• Anesthesia considerations in the obese gravida.

      Tan, Terry; Sia, Alex T; Department of Perioperative Medicine and Anaesthesia, Coombe Women and Infants University Hospital, Dublin, Ireland. (2011-12)
      Obesity is associated with serious morbidity during pregnancy, and obese women also are at a high risk of developing complications during labor, leading to an increased risk for instrumental and Cesarean deliveries. The engagement of the obstetrical anesthetist in the management of this group of high-risk patients should be performed antenatally so that an appropriate management strategy can be planned in advance to prevent an adverse outcome. Good communication between all care providers is essential. The obese patient in labor should be encouraged to have a functioning epidural catheter placed early in labor. Apart from providing analgesia and alleviating physiological derangements during labor, the presence of a functioning epidural catheter can also be used to induce anesthesia quickly in the event of an emergency cesarean section, thus avoiding a general anesthesia, which has exceedingly high risks in the obese parturient. Successful management of the obese patient necessitates a comprehensive strategy that encompasses a multidisciplinary and holistic approach from all care-providers.
    • Annual clinical report 2009 - Coombe Women & Infants University Hospital

      Coombe Women & Infants University Hospital (Coombe Women & Infants University Hospital, 2010)
    • Annual clinical report 2010 - Coombe Women & Infants University Hospital

      Coombe Women & Infants University Hospital (Coombe Women & Infants University Hospital, 2011)
    • Antenatal care in uncomplicated pregnancies

      Barry, Paula; Cowman, Triona (Nursing in General Practice, 2016-05)
      Antenatal care is a routine part of pregnancy for most women in Ireland. Under the Irish Maternity and Infants Care Scheme, 1 care during pregnancy is free. Women can avail of care in the community or hospital setting. National and international department of health policies state that effective antenatal care should focus on the individual woman’s needs and preferences; should be collaborative and should offer continuity of care. 2, 3, 4 The following paper is to guide you on the provision of antenatal care to healthy women, with uncomplicated pregnancies. It gives an overview of recommended care provision, including advice that may be given to women during the antenatal period.
    • Antenatal rubella immunity in Ireland

      O Dwyer, V; Bonham, S; Mulligan, A; O’Connor, C; Farah, N; Kennelly, MM; Turner, MJ (Irish Medical Journal, 2013-09)
      The objective of the study was to identify those women attending for antenatal care who would have benefited from prepregnancy rubella vaccination. It was a population-based observational study of women who delivered a baby weighing e500 g in 2009 in the Republic of Ireland. The womanâ s age, parity, nationality and rubella immunity status were analysed using data collected by the National Perinatal Reporting System. Of the 74,810 women delivered, the rubella status was known in 96.7% (n=72,333). Of these, 6.4%(n=4,665) women were not immune. Rubella seronegativity was 8.0%(n=2425) in primiparous women compared with 5.2%(n=2239) in multiparous women (p<0.001), 14.7%(n=10653) in women <25 years old compared with 5.0%(n=3083) in women e25 years old (p<0.001), and 11.4%(n=780) in women born outside the 27 European Union (EU27) countries compared with 5.9%(n=3886) in women born inside the EU27 countries (p<0.001). Based on our findings we recommend that to prevent Congenital Rubella Syndrome, the health services in Ireland should focus on women who are young, nulliparous and born outside the EU.
    • Aortic isthmus Doppler velocimetry: role in assessment of preterm fetal growth restriction.

      Kennelly, M M; Farah, N; Turner, M J; Stuart, B; Ultrasound and Fetal Medicine Centre, Coombe Women & Infants University Hospital,, Dublin, Ireland. mkennelly@doctors.org.uk (2012-02-01)
      Intrauterine fetal growth restriction (IUGR) is an important pregnancy complication associated with significant adverse clinical outcome, stillbirth, perinatal morbidity and cerebral palsy. To date, no uniformly accepted management protocol of Doppler surveillance that reduces mortality and cognitive morbidity has emerged. Aortic isthmus (AoI) evaluation has been proposed as a potential monitoring tool for IUGR fetuses. In this review, the current knowledge of the relationship between AoI Doppler velocimetry and preterm fetal growth restriction is reviewed. Relevant technical aspects and reproducibility data are reviewed as we discuss AoI Doppler and its place within the existing repertoire of Doppler assessments in placental insufficiency. The AoI is a link between the right and left ventricles which perfuse the lower and upper body, respectively. The clinical use of AoI waveforms for monitoring fetal deterioration in IUGR has been limited, but preliminary work suggests that abnormal AoI impedance indices are an intermediate step between placental insufficiency-hypoxemia and cardiac decompensation. Further prospective studies correlating AoI indices with arterial and venous Doppler indices and perinatal outcome are required before encorporating this index into clinical practice.
    • Are there sex differences in Fetal Abdominal Subcutaneous Tissue (FAST) measurements?

