Adolescent Gynecology Research Articles

#393 : Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA) — A Series of 6 Cases at a Tertiary Referral Centre

Background and Aims: OHVIRA is a rare congenital urogenital anomaly. Diagnosis is often delayed because patients have normal onset of puberty and menstruation if there is partial obstruction with a communicating fenestration in the hemivagina. Symptoms can be non-specific such as abdominal pain and dysmenorrhoea, but urinary retention and a pelvic mass have been reported. Haematocolpos can cause anatomical distortion, making imaging difficult. Definitive management is by vaginoplasty but that can be complex, especially in an anatomically small child, or cases with chronic inflammation. Retrograde bleeding during obstruction is common, leading to endometriosis and ascending infection. This is associated with complex surgery, increased morbidity and subfertility, which is why early diagnosis and timely management are important. Method: Medical records were retrieved from 6 patients with OHVIRA treated between 1 April 2021 and 31 March 2023 at a tertiary referral centre. For each patient, age of diagnosis, referral source, symptoms, diagnostic investigations, diagnostic challenges, anatomical findings, surgical managements, complications and outcomes were reviewed. Results: Patient’s ages ranged from 10 to 33 years. Median age of diagnosis was 30. Cases were referred from paediatric surgery (n=1), gynaecology (n=2), general surgery (n=2) and urology (n=1). Symptoms included abdominal pain (n=4), pyrexia (n=2), intra-menstrual bleeding (n=2) and vaginal discharge (n=1). 3 patients had been misdiagnosed before referral. All had unilateral haematocolpos and underwent ultrasound (n=6) and either MRI (n=4) or CT (n=2), followed by vaginoplasty. 2 patients had emergency surgery for pelvic abscesses. There were no intra- or post-operative complications, or adverse outcomes. Conclusion: Median age at diagnosis was advanced, and symptoms and referral source were variable. Misdiagnosis was frequent. Surgical management was successful with a single stage vaginoplasty. Ascending infection can be a consequence of delayed diagnosis and management. It is important to evaluate any female with dysplastic or absent kidneys for uterovaginal abnormalities.

Clinical and etiological characteristics of infectious vulvovaginitis in children in Zhejiang province from 2009 to 2019

