• Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room.

      Schmölzer, Georg M; Dawson, Jennifer A; Kamlin, C Omar F; O'Donnell, Colm P F; Morley, Colin J; Davis, Peter G; Neonatal Services, The Royal Women’s Hospital, Melbourne, Australia. georg.schmoelzer@me.com (Archives of disease in childhood. Fetal and neonatal edition, 2011-07)
      Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction.
    • Anaesthesia for parturients with severe cystic fibrosis: a case series.

      Deighan, M; Ash, S; McMorrow, R; Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland. Electronic address: maireadeighan@doctors.org.uk. (2014-02)
      Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.
    • Antenatal suspicion of ischemic placental disease and coexistence of maternal and fetal placental disease: analysis of over 500 cases.

      Cooley, Sharon M; Reidy, Fiona R; Mooney, Eoghan E; McAuliffe, Fionnuala M; Fetal Medicine Center, National Maternity Hospital, Dublin, Ireland. (2011-12)
      To investigate the antenatal suspicion of placental disease and the coexistence of maternal and fetal placental ischemic disease.
    • The application of a clinical risk stratification score may reduce unnecessary investigations for pulmonary embolism in pregnancy.

      O'Connor, Clare; Moriarty, John; Walsh, Jennifer; Murray, John; Coulter-Smith, Sam; Boyd, William; Department of Obstetrics and Gynaecology, National Maternity Hospital, Dublin, Ireland. (2011-12)
      To examine the use of the modified Wells score in pregnancy as a risk stratification tool in the diagnosis of pulmonary embolism (PE).
    • Appropriate antenatal corticosteroid use in women at risk for preterm birth before 34 weeks of gestation.

      Mahony, R; McKeating, A; Murphy, T; McAuliffe, F; O'Herlihy, C; Foley, M; National Maternity Hospital Dublin, Holles Street, Dublin 2, Ireland. (2010-07)
      To determine the utilisation of antenatal corticosteroid administration in women presenting at risk of preterm birth (PTB) in a centre where tocolytics are not prescribed.
    • 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.
    • The association between TNF-α and insulin resistance in euglycemic women.

      Walsh, Jennifer M; McGowan, Ciara A; Byrne, Jacinta A; Rath, Ann; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, Ireland; National Maternity Hospital, Dublin, Ireland. Electronic address: msjenniferwalsh@gmail.com. (2013-10)
      Chronic low levels of inflammation have links to obesity, diabetes and insulin resistance. We sought to assess the relationship between cytokine tumor necrosis factor (TNF-α) and insulin resistance in a healthy, euglycemic population. This is a prospective study of 574 non-diabetic mother and infant pairs. Maternal body mass index (BMI), TNF-α, glucose and insulin were measured in early pregnancy and at 28 weeks. Insulin resistance was calculated by HOMA index. At delivery birthweight was recorded and cord blood analysed for fetal C-peptide and TNF-α. In a multivariate model, maternal TNF-α in early pregnancy was predicted by maternal insulin resistance at the same time-point, (β=0.54, p<0.01), and maternal TNF-α at 28 weeks was predicted by maternal insulin resistance in early pregnancy (β=0.24, p<0.01) and at 28 weeks (β=0.39, p<0.01). These results, in a large cohort of healthy, non-diabetic women have shown that insulin resistance, even at levels below those diagnostic of gestational diabetes, is associated with maternal and fetal inflammatory response. These findings have important implications for defining the pathways of fetal programming of later metabolic syndrome and childhood obesity.
    • The association of maternal and fetal glucose homeostasis with fetal adiposity and birthweight.

      Walsh, Jennifer M; Mahony, Rhona; Byrne, Jacinta; Foley, Michael; McAuliffe, Fionnuala M; Department of Obstetrics and Gynecology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. jennifer.walsh@ucd.ie (European journal of obstetrics, gynecology, and reproductive biology, 2011-12)
      To examine the association between maternal and fetal glucose levels and fetal adiposity and infant birthweight.
    • The benefit of early treatment without rescreening in women with a history of gestational diabetes.

      Maher, Nicola; McAuliffe, Fionnuala; Foley, Michael; UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland. mahernicola@hotmail.com (2013-02)
      In this center, women with a history of gestational diabetes (GDM) are treated without rescreening from early pregnancy in any subsequent pregnancies, commencing with a low glycemic diet and insulin if and when indicated. The objective of this study was to see if this practice reduced the incidence of macrosomia compared with the index pregnancy.
    • Caesarean section in a parturient with a spinal cord stimulator.

      Sommerfield, D; Hu, P; O'Keeffe, D; McKeating A, K; Department of Anaesthesia, National Maternity Hospital, Dublin, Ireland. dsommerfield@hotmail.com (2010-01)
      A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.
    • A case of recurrent familial male miscarriages with hypercoiled umbilical cord: a possible X-linked association?

