ORCID Profile
0000-0002-2142-1678
Current Organisations
Cork University Maternity Hospital
,
Rotunda Hospital
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Publisher: BMJ
Date: 04-09-2018
DOI: 10.1136/BMJ.K3546
Abstract: To determine whether intravenous oxytocin is more effective than intramuscular oxytocin at preventing postpartum haemorrhage at vaginal delivery. Double blind placebo controlled randomised trial. University affiliated maternity unit in the Republic of Ireland. 1075 women aged 18 years or older, at term with a singleton pregnancy who were aiming for a vaginal delivery with an actively managed third stage of labour. Women were allocated to an intravenous bolus of oxytocin (10 IU in 1 mL given slowly over one minute) and placebo intramuscular injection (1 mL 0.9% saline) or an intramuscular bolus of oxytocin (10 IU in 1 mL) and placebo intravenous injection (1 mL 0.9% saline given slowly over one minute) at vaginal delivery. Allocation was by a secure web based randomisation service with masking of participants and clinicians to the trial intervention. The primary outcome was postpartum haemorrhage (PPH, measured blood loss ≥500 mL). Secondary outcomes were severe PPH (measured blood loss ≥1000 mL), need for blood transfusion, admission to a high dependency unit, and side effects to oxytocin. Between 4 January 2016 and 13 December 2017, 1075 women were randomised and 1035 (96.3%) included in the primary and secondary analyses (517 in the intravenous oxytocin group and 518 in the intramuscular oxytocin group). The incidence of PPH was not significantly lower in the intravenous group (18.8%, 97/517) compared with intramuscular group (23.2%, 120/518): adjusted odds ratio 0.75 (95% confidence interval 0.55 to 1.03). The incidence of severe PPH, however, was significantly lower in the intravenous group (4.6%, 24/517) compared with intramuscular group (8.1%, 42/518): 0.54 (0.32 to 0.91) as was the need for blood transfusion (1.5% Intravenous oxytocin for the third stage of labour results in less frequent severe PPH, blood transfusion, and admission to a high dependency unit than intramuscular oxytocin, and without excess side effects. Current Controlled Trials ISRCTN14718882.
Publisher: Informa UK Limited
Date: 15-06-2021
Publisher: Wiley
Date: 20-11-2021
Abstract: To investigate whether risk factor‐based screening in pregnancy is failing to identify women with hepatitis C virus (HCV) infection and to assess the cost‐effectiveness of universal screening. Retrospective study and model‐based economic evaluation. Two urban tertiary referral maternity units, currently using risk factor‐based screening for HCV infection. Pregnant women who had been tested for hepatitis B, HIV but not HCV. Anonymised sera were tested for HCV antibody. Positive sera were tested for HCV antigen. A cost‐effectiveness analysis of a change to universal screening was performed using a Markov model to simulate disease progression and Monte Carlo simulations for probabilistic sensitivity analysis. Presence of HCV antigen and cost per quality‐adjusted life year (QALY). In all, 4655 s les were analysed. Twenty had HCV antibodies and five HCV antigen. This gives an active infection rate of 5/4655, or 0.11%, compared with a rate of 0.15% in the risk‐factor group. This prevalence is 65% lower than a previous study in the same hospitals from 2001 to 2005. The calculated incremental cost‐effectiveness ratio (ICER) for universal screening was €3,315 per QALY gained. This study showed that the prevalence of HCV infection in pregnant women in the Dublin region has declined by 65% over the past two decades. Risk factor‐based screening misses a significant proportion of infections. A change to universal maternal screening for hepatitis C would be cost‐effective in our population. Universal maternal screening for hepatitis C is cost‐effective in this urban Irish population.
Publisher: Informa UK Limited
Date: 22-07-2020
Publisher: Springer Science and Business Media LLC
Date: 03-01-2018
DOI: 10.1007/S11845-017-1717-6
Abstract: High-grade serous carcinoma (HGSC) is the most common tubo-ovarian cancer. The fallopian tube harbours the precursor lesion: serous tubal intraepithelial carcinoma (STIC). Bilateral salpingo-oophorectomy is an effective risk-reducing surgical (RRS) strategy for breast cancer susceptibility gene mutation carriers (BRCAm). The value of RRS in those without defined genetic risk is unknown but these women represent a substantial cohort in prophylactic surgical practice. This is a retrospective review of RRS at an Irish university teaching hospital. One hundred and thirty women underwent RRS group 1 = 46 BRCAm group 2 = 19 BRCAm negative/65 genetic status unknown. Group 1 had one occult HGSC. Group 2 had no STIC or cancers and were older and more likely to have hysterectomy and benign pathology. Other pathologies included serous tubal intraepithelial lesions (STIL) (2), p53 signatures (2), endometriosis (6), fibroids/adenomyosis (4) and atypical endometrial hyperplasia (1). More than 60% of women undergoing RRS were BRCAm negative or untested. Counselling of high-risk women without defined germline mutations remains a challenge for gynaecologists because the likelihood of removing STIC lesions or occult invasive cancer is low. Removal of coincidental pathology may give added value to RRS in these women.
Publisher: Wiley
Date: 18-01-2022
DOI: 10.1111/AJO.13479
Abstract: Pregnancy following renal transplantation is increasingly common. Overall pregnancy outcomes are favourable however, specific transplant-related risks do exist. In particular, the risk of caesarean delivery is much higher in renal transplant recipients when compared to the general obstetric population. This is owing to the necessity for preterm delivery in cases of severe and early-onset pre-ecl sia and/or fetal growth restriction. We describe two recent cases of renal transplant injury at caesarean delivery at our institution, a tertiary/quaternary obstetric service, which highlight the potential operative risks associated with abdominal surgery. We propose a standardised approach in the care of transplant recipients undergoing caesarean delivery which is aimed at minimising harm and increasing patient safety.
Publisher: Springer Berlin Heidelberg
Date: 2018
DOI: 10.1007/8904_2017_81
No related grants have been discovered for Ciara McCormick.