1
|
Mörö S, Kosola S, Holopainen E. Girls referred for amenorrhea: analysis of a patient series from a specialist center. Front Public Health 2024; 12:1304277. [PMID: 38435281 PMCID: PMC10906086 DOI: 10.3389/fpubh.2024.1304277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Objective Among adolescents, amenorrhea is a common reason for medical consultation. Despite the variety of underlying etiologies, the prevalence of the causes is incompletely understood. This study aimed to assess the demographic and etiological factors among patients with amenorrhea treated in a single specialist unit of adolescent gynecology. Design Retrospective register study. Methods Medical records of 438 girls evaluated for primary or secondary amenorrhea in a single tertiary care center between 2015 and 2019 were retrospectively reviewed. In all, 423 patients-171 with primary amenorrhea and 252 with secondary amenorrhea-were included in the study. Data on underlying conditions, anthropometric variables, and selected hormonal markers were analyzed. Results Functional hypogonadotropic hypogonadism was the most frequent reason for primary (56%) and secondary (78%) amenorrhea. It was mostly explained by lifestyle-related functional hypothalamic amenorrhea caused by disordered eating, intense exercise, energy deficiency, psychological stress, and their combinations. Conclusion Menstrual pattern is a significant indicator of overall health and well-being among adolescent girls and young women. Functional reasons behind primary and secondary amenorrhea are important to recognize. Treatment often requires long-term lifestyle modifications. The frequency of functional causes also implies that most amenorrhea cases are preventable.
Collapse
Affiliation(s)
- Sara Mörö
- Children’s Hospital and Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Silja Kosola
- Children’s Hospital and Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Research, Development and Innovations, Western Uusimaa Wellbeing Services County, Espoo, Finland
| | - Elina Holopainen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
2
|
Micangeli G, Paparella R, Tarani F, Menghi M, Ferraguti G, Carlomagno F, Spaziani M, Pucarelli I, Greco A, Fiore M, Tarani L. Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1672. [PMID: 37892335 PMCID: PMC10604951 DOI: 10.3390/children10101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
Puberty identifies the transition from childhood to adulthood. Precocious puberty is the onset of signs of pubertal development before age eight in girls and before age nine in boys, it has an incidence of 1/5000-1/10,000 with an F:M ratio ranging from 3:1 to 20:1. Precocious puberty can be divided into central, also known as gonadotropin-dependent precocious puberty or true precocious puberty, and peripheral, also recognized as gonadotropin-independent precocious puberty or precocious pseudopuberty. Thus, the main aim of this narrative report is to describe the standard clinical management and therapy of precocious puberty according to the experience and expertise of pediatricians and pediatric endocrinologists at Policlinico Umberto I, Sapienza University of Rome, Italy. In the suspicion of early sexual maturation, it is important to collect information regarding the age of onset, the speed of maturation of secondary sexual features, exposure to exogenous sex steroids and the presence of neurological symptoms. The objective examination, in addition to the evaluation of secondary sexual characteristics, must also include the evaluation of auxological parameters. Initial laboratory investigations should include serum gonadotropin levels (LH and FSH) and serum levels of the sex steroids. Brain MRI should be performed as indicated by the 2009 Consensus Statement in all boys regardless of chronological age and in all girls with onset of pubertal signs before 6 years of age. The gold standard in the treatment of central precocious puberty is represented by GnRH analogs, whereas, as far as peripheral forms are concerned, the triggering cause must be identified and treated. At the moment there are no reliable data establishing the criteria for discontinuation of GnRH analog therapy. However, numerous pieces of evidence suggest that the therapy should be suspended at the physiological age at which puberty occurs.
Collapse
Affiliation(s)
- Ginevra Micangeli
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (R.P.)
| | - Roberto Paparella
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (R.P.)
| | - Francesca Tarani
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (R.P.)
| | - Michela Menghi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (R.P.)
