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BACKGROUND: Available evidence supports ovary-sparing surgery for benign ovarian neoplasms; however, preoperative risk stratification of pediatric ovarian masses can be difficult. Our objective of this study was to characterize the surgical management of pediatric ovarian neoplasms across 10 children’s hospitals and to identify factors that could potentially aid in the preoperative risk stratification of these lesions. METHODS: A retrospective review of girls and women aged 2 to 21 years who underwent surgery for an ovarian neoplasm between 2010 and 2016 at 10 children’s hospitals was performed. Multivariable logistic regression was used to examine the relationships between the preoperative cohort characteristics, procedure performed, and risk of malignancy. RESULTS: Among 819 girls and women undergoing surgery for an ovarian neoplasm, malignant lesions were identified in 11%. The overall oophorectomy rate for benign disease was 33% (range: 15%–49%) across institutions. Oophorectomy for benign lesions was independently associated with provider specialty (P = .002: adult gynecologist, 45%; pediatric surgeon, 32%; pediatric gynecologist, 18%), premenarchal status (P = .02), preoperative suspicion for malignancy (P < .0001), larger lesion size (P < .0001), and presence of solid components (P < .0001). Preoperative findings independently associated with malignancy included increasing size (P < .0001), solid components (P = .003), and age (P < .0001). CONCLUSIONS: The rate of oophorectomy for benign ovarian disease remains high within the pediatric population. Identification of factors associated with the choice of procedure and the risk of malignancy may allow for improved preoperative risk stratification and fewer unnecessary oophorectomies. These results have been used to develop and validate a multidisciplinary preoperative risk stratification algorithm that is currently being studied prospectively across 10 institutions.

Mature cystic teratomas (MCT) are the most common ovarian tumours seen in children and adolescents. Fifty-two patients

Objective: To present an alternative technique for the creation of a neovagina. Design: Case study. Setting: Academic university gynecology clinic. Patient(s): A patient diagnosed with mullerian agenesis. Intervention(s): Laparoscopically assisted creation of a neovagina by using peritoneum. Main Outcome Measure(s): Patient morbidity and satisfactory intercourse. Result(s): The patient underwent the procedure satisfactorily and was discharged within 24 hours. She had no perioperative or postoperative complications, and she became satisfactorily sexually active. Conclusion(s): The use of laparoscopically mobilized peritoneum in the creation of a neovagina provided the patient with a functional vagina, allowing satisfactory intercourse.

In this study we sought to understand the predictors of a mother's decision (behavior) to vaccinate her daughter with the initial dose of the HPV vaccine.This prospective, cross sectional study involved a convenience sample of 68 mother-daughter dyads recruited to test the hypothesis that the Theory of Planned Behavior (TPB) variables (attitudes toward vaccine, perception of others' opinions, and perceived difficulty in obtaining vaccine) would explain a mother's decision to consent for her daughter to receive the first dose of the HPV vaccine.Mothers and daughters independently completed survey instruments that measure the variables of the TPB (attitude, subjective norms, and perceived behavioral control). Instruments also included measures of parenting style and conflict.The mother's intention to vaccinate was predicted by her attitude (β = .41, P .001), subjective norms (β = .33, P = .002), and perceived behavioral control (β = .24, P = .005). The pathway connecting intention to the decision (yes or no) to vaccinate was significant (β = .41, P .001). Squared multiple correlations for intention and decision, respectively, were .68 and .12. The mothers who chose to vaccinate their daughter did not differ on any of the demographic variables from those who chose not to vaccinate but had significantly different scores on attitude, subjective norms, and intention but not perceived behavioral control.The TPB model demonstrates potential influences on a mother's intention to choose to initiate the HPV vaccination series for her daughter. Influences of attitude, subjective norms and perceived control are potential targets for interventions and tailored social marketing to improve vaccine acceptance.

Objective To report a modification of the laparoscopic Davydov method for creation of a neovagina. Design Case study. Setting University gynecology practice. Patient(s) Female with vaginal agenesis. Intervention(s) Laparoscopically assisted creation of a neovagina using a modified technique to improve both structural and functional capacity. Main Outcome Measure(s) Patient morbidity and satisfaction. Result(s) The patient satisfactorily underwent creation of a neovagina using the laparoscopic modification of the Davydov technique via the Louisville method. Conclusion(s) This laparoscopic modification allows for structural maintenance and functional capacity without increasing postoperative morbidity.

Nancy Sokkary MD , Roshi Mansouri MD, Jennie Yoost MD , Mariel Focseneanu MD, Tania Dumont MD , Meera Nathwani BHSc , Lisa Allen MD, FRCSC , S. Paige Hertweck MD , Jennifer E Dietrich MD, MSc 1,2 1 Baylor College of Medicine, Houston, TX 2 Texas Children's Hospital, Houston, TX 3 University of Louisville, Louisville, KY 4 Washington University School of Medicine, St. Louis, MO 5 The Hospital for Sick Children, Toronto, Ontario

Background: Von Willebrand’s Disease (VWD) is the most common inherited bleeding disorder affecting women and produces significant menorrhagia as its main symptom. Though combined oral contraceptive pills (OCP’s) are the most common treatment modality for menorrhagia, randomized controlled studies to assess their efficacy are lacking. Data on response rates to different doses and combinations of estrogens and progestins in OCP’s, and data on response rates to combined therapy of OCP’s with desmopressin acetate (DDAVP) and/or aminocaproic acid (Amicar) are sparse. Methods: The patient population consisted of 80 patients aged 9–19 years, who were primary referrals to a combined Hematology/Gynecology clinic for evaluation of menorrhagia. A retrospective chart review was done on these patients following an IRB approval. Collected data included age of menarche, onset of menorrhagia, follow up duration, severity of menorrhagia including PBAC score, co-morbidities, family history of bleeding or clotting disorders, blood group, factor VIII coagulant activity, ristocetin cofactor activity, and VW Ag level. VWD was defined as ristocetin cofactor activity