You are very welcome to the 25th edition of the Rotunda GP-Connect E-zine. In this issue Dr. Richard Duffy who is our consultant Perinatal Psychiatrist gives a detail review of the Perinatal Mental Health Services here in the Rotunda. He includes the criteria, the pathway and the referral content and we are very happy that we are able to offer care to woman from booking until a year after they have had their baby. There are a range of issues that can result in women requiring Perinatal Mental Health Services. There is a comprehensive list of services that are commonly used by the Perinatal Mental Health Team and these are given at the end of Dr. Duffy’s review.
On a related topic Ms. Nicole Maiorano who works with the Trinity Centre for Global Health has an informative piece on trauma informed care. The Rotunda Hospital has provided money to get a research programme started in the hospital in conjunction with the Trinity College Centre for Global Health. This research will include the analysis of various data sources such as hospital policies, organization wide surveys with service users and interviews with focus groups. We hope that this will benefit the Rotunda Hospital in terms of moving forward with trauma informed care for all our couples.
General Practitioners within our catchment area are already aware of the planned Centralization of Benign Gynaecology Referrals across North Dublin. We have partnered with Connolly and Beaumont Hospital and will initiate a centralized referrals office in September. The idea centralizing referrals is to try and ensure that the patient pathway is streamlined and that right woman sees the right doctor the first time. There are lots of detail in the article and we believe that this new system will result in a more timely service for women across North Dublin.
Our Senior Clinical Psychologist in Perinatal Health, Ms. Jillian Doyle has a very informative article about the impact of modern technology and the consequences of an online world to young children and parents. She makes the point that not all screen time is equal and that high quality interactive content can support learning whilst on the other hand a prolonged exposure to various screening platforms is possibly harmful. There is a specific role and that limiting screen time particularly to children is very important.
Dr. Aine Dempsey who is working between Connolly Hospital and the Rotunda Hospital is a Consultant Obstetrician and Gynaecologist with a particular interest in complications of early pregnancy. Aine has done a lot of work on this and has a very informative article about bleeding in early pregnancy the risk of an ectopic pregnancy. The clinical features of ectopic pregnancy and then the very common problem of nausea and vomiting particularly in early pregnancy when it can affect up to 80% of women. The second part of her article focuses on Gestational Trophoblastic Disease (GTD) which obviously is a rare pregnancy related condition in which the developing placenta functions like a cancer which can spread outside of the uterus. There is now a national GTD registry which is under the leadership of Professor John Coulter in Cork University Maternity Hospital and Aine outlines the recommendation for pregnancy interval after GTD and the issues around future fertility.
Ms. Carol Rock who is the Clinical Midwifery Specialist in Bereavement has written about the most common complication of pregnancy, that of early pregnancy loss. She details how the Rotunda try and manage early pregnancy loss and support couples through this. I believe a patient centered care approach to managing these complications is critical and the Rotunda Hospital has always prioritized such an approach. As part of that Ann Charlton who is our Chaplin has a detailed article about the chaplaincy services available in the Rotunda and the specific role of bereavement care for parents who have tragically lost a baby.
There are two other things to note, the consultant led semi private care which is available in the hospital for all couples as well as early pregnancy ultrasound, antenatal classes and breast feeding workshops.
Finally just to let you know that on Saturday 17th January next year we will be holding a symposium on fertility and endometriosis; a guide diagnosis and management. Both these areas are extremely important in terms managing women and I do believe that this symposium will prove very popular. If you want to email Ms. Eleanor Power on [email protected] you can reserve your place. With best wishes.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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You are very welcome to the 24th edition of the Rotunda GP-Connect E-zine. Aileen Fleming, our Candidate AMP in Diabetes has written a very informative article about managing diabetes in pregnancy. The postpartum follow up is very important and as Aileen said we have decided that this is best done within General Practice. The decision to allow a fasting glucose and HbA1c is consistent with the NICE guidelines and should be checked 3 months after the delivery. It is now part of the annual screening for chronic disease prevention and allows women, especially those who are breastfeeding, to be effectively screened by a General Practitioner.
