2nd Irish Congress of - IMJ



2nd Irish Congress of

Obstetrics, Gynaecology

and Perinatal Medicine

Irish Perinatal Society (IPS)

Notes

A RANDOMISED CONTROLLED TRIAL OF POLYETHYLENE BAG AND EXOTHERMIC MATTRESS VERSUS POLYETHYLENE BAG ALONE FOR THERMOREGULATION IN PRETERM INFANTS IN THE DELIVERY ROOM: THE BAMBINO TRIAL (ISRCTN31707342)

Authors

Lisa McCarthy (The National Maternity Hospital, Dublin)

Abstract

Hypothermia on NICU admission is associated with increased mortality in preterm infants. While polyethylene bags (PB) increase mean temperature, many infants remain cold despite their use. Using an exothermic mattress (EM) in addition to a PB may reduce the rate of admission hypothermia. The objective of this randomised controlled trial was to determine whether placing newborn very preterm infants in PB on an EM results in more infants with rectal temperature 36.5 – 37.5°C on admission to NICU.

Infants < 31 weeks' were eligible for inclusion, infants with major congenital anomalies were ineligible and written parental consent was obtained before enrollment. Randomisation was stratified by gestational age ( 37.5°C [17/37 (46%) v 6/35 (17%), p= 0.009] on admission to the NICU (Table 1). 

In newborn very preterm infants, using EM in addition to PB in the DR resulted in more infants with temperatures outside the normal range and more hyperthermia on admission to NICU.

A RANDOMISED TRIAL OF SINGLE NASAL PRONG OR FACE MASK FOR RESPIRATORY SUPPORT FOR PRETERM INFANTS IN THE DELIVERY ROOM (ISRCTN59061709)

Authors

Lisa McCarthy (The National Maternity Hospital, Dublin)

Abstract

The International Liaison Committee on Resuscitation recommends that newborns with inadequate breathing or a HR 7.20. Only 1/15 babies required admission to the neonatal unit and this was for unrelated reason (post birth trauma)

The results demonstrated inappropriate use of scalp pH in 12/20 cases being performed unnecessarily on normal or suspicious traces. This highlighted the importance of further education on NICE guidelines within the unit and of the on-going multidisciplinary CTG meetings to improve concordance in assessments.

1. National Institute for Health and Clinical Excellence (2008) [Intrapartum Care CG55]. London: National Institute for Health and Clinical Excellence.

AUDIT OF THE MANAGEMENT OF OBSTETRIC CHOLESTASIS

Authors

Katie Johnston (Guidelines and Audit Implementation Network (GAIN)), Dr Caroline Bryson (Ulster Hospital Dundonald)

Abstract

A region-wide retrospective audit looking at patients with a diagnosis of Obstetric Cholestasis (OC) was carried out across Northern Ireland. We looked at the current diagnosis, management and outcomes of patients with OC, with reference to the Royal College of Obstetricians and Gynaecologists (RCOG) guideline. OC is a rare diagnosis, therefore a regionwide audit made it possible to identify sufficient numbers to look at management and outcomes. 

For the period January to December 2010, patients were identified through the coding department with a diagnosis of OC (ICD-10 Q26.6). Charts were also identified through the laboratory system looking at abnormal bile acids and liver function tests. Proformas were completed using criteria from the RCOG guideline.

87 proformas were included. Less than half the charts had a coded diagnosis of OC. The majority of patients were diagnosed in the third trimester, although 22 patients did not have a clear diagnosis. 80/87 patients had bile acids sent, with 61 elevated results. To exclude other diagnoses, 36% had a viral screen, 27% had an auto-immune screen and 27% had a liver ultrasound. Regarding management, 62 patients had outpatient monitoring. 47 patients had treatment with ursodeoxycholic acid, with 57% of these showing subsequent improvement in liver function tests. 77% of patients were delivered >37 weeks. Looking at those electively delivered primarily for OC, gestation ranged from 35-40 weeks. Of these patients there were 49 inductions, 11 emergency caesareans and 10 elective caesareans. 11/87 patients had infants admitted to neonatal intensive care, and there was one intrauterine death due to OC. 55% had follow-up liver function tests and only 5/87 had postnatal counselling.

This audit has identified the need to accurately diagnose this condition and record this in the notes to allow accurate incidences to be calculated. There is improvement to be made in excluding other causes of abnormal liver function tests to secure the diagnosis of OC. Once the diagnosis has been made, it will allow appropriate decisions to be made regarding treatment, timing of delivery and patient counselling. Follow up and counselling of patients needs to be greatly improved.

