TEXTBOOK PEDIATRIC GYNECOLOGY - 2013

Chapter 2. ORGANIZATION OF SPECIALIZED GYNECOLOGICAL CARE FOR ADOLESCENT GIRLS IN UKRAINE

ORGANIZATION OF THERAPEUTIC AND PREVENTIVE CARE IN PEDIATRIC GYNECOLOGY

Therapeutic and preventive care in PEDIATRIC AND ADOLESCENT gynecology comprises three main stages:

1. Preventive work is carried out in nurseries, kindergartens, schools, children's polyclinics, and inpatient facilities.

The first physician whom parents and girls consult is the pediatrician. The pediatrician must be proficient in health education, capable of identifying developmental abnormalities of the reproductive Organs, and, if a gynecological disorder is suspected, responsible for referring the patient to a specialist—a pediatric gynecologist.

In certain instances, pediatricians also provide basic gynecological Treatment to children admitted to pediatric inpatient departments.

2. Specialized pediatric gynecology offices are established within children's polyclinics. To provide treatment and Prevention, the pediatric gynecologist conducts health education aimed at detecting and preventing gynecological diseases in children. Girls requiring specialized care and comprehensive examination of the reproductive organs are referred to a specialized pediatric gynecology department.

3. The pediatric gynecology department operates as an integral part of the children's inpatient hospital. Because gynecological disorders in girls possess specific Clinical Features, their examination and treatment necessitate close collaboration between pediatric gynecologists and pediatricians.

Health education campaigns are jointly organized and conducted by both the pediatrician and the pediatric gynecologist.

Lectures and discussions are held among the staff of childcare and educational institutions (nurseries, kindergartens, schools, and hospitals), as well as for parents and older girls. These sessions provide parents and staff with a clear and accessible Overview of the anatomical Development of the FEMALE Reproductive System in girls, while highlighting the potential for gynecological pathologies. Parents and childcare personnel must understand that a girl's development involves changes across all organs and systems. During the prepubertal period, a girl's behavior and interpersonal relationships undergo noticeable shifts. Proper hygiene practices tailored to various stages of sexual development are also discussed, with significant emphasis placed on General Principles: personal hygiene, balanced study and rest schedules, and appropriate physical and Water Procedures adapted to the child's age. Excessive physical exertion at any stage of development can lead to abnormal skeletal formation—particularly of the pelvic bones—thereby impairing the maturation of the female body and disrupting hormonal status.

Pediatricians lecturing in maternity hospitals must emphasize Structure/19.html">The Importance of neonatal female genitalia hygiene.

When examining the genitalia of a newborn, the physician evaluates their development and The Nature of any genital secretions. On days 3 to 8 of life, minor Blood-tinged discharge may occur due to a hormonal crisis triggered by the withdrawal of maternal Hormones. Vaginal discharge must not be purulent. Purulent secretions typically indicate perinatal infection (such as gonococcal or trichomonal infection).

From the first days of a girl's life, regular cleansing of the external genitalia with warm water containing a small amount of potassium permanganate solution is recommended, followed by the application of sterile vegetable oil or baby cream. Whitish films, primarily consisting of desquamated epithelium, may accumulate in the folds between the Labia minora and majora. These membranous secretions should be gently removed using a cotton swab moistened with sterile vegetable oil.

During the neutral period of sexual development, in the absence of external genital irritation, girls are advised to take regular hygiene showers and change their underwear in a timely manner (undergarments should be loose-fitting and preferably made of cotton). If the genitalia become contaminated with feces or if redness develops, washing with herbal decoctions (such as chamomile or succession) followed by the application of vegetable oil is recommended. The Use of potassium permanganate solutions and petrolatum is not advised during this age period, as they can cause dryness of the Skin and mucous membranes. Cleansing should always be performed from front to back, toward the anal region. Girls suffering from exudative diathesis, obesity, Urinary Tract infections, diabetes, or frequent acute respiratory infections require special genital care, as vulvovaginitis most commonly develops in these high-risk groups.

The prepubertal period is marked by the appearance of secondary sexual characteristics and anatomical changes in both internal and external reproductive organs. By the end of this period, the girl should be mentally and physically prepared for menarche. Lectures and discussions are conducted with parents and older girls regarding the PHYSIOLOGY OF THE prepubertal and pubertal periods, as well as reproductive hygiene. Since vaginal discharge and mild irritation of the mucosal lining of the reproductive tract may occur during this stage, washing the external genitalia with a weak potassium permanganate solution is recommended.

During Puberty, girls must be instructed in menstrual hygiene practices: washing the external genitalia 2–3 times a day, and changing sanitary pads as needed, at least 2–3 times daily.

