Bir Eğitim ve Araştırma Hastanesine Başvuran Adölesan Gebelerin Tıbbi, Sosyal ve Hukuki Açıdan İncelenmesi

Öz

Amaç: Adölesan gebelikler ülkemizde ve dünyada önemli bir halk sağlığı sorunu olarak karşımıza çıkmaktadır. Bu gebeliklerin önlenebilmesi için her ülke kendi iç politikalarını düzenlemiştir. Ülkemizde de evlilik ve cinsel ilişki yaş sınırları kanunla belirlenmiştir. Bu çalışmada Ocak 2018 – Ağustos 2020 tarihleri arasında Çiğli Eğitim ve Araştırma Hastanesi’ne başvuran, yapılan muayene ve tetkikler sonucunda gebe olduğu belirlenen 18 yaş altı olguların incelenerek, elde edilen verilerin literatürle tartışılması amaçlanmıştır.
Materyal ve Metot: Çalışma kapsamına alınan 18 yaş altı 260 gebe olguya ait tıbbi kayıtlar Hastane Bilgi Yönetim Sistemi üzerinden incelenmiştir. Veriler SPSS programı (versiyon 22.0) ile analiz edilmiştir. Analiz için Fisher Exact ve Pearson ki-kare testleri kullanılmıştır.
Bulgular: Adölesan gebelerin ilk hastane başvurusuna yaşları 13-17 arasında değişmekte olup ortalaması 16,4±0,7 olarak hesaplanmıştır. Medeni durum bilgisine ulaşılan 39 olgudan 31’inin (%79,4) resmi nikâhlı, 4 olgunun (%10,3) ise bekâr olduğu görülmüştür. Adölesanların gebe olduklarının belirlendiği ilk başvurularında gebelik haftaları 3 ila 41 hafta arasında değişmekte olup, 142 olgunun (%54,6) gebeliğinin üçüncü trimesterde olduğu tespit edilmiştir.
Sonuç: Eğitim kurumlarında cinsel sağlık derslerinin yaygınlaştırılması, sağlık kurumlarında adölesan gebeliklerin zararları konusunda hizmet veren polikliniklerin oluşturulması, adölesan gebeliğin kişi ve toplum sağlığı üzerine olumsuz etkilerinin ve ayrıca bir suç teşkil edebileceği gibi hukuki sonuçlarının topluma yeterince duyurulmasının faydalı olacağını düşünmekteyiz.

Anahtar Kelimeler

• Adölesan
• Adölesan gebelik
• Tıbbi
• sosyal ve hukuki inceleme

Medical, Social and Legal Evaluation of Adolescent Pregnancies, who Applied to a Training and Research Hospital

Öz

Aim: Adolescent pregnancies emerge as an important public health problem in our country and in the world. Each country has arranged its own internal policies in order to prevent these pregnancies. In our country, age limits for marriage and sexual intercourse are regulated by law. In this study, it was aimed to evaluate the cases less than age of 18 who applied to Çiğli Training and Research Hospital between January 2018 and August 2020 and were determined to be pregnant as a result of the examinations and tests, and to discuss the obtained data with the literature.
Material and Method: Medical records of 260 pregnant cases less than 18 years of age included in the study were analyzed through the Hospital Information Management System. The data were analyzed with the SPSS program (version 22.0). Fisher Exact and Pearson chi-square tests were used for analysis.
Results: The ages of adolescent pregnant women at their first hospital admission ranged between 13-17 and their average was calculated as 16.4±0.7. It was observed that 31 (79.4%) of the 39 cases whose marital status information was obtained were officially married, and 4 cases (10.3%) were single. Gestational weeks ranged from 3 to 41 weeks when adolescents were determined to be pregnant, and it was found that the pregnancy of 142 cases (54.6%) was in the third trimester.
Conclusion: We think that it will be beneficial to disseminate sexual health courses in educational institutions, establish polyclinics that provide service on the harms of adolescent pregnancies in health institutions, and to adequately announce the negative effects of adolescent pregnancy on individual and public health, as well as its legal consequences.

Anahtar Kelimeler

• Adolescent
• Adolescent pregnancies
• Medical
• social and legal evaluation

Kaynakça

1. Keskin U, Kıncı MF. Adolescence period and pregnancies. Aydoğan Ü, Editor. Adolescent Health and Problems - I. Ankara: Turkish Clinics. 2018:33-8.
2. Şolt A, Yazıcı S. Adolescent pregnancies. HSP 2015;2(2):241-248 doi:10.17681/hsp.3663
3. Kulhan M, Naykı ÜA, Naykı C, et al. Adolescent pregnancies in Erzincan province (Retrospective results of a single center). The Journal of Tepecik Education and Research Hospital 2016;26(3):215-220 doi:10.5222/terh.2016.215
4. Anık Y, Ege E. Nursing approach in early marriages and adolescent pregnancies. Çelebioğlu A, Editor. Adolescent Health and Nursing Approaches. First edition. Ankara: Turkish Clinics. 2019:46-55.
5. World Health Organization (WHO) https://www.who.int/ Access Date: 07.12.2020
6. Yılmaz E, Yılmaz Z, Yazıcı Işıtan Ö, et al. Obstetric and perinatal outcome of adolescent pregnant women who delivered in a training & research hospital. The Journal of Gynecology - Obstetrics and Neonatology 2015;12(6):213-216.
7. Nkhoma DE, Lin CP, Katengeza HL, et al. Girls’ empowerment and adolescent pregnancy: A systematic review. Int J Environ Res Public Health 2020;17:1-14 doi:10.3390/ijerph17051664
8. Finer LB, Zolna MR. Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception 2011;84(5):478-85.

