Adolescent Gynecology Research Articles

Clinical utility of ultrasonography in pediatric and adolescent gynecology: retrospective review of 1313 ultrasound examinations.

Ultrasound is the first-line imaging modality of the pelvis in the pediatric and adolescent gynecology (PAG) population. Ultrasound findings in pre- and postpubertal PAG patients differ from those in adults. Diagnostic models for adnexal pathology have not been validated in this cohort. The primary aim of this study was to evaluate normative findings and the incidence of pathology in this cohort. The secondary aim was to assess the performance of expert opinion alone, as well as using retrospective application of the International Ovarian Tumor Analysis (IOTA) simple rules (SRs) and benign descriptors (BDs) in those found to have an adnexal mass. This was a retrospective review of pelvic ultrasound examinations performed in patients < 18 years of age from January 2017 to July 2021 in one expert center in the UK. Analysis was performed on three age groups: neonatal (aged < 1 year), premenarchal (aged ≥ 1 year) and postmenarchal. The study was locally approved as an audit (GRM_082). Expert review of images of ovarian masses was performed using retrospective application of the IOTA-SRs and IOTA-BDs. In total, data on 1429 pelvic ultrasound examinations were retrieved, of which 116 were excluded, resulting in the inclusion of 1313 ultrasound images (1145 patients). The median age at the first ultrasound scan was 2 days after birth in the neonatal group (n = 20), 8.8 years in the premenarchal group (n = 124) and 16.1 years in the postmenarchal group (n = 961). The status of menarche was unknown in a further 40 patients. Normative ultrasound findings were in keeping with those in the existing literature. Uterine anomalies were seen in 14 (1.2%) patients. Endometrial pathology was rare, with five cases of gestational trophoblastic disease. The most frequent indication for ultrasound scan for each group were a known medical condition in neonates (n = 11 (55.0%)), suspected precocious puberty in premenarchal girls (n = 38 (30.6%)) and abnormal vaginal bleeding in postmenarchal girls (n = 504 (52.4%)). Polycystic ovarian appearances were described in 150 (15.6%) postmenarchal girls. Adnexal pathology was identified in 102 (8.9%) participants on initial ultrasound: four neonates, three premenarchal and 95 postmenarchal patients. Benign cystadenomas and hemorrhagic cysts were the most common adnexal mass type in all groups. Final outcomes were available for 79/95 masses in the postmenarchal group, none of which were malignant. The IOTA-SRs, IOTA-BDs, expert opinion and standard ultrasound reporting could characterize as benign 96.2%, 87.3%, 98.7% and 77.2% of the masses, respectively, all with a specificity of 100%. Eleven patients underwent 12 surgeries overall (three oophorectomies, six cystectomies and three cyst aspirations), with 11 out of 12 masses classified as benign based on retrospective expert assessment. Ultrasound is effective for assessment of the female pelvis in the PAG population. Adnexal masses are common, but few require surgical intervention and most resolve expectantly. The IOTA-BDs and IOTA-SRs maintain their performance in this population. Larger studies are required for the prospective validation of diagnostic models which may aid a fertility-sparing approach to care. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Congenital uterine anomaly with concurrent longitudinal and transverse vaginal septa: Presentation of two Cases.

Didelphic and septate uterus are congenital uterine anomalies caused by the failure of fusion of the Mullerian ducts or resorption of the median septum post-fusion respectively. These can occasionally be associated with a longitudinal vaginal septum. The combination with a transverse vaginal septum is rare, leads to menstrual obstruction, and presents with severe abdominal pain in early adolescence. We present the cases of two 12-year-old girls, presenting with a uterine anomaly and concomitant longitudinal vaginal septum and haematocolpos due to the presence of a transverse vaginal septum. Congenital uterine anomalies can coexist with a longitudinal septum and rarely with a transverse vaginal septum causing obstruction. Early diagnosis and surgical correction of transverse vaginal septum are decisive for the relief of symptoms and the prevention of future complications. Physicians should always consider the presence of complex congenital anomalies in cases of menstrual obstruction. The coexistence of uterine and vaginal anomalies in this study are not adequately described by the existing classification systems, underlining the need for a more inclusive classification system. Obstetrics & Gynecology, Pediatrics, Pediatric & Adolescent Gynecology.

Accessory uterine cavities: a review of cases and an appeal for standard terminology.

