Journal of pediatric and adolescent gynecology最新文献

{"title":"27. Diagnosis of Imperforate Hymen: A Case Study for Quality Improvement","authors":"Avanthi Ajjarapu,&nbsp;Jennifer Dietrich","doi":"10.1016/j.jpag.2025.01.060","DOIUrl":"10.1016/j.jpag.2025.01.060","url":null,"abstract":"<div><h3>Background</h3><div>Imperforate hymen, transverse vaginal septum, vaginal agenesis, and lower vaginal atresia are four common forms of vaginal outlet obstruction. Early differentiation between these anatomic variants is crucial to determine a correct diagnosis and ensure appropriate surgical timing to avoid unnecessary surgical revision or complication. Distinguishing between these variants relies initially on physical exam. When characteristic components are absent, it is critical to obtain imaging to distinguish between other obstructive vaginal anomalies as the presence of hematocolpos or hematometra may occur with many types of obstructive mullerian anomalies. A pelvic ultrasound may be ordered initially as it is more readily available but may not yield enough detailed information. In this circumstance, further imaging should be obtained prior to surgical intervention with Pelvic MRI; the gold standard imaging modality for reproductive tract anomalies. This case reminds the provider of the steps to take for the correct diagnosis as well as recommendations for specialist referral when the presentation is not that of a bulging membrane with blue hue at the introitus.</div></div><div><h3>Case</h3><div>A 13 yo female presented to an outside emergency room with severe, cyclic abdominopelvic pain. A pelvic ultrasound suggested hematometra. She was taken to the operating room due to pelvic exam findings concerning for no vaginal patency. A vaginal dimple was present without blue hue or bulging noted. Intraoperatively, an incision did not reveal release of menstrual contents. The surgery was aborted due to findings inconsistent with imperforate hymen. MRI Pelvis was ordered later and a diagnosis of cervicovaginal agenesis with hematometra was made. Menstrual suppression was then initiated with GnRh antagonist orally. A few years later, the patient was referred to Pediatric and Adolescent Gynecology.</div></div><div><h3>Comments</h3><div>For complex reproductive tract anomalies, pelvic MRI should be ordered following pelvic US as MRI best correlates with the type of anomaly. Avoid going to the operating room if the classic presentation of imperforate hymen is not visualized and confirmed to minimize complications. Optimize pain management to allow time to obtain adequate MRI Pelvis with contrast for optimal delineation of hymenal versus other vaginal and mullerian variants. This includes assessing distance from introitus to defect. Refer to a specialist with expertise in managing obstructive reproductive tract anomalies, when an anomaly other imperforate hymen is suspected.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 243"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"8. Geospatial Distribution of Mullerian Anomalies in the State of Texas between 2012-2024: A Retrospective Cohort Study","authors":"Avanthi Ajjarapu ,&nbsp;Jennifer Dietrich ,&nbsp;Michael Jochum","doi":"10.1016/j.jpag.2025.01.020","DOIUrl":"10.1016/j.jpag.2025.01.020","url":null,"abstract":"<div><h3>Background</h3><div>Etiology of Mullerian anomalies (MA) has long been considered multifactorial, but the specific contributing factors remain unclear. Some genes have been correlated to certain MA, but no genes explain all anomaly types. The role of environmental pollutants (EP), specifically possible endocrine disruptors, has been considered, but not explored to date. We aimed to understand distribution of patients with any MA to assess proximity to EP.</div></div><div><h3>Methods</h3><div>An IRB approved retrospective cohort study was conducted among Pediatric and Adolescent Gynecology patients (</div></div><div><h3>Results</h3><div>526 patients met inclusion/exclusion criteria following initial population analysis with Epic SlicerDicer. A majority of patients identified as White (78%), and non-Hispanic and/or Latino (57%) (Table 1). 34.6% of the cohort was comprised of complex mullerian anomalies. Geographic coordinates by census tract code and anomaly type were plotted on a Texas State map, visually demonstrating MA distribution. Best Fit modeling of study cohort by optimal silhouette width revealed 43 distinct geographic clusters (Figure 1). Among zipcodes with the highest MA prevalence, one was noted in close proximity to a superfund site which is a high hazard EPA classification. Clusters 3 and 4 were of interest due to higher rates of OHVIRA and MRKH. Among waste sites within a 10-mile radius to each cluster, top chemicals emitted included known endocrine disruptors.