Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 – 2014; a descriptive study

Intrapartum fetal death, the death of a fetus during labour, is a tragic outcome of pregnancy. The intrapartum death rate of a country is reflective of the care received by mothers and babies in labour and it is through analysing these cases that good aspects of care, as well as areas for improvement can be identified. Investigating unexpected neonatal deaths that may be associated with an intrapartum event is also helpful to fully appraise intrapartum care. This is a descriptive study of intrapartum fetal deaths and unexpected neonatal deaths in Ireland from 2011 to 2014

Audit of antenatal clinic for high-risk obstetric patients; activity and outcomes

A specialised clinic for the antenatal care of high-risk patients was established in Cork in January 2004. It is led by 2 specialists in materno-fetal medicine and provides care for patients from a large catchment area. Small clinic numbers, specialised midwives, ready access to medical experts and fetal assessment facilities, facilitate an efficient use of resources. We report on the experience and outcomes of this clinic after the first year in operation. A database was set up to store relevant information on patients who attended the clinic in 2004. 143 patients attended. Risk categories included maternal medical disease (62%); multiple pregnancy (11%); previous poor obstetric history (10%); fetal anomaly (8%). Average gestation; 35.9 weeks, average birth weight; 2598g. Caesarean section rate; 41%. Perinatal mortality rate 67 per 1000 (uncorrected); and 20% neonates required NICU care. This approach to highrisk obstetric care resulted in favourable outcomes. The management strategy applied in Cork may be a suitable prototype for comparable areas throughout Ireland

Hyperemesis gravidarum: current perspectives.

Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum

Observation of the Josephson effect in Pb/(Ba,K)Fe2As2 single crystal junctions

We have fabricated c-axis Josephson junctions on single crystals of (Ba,K)Fe2As2 by using Pb as the counter electrode in two geometries, planar and point contact. Junctions in both geometries show resistively shunted junction I-V curves below the Tc of the counter electrode. Microwave induced steps were observed in the I-V curves, and the critical currents are suppressed with an in-plane magnetic field in a manner consistent with the small junction limit. ICRN products of up to 0.3 mV have been observed in these junctions at 4.2 K. The observation of Josephson coupling along the c-axis between (Ba,K)Fe2As2 and a conventional superconductor suggests the existence of a s-wave superconducting order parameter in this class of iron pnictide superconductors.Comment: 16 pages and 3 figure

Patient experience of the Electronic Health Record (EHR) in a maternity unit in Ireland

The introduction of the Electronic Health Records (EHRs) for maternity services in Ireland provided an opportunity to examine patient satisfaction and to examine what patients require from an Electronic Health Record. The implementation of the EHR in Ireland started in 2016, and at present, four of the 19 maternity units are digital. Patients at antenatal booking visits in an Irish maternity unit were invited to participate in the project. The invite was taken up by 201 women. The survey took 10-15 minutes to complete. The survey was conducted nine months following the implementation of the MN-CMS. The survey was anonymous and was divided into three distinctive sections; participant information, regarding the staff encounters on their visits and questions about the new system. 70% of participants rated their overall consultation from very good to outstanding. 73% of participants believe the computer system will ensure quality of care. Participants believe their personal information is safe (65%) in the new computer system. Over 75% of participants did not have any concerns regarding the new computer system. Eighty-one percent of participants noted that they would like access online to their charts and 91% of these respondents would like access to the full chart. Patients in this study were very receptive to the introduction of EHR and noted that it would be beneficial for their care. They also noted the impact the EHR could have on clinic time and interactions with staff. However, patients require access to their charts this they believe would provide them with ownership of their health. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland

Background: The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2–10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation. Objectives: In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005–2013; and to describe the causes, interventions and outcomes of PH cases during 2011–2013. Study design: For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland’s Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases. Results: In 1999–2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005–2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011–2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases. Conclusions: The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high

Sedimentary aggregates in the Peoria Loess of Nebraska, USA

Loess grain size data used to infer transport direction or wind strength are generally derived from vigorously disaggregated samples. However, these data may not adequately represent the effective particle size distribution during loess transport, if the transported dust contained aggregates of fine-grained material. Thin sections of minimally altered C and BC horizons in the late Pleistocene Peoria Loess of Nebraska, USA, indicate the presence of aggregates with diameters of 30–1000 Am. The larger aggregates (\u3e250 μm) are unlikely to have been transported, and are interpreted as the result of soil faunal activity and other pedogenic processes after deposition. Aggregates smaller than 250 Am could have a similar origin, but laser diffraction particle size analysis suggests that many are sedimentary particles. Comparison of minimally and fully dispersed particle size distributions from each sampling site was used to estimate the modal diameter of aggregates. The aggregate modal diameter becomes finer with decreasing loess thickness, representing increasing distance from the source. A similar trend was observed in the modal diameter of fully dispersed particle size distributions, which represents the mode of sand and silt transported as individual grains. We interpret both trends as the result of sorting during transport, supporting the interpretation that many of the aggregates were transported rather than formed in place. Aggregate content appears to increase with distance from the source, explaining a much more rapid downwind increase in clay content than would be expected if clay were transported as particles smaller than 2 Am diameter. Although the Peoria Loess of Nebraska contains sedimentary aggregates, many of the coarse silt and sand grains in this loess were transported as primary particles, were thoroughly exposed to sunlight and are potentially well suited for luminescence dating

Elliptical-core two mode fiber sensors and devices incorporating photoinduced refractive index gratings

Results of experiments performed using germanium-doped, elliptical core, two-mode optical fibers whose sensitivity to strain was spatially varied through the use of chirped, refractive-index gratings permanently induced into the core using Argon-ion laser light are presented. This type of distributed sensor falls into the class of eighted-fiber sensors which, through a variety of means, weight the strain sensitivity of a fiber according to a specified spatial profile. We describe results of a weighted-fiber vibration mode filter which successfully enhances the particular vibration mode whose spatial profile corresponds to the profile of the grating chirp. We report on the high temperature survivability of such grating-based sensors and discuss the possibility of multiplexing more than one sensor within a single fiber

Irish inquiry reports relating to perinatal deaths and pregnancy loss services

Aims: External inquiries are carried out following specific adverse events in healthcare, many in maternity care; to identify issues and make recommendations to improve standards of care. Methods: Ten publically-available national inquiry reports published between 2005-2018 relating to pregnancy loss services, were reviewed by 2 clinicians, separately, examining the content and recommendations from each report. Results: A total of 258 recommendations were made in 9 reports (90%). Five inquiries (50%) clearly stated that affected families were involved and four (40%) involved affected clinical staff. In 9 reports (90%) recommendations included: increase workforce staffing and/or training, strengthen clinical governance, enhance adverse incident management and comprehensive data collection e.g. maternity outcomes. Only two inquiry reports (20%) stated that feedback was sought from key stakeholders prior to publication. Conclusion: A collaborative and standardised inquiry process involving and supporting all persons affected as well as key stakeholders would ensure that all relevant issues are identified, recommendations are implemented and essential lessons are learned