Prognostic factors for the use of intrauterine balloon tamponade in the management of severe postpartum hemorrhage.

OBJECTIVE: To identify prognostic factors associated with successful management of severe postpartum hemorrhage (PPH) using intrauterine balloon tamponade (IUBT). METHODS: Retrospective review of all cases of severe PPH with blood loss greater than 1 L in a tertiary unit in Hong Kong from July 1, 2012, to June 30, 2017. Records of patients who had undergone IUBT insertion were reviewed. Univariate analysis and logistic regression models were used to identify prognostic factors for successful management with IUBT. RESULTS: Of 22 860 deliveries during the study period, severe PPH occurred in 1.4% (n=311), and IUBT was attempted in 26.0% (n=81) of these patients. IUBT alone was successful in arresting hemorrhage in 72.8% (n=59), and the overall rate for avoiding hysterectomy was 86.4% (n=70). Presence of coagulopathy (P=0.048) and placenta accreta (P=0.048) were the adverse prognostic factors associated with higher failure rates. Less blood loss (≤1400 mL) at the time of insertion of IUBT and a positive tamponade test (≤50 mL of blood drained from the uterus within the first 30 minutes after insertion of IUBT) were good predictors for success of IUBT. CONCLUSION: The presence of adverse prognostic factors should prompt early resort to other treatment modalities or hysterectomy as a salvage procedure.

Intraluminal pressure of uterine balloon tamponade in the management of severe post-partum hemorrhage.

AIM: Intrauterine balloon tamponade has been increasingly used for the management of post-partum hemorrhage (PPH) in recent years. However, data on the precise mechanisms and pressure required for the balloon tamponade are scanty in the literature. This study aims to review the intraluminal pressure (ILP) generated by the Bakri intrauterine balloon that is necessary to produce a 'positive tamponade test' during severe PPH. METHODS: This was a prospective cohort study. The ILP of the Bakri balloon was measured using a manometer after a positive tamponade test was clinically achieved during severe PPH (blood loss >1 L). The patient's blood pressure was recorded, and ultrasound scan was performed to verify the position of the balloon and the presence of forward flow in the uterine arteries. The main outcome measure is the ILP of the Bakri balloon required to achieve a positive tamponade test. RESULTS: Twenty patients were included for final analysis. The net ILP measured ranged from 67 to 92 mmHg, and this pressure was lower than the concurrent systolic pressure in all cases. Color Doppler confirmed positive forward flow in the uterine vessels in all cases. There were no differences in the pressure measured with the balloon position, and there was no relationship between the volumes of saline infused and the net pressure. CONCLUSION: A positive tamponade test in an intrauterine balloon is probably achieved by local compression pressure exerted on the vasculature of the placental bed rather than by generating an ILP exceeding systemic blood pressure or by occlusion of flow to the uterine arteries.

Trends in conservative procedures and peripartum hysterectomy rates in severe postpartum haemorrhage.

OBJECTIVE: The objective of this study is to explore whether increase in use of second-line conservative surgical procedures will alter the rate of peripartum hysterectomies in management of severe postpartum haemorrhage (PPH). METHODS: This is a retrospective cohort. All pregnant patients with gestation > = 28 weeks with severe PPH (> = 1.5 L) within 72 h of delivery from year 2000 to 2015 (16-year period) in an obstetric training unit was recruited. Basic patient anthropometric characteristics and the main causes for PPH were calculated. The incidence of any second-line conservative surgical procedures and peripartum hysterectomies were evaluated. The total number of patients in each category was then stratified into four 4 years-intervals (4 quadrennium) to compare trends. RESULTS: The incidence of severe PPH gradually increased over the study period (lowest 0.21% in 2002 to 0.76% in 2015) (p < .001). There is an obvious increasing trend in the overall use of second-line surgical procedures from nil to 82% (p < .001), with balloon tamponade constituting up to 48%. The incidence of successful second-line procedures increased gradually from 72.2% in the second quadrennium to 89% in the fourth quadrennium. The total peripartum hysterectomy rate among cases of severe PPH could be seen to drop from 40.2% in the first to 10.9% in the fourth quadrennium (p = .04). CONCLUSIONS: Despite the increasing trends in PPH, the increasing utilisation of second-line conservative surgical procedures in severe PPH should be able to reduce the need for peripartum hysterectomy.