</div></div><div><h3>Conclusions</h3><div>This is the first study of its kind to assess geospatial distribution of mullerian anomalies and proximity to environmental pollutants. We hope that this data provides the groundwork to further elucidate impact of environmental factors on MA.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 224"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4. A Qualitative Needs Assessment for the Research of Reproductive Tract Anomalies","authors":"Lauryn Roth ,&nbsp;Kendra Hutchens ,&nbsp;Veronica Alaniz","doi":"10.1016/j.jpag.2025.01.037","DOIUrl":"10.1016/j.jpag.2025.01.037","url":null,"abstract":"<div><h3>Background</h3><div>Adolescence is a critical period for the clinical diagnosis, management, treatment, and research of reproductive tract anomalies. There are critical gaps in knowledge regarding best treatment approaches, particularly regarding surgical management and associated long-term outcomes. This qualitative study was conducted to assess the feasibility of a multi-institutional database or registry of children and adolescents with reproductive tract anomalies.</div></div><div><h3>Methods</h3><div>We purposively recruited geographically diverse focus group participants based on their publication record, clinical experience, and knowledge in reproductive tract anomalies. Two virtual focus groups were conducted in March of 2024. The PI moderated the focus groups and a co-investigator served as the observer/note-taker. The focus groups were one hour in duration and followed a semi-structured format. Focus group participants were compensated for their time. Focus group audio recordings were transcribed by a professional transcription company. After an initial familiarization with the data, the investigators developed a codebook and applied codes line-by-line to transcriptions to allow prominent themes to emerge.</div></div><div><h3>Results</h3><div>A total of nine participants joined the two focus groups. See table for themes and illustrative quotes. Participants reported there is very limited research and outcome data available to guide counseling of patients with reproductive tract anomalies. Participants identified a myriad of important and unanswered questions regarding the diagnosis and management of reproductive tract anomalies, linked to differences in management across different institutions. They identified several challenges and barriers to research, including the heterogeneity of these conditions and limited clinician time dedicated to complete this research, which make the development of a multi-institutional database or registry difficult. Participants discussed the need for patients to be involved in developing research agendas and identifying important outcomes. See table for themes and illustrative quotes.</div></div><div><h3>Conclusions</h3><div>There is significant variability in the presentation and management of reproductive tract anomalies with limited outcome data. Surgeons and researchers recognize the need for high-quality data and to develop patient-centered outcomes. A collaborative research database focused on rare and difficult to manage anomalies (i.e. obstructive or vaginal anomalies) is needed but will require overcoming several barriers.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 231"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"34. Entonox Sedation For IUD insertion In Adolescents - A pilot Project","authors":"Christine Osborne,&nbsp;Philippa Brain","doi":"10.1016/j.jpag.2025.01.067","DOIUrl":"10.1016/j.jpag.2025.01.067","url":null,"abstract":"<div><h3>Background</h3><div>The use of inhaled Entonox is a novel approach to providing patient-controlled sedation for an IUD insertion. Entonox sedation can be use in a clinic situation without the need for IV or Anesthetists. The tanks are portable and can refilled and the masks are inexpensive to purchase.</div></div><div><h3>Methods</h3><div>16 subjects were recruited for IUD insertion with patient-controlled Entonox. Informed consent for an IUD insertion and pilot study was obtained. Subjects were included with the following: age greater than 15, BMI less than 30, Patient has had failed attempts at IUD insertion in the clinic or it has been determined through patient assessment that sedation is required to support insertion. Developmentally able to self-administer Entonox. Exclusion criteria included: Patients less than 15, existence of co-morbidities, experienced sexual trauma, known anatomical concerns. Pregnancy tests were performed prior to insertion and routine vaginal swabs taken at time of insertion. Insertions took place in induction rooms and in outpatient clinics. Each patient received a satisfaction survey following insertion using a QR code in Redcap. IRB approval was obtained.</div></div><div><h3>Results</h3><div>16 patients were consented and 100% of them had an IUD successfully inserted under patient-administered Entonox in a clinic setting. The satisfaction survey revealed a satisfaction rate of 90% (range 7-10). 