Teenage pregnancy: problems of a young primigravida. Women's health Pregnancy in a couple of minors what the law says

11.10.2019

The most favorable age for childbearing is for women from 18 to 35 years. The period of “physiological immaturity” is considered to be under 18 years of age, when the foundations of a lifestyle and behavior style are just being formed, which subsequently determines physical and mental health. Pregnant women who have not reached puberty can be called young; their legal age ranges from 12 to 17 years.

Epidemiology
The incidence of teenage pregnancy has increased in many countries over the past 20 years and is trending upward. Every year, 15 million adolescents give birth in the world, which is 2.0-4.5% of the total number of births. The share of young pregnant women is 5% in relation to all pregnant women. In recent years, the proportion of primigravidas among girls under 15 years of age has consistently been 93.5-95.8%, among adolescents 15-19 years old 52.3-54.9%.

As a rule, early pregnancy is unplanned and in 80% of cases ends in artificial termination.

Every eleventh abortion is performed on persons under 19 years of age. Per 100 teenage pregnancies, the number of artificial abortions is 69.1%, childbirth - 16.4%, spontaneous miscarriages - 14.5%. At the same time, 40.0% of adolescents have a repeat pregnancy, and 17.9% have a repeat birth.

Every year, about 1.5 thousand teenagers give birth at the age of 15, 9 thousand at 16 years old and over 30 thousand before reaching 17 years old. The maternal mortality rate among young women has increased from 4.4 per 100,000 live births to 13.4 in recent years.

Factors influencing teenage pregnancy rates:
- high level of sexual activity;
- sexual or physical violence, domestic violence;
- poverty;
- the acceptability of having children in adolescence in the family and environment of a teenager;
- psychological and behavioral factors, reduced cognitive ability, limited ability;
- plan the future or foresee the consequences of one’s actions, as well as a sense of one’s own invulnerability;
- reluctance to use contraceptives (personal reasons or reasons related to the sexual partner);
- intentional pregnancy as the only ritual of transition to adulthood;
- inaccessibility or low quality of medical care in the field of family planning.

Classification
Features of the clinical course of pregnancy, birth of minor primiparas and the condition of newborns are associated with varying degrees of biological maturity of the body.

The indicator of the latter is menstrual age.

It is advisable to divide young pregnant women according to menstrual age into the following groups:
- with a menstrual age of 1 year or less;
- with a menstrual age of 2 years;
- with a menstrual age of 3 years or more.

According to the age:
- up to 9 years - girls with pathologically accelerated puberty, “super-junior primiparous”;
- from 9 to 15 years - no full puberty, “young primiparas”;
- from 15 to 18 years - adolescents who are mature enough to perform reproductive functions up to 9 years - girls with pathologically accelerated puberty, “super-teenage primiparous”;

Depending on the state of health, there are:
- healthy pregnant teenagers;
- young pregnant women with extragenital pathology;
- pregnant teenagers with complicated pregnancies.

Depending on the circumstances of pregnancy:
- young primigravida pregnant women from complete and prosperous families who consider their pregnancy desirable;
- young people from single-parent or dysfunctional families with an unwanted pregnancy;
- young people with pregnancy as a result of rape.

Clinical picture
Pregnancy and childbirth at a young age are associated with a large load on the immature body of a teenager and in 90% occur with complications.

The course of pregnancy is largely determined by the woman’s health status, and in the case of pregnant minors, by the degree of her physical and sexual development. Modern teenagers have a low level of not only physical development, but also general somatic health. Currently, there is an increase in the overall morbidity rate among adolescents. Most of them have one or two diseases of any organs and systems, while 75-86% of girls have chronic somatic diseases. There is a significant relationship between the state of general somatic and reproductive health of adolescent girls. 10-15% have gynecological disorders that limit their fertility. Naturally, in such conditions, in minors, the gestational process occurs with a significant number of complications that adversely affect the condition of the young woman, her fetus and newborn. Most often, pregnancy at a young age is the result of an extramarital affair, associated with a change of sexual partners, therefore during pregnancy in In this age group, infectious and inflammatory processes are registered 1.5-2 times more often, localized in most cases in the urogenital tract. Pregnancy occurring at a young age accelerates the processes of somatic and puberty. Changes occur in the bony pelvis; as pregnancy progresses, it grows, reaching the size characteristic of girls at 16-18 years old. The external conjugate increases more slowly than the others and reaches the normal value only by the 21st year. Thus, with an increase in CF, the frequency of anatomical narrowing (of various forms and degrees) of the pelvis decreases (in adolescents with CF for 1 year it is 66%, in pregnant women with a menstrual cycle of 3 years - 50%). In this regard, breech presentation of fetuses is more common in adolescents than in adult women. At the same time, the elasticity of the ligamentous apparatus, symphysis and cartilaginous zones in young pregnant women is more pronounced than in adults. This provides some flexibility to the bone ring.

Anemia of pregnancy is diagnosed in minors more often than in older women; its frequency varies according to different sources from 4 to 78%. Iron deficiency anemia detected in pregnant minors may be due to: inferiority of the hematopoietic system and its age-related characteristics; insufficient iron supply at birth; loss of blood in case of juvenile bleeding preceding pregnancy. Despite the treatment, hemoglobin recovery rarely occurs, and in some cases anemia continues to progress.

Preeclampsia is considered one of the most common manifestations of maladjustment to pregnancy. The difficulty of objectively assessing the frequency of early preeclampsia in adolescents is that the early stages of pregnancy in most cases fall outside of medical supervision due to the late registration of pregnant minors. The emotional stress associated with out-of-wedlock pregnancy has a significant impact on the incidence and severity of preeclampsia. During juvenile pregnancy, preeclampsia occurs in 12.0 - 76.55%, and more often than moderate and severe. The average time of manifestation of preeclampsia is 2 weeks earlier than in adult pregnant women. Young pregnant women constitute a high-risk group for the development of fetoplacental insufficiency. On average, from 11.0 to 76.0% of pregnant adolescents have chronic placental insufficiency; it is most severe in adolescents with a menstrual age of 12 years. Signs of placental insufficiency are detected by ultrasound examination of the placenta, determined by macro- and micromorphological changes in the placenta, and are indirectly confirmed by the detection of hormonal and immune dysfunctions. In this group, antenatal fetal distress is more often recorded according to the biophysical profile and corticotron hormone.

