Mayer-Rokitansky-Kuster-Hauser syndrome diagnosed by magnetic resonance imaging in a 15-year-old girl.

STUDY OBJECTIVE: Mayer-Rokitansky-Kuster-Hauser syndrome diagnosed by magnetic resonance imaging (MRI) in a 15-year-old girl with primary amenorrhea is reported. DESIGN: The presentation, MRI, and the subsequent evaluation and treatment of an adolescent female patient with Rokitansky syndrome are described. Correlation is made with previous clinical, pathologic, and imaging reports in the literature. SETTING: An adolescent girl with primary amenorrhea was referred to our institution for completion of her diagnostic work-up. Previous limited evaluations suggested the presence of anomalies of the genitourinary tract. Further delineation of the suspected congenital defects was necessary. PARTICIPANT: The 15-year-old female patient was evaluated by the gynecology service. Diagnostic radiology and pediatric urology were consulted. INTERVENTIONS: MRI, physical examination under anesthesia, and cystoscopy were performed. After initial nonoperative treatment, the patient underwent hysterectomy and sigmoid vaginoplasty. MAIN OUTCOME MEASURES: The patient's primary amenorrhea was explained. Mayer-Rokitansky-Kuster-Hauser syndrome was diagnosed. Vaginal agenesis and widely separated rudimentary uterine horns were well shown by the MRI. Associated skeletal anomalies were noted. A treatment plan was initiated based on a good understanding of the anatomic defects. RESULTS: The MRI and physical examination firmly established the diagnosis. The patient was counseled and managed conservatively at first. Hysterectomy and vaginoplasty were subsequently performed. CONCLUSIONS: Mayer-Rokitansky-Kuster-Hauser syndrome is an unusual müllerian-duct anomaly that is a cause of primary amenorrhea. It can be confidently and noninvasively diagnosed with MRI. The MRI demonstration of vaginal, cervical, and uterine morphology contributes significantly to treatment planning and patient management.

Cavernous lymphangioma presenting as a vaginal discharge in a six-year-old female: a case report.

STUDY OBJECTIVE: This case report is written to describe a new and unusual presentation of retroperitoneal cavernous lymphangioma. INTERVENTIONS: A large cystic abdominal mass was discovered during an examination under anesthesia to evaluate a vaginal discharge in a 6-year-old girl. The mass was diagnosed by computed tomography (CT) and removed via laparotomy with argon beam coagulation of smaller cystic lesions. RESULTS: Six months postoperatively, the patient had a negligible amount of vaginal discharge. CONCLUSIONS: Cavernous lymphangioma should be considered as a rare cause of vaginal discharge in young females.

Assessing the acceptability of Norplant contraceptive in four patient populations.

The object of this study was to review the experience of Norplant implants insertion at the University of Colorado Health Sciences Center with specific attention to the potential impact of source of care and/or clinic site of of insertion. Norplant implants were inserted at four different office sites, namely, adolescent-teen, resident, certified nurse midwife, and faculty physician. The charts of all patients who had Norplant implants inserted between April 1991 and September 1992 were reviewed and we attempted to contact each patient by telephone to assess clinical course and acceptability of Norplant contraceptive. We were able to contact 254 of 414 women (61%) who had Norplant implants inserted. The average length of time since Norplant implants insertion was 13.2 months. The only significant demographic difference between groups was that the adolescent-teen patients were younger, of lower parity, less educated, and were more likely to be single than the other three groups. The overall removal proportion was 14.6%, and removal proportions were not significantly different between any of the four groups. The primary reason for removal was unacceptable bleeding (32% of removers). Only 59% of patients returned for follow-up care. Faculty physician patients were significantly more compliant with follow-up compared to adolescent-teen and resident patients (p < 0.01). Patient retention of Norplant contraceptive is unrelated to age or the clinic setting in which the device was inserted. Since similar side effects are experienced by retainers and removers, it is unclear what other factors prompt women to seek removal. Particularly in the teen and resident groups, follow-up is poor.

