Research by staff affiliated to the National Maternity Hospital, Holles St.

Recent Submissions

  • CA125 Measured During Menstruation Can Be Misleading

    Crosby, DA; Glover, LE; Martyn, F; Wingfield, M (Irish Medical Journal, 2018-04)
    Abstract The aim of these case reports and literature review is to report the importance of cyclical variation of serum CA-125 levels in two patients with endometriosis. Two case reports and a literature review of cyclical variation in serum CA-125 levels are discussed. There was significant variation in serum CA-125 levels taken during menses and mid-cycle in these two cases. Serum CA-125 levels increase dramatically during menstruation in women with endometriosis. This is important when assessing disease status.
  • A method to assess obstetric outcomes using the 10-Group Classification System: a quantitative descriptive study.

    Rossen, Janne; Lucovnik, Miha; Eggebø, Torbjørn Moe; Tul, Natasa; Murphy, Martina; Vistad, Ingvild; Robson, Michael (BMJ Publishing Group Ltd, 2017)
    Internationally, the 10-Group Classification System (TGCS) has been used to report caesarean section rates, but analysis of other outcomes is also recommended. We now aim to present the TGCS as a method to assess outcomes of labour and delivery using routine collection of perinatal information.
  • Interpregnancy weight changes and impact on pregnancy outcome in a cohort of women with a macrosomic first delivery: a prospective longitudinal study.

    Crosby, David A; Walsh, Jennifer M; Segurado, Ricardo; McAuliffe, Fionnuala M; Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland. UCD Perinatal Research Centre, School of Medicine, University College Dublin, Dublin, Ireland. CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland. (BMJ Publishing Group Ltd, 2017-06-06)
    To determine the median interpregnancy maternal weight change between first and second pregnancies, and second and third pregnancies and to assess the impact of this weight change on pregnancy outcome in a cohort of women with a macrosomic first delivery.
  • Preventing Excessive Gestational Weight Gain and Postpartum Weight Retention.

    O’Dwyer, V; McAuliffe, F (Irish Medical Journal, 2017-10)
    regnancy and the postpartum period are unique opportunities to promote healthy lifestyle choices including a healthy diet and regular exercise. This is especially important for those who are overweight or obese. Women are weighed at their first antenatal visit and body mass index (BMI) calculated, but not all hospitals routinely weigh women throughout pregnancy. A qualitative Dublin study examined experiences of routine weighing during antenatal care. This study found that women expected to be weighed during pregnancy and postpartum. The benefits of this included providing reassurance and minimising postpartum weight retention. Furthermore, women were eager to receive more information about healthy lifestyle interventions and gestational weight gain (GWG) from healthcare professionals
  • Maternal Nutrition and Glycaemic Index during Pregnancy Impacts on Offspring Adiposity at 6 Months of Age--Analysis from the ROLO Randomised Controlled Trial.

    Horan, Mary K; McGowan, Ciara A; Gibney, Eileen R; Byrne, Jacinta; Donnelly, Jean M; McAuliffe, Fionnuala M (MDPI AG, 2016-01-04)
    Childhood obesity is associated with increased risk of adult obesity and metabolic disease. Diet and lifestyle in pregnancy influence fetal programming; however the influence of specific dietary components, including low glycaemic index (GI), remains complex. We examined the effect of a maternal low GI dietary intervention on offspring adiposity at 6 months and explored the association between diet and lifestyle factors in pregnancy and infant body composition at 6 months. 280 6-month old infant and mother pairs from the control (n = 142) and intervention group (n = 138), who received low GI dietary advice in pregnancy, in the ROLO study were analysed. Questionnaires (food diaries and lifestyle) were completed during pregnancy, followed by maternal lifestyle and infant feeding questionnaires at 6 months postpartum. Maternal anthropometry was measured throughout pregnancy and at 6 months post-delivery, along with infant anthropometry. No difference was found in 6 months infant adiposity between control and intervention groups. Maternal trimester three GI, trimester two saturated fats and trimester one and three sodium intake were positively associated with offspring adiposity, while trimester two and three vitamin C intake was negatively associated. In conclusion associations were observed between maternal dietary intake and GI during pregnancy and offspring adiposity at 6 months of age.
  • Managing Epilepsy in Pregnancy

    O Dwyer, V (Irish Medical Journal (IMJ), 2017-02)
    Epilepsy is one of the commonest medical conditions affecting women of childbearing age1. In the most recent triennial report into maternal deaths in Ireland and the UK, two thirds of women who died had a medical condition. In this report, 14 maternal deaths during pregnancy and up to 42 days postpartum were attributable to epilepsy or seizures; a rate of 0.4 per 100,000 maternities. In 12 of these women’ the cause was sudden unexplained death in epilepsy. Thus, epilepsy remains a high-risk condition in pregnancy. The gold standard of care is a multidisciplinary approach involving obstetricians, a neurologist and an epilepsy nurse specialist2. Like other units in Ireland this multidisciplinary service is currently provided in the National Maternity Hospital’s maternal medicine clinic, in conjunction with neurology services in Beaumont Hospital.
  • Uptake of the Influenza Vaccination in Pregnancy

