Maternal mid-upper arm circumference as a predictor of low birth weight outcome among newborn deliveries of adolescents in a Tertiary Level Hospital

Background@#Maternal malnutrition is a major cause of low birth weight (LBW) newborn outcome especially among adolescent mothers. It is one of the key drivers of child stunting and initiates the vicious cycle of intergenerational malnutrition. The body mass index prior to pregnancy or at the initial trimester is currently being used to establish the desired weight gain throughout pregnancy. However, Filipino adolescents often delay their first antenatal visit at a later stage of pregnancy. Without a baseline weight, the establishment of appropriate weight gain and nutritional status is often challenging. Mid-upper arm circumference (MUAC) was proven to be a good proxy measure of acute malnutrition, however, there was no global consensus on what MUAC cut-off point to use to identify pregnant adolescents at risk for delivering LBW babies. Finding the optimal cut-off could facilitate early identification and intervention of pregnant adolescents who are nutritionally at risk and could eventually break the cycle of intergenerational malnutrition.@*Objectives@#The study aims to determine the association of maternal MUAC and the birth weight outcomes among newborn deliveries of adolescents in a tertiary hospital for a period of six months and to identify the optimal maternal MUAC cut-off point that can be used to predict low birth weight outcome among newborn deliveries of adolescents in a tertiary hospital. Methods. A cross-sectional study was conducted among adolescents ages 10 to 19 years who delivered babies in a tertiary hospital in the Philippines for a period of six months. Maternal MUAC and LBW outcome were documented, and their association was determined using a logistic regression analysis. To measure diagnostic accuracy, the sensitivity, specificity, and the area under the curve were taken for each MUAC point. A receiver operating characteristic (ROC) curve was used to aid the MUAC cut-off determination.@*Results@#Out of 237 newborn deliveries, 35% were noted with low birth weight while 65% had normal birth weight. Most of the mothers were in their late adolescence at 78%. The crude association for the MUAC cut-offs ≤23.00 cm, ≤23.50 cm, and ≤24.00 cm and LBW showed a significant value of 2.19, 2.25, and 2.39 at 95% CI, respectively. However, it is only the cut-off ≤24.00 cm that showed significant results for adjusted association by the logistic regression analysis. The MUAC cut-off ≤24.00 cm also showed a better trade-off value between the sensitivity and specificity. Furthermore, the optimal maternal MUAC measurement that predicts LBW newborn outcome points to ≤24.00 cm cut-off based on the ROC curve.@*Conclusion@#This study shows that the maternal MUAC is predictive of LBW outcome among adolescent deliveries.A MUAC cut-off of ≤24.00 cm was superior to lower cut-offs studied. The pregnant adolescents might need a higher MUAC cut-off than adults to allow timely intervention and prevention of poor neonatal outcomes. By doing this simple screening test, suspected pregnant adolescents can be easily identified and referred for further confirmatory testing.

Fast-track interventions for HIV and AIDS epidemic control among key populations: A rapid review

Background: Despite measures put in place to combat teenage pregnancy, the rate remains high. Community health workers (CHWs) are a cadre of health workers that can help put measures in place to reduce teenage pregnancy in the communities in which they live and work. Aim: This article aims to gain a deeper understanding of CHWs' perceptions regarding teenage pregnancy in the rural districts of Limpopo province. Methods: An exploratory qualitative study approach was employed to collect data from CHWs in two rural districts of Limpopo. A non-probability purposive sampling approach was used to choose 81 CHWs. Eight focus group discussions (FGDs) were organised, and audio recorded to collect data from participants. The discussions were 2­3 h long and conducted in English, and data saturation was attained by the fifth FGDs. Results: An eight-step tech's content analysis approach was employed to deductively code, analyse and summarise data into themes. Three themes emerged: the prevalence of teenage pregnancy in rural villages, factors contributing to teenage pregnancy and challenges faced by CHWs when dealing with teenage pregnancy. Conclusion: The study's findings revealed that CHWs face challenges in their communities when offering appropriate teen pregnancy services and CHWs believe that teen pregnancy numbers remain high. There is a significant barrier in combating teenage pregnancy; if contraceptives are not acceptable to the community, the only solution and option for combating teenage pregnancy is abstinence. Contribution: The CHWs presented their insights of teenage pregnancy in rural communities. The outcomes of this study could help clinical practise, schools, communities, youth-friendly services, policymakers and other non-governmental organisations reduce teenage pregnancy.

Factors contributing to rise in teenage pregnancy in Sekhukhune district, Limpopo province

Background: The Department of Health in South Africa has reported an alarming total of 90 037 teenage girls between the ages of 10 years and 19 years who gave birth from March 2021 to April 2022, across all provinces and districts. The rise in teenage pregnancy is of serious concern as adolescents girls are more likely to experience difficult pregnancies and deliveries which could lead to detrimental effects on their health. Objectives: The study aimed to explore and describe factors contributing to the increase in teenage pregnancy in the Sekhukhune district of Limpopo. Method: The study was conducted in the healthcare facilities of Sekhukhune area. A qualitative, exploratory design was followed. Participants were purposively selected, and data were gathered through face-to-face individual interviews. Data analysis employed Tesch's inductive, descriptive coding method. Results: Negligence, peer pressure, ambiguity, choice, lack of contraceptive use, and lack of family attachment were identified as exacerbating factors in the district's surge in teenage pregnancy. Conclusion: To reduce teen pregnancy, it is crucial to promote contraception, enhance cooperation between schools and the government, involve families in sexual and reproductive health discussions, prioritise a supportive home environment, advocate for child support grants, revitalise school health services, and empower teenagers to make informed choices and resist peer pressure. Contribution: The study will provide guidance to policy makers and other stakeholders in developing appropriate programmes to address the problem and improve the health and socioeconomic status of adolescents in rural areas. This will reduce healthcare costs associated with complications and premature birth. Keywords: factors; teenager; pregnancy; tee

Temporal analysis of maternal, care and newborns characteristics in the city of Guarapuava-PR from 2010 to 2019 / Análise temporal de características maternas, assistenciais e de nascidos vivos do município de Guarapuava-PR de 2010 a 2019

Abstract Objectives: to analyze the temporal trend in maternal, care and newborns characteristics, in the city of Guarapuava, Paraná, Brazil in the period of 2010 to 2019. Methods: ecological temporal tendency study is based on Sistema de Informações sobre Nascidos Vivos (Live Birth Information System). To verify changes on the topics, the Prais-Winsten generalized linear regression was applied. Results: data from 28,919 live births were analyzed in 2019, 15.9% of the pregnancies were adolescents, 49.8% were cesarean deliveries and 9.2% were premature childbirths. A reduction in teenage pregnancy was observed, with annual percentage variation (APV) for mothers aged ten to 14 being -0.14% (p=0.005) and 15 to 19 years old -0.82% (p=0.004); there was an increase in mothers' schooling, with an APV of 60.09% (p=0.026) for eight to 11 years of schooling and 11.27% (p<0.001) for 12 or more; there was an increase of 15.33% (p<0.001) for seven or more prenatal consultations and a decrease in the Apgar classifications considering the risk, with scores from zero to two in the 1st minute with an APV=-0.12 (p=0.010) and scores from three to five in the 5th minute with APV=-0.07 (p=0.011). Conclusions: The city of Guarapuava presents important decreased tendencies in early pregnancy and an increase in mothers' schooling, besides the changes regarding the conditions in which their children are born and how they are welcomed.