Objective: To explore the clinical characteristics, common pathogens in children with vulvovaginitis. Methods: This was a retrospective cases study. A total of 3 268 children with vulvovaginitis were enrolled, who visited the Department of Pediatric and Adolescent Gynecology, Children's Hospital, Zhejiang University School of Medicine from January 2009 to December 2019. Patients were divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Patients were also divided in to 4 groups according to the season of first visit. The pathogen distribution characteristics of infective vulvovaginitis were compared between the groups. Their clinical data were collected and then analyzed by χ2 test. Results: The were 3 268 girls aged (6.2±2.5) years. There were 1 728 cases (52.9%) aged <7 years, 875 cases (26.8%) aged 7-<10 years, and 665 cases (20.3%) aged 10-18 years. Of these cases, 2 253 cases (68.9%) were bacterial vulvovaginitis, 715 cases (21.9%) were fungal vulvovaginitis and 300 cases (9.2%) were vulvovaginitis infected with other pathogens. Bacterial culture of vaginal secretions was performed in 2 287 cases, and 2 287 strains (70.0%) of pathogens were detected, of which the top 5 pathogens were Streptococcus pyogenes (745 strains, 32.6%), Haemophilus influenzae (717 strains, 31.4%), Escherichia coli (292 strains, 12.8%), Staphylococcus aureus (222 strains, 9.7%) and Klebsiella pneumoniae (67 strains, 2.9%). Regarding different age groups, H.influenzae was the most common in children under 7 years of age (40.3%, 509/1 263), S.pyogenes (41.9%, 356/849) was predominantly in children aged 7 to 10 years, and E.coli was predominant in children aged 10 to 18 years (26.3%, 46/175). Susceptibility results showed that S.pyogenes was susceptible to penicillin G (610/610, 100.0%), ceftriaxone (525/525, 100.0%), and vancomycin (610/610, 100.0%); the resistance rates to erythromycin and clindamycin were 91.9% (501/545)and 90.7% (495/546), respectively. For H.influenzae, 32.5% (161/496) produced β-elactamase, and all strains were sensitive to meropenem (489/489, 100.0%) and levofloxacin (388/388, 100.0%), while 40.5% (202/499) were resistant to ampicillin. Among E.coli, all strains were sensitive to imipenem(100%, 175/175). The resistance rates of E.coli to levofloxacin and ceftriaxone were 29.1% (43/148) and 35.1% (59/168), respectively. A total of 48 strains of methicillin-resistant Staphylococcus aureus (MRSA) were isolated with a proportion of 28.3% (45/159) in 3 268 patients. The results of drug susceptibility test showed that all MRSA strains were sensitive to linezolid 100.0% (40/40), vancomycin (45/45, 100.0%), and tigecycline (36/36, 100.0%); the resistance rates of MRSA to penicillin G, erythromycin and clindamycin were 100% (45/45), 95.6% (43/45) and 88.9% (40/45), respectively. All methicillin-sensitive Staphylococcus aureus (MSSA) strains were sensitive to oxacillin (114/114, 100.0%), linezolid (94/94, 100.0%), vancomycin (114/114, 100.0%), and tigecycline (84/84, 100.0%); it's resistance rates to penicillin G, erythromycin and clindamycin were 78.1% (89/114), 59.7% (68/114) and 46.5% (53/114), respectively. The drug resistance rate of MSSA to penicillin G, erythromycin and clindamycin were lower than those of MRSA (χ²=11.71,19.74,23.95, respectively, all P<0.001). Conclusions: The age of consultation for pediatric infectious vulvovaginitis is mainly around 6 years. The most common pathogens are S.pyogenes, H.influenzae and Escherichia coli. Third generation cephalosporins can be used as the first choice of empirical anti-infection drugs. However, the results of drug susceptibility should be considered for targeted treatment.

Patient attendance in virtual paediatric and adolescent gynaecology clinics since the COVID-19 pandemic

Patient attendance in virtual paediatric and adolescent gynaecology clinics since the COVID-19 pandemic

Laparoscopic salvage procedures for adnexal torsion in pediatric and adolescent patients during the COVID-19 pandemic: a retrospective cohort study

BackgroundEarly management for adnexal torsion increases likelihood of ovarian/tubal salvage. The Coronavirus disease of 2019 (COVID-19) pandemic poses delays from symptom-onset to intervention. The primary objective was to evaluate rates of ovarian salvage and tubal salvage following ovarian torsion and adnexal torsion during the COVID-19 pandemic in a pediatric and adolescent gynecology population.MethodsThis was a retrospective quality improvement cohort study of pediatric and adolescent gynecology patients at a single children’s hospital who underwent laparoscopy for suspected ovarian torsion/adnexal torsion between March 2020 to March 2021. Descriptive statistics and t-tests were utilized.ResultsThere were 50 suspected adnexal cases in 47 patients. All underwent laparoscopy, revealing 39 adnexal torsion occurrences in 36 patients and 1 patient with recurrent adnexal torsion three times. All underwent pre-operative COVID-19 testing. Mean age was 13.9 ± 2.6 years for adnexal torsion cohort. Menarche was achieved in 88% (n = 44) and 12% (n = 6) were pre-menarchal. The primary outcome was ovarian salvage and tubal salvage rates, which were 97.4% (n = 38) and 89.7% (n = 35), respectively. Secondary outcomes assessed factors contributing to the primary outcome or operative delays. The mean age of menarche was 11.2 years (salvaged) and 12.5 years (non-salvaged) (p = 0.04). There were no differences in mean pain duration or mean COVID-19 testing time between groups. Left, right and bilateral adnexal torsion occurred in 42% (n = 21), 32% (n = 16), and 4% (n = 2) respectively. The most common pathologies were paratubal cyst (n = 17, 34%) and benign ovarian cyst (n = 16, 32%).ConclusionsOvarian salvage and tubal salvage rates were 97.4% and 89.7%, respectively during the time frame studied. These salvage rates during the study period are comparable to previous rates in a pre-COVID cohort at our institution. Institutional and departmental quality and safety initiatives likely contributed to this outcome.

