Adolescent gynaecology problems in rural South India: a review of hospital admission in a tertiary care teaching hospital in Ammapettai, Tamil Nadu, India A review of hospital admission in a tertiary care teaching hospital in Ammapettai

摘要

Background: Adolescent girl’s knowledge about sexual abuse and awareness of health services is poor. The study is conducted to analyse the gynaecological problems mandating hospitalization and to formulate modalities to improve their health and to ensure safe motherhood. The objectives of this study were to evaluate gynaecological problems in adolescent girls, and to analyse gynaecological emergencies, and to develop modalities to improve adolescent health and for safe motherhood. Methods: Retrospective hospital based observational study of hospital records regarding health issues and awareness of health services among girls in the age group of 13-19 years hospitalized for various medical and surgical problems during the period of January 2015 to January 2016 at Shri Sathya Sai medical college and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India. 50 age, education, social background, knowledge of available health services, contraception and detailed history of menstruation regarding duration, quantity and previous medication prior to admission and their present cause of admission were analysed. Results: Total admission in the year were 50, medical 34 (including 5 girls who had check curettage for postabortal bleeding with severe anemia) and surgical 16. Early adolescent group were 34 (68%)and late adolescent group were 16 (32%), married were 5 (10%) and unmarried 45 (90%). All 50 girls were from low socioeconomic class, with rural background. 84% were school dropout and 40% were unemployed. 20 % of our study subjects were admitted with unsafe abortion with postabortal bleeding with no knowledge about Health services.16% were sexually abused and were raped. Abnormal uterine bleeding(menorrhagia) is the most common gynaecological problem in adolescent girls in our study. DUB (52%) is the most common cause. Second most common cause for abnormal bleeding is postabortal bleeding (40%). The most common surgical procedure done was check curettage for postabortal bleeding in 10%. Next common surgery was laparotomy for ovarian cyst in 6% cases and for torsion adnexal cyst in 6%. Conclusions: The most important cause for admission was anemia following abnormal excessive bleeding P/V due to DUB or postabortal bleeding. Second most important cause was ovarian tumours. Unprotected coitus, sex abuse and repeated unsafe abortions have increased the rate of PID and ectopic pregnancies. The study emphasizes the need to sensitize these young girls on the issue like excessive menstruation, gender relationships, and sex abuses. Create awareness and promote knowledge regarding medical issue, available health services and contraception to prevent unsafe abortion and its sequelae. Active implementation of projects like ARSH - adolescent friendly reproductive services, where confidentiality is maintained and proper counseling regarding contraception and supplementation of iron and folic acid is given to all adolescent girls who are future mothers and to ensure safe motherhood.