OBJECTIVE:To detail the attendance of female Irish Travellers at the national Sexual Assault Treatment Unit (SATU) network. METHODS:Retrospective cross-sectional study examining the attendance of female patients who identified as members of the Irish Traveller community at the national SATU network between 2017 and 2023 and comparing them with all other female attenders. RESULTS:There were 5942 female attendances during the study period, of which 54 were Irish Traveller women with a mean age of 25.9 ± 11.5 years; with 35 (64.8%) presenting within 7 days of assault. Most attended with police involvement (40, 74.1%), assaults most commonly occurred in the victim's home (14, 25.9%) or outdoors (13, 24.1%), and perpetrators were frequently family members (13, 24.1%), intimate/ex-intimate partners (12 combined, 22.2%), acquaintances of more than 24 h (8, 14.8%), or strangers (9, 16.7%). Compared with other female attenders, Irish Traveller women were significantly less likely to present within 24 h (24.1% vs 39.7%; odds ratio [OR] 0.48 P = 0.02) and to report alcohol use in the preceding 24 h (OR 0.33, P < 0.001), but were significantly more likely to report a family member (OR 8.25, P < 0.001) or an intimate/ex-intimate partner (OR 2.04, P = 0.03) as the assailant. CONCLUSION:This study provides the first national analysis of Irish Traveller women attending SATU in Ireland and highlights distinct differences in the patterns of perpetrator relationship and timing of presentation compared with other female attenders.

Introduction Clinical placement on the labour ward is an essential component of Obstetrics and Gynaecology curricula in medical schools worldwide. This clinical learning environment (CLE) provides students with a formative opportunity for experiential learning around labour and delivery. However, the CLE presents challenges to learning, in particular diversity of experiences and opportunities. The simulated learning environment (SLE) has been adopted by medical schools worldwide in order to address such issues. The SLE provides a safe space for students to practise clinical skills around care in labour and delivery. These learning experiences form the sole exposure for many students to labour and delivery. This study examines the learner experience of these environments and the relationship between them. Methods A qualitative research study was performed in the Royal College of Surgeons Ireland. Fourth year undergraduate medical students undertaking their obstetrics and gynaecology rotation were invited to participate. Students attend a labour ward simulation and a week-long clinical placement as part of this rotation. Focus groups were conducted following the simulation and students completed audio diaries during their clinical placement which underwent inductive content analysis. Results Four major concepts emerged from analysis of the data from 29 participating students. Simulation was viewed by students as preparation for the CLE. Learner safety within the simulated learning space was highly valued by students. Learner roles in the SLE were often assigned, while student identity on the labour ward developed from their own engagement, patient interactions, and interprofessional staff. Students identified the emotional aspect of the CLE of the labour ward as a significant impact on their learning experience. Conclusion The SLE was valued as a stepping-stone to prepare for the CLE. The safety afforded by the simulated labour ward was important to the student learning experience. The CLE was conducive to the formation of learner identities and students valued the emotional engagement with patients. These two areas require further exploration within the simulated learning space.

To investigate the prevalence of, and risk factors for, genito-anal injury in females who attended a Sexual Assault Treatment Unit in a capital city following sexual assault. Cross-sectional study. All females who underwent a genital and/or anal forensic examination between 1/1/2023 and 31/12/2023 were included. A standardised dataset of demographic and assault metrics was collated. Genito-anal injury data was contemporaneously collected by forensically trained specialist doctors and nurses using prescribed definitions and a standardised tool. Descriptive bivariate analysis and logistic regression analysis were performed on these data. Statistical significance was defined as a p-value < 0.05. During the study period, 405 women accessed this SATU service of whom 294 (72.6

Sexual violence (SV) while travelling internationally is underreported and pre-travel advice is often focussed on broader tourist safety concerns. International travellers who experience sexual violence face particular challenges. The aim of this paper was to analyse the attendances of people who disclosed having been subjected to SV during international travel to the Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland. Analysis of all people who attended the national SATU network who disclosed an incident of SV experienced during international travel, and comparison of these cases with domestic case attendances. During the 7-year period studied, there were 6,447 attendances to the national SATU network, with 443 incidents reported as occurring outside Ireland; in 66 separate countries. The mean age of international attendees was 26.61 years, with females representing 90.3