The dynamics of changes in the levels of hormones of the fetoplacental complex in the blood of young primigravidas and pregnant women of favorable childbearing age are approximately the same. However, insufficient synthesis of steroids in the fetoplacental complex in biologically immature primiparas persists until childbirth, which serves as a prerequisite for the development of labor abnormalities.

Stress and emotional tension lead to immunological changes in the body of pregnant women, reducing its resistance to environmental influences. The state of the immune system in teenage pregnant women is associated with low reserve capabilities of phagocytes and hypoglobulinemia, which is clinically manifested by an increased incidence of infectious and inflammatory diseases, including in the postpartum period.

The course and outcomes of childbirth depend significantly on the age of the teenager. The question of the duration of labor in minors is of clinical interest. The average duration of labor for minors does not differ from that for adult women. The largest number of rapid and rapid births occurs in first-time mothers with a menstrual age of 3 years, and prolonged ones - in adolescents with a menstrual age of 1 year. The following complications in childbirth are typical for women in labor with CF of 1-2 years:
- anomalies of labor 6.5-37.2%;
- untimely rupture of amniotic fluid 14.7-45.3%;
- bleeding during childbirth and the early postpartum period;
- traumatism of the soft birth canal 4.0-25.5%;
- surgical intervention 2.1-17%;
- purulent-infectious postpartum diseases 20.0-71.7%.

In young primigravidas, the most severe labor stresses are protracted labor and a long anhydrous period. A large percentage of untimely rupture of amniotic fluid is associated with the high location of the presenting part and functional failure of the lower segment of the uterus. The frequent occurrence of this type of pathology is associated with a violation of the regime, especially in the last months of pregnancy. The high percentage of infection of the cervical canal is also important.

Every second minor during pregnancy has an infection of the urogenital tract (chlamydia, trichomoniasis, etc.). For all postpartum women, the greatest stress is blood loss caused by bleeding in the postpartum period. The cause of increased blood loss is uterine hypotension in the early postpartum period, retention of placental tissue caused by a violation of the mechanism of separation of the placenta and the process of excretion of the placenta.

Bleeding in the afterbirth and early postpartum periods is proportional to the severity of anemia. In turn, anemia, which complicates pregnancy in most minors, is a factor in reducing tolerance to blood loss during childbirth.

Obstetric operations and benefits among young women in labor are undertaken no more often than usual in clinical practice. Surgical delivery is performed less frequently than in adults. The factors determining the method of delivery are the size of the pelvis, the expected weight of the fetus, the nature of the presentation, and the girl’s state of health. The course of the postpartum period in minors is often complicated. The structure of complications is dominated by purulent-septic postpartum diseases, which are a consequence of a decrease in the general resistance of the body of young women. Diagnostics

The main obstacle to correct and timely diagnosis is most often the unforeseen and undesirable nature of pregnancy in minors. Teenagers either do not suspect pregnancy or hide it (in 35-55% of cases) and only go to the antenatal clinic at a later date. According to various authors, 8-11% of young women do not attend antenatal clinics at all. A thorough comprehensive examination and systematic medical supervision from the earliest stages of pregnancy is necessary when managing minor pregnant women. Unfortunately, this task often turns out to be unrealistic due to the late turnout of pregnant minors to the doctor. Diagnosis of pregnancy at a young age is based on the standard for diagnosing pregnancy, identifying the same supposed, probable and undoubted signs, ultrasound data, as in adult women, however, the diagnosis is often made late.

Anamnesis
If a teenager has not reached menarche, pregnancy should be excluded; denial of sexual activity is not a reliable criterion for excluding pregnancy.

Laboratory research
Laboratory testing includes qualitative and quantitative determination of human chorionic gonadotropin in urine or blood.

Instrumental studies
The instrumental examination includes an ultrasound scan of the uterus.

Differential diagnosis
During the examination, it is necessary to distinguish pregnancy from the following diseases:
- abnormal development of the uterus;
- kidney prolapse;
- tumors of the pelvis or abdominal cavity;
- obesity;
- all diseases and conditions accompanied by amenorrhea.

Treatment
Pregnancy and delivery with a favorable outcome for the mother and fetus are the main goals of treatment.

Indications for hospitalization
Childbirth in minor women is recommended to be carried out in specialized, highly qualified obstetric institutions, preferably in those where there are specialists with relevant experience and 24-hour anesthesiological and neonatological services. Hospitalization for childbirth should occur at 38-39 weeks. During prenatal hospitalization, an in-depth examination of the woman’s body, readiness for childbirth, and the state of the fetoplacental complex is carried out. It is necessary to have complete and objective information about the reactivity and reserve capabilities of the fetus. Repeated pelvimetry is recommended, since adolescents experience an increase in pelvic size during pregnancy. Based on the data obtained, taking into account the existing complications of pregnancy, an individual plan for the management of childbirth is developed, including the question of the advisability of a planned caesarean section.

Non-drug treatment
The decision on carrying a pregnancy at a young age should be made in each case individually, taking into account such circumstances as the duration of pregnancy, physiological maturity of the body, obstetric and gynecological history, general health, satisfactory social status, desire to have a child, consent of parents or guardians, favorable course of pregnancy.

An obstetrician-gynecologist managing pregnancy in young women needs to look for a special approach, dictated by the unusualness of the situation in psychological and deontological terms, and the emotional lability of the teenager.

Pregnancy can be a crisis for a teenager and her family. A doctor is a person who can offer guidance and support during this time. In addition, the pregnancy management plan should be drawn up taking into account the girl’s position in the family and relationship with her partner. It is very important to counsel adolescents on nutritional issues. Adequate nutrition of pregnant and lactating women ensures not only the proper development of the intrauterine fetus and newborn, but also the most complex physiological changes associated with the course of pregnancy and the formation of lactation mechanisms. It is necessary to discuss the harm of smoking, drinking alcohol and drugs, sexually transmitted infections, contraception and sexuality in the postpartum period. Particular attention should be paid to psychoprophylactic preparation for childbirth. At subsequent visits, emphasize the importance of breastfeeding, teach techniques for breastfeeding, and caring for a newborn. The issue of breastfeeding is resolved in different ways, depending on the wishes of the woman and her family in relation to the newborn.

