Now showing 1 - 10 of 40
  • Publication
    Prevention of Neural Tube Defects in Ireland
    (Irish Medical Organisation, 2017-09) ;
    Neural tube defects (NTDs) are a group of serious congenital malformations, including encephalocoele and spina bifida (SB) which are associated with failure of closure of the neural tube during early embryonic development. They affect approximately one in 1000 births globally, and constitute an important challenge in terms of mortality, morbidity, social and financial costs. Studies indicate that approximately two thirds, but not all, cases of NTDs are preventable. The burden of disease associated NTDs is higher in Ireland than in other countries.
      122
  • 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
      170
  • Publication
    The prevention of neural tube defects in Ireland
    (Irish Medical Journal, 2017-01-01) ;
    Neural tube defects (NTDs) are a group of serious congenital malformations, including anencephaly, encephalocoele and spina bifida (SB) which are associated with failure of closure of the neural tube during early embryonic development. They affect approximately one in 1000 births globally, and constitute an important challenge in terms of mortality, morbidity, social and financial costs. Studies indicate that approximately two thirds, but not all, cases of NTDs are preventable. The burden of disease associated with NTDs is higher in Ireland than in other countries. Ireland has the highest fertility rate in the European Union (EU), and more than twice as many babies with spina bifida are live-born in Ireland compared with the rest of the EU. It is estimated that there are about 500 patients with SB in Ireland. The prevention of NTDs should therefore be a higher healthcare priority in this country than in other well-resourced countries.
      75
  • Publication
    The impact of new guidelines on screening for gestational diabetes mellitus
    Gestational diabetes mellitus (GDM) has important maternal and fetal implications. In 2010, the Health Service Executive published guidelines on GDM. We examined the impact of the new guidelines in a large maternity unit. In January 2011, the hospital replaced the 100g Oral Glucose Tolerance Test (OGTT) with the new 75g OGTT. We compared the first 6 months of 2011 with the first 6 months of 2010. The new guidelines were associated with a 22% increase in women screened from 1375 in 2010 to 1679 in 2011 (p<0.001). Of the women screened, the number diagnosed with GDM increased from 10.1% (n=139) to 13.2% (n=221) (p<0.001).The combination of increased screening and a more sensitive OGTT resulted in the number of women diagnosed with GDM increasing 59% from 139 to 221 (p=0.02).This large increase has important resource implications but, if clinical outcomes are improved, there should be a decrease in long-term costs.
      153
  • Publication
    Preventing neural tube defects in Ireland
    (Irish Medical Times, 2017-11-03)
    Neural tube defects (NTDs) are a group of serious congenital neurodevelopmental malformations, where there is incomplete closure of the neural tube during the first month after conception. In a national audit of 2009-11, the incidence was 1.04/1,000 births: 45 per cent had anencephaly, 49 per cent had spina bifida and 6 per cent had an encephalocolele (McDonnell et al, 2015). Anencephaly is incompatible with survival beyond the first week of life. In contrast, a recent comprehensive report from Temple St Hospital estimated that 500 patients in the country and their families face the lifelong consequences of coping with spina bifida.
      97
  • 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.
      216
  • 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.
      336
  • 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.                          
      142
  • Publication
    Screening for gestational diabetes mellitus selectively in a university maternity hospital
    Aims: Screening for gestational diabetes mellitus (GDM) may be universal or selective based on risk factors. We audited selective screening with an Oral Glucose Tolerance Test (OGTT). Methods: Clinical and laboratory details of the first 200 women who delivered a baby in 2017 were analysed. Results: Based on national recommendations, 46.5% (n=93) had maternal risk factors (RF) and an additional 6.5% (n=13) had fetal RF. Nine women with RF, for unexplained reasons did not have their OGTT. Of the 95 who had their OGTT, the diagnosis of GDM was made in 27.4% (n=26). The diagnosis of GDM was made in an additional 8 women outside selective screening giving an overall incidence of 17.0%. Discussion: More than half of the women needed to be screened selectively for GDM. Compliance with the national recommendations was incomplete and thus the diagnosis of GDM may be missed even in an academic setting.
      111
  • Publication
    Differences in Nulliparous Caesarean Section Rates across Models of Care: A Decomposition Analysis
    To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates. Cross-sectional analysis using a combination of two routinely collected administrative databases was performed. A non-linear extension of the Oaxaca-Blinder method is used to decompose the difference between public and private ELCS and EMCS rates into the proportion explained by the differences in observable maternal, clinical, and hospital characteristics and the proportion that remains unexplained. Of the 29,870 babies delivered to nulliparous women, 7,792 were delivered via CS (26.1 %), 79.6 % of which were coded as EMCS. Higher prevalence of ELCS was associated with breech presentation, other malpresentation, and the mother being over 40 years old. Higher prevalence of EMCS was associated with placenta praevia or placental abruption, diabetes (pre-existing and gestational), and being over 40 years old. The private model of care is associated with ELCS and EMCS rates 6 percentage points higher compared than the public model of care but this differential is insignificant in the fully adjusted models for EMCS. Just over half (53 %) of the 6 percentage point difference in ELCS rates between the two models of care can be accounted for by maternal, clinical and hospital characteristics. Almost 80 % of the difference for EMCS can be accounted for.CONCLUSIONS: The majority of the difference in EMCS rates across models of care can be explained by differing characteristics between the two groups of women. The main contributor to the difference was advancing maternal age. The unexplained component of the difference for ELCS is larger; an excess private effect remains after accounting for maternal, clinical, and hospital characteristics. This requires further investigation and may be mitigated in future with the introduction of clinical guidelines related to CS.
      287Scopus© Citations 12