Operative vaginal delivery (OVD) rates have shown a downward trend in contemporary obstetrics, paralleling the decline in the trainee experience of forceps in some hospitals. We conducted a 20-year single-center study to explore the trajectory of OVD rates as well as assessing the trend of instrument choice and associated neonatal morbidity and mortality rates. This was a retrospective analysis of prospectively collected data at a single tertiary referral center from 2002-2021. All cases of OVD were included. The choice of instrument (forceps or vacuum), rate of hypoxic-ischemic-encephalopathy (HIE) and of neonatal death (NND) after OVD were also recorded. Linear regression analysis was used to determine trends. During the study period, there was a total of 162,460 deliveries. The rate of OVD accounted for 17.4% (n=21,042) of all deliveries or 25.0% of all vaginal deliveries. The overall rate of OVD use showed a non-significant decrease (p=0.33, R2=0.0528, slope=-0.2299) during the 20-year study period. Forceps were used in 4.4% of all deliveries (n=7,197), while vacuum was used in 13.0% (n=21,042). In contrast to other center’s experience, the use of forceps significantly increased during the study period (p=0.006, R2=0.3491, slope=0.5908). There were no statistically significant difference in NND (p=0.067) or HIE (p=0.370) associated with OVD use. Our analysis of OVD use at a single tertiary referral center revealed noteworthy trends. While the overall rate of OVD use showed a non-significant decline, the use of forceps increased significantly. The cause of this increase is likely to be multi-factorial and may reflect institutional commitment on the part of senior clinicians to optimizing forceps training for residents. Despite these shifts in delivery methods, there was no statistically significant difference in neonatal morbidity or mortality associated with OVD use. These findings should be useful for encouraging obstetric residency training programs to either commit to, or maintain, resident exposure to forceps as a useful obstetric skillset.

Sexual violence is common in contemporary society and disproportionally affects adolescents. In order to develop effective treatment, awareness and prevention strategies it is vital that we understand the epidemiology of adolescent sexual assault (SA). The aim of this study is to evaluate attendances by female adolescents to the national sexual assault treatment unit (SATU) network and compare these attendances with adult women accessing the service. This is a cross-sectional study analysing the attendances of all adolescent female attendances at the 6 SATUs in the Republic of Ireland and comparing them with all adult female attendances between 1/1/2017 and 31/12/2022. There were 1014 female adolescent attendances and 3951 female adult attendances consecutively over the timeframe studied. Adult attenders were more likely to attend within 7-days of the alleged assault compared with adolescent attenders (80.3% V 70.2% OR1.513 CI 1.35-1.697 p < 0.001). When compared with adult attenders, adolescent attenders were significantly more likely to disclose being assaulted outdoors (40.9% V 15.7% OR2.607 CI 2.346-2.898 p < 0.01), during the day (58.4% V 34.4% OR1.673 CI 1.565-1.790 p < 0.01), assaulted by a friend/family member (28.9% V 16% OR 1.812 CI1.603-2.049 p < 0.01) and less likely to have consumed alcohol prior to the incident (45.6% V 25.3% OR1.807 CI 1.653-1.975 p < 0.001). Physical injuries were less likely in adolescent attenders (30% V 35.5% OR0.845 CI .758-.942 p = 0.02). A comparison of the characteristics of adolescent and adult female sexual assault disclosures identifies differences regarding location of the incident, relationship to perpetrator and prevalence of alcohol consumption. Knowledge of these factors support appropriate tailoring of treatment, prevention and awareness strategies to help modify the impact and reduce the incidence of SA in the vulnerable adolescent cohort.