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (F.C.); (M.S.)
| | - Francesco Carlomagno
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (F.C.); (M.S.)
| | - Matteo Spaziani
- Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (F.C.); (M.S.)
| | - Ida Pucarelli
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (R.P.)
| | - Antonio Greco
- Department of Sensory Organs, Sapienza University of Rome, 00185 Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, 00185 Rome, Italy
| | - Luigi Tarani
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy (R.P.)
| |
Collapse
|
3
|
Joham AE, Norman RJ, Stener-Victorin E, Legro RS, Franks S, Moran LJ, Boyle J, Teede HJ. Polycystic ovary syndrome. Lancet Diabetes Endocrinol 2022; 10:668-680. [PMID: 35934017 DOI: 10.1016/s2213-8587(22)00163-2] [Citation(s) in RCA: 159] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
Abstract
Polycystic ovary syndrome (PCOS) affects 5-18% of women, and is a reproductive, metabolic, and psychological condition with impacts across the lifespan. The cause is complex, and includes genetic and epigenetic susceptibility, hypothalamic and ovarian dysfunction, excess androgen exposure, insulin resistance, and adiposity-related mechanisms. Diagnosis is recommended based on the 2003 Rotterdam criteria and confirmed with two of three criteria: hyperandrogenism (clinical or biochemical), irregular cycles, and polycystic ovary morphology. In adolescents, both the criteria of hyperandrogenism and irregular cycles are needed, and ovarian morphology is not included due to poor specificity. The diagnostic criteria generates four phenotypes, and clinical features are heterogeneous, with manifestations typically arising in childhood and then evolving across adolescent and adult life. Treatment involves a combination of lifestyle alterations and medical management. Lifestyle optimisation includes a healthy balanced diet and regular exercise to prevent excess weight gain, limit PCOS complications and target weight reduction when needed. Medical management options include metformin to improve insulin resistance and metabolic features, combined oral contraceptive pill for menstrual cycle regulation and hyperandrogenism, and if needed, anti-androgens for refractory hyperandrogenism. In this Review, we provide an update on the pathophysiology, diagnosis, and clinical features of PCOS, and discuss the needs and priorities of those with PCOS, including lifestyle, and medical and infertility treatment. Further we discuss the status of international evidence-based guidelines (EBG) and translation, to support patient self management, healthcare provision, and to set research priorities.
Collapse
Affiliation(s)
- Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | | | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, Hershey, PA, USA
| | - Stephen Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Endocrinology and Diabetes, Monash Health, Melbourne, VIC, Australia.
| |
Collapse
|
4
|
Joham AE, Peña AS. Polycystic Ovary Syndrome in Adolescence. Semin Reprod Med 2022; 40:e1-e8. [PMID: 36096151 DOI: 10.1055/s-0042-1757138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common, complex, and chronic condition that presents many diagnostic and management challenges for managing clinicians. PCOS diagnosis in adolescents presents a particular challenge for treating clinicians due to the overlap of diagnostic features with normal physiological changes during adolescence. Adolescent diagnostic criteria include well-defined menstrual irregularity according to time postmenarche and hyperandrogenism, but does not require the use of pelvic ultrasound. Adolescents with only one criterion should be considered at risk of PCOS and be followed up around transition to adult care. While PCOS was traditionally considered to be a reproductive disorder, PCOS is now recognized to have major metabolic and cardiovascular health consequences and psychological sequelae that can be present from adolescence. Management of PCOS includes healthy lifestyle, metformin, combined oral contraceptive pill, and/or antiandrogens according to symptoms of concern even in adolescents at risk of PCOS.
