The Future of Cesarean Delivery Rates in the United States

Epidemiology of Uterine Fibroids: From Menarche to Menopause

Wise LA et al., 2016·Clinical obstetrics and gynecology

Uterine leiomyomata (UL) have a substantial impact on women's health, but relatively few studies have identified opportunities for primary prevention of these neoplasms. Most established risk factors are not modifiable, including premenopausal age, African ancestry, age at menarche, and childbearing history. The main challenge in studying UL is that a large proportion of tumors are asymptomatic. Herein, we review the epidemiology of UL from published studies to date. We highlight the advantages of ultrasound screening studies and the ways in which their innovative methods have helped clarify the etiology of disease. We conclude with a discussion of promising new hypotheses.

Ovulation disturbances and exercise training

Prior JC et al., 1991·Clin Obstet Gynecol

Body weight and the initiation of puberty

Baker ER, 1985·Clinical obstetrics and gynecology

The onset and progression through the various stages of puberty are influenced by a number of factors (Fig. 2). In both animals and humans, the age of puberty appears to be related more to body weight than to chronologic age. Undernutrition and low body fat, or an altered ratio of lean mass to body fat, seem to delay the adolescent spurt and to retard the onset of menarche. According to Frisch, a minimum level of fatness (17% of body weight) is associated with menarche; however, a heavier minimum weight for height, representing an increased amount of body fat (22%), appears necessary for the onset and maintenance of regular menstrual cycles in girls over 16 years of age. This critical amount of body fat implies that a particular body composition, in addition to other environmental and psychosocial factors, is important in triggering and maintaining the pubertal process.

Adolescent contraception

Bolton GC, 1981·Clin Obstet Gynecol

Both the medical profession and the general public are becoming more and more aware of the need for adolescent contraception and the devastating consequences of the lack of such care. It is the responsibility of family planning providers and educators to offer this type of service tailored to adolescents and their unique needs. The service must include counseling, education, provision of contraceptives, and followup medical care. To better understand adolescent contraception, it is necessary to understand adolescent sexuality, the teenage pregnancy problem, the risks of teenage pregnancy, and the unique aspects of the contraceptive methods available to teenagers. Each of these areas is reviewed. The most important developmental task of adolescence relates to sexual maturation. The child's body undergoes complex changes necessary for adult function, and the sex drive is awakened. The teenager is faced with the task of developing a sexual identity and personal values about sexual behavior. The 2 important tasks in sexual counseling of the adolescent are helping them to decide whether or not they are ready for sexual intimacy and encouraging them to assume responsibility for their sexual behavior. The consequences of adolescent sexual activity are the rise in teenage sexually transmitted diseases and the rise in teenage pregnancies. Medically, the hazards of an an overall increase in incidence of infant mortality 2-3 times that of the normal population; twice as many growth retarded infants born to teen mothers; maternal mortality 60% higher than normal; a low incidence of prenatal care early in pregnancy; and 27% of pregnancies terminated by abortion. Equally important are nonmedical consequences for the teenage parent. In general, the consequences of teen parenthood are more severe for the young mother than for the young father. Teen mothers have a suicide rate 10 times that of the general population. In discussing contraception, attention is directed to all available contraceptive methods (abstinence, sex without intercourse, natural family planning, withdrawal, condoms and vaginal spermicidal agents, diaphragm, IUDs, and abortion), but emphasis is on oral contraceptives (OCs). The popularity of OCs among adolescents is due primarily to 2 the agents are highly effective and their use is not associated directly with the act of coitus. For the physician, there are 2 concerns associated with the use of these exogenous steroids in administration might cause premature closure of the epiphyses and inhibition of full stature development; and the steroids might cause permanent hypothalamic-pituitary dysfunction. Both concerns are relatively unwarranted. The OC might be an excellent choice for the adolescent without medical contraindication, who has established regular menses, and who has intercourse on a regular or fairly frequent basis.