Background: Sexual violence is common in contemporary society and disproportionally affects adolescents. In order to develop effective treatment, awareness and prevention strategies it is vital that we understand the epidemiology of adolescent sexual assault (SA). The aim of this study is to evaluate attendances by female adolescents to the national sexual assault treatment unit (SATU) network in the Republic of Ireland and compare these attendances with adult women accessing the service.Methods: This is a cross-sectional study analysing the attendances of all adolescent female attendances at the 6 SATUs in the Republic of Ireland and comparing them with all adult female attendances between 1/1/2017 and 31/12/2022.Results: There were 1014 female adolescent attendances and 3951 female adult attendances over the timeframe studied. Adult attenders were more likely to attend within 7-days of the alleged assault compared with adolescent attenders (80.3% V 70.2% OR1.513 CI 1.35-1.697 p < 0.001). When compared with adult attenders, adolescent attenders were significantly more likely to disclose being assaulted outdoors (40.9% V 15.7% OR2.607 CI 2.346-2.898 p < 0.01), during the day (58.4% V 34.4% OR1.673 CI 1.565-1.790 p < 0.01), assaulted by a friend/family member (28.9% V 16% OR 1.812 CI1.603-2.049 p < 0.01) and less likely to have consumed alcohol prior to the incident (45.6% V 25.3% OR1.807 CI 1.653-1.975 p < 0.001). Physical injuries were less likely in adolescent attenders (30% V 35.5% OR0.845 CI 0.758-0.942 p = 0.02).Conclusion: A comparison of the characteristics of adolescent and adult female sexual assault disclosures identifies differences regarding location of the incident, relationship to perpetrator and prevalence of alcohol consumption. Knowledge of these factors support appropriate tailoring of treatment, prevention and awareness strategies to help modify the impact and reduce the incidence of SA in the vulnerable adolescent cohort.

Background: Sexual violence is a crime that affects people of all genders. While focus is frequently on female survivors, it is crucial to acknowledge that males also experience sexual violence and to ensure that gendersensitive services are available to all survivors. Understanding the prevalence of, and factors associated with, sexual violence against males is a critical first step in addressing this issue. We aim to address the lack of data in relation to sexual violence against males. Methods: A cross-sectional study of all male attendances at 6 Sexual Assault Treatment Units (SATU) in the Republic of Ireland over a 6-year period and, where applicable, comparison with corresponding female attendances. Results: There were 381 male attendances with an average age of 28.5 years over the study period, representing 7 % of all SATU patients. There was a 24 % increase in male attendances during the study period. 39.1 % presented within 24 h of the assault. 61.9 % reported the crime to the police. Employment status included 37.3 % employed, 24.9 % unemployed, and 26.2 % students, with 86.7 % being Irish nationals. Most incidents occurred on weekdays (53.3 %) and at night (56.7 %). Referrals were primarily from police (55.9 %), and psychological support was provided in 62.3 % of cases. Alcohol (60.4 %) and illicit drugs (20.5 %) were reported before assaults. 18.6 % suspected drug-facilitated assaults. Male assailants constituted 90.1 %, with 13.9 % involving multiple assailants. Male attenders were significantly more likely than females to be assaulted in their assailant's home and to be assaulted by more than one assailant. They were significantly less likely than females to report the crime to the police or to have consumed alcohol. Conclusion: To our knowledge, this is one of the largest case series of male patients attending a sexual assault treatment service to be published in the international literature. Male patients are a distinct group that are increasingly accessing SATU services. Significant differences exist between male and female patients' reported experiences of sexual violence. Knowledge of these factors will support appropriate tailoring of treatment & service provision, prevention and awareness strategies to help modify the impact and reduce the incidence of sexual violence in this cohort.

Invasive genetic testing is routinely recommended to investigate aneuploidy as a cause of cystic hygroma in the first trimester. In the context of normal genetic testing, the predicted outcome is impacted by the presence of co-existing structural anomalies, particularly cardiac anomalies. We reviewed the diagnosis and outcome of these patients to establish contemporary outcome data to aid appropriate counseling. This is a retrospective cohort study in a single large maternity hospital. Cases were identified using a fetal anomaly database and an electronic health record system. Data were collected on all patients with a fetal diagnosis of a nuchal translucency > 3mm with septations from 2007 to 2022. Results of chromosomal analysis, pregnancy outcomes and fetal outcomes were collated and described using summary statistics. During the 15-year period, there were over 135,000 deliveries at our center. 677 cases of septated cystic hygroma were diagnosed. Pregnancy outcome was obtained in 97.5% (n=660) of cases, with 92% (621/677) undergoing invasive prenatal or postnatal testing. 39% (247/621) had a normal karyotype. 38% (249/660) of women underwent termination of pregnancy. In-utero demise occurred in 24% (159/660). Structural anomalies were found in 16% (39/247) of those with normal karyotype. In cases of cystic hygroma, normal invasive testing in the absence of structural anomalies carried a livebirth rate of 86% (164/191), in contrast to an overall livebirth rate of 38% (252/660) in all pregnancies affected by cystic hygroma. Cystic hygroma is a significant finding in early pregnancy which confers a risk of aneuploidy of approximately 60% and is associated with adverse pregnancy outcomes. Outcomes of the study demonstrate a high livebirth rate in those with normal invasive testing and fetal echocardiography. This confirms the significance of appropriate counseling regarding confirmatory invasive testing, and highlights the value of follow-up with detailed anatomy ultrasound.

