Adolescent and pediatric gynecology最新文献

Study Objective: The inflammatory response engendered by cervicovaginal infections is believed to be an important, preventable, antecedent of premature rupture of the membranes. The objective of this study was to test the hypothesis that early histologic evidence of placental inflammation, subchorionic intervillositis, is a more common finding in placentas obtained from women who have cervicitis during gestation than in placentas obtained from other women.

Design, Main Outcome Measure, and Participants/Setting: Standard gross and histologic techniques were used to examine the placentas of 105 poor, black women in relation to three clinical signs of cervicitis: hypertrophic ectopia, friability, and inflammatory discharge.

Results: We found subchorionic intervillositis in 28 (26.7%) of the placentas. Subchorionic intervillositis was significantly associated with both premature rupture of the membranes and neonatal morbidity. Cervicitis was diagnosed in 63.5% of the subjects who were examined. Contrary to the study hypothesis, subchorionic intervillositis was a less common finding in the placentas of study subjects who had cervicitis (6.1% vs. 47.4%; χ² = 12.3 p < 0.001).

Conclusions: We speculate that prompt antibiotic treatment of clinically evident cervicitis eradicated potentially pathogenic microflora and prevented the ascent of the local inflammatory response up the birth canal.

Study Objective: Description of the use of hysteroscopy for vaginal inspection in children.

Design and Participants: Case report of three patients with suspected vaginal injury and/or bleeding.

Setting: The examinations were performed at the Department of OB/GYN University of Medical School of Debrecen, Hungary.

Interventions: Resectoscope with continuous fluid irrigation was used for vaginoscopy to verify the origin of vaginal bleeding and injury.

Result: The method is excellent for vaginal endoscopic examinations in children.

Conclusion: When traditional vaginoscopic examination is impossible, hysteroscopy/resectoscopy with low pressure fluid irrigation can help to verify vaginal disorders.

Ritualistic sexual abuse is a term used to describe sexual abuse linked to symbolic or group clandestine activities with overtones of religious, magical, or Satanic intent. Reports such as these have increased dramatically in the United States over the last two decades, as have reports of group child sexual abuse in general. This literature review is designed to elucidate terminology used and to describe common features of these accounts, probe the dilemmas surrounding credibility and verifiability in these cases, and provide recommendations for improved evaluation and appropriate action when similar situations arise in the future. Supreme attention must be paid to the victims and their families, as more traumatic types of abuse may present a far more difficult path to recovery for both generations.

Study Objective: This study examines the risk of acquisition of multiple episodes of a sexually transmitted disease (STD) as it relates to age of first intercourse and sexual behaviors among high risk adolescent females.

Design: A linear regression model was used to predict number of STD episodes. The relationship between number of STDs and age at first intercourse was also examined with a contingency table.

Setting: Sexually active female adolescents (n = 248) from an urban primary care adolescent clinic were interviewed regarding sexual behaviors by a female research assistant.

Participants: The girls ranged in age from 12 to 21 (mean = 16.9 years); 80% were African-American and 20% were caucasian. The age of first intercourse ranged from 10 to 18. Seventy-four percent of the girls had a history of an STD.

Results: In the final regression mode (adjusted R² = 0.28), a higher number of episodes of STD was significantly related to having a younger age of first intercourse (p < 0.05), more lifetime partners (p < 0.01), and a longer time since first intercourse (p < 0.01). A 4 × 3 contingency table of age of first intercourse and history of STD revealed that those adolescents who are under 13 years when they initiate intercourse are at significantly higher risk for acquiring STD, and those that are 17 and older are at significantly lower risk (chi-square = 25.11, p < 0.01).

Conclusions: These findings are discussed in relation to behavioral risk factors and interventions which aid girls to postpone sexual involvement to the later teen years.

Study Objectives: To provide information on the prevalence of diabetes in pregnancy in women less than 20 years of age; and to compare deliveries with and without the complication of diabetes in teens and older women with regard to cesarean delivery rate, delivery complications, and selected socioeconomic characteristics.

Design, Setting, Participants: Hospital claims for the 389,663 admissions for deliveries, ectopic pregnancies, and abortions from the 69 hospitals with obstetrical services in New Jersey in the years 1984, 1986, 1988.

Main Outcome Measures, Results: Women under 20 accounted for 31,153 (9.9%) of the 314,680 hospitalizations for obstetrical deliveries (DRGs 370–375). An ICD-9-CM code for diabetes mellitus was listed in 180 (0.58%) of teen deliveries. Of 68,836 hospitalizations for abortion (DRGs 380–381), adolescents accounted for 10,140, and of these, 21 (0.2%) had a code for diabetes. Intrauterine fetal death was coded in 1.7% of diabetic and 0.9% of nondiabetic teen deliveries. The cesarean rate was 18% for nondiabetic teens, 37% for diabetic teens, and 46% for diabetic women aged 20–45. The complicated-to-uncomplicated ratios for both cesarean and vaginal deliveries for teens with diabetes were more than six times the ratios for nondiabetic teens and double those for diabetic older women. Among women who had deliveries, diabetic and nondiabetic adolescent groups were similar in percentage of blacks and Hispanics, residence in high perinatal risk geographic area defined by WIC criteria, Medicaid coverage, and self-payment for hospitalization.

Conclusions: State-wide data on adolescent pregnancy complicated by diabetes reveal an increased risk of adverse outcomes. The social and medical issues of teenage pregnancy combined with the problems of a chronic disease call for further prospective studies of management alternatives.

Sexual maturation and growth during induction of puberty with oral ethinylestradiol at low doses were evaluated in seven thalassemic girls, aged 13.6–16.5 years with hypogonadotropic hypogonadism (group 1). They were compared with nine thalassemic girls, aged 9–11.4 years with spontaneous puberty (group 2). Estrogen therapy was started at chronological age (CA) of 14.3 ± 1.12 (M ± SD) years corresponding to bone age (B A) of 11.4 ± 1.07 years. Five patients had vaginal bleeding after about 1 year of therapy, attaining a Tanner pubertal stage of B3–B4. Two patients lacking vaginal bleeding after 15 months of continuative therapy, received estrogen with the addition of medroxyprogesterone acetate. Vaginal bleeding occurred at CA of 15.7 ± 1.0 year (BA 13.1 ± 1.01 years). In group 2, at onset of puberty CA was 10.3 ± 1.05 years (BA 10.1 ± 1.05 years) and at menarche CA was 12.6 ± 0.46 years (BA 12.4 ± 0.32 years). After 3 months of therapy, all patients of group 1 showed a height velocity peak of 7 ± 1.9 cm smaller than in group 2 (cm 9.1 ± 0.98). Height gain until vaginal bleeding, in group 1 (4.8 ± 1.57 cm) was smaller than in group 2 (11.9 ± 3.66 cm). There was no significant difference in either mean height at first vaginal bleeding or in predictive final height between the two groups. No side effects were observed during therapy. It is interesting to note that patients of group 1 showed a serious degree of osteoporosis; in fact, the mean value of bone mineral density was smaller than in Italian normal girls (0.49 ± 0.08 vs. 0.61 ± 0.06 (g/cm²), p < 0.05). In conclusion, the results of this preliminary study indicate that the time of the start of treatment has no significant effect on height; nevertheless, therapy should be started at normal mean age both to avoid psychosocial problems and to reduce the risk of osteoporosis.