Journal of pediatric and adolescent gynecology最新文献

{"title":"8. “I feel like we are walking on eggshells”: Experiences of Pediatric Residents Providing Care for Pregnant Adolescents in Texas Post-Dobbs","authors":"Kyrra Engle ,&nbsp;Zena Karagoli ,&nbsp;Lilly Snellman ,&nbsp;Alexis Bailey ,&nbsp;Sreya Rahman ,&nbsp;Deborah Babalola ,&nbsp;Jennifer Sherwood ,&nbsp;Margaret Wood","doi":"10.1016/j.jpag.2025.01.041","DOIUrl":"10.1016/j.jpag.2025.01.041","url":null,"abstract":"<div><h3>Background</h3><div>In the year following the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization to remove federal protection for abortions, new and unprecedented laws were passed related to pregnancy in Texas and elsewhere. Pediatric residents are often the first point of contact for pregnant adolescents. Examining the impact of these laws on pediatric residents is crucial to understanding gaps and promoting quality patient care in this new political landscape.</div></div><div><h3>Methods</h3><div>Pediatric residents were randomly selected from a Texas pediatric residency program and invited for a virtual, semi-structured, one-to-one interview with a trained study investigator between August and October 2024. Interviews explored residents' experience providing healthcare to pregnant patients and knowledge of current laws governing these interactions in Texas. All interviews were recorded, transcribed, and independently conducted using an inductive coding approach by two investigators. Themes were generated using iterative thematic analysis.</div></div><div><h3>Results</h3><div>Participants (n=11) included 4 third-year pediatric residents and 7 second-year pediatric residents. Inductive coding generated 34 codes consolidated into 8 themes. Data showed fear of discussing abortion was universal among residents with concerns around rules for notifying patients’ parents, and legal ramifications of documentation. Residents also discussed the emotional and moral burden of being limited in the care they can provide and awareness of the unequal impact of restrictive laws on low-income patients. Misconceptions of laws related to reproductive health care were pervasive among residents who were often informed by more senior physicians or non-academic online resources, with most residents assuming stricter versions of current policies. Overall, residents were enthusiastic about learning to care for pregnant patients and desired more clarification in their training.</div></div><div><h3>Conclusions</h3><div>Study findings show high levels of fear discussing abortion and common misconceptions about abortion policy among pediatric residents caring for pregnant adolescents in Texas. Given radical shifts in the U.S. policy environment, new pregnancy-focused training materials are necessary to ensure trainees feel confident caring for this patient population. Increased resident training is especially important in restrictive legal environments like Texas to prevent trainees from “over-implementing” state abortion policies and placing additional restrictions on patients' access to reproductive health services.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 233"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519932","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":"40. Feasibility of Nurse Practitioner Led Vaginal Dilation Therapy: A Retrospective Cohort Study","authors":"Jemimah Raffe-Devine,&nbsp;Aalia Sachedina,&nbsp;Rachel Ollivier,&nbsp;Natasha Prodan Bhalla,&nbsp;Nicole Todd","doi":"10.1016/j.jpag.2025.01.073","DOIUrl":"10.1016/j.jpag.2025.01.073","url":null,"abstract":"<div><h3>Background</h3><div>Vaginal dilator therapy is the recommended first line management in patients with vaginal agenesis to increase vaginal length and improve sexual function and has been demonstrated to be highly effective with minimal risks. A barrier to successful vaginal dilator therapy is the long-term nature of treatment and the requirement for extended follow up over multiple visits. Nurse practitioner led clinics have been shown to have positive clinical outcomes in other disciplines, and use of a multidisciplinary clinic has been shown have an 88% functional success rate in patients undergoing vaginal dilator therapy. Our objective was to assess if nurse practitioner led vaginal dilator therapy is a feasible alternative to pediatric gynecologist led therapy and create an evidence-based model of care.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study. Electronic medical records were searched using the ICD codes for vaginal agenesis and uterine agenesis. Patients were included who had participated in vaginal dilator therapy led by a pediatric gynecologist or by a nurse practitioner at our institution's Women's Health Clinic. The primary outcomes were patient satisfaction, change in vaginal length, and sexual function throughout treatment. We also collected visit details including number and timing of visits, prescribed dilation schedule. This study was approved by the Research Ethics Board.