Background : Virtual reality provides users a unique opportunity to learn through a fully immersive platform that may be beneficial in postgraduate medical education. Objective : The primary objective of the study was to assess the feasibility of virtual reality in the training of obstetrics and gynecology residents in the insertion of a postpartum balloon for management of postpartum hemorrhage. Study Design : A multi-center randomized control trial involving obstetric residents (n=40) from two tertiary level perinatal centers – The National Maternity Hospital & The Rotunda, Dublin, Ireland from July 3rd to July 6th 2023. Participants were randomly assigned to an intervention group (n=21) and a control group (n=19). All participants filled in a pre-study survey assessing knowledge, experience in postpartum hemorrhage management, confidence levels, experience of virtual reality and thoughts on its use in medical education. The intervention group received a virtual reality immersive tutorial whilst the control group received no teaching. The decision not to offer the control group any teaching was to reflect the current situation in our hospitals where there is no regular formal teaching on insertion of postpartum balloon prior to night or weekend duty on the labor ward. The use of VR in this scenario provides residents with a new opportunity for accessible simulation training. Both groups were then tested on insertion of a postpartum uterine balloon in a model pelvis. Residents were timed and insertion technique was objectively marked, in line with manufacturer guidelines. Following insertion on the model, participants completed a survey including assessment of knowledge, confidence levels, satisfaction, side effects & benefits of virtual reality.The primary outcome was a structured objective assessment of the residents on the insertion technique of the balloon in a pelvic model.Secondary outcomes were time taken to complete the task, knowledge and confidence levels and any side effects of virtual reality.We calculated descriptive statistics such as frequency and percentage for categorical data. The paired t-test was used to compare mean scores before and after the intervention, both for the multiple choice questionnaire and confidence levels. Statistical significance was defined as a p-value of <0.05. Results : The intervention group scored significantly better in the objective technique assessment post learning experience compared to the control group (9.29/10 vs 7.26/10, P<0.001). The median time for task completion in the intervention group was significantly less than that of the control group (3minutes vs 4 minutes, P=0.012) and resident confidence improved more in the intervention VR group (0.42 vs 0.62, P<0.001).Both groups scored better in the multiple-choice questionnaire post learning experience, however there was no significant difference between them. Conclusion : Virtual reality is beneficial to residents for teaching insertion of a postpartum balloon, in terms of technique, time taken and confidence levels.

Splenic vein aneurysm (SVA) rupture is a rare clinical entity, with few case reports detailing its occurrence during pregnancy. We describe a case of a SVA rupture and present a systematic review of the literature in relation to splenic vein rupture, with or without aneurysm. Our case was of a 30-year-old woman, Para 4 at 37 weeks' gestation who presented with significant abdominal pain and subsequent maternal collapse. Massive intra-abdominal hemorrhage was identified, with splenic vessel rupture suspected. A splenectomy and partial pancreatectomy were performed along with massive blood product transfusion. There was both maternal and fetal survival with no long-term sequelae at follow-up. Histological examination of the spleen and its vessels noted a SVA rupture. In a subsequent systematic review of the literature, we identified 10 cases of splenic vein rupture with only two previously documented cases of SVA rupture in pregnancy. Maternal and fetal survival has only been reported in two cases of splenic vein rupture, with ours being a third.

