Maggie Dwiggins

Uterine rupture in a primigravid patient with an unscarred bicornuate uterus at term

Background Uterine rupture of an unscarred primigravid uterus is an exceedingly rare event. Cases of spontaneous rupture of an unscarred bicornuate uterus have been reported, but typically occur in the first or second trimester. Case A 28-year-old primigravida at 37 weeks gestation with a known bicornuate uterus and no prior surgery underwent an emergent cesarean section after presenting with severe abdominal pain and signs of fetal compromise. She was found to have a uterine rupture with the fetus free in the abdomen accompanied by a large hemoperitoneum. Both mother and baby did well postoperatively. Conclusion Bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.

Teenage Births—Influence of Sexually Transmitted Diseases During Pregnancy [6M]

INTRODUCTION: Our county in Central Illinois has impressive rates of both teenage pregnancies and sexually transmitted infections (STIs). Prior studies have shown that both teenage birth and lower genital tract infection lead to a higher risk of preterm birth. The primary objective of our study was to determine the prevalence of STIs (Gonorrhea, Chlamydia and Trichomonas) in pregnant teenagers and compare teenagers with and without STIs in regards to preterm delivery and chorioamnionitis. METHODS: We performed a retrospective cohort study by reviewing electronic medical records of females age 19 or younger who delivered between 01/01/2012 and 12/31/14 at our tertiary referral center. Patients with multiple gestation were excluded. After descriptive statistics and univariate analysis, a multivariable logistic regression was used to examine the association between STIs and outcomes controlling for age, marital status, race, parity and smoking status. RESULTS: 562 charts were reviewed, 517 teens with live singleton births identified. The overall rate of STIs during pregnancy was 17.2% (gonorrhea 3.5%, chlamydia 14.7%, trichomonas 3.3%). The rates of preterm deliveries and clinical chorioamnionitis were 18.4% (95/517) and 4.1% (21/517), respectively. STIs were not associated with preterm deliveries or chorioamnionitis (P>.05), but pregnant teenagers with preeclampsia were more likely to have preterm deliveries (P<.01). CONCLUSION: Our rate of preterm deliveries (18.4%) was higher than the national average (11.4%), confirming a higher rate of preterm births in teenagers. Surprisingly, no significant association between STIs and preterm delivery was found in our population, in contrast to previous studies not specific to teenagers.

Health Care Simulation Experience for Rural High School Students [81]

INTRODUCTION: The objective of this study was to develop a simple, easily reproducible intervention for high school seniors and to evaluate the effect it had on their perspective of the health care field. METHODS: The Eureka High School Outreach Program is a half-day event that includes time spent in a wet pathology laboratory and at a simulation center. Simulation sessions include sterile technique, laparoscopy, suturing and knot-tying, blood pressure monitoring, and intravenous placement. Our research design is a prospective, mixed quantitative and qualitative study. Thirty-six junior and senior rural high school students participated in the event and completed presurveys and postsurveys to gauge change in interest level in medicine and the effect of the event on choosing a career. RESULTS: Thirty-six students completed presurveys and postsurveys with a response rate of 88.9%. Before intervention, 58.3% of students reported being interested in health care as an occupation, 55.6% had a mentor in health care, 100% reported intending to pursue higher education, and of those, 27.7% intended to pursue graduate school or higher. After intervention, 65.5% reported increased interest in health care, 78.1% felt it was helpful in choosing a career, and 96.6% had a better understanding of health care. The questions used for qualitative measures were insight from the experience, in what areas would students like more information, and any suggestions for future events. CONCLUSION: Eureka High School Outreach Program is a low-resource, high-effect half-day intervention that is easily replicable and can significantly promote early interest in a health care career for rural students.

