Pediatric and Adolescent Obstetric and Gynecologic Encounters in US Emergency Departments: A Cross-Sectional Study.

STUDY OBJECTIVE: To describe pediatric and adolescent obstetric and gynecologic diagnoses presenting at emergency departments (EDs) in the United States. METHODS: This was a retrospective, cross-sectional study design that utilized the Nationwide Emergency Department Sample (NEDS), which comprised hospital-owned EDs throughout the United States in 2018. The participants included a sample set of female patients from birth to 18 years old. All obstetric and gynecologic (OB/GYN) International Classification of Disease (ICD-10) codes were categorized. Descriptive, bivariate, and multivariate analyses were used to assess diagnoses by age group, hospital type, ED disposition (eg, admission and transfer), payer, and median household income. RESULTS: In 2018, there were 518,244 OB/GYN ED visits by female patients aged less than or equal to 18 years. Vulvovaginal disorders and abnormal uterine bleeding were among the top 5 presentations in all age groups. The top diagnoses varied by age group. Diagnoses with higher morbidity and mortality (ovarian torsion and ectopic pregnancy) had higher admission and transfer rates compared with diagnoses that can be commonly managed in the outpatient setting (vulvar or vaginal disorders). CONCLUSIONS: This is the first study that evaluated OB/GYN diagnoses in pediatric and adolescent patients presenting to the ED. Educational and referral efforts should focus on not only emergency diagnoses, such as ovarian torsion, adnexal masses, and ectopic pregnancy, but also common presentations that can often be managed in the outpatient setting, such as vulvovaginal disorders and abnormal uterine bleeding.

Tasas de egreso hospitalario por torsión ovárica en el período 2018-2021 en Chile según grupo etario: un estudio descriptivo / Ovarian torsion hospital discharge rates in the period 2018-2021 in Chile according to age group: a descriptive study

Introducción: La torsión ovárica (TO) es la rotación completa o parcial del ovario por sobre su propio pedículo vascular. El objetivo es comparar descriptivamente las tasas de egreso hospitalario (TEH) por TO en el período 2018-2021 en Chile. Materiales y métodos: Estudio descriptivo, transversal. Los datos de egresos hospitalarios por TO en Chile entre 20182021 (n=1.599) según grupo etario y días de estadía hospitalaria se obtuvieron del Departamento de Estadísticas e Información de Salud. Se calculó la TEH. No se requirió comité de ética. Resultados: Se determinó una TEH por TO de 4,33/100.000 habitantes entre los años 2018 y 2021, siendo el año 2021 la mayor con 5,92. Los grupos etarios de 10-14 y 15-19 años registraron las mayores TEH de 8,5 y 7,55, respectivamente. El promedio de días de estadía hospitalaria por TO entre los años 2018-2021 fue de 2,15 días, siendo el año 2018 el mayor con 2,3 días. Pacientes de 80 años y más presentaron la mayor duración de estancia hospitalaria con 3,37 días. Discusión: La TEH por TO en Chile aumentó durante los últimos años. En 2020-2021 las mayores TEH por TO se encontraron entre los 10-19 años, probablemente por aumentos en la prevalencia de síndrome de ovario poliquístico en Chile. Los grupos de mayor edad registraron la mayor duración de estancia hospitalaria, pudiendo deberse a una mayor susceptibilidad a complicaciones postquirúrgicas. Considerando la escasa fuente de información al respecto, nuestro estudio permite dar a conocer un perfil epidemiológico nacional actualizado.

