Journal of pediatric and adolescent gynecology最新文献

{"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}

{"title":"1. A case of obstructed hemivagina and ipsilateral renal anomaly complicated by pelvic abscess in an adolescent patient with history of cloacal anomaly","authors":"Roselyn Terrazos-Moreno,&nbsp;Anne Smith","doi":"10.1016/j.jpag.2025.01.034","DOIUrl":"10.1016/j.jpag.2025.01.034","url":null,"abstract":"<div><h3>Background</h3><div>An association between anorectal malformations and mullerian anomalies has been established in the literature. We present a unique case of a patient with cloacal anomaly and obstructed hemivagina and ipsilateral renal anomaly (OHIVRA) complicated by a pelvic abscess.</div></div><div><h3>Case</h3><div>An 18-year-old female with cloacal anomaly and history of genitourinary reconstruction at 3 months old and solitary right kidney presented to the emergency room with left lower quadrant pain and constipation. Ultrasound showed a mass on her left ovary, and she was referred to gynecology. In her workup, MRI found didelphys uterus and left hematocolpos. The patient had no prior knowledge of this anatomy and operative reports from her genitourinary surgeries in Italy reported a normal uterus and vagina. The patient was scheduled for excision of vaginal septum and drainage of hematocolpos. The patient returned to the emergency room 1 week before surgery with worsening pelvic pain. Mild leukocytosis was present, but there was low suspicion for infection due to negative urine cultures and her prophylactic antibiotic regimen. She was discharged in a day. During scheduled surgery, a rectovaginal exam revealed a 2-3 cm palpable fluid collection between the right hemivagina and rectum. Exploration of the right hemivagina revealed purulent fluid. The abscess was drained, intraoperative antibiotics were given, and augmentin was prescribed at discharge. One month later, the patient returned to the emergency room due to septic shock secondary to right-sided pyosalpinx. Infectious disease was involved early in care due to complexity of pelvic anatomy and renal history. An abscess drainage tube was placed by interventional radiology. The patient was given intravenous meropenem and doxycycline which was narrowed to oral amoxicillin and flagyl. MRI 3 months later showed a decrease in the size of the abscess. In follow up visits the patient denied fever or pelvic pain that was present before drainage of abscess.</div></div><div><h3>Comments</h3><div>Coexisting cloacal and renal anomalies should prompt consideration for OHIVRA early on. Normal uterine anatomy should not be assumed based on pre-pubertal records in patients with other anomalies. Re-evaluation at a later age may be necessary if the patient is presenting with menstrual irregularities and pelvic pain. Additionally, surgeons should consider pelvic abscess as a possible intraoperative complication in OHIVRA. The complex anatomy may lend to microperforations that allow a path for bacterial migration from the external environment to the obstructed vagina, as well as between the two vaginas.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 230"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520012","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":"16. Assessing Residents’ Knowledge of Dysmenorrhea in Adolescents and Young Adults","authors":"Hannah Hayward,&nbsp;Michelle Meglin","doi":"10.1016/j.jpag.2025.01.049","DOIUrl":"10.1016/j.jpag.2025.01.049","url":null,"abstract":"<div><h3>Background</h3><div>Our study sought to better understand residents’ knowledge of diagnosis and treatment of primary and secondary dysmenorrhea in adolescents and young adults and whether that knowledge could be improved by a brief educational intervention.</div></div><div><h3>Methods</h3><div>Residents in the Obstetrics and Gynecology and Pediatrics programs at the Medical University of South Carolina completed a pre-lecture survey, attended a focused lecture on dysmenorrhea, and completed a post-lecture survey. The average percent correct for the pre- and post-lecture surveys was compared.</div></div><div><h3>Results</h3><div>Twenty-three residents completed both the pre- and post-lecture surveys. The average score on the pre-lecture survey was 72% and the average score on the post-lecture survey was 92% (p &lt; 0.05). Post-graduate year positively correlated with pre-lecture survey score, with PGY-1 through PGY-4 residents averaging 65%, 72%, 79%, and 82%, respectively, on the pre-lecture survey.</div></div><div><h3>Conclusions</h3><div>We found that an hour-long lecture resulted in a statistically significant improvement in survey scores, suggesting that a brief educational intervention can improve both comfort with and knowledge of the clinical management of these conditions. We also found that post-graduate year (PGY) positively correlated with pre-test score, suggesting that dysmenorrhea is something residents receive clinical exposure to during training and emphasizing the need for foundational education during resident didactics.