• Accuracy of identification of the cricothyroid membrane in female subjects using palpation: an observational study.

      Aslani, Anastasia; Ng, Su-Cheen; Hurley, Michael; McCarthy, Kevin F; McNicholas, Michelle; McCaul, Conan Liam; Department of Anaesthesia, The Rotunda Hospital, Dublin 1, Ireland. (2012-05)
      The cricothyroid membrane (CTM) is the recommended site of access to the airway during cricothyroidotomy to provide emergency oxygenation. Despite the apparent simplicity of the technique, this rescue maneuver frequently fails to achieve its goals and complications are numerous. The reasons for this failure are unclear. We sought to determine the ability of physicians to correctly identify the CTM in female patients.
    • Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

      Tadrous, R; Ni Mhuirchteagh, R; McCaul, C; Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland. (Elsevier, 2011-07)
      Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
    • Anaesthesia for caesarean section in a patient with Sturge-Weber syndrome following acute neurological deterioration.

      Tadrous, R; Ni Mhuirchteagh, R; McCaul, C; Department of Anaesthesia, The Rotunda Hospital, Dublin, Ireland. (2012-02-01)
      Sturge-Weber syndrome consists of facial capillary malformation (port-wine stain) and abnormal blood vessels in the brain or eye. Seizures, developmental delay and intracranial and airway angiomata are principal concerns. We report a 28-year-old primiparous woman at 41 weeks of gestation with Sturge-Weber syndrome who developed unilateral weakness, aphasia, blurred vision and confusion. Preeclampsia was excluded. Neuroimaging showed left sided cerebral oedema and a right parieto-occipital lesion, most likely an angioma. Caesarean section was planned to avoid the risk of angioma rupture during labour. General anesthesia was avoided due to the haemodynamic response to laryngoscopy and reports of seizure-related mortality. Despite the possibility of raised intracranial pressure and precipitation of cerebral herniation, a lumbar epidural block was administered but failed. A subarachnoid block was successfully performed and a healthy infant delivered. The choice of anaesthesia was strongly influenced by detailed radiological investigations and multidisciplinary participation.
    • Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

      Hayes, N E; Aslani, A; McCaul, C L; Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland. nihayes@rotunda.ie (2011-04)
      We describe the anaesthetic management of a patient with Liddle's syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle's syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle's syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.
    • Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

      Hayes, N E; Aslani, A; McCaul, C L; Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland. nihayes@rotunda.ie (2012-02-01)
      We describe the anaesthetic management of a patient with Liddle's syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle's syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle's syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.
    • Anaesthetic outcomes in obese parturients: the effect of assessment in the high-risk clinic.

      Aslani, A; Husarova, V; Ecimovic, P; Loughrey, J; McCaul, C; Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland. (2012-03)
      Obese parturients are at high risk of complications during anaesthesia and early use of epidural analgesia in labour has been recommended for obese patients during labour.
    • The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles.

      Grobman, William A; Lai, Yinglei; Rouse, Dwight J; Spong, Catherine Y; Varner, Michael W; Mercer, Brian M; Leveno, Kenneth J; Iams, Jay D; Wapner, Ronald J; Sorokin, Yoram; et al. (2013-10)
      The objective of the study was to determine whether an individualized growth standard (IS) improves the identification of preterm small-for-gestational-age (SGA) neonates at risk of developing moderate/severe cerebral palsy (CP) or death.
    • Brominated and fluorinated organic pollutants in the breast milk of first-time Irish mothers: is there a relationship to levels in food?

