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1.
Katharine K. Sznajder Kathy S. Tomaszewski Anne E. Burke Maria Trent 《Journal of pediatric and adolescent gynecology》2017,30(1):53-57
Study Objective
To estimate long-acting reversible contraception (LARC) discontinuation rates. Secondary aims were to determine risk factors for discontinuation, describe reasons for discontinuation, evaluate complications related to placement, and estimate pregnancy rates after discontinuation.Design
We conducted a retrospective cohort study of LARC method use through review of electronic medical record data.Setting
Our program is housed in an academic primary care pediatric and adolescent clinic in Baltimore, Maryland.Participants
One hundred sixty women ages 12-24 years who received an intrauterine device or subdermal implant through our program between December 10, 2012 and December 10, 2015.Interventions
None.Main Outcome Measures
Complications from LARC insertion, device discontinuation, reason(s) for discontinuation, pregnancies resulting from device failure, and occurrence of pregnancy within 1 year of discontinuation.Results
Thirty-five women discontinued their LARC method. The 6-month discontinuation rate was 11.3% and the 12-month rate was 21.9%. Discontinuation was associated with history of sexually transmitted infection (adjusted hazard ratio, 3.21; 95% confidence interval, 1.49-6.90). The most common reason for discontinuation was bleeding for the implant and expulsion for the intrauterine device.Conclusion
Our results support the safety and low discontinuation rates of LARC provision to adolescents and young adult women in a primary care setting. Discontinuation rates and reasons are consistent with those described in other studies. 相似文献2.
María I. Tomás-Rodríguez Antonio Palazón-Bru Damian R.J. Martínez-St John Felipe Navarro-Cremades José V. Toledo-Marhuenda Vicente F. Gil-Guillén 《Journal of pediatric and adolescent gynecology》2017,30(2):199-202
Study Objective
In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain.Design
A cross-sectional observational study.Setting
A Spanish University in 2016.Participants
A total of 306 women, aged 18-30 years.Interventions
A questionnaire was filled in by the participants to assess associated factors with dysmenorrhoea.Main Outcome Measures
Our outcome measure was the Andersch and Milsom scale (grade from 0 to 3). Definition: grade 0 (menstruation is not painful and daily activity is unaffected), grade 1 (menstruation is painful but seldom inhibits normal activity, analgesics are seldom required, and mild pain), grade 2 (daily activity affected, analgesics required and give relief so that absence from work or school is unusual, and moderate pain), and grade 3 (activity clearly inhibited, poor effect of analgesics, vegetative symptoms and severe pain).Results
Factors significantly associated with more extreme pain: a higher menstrual flow (odds ratio [OR], 2.11; P < .001), a worse quality of life (OR, 0.97; P < .001) and use of medication for PD (OR, 8.22; P < .001).Conclusion
We determined factors associated with extreme pain in PD in a novel way. Further studies are required to corroborate our results. 相似文献3.
Lindsay M. Kissane Rose Calixte Bogdan Grigorescu Peter Finamore Anthony Vintzileos 《Journal of minimally invasive gynecology》2017,24(1):36-40
Study Objective
To compare operative time in women stratified by body mass index (BMI) undergoing robotic-assisted sacrocolpopexy (RASC). Secondary objectives included characterizing perioperative characteristics and reoperation rates.Design
Retrospective cohort study (Canadian Task Force classification II-2).Setting
University-affiliated teaching hospital.Patients
One hundred seventy-nine consecutive patients who underwent RASC by a single surgeon from 2009 through 2013.Interventions
RASC.Measurements and Main Results
Of 179 patients, 61 (34%) were normal weight (BMI < 25 kg/m2), 72 (40%) were overweight (BMI 25–30 kg/m2), and 46 (26%) were obese (BMI ≥ 30 kg/m2). Overweight patients were significantly older, more parous, more frequently postmenopausal, and more frequently underwent concomitant salpingo-oophorectomy. Median operative times were 202, 206, and 216 minutes in the normal-weight, overweight, and obese groups, respectively (p = .53).Conclusion
Obese women undergoing RASC have similar operative time and procedural characteristics as normal-weight and overweight patients. Longer term outcomes are needed to ensure comparable surgical and anatomic success. 相似文献4.
