COMPARISON OF CLINICOPATHOLOGICAL PARAMETERS WITH HISTOLOGICAL AND MOLECULAR CLASSIFICATION OF BREAST CANCERS

2021 ◽  
pp. 144-149
Author(s):  
K. Indumathi ◽  
E. Theranirajan ◽  
G. Bhavani
Keyword(s):  
Retrospective Study ◽  
Targeted Therapy ◽  
Tertiary Care ◽  
Radical Mastectomy ◽  
Immunohistochemical Method ◽  
Proliferation Index ◽  
Clinicopathological Parameters ◽  
P Value ◽  
Luminal B ◽  
Classi Cation

BACKGROUND: This is a retrospective study of 60 cases, to detect the expression of ER, PR, HER2neu, CK5/6 and Ki67 proliferation index in breast carcinomas by immunohistochemical method and to determine the newer molecular classication. Few patients have recurrence inspite of being diagnosed under the category of low risk and few do well in the high risk group which can be attributed to the molecular level differentiation. AIM: The aim of this study is to categorize the patients under molecular classication, and to compare the clinicopathological parameters with it and to denote the signicance of targeted therapy. MATERIALS AND METHODS: A retrospective study of detecting the expression of the above said markers in modied radical mastectomy specimens received at a tertiary care centre during the period from January 2015 to June 2018. A total of 60 cases which included 30 of IDC NST and 30 cases of special variants were selected for immunohistochemical analysis. RESULTS: Out of the 60 cases studied, the most common was found to be the luminal A type comprising 37% and the least common was the luminal B and hybrid types each comprising 8%. The most common grade for HER2 was Grade III (50%). The association of histological grade with the molecular classication was statistically signicant with the p value of 0.01. Basal type (56%) had the highest incidence of N3 stage. ER, PR, HER2 neu, CK5/6 expression and proliferation index with Ki67 had a statistically signicant association with the molecular classication. High proliferation index (>14%) with Ki67 was noted in Luminal B, Basal and Hybrid types. 78% of the total 60 cases were alive and healthy. One death was reported in HER2, Hybrid and Basal types. The negative kappa value obtained while studying the agreement between the histopathological and molecular classication, indicates that the agreement is worse than chance and hence the importance of molecular classication is substantiated for the targeted therapy.

scholarly journals Pediatric Inflammatory Bowel Disease Associated With Celiac Disease: A Retrospective Study in a Tertiary Care Hospital in Saudi Arabia

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110529
Author(s):  
Mamdouh Qadi ◽  
Mohammed Hasosah ◽  
Anas Alamoudi ◽  
Abdullah AlMansour ◽  
Mohammed Alghamdi ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Saudi Arabia ◽  
Celiac Disease ◽  
Retrospective Study ◽  
Bowel Disease ◽  
National Guard ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Inflammatory Bowel

Background. Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic relapsing disease indicated by inflammation of the gastrointestinal tract. Celiac disease (CeD) is a chronic autoimmune disease of the small bowel. The prevalence of CeD in IBD patients is unknown. Some studies have described the coexistence of the 2 diseases in the same patient. This study aimed to investigate the prevalence of CeD in Saudi Arabian children with IBD. Methods. We used a retrospective study design because data can be collected immediately and is easier to analyze afterward. The study was conducted on IBD patients in the Pediatric Gastroenterology Department at National Guard Hospital, Jeddah, Saudi Arabia. We enrolled Saudi patients aged between 1 and 18 years who had been diagnosed with IBD and CeD based on positive biochemical serology and histology from January 2011 to January 2020. We excluded patients with immunodeficiency disorders. Results. Among the 46 enrolled patients with IBD, CeD was identified in 4, and they did not develop any relapses. We discovered that the weight at IBD diagnosis improved significantly compared to current weight ( P-value < .0001). We also discovered that the height at diagnosis of IBD improved significantly compared to the current height ( P-value < .0001). Additionally, we found no significant associations between UC and CeD ( P-value = 1), or CD and CeD ( P-value = .625). Conclusion. No significant associations were evident between the prevalence of CeD and IBD. More prospective multicenter studies are needed to clarify the prevalence of CeD in children with IBD.

