• Caesarean Section at Full Dilatation and Risk of Major Obstetric Haemorrhage

      O’Dwyer, V; Freyne, A; Joyce, N; Coulter-Smith, S (Irish Medical Journal, 2018-03)
      The purpose of the study was to examine the risk factors for caesarean section (CS) at full dilatation and to assess the risk and management of haemorrhage. The study took place in a tertiary referral maternity hospital. Women who had a CS at full dilatation were included. Clinical and demographic details were recorded. There were 199 cases. The average age was 30.3 years and average BMI was 25.8kg/m2. There were 79.9 % (159) primigravidas and 20.1% (40) multigravidas. The average gestation at delivery was 39.4 weeks. Labour was induced in 46.9 % (92) and spontaneous in 53.8% (107). Oxytocin was used in 67.8 % (135). An instrumental delivery was attempted in 46.7 % (93). The rate of malposition was 46.5 % (92). The average birthweight was 3,629g and 9 babies weighed ≥4.5kg. The average estimated blood loss (EBL) was 665mls and 34 had EBL>1L. Most had an oxytocin infusion (141). Other uterotonic agents were used in 70 women. Seven women had blood transfusions. The highest rate of CS at full dilatation was in primigravidas due to malposition. There was a low rate of major obstetric haemorrhage.
    • Can a more detailed evaluation of excision margins refine cytologic follow-up of women post-LLETZ for high-grade dysplasia?

      Treacy, Ann; Devaney, Deirdre; Mulligan, Niall J; Boyd, William; O'Keane, John Conor; Department of Histopathology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland. anntreacy@mac.com (2010-09)
      The relationship between dysplastic changes in the cervical epithelium and progression to in situ carcinoma and invasive carcinoma has been extensively studied. The removal of dysplastic epithelium through the long loop excision of the transformation zone (LLETZ) in 95% of the cases is curative. About 18% to 37% of LLETZ specimens with dysplasia at the margins have recurrent/residual disease. Earlier small studies suggest that the degree of dysplasia at the margins could predict for recurrence and allow a risk-based stratification of follow-up. We tested this hypothesis in a large group of women post-LLETZ for high-grade dysplasia with follow-up histology and cytology over a 12-year period. The cases were divided according to the excision margin status for dysplasia and if positive, low-grade or high-grade dysplasia. The groups were compared to assess whether the LLETZ specimens' margin status had an impact on the subsequent cytology or histology results. Positive follow-up results were defined as any grade of dysplasia in cytology or histology. Two thousand three hundred twenty-one women had LLETZs containing high-grade dysplasia over the 12-year period. One thousand five hundred thirty-four (66.1%) women had full histology and cytology follow-up available. Eight hundred twenty (53.4%) LLETZ specimens had positive margins and 714 (46.6%) had negative margins. The grade of dysplasia at the margins was available in 796 cases (97%) with 115 (15%) showing low-grade dysplasia and 680 (85%) high-grade dysplasia. One hundred seventy (20.7%) of the specimens with positive margins had positive follow-up results compared with 105 (14.7%) of the specimens with negative margins. The presence of dysplasia at an LLETZ margin is associated with dysplasia on follow-up cytology and histology (P=0.0021); however, the grade of dysplasia at the excision margin is not predictive of recurrent/residual dysplasia.
    • Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.

      Noori, S; McNamara, P; Jain, A; Lavoie, P M; Wickremasinghe, A; Merritt, T A; Solomon, T; Sekar, K; Attridge, J T; Swanson, J R; et al. (2014-08-14)
      Objective:We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.Study Design:A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).Result:Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.Conclusion:We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.Journal of Perinatology advance online publication, 14 August 2014; doi:10.1038/jp.2014.151.
    • Cerebral oximetry for cesarean delivery in a Moyamoya case.

      Ajmal, Muhammad; Thornton, Patrick; Department of Anesthesia, Coombe Women and Infants University Hospital, Dublin, Ireland, ajmal_c@hotmail.com. (2014-10)
    • Changes in vaginal breech delivery rates in a single large metropolitan area.