Impact of nuchal cord on fetal outcomes, mode of delivery, and management: a questionnaire survey of pregnant women.

OBJECTIVES: To explore pregnant women's views on the impact of nuchal cord on fetal outcomes, mode of delivery, and management. DESIGN: Questionnaire survey. SETTING: Antenatal clinic of two regional hospitals in Hong Kong. PARTICIPANTS: A questionnaire survey of all pregnant women at their first visit to the antenatal clinic of United Christian Hospital and Tseung Kwan O Hospital in Hong Kong was conducted between August and October 2012. RESULTS: Most participants (71.8%) were worried about nuchal cord, and 78.3% and 87.7% of them thought that nuchal cord could cause intrauterine death and fetal death during labour, respectively. Approximately 87.5% of participants thought that nuchal cord would reduce the chance of successful vaginal delivery and 56.4% thought that it would increase the chance of assisted vaginal delivery. Most (94.1%) participants thought that it was necessary to have an ultrasound scan at term to detect nuchal cord. In addition, 68.8% thought that it was necessary to deliver the fetus early and 72.8% thought that caesarean section must be performed in the presence of nuchal cord. Participants born in Mainland China were significantly more worried about the presence of nuchal cord than those born in Hong Kong. However, there was no difference between participants with different levels of education. CONCLUSION: Most participants were worried about the presence of nuchal cord. Many thought that nuchal cord would lead to adverse fetal outcomes, affect the mode of delivery, and require special management. These misconceptions should be addressed and proper education of women is needed.

Uterine compression sutures for management of severe postpartum haemorrhage: five-year audit.

OBJECTIVES: To audit the use of compression sutures for the management of massive postpartum haemorrhage and compare outcomes to those documented in the literature. DESIGN: Retrospective study. SETTING: A regional obstetric unit in Hong Kong. PATIENTS: Patients with severe postpartum haemorrhage encountered over a 5-year period from January 2008 to December 2012, in which compression sutures were used for management. MAIN OUTCOME MEASURES: Successful management with prevention of hysterectomy. RESULTS: In all, 35 patients with massive postpartum haemorrhage with failed medical treatment, for whom compression sutures were used in the management, were identified. The overall success rate for the use of B-Lynch compression sutures alone to prevent hysterectomy was 23/35 (66%), and the success rate of compression sutures in conjunction with other surgical procedures was 26/35 (74%). This reported success rate appeared lower than that reported in the literature. CONCLUSION: Uterine compression was an effective method for the management of massive postpartum haemorrhage in approximately 70% of cases, and could be used in conjunction with other interventions to increase its success rate in terms of avoiding hysterectomy.

Optimal delivery for preterm breech fetuses: is there any consensus?

The optimal route for delivery of preterm breech-presenting fetuses remains a clinical dilemma. Available data from the literature are largely based on retrospective cohort studies, and randomised controlled trials are considered impossible to conduct. Consistently however, large population-based surveys have shown that planned caesarean sections for these fetuses were associated with better neonatal outcomes compared with those following vaginal delivery. Nevertheless, the increased surgical risks for the mother having caesarean delivery of an early preterm breech fetus must be balanced with the probable neonatal survival benefits. Planned caesarean section should probably be limited to gestations with at least a fair chance of independent neonatal survival, where vaginal delivery is not imminent, and in the absence of other maternal risk factors. Vaginal delivery would probably include those fetuses that are of marginal viability, and that additional protection from abdominal delivery was unlikely to be beneficial to neonatal outcome.

A comparison of bone mineral density in normal weight and obese adolescents with polycystic ovary syndrome.

