• The Irish Maternity Early Warning System (IMEWS).

      Maguire, P J; O'Higgins, A; Power, K; Turner, M J (Irish Medical Journal, 2014-11)
      In the acute hospital setting, the use of early warning scores (EWS) to monitor vital signs (including heart rate, respiratory rate [RR], blood pressure and temperature) has been shown to be beneficial in the early diagnosis and prompt initiation of treatment in adults with a critical illness 1 . This led to the development of the National Early Warning Score (NEWS) in Ireland by the Health Services Executiveâ s (HSE) Acute Medicine Clinical Care Programme. The NEWS was the first guideline endorsed by the National Clinical Effectiveness Committee (NCEC) and was launched by the Minister of Health Dr James Reilly in 2013. The implementation of NEWS is now mandatory in all acute hospitals. However, NEWS is not suitable for use in pregnancy because a womanâ s vital signs change physiologically from early in pregnancy. National reports in Ireland and the United Kingdom (UK) on maternal mortality have led to recommendations that a modified obstetric EWS be introduced 2,3 . In Ireland, these recommendations have been further supported by separate investigations in 2008 and 2013 on two maternal deaths from sepsis 4,5 .
    • Vaginal breech delivery at term: the doctors' dilemma.

      Turner, M J; Maguire, P J (Irish Medical Journal, 2015-03)
      "When an operation is once performed, nobody can ever prove that it was unnecessary". The Craze for Operations from The Doctorâ s Dilemma: Preface on Doctors by George Bernard Shaw, 1909*. Breech presentation complicates 3-4% of deliveries at term and it is associated with an increased risk of perinatal mortality and morbidity 1,2 . The increased fetal risks may be due to the hypoxia or trauma associated with a vaginal delivery, but this can be minimised if cases suitable for vaginal delivery are carefully selected and labour is supervised by experienced clinical staff 2,3 . The increased fetal risk may also be due to other causes, such as congenital malformations, which are independent of the mode of delivery. Before 2000, the elective caesarean section (CS) rate for breech presentation had been rising as obstetricians attempted to avoid the fetal risks associated with vaginal delivery.