Journal of pediatric and adolescent gynecology最新文献

{"title":"14. Quantitative Sensory Testing in Females with Endometriosis and Chronic Pelvic Pain","authors":"Sinah Esther Kim ,&nbsp;Catherine Stamoulis ,&nbsp;Christine Sieberg ,&nbsp;Jenny Gallagher ,&nbsp;Beth Schwartz ,&nbsp;Stephen Scott ,&nbsp;Michele Hacker ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.027","DOIUrl":"10.1016/j.jpag.2025.01.027","url":null,"abstract":"<div><h3>Background</h3><div>Chronic pelvic/abdominal pain (CPP) due to endometriosis can be unresponsive to standard therapies due to excessive sensitivity to pain known as central sensitization. We studied whether quantitative sensory testing (QST), a psychophysical method examining how the somatosensory nervous system responds to stimuli, differed between females with endometriosis and pain-free individuals.</div></div><div><h3>Methods</h3><div>Females with laparoscopically-confirmed endometriosis and CPP despite hormonal medication use (pain ≥3/ 0-10 scale, ≥14 days/mo) were eligible, and underwent baseline QST for an IRB-approved, multi-site clinical trial. We measured pressure pain threshold (minimum pressure evoking pain) using an algometer, and wind-up temporal summation (perception of pain due to repetitive equally intense stimuli) using electronic Von Frey, in the lower abdomen and control areas (non-dominant third finger nailbed/deltoid). Age-matched data from 107 pain-free females were used as a reference sample. Unadjusted statistical comparisons were conducted using the Mann–Whitney U test. Statistical models with adjustments for age, race, and BMI were developed to examine statistical differences in pain outcomes. Data are reported as median (interquartile range).</div></div><div><h3>Results</h3><div>We enrolled n=85 females with endometriosis (age: 25.3 (13.4)y). Our pain-free cohort included n=107 females (age: 20 (30.0)y; Table 1). Females with endometriosis experienced median (IQR) 3(3) intensity pain, &gt;1 day/week, had lower median pain pressure thresholds (7.4 (8.1)) than the pain-free sample (16.0 (12.9); p&lt; 0.01 based on unadjusted comparisons), and higher median temporal summation of pain (2.0 (2.5) vs. 0.5 (1.0); p&lt; 0.01). These differences remained in adjusted analyses: lower pressure-pain thresholds (regression coefficient (β)=-0.28, 95% confidence interval (CI)= [-0.39, -0.18]) and higher temporal summation (β=1.69, 95% CI= [1.06, 2.31]). In females with endometriosis, median pressure pain threshold was lower on the abdomen compared with the finger (7.4 (8.1) vs. 17.1 (14.7), p&lt; 0.01). No site difference (abdomen vs. deltoid) in temporal summation was estimated (p=0.15).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower pressure-pain thresholds, indicating higher sensitivity to pain, and higher temporal summation measures, reflecting greater increase in pain perception from exposure to repetitive stimuli, compared with pain-free females. The pressure-pain threshold was lower at the lower abdomen vs. finger in those with endometriosis, but temporal summation was the same. Clinicians should consider treatments aimed at reducing central sensitization to pain in those with CPP due to endometriosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 228"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520021","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":"53. Implementation of an Enhanced Recovery After Surgery Pathway in Adolescent Patients Undergoing Laparoscopic Evaluation of Endometriosis","authors":"Lauren Roth ,&nbsp;Madeline Ross ,&nbsp;Ashli Lawson ,&nbsp;Todd Glenski ,&nbsp;Emily Weisberg","doi":"10.1016/j.jpag.2025.01.086","DOIUrl":"10.1016/j.jpag.2025.01.086","url":null,"abstract":"<div><h3>Background</h3><div>In July 2023, a multi-disciplinary team from a tertiary children's hospital implemented an enhanced recovery after surgery (ERAS) pathway to standardize care and improve the perioperative experience for adolescents undergoing diagnostic laparoscopy for endometriosis. Pathway components include pre-operative gynecologic and anesthesia visits, intraoperative multimodal analgesia, and postoperative management (Fig 1 &amp; 2). This study aimed to (1) assess perioperative compliance to the Endometriosis ERAS pathway, and (2) evaluate patient metrics as indicators for pathway efficacy pre- and post- pathway implementation.