scholarly journals CMET-23. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi56-vi56
Author(s):  
Soumya Sagar ◽  
Adam Lauko ◽  
Addison Barnett ◽  
Wei (Auston) Wei ◽  
Samuel Chao ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Systemic Therapy ◽  
Checkpoint Inhibitors ◽  
Care Center ◽  
Performance Status ◽  
Tertiary Care ◽  
P Value ◽  
Surgical Removal

Abstract BACKGROUND Melanoma is the third most common malignancy that results in brain metastasis and is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS 351 patients, treated for MBM at our tertiary care center from 2000–2018, were grouped into: received chemotherapy, ICI, or targeted therapy. 34% of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patients who received ICI, chemotherapy and targeted therapy respectively. A multivariate model was developed including the type of systemic therapy, presence of extracranial metastases, age, KPS and number of intracranial lesions. 114 patients underwent SRS alone, 56 underwent SRS and WBRT, 43 underwent SRS and surgical removal, 28 had surgical removal, SRS and WBRT, and 78 had no intracranial therapy. Compared to patients who received chemotherapy, patients who received immunotherapy had a hazard ratio, HR = 0.628 (confidence interval = 0.396 – 0.994, p-value = 0.047). Presence of EC metastases (HR= 1.25, p-value < .001), lower KPS (HR = .97, p-value < .0001) and multiple brain lesions (HR = 1.117, p-value < .0001) were associated with significantly worse OS. CONCLUSIONS Addition of ICI significantly improves the OS in MBM compared to chemotherapy. Lower performance status, multiple brain metastases, and EC metastases are associated with poor OS.

A RETROSPECTIVE STUDY OF OBSTETRICAL OUTCOME IN ART AND SPONTANEOUS PREGNANCIES.

2019 ◽  
Vol 9 (9) ◽  
pp. 614-621
Author(s):  
Manisha Shrivastava*, Bhanwar Singh Meena
Keyword(s):  
Retrospective Study ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Health Concern ◽  
P Value ◽  
Chronic Hypertension ◽  
Care Hospital ◽  
Spontaneous Conception ◽  
Obstetrical Outcome ◽  
Dm Type 2

Background: Infertility tends to be one of the emerging health concern withtoday’s world .It is a common condition affecting approx 8-9% ofreproductive age group. Infertility diagnosis is divided into etiologies ofovulatory dysfunction, tubal endometriosis, and uterine, unexplained andmale factors. Certain type of infertility such as severe male factors andcomplete tubal obstruction will require ART.Objective:To study obstetrical outcome in pregnancy conceived with assistedreproductive techniques .Materials and Methods: A Retrospective study was done and data wascollected of patients, who have conceived through assisted reproductivetechniques admitted and delivered at tertiary care hospital from January2017 to June 2017.Results: They were anaemia 25(24.27%) and 17(16.19%) in ART andspontaneous conception respectively (p- value<0.147), hypothyroid40(38.83%) and 14(13.33%) in ART and spontaneous conception respectively(p- value<0.0001, highly significant), chronic hypertension 27(26.21%) and4(3.81%) in ART and spontaneous conception respectively (p- value<0.0001,highly significant), DM Type-2 10(9.71%) and 0(0.00%) in ART andspontaneous conception respectively (p- value<0.280, not significant). Studyalso showed that various obstetrical complications common in ART group.They were preterm birth, PIH, Polyhydramnios, Placenta previa, APH,Oligohydromnios, PPROM, GDM, Multiple pregnancies.Conclusion: There was a significant association between obstetricalcomplications with age. Maternal pre-existing disease like anaemia, chronichypertension, hypothyroidism and diabetes mellitus should be treated beforeconception, to improve maternal and perinatal outcome.Keywords: Assisted reproductive technology, SpontaneousConception,Pregnancy.

