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Nelson JM, Compton SD, Farahzad MM, Winfrey OK, Rosen MW. In reply re: The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche. J Pediatr Endocrinol Metab 2023; 36:1193-1194. [PMID: 37899545 DOI: 10.1515/jpem-2023-0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Jessie M Nelson
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah D Compton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mina M Farahzad
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Rager TL, Compton SD, Winfrey OK, Rosen MW. Norethindrone dosing for adequate menstrual suppression in adolescents. J Pediatr Endocrinol Metab 2023; 36:732-739. [PMID: 37279406 DOI: 10.1515/jpem-2023-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We sought to study factors predictive of achieving menstrual suppression with norethindrone vs. norethindrone acetate in adolescents, as optimal dosing is unknown. Secondary outcomes included analyzing prescriber practices and patient satisfaction. METHODS We performed a retrospective chart review of adolescents ages <18 years presenting to an academic medical center from 2010 to 2022. Data collected included demographics, menstrual history, and norethindrone and norethindrone acetate use. Follow-up was measured at one, three, and 12 months. Main outcome measures were starting norethindrone 0.35 mg, continuing norethindrone 0.35 mg, achieving menstrual suppression, and patient satisfaction. Analysis included Chi-square and multivariate logistic regression. RESULTS Of 262 adolescents initiating norethindrone or norethindrone acetate, 219 completed ≥1 follow-up. Providers less often started norethindrone 0.35 mg for patients with body mass index ≥25 kg/m2, prolonged bleeding, or younger age at menarche, but more often for patients who were younger, had migraines with aura, or were at risk of venous thromboembolism. Those with prolonged bleeding or older age at menarche were less likely to continue norethindrone 0.35 mg. Obesity, heavy menstrual bleeding, and younger age were negatively associated with achieving menstrual suppression. Patients with disabilities reported greater satisfaction. CONCLUSIONS While younger patients more often received norethindrone 0.35 mg vs. norethindrone acetate, they were less likely to achieve menstrual suppression. Patients with obesity or heavy menstrual bleeding may achieve suppression with higher doses of norethindrone acetate. These results reveal opportunities to improve norethindrone and norethindrone acetate prescribing practices for adolescent menstrual suppression.
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Affiliation(s)
| | - Sarah D Compton
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA
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Nelson JM, Compton SD, Farahzad MM, Winfrey OK, Rosen MW. The relationship between estrogen and subsequent growth restriction among adolescents with heavy menstrual bleeding at menarche. J Pediatr Endocrinol Metab 2023; 36:255-260. [PMID: 36727420 DOI: 10.1515/jpem-2022-0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We sought to evaluate the impact of estrogen-containing treatment for heavy menstrual bleeding (HMB) on subsequent height compared to progesterone-only or non-hormonal treatment when initiated at menarche. METHODS We performed a retrospective chart review of adolescent females aged 10-15 years who presented to an institution-affiliated outpatient, inpatient, or emergency setting for management of HMB within three months of menarche. Growth records over a 2 year period starting at menarche were recorded, and comparisons made among patients treated with 1) estrogen, 2) progesterone, and 3) non-hormonal methods (controls). Groups were compared using bivariate analysis with Chi-square or Fisher's exact test and linear regression. RESULTS In an analysis of 80 patients at 24 months, the mean increase in height from menarche was 6.4 cm among controls (n=54), 7.2 cm among the progesterone-only group (n=10), and 3.8 cm among the estrogen group (n=16). The estrogen group's increase in height was significantly lower than the control group's, by a mean of 1.8 cm (p=0.04). Change in height did not differ significantly between the progesterone and control groups (p=0.87). Additionally, for every year younger at menarche, there was 1 fewer cm of growth (change in height) at 24 months after menarche (p<0.002). CONCLUSIONS Estrogen-containing treatment for HMB initiated within three months of menarche was associated with reduced growth at 24 months compared to progesterone-only or non-hormonal methods. The clinical applicability of the estrogen group's 1.8 cm absolute reduction in height may have considerable significance for those who are shorter at baseline.