To study and address the diagnostic, management, and classification challenges of unilocular myometrial cystic lesions adjacent to a normal uterine cavity. Describe 23 further cases, and undertake a systematic review using Medline, PubMed and Ovid for similar lesions. 23 cases of accessory uterine cavities presenting to pediatric and adolescent gynecologists in Australia and New Zealand. 92 similar cases of cavitated myometrial masses were identified in the literature. The cases in our series and in the literature were examined for age at presentation, site of lesion, pathology, and presence of other anomalies. All patients in our series were aged ≤ 32 years. All presented with unilocular blood-filled myometrial lesions that did not communicate with the uterine cavity. All were located on the lateral aspect of the uterus in proximity to the round ligament. Of the 22 that have been resected, all were lined by endometrium and smooth muscle. These characteristics are mirrored in the previously described cases in the literature. The frequency of these myometrial cystic masses is such that they can no longer be considered rare. Nevertheless, their etiology remains unclear. These lesions have often been given names suggesting that they are an early representation of adenomyosis. The alternative possibility of a Müllerian anomaly is supported by consistent anatomical location and young age of presentation in most reported cases. Yet the absence of documented associated anomalies raises concerns about this theory. To progress understanding of these lesions, consistent reporting of features including location and the presence or absence of other anomalies is required. In view of this ongoing uncertainty, we recommend the use of the term "accessory uterine cavity (AUC)." This terminology avoids the implication of either a pathological process or a congenital anomaly.

Diagnostic Accuracy of Imperforate Hymen at a Single Referral Center.

Imperforate hymen (IH) is a rare congenital anomaly that results in vaginal outlet obstruction. IH can cause significant morbidity if not managed appropriately, which depends on accurate identification of the condition. However, data on the accuracy of IH diagnosis is limited. This study aimed to investigate the accuracy of IH diagnosis at a single referral center. Institutional Review Board approval was obtained for this retrospective chart review. ICD-10 codes identified patients with "hymenal abnormalities" between 2018 and 2023 at a single children's hospital. The primary outcome was rate of misdiagnosis of IH through comparison of diagnosis codes and chart review. Descriptive statistics and Chi-square or Fischer's exact test were utilized as appropriate. 165 patients met inclusion criteria. 57 were initially diagnosed with IH and of those patients, 28 (49.1%) were misdiagnosed. Additionally, 5 patients initially diagnosed with a different condition were later found to have IH. There was no significant difference in misdiagnosis rate between premenarchal and menarchal patients (p=0.77). There was a significantly higher rate of misdiagnosis amongst generalist Ob/Gyn providers compared to pediatric gynecologists (p=0.04). Many patients with IH may initially be seen by primary care providers. Due to the rarity of the condition and a lack of provider exposure to IH, misdiagnosis is common. IH is important to distinguish from other anomalies of the reproductive tract, as the management differs. Misdiagnosis of IH may lead to incorrect surgical approach and subsequent complications. Training and education surrounding IH, along with referral to pediatric gynecology, may help reduce misdiagnosis.

Ovarian function in adolescents and young adults undergoing cancer treatment: biochemical and ultrasound marker analysis.

Gonadal dysfunction is a major late complication after cancer diagnosis and treatment. We aimed to study the prevalence of premature ovarian insufficiency (POI) and the potential reduction of ovarian reserve in a cohort of adolescent and young adult (AYA) patients undergoing cancer treatments, evaluating ovarian function and reserve markers. We also aimed to analyze how these markers are related to each other and to treatment-related risk factors. We performed a retrospective study, including all female AYA patients undergoing cancer treatment during childhood or adolescence who visited our pediatric gynecology outpatient clinic between January 1, 2018, and August 30, 2023. Serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH), antral follicle count (AFC) and mean ovarian volume were evaluated. The correlations between these markers and how their alterations are related to treatment-related risk factors were analyzed. The prevalence of POI in 95 patients was 18.9 %. A significant positive correlation was observed between AMH levels and both AFC and ovarian volume. AMH was the most reliable serum marker for ovarian function in terms of POI. Independent risk factors for ovarian dysfunction in relation to all the markers analyzed were hematopoietic stem cell transplantation (HSCT) and high doses of alkylating agents (≥6000 mg/m2). Gonadal dysfunction and infertility are quite common in AYA patients undergoing cancer treatment. High-dose alkylating agents and HSCT are the independent risk factors. AMH and FSH values, AFC and mean ovarian volume provide different but consistent information for closely monitoring patients after cancer treatment.

