National Perinatal Epidemiology Center

Cork, Ireland

National Perinatal Epidemiology Center

Cork, Ireland
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Nuzum D.,University College Cork | Meaney S.,National Perinatal Epidemiology Center | O'Donoghue K.,University College Cork
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2014

Objective To explore the personal and professional impact of stillbirth on consultant obstetrician gynaecologists. Design Semi-structured in-depth qualitative interviews. Setting A tertiary university maternity hospital in Ireland with a birth rate of c. 9000 per annum and a stillbirth rate of 4.6/1000. Sample Purposive sample of eight consultant obstetrician gynaecologists (50% of consultant obstetrician gynaecologists in the hospital). Methods Semi-structured in-depth interviews analysed by Interpretative Phenomenological Analysis. (IPA) IPA is a methodology for exploring human experience and its meaning for the individual. Main outcome measures The lived experiences, personal feelings and professional impact of stillbirth on consultant obstetrician gynaecologists. Results Stillbirth was identified as amongst the most difficult experiences for consultants. Two superordinate themes emerged: the human response to stillbirth and the weight of responsibility. The human response to stillbirth was characterised by the personal impact of stillbirth for consultants and, in turn, how that shapes the care they provide. The weight of professional responsibility was characterised by the sense of professional burden and the possibility of a medico-legal challenge - mostly for those who are primarily gynaecologists resulting in the question 'what have I missed?'. Conclusions Despite the impact of stillbirth, no consultant has received formal training in perinatal bereavement care. This study highlights a gap in training and the significant impact of stillbirth on obstetricians, professionally and personally. The provision of support, ongoing education, bereavement training and self-care is recommended. Medico-legal concerns following stillbirth potentially impact on care, warranting further research. © 2014 Royal College of Obstetricians and Gynaecologists.

O'Keeffe L.M.,University of Bristol | Kearney P.M.,University College Cork | Greene R.A.,National Perinatal Epidemiology Center | Greene R.A.,Cork University Maternity Hospital | And 2 more authors.
Obstetrics, Gynaecology and Reproductive Medicine | Year: 2016

Alcohol use during pregnancy is prevalent in Western populations. However, evidence on the effects of alcohol use during pregnancy for neonatal and child health is conflicting and advice regarding the safety of low levels of gestational alcohol consumption varies between countries. We provide a brief overview of current evidence on the effects of gestational alcohol use, its limitations and existing guidelines on alcohol use in pregnancy. © 2016.

Fawsitt C.G.,National Perinatal Epidemiology Center | Fawsitt C.G.,University College Cork | Bourke J.,University College Cork | Greene R.A.,National Perinatal Epidemiology Center | And 3 more authors.
PLoS ONE | Year: 2013

Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland. Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations. Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD (€1,835.06 versus €4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis. Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model. © 2013 Fawsitt et al.

Khalid A.S.,University College Cork | Marchocki Z.,University College Cork | Hayes K.,University of Limerick | Lutomski J.E.,National Perinatal Epidemiology Center | And 4 more authors.
Annals of Clinical Biochemistry | Year: 2014

Background: Thyroid disorders are common in women of childbearing age and are associated with adverse pregnancy outcomes. Physiological changes in pregnancy and the lack of pregnancy-specific reference ranges make managing thyroid disorders in pregnancy challenging. Our aim was to establish trimester-specific thyroid function reference intervals throughout pregnancy, and to examine the prevalence of thyroid autoimmunity in otherwise euthyroid women. Method: This was a prospective, cross-sectional study of thyroid function tests (TFTs) in pregnant women attending a large, tertiary referral maternity hospital. Patients with known thyroid disorders, autoimmune disease, recurrent miscarriage, hyperemesis gravidarum and pre-eclampsia were excluded. TFTs were analysed in the CUH biochemistry laboratory using Roche Modular E170 electrochemiluminescent immunoassay. Trimester-specific reference ranges (2.5th, 50th and 97.5th centiles) were calculated. Results: Three-hundred-and-fifty-one women were included into the analysis. Median maternal age was 30. Thyroidstimulating hormone concentrations showed slightly increasing median centile throughout gestation. Free thyroxine (T4) and T3 decreased throughout gestation. Table 1 demonstrates the calculated percentiles according to gestational weeks. Conclusion: We established pregnancy-specific thyroid function reference intervals for our pregnant population, for use in clinical practice. © The Author(s) 2013 Reprints and permissions:

