Early Pregnancy

and Its

Health Implications

Prepared by :
Prof.Gloria Shiela
E.Coyoca

EVERY YEAR...
139 M births worldwide

289, 000 women die

800 women every day

Ref: WHO, 2015

1 woman every 2 minutes

EVERY DAY ...

Ref: WHO, 2016

830 women die from

preventable causes
related to pregnancy and
childbirth.

99% of all maternal deaths

occur in developing countries.

EVERY YEAR...

16 million girls aged 15 to 19

and some 1 million girls
under 15 give birth

Ref: WHO, 2015

GLOBALLY ...

Complications during pregnancy

& childbirth are the second
cause of death for 15 19 year
old girls

Ref: WHO, 2016

Country

Maternal mortality rate

(deaths/100,000 live
births) 2013

Sierra Leone

1, 100

India

190

Indonesia

190

Philippines

120

Malaysia

29

United States

28

Thailand

26

Belarus

Reference:http://data.worldbank.org/indicator/SH.STA.MMRT

EVERY YEAR...

3 million girls aged 15 19

undergo unsafe abortions

Ref: WHO, 2015

The first 28 days of life (Neonatal period)

the most vulnerable time for a childs survival
In 2015, 2.7 M neonatal
deaths

1 million occur on the

day of birth
close to 2 million die
in the first week of life.

Country

Mortality rate, under-5 (per

1,000 live births) 2015

Chad

139

India

48

Philippines

28

Indonesia

27

Thailand

12

Malaysia

United States

Finland, Iceland, Luxembourg

Reference: http://data.worldbank.org/indicator/SH.DYN.MORT

FACTS...
One in ten young Filipino
women age 15-19 has begun
childbearing

8 percent are already mothers

and another 2 percent are
pregnant with their first child
Ref: National Demographic & Health Survey, 2013

Young adolescents face a

higher risk of complications &
death as a result of
pregnancy

Ref: WHO, 2015

Early childbearing increases

the risks for both mothers and
their newborns

babies born to mothers

under 20 years of age face a
50% higher risk of being
Ref: WHO, 2015

still born

Conde-Agudelo, A., Belizn, J. M., & Lammers, C. (2005). Maternal-perinatal

morbidity and mortality associated with adolescent pregnancy in Latin
America: Cross-sectional study. American journal of obstetrics and
gynecology, 192(2), 342-349.

AGE

Ujah, I. A. O., Aisien, O. A., Mutihir, J. T., Vanderjagt, D. J., Glew, R. H., &
Uguru, V. E. (2005). Maternal mortality among adolescent women in Jos,
North-Central, Nigeria. Journal of Obstetrics & Gynecology, 25(1), 3-6
Olausson, P. O., Cnattingius, S., & Haglund, B. (1999). Teenage pregnancies
and risk of late fetal death and infant mortality. BJOG: An International
Journal of Obstetrics & Gynaecology, 106(2), 116-121.
94.
Mahavarkar, S. H., Madhu, C. K., & Mule, V. D. (2008). A comparative study
of teenage pregnancy. Journal of Obstetrics and Gynaecology, 28(6), 604-60
Chen, X. K., Wen, S. W., Fleming, N., Demissie, K., Rhoads, G. G., & Walker,
M. (2007). Teenage pregnancy and adverse birth outcomes: a large population
based retrospective cohort study. International journal of epidemiology, 36(2),
368-373.

