Journal of pediatric and adolescent gynecology最新文献

{"title":"Ovarian Dermoid Cyst Trajectory in Premenarchal Girls","authors":"Jasneet Aulakh BS,&nbsp;Erin E. Isaacson MD,&nbsp;Sarah D. Compton PhD, MPH,&nbsp;Monica W. Rosen MD","doi":"10.1016/j.jpag.2024.07.003","DOIUrl":"10.1016/j.jpag.2024.07.003","url":null,"abstract":"<div><h3>Study Objective</h3><p>Mature ovarian dermoid cysts (ODCs) are the most common benign ovarian tumors diagnosed in children. However, there is minimal data on management of ODCs in premenarchal patients. This study assesses characteristics associated with expectant (EM) vs surgical (SM) management in premenarchal patients and the growth rate of ODCs in EM patients at a single institution.</p></div><div><h3>Methods</h3><p>Forty-four premenarchal patients, either post-surgical with pathologically-confirmed ODC or having radiologic findings consistent with ODCs, were included. Data collected included demographics, cyst characteristics, imaging findings, presence of symptoms, surgical procedure performed, and ovarian torsion occurrence.</p></div><div><h3>Results</h3><p>Patient age at diagnosis was similar between groups (SM: 8.8 vs EM: 8.0, <em>P</em> = .55). At presentation, 36 patients (82%) underwent SM and 8 (18%) underwent EM. There was a significant difference in cyst size between groups (SM: 8.9 cm vs EM: 3.6 cm, <em>P</em> = .004). Of SM patients, 30% underwent oophorectomy vs cystectomy, with a significant difference in ODC size between procedures (11.8 cm vs 7.7 cm, <em>P</em> = .016). Of EM patients, 75% had at least one and 60% had three follow-up ultrasounds, with average follow-up timeframes of 3.7 and 27 months respectively. Average yearly ODC growth rate for the latter group was 0.8 cm.</p></div><div><h3>Conclusion</h3><p>The average yearly growth rate of ODCs in premenarchal patients within our institution was slower than in older cohorts, and both age and cyst size played significant roles in determining surgical procedure. Continued study on EM in premenarchal ODCs will help define parameters for recommending SM vs EM in this population.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 495-499"},"PeriodicalIF":1.7,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620216","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":"An Exploration of Contraceptive Choice Pathways in Adolescents and Young Adults","authors":"Maria D. Ash MD, MA(Ed) ,&nbsp;Ian S. Watson MS ,&nbsp;Lauren E. Matera DO ,&nbsp;Ashley M. Ebersole MD, MS ,&nbsp;Heather L. Stewart MD ,&nbsp;Emily Price BSN, RN ,&nbsp;Johanna Taylor MSN, APN ,&nbsp;Elise D. Berlan MD, MPH ,&nbsp;Andrea E. Bonny MD","doi":"10.1016/j.jpag.2024.06.009","DOIUrl":"10.1016/j.jpag.2024.06.009","url":null,"abstract":"<div><h3>Purpose</h3><p>To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method.</p></div><div><h3>Methods</h3><p>A retrospective cross-sectional study was conducted of AYA DFAB (<em>N</em> = 2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams.</p></div><div><h3>Results</h3><p>Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at <em>P</em>-value &lt; .001, validating the patterns identified with the Sankey diagrams.</p></div><div><h3>Discussion</h3><p>We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations’ recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 505-509"},"PeriodicalIF":1.7,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603746","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":"Kaposiform Lymphangiomatosis as a Cause of Vaginal Bleeding & Discharge: A Case Report","authors":"","doi":"10.1016/j.jpag.2024.06.005","DOIUrl":"10.1016/j.jpag.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Prepubertal vaginal bleeding is a common presentation for pediatric adolescent gynecologists with a broad differential diagnosis that historically may not have included complex lymphatic anomalies. However, given recent consensus criteria and imaging capabilities, this may be a condition that pediatric adolescent gynecologists see more frequently in the future.</div></div><div><h3>Case</h3><div>We present a case of a 5-year-old pre-pubertal girl whose only presenting symptoms of a rare complex lymphatic anomaly was copious vaginal bleeding. After three vaginoscopies, two hysteroscopies, two pelvic MRIs, and a percutaneous ultrasound guided core needle biopsy, this patient was eventually diagnosed with Kaposiform lymphangiomatosis at age 9 years-old, and she is now being treated medically with sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, with improvement in her symptoms.