- Email: [email protected]
Reviewing the Landscape On Primary Ovarian Insufficiency
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Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78
Table 1 How comfortable are you in discussing the following topics with your adolescent patients and / or their parents? (N¼69) Very Uncomfortable
Somewhat Uncomfortable
Neutral
Somewhat Comfortable
Very Comfortable
4.4% 8.7% 1.5% 10.1% 0% 7.3% 1.5% 2.9%
2.9% 8.7% 7.3% 23.2% 0% 2.9% 1.5% 2.9%
4.4% 10.1% 4.4% 13.0% 4.4% 13.0% 2.9% 8.7%
36.2% 29.0% 37.7% 34.8% 7.3% 27.5% 29.0% 23.2%
52.2% 43.5% 49.3% 18.8% 88.4% 49.3% 65.2% 62.3%
Menstrual Cycle Disturbance Hormone use for cycle control Sexual activity Gay/Lesbian/Transgender issues HPV Vaccination Contraception Sexually transmitted infections Genitourinary Hygiene
Table 2 How often do you discuss the following topics with your adolescent patients and / or their parents? (N¼69)
Menstrual Cycle Disturbance Hormone use for cycle control Sexual activity Gay/Lesbian/Transgender issues HPV Vaccination Contraception Sexually transmitted infections Genitourinary Hygiene
Never
Rarely
Sometimes
Frequently
Always
2.9% 7.3% 1.5% 15.9% 4.4% 4.4% 1.5% 5.8%
4.4% 13.0% 7.3% 46.4% 5.8% 7.3% 7.3% 17.4%
27.5% 37.7% 17.4% 29.0% 8.7% 29.0% 18.8% 27.5%
37.7% 29.0% 42.0% 7.3% 20.3% 40.6% 49.3% 27.5%
27.5% 13.0% 31.9% 1.5% 60.9% 18.8% 23.2% 21.7%
Female pediatricians were more comfortable discussing and managing contraception than their male counterparts (p ¼ 0.0059 and 0.0023, respectively). In addition, females were more likely to discuss sexual activity (p ¼ 0.0011) and hormone use for cycle control (p ¼ 0.0062) with their patients than male practitioners. Age also impacted practitioners comfort level with managing contraception with those practitioners less than forty years of age being more comfortable than their older counterparts (p ¼ 0.0058). The location of residency training (southeast United States versus other locales) and the extent of adolescent training in residency were not associated with physician comfort levels or practices. Conclusions: Pediatricians are comfortable discussing most gynecologic topics with their patients, with the exception of gay/lesbian/transgender issues. Practitioner age and gender influence pediatrician comfort level and likelihood of discussing various gynecologic issues with their patients, with female and younger practitioners demonstrating more comfort.
Comments: Monozygotic twins occur in 3 out of 1000 births worldwide, with monochorionicmonoamniotic twins accounting for only 1-2% of monozygotic twin pregnancies. The incidence of conjoined twins is even more rare, occurring in 1 in 50,000 to 1 in 100,000 births. Both twin and parabiotic studies allow for advancement of knowledge regarding genetic and environmental factors as they contribute to the process in question. Conjoined twins share not only genetics and environment, but also have potential cross-circulation at various points depending on which parts of the corpus are shared, making interpretation of hormonal studies to assess puberty and imaging challenging. No cases previously described report on simultaneous prepubertal vaginal bleeding in twins. This is the first to describe such a situation, occurring in thoracoabominopagus twins.
