National Perinatal Epidemiology Centre - Journal Articles
Permanent URI for this collection
Browse
Recent Submissions
Item Introducing outcome-based education in obstetrics and gynaecology training: Perspectives of trainees and trainers(Elsevier Ltd., 2025-01-08) O'Sullivan, Orfhlaith E.; Leitao, Sara; S. Harney; M.E. Abdalla; O’Donoghue, KeelinBackground and aims: Outcome-based education (OBE) focuses on clearly defined learner goals, offering a structured framework to achieve competency. This study explores the perspectives of trainees and trainers in Obstetrics and Gynaecology (O&G) in Ireland regarding facilitators, barriers, and challenges to implementing OBE. Methods: A national cross-sectional survey was distributed to O&G trainees and trainers in Ireland. Responses were analysed using descriptive statistics and chi-squared tests, and qualitative thematic analysis. Results: A total of 151 trainees and trainers participated in the study. While 61.2% of respondents reported familiarity with the concept of OBE, only 22.4% accurately identified its primary focus on learner goals. Participants highlighted several key benefits of OBE, including the establishment of clearly defined goals and the development of competency in essential skills. However, significant challenges were also identified, such as the perception of unattainable goals for trainees and insufficient training facilities. Additionally, trainer engagement and the lack of allocated time for both trainers and trainees to attend training courses were recognized as major barriers to the successful implementation of OBE. Conclusion: OBE presents a promising educational framework for O&G training, with the potential to modernize and enhance learning outcomes. However, its successful implementation hinges on comprehensive education about its principles and benefits, substantial investment in educational facilities and resources, and the prioritization of training through dedicated and protected time for both trainees and trainers.Item Area-level deprivation as a risk factor for stillbirth in upper-middle and high-income countries: A scoping review(Elsevier B.V., 2025-12-06) Keane, Jessica; Robinson, Laura A.; Greene, Richard A.; Corcoran, Paul; Leitao, SaraBackground: Socioeconomic deprivation has been associated with health inequalities and poor perinatal outcomes. Deprivation is described as a multidimensional concept, with composite indicators (e.g. area-based) developed internationally to study population health. Aim: This scoping review aims to examine published literature on the relationship between area-level deprivation and stillbirth in upper-middle to high-income countries. Methods: The Joanna Briggs Institute methodology for scoping reviews was utilised. The research question based on the Population (studies that examined stillbirth) Concept (area-level deprivation and its impact on stillbirth) Context (upper-middle- to high-income countries) framework. Six scientific databases were searched. Results were screened and reference lists searched to identify relevant literature. Data extraction on study characteristics and evidence of association provided was completed and a narrative summary reported the main findings. Results: A total of 29 studies were included, from 9 countries (majority UK-based: n = 20) published between 1998 and 2023. A variety of composite deprivation indices were utilised, the UK's Index of Multiple Deprivation (IMD) was the most common (n = 8), followed by the Townsend and Jarman indices (n = 6 and n = 3, respectively). Income, employment, education and access to services were the most common factors included as measures of deprivation in the indices. Twenty-two of the 29 studies (75.9%) showed positive correlations between stillbirth and areas identified more socioeconomically deprived. Conclusion: This review suggests that area-level deprivation seems an influencing factor on stillbirth in upper-middle to high-income countries. Focused initiatives to reduce stillbirth among those at higher deprivation related risk may be useful in improving maternal and perinatal outcomes.Item Improving the quality of newborn feeding documentation in an EHR using a mixed methods approach(Elsevier Ltd., 2024-07-24) Sheehan, Orla Maria; Greene, Richard A.; Corcoran, Paul; McKernan, Joye; Murphy, BrendanIntroduction: Newborn feeding is key to infant growth and survival. Accurate feeding documentation can inform care decisions and planning of care. A nutritional dashboard is available within the Electronic Health Record (EHR) which accumulates feeding data in a graphical display. Purpose: To improve the quality of newborn feeding documentation for post-natal ward babies and babies in the Neonatal Intensive Care Unit (NICU). Design and Methods: A multidisciplinary end user expert group (n = 38) was established. Qualitative thematic analyses from this group were used to design new feeding