• 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.
    • A randomised controlled trial using the Epidrum for labour epidurals.

      Deighan, M; Briain, D O; Shakeban, H; O'Flaherty, D; Abdulla, H; Al-Jourany, A; Ash, S; Ahmed, S; McMorrow, R (Irish Medical Journal, 2015-03)
      The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.
    • Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomized trial.

      Mone, F; McAuliffe, F M (Irish Medical Journal, 2015-01)
      Obstetric practice is evolving; the future will see a shift in the focus of care to the pre-conceptual period and early trimester with a move towards interventions which optimize maternal and neonatal outcome. 1 Low dose Aspirin (LDA) is one such intervention. The safety and efficacy of this medicinal product has already been proven 2,3 and subsequently it is now used common in practice for at-risk pregnancies for prevention of pre-eclampsia, fetal growth restriction and complications of anti-phospholipid syndrome.
    • Fetal metabolic influences of neonatal anthropometry and adiposity.

      Donnelly, Jean M; Lindsay, Karen L; Walsh, Jennifer M; Horan, Mary; Molloy, Eleanor J; McAuliffe, Fionnuala M (BioMed Central, 2015)
      Large for gestational age infants have an increased risk of obesity, cardiovascular and metabolic complications during life. Knowledge of the key predictive factors of neonatal adiposity is required to devise targeted antenatal interventions. Our objective was to determine the fetal metabolic factors that influence regional neonatal adiposity in a cohort of women with previous large for gestational age offspring.
    • 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.
    • Neonatal telephone consultations in the National Maternity Hospital

      Travers, CP; Murphy, JFA (Irish Medical Journal, 2014-09)
      Details of telephone consultations concerning infants were recorded prospectively over a two month period in the National Maternity Hospital (NMH). There were one hundred and forty-six calls recorded. One hundred and sixteen (79.5%) calls were from mothers. The average age of the infants was twenty-eight days. Eighty (54.8%) calls were answered by Nursing Staff while the remainder were taken by Doctors. There were thirty-nine (26.7%) calls relating to the gastrointestinal system. There were twenty-seven (18.5%) calls regarding infants with respiratory concerns. The next most common problem was irritability followed by calls concerning jaundice, rashes and umbilical issues. Fifty-five (37.7%) callers were given home care advice or reassurance. Thirty-six (24.7%) were advised to attend a Paediatric Emergency Department (ED). GP visits and Baby Clinic appointments were advised for twenty-four (16.4%) and twenty-three (15.8%) infants respectively while six (4.1%) of the callers were directed to attend NMH immediately.
    • 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
    • Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy.

      Walsh, Jennifer M; Mahony, Rhona M; Canty, Gillian; Foley, Michael E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital,Dublin,Republic of Ireland. (2014-08-28)
      The present study is a secondary analysis of the ROLO study, a randomised control trial of a low-glycaemic index (GI) diet in pregnancy to prevent the recurrence of fetal macrosomia. The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures: birth weight; maternal glucose intolerance; gestational weight gain (GWG). In early pregnancy, 372 women had their mid-upper arm circumference recorded and BMI calculated. Concentrations of glucose, insulin and leptin were measured in early pregnancy and at 28 weeks. At delivery, infant birth weight was recorded and fetal glucose, C-peptide and leptin concentrations were measured in the cord blood. Women who benefited in terms of infant birth weight were shorter, with a lower education level. Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies, with no difference being observed in maternal height. Women who at 28 weeks of gestation developed glucose intolerance, despite the low-GI diet, had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance. They also had significantly higher-interval pregnancy weight gain. For each analysis, women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not. These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance, whereas birth weight is mediated more by genetic factors. It highlights key areas, which warrant further interrogation before future pregnancy intervention studies, in particular, maternal education level and inter-pregnancy weight gain.
    • Pregnant immigrant Nigerian women: an exploration of dietary intakes

      Lindsay, K.L; Gibney, E.R; McNulty, B.A; McAuliffe, F.M (Public Health, 2014-07)
      The aim of the study is to explore the dietary intakes of a prominent ethnic minority group of women from Sub-Saharan Africa during pregnancy, in order to identify nutritional issues of concern which may impact on pregnancy outcomes and whether different food based dietary guidelines may be required to meet their needs.
    • Pregnant immigrant Nigerian women: an exploration of dietary intakes.

