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Corcoran A, Hayes-Ryan D, O'Dwyer V, Cooley S, Ramphul M. Audit of Ireland's first manual vacuum aspiration service. Int J Gynaecol Obstet 2023; 163:302-306. [PMID: 37198749 DOI: 10.1002/ijgo.14836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Manual vacuum aspiration (MVA) is a safe and effective alternative option for the management of first-trimester miscarriage, termination of pregnancy, or retained pregnancy tissue. Ireland's first MVA clinic was set up in the Rotunda Hospital in April 2020. OBJECTIVE To identify the number of women who have undergone MVA since establishing our service, to assess the efficacy and safety of MVA in that service, and to develop local Irish studies that further support the safety of MVA, adding to the international body of evidence. METHODS With the approval and assistance of the Clinical Audit Committee, we obtained a log of all patients who underwent MVA in the first 18 months of the service. We performed a retrospective electronic chart review using Maternal and Newborn Clinical Management System. We collected the data and preformed a descriptive analysis. RESULTS In total, 86 women underwent MVA, 85 (98.8%) of which were successfully completed. There were no immediate procedural complications, inter-hospital transfers, or emergency electric vacuum aspiration (EVA) required. We obtained an incomplete evacuation rate of 4.7% (n = 4). CONCLUSION We have demonstrated that the MVA service in the Rotunda Hospital is a safe, effective management option with advantages for both the patient and the healthcare system. We recommend consideration for provision of funding and resources to enable expansion of this service nationally in order to give women greater autonomy of choice in the management of early pregnancy complications and termination of pregnancy.
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Affiliation(s)
- A Corcoran
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - D Hayes-Ryan
- Department of Obstetrics & Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - V O'Dwyer
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - S Cooley
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - M Ramphul
- Department of Obstetrics & Gynaecology, Rotunda Hospital, Dublin, Ireland
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Hayes-Ryan D, Meaney S, Byrne S, Ramphul M, O'Dwyer V, Cooley S. Womens experience of Manual Vacuum Aspiration: An Irish perspective. Eur J Obstet Gynecol Reprod Biol 2021; 266:114-118. [PMID: 34624739 DOI: 10.1016/j.ejogrb.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Manual Vacuum Aspiration (MVA) is a well-established management option for early pregnancy loss or early termination of pregnancy. MVA is performed as out-patient surgical procedure using local anaesthetic whereby aspiration of uterine contents is achieved through use of a hand-held negative pressure syringe. Ireland's first MVA service was established at the Rotunda Hospital Dublin in April 2020,. The purpose of this study was to gather feedback from women who had undergone MVA in the unit. STUDY DESIGN Prospective mixed methods study of women attending for uterine aspiration under local anaesthetic from July to October 2020 in the unit. Consenting women were contacted one week following MVA via telephone. The survey conducted consisted of structured closed questions along with open-ended questions, to assess womens satisfaction in relation to all aspects of the MVA service. RESULTS Nineteen women took part in the study, a response rate of 86.4%. Participants reported feeling well informed prior to attending for MVA. Prior to the procedure, pain expectation scores were high but actual reported pain scores were much lower. Although some participants did find MVA uncomfortable, the fact the procedure was very quick and the side effects so minimal generally negated this. The location and set up of the clinic scored highly among participants as did the staff of the clinic. Overall satisfaction with the MVA service was high with 84.2% of participants reporting they would opt again for MVA in the future. CONCLUSIONS Women living in Ireland are interested and agreeable with having Manual Vacuum Aspiration as an available option for management of early pregnancy complications. Consideration should be given to expansion of MVA services nationally.
