Mid-West hospital leads Caesarean research

NEW research spearheaded at University Maternity Hospital Limerick (UMHL) has shown a reliable way to predict which first-time mothers are likely to need a Caesarean section when in labour.

The research paper, The Genesis Study, was the only one from outside North America among the first 30 selected, from some 1,600 submissions from all over the world, for oral presentation at the recent annual meeting of the Society for Foetal-Maternal Medicine in Atlanta, Georgia.

The Perinatal Ireland research team showed in the study, which involved some 2,500 first-time mothers, that five key patient characteristics out of 37 characteristics that were analysed can be combined in a mathematical model to predict which patients are more likely to need a Caesarean delivery in labour. These characteristics are older maternal age, shorter maternal height, higher maternal BMI, bigger foetal abdomen size and bigger foetal head size.

The study was designed and proposed in 2009 by Dr Gerry Burke, clinical director for Maternal and Child Health at UL Hospitals’ Group, on the basis of earlier research carried out at the Limerick hospital and developed by the multi-centre Perinatal Ireland.

Perinatal Ireland is a collaborative cross-border research network based at the Rotunda Hospital and the Royal College of Surgeons in Ireland, involving seven large Irish maternity hospitals, under the chairmanship of Professor Fergal Malone, Master of the Rotunda Hospital.

Prof Amanda Cotter, head of the Department of Obstetrics and Gynaecology, UL Graduate Entry Medical School; Dr Khadijah Ifrah Ismail, UL lecturer, and Ciara Ní Laighin, UL research fellow and ultrasonographer conducted the study at the UMHL site.

The Genesis Study was presented in Atlanta to a large international audience of foetal-maternal medicine specialists by Dr Naomi Burke, an Irish trainee obstetrician and gynaecologist.

Commenting on the research, Dr Burke said preparatory work to test the information in a second-phase clinical study, called a randomised trial, is already underway.

“It is likely to lead to safer childbirth for first-time mothers throughout the world. I am grateful to the HRB, to UL and the Mid-Western Hospitals Development Trust for their ongoing support. I wish to pay special tribute to the late Dan Gallery, who, as chairman of Mid-Western Hospitals Development Trust, granted funding to the Perinatal Ireland group in Limerick, the first time the trust had funded a research initiative,” Dr Burke said.

Meanwhile, separate research conducted by the Perinatal Ireland consortium – including UMHL – was given the American Journal of Obstetrics and Gynecology Award for Research Excellence at the conference in Atlanta.

This study, entitled Optimising the definition of intrauterine growth restriction: the multi-centre prospective PORTO Study, showed that when babies are small compared to other babies during pregnancy, they are at increased risk when the placental blood flow is poor or when their weight is in the bottom 3%. The risk for small babies with neither of these two features is low.

The research, led by Dr Julia Unterscheider and published in American Journal of Obstetrics and Gynecology in 2013, has already had a large impact in the scientific community, with more than 80 citations, by far the most for any paper presented at the meeting since 2011.

Commenting on the award, Dr Burke said the UL Hospitals Group is “becoming increasingly focused on academic activity, including teaching and research, as this leads to excellence in clinical care and attracts high-calibre clinicians”.

“It is very pleasing that Irish research is able to compete with, and indeed surpass, some of the best centres in North America and that the American scientific community recognises this,” Dr Burke added.