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P McParland

Publications and source records attributed to P McParland.

At least 19 recordsLinked to original sources
PubMed2006

Update on the management of non-anti D antibodies.

With the development of the Rh D immunoglobulin and utilisation in clinical practice, severe rhesus iso-immunisation is rarely seen today. Antibodies against other blood groups are now more common than anti-D and while the majority do not cause significant haemolysis, there are reports of serious morbidity with antibodies other than anti-D. We reviewed retrospectively all cases (excluding anti-D and anti kell antibodies) where antibodies were detected at routine booking visit between 1997-2001 and correlated the type of antibody to clinical outcome as assessed by coombs test, postnatal phototherapy and transfusion. Our approach to these cases does not involve invasive test as amniocentesis and relies on the ultrasound monitoring, level of antibodies and timely delivery with appropriate paediatric follow up. Over five years period 150 women were identified with antibodies other than anti-D or anti-kell. There were no directly related deaths. Many authorities suggest amniocentesis for specific antibodies to assess fetal haemolysis and plan management. This study support a non-invasive approach with mortality and minimal morbidity.

Blood Group Antigens↗
PubMed2004

The role of placental cytogenetic cultures in intrauterine and neonatal deaths.

Knowledge of chromosomal status is useful in helping to explain fetal and neonatal deaths, but maceration has been felt to compromise the success rate. As well as skin fibroblast culture, the placenta can be sampled and this may be useful where permission for autopsy is refused. We examined placental cytogenetic results from 250 cases over a 5-year period. There was a success rate of 84.4%, with neither weight (< or > 500 g) nor maceration status showing a significant impact. Placentas sampled within 1 day were significantly more likely to give a positive culture. The results suggested that placental cytogenetic cultures should be attempted in all perinatal deaths where such information is desired.

Cells, Cultured↗
PubMed2004

Vein of Galen aneurysm malformation (VGAM): closing the management loop.

We report a case where an antenatal scan showed a cerebral vessel dilatation consistent with a vein of Galen malformation (VGAM). After delivery the diagnosis was confirmed on MRI scan. The infant's condition was stable in relation to the two important clinical indicators, mainly not in congestive cardiac failure and no hydrocephalus. The vein of Galen assessment score as used in Hopital Bicetre was 20/21. The scoring system is based on a multiorgan assessment including the five parameters cardiac, cerebral, respiratory, hepatic and renal (Table 1). A score of < 8 indicates no treatment, 8-12 means immediate intervention while a score > 12 delays intervention to circa six months of age. At four months the head circumference accelerated with hydroceaphalus on scans and the infant became clinically symptomatic. Urgent embolisation was performed. The procedure uses N-butylcyanoacrylate (NBCA) glue as the embolisation agent, which in this case was inserted through the left posteriomedial choroidal artery. Complete obliteration was achieved. The infant subsequently required insertion of a ventriculoperitoneal shunt for the hydrocephalus component. The infant has had no recurrence. He remains well on objective examination he has mild developmental delay. In summary this case highlights the value of antenatal diagnosis,the VGAM assessment score to determine the optimal time of intervention and the effectiveness of embolisation.

Adhesives↗
PubMed2002

Neonatal alloimmune thrombocytopenia in the Irish population: a discrepancy between observed and expected cases.

AIMS: To estimate the rate of detection of neonatal alloimmune thrombocytopenia (NAITP) in the Irish population, to investigate clinical presentation and outcome in affected infants, and to determine the extent, if any, to which this condition is underdiagnosed at present. METHODS: Cases were collected in a retrospective fashion from a review of platelet serology laboratory records from January 1992 to December 2000. Clinical data were obtained from hospital records. Testing for maternal antiplatelet antibody was by one or more of the following: the platelet suspension immunofluorescence test, a commercial antigen capture enzyme linked immunosorbent assay (GTI-PakPlus), and the monoclonal antibody immobilisation of platelet antigens assay. Platelet antigen typing was by the polymerase chain reaction technique with sequence specific primers. RESULTS: Twenty seven serologically verified cases of NAITP were identified in 18 families. Maternal antibody to human platelet antigen 1a accounted for 25 of the 27 confirmed cases. Twenty one of 26 infants were born with severe thrombocytopenia. Nineteen of 27 infants had bleeding manifestations at birth. Petechiae and bruising were most commonly observed (n = 17). There were no documented cases of intracranial haemorrhage in this group but systematic cranial ultrasound was not performed. CONCLUSIONS: Screening studies in predominantly white populations have estimated the incidence of NAITP to be between 1 in 1000 and 1 in 2000 live births. With 50 000 births each year in Ireland, these results give a clinical detection rate for NAITP of just 1 case in 16 500 live births, strongly suggesting that NAITP is currently underdiagnosed. Antenatal screening to detect women at risk of having babies with NAITP is now scientifically feasible and should be considered.