60. Reviewing the Landscape On Primary Ovarian Insufficiency 59. An Unusual Case of Vaginal Bleeding Kelly Blazek MD, Julie Hakim MD, Oluyemisi Adeyemi MD, Jennifer L. Bercaw-Pratt MD, Jennifer E. Dietrich MD* Baylor College of Medicine Houston, Texas
Dr.Julie Hakim MD, Dr.Jennifer Dietrich MD* Division of Pediatric and Adolescent Gynecology, Department of OB/GYN and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
Background: There are major gaps in knowledge relating to Premature Background: Vaginal bleeding in infancy may be related to maternal hormone stimulation that results in withdrawal bleeding. Prepubertal vaginal bleeding can be challenging to assess, however, further evaluation is vital to elucidate the underlying etiology. Until present, no cases of simultaneous prepubertal bleeding have been described in conjoined or separated twins. We report on this occurrence as well as a review of the literature. Case: We describe the case of thoracoabdominopagus conjoined twins. Gynecology was initially consulted in order to help evaluate the twins’ reproductive anatomy as there was concern for ambiguous genitalia noted on prenatal imaging. Following delivery, physical exam revealed a fused perineum with closely approximated solitary urogenital sinus openings externally, and imaging revealed two sets of uterine didelphys. Early postnatal imaging was not able to clearly identify the ovaries. At 3 months of age, both girls experienced prepubertal vaginal bleeding and gynecology was again consulted. MRI pelvis identified an ovarian cyst in one of the twins. The ovarian cyst as well as the vaginal bleeding in both twins resolved spontaneously within one month, and were hypothesized to have been caused by maternal hormone stimulation rather than precocious puberty or other etiology, even though only one twin had an ovarian cyst.
Ovarian Insufficiency (POI) with regards to epidemiology of disease causality in adolescents and young women. The etiology of POI is often thought to be related to genetic conditions, damage from chemotherapy and radiation, permutation in the FMR1 gene, endocrinopathies, infiltrative or autoimmune processes, or remains unknown. However, a recent publication indicated that FMR1 premutations are not as prevalent in women with POI as previous estimates have suggested. Additionally, there have been no recent updates on the epidemiologic aspects of POI in adolescents in the United States. Given advances in techniques for ovarian preservation in girls undergoing chemotherapy and radiation treatment for cancer as well as new techniques for Fragile X testing, the time is right for a baseline analysis of epidemiological factors and etiologies of POI in adolescents. This analysis may aid in development of a consensus on criteria to identify POI and avoid delays in diagnosis and treatment. Methods: IRB approval for this analysis was granted by Baylor College of Medicine and Texas Children’s Hospital. We performed a retrospective chart review and utilized descriptive statistics to analyze cases of POI between 7/2007 and 4/30/2014 using ICD9 codes in patients presenting to a large tertiary care referral center for children and adolescents. Results: Twenty-six met inclusion criteria for diagnosis of POI. Only 10 patients had been seen by a Gynecologist or a specialist in Pediatric and
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78
Adolescent Gynecology. The mean age at diagnosis was 18 years of age. 17 of the patients had a cancer diagnosis, 20 of who received chemotherapy and 18 of who received a bone marrow transplant. Average FSH, LH, and Estradiol values 2.75 years prior to diagnosis were 48 MIU/mL, 25 MIU/mL, and 30 pg/ mL respectively. Lab values were not drawn regularly pre and post diagnosis. Only 14 patients underwent a DEXA analysis on average 2.4 years prior to diagnosis, and only 2 underwent FMR1 analysis for elevated FSH values without a precedent cancer diagnosis or history of chemotherapy or radiation. Hormonal treatment varied widely including 13 treated with combined pills and 16 with conjugated estrogens in oral or patch forms. Conclusions: This analysis forms the most recent review of epidemiological factors related to POI in adolescents and young women in a large tertiary care referral hospital in the United States. Fragile X has been shown to be a less common etiology of POI than previously thought, while cancer diagnosis and especially history of a bone marrow transplant is seen in most of the diagnosed cases. This analysis highlights the importance of ovarian preservation counseling prior to chemotherapy and radiotherapy treatments. It also serves to reinforce the necessity of these patients being seen by Gynecologist who can facilitate an accurate diagnosis with appropriate laboratory analysis, thereby avoiding delays in diagnosis and treatment. Additionally, this analysis may allow clinicians to more accurately counsel patients and their families regarding future fertility, comorbidities, and potential for inheritance.