Drug treatment
During the first stage of labor, due to the high frequency of labor anomalies in minors, it is necessary to carefully monitor the nature of labor and the rate of dilatation of the cervix. To prevent the rapid progress of labor in young women in labor, early amniotomy and irrational use of uterotonic drugs should be avoided. In the active phase of labor, taking into account the age characteristics of young primigravidas, tissue rigidity and lability of the nervous system, to prevent labor anomalies, drug anesthesia of labor should be mandatory. To relieve labor pain, it is advisable to use epidural analgesia. Due to the high frequency of intrapartum fetal hypoxia, monitoring and prevention of hypoxia are necessary.

Surgery
When choosing a method of delivery for young primigravidas, the issue of the need for a cesarean section should be resolved in a timely manner. Indications for its implementation are similar to those for women in labor of optimal fertile age: labor anomalies that are not amenable to conservative therapy, intrapartum fetal hypoxia, clinically narrow pelvis. The young age of a woman in labor should not be an obstacle to timely surgical delivery.

Timing and methods of delivery
The average duration of pregnancy for young women is slightly shorter than for adult women - 37-38 weeks. The shortest average pregnancy duration is usually recorded in minors with CF of 1 year or less, and they also have the highest rate of preterm birth (23%). Post-term pregnancy in young women occurs less frequently than in women of optimal childbearing age. With increasing menstrual age, the frequency of post-term pregnancy increases and in the group of women giving birth with a menstrual age of 3 years, it coincides with the frequency in adult women. Approximate periods of incapacity for work The question of attending an educational institution is decided by a young pregnant woman herself, together with her parents.

Prevention
Pregnancy and childbirth during adolescence entail many medical, psychological and social problems. In this regard, the prevention of pregnancy in minors is particularly active. The concept of safe motherhood implies a set of socio-economic, legal and medical measures that promote the birth of desired children at optimal age periods without a negative impact on the life and health of the mother and ensure the upbringing of born children. Currently, it is necessary to unite medical, pedagogical, social and public organizations to carry out organized forms of work to prevent untimely pregnancy in young people.

Primary prevention involves the creation of effective programs to delay the onset of sexual activity in girls, aimed at teaching safe sexual behavior.

Secondary prevention is the prevention of subsequent pregnancies and births in adolescents through long-term monitoring of young mothers, up to 1-2 years, with individual selection of adequate contraceptive methods.

Forecast
Pregnancy occurs with complications in 90% of minors; pathology of childbirth and the postpartum period is diagnosed in 45-94% of young primigravidas.

The frequency of adverse birth outcomes for the mother and fetus is high, therefore, when predicting complications, it is necessary to take into account whether young primiparous women belong to a certain CF group (1 year or less, 2 years, 3 years or more).

Pregnant women with a menstrual age of 1-2 years at any passport age should be considered at high risk for anemia, prematurity, and birth trauma. Pregnant women with a menstrual cycle of 3 years or more can be considered low risk. With careful and regular monitoring in antenatal clinics and periodic hospitalization, along with other treatment and preventive measures, the outcome of childbirth for the mother and newborn can be favorable.

In the age group with a menstrual age of 1 year or less in the first trimester, pregnancy is most often artificially terminated. In the second trimester, interruption is indicated only in cases where there is a threat to the health or life of the pregnant woman. In the third trimester, it is rational to carry out spontaneous childbirth after sufficiently long preliminary preparation.

Early initiation of sexual relations, combined with low levels of knowledge in this area and poor awareness of contraception, has led to the phenomenon of young motherhood or pregnancy in minors . Pregnant women who have not reached puberty can be called young; their legal age ranges from 12 to 17 years.

For example, in the United States, the teenage birth rate has decreased slightly, but the number of children born out of wedlock has increased. Every day in the United States, approximately 2,700 girls under 20 become pregnant. From 1940 to 1985, the number of children born each year to unmarried American women under age 20 quadrupled. Currently, more than 1 million young girls become pregnant each year; over 65% of them are unmarried. About 40% of these pregnancies end in abortion, and 10% end in miscarriage. The remaining 50% of pregnant women carry their children to term.

In girls under 20 years of age, compared with women of reproductive age, pregnancy is much more likely to be unintended, miscarriages are more common, and they are more likely to have abortions.

Causes of pregnancy in adolescence and young adulthood

One possible factor behind the high rate of teenage pregnancy is that Nowadays society is more tolerant of children born out of wedlock. In the past, pregnant teenagers were usually expelled from school, but now many school systems have developed special programs to help young mothers complete their schooling. In some cultural groups an unmarried mother can receive constant support from both her family and the father of her child. And finally some girls want to give birth and raise a child because they feel the need to be loved. Usually these are young mothers who have been deprived of love, and they expect their children to make up for what they lacked.

About five in 10 sexually active teens are not using birth control. The reason for this is most often ignorance in the field of reproduction, unwillingness to accept responsibility for the consequences of sexual behavior, or a passive attitude towards life. Double standards continue to play a role: representatives of both sexes tend to view the man as the sexual aggressor, and consider the woman responsible for setting the boundaries of sexual relations. At the same time, boys and girls believe that it is more appropriate for a woman to be overcome with passion to the point of madness, and not to take precautions with the help of contraceptives. It is interesting to note that studies have shown that sexually active older teens who attend sex education classes are more likely to use contraception.

Prevalence Pregnancy in minors varies from 12 per 1000 women aged 15–19 years in developed countries to 102 per 1000 in Russia. “Forced teenage motherhood,” which has been typical for a long time in various countries of the world (up to 15 million annually), has become typical for Russia: today 14–15% of all births occur to mothers aged 15–19 years. Approximately 30% of teen pregnancies end in abortion, 56% in childbirth, and 14% in miscarriage.

Every year, about 1.5 thousand mothers give birth at the age of 15, 9 thousand at the age of 16, and over 30 thousand before the age of 17. Perinatal mortality rates (35.04 per 100 thousand live births) among adolescents are 5–8 times higher than in the general population. The out-of-wedlock birth rate among young women is 60.7–68.7%; among mothers who abandon their children, minors range from 52.3 to 63.8%. In the social structure of young mothers, a significant share (72%) belongs to housewives and students of vocational schools and schools. About 13% of teenage mothers have bad habits (smoking, drinking alcohol).

Factors influencing teenage pregnancy rates:

· high level of sexual activity;

· sexual or physical violence, domestic violence;

· poverty;

· the acceptability of having children in adolescence in the family and environment of a teenager;

· psychological and behavioral factors, reduced cognitive ability, limited ability to plan for the future or anticipate the consequences of one's actions, as well as a sense of personal invulnerability;

· reluctance to use contraceptives (personal reasons or reasons related to the sexual partner);

· intentional pregnancy as the only rite of passage into adulthood;

· inaccessibility or low quality of medical care in the field of family planning.

