- Email: [email protected]
Continuation experience with depoprovera in adolescent mothers
156
Poster Presentations
FOLLOW-UP OF ABNORMAL PAP SMEARS IN A HOSPITAL BASED ADOLESCENT CLINIC.Claudia Lavin. M.D. , Elizabeth Goodman, M.D. , Sallly Perlman, M.D. , S. J倒n Ema郎 ， M.D. Children's Hospital, Boston, MA. BACKGROUND: An increasing number of adolescents have abnormal Pap sm個悶 ， and little is know about factors which influence compliance with recommendationsfor reμat Pap smears and referrals for colposcopy. METHODS: Data was collectedon all patientswho were receivinghealth care in a hospital b倡“ ∞mprehensive adolescent clinic and who h abnormal Pap smear be胸前n July I , 1994 and June 30, 1995. Demographicand clinical data included age, race, ethnicity, insurance status, prior abnormal Pap smears and colposcopy (between 1992 and July 1. 1994), Pap smears at tollow-up, results of colposcopy, number of sched叫ed and kept appointments, and number of reminders (telephonecalls, letters). Follow-up 也包 W品then collected through December I , 1995. Data was analyzed using SPSS statistical software. RESULTS: 107 adolescents (mean age 18.2 土2 .4 Y rs; range 11-23 y個rs) had an abnormal Pap during the year. Th e adolescentswere of mixed ethnicity and payor status: 29% were white, 61 % black, 5% other, 6% unknown; 14% were Hispanic. 27% had Medicaid, 37% private insurance, 16% 揖If-pay ， 8% fr臼ca時 ， 6 %other, 6 % missingdata. Th e results of the index Pap smear w晶 : 90 (84%) Atypia, 17 (16 %) SIL LG. Ofthe 64 (60%) who had a 甜cond Pap smear, 32 (50%) were normal, 18 (28%) Atypia and 12 (22) SIL LG. Of the initial 108 patients, the index Pap was the first abnormal Pap for 85 (79 的of the patients; 22 had had a previous abnormal Pap (15 atypi髓 ， 5 SIL LG, 2 SIL HG) and 11 had had a previous colposcopy. 80 patients had no prior colposcopy and atypia on the index Pap sm個r. Of 也臼e ， 50 had a 田cond Pap sm個r. The 鉛cond Pap rev個led 27 (54%) normal, 13 (26%) 的pia ， and 10 (20%) SIL LG. In all 52 (49%) patien個were referred to the hospital's colposcopy clinic but only 28 ac仙ally had colposcopy despite outreach. Amo ng those with no prior colposcopy and atypia on the index Pap, 32 patients were ultimately referred and only 17 kept the appointment. Following col戶scopy patien個kept an averageof 2.1 visi個and mis晶d 1. 1 visi包 . Forboth follow-up for re戶at Pap sm個rs and colposcopy, there are no differenceby 間的， insurance status, age, Pap smear result, prior referral for colposcopy, or number of letters. Th e 0剖 y signifiωnt factor for keeping a referral to colposcopy clinic w品a visit 怕 也e adole民ent clinic after notificationof th
CONTINUATION EXPERIENCE WITH DEPOPROVERA IN ADOLESCENT MOTHERS.SH woods.S. D' Angelo , Department of Pediatrics , university of Kentucky , Lexington , Kentucky. BACKGROUND: Since the advent of FDA approval of Depoprovera for contraceptive use , parenting adolescents have an additional option for contraception. This study was undertaken to determine the continuation rates of Depoprovera in a population of parenting adolescent mothers , to determine the timeliness of visits for subsequent Depoprovera injection , and to determine the choice of contraceptive following the use 。 f Denonrovera. METHODS : Retrospective chart review 01 adolescent mothers utilizing the Young Parents Program which provides prenatal , peripartum , postpartum medical and nursing" care for adolescent mothers as well as medical care for their offspring to the age 。 f five. contraceptive options are addressed by the same staff and choices are recorded at discharge after delivery and at all subsequent visits. A standard form is also used at each follow-up visit to record choice of continuation of current method or choice of another method. 69 charts were reviewed by the same reviewer covering a 15 month time period. RESULTS: 50 (72.4 宅 ) of adolescent mothers continued with Depoprovera during this 15 month time period. 