Colin Kirkham

Myocardial assessment using tissue doppler imaging in preterm very low-birth weight infants before and after red blood cell transfusion

Objective:To investigate myocardial velocities in anemic very low-birth weight (VLBW) preterm infants, pre and post red blood cells transfusion using tissue Doppler imaging echocardiography.Study design:Forty-eight VLBW preterm infants⩽34 weeks and>2 weeks old were prospectively divided: Transfused symptomatic infants (Hematocrit (Hct)<0.30 (n=32)) and non transfused asymptomatic controls (control 1, Hct >0.30 (n=9) and control 2, Hct <0.30 (n=7)). Echocardiography was performed before and 3–5 days after transfusion in the transfused, and the controls were studied at similar intervals. Non parametric tests were used for statistical analysis.Result:Left ventricular (LV) systolic velocity increased (transfused (4.6±0.70 vs 6.0±0.65, P<0.01)) as did LV diastolic velocities (P<0.01) without significant difference over time in each control. The percentage change in LV velocity following transfusion correlated negatively (ρ=0.36) with pre transfusion Hct.Conclusion:There is a significant increase in myocardial performance following transfusion, which is related to the severity of the anemia.

Adjustment of therapeutic LMWH to achieve specific target anti-FXa activity does not affect outcomes in pregnant patients with venous thromboembolism

Venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality in the developed world. Low molecular weight heparins (LMWH) are routinely used to provide therapeutic anticoagulation during pregnancy for women with VTE, with measurement of plasma anti-FXa activity used to guide dosing in certain patient groups. There is limited evidence to support the use of anti-FXa monitoring in pregnant patients. This study seeks to ascertain whether anti-FXa monitoring of pregnant patients with VTE influences patient outcomes. We performed a single-centre case series including two consecutive groups of pregnant patients treated with LMWH for VTE sustained in the index pregnancy with and without monitoring of anti-FXa levels. 35,394 patients delivered during the study period in a large urban stand-alone maternity hospital, with 26 cases of VTE eligible for inclusion. There was no significant difference between the two groups in any clinical outcome; including maternal blood loss at delivery, recurrent thromboembolic events or rates of planned delivery. These data provide clinical evidence to support current international guideline recommendations that measurement of plasma anti-FXa activity in the majority of patients receiving therapeutic-intensity antenatal LMWH is not warranted.

Perinatal outcomes of women with a prior history of unexplained recurrent miscarriage

Abstract Objective: We sought to determine subsequent pregnancy outcomes in a cohort of women with a history of unexplained recurrent miscarriage (RM) who were not receiving medical treatment. Study design: This was a prospective cohort study, of women with a history of three unexplained consecutive first trimester losses, who were recruited and followed in their subsequent pregnancy. Control patients were healthy pregnant patients with no previous adverse perinatal outcome. Results: A total of 42 patients with a history of unexplained RM were recruited to the study. About nine (21.4%) experienced a further first trimester miscarriage, one case of ectopic and one case of partial molar pregnancy. About 74% (23/31) of the RM cohort had a vaginal delivery. There was one case of severe pre-eclampsia. The RM group delivered at a mean gestational age of 38 + 2 weeks and with a mean birthweight of 3.23 kg. None of the neonates were under the 10th centile for gestational age. Overall, there was no significant difference in pregnancy outcomes between the two cohorts. Conclusion: Our study confirms the reassuring prognosis for achieving a live birth in the unexplained RM population with a very low incidence of adverse events with the majority delivering appropriately grown fetuses at term.

Ponderal index (PI) vs birth weight centiles in the low-risk primigravid population: Which is the better predictor of fetal wellbeing?

Our objective was to compare Ponderal index (PI) with birth weight centiles as predictors of perinatal morbidity and to determine which best reflects the presence of placental disease. We prospectively recruited 1,011 low-risk primigravidas and calculated PI and birth weight centiles following delivery. Perinatal morbidity was defined as: pre-term birth (PTB); fetal acidosis; an Apgar score < 7 at 5 min or neonatal resuscitation. Placental disease was defined as chronic uteroplacental insufficiency (CUPI); villous dysmaturity; infection or vascular pathology. Ponderal index was statistically reduced (25.33 vs 27.79 p = 0.001) and the incidence of infant birth weight < 9th centile was statistically higher (11.1% vs 5.1%; p = 0.004) in cases with PTB and in CUPI (26.23 vs 27.84; p = 0.001 and 28.2.1% vs 10.4%; p = 0.002). Both PI and infant birth weight centile < 9th centile for gestational age correlate with PTB, however overall, both are poor predictors of neonatal and placental disease.

The effect of maternal subclinical hypothyroidism on IQ in 7- to 8-year-old children: A case-control review.

In Ireland, pregnant women are not routinely screened for subclinical hypothyroidism (SCH).

Psychosocial trends in couples prior to commencement of in vitro fertilisation (IVF) treatment.

