Consultant Gynaecologist Research Articles

Frequency of Severe Postpartum Hemorrhage After Delivery Among Obese Pregnant Women

Objective: To determine the frequency of severe postpartum hemorrhage after delivery among obese pregnant women. Methods: This case series was carried out from 15th December 2015 to 15th October 2016 at Department of Obstetrics & Gynaecology, Nishtar Hospital, Multan. A total of 505 obese pregnant women with gestational age 38–41 weeks and parity ≤ 3 undergone vaginal delivery or elective cesarean section were included. Women with history of hypertension, diabetes, renal disease and pre-eclampsia were excluded. In vaginal delivery women were given prostaglandin E2 vaginal gel 1 gm and the same dose repeated at six hourly intervals for maximum three doses under supervision of consultant. In patients undergone elective caesarean section, caesarean section was done by consultant gynecologist. After delivery, data was collected for severe postpartum hemorrhage. Results: Age range in this study was 25 to 35 years with mean age of 30.318 ± 2.71 years. Mean gestational age was 39.429 ±1.11 weeks and mean BMI was 28.289± 1.06 Kg/m2. Majority of the patients were of 25–30 years 268(53.1%). Parity of 2–3 was present in 69.3% women. Cesarean Section rate was 34.3% and vaginal delivery was 65.7%. Severe PPH was seen in 11.1% obese women. Conclusion: Obese women should be regarded as high risk for PPH. Keywords: Obesity, Mode of delivery, Severe postpartum hemorrhage

Antifungal effect of hydroethanolic extract of Fridericia chica (Bonpl.) L. G. Lohmann leaves and its therapeutic use in a vulvovaginal candidosis model

Vulvovaginal candidosis (VVC) is one of the most frequent causes of gynecological consultations. Therefore, the development of new antifungal therapies against VVC is relevant. In this context, the leaves of Fridericia chica (Bonpl.) L. G. Lohmann are considered a therapeutic alternative since they are traditionally used in VVC therapy. However, no scientific evidence has supported this use against fungal vaginal infections. Then, we aimed to characterize the antifungal effect of a hydroethanolic extract of F. chica leaves (HEFc) and evaluate the therapeutic potential of this extract in a VVC model. HEFc inhibited the growth of C. albicans (256–1,204 µg/mL) and C. krusei (512 µg/mL) in vitro. HEFc inhibited yeast-to-hypha transition in C. albicans and has a low ability to induce resistance in this species. Intravaginal use of the HEFc at 50 mg/mL causes mycological cure in animals with VVC after 6 days of treatment, similar to the effect observed for the commercial antifungal nystatin. These results support the traditional use of F. chica leaves as a topical therapeutic option to treat VVC.

Posoperatorio de labioplastia de reducción de labios menores mediante técnica de incisión simple con láser CO2

Objective: To determine the postoperative results of the reduction of labia minora using the simple incision technique with CO2 laser, in the period August 2015 - April 2016, in the city of Valencia, Carabobo State. Methods: Descriptive, non-experimental and field study. The sample consisted of 50 patients who attended the gynecology consultation. The technique of direct observation, filling of the clinical history, and evaluation at 7 days postoperatively was used for data collection. Results: Once the data were analyzed, it was obtained as results that the average age of the patients was 32.68 years. Among the postoperative symptoms, 8% reported burning in the operative area in the first 24 hours. Postoperative complications were as follows: bruising 4% and dehiscence 2%. 98% of patients felt satisfied or very satisfied with the process. Conclusion: Complications are minor with the simple incision technique with CO2 laser, it is safe and satisfactory results were obtained. It also allows to dry out the hyperchromic area of the edge of the lips that, in most cases, tends to bother from the aesthetic point of view. The benefits of the tool include better healing, fewer postoperative symptoms and faster recovery. Keywords: Labioplasty, Laser CO2, Reduction technique labia minora, Postoperative labioplasty.