      Farah, Nadine; Stuart, Bernard; Harrold, Emily; Fattah, Chro; Kennelly, Mairead; Turner, Michael J; UCD School of Medicine and Medical Science, Coombe Women and Infants University, Hospital, Dublin 8, Ireland. nadine.farah@ucd.ie (2012-02-01)
      OBJECTIVE: To determine if Fetal Abdominal Subcutaneous Tissue (FAST) measurements using antenatal ultrasound differ between male and female fetuses. STUDY DESIGN: Women who had an ultrasound examination for fetal growth between 20 and 40 weeks gestation were studied. Women with diabetes mellitus were excluded. The fetal anterior abdominal subcutaneous tissue was measured on the anterior abdominal wall in millimetres anterior to the margins of the ribs, using magnification at the level of the abdominal circumference. The fetal sex was recorded after delivery. RESULTS: A total of 557 fetuses were measured, 290 male and 267 female. The FAST measurements increased with gestational age. The FAST increased at the same rate for both male and female fetuses and at any given week there was no sex difference. CONCLUSIONS: The increased fat composition in females reported after birth was not found in abdominal wall subcutaneous fat measurements using ultrasound during pregnancy. Antenatal centile charts for FAST do not need to be based on sex.
    • Are women in early pregnancy following the national pyramid recommendations?

      O'Neill, J L; Keaveney, E M; O'Connor, N; Cox, M; Regan, A; Shannon, E; Turner, M J; Danone Baby Nutrition, Block 1, Deansgrange Business Park, Deansgrange, Co., Dublin. (2011-10)
      Appropriate nutrition in pregnancy is fundamental for maternal and fetal health, and the long-term physiological wellbeing of the offspring. We aimed to determine whether a sample of pregnant women met the national guidelines for healthy eating during pregnancy, and to examine if compliance differs when analysed by Body Mass Index (BMI) category. Subjects completed a 24-hr dietary recall, and had their BMI calculated. The mean age was 27.8 years. The mean BMI was 25.1 kg/m2, with 32 (31.7%) subjects overweight and 14 (13.9%) obese based on BMI category. Although the majority of subjects thought that they had a healthy diet, less than half met the recommended guidelines for each individual food group with achievement of the dairy group being particularly low. Achievement of food group recommendations was not influenced by BMI category. Public health messages on healthy eating guidelines need to be clearly communicated to pregnant women.
    • Aspirin and P2Y12 inhibition attenuate platelet-induced ovarian cancer cell invasion.

      Cooke, Niamh M; Spillane, Cathy D; Sheils, Orla; O'Leary, John; Kenny, Dermot (BioMed Central, 2015-09-09)
      Platelet-cancer cell interactions play a key role in successful haematogenous metastasis. Disseminated malignancy is the leading cause of death among ovarian cancer patients. It is unknown why different ovarian cancers have different metastatic phenotypes. To investigate if platelet-cancer cell interactions play a role, we characterized the response of ovarian cancer cell lines to platelets both functionally and at a molecular level.
    • Aspirin In The Prevention Of Pre-Eclampsia: Where Are We Now?

      Khalid A,; Byrne, B M (Irish Medical Journal, 2018-03)
      Pre-eclampsia is a pregnancy specific multi-systemic disorder that causes maternal and perinatal morbidity and mortality worldwide. It is estimated to complicate between three to five percent of pregnancies and contributes to 8 to 10% of all preterm births1,2. Aspirin inhibits cyclooxygenase in platelets and endothelium in a fashion that alters the balance between the vasoconstrictor thromboxane and the vasodilator prostacyclin. This potentiates vasodilatation and reduces platelet aggregation, contributors to the endothelial dysfunction seen in preeclampsia. Over 100 clinical trials have examined whether or not Aspirin, when prescribed from early pregnancy, can prevent pre-eclampsia, and the consensus is that it reduces the incidence by approximately 10 to 24 % in women that are deemed to be at risk3,4.
    • Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

      Tan, T; Wilson, D; Walsh, A; Hu, P; Power, C; Department of Anaesthesia and Perioperative Medicine, Coombe Women and Infants, University Hospital, Cork Street, Dublin 8, Ireland. tutan@me.com (2012-02-01)
      BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.
    • An audit of caesarean sections for very low birth weight babies.