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Affiliation(s)
- Jessie M Nelson
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah D Compton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mina M Farahzad
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Hoxie JM, Compton SD, Farahzad MM, Winfrey OK, Rosen MW. THE RELATIONSHIP BETWEEN ESTROGEN AND SUBSEQUENT GROWTH RESTRICTION AMONG ADOLESCENTS WITH HEAVY MENSTRUAL BLEEDING. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fei YF, Smith YR, Wan J, Dendrinos ML, Winfrey OK, Quint EH. Should we screen for Müllerian anomalies following diagnosis of a congenital renal anomaly? J Pediatr Urol 2022; 18:676.e1-676.e7. [PMID: 35570178 DOI: 10.1016/j.jpurol.2022.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Despite the well-established embryological relationship in the development of renal and Müllerian structures, no clear guidelines exist regarding screening for Müllerian anomalies (MA) in the setting of a renal anomaly (RA). Delayed diagnosis of MA can have significant reproductive consequences. OBJECTIVE To investigate the prevalence of coexisting MA in patients with congenital RA. STUDY DESIGN This is a retrospective cohort study of females age 12-35 years with a diagnosis of RA, identified by diagnosis codes, who were followed for care between 2013 and 2020. Data were collected on demographics, medical history, clinical presentation, and imaging studies. Descriptive statistics were used to summarize the data. This study was IRB approved. RESULTS A total of 465 patients were included in this study, of whom 326 patients (70.3%) had a pelvic evaluation during the study period. Of these 326 patients, 125 (38.3%) were found to have coexistent MA. About one-third of patients who underwent pelvic evaluation due to pain were found to have MA. For 69.6% (87/125) of patients with MA, the RA was diagnosed prior to the MA. The average age at time of RA diagnosis was 6.4 ± 8.8 years and the average age of MA diagnosis was 16.4 ± 6.9 years. Forty-eight (38.4%) patients had obstructive anomalies. Of the Müllerian obstructions, 93.8% were treated with urgent surgery and the remainder started on hormonal suppression. The prevalence of MA was dependent on the RA diagnosis (Figure). Of patients with a solitary kidney, 67.1% were diagnosed with MA. For other parenchymal RA, the prevalence of MA was 20-23%. In patients with solitary kidney, uterus didelphys was the most common MA (52.1%). Thirty percent of patients with a solitary kidney were diagnosed with an obstructive MA. CONCLUSIONS In this study, 38% of patients with RA who underwent a pelvic evaluation were found to also have MA. Our study shows the strongest association between MA and solitary kidney, but also emphasizes a significant risk with other RA. Almost 40% of patients with diagnosed MA were found to have an obstruction that required urgent treatment. Delays in diagnosis and treatment of Müllerian obstructions can be detrimental for future reproductive health, due to risk of chronic pain, infertility, infection, and endometriosis. Given the high prevalence of MA in patients with RA, especially those with congenital solitary kidney, routine screening with pelvic ultrasound should be performed around the age of expected menarche.
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Affiliation(s)
- Y Frances Fei
- Section of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA.
| | - Yolanda R Smith
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Julian Wan
- Department of Urology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Melina L Dendrinos
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
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Fei YF, Quint EH, Hryhorczuk AL, Winfrey OK, Dendrinos ML. Distal Vaginal Atresia with Spontaneous Perforation: A Case Report. J Pediatr Adolesc Gynecol 2022; 35:383-386. [PMID: 34752931 DOI: 10.1016/j.jpag.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The definitive treatment of distal vaginal atresia is surgery, but menstrual suppression is often helpful for initial management. CASE A 13-year-old presented with primary amenorrhea and progressive abdominal pain. She was diagnosed with distal vaginal atresia and started on hormonal suppression. She then re-presented with heavy vaginal bleeding, and follow-up imaging revealed that spontaneous perforation had occurred. There was now evidence of a tract leading from the obstructed vaginal bulge to the introitus. Vaginoplasty was complicated by the tortuosity of the tract. Under ultrasound guidance, a pull-through vaginoplasty was performed. SUMMARY AND CONCLUSION Spontaneous perforation of an atretic vagina is rare, but in such cases, urgent vaginoplasty is indicated to prevent infection. Despite the presence of a spontaneous tract leading to the obstruction, vaginoplasty can be complex, and intraoperative ultrasound could be beneficial.
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Affiliation(s)
- Y Frances Fei
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan.
