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1.
Laura C. Seidman Kathleen M. Brennan Andrea J. Rapkin Laura A. Payne 《Journal of pediatric and adolescent gynecology》2018,31(2):94-101
Study Objective
To evaluate rates of presumptive anovulation in eumenorrheic adolescents and young adults with moderate to severe primary dysmenorrhea and those without primary dysmenorrhea.Design
Participants completed luteinizing hormone surge ovulation predictor test kits. Anovulatory cycles were defined by never receiving a positive result before the next menstrual period; participants were grouped as anovulatory if they experienced at least 1 anovulatory cycle during study participation. Participants rated daily level of menstrual pain on a 0-10 numeric rating scale.Setting
A university-based clinical research laboratory.Participants
Thirty-nine adolescents and young adults (ages 16-24) with primary dysmenorrhea and 52 age-matched control girls.Interventions and Main Outcome Measures
Rates of presumptive anovulation.Results
One hundred sixty-eight cycles were monitored, 29.8% (N = 50) of which were anovulatory (37.1% [39/105] vs 17.5% [11/63] of cycles in control and dysmenorrhea groups, respectively). During study participation, control girls were significantly more likely to have had at least 1 anovulatory cycle than were girls with primary dysmenorrhea (44.2% [23/52] vs 17.9% [7/39] of participants, respectively; P < .01). Cycle length and number of bleeding days between ovulatory and anovulatory cycles were similar. The primary dysmenorrhea group's maximum menstrual pain ratings did not differ between ovulatory and anovulatory cycles (4.77 and 4.36, respectively; P > .05).Conclusion
Our data support previous findings of increased rates of ovulation in primary dysmenorrhea. However, menstruation after anovulatory cycles can be as painful as menstruation after ovulatory cycles. These data support the idea that regular menses do not necessarily indicate that a normal ovulatory cycle has occurred. Previous implications that ovulation is necessary for the development of substantial menstrual pain are incomplete. 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.
Mark McShane James Perucho Melissa Olsakowski John P. Gaughan Robert T. Brown Lori Feldman-Winter 《Journal of pediatric and adolescent gynecology》2018,31(6):566-570
Study Objective
To determine the rates at which primary care providers elicit menstrual histories from adolescent girls at well visits.Design
Retrospective chart review.Setting
The departments of Pediatrics, Adolescent Medicine, and Family Medicine of Cooper University Healthcare from January 1, 2010 to June 1, 2016.Participants
Women aged 12-21 years who were seen for a well visit in the described setting.Interventions
None.Main Outcome Measures
We searched physician well visit notes for documentation of the following aspects of menstrual history: menarche, last menstrual period, usual length of cycle, and the presence or absence of associated symptoms (such as pain and cramps). The presence or absence of each aspect was recorded in a binary fashion in a deidentified data set.Results
A total of 954 unique charts were analyzed: 415 from Adolescent Medicine, 289 from Family Medicine, and 250 from General Pediatrics at Cooper University Healthcare. Adolescent Medicine was 6.44 times more likely to take a complete menstrual history than Family Medicine (P < .0001) and 5.80 times more likely than Pediatrics (P < .0001). There was no statistical difference between Pediatrics and Family Medicine (odds ratio, 0.55; P = .3150).Conclusion
Menstrual history-taking is often incomplete and can vary between departments, even within the same institution. These results indicate opportunities to raise awareness about the importance of a complete menstrual history and to develop quality improvement initiatives to increase documentation of the complete menstrual history. 相似文献4.