PIP: To refine understanding of the acceptability of Norplant in the US on the basis of different target populations and sources of care, the experiences of four groups of clients who had the implants inserted at University of Colorado Health Sciences Center between April 1991 and September 1992 and could be reached for a postinsertion telephone interview were compared. The 254 women interviewed (61% of total acceptors over this period) were drawn from four clinics: adolescent, resident, certified nurse midwife, and faculty physician. The average length of time since insertion was 13.2 months. As expected, adolescent patients were significantly more likely to be younger, single, less educated, and of lower parity than women in the three other groups. The overall removal rate was 14.6%, with no significant difference among groups or in terms of factors such as age, race, or socioeconomic status; the mean time to removal was 10.2 months. The most common reason for removal (32%) was unacceptable bleeding; however, abnormal bleeding was not significantly associated with the decision to discontinue the method. Weight gain and headache were the only side effects reported significantly more frequently by removers than retainers. Only 150 (59%) women returned for a scheduled postinsertion follow-up visit; compliance was lowest among teens (41%) and highest among patients of faculty (77%). 10 of the 37 women who opted for removal had this procedure performed at another clinic site; this finding suggests that clinic-based studies may underestimate the actual Norplant discontinuation rate.

Which teen mothers choose Norplant?

PURPOSE: The objective of this study was to determine if there are sociodemographic differences between adolescent mothers who choose to use Norplant after delivery and those who do not. We hypothesized that those adolescent mothers who are at highest risk for repeat adolescent pregnancy are least likely to select Norplant as a postpartum contraceptive. METHODS: We prospectively compared the prevalence of epidemiologic risk factors for repeat adolescent pregnancy in a group of 187 consecutively delivered 13-18-year-olds who were enrolled in a comprehensive, multidisciplinary, adolescent-oriented maternity program. The study subjects were interviewed at delivery; 100 subsequently had a Norplant inserted (Norplant users). Student's t-tests and chi-square analyses were used to compare Norplant users and refusers. RESULTS: We found no statistically significant differences between Norplant users and refusers with regard to: age, race, Medicaid, or marital or school status. Compared to Norplant refusers, Norplant users were less likely to be primiparous (79% compared to 90%; p = .04) and more likely to have poor school grades (20% compared to 7%; p = .001). Norplant users were more likely to state that they had had trouble remembering to use contraceptives in the past (32% compared to 14%; p = .005). CONCLUSIONS: These data do not support the study hypothesis and are encouraging because they suggest that Norplant may reduce repeat pregnancy among adolescent parents.

PIP: The hypothesis that those adolescent mothers at greatest risk of a repeat unintended pregnancy are the least likely to select Norplant as a postpartum contraceptive was investigated in a prospective study of 187 consecutively delivered 13-18 year olds enrolled in the Colorado Adolescent Maternity Program. After delivery and prior to hospital discharge, teen mothers participated in a structured interview that collected data on known sociodemographic, psychosocial, pregnancy outcome, and family planning risk factors associated with repeat adolescent pregnancy. There were no statistically significant differences between the 100 postpartum Norplant acceptors and the 87 refusers in terms of age, race, marital status, Medicaid, school enrollment, career goals, social support, or pregnancy and neonatal outcome; however, Norplant users were less likely than refusers to have only one child (79% versus 90%) and more likely to have poor school grades (20% versus 7%). Adolescents who had Norplant inserted after delivery were less likely to express a desire for more children in the next two years than their counterparts who selected other methods. Finally, Norplant acceptors were significantly more likely than refusers to have tried other contraceptive methods (81% versus 63%) and to have experienced problems with other methods (69% versus 46%). 32% of Norplant acceptors compared to only 14% of refusers identified problems remembering to use other methods consistently. Although the teen mothers in this study with a high loading of risk factors for a repeat pregnancy were just as likely to accept Norplant as those considered at lower risk, their participation in a comprehensive adolescent-oriented maternity program may have limited the range of intragroup variability.