Resumo Objetivos: analisar a tendência temporal de características maternas, assistenciais e dos recém-nascidos do município de Guarapuava-PR no período de 2010 a 2019. Métodos: estudo ecológico de tendência temporal com dados do Sistema de Informações sobre Nascidos Vivos. Para verificar mudanças nas características avaliadas, utilizou-se regressão linear generalizada de Prais-Winsten. Resultados: analisaram-se dados de 28.919 nascidos vivos; em 2019, 15,9% das gestações foram de adolescentes, 49,8% dos partos cesáreos e 9,2% partos prematuros. Observou-se redução da gravidez na adolescência, com variação percentual anual (VPA) para mães com dez a 14 anos sendo -0,14% (p=0,005) e 15 a 19 anos -0,82% (p=0,004); aumento da escolaridade das mães, com VPA de 60,09% (p=0,026) para oito a 11 anos de estudo e 11,27% (p<0,001) para 12 ou mais; aumento de 15,33% (p<0,001) para sete ou mais consultas de pré-natal realizadas pelas gestantes e queda nas classificações de Apgar consideradas de risco, com notas zero a dois no 1º minuto com VPA=-0,12 (p=0,010) e notas três a cinco no 5º minuto com VPA=-0,07 (p=0,011). Conclusões: Guarapuava apresentou importantes tendências de redução da gravidez precoce e aumento de escolaridade das mães, além de mudanças sobre as condições em que nascem seus filhos e sobre como são acolhidos.

Avoidability and temporal trend of neonatal mortality in Niteroi/RJ, 2012 to 2022 / Evitabilidade e tendência temporal da mortalidade neonatal em Niterói/RJ, 2012 a 2022

Abstract Objectives: to analyze neonatal deaths according to avoidability and to analyze the temporal trend of neonatal mortality rate (NMR) in Niterói/RJ, 2012-2022. Methods: ecological time series study. Data from Sistema de Informação sobre Nascidos Vivos and Sistema de Informação sobre Mortalidade. NMRs were calculated according to maternal and neonatal variables and trends were estimated using the joinpoint regression. Results: the annual number of live births (LB) fell, with a decreasing trend among adolescents and those with low education level. Of the 324 deaths, most occurred early (0-6 days), by preventable causes in 68.6%, predominating those reducible by adequate care during pregnancy. The overall NMR remained stable, ranging from 4.2 to 6/1,000 LB, being higher at the extremes of maternal age (12.7 and 8.6/1,000 LB in 2022, adolescents and over 35 years old, respectively), in low education level mothers (27.6/1,000 LB in 2022), in neonates <1,500g and <32 weeks (293.1 and 250/1,000 LB in 2022, respectively). NMR trend was upward in low schooling women, white-colored, adolescents and those ≥35 years, in babies weighing <1,500g and >2,500g, and for avoidable causes. Conclusions: the high proportion of preventable causes reveals the reduction potential. There was inequality in NMR and its trend, demanding more equitable health actions.

Resumo Objetivos: analisar os óbitos neonatais segundo evitabilidade e a tendência temporal da taxa de mortalidade neonatal (TMN) em Niterói/RJ, de 2012-2022. Métodos: estudo ecológico de série temporal. Dados provenientes do Sistema de Informações sobre Nascidos Vivos e Sistema de Informação sobre Mortalidade. As TMN foram calculadas segundo variáveis maternas e neonatais e as tendências estimadas pela regressão joinpoint. Resultados: o número anual de nascidos vivos (NV) diminuiu, com tendência decrescente entre mães adolescentes e de baixa escolaridade. Dos 324 óbitos, a maioria ocorreu precocemente, por causas evitáveis (68,6%), predominando aquelas reduzíveis por adequada atenção à gestação. A TMN global mostrou estabilidade, entre 4,2 e 6,0/1000NV, mais elevada nos extremos etários maternos (12,7 e 8,6/1.000 NV em 2022, adolescentes e maiores de 35 anos, respectivamente), nas mães com baixa escolaridade (27,6/1.000 NV em 2022), nos neonatos <1.500g e <32 semanas (293,1 e 250/1.000 NV em 2022, respectivamente). A tendência da TMN foi crescente entre mulheres de baixa escolaridade, brancas, adolescentes e ≥35 anos, nas faixas de peso <1.500g e >2.500g, e por causas evitáveis. Conclusões: a elevada proporção de causas evitáveis revela o potencial de redução. Houve desigualdade da TMN e sua tendência, demandando ações de saúde mais equânimes.

Conocimientos sobre riesgo preconcepcional en adolescentes con vida sexual activa / Knowledge about preconception risk in adolescents with active sexual life

Introducción: Conocer sobre riesgo preconcepcional durante la vida sexual activa en la adolescencia, es de vital importancia para reducir complicaciones materno-fetales. Objetivo: Identificar los conocimientos sobre riesgo preconcepcional que posee un grupo de adolescentes con vida sexual activa. Métodos: Se realizó un estudio descriptivo, transversal, en el Policlínico Docente Aquiles Espinosa Salgado, del municipio Las Tunas, Cuba. El universo fue de 70 féminas y se estudiaron las siguientes variables: pacientes por Grupo Básico de Trabajo, acorde al estado civil, conocimientos sobre métodos anticonceptivos, y conocimientos sobre factores de riesgo preconcepcional y sobre consecuencias del embarazo en la adolescencia. La información obtenida se presentó en tablas, y los resultados se mostraron en porcientos. Resultados: El 65,7 por ciento de las adolescentes posee el estado civil acompañada; el 75,7 por ciento identifica a las tabletas como método anticonceptivo; el 94,3 por ciento reconoce a la adolescencia como un factor no modificable de riesgo preconcepcional, y el 15,7 por ciento cree que la promiscuidad es un factor modificable. La consecuencia del embarazo en la adolescencia más señalada por los estudiados fue interrumpir los estudios, para un 38,5 por ciento. Conclusiones: Las pacientes del Grupo Básico de Trabajo 1 mostraron mayores conocimientos, pero, de forma general, el nivel de conocimientos alcanzado sobre riesgo preconcepcional fue evaluado de mal(AU)

