Pregnant adolescents and their mothers. A shared experience of teen mothering.

PURPOSE: To explore and describe the relationships between African American adolescent mothers and their mothers. DESIGN: A qualitative, descriptive approach was used. METHODS: In-depth, audio-taped interviews, using a semi-structured interview guide with open-ended questions, were conducted with a convenience sample of 12 mother/daughter pairs and three teen mother/mother-figure pairs in a university research area designed for the comfort of the participants. Mothers and daughters were interviewed separately to enhance free expression of their feelings. Participants were recruited through an ongoing study on adolescent motherhood. RESULTS: Four major themes emerged from the analysis. The two symbolic themes were communication between mother and daughter and role change. The two dominant interactive themes were conflict and social isolation. CLINICAL IMPLICATIONS: Nursing assessment of pregnant and parenting teen mothers that includes an assessment of the character of the mother/daughter relationship can be valuable in assisting the pregnant teen toward better health.

Menarche, sexual practices, and pregnancy: model testing.

Rates of adolescent pregnancy and childbearing, while in slight decline in the United States since 1992, remain high enough to warrant significant national concern. Birth rates, however, remain particularly high for minority adolescents. One hundred fifty-two records of African American and Latina adolescents receiving prenatal care from nurse midwives at an inner city university clinic were reviewed to partially test a developmental maturity model of pregnancy using logistic regression. The relationships between age at menarche to sexual practices and age at first pregnancy were examined. Mean age of the sample was 16.5 years, mean age at menarche was 12.2 years, at first coitus was 14.6 years, and at first pregnancy was 15.6 years. Thirty percent of the girls were experiencing second pregnancies. Birth control use by the adolescents was inconsistent, with only 20 percent using birth control at first coitus. Multiple regression analyses produced a model explaining 50 percent of the variance in age at first pregnancy. The predictor variables in the model were age at first coitus, age at menarche, race/ethnicity, and use of birth control at first coitus. Further analyses indicate that for childbearing adolescents, age at first coitus is a classic intervening variable between age at menarche and age at first pregnancy. Early physiologic maturers appear to lack the psychological and cognitive maturity required to cope with their emerging sexuality resulting in early unprotected coitus and pregnancy. Findings provide guidance to healthcare providers for the development of interventions to prevent unplanned pregnancies.

The effect of tocolytic use in the management of symptomatic placenta previa.

OBJECTIVE: The null hypothesis is that tocolysis has no effect on pregnancy prolongation in the aggressive expectant management of symptomatic preterm placenta previa. STUDY DESIGN: One hundred twelve preterm pregnancies with confirmed placenta previa and an initial episode of acute vaginal bleeding were selected for this retrospective analysis. Exclusion criteria included gestational age > or = 35 weeks, delivery within 24 hours of admission, prior treatment for bleeding or preterm labor, and contraindications to tocolytic use. Tocolysis was prescribed, at the discretion of the treating clinical staff, in selected pregnancies with significant uterine contractions after admission of the patient. The majority of treated patients (85%) received intravenous magnesium sulfate and/or oral or subcutaneous beta-sympathomimetics within 24 hours of admission. Most patients remained hospitalized until delivery under this aggressive expectant management protocol. Both treated and untreated control study groups were similar at inclusion with regard to parity, gestational age, contraction frequency, and degree of initial bleeding. Outcome variables for each treatment group were obtained from final chart review. Continuous and categoric variables were compared with Student t test or chi 2 analysis-Fisher's exact test, respectively. RESULTS: The clinical use of tocolysis in symptomatic placenta previa was associated with a clinically significant delay of preterm delivery. Significant improvement in clinical parameters such as interval from admission to delivery (39.2 vs 26.9 days, p < 0.02) and birth weight (2520 vs 2124 gm, p < 0.03) was observed in the tocolysis group. There was no observed statistical difference between the two treatment groups with regard to incidence of recurrent bleeding, interval from admission to first recurrent bleeding, and need for transfusion. There was a trend for patients with multiple bleeding episodes to have been receiving tocolytic therapy (p < 0.10). A trend for requiring a postpartum transfusion was also noted in the tocolysis group (p < 0.09). Treated pregnancies receiving long-term maintenance tocolysis with oral or subcutaneous terbutaline exhibited a greater degree of pregnancy prolongation than those treated with short-term intravenous magnesium alone (43.7 vs 15.3 days, p < 0.02). CONCLUSIONS: This retrospective analysis suggests that tocolytic intervention in cases of symptomatic preterm previa may be associated with clinically significant prolongation of pregnancy and increased birth weight. Tocolytic therapy in these cases does not appear to have an impact on frequency or severity of recurrent vaginal bleeding. Further prospective analysis may delineate the role of tocolysis in the aggressive expectant management of symptomatic placenta previa.