• Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

      Griffin, K M; Pickering, M; O'Herlihy, C; O'Connell, P R; Jones, J F X; Health Sciences Centre, School of Medicine and Medical Sciences, University College Dublin, Ireland. (The British journal of surgery, 2011-08)
      Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.
    • Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.

      Cantwell, Roch; Clutton-Brock, Thomas; Cooper, Griselda; Dawson, Andrew; Drife, James; Garrod, Debbie; Harper, Ann; Hulbert, Diana; Lucas, Sebastian; McClure, John; et al. (BJOG : an international journal of obstetrics and gynaecology, 2011-03)
      In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.
    • Secondary postpartum haemorrhage - a underappreciated danger. A retrospective review of the incidence of hysterectomy for the 37 years at Holles St Hospital

      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 2010
    • Seen but not heard: congenital cytomegalovirus.

      Harrison, G; Waters, A; De Gascun, C F; Boyle, M; Knowles, S; Molloy, E J (Archives of disease in childhood. Fetal and neonatal edition, 2012-09)
    • Serum magnesium in the first week of life in extremely low birth weight infants.

      Noone, D; Kieran, E; Molloy, E J; Department of Paediatrics, National Maternity Hospital, Dublin, Ireland. dgnoone@gmail.com (2012)
      Evidence that antenatal administration of magnesium sulfate (MgSO(4)) to women in preterm labor may confer fetal neuroprotection is growing. MgSO(4) crosses the placenta and can affect the neonate. Magnesium homeostasis in extremely low birth weight (ELBW) infants remains to be clarified.
    • Shoulder dystocia: risk factors and outcomes in 453 consecutive cases

      Heir, M; Walsh, J; Robson, M (American Journal of Obstetrics and Gynaecology, 2012-01)
    • Significantly elevated systemic neutrophil reactive oxygen intermediates are associated with severe neonatal encephalopathy

      O'Hare, F; Watson, R; O'Neill, A; Donoghue, V; O'Donnell, C; Murphy, J; Twomey, A; Molloy, E (Pediatric Research, 2011-11)
      52nd Annual Meeting of the European Society for Paediatric Research UK Oct 2011
    • Simba study: Undergraduate module in simulation training and basic life support

      McElligott, F; Bruell, H; Vaish, S; Nicholson, A; Molloy, E (Archives of Disease in Childhood, 2012-10)
    • Simba Study: Undergraduate module in simulation training and basic life support to improve undergraduate confidence in paediatrics

      Bruell, H; McElligott, F; Vaish, S; Savage, A; Nicholson, A; Molloy, E (Archive of Disease in Childhood, 2013-08-20)
      There are significant differences in resuscitation algorithms for children versus adults. We aimed to enhance confidence of our students in the assessment and management of sick children by developing a simple program with emphasis on Basic Airway management, CPR, and clinical assessment and treatment of children using the A/B/C/D/E system. The course consisted of three parts in small group sessions (10–15 students): BLS, basic Airway and Cardiac arrest management, lasting (1.5 h); DVD and serious illness scenarios on traditional mannequins (2h); Serious illness scenarios in the Simulation baby laboratory (0.5 h). All participants were given a pre course hand out. The course was led by qualified APLS instructors and student confidence was evaluated by a pre and post course questionnaire. Pre course 18.8% of the students would not feel confident to approach a situation with a sick child outside the hospital versus 3.2 % after the course. Three times more Students felt confident manageing a child outside the hospital. Confidence in assessing and managing common paediatric problems in hospital, increased by 22 %, with the greatest increase regarding children with respiratory and cardiac problems. 75% liked the mixture of lectures and practical sessions. Overall more than 80% felt they benefitted from all different parts of the course. Confidence to approach, assess and manage a sick child increased by an average of 18.5%. Medical students found the interactive resuscitation training useful. Formalized simulation and resuscitation training improved medical student confidence and equipped them for in and out-of -hospital paediatric management.
    • The singleton, cephalic, nulliparous woman after 36 weeks of gestation: contribution to overall cesarean delivery rates.

