• Ultrasound in obstetric anaesthesia: a review of current applications.

      Ecimovic, P; Loughrey, J P R; Mater Misercordiae Hospital, Dublin, Ireland. (2010-07)
      Ultrasound equipment is increasingly used by non-radiologists to perform interventional techniques and for diagnostic evaluation. Equipment is becoming more portable and durable, with easier user-interface and software enhancement to improve image quality. While obstetric utilisation of ultrasound for fetal assessment has developed over more than 40years, the same technology has not found a widespread role in obstetric anaesthesia. Within the broader specialty of anaesthesia; vascular access, cardiac imaging and regional anaesthesia are the areas in which ultrasound is becoming increasingly established. In addition to ultrasound for neuraxial blocks, these other clinical applications may be of value in obstetric anaesthesia practice.
    • Universal antenatal screening for Hepatitis C

      Lambert, J; Jackson, V; Coulter-Smith, S; Brennan, M; Geary, M; Kelleher, TB; O’Reilly, M; Grundy, K; Sammon, N; Cafferkey, M (Irish Medical Journal, 2013-05)
    • An unusual presentation of a dermoid cyst.

      Flood, K; Breathnach, F; Gleeson, N; Department of Obstetrics and Gynaecology, RCSI, Rotunda Hospital, Dublin, Ireland. karenflood@rcsi.ie (2010-01)
    • An unusual presentation of a dermoid cyst.

      Flood, K; Breathnach, F; Gleeson, N; Department of Obstetrics and Gynaecology, RCSI, Rotunda Hospital, Dublin,, Ireland. karenflood@rcsi.ie (2012-02-01)
    • Uptake of invasive testing for Aneuploidy after a positive first trimester test

      Kent, E; O'Higgins, A; Dorschner, K; Flood, K; Fleming, A; Malone, FD (2009)
    • The use of a chaperone in obstetrical and gynaecological practice.

      Afaneh, I; Sharma, V; McVey, R; Murphy, C; Geary, M; The Rotunda Hospital, Parnell Square, Dublin 1. iyadafaneh@physicians.ie (2012-02-01)
      The aim of this study was to assess the use of a chaperone in obstetrical and gynaecological practice in Ireland and to explore patients' opinions. Two questionnaires were designed; one for patients and the other one was sent to 145 gynaecologists in Ireland. One hundred and fifty two women took part in this survey of whom 74 were gynaecological and 78 were obstetric patients. Ninety five (65%) patients felt no need for a chaperone during a vaginal examination (VE) by a male doctor. On the other hand 34 (23%) participating women would request a chaperone if being examined by a female doctor. Among clinicians 116 (80%) responded by returning the questionnaire. Overall 60 (52%) always used a chaperone in public practice, in contrast to 24 (27%) in private practice. The study demonstrated that most patients do not wish to have a chaperone during a VE but a small proportion would still request one regardless of the examiner's gender. Patients should be offered the choice of having a chaperone and their opinion should be respected and documented.
    • The use of cold coagulation for the treatment of cervical intraepithelial neoplasia

      Wyse, A; Seah, WA; O’Neill, J; Byrne, P (Irish Medical Journal, 2017-05)
      In 2015, Cold Coagulation was introduced as a treatment for cervical intraepithelial neoplasia (CIN) at our colposcopy clinic. We reviewed the 6-month follow up data of the first 200 women who underwent Cold Coagulation using cytology and HPV status as tests of cure (TOC). A random sample of 200 patients treated by Large Loop Excision of the Transformation Zone (LLETZ) during the same period was used to compare treatment outcome. Six months following treatment,173 (86.5%) of the women treated by CC and 167 (83.5%) treated by LLETZ had negative cytology. (x2= P>0.05). 148 (74%) treated by Cold Coagulation and 166 (83%) treated by LLETZ were HPV negative (x2= P<0.05). One hundred and thirty-nine (70%) women treated by Cold Coagulation and 152 (76%) treated with LLETZ had normal cytology and were HPV negative. This audit of our initial experience supports the observation that Cold Coagulation is as effective as LLETZ in the management of CIN when cervical cytology is used as a test of cure.
    • Using lateral radiographs to determine umbilical venous catheter tip position in neonates

      Butler, G.C.; Al-Assaf, N; Tarrant, A; Ryan, S; EL-Khuffash, A (Irish Medical Journal, 2014-09)
      We aimed to assess the difference in measurement of the distance of the UVC tip from the diaphragm between (Anteroposterior) AP and lateral radiographs and to determine the reliability of the measurement of UVC tip distance from the diaphragm between the two views. A retrospective review of paired AP and lateral radiographs taken to assess UVC tip position was carried out in 25 infants was conducted and reliability analysis was carried out. There was a significant difference in the mean (SD) distance of the UVC catheter above the diaphragm between the AP and lateral radiographs: 8.7 (7.8) mm versus 11.6 (7.3) mm (p=0.003) respectively. Measurements using lateral radiographs were more reliable (Intraclass correlation coefficient: 0.99 vs. 0.93). Inter-observer reliability analysis yielded similar results. Lateral radiographs are more reliable in measurement of UVC tip position and should be performed in conjunction with AP films to aid in determining UVC position.
    • The Utility of Routine Echocardiography in Newborn Infants with a Persistent Oxygen Requirement