Why mothers die?

haemorrhage

hypertension

infections

pre-existing medical
conditions

Reference: WHO 2015

Hemorrhage linked with

anemaia

Frass, K. A. (2015). Postpartum hemorrhage is related to the hemoglobin

levels at labor: Observational study. Alexandria Journal of Medicine, 51(4),
333-337.
Barroso, F., Allard, S., Kahan, B. C., Connolly, C., Smethurst, H., Choo, L., ...
& Stanworth, S. (2011). Prevalence of maternal anaemia and its predictors: a
multi-centre study. European Journal of Obstetrics & Gynecology and
Reproductive Biology, 159(1), 99-105.
Gibbs, C. M., Wendt, A., Peters, S., & Hogue, C. J. (2012). The impact of early
age at first childbirth on maternal and infant health. Paediatric and perinatal
epidemiology, 26(s1), 259-284.1.
94.
Ayuba, I. I., & Gani, O. (2012). Outcome of teenage pregnancy in the niger
delta of Nigeria. Ethiopian journal of health sciences, 22(1), 45-50.

AlZirqi, I., Vangen, S., Forsen, L., & StrayPedersen, B. (2008). Prevalence
and risk factors of severe obstetric haemorrhage. BJOG: An International
Journal of Obstetrics & Gynaecology, 115(10), 1265-1272.

Why babies die?

prematurity and lowbirth-weight

Infections
asphyxia (lack of
oxygen at birth)
birth trauma

 About 16 million girls aged 15

to 19 and some 1 million girls

under 15 give birth every year
most in low- and middleincome countries.
Complications during
pregnancy and childbirth are
the second cause of death for
15-19 year-old girls globally.
Every year, some 3 million
girls aged 15 to 19 undergo
unsafe abortions.
Babies born to adolescent
mothers face a substantially
higher risk of dying than those
born to women aged 20 to 24.

Contexts
For some adolescents, pregnancy

and childbirth are planned and

wanted, but for many they are
not. Adolescent pregnancies are
more likely in poor, uneducated
and rural communities. In some
countries, becoming pregnant
outside marriage is not
uncommon. By contrast, some
girls may face social pressure to
marry and, once married, to have
children. More than 30% of girls
in low- and middle-income
countries marry before they are
18; around 14% before they are
15.

Health effects
Pregnancy and childbirth

complications are the second

cause of death among 15 to 19
year olds globally. However,
there have been significant
drops in the number of deaths
in all regions since 2000, most
notably in South-East Asia
where mortality rates fell from
21 to 9 per 100 000 girls. Some
3 million unsafe abortions
among girls aged 15 to 19 take
place each year, contributing to
maternal deaths and to lasting
health problems.

 Early childbearing increases

the risks for both mothers

and their newborns. In lowand middle-income countries,
babies born to mothers under
20 years of age face a 50%
higher risk of being still born
or dying in the first few
weeks versus those born to
mothers aged 20-29. The
younger the mother, the
greater the risk to the baby.
Newborns born to adolescent
mothers are also more likely
to have low birth weight, with
the risk of long-term effects.

Economic and social

consequences
Adolescent pregnancy can also

have negative social and

economic effects on girls, their
families and communities. Many
girls who become pregnant have
to drop out of school. A girl with
little or no education has fewer
skills and opportunities to find a
job. This can also have an
economic cost with a country
losing out on the annual income
a young woman would have
earned over her lifetime, if she
had not had an early pregnancy.

WHO response
WHO published

guidelines in 2011 with

the UN Population Fund
(UNFPA) on preventing
early pregnancies and
reducing poor
reproductive outcomes.
These made
recommendations for
action that countries
could take, with 6 main
objectives:

 One in ten young

Filipino women age 1519 has begun

childbearing: 8 percent
are already mothers
and another 2 percent
are pregnant with their
first child according to
the results of the 2013
National Demographic
and Health Survey
(NDHS).

 Adolescent pregnancy
Pregnant adolescent

WHO
Many adolescent girls
between 15 and 19
get pregnant
About 16 million
women 1519 years
old give birth each
year, about 11% of all
births worldwide.

 Pregnancy among very

young adolescents is a
significant problem
In low- and middleincome countries,
almost 10% of girls
become mothers by
age 16 years, with the
highest rates in subSaharan Africa and
south-central and
south-eastern Asia.