Abstracts of the 16th European Congress of Paediatric and Adolescent Gynaecology †.

Objectives of Paediatric and Adolescent Gynaecology (PAG): PAG aims to foster a collaborative environment that bridges knowledge from various disciplines to ensure the highest quality of care for children and adolescents with gynaecological issues. The European Association of PAG and HellenicPAG, like all National PAG Societies, support research and education to advance new insights, improve health outcomes, enhance quality of life, and protect future fertility. Additionally, PAG promotes international cooperation by proposing guidelines for good clinical practice in terms of prevention, diagnosis, procedures, and treatment. Scientific Program and Highlights: The scientific committee curated a comprehensive program featuring renowned experts and researchers from across Europe. Over four days, participants explored a wide range of topics through lectures, panel discussions, case studies, debates, video presentations, and workshops. The conference attracted professionals from various disciplines, including gynaecology, paediatrics, paediatric endocrinology, psychology, plastic surgery, and paediatric surgery. The collaboration between the European Association of Paediatric and Adolescent Gynaecology and the Hellenic Society of Paediatric and Adolescent Gynaecology resulted in a cutting-edge scientific program. World-renowned experts (Appendix A) presented on all aspects of paediatric and adolescent gynaecology, with a particular focus on emerging topics such as abortion, global rights, transgender care, teenage pregnancy, and more. Theme-Individualized Care in an Evolving World: The congress theme aligned perfectly with the evolving landscape of PAG. By presenting high-quality, evidence-based topics, the program aimed to equip the next generation of specialists with the knowledge and skills needed to provide individualized care in a rapidly changing world.

Clinical and Ultrasound Features of Normocyclic Non-Hyperandrogenic Adolescents in Early Gynecological Life

Objective: This study aimed to determine the prevalence of polycystic ovarian morphology (PCOM) in healthy postmenarcheal girls and assess whether it represents a crucial physiological phase in gynecological development. Additionally, it evaluated if an elevated stromal-to-surface area (S/A) ratio could identify individuals at risk of developing polycystic ovarian syndrome (PCOS). Design: This is an observational cross-sectional study. Participants: A total of 302 healthy postmenarcheal girls aged 14–18 were included in the study. Setting: The study was conducted at the Pediatric and Adolescent Gynecology Service of the University Hospital Duilio Casula, Monserrato, University of Cagliari, from 2020 to 2023. Methods: Participants were divided into three groups: normal ovarian morphology (NOM), PCOM with normal S/A ratio (PCOM-NS), and PCOM with increased S/A ratio (PCOM-IS). Anthropometric, clinical, hormonal, and ultrasound (US) characteristics were analyzed. Results: The overall prevalence of PCOM was 43% (95% CI: 0.37–0.49). Among 302 subjects, 171 (57%) exhibited NOM, 90 (30%) showed PCOM-NS, and 41 (13%) had PCOM-IS. The age and years of postmenarcheal life were significantly lower in the PCOM-NS group than in the NOM group. PCOM-NS exhibited a higher waist-to-hip ratio, hirsutism prevalence, and follicle count per ovarian section. PCOM-IS was associated with elevated androgen levels. A significant reduction in the PCOM pattern was observed after the third postmenarcheal year, while the NOM pattern increased significantly beyond 5 years postmenarche. Limitations: The study is limited by its cross-sectional design, which precludes establishing causality. Additionally, the exclusion of certain participants due to technical limitations in US evaluation may introduce selection bias. Conclusions: PCOM may represent a normal physiological phase in ovarian development during early adolescence, predominantly observed in the first 1–3 years postmenarche. An increased S/A ratio could help identify adolescents who may benefit from monitoring for potential PCOS development.

Assessing Practice Patterns Regarding Use of Norethindrone Acetate in Adolescents.