36(72宅 ) of these mothers returned on time , i.e. within 12 weeks of the last injection and 14(28宅 ) of these mothers were late for at least one Depoprovera. 3 mothers changed to Norp1ant and all 。 f these mothers had been on time for their Depoprovera injections. 12 mothers changed to oral contraceptive pills and only one of these mothers was late on any of her Depoprovera injections. 2 mothers changed to foam and condoms and all of these were on time for their oepoprovera injections. 2 mothers discontinued Depoprovera to actively pursue pregnancy. No pregnancies occurred during the review period. CONCLUSIONS I In a population of adolescent mothers 19 years of age or younger , Depoprovera is a popular choice. clearly , ~lmC? s t 3/4ths of this group chose to continue Depoprovera during the 15 month review period and 72 ‘ 。f these mothers returned on time for their injection. of those mothers choosing to discontinue Depoprovera 18 of 19 mothers had been 。n .time for their injection. Depoprovera is a convenient methC?d of contraception for adolescent mothers , is easily continued , and allows compliance in an oth
The Practice of Pediatric and Adolescent Gynecology Before 1896. Elaine E. Yordan. MD.Robert A. Yordan, MD, University of Connecticut Health Center , Farmington , Connecticu t. BACKGROUND-The science of medicine is a constantly evolving process which builds on the experiences and observations of the pas t. We hypothesized that the issues of pediatric and adolescent gynecology were also of concern to physicians practicing in the 19th Century. We sought to determine the extent to which our forebears of over 100years-ago considered , diagnosed and treated these problems. METHODS -We conducted an exhau~tive search throu~h two Engli~h languag e: medical journals , The Obstetrical Journal of Great Britain and Ireland (vo l. 1-7, 1873-1880) and Th e American Journal of Obstetrics (vo l. 1-32, 1869-1895) , for articles relating to pediatric and adolescent gynecology. RESULTS -The most frequently encountered subject was the surgical management of congenital absence or atresia of the vagina and associated anomalies of adjacent organs. By 1881, the opinion expressed by many authors was that the method used by Thomas Addis Emmet to create an artificial vagina between the bladder and the rectum by a single stage procedure of blunt dissection and the immediate placement of a glass vaginal dilator gave the best chance of a favorable outcome. Th e practice of making an artificial opening through the rectum was abandoned. In 1882, a review of published reports noted 43% post operative mortality in children treated for benign and malignant ovarian tumors. A review article in 1891 reported a 10% mortality rate associated with treatment of the imperforate hymen. A research article in 1870 noted the mean age at menarche in England to be 14.96 years. Additional subjects in the literature included: •Acquired Venereal Disease in Children" warning of the need for "rigid...scrutiny of the attendants and playmates of children" (1 893) , the enigmatic occurrence of "Vaginal Hemorrhage in an Infant Five-Days-Old· (1 874) , the brutal atrocities perpetrated against "The Child Wives of In dia· (1 895), "Early Pregnancy" reviewing childbirth by young adolescents (1 874) , "Hermaphrodism" (1 886) , "Th e...Hymen and It s Remains...· (1 871) , a ·Case of Fatal Hemorrhage from the Genital Organs· in which a 17-year-old exsanguinated from a vaginal laceration (1 879), "Primary Sarcoma of the Vagina.. .in a Child Three-Years-Old· (1 8
