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Mayer-Rokitansky-Küster-Hauser syndrome is a congenital disorder typified by an underdeveloped female reproductive tract. An exploratory online survey of adults with Mayer-Rokitansky-Küster-Hauser syndrome found that many did not recall receiving the human papillomavirus vaccine, and answers to knowledge questions suggested inadequate human papillomavirus counseling. However, recalled vaccine counseling was associated with improved uptake. [ABSTRACT FROM AUTHOR]

Endometriosis is a chronic condition, with debilitating symptoms affecting all ages. Dysmenorrhea and pelvic pain often begin in adolescence, affecting school, daily activities, and relationships. Despite the profound burden of endometriosis, many adolescents experience suboptimal management and significant delay in diagnosis. The symptomatology and laparoscopic findings of endometriosis in adolescents are often different than in adults, and the medical and surgical treatments for adolescents may differ from those for adults as well. This Narrative Review summarizes the diagnosis, evaluation, and management of endometriosis in adolescents. Given the unique challenges and complexities associated with diagnosing endometriosis in this age group, it is crucial to maintain a heightened level of suspicion and to remain vigilant for signs and symptoms. By maintaining this lower threshold for consideration, we can ensure timely and accurate diagnosis, enabling early intervention and improved management in our adolescent patients. [ABSTRACT FROM AUTHOR]

Objective While postpartum depot medroxyprogesterone acetate (DMPA) is a highly effective form of contraception, some data suggest an association with depressive symptoms. Our objective was to evaluate the relationship between receipt of DMPA in the immediate postpartum period and postpartum depressive symptoms. Study Design This retrospective cohort study included all women who received prenatal and postpartum care at academic obstetric clinics affiliated with a tertiary care institution between January 1, 2008 and December 31, 2014. All women were counseled on contraception prior to hospital discharge. DMPA was available in the hospital pharmacy, and its utilization was documented in the electronic health record. The Patient Health Questionnaire 9 (PHQ-9) was used to screen for postpartum depression for all women at all postpartum visits. A score of 10 or greater was categorized as positive. Bivariable and multivariable analyses were used to identify the association between immediate postpartum DMPA use and a positive postpartum depression screen. Results Of the 5,073 women who met inclusion criteria, 410 (8.1%) received DMPA prior to hospital discharge. Compared with women who did not receive DMPA, women who received DMPA prior to hospital discharge were younger, more likely to identify as Black race or Latinx ethnicity, and more likely to be publicly insured. Clinical characteristics also differed. Women who received DMPA were more likely to be obese and to have experienced prenatal depressive symptoms, been diagnosed with a hypertensive disorder of pregnancy, delivered preterm, and delivered vaginally. Receipt of immediate postpartum DMPA was not associated with having a positive screen for postpartum depression in bivariable (5.4 vs. 6.0%, p = 0.29) or multivariable (adjusted odds ratio 0.94, confidence interval 0.53–1.68) analyses. Conclusion Receipt of postpartum DMPA is not associated with a positive postpartum PHQ-9 screen. Concerns about precipitating postpartum depression should not preclude the utilization of DMPA as a contraceptive agent. Key Points Contraception is an important issue for obstetricians to address with postpartum patients. Concerns have been raised over the relationship between DMPA and depression. Our study shows that DMPA is not associated with a positive postpartum depression screen. [ABSTRACT FROM AUTHOR]

To explore the use duration of a gonadotropin-releasing hormone agonists (GnRHa) plus add-back in adolescents with laparoscopically confirmed endometriosis and the treatment course before and after GnRHa therapy. Retrospective cohort study. We identified 51 subjects with laparoscopically confirmed endometriosis who had participated in a randomized trial of a GnRHa plus add-back as adolescents between 2008 and 2012. Electronic medical records were reviewed to obtain demographic data, clinical characteristics, and treatment outcomes after trial completion. The study was deemed IRB exempt. The average age of participants during trial enrollment was 17.9 ± 1.7 years. Thirty-three participants had stage I endometriosis (65%). The most common treatments trialed before GnRHa therapy were combined oral contraceptives (n = 47, 92%) and progestin-only pills (n = 23, 45%). The average duration of GnRHa use during the trial was 9.5 ± 3.5 months; 34 subjects (67%) completed the 1-year trial. After trial completion, 23 subjects (45%) continued to use a GnRHa with add-back therapy. The mean duration of additional GnRHa use was 31.7 ± 28.6 months, and the longest identified duration was an additional 96 months. Twenty-four subjects switched to other hormonal treatments after trial participation, most commonly oral progestins (n = 15) or combined oral contraceptives (n = 6). Thirteen participants (25%) returned to a therapy that had been trialed before GnRHa use. Almost half the participants in this cohort continued to use a GnRHa with add-back for treatment of endometriosis beyond the 12-month recommended duration. Treatment varied widely after discontinuation of GnRHa, with many participants returning to previously trialed medical therapies. [ABSTRACT FROM AUTHOR]