CAESAREAN HYSTERECTOMY IN THE BELFAST TRUST FOR PLACENTA PRAEVIA/ACCRETA & UNCONTROLLABLE HAEMORRHAGE OVER THE LAST 12 YEARS – A RETROSPECTIVE AUDIT

Authors

Claire Thompson, Jayne Creighton, William Forson (Royal-Jubilee Maternity Service, Belfast)

Abstract

Caesarean Hysterectomy can be a life saving procedure in the event of uncontrollable haemorrhage 1. With the increasing Caesarean Section rate it is becoming more frequent with the subsequent increase in abnormal placentation 1. It remains, however, a potentially difficult procedure with significant maternal morbidity and possible mortality 2. This audit aimed to identify the current incidence of caesarean hysterectomy in the Belfast Trust along with aspects of antenatal, operative and postoperative management. 

This was a retrospective audit. An electronic search was carried out and cases from January 2000 to August 2012 retrieved. Cases of uterine rupture were excluded. Cases involving post partum haemorrhage, placenta praevia & accreta were included. Data extracted using proforma. Standards set against the RCOG GreenTop Guideline 2011 for management of placenta praevia/accrete. 

Twenty seven cases were found which met the inclusion criteria over the last 12 years, 52% of which occurred from years 2008 to 2012.  Demographics of patients showed that 41% were Para 1 or less and that 81% had a previous Caesarean section (50% of which having had only one previous C/Section). Antenatal MRI was not widely available, however 5 patients did have this study with a positive & negative predictive rates of placental invasion at 100%. Thirty-three percent of cases had an antenatal USS comment regarding placental invasion - of these there was a positive predictive rate of 100% but a negative predictive value of 40%. There was 1 case of undiagnosed praevia.There were 44% of cases carried out as an emergency. Antepartum haemorrhage occurred in 56% - with 7 out of 15 cases requiring emergency delivery. Total Abdominal Hysterectomy was performed in 41%, however 30% of cases also required an oophorectomy. A consultant was present at time of incision in 67% and a Gynae Oncology consultant was involved in 81% of cases. The time interval for decision to proceed to hysterectomy was made in under 60 mins in 52% of cases. There were 6 cases where initial haemostasis was achieved but the patient was returned to theatre for hysterectomy. Total estimated blood loss varied greatly, however 67% involved EBLs of over 4000mls and 37% of cases required admission to HDU/ICU. Blood transfusion was required in all but one case and 44% required between 10 and 20 units of packed red cells. Pathology results confirmed abnormal placentation in 63% of cases. 

This audit highlights the increasing incidence of Caesarean hysterectomy in particular with cases of abnormal placentation. Pre-operative radiology can be helpful in detecting placental invasion and subsequently in organisation of operative management. Many of these cases remain technically difficult with high intra-operative blood losses and patients requiring initial high dependency care. This audit hopes to highlight possible ways of improving overall management in particular antenatal detection and operative planning in the future. 

References

1. RCOG Green-Top Guideline Number 27. Placenta praevia, accrete and vasa praevia: diagnosis and management. RCOG London 2011.

2. Confidential Enquiries into Maternal and child Health. Saving mothers Lives 2006-2008. RCOG Press 2011.

CHILDHOOD HOSPITAL ADMISSIONS OF CHILDREN CONCEIVED VIA ASSISTED REPRODUCTIVE TECHNOLOGY

Authors

Mark McComiskey (Queen's University Belfast / Belfast HSC Trust), Mike Stevenson (Queens University, Belfast), Inez Cooke (Queen's University Belfast / Belfast HSC Trust)

Abstract

Relatively scarce but conflicting evidence exists regarding frequency of hospital admissions and utilization of hospital services of children conceived via assisted reproductive technology. Subsequent paediatric health of these children is an important aspect when counselling potential parents prior to commencing ART. The health status of these children also has service management and financial implications for healthcare providers. The purpose of this project was to compare paediatric hospital admission rates of children conceived via assisted reproductive technology with that of the population as a whole.

A retrospective cohort study was constructed using a consent-based registry to identify and follow-up children born via ART. Information on all paediatric hospital admissions from 1st July 1996 through 30th June 2009 within Northern Ireland was collated. Register and admission records were linked and comparisons made between admission rates in the general population and the ART cohort by calculation of standardised admission ratios (SAR's). The project was performed in accordance with HFEA regulations and had ethical approval.