Introduction: Ovarian Torsion (OT) is complete or partial rotation of the ovary above its vascular pedicle. The objective is to descriptively compare the Hospital Discharge Rates (HDR) for OT in the period 2018-2021 in Chile. Material and methods: Descriptive, cross-sectional study. The data of hospital discharge for OT in Chile between 20182021 (n=1,599) according to age group and days of hospital stay were obtained from the Department of Health Information Statistics. HDR was calculated. No ethics committee was required. Results: An HDR for OT of 4.33/100.000 population was determined between the years 2018 and 2021, with 2021 being the highest with 5.92. The age groups of 10-14 and 15-19 years old registered the highest HDR of 8.5 and 7.55, respectively. The average number of days of hospital stay for OT between the years 2018-2021 was 2.15 days, with 2018 being the longest year with 2.3 days. Patients 80 years and older had the longest hospital length of stay with 3.37 days. Discussion: The HDR for OT in Chile has increased in recent years. In 2020-2021 the highest HDR for OT were found between 10-19 years old, probably due to increases in the prevalence of polycystic ovary syndrome in Chile. The oldest age groups recorded the longest average hospital length of stay, which may be due to increased susceptibility to postoperative complications. Considering the limited source of information in this regard, our study allows us to present an updated national epidemiological profile.

Factors Associated with Torsion in Pediatric Patients with Ovarian Masses.

BACKGROUND: Management of ovarian torsion has evolved toward ovarian preservation regardless of ovarian appearance during surgery. However, patients with torsion and an ovarian neoplasm undergo a disproportionately high rate of oophorectomy. Our objectives were to identify factors associated with ovarian torsion among females with an ovarian mass and to determine if torsion is associated with malignancy. METHODS: A retrospective review of females aged 2-21 y who underwent an operation for an ovarian cyst or neoplasm between 2010 and 2016 at 10 children's hospitals was performed. Multivariate logistic regression was used to assess factors associated with torsion. Imaging data were assessed for sensitivity, specificity, and predictive value in identifying ovarian torsion. RESULTS: Of 814 girls with an ovarian neoplasm, 180 (22%) had torsion. In risk-adjusted analyses, patients with a younger age, mass size >5 cm, abdominal pain, and vomiting had an increased likelihood of torsion (P < 0.01 for all). Patients with a mass >5 cm had two times the odds of torsion (odds ratio: 2.1; confidence interval: 1.2, 3.6). Imaging was not reliable at identifying torsion (sensitivity 34%, positive predictive value 49%) or excluding torsion (specificity 72%, negative predictive value 87%). The rates of malignancy were lower in those with an ovarian mass and torsion than those without torsion (10% versus 17%, P = 0.01). Among the 180 girls with torsion and a mass, 48% underwent oophorectomy of which 14% (n = 12) had a malignancy. CONCLUSIONS: In females with an ovarian neoplasm, torsion is not associated with an increased risk of malignancy and ovarian preservation should be considered.

Distinctive pattern of left-right asymmetry of ovarian benign teratomas in Chinese population: a 12-year-long cross-sectional study.

PURPOSE: Given the lack of research on the left-right asymmetry of ovarian teratoma among Chinese patients, this study aimed to determine the lateral distribution and related clinical characteristics of Chinese ovarian teratoma patients treated at a single center. METHODS: We conducted a cross-sectional study of surgical patients pathologically diagnosed with ovarian teratomas in the gynecology inpatient department of the International Peace Maternity and Child Health Hospital in Shanghai between July 2006 and July 2018. RESULTS: Of the 4417 patients with ovarian teratoma, 3835 were finally analyzed. There were 2030 (53.24%) cases of right-sided benign ovarian teratoma versus 1783 (46.76%) cases of left-sided benign teratoma (P < 0.001). The recurrence rate of benign ovarian teratoma was 4.2%; recurrence occurred more often on the left side (left vs. right = 55 vs. 45%, P = 0.033). Compared with the right-sided ovarian teratoma patients, left-sided ones had significantly high recurrence risk (OR 1.430; 95% CI 1.03-1.99). The rate of ovarian torsion in patients with ovarian mature cystic teratomas (MCTs) during intrauterine pregnancy was 3.17 versus 1.72% in non-pregnant MCT patients (P = 0.049). For those MCT patients with intrauterine pregnancy, ovarian torsion occurs more often on the right side (left vs. right = 16.67 vs. 83.33%, P = 0.028). CONCLUSION: This study confirms a distinctive right-side dominance of benign ovarian teratomas. Compared with the right side, recurrent ovarian teratomas occur more often on the left side, requiring close follow-up. Intrauterine pregnancy may increase the risk of ovarian torsion, particularly on the right side, in MCT patients.