Elizabeth J. Geller Emma Babb Andrea G. Nackley Denniz Zolnoun 《Journal of minimally invasive gynecology》2017,24(1):67-73
Study Objective
Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation.Design
Retrospective study (Canadian Task Force classification II-2).Setting
Single university hospital.Patients
Women who have undergone surgery with pelvic mesh implant for treatment of pelvic floor disorders including prolapse and incontinence.Interventions
Telephone interviews to assess pain, sexual function, and general health.Measurements and Main Results
Pain was measured by the McGill Short-Form Pain Questionnaire for somatic pain, Neuropathic Pain Symptom Inventory for neuropathic pain, Pennebaker Inventory of Limbic Languidness for somatization, and Female Sexual Function Index (FSFI) for sexual health and dyspareunia. General health was assessed with the 12-item Short-Form Health Survey. Among 160 enrolled women, mean time since surgery was 20.8 ± 10.5 months, mean age was 62.1 ± 11.2 years, 93.8% were white, 86.3% were postmenopausal, and 3.1% were tobacco users. Types of mesh included midurethral sling for stress incontinence (78.8%), abdominal/robotic sacrocolpopexy (35.7%), transvaginal for prolapse (6.3%), and perirectal for fecal incontinence (1.9%), with 23.8% concomitant mesh implants for both prolapse and incontinence. Our main outcome, self-reported pelvic pain at least 1 year after surgery, was 15.6%. Women reporting pain were younger, with fibromyalgia, worse physical health, higher somatization, and lower surgery satisfaction (all p < .05). Current pelvic pain correlated with early postoperative pelvic pain (p < .001), fibromyalgia (p = .002), worse physical health (p = .003), and somatization (p = .003). Sexual function was suboptimal (mean FSFI, 16.2 ± 12.1). Only 54.0% were sexually active, with 19.0% of those reporting dyspareunia.Conclusion
One in 6 women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early postoperative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection. 相似文献5.
K.M. Sinning D.C. Jude J.L. Yoost 《Journal of pediatric and adolescent gynecology》2018,31(4):400-404
Study Objective
To quantify the “normal” adolescent experience after intrauterine device insertion, to provide appropriate counseling for future adolescents.Design
Prospective cohort study.Setting
Marshall University Department of Obstetrics and Gynecology generalist and adolescent gynecology clinics.Participants
Nulliparous adolescents age 13-18 years and parous adults 18 years of age or older who received a levonorgestrel intrauterine system (LNG-IUS).Interventions
Visual analogue scale (VAS) pain score and medication log was used for data collection for 2 weeks after LNG-IUS insertion. A separate chart review was completed for demographic factors and indications for procedure.Main Outcome Measures
VAS pain scores and medication use was compared between groups.Results
Ninety-three subjects returned the VAS record and medication log (46 adolescents and 47 adults). There was no difference in the incidence of endometriosis or dysmenorrhea, but there was a higher prevalence of menorrhagia among adolescents (30/46, 65.2% vs 10/47, 21.3%; P < .001). Forty-five of forty-seven (95.7%) adults vs 25/46 (54.3%) adolescents had contraception as an indication for intrauterine device use (P < .001). Pain scores were statistically higher among the adolescent group each day (P < .05) in the 2-week study period. The greatest mean differences occurred in the first 4 days. More adolescents (15/46, 32.6%) than adults (6/47, 12.8%) had a pain score greater than 5 during the first 3 days (P = .022). A statistical difference in amount of ibuprofen recorded was only noted on day 1 (P = .023) and day 4 (P = .046).Conclusion
Nulliparous adolescents who undergo LNG-IUS placement experience more postinsertional discomfort compared with parous adults; however, this method should still be considered first-line treatment in this age group. 相似文献6.
Esra Isci Bostanci Sibel Ozler Nafiye Karakas Yilmaz Huseyin Yesilyurt 《Journal of pediatric and adolescent gynecology》2018,31(3):270-273
Study Objective
Polycystic ovary syndrome (PCOS) is a common endocrinopathy among female adolescents and young women. The aim of this study was to investigate the relationship between serum 25-hydroxy vitamin D (25[OH] D) levels and metabolic parameters and other characteristics of PCOS and non-PCOS adolescents.Design
Case-control study.Setting and Participants
We analyzed 31 girls with PCOS as defined using the Rotterdam criteria and 35 girls were non-PCOS control participants.Interventions and Main Outcome Measures
The serum 25(OH) D level was measured. Anthropometric, clinical, endocrine, and metabolic components were determined in both groups.Results
The group with PCOS showed no difference in the level of serum 25(OH) D (14.58 ± 6.15 vs 16.02 ± 7.87; P = .414). In addition to this, no significant correlations were found between serum 25(OH) D levels and endocrine or metabolic parameters in either PCOS patients or control participants.Conclusion
There was no difference in the level of serum 25(OH) D between PCOS patients and matched control participants. Vitamin D deficiency was common among the patients as well as in the control participants. Also, we did not find any relationship between serum 25(OH) D levels and clinical or metabolic profiles in the 2 groups. 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.