ANTIANDROGEN CYPROTERONE ACETATE AS AN ALTERNATIVE TREATMENT FOR POLYCYSTIC OVARY SYNDROME , ACNE AND HIRSUTIS IN ADOLESCENCE. Dramusic V ，R吋an U , Annapoorna V , Oei P L. National University Hospital , 5 Lo wer Kent Ridge Road , Singapore 119074. Period of adolescence has been identified as age group of otherwise During maturational processes of healthy population , but at risk. hypo曲al缸no-piωitary-ov缸ian axis menstrual dysfunction and anovulatory cycles are common and often short lived; yet in some cas自 由ey may lead into persistent hyperandrogenism like PCOS , acne and hirsutism. In the Adolescent Clinics in National University Hospital and School Health Services long follow-up of cases with menstrual disorders has been ∞ nd ucted ， atωrelating to 150 adolescents wi曲PCOS ， 52 % of them had acne and hirsutism. Uniform investigations of patients included clinical features , hormonal investigations , ultrasound findings and psychological screening. Typical features for the group , treatment options and prognosis for fu仙re reproductive abilities are discussed in detai l. Th e majority of patients (82.6%) were tr臼.ted with anti-androgen cyproterone acetate in a preparation containing 2mg + 35 ug ethinyl Estradiol in 也ree weeks ∞urse per month. Following treatment acne resolved completely or showed visible improvement in 93.7~. Varying degree of improvement in hirsutism were noted in ω.8~ of girls. Importantly cyclic function either was normalisωor improv吋in 62. 7 ~ of girls. However the situation remained unchanged in 11.3% and in 26~ worsened. In our opinion ∞mpl ete management of adolescent PCOS should include mωical correction of hormonal disbalance, body weight correction and psychological intervention to ensure healthy adul曲ood and normal reproductive function. Implications of hyperandrogenism in adolescence are multifaceted. Immediate ∞眼前ns are menstrual irregular划位 ， hirsutism and acne associatωwi也 PeOS ， but long standing possible hazards in adult life 缸e impaired fi釘tili句， 。借trogen dependent maJ ignancies 缸吋insul in resistance related conditions. In addition to mentioned health hazards it has become clear 出at adolescent girls with PCOS show low self-esteem and high degrees of psychological distress.
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Poster Presentations
FOLLOW-UP OF ABNORMAL PAP SMEARS IN A HOSPITAL BASED ADOLESCENT CLINIC.Claudia Lavin. M.D. , Elizabeth Goodman, M.D. , Sallly Perlman, M.D. , S. J倒n Ema郎 ， M.D. Children's Hospital, Boston, MA. BACKGROUND: An increasing number of adolescents have abnormal Pap sm個悶 ， and little is know about factors which influence compliance with recommendationsfor reμat Pap smears and referrals for colposcopy. METHODS: Data was collectedon all patientswho were receivinghealth care in a hospital b倡“ ∞mprehensive adolescent clinic and who h abnormal Pap smear be胸前n July I , 1994 and June 30, 1995. Demographicand clinical data included age, race, ethnicity, insurance status, prior abnormal Pap smears and colposcopy (between 1992 and July 1. 1994), Pap smears at tollow-up, results of colposcopy, number of sched叫ed and kept appointments, and number of reminders (telephonecalls, letters). Follow-up 也包 W品then collected through December I , 1995. Data was analyzed using SPSS statistical software. RESULTS: 107 adolescents (mean age 18.2 土2 .4 Y rs; range 11-23 y個rs) had an abnormal Pap during the year. Th e adolescentswere of mixed ethnicity and payor status: 29% were white, 61 % black, 5% other, 6% unknown; 14% were Hispanic. 27% had Medicaid, 37% private insurance, 16% 揖If-pay ， 8% fr臼ca時 ， 6 %other, 6 % missingdata. Th e results of the index Pap smear w晶 : 90 (84%) Atypia, 17 (16 %) SIL LG. Ofthe 64 (60%) who had a 甜cond Pap smear, 32 (50%) were normal, 18 (28%) Atypia and 12 (22) SIL LG. Of the initial 108 patients, the index Pap was the first abnormal Pap for 85 (79 的of the patients; 22 had had a previous abnormal Pap (15 atypi髓 ， 5 SIL LG, 2 SIL HG) and 11 had had a previous colposcopy. 