When Should Gynecology Be Consulted to Manage a Vulvar Abscess? [301]

INTRODUCTION: A variety of treatment approaches are available for vulvar abscess. Many specialties are involved in their management, but criteria for early recognition of high-risk patients and prompt referral guidelines do not exist. METHODS: A retrospective cohort of vulvar abscess cases treated at a single, urban tertiary care center from 2011 to 2013 was identified. Analyses were completed on two groups: pediatric (younger than 18 years old) and adults (older than 18 years old). Univariate analyses examined patient factors associated with length of stay. RESULTS: A total of 250 patients with vulvar abscess were identified. Of those, 54 (25%) were pediatric patients with a mean age of 5 years (standard deviation [SD] 5.6), and 196 (75%) were adults with a mean age 43 years (SD 17.8, range 18–95 years). The prevalence of length of stay of 1 or more days was 57% (n=31) in the pediatric group, and the majority were managed with a surgical procedure (97.8% [53/54]) by nongynecologic surgeons (95.4%). In the adult population, the prevalence of length of stay of 1 or more days was 27% (n=53), and 74.4% (133/180) of adult women had operative procedures performed by a gynecologist. Characteristics that predicted length of stay of 1 or more days were two preoperative comorbidities for children (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.59–3.37) and seven comorbidities for adult women (OR 4.9, 95% CI 6.64–8.00). An increasing trend between comorbidities and number of procedures performed was demonstrated (r=0.497, P=.01). CONCLUSION: This study identified a subset of high-risk patients with vulvar abscess who would benefit from earlier treatment and more specialized services and interventions.

Board #116 - Research Abstract There’s More to Simulation in High School than Driver’s Ed and Fire Drills: Health Care Simulation Experience for Rural High School Students (Submission #8538)

Hypothesis The objective of this study was to provide rural high school students a hands-on experience using healthcare simulations in order to give them a more realistic perception of medicine, stimulate interest in healthcare, and promote a stronger desire to pursue a career in medicine. We developed a simple, easily reproducible intervention for high school seniors and evaluated the impact our simulations had on their perspective of the healthcare field. Methods Eureka High School Outreach Program is a half day event that includes time spent in wet pathology lab where the students examine organ systems, handle anatomy specimens and have small group sessions with instructors. The second part of the morning is spent at a simulation center where an introductory curriculum for exposing students to basic surgical skills is run. The surgical exercises are simple, include specific performance-based learning objectives and have clear instructions. All exercises are adapted to small groups of up to five students and can be completed within twenty minutes. Simulation sessions include sterile technique (scrubbing and gowning), laparoscopy, suturing and knot tying, blood pressure monitoring and IV placement. Thirty six junior and senior high school students participated in the event and completed pre- and - post surveys to gauge change in interest level in medicine and impact of event on choosing a career. Results Thirty-six students completed pre/post surveys, with a response rate 88.9%. Only two students reported having been a part of a simulation event in the past, although presumably every student had at least been a part of a fire drill while at school. Before intervention, 58.3% of students reported being interested in healthcare as an occupation, 55.6% had mentor in healthcare, 100% reported intending to pursue higher education, and of those, 27.7% grad school or higher. After intervention, 65.5% reported increased interest in healthcare, 78.1% felt it was helpful in choosing a career, and 96.6% had a better understanding of healthcare. Conclusion Eureka High School Outreach Program is a low resource, high impact half day intervention that is easily replicable and can significantly promote early interest in a healthcare career for rural students. References 1. Antiel RM, Thompson SM, Camp CL, Thompson GB, Farley DR. Attracting students to surgical careers: Preclinical surgical experience. J Surg Ed 2012:301-305. 2. Drolet BC, Sangisetty S, Mulvaney PM, Ryder BA, Cioffi WG. A mentor-based preclinical elective increases exposure, confidence, and interest in surgery. Am J of Surg 2014;207:179-186. 3. Lee JT, Son JH, Chandra V, Lilo E, Dalman RL. Long-term impact of preclinical vascular skills course on medical student career courses. J Vasc Surg 2011;54:1193-1200. 4. Nitschmann C, Bartz D, Johnson NR. Gynecologic simulation training increased medical student confidence and interest in women’s health. Teaching and learning in Med 2014;26(2):160-163. 5. Patel MS, Khalsa B, Rama A, Jafari F, Salibian A, Hoyt DB, Stamos MJ, Smith BR. Early intervention to promote medical student interest in surgery and the surgical subspecialties. J Surg Ed 2012:81-86. Disclosures None