Children conceived via ART had a significantly lower rate of hospital admissions (all admissions and first hospital admissions) than that of the population as a whole. Children born following ICSI had fewer total hospital admissions than their IVF peers, the difference did not persist when first admissions were analysed. Different-sex twins, but not twins overall, had lower total hospital admissions than singletons. No difference between ART males and females was identified. These findings can be used to reassure couples prior to commencing assisted reproductive treatments.

CLINICAL INFORMATION SUCCESS IN A MATERNITY HOSPITAL

Authors

Louise Reid, Sandra O'Connor (University Regional & Maternity Hospitals), Ita Richardson (University of Limerick), Jennifer Hogan (University College Dublin), Theresa O'Donnoghue, Roy Philip (University Regional & Maternity Hospitals), Gerard Burke (Perinatal Ireland Research Consortium)

Abstract

Clinical staff must have access to high quality information in order to provide safe care to patients. This cannot be provided by clinical information systems (CIS) that are not correctly managed and regularly used. Ensuring the success of CIS in the healthcare environment presents a particular set of difficulties. This paper describes an action research study aimed at improving information success in a maternity hospital.

Following a literature review and an in-house observational case studies, a generic model for a hospital quality assurance program (HQAP), was developed and applied. Modifications to improve the model for use in the clinical environment were applied, resulting in reliable and comprehensive data being made available to clinicians in a timely manner. This was achieved by optimising the in-house Obstetric Management CIS (OMCIS) and by developing a dashboard system, which highlights the most critical interventions and outcomes. A set of organisational benefits and key performance indicators, influenced by the Delone-McLean model [1], were developed to measure the success of OMCIS.

Table 1 provides an overview of the improvements to the OMCIS following implementation of the model. Some organisational benefits have been achieved. The publication of an annual clinical report remains on schedule. A number of items, such as breast-feeding rates, have been identified for improvement. The organisational benefit score increased from 0% to 50% and the performance indicator score increased from 7% to 95%, giving an overall combined score of 72.5%.

Table 1 OMCIS Organisational Benefits

|  |Organisational Benefits and Performance Indicators|Score Prior to |Score Following |

| | |Intervention |Intervention |

|Organisational Benefits |Annual report (25%) |0% |0% |

| |Assurance that obstetric management is efficient |0% |25% |

| |(25%) | | |

| |Quality shortfalls in obstetric management flagged|0% |25% |

| |(25%) | | |

| |Information is actioned in a timely manner (25%) |0% |0% |

|Total |Organisational Benefit Score |0% |50% |

|KPI 1 Governance established |Data entry (5%) |5% |5% |

|for: | | | |

| |Data retrieval (5%) |0% |5% |

| |Technical management (5%) |0% |5% |

| |Data dissemination (5%) |0% |5% |

|KPI 2 Supports in place for |Entering data (5%) |0% |5% |

|staff: | | | |

| |Retrieving data (5%) |0% |5% |

| | Generating reports(5%) |0% |5% |

| |Disseminating reports (5%) |0% |5% |

|KPI 3 Quality and accuracy of |10% of data reviewed (10%) |0% |10% |

|data: | | | |

| |>95% accuracy (10%) |0% |10% |

|KPI 4 Report availability: |All reports available within an acceptable |0% |5% |

| |predefined timeframe (20%) | | |

|KPI 5 Information from reports |Action where data quality low (5%) |0% |5% |

|is used: | | | |

| |Action where information quality low (5%) |0% |5% |

| |Action where user satisfaction indicates. (5%)  |0% |5% |

| | All reports actioned where clinical quality low |0% |0% |

| |(5%) | | |

|Total |Performance Indicator Score |7% |95% |

|Overall Total |Organisational Benefits/Performance Indicators |3.5% |72.5% |

Application of the model resulted in a decrease in the amount of re-inputting of data into the OMCIS by staff members and an increase in the completeness, timeliness and accuracy of the data. Most importantly, valid data are now readily available with potential to inform improvements in patient care. 

1. Delone WH, McLean E, The DeLone and McLean model of information systems success: A ten-year update. JMIS. 2003 Spr;19(4): 9-30.