In addition to teaching hygiene rules, educational sessions for adolescent girls should address the prevention of premature sexual activity. Prior to conducting lectures or discussions with older girls, the pediatrician should consult the homeroom teacher to review the lecture topic, understand the Class demographics and behavior, and ensure that the topic of preventing sexual activity is presented in an appropriate and accessible manner. Older girls must understand that the onset of menstruation does not signal full somatic maturity; the body continues to develop and reaches complete maturity only after the age of 18. During puberty, smoking, substance abuse, and alcohol consumption exert a particularly harmful effect on the entire body and the Gonads. Engaging in sexual activity during puberty can lead to Pregnancy, which at this age is frequently complicated by adverse outcomes. Furthermore, contraceptive use can disrupt the proper establishment of menstrual function and, consequently, the normal development of the reproductive organs. An adolescent girl is not yet psychologically or socially prepared for motherhood and child-rearing. Premature sexual activity, pregnancy, and childbirth lead to long-term negative consequences for both mother and child. Termination of pregnancy, even when performed in medical settings, carries the risk of subsequent Infertility.

During routine medical examinations of adolescent girls, physicians assess the pattern of menstrual function, the degree of secondary sexual development, and perform careful abdominal Palpation. If any gynecological pathology is suspected, the patient is referred immediately to a specialist.

Girls with gynecological disorders must remain under dispensary observation (clinical surveillance) by a pediatric gynecologist. The duration of follow-up depends on the clinical course of the disease. Patients treated for Dysfunctional Uterine Bleeding remain under the care of a pediatric gynecologist for two years following the cessation of bleeding, visiting the clinic once every 3 months. Endometrial Hyperplastic Processes are monitored in girls up to the age of 16. Patients presenting with precocious puberty, secondary Amenorrhea, or Congenital Malformations are kept on the pediatric gynecologist's dispensary registry until age 16, with check-ups scheduled every 3–6 months. Patients who have undergone surgery for ovarian/adnexal tumors are examined every 3–6 months until they reach 16 years of age. Following Inflammatory Diseases of the FEMALE REPRODUCTIVE ORGANS, in the absence of acute exacerbations, girls are monitored for up to 2 years. Patients are officially enrolled in the dispensary registry upon discharge from the inpatient facility. Those requiring continued clinical supervision after the age of 16 are transferred to the women's consultation clinic for further management.

All health-promoting and preventive measures organized and implemented by the pediatrician contribute to the harmonious SEXUAL DEVELOPMENT OF the girl and help prevent future gynecological disorders. Professionally managed educational and therapeutic gynecological care for girls serves as the foundation for preventing obstetric and gynecological pathologies in women of reproductive age.

According to recent literature, the prevalence of gynecological diseases among children and adolescents ranges from 11% to 16.3%. The unit of observation comprises girls aged 0 to 17 years inclusive, categorized into the following age groups: 0–7, 8–10, 11–14 (children), and 15–17 years (adolescents). This age-based distribution allows for the acquisition of data corresponding to the specific Selection/3.html">Stages of development and maturation of the female reproductive system.

The morbidity rate is calculated per 1,000 girls aged 0 to 17 years (representing the overall gynecological morbidity rate in children and adolescents) or per 1,000 girls within each specific age cohort (age-specific morbidity rate).

The frequency and structure of gynecological diseases are evaluated in accordance with the International Classification of Diseases (ICD-10). Depending on the objectives of the study, generalized categories of gynecological conditions or detailed subcategories are utilized. Individual categories may be further refined based on etiological factors.

Studying gynecological morbidity is best conducted across various regions with comparable baseline levels of child health indicators. Prior to initiating the study, researchers typically verify the age demographics of the pediatric and adolescent populations within the surveyed territories.

To clarify the frequency of gynecological disorders, researchers use data from visits to children's outpatient clinics and specialized pediatric and adolescent gynecology offices, the results of routine health check-ups, in-depth selective morbidity studies, and hospitalization records. Morbidity based on inpatient data ("hospital morbidity") can also be analyzed separately.

To collect data, a special questionnaire-card is designed to record information for each female patient. The card is filled out by extracting specific data regarding visits made by children and adolescents to all healthcare facilities within the district (outpatient clinics, hospitals, etc.). Data on diseases (visits) are extracted over a defined period of time—no less than a calendar year—which makes it possible to track seasonal fluctuations throughout the year.

The interval between occurrences of the same disease (or a flare-up of a chronic condition) must be at least 1 month; if the interval is 30 days or less, it is considered a single episode of illness.

Differences in morbidity rates are driven by the quality and accessibility of medical care, the general and sanitary awareness of the pediatric population, and various social factors.

Ensuring the proper Diagnosis of gynecological conditions in children and adolescents requires a systematic and sequential approach to selecting examination Methods.

Clinical examination includes: taking a medical history, a general physical examination with an assessment of physical and sexual development, a gynecological examination, and specialized methods for evaluating the reproductive system.

During routine preventive check-ups, a rectal examination is performed on all adolescents aged 15–17, whereas for children under 14, it is performed only when clinically indicated.

Studying gynecological morbidity in children and adolescents makes it possible to determine the specific share of this pathology within the overall pediatric and adolescent disease structure, identify high-risk groups for reproductive disorders, provide timely treatment, and thereby prevent future impairments of reproductive function.