ObjectiveTo investigate the use of a virtual reality learning environment (VRLE) to enhance medical student knowledge of postpartum hemorrhage (PPH) emergency management and insertion of a postpartum balloon.MethodsA randomized control trial involving medical students from University College Dublin, Ireland. Participants were randomly allocated to the intervention group (VRLE tutorial) or control group (PowerPoint tutorial on the same topic). All participants completed pre-learning experience and post-learning experience surveys. Both groups were timed and assessed on postpartum balloon insertion technique on a model pelvis. The primary outcome was assessment of student knowledge. Secondary outcomes included confidence levels, time taken to complete the task, technique assessment, satisfaction with the learning environment, and side effects of VR.ResultsBoth learning experiences significantly (p < 0.001) enhanced student performance on the post-learning experience multiple choice questionnaire, with no difference between the intervention and control groups. In the intervention group, time for task completion was significantly less compared to the control group (1–2 min vs. 2–3 min, p = 0.039). Both learning experiences significantly (p < 0.001) enhanced student confidence, with no significant difference between intervention and control groups. 100% of the students using the VRLE enjoyed the experience, and 82.4% were very likely to recommend use of VRLE in medical education. 94.1% of the students felt the VRLE was beneficial over didactic teaching.ConclusionReceiving formal instruction, regardless of format, enhances students’ knowledge and confidence of the topic covered. Students who received instruction via the VRLE assembled the postpartum balloon faster than students who received didactic teaching. VR may be beneficial in teaching hands-on procedural skills in obstetrics and gynecology education.

BACKGROUND:Sexual assault (SA) is a prevalent issue with enduring consequences. Post-SA medical care mainly focuses on injuries, sexually transmitted infection (STI) prevention and detection, as well as preventing unwanted pregnancies. Swift access to post-SA medical care is vital with sexual assault treatment units (SATUs) streamlining this care. The primary aim of our study is to report on post-SA care provided at the national SATU network in Ireland with a secondary aim of analysing factors associated with follow-up attendance for STI testing. METHODS:This is a retrospective cohort study of all acute attendances (<7 days from incident) at the national SATU network between 1 January 2017 to 31 December 2022. RESULTS:A total of 4159 acute cases presented during the study period. Emergency contraception (EC) was administered to 53.8% (n=1899/3529) of cases, while postexposure prophylaxis (PEP) for chlamydia was given in 75.1% (n=3124/4159) and for HIV in 11.0% (n=304/3387). Hepatitis B vaccination was initiated in 53.7% (n=2233/4159) of cases. 1.4% (n=59/4159) of the attendees were referred to an emergency department for the treatment of injuries. Follow-up appointments were scheduled for 75.8% (3151/4159) of acute cases. 71.6% (n=2257/3151) attended follow-up.Certain factors were found to correlate with a higher likelihood of attending follow-up appointments: adolescents (p<0.0001), concern about drug-facilitated SA (DFSA) (p=0.01), no consumption of recreational drugs before the incident (p<0.0001), alcohol consumption prior to the incident (p=0.01), and not reporting the crime to the police (p<0.001). However, gender (p=0.06) and the presence of injury at time of primary attendance (p=0.97) were not predictive of likelihood of follow-up attendance. CONCLUSION:This study demonstrates that EC, chlamydia PEP, HIV PEP and hepatitis B vaccination were all administered at SATU. A small proportion of attenders required emergency injury care. Factors influencing attendance at follow-up include age, drug use, alcohol use and police involvement, highlighting the need for tailored patient-centred support.

Background Sexual assault (SA) is a highly prevalent issue, with significant adverse health sequelae. Given that general practitioners (GPs) may serve as the first point of contact for many SA victims, their awareness of post-SA care and appropriate understanding of referral pathways to a sexual assault treatment unit (SATU) are critically important. This study evaluated GP trainees’ knowledge of and comfort with post-SA care. Methods Educational intervention study using a didactic teaching session was delivered by a specialist forensic examiner on post-SA care. A pre and post-study questionnaire was implemented to assess participants’ knowledge and comfort levels with subject material. Significance was set at p -value below 0.05. Results Seventy-five GP-trainees attended the teaching session. Fifty-three completed the pre-teaching questionnaire and 50 completed the post-teaching questionnaire. Only a minority of trainees had received prior teaching in post-SA care as a medical student (13.2% n = 7) or as a postgraduate (28.3% n = 15). After the teaching session, there was a significant improvement trainees’ comfort levels in explaining a forensic examination ( p < 0.0001), referral pathways to a SATU ( p < 0.0001) and offering advice in relation to emergency contraception ( p < 0.0001). There was also a significant improvement in understanding HIV post-exposure prophylaxis (PEP) ( p < 0.001) and forensic examination (FE) time-lines ( p < 0.001). Conclusion This study reveals that GP-trainees have had limited exposure to teaching on post-SA care. Additionally, significant improvements were observed following a 1-h didactic teaching session on post-SA care. Trainees demonstrated increased understanding of SATU referral pathways, understanding of immediate medical care after SA, including PEP and FE timelines.