    Crosby, DA; Deleau, D; Brophy, C; Mcauliffe, FM; Mahony, R (Irish Medical Journal, 2016-09)
    Influenza is caused by a highly infectious RNA virus, which usually occurs in a seasonal pattern with epidemics in the winter months. The objective of this study was to determine the uptake of the influenza vaccine in a pregnant population and ascertain the reasons why some women did not receive it. A prospective cohort study was conducted over a two-week period in January 2016 in the National Maternity Hospital Dublin, a tertiary referral maternity hospital delivering over 9000 infants per year. There were 504 women studied over the 2-week period. Overall, 197(39.1%) women received the vaccine at a mean gestational age 20.9 weeks (SD 7.0). Given the increased rates of influenza in the community and the associated implications for mother and infant, it is important that pregnant women are educated regarding the risks of influenza in pregnancy and encourage this cohort to be vaccinated.
  • Gestational Age at Birth and 'Body-Mind' Health at 5 Years of Age: A Population Based Cohort Study.

    Cronin, Frances M; Segurado, Ricardo; McAuliffe, Fionnuala M; Kelleher, Cecily C; Tremblay, Richard E (2016)
    Numerous studies have identified the effects of prematurity on the neonate's physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000-2002 in the United Kingdom) was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children's general health and severity of behavior problems. The association between parent's general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764) rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor/fair health and/or serious behavior problems), suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32-36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%-6.2%), compared to 1% (0.2-2.3) for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.
  • Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery.

    Robson, Michael; Murphy, Martina; Byrne, Fionnuala (Elsevier, 2015-10)
    Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. It needs to be clinically relevant, robust, and prospective, and must incorporate epidemiological variables. The 10-Group Classification System (TGCS) is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. The system is demonstrated in the present paper using data for 2013 from the National Maternity Hospital in Dublin, Ireland. Interpretation of the classification can be easily taught. The standard table can provide much insight into the philosophy of care in the population of women studied and also provide information on data quality. With standardization of audit of events and outcomes, any differences in either sizes of groups, events or outcomes can be explained only by poor data collection, significant epidemiological variables, or differences in practice. In April 2015, WHO proposed that the TGCS (also known as the Robson classification) is used as a global standard for assessing, monitoring, and comparing cesarean delivery rates within and between healthcare facilities.
  • Standardised versus Individualised Parenteral Nutrition. Further Food for Thought

    McCarthy, R; Segurado, R; Crealey, M; Twomey, A (Irish Medical Journal, 2016-04)
    Parenteral Nutrition may be prescribed as a standard PN (SPN) formulation or as an individualised PN (IPN) formulation. SPN may have advantages in terms of rapid availability, less prescription errors, decreased risk of infection and cost savings but IPN, specifically tailored to an infant’s needs, may achieve better outcomes in terms of nutrient intake and weight gain. The aim of our study was to determine if VLBW infants in our NICU benefited from receiving IPN over currently available SPN solutions. Our findings were that VLBW infants prescribed IPN received significantly more amino acid (28%), glucose (6%), energy (11%) and calcium (8%) from the aqueous phase of PN than had they received a similar volume of SPN. The benefits were seen over all the days for which PN was administered. In conclusion, IPN was found to offer significant benefits to our VLBW infants. Modifications to currently available SPN would result in better SPN formulations. Our study also supported the recent recommendation to reduce the calcium:phosphate ratio in PN solutions to avoid early hypophosphataemia
  • The association between maternal dietary micronutrient intake and neonatal anthropometry - secondary analysis from the ROLO study.

    Horan, Mary K; McGowan, Ciara A; Gibney, Eileen R; Donnelly, Jean M; McAuliffe, Fionnuala M (2015)
    Micronutrients are necessary for fetal growth. However increasingly pregnant women are nutritionally replete and little is known about the effect of maternal micronutrient intakes on fetal adiposity in mothers with increased BMI. The aim of this study was to examine the association of maternal dietary micronutrient intake with neonatal size and adiposity in a cohort at risk of macrosomia.
  • Fetal metabolic influences of neonatal anthropometry and adiposity.

