• 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).
    • 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.
    • Ethnic variation between white European women in labour outcomes in a setting in which the management of labour is standardised-a healthy migrant effect?

      Walsh, J; Mahony, R; Armstrong, F; Ryan, G; O'Herlihy, C; Foley, M; UCD School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. jennifer.walsh@ucd.ie (BJOG : an international journal of obstetrics and gynaecology, 2011-05)
      To test the hypothesis that women from Eastern European countries have lower caesarean delivery rates and higher spontaneous labour rates relative to Irish women in a setting in which the management of labour is standardised.
    • Fetal death in twins.

      Mahony, Rhona; Mulcahy, Celia; McAuliffe, Fionnuala; Herlihy, Colm O; Carroll, Stephen; Foley, Michael E; Department of Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Dublin, Ireland. rhonamahony@hotmail.com (2011-11)
      To examine the pattern and prospective risk of intrauterine fetal death (IUFD) in twin pregnancy by chorionicity.
    • Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences.

      Hehir, Mark P; Reidy, Fiona R; Wilkinson, Michael N; Mahony, Rhona; National Maternity Hospital, Holles St, Dublin, Ireland. Electronic address: markhehir23@gmail.com. (2013-11)
      To examine rates and outcomes of operative vaginal delivery over a 20-year study period and the changing preference for various instruments during this period.
    • Is it safe to prescribe clomiphene citrate without ultrasound monitoring facilities?

      Coughlan, C; Fitzgerald, J; Milne, P; Wingfield, M; Merrion Fertility Clinic, National Maternity Hospital, Dublin, Republic of Ireland. C.J.Coughlan@sheffield.ac.uk (2010-05)
      The majority of triplet and higher order multiple pregnancies now result from ovulation induction/superovulation rather than in vitro fertilisation. However, clomiphene citrate is still widely prescribed by gynaecologists and general practitioners who do not have access to ultrasound monitoring. The objective of our study was to determine the prevalence of multifollicular development with different doses of clomiphene citrate. A retrospective review of transvaginal ultrasound monitoring of 425 cycles in 182 women receiving clomiphene citrate from January 2002 to December 2003, was studied. Three or more follicles of >or= 14 mm were identified in 58 cycles (14%). Patients received 50 mg of clomiphene citrate in 52 of these 58 cycles and 25 mg in the remaining six. One patient was noted to have developed five follicles and 10 patients developed four follicles. One patient developed six follicles, despite receiving only 25 mg clomiphene citrate daily. It was concluded that a significant number of women (14%) developed three or more follicles, despite receiving low doses of clomiphene citrate.
    • Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

      Barrett, Michael Joseph; Donoghue, Veronica; Mooney, Eoghan E; Slevin, Marie; Persaud, Thara; Twomey, Eilish; Ryan, Stephanie; Laffan, Eoghan; Twomey, Anne; Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Ireland. mjjbarrett@hotmail.com (2013-03)
      We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.
    • Mode of delivery at term and adverse neonatal outcomes.

      Walsh, Colin A; Robson, Michael; McAuliffe, Fionnuala M; National Maternity Hospital and UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. colwalsh@hotmail.com (2013-01)
      To determine the relationship between mode of delivery and serious adverse neonatal outcomes in term, singleton, cephalic neonates.
    • The National Neonatal Transport Programme (NNTP) 2004-2009.

      Noone, D; Bowden, A; Twomey, A; Department of Neonatology, National Maternity Hospital, Holles St, Dublin 2. dgnoone@gmail.com (2011-09)
      A retrospective analysis of all National Neonatal Transport Programme (NNTP) transport data from 2004-2009 was performed. 1621 transports were conducted during this period with a yearly average of 271. The majority (96%) were ground transports. 1118 (69%) were forward transfers. Of the 446 (27.5%) retrotransfers, 411 (91%.) were to tertiary centres. When transported, 592 infants (36.5%) were <48 hours old and 770 (47.5%) were <1 week old. 902 transports (55%) involved infants <32 wks birth-gestation and 720 (44%) involved infants weighing <1500gms. Transport for management of patent ductus arteriosus accounted for 357 (22%). The average mobilisation time was 34 minutes. 54% of transports were completed after scheduled service hours. The NNTP currently transports similar numbers of critically ill infants during its 8hr service compared with neonatal transport services that operate 24hr services. Performing PDA ligations in a tertiary neonatal unit would significantly reduce the number of neonatal transports required annually.
    • Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals.

      El-Khuffash, A; Kieran, E; Palmer, K; Molloy, E; Department of Paediatrics, National Maternity hospital, Holles St, Dublin 2. (2011-03)
      Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in neonatal respiratory failure. T UK Collaborative ECMO trial demonstrated cost-effectiveness and substantial improvements in neurological morbidity and mortality. Currently, infants requiring ECMO in Ireland are referred to one of various centres in the UK and Scandinavia. We aimed to review the number of infants referred from Ireland for respiratory ECMO. All infants with a non-cardiac condition referred from Ireland for ECMO were reviewed for diagnosis and outcomes. Eleven infants required ECMO between June 2006 and January 2009 and were referred to the Scandinavian team for ECMO transport although one infant improved and did not require ECMO following the arrival of the team. Four infants died: one infant died prior to arrival of the ECMO team, 3 infants had fatal diagnoses and one infant with congenital diaphragmatic hernia received pre-op ECMO. The median (inter-quartile range) gestational age was 39.7 (38.3-40.7) weeks and birth weight of 3.7 (3.2-4.0) kg. The median age at the decision to transfer for ECMO was 13h (4-123) and the team arrived at 23 h (12-132). All infants had a normal cranial ultrasound and echo prior to ECMO and 2 infants had an abnormal MRI post-ECMO. The time on ECMO was 9 days (3-17) and total length of hospital stay was 32 d (23-36). There were no pre-ECMO clinical or biochemical
    • Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section.

      Higgins, Mary F; Monteith, Cathy; Foley, Michael; O'Herlihy, Colm; Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Ireland. Electronic address: maryhiggins@physicians.ie. (2013-11)
      Placenta accreta, morbid adherence to the uterus to the myometrium, is commonest in association with placenta previa in women previously delivered by caesarean section (CS). It has become proportionally a greater cause of major maternal morbidity and mortality as the frequency of other serious obstetric complications has declined. The aim of this study was to examine the incidence of placenta accreta in the context of a rising caesarean delivery rate.