Osman Karacin Ilknur Mutlu Mesut Kose Fatih Celik Mine Kanat-Pektas Mehmet Yilmazer 《Taiwanese journal of obstetrics & gynecology》2018,57(1):58-63
Objective
This study aims to investigate the possible role of vitamin D deficiency in primary dysmenorrhea by assessing serum 25-hydroxyvitamin D3 levels in a cohort which includes young Turkish women with primary dysmenorrhea and healthy controls.Materials and methods
A total of 683 women who were aged between 18 and 25 years and who were consecutively admitted to the study center were eligible. After the exclusion of 55 women, 184 women with primary dysmenorrhea were randomly assigned into the dysmenorrhea group and 184 women without dysmenorrhea were randomly allocated into the control group.Results
The dysmenorrhea group had significantly less consumption of dairy products (p = 0.001), lower serum calcium (p = 0.001), lower serum vitamin D (p = 0.001) and higher serum parathyroid hormone (p = 0.001) than those of the control group. Hyperparathyroidism was significantly less frequent whereas vitamin D deficiency was significantly more frequent in the dysmenorrhea group (p = 0.001 for each). The dysmenorrhea patients with vitamin D deficiency had significantly higher visual analogue scale (VAS) scores (p = 0.001). Depression, irritability, mood swings, fatigue, headache and breast tenderness were significantly more frequent in the vitamin D deficiency group (p < 0.05 for all). The VAS scores of the dysmenorrhea patients correlated positively and significantly with serum parathyroid hormone levels (r = 0.666, p = 0.001) whereas these VAS scores correlated negatively and significantly with serum vitamin D levels (r = ?0.713, p = 0.001).Discussion
The significant and positive correlation between vitamin D levels and VAS scores and the significant reduction in serum vitamin D levels of the dysmenorrhea patients designate the possible role of vitamin D deficiency in the primary dysmenorrhea. 相似文献9.
Jenny Sadler Gallagher Stacey A. Missmer Mark D. Hornstein Marc R. Laufer Catherine M. Gordon Amy D. DiVasta 《Journal of pediatric and adolescent gynecology》2018,31(4):376-381
Study Objective
To explore the potential occurrence of long-term side effects and tolerability of gonadotropin-releasing hormone agonist (GnRHa) plus 2 different add-back regimens in adolescent patients with endometriosis.Design
Follow-up questionnaire sent in 2016 to patients who participated in a drug trial between 2008 and 2012.Setting
Tertiary care center in Boston, Massachusetts.Participants
Female adolescents with surgically confirmed endometriosis (n = 51) who enrolled in a GnRHa plus add-back trial as adolescents.Interventions
Leuprolide depot 11.25 mg intramuscular injection every 3 months, plus oral norethindrone acetate 5 mg daily or oral norethindrone acetate 5 mg daily and oral conjugated equine estrogens 0.625 mg daily.Main Outcome Measures
Side effects during and after treatment, irreversible side effects, changes in pain, overall satisfaction.Results
The response rate was 61% (25 of 41; 10 subjects could not be located). Almost all (24 of 25) reported side effects during treatment; 80% (16 of 21) reported side effects lasting longer than 6 months after stopping treatment. Almost half (9 of 20) reported side effects they considered irreversible, including memory loss, insomnia, and hot flashes. Despite side effects, participants rated GnRHa plus add-back as the most effective hormonal medication for treating endometriosis pain; two-thirds (16 of 25) would recommend it to others. More participants who received a modified 2-drug add-back regimen vs standard 1-drug add-back would recommend GnRHa and believed it was the most effective hormonal medication.Conclusion
Subjects believed that GnRHa used with add-back was effective and would recommend it to others, despite significant side effects. Those who received 2-drug add-back reported more success than those who received standard add-back. A subset of patients reported side effects they consider to be irreversible. 相似文献10.