    Donnelly, Jean M; Lindsay, Karen L; Walsh, Jennifer M; Horan, Mary; Molloy, Eleanor J; McAuliffe, Fionnuala M (BioMed Central, 2015)
    Large for gestational age infants have an increased risk of obesity, cardiovascular and metabolic complications during life. Knowledge of the key predictive factors of neonatal adiposity is required to devise targeted antenatal interventions. Our objective was to determine the fetal metabolic factors that influence regional neonatal adiposity in a cohort of women with previous large for gestational age offspring.
  • Early pregnancy ultrasound and management – effect of a multifaceted training on physician knowledge

    O’Leary, B; Khalid, A; Higgins, M (2016-02)
    Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.
  • Gentamicin dosing in therapeutic hypothermia; a quality improvement initiative

    Whitla, L; Fitzgerald, D; Twomey, A; Knowles, S; Murphy, JFA (Irish Medical Journal, 2016-01)
    We read with interest a number of articles on gentamicin dosing in neonates treated with therapeutic hypothermia 1-3 . Therapeutic hypothermia has now become the standard of care for newborn infants with hypoxic-ischaemic encephalopathy. Many of these infants concurrently receive gentamicin. Gentamicin is nephrotoxic and ototoxic at high serum concentrations. We therefore carried out a study in The National Maternity Hospital Holles St to analyse trough and peak gentamicin levels in infants who were cooled and compared them to a control group of non-cooled infants.
  • Gynaecology training for higher specialist trainees in obstetrics and gynaecology: a personal view

    Maher, N; Foley, M (Irish Medical Journal (IMJ), 2015-10)
    As a specialist trainee in Obstetrics and Gynaecology in Ireland, I wish to add some supportive information to reinforce the suggestion that the minimum time spent training in gynaecology be one year.
  • National Maternity Hospital Dublin: clinical report 2002

    National Maternity Hospital Holles Street; Keane, Declan; National Maternity Hospital Holles Street (National Maternity Hospital Holles St, 2003)
    2002 saw continuing rise in the birth rate in the hospital. 8022 mothers gave birth to 8162 infants. This was the busiest year since 1983. It was a 4% increase on births compared to 2001. The number of first time mothers delivering in the hospital continued also to increase and the figure for the year was 47.5%. If current trends continue the number of first time mothers will exceed multiparous parents in the ensuing years. The Caesarean section rate for the year was 15.5%. This is a 1% increase on the previous year. A full analysis of the Caesarean section rate can be found in the appropriate chapter. The increase probably represents a rise across all ten groups although it is worth noting that the rise in women who had a previous Caesarean seclion was certainly one of the factors.
  • Development of the National Maternity Hospital.

    National Maternity Hospital (NMH) (National Maternity Hospital (NMH), 2003-11)
    The need for the development of the National Maternity Hospital is well documented. Following extensive consultations with the Department of Health and Children, through the late 1990's, the establishment of a Project Team to advance the development of the hospital was approved and the Project was included in the National Development Plan. The first task of the Project Team was to examine the future role and accommodation needs of the hospital within its designated catchment area, having regard to its relationship with other service providers. In this context a Development Brief was prepared and was finalised during the summer of 200I. The Brief was informed to a large extent by a comprehensive needs assessment exercise commissioned by the Eastern Regional Health Authority.
  • A randomised controlled trial using the Epidrum for labour epidurals.

    Deighan, M; Briain, D O; Shakeban, H; O'Flaherty, D; Abdulla, H; Al-Jourany, A; Ash, S; Ahmed, S; McMorrow, R (Irish Medical Journal, 2015-03)
    The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.
  • Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomized trial.

    Mone, F; McAuliffe, F M (Irish Medical Journal, 2015-01)
    Obstetric practice is evolving; the future will see a shift in the focus of care to the pre-conceptual period and early trimester with a move towards interventions which optimize maternal and neonatal outcome. 1 Low dose Aspirin (LDA) is one such intervention. The safety and efficacy of this medicinal product has already been proven 2,3 and subsequently it is now used common in practice for at-risk pregnancies for prevention of pre-eclampsia, fetal growth restriction and complications of anti-phospholipid syndrome.
  • Oxytocin is unequally distributed in a bag of normal saline - true or false?

    Chummun, K; O’Hora, H; Gaudel, C; Webster, P; Ogunlewe, O; Boylan, P (Irish Medical Journal, 2015-05)
    Oxytocin infusion used in labour can sometimes be left hung on the stand for many hours. There has been no study to determine if oxytocin is equally distributed throughout the infusion bag and if the distribution stays the same with time. We postulated that there may be settling of the molecules such that oxytocin concentrates at the bottom of the infusion bag. Eight infusion bags were prepared by mixing 10 IU of oxytocin in 1 litre of normal saline. The infusion bags were hung on infusion stands for 8 hours after which 10 samples of 100 mls of the solution from each bag were taken in different containers and the concentration of oxytocin calculated using oxytocin specific Enzyme Immunoassay (EIA) in the different samples. No statistically significant correlation between the oxytocin concentration and the sample number was observed (p-value = 0.738). There was no obvious relationship between oxytocin concentration and the sample number in each bag. There was no evidence to suggest that a linear oxytocin concentration gradient develops in a bag of normal saline over an 8-hour period. In fact the distribution appears to be random and unequal.

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