COMPARISON OF INTRA-OPERATIVE COMPLICATIONS OF CAESAREAN-SECTION (PRIMARY PPH) BETWEEN ELECTIVE & EMERGENCY, DAY & NIGHT CS

Authors

Irum Farooq, Miriam Doyle (Midlands Regional Hospital Portlaoise)

Abstract

Caesarean-section is a common operative procedure. The latest publication from the National Perinatal Reporting System shows that CS rate, which was 10.6% in 1990, rose to 25.9% in 2008 in Ireland.Obstetric hemorrhage remains one of the major causes of maternal death both developed and developing countries. Primary postpartum hemorrhage (PPH) is the most common form of major obstetric hemorrhage. The definition of primary PPH is the loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby. PPH can be minor (500–1000 ml) or major (more than 1000 ml). Major could be divided to moderate (1000–2000 ml) or severe(more than 2000 ml).The objective of this study is to assess the rate of intraoperative primary PPH more than 1000ml related to caesarean section and to compare morbidity between elective ,emergency ,day time ,night time.To establish risk factors associated with maternal CS morbidity. Data was collected prospectively from 01/08/2011 to 30/10/2011 ,total 146 patients had Caesarean-section in 3 months in Midland Regional Hospital Portaloise. Data was analysed with Microsoft excel. 

Results

Among 146 patients ,22.6% had PPH .79% had PPH in emergency CS and 21% in elective CS.Similarly PPH was high at night time(19:00-7:00), 64% as compared to 36% in day time (7:00-19:00). Cause of PPH was atonic uterus in 12 patients, uterine inversion in 1 patient , fibroid & septum uterus 1 patient while in 19 patients no cause was found probably bleeding was from angles & vessels.3 patients required blood transfusion and 2 of them needed ICU care. Risk factors for PPH were BMI >30,Previous CS ,Twin pregnancy , Breech in labour ,Placenta previa ,failed induction ,CS at 2nd stage . Conclusion: Proportion o f Emergency caesarean-section need to be reduced either in favour of Elective-CS or by allowing instrumental delivery.Prefer to do at day time because more seniors are involved .Complications increase hospital stay and have financial implications as well.

References

1- Prof Michael Turner,Caesarean section rates, 09/03/2011. RCPI.

2- RCOG Guideline,Prevention and management of postpartum haemorrhage, may 2009.

COMPLICATED SEQUELAE OF PARVOVIRUS AFFECTED PREGNANCIES

Authors

Karen Flood, Naomi Burke, Sieglinde Mullers, Fergal Malone (Rotunda Hospital)

Abstract

During the recent epidemic of Parvovirus infection, three complicated pregnancies were managed in the Rotunda Hospital. The fetuses were significantly affected in all three cases, presenting with ultrasonographic findings consistent with severe anemia; all required intra-uterine fetal transfusions. 

Case 1

The first case involved a 30 year old multip who presented at 20 weeks with severe fetal hydrops and a history of Parvovirus exposure. Severe fetal thrombocytopenia was noted at the time of cordocentesis. Repeated intrauterine transfusions were required however fetal cardiac function deteriorated further which resulted in fetal demise. 

Case 2

The second cases involved a 32 year old multip with confirmed Parvovirus infection who was referred with severe fetal hydrops. Severe thrombocytopenia was again noted however a successful fetal transfusion was performed. Unfortunately the mother subsequently developed Ballantyne (Mirror) syndrome which resolved with expectant management. 

Case 3 

The final case involved a 28 year old multip with a dichorionic twin pair both of which were severely anemic with similar haematocrit levels at cordocentesis. Both twins received the same treatment course however different outcomes were encountered. 

This case series demonstrates the various complications that add further challenging features to the management of pregnancies affected by Parvovirus infection.

CONTEMPORARY MANAGEMENT AND OUTCOMES OF TWIN PREGNANCIES AT A LARGE TERTIARY REFERRAL CENTER

Authors

Mark Philip Hehir, Stephen Carroll, Rhona Mahony (National Maternity Hospital, Dublin)

Abstract

We sought to investigate contemporary management and outcomes of all twin pregnancies in both nulliparous and multiparous patients over an 11-year period.

This was a prospective observational study carried out at a tertiary referral center from 2001-2011. Details of maternal demographics, intrapartum characteristics and outcomes were recorded for analysis.