      Beggan, Caitlin; Mooney, Eoghan E; Downey, Paul; Carroll, Stephen; Reardon, Willie; Department of Histopathology, National Maternity Hospital, Dublin, Ireland. (2014-01)
    • Clinical and ultrasound features of placental maturation in pre-gestational diabetic pregnancy.

      Higgins, Mary F; Russell, Noirin M; Mooney, Eoghan E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Ireland. (2012-10)
      Pre-gestational diabetes (PGDM) is a significant cause of neonatal morbidity and mortality. Delayed villous maturation (DVM) is a placental diagnosis with increased risk of perinatal mortality.
    • Clinical associations with a placental diagnosis of delayed villous maturation: a retrospective study.

      Higgins, Mary; McAuliffe, Fionnuala M; Mooney, Eoghan E; School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
      Delayed villous maturation (DVM) is a spectrum of placental disease characterized by decreased tertiary villus formation, reduced vasculosyncytial membrane formation, and, in its more severe forms, increased large bullous villi. In some series it has been associated with an increased risk of stillbirth in the late third trimester, but overall there are few data on its significance. The aim of this study was to assess perinatal factors associated with, and the clinical significance of, the finding of DVM on placental histology. This was a retrospective study investigating all pregnancies with DVM diagnosed on placental histology in a tertiary level unit between December 2001 and August 2006. Over a 6-year period, 2915 placentas were triaged for histopathological assessment, representing 6.1% of all 48 054 deliveries in this time period. One hundred ninety (6.3%) of these selected cases showed DVM. Fifteen placentas from infants with less than 34 completed weeks of gestation were excluded, leaving 175 for further analysis. When compared with controls matched for gestation and delivering within the same time period (n  =  175), DVM was significantly associated with pregestational diabetes (8% vs 2.8%, P < .05; relative risk 2.8 [95% confidence interval 1.03-7.6]), gestational diabetes (8.6% vs 3.4%, P < 0.05; relative risk 2.5 [95% confidence interval 0.99-6.3]), and prenatal or intrapartum intrauterine death (8.6% vs 0%, P < 0.05). Delayed villous maturation is associated with both gestational and pregestational diabetes mellitus and with perinatal death.
    • Closed and open breathing circuit function in healthy volunteers during exercise at Mount Everest base camp (5300 m).

      McMorrow, R C N; Windsor, J S; Hart, N D; Richards, P; Rodway, G W; Ahuja, V Y; O'Dwyer, M J; Mythen, M G; Grocott, M P W; UCL Centre for Altitude Space and Extreme Environment Medicine, UCL Institute of Child Health, University College London, London, UK. mcmorrow.roger@gmail.com (Anaesthesia, 2012-08)
      We present a randomised, controlled, crossover trial of the Caudwell Xtreme Everest (CXE) closed circuit breathing system vs an open circuit and ambient air control in six healthy, hypoxic volunteers at rest and exercise at Everest Base Camp, at 5300 m. Compared with control, arterial oxygen saturations were improved at rest with both circuits. There was no difference in the magnitude of this improvement as both circuits restored median (IQR [range]) saturation from 75%, (69.5-78.9 [68-80]%) to > 99.8% (p = 0.028). During exercise, the CXE closed circuit improved median (IQR [range]) saturation from a baseline of 70.8% (63.8-74.5 [57-76]%) to 98.8% (96.5-100 [95-100]%) vs the open circuit improvement to 87.5%, (84.1-88.6 [82-89]%; p = 0.028). These data demonstrate the inverse relationship between supply and demand with open circuits and suggest that ambulatory closed circuits may offer twin advantages of supplying higher inspired oxygen concentrations and/or economy of gas use for exercising hypoxic adults.
    • Delayed villous maturation of the placenta: quantitative assessment in different cohorts.