      Lindsay, K L; Gibney, E R; McNulty, B A; McAuliffe, F M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Holles St., Dublin 2, Ireland. Electronic address: karenlindsay88@gmail.com. (2014-07)
      The aim of the study is to explore the dietary intakes of a prominent ethnic minority group of women from Sub-Saharan Africa during pregnancy, in order to identify nutritional issues of concern which may impact on pregnancy outcomes and whether different food based dietary guidelines may be required to meet their needs.
    • 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).
    • National Maternity Hospital annual report 2013

      National Maternity Hospital Holles St (National Maternity Hospital Holles St, 2014-07)
    • A correlation between severe haemolytic disease of the fetus and newborn and maternal ABO blood group.

      Doyle, B; Quigley, J; Lambert, M; Crumlish, J; Walsh, C; McParland, P; Culliton, M; Murphy, K; Fitzgerald, J; Red Cell Immunohaematology Laboratory, Irish Blood Transfusion Service, Dublin, Ireland. (Transfusion medicine (Oxford, England), 2014-06-28)
      To analyse anti-D quantification levels and frequency of intrauterine transfusion (IUT), per maternal ABO blood group.
    • Neurodevelopmental outcome of preterm babies of 1999-2009

      Huggard, D; Slevin, M; Vavasseur, C (Irish Medical Journal, 2014-06)
      The Bayley scale of infant development is employed as the performance indicator at 2 years corrected gestational age for high risk paediatric groups. We compare neurodevelopmental outcomes in two cohorts of VLBW infants born in 1999 to a cohort born a decade later, while also examining the challenges of direct comparison of modified scales: BSID-II (2nd edition of the scales) with Bayley III. BSID â II was used in the 1999 group and Bayley-III for the 2009 cohort. We demonstrated that over a ten year period there was an improvement in neurodevelopmental scores achieved in VLBW babies. Overall there was almost an 8 point increase in the cognitive scores from the 2009 cohort compared with the 1999 cohort in this time period. The mean motor score increased by 6 points when comparing 1999 and 2009. However we highlight the difficulties in comparing developmental scales, and consider whether Bayley-III overestimates developmental ability?
    • Does performing fetal ultrasound assessment once versus twice in the third trimester in low risk women alter the stillbirth rate?

      Mone, F; Meti, S; Ong, S (Irish Medical Journal, 2014-06)
      The aim of this retrospective observational study was to evaluate if performing fetal growth scans once or twice in the third trimester impacts on stillbirth rates in low risk pregnancies. The study was performed in a tertiary centre with 6,000 deliveries per annum. Data on all deliveries was collected via the National Maternity System Database and high risk pregnancies were excluded to calculate the stillbirth rate before and after 2011 when ultrasound assessment was performed twice and once in the third trimester. Between 2009-2012 there were 18,856 low risk-pregnancy deliveries with 45 stillbirths, (average stillbirth rate 0.26%). The stillbirth rate in 2009/2010 was 54/9423 (0.25%). The stillbirth rate in 2012 was 13/5615 (0.27%). [ p= 0.897; chi square= 0.017; df =1]. There was no statistical difference in the stillbirth rate when low risk women were scanned once or twice in the third trimester.
    • 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)
    • What we can learn from generational gaps

      Higgins, MF; O'Gorman, C (Irish Medical Journal (IMJ), 2014-02)
      No matter what stage you are in your career, we defy you to deny that you have not had at least one of these thoughts recently - Medical students these days just don't have the respect for their seniors that we had. We need to learn! But when will we get the time! Social media has no place in medical education. Why can't I use my laptop in the hospital? As we moved slowly up the medical career ladder, we have gradually noticed the differences between the generations. These personal observations have been backed by a recent explosion in opinion articles, lectures and research in this area, much of which can help explain the issues and identify the background to the differences in opinion that previously may have frustrated or challenged relationships 1-3
    • Maternal and neonatal morbidity during off peak hours in a busy obstetric unit. Are deliveries after midnight more complicated?

      Hehir, Mark P; Walsh, Jennifer M; Higgins, Shane; Mahony, Rhona; National Maternity Hospital, Dublin, Ireland. (2014-02)
      We sought to compare maternal and neonatal outcomes in deliveries occurring overnight with those in daylight hours.
    • 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.
    • 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.