Background Female perpetrated sexual assault is under-represented in sexual assault research, and indeed possibly an underreported crime. The aim of this study is to address the lack of comprehensive data in relation to female perpetrated sexual assault attendances to the national sexual assault treatment unit network in the Republic of Ireland. Methods This is a cross-sectional study analysing the attendances of female perpetrated sexual assault attendances at the six sexual assault treatment units in the Republic of Ireland between 1 January 2017 and 31 December 2022. Results There were 95 attendances where the assailant (or one of the assailants) was identified as female. 62% (n=59) of these attendances involved a solo female assailant, 3.2% (n=3) where it was a multiple assailant assault with only female assailants and 34.7% (n=33) cases with male and female assailants. 74.7% (n=71) of victims identified as female, 24.2% (n=23) as male and 1.1% (n=1) as ‘other’. The average age of attenders was 27.0 ± 10.7 years old. 54.7% (n=52) of attendances were within 72 hours of the assault. 52.6% (n=50) of these underwent a forensic examination. 30.5% (n=29) of incidents occurred in the assailant’s home. 23% of assailants were described as a friend of the victim/survivor. 34.7% (n=33) sustained bodily injuries (genital and/or extra-genital). Conclusion Female perpetrated sexual assault is a distinct entity when analysing attendances to the national sexual assault treatment unit network, representing just under 2% of all attendances. We have shown that those who experience these assaults are likely to be female, be assaulted by a single female perpetrator who is known to them and attend a sexual assault treatment unit within 72 hours of the assault. Awareness of the characteristics of these attendances will ultimately allow us to develop appropriate supports for these victims/survivors and to raise awareness of this type of crime.

Swyer syndrome, also known as complete gonadal dysgenesis, is characterized by an individual who has an XY karyotype but is phenotypically female. It is typically diagnosed in adolescence after investigations for primary amenorrhea. The estimated prevalence is 1 in 20,000 to 80,000 births. Mutations in the DNA-binding region of the SRY gene account for approximately 15 to 20% of cases, with the remaining cases caused by other gene mutations. There are no reports of the established diagnosis of Swyer syndrome prenatally, or of the sonographic features that may be associated with it. This report outlines the details of a 33-year-old primigravida in whom a fetal cystic hygroma was noted on ultrasound at 12 weeks gestation. Chorionic villous sampling revealed a diagnosis of fetal Swyer syndrome. The fetus progressed to develop severe fetal hydrops and a parental decision for termination of pregnancy was made at 15 weeks of gestation.

Pattern recognition receptors (PRRs) of the innate immune system represent the critical front-line defense against pathogens, and new vaccine formulations target these PRR pathways to boost vaccine responses, through activation of cellular/Th1 immunity. The majority of pediatric vaccines contain aluminum (ALUM) or monophosphoryl lipid A (MPLA) as adjuvants to encourage immune activation. Evidence suggests that elements of the innate immune system, currently being targeted for vaccine adjuvanticity do not fully develop until puberty and it is likely that effective adjuvants for the neonatal and pediatric populations are being overlooked due to modeling of responses in adult systems. We recently reported that the activity of the cytosolic nucleic acid (CNA) sensing family of PRRs is strong in cord blood and peripheral blood of young children. This study investigates the function of CNA sensors in subsets of neonatal innate immune cells and shows that myeloid cells from cord blood can be activated to express T cell costimulatory markers, and also to produce Th1 promoting cytokines. CD80 and CD86 were consistently up-regulated in response to cytosolic Poly(I:C) stimulation in all cell types examined and CNA activation also induced robust Type I IFN and low levels of TNFα in monocytes, monocyte-derived macrophages, and monocyte-derived dendritic cells. We have compared CNA activation to adjuvants currently in use (MPLA or ALUM), either alone or in combination and found that cytosolic Poly(I:C) in combination with MPLA or ALUM can improve expression of activation marker levels above those observed with either adjuvant alone. This may prove particularly promising in the context of improving the efficacy of existing ALUM- or MPLA-containing vaccines, through activation of T cell-mediated immunity.