10/16 (62.5%) responded to the redcap survey. The patient's perception of success was 86% range (5-10).</div></div><div><h3>Conclusions</h3><div>Entonox patient-administered sedation is an excellent option for insertion of IUD in adolescents. This method allows sedation in a clinic setting and will significantly reduce the demands on expensive resources such as OR time or anesthesia lead procedural rooms. As this is a pilot study numbers are small, only 16 patients, and we recommend confirming outcomes with a larger cohort. Entonox patient-administered anesthesia could also be expanded to support IUD insertions in the adult clinics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 246"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"24. Contraceptive Education in Pediatric Residency: Exploring the Knowledge, Barriers, and Initiatives that Contribute to Effective Adolescent Healthcare","authors":"Hannah Gordon,&nbsp;Eric Whitney","doi":"10.1016/j.jpag.2025.01.057","DOIUrl":"10.1016/j.jpag.2025.01.057","url":null,"abstract":"<div><h3>Background</h3><div>The adolescent population makes up a significant portion of the outpatient panel seen by pediatric residents during their training. Pediatric residency programs notoriously lack the exposure to gynecology and the education needed to address adolescents in regards to contraception care. With this study, we aim to assess contraceptive education practices from the lens of pediatric residents contributing to the enhancement of education in pediatric residency programs.</div></div><div><h3>Methods</h3><div>A questionnaire was distributed to residents from four pediatric residency programs across the United States. It was used to survey experiences and attitudes on contraceptive education, prescribing comfortability, educational gaps, and future directions. The data was collected anonymously and analyzed categorically by percentages and descriptive statistics, as well as multivariate analysis in search of statistical significance.</div></div><div><h3>Results</h3><div>Of the over 300 pediatric residents who received the questionnaire, 42 responded to the survey. Only 66% of residents reported having formal education on contraceptive counseling in medical school, although the majority of residents (59.5%) prescribe it up to 5 times per month. In terms of education, 69% of residents report learning most about contraception in residency on rotations such as Adolescent Medicine. For those who received their contraceptive education during residency, roughly 71% report &lt; 10 hours of education was provided. Of the residents expressing discomfort with prescribing one or more methods, 42.9% related that it was due to inadequate knowledge of the topic. A large majority express the desire to have more hands-on procedural labs to enhance their contraceptive training. Overall, 73% of respondents desired more contraception during their residency training with trends suggesting that contraceptive prescription comfortability increases with PGY year, implying that increased exposure may strengthen skills and knowledge.</div></div><div><h3>Conclusions</h3><div>Many of the residents involved in this study will go on to become primary care providers who will be expected to prescribe contraception independently, bolstered with knowledge gained during their training. However, the data suggests that residents are not receiving equal training in contraception across the spectrum. This in turn is impacting the frequency in which counseling and prescription of contraception occurs in their clinic. This study reinforces the need for a standardized curriculum set in place to ensure residents are gaining the tools needed to provide adequate reproductive healthcare to their adolescent patients and beyond.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 241-242"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2. Availability and Accessibility of an Over-The-Counter Oral Contraceptive Pill in Retail Pharmacies in a Single Midwest US County: An Exploratory Study","authors":"Taylor Argo ,&nbsp;Tracey Wilkinson ,&nbsp;Julie Maslowsky ,&nbsp;Alana Otto","doi":"10.1016/j.jpag.2025.01.014","DOIUrl":"10.1016/j.jpag.2025.01.014","url":null,"abstract":"<div><h3>Background</h3><div>An over-the-counter (OTC) oral contraceptive pill (OCP) containing 75 μg of norgestrel became available without a prescription in US retail stores in March 2024. OTC access to an OCP has the potential to reduce barriers to contraceptive access and improve reproductive health equity, particularly for adolescents; however, removing the requirement for a prescription does not guarantee accessibility. The purpose of this study was to assess the availability and accessibility of the OTC OCP in pharmacies in a single midwest US county.