Collapse
Affiliation(s)
- Anju E Joham
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Melbourne, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| |
Collapse
|
5
|
de Souza Dias Lopes P, Machado SH, Lucena IRS, Marostica PJC. Ultrasound findings of pubertal development in girls with cystic fibrosis and their association with clinical outcomes and Tanner staging. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:632-639. [PMID: 34591408 PMCID: PMC10528569 DOI: 10.20945/2359-3997000000404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/22/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients with cystic fibrosis (CF) have a high incidence of pubertal and growth delay. In girls with CF, pubertal delay has an important psychological impact. Still, only a few studies have explored the occurrence of pubertal delay in girls with CF. The aims of this study were to compare the pubertal development of girls with CF compared with healthy controls regarding Tanner staging and pelvic ultrasound and, in girls with CF, correlate the findings with those of spirometry, body mass index, Shwachman-Kulczycki score (SKS), and genotyping. METHODS This was a cross-sectional, case-control study including 35 girls with CF aged 6-17 years and following up at the Pediatric Pulmonology Outpatient Clinic of a tertiary hospital. These patients were compared with 59 healthy controls who had undergone pelvic ultrasound as part of another study conducted by the same group. Girls with CF were consecutively enrolled in the study during their annual routine check-up visit. Data collected in the CF group included spirometry and anthropometric results, SKS values, bone age, occurrence of current cystic fibrosis-related diabetes (CFRD) and Pseudomonas aeruginosa colonization, history of meconium ileus, genotype, ultrasound parameters, and Tanner stage. RESULTS Pelvic ultrasound findings and Tanner stage reflected less pubertal development in girls with CF compared with healthy controls. Pubertal stage in patients with CF who presented CFRD (3.17 ± 1.16), had chronic colonization by Pseudomonas aeruginosa (3.10 ± 1.10), or were homozygous for the F508del mutation (1.91 ± 1.30) was more delayed than in controls (3.41 ± 1.41). Tanner stage correlated with age at menarche, bone age, and anthropometric and ultrasound data. CONCLUSION Girls with CF presented a delay in pubertal development evaluated by Tanner stage and ultrasound parameters, which was more evident in the presence of comorbidities.
Collapse
Affiliation(s)
- Paula de Souza Dias Lopes
- Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil,
| | - Sandra Helena Machado
- Departamento de Pediatria da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Paulo José Cauduro Marostica
- Departamento de Pediatria, Universidade Federal do Rio Grande do Sul; Serviço de Pneumologia Pediátrica do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| |
Collapse
|
6
|
Villalobos Gálvez M, Beltrán Salazar VP, Pérez Adell M, Durán Feliubadalo C, Corripio R. Updated reference values in pelvic ultrasonography for a Spanish population of healthy girls between 6 and 12 years old. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00233. [PMID: 34277960 PMCID: PMC8279629 DOI: 10.1002/edm2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 11/06/2022]
Abstract
Background Pelvic ultrasonography (PUS) of the uterus and ovaries allows the diagnosis of changes in sexual development. However, the reference values used in Spain originate from old studies conducted in other countries. Objective To determine reference uterine and ovarian measurements by PUS and according to pubertal status and bone age in a Spanish population of healthy girls aged between 6 and 12 years. Materials and methods Descriptive cross-sectional study performed on 221 healthy girls from 2017 to 2019. Ovarian and uterine measurements were described and associated with chronological age, bone age, and Tanner stage. ROC curves were used to assess the predictive value of tests for Tanner stage II. Results We described reference values for all PUS uterine and ovarian measurements assessed. Subjects in Tanner II (thelarche) had a mean age of 9.7 years (SD = 1.1) and mean BMI of 19.2 kg/m2. Fundal-cervical ratio changed from 1:1 to 2:1 at 12 years of chronological age (62.5% with 1:1 ratio; p < 0.0001) and 13 years of bone age (2:1 in 85.71%, p < 0.0001). Mean uterine length for Tanner II was 4.065 cm (SD = 0.736); mean ovarian volume was 2.466 cm3 (SD = 1.719). Bone age, ovarian volume, and uterine length were good predictors of Tanner stage II. Conclusion This is the first study providing reference uterine and ovarian PUS values in a Spanish population of healthy girls aged 6 to 12 years. Use of updated data characteristic of a specific population increases the diagnostic accuracy.
