• 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.
    • A case of recurrent familial male miscarriages with hypercoiled umbilical cord: a possible X-linked association?

      Beggan, Caitlin; Mooney, Eoghan E; Downey, Paul; Carroll, Stephen; Reardon, Willie; Department of Histopathology, National Maternity Hospital, Dublin, Ireland. (2014-01)
    • An exploration of the experiences of mothers as they suppress lactation following late miscarriage, stillbirth or neonatal death

      McGuinness, D; Coghlan, B; Butler, Michelle; National Maternity Hospital, Holles St. UCD School of Nursing Midwifery and Health Systems,The University of British Columbia. (Royal College of Midwives, 2014)
      Objective. To explore the experiences of bereaved mothers as they suppress lactation following late miscarriage (>20 weeks), stillbirth or neonatal death. Method. A qualitative, focused ethnographic approach was used involving in-depth interviews with 15 bereaved mothers, who attended a maternity hospital in Dublin. Data were collected from January to August 2012. Findings. Three key themes were identified: (1) suppression of lactation following the loss of a baby: silent tears; (2) mothering; (3) supportive care needs and the bereaved mother’s experience. This paper focuses on the first global theme. The majority of bereaved mothers found engorgement and leaking milk particularly challenging both physically and emotionally following the loss of their baby; especially as their baby’s funeral or wake took place during this period. The study highlights a number of areas where women could be better prepared for this experience. Conclusion. The findings highlight that the majority of bereaved mothers will require improved guidance and support with their breast care needs following the loss of their baby with awareness and sensitivity to their shortened motherhood.
    • Timing of interventions in the delivery room: does reality compare with neonatal resuscitation guidelines?

      McCarthy, Lisa K; Morley, Colin J; Davis, Peter G; Kamlin, C Omar F; O'Donnell, Colm P F (2013-12)
      To determine the proportion of infants who had the tasks recommended in the neonatal resuscitation guidelines performed within 30 and 60 seconds of birth, and the time taken to perform each task.
    • Routine obstetric ultrasound services

      Walsh, CA; McAuliffe, F; Kinsella, V; McParland, P (Irish Medical Journal (IMJ), 2013-12)
      Antenatal 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.
    • 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.
    • 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.
    • The association between TNF-α and insulin resistance in euglycemic women.

      Walsh, Jennifer M; McGowan, Ciara A; Byrne, Jacinta A; Rath, Ann; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, Ireland; National Maternity Hospital, Dublin, Ireland. Electronic address: msjenniferwalsh@gmail.com. (2013-10)
      Chronic low levels of inflammation have links to obesity, diabetes and insulin resistance. We sought to assess the relationship between cytokine tumor necrosis factor (TNF-α) and insulin resistance in a healthy, euglycemic population. This is a prospective study of 574 non-diabetic mother and infant pairs. Maternal body mass index (BMI), TNF-α, glucose and insulin were measured in early pregnancy and at 28 weeks. Insulin resistance was calculated by HOMA index. At delivery birthweight was recorded and cord blood analysed for fetal C-peptide and TNF-α. In a multivariate model, maternal TNF-α in early pregnancy was predicted by maternal insulin resistance at the same time-point, (β=0.54, p<0.01), and maternal TNF-α at 28 weeks was predicted by maternal insulin resistance in early pregnancy (β=0.24, p<0.01) and at 28 weeks (β=0.39, p<0.01). These results, in a large cohort of healthy, non-diabetic women have shown that insulin resistance, even at levels below those diagnostic of gestational diabetes, is associated with maternal and fetal inflammatory response. These findings have important implications for defining the pathways of fetal programming of later metabolic syndrome and childhood obesity.
    • Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial).

      Peirce, C; Murphy, C; Fitzpatrick, M; Cassidy, M; Daly, L; O'Connell, P R; O'Herlihy, C (2013-09)
      To compare early home biofeedback physiotherapy with pelvic floor exercises (PFEs) for the initial management of women sustaining a primary third-degree tear.
    • A randomised crossover study of low-flow air or oxygen via nasal cannulae to prevent desaturation in preterm infants.

      Hensey, Conor C; Hayden, Eoghan; O'Donnell, Colm Patrick Finbarr; Department of Neonatology, The National Maternity Hospital, Dublin, Ireland. (2013-09)
      To compare the efficacy of low-flow oxygen, low-flow air and sham treatment given via nasal cannulae in preventing desaturation (falls in oxygen saturation (SpO2)) in preterm infants.
    • What is the role and value of extra-mural medical activity

      Murphy, JFA (Irish Medical Journal, 2013-08-20)
      Presently all Irish doctors, apart from trainees, are in the process of getting their educational activities for the past year in order for enrolment in the new medical competence scheme. The intra-mural component is understandable and makes common sense. It gives an existence to oneâ s daily professional life. It is about meeting with oneâ s colleagues at least once a week to discuss aspects of patient care, review of radiological findings and the presentation of data from recent medical papers. The process is cost neutral, time efficient and beneficial for both patients and doctors. It is an important driver for the audit programme. In addition to its educational value it is good for team building and personal professional development. It may not sound very glamorous but its potential is considerable
    • Vitamin D Levels and myocardial function in preterm infants