Beth I. Schwartz Jill S. Huppert Chen Chen Bin Huang Jennifer L. Reed 《Journal of pediatric and adolescent gynecology》2018,31(2):132-137
Study Objective
To create a composite score to predict adnexal torsion in children and adolescents.Design
A prospective cross-sectional study.Setting
Emergency department of a tertiary care children's hospital.Participants
Three hundred twenty-four female participants aged 6-21 years who presented to the emergency department with lower abdominal pain and underwent ultrasound or computed tomography imaging.Interventions
Collection of possible clinical and radiologic predictors of torsion.Main Outcome Measures
The primary outcome was a composite score to predict adnexal torsion. We used χ2 analyses to identify possible risk factors. The classification and regression tree decision method was used to identify risk factor cutoff points. Independent risk factors were combined into a composite score. Receiver operating characteristic curve analyses were used to assessed score performance.Results
Of 324 participants with abdominal pain, 241 underwent imaging, and 6.6% (16 of 241) had torsion. Duration of pain, intermittent pain, nausea, and absence of arterial or venous flow were not associated with torsion. Vomiting (P = .05 in premenarchal subjects; P < .001 in menarchal subjects), adnexal volume (P = .008 in premenarchal subjects; P < .001 in menarchal subjects), and adnexal volume ratio (P = .04 in premenarchal subjects; P < .001 in menarchal subjects) were independent predictors of torsion. These predictors were incorporated into a composite score. No torsions were identified with a score of less than 2. There was an increasing risk of torsion for each 1-point score increase.Conclusion
Independent predictors of torsion can reliably be combined into a composite score to identify children and adolescents at risk for adnexal torsion. This score might aid in improving triage and management of these challenging patients. 相似文献11.
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12.
Hamada Ashry Abd El Wahed Ali Ahmed Emadeldin Arafa Nesreen Abd El Fattah Abd Allah Shehata Ashraf Samir Fahim 《Journal of pediatric and adolescent gynecology》2018,31(6):571-574
Study Objective
Female circumcision (FC) is a deeply rooted practice in Egypt with deblitating physical and psychological consequences. During the past 2 decades there have been sincere efforts to reduce this practice. The objective of this study was to investigate the prevalence of circumcision.Design
Cross-sectional study.Setting
Beni-Suef City, Egypt.Participants
Young women (12-25 years of age).Interventions
A survey was given to 3353 young women residing in Beni-Suef City. Data were collected using a questionnaire that included information about the sociodemographic characteristics of participants, their gynecological data, exposure to FC, and complaints associated with menses during the previous year.Main Outcome Measures
Prevalence of FC in rural areas in Beni Suef.Results
Of the 3353 interviewed women, 1846 (55%) were circumcised. Women residing in rural areas, married women, and those who had illiterate parents were more likely to have experienced circumcision. Students were less likely to be circumcised (P < .05). The circumcised girls reported shorter menstrual cycles and dysuria with menses (P < .05). Dysmenorrhea, generalized aching, and nervousness were the most common complaints associated with menses in both groups, with no statistically significant differences (P > .05).Conclusion
FC is highly prevalent in rural areas in Beni-Suef, however, compared with previous reports it seems that the rates of circumcision have decreased markedly. Despite this decrease, the practice of female genital mutilation is still highly prevalent, suggesting that future research and intervention will be needed to eliminate this practice. 相似文献13.
Aytekin Tokmak Serkan Bodur Selcuk Erkilinc Sule Ozel Yaprak Engin-Ustun 《Journal of pediatric and adolescent gynecology》2018,31(3):263-269
Study Objective
This study was designed to evaluate and compare the serum total prostate-specific antigen (PSA) levels in adolescent girls in with and without polycystic ovarian syndrome (PCOS) to show whether evaluation of PSA levels have a diagnostic benefit over existing diagnostic criteria.Design
Case-control study.Setting
A territory referral center.Participants
A total of 89 (15-19 years) nonobese (body mass index, 18-24.9) adolescents with PCOS (n = 42) and controls without PCOS (n = 47) were enrolled in the study.Interventions
Pathophysiological features of PCOS and serum total PSA levels were determined at the time of study enrollment.Main Outcome Measures
Determination, comparison, and diagnostic performance of serum total PSA levels in diagnosis of PCOS in adolescent girls were the main outcome measures of the study.Results
The serum total PSA levels of adolescents with PCOS were detected to be higher than for control participants (0.63 ± 1.38 ng/mL vs 0.48 ± 0.95 ng/mL) without meeting statistical significance (P = .923). There was a correlation between total PSA levels and indices of insulin resistance like the homeostasis insulin resistance model (r = 0.414; P = .010). The serum total PSA level was not a discriminative parameter for diagnosis of PCOS in adolescent girls (area under the curve, 0.559; P = .476).Conclusion
The serum total PSA level was not a predictor of PCOS in adolescent girls. This finding might be related to the extemporal nature of tissues capable of PSA production and lack of sufficient exposure interval to hyperandrogenemia, rather than lack of stimulatory relationship between serum androgens. 相似文献14.