Collapse
Affiliation(s)
| | | | - Mireia Pérez Adell
- Pediatric Endocrine Department Parc Tauli Sabadell Hospital Universitari Sabadell Spain
| | | | - Raquel Corripio
- Pediatric Endocrine Department Parc Tauli Sabadell Hospital Universitari Sabadell Spain
| |
Collapse
|
7
|
Charlotte D, Djelouah M, Dumange M, Sanchez S, Chrusciel J, Bonneau S, Gabriel R, Hoeffel C, Graesslin O, Raimond E. Magnetic resonance imaging evaluation of cervical length by the women's age: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 254:245-250. [PMID: 33011508 DOI: 10.1016/j.ejogrb.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The anthropometric characteristics of the uterus evolve with pubertal development in girls. It is therefore permissible to ask until these anthropometric characteristics change, in order to know if the cervical length criterion defined for preterm delivery threats is applicable to all ages. The main objective of our study was to analyze the evolution of cervical length with the women's age outside pregnancy to overcome factors related to pregnancy that can affect cervical length. MATERIAL AND METHODS This retrospective descriptive study over a period of 1 year from March 2017 to March 2018. The cervical length measurements were performed by Magnetic Resonnance Imaging. The cervical length was defined by sagittal T2-weighted magnetic resonance imaging (MRI) as the distance on a straight line between the external cervical os (at the point of divergence of the anterior and posterior lips) and the internal cervical os identified by an intersection between the line of the hypersignal of the glandular epithelium and a line passing through the isthmus. RESULTS A total of 209 patients were included. The cervical length ranged from 25.2 mm on average in children under 16 years (23.6-27.1 mm) to 39.7 mm between 36 and 40 years (27.9 -58.9 mm). There was a linear association between age and cervical length, irrespective of maternal anthropometric data (Pearson's coefficient ρ = 0.43, 95% CI 0.32-0.54 (p < 0.01). In multivariate analysis, the only factors associated with cervical length were women's age (p < 0.01) and the prior delivery (p < 0.01). CONCLUSION The cervical length is correlated with women age and the prior delivery.
Collapse
Affiliation(s)
- David Charlotte
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Manel Djelouah
- Department of Radiology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Mathilde Dumange
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Stéphane Sanchez
- Clinical Research Unit and Care Research, Department of Medical Information, Performance Evaluation, Troyes Hospital Center, Troyes, France
| | - Jan Chrusciel
- Clinical Research Unit and Care Research, Department of Medical Information, Performance Evaluation, Troyes Hospital Center, Troyes, France
| | - Stéphanie Bonneau
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - René Gabriel
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Christine Hoeffel
- Department of Radiology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Emilie Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France; Department of Radiology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France; Clinical Research Unit and Care Research, Department of Medical Information, Performance Evaluation, Troyes Hospital Center, Troyes, France.
| |
Collapse
|
8
|
Peña AS, Witchel SF, Hoeger KM, Oberfield SE, Vogiatzi MG, Misso M, Garad R, Dabadghao P, Teede H. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med 2020; 18:72. [PMID: 32204714 PMCID: PMC7092491 DOI: 10.1186/s12916-020-01516-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/11/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. METHODS International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. RESULTS This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years post-menarche; > 90 days for any one cycle (> 1 year post-menarche), cycles< 21 or > 45 days (> 1 to < 3 years post-menarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an 'at risk' label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial. CONCLUSIONS Extensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence.
Collapse
Affiliation(s)
- Alexia S Peña
- Discipline of Paediatrics, The University of Adelaide Robinson Research Institute and Endocrine Department, Women's and Children's Hospital, 72 King William Road, North Adelaide, SA, 5006, Australia.
| | - Selma F Witchel
- Department of Pediatrics, Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M Hoeger
- Department of OBGYN, University of Rochester Medical Center, Rochester, NY, USA
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Columbia University Irving Medical Center, New York, NY, USA
| | - Maria G Vogiatzi
- Division of Endocrinology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Philadelphia, Philadelphia, PA, USA
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC, Australia
| |
Collapse
|
9
|
Huang Z, Yong EL. Ethnic differences: Is there an Asian phenotype for polycystic ovarian syndrome? Best Pract Res Clin Obstet Gynaecol 2016; 37:46-55. [DOI: 10.1016/j.bpobgyn.2016.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/19/2016] [Indexed: 11/17/2022]
|
10
|
Koshiba A, Mori T, Ito F, Tanaka Y, Takaoka O, Takahata A, Kitawaki J. Enlarged uterine corpus volume in women with endometriosis: Assessment using three-dimensional reconstruction of pelvic magnetic resonance images. J Obstet Gynaecol Res 2016; 43:157-163. [PMID: 27762475 DOI: 10.1111/jog.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/08/2016] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Abstract
AIM To assess and compare the uterine volume and endometrium length between women with and without endometriosis, using pelvic magnetic resonance imaging scans. METHODS In this case-control study, a total of 75 nulligravid women (aged 20-45 years) with regular menstrual cycles whose uterus were free of any surgically confirmed lesions were enrolled. The endometriosis group underwent surgery for endometrioma (n = 39), and the control group underwent surgery for non-endometrioma ovarian cysts (n = 36). The primary outcome was uterine corpus volume, which was assessed using three-dimensional reconstructions of preoperative pelvic magnetic resonance imaging scans. RESULTS The mean uterine volume was significantly larger in the endometriosis group than in the control group (mean ± standard deviation, 50.9 ± 14.4 cm3 vs 41.7 ± 14.3 cm3 ; P < 0.01). The longitudinal length and transverse diameter of the corpus and the longitudinal length of the endometrium were also significantly greater in the endometriosis group (all, P < 0.01). CONCLUSIONS An increase in uterine volume and endometrium length was observed in women with endometriosis.