Psychological Symptoms and Service Utilization in Prepubertal and Pubertal Transgender and Gender-Diverse Patients

To describe the demographic characteristics and psychological symptoms of gender-diverse patients and to compare symptoms between prepubertal and pubertal subgroups METHODS: This was a retrospective chart review of all gender-diverse patients seen by at least 1 provider at the Nemours Gender Wellness Program from March 2015 to December 2020. The extracted data included demographic and psychosocial characteristics at baseline and 1-year follow-up visits. Pubertal status was determined by Tanner staging by a pediatric endocrinologist or gynecologist. Descriptive statistics were used to compare these variables between prepubertal and pubertal subgroups. Our sample included 177 individuals at baseline and 96 subjects at the 1-year follow-up visit. Most patients were White (83.0%), non-Hispanic (92.0%), transgender male (72.9%), and pubertal (90.4%). Compared with prepubertal patients, at the baseline visit, pubertal patients had significantly higher rates of current (68.1% vs 17.6%, P < .001) and lifetime (80.0% vs 23.5%, P < .001) depressive symptoms, current anxiety symptoms (70.0% vs 41.2%, P=.01), lifetime suicide attempts (12.5% vs 0%, P < .001), and a formal diagnosis of an eating disorder (5.0% vs 0%, P < .001). Symptoms did not change significantly over time from baseline to the 1-year follow-up visit. We found elevated rates of psychological symptoms and diagnoses in gender-diverse youth, with higher rates in pubertal compared with prepubertal patients. By elucidating how the psychosocial characteristics of gender-diverse children and adolescents differ based on pubertal status, these data can be used to improve current outreach and treatment strategies for transgender pediatric patients.

Sex selection drug and congenital malformations in North India

Background: An increasing incidence of congenital malformations (CMF) has been reported in North India in cases use of traditional drug by Mothers to have male child. Aim was to ascertain the association of Sex selection drug (SSD) and congenital malformations. Methods: This hospital-based age-sex matched pair case control study was done at Advanced Pediatric Centre, Obstretics and Gynaecology department (ANC clinic, Maternity ward, labor room etc.) and Special Clinics, PGIMER, Chandigarh, India in 2019. The mothers were interviewed to collect information about risk factors. Results: Two hundred three CMF (under five children and gestational CMF) cases and same number of controls were studied. Significant association of CMF was observed with the use of sex selection drugs by mothers (OR= 4.35). Conclusions: The use of sex selection drugs is an avoidable risk factor of CMF and is of high public health importance. People need to be educated about this.

Initial von Willebrand factor antigen values in adolescent females predict future values.

Diagnosing von Willebrand Disease (VWD) in adolescent females is challenging as menstruation and physiologic stress elevate von Willebrand factor (VWF) laboratory values. To develop a VWF prediction model for adolescent females based on initial VWF results. We identified female patients aged 9 to 21 years with any VWF laboratory test over a 5-year period (2017-2021) at any Texas Children's Hospital facility. Patient demographics, VWF testing, haemoglobin concentration, serum ferritin and site of clinical testing were collected (initial and subsequent laboratory evaluations). A Bayesian linear regression model was developed. Prediction intervals were analysed to identify thresholds for patients in whom repeat testing was unlikely to identify low VWF levels (<50%), consistent with VWD. A total of 6125 adolescent females underwent VWF testing; 1204 (19.7%) had repeat testing. Based on the prediction model, initial VWF antigen values of 80%, 90% and ≥100% carried a 92.6%, 96.6% and ≥98.0% probability of having repeat normal repeat VWF values, respectively.Subjects assessed in outpatient adolescent medicine or gynaecology clinics were more likely to have low VWF values compared to those assessed in the acute care setting (p<.001). Median presenting haemoglobin and serum ferritin were 12.4g/dL and 13ng/mL, respectively and were similar in those with normal versus low VWF antigen values. Repeat testing in adolescent females whose initial VWF antigen values are ≥90% is unlikely to identify additional patients with VWD. Iron deficiency screening should be performed in all adolescent females.