</div></div><div><h3>Results</h3><div>Thirteen patients were included ranging from 15 to 33 years of age. The most common diagnosis was MRKH (92%). 92% of patients were recorded as unsatisfied with their sexual activity and vaginal length before treatment. Among patients who were seen by a nurse practitioner in association with pediatric gynecology, 80% reported normal sexual function, normal vaginal length, or overall satisfaction with vaginal dilator therapy at time of discharge. This is comparable to 84.6% of patients who were followed by either a nurse practitioner or pediatric gynecology alone. Patients were followed for a mean of 15.6 months and required a mean of 4.7 visits prior to discharge. Optimal spacing between visits was monthly with a prescribed dilation schedule of one to two times per day for 10 minutes at a time.</div></div><div><h3>Conclusions</h3><div>Nurse practitioner led vaginal dilator therapy is a comparable alternative to pediatric gynecology led therapy with similar outcomes as previously reported in the literature. This is a reasonable option to increase access to care for patients with vaginal agenesis without requiring routine specialist involvement.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520845","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. A Rare Case of Premature Ovarian Insufficiency - Poirier-Bienvenu Neurodevelopmental Syndrome (POBINDS)","authors":"Zana Bumbuliene ,&nbsp;Karolina Romeikiene ,&nbsp;Karolina Miseviciute ,&nbsp;Birute Tumiene","doi":"10.1016/j.jpag.2025.01.039","DOIUrl":"10.1016/j.jpag.2025.01.039","url":null,"abstract":"<div><h3>Background</h3><div>Poirier-Bienvenu neurodevelopmental syndrome (POBINDS) is an ultra-rare neurologic disorder characterized by early-onset seizures and impaired intellectual development. The majority of the 81 reported cases are children until puberty and their reproductive health was not discussed. A few studies in pubertal girls reported reproductive health problems: short stature, precocious or delayed puberty, and uterine agenesis.</div></div><div><h3>Case</h3><div>We present an 18-year-old woman with mild intellectual and developmental delays and almost normal psychomotor development, for whom a genetic diagnosis was established when applying for secondary amenorrhea. Three episodes of febrile convulsions have been documented during the patient's childhood. The timing of secondary sexual characteristics development was on time, with menarche at 10 years old. Her periods were regular with moderate bleeding. She was referred to a gynecologist because of secondary amenorrhea at 16 years old. The physical examination did not show any endocrine or metabolic disease. During a transabdominal ultrasound examination, the uterus hypoplasia was discovered. Hormone tests were performed: FSH 104,8 U/l, LH 45,06 U/l, TTH 1,499 mU/l, Prolactin 251,1 mU/l, Estradiol 57 pmol/l, Testosterone 1,51 nmol/l. The combination of elevated gonadotropins and low estradiol levels identifies hypergonadotropic amenorrhea and suggests premature ovarian insufficiency. The patient was referred to genetics for further evaluation. Because of multisystemic damage, growth retardation, and learning disabilities, without confirming a genetic diagnosis through previous chromosomal karyotype tests, targeted whole exome sequencing (WES) was performed. After WES was completed the patient was diagnosed with Poirier-Bienvenu neurodevelopmental syndrome (POBINDS).</div></div><div><h3>Comments</h3><div>Poirier-Bienvenu syndrome in literature is analyzed with a focus on epilepsy and neurodevelopment. The period of puberty and menstrual function in those patients is not discussed. This is the first clinical case to suggest that premature ovarian insufficiency is possible in POBINDS patients.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 232"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519930","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":"19. Birth Factors related to Endometriosis later in life in the light of Neonatal Uterine Bleeding (NUB)","authors":"Judith Dekker ,&nbsp;Dorthe Hartwell ,&nbsp;Anja Bisgaard Pinborg ,&nbsp;Cornelis Lambalk ,&nbsp;Velja Mijatovic ,&nbsp;Øjvind Lidegaard","doi":"10.1016/j.jpag.2025.01.052","DOIUrl":"10.1016/j.jpag.2025.01.052","url":null,"abstract":"<div><h3>Background</h3><div>Sampson's theory of Retrograde menstruation is regarded as an important origin of endometriosis but does not explain all cases of endometriosis. Especially, endometriosis occurring before and during puberty, referred to as early-onset endometriosis which might be explained by the phenomenon of neonatal uterine bleeding (NUB), as it is possibly the first retrograde menstrual bleeding and occurring around the 7th day postpartum. As NUB is more often seen in neonates born post term or after hypertension induced complicated pregnancies, endometriosis later in life might be correlated with gestational age and may show a higher prevalence in woman born after a hypertension-related complicated pregnancy.