      Brennan, Donal J; Murphy, Martina; Robson, Michael S; O'Herlihy, Colm; National Maternity Hospital, Dublin, Ireland. (Obstetrics and gynecology, 2011-02)
      To examine the contribution of singleton, cephalic, term (37 weeks or later) nulliparous cesarean rates to overall cesarean incidence in a single institution during a 35-year period.
    • Soluble triggering receptor expressed on myeloid cells-1 (strem-1) in neonatal sepsis

      O'Currain, E; Doughty, C; Smith, S; Grant, T; O'Hare, F; Culliton, M; Watson, R; O'Neill, A; Molloy, EJ (Pediatric Research, 2011-11)
    • Spindle assembly checkpoint protein expression correlates with cellular proliferation and shorter time to recurrence in ovarian cancer.

      McGrogan, Barbara; Phelan, Sine; Fitzpatrick, Patricia; Maguire, Aoife; Prencipe, Maria; Brennan, Donal; Doyle, Emma; O'Grady, Anthony; Kay, Elaine; Furlong, Fiona; et al. (2014-07)
      Ovarian carcinoma (OC) is the most lethal of the gynecological malignancies, often presenting at an advanced stage. Treatment is hampered by high levels of drug resistance. The taxanes are microtubule stabilizing agents, used as first-line agents in the treatment of OC that exert their apoptotic effects through the spindle assembly checkpoint. BUB1-related protein kinase (BUBR1) and mitotic arrest deficient 2 (MAD2), essential spindle assembly checkpoint components, play a key role in response to taxanes. BUBR1, MAD2, and Ki-67 were assessed on an OC tissue microarray platform representing 72 OC tumors of varying histologic subtypes. Sixty-one of these patients received paclitaxel and platinum agents combined; 11 received platinum alone. Overall survival was available for all 72 patients, whereas recurrence-free survival (RFS) was available for 66 patients. Increased BUBR1 expression was seen in serous carcinomas, compared with other histologies (P = .03). Increased BUBR1 was significantly associated with tumors of advanced stage (P = .05). Increased MAD2 and BUBR1 expression also correlated with increased cellular proliferation (P < .0002 and P = .02, respectively). Reduced MAD2 nuclear intensity was associated with a shorter RFS (P = .03), in ovarian tumors of differing histologic subtype (n = 66). In this subgroup, for those women who received paclitaxel and platinum agents combined (n = 57), reduced MAD2 intensity also identified women with a shorter RFS (P < .007). For the entire cohort of patients, irrespective of histologic subtype or treatment, MAD2 nuclear intensity retained independent significance in a multivariate model, with tumors showing reduced nuclear MAD2 intensity identifying patients with a poorer RFS (P = .05).
    • Standardised versus Individualised Parenteral Nutrition. Further Food for Thought

      McCarthy, R; Segurado, R; Crealey, M; Twomey, A (Irish Medical Journal, 2016-04)
      Parenteral Nutrition may be prescribed as a standard PN (SPN) formulation or as an individualised PN (IPN) formulation. SPN may have advantages in terms of rapid availability, less prescription errors, decreased risk of infection and cost savings but IPN, specifically tailored to an infant’s needs, may achieve better outcomes in terms of nutrient intake and weight gain. The aim of our study was to determine if VLBW infants in our NICU benefited from receiving IPN over currently available SPN solutions. Our findings were that VLBW infants prescribed IPN received significantly more amino acid (28%), glucose (6%), energy (11%) and calcium (8%) from the aqueous phase of PN than had they received a similar volume of SPN. The benefits were seen over all the days for which PN was administered. In conclusion, IPN was found to offer significant benefits to our VLBW infants. Modifications to currently available SPN would result in better SPN formulations. Our study also supported the recent recommendation to reduce the calcium:phosphate ratio in PN solutions to avoid early hypophosphataemia
    • Stereology of the placenta in type 1 and type 2 diabetes.

      Higgins, M; Felle, P; Mooney, E E; Bannigan, J; McAuliffe, F M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2011-08)
      To assess by stereology the placental structure in type 1 (T1DM) and type 2 (T2DM) diabetic pregnancies compared to normal non-diabetic (ND) controls.
    • Stillbirth: The other half of perinatal mortality