Collapse
Affiliation(s)
- Akemi Koshiba
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Fumitake Ito
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yukiko Tanaka
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Takaoka
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Akiko Takahata
- Department of Radiology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| |
Collapse
|
11
|
Kelsey TW, Ginbey E, Chowdhury MM, Bath LE, Anderson RA, Wallace WHB. A Validated Normative Model for Human Uterine Volume from Birth to Age 40 Years. PLoS One 2016; 11:e0157375. [PMID: 27295032 PMCID: PMC4905658 DOI: 10.1371/journal.pone.0157375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/28/2016] [Indexed: 12/05/2022] Open
Abstract
Transabdominal pelvic ultrasound and/or pelvic Magnetic Resonance Imaging are safe, accurate and non-invasive means of determining the size and configuration of the internal female genitalia. The assessment of uterine size and volume is helpful in the assessment of many conditions including disorders of sex development, precocious or delayed puberty, infertility and menstrual disorders. Using our own data from the assessment of MRI scans in healthy young females and data extracted from four studies that assessed uterine volume using transabdominal ultrasound in healthy females we have derived and validated a normative model of uterine volume from birth to age 40 years. This shows that uterine volume increases across childhood, with a faster increase in adolescence reflecting the influence of puberty, followed by a slow but progressive rise during adult life. The model suggests that around 84% of the variation in uterine volumes in the healthy population up to age 40 is due to age alone. The derivation of a validated normative model for uterine volume from birth to age 40 years has important clinical applications by providing age-related reference values for uterine volume.
Collapse
Affiliation(s)
- Thomas W. Kelsey
- School of Computer Science, University of St Andrews, St Andrews KY16 9SX, United Kingdom
| | - Eleanor Ginbey
- School of Medicine, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Moti M. Chowdhury
- Department of Paediatric Radiology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
| | - Louise E. Bath
- Department of Endocrinology and Diabetes, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - W. Hamish B. Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
- * E-mail:
| |
Collapse
|
12
|
Sonographic evaluation of polycystic ovaries. Best Pract Res Clin Obstet Gynaecol 2016; 37:25-37. [PMID: 27118252 DOI: 10.1016/j.bpobgyn.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/27/2016] [Indexed: 10/22/2022]
Abstract
The morphological features of the ovaries in women with polycystic ovary syndrome (PCOS) have been well described by ultrasound imaging technology. These include enlarged ovary size, multiple small follicles of similar size, increased ovarian stromal volume and echogenicity, peripheral distribution of the follicles, and higher stromal blood flow. Ultrasound identification of the presence of polycystic ovarian morphology (PCOM) has been recognized as a component of PCOS diagnosis. With the advance of ultrasound technology, new definition has been proposed recently. There is, however, a paucity of data for the ovarian morphology in normal and PCOS adolescents. Magnetic resonance imaging has the potential to be an alternative imaging modality for diagnosing PCOM in adolescence.