9. Martin, JA. Births: Final Data for 2015. National vital statistics reports: from the centers for disease control and prevention, national center for health statistics. National Vital Statistics System 2017;66(1):1.
10. McIntyre P. Pregnant adolescents delivering on global promises of hope. Geneva, WHO Library Cataloguing-in-Publication Data 2006;4-7.
11. Türkiye Nüfus ve Sağlık Araştırmaları (TNSA). Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü Ankara, Türkiye, 2018. http://www.hips.hacettepe.edu.tr/tnsa2018/rapor/TNSA2018_ana_Rapor.pdf Access Date: 07.12.2020
12. Türkiye İstatistik Kurumu (TÜİK) https://www.tuik.gov.tr/ Access Date: 07.12.2020
13. Başer M. Adölesan cinselliği ve gebelik. Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi 2000;4(1):50-4.
14. Güzel AI, Tokmak A, Ustun YE. Adölesan Gebelikler. Jinekoloji-Obstetrik ve Neonatoloji Tıp Dergisi 2016;13(1).
15. Keskin Kurt R, Karateke A, Aras Z, et al. Maternal and fetal outcomes of adolescent pregnancies in hatay province. ODU Journal of Medicine 2014:e68-e71
16. Ayyıldız T, Topan A, Öztürk Ö, et al. Evaluation of adolescent pregnancies in terms of obstetric outcomes for the mother and the newborn. DEUHFED 2015;8(2):61-66.
17. Akdemir N, Bilir F, Cevrioğlu AS, et al. Investigation of obstetric outcomes of adolescent pregnancies in Sakarya region. Sakaryamj 2014;4(1):18-21 doi:10.5505/sakaryamj.2013.31644
18. İleri A, İleri H, Ata Can. Comparison of maternal and fetal outcomes in adolescent pregnancies. Bozok Med J 2020;10(1):24-9.
19. Yurtçu E, Mutlu S, Çitil A. Comparison of perinatal outcomes between adolescent and adult pregnancies: A retrospective study. Osmangazi Journal of Medicine 2020 Doi: 10.20515/otd.681440
20. Yıldızhan R, Kolusarı A, Edirne T. Analysis of adolescent pregnancies in van region. Van Medical Journal 2009;16(4):124-7.
21. Songur Dağlı S, Karbancıoğlu Cantürk F. Adolescent pregnancies. Bozok Med J 2019;9(1):9-13.
22. İnalöz EY, İngeç M, Topdağı Yılmaz EP. Evaluation of the effects of adolescent pregnancies on maternal and perinatal outcomes in our region. Mustafa Kemal Üniv Tıp Derg 2017;8(30):6-14 Doi: 10.17944/mkutfd.323227
23. Ellibeş Kaya A, Başbuğ A, Sönmez CI. et al. Late adolescent pregnancies, maternal and fetal outcomes. Fam Pract Palliat Care 2017;2(3):22-7 doi: 10.22391/920.327993
24. Melekoğlu R, Evrüke C, Kafadar T, et al. Perinatal outcomes of adolescent pregnancy. J Turk Soc Obstet Gynecol 2013;10:213-9.
25. Zhang T, Wang H, Wang X, et al. The adverse maternal and perinatal outcomes of adolescent pregnancy: A cross sectional study in Hebei. China Pregnancy and Childbirth 2020;20:339. https://doi.org/10.1186/s12884-020-03022-7
26. Türk Medeni Kanunu (TMK) https://www.mevzuat.gov.tr/MevzuatMetin/1.5.4721.pdf Access Date: 07.12.2020
27. Akıntürk T, Karaman DA. Marriage. Civil Law. Beta edition, İstanbul, 2012;236-44.
28. Türk Ceza Kanunu (TCK) https://www.mevzuat.gov.tr/MevzuatMetin/1.5.5237.pdf Access Date: 07.12.2020
29. Balcı RE, İncedal Sonkaya Z, Göçer Ş. Adolescent and non-adolescent pregnant women. East J Med 2020;25(1):19-25 doi: 10.5505/ejm.2020.43265
30. Causey AL, Seago K, Wahl NG, et al. Pregnant adolescents in the emergency department: Diagnosed and not diagnosed. The American Journal of Emergency Medicine 1997;15(2):125-9.
31. Lindahl V, Pearson JL, Colpe L. Prevalence of suicidality during pregnancy and the postpartum. Archives of Women’s Mental Health 2005;8(2):77-87.
32. Kütük S. Pregnancy in adolescents, risks and problems. TAHUD 2012;16(Suppl):31-4 doi:10.2399/tahd.12.s031
33. Öner S, Yapıcı G. Overview of adolescent pregnancies. Turk J Public Health 2010;8(1):30-9.
34. World Health Organization. Early marriages, adolescent and young pregnancies: Report by the Secretariat. WHO, Sixty-Fifth World Health Assembly. Geneva, 2012.
35. Marvin-Dowle K, Soltani H. A comparison of neonatal outcomes between adolescent and adult mothers in developed countries: A systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology: X 6 2020;1-13 100109. doi:10.1016/j.eurox.2020.100109