scholarly journals THER-02. IMPACT OF SYSTEMIC THERAPY IN MELANOMA BRAIN METASTASIS

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i11-i11
Author(s):  
Soumya Sagar ◽  
Adam Lauko ◽  
Addison Barnett ◽  
Wei Wei ◽  
Samuel Chao ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Systemic Therapy ◽  
Checkpoint Inhibitors ◽  
Care Center ◽  
Tertiary Care ◽  
P Value ◽  
Surgical Removal ◽  
Melanoma Brain Metastasis

Abstract BACKGROUND: Melanoma brain metastasis is associated with a median overall survival (OS) of approximately 9 months. In recent years, management of melanoma brain metastases (MBM) by surgery and radiation [stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT)] has been bolstered by targeted therapy and immune checkpoint inhibitors (ICI). METHODS: 351 patients, who underwent treatment for MBM at our tertiary care center from 2000 to 2018, were grouped into those that received chemotherapy, ICI, or targeted therapy. Thirty-four percent of patients treated with ICI had received other systemic therapies as well as part of their management. OS was calculated from the date of diagnosis of the brain metastases. The Kaplan Meier analysis was utilized to determine median OS and difference in OS was determined by utilizing the Cox proportional hazard model. RESULTS: The median survival after the diagnosis of brain metastasis was 10.4, 11.96, and 7.06 months in patients who received ICI, chemotherapy and targeted therapy respectively. A multivariate model was developed including the type of systemic therapy, presence of extracranial metastases, age, KPS and number of intracranial lesions. 114 patients underwent SRS alone, 56 underwent SRS and WBRT, 43 underwent SRS and surgical removal, 28 had surgical removal, SRS and WBRT, and 78 had no intracranial therapy. Compared to patients who received chemotherapy, patients who received immunotherapy had a hazard ratio, HR = 0.628 (confidence interval = 0.396 – 0.994, p-value = 0.047). Presence of EC metastases (HR= 1.25, p-value &lt; .001), lower KPS (HR = .97, p-value &lt; .0001) and multiple brain lesions (HR = 1.117, p-value &lt; .0001) were associated with significantly worse OS. CONCLUSIONS: Addition of ICI significantly improves the OS in MBM compared to chemotherapy. Lower performance status, multiple brain metastases, and EC metastases are associated with poor OS.

scholarly journals Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

2016 ◽  
Vol 8 ◽  
pp. 2016060 ◽  
Author(s):  
Mary Theresa Sylvia ◽  
Biswajit Dey ◽  
Debdatta Basu ◽  
Sajini Elizabeth Jacob ◽  
Rakhee Kar ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Hodgkin Lymphoma ◽  
Bone Marrow Involvement ◽  
Tertiary Care ◽  
Proliferation Index ◽  
Clinicopathological Parameters ◽  
Low Grade ◽  
Female Ratio ◽  
Non Hodgkin Lymphoma ◽  
Granulomatous Response

IntroductionFollicular lymphoma (FL) is an indolent chronic lymphoproliferative disorder of B-cells with variable clinical behaviour. It is the second most common subtype of Non-Hodgkin lymphoma in western countries but reported to have a lower incidence in Asia.Materials and methodsCases of FL diagnosed in the Department of Pathology of our Institute from January 2009 to June 2015 were included in the study. The clinicopathological parameters including staging, histological details and immunohistochemical markers CD20, CD10, Bcl2 and Ki67 were recorded in all the cases.ResultsOf the 497 cases of Non-Hodgkin Lymphoma reported during the study period, 36 (7.2%) cases were follicular lymphoma. The mean age was 50 years with male to female ratio of 3.2:1. Grade 1/ 2 was seen in 70% cases. 22 % cases had low grade with high proliferation index (Ki67 > 40%). Granulomatous response was seen in two cases. Diffuse large cell lymphoma component was present in four cases. Bone marrow involvement and peripheral blood spill was seen in 12 (37.5%) and six cases (18.8%) respectively. 72% cases were in stage 3 or 4.ConclusionIncidence of FL was lower in our study than other Indian studies. FL presented in the elderly, with male predominance and disseminated stage. Features of low grade with high proliferation index, granulomatous response, leukemic involvement and transformation to high grade lymphoma are highlighted in the study.