61. Breastfeeding Knowledge, Attitudes and Exposures in a Community Sample of Adolescents and Young Adults Laura A. Parks MD*, Chelsea Bayer, Shannon Hritz, Kathryn C. Stambough MD, Chrisman Camaryn Robbins MD, MPH Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University in St. Louis, School of Medicine; St. Louis, Missouri
Background: Breastfeeding has significant health and developmental advantages for infants, including optimal nutrient content, maternal antibodies to fight infections, and important bonding interaction between mother and child. Previous studies of adolescent experiences with breastfeeding have shown that younger women are less likely to breastfeed their babies than older women, and have dealt primarily with populations of university students. This study seeks to evaluate the perceptions and knowledge of breastfeeding among both male and female adolescents in an urban setting to gain a better understanding as to why this age group is far less likely to breastfeed than their older counterparts. Methods: Prospective, cross-sectional survey given to walk-in visitors to The SPOT youth center in St. Louis, Missouri. Survey questions included true/false statements about breastfeeding knowledge and agree/disagree statements regarding attitudes towards breastfeeding as well participant characteristics. This project has IRB approval. Results: A total of 166 subjects participated, 39 were male and 127 were female. Median age was 20.8 years (include range?). Fifty-six (34%) were breastfed, seventy-five (43%) were not and the remaining forty-two (24%) were not sure. Twenty-nine (18%) had one or more children and eighteen of those (62%) breastfed at least one of their children. There were two types of questions included on the survey: general knowledge questions and questions to assess general attitudes towards breastfeeding. All of the general knowledge statements were answered correctly by a majority of both males and females, ranging from 65% to 95% correct. A majority of participants, regardless of age, sex or exposure to breastfeeding, had positive attitudes towards breastfeeding. Positive or negative attitudes were determined by either agreeing with positive statements (ex: I respect women who breastfeed their children) or disagreeing with negative statements (ex: Breastfeeding in public is embarrassing). Participants ages 19-24 were more likely state they want to breastfeed their own children than participants ages 13-18 (p ¼ 0.01). Conclusion: Although prior studies show that the under age 24 age group is less likely to breastfeed their children, the data suggests that it is not due to misunderstanding or poor perceptions of breastfeeding. In fact a majority of adolescents and young adults in this study answered
e67
breastfeeding knowledge questions correctly and perceived breastfeeding positively. This suggests that the obstetric and pediatric community should be encouraging adolescent and young mothers to breastfeed and perhaps with better support the incidence of breastfeeding among adolescents and young adults will rise to meet the levels seen in older women.
62. Innovative Use of 3D Printers in Gynecology Dr. Julie Hakim MD, Dr. Adeyemi Oluyemisi MD, Cara Buskmiller, Dr. Rajesh Krishnamurthy MD, Dr. William Cohn MD, Dr. Jennifer E. Dietrich MD* Division of Pediatric and Adolescent Gynecology, Department of OB/GYN and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
Background: Three dimensional printing (3DP) is an emerging family of technologies with wide applications in the medical field. To date, however, 3DP has not been used for applications within the field of gynecology. Vaginal dilators and stents are used post surgery after creation of a neovaginal canal in order to maintain the caliber of the newly created vagina and to avoid restenosis. Vaginal dilators can be used for neovagina creation in patients who decline or who are not candidates for surgical intervention. Currently available stents and dilators exist only in adult vaginal sizes that cannot be used safely or comfortably in the pediatric population. We propose to study the ability to use of 3D printing as it relates to the creation of vaginal stents and dilators to fit a pediatric population. Methods: This protocol was IRB approved through Baylor College of Medicine. We used an available soft flexible vaginal stent (MentorÒ), which measures 3cm x 9.5cm. We also used AmielleÒ comfort vaginal dilators, the smallest size of which measures 9cm x 2cm. We performed a CT scan of both the stent and dilator. We used the Stratasays Objet30ProÒ 3D printer using a high temperature material RGD525 in soft and hard printing materials. Results: Using the Stratasays Objet30ProÒ 3D printer using high temperature material RGD525, we were able to re-print the dilators in order to customize size base on patient needs in a variety of lengths and widths. Conclusions: Three-dimensional printing is being used as a novel way to approach many congenital conditions in the medical field. To date however, it has not yet been applied within the field of Gynecology. Currently there are no vaginal dilators or stents on the medical device market that comfortably and safely fit a pediatric and adolescent population, or sized for a vagina that may have a configuration that would better be suited to a custom stent or dilator. We have successfully shown that 3DP can be used to resize vaginal stents and dilators for the pediatric and adolescent population on the basis of computer models and use of CT imaging. 3DP is an avenue within the field of Pediatric and Adolescent Gynecology with far reaching potential applications that bears future exploration.
