tailieunhanh - PEDIATRIC AND ADOLESCENT GYNECOLOGY

The reproductive tract in pediatric and adolescent patients differs from that of the adult, requiring special techniques and equipment for examination. The gynecologic problems addressed in children and adolescents may differ markedly from those of adult women but may be no less serious. Both the anatomy and physiology of the reproductive tract will change from the hormone-stimulated state of the newborn to the relatively estrogen-free state of the young child to the blossoming of womanhood during adolescence. . | PEDIATRIC AND ADOLESCENT GYNECOLOGY The reproductive tract in pediatric and adolescent patients differs from that of the adult requiring special techniques and equipment for examination. The gynecologic problems addressed in children and adolescents may differ markedly from those of adult women but may be no less serious. Both the anatomy and physiology of the reproductive tract will change from the hormone-stimulated state of the newborn to the relatively estrogen-free state of the young child to the blossoming of womanhood during adolescence. ANATOMIC AND PHYSIOLOGIC CONSIDERATIONS NEWBORN The newborn female reproductive tract has experienced prolonged stimulation by transplacentally acquired maternal hormones. With transection of the umbilical cord these hormone levels fall with slow reversal of their effects over the first month of life. Breast buds are present in most female newborns and some will produce milk if massaged. Breast massage should be avoided to prevent infection or continued milk production. At birth the clitoris is prominent with a clitoral index of cm2 clitoral index length in centimeters X width in centimeters . The labia minora are large and may protrude through bulbous labia majora. The hymen is prominent and red protecting a vagina that averages 4 cm long. A whitish vaginal discharge of mucus and exfoliated cells with an acid pH may be prominent. The uterus may be enlarged 4 cm long with cervical eversion present. The endometrium may slough and vaginal bleeding may occur within a few days after birth. Parents can be reassured that the 527 Copyright 2001 The McGraw-Hill Companies. Click Here for Terms ofUse. 528 BENSON PERNOLL S HANDBOOK OF OBSTETRICS AND GYNECOLOGY bleeding will stop by 10 days of age. The ovaries have not descended from the abdomen and cannot be palpated if normal. YOUNG CHILD UNDER 7 YEARS With little estrogen stimulation the external genitalia have involuted from birth. The labia majora are flat and the labia minora