Jong-Wook Seo Dong-Yun Lee Byung-Koo Yoon DooSeok Choi 《Journal of pediatric and adolescent gynecology》2017,30(2):223-227
Study Objective
Young age is a possible risk factor of endometriosis recurrence after surgery. However, the efficacy of postoperative medical treatment has not been well addressed in adolescents. The purpose of this study was to evaluate whether postoperative medical treatment is as effective in adolescents as it is in adults in the prevention of endometrioma recurrence.Design
A retrospective cohort study.Setting
Samsung Medical Center, Seoul, Korea.Participants
This study included 176 reproductive-aged women who underwent conservative laparoscopic surgery for pathology-confirmed endometrioma. Women were classified into 2 groups according to age: adolescents (20 years of age and younger, n = 34; group I) and reproductive-aged women (aged 25-35 years, n = 142; group II).Interventions
The same surgeon performed all of the surgeries for uniformity. Postoperatively, patients were treated monthly with a gonadotropin-releasing hormone agonist depot for 3-6 months, followed by cyclic oral contraceptives.Main Outcome Measures
Endometrioma recurrence was determined using ultrasonography. The recurrence rate of endometrioma was compared between the 2 groups.Results
During the treatment period (median, 41.0 months; range, 6-159 months), recurrence was noted in 8 cases (4.5%). After adjusting for confounders (which were statistically different between the groups), the cumulative proportion of recurrent endometriomas after 60 months was comparable between the 2 groups (5.3% in group I and 8.5% in group II).Conclusion
Long-term postoperative medical treatment with cyclic oral contraceptives after a gonadotropin-releasing hormone agonist can be as effective in adolescents as it is in adults in the prevention of endometrioma recurrence. 相似文献5.
Soo Yoon Lee Mi-La Kim Seok Ju Seong Jong Woon Bae Yeon Jean Cho 《Journal of pediatric and adolescent gynecology》2017,30(2):228-233
Study Objective
To evaluate the cumulative recurrence rate of endometriomas after a laparoscopic endometriotic cyst enucleation in adolescents and to find the factors associated with recurrence.Design
A multicenter retrospective cohort study.Setting
Three university hospitals.Participants
One hundred five patients surgically treated with laparoscopic enucleation of endometriotic cysts younger than 20 years of age were selected.Interventions
None.Main Outcome Measures
Endometrioma recurrence was considered when transvaginal or transrectal sonography indicated a cystic mass with a diameter of 20 mm or greater. Recurrence rate of endometrioma and median time to recurrence were evaluated.Results
In total, 105 patients were followed for 47.3 (±44.3) months (range, 3-161 months). Seventeen patients (16.2%) experienced recurrence after the first-line surgery and 8 patients (7%) underwent a second surgery. The median time to recurrence was 53.0 (±8.5) months (range, 8-111 months). Using Kaplan-Meier method, the cumulative recurrence rates of endometrioma per patient at 24, 36, 60, and 96 months after the first-line surgery were 6.4%, 10%, 19.9% and 30.9%, respectively. Surgical characteristics, such as the diameter of the cyst, revised American Society for Reproductive Medicine stage, unilateral or bilateral involvement, and coexistence of deep endometriosis were not associated with recurrence in this age group.Conclusion
Although the short-term recurrence rate in adolescents after first-line surgery is relatively low, the recurrence rate appears to be higher according to the follow-up duration. Long-term and continuous follow-up is needed for patients who have undergone surgical treatment for endometriosis in the adolescent period. 相似文献6.
Deirdre A. Quinn Stephanie J. Mitchell Amy Lewin 《Journal of pediatric and adolescent gynecology》2017,30(1):35-40
Study Objective
To explore interpersonal factors associated with maintaining contraceptive use over time among urban, African American teen mothers.Design
Longitudinal study, 2011-2015.Setting
Six pediatric primary care sites in the same city, all of which primarily serve urban, low-income, African American families.Participants
Teen mothers accessing health services for their child at one of the six study sites.Interventions
The current study was a secondary data analysis of data that were collected as part of a patient-centered medical home model intervention, that compared a group of teen mothers and their children who were participants in the intervention with mother-child dyads who were enrolled in standard community-based pediatric primary care. Structured interviews were conducted with teen mothers at baseline/enrollment, when their children were, on average, 3 months old, and again 12 months later.Main Outcome Measures
Maintenance of contraceptive use over time.Results
Teen mothers who perceived any tangible support from their own mothers were significantly less likely to maintain contraceptive use over time (adjusted odds ratio [AOR] = .27). However, teens who perceived any emotional support from their own mothers were nearly four times more likely to maintain contraceptive use (AOR = 3.74). Teens who lived with their own mothers were more than 5 times more likely to maintain contraceptive use over time (AOR = 5.49).Conclusion
To better understand contraceptive discontinuation and thus to prevent repeat pregnancies among teen mothers, it might be necessary to further examine the role of support relationships in teen mothers' contraceptive decision-making. Secondary pregnancy prevention programs should include key support persons. 相似文献7.