</div></div><div><h3>Methods</h3><div>We used our state's licensing database to identify all licensed retail pharmacies in our county and visited these pharmacies between August and October 2024; we excluded pharmacies embedded in clinics and hospitals. We observed the availability, price, and accessibility of the OTC OCP (“the pill”), including availability for purchase of one- and three-month packs, price, and location (on the shelf with no security measures; behind the pharmacy counter; or in a locked security box that requires an employee to open at checkout). We present descriptive statistics of our findings.</div></div><div><h3>Results</h3><div>We visited a total of 44 retail pharmacies, including 16 standalone chain pharmacies, 14 independent local pharmacies, 12 mass merchandise retailers/supermarkets, and two wholesale clubs. The pill was available in 33 pharmacies (75% of those visited). Only three of 14 independent pharmacies (21%) carried the pill. Prices ranged from $18.97- $22.59 for one-month packs (manufacturer's suggested retail price [MSRP]: $19.99) and $47.99 - $55.99 for three-month packs (MSRP: $49.99). In 12 pharmacies (36%), the pill was available on the shelf with no security measures. In 13 pharmacies (39%), the pill was in locked security boxes. In 4 pharmacies (12%), some packs were available on the shelf, while others were in locked security boxes. Four pharmacies (12%) had the pill behind the pharmacy counter.</div></div><div><h3>Conclusions</h3><div>The OTC OCP was available at most pharmacies (75%) in our single US county at the time of data collection; however, few independent pharmacies stocked the product, and only 27% of all pharmacies had the product available without security measures. Prices in our county were generally similar to the MSRP. In more than half (63%) of pharmacies that stocked the pill, the OTC OCP was locked in security boxes or behind the pharmacy counter, requiring an individual to seek an employee to access the pill. Whether these measures affect adolescents' willingness to purchase the OTC OCP or contribute to stigma around contraception are important areas for future study.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 220"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"6. Evaluating the diagnostic work-up of heavy menstrual bleeding and hemostatic efficacy of norethindrone acetate in improving menstrual suppression among adolescent girls with obesity","authors":"Julia Shuford ,&nbsp;Maeve McNamara ,&nbsp;Anna Schwartz ,&nbsp;Morgan Buchanan ,&nbsp;Robert Sidonio ,&nbsp;Nancy Sokkary ,&nbsp;Megan Brown","doi":"10.1016/j.jpag.2025.01.018","DOIUrl":"10.1016/j.jpag.2025.01.018","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent obesity continues to rise in prevalence and is a risk factor for many etiologies of heavy menstrual bleeding (HMB), yet comprehensive guidelines on the evaluation and management of HMB in obese adolescents is lacking. This study aims to (1) characterize the prevalence of obesity and menstrual characteristics among adolescents presenting to the emergency department (ED) with HMB, (2) investigate the hemostatic efficacy of norethindrone acetate (NA) relative to IV conjugated estrogen in obese adolescents.</div></div><div><h3>Methods</h3><div>A retrospective chart review with collection of demographic and clinical data was performed, including all ED encounters (2017-2022, excluding 2020 due to COVID-19 pandemic) at three affiliates of a large tertiary children's hospital that utilized an acute HMB clinical pathway. Obesity was defined by BMI equal to or greater than the 85th percentile. Hemostatic efficacy was defined as follows: red blood cell (RBC) transfusion, tranexamic acid (TXA) utilization, and length of stay (LOS) &gt;36 hours. TXA use was a surrogate for poorly controlled HMB at 24 hours; the clinical pathway recommended adding TXA if HMB persisted despite primary hemostatic agent at 24 hours. T tests and chi squared statistics were used to compare continuous and categorical variables, respectively. Multivariate logistic regression models were used to predict adjusted odds ratios of outcome variables (NA vs. IV conjugated estrogen) separately among all non-obese and obese individuals.</div></div><div><h3>Results</h3><div>Between 2017-2022, 402 adolescents were admitted from the ED for HMB with documented BMI measurements. Over half were obese. Obese adolescents disproportionately identified as Black and reported younger onset of menarche. When adjusting for admission hemoglobin, receiving NA alone was associated with significantly decreased odds of RBC transfusion (AOR: 0.265, 95% CI: 0.104-0.674; p=0.005) relative to receiving IV conjugated estrogen among non-obese individuals. When adjusting for platelet levels, receiving NA alone was associated with significantly decreased odds of TXA utilization (AOR: 0.107, 95% CI: 0.013-0.859; p=0.036) among non-obese individuals. However, among obese individuals, we observed no association with odds of transfusion (p=0.267), TXA utilization (p=0.265) or LOS &gt;36 hours (p=0.472) by hemostatic agent.