Adnexal Torsion in Pregnancy Managed by Laparoscopy Is Associated with Favorable Obstetric Outcomes.

STUDY OBJECTIVE: Most cases of adnexal torsion in pregnancy are currently managed by laparoscopy, which may be associated with increased risks for spontaneous abortion and preterm delivery. We sought to evaluate the obstetric outcomes of these women, with emphasis on their live birth rate and gestational age at delivery. DESIGN: Retrospective cohort study and telephone questionnaire. SETTING: University-affiliated obstetrics and gynecology department. PATIENTS: All pregnant women who underwent laparoscopy for adnexal torsion between 2007 and 2017. Their obstetric outcomes were obtained by retrospective review of medical records and a telephone questionnaire. INTERVENTIONS: Laparoscopy for adnexal detorsion, with or without cyst drainage or cystectomy. MEASUREMENTS AND MAIN RESULTS: The study cohort included 94 women. Most torsion cases (71, 75.5%) were diagnosed in the first trimester of pregnancy, whereas 21 (22.3%) cases and 2 (2.1%) cases were diagnosed in the second and third trimesters, respectively. Conception was achieved by in vitro fertilization or by ovulation induction in 45 (47.9%) cases. The information on pregnancy outcomes was available for 93 women. Of those, live birth was reported for 86 (92.5%) pregnancies, while 6 (6.5%) women had a spontaneous abortion, and 1 woman experienced an intrauterine fetal death. Five cases of spontaneous abortion were diagnosed in the first trimester, all within 3 weeks of surgery. Preterm delivery before 37 gestational weeks was reported for 18 (19.4%) pregnancies and was significantly associated with twin pregnancy (p = .002) and with conception following in vitro fertilization and ovulation induction (p = .03). On logistic regression analysis, preterm delivery was only associated with twin vs singleton gestation (odds ratio, 6.7; 95% confidence interval, 1.3-34.8; p = .02). CONCLUSION: The obstetric outcomes of pregnant women who underwent laparoscopy for adnexal torsion are generally favorable. However, there is a risk for preterm delivery, which is primarily associated with multiple gestations.

Management of inguinal hernia with prolapsed ovary in very low birthweight infants during neonatal intensive care unit hospitalisation.

AIM: Prolapsed ovary (PO) in an inguinal hernia (IH) may cause torsion and infarction; however, the management of IH with PO in very low birthweight (VLBW) infants during neonatal intensive care unit (NICU) hospitalisation remains inconsistent. METHODS: The medical records of 47 IHs in 30 VLBW infants during NICU hospitalisation between 2008 and 2017 were reviewed retrospectively. RESULTS: Of the 47 IHs, PO was diagnosed in 18 (38.3%). Post-natal age and body weight at diagnosis of IH with PO were 71 (44-172) days and 2120 (1305-2965) g, respectively. Seventeen IHs with PO underwent surgery for correction electively just before discharge from the NICU at the age and body weight of 94 (51-187) days and 2645 (2340-2945) g, respectively. Therefore, the time interval between diagnosis and surgery was 15 (7-90) days. There was no torsion of ovary before surgery and no postoperative complications, including apnoea and recurrence. CONCLUSIONS: The high incidence of IH with PO in VLBW infants during NICU hospitalisation was confirmed in this study. Under careful observation, elective IH repair just before discharge from the NICU could be one acceptable option for the management of IH with PO in VLBW infants during NICU hospitalisation to prevent torsion and infarction of ovary.