      Walsh, N; Breathnach, C; El-Khuffash, A; Franklin, O; Corcoran, JD (Irish Medical Journal, 2018-05)
      In the era of antenatal screening for congenital heart disease (CHD), infants presenting with an undiagnosed significant CHD are rare. However, term infants admitted with an initial diagnosis of TTN and a prolonged oxygen requirement often undergo an echocardiogram. We aimed to assess whether this practice yields any additional cases of undiagnosed CHD. We performed a retrospective chart review over a three year period [2013 – 2015] of term (> 36 weeks) infants admitted to the NICU for ≥ 5 days with a diagnosis of TTN and received an echocardiogram. The presence of CHD on the echocardiogram was assessed. Forty-seven infants were enrolled. The median age of echocardiogram was day four [2 – 8]. No infant had a diagnosis of significant CHD on the postnatal echocardiogram. A small muscular VSD was identified in two infants. Routine echocardiography for this cohort of infants to rule out major CHD appears to be unwarranted.
    • Utility of therapeutic drug monitoring in the management of HIV-infected pregnant women in receipt of lopinavir.

      Caswell, R J; Phillips, D; Chaponda, M; Khoo, S H; Taylor, G P; Ghanem, M; Poulton, M; Welch, J; Gibbons, S; Jackson, V; et al. (2011-01)
      The pharmacokinetics of antiretroviral drugs in pregnancy is poorly understood. We reviewed the use of therapeutic drug monitoring (TDM) in clinical settings to document plasma concentrations of lopinavir during pregnancy and investigated how clinicians acted upon TDM results. A retrospective review was carried out of all HIV-infected pregnant women taking boosted lopinavir-based highly active antiretroviral therapy (HAART) at five National Health Service (NHS) centres in the UK between May 2004 and March 2007. Seventy-three women in receipt of lopinavir were identified, of whom 89% had plasma lopinavir concentrations above the suggested minimum recommended for wild-type HIV. Initial TDM results prompted dosage change in 10% and assessment of adherence and/or pharmacist review in 11%. TDM was repeated in 29%. TDM can play an important role in the clinical management of HIV-positive pregnant women, allowing informed dose modification and an alternative measure of adherence.
    • The value of metabolic markers in diagnosis of vitamin 12 deficiency

      Deverrill, D; Fitzsimons PE; Macken, S; Crushell, E; McMahon, C; Mayne, PD; Rotunda Hospital (2009-10)
    • The value of neonatal autopsy.

      Hickey, Leah; Murphy, Amanda; Devaney, Deirdre; Gillan, John; Clarke, Tom; Rotunda Hospital, Dublin, Ireland. leahmariahickey@yahoo.co.uk (2012)
      Neonatal autopsy rates were in decline internationally at the end of the last century. Our objective was to assess the current value of neonatal autopsy in providing additional information to families and healthcare professionals.
    • Viral screening at the time of each donation in ART patients: is it justified?

      Hughes, C; Grundy, K; Emerson, G; Mocanu, E; Human Assisted Reproduction Ireland, Rotunda Hospital, Dublin 1, Dublin. chughes@rcsi.ie (2011-11)
      The frequency for virology testing for couples undergoing assisted reproductive treatment (ART) in Europe is currently under debate, with little scientific data available to support the time-frame imposed by EU legislation. The aim of this study was to determine the incidence of blood-borne viruses (BBV) in this population and to assess the likelihood of seroconversion after an initial negative screen and the possible cost saving to couples.
    • What is new in obstetric antecedents of chronic disease? Best articles from the past year.

      Malone, Fergal D; Rotunda Hospital (2014-04)
      This month, we focus on current research in obstetric antecedents of chronic disease. Dr Malone discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page along with direct links to the abstracts.
    • When no choice of embryos exists, the multiple pregnancy risk is still high.

      Wong, V V; Emerson, G; Mocanu, E; Human Assisted Reproduction Ireland, Rotunda Hospital, Dublin, Republic of Ireland. vuivunwong@yahoo.com (2012-10)
      Multiple pregnancies arising from assisted reproduction are known to be associated with increased medical, psychological, economical and social risks. If only two embryos develop after culture, how should the couple be counselled in relation to the risk of multiple pregnancy? We performed a retrospective review of all IVF/ICSI treatments performed between 1 January 2005 and 31 December 2007, that resulted in double embryos transfer (DET). We identified 623 cycles with a fortuitous DET (Group I) and 635 cycles with an elective DET (Group II). Group II were significantly more likely to have twins when compared with Group I, irrespective of age. Twin rates in Group I were higher in IVF compared with ICSI; 33.3% vs 16.6% in < 35 years old and 16.2% vs 7.6% in 35-40 years old. Therefore, single embryo transfer should be considered for IVF patients below 35 years old, even if only two good quality embryos are available.