</div></div><div><h3>Summary and conclusion</h3><div>Complex lymphatic anomalies should be considered after initial and secondary workups for pre-pubertal vaginal bleeding or copious vaginal discharge are negative. Furthermore, this case illustrates the value of pelvic MRI in the setting of unknown cause of vaginal bleeding when typical workup is negative.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 625-628"},"PeriodicalIF":1.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468872","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":"Comparison of Diagnosis Experiences of Adolescent and Young Adult Polycystic Ovary Syndrome Patients","authors":"","doi":"10.1016/j.jpag.2024.06.007","DOIUrl":"10.1016/j.jpag.2024.06.007","url":null,"abstract":"<div><h3>Study Objective</h3><div>The manner in which an individual experiences a polycystic ovary syndrome (PCOS) diagnosis may affect prognosis and vary with age. This study aimed to evaluate and compare the diagnosis experiences of adolescent and young adult PCOS patients.</div></div><div><h3>Methods</h3><div>PCOS patients from the same institution were divided into two groups according to age and clinic (adolescents diagnosed in the adolescent medicine clinic and young adults diagnosed in the obstetrics and gynecology clinic). Patients completed a questionnaire designed to assess the information and support received during diagnosis, their satisfaction with this information, existing concerns regarding PCOS symptoms, and support requirements.</div></div><div><h3>Results</h3><div>Thirty-six patients were included in each group. Among the participants, 52.8% of the adolescents and 63.9% of the young adults reported that they had consulted more than one specialist before receiving a diagnosis. We found that 83.3% of adolescents and 63.9% of young adults were satisfied with their overall PCOS diagnosis experience. The highest ratio of information given in both groups was related to medical treatment (88.9% in both groups), and the lowest ratios were associated with emotional support (13.9% vs 5.6%). Irregular menstruation was reported to be the most disturbing concern in both groups (94.4% vs 86.1%), and the biggest difference between the two groups was related to body dissatisfaction, which was observed more in adolescents (33.3% vs 5.6%).</div></div><div><h3>Conclusion</h3><div>While overall diagnosis experiences and satisfaction levels were similar across both groups, we identified distinct differences that may warrant attention to address age-specific needs and preferences.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 561-568"},"PeriodicalIF":1.7,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437026","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":"Contraceptive Method Usage Pattern and Percentage of New Pregnancies Among Adolescent and Young Adult Family Planning Patients: A Mixed-Methods Retrospective Study","authors":"","doi":"10.1016/j.jpag.2024.06.008","DOIUrl":"10.1016/j.jpag.2024.06.008","url":null,"abstract":"<div><h3>Objectives</h3><p>Despite increased access to contraceptive methods (CM), the United States still has the highest rate of adolescent pregnancy among industrialized nations, and adolescents from historically marginalized groups are disproportionately affected. In this study, we sought to (1) understand if differences in CM usage were associated with differential percentages of new pregnancies among adolescents and young adult patients attending a family planning (FP) clinic at an urban community practice and (2) identify areas of improvement in our FP counseling.</p></div><div><h3>Methods</h3><p>Mixed-methods study design consisting of (1) a 12-month retrospective chart review and (2) a self-answered cross-sectional survey of FP patients. Chi-square, Fisher's exact tests, and risk ratio were performed to analyze the percentage of new pregnancies according to CM usage.</p></div><div><h3>Results</h3><p>The percentage of new pregnancies was 11 among our FP patients (N = 555) during this study period. As anticipated, pregnancy was associated with no CM use, CM discontinuation, and, interestingly, multiple CM changes (<em>P</em> &lt; .001). The probability of no-pregnancy significantly decreased among patients on no method, who discontinued their CM or made multiple CM changes compared to those with continuous CM use. There was no association between the percentage of new pregnancies and any particular CM type.