National Perinatal Epidemiology Centre

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https://hdl.handle.net/10468/1679

The National Perinatal Epidemiology Centre is based in Cork University Maternity Hospital. The overall objective of the Centre is to collaborate with Irish maternity services to translate clinical audit data and epidemiological evidence into improved maternity care for families in Ireland.

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The development of the Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): a large-scale data sharing initiative
(Public Library of Science, 2013) Lutomski, Jennifer E.; Baars, Maria A. E.; Schalk, Bianca W. M.; Boter, Han; Buurman, Bianca M.; den Elzen, Wendy P. J.; Jansen, Aaltje P. D.; Kempen, Gertrudis I. J. M.; Steunenberg, Bas; Steyerberg, Ewout W.; Rikkert, Marcel G. M. Olde; Melis, René J. F.; ZonMw
Introduction: In 2008, the Ministry of Health, Welfare and Sport commissioned the National Care for the Elderly Programme. While numerous research projects in older persons' health care were to be conducted under this national agenda, the Programme further advocated the development of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) which would be integrated into all funded research protocols. In this context, we describe TOPICS data sharing initiative (www.topics-mds.eu). Materials and Methods: A working group drafted TOPICS-MDS prototype, which was subsequently approved by a multidisciplinary panel. Using instruments validated for older populations, information was collected on demographics, morbidity, quality of life, functional limitations, mental health, social functioning and health service utilisation. For informal caregivers, information was collected on demographics, hours of informal care and quality of life (including subjective care-related burden). Results: Between 2010 and 2013, a total of 41 research projects contributed data to TOPICS-MDS, resulting in preliminary data available for 32,310 older persons and 3,940 informal caregivers. The majority of studies sampled were from primary care settings and inclusion criteria differed across studies. Discussion: TOPICS-MDS is a public data repository which contains essential data to better understand health challenges experienced by older persons and informal caregivers. Such findings are relevant for countries where increasing health-related expenditure has necessitated the evaluation of contemporary health care delivery. Although open sharing of data can be difficult to achieve in practice, proactively addressing issues of data protection, conflicting data analysis requests and funding limitations during TOPICS-MDS developmental phase has fostered a data sharing culture. To date, TOPICS-MDS has been successfully incorporated into 41 research projects, thus supporting the feasibility of constructing a large (>30,000 observations), standardised dataset pooled from various study protocols with different sampling frameworks. This unique implementation strategy improves efficiency and facilitates individual-level data meta-analysis.
Perinatal Mortality in Ireland Annual Report 2011
(National Perinatal Epidemiology Centre, 2013) Manning, Edel; Corcoran, Paul; Meaney, Sarah; Greene, Richard A.; Health Service Executive, Ireland
Severe Maternal Morbidity in Ireland Annual Report 2011
(National Perinatal Epidemiology Centre, 2013-03) Greene, Richard A.; Health Service Executive, Ireland
At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery
(Public Library of Science, 2013-03-06) Fawsitt, Christopher G.; Bourke, Jane; Greene, Richard A.; Everard, Claire M.; Murphy, Aileen; Lutomski, Jennifer E.; National Perinatal Epidemiology Centre, College of Medicine and Health, University College Cork
Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.
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Caesarean delivery and subsequent pregnancy interval: a systematic review and meta-analysis
Surveillance during pregnancy: methods and response rates from a hospital based pilot study of the Pregnancy Risk Assessment Monitoring System in Ireland
(BioMed Central, 2013-09) O'Keeffe, Linda M.; Kearney, Patricia M.; Greene, Richard A.; Health Research Board; National Perinatal Epidemiology Centre, College of Medicine and Health, University College Cork; Cork University Maternity Hospital
Background: Many European countries including Ireland lack high quality, on-going, population based estimates of maternal behaviours and experiences during pregnancy. PRAMS is a CDC surveillance program which was established in the United States in 1987 to generate high quality, population based data to reduce infant mortality rates and improve maternal and infant health. PRAMS is the only on-going population based surveillance system of maternal behaviours and experiences that occur before, during and after pregnancy worldwide.Methods: The objective of this study was to adapt, test and evaluate a modified CDC PRAMS methodology in Ireland. The birth certificate file which is the standard approach to sampling for PRAMS in the United States was not available for the PRAMS Ireland study. Consequently, delivery record books for the period between 3 and 5 months before the study start date at a large urban obstetric hospital [8,900 births per year] were used to randomly sample 124 women. Name, address, maternal age, infant sex, gestational age at delivery, delivery method, APGAR score and birth weight were manually extracted from records. Stillbirths and early neonatal deaths were excluded using APGAR scores and hospital records. Women were sent a letter of invitation to participate including option to opt out, followed by a modified PRAMS survey, a reminder letter and a final survey.Results: The response rate for the pilot was 67%. Two per cent of women refused the survey, 7% opted out of the study and 24% did not respond. Survey items were at least 88% complete for all 82 respondents. Prevalence estimates of socially undesirable behaviours such as alcohol consumption during pregnancy were high [>50%] and comparable with international estimates.Conclusion: PRAMS is a feasible and valid method of collecting information on maternal experiences and behaviours during pregnancy in Ireland. PRAMS may offer a potential solution to data deficits in maternal health behaviour indicators in Ireland with further work. This study is important to researchers in Europe and elsewhere who may be interested in new ways of tailoring an established CDC methodology to their unique settings to resolve data deficits in maternal health.
