Journal of pediatric and adolescent gynecology最新文献_第2页

Postpartum Contraception Use among Adolescent Mothers 青少年母亲产后避孕措施的使用。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.10.011

Julie Maslowsky PhD , Eleanor Esbrook MD , Renee Odom-Konja MPH , Haley Stritzel PhD , Catherine Gimbrone MPH , Dorothy Mandell PhD

Study Objective

To describe patterns of postpartum contraception use among primiparous and multiparous adolescent mothers.

Methods

Cross-sectional data came from the Pregnancy Risk Assessment Monitoring System Phase 7 (2012-2015). The analytic sample included postpartum respondents ages 15-19 in 40 US states (N = 5535). Exposures included age, race, parity, intimate partner violence, psychosocial stressors, prenatal care utilization, postpartum home health visits, and insurance type. The primary outcome was postpartum use of effective contraception. The secondary outcome was reasons for not using postpartum contraception.

Results

Adolescents who attended postpartum check-ups (AOR = 2.12; 95% CI 1.58-2.84) or received home health visits (AOR = 1.37; 95% CI 1.06-1.77) were more likely to use effective contraception postpartum, whereas those experiencing more stressors were less likely (AOR = 0.93; 95% CI: 0.86-1.00). Non-Hispanic Black adolescents were less likely to use effective contraception (AOR = 0.69; 95% CI 0.50-0.94) compared to non-Hispanic White adolescents. Among those who did not use contraception postpartum, having a postpartum home health visit was associated with lower odds of endorsing contraceptive side effects (AOR = 0.33; 95% CI 0.18-0.60) or not wishing to use contraception (AOR = 0.43; 95% CI 0.22-0.86) as reasons for nonuse.

Conclusion

Access to postpartum care via home health and postpartum clinic visits was associated with significantly higher likelihood of using effective contraception. However, disparities persisted among non-Hispanic Black adolescents and those experiencing high levels of psychosocial stress. For postpartum adolescents who do not desire a subsequent birth, increasing their ability to obtain effective contraceptives can be achieved through increased access to postpartum care, particularly for underserved populations.

研究目的：描述初产和多产青少年母亲产后避孕的使用模式。方法：横断面数据来自妊娠风险评估监测系统第7期（2012-2015）。分析样本包括美国40个州15-19岁的产后受访者（N= 5535）。暴露因素包括年龄、种族、胎次、亲密伴侣暴力、心理社会压力源、产前护理利用、产后家庭健康访问和保险类型。主要结局是产后有效避孕的使用情况。次要结果是未使用产后避孕措施的原因。结果：参加产后检查（AOR=2.12; 95% CI: 1.58-2.84）或接受家庭健康访问（AOR=1.37; 95% CI: 1.06-1.77）的青少年更有可能在产后使用有效的避孕措施，而经历更多压力源的青少年更不可能（AOR=0.93; 95% CI: 0.86-1.00）。与非西班牙裔白人青少年相比，非西班牙裔黑人青少年较少使用有效避孕措施（AOR=0.69; 95% CI 0.50-0.94）。在那些产后没有使用避孕措施的妇女中，产后家庭健康访问与赞同避孕副作用（AOR=0.33; 95% CI 0.18-0.60）或不希望使用避孕措施（AOR=0.43; 95% CI 0.22-0.86）作为不使用原因的几率较低相关。结论：通过家庭保健和产后门诊就诊获得产后护理与使用有效避孕措施的可能性显著增加相关。然而，在非西班牙裔黑人青少年和那些经历高水平社会心理压力的青少年中，差异仍然存在。对于不希望再生育的产后青少年，可以通过增加获得产后护理的机会来提高他们获得有效避孕药具的能力，特别是对服务不足的人群。