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Affiliation(s)
- D Hayes-Ryan
- Obstetrics & Gynaecology Department, The Rotunda Maternity Hospital, Dublin, Ireland.
| | - S Meaney
- National Perinatal Epidemiology Centre, University College Cork, Ireland
| | - S Byrne
- Obstetrics & Gynaecology Department, The Rotunda Maternity Hospital, Dublin, Ireland
| | - M Ramphul
- Obstetrics & Gynaecology Department, The Rotunda Maternity Hospital, Dublin, Ireland
| | - V O'Dwyer
- Obstetrics & Gynaecology Department, The Rotunda Maternity Hospital, Dublin, Ireland
| | - S Cooley
- Obstetrics & Gynaecology Department, The Rotunda Maternity Hospital, Dublin, Ireland
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Ramphul M. "Strategies to increase the accuracy and safety of OVD" (Clinical assessment skills and role of ultrasound, simulation training and new technologies to enhance instrument application). Best Pract Res Clin Obstet Gynaecol 2019; 56:35-46. [PMID: 30910445 DOI: 10.1016/j.bpobgyn.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
Abstract
Operative vaginal delivery (OVD) is commonly performed in the UK and Ireland. With skillful practice, the risks to mothers and babies are low. Caesarean section at full dilatation, particularly after failed OVD, can be more hazardous for mothers and babies. It is important to maintain and develop skills in OVD in order to provide it as a safe delivery option when the benefits outweigh the risks. As ultrasound machines have become more readily available on the labour ward, ultrasound assessment has been used to help clinicians diagnose the fetal head position and station, and also to try predict the success of the delivery. Simulation training has successfully been used in the setting of obstetric emergencies and is being developed to teach both technical and communication skills in OVD in order to improve maternal and neonatal outcomes. In this chapter we will discuss strategies to improve the accuracy and safety of OVD in more details.
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Affiliation(s)
- M Ramphul
- Cambridge University Hospitals NHS Trust, Addenbrooke's Hospital, UK.
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Corry EM, Ramphul M, Rowan AM, Segurado R, Mahony RM, Keane DP. Exploring full cervical dilatation caesarean sections–A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 224:188-191. [DOI: 10.1016/j.ejogrb.2018.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/16/2022]
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Ramphul M, Corry E, Rowan A, Mahony R, Fitzpatrick M, O'Brien C, McAuliffe F. 438: Pudendal neuropathy after caesarean section in the second stage of labor. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCarthy CM, Ramphul M, Madden M, Hickey K. The use and success of cold coagulation for the treatment of high grade squamous cervical intra-epithelial neoplasia: a retrospective review. Eur J Obstet Gynecol Reprod Biol 2016; 203:225-8. [PMID: 27343739 DOI: 10.1016/j.ejogrb.2016.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/26/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cold coagulation is recognised as a viable, cost-effective and successful treatment for cervical intraepithelial neoplasia (CIN), being used less frequently than excisional treatments for high grade lesions. We set out to demonstrate successful long term follow-up of patient with high grade CIN treated with cold coagulation. STUDY DESIGN We conducted a retrospective review over a one-year period of women with biopsy-proven CIN 2 and 3 who were treated with cold coagulation to the cervix, attending the colposcopy service of a large tertiary referral hospital. We examined follow-up cervical smear data for three years post treatment of low and high grade CIN, evaluated the success of treatment and re-treatment rates. RESULTS 93 patients were included in our study, with 39 (41.9%) having CIN 1 and 54 (58.1%) diagnosed with CIN 2 or 3. Follow-up smears revealed low levels of recurrent high grade changes in both groups, with 31 (79.5%) of our CIN 1 group having a negative smear one year following treatment with cold coagulation, compared to 44 (81.1%) of patients with CIN 2 and 3. Successful primary treatment (i.e. no requirement for further treatment after 3 year follow-up) occurred in 33 (84.6%) of the CIN 1 group, and 42 (77.7%) of the CIN 2/3 group, demonstrating no statistical significance between re-treatment rates between both groups. CONCLUSIONS This study demonstrates the effectiveness of cold coagulation for the treatment of high grade cervical intraepithelial neoplasia. High success rates, and low re-treatment rates confirm that this is an acceptable primary treatment for CIN 2 and 3.
