An app for assessing the risk of Thrombosis in pregnant women, how to predict the need for an emergency caesarean delivery using simple fetal measurements like fetal head circumference, and how to screen more efficiently for Group B Streptococcus in pregnancy are just some of the exciting and innovative projects being presented at the Rotunda Hospital Research Day on June 2nd 2016.
The Rotunda Hospital is the oldest working maternity hospital in the world and the vision and innovation that underpinned the foundation of the hospital has continued to this day, allowing us to deliver the best quality of care to generations of patients.
The Rotunda Hospital Research Day is a showcase for that vision and for the researchers that follow in that 270 year old tradition. The research being conducted in The Rotunda Hospital answers important questions about conditions like Preeclampsia, Thrombosis and Group B Streptococcus and will help improve the lives and care of parents and children in Dublin, Ireland and around the world.
Dr Jennifer Donnelly, Consultant Obstetrician and Gynaecologist will be presenting The Rotunda Hospital’s award winning risk assessment app for Venous Thromboembolism (VTE), THROMBOCALC. Thrombosis is the leading cause of maternal death worldwide, and most women who died from pregnancy associated VTE between 2011 and 2013 had recognizable risk factors for thromboembolism.
Many of these deaths may have been prevented if VTE risk assessment had been performed and appropriate anticoagulation prescribed. THROMBOCALC is a user-friendly app that ensures all women delivering within the Rotunda Hospital are appropriately assessed for VTE risk and thereby improve the prevention of VTE in these women.
Consultant in Obstetrics and Gynaecology Dr Maeve Eogan, and Consultant Microbiologist Dr Richard Drew, will each discuss the advances their research is making in screening for and treating Group B Streptococcus, an infection which is the most common cause of meningitis in new-borns.
In collaboration with The Friends of the Rotunda, Consultant Neonatologists, Prof Naomi McCallion and Dr Afif El-Khuffash will present a flavour of Rotunda neonatal research and take a look at the impact that public donations are having on the standard of neonatal care and research in the Rotunda Hospital. Recently, the Friends of the Rotunda secured funding for new state-of-the art echocardiography equipment for the Neonatal Unit. This ‘ECHO’ equipment provides information about neonatal cardiac health in real time for neonatologists and helps conduct novel research in the field of neonatal cardiovascular medicine. It provides a better way to care for our sick infants today and ensures we continue to make progress for tomorrow. As part of this session, we will hear from Louise, a Rotunda mum who has directly benefitted from being part of a recent Rotunda researchproject.
Dr Naomi Burke, Consultant Obstetrician and Gynaecologist, will be presenting results from Perinatal Ireland’s GENESIS Study. The GENESIS study looked into new ways to predict if a pregnant woman would require an emergency caesarean section by investigating whether simple fetal ultrasound measurements could be an accurate indicator of what patient is more at risk of needing an emergency caesarean section. Prior to the GENESIS study accurate prediction of this risk was limited however, the study concluded that fetal head measurements combined with five other measurements including advancing maternal age, maternal height and higher body mass index were the best combined predictors of caesarean delivery.
Additionally, Dr Fionnuala Ni Ainle, Consultant Haematologist and Prof Fionnuala Breathnach, Consultant in Obstetrics and Gynaecology will discuss aspects of their research dealing with Preeclampsia. Dr Ni Ainle will discuss the role of blood coagulation mechanisms in this condition, and Prof Breathnach will explore the impact of Low Dose Aspirin in prevention of Preeclampsia in diabetic patients as investigated in the HRB Mother and Baby Clinical Trials Network’s IRELAND trial. Consultant in Infectious Diseases, Prof Jack Lambert, will discuss new treatments for Hepatitis C and the work of the DOVE (Danger of Viral Disease) Clinic, and Dr Karen Flood, Consultant in Obstetrics and Gynaecology, will talk about the rise of Non Invasive Prenatal Testing in the Rotunda Hospital and in Ireland.