Antigens, Human Platelet↗
PubMed1998

Reduced fetal exposure to aspirin using a novel controlled-release preparation in normotensive and hypertensive pregnancies.

OBJECTIVES: To examine the fetal effects of a novel controlled-release, low dose aspirin preparation in normal and hypertensive pregnancies. DESIGN: Random double-blind study. Participants assigned to receive conventional formulation aspirin (75 mg), controlled-release low dose aspirin (75 mg), or a matching placebo. SETTING: National Maternity Hospital, Dublin. PARTICIPANTS: Eighteen women with an uncomplicated pregnancy and 18 women with preeclampsia. MAIN OUTCOME MEASURES: Urine was analysed for metabolites of thromboxane and prostacyclin by gas chromatography, mass spectrometry. Serum thromboxane B2 was determined in maternal and cord blood. RESULTS: Both aspirin preparations reduced maternal serum thromboxane B2 by 95% and induced similar reductions in the urinary 11-dehydro-thromboxane B2, a major metabolite of thromboxane A2 in vivo. In contrast, neither preparation altered urinary 2,3-dinor-6-keto PGF1alpha, the major metabolite of prostacyclin. Despite their similar effects in the mothers, the two aspirin preparations differed in their effects on the fetus. While both suppressed cord fetal thromboxane B2, this was significantly (P < 0.005) less for the controlled-release preparation (210+/-42 ng/ml for placebo vs 109+/-22 ng/ml for controlled-release aspirin and 44+/-9 ng/ml for regular oral aspirin). CONCLUSIONS: At equivalent maternal suppression of serum thromboxane B2, a controlled aspirin release preparation results in lower fetal exposure than regular oral aspirin.

6-Ketoprostaglandin F1 alpha↗
PubMed1997

Laparoscopic laser treatment for endometriosis.

The advent of the use of laparoscopy and lasers in gynaecology has added a further option for the treatment of endometriosis. This study is a retrospective review of the notes of 28 women who had endometriosis treated laparoscopically with an Nd:YAG laser. Results were assessed by subjective reporting of symptoms. Seventy-three percent of patients reported significant or complete resolution of symptoms at three to 26 months follow-up. No major complications were encountered. The results suggest this offers a further treatment option for endometriosis which merits further evaluation.

Adult↗
PubMed1996

Multiple and massive arteriovenous malformations in pregnancy.

Arteriovenous malformations (AVM) are rare in the reproductive years of life. There is a paucity of data regarding AVMs in pregnancy. Pregnancy can influence both the development and the progression of AVMs. The tendency to bleed is unpredictable. Many AVMs undergo spontaneous postpartum regression. We report on a 30-year old primipara with multiple generalised AVMs, both congenital and acquired, and a massive congenital AVM involving her entire right upper limb and shoulder girdle. Magnetic resonance imaging suggested there were AVMs in both the pelvis and the lower abdominal wall. The main management dilemma was mode of delivery. A trial of vaginal delivery was successful after spontaneous onset at term. The patient had a series of significant postpartum haemorrhages, warranting blood transfusion.

Adult↗
PubMed1996

External cephalic version. Does it have a role in modern obstetric practice?

External cephalic version (ECV) for breech presentation at term substantially reduces the incidence of breech birth and cesarean section. Appropriate counseling and surveillance is important to ensure an acceptably low complication rate and reduce potential for litigation. Even a high success rate for ECV only minimally reduces the overall cesarean section rate.

Breech Presentation↗
PubMed1995

Shoulder dystocia--is it predictable?

An unmatched comparative study is described to determine if routine clinical indicators are useful predictors for shoulder dystocia. Parity, maternal weight gain during pregnancy, and a history of a previous large baby and increased operative vaginal delivery rate were more often associated with shoulder dystocia. No other significant associations were found. However, shoulder dystocia can not be predicted accurately antepartum using routinely available clinical factors.

Birth Injuries↗
PubMed1995

High delivery intervention rates in nulliparous women over age 35.

OBJECTIVE: To assess the effect of maternal age and parity on obstetric interventions and pregnancy outcome. STUDY DESIGN: A retrospective review of 35,140 deliveries including 4268 parturients aged 35 years or more (1985-1992). Obstetrical interventions and outcome were analyzed in relation to age and parity. RESULTS: Nulliparous women aged 35 years or more had a 2-fold increase in cesarean delivery rate over younger nulliparae, and 50% more cesarean deliveries than the multiparae aged 35 years or more. Similar trends were observed in preterm labor, labor induction, breech presentation, and instrumental delivery. Higher risk was encountered in neonatal 1 min Apgar scores < 3, and in admissions to the neonatal intensive care unit. There were no differences in all parameters between women over age 40 and women aged 35-40 years. The perinatal mortality was not increased and was similar in all groups. CONCLUSIONS: Nulliparae aged more than 35 years are at increased risk for interventions and cesarean sections. However, women aged 35-40 have a similar risk as women aged over 40 years.

