Journal of pediatric and adolescent gynecology最新文献

Study objective: Compare the length of hospital stay of adolescents admitted for severe anemia (hemoglobin ≤ 8 g/dL) due to acute abnormal uterine bleeding (AUB) treated with high-dose combined oral contraceptive pills (HD-OCPs) versus those treated with HD-OCPs and intravenous conjugated equine estrogen, also referred to as dual therapy.

Design, setting, and participants: This is a single institution retrospective cohort study of adolescents hospitalized for the management of acute AUB and severe anemia between July 1^st, 2004, to January 1^st, 2020. Subjects were excluded if they were pregnant, had a malignancy, thrombocytopenia, treated with other hormonal therapies, or if bleeding stopped prior to admission.

Main outcome measures: Primary outcome was length of hospital stay. Secondary outcomes were rates of complications and side effects secondary to the hormonal medication.

Results: There were 113 subjects included in the study. Seventy-four (65%) received HD-OCPs only, and the remainder received dual therapy. Mean subject age was 13.8 years for both groups. Those who received HD-OCPs alone were hospitalized for an average of 38.4 hours versus 45.6 hours for those who received dual therapy (p=0.0007). The only reported side effect in either group was nausea and/or vomiting, which was higher in the group who received dual therapy than those treated with HD-OCPs alone (85% versus 51.4% respectively, p-value=0.001).

Conclusion: Adolescents who received dual therapy had a longer hospital stay than those who received HD-OCPs alone. There were no complications related to the medication regimens in either group, but those receiving dual therapy had significantly higher rates of anti-emetic use.

Background: Adolescence is a crucial phase in a person's life. The purpose of this study was to evaluate the efficacy of gamification in the education of teenage females on pubertal health.

Methods: This clinical trial, conducted on 90 adolescent girls in XXX, XXX, during the 2023-2024 year, used a multistage cluster sampling method to assign participants randomly to intervention and control groups. The intervention group received weekly puberty health education over four weeks through a gamification platform. Data collection involved a socio-demographic questionnaire as well as puberty awareness and practice assessments, completed by both groups before the intervention, immediately, and one month after study.

Findings: The average puberty awareness and practice scores of the students in the intervention group significantly increased significantly, immediately and four-week after the intervention compared to the control group (P<0.001). The standardized effect sizes for awareness and practice were 0.74 and 0.25, respectively. In the intervention group, puberty awareness siginificanlty increased by 5.28 (95% CI:4.51 to 6.06) and 5.06 points (95%CI:4.31to 5.82) when comparing the two time periods before and immediately after, and before and four weeks after the intervention, respectively. Similarly, the puberty practice score significanly increased by 6.82 (95% CI:4.24 to 9.40) and 8.73 points (95% CI:5.94 to 11.51) in the same time comparisons (P<0.001).

Conclusion: This study demonstrated the effectiveness of using gamification in puberty health education on increasing puberty awareness and practice among adolescent girls. This innovative educational approach can enhance puberty health education programs, leading to better health outcomes for adolescent girls.

Study objective: Imperforate hymen (IH) is a rare congenital anomaly that results in vaginal outlet obstruction. IH can cause significant morbidity if not managed appropriately, which depends on accurate identification of the condition. However, data on the accuracy of IH diagnosis is limited. This study aimed to investigate the accuracy of IH diagnosis at a single referral center.

Methods: Institutional Review Board approval was obtained for this retrospective chart review. ICD-10 codes identified patients with "hymenal abnormalities" between 2018 and 2023 at a single children's hospital. The primary outcome was rate of misdiagnosis of IH through comparison of diagnosis codes and chart review. Descriptive statistics and Chi-square or Fischer's exact test were utilized as appropriate.

Results: 165 patients met inclusion criteria. 57 were initially diagnosed with IH and of those patients, 28 (49.1%) were misdiagnosed. Additionally, 5 patients initially diagnosed with a different condition were later found to have IH. There was no significant difference in misdiagnosis rate between premenarchal and menarchal patients (p=0.77). There was a significantly higher rate of misdiagnosis amongst generalist Ob/Gyn providers compared to pediatric gynecologists (p=0.04).

Conclusion: Many patients with IH may initially be seen by primary care providers. Due to the rarity of the condition and a lack of provider exposure to IH, misdiagnosis is common. IH is important to distinguish from other anomalies of the reproductive tract, as the management differs. Misdiagnosis of IH may lead to incorrect surgical approach and subsequent complications. Training and education surrounding IH, along with referral to pediatric gynecology, may help reduce misdiagnosis.

Study objective: Puberty is associated with important changes in secondary sexual characteristics, but the changes occurring in female external genitalia are not thoroughly described. The aim of this systematic review is to summarize and assess the current scientific knowledge regarding vulvar changes and development during puberty.