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引用次数: 0

Focal Adenomyosis in a 17-Year-Old Patient: A Case Report 17岁患者局灶性脑卒中1例报告

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.10.007

Maja Banović MD, PhD , Dina Gržan MD , Vladimir Banović MD, PhD

引用次数: 0

Authors’ Response to “Responding to Adolescents’ Emotional Needs in Abortion: The Importance of Empathy-Based Counseling and Flexible Choice” 作者对“应对青少年堕胎中的情感需求：移情咨询和灵活选择的重要性”的回应

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.08.004

Laura Kirkpatrick MD

引用次数: 0

Implementation of No-Test Medication Abortions in Primary Care: A Roadmap from an Adolescent and Young Adult Medicine Clinic 实施无测试药物流产在初级保健：路线图从青少年和青年医学诊所。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.09.014

Julia H. Raney MD , Amanda E. Bryson MD, MPH , Chelsea A. Garnett MD , Lisa Mihaly FNP, MS , Sara M. Buckelew MD, MPH , Marissa Raymond-Flesch MD, MPH

Study Objective

Over 2 years post-Roe, 22 states have banned or significantly limited abortion access, exacerbating existing structural barriers to abortions for adolescents and young adults (AYAs), including cost, transportation, parental notification requirements, and confidentiality concerns. We provide a roadmap for and demonstrate the feasibility of implementing no-test medication abortions (MABs) to expand abortion access in an adolescent-focused pediatric primary care setting.

Methods

An interdisciplinary team in an AYA-focused primary care clinic developed and implemented a no-test MAB protocol. Iterative rounds of protocol development engaged stakeholders including hospital leadership, OBGYN consultants, nurses, and program directors for residency, fellowship, and nursing trainees. Frequent interdisciplinary debriefs identified facilitators, barriers, and solutions to optimize care.

Results

Over 6 months, we identified clinic champions, built relationships with key stakeholders, developed clinic protocols, and disseminated MAB clinical training. In our first 6 months of implementation, we provided 4 MABs. Facilitators identified by staff include provider expertise in AYA development and patient and parent preferences for MABs in their medical home. System-level barriers (eg, timely scheduling challenges), staff factors (eg, fear of complications), and patient factors (eg, ambivalence about pregnancy) were identified. Solutions developed include establishing scheduling procedures, formalizing consultative pathways with gynecology, and integrating social work support.

Conclusion

It is feasible for adolescent primary care practices to provide no-test MABs. Through interdisciplinary planning and iterative design, barriers from the health system, clinic staff, and patient levels can be identified and addressed, expanding equitable access to safe, AYA-focused abortion care.

研究目标：在roe案件发生后的两年多时间里，22个州禁止或严重限制了堕胎机会，加剧了青少年和年轻人（AYA）堕胎的现有结构性障碍，包括成本、交通、父母通知要求和保密问题。我们提供了一个路线图，并证明了实施无测试药物流产（mab）的可行性，以扩大流产获得在青少年为重点的儿科初级保健设置。方法：一个跨学科的团队在一个以aya为重点的初级保健诊所开发并实施了一个无测试的MAB协议。反复的协议制定涉及到包括医院领导、妇产科顾问、护理、住院医师项目主管、奖学金和护理实习生在内的利益相关者。频繁的跨学科汇报确定了优化护理的促进因素、障碍和解决方案。结果：在6个月的时间里，我们确定了临床冠军，与主要利益相关者建立了关系，制定了临床方案，并传播了MAB临床培训。在我们实施的前6个月，我们提供了4个单克隆抗体。工作人员确定的促进因素包括提供人员在AYA开发方面的专业知识以及患者和家长在其医疗家中对单克隆抗体的偏好。确定了系统层面的障碍（如及时安排的挑战）、工作人员因素（如对并发症的恐惧）和患者因素（如对怀孕的矛盾心理）。制定的解决方案包括建立日程安排程序，与妇科正式协商途径，以及整合社会工作支持。结论：在青少年初级保健机构中提供免检测单克隆抗体是可行的。通过跨学科规划和迭代设计，可以确定和解决来自卫生系统、诊所工作人员和患者层面的障碍，扩大公平获得安全、以人工流产为重点的人工流产护理的机会。

