Journal of pediatric and adolescent gynecology最新文献

{"title":"7. Fertility Attitudes and Turner Syndrome","authors":"Lauren Roth ,&nbsp;Madeline Ross ,&nbsp;Anne-Marie Priebe ,&nbsp;Jacqueline Maher ,&nbsp;Veronica Gomez-Lobo ,&nbsp;Tazim Dowlut-McElroy","doi":"10.1016/j.jpag.2025.01.019","DOIUrl":"10.1016/j.jpag.2025.01.019","url":null,"abstract":"<div><h3>Background</h3><div>Primary Ovarian Insufficiency is the main reproductive effect in individuals with Turner syndrome (TS). Guidelines recommend disclosure of reduced fertility in individuals with TS and counseling inclusive of options for fertility preservation and family planning. Although ovarian tissue cryopreservation (OTC) and oocyte cryopreservation (OC) are offered to individuals with TS, live births rates remain unknown. Also unknown are the attitudes of adolescents and young adults with TS (AYA-TS) and their parents regarding future fertility. The objective of this study was to compare differences in attitudes between AYA-TS and their parents regarding future fertility and fertility preservation.</div></div><div><h3>Methods</h3><div>After IRB approval, we conducted two studies in sequence of 12- to 25-year-olds with TS and their parents. First, to maximize acceptability/applicability of the Fertility ConcepTS questionnaire, a two-staged Delphi Procedure was implemented during 3 focus groups with AYA-TS and parents to develop/ refine survey questions. Second, a finalized cross-sectional survey was distributed via a social media platform of the Turner Syndrome Global Alliance and during a multidisciplinary TS clinic. Statistical analysis was performed using SPSS. Statistical significance was defined as P &lt;.05.</div></div><div><h3>Results</h3><div>A total of 28 participants were included in the analysis. Sixteen (57%) were AYA-TS and 12 (43%) were parents (Table 1). The median age of AYA-TS was 17.5 (IQR 10.5) years and of parents was 48.0 (IQR 9.3) years. AYA-TS and parents did not differ in their interest in understanding the effects of TS on fertility and pregnancy, their interest building a family, their desire for awareness of the possibility of biological children, and their awareness that feelings about building a family might change (Table 2). AYA-TS and their parents differed in their consideration for adoption (p=.005), use of donor egg (p&lt;.001), use of a gestational carrier (p&lt;.001) and raising a child as a single parent (p=.002). While 6.3%, 18.8%, 37.5% and 31.3% of AYA-TS disagreed/strongly disagreed with adoption, donor egg, gestational carrier, and single parenthood, respectively, all parents agreed/strongly agreed. AYA-TS and their parents differed in their consideration for OC (p=.042), OTC (p=.021), and awareness of change in opportunity for OC/OTC (p=.002). Although all parents agreed/strongly agreed, 18.8%, 43.8%, and 18.5% of AYA-TS, respectively, disagreed/strongly disagreed with OC, OTC, and awareness of change in opportunity for OC/OTC.</div></div><div><h3>Conclusions</h3><div>AYA-TS and their parents have differing attitudes about fertility and fertility preservation. Counselling should include consideration of the needs of AYA-TS alongside parent priorities.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 223"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520006","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":"29. Early growth in first trimester scan in adolescent pregnancies: Results from a comparative cohort study.","authors":"Anastasia Vatopoulou ,&nbsp;Athina Samara ,&nbsp;Hara Skentou ,&nbsp;Katerina Dadouli ,&nbsp;Fani Gkrozou ,&nbsp;Antonios Garas ,&nbsp;Sotirios Sotiriou","doi":"10.1016/j.jpag.2025.01.062","DOIUrl":"10.1016/j.jpag.2025.01.062","url":null,"abstract":"<div><h3>Background</h3><div>In the present study we aim to assess the Crown-rump length (CRL) values measured in first trimester scan in adolescent pregnancies compared with the respective CRL values in adult pregnancies.</div></div><div><h3>Methods</h3><div>All consecutive pregnancies that underwent a first trimester ultrasound scan in two fetomaternal units in Greece during a twelve-year period were included in the present study. Ultrasound findings, demographic characteristics and medical records were retrospectively reviewed and recorded in an anonymous database. Cases with a maternal age&lt; 20 years were characterized as adolescent pregnancies, and all other cases were grouped as adult pregnancies (control group). All statistical analyses were performed using R (version 4.2.2) software packages. The Kolmogorov-Smirnov test was used to test the normality of the variables. Multivariate linear regression model and linear regression model were used to assess the association between the weighted for gestational age CRL and the independent variables. The results are represented as the effect size of the CRL. Statistical significance was set at P&lt; 0.05 (two tailed).</div></div><div><h3>Results</h3><div>In total, 3234 pregnancies were included in the present study; 325 were identified as adolescent pregnancies and 2909 were adult pregnancies. In multivariate analysis, CRL values were statistically significant lower (52.6 mm and 58.8 mm respectively) in adolescent pregnancies (p&lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Based on our results, pregnancy in adolescents has been associated, with statistically significant lower CRL measures compared with adult pregnancies. More prospective studies with larger cohort series are needed.