Adolescent pregnancy is dangerous for the mother

Although adolescents aged 10-19 years account for

11% of all births worldwide, they account for 23% of

the overall burden of disease (disability- adjusted life
years) due to pregnancy and childbirth.
Fourteen percent of all unsafe abortions in low- and

middle-income countries are among women aged 15

19 years. About 2.5 million adolescents have unsafe
abortions every year, and adolescents are more
seriously affected by complications than are older
women.
In Latin America, the risk of maternal death is four

times higher among adolescents younger than 16

years than among women in their twenties.
Many health problems are particularly associated with

negative outcomes of pregnancy during adolescence.

These include anaemia, malaria, HIV and other
sexually transmitted infections, postpartum
haemorrhage and mental disorders, such as
depression.
Up to 65% of women with obstetric fistula develop

this as adolescents, with dire consequences for their

lives, physically and socially.

 Adolescent pregnancy is dangerous for the

child
Stillbirths and death in the first week of life
are 50% higher among babies born to
mothers younger than 20 years than among
babies born to mothers 2029 years old.
Deaths during the first month of life are 50

100% more frequent if the mother is an

adolescent versus older, and the younger
the mother, the higher the risk.
The rates of preterm birth, low birth weight

and asphyxia are higher among the children

of adolescents, all of which increase the
chance of death and of future health
problems for the baby.
Pregnant adolescents are more likely to

smoke and use alcohol than are older

women, which can cause many problems
for the child and after birth.

 Adolescent pregnancy

adversely affects communities

Many girls who become
pregnant have to leave school.
This has long-term
implications for them as
individuals, their families and
communities.
Studies have shown that

delaying adolescent births

could significantly lower
population growth rates,
potentially generating broad
economic and social benefits,
in addition to improving the
health of adolescents.

http://youthproblemsinthephilippines
.weebly.com/teenage-pregnancy.html
Teenage preganancy
Teenage pregnancy is the

condition of being pregnant

of adolescence aged 10 to
19. Those who are affected
are the girl herself up to the
national society. The victims
of teenage pregnancy are
the girl herself, her child,
her parents and relatives
and the national society as
a whole. It will also probably
make her economically
vulnerable.

WHY IS IT A PROBLEM IN OUR SOCIETY?

Teen pregnancy is a communal problem, a family

problem, and a personal problem all rolled into

one. It frequently goes hand in hand with
premarital sex. Problems come when the news
needs to breach each parents party. A spring of
thought flash before ones eyes, and registers
only two; whether, to back the hell up abort the
child or carry on with the pregnancy but sign up
for adoption - or get the hell in have the child
with all its perks and consequences alike.

After which, these impressions simply serve no

purpose but to put them off, and deduce to mere
nuisance to them when the truth of their
situation slowly sinks in. How do they provide for
the child if their parents cut them short
financially? Will they be able to go to grad
school? What will become of their future? What
will become of their childs future? By this time,
they would have to contend with the pressures of
parenthood. Whatll truly bother them in the long
run is the reality of whether or not they can fulfill
their obligation as parents, and the security of
their childs future. Teenage pregnancy is
becoming a societal problem that branches out
to other problems.

What social factors instigate

teenage pregnancy in our country?
In

the developed world, the causes of teenage pregnancy

is different in the sense that it is mostly outside marriage
and carries lots of social stigma. Thus, adolescent sexual
behavior is one of the causes of teenage pregnancy. In our
world today, having sex before 20 yrs is the in thing, it is
even normal all over the world and this is brought about
high levels of adolescent pregnancy which creates sexual
relationship among teenagers without the provision of
comprehensive information about sex.

The

immature and irresponsible behavior arising due to

complex teenage psychology is another important cause of
teenage pregnancies. Teenagers often go through a
number of emotions because of their own transition from
childhood and peer pressure.

Lack

of sexual education causes teens to get abortions as

they ultimately realize their inability to bear the
responsibilities of being a parent at such a young age.

The

lack of attention and affection from family resulting in

depression forces them to seek love and support from
other people, especially members of the opposite sex.