This study aimed to characterize the incidence and management of postoperative vaginal bleeding concerns experienced by transgender adolescents and young adults (AYA) on testosterone hormone therapy after gender-affirming hysterectomy (GAH). This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care children's hospital. The incidence of patient-reported postoperative vaginal bleeding concerns and management of bleeding are described. Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or operative characteristics reached statistical significance in association with postoperative bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding without intervention. Among 11 patients who underwent an exam for evaluation of bleeding, findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%). Over half of transgender AYA on testosterone therapy in this cohort reported postoperative vaginal bleeding concerns that were most often secondary to atrophy and granulation tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding could worsen gender dysphoria, these findings support the need for patient counseling on postoperative bleeding expectations and identification of interventions to reduce vaginal bleeding after GAH. [ABSTRACT FROM AUTHOR]

This study aimed to assess the prevalence of provider self-disclosure (PSD) of intrauterine device (IUD) usage with adolescent patients and identify the content and context of their PSD. A cross-sectional study Providers sex-assigned female at birth who counsel adolescents or young adults on contraception Participants were asked to voluntarily complete a web-based survey disseminated through the North American Society for Pediatric and Adolescent Gynecology listserve. PSD in relation to IUD use (IUD-PSD) and other contraception use Eighty-five respondents completed the survey. Thirty-one (36%) reported that PSD of contraception usage to adolescents is usually or always appropriate, 32 (38%) as neither appropriate nor inappropriate, and 22 (26%) as usually or always inappropriate. Regarding IUDs, 61 respondents have used or are currently using an IUD. Forty-four (72%) IUD users have self-disclosed IUD use to an adolescent by choice, 6 (10%) have only by patient request, and 9 (15%) have never self-disclosed use. Out of 52 IUD users, 32 (62%) stated that IUD-PSD most often occurs when the patient has decided on the IUD but has questions, 25 (48%) when the patient was debating between fewer methods, and 14 (27%) when discussing all contraceptive options with the patient. Respondents who choose to self-disclose IUD use are more likely to disclose other contraceptive use compared with those who do not self-disclose IUD use (P < 0.001) and are also more likely to disclose personal family aspects (P < 0.001). Self-disclosure of IUD usage is relatively common among study respondents and occurs most often after a patient has decided on an IUD. [ABSTRACT FROM AUTHOR]

To study the feasibility of virtual visits for ambulatory encounters in pediatric and adolescent gynecology A retrospective review Boston Children's Hospital Patients who were seen virtually through the Division of Gynecology between January 1, 2020 and June 1, 2020 Patient demographics, visit diagnoses, and operational characteristics of the completed visits There were a total of 654 virtual visits for 614 patients. Ninety-one percent (n=558) of patients were in-state, and the median age of patients was 17 years (range 0 – 37 years). The majority were return visits (n=502, 76.8%), 115 (17.6%) were new patient visits, and 32 (4.89%) were post-operative visits. The median virtual visit duration was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (n=485, 74.2%), abnormal uterine bleeding (n=225, 34.4%), and pelvic pain (n=82, 12.5%). The percentage of virtual visits which required an in-person follow-up visit within 90 days was low (n=14, 2.1%). Five of these were within 30 days from the initial virtual visit, 6 were within 60 days, and 3 were within 90 days. Telemedicine is a feasible method for expanding access to, and healthcare delivery for, pediatric and adolescent gynecology, with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up. [ABSTRACT FROM AUTHOR]

This study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults. We conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least 1-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded. A total of 936 IUD insertions were attempted, 45% for contraception only, 18% for menstrual management only, and 37% for both indications. Insertion was successful in 868 (93%) attempts, and success did not differ by indication (p = 0.74). The mean age at insertion was 18.9 years (SD = 2.4 years), with no difference by indication. Of the completed insertions, 650 (75%) had at least one follow-up during the data analysis period. Excluding those without follow-up, the overall continuation rates were 77% at 1 year, 66% at 2 years, and 54% at 3 years. While continuation rates did not differ by indication at 1 year, at 3 years, continuation was highest among those who sought the device for menstrual management only (contraception = 53%, menstrual = 57%, both = 53%, p < 0.01) Malposition was rare (4.0%), as was device expulsion (2.5%), and these did not differ by indication. IUD continuation rates were high among adolescents and young adults and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use. Adolescents and young adults may seek the hormonal IUD for contraception and/or menstrual management. Our study found that IUD continuation rates were high at 1 year regardless of the indication for utilization. [ABSTRACT FROM AUTHOR]