Introduction: knowing about preconception risk during active sexual life in adolescence is of vital importance to reduce maternal-fetal complications. Objective: To identify the knowledge about preconception risk in a group of adolescents with active sexual life. Methods: A clinical, descriptive, cross-sectional study was conducted in the Polyclinic Aquiles Espinosa Salgado, in the municipality of Las Tunas, Cuba. The universe was 70 women, and the following variables were studied: patients by Basic Working Group, marital status, knowledge about contraceptive methods, and knowledge about preconception risk factors and consequences of teenage pregnancy. The information obtained was presented in tables and the results were shown in percentages Results: 65.7percent of adolescent have accompanied marital status; 75.7percent identify tablets as a contraceptive method; 94.3percent recognize adolescence as a non-modifiable preconception risk factor, and 15.7percent believe that promiscuity is a modifiable factor. The consequence of pregnancy in adolescence most indicated by those studied was interrupting studies, for 38.5%. Conclusions: The patients of the Basic Working Group 1 showed greater knowledge, but in general, the level of knowledge achieved on preconception risk was evaluated as poor(AU)

"O hoje afetando o amanhã": pesquisando gravidez na adolescência no cotidiano escolar / "Today affecting tomorrow": researching teenage pregnancy in everyday school life / "El hoy afecta al mañana": investigación del embarazo adolescente en la vida escolar diaria / «Le présent affecte le futur¼: recherche sur la grossesse des adolescentes dans la vie scolaire quotidienne

Resumo: Este artigo analisou o processo de construção e execução de uma pesquisa acerca da gravidez na adolescência com jovens do ensino médio no cotidiano de uma escola pública estadual de Fortaleza-CE, a partir de um estudo qualitativo com base na pesquisa-intervenção. Por meio de um curso de extensão para estudantes secundaristas, desenvolveu-se uma pesquisa na escola em que as próprias jovens da escola pública foram copesquisadoras do tema gravidez na adolescência no cotidiano escolar. Utilizou-se as ferramentas metodológicas de diários de campo, questionário on-line e restituição. Os resultados mostraram que há diferenças nos papéis de mãe e pai na adolescência, dificuldades para a conclusão da vida escolar e prejuízos na inserção no mercado de trabalho, principalmente para as meninas. Portanto, a pesquisa possibilitou problematizar o lugar de representatividade das pautas de maternidade e paternidade fomentando espaços de escuta e dialogicidade na promoção da equidade com estudantes que experienciam a maternidade e paternidade.

Abstract: This article aimed to analyze the process of constructing and conducting research on teenage pregnancy with high school students in the daily life of a public school in Fortaleza, Ceará, based on a qualitative study using the Intervention Research approach. By an extension course for high school students, a research project was developed in the school in which the public school students themselves were co-researchers on the topic of teenage pregnancy in the school environment. The methodological tools used were field journals, online questionnaires, and restitution. Results showed differences in the roles of the mother and father during adolescence, difficulties in completing education, and obstacles in entering the job market, especially for girls. Therefore, this research could question the representation of maternity and paternity issues, promoting spaces for listening and dialogue in the promotion of equity with students who experience parenthood.

Résumé : Cet article a analysé la construction et réalisation d'une recherche avec de lycéens sur la grossesse adolescente dans la vie quotidienne d'une école publique de Fortaleza-CE, dès une étude qualitative de recherche-intervention. Avec un cours d'extension pour des élèves du secondaire, une recherche a été menée où les élèves de l'école publique étaient co-chercheurs sur la grossesse adolescente dans l'école. Des journaux de terrain, des questionnaires en ligne et des restitutions ont été utilisés. Les résultats ont montré des différences dans les rôles de mère et de père pendant l'adolescence, des difficultés à mener à terme leur scolarité et des préjudices dans leur insertion sur le marché du travail, surtout pour les filles. Donc, la recherche a permis de questionner la représentativité des enjeux de maternité et de paternité, en favorisant des espaces d'écoute et de dialogue pour promouvoir l'équité avec les étudiants qui vivent la maternité et la paternité.

Resumen: Este artículo tuvo como objetivo analizar el proceso de construcción e implementación de una investigación con estudiantes de secundaria sobre el tema del embarazo adolescente en la vida cotidiana de una escuela pública de Fortaleza, Ceará (Brasil), basada en un estudio cualitativo de investigación-intervención. A partir de un curso de extensión, se desarrolló una investigación en la escuela donde las propias estudiantes de secundaria fueron coinvestigadoras sobre el tema del embarazo adolescente. Se utilizaron como herramientas metodológicas un cuestionario en línea, diario de campo y restitución. Los resultados mostraron diferencias en el papel de la madre y el padre durante la adolescencia, dificultades para completar la vida escolar y dificultades para entrar en el mercado laboral, especialmente para las chicas. Por lo tanto, esta investigación permitió problematizar el papel representacional de la maternidad y la paternidad, propiciando espacios de escucha y de diálogo para promover la equidad con los estudiantes que experimentan estos roles.

Quando a maternidade chega mais cedo: uma análise sobre os fatores subjacentes à gravidez na adolescência / When motherhood comes earlier: an analysis of the factors underlying teenage pregnancy / Cuando la maternidad llega más temprano: un análisis de los factores que subyacen al embarazo adolecente

Este artigo é fruto de uma pesquisa que teve como objetivo analisar os fatores subjacentes à gravidez precoce em mães de recém-nascidos(as) internados(as) na Unidade de Terapia Intensiva Neonatal e na Unidade de Cuidados Intermediários Canguru da Maternidade Escola Januário Cicco, em Natal, Rio Grande do Norte. Parte-se do pressuposto de que esses fatores se agregam ao contexto de vida das adolescentes e influenciam diretamente em suas trajetórias e na gestação precoce. Trata-se de uma pesquisa de enfoque misto, a partir de um estudo do tipo exploratório, orientado pelo método dialético-crítico. Para a coleta de dados, foram realizadas oito (08) entrevistas semiestruturadas e um (01) grupo focal com adolescentes de 12 a 18 anos. Os dados foram submetidos à técnica de Análise de Conteúdo. Os resultados evidenciaram que o contexto de vida social, econômico, cultural e familiar de cada adolescente apresenta diversos fatores que influenciam nos significados da gravidez na adolescência e violam a garantia do exercício de direitos como liberdade, saúde, educação, trabalho e cultura, impactando na estruturação e nos projetos de vida dessa população.(AU)

This article derives from a research that aimed to analyze underlying factors of early pregnancy in mothers of newborns admitted to the Neonatal Intensive Care Unit and the 'Kangaroo Method' Intermediate Care Unit at Januário Cicco Maternity Ward in Natal, in the State of Rio Grande do Norte in Brazil. It is considered that these issues are combined to the adolescents' life context directly influence their trajectories and early pregnancy. The research is of mixed approach by means of an exploratory study guided by the dialectical-critical method. In order to collect data, eight (08) semi-structured interviews were realized as well as a focus group that considered adolescents aged from12 to 18 years old. Data was treated by means of Content Analysis. Results point out that the social, economic, cultural and familiar context of each adolescent enables a series of factors that influence and give meaning to teenage pregnancy. It was also seen that these issues violate the guarantee and exercise of rights such as freedom, health, education, work and culture, impacting the structures of their life projects.(AU)