Adult↗
PubMed1994

Doppler ultrasound of the uteroplacental circulation in the prediction of pregnancy outcome in women with raised maternal serum alpha-fetoprotein.

OBJECTIVE: To determine whether Doppler waveforms from the uteroplacental circulation could improve the prediction of pregnancy outcome in women with raised maternal serum alpha-fetoprotein and a structurally normal fetus. The study further attempts to determine whether the presence of an early diastolic notch would constitute a better screening test than waveform patterns. DESIGN: An observational study. SETTING: A tertiary referral obstetric service. SUBJECTS: All women referred to St George's Hospital with a raised maternal serum alpha-fetoprotein had waveform measurements from the uteroplacental circulation after exclusion of fetal abnormalities. Pregnancy outcome was determined by questionnaire sent to the referring clinicians. MAIN OUTCOME MEASURES: Adverse perinatal outcome in the form of preterm labour, low birthweight and perinatal mortality. RESULTS: Data from 332 cases were available for analysis. Women with a normal pattern of uteroplacental waveforms had a perinatal mortality of 9.6/1000. Women with a uniform high resistance pattern had a perinatal mortality of 846/1000, and those with a mixed resistance pattern had a perinatal mortality of 268/1000. Overall there were 27 cases of placental abruption which accounted for eight of the 50 perinatal deaths. The remainder were due to prematurity or low birthweight or both. The presence of the early diastolic notch did not improve on the waveform patterns in the prediction of perinatal death. CONCLUSION: Women with raised maternal serum alpha-fetoprotein and normal Doppler waveform patterns from the uteroplacental circulation can be reassured, but mixed or uniform high resistance patterns should encourage increased surveillance and a search for intervention therapies.

Blood Flow Velocity↗
PubMed1991

Acute twin-twin transfusion: a possible mechanism for brain-damaged survivors after intrauterine death of a monochorionic twin.

Intrauterine death of one twin in monochorionic pregnancies is associated with increased mortality and morbidity for the survivor. This has been attributed to the consequences of intrauterine disseminated intravascular coagulation (DIC) initiated by the dead twin. We describe a case in which the fetal cerebral and renal lesions typically found in survivors occurred without any derangement in coagulation. Instead, acute twin-twin transfusion was suggested by the presence of severe anemia in the surviving fetus at delivery. We suggest that the lesions frequently found in the survivors are often due to acute hemodynamic and ischemic changes resulting from acute twin-twin transfusion at the time of intrauterine death, rather than to late-onset DIC. This hypothesis has an important implication for future management: Intervention must occur before intrauterine death if neurologic sequelae in the survivor are to be prevented.

Brain Diseases↗
PubMed1991

Fetal assessment in postterm pregnancy.

There is considerable disagreement over the management of postterm pregnancies. The main controversy is whether to adopt a policy of routine induction or one of selective induction allied to frequent fetal surveillance. Current evidence suggests that routine induction at 42 weeks' gestation does not increase the risk of instrumental delivery or cesarean section. To adopt the former approach, it is important that gestation is confirmed by early ultrasound examination, which has reduced the true incidence of postterm pregnancy to less than 6%. There have been no recent significant advances regarding methods of fetal surveillance in the postterm pregnancy.

Female↗
PubMed1990

Early Doppler ultrasound screening in prediction of hypertensive disorders of pregnancy.

1198 nulliparous women were screened in early pregnancy (median 18 weeks' gestation) by the recording of doppler ultrasound waveforms from the uteroplacental circulation. After exclusions, the results of 1014 women were available for analysis; 118 (12%) of them had persistently abnormal waveforms on repeat ultrasound scans at 24 weeks and were taken to have a positive test result. Hypertension was significantly more frequent among those women than among women with normal doppler waveforms (29/118 [25%] vs 45/896 [5%]). In addition, hypertension in women with abnormal waveforms was more likely to be severe; 12 (10%) had proteinuria and 15 (13%) intrauterine growth retardation compared with 7 (0.8%) and 0, respectively, of those with normal waveforms. Overall, the test did poorly when assessed by standard statistical means. However, the sensitivity was high for hypertension associated with either proteinuria (63%) or intrauterine growth retardation (100%). The test is cheap, easy to carry out, and non-invasive, and it can be done in early pregnancy; it is therefore a useful means of identifying a high-risk group of pregnant women suitable for therapeutic intervention to reduce the incidence of hypertensive disorders and their complications.

Adult↗