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A Pilot Survey of OB GYN Residents' Attitudes and Behaviors Related to Intrauterine Device Use in Adolescents
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Poster Abstracts / J Pediatr Adolesc Gynecol 24 (2011) e55ee72
about 2-3 cm from the uterine cornua. The left ovary was also absent (Fig 2). The components of the mass were extensively necrotic; however remnants of ovarian histology were noted. The mass was excised from the omentum and the patient was discharged two days later.
Fig. 1. Free floating pelvic mass was noted in the posterior culde-sac.Ă
Results: Of the 18 OB GYN residents surveyed, only 2 (10%) consider the IUD as the first-line choice for contraception in the adolescent patient, with most offering either Depo Provera or oral contraceptive pills. Almost all residents (17/18), however, were willing to insert an IUD in an adolescent patient if asked, with majority reporting the acceptability of IUD insertion in older adolescents, aged 16 and older, especially if parous. Only 2 reported being very comfortable doing IUD insertion in a nulliparous adolescent. Reticence about insertion in patients less than 16 years of age was attributed mostly to concerns about the size of the younger adolescent uterus and the perceived technical difficulty of insertion. Majority (12/18) had inserted an IUD in an adolescent patient in the past year at least once, with the youngest patient at age 14 years. The most commonly identified indication for insertion was postpartum birth control. No resident reported use of the IUD for emergency contraception and menstrual suppression in adolescents. Conclusions: IUDs provide an under-utilized highly effective form of contraception in adolescents. While practice may vary depending on the institution, the preliminary data from this survey reflect the increasing acceptability of IUD use for contraception, especially in the older adolescent population, among OB GYN residents. There is still, however, a prevalent reluctance in considering it as a first-line contraceptive option for adolescents. Resident education should be tailored towards increasing residents' comfort in the use of the IUD in the adolescent patient population.
22. An Assesment of Contraception Need and Provision in Patients Presenting for HPV Vaccination Rachel Perry MD, Miao Crystal Yu, Eden Pappo, Allison Cowett MD, MPH, Bryna Harwood MD, MS University of Illinois at Chicago College of Medicine
Fig. 2. Absent left ovary.Ă
Comments: Forty three cases of autoamputated adnexae are present in the literature dating back to1945. We reviewed these cases looking for common findings. These girls tend to be under the age of 12 (88%) and most (51%) were less than one year old, with a fetal ovarian cyst diagnosed in-utero. Providers should be aware of the risk of acquired auto-amputation of affected adnexae due to a risk of chronic torsion. After autoamputation, oophoropexy of the non-involved ovary might be considered, although this remains highly controversial. Finally, providers should recognize that sequelae may not develop immediately after birth.
21. A Pilot Survey of OB GYN Residents' Attitudes and Behaviors Related to Intrauterine Device Use in Adolescents Mari Charisse B. Trinidad MD St. Luke's Hospital and Health Network, Bethlehem, PA Background: The intrauterine device (IUD) is a well accepted contraceptive option for adult women throughout the world. There has been a recent move in the past few years towards its acceptance for use in adolescents as it provides long term, highly reliable and effective contraception, while eliminating issues with compliance. Data supports the safety of IUDs in adolescents but it continues to remain highly under-utilized. This study aims to identify the current attitudes and behaviors related to IUD use in adolescents by OB GYN residents' training in a large community hospital. Methods: A survey was done among OB GYN residents in different levels of training in a large community hospital setting regarding IUD use in sexually active females aged 19 years and younger.
Background: Adolescents and young adult women are at increased risk for both HPV infection and unintended pregnancy compared to older adults. HPV vaccination and contraception are important preventive interventions for this vulnerable population. We aimed to assess contraceptive need, counseling and provision at the time of HPV vaccination and to measure the association between unintended pregnancy and vaccination completion. Methods: We conducted a retrospective cohort analysis of young women and adolescents aged 13-26 years who presented to the University of Illinois Medical Center between June 2006 and May 2010 for HPV vaccination. After IRB approval was granted, data was abstracted from the electronic medical record using Microsoft ExcelÒ for analysis. The primary outcome variables were contraceptive need assessment, counseling and provision at the initial visit and completion of the vaccination series. In addition, demographic and reproductive history was collected. The analysis was completed using descriptive statistics and Chi-square test for the main outcomes of interest. Results: We identified 520 women and girls with a mean age of 22 years who presented for HPV vaccination during the study period. Assessing contraceptive need: Of the 520, 56 (11%) did not have any assessment of contraceptive need in the medical record, 439 (84%) were heterosexually active; 365 (83%) of those who were sexually active were using a method of contraception at the initial HPV vaccination visit and 4 were actively attempting pregnancy at that time. The most common methods of contraception used were oral contraceptives (93/365, 25%), condoms (77/365, 21%), and depot medroxyprogesterone acetate (DMPA) (75/365, 21%). Only 124 (34%) were using a long-acting reversible method of contraception (DMPA, IUD or implant). Contraceptive counseling and provision: Of the total cohort, 392 (75%) were counseled regarding contraception. Of the 74 who were sexually active and were not using contraception, 49 (66%) were provided a method of contraception at the HPV vaccination visit. During the vaccine series, 38 of the cohort became pregnant, none of the pregnancies occurred among those attempting pregnancy. Pregnancy and vaccination completion: Of the total cohort, we were missing follow up regarding subsequent pregnancy for 128 (25%). Of the 392 for whom we have follow up regarding pregnancy status, 212 (54%)
Poster Abstracts / J Pediatr Adolesc Gynecol 24 (2011) e55ee72
about 2-3 cm from the uterine cornua. The left ovary was also absent (Fig 2). The components of the mass were extensively necrotic; however remnants of ovarian histology were noted. The mass was excised from the omentum and the patient was discharged two days later.