Norethindrone acetate (NETA) is commonly used in adolescent patients for management of heavy menstrual bleeding, menstrual suppression, and endometriosis. Clinical guidelines do not address specific dosing strategies, clinical indications, contraindications, or monitoring. We sought to survey current prescribers of NETA to assess practice patterns of use among adolescent patients. An anonymous cross-sectional survey was sent via email list-serv to members of the North American Society for Pediatric and Adolescent Gynecology Providers (NASPAG). Participants were asked about their own demographics, patterns of use and monitoring of NETA. Seventy-one providers participated in the survey including 46 gynecologists and 22 adolescent medicine trained clinicians. The most common indications for use were menstrual suppression and treatment of endometriosis. Most providers (n=51) used NETA in patients with estrogen contraindications, with over half limiting the maximum dose used (n=24). While 14%(n=9) of providers surveyed had concerns about effects on bone mineral density with prolonged NETA use, only 1 participant routinely obtained dual-energy X-ray absorptiometry (DEXA) scans. 43% of participants using NETA felt there were no absolute contraindications (n=27); others cited liver disease (n=15), active or prior venous thromboembolism (n=7), and inherited thrombophilia or increased clotting risk (n=3) as strict contraindications. NETA is commonly prescribed for adolescents by study participants. Despite widespread use, practice patterns vary regarding eligibility, monitoring, and perceived risks. This likely reflects limited data and highlights the need for further investigations of NETA use. Our study was limited by low response rate that may not be reflective of general clinical practice.

Evaluation of Knowledge, Attitudes, and Practices About HPV Vaccine: A Survey Study of Pediatric and Obstetrics and Gynecology Residents in İzmir, Türkiye

Purpose: The main objective of this study was to evaluate the knowledge, attitudes, and practices of obstetrics and gynecology (OB/GYN) and pediatric residents in Izmir, Turkey, regarding the HPV vaccination. Materials and Methods: This cross-sectional survey study was conducted in five hospitals in Izmir, Turkey, between May and July 2019. The data for this study were obtained from 299 pediatric and 126 OB/GYN residents via an online web-based questionnaire. The statistical analyses were performed using SPSS®. Results: The overall participation rate was 72%. Only 25.2% of the participating residents demonstrated adequate knowledge about the HPV vaccine. The OB/GYN residents had significantly higher knowledge scores than the pediatric residents (median [IQR] = 9.4 [8.4-10.6] vs. 8.4 [7.4-9.8], p=0.007). The vaccination rate among residents was low, with female residents having higher rates of vaccination than male residents (13.6% vs. 1.1%, p

Hypoprolactinemia, a neglected endocrine disorder.

This special issue of Reviews in Endocrine and Metabolic Disorders is dedicated to hypoprolactinemia. Prolactin is known for its actions on the mammary gland including development, preparation for postpartum lactation, as well as synthesis and maintenance of milk secretion. However, prolactin has many other physiological effects on reproduction, embryonic and fetal development, homeostasis, neuroprotection, behavior, and immunoregulation. In clinical practice, physiopathology and clinical consequences of increased prolactin secretion are generally well understood, and medical treatment to decrease prolactin levels is available and effective in most cases. Unlike prolactin excess, hypoprolactinemia has been a neglected endocrine disorder and nospecific replacement therapy is commercially available. Prolactin is the only anterior pituitary hormone not addressed by clinical hypopituitarism guidelines. In recent years, human studies have revealed that hypoprolactinemia is associated with metabolic, sexual and neuropsychologic alterations. Therefore, this special issue of Reviews in Endocrine and Metabolic Disorders is aimed to enhance our incomplete understanding of hypoprolactinemia. A total of 17 articles were authored by respected scientists and clinicians from a variety of disciplines including adult and pediatric endocrinology, pathology, gynecology, reproductive medicine, oncology, and neurosurgery.

Classification of Human Ovarian Follicle Morphology: Recommendations of the NICHD-Sponsored Ovarian Nomenclature Workshop

To develop a consensus on histologic human ovarian follicle staging nomenclature, provide guidelines for follicle density calculation, and assess changes due to fixation to enhance communication among clinicians and ovarian biology researchers in order to gain a deeper understanding of human fertility. Beginning in March 2021, the Ovarian Nomenclature Workshop's Follicle Classification Working Subgroup was organized by the Pediatric and Adolescent Gynecology program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The Follicle Working Subgroup recommends consolidation and expansion of the current classification systems to include six stages of normal preantral follicles, five stages of normal antral follicles, as well as categories of corpus lutea, abnormal preantral follicles, abnormal antral follicles, and other distinct follicle types. The new preantral staging added intermediate stages (primordial, transitional primordial, primary, transitional primary, secondary, multilayer ovarian follicles). The antral follicle staging includes: early pre-selection, selection, dominance, and pre-ovulatory follicles. Abnormal preantral follicles include those with an abnormal oocyte (AMF-o), granulosa cells (AMF-g), or both (AMF-og). We suggest a uniform way of calculating mean follicle density in number of follicles/mm2. To establish a consensus in ovarian follicle terminology, the Ovarian Follicle Working Subgroup of the NICHD Ovarian Nomenclature Workshop standardized Follicle Staging Nomenclature and Follicle Density Calculating Systems so consistent common language can be used among ovarian biology researchers and clinicians.