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 237"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520017","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":"Optimizing Contraceptive Counseling for Adolescents: Meeting the Needs of Undecided Patients","authors":"Khairiyah Khadijah ,&nbsp;Rizky Andana Pohan ,&nbsp;Ririn Dwi Astuti ,&nbsp;Putri Bunga Aisyah Pohan ,&nbsp;Sesilianus Fau ,&nbsp;Muhammad Putra Dinata Saragi ,&nbsp;Erfan Ramadhani","doi":"10.1016/j.jpag.2024.10.001","DOIUrl":"10.1016/j.jpag.2024.10.001","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 213-214"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520094","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":"3. Cardiovascular Risk in Females with Endometriosis","authors":"Madeline Smith ,&nbsp;Margaret Bolan ,&nbsp;Catherine Stamoulis ,&nbsp;Shannon Lyon ,&nbsp;Amy DiVasta","doi":"10.1016/j.jpag.2025.01.015","DOIUrl":"10.1016/j.jpag.2025.01.015","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with endometriosis are at higher risk of cardiovascular (CV) disease, hypertension, high cholesterol, and atherosclerosis. While CV disease is rare in young people, surrogate markers such as the pulse wave velocity (PWV), a measure of arterial stiffness, can predict future CV dysfunction. We sought to determine if females with endometriosis had elevated PWV values, and thus increased CV risk, compared with healthy control subjects. We also investigated whether additional predictors of future CV risk correlated with PWV measurements.</div></div><div><h3>Methods</h3><div>At the baseline visit of a multi-site, randomized clinical trial, n=70 females with laparoscopically-confirmed endometriosis and persistent pelvic pain provided health history and anthropometric measures. Blood samples were obtained for measurement of inflammatory markers (hs-CRP, ESR), lipid profiles (HDL, LDL), and hormonal concentrations (estradiol). PWV was collected by using two pressure probes placed at the carotid artery and femoral artery. The time it takes the pressure wave to go from the upstream probe to the downstream probe provides the Pulse Transit Time. PWV is calculated by dividing the distance traveled by the transit time. Previously obtained normative data from n=1455 from healthy controls were used as reference. Generalized linear regression models with adjustments for age, endometriosis stage and BMI were developed to test the associations of interest. We had local IRB approval.</div></div><div><h3>Results</h3><div>Of the n=70 participants, n=63 (median (interquartile (IQR)) age 25.3 (13.2) y, range 16.1–39.2y)) had PWV scans adequate for analysis. All were using hormonal therapy: 10 (15.9%) combined-hormonal contraception, 27 (42.9%) oral progestin, 31(49.2%) LNG IUD, and 11 (17.5%) other. Participants were excluded for other CV disease risk (n=2 high cholesterol, n=1 hypertension). Demographic and clinical characteristics are summarized in Table 1. About 30% of participants had stage I endometriosis. Median (IQR) PWV was 5.1 (1.2) m/s, lower than normative values for this age range (median=6.1-6.4 m/s for ages &lt; 30 – 39). Respective associations between PWV and hs-CRP, ESR, HDL, and estradiol were nonsignificant (p&gt; 0.15). LDL was positively associated with PWV (regression coefficient (β)=0.02, 95% CI=[0.01, 0.03], p&lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Females with endometriosis had lower PWV measurements compared to age-matched control subjects. LDL was positively associated with PWV; other CV risk markers were not. In this sample, young females with endometriosis did not demonstrate early signs of increased CV risk as measured by PWV. Future studies should investigate the impact of duration of disease and use of hormonal treatment on these findings.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 220-221"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520111","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. Effect of GLP-2 Coated Vaginal Expansion Sleeves (VES) in a Rat Model","authors":"Joshua Colvin,&nbsp;Rachel Cline,&nbsp;Hannah Meyer,&nbsp;Donald Sorrells,&nbsp;Jonathan Alexander,&nbsp;Mila Shah-Bruce","doi":"10.1016/j.jpag.2025.01.016","DOIUrl":"10.1016/j.jpag.2025.01.016","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal atresia is the congenital absence of the vaginal canal. Current treatments include at-home dilation therapy and surgical vaginoplasty. In our previous studies we have created a novel vaginal expansion sleeve (VES) that progressively elongated and retained vaginal expansion with only minor procedural intervention. This study aims to further explore the effect of the VES device on vaginal lengthening utilizing Glucagon-like peptide 2 (GLP-2). GLP-2 is known to promote intestinal tissue proliferation however the research exploring GLP-2′s role in non-intestinal tissues including female reproductive tissue is sparse.