Influența vârstei ginecologice asupra dezvoltării complicațiilor materno-fetale la adolescentele gravide

Abstract

Rezumat Sarcina la adolescente reprezintă o problemă importantă, care este evalută în cadrul numeroaselor programe medicale și sociale. Incidența sarcinilor la adolescente în Republica Moldova între anii 2009-2012 a constituit 1,5-4,0% cazuri. Evoluția sarcinii la adolescente decurge cu anumite particularități datorate imaturității fi ziologice a organismului tânăr în creștere. Acest aspect este caracterizat printr-un număr crescut de complicații ale evoluției sarcinii, nașterii și perioadei post partum, cu implicarea frecventă a aspectelor emoționale și sociale. Vârsta ginecologică (VGi), concomitent cu vârsta cronologică este un factor obstetrical care permite aprecierea riscului de apariție a complicațiilor materno-fetale. Se consideră că VGi este un factor obstetrical care permite aprecierea potențialului risc al rezultatelor materne și fetale. VGi se apreciază concomitent cu vârsta cronologică pentru a evalua riscul obstetrical. A fost efectuat un studiu care a inclus un număr total de 261 gestante, nașterea cărora a fost monitorizată în cadrul IMSP Institutul Mamei și Copilului, pe parcursul anilor 2013-2015. Numărul total de cazuri a fost divizat în 2 loturi în funcție de vârstă: lotul I a inclus 126 (48,3%) paciente cu vârsta între 13-18 ani, iar lotul II – 135 (51,7%) paciente cu vârsta cuprinsă între 19-25 ani. Lotul I a fost divizat în 2 subloturi: sublotul I a inclus 55 cazuri (43,7%) cu VGi≤ 3 ani, iar în sublotul II au fost incluse 71 cazuri (56,3%) cu VGi˃3 ani În concluzie menționăm că sarcinile la adolescente necesită monitorizare minuțioasă și subliniem importanța aprecierii vârstei ginecologice ca factor de risc pentru dezvoltarea complicațiilor perinatale: restricției de creștere intrauterine a fătului, nașterii premature, anomaliilor congenitale și altor complicații. Teenage pregnancy is an important problem, has being evaluated in a huge number of medical and social programs. The incidence of teenage pregnancies in Republic of Moldova, is about 1,5-4,0%, cases recorded between 2009-2012. The evolution of teenage pregnancy has some particularities linked to physiological immaturity of young developed body and characterized by an increased number of complications during pregnancy and post-partum period. Usually here are involved emotional and social factors. Gynecological age is an important obstetric risk factor, which let us appreciate the potential risk of maternal and perinatal outcomes. Chronological age should be used to evaluate teenage pregnancies outcomes. We have done the study to compare obstetric and perinatal outcomes between adult and teenage pregnancies. 261 cases, managed in the Institute of Mother and Child, Chisinau, Republic of Moldova, between 2013-2015, have been evaluated. The total number of cases were divided, according to maternal age, in two main groups: the fi rst group includes 126 (48,3%) patients aged 13-18 years old, and the other 135 (51,7%) pregnant women, aged between 19-25 years, were included in the second group. The fi rst group was divided in 2 subgroups: 55 (43,7%) women with gynecological age ≤ 3 years and 71 (56,3%) pregnant women with gynecological age ˃3 years. In conclusion, we mention that teenage pregnancies need to be evaluated carefully and we highlight the importance of low gynecological age as the criteria of the risk -factor evaluation for intrauterine growth restriction of the fetus, premature birth, congenital anomalies and other obstetric complications.

Подростковая беременность до сих пор остается одной из важных проблем, которая рассматривается в многочисленных социальных и медицинских программах. Частота подростковой беременности в Молдове на протяжении 2009-2012 годов составила 1,5-4,0%. В следствие физиологической незрелости молодого растущего организма течение подростковой беременности имеет некоторые особенности. Это, в свою очередь, ведет к увеличению числа осложнений во время беременности, родов и послеродового периода, в большинстве случаев с вовлечением эмоциональных и социальных аспектов. Считается, что гинекологический возраст (ГВ) наряду с хронологическим возрастом является акушерским фактором риска, который позволяет оценить потенциальный риск для развития осложнений у матери и плода. Нами было проведено исследование, включавшее в общей сложности 261 беременную, которые наблюдались в Перинатальном Центре третьего уровня Центре Матери и Ребенка в течение 2013-2015 годов. Общее число случаев было разделено на 2 группы в зависимости от возраста: I группа - 126 (48,3%) беременных в возрасте от 13-18 лет, II группа - 135 (51,7%) беременных в возрасте от 19 до 25 лет. В последствии I группа была разделена на две подгруппы: в первую подгруппу включены 55 (43,7%) беременных, чей ГВ ≤ 3-х лет, во вторую подгруппу были включены 71 (56,3%) беременная, чей ГВ˃3 лет. На основании данных исследования можно сделать вывод, что при подростковой беременности следует учитывать не только хронологический, но и гинекологический возраст как один из факторов риска развития перинатальных осложнений: задержка внутриутробного развития плода, преждевременные роды, врожденные аномалии и другие осложнения.

Teenage pregnancy is an important problem, has being evaluated in a huge number of medical and social programs. The incidence of teenage pregnancies in Republic of Moldova, is about 1,5-4,0%, cases recorded between 2009-2012. The evolution of teenage pregnancy has some particularities linked to physiological immaturity of young developed body and characterized by an increased number of complications during pregnancy and post-partum period. Usually here are involved emotional and social factors. Gynecological age is an important obstetric risk factor, which let us appreciate the potential risk of maternal and perinatal outcomes. Chronological age should be used to evaluate teenage pregnancies outcomes. We have done the study to compare obstetric and perinatal outcomes between adult and teenage pregnancies. 261 cases, managed in the Institute of Mother and Child, Chisinau, Republic of Moldova, between 2013-2015, have been evaluated. The total number of cases were divided, according to maternal age, in two main groups: the fi rst group includes 126 (48,3%) patients aged 13-18 years old, and the other 135 (51,7%) pregnant women, aged between 19-25 years, were included in the second group. The fi rst group was divided in 2 subgroups: 55 (43,7%) women with gynecological age ≤ 3 years and 71 (56,3%) pregnant women with gynecological age ˃3 years. In conclusion, we mention that teenage pregnancies need to be evaluated carefully and we highlight the importance of low gynecological age as the criteria of the risk -factor evaluation for intrauterine growth restriction of the fetus, premature birth, congenital anomalies and other obstetric complications.