Ovarian Tissue Cryopreservation in Pediatric Centers Across the United States: Practice Patterns and Barriers

Study ObjectiveEvaluate practice patterns in ovarian tissue cryopreservation (OTC) provision. MethodsUnited States providers practicing or developing OTC at pediatric programs were invited to participate in a survey disseminated via the Oncofertility Consortium. ResultsTwenty-seven programs representing a wide geographic area responded, largely representing academic institutions (85.2%). Of these, 21 (77.4%) performed OTC at their facility, the majority for oncology patients receiving gonadotoxic therapy, relapsed patients and non-oncologic patients receiving gonadotoxic therapy (95.7, 87.0, 82.6% respectively). OTC procedures were most commonly performed by pediatric gynecology surgeons (71.4%) via laparoscopic oophorectomy (90.5%) using a heat-based method (55.0%) for dissection. Most centers used an outside compensated service (50%) or a reproductive endocrinology group (45%) for processing tissue. Many (13, 61.9%) performed OTC as standard of care and 7 utilized an IRB for data collection. Of the 8 centers whose OTC programs are in the planning or early stages, frequently identified barriers were lack of priority within their medical team or institution (5/8), lack of protected time (3/8), and lack of funding (3/8). ConclusionsOTC is commonly offered to oncology patients receiving highly gonadotoxic therapy with pediatric gynecologists frequently involved in counseling and performing OTC. Variability exists in offering OTC to other patient populations, as well as in research practices, surgical technique and processing. Institutions continue to face barriers in offering OTC when necessary resources are not prioritized by leadership.

Exploring adolescent contraceptive counseling: A hypothetical daughter scenario

ObjectivesWe aimed to describe contraceptive methods used by clinicians who counsel adolescents to create an aggregate perspective which could be shared with patients. We also explored which method clinicians would recommend to a hypothetical daughter to identify associations between clinicians who had used long-acting reversible contraception (LARC) and potential recommendations. MethodsAn online survey was sent to pediatric and adolescent gynecology academic societies and fellowship/division directors to share with their clinicians. Frequency and percentage of self-reported personal/partner contraceptive method ever use was calculated. Bivariate tests evaluated the relationship between personal LARC use and contraception recommendations. ResultsAcross 669 clinicians, 46 % reported personal/partner LARC use, and 77 % recommended LARC to a hypothetical daughter. LARC users were more likely to recommend LARC for a hypothetical daughter (89 % LARC users recommend it versus 66 % non-LARC users, p < 0.01). ConclusionResults can support shared decision-making counseling discussions. When families ask, “what do you use” or “what would you start for your daughter,” clinicians might consider sharing this aggregate perspective. Practice implicationsIn this study, clinicians who personally use LARC were more likely to recommend LARC for a hypothetical daughter. Clinicians can share this aggregate perspective to reduce personal bias during contraceptive counselling.

Specific features of cytokine synthesis in adolescent girls with oligomenorrhea and low body mass index

The article is devoted to the study of the cytokine component of immunity in teenage girls with oligomenorrhea, underweight and with normal body weight in comparison with teenage girls with a normal menstrual cycle and normal body weight, which is of great importance to pediatric gynecology. Studying of the cytokine profile in oligomenorrhea will allow early identification of the development of many gynecological pathologies, including polycystic ovary syndrome, endometrioid neoplasms, as well as for understanding the pathogenesis of these conditions and developing approaches to their diagnosis and treatment, which is of great practical importance. The authors conducted an immunological study of teenage girls with oligomenorrhea with underweight and normal body weight in comparison with teenage girls with a normal menstrual cycle and normal body weight. Purpose of the study: to study the levels of IL-6, IL-17A, IL-18 and IL-10 in adolescent girls with oligomenorrhea and underweight. Teenage girls (N = 52) aged 13 to 17 years with established menstrual irregularities were examined. The control group consisted of 24 practically healthy girls of the same age. From the study, it was established that girls with oligomenorrhea and underweight have a pronounced increased synthesis of proinflammatory cytokines IL-6, IL-17A and IL-18. In the same group of girls, an increase in the level of the anti-inflammatory cytokine IL-10 was detected, which may be an attempt by the body to compensate for inflammatory processes. However, IL-10 levels remain elevated, which may indicate an immune imbalance. The discovered imbalance in the cytokine profile emphasizes the complexity of the pathogenesis of oligomenorrhea in girls with underweight, and the identified levels of the studied cytokines can serve as biomarkers that will help in diagnosis, assessment of severity, and prediction of the course of the disease state.