Features of the clinical course of pregnancy and childbirth minor primiparas and the condition of newborns are associated with varying degrees of biological maturity of the body. The latter indicator is menstrual age (MA).

By MV, that is, the number of years from the first menstruation to pregnancy, young pregnant women can be divided into the following groups:

· with CF 1 year or less;

· with CF 2 years;

· with CF for 3 years or more.

Depending on the state of health or behavioral characteristics, there are:

· healthy pregnant teenagers;

· young pregnant women with extragenital pathology;

· pregnant teenagers with complicated pregnancies.

Depending on the circumstances of pregnancy:

· young first-time pregnant women from full and prosperous families who consider their pregnancy desirable;

· young people from single-parent or dysfunctional families with unwanted pregnancies;

· young people pregnant as a result of rape.

Pregnancy and childbirth at a young age are associated with a large load on the immature body of a teenager. Over the past decade, the general somatic and reproductive health of adolescents has deteriorated. About 75–86% of girls have chronic somatic diseases, 10–15% have gynecological disorders that limit their fertility. Naturally, in such conditions and against the background of a low level of somatic health of minors, pregnancy occurs with a significant number of complications that adversely affect the condition of the young woman, her fetus and newborn.

Most often, pregnancy in minors is the result of an extramarital affair, associated with a change of sexual partners, therefore, during pregnancy, colpitis is registered 1.5 times more often in this age group. In addition, at 24–35 weeks, almost half experience infectious and inflammatory processes, localized in most cases in the urogenital tract and skin (pyoderma).

Pregnancy occurring at a young age speeds up the process somatic and puberty. Changes in the bony pelvis are especially favorable from an obstetric point of view; as pregnancy progresses, it grows, reaching the size characteristic of girls aged 16–18 years. The external conjugate increases more slowly than the others and reaches the normal value only by the age of 21. As a consequence of a narrow pelvis, breech presentation in adolescents is somewhat more common than in adult women. At the same time, the hydrophilicity and elasticity of the ligamentous apparatus, symphysis and cartilaginous zones in young pregnant women is more pronounced than in adults. This provides some flexibility to the bone ring.

Young pregnant women are 3 times more likely to pregnancy is complicatedanemia. The frequency and severity of this complication in adolescents is inversely proportional to CF, i.e. At a younger age, anemia occurs more often and is more severe. Despite the treatment, hemoglobin recovery rarely occurs, and in some cases anemia continues to progress.

Homeostatic reactions unstable at a young age. One of the most common manifestations of maladjustment to pregnancy is considered gestosis, in minors it is diagnosed in almost every second patient, and more often moderate and severe . The average time for the manifestation of gestosis is 2 weeks earlier than in adult pregnant women. In young primigravidas, pregnancy is often accompanied by chronic placental insufficiency; it is most severe in adolescents with CF for 1–2 years. This group is more likely to register antenatal fetal distress according to biophysical profile and CTG.

The state of the immune system in pregnant adolescents is tense with low reserve capabilities of phagocytes and hypoglobulinemia (IgA), which is clinically manifested increased incidence of infectious and inflammatory diseases , including in the postpartum period.

The course and outcomes of childbirth depend significantly on the age of the teenager.

The average duration of labor for minors does not differ from that for adult women. The largest number of fast and rapid births occurs in first-time mothers with MV 3 years, and prolonged ones - in adolescents with MV 1 year.

The following complications during childbirth are typical for women in labor with CF for 1–2 years:

· clinical discrepancy between the fetal head and the maternal pelvis;

· anomalies of labor - pathological preliminary period, primary weakness of labor

activities, excessively vigorous labor;

· injuries of the birth canal;

hypotonic bleeding.

In women giving birth with CF for 3 years, the structure of complications is as follows:

· rapid or rapid labor;

· primary weakness of labor or discoordinated labor;

· ruptures of the cervix and perineum.

Minor primiparas with CF 1–2 years are leaders in the number of complications such as pathological attachment of the placenta and bleeding against the background of decreased uterine tone. Probably, the cause of these complications may be insufficient preparation of the endometrium due to the morphofunctional immaturity of the reproductive system against the background of a high incidence of gynecological diseases and a history of abortion in some cases.

Obstetric operations and benefits among young women in labor are undertaken no more often than usual in clinical practice.

Childbirth by caesarean section is carried out less frequently than in adults. The determining factors are the size of the pelvis, the nature of the presentation, the expected weight of the fetus and the girl’s state of health. The reduced general resistance of the body of young women, a significant number of colpitis during pregnancy, and frequent complications during childbirth lead to the fact that poor uterine contractions and postpartum inflammation are registered in them 2 times more often than in adult women.

The main obstacle to correct and timely diagnosis of pregnancy in minors is most often the unforeseen and undesirable nature of pregnancy. Teenagers either do not suspect pregnancy or hide it (in 35–55% of cases) and only go to the antenatal clinic at a later date. According to various authors, 8–11% of young women do not attend antenatal clinics at all.

Diagnosis of pregnancy at a young age is based on the “golden” standard for diagnosing pregnancy, identifying the same supposed, probable and undoubted signs and ultrasound data as in adult women, however, the diagnosis is often made late.

If one or more menstrual periods are absent in an adolescent who has reached menarche, pregnancy should be ruled out. Denial of sexual activity is not a reliable criterion for excluding pregnancy!

The decision to carry a pregnancy to term at a young age should be made individually in each case, taking into account such circumstances as gestational age, physiological maturity of the body, obstetric and gynecological history, general health, satisfactory social status, desire to have a child, consent of parents or guardians, favorable course of pregnancy.

Average length of pregnancy for minors slightly less than in adult women - 37.9 weeks. The shortest average pregnancy duration is usually recorded in minors with MV 1 year or less, they also have the highest rate of preterm birth (23%). Post-term pregnancy in young women occurs less frequently than in women of optimal childbearing age. With increase MV the frequency of post-term pregnancy also increases in the group of women giving birth with MV For 3 years it coincides with the frequency in adult women.

The question of attending an educational institution is decided by a young pregnant woman herself, together with her parents.

Currently, it is necessary to unite medical, pedagogical, social and public organizations to carry out organized forms of work to prevent untimely pregnancy in young people.