Philippe Laberge Jose Garza-Leal Claude Fortin David Grainger Delbert Johns Royce T. Adkins James Presthus Cindy Basinski Monte Swarup Richard Gimpelson Nicholas Leyland John Thiel Micah Harris Pamela E. Burnett Gene F. Ray 《Journal of minimally invasive gynecology》2017,24(1):124-132
Study Objective
To assess the safety and effectiveness of the Minerva Endometrial Ablation System for the treatment of heavy menstrual bleeding in premenopausal women.Design
Multicenter, randomized, controlled, international study (Canadian Task Force classification I).Setting
Thirteen academic and private medical centers.Patients
Premenopausal women (n = 153) suffering from heavy menstrual bleeding (PALM-COEIN: E, O).Intervention
Patients were treated using the Minerva Endometrial Ablation System or rollerball ablation.Measurements and Main Results
At 1-year post-treatment, study success (alkaline hematin ≤80 mL) was observed in 93.1% of Minerva subjects and 80.4% of rollerball subjects with amenorrhea reported by 71.6% and 49% of subjects, respectively. The mean procedure times were 3.1 minutes for Minerva and 17.2 minutes for rollerball. There were no intraoperative adverse events and/or complications reported.Conclusion
The results of this multicenter randomized controlled trial demonstrate that at the 12-month follow-up, the Minerva procedure produces statistically significantly higher rates of success, amenorrhea, and patient satisfaction as well as a shorter procedure time when compared with the historic criterion standard of rollerball ablation. Safety results were excellent and similar for both procedures. 相似文献8.
9.
Kristl Tomlin Tammalynn Bambulas Maureen Sutton Vanessa Pazdernik Dean V. Coonrod 《Journal of pediatric and adolescent gynecology》2017,30(3):383-388
Study Objective
To determine if teenage patients receiving prenatal care in an adolescent-focused clinic, emphasizing long-acting reversible contraception (LARC) using motivational interviewing techniques, had higher rates of uptake of postpartum LARC than a control group.Design and Setting
Retrospective cohort study comparing young women who received prenatal care in an adolescent-focused setting with those enrolled in standard prenatal care.Participants
Adolescents between the ages of 13 and 17 years receiving prenatal care within the Maricopa Integrated Health safety-net system between 2007 and 2014.Interventions
Motivational interviewing within the context of adolescent-focused prenatal care.Main Outcome Measures
Rates of uptake of LARC within 13 postpartum weeks.Results
The adjusted rate of LARC for adolescent-focused prenatal care participants by 13 weeks postpartum was 38% (95% confidence interval [CI], 29%-47%) compared with 18% (95% CI, 11%-28%) for standard care participants, with an adjusted odds ratio of LARC use of 2.8 (95% CI, 1.5-5.2). Among patients who received adolescent-focused prenatal care, most (27% vs 12.7%) were using an intrauterine device as opposed to an implantable contraceptive device.Conclusion
Participation in an adolescent-focused antepartum setting using motivational interviewing to emphasize postpartum LARC resulted in nearly 3 times higher rates of uptake compared with standard prenatal care. 相似文献10.