Clinical features of recurrent vulvovaginitis in prepubertal age girls with extragenital diseases

The purpose of the study is to investigate the clinical features of recurrent vulvovaginitis in prepubertal age girls with extragenital diseases. We examined 110 girls with recurrent vulvovaginitis, which were registered with the dispensary of pediatric gynecologist. We divided them into three groups depending on extragenital pathology: I group 38 patients with chronic urinary tract diseases; II 36 girls with allergic diseases; III 36 girls with gastrointestinal pathology, enterobiasis. Girls with chronic diseases of the urinary system complain of the pain and discomfort during urination, malaise in the genital area, discharge from the genital tract. Girls with allergic pathology complain of itching and burning in the genital area, restless behavior, dysuric phenomena. Girls with diseases of the gastrointestinal tract and enterobiasis complain of discomfort in the genital region, discharge from the genital tract because of constipation and bloating. The results of examination of the external genitalia, vulvoscopy also differed in girls. They depended on the acuty of the inflammatory process and predisposing factor. The clinical features of recurrent vulvovaginitis in prepubertal age girls with extragenital pathology were determined by the data of objective and instrumental examination of vulva.

Attitudes about the Provision of Sexual Health Services in an Inpatient Setting

To examine the relationship between clinicians' attitudes about the appropriateness of providing sexual health services in the inpatient setting and confidence in providing services METHODS: An online survey was emailed to pediatric hospitalists, adolescent medicine, and pediatric and adolescent gynecology societies and directors. Confidence in managing 8 sexual health situations was measured on a 4-point Likert scale, summed, averaged, and dichotomized into confident and not so confident. Participants were asked to rate on a 5-point Likert scale their belief that providing sexual health services in the inpatient setting would be appropriate. An adjusted, multivariate logistic regression identified associations between participant demographic characteristics, professional characteristics, and confidence and attitudes about the appropriateness of providing inpatient sexual health services. Among the 610 participants, the mean age was 40 years. Most were females (79%), non-Hispanic White (71%), and practiced pediatric hospital/general medicine (73%). Most (73%) were not so confident across all 8 confidence items. Overall, 61% "strongly agreed" that providing sexual health services in the inpatient setting was appropriate. Participants who reported younger age, being female, and confidence in providing services were significantly associated with strong agreement that it was appropriate to provide sexual health services in the inpatient setting. Those who identified as Christian non-Catholic were significantly less likely to report strong agreement. Most providers strongly agreed that providing sexual health services in the inpatient setting was appropriate, yet most were not so confident in managing sexual health situations. Future studies should focus on addressing concerns and barriers to providing sexual health services.