      Armstrong, K; Onwunmeme, C; Franklin, O; Molloy, E (Archives of Disease in Childhood, 2013-08-20)
      Bakground Low Vitamin D levels have been linked to cardiac failure in the adults and children. Tissue Doppler Imaging (TDI) is evolving as a superior measure of subtle changes in myocardial contractility in preterm infants. We aimed to correlate Vitamin D levels at birth with TDI measures of systolic and diastolic function. Methods Preterm infants < 32 weeks gestation were recruited. Vitamin D levels were measured at birth and echocardiography was carried out on Day 1. TDI myocardial velocities were recorded using a pulsed wave doppler sample from the lateral left/right ventricular wall & intraventricular septum. Peak systolic (S’), early diastolic (E’) and late diastolic (A’) velocities were recorded. Results Ten preterm infants with structurally normal hearts were recruited. Mean (SD) gestational age was 28 (1.7) weeks and birthweight 1.29 (0.3)kg. There was no significant increase in Right ventricular systolic (5.1cm/sec vs 4.8cm/sec)or diastolic myocardial velocity measures (5.2cm/sec vs 5.1cm/sec) or left myocardial velocity systolic (3.7cm/sec vs 3.9cm/sec) or diastolic (4.1cm/sec vs 4.0cm/sec) measures between those with severe Vitamin D deficiency (<30 nmol/L) and those with low normal levels of Vitamin D. Conclusion Neonates with severe Vitamin D deficiency have similar TDI measures of systolic and diastolic velocity to those with near normal levels. In our small cohort severe Vitamin D deficiency appears to cause no impairment in myocardial contractility.
    • 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.
    • Vitamin D nutritional status in preterm infants and response to supplementation.

      McCarthy, Roberta A; McKenna, Malachi J; Oyefeso, Oyinkansola; Uduma, Ogenna; Murray, Barbara F; Brady, Jennifer J; Kilbane, Mark T; Murphy, John F; Twomey, Anne; O' Donnell, Colm P; et al. (2013-07-14)
      Little is known about vitamin D status in preterm infants and their response to supplementation. To investigate this, we assessed serum 25-hydroxyvitamin D (25OHD) levels using RIA in a consecutive sample of stable preterm very low birth weight (VLBW) infants (born ≤ 32 weeks gestation or birth weight ≤ 1·5 kg), and we explored associated factors. Serum 25OHD level was first assessed once infants were tolerating feeds (n 274). If this first 25OHD level was below 50 nmol/l (20 ng/ml), which is the level associated with covering requirements in terms of skeletal health in the majority, then we recommended prolonged augmented vitamin D intake ( ≥ 10 μg (400 IU) daily) from a combination of fortified feeds and vitamin supplements and follow-up re-assessment at approximately 6 weeks corrected age (n 148). The first assessment, conducted at a median for chronological age of 18 (interquartile range (IQR) 11-28) d, found that 78 % had serum 25OHD levels below 50 nmol/l. Multivariable analysis demonstrated that the determinants of serum 25OHD levels were duration of vitamin D supplementation and gestational age at birth (r 2 0·215; P< 0·001). At follow-up, after a median of 104 (IQR 78-127) d, 87 % achieved levels ≥ 50 nmol/l and 8 % had levels >125 nmol/l, a level associated with potential risk of harm. We conclude that low 25OHD levels are an issue for preterm VLBW infants, warranting early nutritional intervention. In infants with serum 25OHD levels < 50 nmol/l, a vitamin D intake of ≥ 10 μg (400 IU) daily achieves target levels in the majority; however, further work is needed to determine the exact dose to safely meet target levels without overcorrection.
    • A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags.

      McCarthy, Lisa K; Molloy, Eleanor J; Twomey, Anne R; Murphy, John F A; O'Donnell, Colm P F; The National Maternity Hospital, Holles Street, Dublin, Ireland. (2013-07)
      Hypothermia on admission to the NICU is associated with increased mortality in preterm infants. Many newborns are hypothermic on admission despite using polyethylene bags (PBs). Using exothermic mattresses (EMs) in addition to PBs may reduce hypothermia but increase hyperthermia. We wished to determine whether placing preterm newborns in PBs on EMs in the DR results in more infants with rectal temperature outside the range 36.5 to 37.5°C on NICU admission.
    • Medical Litigation Across Specialties

      Murphy, JFA (Irish Medical Journal, 2013-07)
      Medical negligence is a major cause of fear and anxiety for doctors. The threat of malpractice consists of 3 factors, the risk of a claim, the probability of a claim leading to a payment, and the size of the payment. The Clinical Indemnity Scheme (CIS) insures against indemnity payments but it cannot protect the doctor against the indirect consequences of litigation including stress, the long hours mounting a defence against the allegation, and the damage to one’s reputation. The adversarial tort system focuses on punishment, blame and compensation. The emotional anguish and potential damage to the doctor’s reputation can be considerable. Doctors subjected to malpractice suits regardless of the outcome may experience depression, anger, frustration and excessive use of alcohol
    • Toll-like receptors in neonatal sepsis.

      O'Hare, Fiona M; William Watson, R; Molloy, Eleanor J (2013-06)
      Toll-like receptors are vital transmembrane receptors that initiate the innate immune response to many micro-organisms. The discovery of these receptors has improved our understanding of host-pathogen interactions, and these receptors play an important role in the pathogenesis of multiple neonatal conditions such as sepsis and brain injury. Toll-like receptors, especially TLRs 2 and 4, are associated with necrotizing enterocolitis, periventricular leukomalacia and sepsis.
    • 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.
    • Pre-operative testing for pregnancy in Dublin day surgery units.

      Wong, L F A; Wingfield, M; Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland. wlfaud@yahoo.co.uk (Springer, 2013-06)
      The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients' pregnancy status prior to elective surgery.