Amy G. Bryant Anna E. Bauer Gretchen S. Stuart Erika E. Levi Matthew L. Zerden Antoinette Danvers Joanne M. Garrett 《Journal of pediatric and adolescent gynecology》2017,30(3):389-394
Study Objective
To compare immediate postpartum insertion of the contraceptive implant to placement at the 6-week postpartum visit among adolescent and young women.Design
Non-blinded, randomized controlled trial.Setting and Participants
Postpartum adolescents and young women ages 14-24 years who delivered at an academic tertiary care hospital serving rural and urban populations in North Carolina.Interventions
Placement of an etonogestrel-releasing contraceptive implant before leaving the hospital postpartum, or at the 4-6 week postpartum visit.Main Outcome Measures
Contraceptive implant use at 12 months postpartum.Results
Ninety-six participants were randomized into the trial. Data regarding use at 12 months were available for 64 participants, 37 in the immediate group and 27 in the 6-week group. There was no difference in use at 12 months between the immediate group and the 6-week group (30 of 37, 81% vs 21 of 27, 78%; P = .75). At 3 months, the immediate group was more likely to have the implant in place (34 of 37, 92% vs 19 of 27, 70%; P = .02).Conclusion
Placing the contraceptive implant in the immediate postpartum period results in a higher rate of use at 3 months postpartum and appears to have similar use rates at 12 months compared with 6-week postpartum placement. Providing contraceptive implants to adolescents before hospital discharge takes advantage of access to care, increases the likelihood of effective contraception in the early postpartum period, appears to have no adverse effects on breastfeeding, and might lead to increased utilization at 1 year postpartum. 相似文献11.
12.
Lauren M. Bergeron Katherine C. Bishop Holly R. Hoefgen Margaret S. Abraham Nhial T. Tutlam Diane F. Merritt Jeffrey F. Peipert 《Journal of pediatric and adolescent gynecology》2017,30(1):123-127
Study Objective
The purpose of this study was to compare ovarian conservation rates and surgical approach in benign adnexal surgeries performed by surgeons vs gynecologists at a tertiary care institution.Design
A retrospective cohort review.Setting
Children's and adult tertiary care university-based hospital.Participants
Patients 21 years of age and younger who underwent surgery for an adnexal mass from January 2003 through December 2013.Interventions
Patient age, demographic characteristics, menarchal status, clinical symptoms, radiologic imaging, timing of surgery, surgeon specialty, mode of surgery, rate of ovarian conservation, and pathology were recorded. Patients were excluded if they had a uterine anomaly or pathology-proven malignancy.Main Outcome Measures
The primary outcome was the rate of ovarian conservation relative to surgical specialty; secondary outcome was surgical approach relative to surgical specialty.Results
Of 310 potential cases, 194 met inclusion criteria. Gynecologists were more likely than surgeons to conserve the ovary (80% vs 63%; odds ratio, 2.28; 95% confidence interval, 1.16-4.48). After adjusting for age, body mass index, mass size, and urgency of surgery, the difference was attenuated (adjusted odds ratio, 1.84; 95% confidence interval, 0.88-3.84). Surgeons and gynecologists performed minimally invasive surgery at similar rates (62% vs 50%; P = .11). A patient was more likely to receive surgery by a gynecologist if she was older (P < .001) and postmenarchal (P = .005).Conclusion
Results of our study suggest that gynecologists are more likely to perform ovarian-conserving surgery. However, our sample size precluded precise estimates in our multivariable model. Educational efforts among all pediatric and gynecologic surgeons should emphasize ovarian conservation and fertility preservation whenever possible. 相似文献13.
Alexa Kaskowitz Elisabeth Quint Melissa Zochowski Amy Caldwell Kavita Vinekar Vanessa K. Dalton 《Journal of pediatric and adolescent gynecology》2017,30(2):184-187
Study Objective
To characterize pediatricians' knowledge, attitudes, and self-efficacy around contraception.Design
Cross-sectional survey.Setting
United States.Participants
National sample of pediatricians.Interventions
Assessment of behaviors of providing contraception.Main Outcome Measures
Reproductive health practice score.Results
Two hundred twenty-three usable surveys were received, from 163 contraceptive prescribers and 60 nonprescribers. The mean reproductive health practice score was 43.1 (SD, 8.2; total possible score, 84). Prescribers differed in their mean reproductive health score (46.0; SD, 7.0) from nonprescribers (34.0; SD, 4.5; P < .001). Prescribers vs nonprescribers differed in their attitude and efficacy in providing contraception. More prescribers believed it was their responsibility to ask about patients' need for birth control, were confident in their ability to prescribe contraception options, and provided contraception to minors despite parental disapproval. Neither group was confident in their ability to place intrauterine devices or believed that the literature supports intrauterine device placement in adolescents. Only efficacy was related to prescribing contraception in a multivariate regression analysis (odds ratio, 1.7; P < .001).Conclusion
In this study, we showed that most pediatricians are contraception prescribers but the overall reproductive health score was low for prescribers and nonprescribers. The odds of prescribing contraception increased with higher self-efficacy scores rather than knowledge alone. Many prescribers and nonprescribers would not prescribe birth control if parents disapproved and do not believe it is their responsibility to assess patients' need for birth control. In addition very few pediatricians have training in long-acting reversible contraception, despite being the recommended method for adolescents. 相似文献14.