63. Exposure to Community Violence and Teen Pregnancy Hilary Cornell II MS, Carly Schuetz MD, Jennie Yoost MD, MSc* Marshall University School of Medicine, Huntington, WV
Background: Pregnancy is unintended in the majority (75%) of adolescents who conceive each year.1 A study also reported that the majority (60.6%) of children and adolescents surveyed in a nationwide sample had experienced or been witness to at least one act of violence in the past 2 year. In assessing risk factors for teen pregnancy, it is important to realize the reasons why contraception was not utilized. One study showed that pregnant adolescents cited “Not ready to prevent pregnancy” as the top reason they became pregnant. Logistical barriers such as cost, parental influence and lack of knowledge about obtaining birth control were less cited reasons for not using contraception.1 While contraception ambivalence is a common reason cited in teen pregnancy 3, no correlation between reasons for contraception non-use and demographic factors have been shown. This study examined the prevalence of those who had witnessed or been victims of violence in our community using a standardized survey. Two separate populations were studied: pregnant teens and pregnant adults. Standardized reasons for contraceptive nonuse were also assessed
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78
Table 1 How comfortable are you in discussing the following topics with your adolescent patients and / or their parents? (N¼69) Very Uncomfortable
Somewhat Uncomfortable
Neutral
Somewhat Comfortable
Very Comfortable
4.4% 8.7% 1.5% 10.1% 0% 7.3% 1.5% 2.9%
2.9% 8.7% 7.3% 23.2% 0% 2.9% 1.5% 2.9%
4.4% 10.1% 4.4% 13.0% 4.4% 13.0% 2.9% 8.7%
36.2% 29.0% 37.7% 34.8% 7.3% 27.5% 29.0% 23.2%
52.2% 43.5% 49.3% 18.8% 88.4% 49.3% 65.2% 62.3%
Menstrual Cycle Disturbance Hormone use for cycle control Sexual activity Gay/Lesbian/Transgender issues HPV Vaccination Contraception Sexually transmitted infections Genitourinary Hygiene
Table 2 How often do you discuss the following topics with your adolescent patients and / or their parents? (N¼69)
Menstrual Cycle Disturbance Hormone use for cycle control Sexual activity Gay/Lesbian/Transgender issues HPV Vaccination Contraception Sexually transmitted infections Genitourinary Hygiene
Never
Rarely
Sometimes
Frequently
Always
2.9% 7.3% 1.5% 15.9% 4.4% 4.4% 1.5% 5.8%
4.4% 13.0% 7.3% 46.4% 5.8% 7.3% 7.3% 17.4%
27.5% 37.7% 17.4% 29.0% 8.7% 29.0% 18.8% 27.5%
37.7% 29.0% 42.0% 7.3% 20.3% 40.6% 49.3% 27.5%
27.5% 13.0% 31.9% 1.5% 60.9% 18.8% 23.2% 21.7%
Female pediatricians were more comfortable discussing and managing contraception than their male counterparts (p ¼ 0.0059 and 0.0023, respectively). In addition, females were more likely to discuss sexual activity (p ¼ 0.0011) and hormone use for cycle control (p ¼ 0.0062) with their patients than male practitioners. Age also impacted practitioners comfort level with managing contraception with those practitioners less than forty years of age being more comfortable than their older counterparts (p ¼ 0.0058). The location of residency training (southeast United States versus other locales) and the extent of adolescent training in residency were not associated with physician comfort levels or practices. Conclusions: Pediatricians are comfortable discussing most gynecologic topics with their patients, with the exception of gay/lesbian/transgender issues. Practitioner age and gender influence pediatrician comfort level and likelihood of discussing various gynecologic issues with their patients, with female and younger practitioners demonstrating more comfort.