Este artículo es fruto de una investigación que tuvo como objetivo analizar los factores subyacentes del embarazo precoz en madres de recién-nascidos(as) internados en la Unidad de Cuidados Intensivos Neonatal e en la Unidad de Cuidados Intermedios Canguru de la Maternidad Escuela Januário Cicco en Natal-Rio Grande do Norte en Brasil. Partiendo de la suposición de que esos factores se añaden al contexto de vida de las adolescentes e influencian directamente sus trayectorias y el embarazo precoz. Tratase de una investigación con enfoque mixto, a partir de un estudio de tipo exploratorio, orientado por el método dialéctico-crítico. Para la colecta de datos, fueron realizadas ocho (08) entrevistas semiestructuradas y un (01) grupo focal con adolescentes de 12 a 18 años. Los datos fueron sometidos a la técnica de Análisis de Contenido. Los resultados mostraron que el contexto de vida social, económico, cultural y familiar de cada adolescente presenta varios factores que influyen en los significados del embarazo adolescente y violan la garantía del ejercicio de derechos como libertad, salud, educación, trabajo y cultura, incidiendo en la estructuración y los proyectos de vida de esta población.(AU)

Estado nutricional de gestantes adolescentes assistidas pela Atenção Básica: um estudo de série temporal com dados do estado de Minas Gerais / Nutritional status of pregnant adolescents assisted in Primary Care: A time series study with data from the state of Minas Gerais

Estudo ecológico, de série temporal, que teve como objetivo analisar a tendência do estado nutricional de gestantes adolescentes assistidas pela atenção primária à saúde em Minas Gerais. Os dados foram provenientes do Sistema de Vigilância Alimentar e Nutricional, referente ao estado nutricional de 140.969 gestantes adolescentes entre os anos de 2010 a 2019; apresentados em variação percentual anual por meio da regressão linear simples. O baixo peso mostrou tendência decrescente nas macrorregiões Sul e Triângulo do Norte com variação anual de -0,88% (IC95% -1,67; -0,09) e -0,79% (IC95% -1,06; -0,51) e o excesso de peso registrou tendência crescente nas macrorregiões Nordeste, Noroeste, Norte, Triângulo do Sul e Vale do Aço com a variação anual de 0,28% (IC95% 0,04;0,52), 0,37% (IC95% 0,23;0,51), 0,64% (IC95% 0,32;0,95), 0,44% (IC95% 0,18;0,70) e 0,57% (IC95% 0,26;0,88), respectivamente. Conclui-se que, no período avaliado, houve a tendência de aumento do excesso de peso entre as gestantes adolescentes no estado de Minas Gerais, acompanhando o processo de transição nutricional no país (AU).

An ecological and time-series study to analyze trends in the nutritional status of pregnant adolescents assisted in Primary Health Care in Minas Gerais. The data came from the Food and Nutrition Surveillance System, referring to the nutritional status of 140,969 pregnant adolescents between 2010 and 2019, presented in annual percentage change using simple linear regression. Low weight showed a decreasing trend in the South and Northern Triangle macro-regions with annual variations of -0.88% (95% CI: -1.67;-0.09) and -0.79% (95% CI: -1.06;-0.51); in turn, excess weight recorded an increasing trend in the Northeast, Northwest, North, Southern Triangle and Vale do Aço macro-regions, with annual variations of 0.28% (95% CI: 0.04;0.52), 0.37% (95% CI: 0.23;0.51), 0.64% (95% CI: 0.32;0.95), 0.44% (95% CI: 0.18;0.70), and 0.57% (95% CI: 0.26;0.88), respectively. It is concluded that, during the evaluated period, there was an increasing trend in excess weight among pregnant adolescents in the state of Minas Gerais, following the nutritional transition process in the country (AU).

Síndrome de disfunción orgánica múltiple progresiva en embarazo adolescente: reporte de caso clínico / Progressive multiple organ dysfunction syndrome in adolescent pregnancy: case report

INTRODUCCIÓN: El embarazo adolescente es un proceso fisiológico, pero puede evolucionar con parto prematuro, patologías obstétricas o médicas graves, mortalidad o secuelas para madre e hijo/a. Nuestro objetivo es reportar el síndrome de disfunción orgánica múltiple progresiva secundario a pielonefritis y sepsis ocurrido durante el preparto, parto y puerperio de embarazo adolescente y sus secuelas. CASO CLÍNIO: Adolescente de 14 años, con embarazo de 27 semanas de gestación controlado desde las 8 hasta 25 semanas. Ingresó de urgencia en unidad de alto riesgo obstétrico por signos de parto prematuro, pielonefritis e injuria renal aguda. Se inició tratamiento con cefazolina intravenosa y betametasona para maduración pulmonar, nifedipino oral y sulfato de magnesio para prevención del parto prematuro y protección neuronal fetal, evolucionando con hipotensión sostenida y shock séptico. A las 13 horas después del ingreso, fue trasladada a unidad de paciente crítico donde evolucionó con falla orgánica múltiple persistente y progresiva durante 28 días, afectando sucesivamente los sistemas cardiovascular, hematológico, respiratorio y gastrointestinal. Se trató con drogas vasoactivas, antibióticos, ventilación mecánica invasiva, ultrafiltración, hemodiálisis, drenaje pleural y colecistectomía. A las 24 horas de ingreso a cuidado intensivo, ocurrió el parto prematuro vaginal. La embarazada desarrolló enfermedad renal crónica etapa KDIGO 5 ( V) y se encuentra en espera de trasplante renal. Por su parte, la recién nacida prematura viva presentó asfixia neonatal severa, displasia broncopulmonar y encefalopatía hipóxico-isquémica. CONCLUSIONES: El embarazo adolescente complicado es una emergencia sanitaria. El diagnóstico y manejo oportuno de la pielonefritis, shock séptico y disfunción orgánica asociada a la sepsis pueden evitar mortalidad y secuelas permanentes materna y/o neonatal.

INTRODUCTION: Adolescent pregnancy is a physiological process, but it can evolve with premature delivery, severe obstetric or clinical pathologies, mortality, or sequelae for mother and child. We aim to report the progressive multiple organ dysfunction syndrome secondary to pyelonephritis and sepsis during prepartum, delivery, and puerperium of adolescent pregnancy and its sequelae. CASE REPORT: A 14-year-old adolescent with a pregnancy of 27 weeks of gestation controlled from 8 to 25 weeks. She was urgently admitted to the high-risk obstetric unit due to signs of preterm labor, pyelonephritis, and acute renal injury. Treatment was started with intravenous cefazolin and betamethasone for lung maturation, oral nifedipine, and magnesium sulfate to prevent preterm labor and fetal neuronal protection, evolving with sustained hypotension and septic shock. At 13 hours after admission, she was transferred to the intensive care unit, where she evolved with persistent and progressive multiple organ failure for 28 days, progressively affecting the cardiovascular, hematologic, respiratory, and gastrointestinal systems. She was treated with vasoactive drugs, antibiotics, invasive mechanical ventilation, ultrafiltration, hemodialysis, pleural drainage, and cholecystectomy. Twenty-four hours after admission to intensive care, preterm vaginal delivery occurred. She developed chronic kidney disease stage KDIGO 5 (Kidney Disease Improving Global Outcomes V) and is awaiting renal transplantation. On the other hand, the preterm newborn presented severe neonatal asphyxia, bronchopulmonary dysplasia, and hypoxic-ischemic encephalopathy. CONCLUSION: Complicated adolescent pregnancy is a health emergency. Avoiding delays in the diagnosis and treatment of pyelonephritis, septic shock and the progressive multiple organ dysfunction syndrome can prevent mortality and permanent sequelae, both maternal and neonatal.

