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ABSTRACT: To examine our experience with intrauterine device (IUD) use in adolescents and young women.
Retrospective descriptive study evaluating outcomes after IUD insertion for patients 21 years or less over an 8-year period.
Three sites including a Pediatric and Adolescent gynecology private practice, a Title X clinic, and community based, grant funded clinic serving a high risk teen population.
Females from menarche to age 21.
The probability of IUD retention, differences in IUD retention probabilities between two age groups, and risk factors for IUD removal, expulsion, and infection were evaluated.
233 records showed 50% of the <18-year-old age group and 71.5% of the 18-21-year-old group had their IUD in place at 5 years. Age was found to be a significant factor for removal (P < 0.001), with under 18-year-olds at greater risk of removal/expulsion (hazard ratio (HR) = 2.85). Parity (RR = 5.6 for nulliparous vs multiparous patients, P < 0.001) and prior STI (RR = 5.5, P < 0.001) were significant risk factors for infection. Nulliparous patients were at higher risk of expulsion (P = 0.045), though age was not a statistically significant risk factor.
The rate of continuation was lower in adolescents under 18 compared to 18-21-year-olds, but was still higher than for other hormonal contraceptives. Despite this groups' high risk for STI the IUD did not increase the risk of infection and may offer some degree of protection. IUDs appear to be a safe option in young adolescents (<18 years old) and nulliparous women.
Journal of pediatric and adolescent gynecology 06/2012; 25(3):195-200. · 0.90 Impact Factor
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ABSTRACT: Women bleed with menses, during childbirth, and after childbirth. Women are more likely to manifest a bleeding disorder as they have more opportunities to experience bleeding challenges in their lifetime. Bleeding disorders such as hemophilia and von Willebrand disease affect 2.5-3 million American women. The most common inherited bleeding disorder in the population is von Willebrand disease with an estimated prevalence of 1-2%. von Willebrand factor (vWF) is required to adhere platelets to exposed subendothelium and protects factor VIII from proteolysis in the circulation. The prevalence of vWF rises in studies involving women with menorrhagia, with estimates ranging as high as 10-20% in white women, and 1-2% among African American women. Other bleeding disorders seen in adolescents with menorrhagia are disorders of inherited platelet dysfunction, clotting factor deficiencies, thrombocytopenia, and disorders of the fibrinolytic pathway. Not only are women more likely to present early in their life with a bleeding disorder, they are also more likely to have other gynecologic manifestations as a result of these disorders. This article presents an overview of the problem and touches upon the different management strategies available.
Journal of pediatric and adolescent gynecology 10/2010; 23(6 Suppl):S15-21. · 0.90 Impact Factor
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S Paige Hertweck
Obstetrics and Gynecology Clinics of North America 04/2009; 36(1):xv-xvi. · 1.70 Impact Factor
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Christine C Johnson,
Ronald T Burkman,
Melanie A Gold,
Robert T Brown,
Zeev Harel,
Ann Bruner,
Margaret Stager,
Laura K Bachrach, S Paige Hertweck,
Anita L Nelson,
Dorothy A Nelson,
Susan M Coupey,
Alison McLeod,
Henry G Bone
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ABSTRACT: This analysis was conducted to assess the baseline data and design methodology within an observational longitudinal comparison of use vs. nonuse of the injectable (intramuscular) contraceptive depot medroxyprogesterone acetate (DMPA-IM) and its effect on bone mass in adolescent women.
A prospective, observational, open-label, unmatched-cohort, safety study in females aged 11-18 years. Participants either self-selected DMPA-IM (Depo-Provera) 150 mg to be administered every 12 weeks for up to 240 weeks with a 120-week post-treatment follow-up or were nonusers (users of nonhormonal contraception or sexually abstinent) who were to be followed up for up to 360 weeks. As each participant entered the study, bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine, hip and femoral neck regions, along with total body bone mineral content; serum and urine specimens were obtained for assay of bone metabolism markers and participants' histories of parity and tobacco and alcohol use were obtained.
A total of 389 participants were enrolled: 169 elected to begin DMPA-IM; 26 chose nonhormonal methods and 194 were abstinent. The baseline characteristics indicated significant disparities between DMPA-IM users and nonusers: compared with the nonusers, DMPA-IM users had more advanced chronologic and gynecologic ages, were more likely to have smoked, been pregnant and included more blacks. These factors would likely influence bone accretion rates independent of DMPA-IM exposure. Comparison of participant BMDs with standard reference data revealed that the study cohorts did not match reference populations closely enough to make a direct between-cohort comparative analysis feasible.
The baseline differences in cohort characteristics preclude a meaningful comparison of mean BMD changes over time between DMPA-IM users and nonusers cohorts, and comparisons of changes in Z-scores between cohorts were also not appropriate. Therefore, within-participant BMD decreases from baseline were established as safety thresholds, and the proportion of individuals crossing those thresholds on a persistent or progressive basis was identified as the revised primary end point.
Contraception 05/2008; 77(4):239-48. · 2.72 Impact Factor
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ABSTRACT: To report a modification of the laparoscopic Davydov method for creation of a neovagina.
Case study.
University gynecology practice.
Female with vaginal agenesis.
Laparoscopically assisted creation of a neovagina using a modified technique to improve both structural and functional capacity.
Patient morbidity and satisfaction.
The patient satisfactorily underwent creation of a neovagina using the laparoscopic modification of the Davydov technique via the Louisville method.