      Khalifeh, A; Farah, N; Turner, M; UCD School of Medicine and Medical Science, Coombe Women and Infants University, Hospital, Dublin, Ireland. (2012-02-01)
      This study reviewed caesarean sections for very low birth weight babies in a tertiary referral maternity hospital. Maternal and neonatal complications were recorded and classified according to uterine incision type. We reviewed medical records of 89 women over a period of 2 years. The indication for the caesarean section influenced the type of uterine incision made (p = 0.004). Women who had antepartum haemorrhage were more likely to need a vertical incision. There was also a higher incidence of vertical incisions for gestations <28 weeks (p = 0.029). Surprisingly, when the computerised discharge summaries were reviewed retrospectively, all the vertical uterine incisions were recorded as lower segment caesarean sections. This would have a clinical impact on those women in future pregnancies, especially in a highly mobile population.
    • An audit of urinary tract infections in very low birth weight infants--what are we missing?

      Perrem, L M; O'Neill, R; O'Grady, M; White, M (Irish Medical Journal, 2015-01)
      Urinary Tract Infections (UTIs) are a leading cause of bacterial infection in infants and the National Institute of Clinical Excellence recommends that UTIs are actively sought in paediatric patients. 1 Their incidence ranges from between 0.1- 2.0% in full-term newborns, increasing to a reported 25% in preterm and very low birth weight (VLBW) infants. 2-4 The urinary tract is an extremely rare source of infection in the first 72 hours of life and thus routine urine culture in this population is deemed unnecessary. 4 Conversely, UTIs frequently present with late-onset sepsis (LOS) in the VLBW population 1,2 and urine culture is an essential element of a complete sepsis evaluation in this cohort. 1,3 Despite a high incidence of UTI, urine culture is frequently neglected in Neonatal Intensive Care Units (NICUs) 3 as obtaining a clean-catch sample is time consuming and the use of invasive second-line collection methods is limited by fear of complications and medical staff procedural inexperience. Identifying the source of infection will influence subsequent radiological investigations 1 and ensure appropriate treatment.
    • Barriers and facilitators to implementing addiction medicine fellowships: a qualitative study with fellows, medical students, residents and preceptors.

      Klimas, J; Small, W; Ahamad, K; Cullen, W; Mead, A; Rieb, L; Wood, E; McNeil, R (Biomed Central, 2017)
      Although progress in science has driven advances in addiction medicine, this subject has not been adequately taught to medical trainees and physicians. As a result, there has been poor integration of evidence-based practices in addiction medicine into physician training which has impeded addiction treatment and care. Recently, a number of training initiatives have emerged internationally, including the addiction medicine fellowships in Vancouver, Canada. This study was undertaken to examine barriers and facilitators of implementing addiction medicine fellowships.
    • Bedside detection of low systemic flow in the very low birth weight infant on day 1 of life.

      Miletin, J; Pichova, K; Dempsey, E M; Department of Paediatrics and Newborn Medicine, Coombe Women and Infants, University Hospital, Dolphin's Barn, Dublin 8, Ireland. miletinj@yahoo.com (2012-02-01)
      We aimed to assess the relationship between the clinical and biochemical parameters of perfusion and superior vena cava (SVC) flow in a prospective observational cohort study of very low birth weight (VLBW) infants. Newborns with congenital heart disease were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. Capillary refill time (forehead, sternum and toe), mean blood pressure, urine output and serum lactate concentration were also measured simultaneously. Thirty-eight VLBW infants were examined. Eight patients (21%) had SVC flow less than 40 ml/kg/min. There was a poor correlation between the capillary refill time (in all sites), mean blood pressure, urine output and SVC flow. The correlation coefficient for the serum lactate concentration was r = -0.28, p = 0.15. The median serum lactate concentration was 3.5 (range 2.8-8.5) vs. 2.7 (range 1.2-6.9) mmol/l (p = 0.01) in low flow versus normal flow states. A serum lactate concentration of >2.8 was 100% sensitive and 60% specific for detecting a low flow state. Combining a capillary refill time of >4 s with a serum lactate concentration of >4 mmol/l had a specificity of 97% for detecting a low SVC flow state. Serum lactate concentrations are higher in low SVC flow states. A capillary refill time of >4 s combined with serum lactate concentrations >4 mmol/l increased the specificity and positive and negative predictive values of detecting a low SVC flow state.
    • Behavioural change in relation to alcohol exposure in early pregnancy and impact on perinatal outcomes--a prospective cohort study.