Trajetórias afetivo-sexuais de adolescentes em situação de pobreza e suas decisões-ações intencionais para engravidar / Affective-sexual trajectories of adolescents in poverty and their intentional decisions-actions to become pregnant / Trayectorias afectivo-sexuales de adolescentes en situación de pobreza y sus decisiones-acciones intencionales para conseguir embarazar

Objetivo: entender como eventos relacionais, posições sobre métodos contraceptivos e negociações com o parceiro sobre ter o filho encontram-se implicados nos engravidamentos das participantes. Método: participaram dezesseis grávidas entre 15 e 19 anos, que intencionaram o evento, selecionadas em território de vulnerabilidade social de uma capital brasileira. Foram realizadas entrevistas presenciais, orientadas por temas, com o uso adicional dos recursos: autorretrato, mapa relacional, foto-elicitação e WhatsApp, considerando preceitos da Análise de Conteúdo Temática. Resultados: os engravidamentos mostraram-se intrincados à intenção de constituir uma família com filhos, à construção de trajetórias afetivo-sexuais direcionadas a esse desfecho, com contracepção secundária, e à decisão do ter filho pouco refletida e negociada com o par, caracterizada por pressão, imposição e transferência de responsabilidade, exercida por ambos. Conclusão:a abordagem, pelos profissionais de saúde, do engravidar de adolescentes requer considerar a influência nelas imbricada de aspectos de ordem subjetiva, relacional, agencial e social.

Objective: to understand how relational events, contraceptive positions and negotiations with the partner about having a child are implicated in the participants' pregnancies. Method: A total of 16 pregnant young women aged between 15 to 19 years who became pregnant intentionally, selected from a socially vulnerable territory in a Brazilian state capital, participated in the study. Face-to-face interviews guided by themes were conducted, with additional use of the self-portrait, relational map, photo-elicitation, and WhatsApp resources, considering Thematic Content Analysis concepts. Results: the pregnancies were intimately related to the intention of building a family with children, to the construction of affective-sexual trajectories directed at this outcome, with secondary contraception, and to the decision of having a child, little reflected and negotiated, characterized by pressure, imposition and transfer of responsibility, exercised by both. Conclusion:when discussing pregnancy during adolescence, health professionals must consider the subjective, relational, agency and social aspects imbricated in such choice.

Objetivo: entender cómo los hechos relacionales, las posturas sobre los métodos anticonceptivos y las negociaciones con la pareja sobre tener un hijo intervienen en el embarazo de las participantes. Método: participaron 16 embarazadas de entre 15 y 19 años de edad que pretendían el evento, seleccionadas en un territorio de vulnerabilidad social, en una capital brasileña. Se realizaron entrevistas cara a cara, guiadas por temas, con el uso adicional de recursos de autorretrato, mapa relacional, fotoelicitación y WhatsApp; y se consideraron los preceptos del Análisis de Contenido Temático. Resultados: destacan en sus embarazos la intención de constituir una familia con hijos, la construcción de trayectorias afectivo-sexuales encaminadas a ese desenlace, con anticoncepción secundaria, y la decisión de tener un hijo poco discutida y negociada con la pareja, caracterizada por la presión, la imposición y la transferencia de responsabilidad, ejercida por ambos. Conclusión:el abordaje del embarazo en adolescentes por parte de los profesionales de la salud requiere considerar la influencia imbricada de aspectos subjetivos, relacionales, de agencia y sociales

Caracterización de embarazos en adolescentes atendidas en el Hospital Regional de Talca: estudio retrospectivo (2017-2022) / Characterization of adolescent pregnancy treated at the Regional Hospital of Talca: retrospective study (2017-2022)

Teenage pregnancy is a health problem that, despite being in decline, continues to be an important component in maternal and fetal morbidity and mortality. The objective of this investigation is to examine the data on adolescent pregnancies obtained from the Regional Hospital of Talca, describe the results collected and compare them with information found in the literature, analyzing the most relevant aspects, in order to provide a greater perspective on the subject, and therefore, contribute to the generation of new prevention measures. In this retrospective and descriptive observational study, the data of all pregnant women under 20 years who gave birth during the period from February 2017 to November 2022 and were treated at the Regional Hospital of Talca were collected and analyzed. For the analysis of the data, a script was made in Python. Obtaining as a result 1,566 pregnant adolescents, with an average age of 17.67 years, 89.6% primigest, in terms of newborns, 13.6% were premature and 5.8% of them extremely premature. 1.2% of newborns (both live births and stillborns/stillborns) developed some malformation.

Percepção de adolescentes atendidas na Atenção Primária à Saúde sobre o período gravídico-puerperal em um município do Rio Grande do Sul / Perception of adolescents assisted in primary health care about the pregnancy-puerperal periodin a municipality of Rio Grande do Sul

O período gravídico-puerperal é caracterizado por diversas transformações no corpo e na vida de uma mulher, marcado por mudanças biopsicossociais, e quando vivenciados na adolescência e puberdade essas transformações acabam se intensificando. O objetivo do estudo foi identificar a percepção de adolescentes atendidas na Atenção Primária à Saúde sobre o período gravídico-puerperal. Trata-se se uma pesquisa de abordagem qualitativa, descritiva e exploratória, realizada com cinco puérperas adolescentes entre a faixa etária de 15 a 19 anos, em duas Estratégias de Saúde da Família, de um município do Rio Grande do Sul/RS, durante o segundo semestre de 2020, por meio de uma entrevista semiestruturada composta por perguntas abertas e fechadas. As adolescentes foram convidadas a participar da pesquisa no momento que estavam aguardando o atendimento nos serviços. As entrevistas foram gravadas em áudio, e posteriormente transcritas na íntegra. Após a análise dos dados produzidos, optou-se pela construção de três categorias temáticas, as quais são: percepções de adolescentes sobre a maternidade, facilidades e dificuldades encontradas no período gravídico-puerperal, orientações e rede de apoio. A pesquisa possibilitou compreender as percepções das adolescentes sobre maternidade, identificar as mudanças físicas, psíquicas e sociais ocorridas durante o período gravídico-puerperal, bem como compreender a sua rede de apoio.

The pregnancy-puerperal period is characterized by several transformations in a woman's body and life, marked by biopsychosocial changes, and when experienced in adolescence and puberty these transformations end up intensifying.The objective of the study was to identify the perception of adolescents assisted in primary health care about the pregnancy-puerperal period. This is qualitative, descriptive and exploratory research, carried out with five adolescent mothers aged between15 and 19 years, in two Family Health Strategies, in a city in Rio Grande do Sul/RS, during the second half of 2020, through a semi-structured interview consisting of open and closed questions. Adolescents were invited to participate in the research whilethey were waiting to be seen at the services. The interviews were audio-recorded and later fully transcribed. After analyzing the data produced, it was decided to construct three thematic categories, which are: Perceptions of adolescents about motherhood,Facilities and difficulties encountered in the pregnancy-puerperal period and Guidelines and support network. The research made it possible to understand the adolescents' perceptions about motherhood, identify the physical, psychological and social changes that occurred during the pregnancy-puerperal period, as well as understand their support network.