Primary prevention implies the creation of effective programs to delay the onset of sexual activity in girls, aimed at teaching safe sexual behavior, the ability to say “no,” and increasing access to contraceptives.

Secondary prevention - this is the prevention of subsequent pregnancies and births in adolescents through long-term - up to 1-2 years of monitoring of young mothers with individual selection of adequate contraceptive methods.

Pregnancy occurs with complications in 70–98% of minors; pathology of childbirth and the postpartum period is diagnosed in 45–94% of young primigravidas.

Incidence of adverse birth outcomes for mother and fetus is high, therefore, when predicting complications, it is necessary to take into account whether young primiparas belong to a certain group MV(1 year or less, 2 years, 3 years or more). Pregnant women with MV 1–2 years at any rated age are considered to be at high risk for anemia, prematurity, and birth trauma.

· Pregnant women MV 3 years or more can be considered low risk. With careful and regular monitoring in the conditions of antenatal clinics and periodic hospitalization, along with other treatment and preventive measures, the outcome of childbirth for the mother and newborn can be favorable.

· In the age group with MV 1 year or less in the first trimester, pregnancy is most often artificially terminated. In the second trimester, interruption is indicated only in cases where there is a threat to the health or life of the pregnant woman. In the third trimester, it is rational to carry out spontaneous childbirth after sufficiently long preliminary preparation.

How does early motherhood affect the further development of a teenage girl? Typically, young mothers leave school early; they tend to work in the lowest paid jobs and experience greater job dissatisfaction. They are more likely to become dependent on government support. New mothers must continue their own personal and social development while attempting to adapt to the 24-hour needs of an infant or young child.

Impact of early fatherhood on the lives of young men can also be negative and have long-term consequences. Many feel pressure to support their new families, so young fathers often drop out of school and typically receive less education than their peers who do not have children. They are also more likely to get unskilled, low-paid jobs. Over time, they are more likely to have family problems, which often lead to divorce. Often, teens who become pregnant face strong disapproval from their family or are already in conflict with their parents by the time they become pregnant. However, if they do not marry, they often have no choice and must continue to live at home in a dependent position during pregnancy and after childbirth. Therefore, in order to avoid such a situation, some teenage girls are motivated to get married and start their own household. But marriage is not always the best solution to a young mother's problems. Some researchers believe that, despite the fact that early motherhood interferes with maturation, in many cases it is preferable to early motherhood combined with early marriage! According to statistics, marriage in late adolescence is more likely to lead to dropping out of school than teenage pregnancy. In addition, those who get married at such a young age are more likely to get divorced than those who have children first and get married later.

Children of teenage parents are also at a disadvantage compared to children of older parents. They may suffer because their parents lack experience in fulfilling adult responsibilities and caring for others. Because these young parents experience stress and frustration, they are more likely to neglect or abuse their children. If factors such as poverty, disagreements between spouses and poor education of parents are simultaneously present in the family, then the chances of these problems occurring in the child increase.

However, some young parents do an excellent job raising their children while they continue to grow up themselves. To do this, they almost always need help. The most important social task remains to help young parents and their children, aimed at ensuring that they develop successfully and become productive members of society.

Although this issue is beyond the scope of this section, we decided to dwell on some of the problems that a gynecologist faces.

Childbirth is said to occur when the girl is under 16 years of age; It is difficult to determine the lower age limit, since childbirth also occurs in children suffering from premature puberty. Still, girls aged 11-15 years are considered to be minors giving birth.

A completely different criterion applies to pregnancy that occurs after premature puberty, since the somatic development of girls under 10 years of age is so pronounced that it is necessary to take into account their static relationships; Anecdotal reports indicate a surprisingly favorable course of pregnancy development processes.

The problems of childbirth among minors have long received much attention; This problem was dealt with by very authoritative specialists, such as Moriceau; Since then, various issues related to childbirth among minors have been periodically discussed in the literature. Of the older authors, Specht (1916) and David and Szekely (1924) studied this issue in detail. In recent years, a large number of reports have been published, including the work of Hungarian clinicians.

The optimal age for childbirth is considered to be 19-22 years (Stockel, 1951); At this age, growth ends, the body is fully developed, elasticity and tissue condition are optimal.

Girls who become pregnant before age 16 develop faster during pregnancy. An increased level of steroids in the blood helps accelerate the development of the genital organs and especially the development of the pelvic bones. The size of the pelvis in primiparous minors is undoubtedly smaller than in adult women, but significantly larger than what corresponds to the passport age; their pelvis is suitable for childbirth. It must be emphasized that this does not apply to pregnant minors under 10 years of age who suffer from precocious puberty.

Childbirth among minors does not have any harmful consequences and does not negatively affect the further development of the girl (Stockel, 1951).

A girl’s body becomes sexually mature and capable of reproduction when somatic development has reached such a stage that the body can already cope with the increased load during pregnancy. When considering issues in connection with premature puberty, it has already been noted that childbirth, even in little girls, does not have a harmful effect on her further development and ability to reproduce.

If we approach this problem only taking into account somatic development, then childbirth in minors is not a special pathology; however, we must not forget that mental development at this age is still insufficient, therefore pregnancy and childbirth at this age are considered undesirable. As mentioned above, during puberty, abrupt somatic development occurs, but it is not accompanied by corresponding mental development and the girl does not yet have life experience.

What is the manifestation of insufficient mental development? According to Marchetti and Menaker (1950), toxicosis of pregnancy and eclampsia are observed in pregnant minors 7 times more often than in adult women, since minor pregnant women do not follow a diet and do not follow the doctor’s medication prescriptions. In minors, perinatal fetal mortality is very high (Specht, 1916; David es Szekely, 1924; Marchetti a. Menaker, 1950; Burger, 1950; Stokel, 1951, etc.). If underage mothers with an insufficiently developed maternal instinct and insufficient life experience receive support from their parents, then perinatal mortality is somewhat reduced. Minor age in itself is not an indication for termination of pregnancy (Olsen, 1936).

Course of pregnancy. In pregnant minors, spontaneous miscarriages occur less frequently than in women over the age of 20 (Poliakoff, 1958; Israel a. Woutersz, 1963). Pregnancy proceeds relatively well, vomiting occurs rarely. The prognosis for pregnant minors is no worse than for adult pregnant women.

Complications during pregnancy, such as anemia and bleeding, occur less frequently than in adults. The only exception is toxicosis of pregnancy, which is observed much more often in primiparous minors (Israel a. Woutersz, 1963; Poliakoff, 1958); this was also noted by older authors.

