Maternal and neonatal hyponatraemia: a comparison of Hartmanns solution with 5% dextrose for the delivery of oxytocin in labour

We performed a randomised controlled trial to compare the effect on neonatal and maternal serum sodium of using oxytocin in Hartmanns solution compared to the standard 5% Dextrose regimen for induction or augmentation in labour. We found significantly decreased maternal and neonatal serum sodium concentrations in the 5% Dextrose group compared to the Hartmanns group.

Idiopathic mesenteric thrombosis following caesarean section

Mesenteric venous thrombosis, "the great mimicker", is a very rare disorder in pregnancy and the puerperium, particularly when not associated with any pre-existing thrombophilia or autoimmune states. We describe a patient requiring a resection of 150 cm of gangrenous small bowel after uncomplicated elective Caesarean section. The only risk factor for thrombosis was recovery from an elective Caesarean section, a condition classified by the Royal College of Obstetricians and Gynaecologists as "low risk". Death from thromboembolism is the leading cause of maternal mortality and should always be considered with unusual post partum symptoms. Early diagnosis of mesenteric vascular occlusion is difficult and recent evidence suggests that elevated GST isoenzyme may be helpful. In all cases of MVT anti-coagulation is the basis of treatment. Patients who are not anti-coagulated after surgery have a recurrence rate of 25 per cent compared with 13 per cent of heparinised post-operative patients. As no other pre-existing cause for MVT was found, management was with warfarin for 6 months, the oral contraceptive pill was contraindicated and heparin prophylaxis was recommended for future pregnancies.

Management of women with major placenta praevia without haemorrhage: A questionnaire-based survey of Irish obstetricians

Our aim was to determine individual management of women with major placenta praevia without antepartum haemorrhage (APH) using a questionnaire-based study. Placenta praevia complicates one in 200 pregnancies. It is associated with maternal mortality of 0.03%. The maternal, fetal and neonatal morbidity and mortality are due to the complications of haemorrhage and prematurity. APH due to placenta praevia is unpredictable and this may explain the traditional inpatient approach to management. This approach may be justified in those with bleeding, it is questionable in those who have not bled. A total of 121 obstetricians replied (63%), to 192 questionnaires sent out. Of these, 48 obstetricians would admit all women with major placenta praevia without APH, while 69 would manage them on an outpatient basis. When asked whether or not they agreed with outpatient management, 21 agreed strongly, 51 tended to agree, 23 tended to disagree and 13 disagreed strongly. Over half of the obstetricians adopt an outpatient management approach.

Acceptability of routine enquiry regarding domestic violence in the antenatal clinic

Domestic Violence poses a significant health risk for the woman and her baby. We wished to determine the acceptability of routine questioning for domestic violence in the maternity hospital setting. A non-anonymised questionnaire was completed by 481 women attending for booking antenatal appointment in a maternity hospital antenatal clinic. The doctor asked four questions regarding experience of partner abuse, The acceptability of these questions was determined. 468 (99%) patients found the questions acceptable and said it would be helpful to ask all patients. Sixty-one (12.9%) women gave a history of at least one form of partner abuse. We concluded that routine enquiry about domestic violence during hospital antenatal visits is acceptable to women and perceived by them to be worthwhile.

Maternal Mortality in Women with Epilepsy

It is estimated that, in Ireland, there are 10,000 women with epilepsy of childbearing potential1. In this paper the maternal mortality rate for women with epilepsy attending the Rotunda Hospital Epilepsy Clinic 2004 - 2013 was determined. There were 3 maternal deaths in women with epilepsy during this time, which represents a mortality rate of 0.8%. In those women who died, there were concerns in relation to risks to the foetus by taking Anti-Epileptic Drugs (AED) and also issues with access to neurology services before pregnancy, acceptance of specialist support and lack of consistency in advice from health care professionals outside of Ireland. Implementing the nationally agreed care plan for women with epilepsy will improve the quality of care given and potentially we will see a reduction in maternal mortality in these women.

Marrow changes and reduced proliferative capacity of mesenchymal stromal cells from patients with "no-option" critical limb ischemia; observations on feasibility of the autologous approach from a clinical trial

BACKGROUND AIMS

Approximately 1 in 3 patients with critical limb ischemia (CLI) are not suitable for surgical or endovascular revascularization. Those "no-option" patients are at high risk of amputation and death. Autologous bone marrow mesenchymal stromal cells (MSCs) may provide a limb salvage option. In this study, bone marrow characteristics and expansion potentials of CLI-derived MSCs produced during a phase 1b clinical trial were compared with young healthy donor MSCs to determine the feasibility of an autologous approach. Cells were produced under Good Manufacturing Practice conditions and underwent appropriate release testing.

METHODS

Five bone marrow aspirates derived from patients with CLI were compared with six young healthy donor marrows in terms of number of colony-forming units-fibroblast (CFUF) and mononuclear cells. The mean population doubling times and final cell yields were used to evaluate expansion potential. The effect of increasing the volume of marrow on the CFUF count and final cell yield was evaluated by comparing 5 CLI-derived MSCs batches produced from a targeted 30 mL of marrow aspirate to five batches produced from a targeted 100 mL of marrow.

RESULTS

CLI-derived marrow aspirate showed significantly lower numbers of mononuclear cells with no difference in the number of CFUFs when compared with healthy donors' marrow aspirate. CLI-derived MSCs showed a significantly longer population doubling time and reduced final cell yield compared with young healthy donors' MSCs. The poor growth kinetics of CLI MSCs were not mitigated by increasing the bone marrow aspirate from 30 to 100 mL.

CONCLUSIONS

In addition to the previously reported karyotype abnormalities in MSCs isolated from patients with CLI, but not in cells from healthy donors, the feasibility of autologous transplantation of bone marrow MSCs for patients with no-option CLI is further limited by the increased expansion time and the reduced cell yield.

Analysis of endometrial carcinoma

Between 1980/86 there were 58 cases of uterine cancer reviewed at the Mater Misericordiae Hospital, of which 49 (84.5%) had endometrial adenocarcinoma. The median survival in Stage I disease was 30 months and where applicable the overall five-year survival rate was 43.75%. These survival rates are less than those reported from most other centres. This reduced survival rate was not related to presentation with more advanced disease. However, patients were of an older age and had a greater number of poorly differentiated tumours than in other reported series. Comparative results with other centres in Ireland would be assisted by the establishment of a National Tumour Registry.

Intrapartum asphyxia in term and post term infants

Many attempts have been made to identify infants at risk of suffering asphyxial brain damage. In a retrospective review of records at the Rotunda Hospital over a five year period all infants who died or suffered seizures, presumed secondary to asphyxia, were compared with the general hospital population. Out of 28,655 deliveries reviewed, there were 13 deaths in infants at or after term associated with perinatal asphyxia, and 32 surviving infants had asphyxial seizures. Seizures were regarded as asphyxial in origin if they occurred in the first forty eight hours of life and were associated with other clinical evidence of asphyxia. The incidence of abnormal presentations, assisted breech deliveries, instrumental deliveries and emergency caesarean sections was all increased in the asphyxial categories compared to the control population. Referral to the fetal assessment unit was associated with a seizure rate of 0.16/1000 live births compared with a rate of 1.4/1000 in the remaining non referred hospital population. Nineteen percent of the infants who seized subsequently developed cerebral palsy. It would appear from our data that referral to the fetal assessment unit and the consequent assignment to "high risk" status is associated with low risk in terms of asphyxial outcome.