15.
Tazim Dowlut-McElroy Jeanette Higgins Karen B. Williams Julie L. Strickland 《Journal of pediatric and adolescent gynecology》2018,31(1):19-22
Study Objective
To evaluate the characteristics of girls with accidental genital trauma (AGT) who can be managed in the emergency department (ED) vs the operating suite (OS).Design
Retrospective cohort.Setting
ED at a children's hospital in a metropolitan area.Participants
Girls aged 0-18 years with AGT.Interventions and Main Outcome Measures
Factors associated with need for evaluation and repair of AGT in the OS.Results
A total of 359 girls were included in the analysis. The mean age was 6 ± 3 years. Most girls presented with pain and bleeding, 321/359 (89%). Straddle injury was the most common mechanism, 258/355 (73%). The most commonly injured site was the labia, 225/358 (63%) and the most common type of injury was laceration, 308/357 (86%). Factors significantly associated with treatment in the OS included older age, transfer from another institution, penetrating injuries, injuries involving the hymen/vagina/urethra/anus, and injuries larger than 3 cm in size. The odds of requiring general anesthesia in the OS were 5.5 times higher for injuries larger than 3 cm (95% confidence interval, 2.8-10.9; P < .0001) and 4.1 times greater if the patient was transferred from another facility (95% confidence interval, 1.3-13.3; P < .02).Conclusion
Most AGT can be managed expectantly. Penetrating injuries, injuries to the hymen/vagina/urethra/anus, and injuries with a maximal size of 3 cm should be considered as indications for management in the OS. With adequate procedural sedation, most girls with minor injuries as a result of AGT can undergo a thorough examination and repair of AGT in the ED. 相似文献16.
Hyun-Woong Cho Yu-Jin Koo Kyung-Jin Min Jin-Hwa Hong Jae-Kwan Lee 《Journal of pediatric and adolescent gynecology》2017,30(2):203-208
Study Objective
To evaluate the incidence of pelvic inflammatory disease (PID) in virgin women and investigate the clinical characteristics of the patients.Design
Retrospective chart review and literature review.Setting
Tertiary academic center.Participants
Virgin women who were confirmed to have PID via surgery from 2002 to 2014.Interventions
None.Main Outcome Measures
The evaluation of medicosurgical history, clinical progress, surgical record, and pathologic reports.Results
Of 122 patients diagnosed with PID via surgery, 5 women were virgins (4.1%). The median age was 21 years (range, 14-24 years), and all patients presented with abdominal pain. The median diameter of the pelvic abscess pocket on preoperative imaging was 4.5 cm (range, 2.6-15 cm). Only 1 case was preoperatively diagnosed as a tubo-ovarian abscess; the others were expected to be benign ovarian tumors, such as endometrioma and dermoid cysts. No possible source of infection was identified for any patient, except 1 who had a history of an appendectomy because of a ruptured appendix. The results of the histopathological analysis of the excisional biopsy performed during surgery in 4 cases were consistent with acute suppurative inflammation. After postoperative antibiotic use, the conditions of all patients stabilized, and they were discharged from the hospital on median postoperative day 9.Conclusion
PID in virgin women is rare, but it should be considered in all women with abdominal pain, regardless of sexual history. 相似文献17.