(062) Do Polish Adolescents Sexual Minorities have Poorer Sleep? - Analysis from POLKA 18 Pilot Study

Abstract Introduction Sleep duration might be affected by many mental states that are a result of discrimination, lack of social acceptance and stressful lifestyle. Sexual minorities in unfriendly environments are at risk of the aforementioned conditions and significantly affect their sleep therefore interfere with their circadian rhythm, health outcomes and quality of life. Objectives This study aims to estimate the association between duration of sleep among Polish adolescent sexual minorities groups. Methods The data on the level of sleep were retrieved from POLKA 18 study, funded by ESC, which is a youth-led cross-sectional analytical study of Polish adolescents. A paper-based self-reported questionnaire, building up on the interdisciplinary model of holistic approaches in adolescent gynaecology, has been used to collect data from schools in five Polish regions. The questionnaires were distributed in the schools during the time of April-June 2019 by local research associates, who are medical students. The obtained data has been analysed using STATA 16. Results We received 650 results and included 632 in our final analysis. We have asked our respondents a question on which sexual orientation they identify with and 2.6% of them declared being attracted to people from the same sex, 4.27% declared as bisexual, 0.8% asexual. Overall, 41.3% of the respondents reported sleeping less than 6 hours a night. It seems that there is a strong association between the length of sleep and sexual orientation with LGBA youth being less likely to reach recommended 7 hours of sleep a night. 41.2% who identified as gay/lesbians and 40.7% who identified as bisexual reported having less than 7 hours of sleep duration in comparison to 60.2% of their heterosexual counterparts. (p&amp;lt;0.001). Conclusions American National Sleep Foundation recommends 7-9 hours of sleep for young adults aged 18-25 (National Sleep Foundation, 2015) and our study reports that youth identified as sexual minorities are less likely to reach the recommended hours of sleep in comparison to their heterosexual peers. Although ourstudy focused solely on the duration of sleep, other studies reported a higher prevalence of many other sleep disturbances, such as insomnia that has strong correlation with stress levels and mental health problems (Galinsky et al., 2018; Fricke et al., 2017; Chen et al., 2017). Moreover, other reports from Korea and China show that those who had shorter sleep duration were more likely to have depressive symptoms and suicidal tendencies (Li et al., 2017; Lee et al., 2017). In multiple studies, sexual minorities have reported more prevalence of mental health problems. Therefore, appropriate sleeping hygiene should be accounted as one of the important factors and strategies to improve mental health among adolescents, especially those identified as part of sexual minorities. Disclosure No.

Caregiver goals and satisfaction for menstrual suppression in adolescent females with developmental disabilities: A prospective cohort study

BackgroundAdolescents with developmental disabilities and their caregivers often seek menstrual management. Caregivers frequently serve as medical decision-makers, and little is known about caregiver goals for menstrual management and satisfaction over time. ObjectiveAssess caregiver reasons for initiating menstrual management in adolescents with disabilities and satisfaction over 12 months. MethodsProspective cohort study of caregivers of adolescents with developmental disabilities seeking menstrual management at a pediatric and adolescent gynecology clinic. Data derive from caregiver surveys and adolescents' electronic medical records. ResultsNinety-two caregiver-adolescent pairs enrolled. The mean age of adolescents was 14.4 (±2.6). The most common method started was levonorgestrel intrauterine device (LNG-IUD; 52, 56.5%), followed by oral norethindrone acetate (21, 22.8%). Caregivers cited hygiene concerns (84.8%), behavioral problems (52.2%), and heavy/excessive bleeding (48.9%) as reasons for initiating menstrual suppression. Caregivers who identified hygiene or heavy/excessive bleeding as the most important reason for management were more likely to select LNG-IUD (p = 0.009). Caregivers who cited behavioral/mood or seizure concerns as the most important reason were more likely to choose other methods (p < 0.05). At 12 months, caregiver satisfaction with all methods was high (66.2–86.9 on a 100-point scale). For every additional day of bleeding, satisfaction decreased by 3.7 points (95% CI: 2.3–5.0). ConclusionsCaregiver satisfaction with all methods is high; however, it negatively correlates with days of bleeding. Caregiver reasons for menstrual suppression influence the method chosen. Management may reflect both patient and caregiver priorities; research is needed to better understand shared decision-making models that promote reproductive autonomy in adolescents with a developmental disability.