Gravidez na adolescência: percepção dos enfermeiros sobre a assistência de enfermagem / Pregnancy in adolescence: nurses' perception about nursing care / Embarazo en la adolescencia: percepción de las enfermeras sobre el cuidado de enfermería

Objetivo: Descrever a percepção dos enfermeiros da atenção básica sobre a assistência pré-natal direcionada às adolescentes grávidas. Métodos: Trata-se de um estudo descritivo, transversal de natureza qualitativa, desenvolvido nas Unidades Básicas de Saúde do Guamá em Belém ­ Pará, de maio a abril de 2021. Resultados: Participaram 15 enfermeiros, norteado por um formulário semiestruturado, tendo os dados analisados pela técnica de Laurence Bardin, resultando seis categorias temáticas acerca da percepção sobre o atendimento pré-natal com adolescentes. Conclusão: Percebe-se a percepção do impacto positivo da assistência de enfermagem no pré-natal de adolescentes grávidas, todavia necessita de melhorias estruturais no atendimento, formação continuada dos profissionais e captação precoce da adolescente grávida. (AU)

Objective: describe the perception of nurses in primary care about prenatal care aimed at pregnant adolescents. Methods: This is a descriptive, cross-sectional study of a qualitative, developed in the Basic Health Units of Guamá in Belém ­ Pará, from May to April 2021. Results: Fifteen nurses participated, guided by a semi-structured form, with the data analyzed using the Laurence Bardin technique, resulting in six categories about the perception of prenatal care with adolescents. We conclude that nurses are aware of the positive impact that nursing care has on the conduct of pregnancy and the formation of autonomy for adolescents. Conclusion: The perception of the positive impact of nursing care on prenatal care for pregnant teenagers is perceived, however, it needs structural improvements in care, continued training of professionals and early capture of pregnant teenagers. (AU)

Objetivo: describir la percepción de enfermeras de atención primaria sobre la atención prenatal dirigida a adolescentes embarazadas. Métodos: Se trata de un estudio descriptivo, transversal de carácter cualitativo, desarrollado en las Unidades Básicas de Salud de Guamá en Belém - Pará, de mayo a abril de 2021. Resultados: Participaron quince enfermeros, guiados por un formulario semiestructurado, con los datos analizados mediante la técnica de Laurence Bardin, resultando en seis categorías temáticas sobre la percepción de la atención prenatal con adolescentes. Conclusión: Se percibe la percepción del impacto positivo del cuidado de enfermería en el cuidado prenatal de las adolescentes embarazadas, sin embargo, requiere mejoras estructurales en la atención, capacitación continua de los profesionales y reclutamiento temprano de las adolescentes embarazadas. (AU)

Dilemmas and management of a pregnant 10-year-old sexual assault victim / Philippine Journal of Obstetrics and Gynecology

@#There has been a dramatic increase in very young adolescent pregnancies in recent years, with pregnancies documented in children as young as 10 years old, likely from sexual abuse. This article presents a 10-year-old female who initially consulted at the emergency room in her 27th week of pregnancy as a result of recurrent sexual abuse. Prompt assessment, diagnosis, and appropriate referrals to Obstetrics, Pediatric Adolescent Clinic, Psychiatry, and Child Protection Unit rendered optimal management for the patient. Dilemmas encountered in managing the case included preterm labor, large-for-gestational-age baby, immature pelvis, and approach to the appropriate mode of delivery compounded with management of trauma from sexual abuse. A multidisciplinary approach in managing these dilemmas achieved optimal outcomes with the patient delivering a live baby boy, appropriate for gestational age via cesarean section at term.

Funcionalidad Familiar de Adolescentes Asistentes a control prenatal. Cartagena 2021 / Family functionality of adolescents attending prenatal control. Cartagena 2021 / Funcionalidade familiar dos adolescentes que frequentam os cuidados pré-natais. Cartagena 2021

Introducción: El embarazo en la adolescencia tiende a presentar repercusiones personales, sociales, educativas y psicológicas en la madre y en el hijo. Es por ello por lo que el apoyo de la familia y su funcionalidad resultan cruciales. Objetivo: Determinar el nivel de funcionalidad familiar existente en las familias de las adolescentes gestantes asistentes a controles prenatales en tres instituciones de salud de Cartagena-Colombia durante 2021. Materiales y Métodos: Estudio descriptivo, de corte transversal, y asociación. La población estuvo constituida por 780 adolescentes gestantes que asisten a controles prenatales en dos instituciones. Se determinó una muestra de 185 adolescentes gestantes, seleccionadas mediante muestreo probabilístico. Fue aplicado instrumento sociodemográfico y APGAR familiar. Resultados: Las gestantes participaron de la institución A (50,81%) y de la institución B (44,32%), se trató de adolescentes bachilleres (58,92%), que conviven en unión libre (51,35%), en familias nucleares de origen (32,97%) y sus familias devengan ingresos entre 1 ­ 2 salarios mínimos (48,11%). El embarazo actual no fue planeado, y a los controles prenatales asisten con la mamá (31,35%), la pareja (27,57%) o solas (22,16%). La funcionalidad normal fue la más frecuente (99,46%), y se presentó asociación (p ≤ 0,05) con las instituciones, con la tipología familiar de naturaleza monoparental conformada y con el acompañamiento a los controles prenatales. Conclusión: Se determinó un nivel de funcionalidad familiar normal en las familias de las adolescentes gestantes asistentes a controles prenatales en dos instituciones de salud de Cartagena.

Introduction: Pregnancy in adolescence tends to have personal, social, educational, and psychological repercussions on the mother and child. That is why the support of the family, and its functionality are crucial. Objective: To determine the level of family functionality existing in the families of pregnant adolescents attending prenatal check-ups in three health institutions in Cartagena-Colombia during 2021. Materials and Methods: Descriptive, cross-sectional, and association study. The population consisted of 780 pregnant adolescents who attend prenatal check-ups in two institutions. A sample of 185 pregnant adolescents, selected by probabilistic sampling, was estimated. Sociodemographic instrument and family APGAR were applied. Results: Pregnant women participated in institution A (50.81%) and institution B (44.32%), they were high school adolescents (58.92%), who live together in a free union (51.35%), in nuclear families of origin (32.97%) and their families earn between 1 ­ 2 minimum wages (48.11%). The current pregnancy was not planned, and prenatal check-ups are attended by the mother (31.35%), the couple (27.57%) or alone (22.16%). Normal functionality was the most frequent (99.46%) and was correlated (p ≤ 0.05) with the institutions, with the family typology of a single-parent nature formed and with the accompaniment to prenatal controls. Conclusion: A normal level of family functionality was determined in the families of pregnant adolescents attending prenatal check-ups in two health institutions in Cartagena.