Jacquelyn M. Powers Joseph R. Stanek Lakshmi Srivaths Fareeda W. Haamid Sarah H. O&#x;Brien 《Journal of pediatric and adolescent gynecology》2018,31(5):446-450
Study Objective
To assess the frequency, severity, and inpatient management of girls admitted with heavy menstrual bleeding and iron deficiency anemia at US children's hospitals, with a focus on hematologic considerations.Design
Retrospective multicenter cohort study from October 2012 through September 2015.Setting
Children's hospitals submitting data to the Pediatric Health Information System.Participants
Female patients, age 8-18 years, admitted with heavy menstrual bleeding and anemia as either a primary or secondary diagnosis. Patients with cancer, immune thrombocytopenic purpura, aplastic anemia, and pregnancy were excluded.Interventions and Main Outcome Measures
Hemostatic evaluation; provision of iron therapy.Results
We identified 1183 admissions (1134 unique patients). Patients’ median (interquartile range) age was 14 (11-17) years. Forty-one percent were Caucasian (n = 480), 31% African American (n = 371), and 26% Hispanic ethnicity (n = 310). Intensive care use occurred in 5% of admissions (n = 56). Hemostatic assessment was inconsistent; 15% (n = 182) had no such evaluation. Two-thirds (n = 797; 67%) involved transfusions, 37% (n = 433) received no inpatient iron therapy, and 17% (n = 197) received no hormonal or antifibrinolytic therapy. Hemostatic evaluation was associated with intensive care use: odds ratio (OR), 4.80 (95% confidence interval [CI], 1.16-19.86; P = .03); emergency department visit: OR, 2.60 (95% CI, 1.86-3.65; P < .01); private insurance: OR, 1.62 (95% CI, 1.12-2.35; P = .01); and younger age: OR, 0.84 (95% CI, 0.77-0.92; P < .01).Conclusion
Hundreds of girls with heavy menstrual bleeding and anemia are hospitalized at US children's hospitals each year with variable inpatient hematologic evaluation and management. Future guidelines should emphasize early identification of at-risk patients and promote effective implementation strategies to reduce the burden of this preventable complication. 相似文献18.
Harriet Mary Gunn Meng-Che Tsai Alexandra McRae Katharine S. Steinbeck 《Journal of pediatric and adolescent gynecology》2018,31(6):557-565.e6
Study Objective
Understanding what constitutes a normal menstrual cycle during the first gynecological year (GY1) is a common concern of adolescents and clinicians. However, limited high-quality evidence exists. We aimed to summarize published literature regarding menstrual and ovulatory patterns in GY1.Design, Setting, Participants, Interventions, and Main Outcome Measures
Electronic databases (MEDLINE, Pre-MEDLINE, Embase, Web of Science, CINAHL, Cochrane Library) were systematically searched from database inception to 2018. Eligible studies described menstrual cycles, symptoms, or validated ovulatory data in healthy adolescents in GY1. Two authors independently screened studies, extracted data, and assessed methodological quality.Results
Twenty-two studies involving more than 2000 adolescents were included. Thirteen recorded menstrual cycle and/or symptom data and 14 measured ovulation. Mean cycle length ranged from 32 to 61 days and decreased throughout GY1. Mean menses length was 4.9 to 5.4 days. Frequent menstrual bleeding was reported in up to 23% of participants, infrequent menstrual bleeding in up to one-third, and “irregular menstrual bleeding” in up to 43%. Dysmenorrhea was reported by 30%-89% of participants. Prevalence of ovulatory cycles identified using luteal phase serum or salivary progesterone or urinary pregnanediol was 0 to 45% and increased throughout GY1. However, all used definitions that would be considered subovulatory in clinical practice.Conclusion
Menstrual and ovulatory patterns in GY1 are diverse and differ from those of adults. A transitional phase of menstrual and ovulatory immaturity is common. However, ovulation, irregular cycles, and dysmenorrhea are not uncommon. As such, safe sexual practice should be advocated and prompt medical management should be accessible. 相似文献19.
Katherine Croft Patricia J. Mattingly Patrick Bosse R. Wendel Naumann 《Journal of minimally invasive gynecology》2017,24(1):62-66
Study Objective
To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure.Design
Prospective cohort study (Canadian Task Force classification III).Setting
Academic-affiliated community hospital.Patients
Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015.Intervention
The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July–September 2015) to gauge the impact of physician cost education.Measurements and Main Results
Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July–September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually.Conclusion
Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings. 相似文献20.
Ching-Jung Lin Teh-Fu Hsu Yen-Hou Chang Ben-Shian Huang Ling-Yu Jiang Peng-Hui Wang Yi-Jen Chen 《Taiwanese journal of obstetrics & gynecology》2018,57(1):47-51