Perinatal Mortality in Ireland Annual Report 2012
(National Perinatal Epidemiology Centre, 2014) Manning, Edel; Corcoran, Paul; Meaney, Sarah; Greene, Richard A.; Health Service Executive, Ireland
Private health care coverage and increased risk of obstetric intervention
(BioMed Central, 2014-01-13) Lutomski, Jennifer E.; Murphy, Michael; Devane, Declan; Meaney, Sarah; Greene, Richard A.
Background: When clinically indicated, common obstetric interventions can greatly improve maternal and neonatal outcomes. However, variation in intervention rates suggests that obstetric practice may not be solely driven by case criteria. Methods: Differences in obstetric intervention rates by private and public status in Ireland were examined using nationally representative hospital discharge data. A retrospective cohort study was performed on childbirth hospitalisations occurring between 2005 and 2010. Multivariate logistic regression analysis with correction for the relative risk was conducted to determine the risk of obstetric intervention (caesarean delivery, operative vaginal delivery, induction of labour or episiotomy) by private or public status while adjusting for obstetric risk factors. Results: 403,642 childbirth hospitalisations were reviewed; approximately one-third of maternities (30.2%) were booked privately. After controlling for relevant obstetric risk factors, women with private coverage were more likely to have an elective caesarean delivery (RR: 1.48; 95% CI: 1.45-1.51), an emergency caesarean delivery (RR: 1.13; 95% CI: 1.12-1.16) and an operative vaginal delivery (RR: 1.25; 95% CI: 1.22-1.27). Compared to women with public coverage who had a vaginal delivery, women with private coverage were 40% more likely to have an episiotomy (RR: 1.40; 95% CI: 1.38-1.43). Conclusions: Irrespective of obstetric risk factors, women who opted for private maternity care were significantly more likely to have an obstetric intervention. To better understand both clinical and non-clinical dynamics, future studies of examining health care coverage status and obstetric intervention would ideally apply mixed-method techniques.
Cesarean section and rate of subsequent stillbirth, miscarriage and ectopic pregnancy: a Danish register-based cohort study
(Public Library of Science, 2014-07-01) O'Neill, Sinéad M.; Agerbo, Esben; Kenny, Louise C.; Henriksen, Tine B.; Kearney, Patricia M.; Greene, Richard A.; Mortensen, Preben Bo; Khashan, Ali S.; Fisk, Nicholas M.; Health Research Board; Science Foundation Ireland; National Perinatal Epidemiology Centre, College of Medicine and Health, University College Cork
Background: With cesarean section rates increasing worldwide, clarity regarding negative effects is essential. This study aimed to investigate the rate of subsequent stillbirth, miscarriage, and ectopic pregnancy following primary cesarean section, controlling for confounding by indication. Methods and Findings: We performed a population-based cohort study using Danish national registry data linking various registers. The cohort included primiparous women with a live birth between January 1, 1982, and December 31, 2010 (n = 832,996), with follow-up until the next event (stillbirth, miscarriage, or ectopic pregnancy) or censoring by live birth, death, emigration, or study end. Cox regression models for all types of cesarean sections, sub-group analyses by type of cesarean, and competing risks analyses for the causes of stillbirth were performed. An increased rate of stillbirth (hazard ratio [HR] 1.14, 95% CI 1.01, 1.28) was found in women with primary cesarean section compared to spontaneous vaginal delivery, giving a theoretical absolute risk increase (ARI) of 0.03% for stillbirth, and a number needed to harm (NNH) of 3,333 women. Analyses by type of cesarean section showed similarly increased rates for emergency (HR 1.15, 95% CI 1.01, 1.31) and elective cesarean (HR 1.11, 95% CI 0.91, 1.35), although not statistically significant in the latter case. An increased rate of ectopic pregnancy was found among women with primary cesarean overall (HR 1.09, 95% CI 1.04, 1.15) and by type (emergency cesarean, HR 1.09, 95% CI 1.03, 1.15, and elective cesarean, HR 1.12, 95% CI 1.03, 1.21), yielding an ARI of 0.1% and a NNH of 1,000 women for ectopic pregnancy. No increased rate of miscarriage was found among women with primary cesarean, with maternally requested cesarean section associated with a decreased rate of miscarriage (HR 0.72, 95% CI 0.60, 0.85). Limitations include incomplete data on maternal body mass index, maternal smoking, fertility treatment, causes of stillbirth, and maternally requested cesarean section, as well as lack of data on antepartum/intrapartum stillbirth and gestational age for stillbirth and miscarriage. Conclusions: This study found that cesarean section is associated with a small increased rate of subsequent stillbirth and ectopic pregnancy. Underlying medical conditions, however, and confounding by indication for the primary cesarean delivery account for at least part of this increased rate. These findings will assist women and health-care providers to reach more informed decisions regarding mode of delivery.