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | | | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
| | - Melina L Dendrinos
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan
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Crain CL, Winfrey OK, Jackson WL, Pauley A, Yoost JL. Teaching Pediatric Straddle Injury Repair with Use of a 3D Printed Model. J Pediatr Adolesc Gynecol 2021; 34:862-864. [PMID: 34044178 DOI: 10.1016/j.jpag.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To determine the utility of a 3D vulvar model for teaching pediatric straddle injury repair. DESIGN Prospective study. SETTING Two academic hospitals. PARTICIPANTS Twenty obstetrics and gynecology residents INTERVENTIONS AND MAIN OUTCOME MEASURES: Knowledge score on the basis of a 7-question pre/post test. Likert scale questions evaluated the 3D model as a teaching tool. RESULTS Twenty residents participated; 2 (10%) had ever repaired a straddle injury. Knowledge scores increased after model use and didactic session from 3.05 of possible 7 to 6.35; P = .001. Only 2/20 (10%) residents "agreed" or "strongly agreed" with the statement, "I am comfortable repairing a straddle injury" before the intervention, compared with 19/20 (95%) afterward (P < .001). Of 20 residents, 19 (95%) believed that it simulated surgical experience "very well" or "well." CONCLUSION The use of a 3D pediatric vulvar model can simulate surgical experience and can be an effective teaching tool when combined with a didactic session on pediatric straddle injury.
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Affiliation(s)
- Courtney L Crain
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky
| | - Wendy L Jackson
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, Kentucky
| | - Amanda Pauley
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia
| | - Jennie L Yoost
- Department of Obstetrics and Gynecology, Marshall University, Huntington, West Virginia.
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Nelson LW, Richardson D, Chavan NR, Kapoor H, Stanley ZD, Gulati V, Winfrey OK, Khurana A. Correlation of placental MR imaging signs and pathologic diagnosis of placenta accreta spectrum: Retrospective single center case series. Eur J Obstet Gynecol Reprod Biol 2021; 262:239-247. [PMID: 34091159 DOI: 10.1016/j.ejogrb.2021.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Alongside initial screening obstetric US, use of placental MRI has been increasing in the last few decades to aid with antenatal diagnosis and delivery planning in Placenta Accreta Spectrum (PAS). The aim of this study was to determine if the MRI pathophysiological sign subcategories described in the current literature can predict the severity of pathologic diagnosis. METHODS Institutional imaging records were reviewed for placental MRIs performed for suspicion of PAS in the last decade. Electronic health records were searched for patient history and pathology. The 59 MRI studies were reviewed using the 11 MRI signs described by the SAR and ESUR joint consensus statement. Further breakdown of the signs was divided by underlying pathophysiologic subcategories including gross morphologic, interface and tissue architecture signs. RESULTS Pathologic diagnosis yielded 34 cases: accreta 4/34, incerta 14/34, percreta 10/34 and normal 6/34. Of the accreta cases all of them demonstrated at least two interface and half of the cases had tissue architecture signs, 13/14 increta cases demonstrated interface signs and 12/14 demonstrated tissue architecture signs, 9/10 percreta cases had two interface and at least six demonstrated three tissue architecture signs. Statistical analysis showed significant difference between pathologic diagnosis and the number of positive interface signs with p = 0.02. DISCUSSION Interface signs were the most objective and sensitive MRI subcategory. Statistical analysis determined there was a significant difference between PAS diagnosis and number of interface signs present. This subcategory has the most overlap with classic US signs which are traditionally used before MRI referral.
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Affiliation(s)
- Leslie W Nelson
- Department of Radiology, University of Kentucky, 800 Rose St, HX 316, Lexington, KY, USA
| | - Darington Richardson
- University of Kentucky College of Medicine, 800 Rose St, MN 150, Lexington, KY, USA
| | - Niraj R Chavan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, 800 Rose St, Lexington, KY, USA
| | - Harit Kapoor
- Department of Radiology, University of Kentucky, 800 Rose St, HX 316, Lexington, KY, USA
| | - Zachary D Stanley
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, 800 Rose St, Lexington, KY, USA
| | - Vaibhav Gulati
- Department of Radiology, Imaging Associates at National Heart Institute, New Delhi, India
| | - Olivia K Winfrey
- Department of Obstetrics and Gynecology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA
| | - Aman Khurana
- Department of Radiology, University of Kentucky, 800 Rose St, HX 316, Lexington, KY, USA.
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