Almost all authors note that childbirth in minors proceeds favorably. Fetal malpositions are rare; the only exception is breech presentation of the fetus, which occurs somewhat more often in minors (Burger, 1950).

The duration of labor is shorter than in adult women; Marchetti and Menaker (1950), having studied the course of labor in 634 minors, found that labor lasted an average of 13.5 hours; A similar observation was reported by Specht (1916). Labor weakness and prolonged labor are very rare; Caesarean sections are not required more often than in adults.

Soft tissue damage and blood loss during childbirth are less than in adults.

Summarizing all observations; we can say that childbirth in minor primigravidas proceeds more favorably than in adult women.

Fetal condition. Poliakoff (1958) studied the condition of the fetus in 299 minor women in labor (their age was 11-15 children) in 17.7% of cases the fetal weight was less than 2500 g; fetal weight generally corresponded to maturity.

There are no precise statistics regarding the incidence of congenital malformations.

Perinatal mortality is slightly below average; based on the material of Poliakoff (1959) it was 5.9%. According to Israel and Woutersz (1963), perinatal mortality among minors aged 11-20 years was 1.5%, and among women giving birth over 20 years old - 1.62%.

Postpartum period. All authors note that morbidity and mortality in the postpartum period among minors is lower than among adult women. Thromboembolic diseases almost never occur, and postpartum involution is very favorable. Lactation is also favorable.

For an abortion by the hand

In Russia, out of 1000 pregnancies, 102 are pregnancies of adolescents from 12 to 17 years old. At the same time, few people “make it to the point of childbirth”: approximately 70% have an abortion, 14% lose a child through miscarriage. The majority—almost 70%—of pregnant teen girls are unmarried.

It is often the parents who initiate the abortion of a pregnant teenage daughter. Shocked by their daughter’s confession, the parents bring their daughter to the clinic almost by force. But, having quickly solved, as it seems to them, an immediate problem and eliminated the “shame of the family,” parents do not take into account the long-term problem: according to statistics, up to 70% of girls who have an abortion at a young age are then unable to get pregnant. And this means there will be no grandchildren.

What to do if an unwanted event has already happened? How can a teenage girl tell her parents about him? How can parents survive the legitimate shock and act based not on emotions, and not on the short-term, but on the genuine, long-term interests of their daughter and the entire family?

How to tell and how to accept

According to a psychologist at the Office of Crisis Situations for Pregnant Women Yulia Mytnitskaya, The first and most important thing in this situation for a girl is to accept her pregnancy as a fact and tell her parents about it. It happens that, struck by such news, a girl falls into a stupor, hides from everyone, and then suddenly, for quite some time, begins to act radically, trying to “get rid of the problem” on her own, having read on the Internet or heard enough from her friends. This can be not only harmful, but deadly.

If a girl is afraid to tell her parents about everything, she can call a crisis center for pregnant women, which exists in many cities today. The center’s specialists will help her get her bearings and tell her, literally word by word, how to say “that” in her father’s house.

After a girl tells her parents about pregnancy, task No. 1 for her and her family is to try to understand each other’s feelings. Parents need to see behind their daughter’s “misdemeanor” her pain and fear. Indeed, although the reasons that lead to pregnancy of a teenage girl may be different (a girl can become a victim of sexual violence in the family or outside it, and there are also cases when teenage girls specifically become pregnant, considering this an “initiation” into adulthood) , in most cases, finding out that you are pregnant at 13-14 years old is a huge stress. And the main thing for a pregnant girl is not to lose support, protection of her family, and not to lose contact with her parents. She can behave impudently, defiantly, or whatever she wants, but in her heart she is waiting for help.

But it is also important for a girl to understand that telling her parents about her pregnancy is no less stressful. For parents, this news poses a lot of problems, material and moral, which they, as adults, will have to solve. However, a considerable part of the responsibility for what happened to their daughter lies with the parents. According to psychologists, lack of contact with the mother is considered the main reason for the daughter’s early pregnancy. Often no one told the girl what was happening to her body at 13-14 years old, what new opportunities and risks appeared. She is defenseless in the face of her growing up, does not know about the intricacies of communication with the opposite sex, responsibility and consequences.

It is important to analyze your relationship with your child and try to protect him from irreparable decisions: succumbing to despair, a pregnant girl can run away from home or commit suicide.

Often the initiators of an abortion of a teenage girl are her parents. But according to statistics, up to 70% of girls who have an abortion at a young age then cannot get pregnant. And this means there will be no grandchildren

The whole family can participate in making decisions about the future child: parents and the future father have voting rights. But the final decision must be made by the pregnant girl. And it is important for her older loved ones to remember that early motherhood is better than late regrets about its absence.

Dad under 16

You should not push the topic of the wedding of your daughter and the child’s father against their will. Conflicts in a couple will not have a positive effect on either the course of pregnancy or the upbringing of the child.

If the future father is also a minor, his parents should find out about the fact of pregnancy. Even if their son is not ready for fatherhood, perhaps they themselves can help and support the mother of their future grandson. If the young father is ready to start a family, then meeting the parents is simply necessary.

If a minor father of a child raises the question of his paternity, he has the right to do so. But it’s not difficult to solve this issue today - there is a paternity test. A minor mother, regardless of age, can submit a joint application with the child’s father to establish paternity to the registry office. Here, even the consent of the girl’s parents (or her guardian) is not necessary. If the young father refuses to submit such an application, then the girl can go to court and demand paternity be established. The only condition: she must be 14 years old. Until this age, such a claim can be brought by her parents or guardian.

If the young mother is a schoolgirl

It is advisable for parents to organize the young mother’s day so that she has time to care for the child, relax and have the opportunity to continue her studies.

If the mother is studying at school, it is better to interrupt her studies for a while or switch to home schooling than to expose the girl to constant additional stress. And for others, especially students, it is wrong to constantly see a pregnant classmate. After all, this is not the norm for a girl to become pregnant at 13-15 years old.

Forms of support

Courses for pregnant women. Photo: Deacon Andrey Radkevich

You can offer your daughter a partner birth (when someone close to you is present during the birth). This is especially important if the baby's father is not involved in the pregnant woman's life. The birth partner can be a mother or an older friend who has given birth - the choice depends on the girl herself. But don't insist on this.

