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1.

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   

2.

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   

3.

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   

4.

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   

5.

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   

6.

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   

7.

Study Objective

To assess the feasibility of total robotic radical surgery (TRRS) in patients with locally advanced cervical cancer (LACC) who receive chemoradiation therapy (CT/RT).

Design

A prospective (preplanned) study of a nonrandomized controlled trial (Canadian Task Force classification level 2).

Setting

Catholic University of the Sacred Hearth, Rome, Italy.

Patients

Between September 2013 and January 2016, a total of 40 patients with LACC (Fédération Internationale de Gynécologie et d'Obstétrique stage IB2–III) were enrolled in the study.

Interventions

Robotic radical hysterectomy (RRH) plus pelvic and/or aortic lymphadenectomy was attempted within 6 weeks after CT/RT. The feasibility of TRRS as well as the rate, pattern, and severity of early and late postoperative complications were analyzed.

Measurements and Main Results

After CT/RT, 29 patients (72.5%) underwent type B2 RRH, and 11 (27.5%) underwent type C1 RRH. Pelvic lymphadenectomy was performed in all cases. TRRS was successful in 39 of 40 cases (feasibility rate = 97.5%). In patients successfully completing TRRS, the median operating time was 185 minutes (range, 100–330 minutes), and the median blood loss was 100 mL (range, 50–300 mL). The median time of hospitalization counted from the first postoperative day was 2 days (range, 1–4 days). No intraoperative complications were recorded. During the observation period (median = 18 months; range, 4–28 months), 9 of 40 (22.5%) experienced postoperative complications, for a total number of 12 complications. As of April 2016, recurrence of disease was documented in 5 cases (12.5%).

Conclusion

TRRS is feasible in LACC patients administered preoperative CT/RT, providing perioperative outcomes comparable with those registered in early-stage disease, and LACC patients receiving neoadjuvant chemotherapy.  相似文献   

8.

Study Objective

To evaluate the outcomes of laparoscopic surgery for the treatment of adnexal pathology in older children and adolescents.

Design

A retrospective cohort review.

Setting

A tertiary academic center in Istanbul, Turkey.

Participants

Pediatric and adolescent patients aged between 9 and 19 years (n = 69) who underwent laparoscopic surgery for adnexal pathology from January 2005 through September 2015. The patients who were pregnant or with non-gynecologic pathology detected during surgery were excluded from the study.

Interventions

Patients were divided into 2 groups according to their age. Group 1 consisted of 31 patients aged between 9 and 16 years and group 2 included 38 patients aged between 17 and 19 years.

Main Outcome Measures

The indication for surgery, procedures performed, anesthesia time, length of hospital stay, pathology findings, and complication rates were evaluated.

Results

Ovarian cystectomy and adnexal detorsion with or without cystectomy were the most frequently performed. Ovary-sparing conservative surgery was possible for all patients, except those with gonadal dysgenesis and testicular feminization (n = 6), who underwent laparoscopic gonadectomy. The most common pathologic finding was mature cystic teratoma (30.2%), followed by benign paratubal cyst, and simple cysts of the ovary. Anesthesia time was shorter in group 2 (P = .018). The procedures performed, length of hospital stay, complication rate, and pathology findings were not significantly different between the 2 groups.

Conclusions

Laparoscopic surgery can be successfully performed as an efficient, safe, and well tolerated procedure for treating a wide variety of adnexal pathology among children and young adolescents without any significant variation between different age groups.  相似文献   

9.
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10.

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   

11.

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   

12.

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   

13.
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14.

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   

15.

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   

16.

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   

17.
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18.

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   

19.
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20.

Study Objective

To assess the association between medroxyprogesterone acetate exposure and bone mineral density (BMD) loss and weight change in adolescents.

Design

Forty-eight-week prospective, randomized trial conducted May 2012-April 2014.

Setting

Recruitment occurred in the general community and outpatient clinics in central Ohio.

Participants

Self-referred sample of 34 female adolescents aged 12-21 years initiating depot medroxyprogesterone acetate (DMPA).

Interventions

Randomization to 1 of 3 DMPA doses (150, 104, or 75 mg) given intramuscularly every 12 weeks for 48 weeks.

Main Outcome Measures

Absolute and percent change in BMD from 0-48 weeks at the L1-L4 lumbar spine, total hip, and femoral neck; absolute and percent change in weight at 48 weeks.

Results

DMPA dose was associated with medroxyprogesterone acetate exposure as evidenced by a direct relationship (P < .001) between dose group and area under the concentration time curve. At 48 weeks, no significant BMD decreases were seen in the 75 mg dose group. The 104 and 150 mg dose groups experienced significant (P < .01) decreases in L1-L4 lumbar spine BMD (3.1% and 4.0%, respectively). The 150 mg group also had significant (P < .05) decreases in total hip (3.0%) and femoral neck (4.0%) BMD. No group differences in weight change were observed. No pregnancies occurred in any DMPA dose group.

Conclusions

Our data provide evidence of a dose-response relationship between DMPA and BMD loss. Intramuscular DMPA doses less than 150 mg can decrease risk of BMD loss in adolescents. The risk/benefit ratio of lower-dose DMPA should be further investigated in larger and more diverse adolescent populations.  相似文献   

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