      Hehir, Mark P; O'Connor, Hugh D; Kent, Etaoin M; Fitzpatrick, Chris; Boylan, Peter C; Coulter-Smith, Samuel; Geary, Michael P; Malone, Fergal D; Rotunda Hospital, Dublin, Ireland. markhehir23@gmail.com (2012-06)
      Vaginal breech delivery rates have been accepted widely to be in decline and the Term Breech Trial (TBT) has recommended delivery of a breech-presenting infant by elective cesarean section delivery. Our aim was to examine the rate of vaginal delivery of term breech pregnancies in the 8 years before and after the publication of the TBT.
    • Changing rates of antepartum death and attitudes to postmortem over a 10 year period

      O'Connor, H; Hehir, M; Robson, M; Coulter-Smith, S; Malone, F D (Mosby Inc., 2011-01)
    • Changing trends in diabetes mellitus in pregnancy.

      Khalifeh, A; Breathnach, F; Coulter-Smith, S; Robson, M; Fitzpatrick, C; Malone, F; Rotunda Hospital (2014-02)
      The purpose of this study was to identify any changing trends in the incidence and caesarean section (CS) rate of pre-gestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM) over a 10- year period, between 1999 and 2008. Although the incidence of pre-gestational DM has not significantly changed over the course of the last 10 years, there is an obvious rising trend in the incidence of GDM. Despite an increase in the overall CS rate during this time period, a parallel increase in the CS rate has not been observed among women whose pregnancies are complicated either by gestational or by pre-gestational diabetes (PGD).
    • Changing trends in peripartum hysterectomy over the last 4 decades.

      Flood, Karen M; Said, Soha; Geary, Michael; Robson, Michael; Fitzpatrick, Christopher; Malone, Fergal D; Department of Obstetrics and Gynaecology, Rotunda Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland. (2009-06)
      The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years.
    • Changing trends in peripartum hysterectomy over the last 4 decades.

      Flood, Karen M; Said, Soha; Geary, Michael; Robson, Michael; Fitzpatrick, Christopher; Malone, Fergal D; Department of Obstetrics and Gynaecology, Rotunda Hospital, Royal College of, Surgeons in Ireland, Dublin, Ireland. (2012-02-01)
      OBJECTIVE: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years. STUDY DESIGN: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital. RESULTS: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001). CONCLUSION: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.
    • Chronic uteroplacental insufficiency can be associated with normal birth weight in both twin and singleton placentas: a stereological study

      Mthunzi, A; Kent, E; Cooley, S; Donnolly, J; O'Malley, A; Geary, M; Gillan, J; Breathnach, F; Malone, F D (Mosby Inc., 2011-01)
    • Circulating pro- and anticoagulant levels in normal and complicated primigravid pregnancies and their relationship to placental pathology

      Donnelly, J.C.; Cooley, S.M.; Walsh, T.A.; Smith, O.P.; Gillan, J.; McMahon, C.; Geary, M.P.; Rotunda Hospital (2013-04)
    • Clinical pregnancy from a vitrified/warmed human blastocyst

      Emerson, G; Deignan, K; O’Toole, R; Afridi, S; Hughes, C; Roopnarinesingh, R; Mocanu, E (Irish Medical Journal (IMJ), 2013-10)
      The first pregnancy after vitrification of a human blastocyst (day 5 of embryo culture) was reported by Yokota et al. in 2000. Since then more attention has been given to the technique of vitrification and its safe application in ART. To the best of our knowledge, this is the first report of a clinical pregnancy resulting in a live birth from the transfer of a vitrified/ warmed human blastocyst in the Republic of Ireland.
    • Clinical risk factors are not predictive of Hepatitis C PCR positivity

      Kent, E; O'Higgins, A; Dorschner, K; Rotunda Hospital (2009)
    • Coagulopathy screening in infants < 26 weeks gestation and intraventricular haemorrhage

      Okofar, I; Alawaysheh, F; McCallion, N; Rotunda Hospital (IPA, 2009)