</p></div><div><h3>Conclusion</h3><p>Despite adequate access to FP patient services and high patient satisfaction levels, our findings indicate a need to adopt a more patient-centered approach in our FP counseling that addresses patient's reproductive life plans, preferences, and method side effects to increase CM uptake and satisfaction and decrease frequency of CM changes which is associated with increased risk of mistimed pregnancy during method switching.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 516-522"},"PeriodicalIF":1.7,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437027","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":"Oral Hormone Replacement Therapy and Uterine Volume in Korean Adolescents with Turner Syndrome: A Retrospective Case-Control Study","authors":"","doi":"10.1016/j.jpag.2024.06.006","DOIUrl":"10.1016/j.jpag.2024.06.006","url":null,"abstract":"<div><h3>Study Objective</h3><div>We aimed to identify critical factors for uterine development by comparing uterine volume (UV) among patients with Turner syndrome (TS) who underwent pubertal induction (PI), patients with TS who had natural menarche (NM), and patients in a non-TS control group.</div></div><div><h3>Methods</h3><div>This retrospective case-control study included patients with TS who had undergone PI with oral estrogen in a PI group (<em>n</em> = 31) and an NM group (<em>n</em> = 7). The control group included patients without TS with spontaneous puberty who underwent pelvic ultrasound at 16 years of age. For TS patients, both the UV from the first ultrasound performed at age 16 or older (1st-UV) and the UV from the most recent final ultrasound (final-UV) were obtained.</div></div><div><h3>Results</h3><div>The 1st-UV was larger for patients in the NM group than those in the PI group (<em>P</em> &lt; .001), but did not differ significantly between the NM and control groups (<em>P</em> = .375). The final-UV of the PI group was larger than their 1st-UV (<em>P</em> &lt; .001), but still smaller than the NM group (<em>P</em> = .021). Hormone replacement therapy (HRT) duration and 1st-UV of PI group were positively correlated (<em>P</em> = .048). There were no variables that were significantly correlated with final-UV of PI group.</div></div><div><h3>Conclusion</h3><div>Patients with TS who experienced NM showed normal uterine development, but TS patients who underwent PI showed significantly smaller, undeveloped UV. While HRT duration and UV are positively correlated at the beginning of HRT, it is unclear what determines the final UV; however, late PI initiation and use of oral estrogen probably contributed to the lack of UV development.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 6","pages":"Pages 555-560"},"PeriodicalIF":1.7,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437028","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":"Ovary and Fallopian Tube Displacement in an Adolescent Patient with a History of Omphalocele","authors":"","doi":"10.1016/j.jpag.2024.06.003","DOIUrl":"10.1016/j.jpag.2024.06.003","url":null,"abstract":"<div><h3>Background</h3><p>Omphalocele is an abnormality in which fetal abdominal organs protrude through the abdominal wall.</p></div><div><h3>Case Report</h3><p>We report the case of a 13-year-old female with a history of omphalocele repair who presented with acute periumbilical pain, nausea, and vomiting. A computed tomography scan showed a para-ovarian cyst and mild dilation of the small bowel. During laparoscopy, the right ovary and fallopian tube were detached from the uterus and located behind the cecum. Despite this displacement, the ovary appeared to have retained functionality with intact blood supply. We hypothesize that surgical repair led to pelvic adhesion that caused torsion and avulsion of the fallopian tube and utero-ovarian ligament that led to the displacement.</p></div><div><h3>Conclusion</h3><p>This anatomical change should be considered in surgical patients with a history of omphalocele repair.