PubMed | National Perinatal Epidemiology Center
Type: Journal Article | Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians | Year: 2014

Re-emerging syphilis outbreaks across Europe have led to increasing syphilis rates among women of child-bearing age. We, therefore, identified all forms of syphilis cases among women hospitalized for delivery in Ireland over a six-year period. Cases per annum ranged from 10 to 24 (13.8-32.9 per 100000 maternities). Rates of syphilis in this universally screened cohort were four times higher than the general Irish population. Future studies examining the incidence of congenital syphilis as well as patterns in follow-up treatment for the sero-positive mother and her infant are needed to better guide clinical intervention.

PubMed | National Perinatal Epidemiology Center
Type: Journal Article | Journal: Obstetrics and gynecology | Year: 2011

To estimate nationally representative incidence rates of maternal morbidities and to examine if the incidence of maternal morbidity increased during a 4-year study period.We conducted a population-based retrospective cohort study of women delivering in hospitals in Ireland between 2005 and 2008 using nationally representative hospital discharge data from the Hospital In-Patient Enquiry data set. Using singleton deliveries, we categorized International Classification of Diseases 10, Australian Modification diagnostic codes into 38 clinically relevant maternal morbidity groups and assessed the incidence of morbidities potentially affecting labor, delivery, and the puerperium. Significant trends in morbidity over the course of the study period were determined using Cochran-Armitage tests.Exclusive of cesarean delivery, approximately one in six women (17.2%) had a maternal morbidity diagnosed during Hospitalization. When cesarean delivery was included as an additional indicator of morbidity, more than one third (35.6%) had a maternal morbidity diagnosed. The percentage of women with either hemorrhage and genital tract trauma (6.5%) or pregnancy-induced conditions (6.4%) diagnosed were similar. Overall, 4.5% of women had nonacute or chronic conditions diagnosed, 1.6% had infections diagnosed, and 0.6% had acute medical conditions diagnosed. Between 2005 and 2008, rates significantly (P<.001) increased for postpartum hemorrhage, pelvic and perineal trauma, and gestational diabetes.Maternal morbidities in Ireland are common and changing, underscoring the benefits of continuous comprehensive examination of maternity care services for all women during childbirth to address treatment of morbidities and to potentially prevent new morbidities.

PubMed | National Perinatal Epidemiology Center
Type: Comparative Study | Journal: European journal of obstetrics, gynecology, and reproductive biology | Year: 2012

To determine the population-based rates of severe maternal morbidity during childbirth hospitalisation and associated characteristics in the Republic of Ireland and to directly compare incidence rates with Australia.Retrospective cohort study of 330,955 childbirth hospitalisations between 2005 and 2009. Using validated diagnostic criteria from Australia, we examined hospital discharge records (ICD-10-AM) to identify likely cases of severe maternal morbidity. We derived overall and category-specific morbidity incidence rates and examined five-year trends. Unadjusted relative risks were computed to assess sociodemographic and obstetric factors associated with morbidity status.The severe maternal morbidity five-year incidence rate was 1.34 per 100 deliveries. Between 2005 and 2009, the overall rate of severe morbidity significantly increased from 1.31 to 1.55 cases per 100 deliveries (test for trend p-value <0.001). Similar to Australia, the most frequently diagnosed severe morbidity indicators in Ireland were blood transfusion (112.6 per 10,000 deliveries), evacuation of haematoma (7.2 per 10,000 deliveries) and dilation and curettage with general anaesthesia (3.9 per 10,000 deliveries). In the Irish cohort, the risk of severe morbidity was more than three-fold (RR 3.48; 95% CI: 3.06-3.95) among women carrying multiple gestations and more than four-fold (RR 4.37; 95% CI: 3.66-5.22) among women with a stillbirth. Further, severe morbidity risk was 2.62 times higher among women with a pre-existing medical condition (RR 2.62; CI 2.03-3.37).Our use of low-cost administrative data to identify severe maternal morbidity contributes to a growing body of international initiatives to inform preventive efforts. The ability to directly compare morbidity rates is advantageous, underscoring the need for a uniform definition of severe morbidity to promote accurate and reliable international comparisons.

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