PP.39 Teenage Pregnancy – A Decade Since the UK Department of Health Teenage Pregnancy Strategy Plan: A Review in a University Teaching Hospital in London, UK

Abstract

Background: (1) In 1999, the UK Department of Health Teenage Pregnancy Strategy Plan pledged to reduce the pregnancy rate by 50% in teenagers <18 yrs old by 2010. (2) The UK Office for National Statistics data showed that from 1999-2009, the teenage pregnancy rate only fell by 13.3%. (3) In 2009, the UK average teenage pregnancy rate was 38.3 per 1,000 compared to 54.3 per 1,000 in Barking and Dagenham (high-risk area served by this hospital). Aim: This retrospective study reviewed all viable teenage pregnancies from Jan 1, 2010 to Dec 31, 2010 at a large University Teaching Hospital NHS Trust, London, UK (10,000 deliveries per year). Materials and Methods: Data was obtained from the computerised Labour Ward Admissions, Birth Notification and Operating Theatre Registries. Results: During this one year 257 teenagers delivered 260 viable babies >28 weeks gestation. Gynaecology cases (early miscarriages, and abortions) and 3rd-trimester losses were coded differently thus excluded. The study group included primigravida (230/257 = 89.49%) and multiparous (27/257 = 10.51%). The ages ranges from 14 yrs to 19 yrs, with mean age = 18.29 yrs. Ten (10/257, 3.89%) teenagers were <16 yrs old. The mode of delivery was - Instrumental deliveries (29/257 = 11.28%), Caesarean section (36/257 = 14.01%), and Spontaneous Vaginal deliveries (192/257 = 74.71%). The mean±SD fetal birth weights were - Instrumental delivery 3.389±0.468 kg, Caesarean section 3.106±0.752 kg; and Spontaneous Vaginal Delivery 3.117±0.501 kg. Maternal morbidity - (a) Third-degree tear (n = 3), (b) Pre-eclampsia (n = 12), (c) PPH >1 litre (n = 4). Fetal complications - (a) SCBU admission (n = 7), (b) Stillbirth (n = 3), (c) Shoulder dystocia (n = 2). Conclusions: Teenage pregnancy remains a challenge, as the UK has the highest teenage pregnancy rate in Europe, in spite of the DOH Teenage Pregnancy Strategy Plan. (1) Mode of delivery - The caesarean section rate was significantly lower, 14.01% vs 24%, the spontaneous vaginal delivery rate was higher, 74.71% vs 65%, but the instrumental delivery rate was similar, 11.28% vs 10%, compared to the UK average (Caesarean Section Sentinel Audit). (2) Teenage Pregnancy Midwife - A dedicated midwife co-ordinated continuity of care - antenatal, intrapartum & postpartum and additional support with Social Services, as teenagers continue to book late. (3) Multiparous teenagers - There were 10.51% (27/257) multiparous teenagers [18 yrs old - 7/27 & 19 yrs old - 20/27]. Contraceptive advice remains essential.