To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes. A retrospective review. Boston Children's Hospital. Transmasculine persons younger than 26 years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1, 2020. Not applicable. An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes. Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%) were first treated with combined oral contraceptives, but 14/23 (61%) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of 35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed 20 months after initiating testosterone treatment. Their endometriosis was treated with combined oral contraceptives, danazol, or progestins; four experienced suboptimal response during treatment with these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when using testosterone. Five patients with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced persistent symptomatology with combined testosterone and progestin therapies. To our knowledge, this is the first study to characterize endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease confirmation. Although testosterone treatment can resolve symptoms in some, others might require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when they are using testosterone. [ABSTRACT FROM AUTHOR]

Endometriosis is the leading pathologic cause of dysmenorrhea and chronic pelvic pain among adolescents. The appearance of endometriosis in adolescents may be different from that in female adults, resulting in delayed recognition and intervention. This article addresses the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of endometriosis in the adolescent. [ABSTRACT FROM AUTHOR]

Objective  We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. Study Design  This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. Results  Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p  < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48–0.99). Conclusion  Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit. [ABSTRACT FROM AUTHOR]

Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare diagnosis; patients classically present with dysmenorrhea and increasing pelvic pain. Unusual manifestations of OHVIRA syndrome might occur as a result of patient anatomy and the rupture or relief of the obstructed hemivagina. We present a 15-year-old patient with OHVIRA syndrome who developed a spontaneous cervicovaginal fistula and subsequently underwent hemihysterectomy. [ABSTRACT FROM AUTHOR]

Study Objective To evaluate the prevalence of anemia among female adolescents and young adults seeking abortion care at a county hospital, and to determine its associated factors. Design A cross-sectional retrospective study. Setting John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois. Participants Young women (N = 2916; ages 11-24 years) who underwent first trimester medical or surgical termination in 2016. Interventions and Main Outcome Measures Hemoglobin concentration at time of presentation, age, gestational age, body mass index, race/ethnicity, education, sexually transmitted infection status, and insurance status. Results On average, women were 21 (SD, 2.2) years old, 87% (2545 of 2916) African-American, and 64% (1863 of 2916) were Medicaid recipients. Gestational age at time of presentation ranged from 4 weeks 6 days to 13 weeks 6 days, and 58% (1695 of 2916) had surgical termination. Overall, 16% (451 of 2916) had hemoglobin concentrations of less than 11 g/dL. Categorization of severity showed that 4% (126 of 2916) of women had moderate and 11% (325 of 2916) had mild anemia. Only 2.6% of women (75 of 2916) had any history of anemia, and 91% (412 of 451) of anemic women did not have a preexisting anemia diagnosis. Fifteen percent of anemic women (51 of 451) had positive sexually transmitted infection screening, but positive status was not associated with anemia in crude or multivariable models ( P = .4-.6). In a multivariable model, later gestational age, decreasing body mass index, and multiparity were significantly associated with anemia prevalence after adjustment. Conclusion Our study showed an elevated prevalence of undiagnosed anemia. Ultimately, the abortion care setting can be an intersection for continued ambulatory care and provides an important opportunity to diagnose and educate young women on anemia management. [ABSTRACT FROM AUTHOR]

Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome, is a rare genetic disorder characterized by a predisposition to various benign and malignant tumors, including ovarian fibromas. The purpose of this study is to report the presentation and management of patients with Gorlin Syndrome and ovarian fibromas at a single institution. This was an IRB-approved retrospective chart review of adolescents with a diagnosis of Gorlin Syndrome who received care at a single tertiary care center from 1990 to 2022. Medical records were reviewed for demographics, clinical characteristics, and treatment outcomes. A total of four patients were identified, with a median age of 14 years (range 5-18) at the time of surgery (Table 1). Three patients had a known diagnosis of Gorlin syndrome before presentation to a gynecologist due to prior diagnoses of basal cell carcinomas. One patient was diagnosed with Gorlin syndrome only after a diagnosis of ovarian fibroma; this 5-year-old underwent right salpingo-oophorectomy of a torsed 4.3 cm fibroma with necrotic adnexa. At age 17, she had recurrence of an asymptomatic 4.5 cm fibroma on the left ovary and underwent a cystectomy. An oophorectomy was performed in all two patients who presented with symptoms of adnexal torsion, as well as in one asymptomatic 18-year-old with a 7.6 cm ovarian fibroma without discrete borders amenable to cystectomy. The dominant fibromas at time of surgery ranged in size from 4 to 9 cm, and three had multiple fibromas (maximum 9) present. Of the three patients who had surveillance imaging, two with prior oophorectomy had recurrence in the remaining contralateral ovary. Of the three patients that had transverse laparotomies on initial presentation, two underwent unilateral oophorectomies, and one had a cystectomy. The remaining patient underwent a laparoscopic right salpingo-oophorectomy of a torsed right ovary and left ovarian cystectomy in the setting of multiple bilateral lesions. To our knowledge, this is the largest series documenting the presentation and surgical management of ovarian fibromas in pediatric patients with Gorlin Syndrome. Ovarian fibroma treatment varied widely, and the presence of multiple and bilateral ovarian lesions raised the likelihood of oophorectomy. Ovarian conservation should be prioritized in patients with Gorlin Syndrome, as they are at high risk of iatrogenic menopause and infertility secondary to oophorectomy with their initial or repeat surgical management. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1377574-1-ANY.docx [ABSTRACT FROM AUTHOR]