The Reception of the User in Gynecological and Obstetrical Consultation of the Nianankoro Fomba Hospital of Segou (Mali)

Introduction: The observation of long queues at the counter and at the consultation had prompted the initiative of this survey whose aim was to assess the quality of reception in order to identify the difficulties of users at the counter and at the gynecology and obstetrics consultation. Methodology: This was a prospective descriptive cross-sectional study that took place in the Obstetrics and Gynecology Department of the Nianankoro Fomba Hospital in Segou from April 15 to May 9, 2019. Recruitment was based on verbal informed consent, availability of clients and respect of anonymity. Results: The study included 68.28% of the users who came to the counter for an outpatient gynecological or obstetrical consultation. The average age of the users was 27.2 years. The average waiting time at the counter was 2 hours and 12 minutes, and the average consultation time was 39.5 minutes. The overall satisfaction rate of the users was 35%. The reasons for dissatisfaction were related to problems encountered by users, including: long waiting times, verbal aggression at the counters, and the unavailability of agents to provide clear information to users. However, it should be noted that 86.7% of dissatisfied users preferred to remain anonymous about the reasons for their dissatisfaction. Conclusion: This study allowed us to take a concrete and objective look at the strengths and weaknesses of the reception of users, and at the same time to obtain basic information to develop a plan to improve the quality of care through reception.

Epidemiological Clinical Aspects and Medical Management of Sexual Assault in the Region of Ségou in Mali

Introduction: Sexual assault is an act of a sexual nature perpetrated on another person without their consent. Goal: To describe the epidemio-clinical aspects and the medical management of sexual assault in the Segou region. Methodology: This was a retro-prospective descriptive study from September 2010 to September 2018 on the alleged female victims of sexual assault registered in the Gynecology and Obstetrics departments of the hospital and the sanitary quarters of Ségou. Results: We recorded 107 cases of sexual assault out of 47,729 gynecological consultations, representing a hospital prevalence of 0.22%. The victims were between 10 and 15 years old in 48.59% of the cases. Students were the most represented with 53.27% (57/107) of cases. Genito-genital contact was recorded in 90.65% (97/107) of cases. Vulvo-perineal lesions were present in 44.86% (48/107) of survivors. Hymenial deflowering was the most frequent traumatic genital lesion accounting for 43.70% (21/48) of old cases and 27.00% (13/48) of recent cases. Sexual assault was committed by a single individual in 60.75% (65/107) of cases and by a friend of the victim in 21.5% (23/107) of cases. The survivors had consulted within 24 hours of the sexual assault in 53.27% (57/107) of the cases, the treatment was medical in 68.22% (73/107) and medical-surgical in 4.7% (5/107), post-exposure prophylaxis to the Human Immunodeficiency Virus (HIV) was performed in only 26.16% (28/107) of survivors. Conclusion: Sexual assault remains a concern although its frequency is low. This scourge mainly affects children and adolescents, and the lesions are mainly genitals.

Assessment of the availability of sexual and reproductive healthcare for Venezuelan migrant women during the SARS-CoV-2 pandemic at the north-western border of Brazil-Venezuela

BackgroundThe public healthcare system of Roraima state, at the north-western border Brazil-Venezuela, experienced an impact due to the incoming of Venezuelan migrants and to the SARS-CoV-2 (COVID-19) pandemic. After the beginning of the pandemic, the Brazilian government closed the border; however, migration continued through informal paths. There is scarce information regarding the availability of sexual and reproductive health (SRH) services at settings impacted both by migration and the COVID-19 pandemic. Consequently, we aimed to assess the availability and access to SRH services for Venezuelan migrant at Roraima state during the COVID-19 pandemic. MethodsWe conducted a cross-sectional study with data collected during the pandemic using an electronic questionnaire. We interviewed three policy makers responsible for the directorate of primary care both at the municipal and state level; the directors of the two public hospitals and the two referral centres for women's health in Boa Vista, and in Pacaraima the director of the hospital and of the basic health post. We also interviewed 20 out of the 34 (58.8%) managers of the basic health posts in Boa Vista and 10 healthcare providers (physicians and nurses). Data collected covered issues pertaining to access to SRH services, and explored the impacts of the COVID-19 on continuation, access, and use of SRH services. ResultsIt was reported that 60% of the beds in the public sector were reallocated for COVID-19 cases and 26 out of the 34 (76%) health posts assessed interrupted the provision of SRH services, including contraceptive provision and gynaecological consultation, since these were considered not essential services. Most of the participants, (25/36; 69.4%) reported that both the state and the municipal health authorities implemented community outreach using telephone, social media, radio, and television, with guidance for the population on how to seek care using the healthcare network. ConclusionsThe healthcare system in Roraima was impacted firstly by the need to provide SRH to a large number of Venezuelan migrant women, and after an effort to adapt to the reality that this migrant crisis posed; this system was affected by the needs to adapt to the COVID-19 pandemic.