Collapse
|
13
|
Zung A, Kori M, Burundukov E, Ben-Yosef T, Tatoor Y, Granot E. Homozygous deletion of TRMT10A as part of a contiguous gene deletion in a syndrome of failure to thrive, delayed puberty, intellectual disability and diabetes mellitus. Am J Med Genet A 2015; 167A:3167-73. [PMID: 26297882 DOI: 10.1002/ajmg.a.37341] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 08/10/2015] [Indexed: 12/31/2022]
Abstract
Two recent reports describe a new syndrome of intellectual disability, short stature, microcephaly, and young onset diabetes or disturbed glucose metabolism in association with inactivating mutations in the TRMT10A gene. We investigated the clinical spectrum presented by a 17-year-old female with a homozygous contiguous gene deletion involving the TRMT10A gene. From infancy, she presented with failure to thrive and microcephaly. Puberty was characterized by a slow and an inconsistent course of progression. Concomitantly, gonadotropin levels fluctuated between low and high levels which were compatible with gonadal failure. Unlike the previous reports, the patient had ketoacidosis at onset of diabetes and islet cell autoantibodies. Nevertheless, glycemic control was excellent (HbA1C 5.0%-6.2%). RT-PCR and Western blot analysis demonstrated a complete abolishment of TRMT10A mRNA and its translated protein. In order to elucidate the nature of diabetes in this patient, endogenous insulin secretion and glycemic control were evaluated by a glucagon stimulation test and continuous glucose monitoring both during insulin treatment and off therapy. Endogenous insulin secretion still persisted 22 months after onset of diabetes and relatively normal glucose levels were kept over 3 days without insulin treatment. The fluctuating course of puberty and diabetes may reflect intermittent apoptotic damages due to sensitization of the relevant cells to various stress agents in the absence of functional TRMT10A.
Collapse
Affiliation(s)
- Amnon Zung
- Pediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Michal Kori
- Pediatric Gastroenterology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Ella Burundukov
- Pediatric Endocrinology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Tamar Ben-Yosef
- Department of Genetics, The Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yasmin Tatoor
- Department of Genetics, The Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa, Israel
| | - Esther Granot
- Hadassah Medical School, Hebrew University, Jerusalem, Israel.,Division of Pediatrics, Kaplan Medical Center, Rehovot, Israel
| |
Collapse
|
14
|
Bakhsh H, Dei M, Bucciantini S, Balzi D, Bruni V. Premature ovarian insufficiency in young girls: repercussions on uterine volume and bone mineral density. Gynecol Endocrinol 2015; 31:65-9. [PMID: 25203144 DOI: 10.3109/09513590.2014.958987] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVE To evaluate biological differences among young subjects with premature ovarian insufficiency (POI) commencing at different stages of life. DESIGN Retrospective observational study. SETTING Careggi University Hospital Participants: One hundred sixty-two females aged between 15 and 29 years with premature ovarian insufficiency. METHODS Data were collected as a retrospective chart review of baseline evaluation at diagnosis of premature ovarian insufficiency (POI). About 162 participants were divided into four groups based on gynecological age. Two primary outcome variables (uterine development and bone mineral density (BMD)) were analyzed in terms of differences among groups and in a multivariate logistic regression analysis. RESULTS Uterine development was clearly jeopardized when estrogen insufficiency started at a very young age. Total body BMD showed significant differences among the four groups studied, clearly corresponding to the duration of ovarian function. Data were discussed in relation to the choice of hormone replacement therapy regimens.
Collapse
Affiliation(s)
- Hanadi Bakhsh
- Pediatric and Adolescent Gynecology Unit, Careggi Hospital , Florence , Italy
| | | | | | | | | |
Collapse
|
15
|
Radivojevic UD, Lazovic GB, Kravic-Stevovic TK, Puzigaca ZD, Canovic FM, Nikolic RR, Milicevic SM. Differences in anthropometric and ultrasonographic parameters between adolescent girls with regular and irregular menstrual cycles: a case-study of 835 cases. J Pediatr Adolesc Gynecol 2014; 27:227-31. [PMID: 24656703 DOI: 10.1016/j.jpag.2013.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/22/2013] [Accepted: 11/01/2013] [Indexed: 01/21/2023]
Abstract
STUDY OBJECTIVE Exploring the relation between the age, time since menarche, anthropometric parameters and the growth of the uterus and ovaries in postmenarcheal girls. DESIGN Cross sectional. SETTING Department of Human reproduction at a tertiary pediatric referral center. PARTICIPANTS Eight hundred thirty-five adolescent girls. INTERVENTIONS Postmenarcheal girls were classified according to the regularity of their menstrual cycles in 2 groups (regular and irregular cycles) and compared. Anthropometric measurements and ultrasonographic examination of the pelvis was conducted with all participants. MAIN OUTCOME MEASURES Anthropometric and ultrasonographic parameters were evaluated. RESULTS Results of our study showed that girls with regular and irregular cycles differed in height, weight, body mass index, percentage of body fat and ovarian volumes. The size of the ovaries decreases in the group of girls with regular cycles (r = 0.14; P < .005), while it increases in girls with irregular cycles (r = 0.15; P < .001) with advancing age. Uterine volume in all patients increases gradually with age reaching consistent values at 16 years (r = 0.5; P < .001). Age at menarche, the time elapsed since menarche, the height, weight, body mass index and percentage of body fat in patients correlated with uterine volume. Ovarian volume correlated with patients' weight, BMI and percentage of fat. CONCLUSION Uterus continues to grow in postmenarcheal years, with increasing height and weight of girls, regardless of the regularity of cycles. Postmenarcheal girls with irregular cycles were found to have heavier figures and larger ovaries.