Fig. 1. Free floating pelvic mass was noted in the posterior culde-sac.Ă
Results: Of the 18 OB GYN residents surveyed, only 2 (10%) consider the IUD as the first-line choice for contraception in the adolescent patient, with most offering either Depo Provera or oral contraceptive pills. Almost all residents (17/18), however, were willing to insert an IUD in an adolescent patient if asked, with majority reporting the acceptability of IUD insertion in older adolescents, aged 16 and older, especially if parous. Only 2 reported being very comfortable doing IUD insertion in a nulliparous adolescent. Reticence about insertion in patients less than 16 years of age was attributed mostly to concerns about the size of the younger adolescent uterus and the perceived technical difficulty of insertion. Majority (12/18) had inserted an IUD in an adolescent patient in the past year at least once, with the youngest patient at age 14 years. The most commonly identified indication for insertion was postpartum birth control. No resident reported use of the IUD for emergency contraception and menstrual suppression in adolescents. Conclusions: IUDs provide an under-utilized highly effective form of contraception in adolescents. While practice may vary depending on the institution, the preliminary data from this survey reflect the increasing acceptability of IUD use for contraception, especially in the older adolescent population, among OB GYN residents. There is still, however, a prevalent reluctance in considering it as a first-line contraceptive option for adolescents. Resident education should be tailored towards increasing residents' comfort in the use of the IUD in the adolescent patient population.
22. An Assesment of Contraception Need and Provision in Patients Presenting for HPV Vaccination Rachel Perry MD, Miao Crystal Yu, Eden Pappo, Allison Cowett MD, MPH, Bryna Harwood MD, MS University of Illinois at Chicago College of Medicine
Fig. 2. Absent left ovary.Ă
Comments: Forty three cases of autoamputated adnexae are present in the literature dating back to1945. We reviewed these cases looking for common findings. These girls tend to be under the age of 12 (88%) and most (51%) were less than one year old, with a fetal ovarian cyst diagnosed in-utero. Providers should be aware of the risk of acquired auto-amputation of affected adnexae due to a risk of chronic torsion. After autoamputation, oophoropexy of the non-involved ovary might be considered, although this remains highly controversial. Finally, providers should recognize that sequelae may not develop immediately after birth.
21. A Pilot Survey of OB GYN Residents' Attitudes and Behaviors Related to Intrauterine Device Use in Adolescents Mari Charisse B. Trinidad MD St. Luke's Hospital and Health Network, Bethlehem, PA Background: The intrauterine device (IUD) is a well accepted contraceptive option for adult women throughout the world. There has been a recent move in the past few years towards its acceptance for use in adolescents as it provides long term, highly reliable and effective contraception, while eliminating issues with compliance. Data supports the safety of IUDs in adolescents but it continues to remain highly under-utilized. This study aims to identify the current attitudes and behaviors related to IUD use in adolescents by OB GYN residents' training in a large community hospital. Methods: A survey was done among OB GYN residents in different levels of training in a large community hospital setting regarding IUD use in sexually active females aged 19 years and younger.
Background: Adolescents and young adult women are at increased risk for both HPV infection and unintended pregnancy compared to older adults. HPV vaccination and contraception are important preventive interventions for this vulnerable population. We aimed to assess contraceptive need, counseling and provision at the time of HPV vaccination and to measure the association between unintended pregnancy and vaccination completion. Methods: We conducted a retrospective cohort analysis of young women and adolescents aged 13-26 years who presented to the University of Illinois Medical Center between June 2006 and May 2010 for HPV vaccination. After IRB approval was granted, data was abstracted from the electronic medical record using Microsoft ExcelÒ for analysis. The primary outcome variables were contraceptive need assessment, counseling and provision at the initial visit and completion of the vaccination series. In addition, demographic and reproductive history was collected. The analysis was completed using descriptive statistics and Chi-square test for the main outcomes of interest. Results: We identified 520 women and girls with a mean age of 22 years who presented for HPV vaccination during the study period. Assessing contraceptive need: Of the 520, 56 (11%) did not have any assessment of contraceptive need in the medical record, 439 (84%) were heterosexually active; 365 (83%) of those who were sexually active were using a method of contraception at the initial HPV vaccination visit and 4 were actively attempting pregnancy at that time. The most common methods of contraception used were oral contraceptives (93/365, 25%), condoms (77/365, 21%), and depot medroxyprogesterone acetate (DMPA) (75/365, 21%). Only 124 (34%) were using a long-acting reversible method of contraception (DMPA, IUD or implant). Contraceptive counseling and provision: Of the total cohort, 392 (75%) were counseled regarding contraception. Of the 74 who were sexually active and were not using contraception, 49 (66%) were provided a method of contraception at the HPV vaccination visit. During the vaccine series, 38 of the cohort became pregnant, none of the pregnancies occurred among those attempting pregnancy. Pregnancy and vaccination completion: Of the total cohort, we were missing follow up regarding subsequent pregnancy for 128 (25%). Of the 392 for whom we have follow up regarding pregnancy status, 212 (54%)