Careful history taking and targeted examination may lead to diagnosis in the case of prepubertal vaginal bleeding. However, in more difficult cases, practitioners should not hesitate to examine a patient in the operating room using general anesthesia to elicit the cause. Although sexual abuse and malignancy are always on the differential, most causes of bleeding are benign and easily treated.
BackgroundUterine rupture of an unscarred primigravid uterus is an exceedingly rare event. Cases of spontaneous rupture of an unscarred bicornuate uterus have been reported, but typically occur in the first or second trimester.CaseA 28-year-old primigravida at 37 weeks gestation with a known bicornuate uterus and no prior surgery underwent an emergent cesarean section after presenting with severe abdominal pain and signs of fetal compromise. She was found to have a uterine rupture with the fetus free in the abdomen accompanied by a large hemoperitoneum. Both mother and baby did well postoperatively.ConclusionBicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.
Background. Adolescents have an increased risk of preterm birth (PTB) and sexually transmitted infections (STIs). We examined the prevalence and impact of STIs (gonorrhea, chlamydia, and trichomonas) on PTB and chorioamnionitis in pregnant adolescents. Methods. This retrospective cohort study utilized the first pregnancy delivered at an urban hospital among patients≤19 years old over a 5-year period. Poisson regression with robust standard errors was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of the association between STIs and PTB (<37 weeks) and chorioamnionitis identified by clinical or placental pathology criteria. Results. 739 deliveries were included. 18.8% (n=139) of births were preterm. The overall prevalence of STIs during pregnancy was 16.5% (Chlamydia trachomatis: 13.1%, n=97; Trichomonas vaginalis: 3.7%, n=27; and Neisseria gonorrheae: 3.1%, n=23). Detection of C. trachomatis, T. vaginalis, or N. gonorrheae was not associated with increased PTB. While infection with N. gonorrheae and C. trachomatis did not increase the likelihood of any chorioamnionitis, infection with T. vaginalis significantly increased the likelihood of any chorioamnionitis diagnosis (aPR 2.19, 95% CI 1.26-3.83). Conclusion. In this adolescent population with a high rate of PTB, in whom most received appropriate STI treatment, we did not find an association between STI during pregnancy and an increased rate of PTB. However, an infection with T. vaginalis was associated with an increased likelihood of chorioamnionitis. Early detection of STIs may prevent adverse pregnancy outcomes. Continued vigilance in STI screening during pregnancy, including consideration of universal Trichomonas vaginalis screening, is merited in this high-risk population.
Context
Women with classic congenital adrenal hyperplasia (CAH) are exposed to elevated androgens in utero causing varying levels of 46,XX virilization. The majority undergo feminizing genitoplasty early in life, with potential impact on sexual function and health-related quality of life (HRQoL).
Objective
We aimed to determine how sexual and lower urinary tract function, body image and global HRQoL differs between patients with classic CAH and controls, and characterize how gynecologic anatomy contributes to outcomes.
Methods
36 women with classic CAH and 27 age-, race- and marital-status-matched controls underwent standardized gynecological examination and validated questionnaires. The responses were analyzed in relation to gynecological measurements, genotype and disease status.
Results
Compared to controls, women with CAH were more likely to have sexual dysfunction (P=0.009), dyspareunia (P=0.007) and other pelvic pain (P=0.007), were less likely to be heterosexual (P=0.013) or ever have been sexually active (P=0.003), had poorer body image independent of BMI (P&0.001) and had worse HRQoL in the areas of general health (P=0.03) and pain (P=0.009). Women with CAH had smaller vaginal calibers and perineal body lengths and larger clitoral indexes when compared to controls (P&0.001). A larger vaginal caliber in CAH women was associated with better overall sexual function (P=0.024), increased sexual satisfaction (P=0.017), less pain (P&0.001), and greater number of sexual partners (P=0.02).
Conclusions
Women with CAH have increased rates of sexual dysfunction, poor body image and poor HRQoL, which is mitigated in women with a larger vaginal caliber. Management aimed at optimizing vaginal caliber might improve sexual function.
Impairment of fertility and sexual/reproductive health are common after oncologic therapy, and are known to have negative impacts on romantic relationships and psychosocial well-being among childhood cancer survivors. The Pediatric Initiative Network (PIN) is an international, multidisciplinary group of providers within the Oncofertility Consortium dedicated to preserving and protecting the fertility of children and adolescents at risk for infertility due to medical conditions or treatments. The PIN and its Best Practices and Research committees meet virtually throughout the year, with one annual in-person meeting. The purpose of this ''proceedings'' is to highlight key discussion points from the annual PIN meeting which took place on November 11, 2019, to 1) provide a context for pediatric groups across the country on what oncofertility programs are currently doing and why, and 2) inform stakeholders of past, present and future initiatives that may be of value to them and the patient populations they serve.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.