Overprotection

gives rise to frustration and a feeling of not

being loved and cared for. Thus, balance is the key to avoid
this problem. Lack of affectionate supervision of parents or
guardians results into the adolescents or teenage girls
becoming pregnant

Health Implications
Depression and

anxiety in early
pregnancy are
associated with risk
for subsequent
preeclampsia, a
risk further
increased by
bacterial vaginosis.

Kurki, T., Hiilesmaa, V., Raitasalo, R.,

Mattila, H., & Ylikorkala, O. (2000).

Depression and anxiety in early
pregnancy and risk for
preeclampsia. Obstetrics &
Gynecology, 95(4), 487-490.

 Teenage pregnancy

increases the risk of

adverse birth outcomes
that is independent of
important known
confounders. This finding
challenges the accepted
opinion that adverse birth
outcome associated with
teenage pregnancy is
attributable to low
socioeconomic status,
inadequate prenatal care
and inadequate weight
gain during pregnancy.

Chen, X. K., Wen, S. W., Fleming, N.,

Demissie, K., Rhoads, G. G., &

Walker, M. (2007). Teenage
pregnancy and adverse birth
outcomes: a large population based
retrospective cohort study.
International journal of
epidemiology, 36(2), 368-373.

 adolescents aged

15 years or
younger had higher
risks for maternal
death, early
neonatal death,
and anemia
compared with
women aged 20 to
24 years.
Ref:

Conde-Agudelo, A., Belizn, J. M., &

Lammers, C. (2005). Maternalperinatal morbidity and mortality

associated with adolescent
pregnancy in Latin America: Crosssectional study. American journal of
obstetrics and gynecology, 192(2),
342-349.

Effects on Mothers
Preterm labour
Anemia
Reference:Watcharasera

nee, N., Pinchantra, P., &

Piyaman, S. (2006). The
incidence and
complications of
teenage pregnancy at
Chonburi Hospital. J Med
Assoc Thai, 89(Suppl 4),
S118-23.

Conde-Agudelo, A., Belizn, J. M., & Lammers, C. (2005). Maternal-perinatal

morbidity and mortality associated with adolescent pregnancy in Latin
America: Cross-sectional study. American journal of obstetrics and
gynecology, 192(2), 342-349.
(

Anemia

Watcharaseranee, N., Pinchantra, P., & Piyaman, S. (2006). The incidence

and complications of teenage pregnancy at Chonburi Hospital. J Med Assoc
Thai, 89(Suppl 4), S118-23.

Meier, P. R., Nickerson, H. J., Olson, K. A., Berg, R. L., & Meyer, J. A. (2003).
Prevention of iron deficiency anemia in adolescent and adult pregnancies.
Clinical medicine & research, 1(1), 29-36.
Toteja, G. S., Singh, P., Dhillon, B. S., Saxena, B. N., Ahmed, F. U., Singh, R.
P., ... & Sarma, U. C. (2006). Prevalence of anemia among pregnant women
and adolescent girls in 16 districts of India. Food and Nutrition Bulletin,
27(4), 311-315.

Klein, J. D. (2005). Adolescent pregnancy: current trends and issues.

Pediatrics, 116(1), 281-286.

Preterm labor

Watcharaseranee, N., Pinchantra, P., & Piyaman, S. (2006). The incidence

and complications of teenage pregnancy at Chonburi Hospital. J Med Assoc
Thai, 89(Suppl 4), S118-23.

Kumar, A., Singh, T., Basu, S., Pandey, S., & Bhargava, V. (2007). Outcome of
teenage pregnancy. The Indian Journal of Pediatrics, 74(10), 927-931.

Mahavarkar, S. H., Madhu, C. K., & Mule, V. D. (2008). A comparative study

of teenage pregnancy. Journal of Obstetrics and Gynaecology, 28(6), 604-607.