Collapse
Affiliation(s)
- Ubavka D Radivojevic
- Department of Human Reproduction, Mother and Child Healthcare Institute "Dr Vukan Cupic," Belgrade, Serbia.
| | - Gordana B Lazovic
- Institute of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara K Kravic-Stevovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zarko D Puzigaca
- Department of Human Reproduction, Mother and Child Healthcare Institute "Dr Vukan Cupic," Belgrade, Serbia
| | | | - Rajko R Nikolic
- Department of Human Reproduction, Mother and Child Healthcare Institute "Dr Vukan Cupic," Belgrade, Serbia
| | - Srboljub M Milicevic
- Institute of Gynecology and Obstetrics, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
16
|
Verguts J, Ameye L, Bourne T, Timmerman D. Normative data for uterine size according to age and gravidity and possible role of the classical golden ratio. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:713-717. [PMID: 23754297 DOI: 10.1002/uog.12538] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 05/10/2013] [Accepted: 05/29/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To document normal measurements (length, width, anteroposterior (AP) diameter) and proportions of the non-pregnant uterus according to age and gravidity. We hypothesized that uterine proportions conform to the classical 'golden ratio' (1.618). METHODS This was a retrospective study of ultrasonographic measurements of the length, width and AP diameter of non-pregnant uteri recorded in our database between 1 January 2000 and 31 July 2012. All patients for whom abnormal findings were reported were excluded and only the first set of measurements for each patient was retained for analysis. Loess (local regression) analysis was performed using age and gravidity as explanatory variables. RESULTS Measurements of 5466 non-pregnant uteri were retrieved for analysis. The mean length was found to increase to 72 mm at the age of 40 and decrease to 42 mm at the age of 80 years. Gravidity was associated with greater uterine length, width and AP diameter. Mean length/width ratio was found to be 1.857 at birth, decreasing to 1.452 at the age of 91 years. At the age of 21 years, the mean ratio was found to be 1.618, i.e. equal to the golden ratio. Increasing gravidity was associated with lower mean length/width ratio. CONCLUSIONS Uterine size in non-pregnant women varies in relation to age and gravidity. Mean length/width ratio conformed to the golden ratio at the age of 21, coinciding with peak fertility.
Collapse
Affiliation(s)
- J Verguts
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Jessa Hospital, Hasselt, Belgium
| | | | | | | |
Collapse
|
17
|
Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome. Fertil Steril 2013; 101:280-287.e1. [PMID: 24188871 DOI: 10.1016/j.fertnstert.2013.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the diagnostic potential of ultrasonographic markers of ovarian morphology, used alone or in combination, to predict polycystic ovary syndrome (PCOS). DESIGN A diagnostic test study using cross-sectional data collected from 2006-2011. SETTING Academic hospital and clinical research unit. PATIENT(S) Eighty-two women with PCOS and 60 healthy female volunteers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicle number per ovary (FNPO), ovarian volume (OV), follicle number per single cross-section (FNPS), follicle distribution pattern, stromal area, ovarian area, stromal-to-ovarian area ratio (S:A), and stromal index (SI). RESULT(S) Follicle number per ovary best predicted PCOS (R(2) = 67%) with 85% sensitivity and 98% specificity, followed by OV (R(2) = 44%), and FNPS (R(2) = 36%). Neither S:A nor SI had predictive power for PCOS. In combination, FNPO+S:A and FNPO+SI most significantly predicted PCOS (R(2) = 74% vs. 73%, respectively). The diagnostic potentials of OV and FNPS were substantially improved when used in combination (OV+FNPO, R(2) = 55%). CONCLUSION(S) As a single metric, FNPO best predicted PCOS. Although the addition of S:A or SI improved the predictive power of FNPO, gains were marginal, suggesting limited use in clinical practice. When image quality precludes a reliable estimation of FNPO, measurements of OV+FNPS provide the next closest level of diagnostic potential.