Comments: Monozygotic twins occur in 3 out of 1000 births worldwide, with monochorionicmonoamniotic twins accounting for only 1-2% of monozygotic twin pregnancies. The incidence of conjoined twins is even more rare, occurring in 1 in 50,000 to 1 in 100,000 births. Both twin and parabiotic studies allow for advancement of knowledge regarding genetic and environmental factors as they contribute to the process in question. Conjoined twins share not only genetics and environment, but also have potential cross-circulation at various points depending on which parts of the corpus are shared, making interpretation of hormonal studies to assess puberty and imaging challenging. No cases previously described report on simultaneous prepubertal vaginal bleeding in twins. This is the first to describe such a situation, occurring in thoracoabominopagus twins.
60. Reviewing the Landscape On Primary Ovarian Insufficiency 59. An Unusual Case of Vaginal Bleeding Kelly Blazek MD, Julie Hakim MD, Oluyemisi Adeyemi MD, Jennifer L. Bercaw-Pratt MD, Jennifer E. Dietrich MD* Baylor College of Medicine Houston, Texas
Dr.Julie Hakim MD, Dr.Jennifer Dietrich MD* Division of Pediatric and Adolescent Gynecology, Department of OB/GYN and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
Background: There are major gaps in knowledge relating to Premature Background: Vaginal bleeding in infancy may be related to maternal hormone stimulation that results in withdrawal bleeding. Prepubertal vaginal bleeding can be challenging to assess, however, further evaluation is vital to elucidate the underlying etiology. Until present, no cases of simultaneous prepubertal bleeding have been described in conjoined or separated twins. We report on this occurrence as well as a review of the literature. Case: We describe the case of thoracoabdominopagus conjoined twins. Gynecology was initially consulted in order to help evaluate the twins’ reproductive anatomy as there was concern for ambiguous genitalia noted on prenatal imaging. Following delivery, physical exam revealed a fused perineum with closely approximated solitary urogenital sinus openings externally, and imaging revealed two sets of uterine didelphys. Early postnatal imaging was not able to clearly identify the ovaries. At 3 months of age, both girls experienced prepubertal vaginal bleeding and gynecology was again consulted. MRI pelvis identified an ovarian cyst in one of the twins. The ovarian cyst as well as the vaginal bleeding in both twins resolved spontaneously within one month, and were hypothesized to have been caused by maternal hormone stimulation rather than precocious puberty or other etiology, even though only one twin had an ovarian cyst.
