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Length of Labor and Delivery Outcomes of Nulliparous Filipino Adolescents Who

Underwent Spontaneous Labor at Philippine Childrens Medical Center from January 2016 to

June 2017:
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Abbreviations

OB/GYN- Obstetrics and Gynaecology

NEC- National Ethics Committee NEC

NICU- Neonatal Intensive Care Unit

IRB -Institutional Review Board IRB

PROM- premature rupture of membranes

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Introduction

Teenage and adolescent pregnancy has been on the rise annually. This has attracted a

big interest which is solely focused on finding out Length of Labor and Delivery Outcomes

of Nulliparous Filipino Adolescents. The research will, therefore, try to answer the influence

maternal age has on delivery outcomes and length of labor for teenage pregnancy. Notably,

teenagers form the smallest percentage of obstetric patients. However, this is a susceptible

group that has generated special and unique concerns (Hui, 2010 p.227). The length of labor

increases with maternal age for both nulliparous and multiparous women.

Significant of the Study

The research has a lot of benefits in answering the questions that are focused on

teenage and adolescent pregnancy. As noted earlier, teenage pregnancy can result in a lot of

problems in their biological functionality. Therefore, complications related to obstetrics and

gynaecology (OB/GYN) such as early neonatal death, low birth weight, postpartum

depression, and maternal mortality, puerperal endometritis, postpartum hemorrhage, maternal

anemia and preterm delivery can be researched on to mitigate the problem (Cohen, 2015

p.425). Its also an essential way of creating awareness to the young people in Filipino. The

main agenda of the awareness is curbing non-health pregnancy-related issues such as

increased burden of child care while still being a child, poor school performance, a way of

shielding the high rate of teenage pregnancy which results in early marriage, social stigma

and poverty (Kawakita, 2016 p.131; Natividad, 2014 p.30).

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Literature Review

There are more health risks to adolescent pregnancies than there are in adults (Torvie,

2015 p.95). Studies show that complications such as neonatal death, anaemia, preeclampsia,

eclampsia, hypertension, low birthweight and preterm delivery are very prevalent among

teenagers. Older women and adults have more Caesarean deliveries than younger adults and

adolescents. Nevertheless, the teenagers who undergo operative vaginal and Caesarean

deliveries are at a higher risk of obstetric complications (Hui, 2010 p.227). Normal labor can

be characterized by fetal descent and cervical dilation to give graphic patterns which are vital

for obstetric practice (Cohen, 2015 p. 422). Conclusively, the progress of labor is largely

affected by age, body weight, and maternal ethnicity.

To date, no research have substantial information for review correlating between

Delivery outcomes and healthy labor in adolescents. This is because most of the results

obtained from previous studies on this subject yielded conflicting results with extensive

heterogeneous results. Since the study is aimed at bridging this gap and answering the

knowledge gap, then it will aid and help the obstetric providers to become more conscious of

the special needs of pregnant adolescents and teenagers. This will help in creating awareness

to adolescents and as a result decrease pregnancy rates, improve the delivery outcomes and

optimize intrapartum management as well.

Conceptual Framework

Maternal age is a factor to consider when researching on delivery outcomes. As

discussed above, adolescent pregnancy is on the rise particularly, in Filipino. As a result, a lot

of obstetrics and gynaecology problems have been experienced especially when childbirth is

through vaginal operative and caesarean process. Knowledge of the correlation between the
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two can help the healthcare providers to approach pregnancies for adolescents and prevent

the adverse effects related to pregnancies especially in preventing infant mortality. The

framework for this study will, therefore, consider some factors related to early teenage

pregnancy such as socio-demographic factors such as social class, age, ethnicity and level of

education to determine the age group that is highly susceptible.

Objectives

Main Objectives

To determine the progress of labor of Filipino adolescents and correlate it to delivery

outcomes

Specific Objectives

1. To determine the demographics of adolescent pregnancies such as race, age, ethnic

group, social class, and religion.

2. Determine the progress of labor of adolescent pregnancies and compare it with the

general population
3. To determine the maternal outcomes of adolescent pregnancies and compare with the

general population such as;

3rd and 4th-degree perineal tears

need for blood transfusion

prolonged hospital stay

postpartum hemorrhage

postpartum endometritis
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4. To determine the neonatal outcomes of infants delivered by adolescents and compare

it with infants delivered by the general population such as;

birth weight

apgar score

neonatal infection

administration of antibiotics

NICU admission

prolonged hospital stay

Operational Definition of Terms and Variable

Adolescent Transitional stage of psychological and physical development and normally

occurs between puberty to adulthood.

Maternal It is an adjective word that relates to a mother of a baby during the time of birth.

Nulliparous-A word used to describe a woman who has never experienced labor or given

birth.

Multiparous- Term used to describe a woman who has given birth before.

Gravidity- Refers to the number of times a female has been in labor

Parity- In relation to gravidity, it describes gestation age in which a woman has been

pregnant.

Cephalic- relating to the head.

Degree perineal tears-its the laceration of the skin.

Blood Transfusion-Transfer of blood from one person to another.