Collapse
|
18
|
Kelsey TW, Dodwell SK, Wilkinson AG, Greve T, Andersen CY, Anderson RA, Wallace WHB. Ovarian volume throughout life: a validated normative model. PLoS One 2013; 8:e71465. [PMID: 24019863 PMCID: PMC3760857 DOI: 10.1371/journal.pone.0071465] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/07/2013] [Indexed: 12/18/2022] Open
Abstract
The measurement of ovarian volume has been shown to be a useful indirect indicator of the ovarian reserve in women of reproductive age, in the diagnosis and management of a number of disorders of puberty and adult reproductive function, and is under investigation as a screening tool for ovarian cancer. To date there is no normative model of ovarian volume throughout life. By searching the published literature for ovarian volume in healthy females, and using our own data from multiple sources (combined n = 59,994) we have generated and robustly validated the first model of ovarian volume from conception to 82 years of age. This model shows that 69% of the variation in ovarian volume is due to age alone. We have shown that in the average case ovarian volume rises from 0.7 mL (95% CI 0.4–1.1 mL) at 2 years of age to a peak of 7.7 mL (95% CI 6.5–9.2 mL) at 20 years of age with a subsequent decline to about 2.8 mL (95% CI 2.7–2.9 mL) at the menopause and smaller volumes thereafter. Our model allows us to generate normal values and ranges for ovarian volume throughout life. This is the first validated normative model of ovarian volume from conception to old age; it will be of use in the diagnosis and management of a number of diverse gynaecological and reproductive conditions in females from birth to menopause and beyond.
Collapse
Affiliation(s)
- Thomas W. Kelsey
- School of Computer Science, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Sarah K. Dodwell
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - A. Graham Wilkinson
- Department of Paediatric Radiology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Tine Greve
- Laboratory of Reproductive Biology, Section 5712, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Claus Y. Andersen
- Laboratory of Reproductive Biology, Section 5712, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - W. Hamish B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
- * E-mail:
| |
Collapse
|
19
|
D'Agostini C, de Oliveira M, D'Souza-Li L. Comparison of cervical length in adult and adolescent nulliparae at mid-gestation. J Pediatr Adolesc Gynecol 2013; 26:209-11. [PMID: 23773795 DOI: 10.1016/j.jpag.2013.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/01/2013] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To compare cervical lengths of adolescents and adults in mid-gestation. DESIGN An analytical, observational, and cross-sectional study. SETTING Public health system in the city of Blumenau, Brazil. PARTICIPANTS Primigravidae adolescents under the age of 16 and adults over age 20 (n = 40/group) were systematically sampled. INTERVENTIONS Cervical measurements were performed between 21 and 24 weeks of gestation through transvaginal ultrasonography using a previously validated method. MAIN OUTCOME MEASURES Mean cervical length (Mann-Whitney test) and percentage of cervices below 25 mm (Fisher exact test). RESULTS For adolescents and adults, average uterine cervix lengths were 28 ± 6.6 mm 33 ± 4.1 mm (P < .0001), respectively, and the proportion of cervixes below 25 mm were 27.5% and 7.5% (P < .02), respectively. In addition, adolescents had significantly lower gynecologic age, education, and family income than adults. CONCLUSION Primigravida adolescents under the age of 16 have shorter cervices than adults, and a higher percentage of adolescents have cervices shorter than 25 mm. This may be associated with the higher risk of preterm birth observed in adolescents and suggests that this population requires special attention in prenatal care.
Collapse
Affiliation(s)
- Carla D'Agostini
- Faculty of Medical Science, University of Campinas, and Department of Medicine, Health Sciences Center, Regional University of Blumenau, Blumenau, Brazil.
| | | | | |
Collapse
|
20
|
Amies Oelschlager AME, Sawin R. Teratomas and Ovarian Lesions in Children. Surg Clin North Am 2012; 92:599-613, viii. [DOI: 10.1016/j.suc.2012.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
21
|
|