Epidemiological Aspects and Results of the Management of Polycystic Ovary Syndrome at the CNHU-HKM of Cotonou

Introduction: Polycystic Ovarian Syndrome (PCOS), also known as Stein Leventhal Syndrome, is one of the common endocrine diseases affecting women of childbearing age and the leading cause of anovulatory infertility worldwide. The aim of this study was to describe the clinical, paraclinical and therapeutic aspects of PCOS at the University Clinic of Obstetrics and Gynaecology of the National Hospital and University Centre Hubert Koutoukou MAGA of Cotonou (CNHU). Patients and Method: The study was doing in the University Clinic of Gynecology and Obstetrics of the CNHU-HKM. This was a descriptive and analytical longitudinal study with retrospective and prospective data collection over a period of 7 years from January 2015 to December 2021. It focused on women of childbearing age seen in gynecological consultation. Results: The frequency of PCOS was 2.53%. The mean age of the patients was 27.28 ± 6.55 years. They were educated for the most part with a university level in 43.8% of cases. Obstetrically they were nulligest (45.63%) and nulliparous in 60% of cases. The history of spontaneous miscarriages was found in 61.11%. The main reasons for consultation were menstrual disorders (51%) followed by the desire for pregnancy (40.6%). Clinically, obesity (30%), overweight (33.1%), high blood pressure (20.63%), hirsutism (24%) and acne (27%) were noted. All the women had micropolycystic ovaries in ultrasound. Testosterone was elevated in 61% of cases. Phenotype D was found in 45.63% of patients. All these patients were put under lifestyle and dietary measures, Metformin (13.80%) and estrogen-progestogen (18.80%). The outcome of the treatment was assessed by cycle regularity, regression of hirsutism, weight loss, fertility and fertility. The cycle was normalised in most cases with notable regression of physical signs of hyperandrogenism. The cycle was normalized in most cases with the notable regression of physical signs of hyperandrogenism. We had recorded 25 pregnancies including one miscarriage. The occurrence of pregnancy was obtained in 50% of these women after 12 months and in less than 20% after 24 months. Conclusion: PCOS was common in the CUGO of the CNHU-HKM. A population-based epidemiological study seems necessary to better appreciate the risk factors of this endocrine syndrome and its repercussions on fertility and metabolic diseases such as type 2 diabetes, obesity and hypertension.

Factors associated with fertility counseling of reproductive age women presenting for initial gynecologic oncology consultation

Factors associated with fertility counseling of reproductive age women presenting for initial gynecologic oncology consultation

Cáncer de cuello uterino. Incidencia registrada en el Hospital “Dr. Domingo Luciani” en el año 2020

Objective: To estimate the incidence of cervical cancer (CCU) in the year 2020 in the gynecology oncology consultation of the Obstetrics and Gynecology Service of the Hospital “Dr. Domingo Luciani”. Method: Retrospective, descriptive study, where the clinical histories of the patients diagnosed with cervical cancer who attended the first oncology gynecology consultation were reviewed, the period from January to December 2020. Results: Sixty patients met the inclusion criteria, the variables studied were age, histological type, stage at the time of diagnosis and indicated treatment;14.52% were diagnosed with cervical cancer; the mean age at the time of diagnosis was 43.15 years; the most common histological group was squamous, (96.67%). Regarding staging, 28 cases (46.67%) were diagnosed in stage IIIB, 14 cases (23.33%) in stage IIB, and only 6.66% were diagnosed in early stages. Treatment indicated radiotherapy and chemotherapy. Conclusion: We show in the present study that cervical cancer represents a significant percentage of gynecological consultations, that unfortunately the diagnosis is made in advanced stages, negatively affecting the prognosis of these patients and that the age at which it predominates is in full productive life of the women. affected women, constituting a real public health problem and chaos for families and society. Keywords: Cervical cancer, Incidence, Carcinoma, Adenocarcinoma, Stage

Pre-operative wait times in high-grade non-endometrioid endometrial cancer: Do surgical delays impact patient survival?