scholarly journals The modifications in surgical technique and its impact on short term morbidity in modified radical mastectomy: a tertiary care hospital experience

2019 ◽  
Vol 6 (12) ◽  
pp. 4354
Author(s):  
Arnab Bandyopadhyay ◽  
Rajnish Talwar ◽  
Amol Patel ◽  
Pradeep Jaiswal
Keyword(s):  
Pilot Study ◽  
Tertiary Care ◽  
Radical Mastectomy ◽  
P Value ◽  
Care Hospital ◽  
Flap Necrosis ◽  
Modified Radical Mastectomy ◽  
Tertiary Care Centre ◽  
Shoulder Dysfunction ◽  
Positive Effects

Background: Necrosis of flap margins, postoperative pain and shoulder dysfunction are amongst the main concerns of the breast surgeon performing modified radical mastectomy (MRM). This pilot study is aimed to evaluate the effects of these procedural modifications and whether should it be included as a standard practice.Methods: A total of 150 MRM patients are evaluated in this single arm cohort study in a tertiary care centre over a time period of 2 years (2014-2016). The following modifications are adopted in the usual procedure of the MRM: double skin incision and elective excision of the skin margins, injecting long acting local anesthetic agent (bupivacaine) preoperatively around the nerve pedicles in axilla and postoperative positioning of arm in hyper abduction and early resumption of Shoulder exercisesResults: Flap margin necrosis has reduced considerably (2.6%) in comparison to historical data (15%). Pain relief was significantly less on first post-operative day (mean VAS score 2.93) which encouraged early shoulder mobilisation. Flap necrosis was more in T4 tumours (75% vs 25%) which was significant with a p value of .004. Similarly flap necrosis at 48hrs was more with the patients who received neoadjuvant chemotherapy (NACT) with a p value of 0.047. Higher nodal burden was significantly correlated with flap necrosis with a p value of .002.Conclusions: This pilot study provides preliminary evidence of the positive effects of the proposed modifications on minimising morbidity following MRM further convincing evidence by way of multi-centric randomized control trials, will be required to validate the conclusions of this study.

scholarly journals Fetomaternal outcome following labour induction in oligohydramnios and borderline liquor: a retrospective study in a tertiary care hospital

2018 ◽  
Vol 7 (11) ◽  
pp. 4615
Author(s):  
Jyothi Susan Thomas ◽  
Mary Daniel ◽  
Sangeetha Selvaraj
Keyword(s):  
Retrospective Study ◽  
Amniotic Fluid ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Morbidity And Mortality ◽  
Labour Induction ◽  
P Value ◽  
Care Hospital ◽  
Parametric Data

Background: Amniotic fluid provides a protective milieu for the growing fetus in pregnancy and labour. A decrease in the amniotic fluid volume has been associated with increased maternal morbidity and fetal morbidity and mortality. The purpose was to compare the effect of labour induction on the fetomaternal outcome in women with oligohydramnios, borderline liquor and normal liquor at term.Methods: A retrospective study of all the labour induction in women with oligohydramnios, borderline liquor and normal liquor volume at 37-42 weeks gestation in a tertiary care teaching hospital. The demographic characteristics, maternal outcomes like mode of delivery, indication for operative delivery, meconium stained liquor and perinatal outcomes were compared in between the three groups. Parametric data was compared by chi-square test and non-parametric data by students’-test. A p-value less than 0.05 was taken as significant.Results: Among the 2338 deliveries during the study period, labour was induced in 266 women (11.3%). Out of which, 109 cases (40.9%) in oligohydramnios group, 111cases (41.7%) in borderline liquor group and 46 cases in normal liquor group. The incidence of meconium stained liquor, the number of operative deliveries and fetal distress was significantly higher and significantly lower birth weight (<2.5 kg) in the group with oligohydramnios and borderline liquor (p <0.05). Low Apgar score and admission to neonatal intensive care unit was higher in the oligohydramnios group (p<0.05).Conclusions: Induction of labour on detecting borderline liquor at term may help in reduction of maternal and fetal morbidity and mortality.