Introdução: A gravidez na adolescência tende a ter repercussões pessoais, sociais, educacionais e psicológicas sobre a mãe e o filho. É por isso que o apoio da família e sua funcionalidade são cruciais. Objetivo: Determinar o nível de funcionalidade familiar existente nas famílias de adolescentes gestantes que participam de check-ups pré-natal em dois instituições de saúde em Cartagena-Colômbia durante 2021. Materiais e métodos: Estudo descritivo, transversal e associacao de estudo. A população era composta por 780 adolescentes gestantes que frequentam o pré-natal em dois instituições. Foi estimada uma amostra de 185 adolescentes gestantes, selecionadas por amostragem probabilística. Foram aplicados instrumentos sociodemográficos e APGAR familiar. Resultados: Gestantes participaram da instituição A (50,81%) e da instituição B (44,32%), eram adolescentes do ensino médio (58,92%), que vivem juntas em união gratuita (51,35%), em famílias nucleares de origem (32,97%) e suas famílias ganham entre 1 e 2 salários-mínimos (48,11%). A gestação atual não foi planejada, e os check-ups pré-natal são atendidos pela mãe (31,35%), pelo casal (27,57%) ou sozinho(22,16%). A funcionalidade normal foi a mais frequente (99,46%), e foi correlacionada (p ≤ 0,05) com as instituições, com a tipologia familiar de natureza monoparental conformada e com o acompanhamento aos controles pré-natais. Conclusão: Foi determinado um nível normal de funcionalidade familiar nas famílias de adolescentes gestantes que frequentam oscheck-ups do pré-natal em dois instituições de saúde de Cartagena.

Gestantes em Cruzeiro do Sul, Acre: características demográficas e socioeconômicas, ocorrência e fatores associados aos distúrbios hipertensivos na gravidez / Pregnant women in Cruzeiro do Sul, Acre: demographic and socioeconomic characteristics, occurrence and factors associated with hypertensive disorders in pregnancy

Introdução: A gravidez é um período de várias alterações fisiológicas, anatômicas, psicológicas e sociais na vida da mulher. As gestantes e seus bebês necessitam de cuidados específicos. A assistência adequada à saúde durante o período de gestacional é essencial para a prevenção ou diminuição dos agravos a saúde materno-infantil. Objetivos: a) Identificar as evidências disponíveis na literatura sobre o papel da enfermagem na assistência as gestantes com síndromes hipertensivas na gestação (Artigo 1); b) Analisar a concordância entre dados de peso pré-gestacional, peso na gravidez, altura e pressão arterial sistólica (PAS) e diastólica (PAD) registradas tanto na caderneta da gestante quanto nas informações obtidas no estudo longitudinal MINA-Brasil (Artigo 2); c) Investigar a ocorrência e fatores associados aos distúrbios hipertensivos na gravidez (DHG) e complicações neonatais no município de Cruzeiro do Sul, Acre (Artigo 3); d) Investigar as características socioeconômicas e obstétricas de parturientes adolescentes e suas complicações sobre a saúde materna e neonatal entre participantes da coorte de nascimentos MINA-Brasil (Artigo 4). Método: Trata-se de análise de dados da linha de base do estudo MINA-Brasil. Entre fevereiro de 2015 e maio de 2016, gestantes inscritas no pré-natal da área urbana foram rastreadas e duas avaliações foram realizadas: 1ª avaliação no segundo trimestre e a 2ª avaliação no terceiro trimestre de gravidez. Informações sobre condições socioeconômicas e demográficas, histórico de saúde e estilo de vida e medidas antropométricas foram obtidas pela equipe de pesquisa. Posteriormente, entre julho de 2015 e junho de 2016, foi realizado registro diário das internações para parto na única maternidade do município, dando início a coorte de nascimento de base populacional do estudo MINA-Brasil. As análises utilizadas neste estudo incluíram uma análise integrativa da literatura (Artigo 1), análise de concordância entre as medidas antropométricas e de pressão arterial registradas na caderneta da gestante e aferidas pela equipe do estudo MINA-Brasil (Artigo 2). Também foram utilizados modelos de regressão múltiplos de Poisson com variância robusta para avaliar os fatores associados aos distúrbios hipertensivos no parto (Artigo 3) e os fatores associados a parturientes adolescentes (Artigo 4). O nível de significância estatística adotado nas análises foi p <0,05. Resultados: No Artigo 1, ao todo, 13 estudos foram selecionados para a análise, divididos em 3 categorias: 1. O conhecimento dos profissionais de enfermagem sobre as síndromes hipertensivas na gestação; 2. Os cuidados de enfermagem à gestante com síndromes hipertensivas na gestação e seus neonatos; 3. A sistematização da assistência em enfermagem no cuidado as síndromes hipertensivas na gestação. No Artigo 2, foram analisados dados de 428 gestantes. Houve concordância moderada entre as informações para o peso pré-gestacional autorreferido (0,935) e altura (0,913), e concordância substancial para o peso da gestante no segundo (0,993) e terceiro (0,988) trimestres de gestação. Verificou-se baixa concordância da PAS e PAD no segundo (PAS=0,447; PAD=0,409) e terceiro (PAS=0,436; PAD=0,332) trimestres gestacionais. No Artigo 3 (n=1521), a prevalência de DHG foi de 11,0% (IC 95%: 9,5-12,7). Os fatores associados à prevalência de DHG foram idade materna ≥ 35 anos (RP: 1,9; IC 95%: 1,3-3,0), ser primigesta (RP: 2,0; IC 95%: 1,5-2,7), obesidade pré-gestacional (RP: 2,7; IC 95%: 1,9-4,0), maior ganho de peso gestacional (RP do quartil mais alto: 2,5; IC 95%: 1,6-3,8), hipertensão crônica (RP: 3,6; IC 95%: 2,7-4,9) e parto cesáreo (RP: 1,8; IC 95%: 1,6-2,0) e prematuridade (RP: 2,0; IC 95%: 1,3-3,2). No Artigo 4, entre as puérperas estudadas (n=1525), 26,2% (IC95%: 24,0-28,4) eram adolescentes. Quando comparadas com as parturientes adultas, os fatores associados à maior prevalência de parto na adolescência foram ter 9 anos ou menos de estudo (RPaj:1,36; IC95%: 1,14-1,61), pertencer aos menores quartis do índice de riqueza (1° quartil: RPaj:1,40; IC95%: 1,08-1,80) (2° quartil: RPaj:1,37; IC95%: 1,08-1,74), ser primigesta (RPaj:3,69; IC95%: 2,98-4,57), apresentar baixo IMC pré-gestacional (RPaj:1,28; IC95%: 1,04-1,57), infecção urinária na gravidez (RPaj:1,25; IC95%: 1,07-1,46) e menos de 6 consultas de pré-natal (RPaj:1,42; IC95%: 1,21-1,66). Conclusões: Nossos resultados reforçam a importância de conhecer as características das gestantes e seus neonatos e os desfechos adversos que afetam sua saúde na Amazônia Ocidental Brasileira. Esses resultados poderão contribuir para o planejamento e melhoria de programas de assistência à saúde materno-infantil nos mais diversos níveis de atenção, configurando-se em uma ferramenta importante, baseada em evidencias cientificas, que abrange várias reflexões sobre a saúde materna e neonatal.