ObjectivePractice guidelines advocating for regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were published in Ontario in June 2013. Our objectives were to determine whether this policy affected surgical wait times, and whether longer wait time to surgery is a predictor of survival in high grade endometrial cancer patients. MethodsThis was a population-based retrospective cohort study, which included patients diagnosed with high-grade non-endometrioid endometrial cancer who had a hysterectomy between 2003 and 2017. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between surgical wait time and overall survival (OS). ResultsWe identified 3518 patients who underwent hysterectomy for high-grade non-endometrioid endometrial cancer. Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 53 days compared to 57 days pre-regionalization (p = 0.0007), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p = 0.0006). Survival was inferior for patients who had surgery within 14 days of diagnosis (HR death 2.7 for 1–7 days, 95% CI 1.61–4.51, and HR death 1.96 for 8–14 days, 95% CI 1.50–2.57), reflective of disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic oncology appointment (HR death 1.19 for 46–60 days, 95% CI 1.04–1.36, and HR death 1.42 for 61–75 days, 95% CI 1.11–1.83). ConclusionsRegionalization of surgery for high-grade endometrial cancer has not had an impact on surgical wait times. Patients who have surgery more than 45 days after surgical consultation have reduced survival.

Secondary Infertility in Port Harcourt: Pattern and Socio-Dermographic Relationship

Background: Secondary Infertility is viewed as a social stigma, especially in Nigeria, due to the high premium placed on procreation. Observation suggests that this condition is on the increase in our environment. Hence, the need to determine the pattern and the relationship between the socio-demographic factors with infective causes of this condition; which will subsequently allow the tailoring of the individual investigation and subsequent treatment.
 Objective: To determine the prevalence and pattern as well as the relationship between the socio-demographic factors with infective causes of secondary infertility among women who attended the gynaecological clinic of the University of Port Harcourt Teaching Hospital (UPTH) between January 2012 and December 2016
 Methods: This is a retrospective descriptive study design, based on findings from the folders, admission and outpatient registers, of infertile couples presenting at the gynaecology clinic of the University of Port Harcourt Teaching Hospital, over a five-year period (January 2012 – December 2016). Data were collected from all documented and laboratory findings. The data extracted from the case records were the socio-demographic characteristics of the patient, the duration of infertility as well as the causes. They were analyzed using SPSS version 20.
 Results: The mean age of women was 33.14±4.93 years. The prevalence of secondary infertility was 12% of all outpatient gynaecological consultation. The mean duration of secondary infertility was 3 years.
 The infective causes of secondary infertility [recurrent pelvic inflammatory disease(PID), sexually transmitted infections(STI), post abortal sepsis, puerperal sepsis, HIV/AIDS, mumps orchitis were commoner among the 31-40 years’ category, (45.8%), the infective causes were also commoner among women with primary level of education, (62.5%, p-value=0.001) as well as women who were self-employed (49%, p-value=0.041). Recurrent pelvic inflammatory disease was identified in majority of cases (37.1%). Abnormal semen analysis, hyper-prolactinaemia and uterine fibroid, also contributed significantly to infertility; 18.5%, 19.7% and 24.3% respectively.
 Conclusion: Infective causes are at the root cause of secondary infertility; the more educated the couple, the higher their socioeconomic status, the lesser the impact of infection on secondary infertility.

Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study.

ObjectiveTo determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.DesignProspective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the “Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes”.Setting44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.Participants6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.ExposuresPlanned and actual senior clinician presence, unit size, and weekend opening.Main outcome measuresUnplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.Results205/6397 (3.2%; 95% CI 2.8–3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.ConclusionsInvolvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

Aerobic Isolates from Gestational and Non-Gestational Lactating Bitches (Canis lupus familiaris).

