Now showing 1 - 10 of 29
  • Publication
    Neonatal Brachial Plexus Palsy and causation
    (Irish Medical Organisation, 2016-08) ;
    A vaginal childbirth is the result of the internal (endogenous) expulsive forces of uterine contractions, usually supplemented by active maternal pushing. Depending on the clinical circumstances, additional external (exogenous) traction forces may be required from the birth attendant. This blend of internal and external forces varies from birth to birth. Women who have had a previous vaginal delivery, for example, may deliver successfully with uterine contractions alone and the role of the birth attendant may be simply to control and slow the delivery so that trauma to the maternal perineum from stretching by the fetal head.
  • Publication
    The use of digital media by women using the maternity services in a developed country
    The provision of high quality healthcare information about pregnancy is important to women and to healthcare professionals and it is driven, in part, by a desire to improve clinical outcomes. The objective of this study was to examine the use of digital media by women to access pregnancy information. A questionnaire was distributed to women attending a large maternity hospital. Of the 522 respondents, the mean age was 31.8 years, 45% (235/522) were nulliparous, 62% (324/522) lived in the capital city and 29% (150/522) attended the hospital as private patients. Overall 95% (498/522) used the internet for pregnancy information, 76% (399/522) had a smartphone and 59% (235/399) of smartphone owners had used a pregnancy smartapp. The nature of internet usage for pregnancy information included discussion forums (70%), social networks (67%), video media (48%), e-books (15%), blogs (13%), microblogs (9%) and podcasts (4%). Even women who were socially disadvantaged reported high levels of digital media usage. In contemporary maternity care women use digital media extensively for pregnancy information. All maternity services should have a digital media strategy.
  • Publication
    Pilot evaluation of an online weight management programme
    This intervention examined the efficacy of a six-week online weight loss programme. Students and staff of a third level institution (n=183) were recruited to the programme which provided individualised dietary advice for weight loss. Eighty-five participants (mean age 29.7 years, mean BMI 28.9kg/m2, 33% male) met the minimum inclusion criterion of logging on to the study website at least twice. All participants who completed the full six-week programme lost weight (n=31), with significant reductions in mean weight (2.8kg), BMI (0.9kg/m2) and waist circumference (4.1cm) observed between the start and end of the programme (all P<0.001). Among "completers", males lost more weight than females (4.2kg vs. 1.9kg, P=0.004). One in four completers lost >5% of their bodyweight, with reductions in biscuit and alcohol consumption being most predictive of weight loss. These findings suggest that individualised online dietary advice is effective in achieving short-term weight loss, especially in males.
  • Publication
    Maternal Obesity and Neck Circumference
    Obese women are more likely to require general anaesthesia for an obstetric intervention than non-obese. Difficult tracheal intubation and oxygen desaturation is more common in pregnancy. Failed tracheal intubation has been associated with an increase in neck circumference (NC). We studied the relationship between maternal obesity and NC as pregnancy advanced in women attending a standard antenatal clinic. Of the 96 women recruited, 13.5% were obese. The mean NC was 36.8cm (SD 1.9) in the obese women compared with 31.5cm (SD 1.6) in women with a normal BMI (pp<0.001) at 18-22 weeks gestation. In the obese women it increased on average by 1.5cm by 36-40 weeks compared with an increase of 1.6 cm in women with a normal BMI. The antenatal measurement of NC is a simple, inexpensive tool that is potentially useful for screening obese women who may benefit from an antenatal anaesthetic assessment.
  • Publication
    Vaginal Breech Delivery at Term: the Doctors' Dilemma
    (Irish Medical Organisation, 2015-03) ;
    "When an operation is once performed, nobody can ever prove that it was unnecessary". The Craze for Operations from The Doctor’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. 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. 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
  • Publication
    Caesarean Section and Maternal Obesity
    (InTech, 2012-05-23) ;
    In developed countries in women of reproductive age an increase in obesity levels has been widely reported with an associated increase in maternal obesity (Yu et al, 2006, Heslehurst et al, 2008, Huda et al, 2010). Obesity in pregnancy is associated with an increased incidence of medical complications including gestational diabetes mellitus, pre-eclampsia and venous thromboembolism (Huda et al, 2010). As a result, in part, obesity is associated with a higher incidence of obstetric interventions such as caesarean section, as well as an increase in pregnancy complications including haemorrhage, infection and congenital malformations (Yu et al, 2006, Heslehurst, 2008). The World Health Organization criteria define a Body Mass Index (BMI) <18.5kg/m2 as underweight, 18.5-24.9 as normal weight, 25.0-29.9 as overweight and > 29.9 as obese. Obesity can be further subcategorised into class one obese which is 30.0-34.9, class two 35.0-39.9 and class three >40.0.
