Adolescent pregnancy remains a health issue worldwide also in developed countries, since it has been associated with adverse maternal and neonatal outcomes. Some data suggest that very young adolescents have higher risk, likely due to immaturity. Therefore, we aimed to assess the influence of maternal age on complications during gestation and labor in pregnant women between 13 and 19 years of age. In particular, we evaluated the possible association between maternal age and obstetric, fetal and labor complications. This is a retrospective, observational and exploratory study conducted at Hospital Universitario La Paz (HULP, Madrid, Spain). The clinical history of 279 women who delivered between 2013 and 2018 was analyzed. Maternal age and the presence of maternal, fetal and labor complications, as well as risk of postpartum depression and breastfeeding intention, were recorded. General regression models were used to analyze the contribution of maternal age on each complication. The percentage of adolescent pregnancies at HULP between 2013 and 2018 was 0.9%. The risk of all the maternal complications analyzed decreased significantly with every year of age of the mother (hyperemesis, lower back pain, anemia, gestational diabetes mellitus, and threat of premature labor and premature rupture of membranes). Every year of maternal age decreased 0.8-fold [0.8; 0.9] the prevalence of fetal complications and also reduced the risk of C-section, postpartum hemorrhage and obstetrical hysterectomy. Furthermore, higher maternal age increased 1.1-fold [1.0; 1.2] the breastfeeding intention. In conclusion, young adolescents are at higher risk of complications during pregnancy and labor.
and OR 0.785, 95% CI 0.670-0.920, p=0.003) (figure 1). Furthermore, in the group of obese patients, in 25 cases (7.4%) the SLN dissection did not lead to the identification of lymphnode tissue at final histopathological examination ('empty packet dissection') (Group1 vs Group 2: 3.9% vs 7.4%, p=0.046) (table 1). Conclusion* Controlling for the variables that have been proved to negatively influence the SLN detection rate, BMI was confirmed as a statistically relevant predictor of mapping failure. In addition, obese women had a significantly higher odds of empty packet dissection, which could lead to an unintended surgical understaging.
SLNs were processed with an ultrastaging technique. Between 26 June 2014 and 31 December 2019 with 333 patients we applied the previous treatment algorithms. Between January and 30 August 2021 we did only SNL in 45 patients. Result(s)* Comparation of the results between the ancient and the new serie (ancient/new): Detection rate 94%/97.7% overall for SLNs; 91.3%/97.7% overall for pelvic SLNs; 70.5%/88.8% for bilateral SLNs; 68.1%/88.8% for paraaortic SLNs, and 2.9%/0% for isolated paraaortic SLNs. Macrometastasis 18%/6% patients and microdisease 17.6%/ 8.8% patients, overall rate of LN involvement 16.2%/11%. Isolated Aortic metastases 4.2%/2.2% (14/333-1/45). Assuming the results of the ancient serie there was one false/negative (negative SLN with positive lymphadenectomy). Our sensitivity of detection was 98.3% (95% CI 91-99.7), specificity 100% (95% CI 98.5-100), negative predictive value 99.6% (95% CI 97.8-99.9), and positive predictive value 100% (95% CI 93.8-100). Conclusion* SLN biopsy is an acceptable alternative to systematic lymphadenectomy for LN staging in stage I/II. We avoid 22/45 (48.8%) lymphadenectomies with new algorithm, reducing the morbidity in our patients. Our surgical times were shorter improving our theaters efficiency with all that implies for. Additionally, this technique allows a high rate of aortic detection, identifying a non-negligible percentage of isolated aortic metastases. Isolated Aortic metastases in endometrial cancer are possible and we should not give up actively looking for them.
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