Psychosocial factors influencing teenage sexual activity, use of contraception and unplanned pregnancy

Objective: to compare teenagers who become unintentionally pregnant and teenagers who have never been pregnant but are using contraception on matters related to family/partner stability, and communication with a parent or stable sexual partner about sexual matters.Design: survey utilising self-completed questionnaire.Setting: a hospital antenatal clinic and community-based family planning clinic.Participants: 30 teenagers with an unplanned pregnancy and 31 ‘never-pregnant’ teenagers using contraception.Findings: the two groups were similar on demographic factors, mean age at which sexual intercourse was first experienced, total number of sexual partnerships, the number of teenagers having a current, regular boyfriend and mean length of the interval between when the teenagers first started going out with their boyfriend and when first sexual intercourse took place. Teenagers in the family planning clinic group were more likely to be living with both natural parents and to be still at school or in higher education. The mean length of time pregnant teenagers had been going out with their boyfriend was longer, they were more likely to be cohabiting with him and to be unemployed. Participants from the antenatal clinic group communicated more with their mothers about sexual matters than those in the family planning clinic group, who were more likely to seek this information from books. The family planning clinic participants were more likely to discuss personal rules and values with friends than those in the antenatal clinic group.Implications for practice: to develop understanding of factors predisposing to unplanned pregnancy during adolescence and to implement measures to counter them, further studies to examine the influence of teenagers' perceptions of family relationships and future life prospects on contraception use and unplanned pregnancy were identified.     

A comparison of prostaglandin E2 pessaries and laminaria tents for ripening the cervix before termination of pregnancy

Summary. Forty primigravid womcn aged 15–45 years were randomly allocated to receive either an intravaginal pessary of 3 mg prostaglandin E, (PGE₂) or an intracervical 5-mm laminaria tent (LT) 12–16 h before termination of pregnancy at 6–14 weeks gestation. The degree of dilatation of the cervix a t operation and its resistance t o further dilatation during the procedure were assessed by a 'blind' operator. Laminaria tents were more effective in achieving dilatation and softening of the cervix than were PGE₂ pessaries and in 40% of women no further dilatation was necessary. There were no associated side-effects or complications. A cervical tear occurred in two of 20 patients treated with PGE₂ pessaries and all 20 required further dilatation of the cervix. Laminaria tents provide a simple. safe, acceptable and effective means of 'ripening' the cervix prior to termination of early pregnancy.     

Urinary oestrogen levels and follicle ultrasound measurements in clomiphene induced cycles with an endogenous luteinizing hormone surge

Summary. Total oestrogen in urine and the ultrasonic size of the follicles were measured in relation to the onset of the endogenous luteinizing hormone (LH) surge (day 0) in 18 cycles induced with clomiphene citrate in an in-vitro fertilization programme. Oestrogen values in urine (μg/24 h) increased progressively during the late follicular phase up to the day of the onset of the surge. The mean maximum follicle diameter (22·3, SD 4·7 mm) estimated by ultrasound was measured on day 0. At the onset of the LH surge, the values of urinary total oestrogen showed a better relation with the total volume of the first three follicles in order estimated by ultrasound ( r = 0·71) than with the mean ultrasonic diameter of the leading follicle ( r = 0·56). A wide range of individual values for both urinary oestrogen and follicle size was found. In another group of 32 women treated with clomiphene for recovery of oocytes used for research purposes, a good correlation was found between the mean ultrasonic follicle diameter 16 h before the laparoscopy and the follicle diameter calculated from the fluid volume at aspiration ( r = 0·80). These results suggest that the decision when to give human chorionic gonadotrophin (hCG) in an in-vitro fertilization programme remains arbitrary in many individual cases. Apart from the oestrogen levels, the calculation of the size of all follicles, instead of only the leading one, may give further help in timing the hCG.