      Pratt, Iona; Anderson, Wayne; Crowley, Dominique; Daly, Sean; Evans, Rhodri; Fernandes, Alwyn; Fitzgerald, Margaret; Geary, Michael; Keane, Declan; Morrison, John J; et al. (2013)
      Brominated flame retardants - polybrominated diphenyl ethers (PBDEs), polybrominated biphenyls (PBBs), hexabromocyclododecane (HBCD) and others - have been measured in 11 pooled breast milk samples from 109 first-time mothers in Ireland. Additionally, the study has measured levels of polybrominated dibenzo-p-dioxins and furans (PBDD/Fs), mixed halogenated dioxins (PXCC/Fs) and biphenyls (PXBs), polychlorinated naphthalenes (PCNs) and perfluoroalkylated substances (PFAS) in these samples. The mean sum of 19 PBDEs including BDE-209 was 4.85 ng g(-1) fat, which is comparable with that found in other European countries. BDE-47, BDE-153, BDE-209, BDE-99 and BDE-100 were found at the highest concentrations. The only PBBs detected consistently were BB-77, BB-126 and BB-153, with highest concentrations being found for BB-153 (mean = 0.13 ng g(-1) fat). The mean sum of HBCD enantiomers was 3.52 ng g(-1) fat, with α-HBCD representing over 70% of the total. Of the other brominated flame retardants - tetrabromobisphenol-A (TBBP-A), hexabromobenzene (HBB), decabromodiphenylethane (DBDPE) and bis(2,4,6-tribromophenoxyethane) (BTBPE) - examined, only TBBP-A was detected above the limit of detection (LOD), in two of the 11 pools analysed. All measured PBDF congeners were observed (at 0.02-0.91 pg g(-1) fat), but 2,3,7,8-tetrabromo-dibenzodioxin (TeBDD) was the only PBDD detected, with a mean concentration of 0.09 pg g(-1) fat. The occurrence of the mixed chlorinated/brominated dibenzodioxins, dibenzofurans and biphenyls, 2-B-3,7,8-CDD, 2,3-B-7,8-CDF, 4-B-2,3,7,8-CDF, PXB 105, PXB 118, PXB 126 and PCB 156 in breast milk in the current study may indicate that levels of these contaminants are increasing in the environment. Polychlorinated naphthalenes were detected in all samples, but not perfluorooctane sulfonate (PFOS) and other PFAS. The pattern of occurrence of these brominated and fluorinated persistent organic pollutants (POPs) in Irish breast milk shows a general relationship to their occurrence in food, as reported in a number of surveillance studies carried out by the Food Safety Authority of Ireland.
    • 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.
    • Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

      McMorrow, R C N; Ni Mhuircheartaigh, R J; Ahmed, K A; Aslani, A; Ng, S-C; Conrick-Martin, I; Dowling, J J; Gaffney, A; Loughrey, J P R; McCaul, C L; et al. (2012-02-01)
      BACKGROUND: Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial. METHODS: Eighty patients were randomized to one of four groups to receive (in addition to spinal anaesthesia) either spinal morphine 100 microg (S(M)) or saline (S(S)) and a postoperative bilateral TAP block with either bupivacaine (T(LA)) 2 mg kg(-1) or saline (T(S)). RESULTS: Pain on movement and early morphine consumption were lowest in groups receiving spinal morphine and was not improved by TAP block. The rank order of median pain scores on movement at 6 h was: S(M)T(LA) (20 mm)
    • Comparison of transversus abdominis plane block vs spinal morphine for pain relief after Caesarean section.

      McMorrow, R C N; Ni Mhuircheartaigh, R J; Ahmed, K A; Aslani, A; Ng, S-C; Conrick-Martin, I; Dowling, J J; Gaffney, A; Loughrey, J P R; McCaul, C L; et al. (2011-05)
      Transversus abdominis plane (TAP) block is an alternative to spinal morphine for analgesia after Caesarean section but there are few data on its comparative efficacy. We compared the analgesic efficacy of the TAP block with and without spinal morphine after Caesarean section in a prospective, randomized, double-blinded placebo-controlled trial.
    • Delayed fetal bradycardia and death following intrauterine fetal transfusion.

      Said, S; Fleming, A; Devaney, D; Malone, F D; Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, (RCSI), Rotunda Hospital, Dublin, Republic of Ireland. sohatohamy@hotmail.com (2012-02-01)
    • Delayed fetal bradycardia and death following intrauterine fetal transfusion.

      Said, S; Fleming, A; Devaney, D; Malone, F D; Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland (RCSI), Rotunda Hospital, Dublin, Republic of Ireland. sohatohamy@hotmail.com (2009-08)
    • First Irish birth following IVF therapy using antagonist protocol.

      Mocanu, E V; Kondaveeti, N; Kelly, J; Hennelly, B; Burke, L; Hughes, C; HARI Unit, Rotunda Hospital, Dublin 1, Ireland. emocanu@rcsi.ie (2012-02-01)
      BACKGROUND: During in vitro fertilization (IVF), the prevention of a premature LH surge was traditionally achieved using a gonadotrophin releasing hormone agonist (GnRH-a), and more recently, a GnRH antagonist. AIMS: We report a case of a 37 year old treated using the GnRH antagonist in a second completed cycle of IVF. METHODS: IVF was performed for primary infertility of 5-year duration due to frozen pelvis secondary to endometriosis. RESULTS: Following controlled ovarian hyperstimulation, oocyte recovery and fertilization, cleavage and transfer of two zygotes, a pregnancy established. A twin gestation was diagnosed at 7-weeks scan and pregnancy ended with the delivery of twin girls by emergency caesarean section. CONCLUSION: This is a first report of a delivery following IVF using the antagonist protocol in Ireland. Such therapy is patient friendly and its use should be introduced on a larger scale in clinical practice.
    • First Irish birth following IVF therapy using antagonist protocol.