Jolly, M. C., Sebire, N., Harris, J., Robinson, S., & Regan, L. (2000). Obstetric
risks of pregnancy in women less than 18 years old. Obstetrics & Gynecology,
96(6), 962-966.

Al-Ramahi, M., & Saleh, S. (2006). Outcome of adolescent pregnancy at a

university hospital in Jordan. Archives of Gynecology and obstetrics, 273(4),
207-210..

Low birthh weight

Chen, X. K., Wen, S. W., Fleming, N., Demissie, K., Rhoads, G. G., &
Walker, M. (2007). Teenage pregnancy and adverse birth outcomes: a
large population based retrospective cohort study. International
journal of epidemiology, 36(2), 368-373.

Mahavarkar, S. H., Madhu, C. K., & Mule, V. D. (2008). A

comparative study of teenage pregnancy. Journal of Obstetrics and
Gynaecology, 28(6), 604-607..
Kerber, K. J., Et al. (2007). Continuum of care for maternal, newborn,
and child health: from slogan to service delivery. The Lancet,
370(9595), 1358-1369.
Gilbert, W., Jandial, D., Field, N., Bigelow, P., & Danielsen, B.
(2004). Birth outcomes in teenage pregnancies. The journal of
maternal-fetal & neonatal medicine, 16(5), 265-270.
Ashdown-Lambert, J. R. (2005). A review of low birth weight:
predictors, precursors and morbidity outcomes. The Journal of the
Royal Society for the Promotion of Health, 125(2), 76-83.

Depression

Kurki, T., Hiilesmaa, V., Raitasalo, R., Mattila, H., & Ylikorkala, O.
(2000). Depression and anxiety in early pregnancy and risk for
preeclampsia. Obstetrics & Gynecology, 95(4), 487-490.

Beirne, S.,2015. What are the rsiks of Teenage pregnancy?

http://www.livestrong.com/article/113172-risks-teenage-pregnancy/

Reid, V., & Meadows-Oliver, M. (2007). Postpartum depression in

adolescent mothers: an integrative review of the literature. Journal
of Pediatric Health Care, 21(5), 289-298..
Figueiredo, B., Pacheco, A., & Costa, R. (2007). Depression during
pregnancy and the postpartum period in adolescent and adult
Portuguese mothers. Archives of women's mental health, 10(3), 103109.
Klein, J. D. (2005). Adolescent pregnancy: current trends and issues.
Pediatrics, 116(1), 281-286.

Stillbirths

Kumar, A., Singh, T., Basu, S., Pandey, S., & Bhargava, V. (2007).
Outcome of teenage pregnancy. The Indian Journal of Pediatrics,
74(10), 927-931.
.
Conde-Agudelo, A., Belizn, J. M., & Lammers, C. (2005). Maternalperinatal morbidity and mortality associated with adolescent
pregnancy in Latin America: Cross-sectional study. American journal
of obstetrics and gynecology, 192(2), 342-349.
Kost, K., & Henshaw, S. (2014). US teenage pregnancies, births and
abortions, 2010: National and state trends by age, race and ethnicity.
New York, NY: Guttmacher Institute.
Malabarey, O. T., Balayla, J., Klam, S. L., Shrim, A., & Abenhaim, H.
A. (2012). Pregnancies in young adolescent mothers: a populationbased study on 37 million births. Journal of pediatric and adolescent
gynecology, 25(2), 98-102..
Mukhopadhyay, P., Chaudhuri, R. N., & Paul, B. (2010). Hospitalbased perinatal outcomes and complications in teenage pregnancy in
India. Journal of Health, Population and Nutrition, 494-500.7(6),
703.

 Anemia will lead

to:
Premature birth
With severe

anemia the
babys
development
maybe affected

 Teenage pregnancy

was assciated with

a significantly
higher risk of PIH,
eclmapsia,
premature onset of
labour, fetal
deaths, &
premature delivery.

Ref: Kumar, A., Singh, T., Basu, S.,

Pandey, S., & Bhargava, V. (2007).

