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Objectives
Solve the medico legal issues in teen
pregnancy
Focus on medical problems that can arise in
an adolescent pregnancy
Identify psychosocial issues that a teenager
will face during and after a pregnancy
Prevention teen pregnancy
Teen pregnancy
Teen pregnancy
Early births around the world
Fewer than 10% of girls have a baby before the age of 18 in (lowest first);
Japan, Germany, Poland, France, China, Tunisia, Sri Lanka, Great Britain,
Morocco, Burundi, Philippines, Rwanda, United States of America, Thailand
10-20% of girls have a baby before the age of 18 in: Turkey, Peru, Trinidad,
Teen pregnancies in
Malaysia
Teen pregnancies on the rise with 111 reported
this year
As of April, the department has already seen 111 such
cases. This number is a dramatic increase compared
to the 131 cases throughout last year. In 2008, there
were 107 teenage girls who got pregnant.
They were placed at Taman Seri Puteri, a rehabilitation
centre and shelter that provides training for
youngsters, especially teenage girls who face social
problems.
The star online archives
Teen pregnancy
Case Cont
Further history reveals that MJ is a Form4
Case cont
What would you do next?
A) You would order a UPT test
B) You would call her parents to inform..
C) Yell at her that she has cheated her
parents
D)Ask her to come with her parents..
Medico legal
aspect
of
Teen pregnancy
Case cont
What would you do next?
A) You would order a UPT test
B) You would call her parents to inform..
C) Yell at her that she has cheated her
parents
D)Ask her to come with her parents..
If JM hesitates
Calm down the patient
Respect patient autonomy
Ask why/what she is afraid of
ask about her parents actual or anticipated
reactions
Offer help, "Do you need help telling
parents/guardian about your pregnancy?"
Explain JM the legal issue that she need
parental consent to get any medical help
Get her permission to call her parents
report
If parents are not comfortable/hesitating, get
the child protector involved in this case
Make sure it is reported to the police either
way
Case Cont
The child protector agrees to file the police
report
You explained the procedures to the parents
and about to leave the room, JMs mother
begins to weep and explains you her fear of
social stigma. She wants to get that baby
aborted
How to handle the situation?
situations only:
When a woman's life is in danger
When a woman's physical health is in danger
When a woman's mental health is in danger
A woman must consent to an abortion, and
she must have a medical professional's
authorisation.
Health problems
associated with
adolescent
pregnancy
Placenta previa
Pregnancy-induced hypertension
(PIH occurs in about 5% of the population of pregnant women)
Premature delivery
( STI , UTI, PIH )
Significant anemia
(insufficient amount of healthy caloric intake,
% of anemia high in 15-19 year old than women from 20-44)
WHO 2006. pregnant adolescents- delivering on global promise of hope
birth)
-alcohol (fetal alcohol syndrome)
-drugs (high rate STI, HIV)
pregnant adolescent.
Depression is common among pregnant teens.
Feelings of anxiety and fear also increase in
teenage parents as well as pregnant teens.
WHO 2006. pregnant adolescents- delivering on global promise of hope
Case Cont
JMs anemia is corrected with iron
Case Cont
She is kept on bed rest with monitoring fetal
- small pelvis
- immature pelvis
-abnormal lie
intervention.
Pressure from the baby's head can cause
necrosis, leading to a tear between the vagina
and bladder (vesico-vaginal fistulae VVF) or
between the vagina and rectum (recto-vaginal
fistulae).
weight baby.
Low-birth weight babies are more than twenty
times as likely to die in their first year of life versus
a normal-weight baby.
Low birth weight and pre maturity raise the
probability of infant death, blindness, deafness,
mental retardation and cerebral palsy.
Lack of access to medical care and lack of
immunization or vaccination
Sudden infant death syndrome (SIDS)
disabilities.
Less likely to receive early and continuing cognitive
and social stimulation, resulting in underdeveloped
intellect and lower rates of academic achievement.
Psychosocial
issues
she came with her mother for the 6 weeks follow up.
After the physical exam, you have advised her
mother to start JM on contraception which would
prevent her from future pregnancy. Her mother
refused to accept the option. She said her daughter
learnt her lesson by going through this 10 month of
shelter life. She will never ever going to do the same
mistake, she has promised her already. You have no
choice you have documented the conversation. And
gave a 2 week apt to come back to discuss about
that matter again. They didnt show up for their apt.
"For
Prevention
Providing continuous support for contraceptive use can
Prevention
Immediate postpartum or postabortal IUD
Prevention
In the Contraceptive CHOICE study
Efficacy analysis at 12, 24, and 36 months
Case Cont
After a year and a half passed by, JM showed up
Case Cont
She is 17 now!
She can consent for her SI,
Under 18
Need parental consent for further
management???
Gillick competence
What is it?
Can We apply this law in this situation?
Gillick competence
References
http://www.cdc.gov/teenpregnancy/
http://www.who.int/maternal_child_adolescent
/topics/adolescence/en/
http://www.medscape.com/viewarticle/714795
_3
http://en.wikipedia.org/wiki/Gillick_competenc
e
Betsy B. Kennedy et al. Intrapartum Management
Modules: A Perinatal Education Program