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 527-529"},"PeriodicalIF":1.7,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1083318824002328/pdfft?md5=7bfe1375a1a849b903a6bb6b2775a710&pid=1-s2.0-S1083318824002328-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Menstrual Health and Hygiene Educational Initiatives for American Middle and High School Menstruating Students: A Scoping Review","authors":"","doi":"10.1016/j.jpag.2024.06.004","DOIUrl":"10.1016/j.jpag.2024.06.004","url":null,"abstract":"<div><p>According to the American Medical Women's Association, period poverty refers to “inadequate access to menstrual hygiene tools and education, including but not limited to sanitary products, washing facilities, and waste management.” A component of period poverty in the US can be attributed to the neglect of menstrual education and lack of menstrual health and hygiene tools in schools. This scoping review aims to examine the educational methods employed to improve menstrual knowledge in middle and high school menstruating students in both school and clinical settings. It also highlights gaps and barriers in equitable access to menstrual hygiene products. The five-stage framework by Arksey and O'Malley (2005) and the updated Joanna Briggs Institute (JBI) guide were used to guide the review. Six studies were retained for analysis. Two-thirds of menstruating students reported using at least one of the school's resources to obtain period products, and one-third of the participants reported missing school due to a lack of period products. Nearly half of the students needed period products at least once in the past school year but lacked the financial resources to purchase such products. Menstruating students reported embarrassment and a need for secrecy when accessing school bathrooms since the social and physical environments of school bathrooms heightened their discomfort while menstruating. Although a majority of adolescent students had basic knowledge of menstrual periods prior to menarche, the depth of their understanding of menstruation was limited. Findings from this review can inform the future development of evidence-based educational interventions to improve the overall menstruation experience for US menstruating adolescents.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 465-476"},"PeriodicalIF":1.7,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427050","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":"FIGIJ and NASPAG Advocacy Statement Supporting Fertility Preservation for Pediatric and Adolescent Patients Receiving Gonadotoxic Therapy","authors":"","doi":"10.1016/j.jpag.2024.06.001","DOIUrl":"10.1016/j.jpag.2024.06.001","url":null,"abstract":"","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 457-459"},"PeriodicalIF":1.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141331143","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":"Adolescents’ Intention to Use Long-Acting Reversible Contraception Postpartum","authors":"","doi":"10.1016/j.jpag.2024.06.002","DOIUrl":"10.1016/j.jpag.2024.06.002","url":null,"abstract":"<div><h3>Study Objective</h3><p>Multiparous teens, compared to primiparous teens, are at increased risk for adverse neonatal and maternal outcomes. Long-acting reversible contraception (LARC) is infrequently used among postpartum teens. This study identifies predictors of teens’ intentions to use LARC postpartum when it is widely available.</p></div><div><h3>Methods</h3><p>Colorado teens who were patients during their pregnancy in an adolescent-centered clinic where all common methods of contraception were easily accessible were surveyed in clinic during their third trimester and following delivery regarding life circumstances (relationships, stress, and family function) and intended method of postpartum contraception. Multinomial logistic regression analyses were used to examine predictors of intended postpartum contraceptive method: LARC, non-LARC effective (condoms, birth control pills, shot, patch, or ring), or low-effective method or no contraception (abstinence, no method, or undecided).</p></div><div><h3>Results</h3><p>A total of 1203 patients were enrolled. Greater life stress was associated with greater likelihood of intending to use low-effective contraception versus LARC postpartum. Teens in a longer relationship with their baby's father (versus those never in a relationship with the baby's father) were less likely to intend to use low-effective contraception or non-LARC effective methods and more likely to intend to use LARC postpartum.</p></div><div><h3>Conclusion</h3><p>When structural barriers are minimized, non-clinical factors such as relationship context and life stress are most associated with postpartum LARC use intentions. Health care providers can help teen patients obtain the postpartum contraception the patients believe is best by employing developmentally appropriate, person-centered care that is sensitive to life stressors and relationship context.</p></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"37 5","pages":"Pages 510-515"},"PeriodicalIF":1.7,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327616","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}