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引用次数: 0

Perforated Rotated Mesenteric Cyst Presenting as Acute Abdominal Pain in a Female Pediatric Patient: A Case Report 穿孔旋转肠系膜囊肿表现为急性腹痛的女儿科患者：一个病例报告。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.09.011

Valerie Josephine Dirjayanto MRes , Astrid Indrafebrina Sugianto MD, BMedSci , Riana Pauline Tamba MD, PhD

Introduction

Although more than half of cases are asymptomatic or mild in symptoms, mesenteric cysts can present clinically and radiologically similar to gynecologic diseases.

Case

A female child presented with worsening episodes of abdominal pain 1 day before admission. Abdominal x-ray suggested mechanical obstruction of the small bowel, and CT scan suggested ileal abnormality.

Discussion

During open surgery, we found 2 rotated chylous mesenteric cysts, accompanied by adhesions and jejunal perforation 57 cm from the ligament of Treitz. Cyst excision, adhesiolysis, ileo-ileal resection, and anastomosis were performed.

Conclusion

Although rare and challenging to identify, mesenteric cysts should be kept in the differential diagnosis of female children presenting with abdominal pain.

简介：虽然超过一半的病例无症状或症状轻微，但肠系膜囊肿的临床和放射学表现与妇科疾病相似。病例说明：一女患儿入院前1天腹痛加重。腹部x线提示机械性小肠梗阻，CT提示回肠异常。讨论：在开放手术中，我们发现两个旋转的乳糜肠系膜囊肿，伴粘连和空肠穿孔，距Treitz韧带57厘米。行囊肿切除、粘连松解、回肠-回肠切除术、吻合术。结论：虽然肠系膜囊肿罕见且难以识别，但在以腹痛为表现的女性儿童中应保留其鉴别诊断。

引用次数: 0

Improving Minimally Invasive Surgical Approaches to Large Adnexal Masses in Pediatric Gynecology: Combining Mini-Laparotomy With Single Port Laparoscopy 改进小儿妇科大附件肿物的微创手术入路：小剖腹与单口腹腔镜相结合。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.09.012

Megan F. Sumida MD , Olivia K. Winfrey MD, MPH , Julie Hakim MD , Jennifer E. Dietrich MD, MSc

In pediatric populations large ovarian cysts are often benign, and minimally invasive approaches are preferred to minimize perioperative pain and recovery, allow for same day discharge, and improve incision cosmesis. Ovarian preservation is also prioritized and cystectomy is preferred over oophorectomy. While tactile sensation and dexterity are improved in mini laparotomy cases, there are limitations with visualization that are improved with laparoscopy. We describe a technique that employs both diagnostic laparoscopy and mini laparotomy using the GelPOINT Mini™ Advanced Access Platform for single site laparoscopy in pediatric patients. This case series includes cysts ranging 7-24 cm with benign preoperative risk stratification, in patients aged 3-16 years, who underwent successful same-day, ovarian-sparing surgery with the benefits of both open and laparoscopic procedures.

在儿科人群中，较大的卵巢囊肿通常是良性的，微创方法可以最大限度地减少围手术期疼痛和恢复，允许当天出院，并改善切口美容。卵巢保存也是优先考虑的，膀胱切除术优于卵巢切除术。虽然在小型剖腹手术病例中触觉和灵活性得到了改善，但腹腔镜手术改善了视觉上的局限性。我们描述了一种使用GelPOINT mini™高级访问平台进行儿科患者单部位腹腔镜检查的诊断腹腔镜和迷你剖腹手术技术。本病例系列包括7-24厘米的囊肿，术前良性风险分层，患者年龄3至16岁，接受了成功的当天卵巢保留手术，开放和腹腔镜手术均有好处。

引用次数: 0

Nonsedated Intrauterine Device Experiences Among Transgender and Cisgender Adolescents and Young Adults in the Outpatient Setting 门诊跨性别、顺性别青少年和年轻人使用非镇静宫内节育器的经验。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.08.007