Methods: PubMed, Embase, Web of Science, and Cochrane were searched, using keywords related to "puberty", "vulva", and "morphology". Inclusion criteria were observational studies describing vulvar development in individuals between the ages of 8 and 16 years. The outcomes of interest were quantitative and/or qualitative descriptions of the vulva, including anatomical, physiological and histological changes.

Results: Of the 1658 articles screened, 10 were included. The mean clitoral glans diameter increases during puberty, as does the length of the clitoral hood. The clitoral hood changes, to become more retractile and rugose. The inner labia width and length increases throughout puberty, and the development of inner labia varies between individuals, with labial asymmetry being a common characteristic. The most frequent hymenal configuration found during puberty is the crescentic form, and features such as hymenal mounds, longitudinal intravaginal ridges, and most notches, are physiological.

Conclusion: Reliable data on pubertal development of the external female genital organs is scarce. Future research is needed in order to provide more precise data to help categorize vulvar development into stages. A detailed description of vulvar maturation into sequential stages throughout puberty (as done by the Tanner scale for the male homologous structures) can increase knowledge of its morphological diversity and help reach clinical consensus on the nature of pathological variants. In addition, better knowledge of vulvar diversity is of importance to both healthcare professionals and individuals, and may empower and promote self-esteem.

Background: Uterine leiomyomas are rare in the adolescent age group, with smooth muscle tumors of unknown malignant potential (STUMP) tumors being even exceedingly rarer in young patients.

Case: Three cases aged 19 years, two with abnormal uterine bleeding and one with pelvic pain, were admitted to the hospital. Uterine myomas measuring 5, 7 and 12 centimeters were detected in the patients. Myomectomy was performed in patients with complaints resistant to medical treatment. Pathologic examinations revealed that one of the complaints was a STUMP tumor, which is very rare in the adolescent and young age group. The other two examinations revealed benign uterine fibroids.

Summary and conclusion: Although uterine myomas are quite rare in the adolescent age group, they should be considered in patients with pelvic pain, pelvic mass, and abnormal uterine bleeding. In this age group, uterine myomas and even STUMP tumors should be included in the differential diagnosis.

Study objectives: Primary Dysmenorrhea (PD) is a prevalent gynaecological condition affecting young females, characterized by cyclic, cramping pelvic pain with no organic pathology. It can significantly impact their Quality of life (QOL) and academic performance. The study aimed to determine the effect of therapeutic taping on clinical symptoms, QOL and academic performance of students with PD.

Design: It was a single-blind, parallel design, Randomized controlled trial SETTING: Study conducted from May to September 2023 in Girls Hostel, Islamabad, Pakistan.

Participants: Women aged 18-25 years with PD and pain severity of VAS ≥4 were recruited. Those with other health conditions and having an allergy to Kinesio taping (KT) were excluded from the study.

Intervention: A total of 66 women have completed the study. They were randomly assigned to three groups: experimental (KT), sham tape (ST), and control group (CG). KT tape was applied to the suprapubic and sacral regions using the ligament technique in the KT group and without stretch in the ST group. Assessments were taken at baseline, 8th and 12th weeks.

Main outcome measures: The study tools were the visual analogue scale (VAS), menstrual symptoms questionnaire (MSQ), Health-related quality of life (SF-36) and Academic Performance Questionnaire (APQ). Data analysis was done using SPSS-25.

Results: The participants' mean age (years) was (KT: 22.04±2.13, Sham: 22.35±3.11 and CT: 23±2.52). Between-group analysis shows a statistically significant difference in VAS (p<0.05) and MSQ (p<0.01) after the 12^th week of intervention, whereas the APQ score was statistically significant (p <0.01) on the 8th and 12^th week. Similarly, the SF-36 score was significant for both physical (p<0.001) and mental (p<0.05) component summary between the intervention groups.

Conclusion: Kinesio Taping is an effective intervention option for pain reduction, menstrual symptom relief, and improved academic performance for individuals with PD.

Study objective: Despite falling teen birth rates in the United States, there is a disproportionate burden of teen births in rural regions. The study aims to investigate the characteristics of teenage mothers and examine the relationships between teen birth and adverse birth outcomes in the rural Appalachian state of West Virginia (WV).

Methods: Data was obtained from a population-based cohort (Project WATCH) of all singleton live births in WV between May 2018 and April 2023. The primary exposure variable was mothers who gave birth when they were less than 20 years old (teenage births v. adult). Primary outcomes included birthweight, gestational age, NICU admission, 5-minute Apgar score, and breastfeeding status.

Results: Of 86,447 live births, 5,310 (6.15%) were birth to teenage mothers. Maternal characteristics of teenage mothers included minority racial groups, lower education, Medicaid, rural residence, and inadequate prenatal care. Teenage births were associated with lower mean birthweight aMD [b = -49.31g. (-65.37, -33.24)], low birthweight [<2500g. vs. ≥2500 g., aRR = 1.11 (1.0, 1.24)], and small for gestational age [v. appropriate for gestational age, aRR = 1.21 (1.12,1.30)]. Teenage mothers were less likely to exclusively breastfeed at discharge [aRR, 1.20 (1.11, 1.28)]. Analyses adjusted for maternal race/ethnicity, education, health insurance, smoking, substance use, prenatal care, diabetes, and residence type.