Recurrence rate of breast cancer after modified radical mastectomy at tertiary care hospital

2021 ◽  
Vol 15 (10) ◽  
pp. 2739-2741
Author(s):  
Asiya Shabbir ◽  
Shahid Hussain ◽  
Muhammad Asif
Keyword(s):  
Breast Cancer ◽  
Recurrence Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Radical Mastectomy ◽  
P Value ◽  
Care Hospital ◽  
Age Group ◽  
Modified Radical Mastectomy ◽  
Cross Sectional

Objectives: To assess the recurrence rate of breast cancer after modified radical mastectomy in cases of breast cancer at tertiary care hospital. Material and methods: Between the March 2020 to September 2020 (over the period of 6 months) total 110 women with breast cancer having age range 30-60 years were recruited from Department of Surgery, Bahawal Victoria Hospital Bahawalpur for this cross sectional study. Modified radical mastectomy was performed in all selected patients. At 6 months follow up, all the selected patients was again examined for recurrence of breast cancer. Results: Total 110 patients with breast cancer were recruited. Mean age of the patients was 43.56 ± 8.9 years. Recurrence of breast cancer was found in 25 (23%) cases. Total 11 (10%) patients belonged to age group <30 years followed by 13 (11.82%) patients to age group 30-40 years, 41 (37.27%) to age group 41-50 years and 45 (40.91%) patients to age group 51-60 years. Recurrence of breast cancer was noted in 2 (18.18%) patients, 3 (23.08%) patients, 10 (24.39%) patients and 10 (22.22%) patients respectively. Statistically insignificant association of recurrence with age group was noted with p value 0.9776. Conclusion: Results of this study showed a higher rate of recurrence of breast carcinoma after modified radical mastectomy. Most of the patients belonged to 5th decade of life. Parity, educational status and marital status showed no association with recurrence of breast cancer.

scholarly journals Clinicopathological Analysis of Whipple’s Pancreaticoduodenectomy Specimens in a Tertiary Care Hospital with Special Emphasis on Grossing

2021 ◽  
Author(s):  
Ashima Nagesh Amin ◽  
Christol Blanch Moras ◽  
T Umashankar
Keyword(s):  
Lymph Node ◽  
Perineural Invasion ◽  
Tertiary Care ◽  
Clinicopathological Parameters ◽  
Lymph Node Status ◽  
P Value ◽  
Common Symptom ◽  
Care Hospital ◽  
Whipple’S Procedure ◽  
The Mean