</div></div><div><h3>Methods</h3><div>The VES is a cylindrical, spring-like device with resin caps. Each VES was cut to 1.3x the current vaginal canal length, coated with 50µg GLP-2 via cross-linking with polyvinyl alcohol, inserted into the vaginal canals of 4 Sprague Dawley rats, and anchored with nonabsorbable sutures. Each week, the sleeves were removed and replaced with a serially longer VES over three weeks measuring 1.3x the current length of the vaginal canal. Rats were monitored for another 2 weeks to assess for any decrease in vaginal length. Vaginal lengths were measured prior to initial VES insertion and weekly during the 5-week trial.</div></div><div><h3>Results</h3><div>Serial deployment of GLP-2 coated VES devices resulting in an increase in vaginal length from 26.25 ± 0.96 mm to 35.5 ± 3.11 mm (p&lt; 0.001, week 5). Histologically, diffuse vaginal wall thinning with preservation of the epithelial, mucosal, and muscular layers was seen. Mild to moderate inflammation was also noted as evidenced by intraepithelial and and subepithelial lymphoid infiltrate.</div></div><div><h3>Conclusions</h3><div>The serial implantation of GLP-2 VES resulted in significant and retained expansion of the rat vagina comparable to the previous non-GLP-2 VES with both rounds of devices producing an average vaginal length of 35.5 mm with retained tissue architecture. The GLP-2 VES suggests a minimally invasive alternative for vaginal atresia treatment.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 221"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520112","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":"48. Gynecology Concerns for Children and Adolescents with Genitourinary Perineal Vascular Anomalies: A Retrospective Analysis","authors":"Anna Ujvary ,&nbsp;Maya Younoszai ,&nbsp;Xing Wang ,&nbsp;Shane Morrison ,&nbsp;Jonathan Perkins ,&nbsp;Katherine Debiec","doi":"10.1016/j.jpag.2025.01.081","DOIUrl":"10.1016/j.jpag.2025.01.081","url":null,"abstract":"<div><h3>Background</h3><div>We investigated the prevalence, management, and outcomes of genitourinary-perineal vascular anomalies (GUP-VAs), focusing on gynecologic concerns in pediatric patients with vulvar anatomy. We compared infantile hemangiomas (IHs) and vascular malformations (VMs) regarding symptom prevalence, functional impairment, treatment approaches, and outcomes. We hypothesized that VMs are associated with more significant gynecologic symptoms, functional impairment, and a higher likelihood of reproductive health counseling. The study aims to further understand gynecologic and developmental needs to improve clinical outcomes and personalized care.</div></div><div><h3>Methods</h3><div>Following IRB approval, we conducted a retrospective chart review of 119 patients treated for GUP-VAs at Seattle Children's between 1998 and 2024. Patients aged 0-21 years with vulvar anatomy and a GUP vascular anomaly diagnosis were included. Data on demographics, anatomic location, symptoms, functional impairments, treatment modalities, and gynecologic concerns were analyzed. Statistical comparisons between IHs and VMs were conducted using Mann-Whitney U tests for continuous variables and Fisher's exact test for categorical variables, focusing on symptoms, impairments, and treatment outcomes.</div></div><div><h3>Results</h3><div>Of the 119 patients, 98 (82.4%) had IHs and 21 (17.6%) had VMs. VMs were significantly associated with symptoms of mass (p &lt; 0.001), dyspareunia (p = 0.030), and functional impairments such as pain (p = 0.001) and emotional concerns (p = 0.005). Observation (p = 0.003) and pharmacotherapy (p = 0.004) were more common for IHs, while more invasive treatments like sclerotherapy (p &lt; 0.001) and excision (p = 0.057) were used more frequently for VMs. Post-treatment, patients with VMs showed significant improvements in pain (p = 0.043) and emotional well-being (p = 0.030). Gynecologic issues, such as menstrual irregularities, were prevalent in venolymphatic (100%) and lymphatic malformations (50%), while 50% of patients with lymphatic malformations reported sexual dysfunction. Contraceptive and pregnancy counseling were more common in patients with VMs, particularly those with Klippel-Trenaunay syndrome (66.7%).</div></div><div><h3>Conclusions</h3><div>VMs in the GUP region are associated with more severe symptoms and greater functional impairments compared to IHs. These findings highlight the physical and emotional impact of VMs and the importance of addressing gynecologic and reproductive health in this population. Treatment outcomes showed significant improvements in pain and emotional well-being, emphasizing the need for early diagnosis and multidisciplinary management to optimize patient outcomes.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 251-252"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520217","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}