Pregnant adolescents have greater risks of complications than the average pregnant woman. Their young age predisposes them to several factors that could threaten their pregnancy and themselves. Because of this, healthcare providers must be aware of how to handle pregnant adolescents with complications and the interventions that go with them.
- A baseline blood pressure must be established because adolescents are more prone to PIH than the average pregnant woman.
- Measuring the blood pressure is especially important if the adolescent has not had her blood pressure checked since preschool or school-age as long as 10 years earlier.
- Bed rest, preferably in a side-lying position, is the best intervention for a pregnant adolescent with pregnancy-induced hypertension.
- A pregnant adolescent may feel more at ease if she can lie down in a place where she can still be aware of household activities than be confined on her own at her bed room.
- Help the adolescent establish a specific routine for bed rest, whether she can sit up in a lounge chair or is strictly confined in bed, or if she can shower or use the bathroom.
- Adolescent girls would want to have some activities while on bed rest, so allow them to listen to music, work on their home works, or have a friend over.
- Ensure that the girl does not misinterpret that being on bed rest means that she is sick because she might reduce her nutritional intake or curtail her body hygiene.
- Low-dose aspirin may be prescribed to reduce the symptoms of hypertension of pregnancy.
- Emphasize strict compliance to medications because adolescents are often not reliable at taking daily medicine especially if it seems unimportant.
- If the hypertension continues after a period of bed rest at home or if the symptoms of PIH are advanced when they are first discovered, the girl must be admitted to the hospital for a better enforced bed rest.
- As soon as the fetus is mature, labor will be induced or cesarean birth scheduled.
Iron Deficiency Anemia
- Most adolescent girls are deficient in iron because they have a low protein diet prior to pregnancy, and the diet could not balance the amount of iron lost during menstrual flows.
- Symptoms of IDA include chronic fatigue, pale mucous membranes, and hemoglobin level less than 11 g/dL.
- Iron deficiency anemia is associated with pica, or the ingestion of inedible substances.
- A pregnancy compounds anemia because the girl must supply enough iron for fetal growth and her increasing blood volume.
- All pregnant women should take an iron and folic acid supplement, especially pregnant adolescents.
- Assist the adolescent in planning for a daily time for taking her iron supplement and review with her the iron-rich foods she needs to eat daily.
- When the body already has enough iron, it will start forming reticulocytes or immature red blood cells rapidly.
- A reticulocyte count may be obtained in 2 weeks to evaluate the levels and prove that the girl is taking her iron supplements.
- Other methods in assessing for adherence are taking a stool swab and assessing it for black tinge of an iron supplement or reassessing her serum iron level.
- Since an adolescent’s uterus is not yet fully grown, they are at high risk for preterm labor.
- By the third month of pregnancy, review the signs of preterm labor with the adolescent.
- Emphasize that labor contractions begin like sweeping contractions no more intense than menstrual cramps and any vaginal bleeding is suspicious of labor and should be reported.
- Most adolescent girls have gained their knowledge of labor from television, so they might dismiss light contractions as simple discomfort, not realizing they might be the start of labor.
- If the adolescent recognized labor contractions, they can seek care to have premature labor halted.
Having a baby at a young age is a real challenge for adolescents, especially because complications abound their pregnancy. It is the role of health care providers to guide these girls, educate the, and enforce the things that should be adhered to by a pregnant adolescent for a safe and meaningful pregnancy ahead.
- Cephalopelvic disproportion is suggested by a lack of engagement at the beginning of labor, a prolonged first stage of labor, and poor fetal descent.
- Adolescent labor is just the same as the labor of an older woman if CPD is absent.
- Graphing labor progress is a good way to detect labor that is becoming abnormal.
- Be certain that an adolescent has a support person with her in labor so she can relax and breathe effectively with contractions.
- If this person is also an adolescent, you may need to serve as the true support person, or at least spend considerable time coaching so this person can support the girl in labor.
- Young adolescents are more prone to postpartum hemorrhage than the average woman because if a girl’s uterus is not yet fully developed, it becomes overdistended by pregnancy.
- An overdistended uterus could not contract as effectively as a normally distended uterus does in the postpartum period, allowing bleeding to occur.
- Adolescents also may have frequent or deeper perineal and cervical lacerations than older women because of the size of the infant in relation to their body.
- However, young adolescents are generally healthy and have supple body tissue that allows for adequate perineal stretching.
- If there is a laceration, it usually heals readily without complication.