</div></div><div><h3>Methods</h3><div>Data were extracted from the Danish Health Register (update 2023) and the Medical Birth Register (Danish new-borns from 1977-1999). Women with and without endometriosis will be compared. Using cross-sectional and longitudinal models we compared the prevalence of the following parameters in both cases and controls: gestational age, birth weight, hypertensive disorders diagnosed in the pregnancy of the mother i.e. pregnancy induced hypertension, preeclampsia, HELLP.</div></div><div><h3>Results</h3><div>A total of 681970 daughters could be evaluated divided in two groups: no endometriosis (n=667524) and with endometriosis (n=14446). A significant negative correlation was seen for the parameter post term. Less daughters with endometriosis were born after the gestational age of 41 weeks. RR=0.93 (95% CI 0.90-0.96) and p&lt; 0.001. The prevalence of daughters with and without endometriosis, born after a pregnancy with all hypertensive disorders combined was similar. RR=1,00 (95% CI 0.92-1.08) and p NS. However, in the group with only hypertension or pre-eclampsia there was a slightly higher prevalence of daughters with endometriosis. RR=1.07 (95% CI 1.00-1.15) p=0.0495. This difference was even more clear in the group with hypertension or pre-eclampsia and born postterm showing a higher prevalence of daughters with endometriosis. RR = 1.19 (95% CI 1.02-1.39) p=0.03. These are preliminary results and a full evaluation of the groups is in progress at the moment.</div></div><div><h3>Conclusions</h3><div>Preliminary results not directly support the theory of NUB as an origin of endometriosis later in life. Hypertension and preeclampsia might have an association with endometriosis.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 238-239"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520119","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":"60. Kleinfelter Mosaicism in a Phenotypic Female: A Case Report","authors":"Bianca Batista ,&nbsp;Nichole Tyson","doi":"10.1016/j.jpag.2025.01.093","DOIUrl":"10.1016/j.jpag.2025.01.093","url":null,"abstract":"<div><h3>Background</h3><div>Kleinfelter Mosaicism is a rare phenomenon, with only about 20 cases of 47, XXY/ 46, XX mosaicism reported in the literature. Of these, only two patients were phenotypically female, lending little data to predict the risk of germ cell tumors or the status of future fertility for our phenotypically female patient. This poster aims to review the recorded cases of 47, XXY/ 46, XX mosaicism to increase awareness of this rare condition and to discuss the relationship of this condition to other differences in sexual development in order to assess the specific health risks our patient may face.</div></div><div><h3>Case</h3><div>Our patient presented as a 10 month old female who had an abnormal NIPT indicating an abnormality of the Y chromosome. A karyotype analysis at age 4 weeks revealed 47, XXY [5] / 46, XX [45] and subsequent FISH analysis for the SRY gene revealed the presence of the Y chromosome in 11.5% of nuclei. The patient had normal appearing external female genitalia on physical exam and had no other concerns with health or development. Labs at age 6 months revealed normal hormone levels and U/S identified a small uterus and a candidate for a right ovary, but did not visualize a left ovary. Parents opted for no intervention at this time and they were advised to request that her pediatrician provide biannual abdominal exams to assess for masses and to return to the Differences in Sexual Development clinic every 3-4 years for further evaluation.</div></div><div><h3>Comments</h3><div>Kleinfelter Syndrome as a whole is associated with higher rates of germ cell tumors than the general population. The other reported cases of 47, XXY / 46, XX type of Kleinfelter mosaicism share similarities with both ovotesticular DSD (OT-DSD) and complete gonadal dysgenesis (OT-DSD). Both of these conditions have different risks associated with germ cell tumors and different fertility profiles. All but two of these cases, however, developed as phenotypic males, leaving a gap in the medical community's understanding of how our patient might develop.