Opieka pielęgniarska w ginekologii wieku rozwojowego – konteksty etyczne

Also from the point of view of family medicine, the cooperation of a doctor and a nurse in the care of girls with gynecological problems is important. The important ethical context was also discussed here, also referring to the code of nursing ethics. In her work, the nurse cooperates with the doctor – it is important to know the indications for gynecological examination of the child. A preventive gynecological examination or medical advice in this specialty should be performed by a trained pediatric gynecologist assisted by a trained nurse. If necessary, the examination may be carried out by an experienced gynecologist on duty in the admission room of the hospital or a doctor of another specialty with due diligence both in terms of examination and medical documentation. Performing their professional functions in a conscious, competent and responsible manner, nurses make creative efforts to develop nursing professional ethics, in conjunction with the desire to define and explain the essence of nursing and extend independence and professional responsibility, which is also important in gynecological care of girls.

Re-discussion on importance and development of adolescent gynecology

Re-discussion on importance and development of adolescent gynecology

Reproductive Problems in Adolescent and Young Adult Gynecology Cancer Survivors: A Systematic Review

Reproductive Problems in Adolescent and Young Adult Gynecology Cancer Survivors: A Systematic Review

Standard Opioid Prescribing in Pediatric and Adolescent Gynecology [ID: 1381154

INTRODUCTION: Enhanced Recovery After Surgery principles reduce opioid use postoperatively. There are no recommendations for optimal opioid dose prescribing for postoperative pain. The aim of this quality improvement project was to assess postoperative opioid use after pediatric gynecologic surgeries and establish standard opioid prescriptions across all surgeons based on procedural type. METHODS: Counseling on postoperative care including pain management was provided preoperatively and postoperatively. At the 2-week postoperative visit, patients were asked the number of opioid doses used and their pain control satisfaction. Baseline data were collected for 6 months with surgeons prescribing opioid doses via personal preference. After reviewing the prescribing practices and number of doses used, standard opioid doses were established with 10 doses provided for laparotomy with incision greater than or equal to 5 cm, 5 doses for laparoscopy or mini-laparotomy with incision(s) 4 cm or less, 5 doses for combined laparoscopic/vaginal approach, and 0 doses for vaginal cases. Data collection was repeated after implementation of standard opioid dose prescriptions. RESULTS: Complete data were recorded for 30 cases prior to implementation and 29 cases after implementation. Standard opioid dosing resulted in 30% decrease in total opioid doses (252–176 doses; P=.014) and 15% reduction in unused doses (162–137 doses). Forty-three percent of patients used no opioid doses. There was no significant difference in patient satisfaction (P=.014) in pain control. CONCLUSION: Application of standard opioid dose prescribing is feasible for common pediatric gynecologic surgeries without affecting patient satisfaction. This quality improvement project suggests further reduction in standard dose prescriptions is possible.

Correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) measures with unplanned healthcare resources utilization (HRU) among patients with epilepsy (PWE): a retrospective cohort study (P6-1.001)