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Prolonged Hospital Stay- Extended stay in the hospital due to health problems not handled

within the expected period.

Postpartum Haemorrhage- its the excessive loss of blood within 24 hours after childbirth.

Postpartum Endometritis- this is an infection of the decidua

Birth weight- its the average weight of the baby after birth.

Apgar score- refers to the assessment to the baby after birth to determine their health status

and how well they can cope with the environment to avoid further complications.

Neonatal infection- This are infections to a new-born baby after their birth.

NICU admission- its the admission of new-born babies to the intensive care units.

Methodology

Research Design

The study will be conducted by incorporating both quantitative and qualitative

analysis. This will use a prospective pregnancy group of more than 50 nulliparous Filipino

adolescents who underwent spontaneous labor at Philippine childrens medical center from

January 2016 to June 2017. The research will be conducted in three phases where the first

phase will be taken between the first three months followed by the second taking from the 3rd

to the 9th month and lastly the three months after birth. Data with regard to pregnancy will be

obtained after reviewing hospital case notes. The subjects will also fill questionnaires and

others will be interviewed. In addition, information regarding their progress before and after

birth will be collected and recorded for reviewing.

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Target population, subject sampling, sample size calculation

For a better longitudinal and comparative study, the target group will be adolescent

patients below the age of 19 and the comparator group of 20-24 years old. To function within

the time limit, the investigation will be done through Stratified sampling with a sample size

of 50 patients. These subjects will be obtained from hospitals during their clinical visits

through coordination with the healthcare practitioners after having their approval.

Sample Size Calculation

This will be carried out by calculating the mean, average and drawing curves

comparing the Nulliparous and Multiparous health conditions after birth.

Intervention and Implementation

This process is conducted for the sake of the patients health. Women in labor ward

face various incidences like premature rapturing of membranes. The clinical officer in charge

should intervene and offer medical help to protect the baby and the patient. On the other

hand, an anaesthesia and Oxytocin can be used to reduce the sensation during childbirth.

Outcomes Assessment

Outcomes to be determined are length and progress of labor, maternity outcomes

which include; 3rd and 4th degree perineal tears, need for blood transfusion, prolonged

hospital stay, postpartum hemorrhage, postpartum endometritis and neonatal outcomes such

as birth weight, apgar score, neonatal infection, administration of antibiotics, NICU

admission and prolonged hospital stay.

Instrument to be used

During the first few months, the electronic fetal monitoring machine will be used.

Instruments needed for the study will include; forceps, ventouse, and vaginal speculum.
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Plan for analysis

The analysis will be limited since the sample size is not large and the results might be

biased or not conclusive. However, better and reliable results can be obtained for analysis by

taking the first and second stages of labor and comparing it to the outcomes.

Ethical considerations

The declaration of the ethical National Guidelines for Biomedical Research of the

National Ethics Committee (NEC) of the Philippines will be the standards in which the

research will be conducted. No data will be recorded in an audio-visual format and the results

obtained will be preserved and kept in a very confidential manner. In addition, it must

undergo an approval by Institutional Review Board (IRB). The subjects will not be referred

by their names but by use of unique alphanumeric code. Finally, the data can only be assessed

by the primary investigator upon completion and should be protected in a password-protected

database.

Data collection

Data shall be collected by the primary investigator by examining the patients

charts/logbooks and tabulated using Microsoft Excel.

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Time Table
August-September 2017 Submission of study protocol and approval

by the IRB
September-October 2017 Data gathering and analysis
October 2017 Preparation of the manuscript
November-December 2017 Presentation of research

Budget / Other technical needs

Function Amount

Statistical analysis P15000

Printing P1000

References

Cohen, W.R. and Friedman, E.A., 2015. Misguided guidelines for managing labor. American

journal of obstetrics and gynecology, 212(6), pp.753-e1.

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Cohen, W.R., and Friedman, E.A., 2015. Perils of the new labor management guidelines.

American journal of obstetrics and gynecology, 212(4), pp.420-427.

Greenberg, M.B., Cheng, Y.W., Sullivan, M., Norton, M.E., Hopkins, L.M. and Caughey,

A.B., 2007. Does length of labor vary by maternal age?. American journal of

obstetrics and gynecology, 197(4), pp.428-e1.

Hui, J., Hahn, P.M., Jamieson, M.A. and Palerme, S., 2010. The duration of labor in

adolescents. Journal of pediatric and adolescent gynecology, 23(4), pp.226-229.

Kawakita, T., Wilson, K., Grantz, K.L., Landy, H.J., Huang, C.C. and Gomez-Lobo, V., 2016.

Adverse maternal and neonatal outcomes in adolescent pregnancy. Journal of

pediatric and adolescent gynecology, 29(2), pp.130-136.

Natividad, J., 2014. Teenage Pregnancy in the Philippines: Trends, Correlates and Data

Sources. Journal of the ASEAN Federation of Endocrine Societies, 28(1), p.30.

Torvie, A.J., Callegari, L.S., Schiff, M.A. and Debiec, K.E., 2015. Labor and delivery

outcomes among young adolescents. American journal of obstetrics and gynecology,

213(1), pp.95-e1.