  • Publication
    Can fetal macrosomia be predicted and prevented?
    (CRC Press/Taylor & Francis, 2016-06-06) ;
    The macrosomic fetus is at risk of perinatal complications such as shoulder dystocia, brachial plexus injury, clavicular fracture, and meconium aspiration. In the neonatal period, macrosomic infants are at risk of hypoglycemia, hyperbilirubinemia, and hypomagnesemia. The mother of a macrosomic infant is at increased risk of prolonged labor, operative vaginal delivery, perineal trauma, and caesarean section.
  • Publication
    Antenatal Rubella Immunity in Ireland
    The objective of the study was to identify those women attending for antenatal care who would have benefited from prepregnancy rubella vaccination. It was a population-based observational study of women who delivered a baby weighing ≥500 g in 2009 in the Republic of Ireland. The woman’s age, parity, nationality and rubella immunity status were analysed using data collected by the National Perinatal Reporting System. Of the 74,810 women delivered, the rubella status was known in 96.7% (n=72,333). Of these, 6.4%(n=4,665) women were not immune. Rubella seronegativity was 8.0%(n=2425) in primiparous women compared with 5.2%(n=2239) in multiparous women (p<0.001), 14.7%(n=10653) in women <25 years old compared with 5.0%(n=3083) in women ≥25 years old (p<0.001), and 11.4%(n=780) in women born outside the 27 European Union (EU27) countries compared with 5.9%(n=3886) in women born inside the EU27 countries (p<0.001). Based on our findings we recommend that to prevent Congenital Rubella Syndrome, the health services in Ireland should focus on women who are young, nulliparous and born outside the EU.
  • Publication
    Recent trends in vaginal birth after caesarean section
    In developed countries, caesarean section (CS) rates continue to escalate and in Ireland nearly one in three women are now delivered by CS. The purpose of this study was to compare the management of women after one previous CS in two large Dublin maternity hospitals with the management in two other well-resourced countries. Data were analysed for Dublin, Massachusetts in the United States, and Hesse in Germany. It was found that since 1990, the CS rate in Dublin has increased by much more than in the other areas. This increase may be explained by the precipitous fall in the vaginal birth after CS rate because the rates in Massachusetts and Hesse in 1990 were initially much lower. Changes in the clinical management of women with one previous CS are a major contributor to the rising CS rates and are likely to be an ongoing driver of CS rates unless clinical practices evolve.                          
  • Publication
    Provision of Information about Infant Feeding Postpartum Through Digital Media
    Abstract Women seek information about infant feeding from multiple sources, which may conflict. Increasingly women use digital media for pregnancy information. This study examined women's use of digital media for information on infant feeding. In addition to clinical and socio-demographic data, detailed data concerning women's infant feeding practices and their use of digital media for infant feeding information were collected. We surveyed 295 women who attended nine months postpartum as part of a longitudinal study on maternal weight trajectories. Digital media was used by 130 women (44.1%) to access information on infant feeding, which is higher than hitherto reported. Women who did not use digital media were more likely to be multigravidous (p = 0.03), to be socially disadvantaged (p = 0.01), and were less likely to breastfeed (p = 0.01). However, on multivariable analysis, only women economically disadvantaged were less likely to use digital media [OR 0.25, p < 0.02]. The types of digital media used varied, and an overwhelming majority were non-subscription resources. Less than 5% of women used professional evidence-based digital media sources. The use of digital media was not associated with the timing of weaning. Information on infant feeding should be evidence-based and provided digitally to women across all socioeconomic gradients as part of an e-health national policy.