ABSTRACT. Many clinicians expect that a history of penile-vaginal penetration will be associated with examination findings of penetrating trauma. A retrospective case review of 36 pregnant adolescent girls who presented for sexual abuse evaluations was performed to determine the presence or absence of genital findings that indicate penetrating trauma. Historical information and photograph documentation were reviewed. Only 2 of the 36 subjects had definitive findings of penetration. This study may be helpful in assisting clinicians and juries to understand that vaginal penetration generally does not result in observable evidence of healed injury to perihymenal tissues. Pediatrics 2004;113:e67-e69. URL: http://www.pediatrics.org/cgi/content/full/113/1/e67; child sexual abuse, genital anatomy, pregnancy, adolescent.A review of the medical literature over the past 15 years regarding genital findings in female children and adolescents evaluated for sexual abuse reveals a number of trends: identification and recognition of congenital anatomic variants has increased 1-3 ; identification and recognition of acute and healed findings of penetrating trauma to the hymen and vagina has decreased 4 ; and the emphasis on recoverable evidence in cases of child sexual abuse has waned. 5,6 For example, in an earlier study of sexually active adolescents, 74% had complete clefts in the posterior half of the hymen, a finding attributed to penile-vaginal penetration. 7 However, a more recent study of 2384 children and adolescents receiving medical examinations for sexual abuse indicated that 96% of the subjects had normal or nonspecific examination findings. 4 Similarly, findings that formerly were attributed to penetrating trauma (eg, partial clefts in the posterior half of the hymen) have now been documented in girls selected and screened for nonabuse. 8 These recent research findings have created questions and controversies not only concerning the interpretation of medical findings but also the potential for misperceptions to occur when presenting a case of child sexual abuse in court. Individuals without medical knowledge and physicians without expertise expect physical evidence to support a history of penile-vaginal penetration and believe that a doctor can determine from a vaginal examination whether a woman-or a child-is a virgin. 9 Although some researchers have suggested that "It's normal to be normal," 10 normal or nonspecific findings on examination can be misinterpreted as meaning "nothing happened." METHODSThe purpose of this study was to summarize the medical history and genital examination findings in 36 adolescents who were pregnant at the time of, or shortly before, their sexual abuse examination. The medical history and photocolposcopic slides were reviewed; patient age, history of consensual sexual contact, gestational age of the fetus, and written documentation of the examination findings were analyzed. All the authors reviewed all the images jointly and were blinded to medical history other than pregnancy status;...

BackgroundGestational diabetes is a risk factor for future development of type 2 diabetes. The primary aim of this study was to estimate the prevalence of postpartum glucose tolerance status evaluation in pregnancies complicated by gestational diabetes 6–12 weeks after delivery. The secondary one was to identify the factors that are implicated with postpartum glucose retesting.MethodsThis was a retrospective study performed with a cohort of women with gestational diabetes, with prenatal care and delivery at a tertiary care center, from January 2013 to April 2017. The diagnosis of gestational diabetes was based on IADPSG criteria (Fasting ≥ 92 mg/dl, 1 h ≥ 180 mg/dl and/or 2 h ≥ 153 mg/dl, respectively) and the diagnosis of type 2 diabetes and prediabetes were made using the 2016 ADA’s criteria (fasting and 2 h after glucose load ≥ 126 mg/dl and/or ≥ 200 and 100–125 mg/dl and/or 140 and 199 mg/dl, respectively). All women had an appointment scheduled 6–12 weeks postpartum with the results of a 75-g oral glucose tolerance test (OGTT).ResultsOf the 152 evaluated women, 21 (13.8%) returned with the postpartum OGTT results. Of these, 9 (45.0%) had a diagnosis of prediabetes. The use of insulin during gestation was the only factor implicated in a higher adherence rate to postpartum testing OR 6.33 (p 0.002). No significance was found for other demographic and clinical variables (age, family income, years of study, parity, gestational age at first visit, smoking, family history of type 2 diabetes, diagnosis of gestational diabetes before the third trimester, pregestational body mass index, previous history of gestational diabetes and ethnicity).ConclusionThe majority of patients with gestational diabetes did not return postpartum to perform OGTT and in our study the only factor implicated in a higher postpartum return was the use of insulin during pregnancy. Considering that 45.0% were diagnosed with prediabetes, diabetes care teams should initially identify non-adherent patients.

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