Journal of pediatric and adolescent gynecology最新文献

Background: Complete androgen insensitivity syndrome (CAIS) is a disorder of sex development characterized by a female phenotype in 46,XY individuals. Given the increased risk of testicular tumors, prophylactic bilateral orchiectomy is offered to patients with CAIS. While CAIS has traditionally been associated with infertility, recent evidence demonstrating the presence of germ cells in the testes of affected individuals raises the possibility of fertility preservation at the time of gonadectomy.

Case: We present a case of gonadal tissue cryopreservation (GTC) following orchiectomy in a 16-year-old patient with CAIS. Half of each testis was sent for GTC, and the remaining tissue for histopathological examination, which revealed no definitive germ cells.

Summary and conclusion: This case report discusses tumor risk, fertility potential and ethical considerations surrounding GTC in CAIS.

Objective: Members of NASPAG provide reproductive health care to adolescent patients. This document aims to provide a comprehensive overview of the recommended counseling for any clinician caring for an adolescent patient with a positive pregnancy test, while addressing legal, ethical, and clinical considerations. The document will discuss strategies for guiding patients through the pregnancy testing process, as well as various issues to consider when ordering tests, disclosing results, and managing the situation if the test is positive. Due to variability between institutions and clinical scenarios, this review will not explicitly advise for or against universal pregnancy testing in medical settings.

Study objective: To compare intraoperative cyst rupture, peritonitis, and cyst recurrence after ovarian dermoid surgery via laparoscopy versus laparotomy in pediatric and adolescent patients.

Methods: A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews. Five bibliographic databases (MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science) and 3 clinical trial registries were searched from inception to August 29, 2024. Eligible studies included quasi-randomized trials and prospective/retrospective cohort studies evaluating intraoperative cyst rupture, peritonitis, or cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery. Two authors independently performed title-abstract and full text screening and independently extracted data. Meta-analyses of cyst rupture and cyst recurrence after laparoscopy versus laparotomy for ovarian dermoid surgery were performed and presented in forest plots. Risk ratios for cyst rupture were pooled with a random-effects model, and for cyst recurrence were pooled with a fixed-effect model. Quality assessment was assessed using the Newcastle-Ottawa Scale.

Results: A total of 1021 studies were identified, with 6 studies included (2000-2022; Canada, United States, Poland). We included 481 (53.9%) patients who underwent laparoscopy, 353 (39.5%) who underwent laparotomy, and 59 (6.6%) who underwent laparoscopy converted to laparotomy. For meta-analysis, 5 studies were included for cyst rupture, and 4 studies were included for cyst recurrence. Random-effects meta-analysis demonstrated a significantly higher risk of cyst rupture with laparoscopy (RR = 2.47; 95% CI, 1.40-4.37). Fixed-effect meta-analysis found no significant difference in cyst recurrence between laparoscopy and laparotomy (RR = 0.92; 95% CI, 0.41-2.08). No cases of chemical peritonitis were observed.

Conclusion: For the surgical management of ovarian dermoid cysts in children, laparoscopy may carry a higher risk of intraoperative cyst rupture compared to laparotomy, however our work highlights that subsequent post-operative peritonitis was not clinically observed and recurrence rates remained similar.

Study objective: Concordance between contraceptive preferences and use is an indicator of person-centered contraceptive care. Adolescents and young adults (AYA) face barriers that may prevent them from fulfilling their contraceptive preferences. We sought to assess the prevalence and predictors of preference-concordant contraceptive use among AYA and examine its associated with person-centered contraceptive counseling (PCCC).

Design: We conducted a secondary analysis of a cross-sectional survey.

Setting: The survey was nationally representative of the United States and administered in 2022.

Participants: The sample included 516 participants, including adolescents (aged 15-17) and young adults (aged 18-24), who were assigned female at birth.

Main outcome measures: The primary exposure was receipt of PCCC at most recent contraceptive care visit. The main outcome was preference-concordant contraceptive use, measured among contraceptive users and nonusers.

Results: Fewer than 60% of AYA had preference-concordant contraceptive use or nonuse, and 19% were uncertain about their preferences. Adolescents were less likely than young adults to use a preferred method and more likely to be content nonusers or uncertain nonusers. Only 28% of participants received PCCC at their most recent visit. PCCC was associated with increased preference-concordant vs preference nonconcordant use (adjusted risk ratio: 1.45; 95% CI: 0.75, 2.82), though this was not statistically significant.

Conclusion: Many AYA are not fulfilling their contraceptive preferences, and uncertainty about method use is common, particularly among adolescents. Person-centered contraceptive counseling may support preference-concordant use, but broader structural, interpersonal, and informational barriers must also be addressed to promote equitable, preference-aligned contraceptive care and access.

This case report describes the management of severe menorrhagia in a 13-year-old girl diagnosed with Glanzmann thrombasthenia (GT), a rare inherited platelet disorder. The patient presented with excessive menstrual bleeding, leading to hypovolemic shock. Diagnosis was confirmed by flow cytometry and genetic testing. Treatment included blood product transfusions, tranexamic acid, and ormeloxifene administration. This case required complex management beyond typical hypovolemic shock protocols because of the underlying platelet dysfunction. Long-term management involves oral contraceptives, desmopressin, and counseling on bleeding precautions. This case highlights the challenges in managing GT, emphasizing the need for a multidisciplinary approach, tailored treatment strategies, and consideration of future therapeutic options such as hematopoietic stem cell transplantation and gene therapy. The report also discusses the rationale behind the treatment choices, including the use of ormeloxifene and cryoprecipitate, and compares the management approach to established guidelines. Additionally, it addresses the importance of genetic counseling, patient education, and ongoing research in improving outcomes for patients with GT.

Background: Sterile abscess formation after leuprolide acetate (LA) injection is rare and can lead to discomfort, scarring, and decreased treatment efficacy. Our objective is to highlight this rare side effect to aid in more thorough patient administration counseling.

Clinical case: A 19 year-old female with history of LA treatment for precocious puberty and new diagnosis of endometriosis developed a severe injection site sterile abscess requiring surgical incision and drain placement, and hospitalization after first LA injection for endometriosis treatment.

Conclusion: LA is a common treatment for refractory endometriosis in pediatric patients, but providers may be unaware of the risk of sterile abscess. We did not identify any predictive or preventative factors but propose that prior treatment may have increased risk in this case.