a result of caesarean section deliveries performed in adolescence. Table I. The birth weight, gestational age and type of delivery and distribution of the first four indications for cesarean section in both groups.