STUDY OBJECTIVE: To evaluate whether there are any differences in bone mineral density (BMD) between normal weight and obese adolescents suffering from polycystic ovary syndrome (PCOS) with oligo/amenorrhea. DESIGN: Prospective cohort study. SETTING: Adolescent gynecology clinic in a general service hospital. PARTICIPANTS: Subjects consisted of adolescents between 16 to 18 years of age presenting with oligo/ amenorrhea with ultrasound morphology of polycystic ovaries ± evidence of hyperandrogenism over 24 months. Controls consisted of consecutive eumenorrheic patients within the same age group. INTERVENTIONS: All underwent full hormonal profile assessment, and dual energy X-ray absorptiometry and peripheral quantitative computed tomography scans. MAIN OUTCOME MEASURES: Areal and volumetric BMD parameters. RESULTS: Of 37 adolescents with PCOS, 12 (32%) were obese with BMI ≥25, of which 9/12 (75%) were hyperandrogenic. The control group consisted of 40 normal weight eumenorrheic girls. The PCOS group overall had lower lumbar spine BMD values as compared to the controls (0.91 vs 0.97 g/ cm(2), P = 0.033). The normal weight PCOS group had lower BMD at the spine (0.90 vs 0.97 g/ cm(2), P = 0.027), trochanter (0.66 vs 0.71 g/ cm(2), P = 0.039) as well as volumetric distal tibial core sites (268 vs 296 mg/ cm(3)) as compared to eumenorrheic controls, but there were no significant BMD differences between the obese PCOS group and the eumenorrheic controls. CONCLUSIONS: Normal weight PCOS adolescents with oligo/amenorrhea have marginally lower BMD values than controls, but obese PCOS adolescents have BMD values compatible with eumenorrheic adolescents.

Prenatal diagnosis and assessment of facial clefts: where are we now?

Orofacial clefts are one of the most common non-syndromic congenital structural abnormalities. Prenatal diagnosis of such defects has traditionally been made by ultrasound examination. With the advent of routine second-trimester ultrasound screening for morphological abnormalities in the recent two decades, the prenatal detection rate of such abnormalities has progressively increased. While conventionally, two-dimensional scanning has been used for screening of lip clefts, the development of three-dimensional ultrasound scanning technology has allowed more easy visualisation of the defects, as well as more accurate evaluation of palatal clefts. Various three-dimensional scanning techniques to assess such defects have been advocated in the recent 5 to 6 years, but as yet there is no consensus as to the most effective and practical methods. As fetal magnetic resonance imaging gradually becomes an accessible modality of imaging in modern obstetrics, it is likely to become an additional tool to assess these defects.

Bone mineral density changes during pregnancy in actively exercising women as measured by quantitative ultrasound.

OBJECTIVE: To evaluate whether bone mineral density (BMD) changes in women engaged in active exercises during pregnancy would be different from non-exercising women. METHODS: Consecutive patients with singleton pregnancies who were engaged in active exercise training during pregnancy were prospectively recruited over a period of 6 months. Quantitative USG measurements of the os calcis BMD were performed at 14-20 weeks and at 36-38 weeks. These patients were compared to a control cohort of non-exercising low-risk women. RESULTS: A total of 24 physically active women undergoing active physical training of over 10 h per week at 20 weeks gestation and beyond (mean 13.1 h, SD 3.3) were compared to 94 non-exercising low-risk women. A marginal fall in BMD of 0.015 g/cm(2) (SD 0.034) was demonstrable from early to late gestation in the exercising women, which was significantly lower than that of non-exercising women (0.041 g/cm(2); SD 0.042; p = 0.005). Logistic regression models confirmed that active exercises in pregnancy were significantly associated with the absence of or less BMD loss in pregnancy. CONCLUSION: In women actively engaged in physical training during pregnancy, the physiological fall in BMD during pregnancy was apparently less compared to those who did not regularly exercise.

Noninvasive prenatal diagnosis of fetal trisomy 18 and trisomy 13 by maternal plasma DNA sequencing.

Massively parallel sequencing of DNA molecules in the plasma of pregnant women has been shown to allow accurate and noninvasive prenatal detection of fetal trisomy 21. However, whether the sequencing approach is as accurate for the noninvasive prenatal diagnosis of trisomy 13 and 18 is unclear due to the lack of data from a large sample set. We studied 392 pregnancies, among which 25 involved a trisomy 13 fetus and 37 involved a trisomy 18 fetus, by massively parallel sequencing. By using our previously reported standard z-score approach, we demonstrated that this approach could identify 36.0% and 73.0% of trisomy 13 and 18 at specificities of 92.4% and 97.2%, respectively. We aimed to improve the detection of trisomy 13 and 18 by using a non-repeat-masked reference human genome instead of a repeat-masked one to increase the number of aligned sequence reads for each sample. We then applied a bioinformatics approach to correct GC content bias in the sequencing data. With these measures, we detected all (25 out of 25) trisomy 13 fetuses at a specificity of 98.9% (261 out of 264 non-trisomy 13 cases), and 91.9% (34 out of 37) of the trisomy 18 fetuses at 98.0% specificity (247 out of 252 non-trisomy 18 cases). These data indicate that with appropriate bioinformatics analysis, noninvasive prenatal diagnosis of trisomy 13 and trisomy 18 by maternal plasma DNA sequencing is achievable.

