Interaction of culture and grief amongst women who terminated a pregnancy in adolescence: A narrative approach

Background: Culture plays a vital role in resolving grief in African communities. However, women who terminate a pregnancy in adolescence are typically not exposed to cultural rituals that could ease their grief.Objectives: The purpose of this article is to explore the interaction of culture and grief amongst women who terminated a pregnancy in adolescence.Method: A qualitative exploratory study was undertaken using a narrative approach. Unstructured interviews were conducted to solicit narratives from 11 women who terminated a pregnancy in adolescence.Results: Data were analysed through narrative, thematic data analysis. Three themes emerged from the findings: delayed post-traumatic growth, low body esteem and an alteration in the development of maternal identity.Conclusion: The study intended to explore the interaction of culture and grief amongst women who terminated a pregnancy in adolescence. The researcher determined that women who had not honoured their culture because of the secrecy surrounding the termination of pregnancy had delayed healing and an altered self-image.

Analysis of Antenatal Care Quality in Cases of Referred Pregnant Women in Emergency Rooms Based on MCH Book Records

Objective: To determine the quality of antenatal care received by pregnant women, and perceptions of pregnant women and antenatal care providers regarding antenatal care.Method: A quantitative and qualitative study of cases of referred pregnant women in the Emergency Room (ER) of Dr. Cipto Mangunkusumo Hospital (RSCM) from 2017–2018 was conducted. Quantitative data was obtained by assessing the overall completeness of filling in the Maternal Child Health (MCH) book used to report the antenatal care received by the subjects. The completeness of antenatal care in the health facility was obtained using a checklist. Qualitative data was obtained by interviewing pregnant women and antenatal care providers in health facilities.Result: There were 1.442 cases of referred pregnant women in RSCM’s ER for the year 2017–2018, of whom 820 possessed and could show their MCH Book. Pregnancy in adolescence below 20 years (9.1%) and pregnancy after age 35 (19.5%) were reported. Most pregnant women were well educated (74.3%), referred from hospital or clinic (57.6%), received antenatal care in a public health center (38.7%), were in labor (32%), and were in the third trimester of pregnancy (92%). All subjects presented an incomplete MCH book. Almost half had inadequate antenatal frequency (46%). The completeness of antenatal care components in health care was 90–100%. Qualitatively, the perceptions of mothers and antenatal care providers regarding quality of antenatal care, was inadequate.Conclusion: The quality of antenatal care in the case of referred pregnant women at the RSCM’s ER based on MCH Book records did not meet the required standard.Keywords: antenatal care quality, MCH book Abstrak Tujuan: Menentukan kualitas asuhan antenatal pada kasus rujukan ibu hamil di IGD RSCM yang memiliki buku KIA, dan persepsi ibu hamil yang memiliki buku KIA dan tenaga kesehatan pemberi layanan kesehatan tentang asuhan antenatal. Metode: Dilakukan studi kuantitatif dan kualitatif pada kasus rujukan ibu hamil di IGD RSCM yang memiliki buku KIA tahun 2017-2018. Pengambilan data kuantitatif dilakukan dengan telaah kelengkapan pengisian buku KIA secara umum, Kelengkapan komponen asuhan antenatal di fasilitas layanan kesehatan (fasyankes) asal asuhan antenatal didapatkan dari survei menggunakan daftar tilik. Pengambilan data kualitatif dilakukan dengan wawancara mengenai persepsi ibu hamil dan tenaga kesehatan pemberi pelayanan asuhan antenatal di fasyankes asal asuhan antenatal Hasil: Terdapat 1.442 kasus rujukan ibu hamil di IGD RSCM selama tahun 2017- 2018, 820 di antaranya memiliki dan dapat menunjukkan buku KIA. Terdapat subjek dengan usia kehamilan remaja dibawah 20 tahun (9,1%) dan usia diatas 35 tahun (19,5%). Sebagian besar ibu hamil yang dirujuk cukup berpendidikan (74,3%), dirujuk oleh RS atau klinik (57,6%) dan mendapat asuhan antenatal di puskesmas (38.7%), dalam status persalinan inpartu (32%), dengan usia kehamilan trimester III (92%). Semua subjek (100%) dinyatakan tidak lengkap dalam pengisian halaman di buku KIA. Hampir setengah subjek mempunyai jumlah kunjungan antenatal yang tidak ideal (46%). Kelengkapan komponen asuhan antenatal di fasyankes asal asuhan antenatal berkisar 90-100%. Secara kualitatif, didapatkan persepsi ibu hamil dan tenaga kesehatan pemberi asuhan antenatal, terhadap kualitas asuhan antenatal masih kurang tepat.Kesimpulan: Kualitas asuhan antenatal pada kasus rujukan ibu hamil di IGD RSCM berdasar rekam Buku KIA belum memenuhi standar. Kata kunci: buku KIA , kualitas asuhan antenatal.