Perinatal Mortality in Ireland Annual Report 2013
(National Perinatal Epidemiology Centre, 2015) Manning, Edel; Corcoran, Paul; Meaney, Sarah; Greene, Richard A.; Health Service Executive, Ireland
Severe Maternal Morbidity in Ireland Annual Report 2012 and 2013
(National Perinatal Epidemiology Centre, 2015) Corcoran, Paul; Manning, Edel; Meaney, Sarah; Greene, Richard A.; Health Service Executive, Ireland
Perinatal Mortality in Ireland Annual Report 2014
(National Perinatal Epidemiology Centre, 2016) Corcoran, Paul; Manning, Edel; O'Farrell, Irene B.; McKernan, Joye; Meaney, Sarah; Drummond, L.; de Foubert, Paulette; Greene, Richard A.; Health Service Executive, Ireland
Severe Maternal Morbidity in Ireland Annual Report 2014
(National Perinatal Epidemiology Centre, 2016) Manning, Edel; Corcoran, Paul; O'Farrell, Irene B.; de Foubert, Paulette; Drummond, Linda; McKernan, Joye; Meaney, Sarah; Greene, Richard A.
Very Low Birth Weight Infants in the Republic of Ireland Annual Report 2014
(National Perinatal Epidemiology Centre, 2016) Twomey, Anne; Murphy, Brendan P.; Drummond, Linda; Corcoran, Paul; O'Farrell, Irene B.; Greene, Richard A.; Health Service Executive, Ireland
A qualitative study investigating the barriers to returning to work for breastfeeding mothers in Ireland
(BioMed Central, 2016-06-10) Desmond, Deirdre; Meaney, Sarah
Background: The World Health Organization (WHO) recommends that mothers exclusively breastfeed for the first 6 months of an infant’s life. In Ireland, currently paid maternity leave is 26 weeks and the expectant mother is required by law to finish work 2 weeks before her expected delivery date. Mothers wishing to exclusively breastfeed for 6 months or longer find themselves having to take holiday leave or unpaid leave from work in order to meet the WHO’s guidelines. The aim of this study is to explore women’s experiences of breastfeeding after their return to work in Ireland. Methods: This study was carried out utilizing a qualitative design. Initially 25 women who returned to the workforce while continuing to breastfeed were contacted, 16 women returned consent forms and were subsequently contacted to take part in an interview. Interviews were recorded and transcribed verbatim and thematic analysis was employed to establish recurring patterns and themes throughout the interviews. Results: Women noted that cultural attitudes in Ireland coupled with inadequate or inconsistent advice from health professionals posed the biggest challenge they had to overcome in order to achieve to 6 months exclusive breastfeeding. The findings of this study illustrate that mothers with the desire to continue to breastfeed after their return to work did so with some difficulty. Many did not disclose to their employers that they were breastfeeding and did not make enquiries about being facilitated to continue to breastfeed after their return to the workplace. The perceived lack of support from their employers as well as embarrassment about their breastfeeding status meant many women concealed that they were breastfeeding after their return to the workplace. Conclusion: While it has been suggested that WHO guidelines for exclusive breastfeeding for 6 months may be unattainable for many women due to work commitments, a different problem exists in Ireland. Mothers struggle to overcome cultural and societal obstacles coupled with inadequate support from health professionals. Encouraging and facilitating women to continue to breastfeed after they return to work will help to normalise breastfeeding within Irish culture and promote continued breastfeeding as a viable option for working mothers.
