• Obstetric outcome with low molecular weight heparin therapy during pregnancy.

      Donnelly, J; Byrne, J; Murphy, K; McAuliffe, F; Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles St, Dublin 2. jenniferdonnelly@mac.com (Irish Medical Journal (IMJ), 2012-01)
      This was a prospective study of women attending a combined haematology/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.
    • Old primips and big babies; Changing the art of obstetrics

      Flood, K; Murray, A; Unterscheider, J; Breathnach, F; Robson, M; Fitzpatrick, C; Coulter-Smith, S; Malone, F (Irish Journal of Medical Science, 2011-02)
      Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting Junior Obstetrics & Gynecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Matenity Hospitals Report Meeting Friday 26th Nov 2010
    • Optimum timing of delivery for monochorionic twins: Evidence from the prospective multicenter ESPRiT study

      Daly, S; Higgins, J; Burke, G; Carroll, S; Higgins, S; Geary, M; Breathnach, F; Dicker, P; Manning, F; Malone, F; et al. (Am J Obstet Gynecol, 2011-01)
      Society for Maternal-Fetal Medicine. The Pregnancy Meeting Feb 2011
    • Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial.

      Dawson, Jennifer A; Schmölzer, Georg M; Kamlin, C Omar F; Te Pas, Arjan B; O'Donnell, Colm P F; Donath, Susan M; Davis, Peter G; Morley, Colin J; Newborn Services, The Royal Women's Hospital, Melbourne, Australia. jennifer.dawson@thewomens.org.au (The Journal of pediatrics, 2011-06)
      To investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV) immediately after birth with a T-piece have higher oxygen saturation (SpO₂) measurements at 5 minutes than infants ventilated with a self inflating bag (SIB).
    • Oxytocin is unequally distributed in a bag of normal saline - true or false?

      Chummun, K; O’Hora, H; Gaudel, C; Webster, P; Ogunlewe, O; Boylan, P (Irish Medical Journal, 2015-05)
      Oxytocin infusion used in labour can sometimes be left hung on the stand for many hours. There has been no study to determine if oxytocin is equally distributed throughout the infusion bag and if the distribution stays the same with time. We postulated that there may be settling of the molecules such that oxytocin concentrates at the bottom of the infusion bag. Eight infusion bags were prepared by mixing 10 IU of oxytocin in 1 litre of normal saline. The infusion bags were hung on infusion stands for 8 hours after which 10 samples of 100 mls of the solution from each bag were taken in different containers and the concentration of oxytocin calculated using oxytocin specific Enzyme Immunoassay (EIA) in the different samples. No statistically significant correlation between the oxytocin concentration and the sample number was observed (p-value = 0.738). There was no obvious relationship between oxytocin concentration and the sample number in each bag. There was no evidence to suggest that a linear oxytocin concentration gradient develops in a bag of normal saline over an 8-hour period. In fact the distribution appears to be random and unequal.
    • Parental perception of the quality of primary care paediatric services

      Chukwu, JM; Molloy, EJ; Morgan, J (Pediatric Research, 2011-11)
    • Parents' attitudes towards infant safety during air travel.

      Bahari, M; Prunty, N; Molloy, E J (2011-07)
    • The perception and impact of a "Breaking Bad News" module on paediatric medical students

      McElligott, F; Nicholson, A; Molloy, EJ (Archives of Disease in Childhood, 2012-10)
    • Performance improvement and health cost reduction

      Murphy, JFA (Irish Medical Journal, 2012-06)
      Health care expenditure in Ireland has reached 9.5% of GDP (2009 data). This figure is similar to the UK and is in line with most other European countries apart from France and the Netherlands which are higher at over 11%. In most western societies health spending is rising faster than economic growth, a trend that was first observed in the 1970s and has continued unchecked. The spending on health in the US at 18% is almost twice as high as Europe and has now reached crisis point. This represents $7960 per capita compared with the OECD average $3223. Yet despite this massive investment the US cannot guarantee access to healthcare for all its population. With the global down turn there is an increasing impetus for all countries to contain their health spend. Healthcare is barely covering its costs. Resources are finite and without properly planned containment, rationing may become necessary. It is imperative that the health professions set down the priorities for medical care rather than having a solution imposed on them and their patients.
    • Perinatal treponema pallidum: Evidence based guidelines to reduce mother to child transmission

      Freyne, B; Stafford, A; Knowles, S; O’ Hora, A; Molloy, E (Irish Medical Journal (IMJ), 2014-01)
      Universal antenatal screening for T. pallidum is standard in Irish maternity units. The prevalence of adult syphilis has increased in Ireland. We audited the neonatal management of infants exposed to T. pallidum in utero. A cross sectional retrospective analysis of all pregnancies with confirmed positive serology for T. pallidum from January 2005 to December 2010 was conducted at the National Maternity Hospital, Holles St. Data were analysed using SPSS 14.0. Ethical approval was obtained. There were 55,058 live births during the study period. Fifty-eight women had positive serology and 41 met inclusion criteria. Infant evaluation and follow up was decided by allocation to an evidence based algorithm. Twenty-one infants (51%) were accurately allocated and assessed, 5 (12%) had a partial assessment and the algorithm was incorrectly applied in 15 (36%) of cases. Failure to adhere to evidence based neonatal guidelines is common and undermines efficacy of the screening program.
    • Petussis has re-emerged

      Murphy, JFA (Irish Medical Journal, 2012-07)
      The Confidential Enquiries into Maternal Deaths (CEMD) is being disbanded and will be incorporated into a new structure called MBRRACE-UK, throughout the UK1. The CEMD, which has been in existence since 1952, was highly valued by clinicians. It had an unbroken 60 year history in existence. It set the bar for higher obstetric standards. It monitored the causes of maternal death and improved safety. It operated through a system of anonymised case records of obstetric deaths. A group of regional and national assessors examined the circumstances around each case. The assessors then made recommendations on the lessons to be learned. The Enquiry had widespread support among obstetricians and was an important voice in advocating better maternal care. It constantly stressed the important of clinical vigilance. It emphasised that old messages need to be frequently repeated and that there is no room for inertia. Its strength was its ability to identify avoidable causes of maternal death in a no-blame culture. This resulted in an almost total buy-in. After preparation of the Report and before its publication all maternal death forms, relevant documents and files related to the period of the report are destroyed and all electronic data is irreversibly destroyed.
    • Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers.