15.
16.
Vrunda Bhavsar Desai Xiaoyue M. Guo Linda Fan Jason D. Wright Xiao Xu 《Journal of minimally invasive gynecology》2017,24(1):151-158.e1
Study Objective
To examine utilization patterns of different laparoscopic approaches in inpatient hysterectomy and identify patient and hospital characteristics associated with the selection of specific laparoscopic approaches.Design
Using data from the 2007 to 2012 National (Nationwide) Inpatient Sample (NIS), we identified adult women undergoing inpatient laparoscopic hysterectomy for nonobstetric indications based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Benign cases were categorized based on laparoscopic approach, classified as total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), or laparoscopic supracervical hysterectomy (LSH). We assessed changes in the use of these approaches during 2007 to 2012, and used multinomial logistic regression to examine the association of patient and hospital characteristics with the choice of laparoscopic approach in 2012. The NIS sample weights were applied to generate nationally representative estimates.Design Classification
Retrospective study (Canadian Task Force classification III).Setting
Hospital inpatient care nationwide.Patients
Female adult patients in the NIS database who underwent an inpatient laparoscopic hysterectomy between 2007 and 2012.Intervention
Inpatient laparoscopic hysterectomy.Measurements and Main Results
Of the inpatient laparoscopic hysterectomies performed in 2012, 83.2% were for benign indications. The TLH approach accounted for 48.3% of all laparoscopic hysterectomies, followed by LAVH at 37.3% and LSH at 14.4%. Robotic assistance was reported in 45.0% of all cases and 72.3% of malignant hysterectomies. An examination of temporal trends during 2007 to 2012 demonstrates a shift in the laparoscopic approach from LAVH toward TLH, with a slight decrease in LSH. Patient race/ethnicity, income, indication for hysterectomy, and comorbid conditions, as well as hospital teaching status, urban/rural location, bed size, type of ownership, and geographic region, were significantly associated with the choice of laparoscopic approach.Conclusion
Benign laparoscopic hysterectomy is increasingly performed as TLH rather than LAVH. In addition to clinical factors, the selection of laparoscopic approach is influenced by patient socioeconomic and hospital characteristics. 相似文献17.
Yuqing Chen Lixiang Liu Yuanna Luo Minghui Chen Yang Huan Ruili Fang 《Journal of minimally invasive gynecology》2017,24(1):74-79
Study Objective
To evaluate the prevalence and impact of chronic endometritis (CE) in patients with intrauterine adhesions (IUAs).Design
Prospective cohort study (Canadian Task Force classification II-2).Setting
University-affiliated hospital.Patients
Eighty-two women with moderate to severe IUAs.Interventions
Transcervical resection of adhesions (TCRA) and endometrial biopsy were performed in all patients. According to results of the endometrial biopsy, participants were classified into 2 groups: 29 patients with CE (CE group) and 53 women without CE (NCE group). Second-look hysteroscopy assessed the impact of TCRA using the American Fertility Society classification system.Measurements and Main Results
Prevalence of CE, reformation of adhesions, and reduction of adhesion score were studied. Thirty-one women (37.8%) presented with visual signs of CE at hysteroscopy, confirmed by histology in 29 of 82 patients (35.4%). In hysteroscopic diagnosis of CE, sensitivity and specificity were 79.3% (23/29) and 84.9% (45/53), respectively. At second-look hysteroscopy, the recurrence of adhesions in the CE group was significantly higher than in the NCE group (44.8% vs 20.8%, respectively; p = .022). The median reduction of adhesion score was significantly greater in the NCE group (median, 8; range, 0–12) than in the CE group (median, 5; range, 0–10).Conclusion
CE in women with IUAs may be a contributing factor in higher adhesion recurrence, indicating chronic inflammation may play a role in IUA recurrence. (Clinical Trial Registration No.: NCT02744807.) 相似文献18.