Inability to Adapt Postpartum
- The immediate postpartum period may be an almost unreal time for an adolescent.
- Giving birth is such a stress and a major crisis that all women have difficulty integrating it into their life.
- It may be particularly difficult for an adolescent.
- The girl may block out the hours of labor as if they did not happen.
- If she was particularly frightened by labor, she may have received a narcotic, so her memory of labor hours may be unclear.
- Urge the girl to talk about labor and birth to make the happening real to her or postpartum depression may occur.
Deficient Knowledge in Infant Care
- Adolescents show the same positive bonding behavior with their infants as their more mature counterparts.
- They may, however, lack sufficient knowledge in infant care.
- Although they may consider themselves to be knowledgeable in child care because they have babysat for a neighbor’s child or a sibling, they can be overwhelmed in the postpartum period to realize that when the baby is their own, child care is not as simple as it once seemed.
- When the child cries they cannot hand it to someone else, but at the end of 4 hours, when they are tired of caring for their baby, they cannot leave and walk away.
- These things may have been discussed with an adolescent during pregnancy, but these feelings may not become prominent until the child is actually born.
- Spend time with a girl observing how she handles her infant and demonstrate bathing and changing the baby appropriately.
- Model good parenting behaviors whenever possible by being aware of how you hold and care for the child.
- However, most adolescent mothers do not breastfeed because they perceive breastfeeding as something that will tie them down and also because of the reality that they will return to school full time soon.
- Educate them about the importance of breastfeeding and tips on how to incorporate it into a busy lifestyle.
- Help young mothers who do not choose breastfeeding to find a feeding method that is satisfying to them and safe for the infant as part of the process of being a young but effective new mother.
Practice Quiz: Complications of Adolescent Birth and Postpartum Period
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Practice Quiz: Complications of Adolescent Birth and Postpartum Period
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Practice Quiz: Complications of Adolescent Birth and Postpartum Period
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Answers and Rationale
1. What are the signs that suggest cephalopelvic disproportion?
A. Firm engagement and intact bow.
B. Ruptured bow and lack of engagement.
C. Lack of engagement and poor fetal descent.
D. Poor fetal descent and intact bow.
2. Why is an adolescent girl more prone to postpartum hemorrhage than the average woman?
A. Their blood vessels are too delicate.
B. Their uterus is not yet fully mature so it becomes overdistended and cannot contract effectively.
C. Their uterus is already matured yet has weak uterine muscles.
D. They do not know how to push effectively.
3. A pregnant adolescent is extremely frightened of her labor stage. The physician will prescribe which of the following?
4. An adolescent mother does not want to breastfeed her baby. Which of the following measures should the nurse take?
A. Help the adolescent find a feeding method that is satisfying to them and safe for the infant.
B. Reprimand the adolescent because breastfeeding is important for the baby.
C. Report the adolescent to the physician.
D. Allow the adolescent not to breastfeed her infant and suggest formula milk.
5. A pregnant adolescent just gave birth to her infant and she seem depressed. Which of the following should the nurse do?
A. Refer her to a psychiatrist.
B. Leave the girl alone with her infant so they can bond.
C. Let the girl take a psychologic test.
D. Urge the girl to share her labor and birth experience.
6. An adolescent was placed on an iron supplement because her hemoglobin level was below normal. What is a common test to demonstrate adherence to an iron supplement?
A. Analyzing her urine for iron deposits.
B. Assessing if her skin appears darker.
C. Assessing her reticulocyte count.
D. Measuring if she has grown in height.
7. A 14-year-old pregnant adolescent is in her 4th month of pregnancy. To help prevent the development of anemia, the nurse would do which of the following?
A. Instruct her to report black stools, which indicate that she is bleeding internally because of iron intake.
B. Tell the girl if she takes an iron supplement each day she would not have to eat foods like liver.
C. Tell the girl that she needs to eat balanced meals and snacks to help her be well nourished.
D. Instruct her regarding the signs of labor before she completes her fifth month of pregnancy.
8. When planning a teaching strategy for the pregnant adolescent, the nurse should do which of the following?
A. Omit information related to minor pains of pregnancy to prevent the adolescent from developing hypochondria.
B. Explain how healthy eating and exercise habits will help the teen look and feel better.
C. Emphasize the importance of frequent urine and blood testing to ensure that she is drug-free.
D. Inform the teen she should consider the needs of her baby first when eating or planning activity.
9. A pregnant adolescent who is 16 years old and 7 months pregnant has been diagnosed with early symptoms of pregnancy-induced hypertension. An outcome that would be appropriate for the teen would include which of the following?