      Murphy, JFA (Irish Medical Journal, 2012-01)
      Stillbirth is fetal death after 20 weeks gestation1. There are a number of definitions and classifications. WHO defines a stillbirth as a baby BW ≥500g, ≥22 weeks gestation who died before or during birth. However for international comparisons it recommends that reporting be restricted to those with BW>1000g and gestation ≥28 weeks. In Ireland stillbirths must be registered, the definition being BW≥500g or having reached a gestational age ≥ 24 weeks. Stillbirth affects 1 in 160 pregnancies2 and numerically it equals the number of infant deaths in the first year of life. At the beginning of the third trimester of pregnancy the baby weighs 1 Kg and the risk of stillbirth is 1- 2%. The possibility of a stillbirth increases with maturity throughout the third trimester and is 3 times greater at 40 weeks than at earlier gestational ages3. This is relevant for the 5-10% of pregnancies that continue ≥42 weeks. If managed expectantly one in 400 post-term pregnancies will end in a stillbirth. Since 2003 the stillbirth rate has remained static in the US at 3.0 stillbirths per 1000 births. Prior to 2003 the stillbirth rate had declined 1.4% annually while the infant mortality rate fell twice as fast at 2.8%. Globally there are 2.6 million stillbirths annually. In Ireland the stillbirth rate is 3.3 per 1000 births which equates to 230 deaths per year. Despite its frequent occurrence stillbirth has been a relatively neglected component of perinatal medicine. Because a definitive cause cannot be identified in many cases, counselling is very difficult. This lack of scientific causation data has resulted in professional fatalism towards the stillbirth problem.
    • Successful fetoscopic laser coagulation for twin-to-twin transfusion syndrome under local anaesthesia.

      Cooley, S; Walsh, J; Mahony, R; Carroll, S; Higgins, S; McParland, P; McAuliffe, F; National Maternity Hospital, Holles St, Dublin 2. smcooley@hotmail.com (2011-06)
      A review of the efficacy and outcome of fifteen fetoscopic laser ablations under local anaesthesia for twin to twin transfusion syndrome (TTTS) in the National Maternity Hospital Dublin was undertaken. The mean gestation at laser was 19.7 weeks (range 16-25 weeks) with a mean gestation at delivery of 29.1 weeks (range 20-35 weeks). The overall liveborn birth rate was 79% (22 infants) and one pregnancy was still ongoing. There were four neonatal deaths secondary to complications of prematurity. The surviving eighteen infants (64%) undergo regular paediatric review. The procedure was performed successfully in all cases with local anaesthesia. In no case was there maternal discomfort that warranted the procedure to be abandoned and good visual access of the vascular anastamoses was obtained in all cases. Local anaesthesia therefore offers a safe effective anaesthetic option for fetoscopic laser coagulation in monochorionic pregnancies complicated by TTTS.
    • Suprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis.

      Healy, Eibhlín F; Walsh, Colin A; Cotter, Amanda M; Walsh, Stewart R; Graduate Entry Medical School, University of Limerick, and National Maternity Hospital, Dublin, Ireland. (2012-09)
      Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations.
    • Survey of nasal continuous positive airways pressure (NCPAP) and nasal intermittent positive pressure ventilation (NIPPV) use in Irish newborn nurseries.

      Kieran, Emily A; Walsh, Helen; O'Donnell, Colm P F (Archives of disease in childhood. Fetal and neonatal edition, 2011-03)
    • A survey of obstetricians' views on placental pathology reporting.

      Walsh, Colin A; McAuliffe, Fionnuala M; Turowski, Gitta; Roald, Borghild; Mooney, Eoghan E (2013-06)
      To determine the opinion of clinical obstetricians regarding interpretation of placental reports, including a recently proposed Norwegian classification system.
    • Survival in women with ovarian cancer before and after the introduction of adjuvant paclitaxel; a 25-year, single institution review.

      Shireen, R; Brennan, D; Flannelly, G; Fennelly, D; Lenehan, P; Foley, M; Department of Obstetrics, National Maternity Hospital, Holles St., Dublin 2. (2012-02)
      Adjuvant chemotherapy regime for ovarian cancer patients remains to be a contentious issue. The aim of this study was to compare the overall and progression-free survival of women with ovarian cancer before and after introduction of paclitaxel in our unit in 1992. A sample of 112 women who received adjuvant therapy following surgery for ovarian cancer was collected, 68 (61%) received platinum+alkylating agent before 1992 and later 44 (39%) received platinum+paclitaxel. Five-year survival was same in both treatment groups when there was no macroscopic disease after surgery (78% versus 70%) and when residual disease was <2 cm (50% versus 40%). Survival was greater in women with residual disease >2 cm in the platinum+paclitaxel group (50% versus 24%), (p = 0.04). However, progression-free survival was similar in both groups irrespective of stage or residual volume of disease. Therefore consideration to selective use of paclitaxel could reduce patient morbidity and costs significantly.