Over the last 4 months of 2024 and from January to February of this year, we implemented a very effective programme to offer immunisation to all newborn babies against RSV respiratory infection. As you know the disease burden of this infection can be considerable and many babies and young children end up being admitted to hospital and some of them are extremely ill. We managed to implement the programme and Emer Croke was the coordinator for what turned out to be a very successful RSV Pathfinder programme. Ultimately over 82% of the babies who met the criteria were immunised with Nirsevimab; by using our electronic health care medical record and with the help of Leon O’Hagan, who was the Senior Pharmacist and Informatics person, we were able to look specifically at the women who declined immunisation and will work with these women to try and improve uptake later this year when the programme will be repeated. Leon has a very detailed report which gives you an in-depth look at the results.
The journey initiative, which has made a huge difference to those couples who came through our Fetal Medicine Unit and are faced with a difficult diagnosis, forms the final report in this month’s Rotunda GP-Connect. As you can see there are multiple aspects to this journey project and I would like to complement our Fetal Medicine Midwives who have taken on this initiative and have brought it forward.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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You are very welcome to the February edition of the Rotunda GP-Connect. We had a historic opening of our new facility in Hampson House in January were the Tánaiste as he was at that time and Taoiseach as he is today Mr. Micheál Martin enthusiastically opened what we believe is a wonderful addition to the campus of the Rotunda Hospital. We have a new and expanded Paediatric Outpatient Department, two new Maternity Outpatients floors, a modern Colposcopy Suite and additional areas for Perinatal Health and other Allied Health Services such as Social Work, Radiology and Dietetics. This is the first part of a plan to develop significant additional facilities on the Rotunda Hospital Campus which will provide modern Neonatal High Dependency and Special Care Baby Units, an expanded Labour Ward and significant Post Natal accommodation.
The Community Midwifery Service which cares for over 2,000 pregnant woman annually has a detailed piece in this E-zine. The Rotunda is very proud of the fact that this service operates in the community and brings care to the women and families that we serve in locations located across North Dublin from Balbriggan to Finglas and Cabra. We have several midwifery specialists who work within the Community Midwifery Service and deliver the highest quality of care to women both antenally and postnatally. Dr. Fiona Keogh has a very informative chapter on “The Management of Pelvic Organ Prolapse in the Community”. Some of you may know we held an Educational Event here last month were Fiona and her colleagues outlined the management of pelvic organ prolapse and gave instruction in the use of the wide range of pessaries that are now available.
The final part of this E-Zine is on informative list of resources for the Management of Common Feeding problems in Primary care. I hope you will find these useful and there is a QR Code for more information on introducing family meals and weaning new born infants.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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It is my pleasure to welcome you to the 22nd edition of the Rotunda GPConnect E-zine. Our online educational study evening will take place on Thursday, 10th October 2024. There is a zoom webinar code which can be obtained by scanning the QR code on the front of this publication. There were four talks at the virtual GP evening, which are identical to the “in-person” event which took place earlier this year and concentrate on our emergency room, common feeding problems, the management of urinary incontinence and a perinatal mental health update from our Perinatal Mental Health team.
In this E-zine we have a very informative article by our newly appointed consultant colleague, Dr. Fiona Reidy, on endometriosis. This chronic and difficult to manage condition has a variety of hormonal management options as well as surgical options, but the importance of treating symptoms and supporting women from a psychological point-of-view cannot be overstated. The Rotunda endometriosis hub is led by Dr. Niamh Daly and Ms. Shelby José as the clinical nurse specialist. Shelby has a very helpful article about the Rotunda Endometriosis Hub which can provide multi-disciplinary care to women with this debilitating diagnosis.
The Rotunda Menopause Clinic, which is led by Dr. Caoimhe Hartley, is a clinic designed for women with complex menopause problems. The GP referral pathway is outlined within this E-zine and gives valuable information on what the referral criteria for the clinic are as well as a link to the Rotunda Menopause clinic.