Outcome of teenage pregnancy. The
Indian Journal of Pediatrics, 74(10),
927-931.

Pregnancy Induced
Hypertension

Pre eclampsia
Eclampsia

Ref: Aliyu, M. H., Luke, S., Kristensen,

S., Alio, A. P., & Salihu, H. M. (2010).
Joint effect of obesity and teenage
pregnancy on the risk of preeclampsia:
a population-based study. Journal of
Adolescent Health, 46(1), 77-82.

Pregnancy induced
hypertension(PIH)

Aliyu, M. H., Luke, S., Kristensen, S., Alio, A. P., & Salihu, H. M. (2010).
Joint effect of obesity and teenage pregnancy on the risk of preeclampsia: a
population-based study. Journal of Adolescent Health, 46(1), 77-82.

Kumar, A., Singh, T., Basu, S., Pandey, S., & Bhargava, V. (2007). Outcome of
teenage pregnancy. The Indian Journal of Pediatrics, 74(10), 927-931.
.

Mahavarkar, S. H., Madhu, C. K., & Mule, V. D. (2008). A comparative study

of teenage pregnancy. Journal of Obstetrics and Gynaecology, 28(6), 604-607..
Ujah, I. A. O., Aisien, O. A., Mutihir, J. T., Vanderjagt, D. J., Glew, R. H., &
Uguru, V. E. (2005). Maternal mortality among adolescent women in Jos,
North-Central, Nigeria. Journal of Obstetrics & Gynecology, 25(1), 3-6.

Vatten, L. J., Romundstad, P. R., Holmen, T. L., Hsieh, C. C., Trichopoulos, D.,
& Stuver, S. O. (2003). Intrauterine exposure to preeclampsia and adolescent
blood pressure, body size, and age at menarche in female offspring. Obstetrics
& Gynecology, 101(3), 529-533.

 Preterm deliveries

Ref: Ref: Mukhopadhyay, P.,

Chaudhuri, R. N., & Paul, B. (2010).

Hospital-based perinatal outcomes
and complications in teenage
pregnancy in India.Journal of
Health, Population and Nutrition,
494-500

 Postpartum

depression
Ref: Beirne,

S.,2015. What are

the rsiks of
Teenage
pregnancy?
http://www.livestro
ng.com/article/113
172-risks-teenagepregnancy/

 incidence of

cesarean section is
higher

Effects on Neonates
Low birth weight
Ref:

Reference:Watcharase
ranee, N., Pinchantra,
P., & Piyaman, S.
(2006). The incidence
and complications of
teenage pregnancy at
Chonburi Hospital. J
Med Assoc Thai,
89(Suppl 4), S118-23.

We analyzed data from

341,708 completed singleton

pregnancies in the North West
Thames region between 1988
and 1997. Pregnancy
outcomes were compared by
age at delivery in women less
than 18 years old (n = 5246)
and 1834 years old (n =
336,462); women 35 years old
or older (n = 48,658) were
excluded. Data are presented
as percentages of women less
than 18 and 1834-year-old
women, with adjusted odds
ratios (OR) and 99%
confidence intervals (CI).

 Low birth weights

Stillbirths
Ref: Ref: Mukhopadhyay, P.,

Chaudhuri, R. N., & Paul, B. (2010).

Hospital-based perinatal outcomes
and complications in teenage
pregnancy in India.Journal of
Health, Population and Nutrition,
494-50

 Prematurity
Low birth weight
Neonatal death

Ref: Cunnington, A. J. (2001). What's

so bad about teenage pregnancy?.

Journal of Family Planning and
Reproductive Health Care, 27(1), 3641.

Childhood outcomes at
age 14
psychological

behavior
Ref: Shaw, M., Lawlor, D. A., &

poorer school

performance
poorer reading

ability

Najman, J. M. (2006). Teenage

children of teenage mothers:
psychological, behavioural and
health outcomes from an Australian
prospective longitudinal study.
Social science & medicine, 62(10),
2526-2539.
Chicago

 were more likely to

have been in
contact with the
criminal justice
system
were more likely to

smoke regularly
and to consume
alcohol.

