Now showing 1 - 9 of 9
  • 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.
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  • 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.
      223
  • Publication
    Impact of Implementing Preanalytical Laboratory Standards on the Diagnosis of Gestational Diabetes Mellitus: A Prospective Observational Study
    (American Association for Clinical Chemistry, 2016-02) ; ; ; ; ;
    Background: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, but risk is reduced with identification and early treatment. Glucose measurements are affected by preanalytical sample handling, such as temperature of storage, phlebotomy–analysis interval, and use of a glycolysis inhibitor. We evaluated glucose concentrations and the incidence of GDM after strict implementation of the American Diabetes Association (ADA) preanalytical guidelines, compared with usual hospital conditions. Methods: Women screened selectively for GDM at 24 –32 weeks’ gestation were recruited at their convenience before a 75-g oral glucose tolerance test. Paired samples were taken: the first sample followed ADA recommendations and was transferred to the laboratory on an iced slurry for immediate separation and analysis (research conditions), and the second sample was not placed on ice and was transferred according to hospital practice (usual conditions). Results: Of samples from 155 women, the mean fasting, 1-h, and 2-h results were 90.0 (12.6) mg/dL [5.0 (0.7) mmol/L], 142.2 (43.2) mg/dL [7.9 (2.4) mmol/L], and 102.6 (32.4) mg/dL [5.7 (1.8) mmol/L], respectively, under research conditions, and 81 (12.6) mg/dL [4.5 (0.7) mmol/L], 133.2 (41.4) mg/dL [7.4 (2.3) mmol/L], and 99 (32.4) mg/dL [5.5 (1.8) mmol/L] under usual conditions (all P 0.0001). GDM was diagnosed in 38.1% (n 59) under research conditions and 14.2% (n 22) under usual conditions (P 0.0001). The phlebotomy–analysis interval for the fasting, 1-h, and 2-h samples was 20 (9), 17 (10), and 17 (9) min under research conditions and 162 (19), 95 (23), and 32 (19) min under usual conditions (all P 0.0001). All cases of GDM were diagnosed on fasting or 1-h samples; the 2-h test diagnosed no additional cases. Conclusions: Implementation of ADA preanalytical glucose sample handling recommendations resulted in higher mean glucose concentrations and 2.7-fold increased detection of GDM compared with usual hospital practices.
      395Scopus© Citations 46
  • Publication
    Duration of periconceptional folic acid supplementation in women booking for antenatal care
    OBJECTIVE: To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices.DESIGN: Cross-sectional observational study. Women's clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher.SETTING: A large university maternity hospital, Republic of Ireland, January 2014-April 2016.SUBJECTS: Women (n 856) recruited at their convenience in the first trimester.RESULTS: While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed.CONCLUSIONS: As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.                          
      438Scopus© Citations 12
  • 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.
      495
  • Publication
    The interplay between maternal obesity and gestational diabetes mellitus
    There is a strong epidemiological association between maternal obesity and gestational diabetes mellitus (GDM). Since the publication of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study on women with mild hyperglycemia in 2008, new criteria have been introduced in maternity services internationally for the diagnosis of GDM. As a result, the diagnosis of GDM may be made in one-third of obese women (n=68). The aim of this review was to examine the interplay between maternal obesity and GDM in light of the HAPO study and the subsequent revised diagnostic criteria. Obesity and GDM are important obstetric risk factors because they both are potentially modifiable. However, the new international criteria for the diagnosis of GDM have serious resource implications for maternity services provided to the large number of women attending for care in developed countries. Further consideration needs to be given as to whether obese women with mild hyperglycemia need to be referred to a multidisciplinary team antenatally if they do not require insulin treatment.
      777Scopus© Citations 18
  • Publication
    A national survey of preanalytical handling of oral glucose tolerance tests in pregnancy
    While the criteria for the diagnosis of gestational diabetes mellitus (GDM) continue to be mired in controversy with a lack of international consensus, many countries and the World Health Organization have adopted the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations. In addtion, revised stricter recommendations have also been produced and endorsed by the National Academy of Clinical Biochemistry (NACB) for laboratory standards in the analysis of maternal glucose measurements.
    Scopus© Citations 10  407
  • 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.                          
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  • Publication
    Neonatal Brachial Plexus Palsy and causation
    (Irish Medical Organisation, 2016-08-08) ;
    A vaginal childbirth is the result of the internal (endogenous) expulsive forces of uterine contractions, usually supplemented by active maternal pushing1. 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 is minimised. In contrast, additional traction may be required by an obstetrician at the time of an operative vaginal delivery for fetal distress or dystocia. The strength of the traction required may be increased by clinical factors, for example, fetal macrosomia or malposition. The traction should be axial in the direction of the birth canal, which is a vector combining horizontal and vertical traction at 25-45 degrees below the horizontal when the woman is in the lithotomy position.
      198