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 257-258"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520124","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":"38. Exploring the Relationship Between Stress and Menstrual Cycle Abnormalities in Adolescent Females","authors":"Grace Sarris,&nbsp;Jessica Zhang,&nbsp;Tatiana Salloum,&nbsp;Katherine Hofmann,&nbsp;Daniela Fernandez-Bergnes,&nbsp;Edith Duncan,&nbsp;Judith Simms-Cendan","doi":"10.1016/j.jpag.2025.01.071","DOIUrl":"10.1016/j.jpag.2025.01.071","url":null,"abstract":"<div><h3>Background</h3><div>Abnormal menstrual patterns often result from dysregulation or immaturity of the hypothalamic-pituitary-ovarian (HPO) axis, a biological process influenced by stress and elevated cortisol levels. Prior work done in India demonstrated a link between elevated stress in teenagers and abnormal menses. Our study explores the relationship between psychological stress and irregular menstrual cycles in adolescent girls in the United States to establish baseline data to inform strategies for improving female teenage health.</div></div><div><h3>Methods</h3><div>The institution's IRB approved our study. We distributed an anonymous survey to new patients at our large university outpatient pediatric gynecology clinic. Eligible patients were non-pregnant, English or Spanish-speaking individuals under 21 years old, not on hormonal therapies, with no history of chemotherapy, radiation, uterine agenesis, or primary ovarian insufficiency. Consent from legal guardians and assent from participants was obtained as appropriate. Participants completed the survey, which included the Perceived Stress Scale (PSS), a questionnaire about their menstrual cycles, and basic demographic information. Data analysis included descriptive statistics. Categorical variables were analyzed using chi-square tests, with a p-value of &lt; 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Of 100 participants, 64 met the criteria for abnormal menses, indicated by a frequency of menses more or less frequently than 1/month, a cycle lasting &gt;7 days or &lt; 4 days, or a heavy flow requiring 5+ changes of saturated sanitary pads/tampons daily. The majority (84%) of the population was Hispanic. Most participants reported moderate (62) to high (27) stress levels. Despite the high incidence of stress, it was not found to be a predictor of abnormal menses (p=0.71). Anxiety and depression were reported by 29 and 18 participants, respectively. These comorbidities were not predictive of stress either. Still, 74 participants reported experiencing mood changes either fairly or very often during their menstrual cycle.</div></div><div><h3>Conclusions</h3><div>The incidence of both irregular menses and elevated stress levels in our minority-majority population is notable. However, in this study, no statistically significant association was found between the two variables. Stress's impact on the HPO axis, and therefore menses, may not be as strong as previously thought, but the frequency of both variables indicates the need for a larger study. Our findings highlight the need for further research into adolescent stress to reduce these heightened levels in young girls and to better understand factors influencing menstrual abnormalities.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 247-248"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520843","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":"13. Adolescent Levonorgestrel Intrauterine Device Experience and Satisfaction","authors":"Shannon Howard ,&nbsp;Ryan Bradley ,&nbsp;Eduardo Lara-Torre","doi":"10.1016/j.jpag.2025.01.046","DOIUrl":"10.1016/j.jpag.2025.01.046","url":null,"abstract":"<div><h3>Background</h3><div>In adolescents, the first line contraception method recommended by the American College of Obstetricians &amp; Gynecologists (ACOG) is long-acting reversible contraception (LARC) such as an IUD, yet they are rarely utilized. In numerous studies providers have reported hesitation due to patient's lack of parity and age. This study aimed to explore the experience and satisfaction of adolescents with levonorgestrel IUDs, as well as compare between the available brands (Skyla, Kyleena, and Mirena).</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed to attain patients meeting inclusion criteria (females 10-21 with IUD insertion between 2011-2021). Patients were emailed a survey obtaining age at insertion, IUD brand, reason for IUD insertion, side effects, device continuation, rate of satisfaction (1-10), et cetera. Results were used to determine satisfaction rates, overall and specific, and if satisfaction varied between IUD brands/types. Descriptive statistical analysis was performed.</div></div><div><h3>Results</h3><div>A total of 102 individuals were surveyed. Overall satisfaction was not statistically different (p = 0.2004) between levonorgestrel IUDs, with individuals overall satisfied with their IUD experience. In this study there was a statistically significant difference in the proportion of individuals experiencing significant post-insertion pain among the three IUD brands (p = 0.0282). Kyleena has the highest percentage of individuals experiencing significant post-insertion pain (65.12%), followed by Skyla (62.50%) and Mirena (54.17%).