<h3>Objective:</h3> To evaluate whether PROMIS scores correlate with unplanned HRU among PWE. <h3>Background:</h3> Mental, physical, and social health determinants have a significant effect on quality of life with sparse data on their effect on unplanned HRU. <h3>Design/Methods:</h3> We utilized the PROMIS-16 questionnaire to assess patients’ mental, physical, and social health. Patients completed the questionnaire as part of routine medical care at outpatient neurology clinic visits. We performed a retrospective analysis of the PROMIS measures completed between June 2018, and August 2022. PROMIS data was combined with Health Plan claims data on utilization at 7, 30 and 90-day from the index clinic visit and analyzed using a logit model. A pathologic score in each of the 8 PROMIS measures (Anxiety&gt;62, Depression&gt;60, Fatigue &gt;65, Pain&gt;65, Sleep Disturbance&gt;65, Cognition&lt;35, Physical function&lt;35, Social scores&lt;35) was analyzed as an independent predictor of unplanned HRU in each of 4 domains (Mortality all causes, Hospitalization all causes, ED treat and release all causes and Urgent care all causes). <h3>Results:</h3> The cohort included 6485 unique PWE (13159 encounters; 53.1% females, 10.1% black, median age 46.4-years). The following statistically significant correlations emerged: 1) pathological Physical Function and Social Scores were associated with 90-day mortality; 2) pathological Fatigue, Pain, Sleep Disturbance, Physical Function, and Social Scores were associated with 7-day Hospitalization, 3) Pathological Anxiety, Depression, Fatigue, Pain, Physical Function, and Social Scores were associated with 7-day ED visits, 4) Pathological scores on each of the 8 measures correlated with 90-day Hospitalization (7 measures with a 30-day) and ED visits (5 measures with a 30-day), and 5) Pathological Fatigue scores correlated with 90-day urgent care utilization. <h3>Conclusions:</h3> PROMIS scores are associated with unplanned HRU at short index times from outpatient neurology clinic visits among PWE. This prognostic utility supports the routine collection of patient-reported health measures in clinical practice along with developing timely interventions. <b>Disclosure:</b> Dr. Urban has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. The institution of Dr. Kirkpatrick has received research support from American Academy of Neurology. The institution of Dr. Kirkpatrick has received research support from Academic Pediatric Association. The institution of Dr. Kirkpatrick has received research support from American Academy of Pediatrics. The institution of Dr. Kirkpatrick has received research support from Society of Family Planning. The institution of Dr. Kirkpatrick has received research support from North American Society for Pediatric and Adolescent Gynecology. Dr. Rajasekaran has a non-compensated relationship as a PI with UCB Drug study that is relevant to AAN interests or activities. Dr. Rajasekaran has a non-compensated relationship as a PI with Engrail Drug study that is relevant to AAN interests or activities. Dr. Fong has nothing to disclose. Dr. Hanmer has nothing to disclose. Dr. Bagic has nothing to disclose. The institution of Dr. Thirumala has received research support from University of Pittsburgh.

Pregnancy and Breastfeeding: A Survey of People with Epilepsy about their Experiences and Attitudes (P14-1.010)

Pregnancy and Breastfeeding: A Survey of People with Epilepsy about their Experiences and Attitudes (P14-1.010)

A Retrospective Textual Analysis of Sexual and Reproductive Health Counseling for Adolescent and Young Adult Women with Epilepsy (P3-9.011)

<h3>Objective:</h3> To analyze documentation of pediatric neurologists’ counseling regarding sexual and reproductive healthcare (SRH) for adolescent women with epilepsy (WWE) <h3>Background:</h3> The American Academy of Neurology (AAN) recommends annual SRH counseling for WWE beginning at menarche. Pediatric neurologists self-report discussing SRH concerns infrequently with adolescent WWE. Documentation of such counseling has not been defined. <h3>Design/Methods:</h3> We retrospectively studied outpatient pediatric neurology notes (n=3663) for WWE age 13–21 using natural language processing to investigate documentation of SRH counseling. Notes were segmented into 388,019 sentences and evaluated for references to SRH counseling regarding: menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in Watchful and utilized spaCy machine learning to identify additional counseling instances. We repeated this process iteratively until no new relevant sentences were identified. Two external reviewers assessed for validity (n=400 sentences, Cohen’s kappa for all categories &gt;0.88); we then removed sentences reviewers disagreed on (n=13) and calculated kappa values between the model and reviewers (&gt;0.98). We evaluated aggregated labeled texts for each patient per calendar year (n=2277 patient-years) with descriptive statistics and logistic regression (adjusting for race, age, and teratogen use). <h3>Results:</h3> Nearly half of patient-years had no mention of SRH counseling (49.1%). Among 971 WWE, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of teratogens (OR=1.26, p=0.020; OR=1.27, p=0.028). Documentation regarding contraception, folic acid, and sexual activity was associated with older patients (OR=1.28, p=0.000; OR=1.26, p=0.000; OR=1.26, p=0.004). Documentation of sexual activity was decreased among patients identifying as White (OR=0.40, p=0.012). <h3>Conclusions:</h3> Pediatric neurologists counsel WWE on SRH less frequently than recommended by the AAN based on chart documentation. <b>Disclosure:</b> Dr. Harrison has nothing to disclose. The institution of Dr. Kirkpatrick has received research support from American Academy of Neurology. The institution of Dr. Kirkpatrick has received research support from Academic Pediatric Association. The institution of Dr. Kirkpatrick has received research support from American Academy of Pediatrics. The institution of Dr. Kirkpatrick has received research support from Society of Family Planning. The institution of Dr. Kirkpatrick has received research support from North American Society for Pediatric and Adolescent Gynecology. Dr. Hochheiser has a non-compensated relationship as a Researcher with Veteran’s Administration that is relevant to AAN interests or activities. Dr. Sogawa has nothing to disclose. The institution of Traci Kazmerski has received research support from Cystic Fibrosis Foundation. Traci Kazmerski has received personal compensation in the range of $5,000-$9,999 for serving as a PEP Trainer with Cystic Fibrosis Foundation.