      Murphy, Deirdre J; Mullally, Aoife; Cleary, Brian J; Fahey, Tom; Barry, Joe; Academic Department of Obstetrics & Gynaecology, Coombe Women and Infants University Hospital & Trinity College Dublin, Dublin, Dublin 8, Republic of Ireland. deirdre.j.murphy@tcd.ie (2013)
      There has been limited research addressing whether behavioural change in relation to alcohol exposure in pregnancy results in better perinatal outcomes.
    • Body Mass Index (BMI) in women booking for antenatal care: comparison between selfreported and digital measurements.

      Fattah, Chro; Farah, Nadine; O'Toole, Fiona; Barry, Sinead; Stuart, Bernard; Turner, Michael J; UCD School of Medicine and Medical Science, Coombe Women and Infants University, Hospital, Dublin, Ireland. (2012-02-01)
      OBJECTIVE: We set out to compare measurement of Body Mass Index (BMI) with selfreporting in women early in pregnancy. STUDY DESIGN: We studied 100 women booking for antenatal care in the first trimester with a normal ongoing pregnancy. Selfreported maternal weight and height were recorded and the Body Mass Index was calculated. Afterwards maternal weight and height were digitally measured and actual BMI was calculated. RESULTS: If selfreporting is used for BMI classification, we found that 22% of women were classified incorrectly when BMI was measured. 12% of the women who were classified as having a normal selfreported BMI were overweight and 5% classified as overweight were obese. Similar findings have been reported outside pregnancy. CONCLUSIONS: These findings have implications for clinical practice, and for research studies exploring the relationship between maternal adiposity and pregnancy complications.
    • Body mass index and blood pressure measurement during pregnancy.

      Hogan, Jennifer L; Maguire, Patrick; Farah, Nadine; Kennelly, Mairead M; Stuart, Bernard; Turner, Michael J; Coombe Women and Infants University Hospital, Dublin, Ireland., Jennifer.Hogan@ucdconnect.ie (2012-02-01)
      OBJECTIVE: The accurate measurement of blood pressure requires the use of a large cuff in subjects with a high mid-arm circumference (MAC). This prospective study examined the need for a large cuff during pregnancy and its correlation with maternal obesity. METHODS: Maternal body mass index (BMI), fat mass, and MAC were measured. RESULTS: Of 179 women studied, 15.6% were obese. With a BMI of level 1 obesity, 44% needed a large cuff and with a BMI of level 2 obesity 100% needed a large cuff. CONCLUSION: All women booking for antenatal care should have their MAC measured to avoid the overdiagnosis of pregnancy hypertension.
    • Body Mass Index and spontaneous miscarriage.

      Turner, Michael J; Fattah, Chro; O'Connor, Norah; Farah, Nadine; Kennelly, Mairead; Stuart, Bernard; UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, , Dublin 8, Ireland. michael.turner@ucd.ie (2012-02-01)
      OBJECTIVE: We compared the incidence of spontaneous miscarriage in women categorised as obese, based on a Body Mass Index (BMI) >29.9 kg/m(2), with women in other BMI categories. STUDY DESIGN: In a prospective observational study conducted in a university teaching hospital, women were enrolled at their convenience in the first trimester after a sonogram confirmed an ongoing singleton pregnancy with fetal heart activity present. Maternal height and weight were measured digitally and BMI calculated. Maternal body composition was measured by advanced bioelectrical impedance analysis. RESULTS: In 1200 women, the overall miscarriage rate was 2.8% (n=33). The mean gestational age at enrolment was 9.9 weeks. In the obese category (n=217), the miscarriage rate was 2.3% compared with 3.3% in the overweight category (n=329), and 2.3% in the normal BMI group (n=621). There was no difference in the mean body composition parameters, particularly fat mass parameters, between those women who miscarried and those who did not. CONCLUSIONS: In women with sonographic evidence of fetal heart activity in the first trimester, the rate of spontaneous miscarriage is low and is not increased in women with BMI>29.9 kg/m(2) compared to women in the normal BMI category.