</div></div><div><h3>Conclusions</h3><div>LARCs are the first-line recommendation for contraception in adolescents. Adolescents who have levonorgestrel IUDs placed have an overall positive experience and are satisfied with their decision. There is no significant difference in satisfaction between levonorgestrel IUDs.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 235"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519729","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":"30. Effect Of Ovarian Tissue Cryopreservation On Oncologic/Autoimmune Therapeutic Timeline","authors":"Elodia Caballero,&nbsp;Megan McCracken,&nbsp;Stephanie Cizek","doi":"10.1016/j.jpag.2025.01.063","DOIUrl":"10.1016/j.jpag.2025.01.063","url":null,"abstract":"<div><h3>Background</h3><div>Fertility preservation is an integral part of comprehensive cancer care for young patients as well as other medical conditions requiring gonadotoxic treatment. As of 2019, the American Society for Reproductive Medicine considers ovarian tissue cryopreservation (OTC), the only fertility preservation option for prepubertal patients with ovaries, no longer experimental and a standard fertility preservation option. Despite these recommendations, services remain underutilized. Qualitative studies examining clinician and patient perceived barriers have cited fertility care as a secondary concern with potential impacts on delaying urgent treatment. OTC can be performed quickly, often within 5-7 days of referral, involving laparoscopic unilateral oophorectomy, which has been shown to be safe and effective in prepubertal youth. Our study aims to assess if performing OTC results in any delay in a patient's oncologic or autoimmune therapy start time.</div></div><div><h3>Methods</h3><div>A retrospective chart review of 58 patients who had undergone OTC due to anticipated gonadotoxic therapy from 1999 - 2024 in a single university hospital setting treating a primarily insured population. Treatment lag time, calculated from date of expected start date to actual start date was measured along with sociodemographic variables such as ethnicity and age at the time of OTC as well as clinical diagnosis.</div></div><div><h3>Results</h3><div>Out 58 patients who had undergone OTC, 57 patients had records available to review. 1 patient was excluded as she had no gonadotoxic treatment, yielding 56 patient records for review. The majority of the patients identified as non-Latine white at 51.7% (29/56). Mean age at the time of OTC was 21 years old, ranging from 5 months to 45 years. Mean treatment lag time was 0 days, where 98.2% (55/56) of patients had no treatment delay. The 1 patient who did have a delay, upon further chart evaluation revealed that her delay in care was due to methemaglobinemia, unrelated to her OTC.</div></div><div><h3>Conclusions</h3><div>In our study population, undergoing OTC did not delay initiation oncologic or autoimmune therapy. OTC can be performed quickly via unilateral oophorectomy in patients with planned gonadotoxic therapy and is crucial to preserve future fertility for the possibility of genetic parenthood.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 244"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519870","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":"9. Hemostatic efficacy of norethindrone acetate versus IV conjugated estrogen for adolescents presenting to the emergency room with heavy menstrual bleeding","authors":"Maeve McNamara ,&nbsp;Julia Shuford ,&nbsp;Anna Schwartz ,&nbsp;Morgan Buchanan ,&nbsp;Robert Sidonio ,&nbsp;Nancy Sokkary ,&nbsp;Megan Brown","doi":"10.1016/j.jpag.2025.01.021","DOIUrl":"10.1016/j.jpag.2025.01.021","url":null,"abstract":"<div><h3>Background</h3><div>Heavy menstrual bleeding (HMB) is a common complaint among adolescent females, but standardized guidelines for first line treatment agents are lacking in this population. A clinical pathway was developed in 2017 utilizing intravenous (IV) conjugated estrogen for acute HMB. To reduce costs and transition to oral therapy, a 2019 pathway was adapted to use oral norethindrone acetate (NA) for most patients versus IV conjugated estrogen. This study compares hemostatic efficacy of NA versus IV conjugated estrogen among adolescents with acute HMB.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed including all emergency department (ED) encounters at a tertiary children's hospital and affiliates which utilized a clinical pathway between treatment period 1 (02/01/17- 12/31/19) and 2 (01/01/21-12/31/22; excluding 2020 due to impact of COVID-19 pandemic). Demographics, laboratory tests, and treatment outcomes were collected. Hemostatic efficacy was defined as follows: length of stay (LOS), red blood cell (RBC) transfusion, tranexamic acid (TXA) utilization and menstrual suppression at 90 and 180 days. Per protocol, TXA was added if HMB persisted after 24 hours of a primary agent. T tests and chi squared statistics compared continuous and categorical variables, respectively. Multivariate logistic regression models predicted adjusted odds ratios of outcome variables (NA vs. IV conjugated estrogen), controlling for hemoglobin and treatment period.