      Bartels, Helena C; Postle, James D; Downey, Paul; Brennan, Donal J; 1 National Maternity Hospital, Holles Street, Dublin 2, Ireland. 2 UCD School of Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland (Hindawi, 2018-01-01)
      Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. The diagnosis of a PAS is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial fibres. The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. A number of diagnostic serum biomarkers have been investigated in PAS, including human chorionic gonadotropin (HCG), pregnancy-associated plasma protein-A (PAPP-A), and alpha-fetoprotein (AFP). They have shown variable reliability and variability of measurement depending on gestational age at sampling. At present, a sensitive serum biomarker for invasive placentation remains elusive. In summary, there are a limited number of studies that have contributed to our understanding of the molecular biology of PAS, and additional biomarkers are needed to aid diagnosis and disease stratification.
    • The placenta as a compensatory iodine storage organ.

      Burns, Robert; O'Herlihy, Colm; Smyth, Peter P A; UCD Health Sciences Centre, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. (Thyroid : official journal of the American Thyroid Association, 2011-05)
      The production of iodine-containing thyroid hormones necessary for brain development in the fetus depends not only on maternal dietary intake but also on placental iodine transport. The optimum level of iodine nutrition during pregnancy and the proportion of the pregnant population reaching this level have previously been evaluated. Little information exists on the ability of the placenta to either accumulate or store iodine. This study aims to investigate iodine uptake and tissue iodine content within placental tissue obtained from women delivering at term.
    • Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective ESPRiT Study.

      Kent, Etaoin M; Breathnach, Fionnuala M; Gillan, John E; McAuliffe, Fionnuala M; Geary, Michael P; Daly, Sean; Higgins, John R; Dornan, James; Morrison, John J; Burke, Gerard; et al. (American journal of obstetrics and gynecology, 2011-10)
      The purpose of this study was to evaluate the impact of noncentral placental cord insertion on birthweight discordance in twins.
    • Placental pathology in small for gestational age infants

      Thorne, J; Downey, P; Mooney, EE (Irish Medical Journal, 2014-09)
      Infants with intrauterine growth restriction (IUGR) are at an increased risk of perinatal disease, including death. Many, but not all small for gestational age infants (SGA) have IUGR. Placental disease is an important cause of IUGR, and gross and microscopic examination is critical in explaining such cases. Reports of placentas from infants with a birth weight <2SD from the mean (approx 3rd centile) born between Jan 2004-Dec 2011 were evaluated. The principal pathology was determined in each case. Where two or more pathologic findings were present, they were ranked as principal and co-existing in terms of severity. There were 69,493 deliveries over the study period. 461 SGA cases were identified. No placenta was available in 44 cases, and 21 cases of known anomalies were excluded, leaving a study group of 396 cases. Pathology potentially causing or contributing to SGA and/or IUGR was identified in 84.1% of cases. Significant co-existing pathology was seen in 88 cases (22%). Placental examination provides key information in understanding abnormal fetal growth
    • Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT Study.

      Kent, Etaoin M; Breathnach, Fionnuala M; Gillan, John E; McAuliffe, Fionnuala M; Geary, Michael P; Daly, Sean; Higgins, John R; Hunter, Alyson; Morrison, John J; Burke, Gerard; et al. (American journal of obstetrics and gynecology, 2012-09)
      We sought to evaluate the association between placental histological abnormalities and birthweight discordance and growth restriction in twin pregnancies.
    • Placental stereology in diabetic pregnancy

      Higgins, M; Felle, P; Mooney, EE; Bannigan, J; McAuliffe, F (Irish Journal of Medical Science, 2011-02)
      Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2011
    • Planned hospital discharge: A strategy for reducing lenght of stay of low birth weight (VLBW<1500g) infants in NICU

      Neary, E; Al-Assaf, N; MCDermott, C; Sheehan, K; Kirkham, C; Corcoran, D; Molloy, E; McCallion, N; Clarke, T (Pediatric Research, 2011-11)
      52nd Annual Meeting of the European Society for Paediatric Research Newcastle UK October 2011
    • Planning for the delivery of the future – a midwifery workforce planning project

      Carolan, S; National Maternity Hospital, Holles St. (The International Society for Quality in Health Care, 2009)
      The primary objective of this project was to undertake a midwifery workforce planning project in an effort to ascertain the current and projected skill-mix requirements for the postnatal midwifery service of the National Maternity Hospital, Ireland. A further and equally important objective was the accurate identification of midwifery and non-midwifery activity, thus facilitating the implementation of multiple process improvements in the delivery of postnatal care to mothers and infants. The Midwifery service of the National Maternity Hospital embarked on a land-mark project incorporating two approaches for the very first time not only here in Ireland but across the British Isles.
    • Plastics bags reduce hypothermia in newly born infants in the developing world.

      O'Donnell, Colm P F; Department of Neonatology, The National Maternity Hospital, , Dublin, Ireland. (2014-04)