Liz Abernathey MD, MS , Morgan E. Ryan MS , Carly E. Milliren MPH , Kym Ahrens MD, MPH , Amy D. DiVasta MD, MMSc , Sarah Pitts MD , Michelle Escovedo MD , Sofya Maslyanskaya MD , Sarah A. Golub MD, MPH

Study Objective

This study compares the demographic characteristics and experiences of three different groups of adolescent and young adults (AYAs) seeking nonsedated intrauterine device (IUD) insertion in the outpatient setting: (1) cisgender individuals, (2) transgender and gender diverse (TGD) individuals receiving gender-affirming testosterone therapy, and (3) TGD individuals not receiving gender-affirming testosterone therapy.

Methods

This retrospective cohort study included AYAs age 13-21 years seeking IUD insertion. Data were obtained from the electronic health record via a pre-existing, multi-institutional shared quality improvement collaborative. The patient population was characterized by descriptive statistics; inferential statistics compared procedural complications, outcomes, and patient-reported side effects. Unadjusted Kaplan–Meier and Cox proportional-hazard modeling assessed continuation rates.

Results

Of the 683 participants attempting IUD insertion, 623 were cisgender individuals, 18 were TGD individuals on gender-affirming testosterone, and 42 were TGD individuals not on testosterone. There was no difference in insertion indication (P = .25). TGD patients on testosterone were more likely to have experienced a procedural adverse event (17%; P = .04), and to have reported pain beyond expectation (P = .003), although insertional success did not differ significantly between groups (P = .22).

Conclusion

TGD AYAs had similar reasons as cisgender patients for seeking the IUD. While TGD individuals on testosterone were more likely to have pain or an adverse procedural event, insertional success did not differ. One-year IUD continuation rates were similarly high in all groups.

研究目的：本研究比较了三种不同的青少年和年轻人（AYAs）在门诊寻求非镇静宫内节育器（IUD）插入的人口统计学特征和经历：(1)顺性别个体，(2)变性和性别多样化（TGD）个体接受性别肯定睾酮治疗，(3)TGD个体不接受性别肯定睾酮治疗。方法：本回顾性队列研究纳入13 ~ 21岁寻求宫内节育器植入的青少年。数据通过预先存在的多机构共享质量改进（QI）协作从电子健康记录中获得。患者群体特征采用描述性统计；推断统计学比较了手术并发症、结果和患者报告的副作用。未调整的Kaplan-Meier和Cox比例风险模型评估了延续率。结果：在683例尝试插入宫内节育器的参与者中，623例为顺性别个体，18例为使用性别确认睾酮的TGD个体，54例为未使用睾酮的TGD个体。插入指征无差异（p=0.25）。使用睾酮的TGD患者更有可能经历手术不良事件（17%,p=0.04），并报告超出预期的疼痛（p=0.003），尽管插入成功率在两组之间没有显著差异（p=0.22）。结论：TGD患者寻求宫内节育器的原因与顺性患者相似。虽然接受睾酮治疗的TGD患者更有可能出现疼痛或不良手术事件，但插入成功率并无差异。在所有组中，1年的宫内节育器延续率相似地高。

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引用次数: 0

Bridging the Gap between Hypothyroidism and Precocious Puberty: A Case Report of Van Wyk Grumbach Syndrome 弥合甲状腺功能减退与性早熟之间的差距：Von Wyk Grumbach综合征1例报告。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.09.005

Om Kumari MBBS, MS, Neetu Sharma MBBS, MS, Megha Jindal MBBS, Kanak Dubey MBBS, DNB, Latika Chawla MBBS, MD

Introduction

Van Wyk Grumbach syndrome (VWGS) is a rare clinical entity that presents with the triad of precocious puberty, polycystic ovaries, and severe hypothyroidism. VWGS is an uncommon cause of precocious puberty characterized by the dissociation of gonadarche and adrenarche. Unlike other etiologies of precocious puberty, VWGS is associated with absent growth acceleration and delayed bone maturation due to prolonged, untreated hypothyroidism. The diagnosis is often delayed or overlooked, as the overt or unusual pubertal manifestations may overshadow the subtle signs of hypothyroidism. Failure to identify hypothyroidism as the cause of ovarian cysts and precocious puberty may lead to catastrophic ovary resection and oophorectomy in prepubertal girls and adolescents.