During the study period there were 93,241 deliveries at the hospital. There were 1457 twin pregnancies > 24 weeks gestation, of these 736 were in nulliparas, giving an incidence of 1.7/100 nulliparous pregnancies. When nulliparous twin pregnancies were examined, the mean maternal age was 31.7 ± 5.4 years. A total of 66.4% of women (489/736) required caesarean delivery. Approximately 29% (212/736) of twins underwent elective caesarean delivery and a further 262 (35.5%) sets of twins required emergency caesarean delivery, finally 5.7% (15/262) required caesarean delivery of the 2nd twin after vaginal delivery of the first infant. The rate of induction of labour was 25.4% (187/736). Approximately 17.5% (89/509) of babies had a vaginal breech delivery and 25.5% (130/1472) required instrumental delivery. Of the liveborn infants 53 (3.7%) had an Apgar of 24 weeks gestation, giving an incidence of 1.4/100 multiparous pregnancies. The mean maternal age was 33.5 ± 4.8 years, the median parity was 1 and 161 mothers (22.3%) had at least 1 previous Cesarean delivery. A total of 41.8% of women (302/721) required caesarean delivery. Approximately 25% (184/721) of twins underwent elective caesarean delivery and a further 106 (14.7%) sets of twins required emergency caesarean delivery, finally 2.8% (12/431) required caesarean delivery of the 2nd twin after vaginal delivery of the first baby. The rate of induction of labor was 32.1% (232/721). Approximately 16.7% (142/850) of babies had a vaginal breech delivery and 6.1% (52/850) required instrumental delivery. 26 infants (1.8%) had an Apgar of 90th centile was calculated.

Results

A total of 56 participants completed the study. The mean maternal age was 31 (±5.6 SD) and the mean BMI was 25.9 (±4.9 SD). A total of 784 FHC measurements were taken. The inter sonographer variation estimations approached zero. The intra-sonographer error, sensitivities and specificities for each gestational age were calculated. The sensitivity and specificity of a FHC measured at 40 weeks gestation for predicting a neonatal head circumference >90th centile was 79% and 23% with an intra-observer error of 1.01cm. 

Conclusion

It may be feasible to use the FHC as a valuable screening tool in predicting a neonate with a large HC and therefore the inherent risk this carries for an intrapartum caesarean delivery. A large prospective study should now be carried out to investigate the use of FHC as a screening tool for intra partum caesarean section. The sensitivity and specificity may be improved by combining the FHC with fetal and maternal anthropometric measurements associated with an increased risk of caesarean delivery.

FIVE YEAR RETROSPECTIVE REVIEW OF ANTENTAL LAMIVUDINE (LAM) TO REDUCE THE PERINATAL TRANSMISSION OF HEPATITS B VIRUS (HBV)

Authors

Amanda Ali, Kate Glennon (Rotunda Hospital), Barry Kelleher (Mater Misericordiae University Hospital), Eogan Eogan, Valerie Jackson, Marion Brennan, Mairead Lawless, Wendy Ferguson (Rotunda Hospital), John Lambert(Mater Misericordiae University Hospital)

Abstract

Vertical transmission of HBV is the main cause of chronic HBV infection and is a problem in endemic areas. Transmission can be prevented by vaccination of at risk-infants, but despite prophylaxis, perinatal transmission occurs in a small proportion of infants who receive complete active–passive immunization. High maternal viraemia has been associated with vaccination breakthrough. LAM treatment in HBV carrier-mothers with high degree of infectiousness in late pregnancy effectively prevented HBV intrauterine infection and mother-to-child transmission. [1] We conducted this study to review the safety and efficacy of LAM in reducing the perinatal transmission of HBV.

Medical charts of all HBV positive women who received treatment with LAM and who booked for antenatal care between 2007 and 2012 were retrospectively reviewed. Patients were offered treatment when the viral load was >20-100million IU/ml with no hepatitis co-morbidities and no evidence of decompensated liver disease. 

Between 2007 – 2012, 34 pregnant HBV positive women received treatment with LAM during the third trimester. All patients were HbeAg positive, and 6/34 were anti-HbCore IgM positive, indicative of acute infection. Where tested, the predominant genotypes were B and C, occurring in 16/33 and 11/33 cases respectively. Genotype D was noted in 4/32 women (all Eastern European). One woman in the cohort was co-infected with Hepatitis C. The median baseline Viral Load (VL) was > 170million IU/ml, and patients received a median of 12 weeks LAM (range 6-18 weeks). The median VL closest to delivery was 285,917.5 IU/ml. No resistance to LAM was identified in the 70% who had this assay performed post treatment. The median gestation at delivery was 39 weeks (range 37 – 41 weeks); 17/33 had a normal vaginal delivery, 5/33 had an instrumental delivery, 9/33 had a C section (2 elective, 7 emergency) and 2 delivered elsewhere. . Median birth weight was 3.49kg (range 2.33-4.72kg). All babies received HBV IgG and the first dose of vaccine within the first 24hours of life. Of 33 live born infants, 17 were not infected, 8 left the country prior to the 8-month serology test, 6 have serology pending (not yet 8 months) and 2 were lost to follow up.