Courses for pregnant women can be a big help for a girl. At them she will not only learn about the psychophysiology of pregnancy, childbirth, and child care, but will also be in an environment of “like-minded people,” people with similar interests. Such an environment for a girl under stress can become positive. The courses include psychologists who can tell you about the specifics of your situation and get advice.

It is important for the parents of a teenage girl not only to take on part of the worries about her, but also to help their daughter grow up

Every woman initially has a maternal instinct. And if the pregnancy occurred before his awakening, it is necessary to awaken him using various options: courses in preparation for childbirth, communication with mothers who are in a state of desired pregnancy or have babies, going to children's stores with vests and rattles.

And very important: it is important for the parents of a teenage girl not only to take on part of the worries about her, but also to help their daughter grow up, analyze mistakes, learn to overcome difficulties and make independent decisions.

What if you were kicked out of your home?

Sometimes parents, outraged by their daughter’s pregnancy and her refusal to have an abortion, simply drive her out of the house. In this case, the expectant mother has several options.

If she is registered in her parents’ apartment, then by law no one has the right to kick her out. Therefore, in this case, you can safely go to the local police officer or call the police - the competent authorities will quickly cool the hot heads of the parents. Guardianship authorities that protect the rights of minors may also be interested in this situation. This is a legal way to return to the apartment.

You can give your parents time to calm down and come to their senses. Most likely, they will very quickly regret their hasty decision and will do their best to look for their expelled daughter. In the meantime, you can go to relatives or friends with whom you can “stay” for a while. There is absolutely no need to tell them about your pregnancy. The main thing is not to turn off the phone in the heat of despair so that parents can call and call back.

Teenage pregnancy is a major social and economic problem in most countries of the world. According to the United Nations Population Fund, every year more than 7 million adolescents in the world experience pregnancy ending in childbirth.

When working with pregnant minors, practicing obstetricians and gynecologists are often faced with not only medical, but also social and legal aspects of teenage pregnancy. Despite the fairly high prevalence of teenage pregnancy in modern society, obstetricians and gynecologists, especially primary care providers, often do not have sufficient knowledge in this matter and make mistakes that entail both a violation of the rights of pregnant teenagers themselves and problems with authorities and law enforcement. problems arising at a medical institution due to non-compliance with the legislation of the Russian Federation in the field of protecting the rights of minors.

Considering the above, familiarization of the general obstetric community with the legal framework of working with pregnant adolescents seems extremely important.

Every woman, regardless of age, has the right to independently decide the issue of motherhood. Despite the availability and accessibility of modern contraceptive methods, artificial termination of pregnancy remains a common method of family planning in Russia.

A necessary precondition for performing an abortion operation is the woman's informed voluntary consent, based on information about her state of health, the duration of pregnancy, the possible consequences of its termination, etc., provided by medical workers. It should be noted that currently the only social indication for artificial termination of pregnancy is pregnancy resulting from rape, that is, a crime provided for in Article 131 of the Criminal Code of the Russian Federation (Criminal Code of the Russian Federation), in accordance with paragraph 1 of the Decree of the Government of the Russian Federation of 02/06/2012. No. 98 “On social indications for artificial termination of pregnancy”, the minor age of a pregnant woman is currently not a social indication for termination of pregnancy. Artificial termination of pregnancy for social reasons is carried out up to 22 weeks
pregnancy.

In accordance with the Order of the Ministry of Health and Social Development of the Russian Federation dated December 3, 2007 No. 736 “On approval of the list of medical indications for artificial termination of pregnancy” (with amendments and additions), the medical indication for artificial termination of pregnancy is the state of physiological immaturity of the pregnant woman before reaching age 15 years. In this case, artificial termination of pregnancy is carried out before 22 weeks of pregnancy. In more than 22 weeks of pregnancy, the issue of termination of pregnancy for these indications is decided individually by a council of doctors.

The degree of independence in the decision to have an abortion depends on the age of the pregnant minor, which is determined by Article 54 of the Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation.” To carry out this operation in relation to a minor who has not reached the full age of 15, it is necessary to obtain the consent of her legal representatives (parents or persons replacing them: guardians, trustees, representatives of child care institutions) after providing them with all the necessary information. A pregnant minor under 15 years of age will be required to continue the pregnancy even against her will, unless her legal representatives consent to an artificial termination of the pregnancy. There are situations in life when, for medical reasons, there is a need to terminate a pregnancy, despite the desire to keep the child. If the pregnant woman herself or her legal representatives refuse medical intervention, the pregnant minor (and if she has not reached the full 15 years of age, also her legal representatives) must be explained in an accessible form the possible adverse consequences associated with refusal to terminate the pregnancy, the risk to life and health. Refusal of medical intervention in this case is documented in the medical documentation indicating the possible consequences and signed by the minor (who has reached the age of 15), or her legal representative, as well as a medical professional. In the absence of legal representatives, in pursuance of Article 20 of the Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”, the decision on the need for emergency medical intervention is made by a council of doctors, and if it is impossible to assemble a council - the directly treating (duty) doctor, who is obliged to subsequently notify officials of the medical institution and legal representatives about this. It also happens that the legal representatives of a pregnant minor insist on carrying out an operation to terminate the pregnancy against her wishes. In this situation, the constitutional principle of physical integrity of the individual, prescribed in Article 22 of the Constitution of the Russian Federation, comes into force; in accordance with it, any person has the right to make independent decisions regarding actions in relation to his body.
Based on the general meaning of the legislation of the Russian Federation, the consent of legal representatives to artificially terminate a pregnancy, against her will, may be the basis for compulsory surgical intervention only in cases where it is necessary to save the life of the minor pregnant woman herself. A minor aged 15 years or older decides on the issue of termination of pregnancy quite independently on a general basis.

It is very important to note that in all cases when a pregnant minor applies to a medical organization, information about her must be transferred to the police department at the place of registration in accordance with Article 9 of the Federal Law of the Russian Federation of June 24, 1999 No. 120-FZ “On the fundamentals of the system for the prevention of neglect and juvenile delinquency." It must be remembered that sexual intercourse and other acts of a sexual nature committed by a person who has reached the age of eighteen with a person known to be under the age of sixteen, as well as indecent acts against a person known to be under the age of sixteen, fall under Articles 134-135 of the Criminal Code RF. Therefore, despite the contradictions that arise, if necessary, automatically inform the police when a pregnant minor contacts the provisions of Article 13 of the Federal Law of the Russian Federation of November 21, 2011 No. 323-FZ
“On the basics of protecting the health of citizens in the Russian Federation”, a medical institution is obliged to transmit information
about a pregnant minor admitted, and, in controversial cases, the courts almost always recognize the obligation of the medical institution to transfer this information to the police, contrary to the provisions on maintaining medical secrecy.