Nicole Hubner Jacob Charles Langer Sari Kives Lisa Mary Allen 《Journal of pediatric and adolescent gynecology》2017,30(1):132-137
Study Objective
The aim of this study was to document the change in ovarian conservation rate after ovarian torsion as a result of continuous quality improvement (CQI) measures, and to determine factors that contribute to this outcome.Design
A retrospective, uncontrolled before-and-after study.Setting
An academic children's hospital.Participants
Female adolescents younger than 18 years with surgically confirmed ovarian torsion from April 1, 1988 to October 15, 2013; excluding cases from 2003 (intervention period).Interventions
Implementation of CQI measures including educational programs, collaborative care pathways, and quality review with the goal of improving ovarian conservation.Main Outcome Measures
Demographic characteristics, details on presentation, investigations, consultation, surgical intervention, surgical findings, pathology, postoperative course, and follow-up imaging.Results
One hundred thirty-nine patients met inclusion criteria (42 pre-CQI cohort and 97 post-CQI cohort). Mean ages were 9.96 and 10.33 years, respectively. Ovarian conservation rates were 47.6% compared with 85.6%, respectively (P < .001). The following factors differed between cohorts: fever (P = .003), ultrasound completed (P = .001), time from first health care provider visit to imaging (P = .025), time from specialist consultation to surgery (P = .002), surgical start time within 1 hour of booking (P < .001), and gynecologist present in operating room (P < .001). A log-binomial regression model showed that gynecology presence in the operating room (relative risk [RR], 2.043) was associated with untwisting. Increasing time from specialist consultation to surgery (RR, 0.986 per hour) was inversely associated with untwisting. Fever at presentation was also inversely associated with untwisting (RR, 0.666).Conclusion
The implementation of CQI measures was associated with a significant increase in ovarian conservation rate. 相似文献19.
Jennie Lee Yoost Rachael Whitley Starcher Rebecca Ann King-Mallory Nafeeza Hussain Christina Ann Hensley Todd William Gress 《Journal of pediatric and adolescent gynecology》2017,30(2):193-198
Study Objective
To evaluate the use of telehealth to teach reproductive health to rural areas with high rates of teen pregnancy.Design
Prospective cohort study.Setting
Two high schools in rural West Virginia.Participants
High school female students who attended telehealth sessions.Interventions
Teleconferencing equipment connected rural high schools to a distal academic institution. Telehealth sessions included reproductive health and life skills topics. Demographic information, session pre- and post-tests, and 6- month assessment was obtained.Main Outcome Measures
Reproductive health knowledge, behavior, and self-efficacy were assessed at intervention and at 6 months, along with Likert scale evaluation of telehealth as an educational tool.Results
Fifty-five students participated in the program with an average age of 16.14 (SD 1.24) years. Only 20% (10/50) of subjects' mothers and 12% (6/50) of subjects' fathers had achieved education beyond high school, and 20% (10/50) of subject's mothers had experienced teen pregnancies (age 18 or younger). Sexual activity was reported among 52% (26/50) of subjects, 4/50 (8%) reported desire to become pregnant within the next year, and 4/50 (8%) reported already pregnant. Thirty-seven students completed the 6-month follow-up survey. Reported condom use increased from 20% (10/50) at baseline to 40% (15/37) at 6 months (P = .04) and hormonal contraception use increased from 22% (11/50) to 38% (14/37) (P = .12). Report of human papillomavirus vaccination increased from 38% (10/26) to 70% (26/37) (P = .001) among all subjects. At 6 months, 91.8% (34/37) reported the use of telehealth was “very effective” as a means to teach the material.Conclusions
Telehealth is an effective tool to teach reproductive health to rural areas. 相似文献20.
Hannah L.H. Lange Brittny E. Manos M. David Gothard Lynette K. Rogers Andrea E. Bonny 《Journal of pediatric and adolescent gynecology》2017,30(2):169-175