Simple SummaryMastitis represents the inflammation of the mammary gland, and it affects all mammals. It is usually caused by bacterial agents, but other organisms such as fungi or parasites can be responsible for the onset of mastitis. In bitches, mastitis is considered a genuine emergency, since it can affect both the mother and the pups. Left untreated, it can lead to the loss of the bitch and the entire litter. The aim of this study was to evaluate the bacterial load from the milk of healthy bitches and from bitches with mastitis. The main isolated bacterial families were the Staphylococcaceae, Enterobacteriaceae and Enterococcaceae families. The bacterial load from bitches’ overt pseudopregnancy seems to have a lower bacteriological burden than periparturient females. Some of the isolated milk strains of lactating bitches are also responsible for nosocomial infection. The transmission of such strains from humans to animals or vice versa is possible. Environmental hygiene needs to be adequately addressed, alongside a minimum manipulation of the lactating mammary glands where possible.Mastitis is a complex and well-defined mammary gland pathology, and an emergency in bitches. In dogs, its prevalence is about 1% of all reported diseases and about 5.3% of all reproductive pathologies. Lactating bitches are naturally prone to developing mastitis since puppies can easily overstimulate the epidermal layer of nipples during feeding, facilitating bacterial colonization of the glands. This study aimed to describe the aerobic bacterial flora isolated from milk samples derived from a cohort of patients (n = 87) diagnosed with clinical mastitis (n = 29), subclinical mastitis (n = 17) and healthy mammary glands (n = 46). All of the patients underwent a gynecology consultation to diagnose mammary gland afflictions; physical examination results were coupled with traditional hematological findings. The milk samples were plated on specific microbiological media for bacterial isolation. Among the 162 milk samples analyzed, 93.2% (151/162) had a positive microbiological result, while 6.8% (11/162) were sterile. The bacteriological profile of the milk samples showed 47 different species. The most common bacterial families detected in healthy bitches and bitches with subclinical and clinical mastitis were the Staphylococcaceae, Enterobacteriaceae and Enterococcaceae families. The results indicated that half of the isolated bacteria are novel findings in dogs and that some of them are normal components of human milk.

Second Solid Cancers After Hematopoietic Stem Cell Transplantation: Active Surveillance During Long-term Follow-up.

Second Solid Cancers After Hematopoietic Stem Cell Transplantation: Active Surveillance During Long-term Follow-up.

Rural patients highly satisfied with gynaecological oncology care via telehealth.

Introduction of telehealth for gynaecological oncology consultations aims to improve access to specialised care for rural and remote Queensland women with gynaecological malignancies. This survey examines patient satisfaction with gynaecological oncology consultations via telehealth after introduction of the service in Far North Queensland in 2017. Patients who accessed the gynaecological oncology telehealth service at Cairns Hospital from January 2019 to June 2020 were invited to participate in the study. Demographic details and results of a satisfaction survey were investigated. The questionnaire included 16 statements measured on a five-point Likert scale and three open-ended questions, which were coded into related responses and predominant themes developed. Fifty-three patients completed the study. The mean satisfaction score across all questions was 90.5% (standard deviation 8.7%). The lowest overall patient score was 77.5% and the highest was 100%. Themes emerging from the open questions were emotions experienced by women, communication, relationship building and acceptability of the service. Patients were highly satisfied with the telehealth service. Our findings encourage further development and research into telehealth care models for surgical disciplines such as gynaecological oncology.

Étude médico-légale prospective sur la caractérisation de l’examen génital chez des femmes ayant une activité sexuelle consentie

ObjectiveThe number of women victims of sexual assault remains high, despite prevention and information campaigns. These victims can be adolescent girls, women of childbearing age or postmenopausal women. As part of examinations of victims of sexual assault, the morpho-anatomical diversity of the female genitalia requires knowledge of the physiological variations existing by the practitioners caring for these victims. Our work aimed to describe and characterize the genital examination of women with consented sexual activity. MethodOur cohort consisted of 196 women aged 14 to 81, examined in the context of medical gynecology consultations in two French maternity hospitals. ResultsRecent genital traumatic injuries were found in 12.8% of women whose last sexual intercourse was less than 5days old. Intact hymens, free from traumatic tearing despite regular sexual activity, were present in 10.7% of these women. ConclusionThus, in many cases, genital examination alone cannot confirm or deny the existence of prior sexual intercourse, whether or not it was consented to. The development of work on data on female genital anatomy would make it possible to optimize the medico legal care of victims of sexual assault.

Pelvic venous thrombosis

While the thrombotic risk associated with lower limb venous reflux has been clearly reported in the literature, evidence is lacking on the potentially similar procoagulant effect generated by a venous incompetence in the pelvic region. A recent publication identified an incidental periuterine venous plexus thrombosis in 3% of the women undergoing a gynaecological consultation for whatever reason, suggesting a potentially underestimated condition worthy of further investigation. The present paper analyses the available literature on the topic, providing an insight covering both pathophysiological and clinical aspects.