</div></div><div><h3>Methods</h3><div>This was an IRB approved, single-site study of patients aged 12-20 undergoing laparoscopy for endometriosis. Data was collected from 6/2022-6/2023 (pre-ERAS) and 8/2023- 8/2024 (post-ERAS). To assess pathway compliance (aim 1) the rates of preoperative prescription, referral placement, day of surgery preoperative medication, preoperative carbohydrate loading, intraoperative anesthesia bundle, and postoperative prescriptions were measured. Post Anesthesia Care Unit (PACU) length of stay, discharge pain score, and patient concerns (ER visit, phone call/message, or readmissions) were interpreted as surrogate metrics for pathway efficacy (aim 2) and were analyzed pre and post intervention using independent t-tests and Chi squared/Fisher's exact tests. All data analysis was performed using SPSS.</div></div><div><h3>Results</h3><div>53 patients were included (20 pre and 33 post-ERAS). Mean age was 16.6 years (SD 1.7). Compliance was as follows: 81% preoperative prescriptions, 45% pain management referrals, 33% physical/occupational therapy, 76% day of surgery preoperative medications, 39% preoperative carbohydrate load, 87% intraoperative bundle compliance, and 61% postoperative prescriptions. PACU length of stay, discharge pain scores, and patient concerns were not significantly different pre vs post ERAS.</div></div><div><h3>Conclusions</h3><div>The Endometriosis ERAS pathway was a multidisciplinary team effort and has overall high compliance but leaves room for improvement in some facets (particularly specialty referrals and preoperative carbohydrate loading). While our data does not show improved patient metrics in the pre vs post pathway group, this is likely reflective of our efforts to emulate this pathway in the year leading up to implementation. Future directions include: analyzing a pre-ERAS group more remote from the pathway start date, revisiting the multidisciplinary team to see what barriers exist to improve compliance, and eliciting qualitative feedback from patients about their perspective.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 254-255"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520116","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":"45. FOXL2-induced BPES and POI with Hyperandrogenism and Normal Estradiol: A Clinical Conundrum","authors":"Jennifer Silk,&nbsp;Katelyn Day,&nbsp;Janeen Arbuckle","doi":"10.1016/j.jpag.2025.01.078","DOIUrl":"10.1016/j.jpag.2025.01.078","url":null,"abstract":"<div><h3>Background</h3><div>Patients with FOXL2 resulting in BPES (blepharophimosis, ptosis, epicanthus inversus syndrome) are at an increased risk of premature ovarian failure (POI). Hyperandrogenism alongside normal estradiol levels in the setting of POI is not noted in the literature.</div></div><div><h3>Case</h3><div>A 15-year-old female with a known history of FOXL2 gene and BPES presented to pediatric gynecology (PAG) due to secondary amenorrhea after experiencing only one episode of menses at age 12. Thelarche occurred at age 9 and prior workup was notable for elevated free and total testosterone, DHEAS, and FSH. She had a prior normal estradiol, prolactin, karyotype, 21-hydroxylase antibodies, thyroid antibodies, and Fragile X screen. Her physical exam was remarkable for tanner 4 tuberous breast and thick course hair on the face, check, and back consistent with hirsutism. Repeat FSH remained extremely elevated and estradiol remaining within normal pubertal range. Given persistent androgen excess on labs and physical exam findings, a pelvic ultrasound and CT abdomen/pelvis was completed to rule out tumors of the adrenal glands or ovaries which were unremarkable. Because her FSH remained persistently elevated with normal estradiol, an AMH was completed and noted to be 0.1. She also completed a DEXA scan which showed normal bone mineral density. She subsequently completed a congenital adrenal hyperplasia (CAH) panel which was normal with the exception of elevated testosterone. The patient attempted a Provera challenge with no withdrawal bleed. With known genetic predisposition and two FSH levels markedly elevated, patient formally met criteria for POI. Despite extensive workup, no etiology was identified for her persistent androgen excess but given her clinical and laboratory findings, she did meet criteria for PCOS. Interestingly her estrogen level remained within normal limits despite the diagnosis of POI. She was started on oral contraceptive pills for hirsutism, hormone replacement, and contraception.