Leuprolide acetate is a gonadotropin-releasing hormone agonist (GnRHa) and a treatment option for endometriosis, but it is not approved for use beyond 12 months due to the potential long-term side effects on bone density. Small cohort studies in adults have demonstrated "off label" use beyond this timeframe, and it is unknown if GnRHa is continued for long-term use in adolescents. Additionally, alternative treatment options following GnRHa discontinuation are poorly understood. This study aimed to describe the long-term use of leuprolide acetate in adolescents with endometriosis and to explore the treatment course after its discontinuation. We identified 51 subjects with laparoscopically-confirmed endometriosis who had participated in a year-long randomized clinical trial of GnRHa plus add-back as adolescents between 2008-2012. Electronic medical records were reviewed to obtain demographic data, clinical characteristics, and treatment outcomes following trial completion. The study was deemed IRB exempt. The average age of participants during trial enrollment was 17.9 ± 1.7 y. Thirty-three participants had stage I endometriosis (65%), whereas n=18 had stage II endometriosis (35%). The most common treatments trialed before GnRHa were combined oral contraceptive pills (n=47, 92%) and progestin-only pills (n=23, 45%). The average duration of GnRHa use during the trial was 9.5 ± 3.5 months; 34 subjects (67%) completed the one-year trial. After completion of the one-year trial, 23 subjects (45%) continued to use GnRHa with add back therapy. Mean duration of GnRHa use after trial completion was an additional 31.7 ± 28.6 months, and the longest identified duration an additional 96 months. Twenty-four subjects switched to other hormonal treatments after trial participation, most commonly oral progestins (n=15) or combined oral contraceptives (n=6). Thirteen participants (25%) returned to a therapy that had been trialed before GnRHa. Almost half the participants continued to utilize GnRHa with steroid add-back beyond the 12-month recommended duration. As there are no data supporting one treatment over another, the treatment choice utilized by each subject varied widely after discontinuation of GnRHa, with many returning to previously trialed medical therapies. [ABSTRACT FROM AUTHOR]

The intrauterine device (IUD) is a long-acting reversible contraceptive with potential non-contraceptive benefits. Adolescents and young adults (AYA) may seek the IUD for menstrual manipulation, but there is minimal literature on its continuation when used for non-contraceptive reasons. The objective of this study was to estimate and compare continuation rates of the IUD placed for contraceptive or menstrual manipulation indications. This prospective cohort study included all IUD insertions from January 1, 2017, through December 31, 2020, with at least 1-year follow-up, across 4 Adolescent Medicine practices. IUD insertions were attempted in the outpatient clinic setting and included all IUD types. The indication for placement (contraception, menstrual management, or both) was identified at time of insertion, and insertions without known indication were excluded. Routine clinical information was captured at insertion, follow-up, and removal visits. One-, two-, and three-year IUD continuation rates were assessed, as well as complications and cited reasons for removal. Analysis included Cochran-Mantel-Haenszel chi-square tests for categorical variables. Cox proportional-hazard modeling was used to examine predictors of time to discontinuation, accounting for site using a robust sandwich estimator to adjust standard errors. The study was IRB approved at all participating institutions. A total of 970 IUD insertions were attempted, 46% for contraception only, 17% for menstrual management only, and 36% for both indications. Insertion was successful in 901 (93%) attempts, and success did not differ by indication (p=0.87). The mean age of patients at insertion was 18.9 years (SD=2.40 y), with no significant difference by indication. The IUD continuation rate at 1 year was 88% and 82.2% at 3 years. There were no statistically significant differences in the continuation rate by indication at 1 year (p=0.22); however, at 3 years, patients seeking the IUD for contraception alone were less likely to still have the device (p< 0.001, Figure 1). Reasons for removal (n=175) did not differ by indication (Table 1). Malposition was rare (4%), as was device expulsion (3%), and these did not differ by indication. IUD continuation rates were high among AYA and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use. Supporting Figures or Tables: https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1353628-1-ANY(3).docx https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1353628-2-ANY(8).docx [ABSTRACT FROM AUTHOR]