Changes in bone mineral density of the os calcis as measured by quantitative ultrasound during pregnancy and 24 months after delivery.

AIM: To evaluate the use of quantitative ultrasound measurement of the os calcis to monitor bone mineral density (BMD) changes in pregnancy and 24 months after delivery. METHODS: Low-risk patients booked before 20 weeks of gestation were recruited prospectively over a period of 12 months. BMD measurements of the os calcis were taken using quantitative ultrasound between 14 and 20 weeks and after 36 weeks using the Hologic Sahara system. Body weight and fat composition were also measured at each occasion. The measurements were repeated 24-28 months after the index delivery. Those who were delivered preterm or those diagnosed to have significant medical or antenatal complications were excluded. RESULTS: A total of 95 patients completed the study, of which 55 (57.8%) were primiparous and 40 (42%) were multiparous. A mean fall in BMD of 0.0389 g/cm(2) was demonstrable from early to late gestation. The mean BMD difference between the 2-year assessment and early pregnancy (Δ BMD) was -0.008 g/cm(2) . Δ BMD was negligible for multiparous women compared to a small loss in primiparous women (0.0006 vs. -0014 g/cm(2) , P = 0.026). There were no significant differences in Δ BMD between those who lactated for over 16 weeks (n=35) and those who did not (n=60). A logistic regression model showed that the extent of BMD loss during pregnancy and pregnancy weight gain were significant factors associated with BMD changes 24 months after delivery. CONCLUSION: Bone mineral density loss during pregnancy that was detectable by quantitative ultrasound at the os calcis has largely recovered at 24 months after delivery.

Training in emergency obstetric skills: is it evidence-based?

In recent years, training in emergency obstetric skills has moved from the traditional clinical teaching in the labour ward to specific, targeted skills and scenario-based courses utilising mannequins and simulators. Such changes have been necessary, largely as a result of the limitations of traditional clinical teaching when it comes to genuine patient encounters in an emergency situation. The range of simulations now available extends from simple pelvic models to sophisticated computer-based birth simulators. Evidence for the effectiveness of such simulated training is gradually emerging, and in general, transfer of knowledge, improvement of clinical skills and teamwork are all enhanced. However, unequivocal evidence that such teaching improves clinical outcomes is still lacking. Further prospective research on the impact of emergency obstetric training courses as a means of reducing adverse perinatal outcomes is warranted.

Non-invasive prenatal assessment of trisomy 21 by multiplexed maternal plasma DNA sequencing: large scale validity study.

OBJECTIVES: To validate the clinical efficacy and practical feasibility of massively parallel maternal plasma DNA sequencing to screen for fetal trisomy 21 among high risk pregnancies clinically indicated for amniocentesis or chorionic villus sampling. DESIGN: Diagnostic accuracy validated against full karyotyping, using prospectively collected or archived maternal plasma samples. SETTING: Prenatal diagnostic units in Hong Kong, United Kingdom, and the Netherlands. PARTICIPANTS: 753 pregnant women at high risk for fetal trisomy 21 who underwent definitive diagnosis by full karyotyping, of whom 86 had a fetus with trisomy 21. Intervention Multiplexed massively parallel sequencing of DNA molecules in maternal plasma according to two protocols with different levels of sample throughput: 2-plex and 8-plex sequencing. MAIN OUTCOME MEASURES: Proportion of DNA molecules that originated from chromosome 21. A trisomy 21 fetus was diagnosed when the z score for the proportion of chromosome 21 DNA molecules was >3. Diagnostic sensitivity, specificity, positive predictive value, and negative predictive value were calculated for trisomy 21 detection. RESULTS: Results were available from 753 pregnancies with the 8-plex sequencing protocol and from 314 pregnancies with the 2-plex protocol. The performance of the 2-plex protocol was superior to that of the 8-plex protocol. With the 2-plex protocol, trisomy 21 fetuses were detected at 100% sensitivity and 97.9% specificity, which resulted in a positive predictive value of 96.6% and negative predictive value of 100%. The 8-plex protocol detected 79.1% of the trisomy 21 fetuses and 98.9% specificity, giving a positive predictive value of 91.9% and negative predictive value of 96.9%. CONCLUSION: Multiplexed maternal plasma DNA sequencing analysis could be used to rule out fetal trisomy 21 among high risk pregnancies. If referrals for amniocentesis or chorionic villus sampling were based on the sequencing test results, about 98% of the invasive diagnostic procedures could be avoided.

