Browsing National Maternity Hospital Holles St. by Subjects
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Early pregnancy ultrasound and management – effect of a multifaceted training on physician knowledgeVaginal 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.
Routine obstetric ultrasound servicesAntenatal ultrasonography is widely used in pregnancy to assess fetal growth, wellbeing and anatomy. Although ultrasound screening is now an integral part of routine antenatal care, recommendations for the delivery of obstetric ultrasound vary from country to country. A recent survey of English maternity units reported that 100% of women are offered routine mid-trimester fetal anomaly scanning, in line with expert recommendations. Currently in Ireland, no national guidance exists to inform practitioners on the minimum standards for obstetric ultrasound practice. In 2012, we conducted a structured telephone survey of all 20 maternity units in Ireland (n=74,377 births). Routine mid-trimester anomaly scanning was offered universally to all women in 7/20 (35%) units, offered selectively to some women in 9/20 (45%) units and not offered to any women in 4/20 (20%) of units. The time allotted for a complete fetal anatomical survey was 10-15 minutes in 4/16 (25%) units, 20 minutes in 7/16 (44%) units and 25-30 minutes in 5/16 (31%) units. Written guidelines on the appropriate management of â soft markersâ for fetal aneuploidy were routinely used in 11/16 (69%) of units. In no Irish unit currently, are images from fetal anomaly scanning routinely reviewed by an Obstetrician with an interest in fetal medicine. 19/20 (95%) of respondents believed that a minimum of 2 scans should be offered in routine uncomplicated pregnancies. Improvements in the availability of obstetric ultrasound to pregnant women in Ireland will require increased staffing numbers at both the ultrasonographer and fetal specialist levels. There is a clear need for national guidelines on the provision of routine obstetric ultrasound in Ireland.