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Affiliation(s)
- C M McCarthy
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland.
| | - M Ramphul
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland
| | - M Madden
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland
| | - K Hickey
- Department of Gynaecology, University Hospital Limerick, Limerick, Ireland
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Ramphul M, Thanikkel LJ, Ross Russell R. M27 Wheezes, coughs and splutters: how do paediatric trainees manage them? Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ramphul M, Kennelly MM, Burke G, Murphy DJ. Risk factors and morbidity associated with suboptimal instrument placement at instrumental delivery: observational study nested within the Instrumental Delivery & Ultrasound randomised controlled trial ISRCTN 72230496. BJOG 2015; 122:558-63. [DOI: 10.1111/1471-0528.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2014] [Indexed: 10/24/2022]
Affiliation(s)
- M Ramphul
- Department of Obstetrics and Gynaecology; Trinity College Dublin; Coombe Women and Infants University Hospital; Dublin Ireland
| | - MM Kennelly
- University College Dublin; Coombe Women & Infant's University Hospital; Dublin Ireland
| | - G Burke
- Department of Obstetrics and Gynaecology; Graduate Entry Medical School; University of Limerick; Mid-Western Regional Maternity Hospital; Limerick Ireland
| | - DJ Murphy
- Academic Department of Obstetrics and Gynaecology; Trinity College Dublin; Coombe Women and Infants University Hospital; Dublin Ireland
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Crosby DA, Ramphul M, Murphy DJ. Antenatal discussion of the risks and benefits of VBAC and ERCS: Letter in response to BJOG themed issue 'Management of pregnancy after caesarean section'. BJOG 2014; 121:1440-1. [PMID: 25250925 DOI: 10.1111/1471-0528.12881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- D A Crosby
- Academic Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland; Coombe Women and Infants University Hospital, Dublin, Ireland
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Ooi PV, Ramphul M, Said S, Burke G, Kennelly MM, Murphy DJ. Ultrasound assessment of fetal head circumference at the onset of labor as a predictor of operative delivery. J Matern Fetal Neonatal Med 2014; 28:2182-6. [DOI: 10.3109/14767058.2014.980810] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Butler K, Ramphul M, Dunney C, Farren M, McSweeney A, McNamara K, Murphy DJ. A prospective cohort study of the morbidity associated with operative vaginal deliveries performed by day and at night. BMJ Open 2014; 4:e006291. [PMID: 25354825 PMCID: PMC4216855 DOI: 10.1136/bmjopen-2014-006291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate maternal and neonatal outcomes associated with operative vaginal deliveries (OVDs) performed by day and at night. DESIGN Prospective cohort study. SETTING Urban maternity unit in Ireland with off-site consultant staff at night. POPULATION All nulliparous women requiring an OVD with a term singleton fetus in a cephalic presentation from February to November 2013. METHODS Delivery outcomes were compared for women who delivered by day (08:00-19:59) or at night (20:00-07:59). MAIN OUTCOME MEASURES The main outcomes included postpartum haemorrhage (PPH), anal sphincter tear and neonatal unit admission. Procedural factors included operator grade, sequential use of instruments and caesarean section. RESULTS Of the 597 women who required an OVD, 296 (50%) delivered at night. Choice of instrument, place of delivery, sequential use of instruments and caesarean section did not differ significantly in relation to time of birth. Mid-grade operators performed less OVDs by day than at night, OR 0.60 (95% CI 0.43 to 0.83), and a consultant supervisor was more frequently present by day, OR 2.26 (95% CI 1.05 to 4.83). Shoulder dystocia occurred more commonly by day, OR 2.57 (95% CI 1.05 to 6.28). The incidence of PPH, anal sphincter tears, neonatal unit admission, fetal acidosis and neonatal trauma was similar by day and at night. The mean decision to delivery intervals were 12.0 and 12.6 min, respectively. CONCLUSIONS There was no evidence of an association between time of OVD and adverse perinatal outcomes despite off-site consultant obstetric support at night.
