Anne Marie Amies Oelschlager

Management of Large Ovarian Neoplasms in Pediatric and Adolescent Females

The overwhelming majority of ovarian cysts in pediatric and adolescent girls are physiologic; however, large simple and complex ovarian lesions often require surgical intervention due to the increased risk of neoplasia. In this review article, we discuss the preoperative evaluation and intraoperative management of large ovarian neoplasms. We review the current literature regarding long term ovarian function and fertility, rates of recurrence and residual disease, and novel surgical approaches. Managing large ovarian neoplasms in the pediatric and adolescent population requires careful preoperative and intraoperative care to optimally resect neoplasia while maximizing fertility and minimizing pain.

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum

The degree of exposure to Pediatric and Adolescent Gynecology (PAG) varies across academic programs in Obstetrics and Gynecology, Pediatrics, and Adolescent Medicine. Nevertheless, these programs are responsible to train residents and provide opportunities within their training programs to fulfill PAG learning objectives. To that end, North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG resident education by disseminating the Short Curriculum with specific learning objectives and list of essential resources where key concepts in PAG can be covered.

Teratomas and ovarian lesions in children.

Ovarian pathology in children is common and the pathology can be quite diverse. The most common benign ovarian tumor in childhood is a teratoma. In this article, we discuss the origin of these germ cell tumors followed by a complete discussion of ovarian pathology.

Unverifiable and erroneous publications reported by obstetrics and gynecology residency applicants

OBJECTIVE: To estimate the rate of erroneous and unverifiable publications in applications for an obstetrics and gynecology residency and to determine whether there were associated characteristics that could assist in predicting which applicants are more likely to erroneously cite their publications. METHODS: This was a review of the Electronic Residency Application Service applications submitted to the University of Washington obstetrics and gynecology residency for the 2008 and 2009 matches. Publications reported to be peer-reviewed articles and abstracts were searched by querying PubMed, Google, and journal archives (first tier), topic-specific databases (second tier), and by e-mailing journal editors (third tier). Errors were categorized as minor, major, and unverified. RESULTS: Five-hundred forty-six (58%) of 937 applicants listed a total of 2,251 publication entries. Three-hundred fifty-three applicants (37.7%) listed 1,000 peer-reviewed journal articles and abstracts, of which 751 were reported as published and 249 as submitted or accepted. Seven-hundred seventy (77.0%) publications were found by a first-tier search, 51 (5.1%) were found by a second-tier search, 23 (2.3%) were found by a third-tier search, and 156 (15.6%) were unverified. Of the 353 applicants listing peer-reviewed articles or abstracts, 25.5% (90 of 353) committed major errors, 12.5% (44 of 353) committed minor errors, and 24.1% (85 of 353) had articles or abstracts that were unverified. CONCLUSION: Most applicants reported their publications accurately or with minor errors; however, a concerning number of applicants had major errors in their citations or reported articles that could not be found, despite extensive searching. Reported major and unverified publication errors are common and should cause concern for our specialty, medical schools, and our entire medical profession. LEVEL OF EVIDENCE: III

Long Curriculum in Resident Education.

1 Pediatric and Adolescent Gynecology, Kosair Childrens Hospital, Louisville, Kentucky 2 Pediatric and Adolescent Gynecology, Seattle Childrens Hospital, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington Division of Adolescent Medicine, Childrens Hospital at Memorial University Medical Center, Mercer School of Medicine, Savanah, Georgia Division of Adolescent Medicine, Seattle Childrens Hospital, University of Washington School of Medicine, Seattle, Washington 5 Pediatric and Adolescent Gynecology, Childrens Hospital Colorado, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 7 Section of Adolescent Medicine, Childrens Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado Division of Adolescent Medicine, Childrens Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island 10 Pediatric and Adolescent Gynecology, Childrens Hospital of Eastern Ontario, Department of Obstetrics and Gynecology, University of Ottawa, Canada

