National Perinatal Epidemiology Centre - Journal Articles
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Item Predicting risk of postpartum haemorrhage during the intrapartum period in a general obstetric population(Elsevier B. V., 2022-09) Maher, Gillian M.; McKernan, Joye; O'Byrne, Laura; Corcoran, Paul; Greene, Richard A.; Khashan, Ali S.; McCarthy, Fergus P.; Health Research BoardObjective: To develop and validate (both internally and externally) a prediction model examining a combination of risk factors in order to predict postpartum haemorrhage (PPH) in a general obstetric Irish population of singleton pregnancies. Study design: We used data from the National Maternal and Newborn Clinical Management System (MN-CMS), including all singleton deliveries at Cork University Maternity Hospital (CUMH), Ireland during 2019. We defined PPH as an estimated blood loss of = 1000 ml following the birth of the baby. Multivariable logistic regression with backward stepwise selection was used to develop the prediction model. Candidate predictors included maternal age, maternal body mass index, parity, previous caesarean section, assisted fertility, gestational age, fetal macrosomia, mode of delivery and history of PPH. Discrimination was assessed using the area under the receiver operating characteristic curve (ROC) C-statistic. We used bootstrapping for internal validation to assess overfitting, and conducted a temporal external validation using data from all singleton deliveries at CUMH during 2020. Results: Out of 6,077 women, 5,807 with complete data were included in the analyses, and there were 270 (4.65%) cases of PPH. Four variables were considered the best combined predictors of PPH, including parity (specifically nulliparous), macrosomia, mode of delivery (specifically operative vaginal delivery, emergency caesarean section and prelabour caesarean section), and history of PPH. These predictors were used to develop a nomogram to provide individualised risk assessment for PPH. The original apparent C-statistic was 0.751 (95% CI: 0.721, 0.779) suggesting good discriminative performance. There was minimal optimism adjustment to the C-statistic after bootstrapping, indicating good internal performance (optimism adjusted C-statistic: 0.748). Results of external validation were comparable with the development model suggesting good reproducibility. Conclusions: Four routinely collected variables (parity, fetal macrosomia, mode of delivery and history of PPH) were identified when predicting PPH in a general obstetric Irish population of singleton pregnancies. Use of our nomogram could potentially assist with individualised risk assessment of PPH and inform clinical decision-making allowing those at highest risk of PPH be actively managed.Item Irish inquiry reports relating to perinatal deaths and pregnancy loss services(Irish Medical Organisation, 2020-02) Helps, Änne; Leitao, Sara; O'Byrne, L.; Greene, Richard A.; O'Donoghue, KeelinAims: 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.Item The psychosocial impacts of cybervictimisation and barriers to seeking social support: Young people's perspectives(Elsevier Ltd., 2020-02-15) Dennehy, Rebecca; Meaney, Sarah; Cronin, Mary; Arensman, Ella; Health Research BoardThe negative impact of cyberbullying on the mental health of victims is well established. However, qualitative research related to the mental health impacts of cybervictimisation and how these are experienced by young people is scarce. In particular, little is known about young people's perceptions of the association between cyberbullying and suicidal behaviours. This paper reports findings on the mental health impacts of cyberbullying, and barriers to seeking social support, from eleven focus groups with 64 young people aged fourteen to seventeen (53% female), across four secondary schools. Thematic analysis identified two central themes: The Psychological Nature of Cyberbullying (sub-themes include Trapped by the Omni-Presence of Cyber Technology; Negative Overthinking; The Impacts of Negative Overthinking on Young People's Lives; and Suicide as a Means of Escape) and Barriers to Help-Seeking (including sub-themes Needing Help Regarded as Sign of Weakness; Young People Unable to Identify and Express Feelings; Lack of Confidence in Parents Ability to Provide Support; and Inappropriate School Intervention). Cyberbullying was described as more psychological in nature and impact than traditional bullying with increased deleterious effect on the mental health and wellbeing of victims. Victims experience rumination and worry fuelled by the omni-present, pervasive, and permanent nature of cyber interactions. Young people's inability to seek support maintains and exacerbates victimsâ distress. Participants perceived suicide as a viable escape route for young victims defeated and entrapped by cybervictimisation and their own negative thoughts. Interventions should address emotional competence and mental health literacy in young people, as well as empowering support networks including parents, peers, and school personnel, to foster an environment that promotes help-seeking.Item An exploration of women's experience of taking part in a randomized controlled trial of a diagnostic test during pregnancy: A qualitative study(Blackwell Publishing Ltd, 2019-10-02) Hayes-Ryan, Deirdre; Meaney, Sarah; Nolan, Caroline; O'Donoghue, KeelinObjective: To explore pregnant women's views of participation in a clinical research trial while pregnant. Design: Prospective nested qualitative cohort study embedded within a national, multi‐site randomized controlled trial of a diagnostic test for preeclampsia: Placental Growth Factor. One‐to‐one in‐depth semi‐structured interviews were undertaken with 19 women who had recently participated in the trial at a single recruiting site. The interviews were conducted in private, recorded digitally and transcribed verbatim. Setting: Single tertiary maternity hospital currently recruiting eligible women onto an on‐going randomized controlled trial (NCT 02881073). Participants: Women who had participated in the PARROT Ireland randomized controlled trial during their recent pregnancy. Methods: Thematic analysis was utilized. Each line of the transcribed interviews was coded into a category by two researchers. The resultant categories were reviewed, and those with similarities were pooled allowing the development of themes. Main Outcome Measures: Women's opinions and experience of participation in a randomized controlled trial of an interventional diagnostic test during their pregnancy. Results: Four major themes were identified as follows: (a) Understanding of preeclampsia, (b) Motivators for clinical trial participation, (c) Barriers to decision making and (d) Influence of PARROT Ireland on pregnancy experience. Conclusions:Women are generally interested and positively inclined to participate in research during pregnancy. The potential of risk is an important consideration for eligible pregnant woman. Information and support by both researchers and clinicians are paramount in aiding women's understanding of a research trial.Item Communication skills in Obstetrics: what can we learn from bereaved parents?(Irish Medical Organisation, 2017-02) Nuzum, Daniel; Meaney, Sarah; O'Donoghue, KeelinCommunicating bad news in obstetrics is challenging. This study explores the impact of how bad news was communicated to parents following a diagnosis of stillbirth. Qualitative in-depth interviews were conducted with 12 mothers and 5 fathers, bereaved following stillbirth at a tertiary maternity hospital where the perinatal mortality rate is 5.2/1000. Data were analysed using Interpretative Phenomenological Analysis. How the diagnosis of stillbirth was communicated had a profound and lasting impact on parents. Dominant superordinate themes were Language used, Sensitivity and Diversionary techniques. Parents recalled in detail where and how bad news was broken and language used. Diversionary techniques created a sense of mistrust especially when parents felt information was being withheld. Bereaved parents valued privacy at the time of diagnosis of stillbirth. This study highlights the importance of language, sensitivity and environment where clinicians can learn from the experiences of bereaved parents who value open, sensitive and honest communication. The results of this study highlight the importance of patient-focused communication training for clinicians.