Ms Anne O’Byrne, who is our head librarian and has a wealth of knowledge on the history of the Rotunda Hospital, has a very informative article on the Rotunda. This Baroque-style chapel in the middle of the original hospital building is a testament to Dr Bartholomew Mosse who built the Rotunda to care for the poor people of Dublin. The chapel was first open in 1762, was a huge benefit to the hospital in terms of religious services, which were conducted weekly and remains available for services today. The Chapel is also a respite for women from the busy postnatal ward in which it is located. This year the chapel is part of the Dublin Culture Night which takes place on Friday, 20th September 2024.
Post pandemic parenting is a very informative article written by Ms. Amanda Scott and Ms. Gillian Doyle and outlines some of the research that is ongoing in this area after what was a very unusual two years in all our lives. The effect on society, and in particular children, forms the basis for this article and raises multiple potential issues which to be honest I had never considered.
Finally, the Rotunda is one of six publicly funded fertility hubs and the contact details of this new service are available on the final page of this E-zine. Many thanks for your ongoing support of the Rotunda and I would like to finish by acknowledging and thanking Ms. Eleanor Power, who is our very effective GP Liaison person.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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It is my pleasure to write an introduction for the 21st edition of the Rotunda GP-Connect E-zine in which we have four very informative articles covering fertility, the sexual assault treatment unit, management of post bariatric surgery patients during pregnancy and our Emergency Assessment Unit.
Glenda Sanbenero and Chloe Kelly our two Clinical Fertility Midwife Specialists are part of a multidisciplinary team providing care to couples experiencing difficulty achieving a pregnancy. There is now accepted criteria for referring to the National Fertility Hub and the referrals are triaged by one of our consultants and a questionnaire is sent to the couple. Once the questionnaire has been completed an appointment will be organised with a member of the team and initial fertility investigations are performed. The article is very informative in terms of what these initial investigations would be and details the services that are available to couples within the Rotunda Fertility Hub.
Dr. Dan Kane who is a Specialist Registrar and a forensic examiner within the Rotunda Sexual Assault Treatment Unit has a very informative article about the care provided within this unit. This Unit, was the first Sexual Assault Treatment Unit in Europe, offers care to people of all genders who are over 14 years of age. It operates 24/7 and there are essentially three options; a forensic examination with a member of the Garda Síochána, a health check and a forensic examination without An Garda Síochána involvement. The pathway is detailed with a description of what is involved in each of these options and the referral pathways.
The third article in this particular E-zine refers to the management of patients post bariatric surgery during pregnancy. The numbers being referred to the Rotunda are increasing year on year and we cared for 84 women post bariatric surgery in 2023. This article is particularly detailed and I certainly believe it will be very useful and it is almost counter intuitive that this group could suffer from malnutrition with a subsequent increase risk of adverse maternal and fetal outcomes. There is a recommendation now that women should wait 12- 18 months post-surgery as this may further increase the risk of maternal complications.
The final article is written by one of our Advance Midwife Pactioneers in our Emergency Assessment Unit Ms. Debra England. Debra outlines areas were referrals may not be useful and also gives some details about our Day Assessment Unit which is open 7 days a week. Debra and her colleagues run a 24/7 day service. The article highlights the increase pressures on Emergency Departments and in particular ours in the Rotunda with referrals that could be better managed within the community
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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This year promises to be a very exciting time for the Rotunda Hospital as it develops its campus within the Northside of Dublin City. While the Earl Building will provide state of the art facilities for our paediatric and hospital based pregnancy care, the purchase of Dominick Street Lower by the H.S.E. will enable us to transform our gynaecology services.
Key to this service provision is our colleagues in primary healthcare and in this edition of the E-zine we outline the basis for this new service. Essentially this service is predicated upon primary healthcare doctors, who know their patients better than anyone, to indicate to us the sub-specialty area within gynaecology which would best serve the individual women who they are caring for. To that end we would ask that you would identify the specific problem that your patient is presenting to you with and we will then ensure that an appropriate care pathway is generated for that woman.
The aim of this service is to ensure that the right woman sees the right doctor the first time they are seen within secondary care. Your co-operation and help with this is absolutely essential to providing this service. Professor Dorothy Ryan and Dr. Brian Harnedy have written a very informative article on evaluating dyspnoea in pregnancy. This is a common presentation among pregnant women and their insights are extremely important in terms of identifying those women who need extra care.