Introduction: Pancreaticoduodenectomy (PD) is done for a myriad of tumours as well as inflammatory condition affecting the duodenum, common bile duct, ampulla of vater and the head of pancreas. The diagnostic accuracy of the histopathology report is largely determined by the preliminary meticulous gross examination of the specimen. Aim: To comprehensively analyse the clinicopathological parameters of Whipple’s specimen and thus evaluate the trends in indication of Whipple’s procedure in Southern India .Materials and Methods: This was an observational time bound descriptive study done in the Department of Pathology, Father Muller Medical College Hospital, Mangalore, Karnataka from May 2014 to April 2019 wherein histopathological and clinical data of all the patients who underwent Whipple’s procedure were retrieved and analysed. The gross specimens were retrieved from the museum and records were assessed for the type of grossing method employed. The H&E slides were reassessed for the tumour type, grade, margins, perineural and angioinvasion, lymph node status and staging. Immunohistochemical marker (CD 117) and cytochemical like Mucicarmine and Alcian blue were employed wherever required. Descriptive analysis of the data involved calculating percentage, mean, median and range. The p-value was calculated using Fischer-Exact test with statistical significance level at <0.05. Results: Total of 45 patients underwent Whipple’s procedure, of which 28 (62.2%) were males and 17 (37.8%) were females with a ratio of 1.6:1. The most common symptom was jaundice (33 cases-73.3%) followed by pain abdomen (7 cases-15.6%). The mean age was 56.2 years. The mean tumour size was 2.8 cm. Malignancy was seen in (43 cases- 95.6%). The others being, inflammatory lesions (2 cases-2.2%). The most common site of localisation of tumours was periampullary (16 cases-37.2%) followed by pancreatic head (15 cases-34.9%).The most common histological subtype was adenocarcinoma (40 cases-93%). There were two cases of grade 2 neuroendocrine tumours (2 cases-4.7%) and one case (2.3%) of malignant Gastrointestinal Stromal Tumour (GIST). Lymph node positivity was most commonly seen in pancreatic cancers (7 cases-46.7%) with a significant p-value of 0.001. Lymphovascular invasion were seen in 16 cases (37.2%) and perineural invasion in 23 cases (53.5%). The most common tumour stage was T2 (16 cases-37.2%) followed by T3 (12 cases-27.9%). Margins were free in most of the malignant tumours (37 cases-86.04%). Conclusion: Thorough gross inspection of the Whipple’s specimen along with sound knowledge of the anatomy of the region is of utmost importance. The present analysis showed that periampullary adenocarcinoma was the most common subtype, many of the cases being diagnosed at an advanced stage, emphasising on early diagnosis through clinicoradiological modalities and guided biopsies. A meticulous and careful evaluation of the Whipple’s specimen is a pre-requisite for accurate histopathological differentiation of tumours originating in this anatomical region. Subtyping the tumor,reporting margin clearance, lymphovascular and perineural invasion, also has prognostic implications. Whipple’s PD may rarely be done for non-neoplastic conditions like chronic pancreatitis.

scholarly journals Obstetrical and perinatal outcome in adolescent pregnancy: a retrospective study at a tertiary care center in rural India

2019 ◽  
Vol 8 (5) ◽  
pp. 1733
Author(s):  
Arpitha Shruthi ◽  
Sheela S. R. ◽  
Vishnu Priya Kesani
Keyword(s):  
Retrospective Study ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Adolescent Pregnancy ◽  
Adolescent Mothers ◽  
Tertiary Care ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Significant Difference

Background: Adolescent pregnancy is a serious health and social problem worldwide. The aim of this study was to determine the obstetrical and perinatal outcomes of nulliparous adolescent pregnancies in a tertiary care centre in rural India.Methods: This is a retrospective study conducted between April 2017 and March 2018.Adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. The factors under study included obstetric complications and neonatal outcomes. The association was considered significant at P-value <0.05.Results: 450 women were included in the study group and 460 to the control group. The incidence of adolescent pregnancy was 18.3% during the study period. The adolescent mothers had a significantly higher incidence of preeclampsia (12.8 % vs 8.4 %; p = 0.03), eclampsia (3.5% vs 1.5%; p = 0.01), preterm delivery (18.6% vs 10.8%; p = 0.0009), low birth weight (39.1 % vs 24.2 %; p = 0.00001),very low birth weight babies (13.7 % vs 8.7 %; p = 0.01) compared to control group. There was higher proportion of NICU admissions in adolescent group (20.8% vs 12.3 %; p = 0.0005) compared to control group. No significant difference was found regarding postpartum complications and still birth.Conclusions: Adolescent pregnancy is associated with poorer feto-maternal outcomes. Regular antenatal visits, adequate nutritional supplementation and early detection of high-risk factors may contribute in decreasing the obstetric risk of childbirth in adolescent mothers.

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