Standardizing the evaluation and management of iron deficiency anemia secondary to heavy menstrual bleeding in the emergency department.

Comprehensive guidelines for the management of iron deficiency anemia (IDA) in adolescents with heavy menstrual bleeding (HMB) presenting to the emergency department (ED) are lacking, leading to variability in care. We aimed to standardize the evaluation and management of these patients through the development and implementation of an evidence-based algorithm using quality improvement methodology. Baseline data of the target population identified variability across four key measures of clinical management: therapy choice and administration, laboratory evaluation, hematology service consultation, and patient disposition. Literature review and consensus from pediatric hematology and gynecology providers informed a draft algorithm that was refined in an iterative multidisciplinary process. From December 2022 to July 2023, we aimed to achieve a 25% relative increase in patients to receive optimal management per the algorithm, while using sequential Plan-Do-Study-Act (PDSA) cycles. Process measures focusing on provider documentation and balancing measures, such as ED length of stay, were assessed concurrently. Forty-nine patients were evaluated during four PDSA cycles. Improvement of ≥40% above baseline regarding recommended therapy administration was achieved across four PDSA cycles. Adherence to recommended therapy choice improved from 57% (baseline) to 100%, minimal laboratory evaluation from 14% to 83%, hematology consultation from 36% to 100%, and appropriate disposition from 71% to 100%. ED length of stay remained stable. Implementation of a standardized algorithm for management of IDA secondary to HMB in adolescents in the ED increased adherence to evidence-based patient care.

Ювенільна фіброаденома: сучасні тенденції діагностування та лікування множинних і рецидивних форм патології (аналітичний огляд літератури та власне спостереження)

Neoplastic lesions of the mammary gland in children are mostly benign in nature, which is associated with the normal development of the mammary gland. Malignant neoplasms in childhood are very rare. The specific gravity of breast cancer in teenagers is no more than 0.1 % of all breast cancer cases and less than 1% of all cancer cases among children. The malignant potential of breast fibroadenoma is quite low and ranges from 0.125% to 0.02%. The aim is to highlight modern approaches diagnosis and treatment of juvenile fibroadenoma according to literature sources and own experience. The conducted analysis of the state of modern scientific research regarding the problem of fibroadenoma in general and especially their juvenile forms, taking into account a certain own experience in the treatment of this pathology, prompts, in our opinion, the expediency of considering the recurrent course of the disease in pediatric practice from the angle of possible "continued growth" in relation to the pathological condition in general. The phenomenon of "continued growth" should be specifically discussed only in those cases, in the process of primary removal of juvenile fibroadenomas in one and/or contralateral mammary gland, during clinical and instrumental examination, there are no signs of any additional neoplasms. Juvenile fibroadenoma in pediatric treatment remains an actual problem that requires further fundamental and multifaceted study and wider coverage among specialists of various specialties – pediatric surgeons, pediatric gynecologists, mammologists, pediatricians, family doctors. In the modern medical literature, studies regarding the recurrent course of juvenile fibroadenoma are insufficiently covered, which hinders the development of a modern strategy for the treatment of this pathological condition, including the determination of predictors of the disease and its stages, indications for surgical intervention. In the case of recurrent course of juvenile fibroadenoma, regardless of the size of the tumor, it is necessary to enucleate the tumor with its mandatory morphological verification. The authors declare no conflict of interest.