Director of Research and Academic Affairs, Dr Joanna Griffin said of the day;
“We are delighted to showcase the exciting and innovative research projects that are taking place at The Rotunda Hospital. It is especially encouraging to see the outputs of our research contributing to improvements in patient care at The Rotunda, nationally and internationally.”
Commenting on the range of research outputs, Master of the Rotunda, Prof Fergal Malone said;
“It is both heartening and exciting to see such dynamic research outputs being developed and disseminated from the Rotunda. The multi-disciplinary aspect of the research teams draws on the expertise of our world-class clinical researchers while benefiting from the hospital organisation and patients of the Rotunda to deliver cutting edge research results that will continue to have major international impact”.
For more information, please contact Cormac McAdam at cormacmcadam@rcsi.ie or 00353 87 232 9101
About The Rotunda Hospital
In 1745 Bartholomew Mosse founded the original Dublin Lying-In Hospital as a maternity training hospital in George’s Lane. The hospital was a unique institution in that it was the first of its kind. The hospital moved to its current premises on Parnell Square in 1757 where it became the “The New Lying in Hospital”. Today, the hospital is simply known as “The Rotunda” and remains an independent, voluntary organisation operating under Charter with an independent Board of Governors and executive management team led by the Master of the Rotunda. The ethos and core values of its founder are still at the heart of the hospital and this is demonstrated through the care and dedication of the staff and the Board of Governors of the Hospital. Over time the hospital has evolved into a 198 bed teaching hospital which provides specialist services in order to support women and their families at a local, regional and national level.
Specialist Services at The Rotunda Hospital include advanced fetal diagnosis and therapy, minimally invasive gynaecologic surgery, neonatology, colposcopy, community midwifery services, and the Sexual Assault Treatment Unit.
The specialist services provided by The Rotunda Hospital are fully supported by a range of subspecialist services such as Anaesthetics, Haematology, Radiology, Psychiatry, and Allied Health Services within the Hospital and joint services such as Cardiology, Endocrinology, Gastroenterology, Infectious Diseases with acute adult hospitals.
Rotunda Hospital Research Day – Selected Talk Summaries
WHY GUESS WHEN WE CAN TEST? Feasibility and impact of screening for Group B Streptococcus at Labour Onset
Dr Maeve Eogan
Consultant in Obstetrics and Gynaecology, Rotunda Hospital
The Rotunda Hospital is currently conducting a pilot study assessing how and when we test for Group B Strep – specifically at the onset of labour. If we can test for GBS quickly and reliably when labour begins, as close as possible to the optimum treatment period, we will be able to properly treat pregnant women with GBS and reduce the risk of infection for their new-borns – but also, we will be able to reduce the use of unnecessary antibiotics for those whose GBS has disappeared by the time of birth.
Group B Streptococcus (GBS) is a common bacterium and approximately one in 4 women in Ireland carry GBS. It usually causes no symptoms, so most women are unaware that they carry GBS. And importantly, GBS carriage may come and go. The risk of GBS being passed from a mother to a baby is highest during labour. For that reason, the treatment course of antibiotics is only given after labour begins.
A positive test for GBS during pregnancy doesn’t necessarily mean a pregnant woman will have GBS at the time of birth, and also conversely a negative test during pregnancy doesn’t mean a pregnant woman won’t have GBS at the time of birth. At the moment, pregnant women who test positive for GBS during pregnancy receive an antibiotic treatment, even though the GBS may have gone by labour. Testing for GBS at the onset of labour reduces this unnecessary antibiotic use, and provides better outcomes for women with GBS and their children.
TROMBOCALC: Personalised Postpartum Venous Thromboembolism Risk Assessment
Dr Jennifer Donnelly
Consultant Obstetrics and Gynaecology, Rotunda Hospital and Mater Misericordiae Hospital
Venous thromboembolism (VTE) is the formation of blood clots in the vein.It’s a leading cause of death and disability worldwide and also remains the leading cause of direct maternal death.