We report two patients with bilateral pulmonary embolism who presented to our county hospital reproductive health services clinic. Both patients underwent an uncomplicated first-trimester aspiration abortion while on therapeutic unfractionated heparin therapy. Anticoagulation therapy may be modified to safely perform first-trimester surgical termination without significant blood loss. [ABSTRACT FROM AUTHOR]

A secondary somatic malignancy (SSM) occurs due to malignant transformation of a somatic component in a mature cystic teratoma (MCT). The phenomenon is rare, occurring in only 0.2-2% of MCTs, and can mimic immature teratoma. In general, prognosis of mature cystic teratoma with SSM is worse than with MCT alone, and consideration of additional adjuvant therapies specific to the given secondary somatic neoplasm is warranted. A 15-year-old adolescent female presented for ambulatory gynecologic care with abdominal swelling. Imaging studies identified an 18 cm complex pelvic mass with calcifications and fatty elements consistent with a dermoid cyst (Figure 1). Serological tumor biomarkers were within normal ranges. The patient underwent exploratory laparotomy with a midline vertical incision. Intraoperative findings revealed a large right ovarian mass with a smooth capsule, but no normal identifiable ovarian tissue. The contralateral ovary and bilateral fallopian tubes were normal in appearance. Pelvic washings were obtained, and an uncomplicated right oophorectomy was performed without spillage. Pathologic evaluation revealed a cystic and solid mature teratoma with elements from all three germ layers. Upon microscopic examination, a solid area with nodular disorganized primitive neural tissue morphologically resembling desmoplastic nodular medulloblastoma was identified bordering areas with more well-differentiated cerebellar features. The primitive neural tissue had abundant mitoses, and multi-layered rosettes and tubules were not seen. Supporting the morphologic impression, synaptophysin was positive throughout the neural tissue, and along with reticulin, accentuated the nodular areas; while GFAP, vimentin, and OLIG2 stains were negative (Figure 2). Next-generation based sequencing panel and DNA methylation studies did not identify any Tier I molecular alterations or methylation profile matches, respectively. There was no tumor extension beyond the capsule margins of the MCT. The patient was referred to oncology and noted to have no evidence of disease on post-operative imaging. No further treatment was indicated, with plan for surveillance imaging. SSM arising from an ovarian MCT is a rare phenomenon that may not be identified until after surgical management. As there may not be suspicious features of SSM on preoperative imaging, mature teratomas should be handled with surgical caution in order to avoid spillage of potential malignant contents in what may otherwise appear to be a benign MCT. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1377580-1-ANY(2).pdf https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1377580-2-ANY.pdf [ABSTRACT FROM AUTHOR]

Abstract Study Objective To examine characteristics of adolescent patients presenting for multiple terminations within 1 year and evaluate sexually transmitted infection (STI) status at each visit. Design, Setting, and Participants Cross-sectional retrospective chart review to identify women younger than age 20 years who underwent multiple abortions during 1 year at John H. Stroger, Jr Hospital of Cook County. Interventions None. Main Outcome Measures Rates and results of STI testing at each abortion encounter. Results We identified 381 adolescent patients with 2 or more abortions in 1 year. Of the 285 women who received STI testing at both clinical encounters, we identified 12 women with Chlamydia trachomatis (CT)/ Neisseria gonorrhoeae (GC) coinfection. Among patients who were not coinfected, 47 of 273 (17.2%) and 4 of 273 (1.5%) tested positive for CT and GC at the initial visit, respectively. Among women who were STI negative at the time of their first abortion, 25 of 226 (11.1%) were positive for CT and 1 of 269 (0.37%) was positive for GC at the time of their second termination. Conclusion Young women in our study had higher baseline rates of CT and GC than rates reported by the Centers for Disease Control and Prevention for an age-matched population. High rates of positivity at the second visit might indicate a need for increased health education and/or frequency of testing in high-risk groups. In the adolescent population for whom patient encounters can be limited, the abortion care visit provides an opportunity to provide education and mitigate risk. [ABSTRACT FROM AUTHOR]