</div></div><div><h3>Conclusions</h3><div>In the setting of acute HMB, treatment with NA is associated with reduced odds of RBC transfusion and TXA utilization among non-obese but not obese individuals, highlighting the potential disparities in treatment response based on obesity status.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 222-223"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10. Addressing Adolescent Sexual and Reproductive Health Needs during Inpatient Psychiatric Admission","authors":"Radhika Amin,&nbsp;Paris Stowers,&nbsp;Shandhini Raidoo","doi":"10.1016/j.jpag.2025.01.043","DOIUrl":"10.1016/j.jpag.2025.01.043","url":null,"abstract":"<div><h3>Background</h3><div>Both adolescents and people with psychiatric disorders are disproportionately affected by adverse sexual and reproductive health (SRH) outcomes but little is known about their specific SRH needs. Inpatient settings provide a unique opportunity to address SRH concerns because adolescents often miss out on school-based SRH education when hospitalized. The primary objective was to identify adolescent patients’ perceptions of the SRH services they are receiving at an inpatient adolescent psychiatric unit in Honolulu, Hawai'i.</div></div><div><h3>Methods</h3><div>The Queen's Medical Center Institutional Review Board (IRB; protocol RA-2020-26) approved this qualitative research study. We identified patients aged 14-19 admitted to the inpatient psychiatric unit who had received SRH care during their current admission. Permission to approach patients was obtained from the patient's primary attending and written informed consent was obtained at the time of each interview. We conducted semi-structured interviews with participants about their experiences with SRH care until thematic saturation was reached. The interviews were recorded, transcribed, and analyzed through the iterative process of content analysis to identify themes and relationships between ideas.</div></div><div><h3>Results</h3><div>Eleven adolescents were interviewed from 2022-2023. We collected patient demographics and clinical characteristics, including race, diagnosis, and type of SRH services received. Six themes were identified: 1) patients value healthcare providers’ experience and expertise, 2) inpatient hospitalization is an appropriate time to address SRH needs, 3) interaction between mental health and decision making for SRH choices is complex, 4) access to SRH care in the outpatient setting is variable and dependent on social factors, 5) female family members play a key role in SRH care, and 6) most patients received SRH education in school and deemed school is an appropriate place to learn this information despite some negative aspects of the school-based setting.</div></div><div><h3>Conclusions</h3><div>This study revealed the important role of healthcare providers in the inpatient setting and female family members in the outpatient setting in supporting adolescents with psychiatric disorders and their SRH needs. Healthcare providers are accessible to adolescents during an inpatient admission while access in the outpatient setting can be highly dependent on social support factors. The inpatient setting is a valuable place to address adolescents’ SRH needs and should be linked to outpatient resources for continuity of care following hospital discharge.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 234"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"33. Enhancing Clinical Documentation for DSD Patients: A Retrospective Evaluation of a Standardized Physical Exam Template","authors":"Alexandra Herweck ,&nbsp;Brittany Jean-Louis ,&nbsp;Anisha Chada ,&nbsp;Nancy Sokkary","doi":"10.1016/j.jpag.2025.01.066","DOIUrl":"10.1016/j.jpag.2025.01.066","url":null,"abstract":"<div><h3>Background</h3><div>Disorders of Sex Development (DSD) encompass a wide spectrum of phenotypes, making individualized treatment challenging. The DSD Translational Research Network (TRN) has advocated for standardized documentation of physical exam findings to better tailor management. One institution's DSD clinic identified limitations in its existing documentation practices, which hindered comprehensive care. In response, the clinic developed and implemented a standardized physical exam template in the Electronic Medical Record for use in both clinical visits and the operating room, aiming to improve data collection and inform more specific treatment recommendations. The primary objective of this study is to assess the use of a newly implemented template to capture DSD-specific exam findings, in alignment with TRN recommendations. The frequency of documentation of each specific data point on the recommended exam will be evaluated.