Colin A Walsh

Royal North Shore Hospital · Maternal-Fetal Medicine

Activity restriction has traditionally been recommended to pregnant women, especially high‐risk patients, to reduce preterm birth. However, there is no scientific evidence that bed‐rest reduces preterm birth and, in many studies, women on bed‐rest had higher rates of delivering preterm. Bed‐rest in pregnancy is associated with significant physiolog...

IntroductionFatal antepartum fetomaternal hemorrhage is a relatively uncommon clinical presentation, though it is one which appears quickly and without warning. The pathophysiology of this disease is unclear, and the incidence does not appear to be decreasing in line with overall antepartum mortality. This study was undertaken to analyse trends in...

It is well established that the death of one fetus in a monochorionic twin pregnancy places the surviving twin at significant risk for neuro-developmental delay or death. Although the early 1st trimester “vanishing twin” has not traditionally been considered a major risk, the precise gestational threshold beyond which a surviving twin is at risk re...

OBJECTIVE: To document detection of fetal congenital heart disease (CHD) in relation to (i) indication for referral, (ii) chromosomal and (iii) extracardiac abnormalities METHOD: All fetal echocardiograms performed in our institution from 2007-2011 were reviewed retrospectively. Indication for referral, cardiac diagnosis based on the World Health...

There are currently limited data describing the natural history and outcome for fetal trisomy 13 diagnosed prenatally. The aim of this study was to evaluate the fetal and neonatal outcome for pregnancies with an established prenatal diagnosis of fetal trisomy 13, and a parental decision for continuation of the pregnancy. To this end, the obstetric...

Objective To determine the critical maternal antibody threshold for specialist referral in Rh(D) alloimmunisation.MethodsA retrospective 16-year cohort study at the national tertiary fetal medicine centre for management of alloimmunisation. Rh(D) alloimmunised pregnancies were extracted from an institutional database and the maternal Anti-D levels...

Objectives To analyse the incidence of additional alloantibody formation following intrauterine red cell transfusion and to evaluate the feasibility of providing extended phenotype-matched red cells in future intrauterine transfusion (IUT).BackgroundIUT is performed in severe, life-threatening fetal anaemia, usually in alloimmunised pregnancies. It...

Objective To analyse anti-D quantification levels and frequency of intrauterine transfusion (IUT), per maternal ABO blood group.Background Maternally derived red cell allo-antibodies can target fetal red cell antigens in utero leading to haemolytic disease and fetal anaemia. When a clinically significant allo-antibody is formed the priority is asce...

Objective: To determine the mode of delivery in pregnancies complicated by complex fetal congenital heart disease (CHD). Study design: Five-year retrospective cohort study at a tertiary fetal medicine center (2007 to 2011). Cases of complex fetal CHD (n=126) were compared with 45 069 non-anomalous singleton infants ⩾500 g to determine rates of e...

Antenatal ultrasonography is widely used in pregnancy to assess fetal growth, wellbeing and anatomy. Although ultrasound screening is now an integral part of routine antenatal care, recommendations for the delivery of obstetric ultrasound vary from country to country. A recent survey of English maternity units reported that 100% of women are offere...

Abstract Introduction: Umbilical artery thrombosis is a rare occurrence, and is associated with poor neonatal outcomes. We present a series of 7 cases occurring over a 13 year period. Methods: The National Maternity Hospital is a tertiary referral centre, with approximately 10,000 births per annum. Cases were identified by a keyword search on the l...

There is uncertainty regarding the optimal method of achieving bladder drainage at the time of gynaecologic surgery. As both transurethral catheterization (TUC) and suprapubic catheterization (SPC) have the potential to cause harm, it is important that gynaecologists have accurate evidence upon which to base their bladder drainage policy. Several c...

To determine the antenatal course of severe red cell alloimmunisation in pregnancies requiring intrauterine fetal transfusion. A retrospective cohort study over 16 years in a single national quaternary fetal medicine centre. From 1996 to 2011, 242 red cell intrauterine transfusions (IUT) were performed in 102 alloimmunised pregnancies. Antibody typ...

: To determine the relationship between mode of delivery and serious adverse neonatal outcomes in term, singleton, cephalic neonates. : A 10-year study of 64,555 term neonates reaching the second stage of labor in a single tertiary obstetric unit from 2000 to 2009. Multiple pregnancies, preterm deliveries (before 37 weeks of gestation), and lethal...

Background Anomalies of the fetal central nervous system (CNS) require considerable expertise. In 2010 we launched a Perinatal Neurosurgical Clinic, wherein fetal CNS anomalies are assessed and counselled by a multi-disciplinary team, comprising a fetal medicine specialist, a paediatric neurosurgeon, a paediatric radiologist and a specialist nurse....