</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":"143519869","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. A novel approach for controlled drainage of giant ovarian cysts through mini-laparotomy","authors":"Victoria Huynh ,&nbsp;Megan Sumida ,&nbsp;Kathleen McDowell Takahashi ,&nbsp;Ana Cisneros-Camacho ,&nbsp;Amitha Ganti ,&nbsp;Jennifer Bercaw-Pratt ,&nbsp;Sanjeev Vasudevan ,&nbsp;Olivia Winfrey","doi":"10.1016/j.jpag.2025.01.036","DOIUrl":"10.1016/j.jpag.2025.01.036","url":null,"abstract":"<div><h3>Background</h3><div>Large ovarian cysts in adolescents often present with low malignancy risk, prompting discussions about optimal surgical strategies. Minimally invasive methods aim to reduce complications, pain, hospitalization length, and scar appearance. As such, there is a desire to utilize less invasive approaches for the removal of large to giant masses. However, the advantages of minimally invasive surgery must be balanced with the risks of spillage, including malignant seeding and upstaging, chemical peritonitis, and recurrence. A few minimally invasive techniques have been proposed, including adherence of surgical gloves or bandages, controlled drainage with catheters, or use of the Alexis laparoscopic system. These techniques are poorly standardized and can fail to remain adherent during the case. We aim to describe a unique approach for the safe drainage of giant ovarian cysts.</div></div><div><h3>Case</h3><div>We present four adolescents with giant ovarian cysts (10-30 cm) and low pre-operative concern for malignancy, who proceeded to surgery for definitive treatment of the mass and associated symptoms. In all cases, a 4-6 cm midline infraumbilical incision was used. After obtaining adequate exposure of the mass, we adhered the rigid ring of a sterile 3 cm silo bag designed for ventral wall defects (Image 1) to a dried surface of the mass using sterile surgical glue. After ensuring the glue was dry, we trimmed off the closed distal end of the bag to allow access to the cyst surface. Through the constructed opening of the bag, the cyst was then entered sharply and contents were drained. In three cases, no spillage of contents was noted (Image 2) after multiple (1.9-5) liters were drained. In one case, there was minimal spillage noted due to malfunction of the suction device. In all but one case, the ovarian cortex was spared after cystectomy. In all cases, the bags remained firmly adherent to the ovarian cortex until the ovary and cyst could be exteriorized. There were no postoperative complications, and patients were discharged on postoperative days 0-2.</div></div><div><h3>Comments</h3><div>We introduce a safe, ovarian-sparing approach for extracorporeal drainage of giant adnexal cysts using a silo bag for spillage prevention through a mini-laparotomy incision. We believe this technique would be readily reproducible at many hospitals.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Pages 230-231"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519878","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":"37. Examining contraceptive knowledge, use and preferences of adolescents hospitalized with psychiatric disorders","authors":"Abigail Underwood ,&nbsp;Alicia Bunger ,&nbsp;Brittny Manos ,&nbsp;Elise Berlan","doi":"10.1016/j.jpag.2025.01.070","DOIUrl":"10.1016/j.jpag.2025.01.070","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with psychiatric symptoms have unique sexual health needs. These adolescents can have younger age at first sex, less frequent and/or inconsistent contraception use, and higher risk sexual behaviors than their peers without psychiatric symptoms. We examined contraception knowledge, use, and preferences among adolescents assigned female at birth (AFAB) hospitalized for psychiatric care, in addition to patient factors associated with contraceptive use.</div></div><div><h3>Methods</h3><div>Between November 2021 and March 2023, we recruited 451 adolescents AFAB ages 14-17 from 4 inpatient psychiatric units at a large children's hospital. As part of a larger study examining integration of contraception care in inpatient psychiatric settings, participants answered a survey about reproductive health, mental health, contraception knowledge, use, and preferences. The survey was administered via an electronic tablet using REDCap. Participants received a gift card incentive. Descriptive statistics included mean and standard deviation (SD) for continuous variables and frequencies and percentages for categorical variables. We used logistic regression to examine characteristics associated with contraception use. This study was approved by the institutional review board.</div></div><div><h3>Results</h3><div>Mean age was 16.1 (95% CI: 14.1-18.1); 65.4% identified as white and 9.3% identified as Hispanic. Most respondents reported knowledge about the contraceptive pill (98.9%), implant (76.1%), intrauterine device (IUD; 75.2%), and injectable (51.4%). Among the 44.6% of respondents that reported ever having intercourse, condoms (49.3%), withdrawal (29.4%) and contraceptive pills (23.4%) were the most common methods of contraception. Some (37.3%) reported using multiple methods and few (13.4%) reported using no method to prevent pregnancy. When asked to select their preferred method, participants chose contraceptive pills (38.6%) most, followed by the implant (16.0%) and IUD (11.3%). Age was significantly associated with contraceptive use (OR: 1.6; 95% confidence interval 1.3, 1.9; p&lt; 0.001) with older adolescents reporting higher odds of contraceptive use. Patient race, experience with sexual education, and insurance status were not significantly associated with contraceptive use.