Obstetrician-gynecologists and neonatologists of maternity hospitals often have to deal with issues of family law. The rights and responsibilities of parents arise as a result of establishing the origin of their child. At the same time, an entry about the parents is made in the birth certificate issued by the civil registry office. Regardless of the age of the baby’s mother, an entry is made on the child’s birth certificate certifying the fact of her motherhood. According to Article 48 of the Family Code of the Russian Federation (FC RF), an entry about the father (including a minor) is entered into the birth certificate on the basis of a joint application to the civil registry office made by the father and mother. There are no age restrictions in this regard, and the consent of the legal representatives of minors is not required. If voluntary establishment of paternity cannot be carried out for some reason, the minor mother has the right to file a claim in court to establish paternity. In this case, minor parents who have reached the age of 14 can act as plaintiffs in court. If a minor parent is under 14 years of age, the plaintiffs in paternity cases are his parents. According to Article 62 of the RF IC, paternity can be established in relation to a minor, but only if he is already 14 years old. Recognition of paternity brings benefits for the child, which include rights to alimony, inheritance, social benefits and the right to support from the father, which guarantees social protection for the child. Interest
and the support of the father - whether married to the mother or not - is of great importance for the development of the child.

Also, according to Article 62 of the Family Code of the Russian Federation (FC RF), regardless of age, minor parents have the right to live together with their child and participate in his upbringing. The UN Convention on the Rights of the Child (Article 9), valid for Russia, speaks of the inadmissibility of separating a child from his parents against the wishes of the latter, unless this is caused by the need to protect the rights and interests of the child. The scope of the rights of minor parents in relation to their child and other rights associated with them depends, firstly, on the age of the parents and, secondly, on whether they are married to each other. From the time of marriage, minor citizens are recognized as fully capable, and minor parents of any age, if married, exercise parental rights independently. According to Article 13 of the RF IC, if there are good reasons, local government bodies at the place of residence of minors who wish to get married have the right to allow them to get married if they have reached the age of 16. It is worth noting that the subjects of the Russian Federation have the right to independently establish the procedure and conditions under which marriage may be permitted for persons under 16 years of age, for example, Law of the Moscow Region dated May 29, 1996 No. 17/96-OZ “On the procedure and conditions for marriage in the territory of the Moscow region of persons under the age of sixteen" allows marriage under special circumstances (pregnancy, the birth of a child for persons wishing to marry, an immediate threat to the life of one of the parties) from the age of 14.

If the marriage between minor parents is not registered, and, accordingly, the minor parents are not fully capable, Article 62 of the RF IC determines the age criteria for their independence in the exercise of parental rights. Minor parents have the right to independently exercise their parental rights when they reach the age of 16, and until that time, a newly born child may be assigned a guardian (usually the legal representative of one of the minor parents), who will raise them together with the minor parents. The meaning of establishing guardianship is that, due to incompleteness or lack of legal capacity, a minor parent is not able to protect the rights and interests of his child without the help of adults.

It should be noted that according to Article 35 of Part 1 of the Civil Code of the Russian Federation (Civil Code of the Russian Federation), a person can be appointed as a guardian only with his consent. If, for one reason or another, it is impossible to satisfy the request of a person applying for the role of a guardian to appoint him as such, and also in the absence of applicants, according to Article 123 of the RF IC, the protection of the rights and interests of the child of minor parents is entrusted to the guardianship and trusteeship authorities. Disagreements arising between minor parents and the child’s guardian are resolved by the guardianship and trusteeship authorities, which in such cases make recommendations that are binding. When a minor parent reaches 16 years of age, he gains full independence in the exercise of parental rights, and guardianship over his child is terminated automatically, unless the minor parent for some reason does not care about his child. Then the guardianship remains, but its basis changes.

One of the most important points is the fact that, according to Article 26 of Part 1 of the Civil Code of the Russian Federation, minors aged 14 to 18 years have the right to independently, without the consent of a legal representative, dispose of their earnings, scholarships and other income. Consequently, minor parents of the specified age may be assigned the benefits due to them as citizens with children, and they have the right to independently dispose of these benefits.

A separate problem that maternity hospitals face is the refusal of a minor woman in labor to abandon her child and leave him in the maternity hospital. Russian legislation does not provide for any age restrictions for making this kind of decision. It should be noted that minor parents who are unable to raise their child for some reason, as well as single mothers (fathers), can apply to have their child admitted to the Orphanage for a time. With such a temporary placement of children with parents in the Orphanage, an agreement is drawn up on the duration of the child’s stay there. The agreement also stipulates the participation of parents in the care and upbringing of the child.

If the child is abandoned and the child is left in the maternity hospital, the minor mother is deprived of parental rights in court. Deprivation of parental rights to a minor mother does not prevent the child's father, including a minor, from taking him up. In the event of a situation of child abandonment, in accordance with Article 122 of the RF IC, the management of the medical organization where the birth took place transmits information to the guardianship and trusteeship authorities at the actual location of the child.

To adopt a child, according to Article 129 of the RF IC, the consent of his parents is required. The latter then lose parental rights in relation to their child. According to the same article 129 of the RF IC, when adopting a child of minor parents under the age of 16, the consent of their legal representatives or the guardianship authority is also required. If the legal representatives refuse to give consent to the adoption of the child, it cannot be carried out even with the consent of the minor parent. At the same time, the consent of legal representatives cannot replace the consent of a minor parent. Minor parents independently consent to the adoption of their child by other persons only if they are married to each other.

It is necessary to recall that having become pregnant and becoming parents, having acquired additional rights and responsibilities, adolescents retain all the rights granted by law to minor children. Obstetrician-gynecologists, who in everyday practice are faced with this complex category of patients, not only from a medical, but also from a socio-legal point of view, behind whom there are numerous regulatory authorities of the state, must be extremely careful in complying with the current regulatory legal acts of Russian legislation, so that not to violate the rights of minor pregnant and postpartum women and thereby not to create, at times, very serious problems that can only be resolved in court, problems for your medical institution, and for this you need to know very well the social and legal features of pregnancy and childbirth in minors.