• Quality of care in the management of major obstetric haemorrhage.

      Johnson, S N; Khalid, S; Varadkar, S; Fleming, J; Fanning, R; Flynn, C M; Byrne, B; Coombe Women and Infant's University Hospital, Dolphin's Barn, Dublin 8. (2012-02-01)
      Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM). 31 cases were identified yielding an incidence of 3.5/1000 deliveries. The predominant causes were uterine atony 11 (35.4%), retained products of conception 6 (19.3%) and placenta praevia/accreta 6 (19.3%). Excellent initial resuscitation and monitoring was noted with a high level of senior staff input. Indicators of QOC compared favourably with the SAMM. Areas for improvement were identified. This pilot study demonstrates the feasibility of detailed prospective data collection in MOH in a busy Dublin obstetric unit with a view to developing a national audit. Standardization of definitions allows for international comparisons.
    • To screen or not to screen for subclinical hypothyroidism in pregnancy?

      Freyne, A; Byrne, B (Irish Medical Journal, 2013-06)
      Not unlike screening for gestational diabetes, controversy prevails over the value of screening for thyroid disease in pregnancy. Fortunately, overt hypothyroidism is rare in pregnancy (0.3-0.5%) because it is associated with infertility and increased rates of first trimester miscarriage. Studies suggest that obstetric complications such as hypertension, placental abruption, preterm delivery, perinatal morbidity and mortality are increased in women with hypothyroidism in pregnancy1 and there is evidence that the offspring of untreated mothers have neuropsychological and cognitive impairment. Subclinical hypothyroidism (Elevated TSH and normal Free T4) is estimated to be present in 2 â 2.5% of pregnant women. It is not as clearly associated with adverse obstetric and neonatal outcome but there is some evidence that maternal subclinical hypothyroidism is associated with impaired psychomotor development in the offspring 2.
    • An unusual reproductive consequence of needle excision of the transformation zone.

      Ramphul, M; Dimitriou, E; Byrne, B; Coombe Women and Infants University Hospital, Dublin, Ireland. ramphulm@tcd.ie (2012-02-01)