Hormone Replacement Therapy after Pubertal Induction in Adolescents and Young Adults with Turner Syndrome: A Survey Study

Introduction: Turner syndrome (TS) is associated with primary ovarian insufficiency (POI) and most adolescents and young adults (AYA) with TS require treatment with hormone replacement therapy (HRT). International consensus guidelines are unclear on the optimal formulation and dosing for HRT after pubertal induction. This study assessed current HRT practice patterns of endocrinologists and gynecologists in North America. Methods: Email listserv members of the North American Society for Pediatric and Adolescent Gynecology (NASPAG) and the Pediatric Endocrine Society (PES) were invited to complete a 19-question survey to assess HRT treatment preferences for the management of POI after completion of pubertal induction in AYA with TS. Descriptive analysis and multinomial logistic regression to predict factors associated with preferred HRT are presented. Results: 155 providers (79% pediatric endocrinology, 17% pediatric gynecology) completed the survey. Although 87% (135) reported confidence in prescribing HRT, only half (51%, 79) were aware of published guidelines. Factors significantly associated with preferred HRT included specialty (p = 0.032) and number of patients with TS seen every 3 months (p = 0.024). Gynecologists were 4 times less likely than endocrinologists to prefer hormonal contraceptives and 4 times more likely to favor transdermal estradiol dose of 100 μg/day as compared to lower doses. Conclusion: Although most endocrinologists and gynecologists report confidence in prescribing HRT to AYA with TS after pubertal induction, there are clear differences in provider preferences based on specialty and higher volume of patients with TS in their practice. Additional studies on comparative effectiveness of the HRT regimens and evidence-based guidelines are necessary for AYA with TS.

Management of Acute Genital Ulcers: A Survey of North American Pediatric and Adolescent Gynecology Care Providers

IntroductionAcute genital ulcers are painful ulcerations of the lower vagina and vulva, with limited data to guide management. We aimed to survey care providers to understand the workup and management of acute genital ulcers across North America. MethodsA cross-sectional survey was distributed to members of NASPAG. Data are presented descriptively, and management practices between care providers are compared using Fisher's exact test. ResultsResponses from 100 NASPAG members were included. Common diagnostic tests performed were herpes simplex virus PCR (82%), Epstein-Barr virus serology (56%), and cytomegalovirus serology (47%). Topical steroids were considered by 67% on the basis of the degree of accompanying inflammation. There was no difference in corticosteroid prescriptions according to the type or location of providers (P > .05). DiscussionCollaboration between pediatric and adolescent gynecology care providers is needed to prospectively evaluate the effectiveness of treatment modalities and develop evidence-based guidelines.