data entry and review elements. Quantitative pre-post design was used to assess feeding documentation for both post-natal ward baby charts (n = 134) and NICU baby charts (n = 188). Descriptive statistics and Pearson's chi-square were used to assess pre-post differences and statistical significance. The use of a nutritional dashboard was assessed using system audit logs and analyzed using Poisson regression testing. Results: Post-natal ward babies had improvements in structured feeding documentation by 91.6% (from 17.9% to 34.3%) (p = 0.031). NICU data feeding documentation improved by 25% (from 72.3% to 90.4%) (p = 0.001). Use of the nutritional dashboard however reduced in the post period. Conclusion: This study has positively demonstrated improvements in the quality of newborn feeding documentation within the patient's EHR can be achieved through a collaborative multidisciplinary approach optimising EHR design. Practice implications: The benefit of a multidisciplinary approach to EHR design is paramount to promoting superior quality data entry compliant with individual workflows.Item Factors affecting third‐stage management and postpartum hemorrhage in planned midwife‐led home and birth center births in the United States(John Wiley & Sons, Inc., 2020-07-29) Erickson, Elise N.; Bovbjerg, Marit L.; Cheyney, Melissa J.; Foundation for the Advancement of Midwifery; National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Fulbright Association; Health Resources and Services AdministrationBackground: Postpartum hemorrhage (PPH) is a potential childbirth complication. Little is known about how third-stage labor is managed by midwives in the United States, including use of uterotonic medication during community birth. Access to uterotonic medication may vary based on credentials of the midwife or state regulations governing midwifery. Methods: Using data from the Midwives of North America 2.0 database (2004-2009), we describe the PPH incidence for women giving birth in the community, their demographic and clinical characteristics, and methods used by midwives to address PPH. We also examined PPH rates by midwifery credentials and by the presence of regulations for legal midwifery practice. Results: Of the 17 836 vaginal births, 15.9% had blood loss of over 500 mL and 3.3% had 1000 mL or greater blood loss. Midwives used pharmaceuticals to prevent or treat postpartum bleeding in 6.3% and 13.9% of births, respectively, and the rate of hospital transfer after birth was 1.4% (n = 247). In adjusted analyses, PPH was less likely when births occurred at home vs a birth center, if the midwife had a CNM/CM credential vs a CPM/LM/LDM credential, or if the woman was multiparous without a history of PPH or prior cesarean birth. PPH was more likely in states with barriers to midwifery practice compared with regulated states (OR: 1.26; 95% CI, 1.16-1.38).Conclusions: Women giving birth in the community experienced low overall incidence of PPH-related hospital transfer. However, the occurrence of PPH itself would likely be reduced with improved legal access to uterotonic medication.Item Discharge age and weight for very preterm infants in six countries: 2012-2020(Karger International, 2023-01) Edwards, Erika M.; Greenberg, Lucy T.; Horbar, Jeffrey D.; Gagliardi, Luigi; Adams, Mark; Berger, Angelika; Leitao, Sara; Luyt, Karen; Ehret, Danielle E. Y.; Rogowski, Jeannette A.Postmenstrual age for surviving infants without congenital anomalies born at 24-29 weeks' gestational age from 2005 to 2018 in the USA increased 8 days, discharge weight increased 316 grams, and median discharge weight z-score increased 0.19 standard units. We asked whether increases were observed in other countries. We evaluated postmenstrual age, weight, and weight z-score at discharge of surviving infants without congenital anomalies born at 24-29 weeks' gestational age admitted to Vermont Oxford Network member hospitals in Austria, Ireland, Italy, Switzerland, the UK, and the USA from 2012 to 2020. After adjustment, the median postmenstrual age at discharge increased significantly in Austria (3.6 days, 99% CI [1.0, 6.3]), Italy (4.0 days [2.3, 5.6]), and the USA (5.4 days [5.0, 5.8]). Median discharge weight increased significantly in Austria (181 grams, 99% CI [95, 267]), Ireland (234 [143, 325]), Italy (133 [83, 182]), and the USA (207 [194, 220]). Median discharge weight z-score increased in Ireland (0.24 standard units, 99% CI [0.12, 0.36]) and the USA (0.15 [0.13, 0.16]). Discharge on human milk increased in Italy, Switzerland, and the UK, while going home on cardiorespiratory monitors decreased in Austria, Ireland, and USA and going home on oxygen decreased in Ireland. In this international cohort of neonatal intensive care units, postmenstrual discharge age and weight increased in some, but not all, countries. Processes of care at discharge did not change in conjunction with age and weight increases.