Strikingly, most women who died from pregnancy associated VTE between 2011-2013 had recognizable risk factors for thromboembolism. Many of these deaths may have been prevented if VTE risk assessment had been performed and appropriate anticoagulation prescribed
The Rotunda Hospital’s strategy to improve VTE prevention is to implement a user-friendly app, called Thrombocalc, to ensure all women delivering within the Rotunda Hospital are appropriately assessed for VTE risk and thereby improve the prevention of VTE in these women.
From September 2014 through December 2015, Thrombocalc was used to prospectively assess VTE risk in 8,322 women. In the last quarter of 2015, formal VTE risk assessment with Thrombocalc was carried out in 92% of women delivering in the Rotunda Hospital.
The Thrombocalc project won the HRB Healthcare Innovation Award at the IMSTA Med-Tech awards 2015 and earned an Honourable Mention in Center for Disease Control HA-VTE Prevention Challenge 2015.
THE IRELAND STUDY: Investigating the role of early low dose aspirin in pre existing Diabetes
Prof Fionnuala Breathnach
Consultant in Obstetrics and Gynaecology
RCSI, Rotunda Hospital
Pre-eclampsia is a condition that affects 2-8% of pregnancies. It causes increased blood pressure in pregnancy and protein in the urine which can cause eclampsia (seizures). Internationally it is a major cause of poor outcome in pregnancy for both mother and baby. Women who have pre-gestational diabetes are at higher risk for pre-eclampsia and fetal growth restriction due to the kidney damage associated with diabetes.
Low dose aspirin may have a role in the prevention of pre-eclampsia – especially in high risk women but studies so far have yielded conflicting results. Initial studies suggest a protective effect but few studies investigate the role of aspirin in preventing preeclampsia specifically in women with diabetes.
The HRB Mother and Baby Clinical Trials Network’s IRELAND pilot study led by Prof Fionnuala Breathnach aims to answer the question; does low-dose aspirin therapy in pregnancy carry the potential to optimise pregnancy outcome in this high-risk group?
GENESIS: How to Predict Caesarean Delivery in the Nulliparous Patient
Dr Naomi Burke,
Consultant in Obstetrics and Gynaecology,
Rotunda Hospital
In contemporary obstetric practice the majority of women now require medical intervention for safe childbirth. Despite all of this obstetric intervention we cannot predict which women will experience the greatest of difficulties during labour.
The aim of the Perinatal Ireland GENESIS study is to investigate whether fetal head circumference either alone or in combination with other measurements or factors can identify women who might need an unplanned caesarean section once labour has begun. Previously there was no test which could predict who would require an emergency caesarean section. The study looked at certain patient information such as height and weight and the measurements of the baby between 39 and 40 weeks gestation to see if any of these measurements can be used in clinical practice to predict who would require a caesarean section or instrumental delivery.
Of the 2,336 women recruited to the Genesis Study, 21% had an unplanned cesarean delivery. In the analysis, five parameters were determined to be the best combined predictors of Caesarean Delivery. These were advancing maternal age, short maternal height, higher body mass index, a larger fetal abdominal circumference and increasing fetal head circumference. The study’s conclusion was that, by using these five factors, overall risk of Caesarean Delivery in women at term can be better determined.
The Impact of Donations on Neonatal Care
Prof Afif El-Khuffash
Consultant Neonatologist
Rotunda Hospital
In collaboration with The Friends of the Rotunda, Neonatology Department Head, Prof Afif El-Khuffash will explore the impact that donations from the public are having on the standard of Neonatal care and research in the Rotunda Hospital. Recently, the Friends of the Rotunda secured funding for a new state-of-the-art echocardiography machine for the Neonatal Unit. The ‘ECHO’ machine provides physiological information in real time for our neonatologists and helps conduct novel research in the field of neonatal cardiovascular medicine. It provides a better way to care for our sick infants today and ensures we continue to make progress for tomorrow. To explore the benefits of the new Echo machine, Prof El-Khuffash will be joined by Louise, one of the recent participants in the Hospital’s HANDLE study which is validating the effectiveness and ease of use of the new machine.