Successful pregnancy in patients with exstrophy-epispadias complex

INTRODUCTION With advances in genitourinary reconstructive surgery, women with exstrophy-epispadias complex (EEC) have improved health and quality of life, and may reach reproductive age and consider pregnancy. Despite literature suggesting impaired fertility and higher risk with pregnancy, childbirth is possible. Medical comorbidities, including müllerian anomalies, contribute to increased risk of obstetric and urologic complications during pregnancy. OBJECTIVES We reviewed our experience with EEC patients who achieved pregnancy to investigate (1) urological characteristics of women who achieved pregnancy; (2) pregnancy management, complications, and delivery; and (3) neonatal outcomes. We developed recommendations for managing pregnancy in women with EEC. STUDY DESIGN/RESULTS This was a retrospective chart review of 36 female patients with EEC seen at our institution between 1996 and 2013. Female patients less than 18 years, and patients who did not have documented pregnancy were excluded. This resulted in a total of 12 patients with 22 pregnancies. All women with successful pregnancy had bladder exstrophy. The majority had undergone prior bladder augmentation (75%) and were on self-catheterization programs (92%). Thirty-six percent had symptomatic urinary tract infections (UTIs) during pregnancy. Five women had more than one pregnancy. There were four terminations of pregnancy. Of 18 desired pregnancies, there were four spontaneous abortions (SABs) (22%) and 16 live births (78%). The cesarean delivery (CD) rate was 100% (14/14), of which the majority were vertical (classical) uterine incisions with a paramedian skin incision. With the exception of one patient, there were no CD surgical complications. The mean gestational age at delivery was 36 weeks (Range 25 4/7 to 39 4/7 weeks) among eight pregnancies with known gestational age. There were no stillbirths, one neonatal death and no birth defects. DISCUSSION Women with EEC can have successful pregnancies, though at increased risk for preterm delivery and SABs. In our cohort, the rate of SAB is similar to that described in prior studies. Symptomatic UTIs likely due to self-catheterization were common. Cesarean delivery using a paramedian skin incision and classical uterine incision were not associated with major complications in this cohort. Limitations include reliance on retrospective data and small sample size. The strength of this study is the longitudinal detailed management of pregnancies in EEC women by a single team over time. A multidisciplinary approach to providing a continuum of care from pediatrics through adolescence to adulthood optimizes successful transitions, reproductive health, and successful pregnancies. Based on our experience, an algorithm providing guidance for pregnancy management was developed.

Where Do Medical Students Turn? The Role of the Assigned Mentor in the Fabric of Support During Medical School

Background: The University of Washington School of Medicine implemented an assigned mentoring program in 2002. The College Mentors are assigned at matriculation, advise students throughout medical school, and teach and evaluate students in the 2nd-year Introduction to Clinical Medicine course. Purpose: The purpose of the study was to determine from whom students report they would seek advice and support for academic, professional, personal, and research issues. Methods: A cross-sectional cohort survey asking students whom they would first contact about academic, personal, professional, and research issues was administered to three cohorts of students in 2007. Results: Students reported that they would contact their College Mentor first for general academic progress (49.6%), personal issues (36.2%), and professional issues (64.1%) but not for research issues. Conclusions: Students identified their College Mentor as a primary contact for academic, professional, and personal issues, suggesting that neither the mentors’ assigned status or evaluator role were barriers to the mentoring relationship.

Providing Long-Acting Reversible Contraception Services in Seattle School-Based Health Centers: Key Themes for Facilitating Implementation

PURPOSE The purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners. METHODS We conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups. RESULTS The most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff. CONCLUSIONS LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women.

Primary vaginal dilation for vaginal agenesis: strategies to anticipate challenges and optimize outcomes.

Purpose of review Primary vaginal dilation is patient controlled, safe, less painful, and much lower cost compared with operative vaginoplasty and is considered first-line treatment for vaginal agenesis for women with Mayer–Rokitansky–Küster–Hauser syndrome and androgen insensitivity syndrome. Recent findings This review will highlight studies that assess the optimal methods of primary vaginal dilation and clarify ideal counseling, frequency of dilation, management of side-effects, and long-term physical and psychological outcomes. Summary Providers who care for women with vaginal agenesis should be prepared to not only teach the technical skill of dilation, but also to assess readiness and troubleshoot symptoms associated with dilation.