Bone mineral density changes in pregnancies with gestational hypertension: a longitudinal study using quantitative ultrasound measurements.

OBJECTIVE: To compare the maternal bone mineral density (BMD) changes in gestational hypertensive and normotensive pregnancies using quantitative ultrasound. METHODS: Consecutive patients were recruited from a general obstetric clinic over a period of 9 months. BMD measurements were performed at the os calcis in early pregnancy before 20 weeks and in the late third trimester after 36 weeks, using a Hologic Sahara Clinical Bone Sonometer system. These patients were followed up in accordance with standard antenatal protocol. The diagnosis of gestational hypertension (GH) was made based on a standard institutional protocol. The changes in BMD from early to late pregnancy were compared between those with/without GH. RESULTS: A total of 450 patients with complete data were analyzed. The overall incidence of GH was 4.8% (n = 22), of which 1.7% (n = 8) fulfilled the definitions of severe pre-eclampsia. A mean BMD loss of 0.0382 g/cm2 (around 6% of early pregnancy BMD) [corrected] was demonstrable from early to late gestation The hypertensive group has marginally higher mean BMD loss as compared to the normotensive group (0.052 vs. 0.037 g/cm²; P = 0.037). However, regression analysis models showed that early pregnancy BMD values, early pregnancy fat percentage and fat accumulation in pregnancy were significant factors affecting BMD loss during pregnancy, while GH was not in the equations. CONCLUSION: The development of gestational hypertensive disorders apparently does not have any significant impact on BMD changes during pregnancy.

Fetal umbilical arterial and venous Doppler measurements in gestational diabetic and nondiabetic pregnancies near term.

OBJECTIVE: To compare Doppler measurements of umbilical arteries (UAs) and veins (UV) in diabetic and nondiabetic pregnancies near term. METHODS: Consecutive patients with gestational diabetes mellitus (GDM) were prospectively recruited from a regional obstetric service over an 18-month period. Doppler assessment of the UA and UV done within 10 days from delivery were used for analysis. Similar measurements were performed in a control group of nondiabetic nonhypertensive patients near term. RESULTS: All of the Doppler waveform patterns were within normal in the cohort of 140 patients (GDM 84, normal 62). The mean PI values for the UA and the mean total umbilical venous flow (TUVF) and TUVF per unit birth weight did not differ significantly between diabetic and nondiabetic pregnancies. Large-for-gestational-age fetuses showed higher TUVF than normal size fetuses, but the TUVF per unit birth weight was higher for small-gestational-age fetuses. These differences were independent of their diabetic status. CONCLUSION: Umbilical arterial and venous Doppler measurements near term were unable to distinguish between diabetic and nondiabetic pregnancies. Umbilical venous flow volume was apparently more sensitive to the size of the fetus than to the maternal diabetic state.

Body fat composition and weight changes during pregnancy and 6-8 months post-partum in primiparous and multiparous women.

OBJECTIVE: To compare changes in maternal weight and body fat composition from early to late pregnancy and 6-8 months postnatally between primiparous and multiparous patients. METHODS: Maternal weight and body fat percentage were assessed in a cohort of low-risk uncomplicated women in a general antenatal clinic at 14-20 weeks gestation, after 36 weeks, and around six to eight months after delivery using a Tanita TBF 105 Fat Analyser. Maternal epidemiological and anthropometric data, as well as pregnancy characteristics and perinatal outcome, were derived from standard antenatal records after delivery. The cohort was stratified into primiparous and multiparous women for comparison. RESULTS: In a cohort of 104 women, 55 (52.8%) were primiparous and 49 (47.1%) were multiparous. A relatively good overall correlation between body fat percentage gain and weight gain was observed (correlation coefficient 0.33) from early to late pregnancy. Primiparous women had higher weight gain (12 kg) and higher body fat gain (7.7%) during the pregnancy compared to multiparous women (10.8 kg and 6%, respectively), and they also retained more of the fat accumulated during pregnancy (1.92% vs - 0.44%, P < 0.001) when assessed over six months after their delivery. CONCLUSION: The findings could represent more exaggerated physiological responses to the pregnant state in the primiparous woman as compared to multiparous women.

