To evaluate the incidence and follow-up of pregnancy among adolescents with rheumatic fever (RF) attended at the authors' service.
A retrospective evaluation was undertaken of 510 patients with a diagnosis of RF according to records from 1983 to 2001.
We evaluated 510 patients, 123 (43%) were female adolescents. Sixteen (13%) patients became pregnant during this period, with a total of 19 gestations (one presented two gestations and another three); 14 realized the prenatal care appropriately. Age of the first gestation ranged from 14 to 19 years (mean 16.7); and age at the beginning of sexual activity ranged from 13 to 18 years (mean 15.2). Mitral insufficiency occurred in 15 cases associated with aortic insufficiency in 5. Intercurrent disease during prenatal care was observed in two patients: in one there was recurrence of RF with chorea and in the other HIV infection. Vaginal delivery occurred in seven adolescents, forceps delivery in three and cesarean in four: one with HIV, one with twin pregnancy and two with functional dystocia. Thirteen newborn were adequate for gestational age and only the twins were premature. In the postpartum, one patient presented infection in the surgical incision and another had mammary abscess. No patient reactivated RF in childbirth or postpartum.
Pregnancies did not present cardiac decompensation, there was however predominance of mild valvulitis. Precocious sexual activity and greater incidence of pregnancy among adolescents are realities in the pediatric rheumatology clinics; consequently there is a need for improved orientation in relation to sexuality and use of birth-control methods in the routine of such services.