This laparoscopic modification allows for structural maintenance and functional capacity without increasing postoperative morbidity.
Fertility and sterility 12/2007; 88(5):1431-4. · 3.97 Impact Factor
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ABSTRACT: This retrospective study sought to examine the importance of family history of cardiovascular disease (CVD) or venous thromboembolism (VTE) in predicting risk for an inherited thrombophilia.
A cohort of 88 adolescent females who had a thrombophilia panel in the last three years was identified for this retrospective chart review. Family history data of CVD or VTE were collected in addition to laboratory results from the thrombophilia screen.
Adolescent patients who had a thrombophilia screen within the last three years at University OB-GYN Associates, Louisville, KY.
Within the cohort (n=88), 21% of patients were found to have a documented thrombophilia. At least 47% of individuals diagnosed with thrombophilia had more than one screening abnormality. A family history of VTE was noted to have a positive predictive value (PPV) of 40% and a negative predictive value (NPV) of 88% for detection of thrombophilia. Patients with a family history of CVD alone carried a PPV of 24% and NPV of 100%. Finally, among individuals with both family history risk factors, PPV was strengthened at 52% while NPV remained unchanged.
Within the last decade, inherited thrombophilias have gained more clinical interest. While thrombophilia disease prevalence data is available for the adult population, there remains a paucity of data in adolescents. Our results reinforce the importance for screening adolescent females, prior to contraceptive administration, if family history risk factors exist.
Journal of Pediatric and Adolescent Gynecology 09/2007; 20(4):221-4. · 1.54 Impact Factor
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ABSTRACT: Amenorrhea resulting from crushing trauma of the pelvis is exceptionally rare. The purpose of this case report is to describe the diagnosis of and successful surgical correction of traumatic separation of the cervix from the uterine corpus.
A nulligravida presented with a complaint of secondary amenorrhea after a motor vehicle accident in which she sustained a crush-type injury to the pelvis. Ultrasonography and laparotomy revealed a complete separation of the uterine corpus from the cervix. The uterine corpus was approximated to the cervix with circumferentially placed sutures to establish a patent outflow tract from the endometrial cavity to the cervical canal.
This case demonstrates the successful surgical correction of secondary amenorrhea resulting from traumatic separation of the uterine corpus from the cervix. Normal menstruation resumed 6 weeks after surgery.
Obstetrics and Gynecology 09/2007; 110(2 Pt 2):528-30. · 4.73 Impact Factor
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ABSTRACT: Undescended ovaries are frequently seen in conjunction with uterine malformations and are typically found during the course of an infertility evaluation. Other important clinical signs may prompt evaluation in an adolescent patient, though this may also be an incidental finding. An understanding of embryologic features is critical for management. It is additionally important to explain to patients and families that this is a normal developmental variant of the ovary that does not require removal in the absence of concerning pathology.
Journal of Pediatric and Adolescent Gynecology 05/2007; 20(2):57-60. · 1.54 Impact Factor
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Obstetrics and Gynecology 03/2006; 107(4):51S. · 4.73 Impact Factor
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Journal of Pediatric and Adolescent Gynecology 01/2006; 18(6):435-7. · 1.54 Impact Factor
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Journal of Pediatric and Adolescent Gynecology 07/2005; 18(3):175-7. · 1.54 Impact Factor
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ABSTRACT: Periclitoral abscesses in premenarchal girls is a serious condition and can have negative implications for future reproductive health. Recurrent periclitoral abscess in premenarchal girls is rare.
An 11-year-old, premenarchal girl presented complaining of dysuria, vulvar swelling, pain and erythema of the clitoral hood and a similar episode 12 months previously. Intravenous antibiotics and local measures resulted in spontaneous drainage of the abscess. On day 3 the area was healing, and the patient was discharged on oral antibiotics and sitz baths. At her 6-month follow-up, she had a normal clitoral hood without tenderness or erythema.
Broad-spectrum antibiotics and local measures may prevent surgical treatment and potential associated reproductive morbidity.
The Journal of reproductive medicine 01/2005; 49(12):983-5. · 0.87 Impact Factor
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ABSTRACT: To examine bone mineral density (BMD) on a semi-annual basis among control subjects and adolescent females receiving depot medroxyprogesterone acetate (DMPA) injection or oral contraceptives.
Non-randomized prospective study.
Teenage pregnancy prevention intervention clinic.
Adolescent females who were new users of DMPA injection (N=58, age 12-21) or the oral contraceptive pill (N=71, age 11-19) and normal menstruating girls (N=19, age 15-18).
Baseline and 6-monthly measures of lumbar vertebral BMD using dual-energy X-ray absorptiometry over a 2-year period.
comparison of percent change on BMD over time between DMPA users, pill users, and normal menstruating girls.
There was no difference on group characteristics at baseline except for the ethnicity between the controls and the DMPA group. There was a statistically significant decrease in BMD between DMPA users and controls at 6 months (-3.02% change, P=0.014) 12 months (-3.38% change, P=0.001) 18 months (-4.81% change, P<0.001) and 24 months (-6.81% change, P=0.010). There was no statistical difference between pill users and controls.
There is a relationship between DMPA use and a decrease in BMD compared to normal menstruating controls that seems to persist up to 24 months.
Journal of Pediatric and Adolescent Gynecology 02/2004; 17(1):17-21. · 1.54 Impact Factor
