University Maternity Hospital Limerick Research Articles

Anxiety in a Specialist Perinatal Mental Health Service: patient characteristics, management, and outcomes.

To outline characteristics of patients with anxiety diagnoses attending a Specialist Perinatal Mental Health Service (SPMHS) in Ireland, the mental health care received by those patients, mental health and obstetric outcomes for those patients, and immediate neonatal outcomes for their babies. A retrospective chart review was conducted of patients with antenatal anxiety diagnoses who attended the SPMHS in University Maternity Hospital Limerick, from initiation of the service to the end of its first year. Data were collected on 100 patients, 81 with a mental health diagnosis prior to attending the SPMHS, 32 with prior engagement with psychiatry, and 23 with a previous perinatal diagnosis. The mean age of patients was 32.4 (19-47, std 6.158). Beyond initial assessment, the Mental Health Midwife was involved in the care of 61% of patients, more than any other specialty including psychiatry. Twenty-seven patients had psychiatric medication either started or altered by the SPMHS. The most common reason for eventual discharge was that patients were well. Two patients presented in mental-health-related crisis to emergency services and one patient was admitted to an acute psychiatric ward. Patients attending the SPMHS for anxiety spanned a broad spectrum of demographics and diagnoses and received varied set of interventions. A significant proportion of patients had a primary diagnosis of Pregnancy-related anxiety. The Mental Health Midwife played a key role in management of these patients. Though rates of mental health crises and admissions were low, the absence of a Mother and Baby Unit in Ireland was highlighted.

An evaluation of adherence to folic acid supplementation in pregnant women during early gestation for the prevention of neural tube defects.

Neural tube defects (NTD) are potentially preventable by periconceptual folic acid supplementation. Women with obesity are at higher risk of NTD, therefore, are recommended a higher dose of 5 mg folic acid to mitigate this risk. The aim of this study was to evaluate maternal practice of folic acid supplementation amongst the antenatal population in relation to maternal obesity status. Prospective observational study. Women ≤18 weeks' gestation at their first antenatal appointment attending University Maternity Hospital Limerick (Ireland) were recruited. Maternal height and weight were measured. Obesity was defined at a threshold of ≥30·0 kg/m2 and ≥27·5 kg/m2 when adjusting for ethnicity. A two-part questionnaire captured maternal characteristics and assessed supplementation compliance, commencement and dosage. Fisher's exact test for independence analysed differences in variables. A P value of <0·05 was considered significant. A total of 328 women participated over a duration of 6 weeks. Mean gestational age was 12·4 ± 1·4 weeks and mean BMI 26·7 kg/m2 ± 5·2 kg/m2. 23·8 % (n 78) were classified as obese. 96·5 % (n 315) were taking folic acid and 95·7 % (n 314) supplemented daily. 30·2 % (n 99) commenced supplementation 12 weeks prior to conception. Overall, 57·9 % (n 190) of women met folic acid supplementation dose requirements. 89·1 % (n 55) of women with obesity did not. Women with obesity were less likely to meet the higher folic acid supplementation dose requirements (P =< 0·001). Folic acid supplementation practices within this cohort were suboptimal to prevent their risk of NTD. This study showed inadequate compliance of folic acid supplementation, and inadequate dosage for women with obesity. Increased patient education and awareness are needed within the antenatal period of pregnancy to bring folic acid supplementation practices in line with best practice guidelines.

17 Venous thromboembolism – Prevention is better than cure

Introduction: Venous thromboembolism (VTE) is the leading direct cause of maternal morbidity and mortality with pregnancy and puerperium as the major risk factors. In the year 2016-2017, University Maternity Hospital Limerick has noted an increase in the incidence of VTE in pregnant and postnatal women. In order to mitigate the problem, RCOG (Royal College of Obstetricians and Gynaecologist)-approved VTE risk assessment tool was introduced locally to identify the risk factors and managed accordingly.

Pregnancy outcomes in women with onset of type 1 diabetes mellitus less than 18 years of age

BackgroundPregnancy in women with type 1 diabetes mellitus (T1DM) is associated with an increased risk of congenital malformations, obstetric complications and neonatal morbidity. This study aims to investigate maternal, perinatal...

Word cloud analysis and single word summarisation as a new paediatric educational tool: Results of a neonatal application.

To analyse the value of computerised 'word cloud' (WC) generated from spontaneously articulated 'single word summarisation' (SWS) by medical students to assist their learning during the neonatal intensive care unit placement. To highlight WC as a potential new tool in paediatric teaching, improving student engagement and reflective feedback. An observational study was conducted in the neonatal intensive care unit of University Maternity Hospital Limerick, Ireland for 5 years (October 2012 to September 2017). One faculty member prospectively recorded SWS in neonatology by graduate entry medical students. An online 'WC generator' under an open-source licence was used to compute the WC. Hospital audit committee approved the study. A total of 268 SWS were recorded consecutively from 268 medical students towards the WC generation. Structured multi-response student feedback showed SWS and WC as stimulating, unique and creative. Powerpoint presentation of the computed WC prompted students to reflect on their chosen words and that of peers. Visualisation of medical student-generated SWS as a WC could stimulate interaction, reflection and clinical discussion, thus assisting teachers to foster better student engagement. This innovative educational tool equips students to 'convey more with fewer words' and has the potential transferability to other clinical disciplines.