Stillbirth
The definition of stillbirth is

the birth of a baby who is

born without any signs of
life at or after 24 weeks of
pregnancy. A baby may
have died during late
pregnancy (called
intrauterine death). More
unusually, a baby may have
died during labour or birth
(called intrapartum death).
http://www.babycentre.co.u

k/a1014800/when-a-babyis-stillborn#ixzz40mezcPZn

What causes a baby to be stillborn in the womb?

There are wide-ranging reasons why a baby may die in the womb

(uterus). These reasons include how the placenta works, genetic

factors, a mum's health, age and lifestyle, and infection.
Problems with the placenta are thought to be the most common

cause of a baby dying in the womb. The medical term for this is
placental insufficiency. About two thirds of babies who die in the
womb are thought to be lost because of placental insufficiency.
The exact reasons why the placenta may not work properly are not

fully understood. But doctors do know that if the placenta isn't

working well, the blood vessels that connect a mum to her baby
become constricted. This results in a drop in nutrients and oxygen to
a baby, causing growth problems.
When a baby has growth problems it's called fetal or intrauterine

growth restriction (IUGR). These babies are also sometimes called

small for gestational age or small-for-dates.
Many babies who are stillborn are premature and smaller than they

should be for their stage of pregnancy.

The pregnancy illness pre-eclampsia can also reduce blood flow to

the baby via the placenta.

Sometimes, a genetic or chromosomal defect may cause a baby to be

stillborn. This is thought to be the reason about 10 per cent of the

time. This may mean that a baby's brain, heart or another vital organ
has not developed properly
http://www.babycentre.co.uk/a1014800/when-a-baby-is-

stillborn#ixzz40mfyASmZ

What happens when a baby dies in the womb?

When a baby dies in the womb, the sad truth is that the mum still has to go

through with the birth, as it's better for her health and her physical recovery. It is
rare for a stillborn baby to be born by caesarean section.
The loss of your baby will have come as a great shock. You may not be thinking

about yourself at all, but doctors still have to advise you about what's best for
you.
Your medical team will be sensitive to your feelings while explaining what

happens next. In most cases, your labour will have to be started artificially
(induced). Your doctors will discuss this with you and give you time to absorb
what they have said before starting to induce your labour.
Some parents want to have the induction as soon as possible. Others prefer to

wait for a day or two so that they have time to take in what has happened and to
see if labour starts by itself.
You may feel too numb to make a decision. All the while, your doctors will be

concerned about your health. If they think there's a chance your health may be
affected, for example, if you have an infection, they'll advise you to have labour
induced straight away
Whether you go into labour naturally, or your doctor induces your labour, you

will have a private labour room at the hospital. Your midwife or doctor will give
you very effective pain relief, which will be morphine-based. You'll be able to
control the amount of morphine you receive through a hand-controlled pump.
If you are expecting twins or more, and the death of one baby has been

discovered, your doctor may advise you not to have an induction of labour. A lot
will depend on your particular circumstances: whether or not your babies share a
placenta, and at what stage the loss occurred. Your doctor may say it's best to
give your other baby or babies a chance to develop and mature a bit longer in
your womb.
Your babies can then be born at the same time, when it's best for your healthy

baby or babies. Some parents are upset by the idea of carrying the babies
together in this way, although others find it comforting that their babies are
together

What causes a baby to be stillborn during labour and

birth?
It's rare for a baby to die unexpectedly during labour

or birth. Most stillborn babies are lost when they are

still in the womb.
However, sadly, a few babies are stillborn because

of something that happened during labour or birth.