Case Presentation

We present a case of VWGS in a 7-year-old girl presenting with a painful abdomen with precocious puberty and menarche. A relevant review of the literature on this uncommon clinical entity is also presented.

Conclusion

This study underscores the importance of recognizing the atypical presentation of prolonged hypothyroidism with precocious puberty in young children. This emphasizes the need for clinicians to consider the rare entity of VWGS, which could help prevent delays in appropriate management.

简介：Von Wyk Grumbach综合征（VWGS）是一种罕见的临床症状，表现为性早熟、多囊卵巢和严重甲状腺功能减退。VWGS是一种罕见的性早熟的原因，其特征是性腺和肾上腺素的分离。与其他性早熟的病因不同，VWGS与长期未经治疗的甲状腺功能减退症导致的生长加速缺失和骨成熟延迟有关。诊断常常被延误或忽视，因为明显或不寻常的青春期表现可能掩盖了甲状腺功能减退的微妙迹象。未能确定甲状腺功能减退是卵巢囊肿和性早熟的原因可能导致青春期前女孩和青少年灾难性的卵巢切除术和卵巢切除术。病例介绍：我们报告了一例VWGS在一个07岁的女孩表现为腹部疼痛，性早熟和月经初潮。相关的文献回顾，这一罕见的临床实体也提出。结论：本研究强调了认识到幼儿性早熟伴慢性甲状腺功能减退的非典型表现的重要性。它强调临床医生需要考虑VWGS的罕见实体，这可以帮助防止适当管理的延误。

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引用次数: 0

Comparing Medical Abortion Outcomes and Experiences Between Young and Adult Women: Evidence From Urban Cambodia 比较年轻和成年妇女的药物流产结果和经验：来自柬埔寨城市的证据。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.07.007

Erin Pearson PhD, MPH , Paige Logan MPH , Elisabeth Eckersberger PhD, MPA , Jamie Menzel MPH , Bunsoth Mao MD , Sovanthida Suy MAppStat, MSc , Vonthanak Saphonn MD, PhD, MSc , Nathalie Kapp MD, MPH

Introduction

Self-managed abortions are increasingly common globally, but little is known about young women’s experiences.

Methods

Secondary analysis of data from 1847 women accessing MA in urban Cambodia in 2018-2019 and in-depth interviews with seven women aged 15-19. Descriptive statistics compared young and adult women on self-reported abortion outcomes and experiences in clinics and pharmacies, and qualitative data contextualized quantitative findings.

Results

Young women were better represented among clinic clients (30.0%) compared to pharmacy clients (20.2%). Young women had comparable MA success rates and better MA experiences across settings, but young pharmacy clients were more likely to seek support from friends and family.

Discussion

Young women had comparable MA outcomes and experiences as adult women in both clinics and pharmacies, but young women self-managing their abortions may require information and support beyond the pharmacist.