Кадрове забезпечення медичної допомоги дітям в Україні в умовах війни та пандемії COVID-19

Most countries around the world report risks to children's health care due to a growing shortage of paediatricians. Аim - to analyse the staffing of paediatric health care in Ukraine in the context of the ongoing war and the COVID-19 pandemic. Materials and methods. The methods used were a systematic approach and comparative analysis of data from the state institution "Centre for Public Health of the Ministry of Health of Ukraine" for 2020-2023. Results. During the years of the pandemic and full-scale aggression of the Russian Federation, the number of paediatricians in Ukraine decreased by 1006 people, which led to a corresponding decrease in the paediatric care coverage rate by 12.5% to 1.19 per 1000 children, which may affect the quality and accessibility of medical care for children, especially newborns. The largest staff losses during the pandemic and war have been in paediatric pathology, pulmonology, phthisiology, infectious diseases, immunology, dentistry, dermatology, neurology, gynaecology, gastroenterology and neonatology, which has already led to problems in the availability of specialised paediatric care for children and newborns, especially in the frontline and de-occupied areas. In such difficult conditions, pediatric doctors and the system of providing medical care to Ukrainian children in general have proven their viability and are still able to withstand the double pressure of war and the COVID-19 pandemic, preventing a significant increase in child morbidity and infant mortality. Conclusions. In order to eliminate the shortage of personnel, it is urgent to increase the number of doctors trained at higher medical educational institutions in specialty 228 «Paediatrics» to 1,000 per year, to adjust the state order and admission conditions accordingly, and to introduce paediatric residencies in the most popular specialties. No conflict of interests was declared by the authors.

Reasons for consultation in gynecological and obstetrical emergencies among adolescents in Tunisia.

The main objective is to study gynecological and obstetrical emergencies among adolescents admitted to the emergency room in our department. At the Farhat Hached University Hospital in Sousse's Obstetrics and Gynecology Department, we carried out a retrospective study. Sociodemographic andclinical characteristics of adolescents who consulted over a period of 12 months were described. We recorded 78 emergencies during the study period, representing a frequency of 0.39 %. Gynecological and obstetrical emergencies in adolescents are dominated by abdominal-pelvic pain (36 %), followed by pregnancy diagnoses (16.7 %), and dysmenorrhea in 10 % of cases. Admission decisions were made in only 6.4 % of cases. Advances in adolescent gynecology highlight the importance of specialized care for this population, crucial for preventive healthcare. Evaluation and management rely on recognizing clinical challenges and understanding specific issues.

Analyzing RBC Transfusion Practices Using Quality Indicators: A Retrospective Transfusion Audit.

Objectives Overordering of blood products, particularly packed red blood cells (PRBC), leads to inefficiencies and financial burdens within healthcare systems. The objective of this audit was to assess PRBC utilization practices against established quality indicators to enhance efficiency and reduce wastage in a newly established tertiary care hospital in Northern India. Materials and methods A retrospective audit was conducted in the department of transfusion medicine. Data were collected from departmental records and analyzed using various quality indicators, such as crossmatch to transfusion ratio (CTR), transfusion probability (%T), transfusion index (TI), and utilization rate (UR). Microsoft Excel was utilized for statistical calculations including range, percentage, ratio, and quality indicators. Results A total of 1,488 PRBC requisitions were received, 997 (67%) originated from various surgical specialties. The overall CTR was 1.88, with medical and surgical specialties having CTRs of 1.3 and 2.6, respectively. Overall %T was 53.8%, which in medical departments was 85% and in surgical departments was 38.5%. TI was 0.68 overall, which varied among medical (1.1) and surgical (0.48) specialties. The overall UR was 53.14%. Peri-operative blood loss (48%) and anemia (46%) were the primary indications for transfusions. Cardiothoracic and vascular surgery (CTVS), General surgery, and orthopaedics exhibited appropriate blood utilization practices, whereas ear nose and throat (ENT), pediatric surgery, urology, neurosurgery, and obstetrics and gynecology (OBGY) showed tendencies toward overordering and underutilization. Conclusion This audit highlights significant issues related to blood utilization practices, particularly overordering and underutilization in certain surgical specialties within the studied institution. While these findings underscore the potential benefits of implementing audit-driven policies to enhance efficiency and reduce wastage, the results are specific to this institution and may not be universally applicable. Further studies across multiple institutions are recommended to validate these findings and develop broader guidelines for optimizing blood utilization in healthcare systems.

Ovarian hemostasis and ovarian reserve: the perspective of a pediatric gynecologist

Ovarian hemostasis and ovarian reserve: the perspective of a pediatric gynecologist