</div></div><div><h3>Comments</h3><div>Given the rarity of documented associations between BPES, hyperandrogenism, and normal estradiol levels in the setting of POI, other conditions like PCOS should be considered in said patients. This case emphasizes the importance of extensive laboratory and imaging workup for unique patients as well as the value of multidisciplinary teamwork between genetics, PAG, and reproductive endocrinology. In addition, the providers recognized the importance of monitoring bone health and contraceptive needs in this unusual clinical scenario.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 250"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520214","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":"25. Correlation of serum inhibin B and radiographic hemorrhagic cyst: A case for conservative management","authors":"Jennifer Silk,&nbsp;Sarah Hill,&nbsp;Laura Stafman,&nbsp;Blair Lacy","doi":"10.1016/j.jpag.2025.01.058","DOIUrl":"10.1016/j.jpag.2025.01.058","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian neoplasms occur 2.6 per 100,000 in the child and adolescent population and are usually benign in nature. The incidence of pediatric ovarian malignancy is poorly understood, as it is exceedingly rare, though when present, adnexal masses are diagnosed as gynecologic malignancy 3-8% of the time. Tumors markers like inhibins can be used to differentiate between benign and malignant lesions. Inhibin B is generally thought to be elevated in granulosa cell malignancies and can be a cause of primary or secondary amenorrhea. No literature, however, has demonstrated an association with an elevation of inhibin B with benign pathologies as discussed in this case.</div></div><div><h3>Case</h3><div>A 12-year-old female presented to pediatric gynecology with a left adnexal mass incidentally noted on renal ultrasound while undergoing evaluation for pediatric hypertension. Menarche occurred at age 11 with regular monthly cycles. An abdominal ultrasound and CTAP were notable for a 5.3 × 4.9 × 4.2cm thin walled cyst in left ovary concerning for hemorrhagic cyst. Labs demonstrated normal estradiol, testosterone, aldosterone, bHCG, inhibin A, and AFP. Inhibin B was elevated to 464. Given patient age and reassuring findings on ultrasound, it was ultimately decided to trend serum inhibins, mass size with ultrasound, and consult pediatric surgery given possible gynecologic malignancy. Repeat imaging 4 weeks later showed a stable hemorrhagic cyst and down trending inhibin B at 180. At 8 weeks from onset, imaging demonstrated interval resolution hemorrhagic cyst and inhibin B at 118. Given the improvements, repeat imaging and inhibin was obtained five months later with no evidence of recurrence of hemorrhagic cyst and normalized inhibin B at 35.</div></div><div><h3>Comments</h3><div>Limited data exists regarding conservative treatment of adnexal masses that are benign in nature in the setting of elevated tumor markers in pediatric and adolescent patients. In this case, a benign appearing lesion was associated with elevations of inhibin B, which raised concern for gynecologic malignancy. In absence of high-risk ultrasonographic features or symptoms of hyperestrogenism that one would expect in juvenile granulosa cell tumor, the clinical picture was consistent with benign pathology. Thus, inhibin was trended to normal range and correlated with simultaneous resolution of the cyst. An unnecessary surgical procedure was avoided in this asymptomatic patient. Further studies need to be collected to validate the use of trending inhibin B in the setting of benign adnexal pathologies like hemorrhagic cysts.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 242"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519939","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":"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}