导言：自我管理堕胎在全球越来越普遍，但对年轻女性的经历知之甚少。方法：对2018-2019年柬埔寨城市1847名接受MA治疗的女性的数据进行二次分析，并对7名15-19岁的女性进行深度访谈。描述性统计比较了年轻妇女和成年妇女在诊所和药房自我报告的堕胎结果和经历，定性数据将定量结果纳入背景。结果：年轻女性在诊所客户（30.0%）中比药房客户（20.2%）更具代表性。年轻女性在不同的环境中有相似的MA成功率和更好的MA体验，但年轻的药房客户更有可能从朋友和家人那里寻求支持。讨论：在诊所和药房，年轻女性的MA结果和经历与成年女性相当，但年轻女性自我管理堕胎可能需要药剂师以外的信息和支持。

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引用次数: 0

“I am so grateful you made me do this”: Navigating AYA-Caregiver Discordance on Shared Decision-making about Fertility Preservation “我很感激你让我这样做”在关于生育保护的共同决策中导航保姆和护理人员的不一致。

IF 1.8 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of pediatric and adolescent gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.jpag.2025.09.016

J.L. Feuerstein DO , S. Menon MD , B. Lockart DNP, APRN, NP , S. Zarnegar-Lumley MD , A.K. Johnson PhD

Study Objective

As survival rates improve for adolescents and young adults (AYAs) with cancer, understanding barriers to fertility preservation (FP) decision-making has become increasingly important. FP decisions involve both AYAs and caregivers, yet discordance in fertility goals is common and may hinder FP utilization. The factors contributing to discordance and its impact remain underexplored. This study used the Ottawa Decision Support Framework (ODSF), which identifies essential medical decision-making needs and categorizes barriers into 7 domains, to examine the experiences of discordance in FP decision-making.

Methods

Semi-structured qualitative interviews were conducted with AYA-caregiver dyads who experienced discordance during FP decision-making. Participants were aged 12-25, were ≥6 months post-cancer diagnosis, read and spoke English, and were at risk for infertility due to gonadotoxic therapy. Interviews were conducted via ZOOM between July 2024 and January 2025. Data analysis used a content analysis approach guided by existing theory and the ODSF.

Results

Caregivers emphasized accurate information, AYAs’ maturity, and seeking external advice, whereas AYAs had greater difficulty with internal confidence and decision-making uncertainty. Caregivers often assumed directive roles due to treatment urgency and perceived AYA immaturity. AYAs, despite valuing autonomy, deferred to caregivers due to emotional distress and limited knowledge.

Conclusion

The ODSF-guided analysis revealed several sources of discordance, though none led to FP refusal. Structured counseling mitigated decisional conflict, and all participants expressed decision satisfaction. The findings support structured counseling to align AYAs’ autonomy with caregiver support. Future studies should include more diverse sociodemographic, multi-institutional samples and the perspectives of those who declined FP.

研究目的：随着癌症青少年和青壮年（AYAs）存活率的提高(1)，了解生育保留（FP）决策的障碍变得越来越重要。计划生育决策涉及到AYAs和照顾者，但生育目标的不一致是常见的，可能会阻碍计划生育的利用。造成不一致的因素及其影响仍未得到充分探讨。本研究使用渥太华决策支持框架（ODSF），该框架确定了基本的医疗决策需求，并将障碍分为七个领域(2)，以检查计划生育决策中不一致的经验。方法：采用半结构化的定性访谈，对计划生育决策过程中出现不一致的护理人员夫妇进行访谈。参与者年龄在12-25岁，癌症诊断后≥6个月，能阅读和说英语，有因促性腺毒素治疗导致不孕的风险。访谈在2024年7月至2025年1月期间通过ZOOM进行。数据分析采用现有理论和ODSF指导下的内容分析方法。结果：照顾者强调信息的准确性、aya的成熟度和寻求外部建议，而aya在内部信心和决策不确定性方面存在较大困难。由于治疗的迫切性和AYAs的不成熟，护理人员通常承担指导角色。AYAs虽然重视自主权，但由于情绪困扰和知识有限，他们服从于照顾者。结论：odsf引导的分析揭示了几个不一致的来源，尽管没有一个导致FP拒绝。结构化咨询减轻了决策冲突，所有参与者都表达了决策满意度。研究结果支持结构化咨询，使aya的自主权与照顾者的支持保持一致。未来的研究应该包括更多样化的社会人口统计，多机构样本和那些拒绝计划生育的人的观点。

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引用次数: 0