Facing infertility and undergoing fertility treatment can create emotional turmoil in couples’ lives. It is essential for fertility therapy providers to assess the coping and communication strategies of couples before treatment in order to provide appropriate support. We performed a two time point (year 2003 & year 2009) cross-sectional study of patients attending our services to undergo in vitro fertilisation. All couples attending the Human Assisted Reproduction Ireland Unit, a tertiary referral academic centre at the Rotunda Hospital, were requested to complete a psychosocial questionnaire before commencing the treatment. The questions assessed couples’ understanding of their own infertility, family background and support, relationship traits and stress levels prior to commencing fertility treatment. A total of 180 patients participated in the study. Our findings showed that within a 6-year time span, couples’ attitudes have changed significantly. Compared to 6 years ago, couples now have a better understanding of infertility and are seeking treatment quicker. Interestingly, we showed higher stress levels nowadays with fewer couples following routine stress management. We also identified specific gender differences in that women have a more open attitude in discussing infertility and seeking more support from friends and family compared to men.

Perinatal mortality or severe neonatal encephalopathy among normally formed singleton pregnancies according to obstetric risk status:” is low risk the new high risk?” A population-based cohort study

OBJECTIVE To evaluate the capacity of the current system of obstetric risk stratification at the outset of pregnancy to predict severe adverse perinatal outcome. STUDY DESIGN This retrospective cohort study of singleton pregnancies over a five year period (2009-2013) was performed at the Rotunda Hospital, Dublin, Ireland. High-risk or low-risk status was assigned retrospectively to a large consecutive cohort of women with a normally-formed singleton pregnancy on the basis of factors analyzed at the first prenatal hospital visit. The incidence of severe perinatal morbidity and mortality were compared between high- and low-risk groups to determine the predictive utility of risk stratification at the outset of pregnancy for severe perinatal morbidity. RESULTS During the study period, 41,044 patients registered for prenatal care. 25,702;(63%) were deemed low-risk and 15,342;(37%) high-risk. Low-risk women were statistically more likely to be nulliparous (p < 0.0001) and to have a spontaneous or operative vaginal delivery (p < 0.0001). High-risk women were more likely to be multiparous and to undergo Caesarean delivery (p < 0.0001). The perinatal mortality rate was 3.8 per-1000 in low-risk pregnancies and 6.1 per-1000 in the a priori high-risk group (p = 0.012). The incidence of severe neonatal encephalopathy (NNE) was 1.8 and 0.65 per-1000 in the low and high-risk groups respectively (p = 0.0025). CONCLUSION Where low-risk status is assigned at registration, neonatal encephalopathy is more prevalent. This data is relevant for the design of prenatal care models and demonstrates that assignment of low obstetric risk on the basis of maternal or pre-pregnancy factors alone may erroneously be interpreted as conferring low-risk status to the fetus.

Erratum to: P47 A review of Massive Obstetric Haemorrhage (MOH) in the East of Ireland and its association with Maternal Obesity

Introduction: Massive obstetric haemorrhage (MOH), blood loss of >2000 ml, is a life-threatening emergency in the postpartum. The aim of this review is to address the incidence of maternal obesity, a modifiable risk factor contributing to MOH. Methods: This 6-year retrospective review involved the interrogation of the annual clinical reports of the tertiary maternal centres in the East of Ireland between the years 2009-2014. We assessed patient risk factors for developing MOH in the antenatal period with a focus on maternal obesity (Body Mass Index (BMI) ≥30 Kg/m2). Associations between categorical variables were tested using Pearson’s chisquare test. Results: The incidence of MOH was 2.21/1,000 livebirths during the 6-year period. Of those women 20.5% of cases had BMIs recorded and 34.72% of those with recorded BMI were obese. Within the obese cohort, patients suffered an average blood loss of 2820 ml in the first 24 hours postpartum, with 88% requiring a blood transfusion. There was a significant association between maternal obesity and developing MOH: (X2 (1) = 32.63, p-value < 0.001). Discussion: Maternal obesity is a preventable risk factor that contributes to MOH. As detailed in the most recent report by the World Health Organization (WHO) presented at the 2015 European

PP.30 The Effect of Maternal Sublinical Hypothyroidism on the IQ of Children

In our practise, pregnant women are not routinely screened or treated for subclinical hypothyroidism (SCH) Our objective was to compare the IQ of children whose mothers had been diagnosed with SCH antenatally with closely matched controls. In a previous study we screened 1000 healthy nulliparous patients for SCH. Those with overt hypothyroidism were treated, whereas those with SCH were contacted postnatally for paediatric follow-up. SCH (defined as reduced free T4 with normal TSH, or normal free T4 with raised TSH) was found in 4.6% (n = 46) All children underwent a formal neurodevelopmental assessment at age 7 to 8 years by a psychologist blinded to the original maternal thyroid status. From the cases, 23 mothers agreed to assessment of their children as well as 47 controls. The children in the control group had higher mean scores than those in the case group across Verbal Comprehension Intelligence, Perceptual Reasoning Intelligence, Working Memory Intelligence, Processing Speed Intelligence and Full Scale IQ. Statistical testing confirmed a statistically significant difference in IQ between the groups. This had a 95% confidence interval (.144, 10.330) Our results highlight significant differences in IQ of children of mothers who had unrecognised SCH during pregnancy. Our study size and design prevents us from making statements on causation but our data suggests significant public health implications in terms of routine thyroid screening in pregnancy. The results of prospective intervention trials to address a causative association will be vital to address this issue.