The Meanings of Pregnancy in Adolescence for Young People without a History of Pregnancies

In the academic literature there is lack of studies on teenage pregnancy in young people who have not experienced pregnancy. This article aimed to investigate and analyze the meanings of teenage pregnancy for adolescents without a gestation history. The participants were 37 adolescents with no pregnancy history (22 males and 15 females), aged between 12 and 18 years old. The thematic design-story procedure was used as instrument, in which the young individuals were asked to draw “a pregnant adolescent in their Community”. To systematize the data, Bardin’s content analysis was used. Thirteen themes were observed, the most frequent being related to families, relationships and/or friends and very early pregnancies, showing the relevance of these themes for adolescents. It is concluded that teenage pregnancy, in its majority, was seen as disadvantageous, but also as desired by some young individuals, pointing to the ambiguity of the phenomenon.

Gravidez na adolescência e o risco de pré-eclâmpsia

Introdução: A gravidez na adolescência é compreendida como aquela que envolve meninas de 10 a 19 anos e está frequentemente associada ao maior risco de ocorrência de desfechos adversos maternos e neonatais, levando ao aumento da morbimortalidade perinatal. A pré-eclâmpsia é uma das complicações mais comuns da gravidez na adolescência, e é clinicamente definida pela presença de hipertensão arterial sistêmica (pressão arterial sistólica ≥140 mmHg ou diastólica ≥90 mmHg) após a 20ª semana de gestação, acompanhada de proteinúria ou lesão de outros órgãos. Essa patologia está relacionada com a imaturidade biológica uterina, fatores socioeconômicos e condições metabólicas, sendo portanto um problema de saúde pública. Objetivo: Analisar a probabilidade da pré-eclâmpsia na gravidez na adolescência e suas complicações. Métodos: Revisão de literatura por meio do banco de dados PubMed, mediante as palavras-chaves: “pre-eclampsia”, “pregnancy in adolescence”, “risk factors”. Foram encontrados 55 artigos dos últimos 18 anos, e 11 foram selecionados para a elaboração do estudo. Incluíram-se artigos que citavam a pré-eclâmpsia como um dos efeitos adversos possíveis na gestação na adolescência e excluíram-se aqueles que abordavam apenas os efeitos neonatais. Resultados: A gravidez na adolescência frequentemente ocorre de forma não planejada (p<0,001), além de apresentar riscos aumentados para pré-eclâmpsia (p=0,001) e hipertensão gestacional (p<0,001). Também foi observada maior probabilidade de esses eventos ocorrerem em idades mais precoces, isto é, adolescentes menores de 16 anos possuem maiores chances de pré-eclâmpsia, eclâmpsia e gravidez ectópica (odds ratio — OR=2,974) quando comparadas às maiores, para as quais a prevalência desses eventos é similar à dos adultos. Outras complicações também costumam estar presentes em gestações dessa faixa etária (p=0,002), como o baixo peso ao nascer e a prematuridade (p<0,001) (TEMBO et al., 2020), além de hemorragia e atonia uterina, que podem surgir em consequência da pré-eclâmpsia (p<0,001). Ademais, fatores socioeconômicos parecem ter associação com a ocorrência de pré-eclâmpsia/eclâmpsia (p=0,05), havendo prevalência maior em países de baixa/média renda, além de fatores fisiológicos, como índice de massa corporal pré-gestacional (p=0,002) e ganho de peso gestacional (p=0,03). Conclusão: Apesar de diversos estudos apresentarem riscos consideráveis de pré-eclâmpsia na gravidez na adolescência, esse tema ainda apresenta muitas controvérsias, sendo necessários mais estudos, já que se trata também de uma questão de saúde pública.