      Mocanu, E V; Kondaveeti, N; Kelly, J; Hennelly, B; Burke, L; Hughes, C; HARI Unit, Rotunda Hospital, Dublin 1, Ireland. emocanu@rcsi.ie (2010-09)
      During in vitro fertilization (IVF), the prevention of a premature LH surge was traditionally achieved using a gonadotrophin releasing hormone agonist (GnRH-a), and more recently, a GnRH antagonist.
    • The follicular stigma--a window for better understanding of ovulation.

      Das, Asish; Khan, H; Mocanu, E; Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland. asishdas65@gmail.com (2011-08)
    • How effective is amniotomy as a means of induction of labour?

      Cooley, S M; Geary, M P; O'Connell, M P; McQuillan, K; McParland, P; Keane, D; Rotunda Hospital, Parnell Square, Dublin 1, Ireland. smcooley@hotmail.com (2012-02-01)
      BACKGROUND: Amniotomy or artificial rupture of membranes is routinely used for induction of labour. AIMS: To assess the efficacy of amniotomy alone for induction. METHODS: A retrospective descriptive study of 3,586 cases of amniotomy for induction of labour between July 1996 and December 1999. RESULTS: In total, 26,670 women delivered in the National Maternity Hospital during the study period. Of these 4,928 women required induction of labour and 72.8% of these (n = 3,586) underwent amniotomy only for induction of labour. Spontaneous labour occurred in 90.1% of the women who underwent amniotomy within 24 h. Oxytocin as an induction agent was employed in 9.8% of cases. Overall, 80.5% of the women had a spontaneous delivery, 7.3% had a ventouse delivery, 4.3% had a forceps delivery, and 7.9% underwent a caesarean section. In total, 90.5% of multips and 63.4% of primips had a spontaneous vaginal delivery. CONCLUSIONS: Amniotomy is a simple, safe and effective method of induction of labour.
    • How effective is amniotomy as a means of induction of labour?

      Cooley, S M; Geary, M P; O'Connell, M P; McQuillan, K; McParland, P; Keane, D; Rotunda Hospital, Parnell Square, Dublin 1, Ireland. smcooley@hotmail.com (2010-09)
      Amniotomy or artificial rupture of membranes is routinely used for induction of labour.
    • Impact of adjusting for the reciprocal relationship between maternal weight and free thyroxine during early pregnancy.

      Haddow, James E; Craig, Wendy Y; Palomaki, Glenn E; Neveux, Louis M; Lambert-Messerlian, Geralyn; Canick, Jacob A; Malone, Fergal D; D'Alton, Mary E; Division of Medical Screening and Special Testing, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA. jhaddow@ipmms.org (2013-02)
      Among euthyroid pregnant women in a large clinical trial, free thyroxine (FT4) measurements below the 2.5th centile were associated with a 17 lb higher weight (2.9 kg/m(2)) than in the overall study population. We explore this relationship further.
    • The impact of ultrasonographic placental architecture on antenatal course, labor and delivery in a low-risk primigravid population.

      Cooley, Sharon M; Donnelly, Jennifer C; Walsh, Thomas; McMahon, Corrina; Gillan, John; Geary, Michael P; Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland., smcooley@hotmail.com (2012-02-01)
      OBJECTIVE: To ascertain the impact of placental architecture on antenatal course and labor delivery in a low-risk primigravid population. METHODS: This study involves prospective recruitment of 1011 low-risk primigravids with placental ultrasound at 22?24 weeks and 36 weeks. Detailed postnatal review of all mothers and infants was undertaken. Retrospective analysis of ultrasound and clinical outcome data was performed. RESULTS: Eight hundred ten women with complete outcome data were available. Anterior placentation was statistically associated with intrauterine growth restriction (IUGR) and preterm birth and fundal placentation was significantly associated with a higher incidence of pregnancy-induced hypertension and infants with a birthweight less than the 9th centile. Placental infarcts in the third trimester was significantly increased in cases complicated by pre-eclampsia (PET) and in cases with fetal acidosis. Placental calcification was associated a 40-fold increase in the incidence of IUGR. Placental lakes in the second trimester were more prevalent in patients with threatened miscarriage. Increased placental thickness was associated with a higher rate of fetal acidosis. The Grannum grade of the placenta was higher with threatened first or second trimester loss, PET and in infants born less than 9th centile for gestation. CONCLUSION: Placental site and architecture impact on the incidence of maternal and fetal disease.