Inter and intra-reliability of ultrasonography for the measurement of abdominal subcutaneous & visceral adipose tissue thickness at 12\u2009weeks gestation

BackgroundExcess abdominal adiposity cause metabolic disturbances, particularly in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. This study outlines a non-invasive methodology for the measurement of adipose tissue in pregnancy and determines the intra- and inter-observer reliability of ultrasound (US) measurements of the two components of adipose tissue (subcutaneous (SAT) and visceral adipose tissue (VAT)) within a pregnant population.MethodsThirty pregnant women were recruited at the end of their first trimester, from routine antenatal clinic at the University Maternity Hospital Limerick, Ireland. Measurements of adipose tissue thickness were obtained using a GE Voluson E8 employing a 1–5 MHz curvilinear array transducer. Two observers, employing methodological rigour in US technique, measured thickness of adipose tissue three times, and segmented the US image systematically in order to define measurements of SAT and VAT using specifically pre-defined anatomical landmarks.ResultsIntra-observer and inter-observer precision was assessed using Coefficient of Variation (CV). Measurements of SAT and total adipose for both observers were < 5% CV and < 10% CV for VAT in measures by both observers. Inter-observer reliability was assessed by Limits of Agreement (LoA). LoA were determined to be − 0.45 to 0.46 cm for SAT and − 0.34 to 0.53 cm for VAT values. Systematic bias of SAT measurement was 0.01 cm and 0.10 cm for VAT. Inter-observer precision was also assessed by coefficient of variation (CV: SAT, 3.1%; VAT, 7.2%; Total adipose, 3.0%).ConclusionIntra-observer precision was found to be acceptable for measures of SAT, VAT and total adipose according to anthropometric criterion, with higher precision reported in SAT values than in VAT. Inter-observer reliability assessed by Limits-Of-Agreement (LoA) confirm anthropometrically reliable to 0.5 cm. Systematic bias was minimal for both measures, falling within 95% confidence intervals. These results suggest that US can produce reliable, repeatable and accurate measures of SAT and VAT during pregnancy.

Spiritual care in neonatology: analysis of emergency baptisms in an Irish neonatal unit over 15 years

Emergency baptism remains an important emotional and spiritual element for many parents of critically ill infants in the neonatal unit. There is no published data available as to which neonates are baptised and their outcomes. To evaluate trends, outcomes and characteristics of newborn infants baptised over a 15-year period in an Irish maternity hospital. Retrospective study of infants baptised in University Maternity Hospital Limerick (UMHL) over a 15-year period. Patients were identified from the 'register of baptisms' for the years 2002-2016. A total of 354 neonates were identified and further information was available for 341. We observed a gradual decline of emergency baptisms over the 15-year period. A total of 114 (32.2%) infants were term and 199 (56.2%) preterm. A total of 288 infants (81.5%) were baptised by Catholic priest, 61 (17.3%) by staff member, 1 (0.3%) by family member and in 3 cases (0.9%) the person baptising was unrecorded. Day of baptism varied from 1 to 88 with a mean age of 4.6days. A total of 113 (31.9%) neonates died after baptism. Majority of infants baptised were preterm and low birth weight, with predominance of extremely low birth weight (ELBW) who also had proportionately higher mortality 47 (47.5%) following the baptism. Emergency baptism remains an important element in the spiritual care of the critically ill newborn infants and their families. Maternity hospitals and neonatal units should have access to emergency baptism service or other equivalent 'spiritual blessings' as appropriate to the faiths followed by the family, especially in an emerging multi-faith population.

Utilization of conventional radiography in a regional neonatal intensive care unit in Ireland

Objective: To audit the demand and radiation exposure of conventional radiography in a regional neonatal intensive care unit (NICU) in Ireland.Methods: A retrospective study of radiographs performed on all admissions to the NICU in University Maternity Hospital Limerick (UMHL) over 2 years.Results: A total of 1405 radiographs were performed on 506 infants. 153.5 radiographs per 1000 live births was the observed demand and 44% of radiographs were done out of hours. 47% of all radiographs were performed on infants <1500 g. Median number of radiographs per infant was one (IQR 1–2; range 1–39). Significant negative correlation was observed between number of radiographs and gestational age. Mean lung radiation doses estimated using published values for normal weight (>2500 g), very low birth weight (VLBW), and extremely low birth weight (ELBW) infants based on the median number of chest X-rays were 31.7 µGym, 84.66 and 232.75 µGy, respectively.Conclusions: Conventional radiography remains a key diagnostic tool in neonatology particularly in VLBW and ELBW infants and is invaluable in supporting timely clinical decision making. Clinicians should be aware of the cost and potential hazards of neonatal radiography and is recommend that the cumulative radiation exposure among the ELBW and VLBW infants is monitored. Increasing awareness and standardisation of point-of-care ultrasonography could decrease the reliance on conventional radiography in neonatal units.