      Treacy, Ann; Higgins, Mary; Kearney, John M; McAuliffe, Fionnuala; Mooney, Eoghan E; Department of Pathology, National Maternity Hospital, Dublin, Ireland. anntreacy@mac.com (2013)
      Placental villous maturation is maximal in the 3rd trimester, with an abundance of terminal villi. Delayed villous maturation (DVM) of the placenta is associated with chromosomal abnormalities, gestational diabetes, and an adverse outcome. This study compares quantitative assessment of vasculo-syncytial membranes (VSM) in cases of liveborn infants, perinatal deaths, and controls. Cases were selected as follows: (1) liveborn infants with a qualitative diagnosis of DVM (n  =  15); (2) controls matched for gestational age whose placentas did not have DVM (n  =  15); (3) stillbirths (SB)/neonatal deaths (NND) showing DVM (n  =  13); and (4) SB from autopsies in which DVM was felt to be the cause of death (COD) (n  =  12). Vasculo-syncytial membranes were counted in 10 terminal villi in each of 10 consecutive high-power fields on 3 slides. Data analysis was carried out using SPSS. Liveborn cases with DVM showed statistically significantly less VSM than controls (mean 1.01 vs 2.42, P < 0.0001). The SB/NND group also showed significantly less VSM than the control group (mean 0.46 vs 2.42, P < 0.0001) and less than the liveborn DVM group (mean 0.46 vs 1.01, P  =  0.001). The COD group was significantly different from the control group (mean 0.42 vs 2.42, P < 0.0001) and the liveborn DVM group (mean 0.42 vs 1.01, P < 0.0001) but not significantly different from the SB/NND group. There is a quantitative reduction in VSM in cases of DVM compared to controls.
    • Diagnostic and therapeutic dilemma associated with atypical glandular cells on liquid-based cervical cytology.

      Chummun, K; Fitzpatrick, M; Lenehan, P; Boylan, P; Mooney, E; Flannelly, G; National Maternity Hospital, Dublin, Ireland. (2012-12)
      In 2008, the management of women in Ireland with atypical glandular cells changed to immediate referral to colposcopy. The optimal management of these women is unclear. A balance between the detection of occult disease and overtreatment is required.
    • Dietary iodine intake in pregnancy: an update.

      Smyth, P; O'Herlihy, C (Irish Medical Journal (IMJ), 2012-01)
    • The dual influences of age and obstetric history on fecal continence in parous women.

      Eogan, Maeve; O'Brien, Conor; Daly, Leslie; Behan, Michael; O'Connell, P Ronan; O'Herlihy, Colm; Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2011-02)
      To assess whether women who underwent forceps delivery were more likely than those who delivered either normally (spontaneous vaginal delivery [SVD]) or by cesarean to experience deterioration in fecal continence as they aged.
    • Effect of injury on S1 dorsal root ganglia in an experimental model of neuropathic faecal incontinence.

      Peirce, C; O'Herlihy, C; O'Connell, P R; Jones, J F X; School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland. (The British journal of surgery, 2011-08)
      An experimental model of neuropathic faecal incontinence has recently been established. This study aimed to quantify and compare the effect of crush and compression injury on first-order sensory neurones of the inferior rectal nerve (IRN) using a nuclear marker of axonal injury, activating transcription factor (ATF) 3.
    • Endometrial aspiration biopsy: a non-invasive method of obtaining functional lymphoid progenitor cells and mature natural killer cells.

      McMenamin, Moya; Lysakova-Devine, Tatyana; Wingfield, Mary; O'Herlihy, Colm; O'Farrelly, Cliona; UCD School of Medicine and Medical Science, Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. moyamcmenamin@gmail.com (2012-09)
      The aim of this study was to compare the efficacy of endometrial aspiration biopsy (EAB) with the more traditional dilatation and curettage (D&C) for the procurement of lymphoid progenitor cells and uterine natural killer (NK) populations in endometrial tissue. This prospective observational study conducted in a tertiary referral university hospital examined endometrium obtained from 32 women admitted for laparoscopic gynaecological procedures. Each participant had endometrium sampled using both EAB and D&C. Both methods were assessed as a source of uterine NK and lymphoid progenitor cells. Similar proportions of mature CD45+CD56+ NK cells (range 25.4-36.2%) and CD45+CD34+ lymphoid progenitors (range 1.2-2.0%) were found in tissue obtained using both EAB and D&C. These cells were adequate for flow cytometric analysis, magnetic bead separation and culture. Colony formation by the CD34+ population demonstrated maturational potential. Tissues obtained via endometrial biopsy and D&C are equivalent, by analysis of uterine NK and lymphoid progenitor cells. The aim of this study was to compare two methods of endometrial sampling - endometrial aspiration biopsy and traditional dilatation and curettage - for the procurement of haematopoietic stem cells and uterine natural killer (NK) populations in endometrial tissue. Thirty-two women who had gynaecological procedures in a tertiary referral hospital participated in this study and had endometrial tissue collected via both methods. Similar populations of mature NK cells and haematopoietic stem cells were found in tissue obtained using both endometrial aspiration biopsy and dilatation and curettage. Tissue obtained via endometrial aspiration biopsy was adequate for the culture and growth of haematopoietic stem cells. We conclude that tissue obtained via endometrial biopsy and dilatation and curettage is equivalent, by analysis of uterine NK and haematopoietic stem cells using flow cytometry. This has implications for further more extensive study of endometrial haematopoietic stem cell populations, as these samples can be collected in a clinical setting without a requirement for general anaesthesia.