A. Regularly perform knee-chest exercises three times a day to strengthen her vascular system.
B. State her intention to watch for pale mucous membrane and note any cravings, which are signs of PIH.
C. Verbalize her understanding that she is ill and must remain in bed to get well.
D. Verbalize a plan for obtaining school work while resting at home until the baby is born.
10. The nurse is teaching a pregnant adolescent about the signs of iron deficiency anemia. Which of the following are the correct signs?
1. Answer: C. Lack of engagement and poor fetal descent.
- C: Because of the shoulder presentation, there is difficulty in descent and engagement.
- A: Firm engagement and intact bow are signs of a progressing labor.
- B: Ruptured bow is a sign of progressing labor but lack of engagement means that there is something that impedes engagement.
- D: Poor fetal descent is a sign of CPD except for intact bow.
2. Answer: B. Their uterus is not yet fully mature so it becomes overdistended and cannot contract effectively.
- B: Adolescent girls’ uteri are not yet mature, so when they become pregnant their uterus tends to over distend resulting in ineffective contractions.
- A: Their blood vessels are not too delicate to warrant extreme hemorrhage during childbirth.
- C: Adolescent girls’ uteri are not yet mature.
- D: If educated properly and they are able to follow instructions, they may be able to give birth safely and push effectively.
3. Answer: D. Narcotics
- D: Narcotics are the drug of choice for pregnant adolescents who fear their labor, and the result is unclear memories of her labor hours.
- A: SSRIs are given for psychiatric patients.
- B: PPIs relieve gastrointestinal symptoms.
- C: Macrolides treat infections.
4. Answer: A. Help the adolescent find a feeding method that is satisfying to them and safe for the infant.
- A: If the adolescent does not want to breastfeed, assist her in finding other ways to feed her baby just as long as it is safe to do so.
- B: Reprimanding the adolescent is not necessary; she is allowed to decide for herself and her infant.
- C: There is no need to report to the physician; the nurse can perform her independent nursing function through client education.
- D: the physician would be the one to prescribe if the infant needs formula milk or not.
5. Answer: D. Urge the girl to share her labor and birth experience.
- D: Allow the girl to talk about her labor and birth so that her feelings could be vented out and avoid postpartum depression.
- A: Referring the girl to the psychiatrist should be done by her physician if needed.
- B: The nurse should assist the girl in caring for her infant especially because her psychological health may be unstable.
- C: A psychology test is not necessary.
6. Answer: C. Assessing her reticulocyte count.
- C: Blood reticulocyte levels are used to evaluate adherence to iron supplements.
- A: Iron deposits cannot be found in the urine.
- B: A dark skin is not an indication of low blood reticulocyte count.
- D: An increase in height is not an indication of adherence to iron supplement.
7. Answer: C. Tell the girl that she needs to eat balanced meals and snacks to help her be well nourished.
- C: A well-balanced diet is the best solution to avoid iron deficiency anemia and stock up on vitamins and minerals.
- A: Black stools may indicate intake of iron supplement yet it also indicates internal bleeding.
- B: iron supplements should be complemented with foods rich in iron.
- D: The nurse may educate about the signs of labor but it does not indicate prevention about anemia.
8. Answer: B. Explain how healthy eating and exercise habits will help the teen look and feel better.
- B: Teens feel conscious of their appearance, so to help the girl adjust to her pregnancy, incorporate in teachings the importance of looking and feeling good.
- A: Nothing should be withheld from the adolescent to gain her trust.
- C: Urine and blood testing is necessary but performing them once would be enough.
- D: Both the needs of the teen and her baby should be given attention.
9. Answer: D. Verbalize a plan for obtaining school work while resting at home until the baby is born.
- D: The teen may want to be kept busy during bed rest and doing her home work is one of the things that she can do.
- A: The teen should avoid strenuous activities because she is at bed rest.
- B: Pale mucous membranes and pica is a sign of iron deficiency anemia.
- C: The adolescent must understand that being kept at bed rest is not a sign of illness.
10. Answer: B. Pale mucous membranes and fatigue.
- B: Pale mucous membranes and fatigue are some of the signs of iron deficiency anemia.
- A: Preterm labor contractions are a sign of preterm labor.
- C: A hemoglobin level of more than 11 g/dL is a sign of adequate iron stores.
- D: Blood pressure of more than 140/90 mmHg is a sign of PIH.