</div></div><div><h3>Conclusions</h3><div>Many adolescents hospitalized with psychiatric disorders are sexually active. Despite knowledge of contraceptives and preferences for more effective methods, their use of condoms and withdrawal may indicate their contraceptive needs are not being met. As adolescents face increasing rates of psychiatric symptoms, effort is recommended to ensure they have accessible sexual health services.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 247"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520015","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":"Urethral Prolapse in the Course of Cystic Fibrosis: A Case Report","authors":"Anna Mordarska MD ,&nbsp;Karolina Kowalczyk MD, PhD ,&nbsp;Grzegorz Kudela MD, PhD ,&nbsp;Agnieszka Drosdzol-Cop MD, PhD","doi":"10.1016/j.jpag.2025.02.009","DOIUrl":"10.1016/j.jpag.2025.02.009","url":null,"abstract":"<div><div>This case report highlights a rare occurrence of urethral prolapse (UP) in a 7-year-old girl diagnosed with cystic fibrosis (CF). The patient displayed a protruding, swollen, and bleeding mass at the urinary orifice, accompanied by chronic constipation and a recent respiratory syncytial virus (RSV) infection. Cystovaginoscopy and circumferential excision were performed, leading to a successful outcome. Since the operation, the patient has been pain-free. The association between CF and UP underscores the need for heightened awareness among clinicians. The report focuses on recognizing and managing UP in pediatric CF patients to provide the best possible care.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 4","pages":"Pages 525-527"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537329","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":"58. Is Reproductive Health Knowledge Protective Against Adolescent Pregnancy?","authors":"Wendy Jackson,&nbsp;Stephanie Stockburger,&nbsp;Mary Nunn,&nbsp;Madison Tackett,&nbsp;Rachel Cooper","doi":"10.1016/j.jpag.2025.01.091","DOIUrl":"10.1016/j.jpag.2025.01.091","url":null,"abstract":"<div><h3>Background</h3><div>Though teen pregnancy rates are declining, it remains a pressing issue. Data is limited on prevention of teen pregnancy but contraception and engagement with family and community have been identified as protective. A more universal intervention may have more equitable results. This study aims to identify if knowledge of female genitourinary (GU) structures is associated with nulliparity in adolescents, assessed by identification of anatomical structures on a digital image. Nulliparous adolescents will identify more female GU structures correctly than parous adolescents.</div></div><div><h3>Methods</h3><div>Subjects were adolescents (12-21 years old) and patients of University of Kentucky's Adolescent Medicine Clinic (AMC) or Young Parent Program Clinic (YPP). Participant's received a $20 check through the mail after completing a survey on an iPad with questions about demographics, educational background, and identification of GU structures. The survey was offered in English and Spanish. This was a cross-sectional study with purposive sampling. Sample size was 103, 55 from the AMC and 48 from YPP. Fisher's exact, χ2, and Shapiro-Wilk normality tests were used to compare answers between the two groups. Statistical significance was set at p≤0.05, all tests were two-sided. Respective clinic attendance was the predictive variable. The primary outcome was the number and percent of GU structures identified correctly. University of Kentucky Institutional Review Board approved this study (#81195).</div></div><div><h3>Results</h3><div>The participants in AMC scored significantly higher than YPP participants having a higher median overall correct responses (17 vs 13). The median percent correct was 89.5% in the AMC group and 68.4% in the YPP group (Table 2). Therefore, the hypothesis was accepted as true. Grade of reproductive education differed significantly between groups. In the AMC group 41.1% reported education in grades 6-9, 39% beyond high school, and 20.5% received no education compared to 58.5%, 29% and 12% in the YPP group, respectively (Table 1).</div></div><div><h3>Conclusions</h3><div>These results suggest reproductive health knowledge may serve as a protective variable against teen pregnancy. Though a majority of nulliparous teens reported receiving education after high school or no education at all. Interestingly, students are taught reproductive anatomy, but these concepts are not revisited at later grade levels (10-12) when adolescents may be more likely to engage in sexual activity. Despite health education being implemented in schools, the delivery and delivery timing may be ineffective. These conclusions are limited by the cross-sectional design of the study but strengthened by a racially and ethnically diverse sample population.</div></div>","PeriodicalId":16708,"journal":{"name":"Journal of pediatric and adolescent gynecology","volume":"38 2","pages":"Page 256"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519705","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":"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":"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}