80 patients had no prior colposcopy and atypia on the index Pap sm個r. Of 也臼e ， 50 had a 田cond Pap sm個r. The 鉛cond Pap rev個led 27 (54%) normal, 13 (26%) 的pia ， and 10 (20%) SIL LG. In all 52 (49%) patien個were referred to the hospital's colposcopy clinic but only 28 ac仙ally had colposcopy despite outreach. Amo ng those with no prior colposcopy and atypia on the index Pap, 32 patients were ultimately referred and only 17 kept the appointment. Following col戶scopy patien個kept an averageof 2.1 visi個and mis晶d 1. 1 visi包 . Forboth follow-up for re戶at Pap sm個rs and colposcopy, there are no differenceby 間的， insurance status, age, Pap smear result, prior referral for colposcopy, or number of letters. Th e 0剖 y signifiωnt factor for keeping a referral to colposcopy clinic w品a visit 怕 也e adole民ent clinic after notificationof th
CONTINUATION EXPERIENCE WITH DEPOPROVERA IN ADOLESCENT MOTHERS.SH woods.S. D' Angelo , Department of Pediatrics , university of Kentucky , Lexington , Kentucky. BACKGROUND: Since the advent of FDA approval of Depoprovera for contraceptive use , parenting adolescents have an additional option for contraception. This study was undertaken to determine the continuation rates of Depoprovera in a population of parenting adolescent mothers , to determine the timeliness of visits for subsequent Depoprovera injection , and to determine the choice of contraceptive following the use 。 f Denonrovera. METHODS : Retrospective chart review 01 adolescent mothers utilizing the Young Parents Program which provides prenatal , peripartum , postpartum medical and nursing" care for adolescent mothers as well as medical care for their offspring to the age 。 f five. contraceptive options are addressed by the same staff and choices are recorded at discharge after delivery and at all subsequent visits. A standard form is also used at each follow-up visit to record choice of continuation of current method or choice of another method. 69 charts were reviewed by the same reviewer covering a 15 month time period. RESULTS: 50 (72.4 宅 ) of adolescent mothers continued with Depoprovera during this 15 month time period. 36(72宅 ) of these mothers returned on time , i.e. within 12 weeks of the last injection and 14(28宅 ) of these mothers were late for at least one Depoprovera. 3 mothers changed to Norp1ant and all 。 f these mothers had been on time for their Depoprovera injections. 12 mothers changed to oral contraceptive pills and only one of these mothers was late on any of her Depoprovera injections. 2 mothers changed to foam and condoms and all of these were on time for their oepoprovera injections. 2 mothers discontinued Depoprovera to actively pursue pregnancy. No pregnancies occurred during the review period. CONCLUSIONS I In a population of adolescent mothers 19 years of age or younger , Depoprovera is a popular choice. clearly , ~lmC? s t 3/4ths of this group chose to continue Depoprovera during the 15 month review period and 72 ‘ 。f these mothers returned on time for their injection. of those mothers choosing to discontinue Depoprovera 18 of 19 mothers had been 。n .time for their injection. Depoprovera is a convenient methC?d of contraception for adolescent mothers , is easily continued , and allows compliance in an oth
The Practice of Pediatric and Adolescent Gynecology Before 1896. Elaine E. Yordan. MD.Robert A. Yordan, MD, University of Connecticut Health Center , Farmington , Connecticu t. BACKGROUND-The science of medicine is a constantly evolving process which builds on the experiences and observations of the pas t. We hypothesized that the issues of pediatric and adolescent gynecology were also of concern to physicians practicing in the 19th Century. We sought to determine the extent to which our forebears of over 100years-ago considered , diagnosed and treated these problems. METHODS -We conducted an exhau~tive search throu~h two Engli~h languag e: medical journals , The Obstetrical Journal of Great Britain and Ireland (vo l. 1-7, 1873-1880) and Th e American Journal of Obstetrics (vo l. 1-32, 1869-1895) , for articles relating