Conclusions: Teenage births are high in WV and are linked to adverse infant outcomes. These findings may help identify at-risk groups for support and provide policymakers with information to design effective interventions to prevent teenage births and its negative outcomes.

Study objective: To explore menstrual cycle symptoms, information sources and menstrual health literacy in young women (aged 13-25) and those who menstruate in Aotearoa New Zealand.

Design and setting: Cross-sectional online survey in Aotearoa New Zealand.

Participants: 1334 respondents (age 13-25 years, mean age 19.8), who have had at least three periods and were currently living in New Zealand.

Interventions: Online survey hosted by Qualtrics between October 2021, and January 2022.

Main outcome measures: Information on menstrual cycle characteristics and symptoms, and menstrual health literacy.

Results and conclusions: Respondents reported high rates of regular dysmenorrhoea (89%), fatigue/tiredness (78.1%) and mood changes (72.5%) associated with menstruation. A higher proportion of rangatahi (younger generation) Māori reported irregular cycles (53.5%) compared to non-Māori respondents (41.7%). Normalisation of symptoms, especially pain (80.2%), was high. Most respondents recognised the need to see a doctor for period pain which impacted their daily lives (84.7%). However, non-cyclical pelvic pain (45.7%), heavy bleeding (39%) and intermenstrual bleeding (29%) were less likely to be recognised as symptoms that require a doctor's visit. The main sources of menstrual health knowledge prior to menarche were a family member (74.2%) and health and physical education classes at school (63.7%). Many young people reported receiving little or no information about periods prior to menarche (37.9%), with very few respondents receiving information on how to manage menstrual symptoms (15.1%). Menstrual symptoms are common and the provision of culturally safe information and opportunities to learn is important for young people, whānau, schools and healthcare practitioners.

Background: Individuals with disabilities experience a higher prevalence of sexually transmitted infections (STIs) compared to their counterparts without disabilities; however, there is limited data on whether they are screened for STIs at the same rate. The aim of this study was to determine whether adolescents and young adults with disabilities undergo routine screening for STIs at lower rates than individuals without disabilities.

Methods: We performed a retrospective cohort study of female patients aged 16-21 years who were seen between July 2021 and August 2023 by pediatrics, internal medicine/pediatrics, or family medicine at a single institution. Disability status was determined via ICD-10 codes. STI testing information was obtained by chart review. Data were analyzed using multiple logistic regression, and adjusted odds ratios were reported for race, ethnicity, age, and disability.

Results: Among 6906 eligible patients, 90 (1.3%) had a disability. Individuals with disabilities underwent STI screening at lower rates (60% vs 77.2%, p<.001). There were lower odds of STI screening for individuals with any disability (aOR 0.38, 95% CI 0.24-0.61, p<.001), a physical disability (aOR 0.26, 95% CI 0.09-0.72, p=.008), or an intellectual disability (aOR 0.37, 95% CI 0.21-0.64, p<.001) when adjusting for race, ethnicity, and age.

Conclusions: The rate of STI screening among adolescents and young adults with disabilities was lower compared to those without disabilities. Universal testing may help normalize STI screening so that individuals with a higher risk of STIs are not missed. Further research is indicated to identify and mitigate factors that lead to lower rates of screening.

Objectives: To assess the level of awareness among Malaysian healthcare providers (HP) regarding Paediatrics and Adolescent Gynaecology (PAG) services. Additionally, the study evaluates HP's knowledge of the HEADSS¹ questionnaire (Home Environment, Education and Employment, Activities, Drugs, Sexuality, Suicide and depression) and their understanding of acute abdominal pain in female adolescents.

Methods: A simple, 5-question online survey was conducted nationwide among registered Malaysian HP, including doctors, nurses, assistant medical officers (AMO) and medical attendants (MA).

Results: A total of 529 HP participated in the survey, with a median age of 35 years. Majority had more than 5 years working experience (74.7%), worked in specialist hospitals (66.7%). Only 56.3% of HP had heard of PAG services, while 43.7% were familiar with the HEADSS tool, with 60.2% using it in practice. Awareness was higher among doctors (61.4%), senior HP (59.2%), and those in specialist hospitals (69.7%). Among doctors, both experience and workplace significantly impacted their awareness. Notably, 2% of doctors were unsure about which specialty for referrals when managing acute abdomen in adolescents.

Conclusion: Overall, awareness of PAG services is low, with only 56.3% of HP and 61.4% of doctors familiar with the specialty. Management practices vary and lack standardization. We recommend implementing standardized training programs to improve the awareness and care for adolescent patients.