Ovarian Insufficiency (POI) with regards to epidemiology of disease causality in adolescents and young women. The etiology of POI is often thought to be related to genetic conditions, damage from chemotherapy and radiation, permutation in the FMR1 gene, endocrinopathies, infiltrative or autoimmune processes, or remains unknown. However, a recent publication indicated that FMR1 premutations are not as prevalent in women with POI as previous estimates have suggested. Additionally, there have been no recent updates on the epidemiologic aspects of POI in adolescents in the United States. Given advances in techniques for ovarian preservation in girls undergoing chemotherapy and radiation treatment for cancer as well as new techniques for Fragile X testing, the time is right for a baseline analysis of epidemiological factors and etiologies of POI in adolescents. This analysis may aid in development of a consensus on criteria to identify POI and avoid delays in diagnosis and treatment. Methods: IRB approval for this analysis was granted by Baylor College of Medicine and Texas Children’s Hospital. We performed a retrospective chart review and utilized descriptive statistics to analyze cases of POI between 7/2007 and 4/30/2014 using ICD9 codes in patients presenting to a large tertiary care referral center for children and adolescents. Results: Twenty-six met inclusion criteria for diagnosis of POI. Only 10 patients had been seen by a Gynecologist or a specialist in Pediatric and
Poster Abstracts / J Pediatr Adolesc Gynecol 28 (2015) e41ee78
Adolescent Gynecology. The mean age at diagnosis was 18 years of age. 17 of the patients had a cancer diagnosis, 20 of who received chemotherapy and 18 of who received a bone marrow transplant. Average FSH, LH, and Estradiol values 2.75 years prior to diagnosis were 48 MIU/mL, 25 MIU/mL, and 30 pg/ mL respectively. Lab values were not drawn regularly pre and post diagnosis. Only 14 patients underwent a DEXA analysis on average 2.4 years prior to diagnosis, and only 2 underwent FMR1 analysis for elevated FSH values without a precedent cancer diagnosis or history of chemotherapy or radiation. Hormonal treatment varied widely including 13 treated with combined pills and 16 with conjugated estrogens in oral or patch forms. Conclusions: This analysis forms the most recent review of epidemiological factors related to POI in adolescents and young women in a large tertiary care referral hospital in the United States. Fragile X has been shown to be a less common etiology of POI than previously thought, while cancer diagnosis and especially history of a bone marrow transplant is seen in most of the diagnosed cases. This analysis highlights the importance of ovarian preservation counseling prior to chemotherapy and radiotherapy treatments. It also serves to reinforce the necessity of these patients being seen by Gynecologist who can facilitate an accurate diagnosis with appropriate laboratory analysis, thereby avoiding delays in diagnosis and treatment. Additionally, this analysis may allow clinicians to more accurately counsel patients and their families regarding future fertility, comorbidities, and potential for inheritance.
61. Breastfeeding Knowledge, Attitudes and Exposures in a Community Sample of Adolescents and Young Adults Laura A. Parks MD*, Chelsea Bayer, Shannon Hritz, Kathryn C. Stambough MD, Chrisman Camaryn Robbins MD, MPH Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Washington University in St. Louis, School of Medicine; St. Louis, Missouri
Background: Breastfeeding has significant health and developmental advantages for infants, including optimal nutrient content, maternal antibodies to fight infections, and important bonding interaction between mother and child. Previous studies of adolescent experiences with breastfeeding have shown that younger women are less likely to breastfeed their babies than older women, and have dealt primarily with populations of university students. This study seeks to evaluate the perceptions and knowledge of breastfeeding among both male and female adolescents in an urban setting to gain a better understanding as to why this age group is far less likely to breastfeed than their older counterparts. Methods: Prospective, cross-sectional survey given to walk-in visitors to The SPOT youth center in St. Louis, Missouri. Survey questions included true/false statements about breastfeeding knowledge and agree/disagree statements regarding attitudes towards breastfeeding as well participant characteristics. This project has IRB approval. Results: A total of 166 subjects participated, 39 were male and 127 were female. Median age was 20.8 years (include range?). Fifty-six (34%) were breastfed, seventy-five (43%) were not and the remaining forty-two (24%) were not sure. Twenty-nine (18%) had one or more children and eighteen of those (62%) breastfed at least one of their children. There were two types of questions included on the survey: general knowledge questions and questions to assess general attitudes towards breastfeeding. All of the general knowledge statements were answered correctly by a majority of both males and females, ranging from 65% to 95% correct. A majority of participants, regardless of age, sex or exposure to breastfeeding, had positive attitudes towards breastfeeding. Positive or negative attitudes were determined by either agreeing with positive statements (ex: I respect women who breastfeed their children) or disagreeing with negative statements (ex: Breastfeeding in public is embarrassing). Participants ages 19-24 were more likely state they want to breastfeed their own children than participants ages 13-18 (p ¼ 0.01). Conclusion: Although prior studies show that the under age 24 age group is less likely to breastfeed their children, the data suggests that it is not due to misunderstanding or poor perceptions of breastfeeding. In fact a majority of adolescents and young adults in this study answered
e67
breastfeeding knowledge questions correctly and perceived breastfeeding positively. This suggests that the obstetric and pediatric community should be encouraging adolescent and young mothers to breastfeed and perhaps with better support the incidence of breastfeeding among adolescents and young adults will rise to meet the levels seen in older women.