Pleasure, womanhood and the desire for reconstructive surgery after female genital cutting in Belgium

Growing numbers of women are showing interest in clitoral reconstructive surgery after ‘Female Genital Mutilation’. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requested surgery at the Brussels specialist clinic between 2017 and 2020, this paper looks at two cases of women who actually enjoy sex and experience pleasure but request the procedure to become ‘whole again’ after stigmatising experiences with health-care professionals, sexual partners or gossip among African migrant communities. An ethnographic approach was used including indepth interviews and participant observation during reception appointments, gynecological consultations, sexology and psychotherapy sessions. Despite limited evidence on the safety of the surgical intervention, surgery is often perceived as the ultimate remedy for the ‘missing’ clitoris. Such beliefs are nourished by predominant discourses of cut women as ‘sexually mutilated’. Following Butler, this article elicits how discursive practices on the physiological sex of a woman can shape her gender identity as a complete or incomplete person. We also examine what it was that changed the patients’ mind about the surgery in the process of re-building their confidence through sexology therapy and psychotherapy.

Adnexal Torsion: Narcotic Administration and Gynecologists’ Diagnostic Accuracy

<h3>Study Objective</h3> To determine Gynecologists' accuracy in diagnosing adnexal torsion (AT) and determine differences in in the amount of narcotics administered in morphine milligram equivalent (MME) in patients who received gynecology consultation for AT. <h3>Design</h3> A retrospective cohort study between 2017-2020. <h3>Setting</h3> A tertiary, academic medical center. <h3>Patients or Participants</h3> 138 women received a gynecologic consultation in the emergency room to rule out AT. <h3>Interventions</h3> Surgical intervention. <h3>Measurements and Main Results</h3> 138 women met inclusion criteria. 32 of them (23%) underwent diagnostic laparoscopy for suspected AT, and 18 (56%) were confirmed to have AT. The MME median in patients undergoing surgery was 6.25 mg, which was significantly higher than 2.5 mg in patients who did not undergo surgery (p = 0.0011). MME medians for women who had surgically confirmed AT and those who underwent surgery but did not have AT were 7.25 mg and 4 mg respectively, which was not significantly different (p = 0.2221). Age, race (white vs non-white), payer status (insured vs uninsured), history of sexually transmitted disease or ovarian cyst, and pain severity did not differ between the group of women that underwent surgery and the group of women that did not. However, there was a significant difference in the presence of vomiting (p = <0.001), leukocytosis (p = 0.0073), and overall larger ovarian mass (p = <0.0001) in women who had surgery. On multivariate regression analysis controlling for leukocytosis and ovarian mass, MME was independently associated with the decision to proceed with surgery (p = 0.0119). <h3>Conclusion</h3> While this study highlights no statistically significant difference in MME administration and accuracy of AT diagnosis due to small sample size, there was a difference in MME administration between women undergoing surgery and those who did not. Determining which predictors and to what extent they may impact the diagnosis and decision to proceed with surgery remain an area that warrants further investigation.

Breast pathology in adolescence.

Description of breast pathology in adolescents. A retrospective descriptive study of adolescents who were referred to the Gynecology consultation of a tertiary pediatric hospital for suspected breast pathology, in the period from the 1st June 2011 to the 30th December 2018. One hundred and two female adolescents (11 to 18 years old) with suspected breast pathology were referred (6% of the motives for consultation), with confirmation in 58 (56.9%), who were included in the study. The reasons for referral were breast masses (66%), anomalies in breast size or symmetry (29%) and infection (5%). Of breast masses, the most frequent diagnosis was fibroadenoma (76%), followed by fibro-cystic pathology (18%). In most cases, a conservative approach was chosen, with clinical and imaging surveillance. Surgery was required in 29% of these cases. Anomalies in breast size and symmetry were observed in 17 adolescents. Two adolescents were submitted to symmetrization, after 18 years of age. Infectious and inflammatory pathology occurred in three cases: two mastitis and one retroareolar cyst. The approach consisted mainly of antibiotherapy. There were no cases of malignant breast disease. Lumps or breast masses are the most frequent breast pathology in adolescence, and in the majority of cases surveillance was recommended, as they are a mere sign of hormonal oscillations at this age. Objective examination and/or breast ultrasound are usually enough to make the diagnosis. The approach must be mainly conservative, since malignancy is extremely rare in this age group.