Introduction: Pregnancy is a period of several physiological, anatomical, psychological and social changes in a woman's life. Pregnant women and their babies need specific care. Adequate health care during the gestational period is essential for the prevention or reduction of maternal and child health problems. Objective: a) To identify the available evidence on the role of nursing in assisting pregnant women with hypertensive syndromes during pregnancy (Article 1); b) To analyze the agreement between data on pre-gestational weight, gestational weight gain, height, and systolic (SBP) and diastolic (DBP) blood pressure data recorded both in the prenatal care card and in the information obtained in the MINA-Brazil study (Article 2); c) To investigate the occurrence and factors associated with hypertensive disorders in pregnancy (HDP) and neonatal complications in women living in the Brazilian Western Amazon (Article 3); d) To investigate the socioeconomic and obstetric characteristics of adolescent parturients and their complications on maternal and neonatal health among participants of the MINA-Brasil birth cohort in the municipality of Cruzeiro do Sul, Acre ( Article 4). Methods: Baseline data from the MINA-Brazil cohort study were analyzed. Between February 2015 and May 2016, pregnant women enrolled in prenatal care in the urban area were screened and two evaluations were performed: 1st evaluation in the second trimester and the 2nd evaluation in the third trimester of pregnancy. Information on socioeconomic and demographic conditions, health and lifestyle history, and anthropometric measurements were obtained by the research team. Subsequently, between July 2015 and June 2016, a daily record of admissions for childbirth was carried out in the only maternity hospital in the municipality, starting the population-based birth cohort of the MINA-Brazil study. First, an integrative literature review was performed (Article 1), following data analyzes of agreement between anthropometric and blood pressure measurements recorded in the prenatal care card and measured by the MINA-Brazil study team (Article 2). Multiple Poisson regression models with robust variance were also used to assess factors associated with hypertensive disorders at childbirth (Article 3), and factors associated with adolescent parturients (Article 4). The level of statistical significance adopted was p <0.05. Results: In Article 1, overall 13 studies were selected for analysis, divided into 3 categories: 1. Nursing professionals' knowledge about hypertensive syndromes during pregnancy; 2. Nursing care for pregnant women with hypertensive syndromes during pregnancy and their newborns; 3. The systematization of nursing care in the care of hypertensive syndromes during pregnancy. In Article 2, data from 428 pregnant women were analyzed. There was moderate agreement between the information for self-reported pre-pregnancy weight (0.935) and height (0.913), and substantial agreement for the pregnant woman's weight in the second (0.993) and third (0.988) trimesters of pregnancy. There was a low agreement between SBP and DBP in the second (SBP=0.447; DBP=0.409) and third (SBP=0.436; DBP=0.332) trimesters. In Article 3 (n=1521), the prevalence of HDP was 11.0% (95% CI: 9.51-2.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), being primiparous (PR: 2.0; 95% CI: 1.5- 2.7), pre-gestational obesity (PR: 2.7; 95% CI: 1.9-4.0), greater gestational weight gain (PR of the highest quartile: 2.5; 95% CI: 1.6-3.8), chronic hypertension (PR: 3.6; 95% CI: 2.7-4.9) and diabetes in pregnancy (PR: 1.9; 95% CI: 1.1-3, two). HDP were associated with the risk of cesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). In Article 4, among the postpartum women studied (n=1525), 26.2% (95%CI: 24.0-28.4) were adolescents. When compared with adult parturients, the factors associated with a higher prevalence of childbirth in adolescence were: having 9 years or less of schooling (PRaj: 1.36; 95%CI: 1.14-1.61), belonging to the lowest quartiles of the index wealth (1st quartile: RPaj:1.40; 95%CI: 1.08-1.80) (2nd quartile: PRaj:1.37; 95%CI: 1.08-1.74), being a primiparous (PRaj:3.69; 95%CI: 2.98-4.57), having a low pre-gestational BMI (PRaj:1.28; 95%CI: 1.04-1.57), urinary tract infection in pregnancy (PRaj: 1.25; 95%CI: 1.07-1.46) and less than 6 prenatal consultations (PRaj:1.42; 95%CI: 1.21-1.66). Conclusions: Our results reinforce the importance of knowing the characteristics of pregnant women and their newborns and the adverse outcomes that affect their health in the Western Brazilian Amazon. These results can contribute to the planning and improvement of maternal and child health assistance programs at the most diverse levels of care, constituting an important tool, based on scientific evidence, which encompasses several reflections on maternal and neonatal health.

Desfechos obstétricos em parto de adolescentes: estudo transversal / Obstetric outcomes in adolescents birth: cross-sectionalstudy

A gravidez na adolescência é um problema de saúde pública mundial e apresenta maior risco de morbimortalidade materna e neonatal. Objetivo: analisar os desfechos maternos em adolescentes de risco habitual e alto risco gestacional. Método: Trata-se de um estudo transversal realizado com adolescentes com idade entre 10 a 19 anos. A amostra utilizada no estudo foi de 220 adolescentes. Foram utilizados como testes estatísticos o X² e, quando necessário, o teste exato de Fisher ou Mid-P. Foi considerado o valor de p<0,05. Resultados: Observou-se que as adolescentes de risco habitual apresentaram gestação não desejada (p=0,033) e lacerações perineais durante o parto vaginal (p<0,001) e as de alto risco tiveram alterações da gestação (p<0,001), episiotomia (p= 0,038) no parto e internações em Unidade de Terapia Intensiva (UTI) (p=0,015). Conclusão: As adolescentes de alto risco gestacional necessitam de uma atenção especializada durante o ciclo gravídico-puerperal, para prevenir alterações gestacionais, quadros clínicos graves, internação em UTI e desfechos neonatais adversos, com intuito de melhorar a qualidade de vida perinatal

Teenage pregnancy is a global public health problem and presents a higherrisk of maternal and neonatal morbidity and mortality. This study aims to analyze the maternal outcomes in adolescents of usual riskand high gestational risk. Methods: This is a crosssectional study, carried out with adolescents aged 10to 19 years. The sample used in the study consisted of 220 adolescents. X² were used asstatistical tests, when necessary, Fisher's exact test or Mid-P was used. Ap value <0.05 wasconsidered. Results:it was observed that the usual risk adolescents had unwantedpregnancies (p= 0.033) and perineal lacerations during vaginal delivery (p<0.001) and thehigh risk ones had changesin pregnancy (p<0.001), episiotomy was performed (p= 0.038)and admitted to theIntensive Care Unit (ICU) (p= 0.015). Conclusions: Adolescentsat high gestational risk need specialized care during the pregnancy-puerperal cycle, to prevent gestational changes, severe clinical conditions, ICU admission and adverse neonatal outcomes, withthe aim of improving perinatal quality of life

Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).