Back pain symptoms and bone mineral density changes in pregnancy as measured by quantitative ultrasound.

OBJECTIVE: To evaluate whether back pain symptoms in pregnancy are associated with bone mineral density (BMD) changes as measured by quantitative ultrasound at the os calcis. METHODS: Consecutive patients were recruited from a general obstetric clinic over 1 year. Quantitative ultrasonographic measurements of BMD were performed at the os calcis between weeks 14-20 and 36-38. They were then surveyed for back pain symptoms experienced during pregnancy in the early postpartum period, and these were subsequently correlated with BMD changes. RESULTS: Of a total of 463 patients, 231 (49.8%) reported one or more episodes of significant back pain during pregnancy. A mean fall in BMD of 0.0395 g/cm(2) was demonstrable from early to late gestation. Those with back pain symptoms have higher mean BMD loss at the os calcis during pregnancy compared to those without back pain (0.038 vs. 0.029 g/cm(2); p = 0.012). A logistic regression model showed that weight gain and BMD loss in pregnancy were significantly associated with back pain symptoms. CONCLUSION: Back pain symptoms in pregnancy were associated with a greater fall in BMD at the os calcis, supporting the hypothesis that BMD changes could have an etiological role in back pain during pregnancy.

Bone mineral density changes in gestational diabetic pregnancies-a longitudinal study using quantitative ultrasound measurements of the os calcis.

To compare the maternal bone mineral density (BMD) changes in gestational diabetic and non-diabetic pregnancies using quantitative ultrasound measurements of the os calcis, BMD measurements were performed at the os calcis in early pregnancy before 20 weeks and in the late third trimester after 36 weeks, using a Hologic Sahara Clinical Bone Sonometer system. Random glucose screening and direct oral glucose tolerance testing were used to diagnose gestational diabetes mellitus (GDM) according to World Health Organization criteria, which was then treated according to a standard protocol. In a cohort of 480 patients, there were 96 gestational diabetic patients (14 GDM and 82 with impaired glucose tolerance). The mean BMD loss was higher in diabetic patients compared with controls (0.038 vs. 0.025 g/cm2, p = 0.048). A regression model of all pregnancies showed that higher fat accumulation was related to lower BMD loss, but diabetic status was not in the equation. Within diabetic pregnancies, lower initial BMD values, higher fat accumulation and higher early-pregnancy body mass index were associated with lower BMD loss. While gestational diabetic women had higher BMD loss than non-diabetic women, this was apparently secondary to other anthropometric factors rather than due directly to the gestational diabetic state.

Comparison of quality of life scores among non-exercising adolescent females and adolescent dancers with oligomenorrhea and amenorrhea.

STUDY OBJECTIVE: To evaluate whether oligomenorrhea and amenorrhea in adolescent females would have a negative effect on the standard quality of life (QOL) scores as compared to eumenorrheic adolescents, and whether such scoring would differ between those with exercise related oligo/amenorrhea or those with hypothalamic/ovarian causes. DESIGN: Prospective cross-sectional observational survey. METHODS: Young dancers were recruited from the Sports Clinic of a collegial School of Dance, and non-dancers were recruited from a hospital-based adolescent gynecology clinic. All subjects completed a structured self-answering questionnaire recording epidemiological data and a 36-item Short Form Health Survey (SF-36). All subjects had a full hormonal profile and pelvic ultrasound to study ovarian morphology. RESULTS: Sixty-six dancers (19 with exercise-related oligo/amenorrhea and 47 eumenorrhoeic) and 90 non-dancers (45 eumenorrhoeic and 45 oligo/amenorrheic) were analyzed, all 16-20 years of age. There was no difference in the scoring between eumenorrheic dancers and non-dancers. Oligo/amenorrheic dancers did not score lower than eumenorrheic dancers. Compared with eumenorrheic subjects or to oligo/amenorrheic dancers, oligo/amenorrheic non-dancers had significantly lower QOL scores in the domains of physical functioning (PF) and general health (GH) and vitality (VT). CONCLUSION: Compared with eumenorrheic adolescents, QOL scores were lower in non-exercising adolescents with oligo-amenorrhea, but not those with exercise related oligo/amenorrhea. The negative effects of oligomenorrhea and amenorrhea on quality of life were apparently attenuated if the menstrual dysfunction was related to physical training.