When something goes wrong during birth, it is a
traumatic and frightening experience for parents.
They may not understand what is going on, as
hospital staff may be too busy dealing with the
emergency to explain things clearly.
If a baby is very large, in rare instances, his

shoulders may get stuck as he leaves the birth canal

(shoulder dystocia), severely reducing the flow of
oxygen to him. Most babies recover well, but very
rarely, shoulder dystocia can result in a baby being
stillborn.
Another rare cause of loss is problems with the

umbilical cord and resulting loss of oxygen to the

baby. The cord can slip through the cervix before the
baby or become wrapped around a baby's neck.
http://www.babycentre.co.uk/a1014800/when-a-

baby-is-stillborn#ixzz40mgiMKTO

Prematurity
A premature birth

is a birth that takes

place more than
three weeks before
the baby is due. In
other words, a
premature birth is
one that occurs
before the start of
the 37th week of
pregnancy.
Normally, a
pregnancy usually

The problem
An estimated 15 million babies are born

too early every year. That is more than 1

in 10 babies. Almost 1 million children die
each year due to complications of preterm
birth. Many survivors face a lifetime of
disability, including learning disabilities
and visual and hearing problems.
Globally, prematurity is the leading cause

of death in children under the age of 5.

And in almost all countries with reliable
data, preterm birth rates are increasing.
Inequalities in survival rates around the

world are stark. In low-income settings,

half of the babies born at or below 32
weeks (2 months early) die due to a lack
of feasible, cost-effective care, such as
warmth, breastfeeding support, and basic
care for infections and breathing
difficulties. In high-income countries,
almost all of these babies survive.

The solution
More than three-quarters of premature

babies can be saved with feasible,

cost-effective care, e.g. essential care
during child birth and in the postnatal
period for every mother and baby,
antenatal steroid injections (given to
pregnant women at risk of preterm
labour and under set criteria to
strengthen the babies lungs),
kangaroo mother care (the baby is
carried by the mother with skin-to-skin
contact and frequent breastfeeding)
and antibiotics to treat newborn
infections.
To help reduce preterm birth rates,

women need improved care before,

between and during pregnancies.
Better access to contraceptives and
increased empowerment could also
help reduce preterm births.

Why does preterm birth happen?

Preterm birth occurs for a variety

of reasons. Most preterm births

happen spontaneously, but some
are due to early induction of
labour or caesarean birth,
whether for medical or nonmedical reasons.
Common causes of preterm birth

include multiple pregnancies,

infections and chronic conditions
such as diabetes and high blood
pressure; however, often no cause
is identified. There could also be a
genetic influence. Better
understanding of the causes and
mechanisms will advance the
development of solutions to
prevent preterm birth.

Where and when does

preterm birth happen?

More than 60% of

preterm births occur in

Africa and South Asia,
but preterm birth is truly
a global problem. In the
lower-income countries,
on average, 12% of
babies are born too early
compared with 9% in
higher-income countries.
Within countries, poorer
families are at higher risk

The 10 countries with the greatest number of

preterm births
India: 3 519 100
China: 1 172 300
Nigeria: 773 600
Pakistan: 748 100
Indonesia: 675 700
The United States of

America: 517 400

Bangladesh: 424 100
The Philippines: 348 900
The Democratic Republic
of the Congo: 341 400
Brazil: 279 300

Guidelines to improve preterm birth outcomes

WHOshas developed new

guidelines with recommendations

for improving outcomes of preterm
births. This set of key interventions
can improve the chances of survival
and health outcomes for preterm
infants. The guidelines include
interventions provided to the
mother for example steroid
injections before birth, antibiotics
when her water breaks before the
onset of labour, and magnesium
sulfate to prevent future
neurological impairment of the
child. As well as interventions for
the newborn baby for example
thermal care (e.g. kangaroo mother
care when babies are stable) , safe
oxygen use, and other treatments
to help babies breathe more easily.

Low birth weight

Is defined as a

birth weight of a
live born infant of
less than 2,500 g
(5 pounds 8
ounces) regardless
of gestational age.