</div></div><div><h3>Results</h3><div>Between 2017-2022, 787 adolescents presented to the ED for HMB. Over half (n=402, 58.2%) were admitted and had BMI measurements, of which 126 (31.3%) received NA as primary therapy and 208 (51.7%) received IV conjugated estrogen. Receiving NA alone was associated with shorter LOS (p&lt; 0.001), fewer RBC transfusions (p=0.005) and lower TXA utilization (p=0.009) relative to receiving IV conjugated estrogen. In multivariate logistic regression, when controlling for hemoglobin and treatment period, receiving NA alone was associated with lower odds of RBC transfusion (AOR: 0.391, 95% CI: 0.182-0.838, p=0.016) and TXA utilization (AOR: 0.268, 95% CI: 0.105-0.682; p=0.006) relative to IV conjugated estrogen. We observed no significant differences in adjusted odds of LOS &gt;36 hours, or menstrual suppression at 90- and 180-day follow-up visits by hemostatic agent.</div></div><div><h3>Conclusions</h3><div>Among adolescents with acute HMB, receiving NA was associated with reduced odds of RBC transfusion and TXA utilization relative to receiving IV conjugated estrogen. NA may offer a more cost-effective option with comparable efficacy for acute HMB in adolescents.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 224-225"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520008","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":"22. Clinical and Biochemical Characteristics of Adolescent Females in the United States at Time of PCOS Diagnosis: Results from the CALICO multi-center database","authors":"Lauryn Roth ,&nbsp;Grayson Carey ,&nbsp;Laura Torchen ,&nbsp;Tim Vigers ,&nbsp;Janet Snell-Bergeon ,&nbsp;Jacqueline Reyes Diaz ,&nbsp;Anshu Gupta ,&nbsp;Manmohan Kamboj ,&nbsp;Melanie Cree ,&nbsp;CALICO Consortium","doi":"10.1016/j.jpag.2025.01.055","DOIUrl":"10.1016/j.jpag.2025.01.055","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with polycystic ovary syndrome (PCOS) are a heterogeneous population with variable phenotypes. We describe the clinical and biochemical characteristics of a regionally and racially diverse cohort of adolescents, at the time of PCOS diagnosis, in the United States.</div></div><div><h3>Methods</h3><div>These data derive from the retrospective Clinical Adolescent Polycystic Ovary (CALICO) Database, including data from 15 U.S. sites of adolescents diagnosed with PCOS per 2023 international guidelines. Data from the initial PCOS diagnostic encounter were included. Sample size differs with each variable due to documentation and clinical practice differences across sites. To harmonize differences in hormonal assays, these variables are reported as the percentage of the upper limit of normal (%ULN) for each assay. Data were divided by overweight/obesity status (BMI &gt;85%ile). Continuous variables were compared using linear model ANOVA or t-tests and categorical variables were compared using Pearson's Chi-squared test.</div></div><div><h3>Results</h3><div>This cohort includes 839 youth from across the U.S. (34.1% from the Southeast, 25.7% from the Midwest, 21% from the West, 16.2% from the Northeast, and 3% from the Southwest) who were of diverse race/ethnicity (65.5% Caucasian, 20.4% Black, 34.5% Hispanic). The median age of menarche was 11.5 years (IQR, 11, 12.5) and median age of PCOS diagnosis was 15.3 years (IQR, 14.2, 16.4). Menstrual patterns included primary amenorrhea in 9.3%, &lt; 21 days between periods in 5.0%, and &gt;45 days between periods in 85.6% of individuals. Hirsutism severity was documented in 48.7% of encounters with 34.4% reporting no hirsutism and 8.3% reporting severe hirsutism. Facial acne severity was documented in 65.4% of encounters with 26.2% reporting mild acne and 6.6% reporting severe acne. Biochemical markers including free and total testosterone, DHEA-S, FSH and LH were assessed in &gt;60% of encounters at time of diagnosis. When stratified by overweight/obese status, those with overweight/obesity had significantly higher free testosterone but lower SHBG, androstenedione and LH. There were no significant differences by weight status in total testosterone, DHEA-S, FSH or AMH (Table 1).</div></div><div><h3>Conclusions</h3><div>In this study, we characterize the presentation of adolescents at time of PCOS diagnosis in the U.S. with data collected from a geographically, ethnically and racially diverse cohort of individuals. Weight status significantly impacted the levels of some biochemical markers used in the diagnostic evaluation of PCOS.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 240-241"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519936","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}