to pediatric and adolescent gynecology. RESULTS -The most frequently encountered subject was the surgical management of congenital absence or atresia of the vagina and associated anomalies of adjacent organs. By 1881, the opinion expressed by many authors was that the method used by Thomas Addis Emmet to create an artificial vagina between the bladder and the rectum by a single stage procedure of blunt dissection and the immediate placement of a glass vaginal dilator gave the best chance of a favorable outcome. Th e practice of making an artificial opening through the rectum was abandoned. In 1882, a review of published reports noted 43% post operative mortality in children treated for benign and malignant ovarian tumors. A review article in 1891 reported a 10% mortality rate associated with treatment of the imperforate hymen. A research article in 1870 noted the mean age at menarche in England to be 14.96 years. Additional subjects in the literature included: •Acquired Venereal Disease in Children" warning of the need for "rigid...scrutiny of the attendants and playmates of children" (1 893) , the enigmatic occurrence of "Vaginal Hemorrhage in an Infant Five-Days-Old· (1 874) , the brutal atrocities perpetrated against "The Child Wives of In dia· (1 895), "Early Pregnancy" reviewing childbirth by young adolescents (1 874) , "Hermaphrodism" (1 886) , "Th e...Hymen and It s Remains...· (1 871) , a ·Case of Fatal Hemorrhage from the Genital Organs· in which a 17-year-old exsanguinated from a vaginal laceration (1 879), "Primary Sarcoma of the Vagina.. .in a Child Three-Years-Old· (1 8
ANTIANDROGEN CYPROTERONE ACETATE AS AN ALTERNATIVE TREATMENT FOR POLYCYSTIC OVARY SYNDROME , ACNE AND HIRSUTIS IN ADOLESCENCE. Dramusic V ，R吋an U , Annapoorna V , Oei P L. National University Hospital , 5 Lo wer Kent Ridge Road , Singapore 119074. Period of adolescence has been identified as age group of otherwise During maturational processes of healthy population , but at risk. hypo曲al缸no-piωitary-ov缸ian axis menstrual dysfunction and anovulatory cycles are common and often short lived; yet in some cas自 由ey may lead into persistent hyperandrogenism like PCOS , acne and hirsutism. In the Adolescent Clinics in National University Hospital and School Health Services long follow-up of cases with menstrual disorders has been ∞ nd ucted ， atωrelating to 150 adolescents wi曲PCOS ， 52 % of them had acne and hirsutism. Uniform investigations of patients included clinical features , hormonal investigations , ultrasound findings and psychological screening. Typical features for the group , treatment options and prognosis for fu仙re reproductive abilities are discussed in detai l. Th e majority of patients (82.6%) were tr臼.ted with anti-androgen cyproterone acetate in a preparation containing 2mg + 35 ug ethinyl Estradiol in 也ree weeks ∞urse per month. Following treatment acne resolved completely or showed visible improvement in 93.7~. Varying degree of improvement in hirsutism were noted in ω.8~ of girls. Importantly cyclic function either was normalisωor improv吋in 62. 7 ~ of girls. However the situation remained unchanged in 11.3% and in 26~ worsened. In our opinion ∞mpl ete management of adolescent PCOS should include mωical correction of hormonal disbalance, body weight correction and psychological intervention to ensure healthy adul曲ood and normal reproductive function. Implications of hyperandrogenism in adolescence are multifaceted. Immediate ∞眼前ns are menstrual irregular划位 ， hirsutism and acne associatωwi也 PeOS ， but long standing possible hazards in adult life 缸e impaired fi釘tili句， 。借trogen dependent maJ ignancies 缸吋insul in resistance related conditions. In addition to mentioned health hazards it has become clear 出at adolescent girls with PCOS show low self-esteem and high degrees of psychological distress.
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