Perinatal outcomes of reduced fetal movements: A cohort study
(BioMed Central, 2016-07-19) McCarthy, Claire M.; Meaney, Sarah; O'Donoghue, Keelin
Background: The perception of reduced fetal movement (RFM) is an important marker of fetal wellbeing and is associated with poor perinatal outcome (such as intra-uterine death). Methods: We conducted a prospective study of women presenting with RFM over 28 weeks’ gestation to a tertiary-level maternity hospital. We examined pregnancy outcomes and compared them to a retrospectively collected control group delivering contemporaneously. Results: In total, 275 presentations were analysed in the RFM group, with 264 in the control group. Women with RFM were more likely to be nulliparous (p?=?0.002) and have an induction of labour (p?=?0.0011). 26.5 % (n?=?73) of cases were admitted following presentation with RFM, and 79.4 % (n?=?58) delivered on primary presentation. Overall, 15.2 % (n?=?42) women were induced for RFM specifically. Conclusion: This prospective study shows the increased burden of care required by those with RFM, including increased neonatal unit admission rates, increased induction rates and higher surveillance demands, demonstrating the need for increased attention to this area of practice.
Women's experience of maternal morbidity: A qualitative analysis
(BioMed Central, 2016-07-25) Meaney, Sarah; Lutomski, Jennifer E.; O'Connor, L.; O'Donoghue, Keelin; Greene, Richard A.
Background: Maternal morbidity refers to pregnancy-related complications, ranging in severity from acute to chronic. In Ireland one in 210 maternities will experience a severe morbidity. Yet, how women internalize their experience of morbidity has gone largely unexplored. This study aimed to explore women’s experiences of maternal morbidity. Methods: A qualitative semi-structured interview format was utilized. Purposive sampling was used to recruit 14 women with a maternal morbidity before, during or after birth; nine women were diagnosed with one morbidity including hypertensive disorders, haemorrhage, placenta praevia and gestational diabetes whereas five women were diagnosed with two or more morbidities. Thematic analysis was employed as the analytic strategy. Results: Four superordinate themes were identified: powerlessness, morbidity management, morbidity treatment and socio-behavioural responses to morbidities. Women were accepting of the uncontrollable nature of the adverse outcome experienced. While being treated for trauma, women were satisfied to relinquish their autonomy to ensure the safety of themselves and their babies. However, these events were debilitating. Women’s inability to control their own bodies, as a result of the morbidity, contributed to high levels of frustration and anxiety. Morbidities impacted greatly on women’s quality of life and sometimes these effects persisted for a prolonged period after delivery. Women felt that they were provided very little information on the practicalities of living with their condition; many were uncertain how to manage their morbidities in the home setting. Conclusion: Healthcare providers should ensure that women who experience a maternal morbidity are fully debriefed and have sufficient information on the morbidity including ongoing care and expectations prior to discharge.
Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland
(Elsevier Ltd, 2016-10-27) Campbell, Sarah M.; Corcoran, Paul; Manning, Edel; Greene, Richard A.; Health Service Executive, 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.
Severe Maternal Morbidity in Ireland Annual Report 2015
(National Perinatal Epidemiology Centre, 2017) Manning, Edel; O'Farrell, Irene B.; Corcoran, Paul; de Foubert, Paulette; Drummond, L.; McKernan, Joye; Meaney, Sarah; Greene, Richard A.; Health Service Executive, Ireland
What women want: exploring pregnant women's preferences for alternative models of maternity care
(Elsevier Ireland Ltd, 2017) Fawsitt, Christopher G.; Bourke, Jane; Lutomski, Jennifer E.; Meaney, Sarah; McElroy, Brendan; Murphy, Rosemary; Greene, Richard A.; Health Service Executive
Depending on obstetric risk, maternity care may be provided in one of two locations at hospital level: a consultant-led unit (CLU) or a midwifery-led unit (MLU). Care in a MLU is sparsely provided in Ireland, comprising as few as two units out of a total 21 maternity units. Given its potential for greater efficiencies of care and cost-savings for the state, there has been an increased interest to expand MLUs in Ireland. Yet, very little is known about women’s preferences for midwifery-led care, and whether they would utilise this service when presented with the choice of delivering in a CLU or MLU. This study seeks to involve women in the future planning of maternity care by investigating their preferences for care and subsequent motivations when choosing place of birth. Qualitative research is undertaken to explore maternal preferences for these different models of care. Women only revealed a preference for the MLU when co-located with a CLU due to its close proximity to medical services. However, the results suggest women do not have a clear preference for either model of care, but rather a hybrid model of care which encompasses features of both consultant- and midwifery-led care

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