Our Physiotherapy department have written a very helpful article on pregnancy related pelvic girdle pain. This pain, which can affect up to two thirds of pregnant women, can cause significant disability. Interestingly exercise may actually prevent or reduce the incidents of pelvic girdle pain.
Over many years now, and in particular since 2019, the Perinatal Mental Health service has developed within the Rotunda. Ursula Nagle, who is an Advanced Midwife Practitioner, has helped to establish the Perinatal Trauma Clinic. Unfortunately, some women do experience a traumatic birth and require additional care following this. Ursula and her team have written a very informative article about birth trauma and the service.
With every good wish for 2024.
Professor Sean Daly,
Master/CEO, Rotunda Hospital.
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I would like to warmly welcome you to the 18th edition of the Rotunda GP – Connect E-Zine. This issue covers a wide variety of important services within the Rotunda Hospital. Ms. Debbie Lambert who is our genetics counsellor and has made a huge difference to the way that we evaluate suspected cases of fetal abnormality and gives an overview of what she does day to day. Her email which is [email protected] and she fills a huge gap in terms of how General Practitioners can access Genetic services. We are now part of a National Perinatal Genetics service which lies under the umbrella of a National Genetics Service and this will allow us to develop our services very significantly over the coming years.
Dr. Amy Worrall, is one of the non-consultant hospital doctors at the Rotunda and has written an excellent overview of the management of Bartholin’s cysts. Bartholin cysts abscesses can become large and are almost invariably painful. The surgical treatment for these abscesses is well detailed in Dr. Worrall’s description and I hope this will be useful as an explanation to women who are undergoing this management.
Ms. Amanda Scott is our Clinical Nurse Specialist for Speech & Language Therapy in the Rotunda has then contributed a wonderful piece on her service. She also talks in detail about babies and their feeding difficulties and provides a, go sign and stop sign information piece which is very clinically useful.
Ms. Amy Rochford is the candidate for Advanced Midwife Practitioner in Early Pregnancy Assessment & Emergency Care and outlines in some detail the service and pathways for the women who require these services. She also gives contact details so that people can self-refer to these services. These services which are available Monday – Friday in the mornings will hopefully expand into all day services.
Finally I am delighted to inform you that the Annual Rotunda Autumn Lunch in 2023 will raise money to support the vital Mental Health Services we provide to women who come to the Rotunda Hospital for care. This Charity Lunch which will take place on Friday 20th October in the Round Room at the Mansion House starts at 12.30 p.m. and promises to be a really great event.
I would like to take this opportunity to wish you a great summer and I look forward to seeing you all in the autumn when we will hold our next GP event.
Yours sincerely,
Professor Sean Daly.
Consultant Obstetrician/Gynaecologist.
Master/CEO, Rotunda Hospital.
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Welcome to the 11th edition of the Rotunda Hospital GP Connect newsletter – designed to keep you updated on new developments at the Rotunda and to provide educational advice on clinical topics of interest.
We are now firmly in the midst of the ongoing COVID-19 pandemic and ongoing complete community lockdown, which is having a significant impact on how we provide clinical services for our patients and our referring doctors. This includes restrictions on hours of visiting at the hospital, who can visit the hospital, who can accompany patients to the hospital, and efficacy of providing certain clinical services in a “virtual” format.
We have been fortunate at the Rotunda to have the benefit of an extremely dynamic hospital laboratory, which has enabled us to provide rapid PCR-based diagnostics for COVID-19, delivering results in some cases in 1-2 hours. Additionally, following HSE-mandated care pathways, we have instituted COVID-19 testing for all admissions to the hospital, including both elective and emergency admissions. We have also commenced our COVID-19 vaccination drive, with 80% of our staff already vaccinated, as well as being able to vaccinate some of our local GPs because of the efficiency of our teams in extracting the maximum possible vaccine doses.
While we look forward to the end of COVID-19 restrictions at some point in 2021 when the pandemic hopefully comes under control, we are most grateful for the significant cooperation and support that we have received from you, our GP colleagues in managing this once-in-a-generation challenge. We have also learned new ways of delivering services during the pandemic that have forced efficiencies that we will continue into the future.