62. Innovative Use of 3D Printers in Gynecology Dr. Julie Hakim MD, Dr. Adeyemi Oluyemisi MD, Cara Buskmiller, Dr. Rajesh Krishnamurthy MD, Dr. William Cohn MD, Dr. Jennifer E. Dietrich MD* Division of Pediatric and Adolescent Gynecology, Department of OB/GYN and Pediatrics, Baylor College of Medicine and Texas Children’s Hospital
Background: Three dimensional printing (3DP) is an emerging family of technologies with wide applications in the medical field. To date, however, 3DP has not been used for applications within the field of gynecology. Vaginal dilators and stents are used post surgery after creation of a neovaginal canal in order to maintain the caliber of the newly created vagina and to avoid restenosis. Vaginal dilators can be used for neovagina creation in patients who decline or who are not candidates for surgical intervention. Currently available stents and dilators exist only in adult vaginal sizes that cannot be used safely or comfortably in the pediatric population. We propose to study the ability to use of 3D printing as it relates to the creation of vaginal stents and dilators to fit a pediatric population. Methods: This protocol was IRB approved through Baylor College of Medicine. We used an available soft flexible vaginal stent (MentorÒ), which measures 3cm x 9.5cm. We also used AmielleÒ comfort vaginal dilators, the smallest size of which measures 9cm x 2cm. We performed a CT scan of both the stent and dilator. We used the Stratasays Objet30ProÒ 3D printer using a high temperature material RGD525 in soft and hard printing materials. Results: Using the Stratasays Objet30ProÒ 3D printer using high temperature material RGD525, we were able to re-print the dilators in order to customize size base on patient needs in a variety of lengths and widths. Conclusions: Three-dimensional printing is being used as a novel way to approach many congenital conditions in the medical field. To date however, it has not yet been applied within the field of Gynecology. Currently there are no vaginal dilators or stents on the medical device market that comfortably and safely fit a pediatric and adolescent population, or sized for a vagina that may have a configuration that would better be suited to a custom stent or dilator. We have successfully shown that 3DP can be used to resize vaginal stents and dilators for the pediatric and adolescent population on the basis of computer models and use of CT imaging. 3DP is an avenue within the field of Pediatric and Adolescent Gynecology with far reaching potential applications that bears future exploration.
63. Exposure to Community Violence and Teen Pregnancy Hilary Cornell II MS, Carly Schuetz MD, Jennie Yoost MD, MSc* Marshall University School of Medicine, Huntington, WV
Background: Pregnancy is unintended in the majority (75%) of adolescents who conceive each year.1 A study also reported that the majority (60.6%) of children and adolescents surveyed in a nationwide sample had experienced or been witness to at least one act of violence in the past 2 year. In assessing risk factors for teen pregnancy, it is important to realize the reasons why contraception was not utilized. One study showed that pregnant adolescents cited “Not ready to prevent pregnancy” as the top reason they became pregnant. Logistical barriers such as cost, parental influence and lack of knowledge about obtaining birth control were less cited reasons for not using contraception.1 While contraception ambivalence is a common reason cited in teen pregnancy 3, no correlation between reasons for contraception non-use and demographic factors have been shown. This study examined the prevalence of those who had witnessed or been victims of violence in our community using a standardized survey. Two separate populations were studied: pregnant teens and pregnant adults. Standardized reasons for contraceptive nonuse were also assessed