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Affiliation(s)
- Katherine Butler
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Meenakshi Ramphul
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Clare Dunney
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Maria Farren
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Aoife McSweeney
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Karen McNamara
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
| | - Deirdre J Murphy
- Academic Department of Obstetrics & Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork, Dublin, Republic of Ireland
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Ramphul M, Murphy DJ. Authors' reply: Does ultrasound determination of fetal occiput position improve labour outcome? BJOG 2014; 121:1312-3. [PMID: 25155322 DOI: 10.1111/1471-0528.12957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M Ramphul
- Academic Department of Obstetrics & Gynaecology, Trinity College Dublin, Coombe Women & Infants' University Hospital, Dublin, Ireland
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Ramphul M, Ooi PV, Burke G, Kennelly MM, Said SAT, Montgomery AA, Murphy DJ. Instrumental delivery and ultrasound : a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery. BJOG 2014; 121:1029-38. [DOI: 10.1111/1471-0528.12810] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M Ramphul
- Department of Obstetrics and Gynaecology; Trinity College Dublin; Coombe Women and Infants University Hospital; Dublin Ireland
| | - PV Ooi
- Mid-Western Regional Maternity Hospital; Limerick Ireland
| | - G Burke
- Department of Obstetrics and Gynaecology; Graduate Entry Medical School; University of Limerick; Mid-Western Regional Maternity Hospital; Limerick Ireland
| | - MM Kennelly
- University College Dublin; Coombe Women & Infant's University Hospital; Dublin Ireland
| | - SAT Said
- Mid-Western Regional Maternity Hospital; Limerick Ireland
| | - AA Montgomery
- Bristol Randomised Trials Collaboration School of Social and Community Medicine; University of Bristol; Bristol UK
| | - DJ Murphy
- Department of Obstetrics and Gynaecology; Trinity College Dublin; Coombe Women and Infants University Hospital; Dublin Ireland
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Murphy DJ, Burke G, Montgomery AA, Ramphul M. Study protocol. IDUS - Instrumental delivery & ultrasound: a multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery. BMC Pregnancy Childbirth 2012; 12:95. [PMID: 22970933 PMCID: PMC3490917 DOI: 10.1186/1471-2393-12-95] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/07/2012] [Indexed: 11/25/2022] Open
Abstract
Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496
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Affiliation(s)
- Deirdre J Murphy
- Academic Department of Obstetrics & Gynaecology, Trinity College Dublin & Coombe Women & Infant's University Hospital, Dublin, Ireland
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Farah N, Murphy M, Ramphul M, O'Connor N, Kennelly MM, Turner MJ. Comparison in maternal body composition between Caucasian Irish and Indian women. J OBSTET GYNAECOL 2012; 31:483-5. [PMID: 21823843 DOI: 10.3109/01443615.2011.581316] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The use of body mass index (BMI) for the diagnosis of obesity has limitations, especially when comparing ethnic groups with different body proportions. The aim of this prospective study was to compare maternal body composition in early pregnancy between Caucasian Irish and Indian women. A total of 81 Indian women and 81 Irish Caucasian women were matched for age, parity and BMI. Maternal weight and height were measured, and body composition analysed using bioelectrical impedance. The Irish women were taller and weighed more than the Indian women (p<0.001). At any given BMI, the Indian women had a higher total body fat percentage, visceral fat level and high fat percentage than the Irish women (p=0.024, 0.001 and 0.001, respectively). Our findings suggest that lower BMI cut-offs should be used for screening for gestational diabetes mellitus in Indian women attending our antenatal services.
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Affiliation(s)
- N Farah
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
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Ramphul M, Dimitriou E, Byrne B. An unusual reproductive consequence of needle excision of the transformation zone. J OBSTET GYNAECOL 2010; 30:311-2. [PMID: 20373940 DOI: 10.3109/01443610903585226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Ramphul
- Coombe Women and Infants University Hospital, Dublin, Ireland.
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