We look forward to interacting virtually with as many of our GP colleagues as possible at our next GP Study Evening, scheduled for March 9.
Yours sincerely,
Professor Fergal Malone,
Master, The Rotunda Hospital
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Welcome to our eighth edition of the Rotunda GP Connect E-zine- Our regular communication tool to update our referral General Practitioners on the latest developments at the Rotunda, including providing educational updates on our clinical services.
Firstly, I would like to wish a happy and healthy New Year to all of our referral doctors as we look forward to an exciting 2020 filled with new innovations with our clinical services. The Rotunda remains the busiest maternity hospital in Ireland, delivering 8,411 babies and caring for over 9,500 mothers in 2019. Despite falling birth rates throughout Ireland, the Rotunda has solidified its position as the busiest maternity hospital in Dublin and Ireland, due to natural population growth in its catchment area and the increasing popularity of the Rotunda in public perception. Indeed, the second series of the acclaimed television documentary, The Rotunda, has further enhanced the reputation of the hospital amongst the general public, resulting in increased demands for our services.
At the end of 2019 we completed the first full year since we were the first to roll out pregnancy termination services following the repeal of the Eighth Amendment in 2018. This has been an excellent example of mutual collaboration and support between primary care and hospital-based health services, with the Rotunda’s Pregnancy Options Service working closely to support our referral GPs.
We have also recruited additional consultant obstetrician-gynaecologists and other allied health professionals to further expand our clinical service offerings. One of our major goals for 2020 will be to increase the capacity for routine gynaecology referrals, both at traditional gynaecology clinics and at “one stop/ see and treat” outpatient hysteroscopy clinics.
We plan a further GP Educational Study Evening on March 25, 2020, and I hope to welcome as many of you as possible to what will be another effective meeting to enhance knowledge of our services and troubleshooting how best to get the most out of our clinical partnership.
As always, I remain constantly available for direct communication with you if at any time you are having challenges accessing our services or indeed if you have any ideas on how best to improve our service offering to our GP community
Yours sincerely,
Professor Fergal Malone,
Master, The Rotunda Hospital
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In this issue:
Our next GP Study Evening on the 25th of March
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Meet our expanded team of Consultants in our Private and Semi-Private services.
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Ms Deirdre Daly, Assistant Professor in the School of Nursing and Midwifery TCD, introduces the new, free, online educational course, Women’s Health After Motherhood (WHAM).
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Fergal O’Shaughnessy provides an update on Ondansetron as a potential treatment option for women with Hyperemisis Gravidarum
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Dr Vicky O’Dwyer, Consultant Obstetrician and Gynaecologist, overviews the Rotunda Hospital Colposcopy Service
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And
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Patricia Butler, Bereavement Support Midwife, outlines our Bereavement Service in the Rotunda Hospital
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Save the Dates!
25th March – GP Study Evening
22nd April – Practice and Public Health Nurse Study Evening
5th May – Safe in our Hands Conference – Celebrating World Hand Hygiene Day and International Day of the Midwife
The Rotunda Hospital invited our GP colleagues to an educational study evening on the 18th of October, to build stronger relationships with our colleagues in general practice, and other allied health professionals.
Prof Fergal Malone, Master of the Rotunda, opened our GP study evening and spoke about what an exciting time it is for the Hospital, with many changes on the horizon, including our move to the grounds of Connolly Hospital and the new Maternal and Newborn CMS electronic health records, due to come online in November.
Prof Malone also mentioned our new GP E-zine that will keep GPs informed of services and innovations in the Hospital.
You can read the first issue here, and sign up to receive the next issues straight into your inbox here.
Dr Karen Flood was the first speaker, and explored the topic of prenatal testing in the Hospital & the advances that have been made in non-invasive methods of prenatal testing in the last few years.
Then, Advanced Midwife Practitioner Bernadette Gregg spoke about the referral pathways in the Hospital for patients attending the Emergency & Assessment Unit.
Dr Naomi Burke rounded off the evening, speaking about triage & pathways for gynaecological emergencies here in the Hospital.
We want to thank all who attended.
You can see some photos from the evening below.