Treatment with LAM is a safe and effective. No vertical transmission of HBV was noted, and no adverse maternal or fetal effects were reported. 

[1] Obstet Gynecol. 2010 Jul;116(1):147-59. Lamivudine in late pregnancy to interrupt in utero transmission of hepatitis B virus: a systematic review and meta-analysis.Shi Z, Yang Y, Ma L, Li X, Schreiber A.Department of Chemistry and Biology, Temple University 

GESTATIONAL WEIGHT GAIN ACCORDING TO BMI AT THE NATIONAL MATERNITY HOSPITAL

Authors

Maria Kennelly (Mid-West Regional Maternity Hospital, Limerick), Sorca O'Brien (National Maternity Hospital, Dublin), Fionnuala McAuliffe (University College Dublin)

Abstract

Excessive gestational weight gain is associated with increasing incidence of adverse pregnancy outcomes such as pre-eclampsia and large for gestational age (LGA) infants. Excessive weight gain is also associated with post partum weight retention which puts women at increased risk of long-term morbidity from cardiac, metabolic and neoplastic diseases. 

The aim our study was to determine the average measured gestational weight gain according to BMI amongst women who attended the National Maternity Hospital and compare this average gestational weight gain to those recommended by the Institute of Medicine.

This was a retrospective review of the charts of 100 consecutive women who delivered in January 2011 at the National Maternity Hospital. It is standard for each pregnant woman to be weighted at each antenatal visit. 

A total of 100 women's charts were reviewed retrospectively. The mean gestational age of first measured weight was 11 weeks (range 9-15). Of these, 2% were in the underweight group for BMI, 60% were classified as being in the normal BMI range, 34% in the overweight range and 4% in the obese group. Overall the average gestational weight gain was 12kg and weekly weight gain was 0.4kg/week, The average gestational weight gain amongst the 3 groups were as follows: BMI 30, 11.5 kg, 0.4kg/week

Women in the underweight, normal and overweight BMI category adhered to international institute of medicine guidelines with respect to gestational weight gain. Patients in the obese group exceeded this.

HAEMATOLOGICAL INDICES IN PREGNANCY: AN IRISH TERTIARY CENTRE EXPERIENCE

Authors

Claire McCarthy (Cork University Maternity Hospital), Mary R. Cahill (Cork University Hospital), Keelin O'Donoghue (Cork University Maternity Hospital)

Abstract

Physiological and haematological changes occur during pregnancy to accommodate maternal and fetal needs, and normal ranges are altered for haematinics and haemoglobin. Normal results in pregnancy may be thus mis-interpreted as pathological. International guidelines recommend minimum haematological sampling at booking (0-14 weeks) and 28 weeks. 

We conducted a retrospective audit of randomly selected antenatal charts, between January and April 2012. Data collected included haematological indices through pregnancy and for one week post-partum, supplement use and patient demographics.

Our sample group included 176 women, with a total of 757 investigations performed. There were 100 vaginal deliveries, 76 caesarean deliveries, and 3 post-partum haemorrhages. Birth weights ranged from 2.37kg to 4.9kg and gestational age at delivery from 35 to 42 weeks. 155 patients had more than 2 sets of haematological investigations during pregnancy, with 83 patients having more than 5 separate haematological samples taken. 39.7% had haematinic investigations performed, with 8 of these patients had sub-optimal ferritin levels. Only 3 patients were defined as anaemic (haemoglobin 24 hours) (PPROM) and preterm labour( PTL) .

METHOD

Prospective study of all non-anomalous singleton preterm deliveries < 34 weeks gestation over 4.5 years (2008-12) at NMH.. In utero transfers were excluded.

Results

Among 42,455 mothers there were 385 preterm births ( 0.9%) : materno-fetal fetal -169(0.4%),PPROM -104( 0.2%) and PTL-112( 0.3%) . Overall 17 (0.4%) of preterm births had a previous LLETZ procedure . The incidence of previous LLETZ by category of preterm birth was:- materno fetal ( 0.6%) and was significantly greater for both PPROM (7%) and PTL (8%). (P0.05; NS; n=6). Plasma sLOX-1 concentration and omental vessel LOX-1 expression were not significantly different in any group. Incubation of normal pregnant vessels in PE plasma impaired relaxation to bradykinin (BK) when compared with vessels incubated in NP plasma (Rmax 50 ± 3% vs. 96 ± 1%; P ................
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