</div></div><div><h3>Methods</h3><div>Institutional Review Board approval was obtained. A retrospective chart review was conducted on all patients seen in the DSD clinic, including those who underwent a DSD-related surgeries, from January 2019 to June 2024. Data collected included demographics (age, race), clinical details (hormonal therapies, prior surgeries, diagnosis, karyotype, assigned/reared gender, gender identity), and the presence of gender dysphoria. Eighteen physical exam specifics recommended by the DSD TRN were evaluated, covering measurements related to internal and external genital anatomy. The use of the standardized physical exam template and whether clinical photographs were taken to document these findings were also recorded.</div></div><div><h3>Results</h3><div>Preliminary data revealed that prior to template implementation, common diagnoses were classical CAH and complete AIS, while the least common was 5-alpha reductase deficiency. Clitoral measurement was the most frequently assessed genital finding, recorded in 60.6% of cases. Documentation of external gonadal evaluation and urogenital sinus was recorded in only 27.2% and 21.2 % of cases respectively. Data collection from post-implementation encounters is ongoing, and we aim to compare the frequency of documentation before and after the template's introduction, along with the use of clinical photographs.</div></div><div><h3>Conclusions</h3><div>We anticipate that the implementation of a standardized template will significantly improve documentation of DSD-specific physical exam findings and aid in the management of this diverse population. This successful approach can be adapted by other DSD clinics, enhancing research capabilities and improving patient outcomes nationwide.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 246"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"26. Delayed hypersensitivity reaction to Mirena IUD","authors":"Eva Chorna Sherman,&nbsp;Monique Regard","doi":"10.1016/j.jpag.2025.01.059","DOIUrl":"10.1016/j.jpag.2025.01.059","url":null,"abstract":"<div><h3>Background</h3><div>Immune-mediated hypersensitivity reactions have been documented in response to endogenous and exogenous progesterone including the levonorgestrel-containing intrauterine device (IUD), with reactions ranging from urticaria to angioedema and anaphylaxis. Typically, reactions to progesterone have been described as acute or chronic in onset with long lasting symptoms. This case will discuss a unique timeline of onset and symptom progression.</div></div><div><h3>Case</h3><div>A 22-year-old patient presented to the ED with 3 days of worsening itching, burning and tingling. The patient had been seen that morning by her Pediatric Adolescent Gynecologist (PAG) for follow up 6.5 weeks after placement of a Mirena IUD for long-term management of endometriosis. She had been on the oral contraceptive pill Lo Loestrin for over one year, while IUD in situ. PAG decided not to remove IUD since symptoms were still mild, pending input from allergist for evaluation of alternate causes. Symptoms progressed throughout the day to include upper and lower extremity swelling bringing her to the ED, at which time she was discharged with antihistamines. However, swelling continued to worsen and she returned to ED 24 hours later. Physical exam was notable for maculopapular erythema and edema to the face palms and soles of feet. IUD was removed immediately, and patient was treated with Solu-Medrol and Benadryl with symptomatic improvement. She was discharged to home with prednisone, and symptoms resolved over the next 3 days. Follow up with outpatient immunologist determined case to be consistent with delayed hypersensitivity reaction in response to exogenous progesterone from the IUD. She has had no recurrence of symptoms since the IUD was removed.</div></div><div><h3>Comments</h3><div>While there is no absolute confirmation that the IUD was the sole cause of her acute pruritus and edema, there is a strong correlation between symptom onset and resolution relative to IUD insertion and removal. Documented cases of hypersensitive reactions in response to progesterone exposure have a timeline that generally fall within 2 categories. First is acute symptom onset appearing within several days of IUD insertion or second, chronic symptoms appearing months later and lasting years. This case illustrates an unusual timeline of progesterone-based IUD reaction with acute onset of symptoms 6 weeks after insertion progression within days to severe symptoms. Recognizing that an allergic reaction to a Mirena IUD can occur in this timeline and escalate to potentially life-threatening anaphylaxis is crucial since removing the Mirena IUD allergen is the cure.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 242-243"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}