Background Currently, maternal Rh-D antibody levels are primarily used to triage which alloimmunized women warrant enhanced surveillance with middle cerebral artery Doppler. Traditionally, maternal Rh-D antibody levels ≤15 IU/ml have indicated, at worst, mild anaemia and provided reassurance. This threshold has not been widely studied. Methods A pr...

Background Our unit offers a comprehensive fetal echocardiograhy service to expectant mothers who are at increased risk of having a fetus with a cardiac defect. Methods A prospective study from January 2007 to December 2011. Cases of fetal echocardiography were extracted and analysed for referral indication, the presence of extra-cardiac anomalies...

Objective To compare mode of delivery in fetuses with known congenital heart disease (CHD) versus the background rate in non-anomalous fetuses. Methods We examined all cases of prenatally-diagnosed CHD over the 5-year study period, 2007–2011. Data were extracted from computerised patient records. Control data for non-anomalous fetuses were obtained...

Objective: To determine the opinion of clinical obstetricians regarding interpretation of placental reports, including a recently proposed Norwegian classification system. Methods: Paper and online surveys were circulated to practicing obstetricians in Ireland. Data on clinician experience, clinical workload, and exposure to placental pathology...

To document detection of fetal congenital heart disease (CHD) in relation to (i) indication for referral, (ii) chromosomal and (iii) extracardiac abnormalities METHOD: All fetal echocardiograms performed in our institution from 2007-2011 were reviewed retrospectively. Indication for referral, cardiac diagnosis based on the World Health Organization...

Caesarean section (CS) is the most common major surgical procedure performed worldwide. Traditionally, creation of a bladder flap (BF) has been a routine surgical step at CS although recent randomised controlled trials (RCTs) have begun to question its value. We performed a meta-analysis of RCTs examining the benefits of BF formation at CS. Pubmed,...

Abstract Objectives: To systematically review the literature on the use of probiotics in pregnancy and their impact on maternal outcomes. Methods: Online databases were searched in April 2012 using the following terms to identify eligible studies: "probiotics", "pregnancy", "maternal outcomes" and "metabolism". Primary outcomes of selected studies...

Selective fetoscopic laser photocoagulation (SFLP) is now the treatment of choice for twin–twin transfusion syndrome (TTTS). The incidence of recurrent TTTS following SFLP has been inconsistently reported across different studies. We performed a systematic review of TTTS recurrence following SFLP. PubMed and MEDLINE online databases were searched f...

Purpose: Although several studies have examined the relationship between adenosine triphosphate release from the urothelium and bladder sensations including painful filling and urgency, the association between bacteriuria and urothelial adenosine triphosphate release has not been well studied. We evaluated women with refractory detrusor overactivi...

Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and ure...

Objective To examine perinatal outcomes following intrauterine fetal transfusion (IUT), in a single tertiary fetal medicine unit over a 15-year period. Study design A retrospective analysis of women undergoing IUT in the National Maternity Hospital, Dublin from 1996-2010. Eligible cases were identified from a prospectively collated transfusion regi...

This is a prospective randomized controlled trial of cough versus no cough test in the tension-free vaginal tape (TVT) procedure to determine its effect upon voiding dysfunction and 12-month efficacy. The trial was conducted in a single tertiary urogynecology unit. Women ≥21 years old with primary urodynamic stress incontinence without voiding dysf...

What’s known on the subject? and What does the study add? Although synthetic mid‐urethral slings are now generally accepted as the first‐line surgical treatment of female stress incontinence, there is concern that newer slings are being used prematurely, before sufficient evidence exists. The 3 rd generation “mini‐slings” are inserted via a single...

Synthetic mid-urethral slings (MUSs) have been widely adopted for female stress urinary incontinence (SUI). Practitioners are encountering increasing numbers of women with recurrent SUI after a failed MUS. Several studies over the past 18 months have reported outcomes for secondary continence procedures in this context and form the basis of this re...

Older studies suggesting an association between detrusor overactivity and bacteriuria used an outdated microbiological threshold. We hypothesised that bacteriuria ≥10(3) CFU/ml would be more prevalent in women with urinary incontinence than continent controls. A prospective, cross-sectional study of prevalence of bacteriuria ≥10(3) colony-forming u...

Background. Previous studies suggest an association between idiopathic detrusor over-activity (IDO) and high-count bacteriuria (>10 5 CFU/mL). Recently, the importance of low-count bacteriuria (10 3 -10 5 CFU/mL) in dysuric women with has been recognised. However, the optimal microbiological thresh-old for women with overactive bladder (OAB) sympto...

Recent studies using universal cystoscopy have demonstrated a higher rate of urinary tract injury at major gynaecological procedures than previously thought. These injuries are associated with significant medical and medico-legal implications. The sensitivity of visual inspection is low and cystoscopic screening with intravenous dye improves detect...

Since the description of the overactive bladder (OAB) syndrome, which excludes infection, the precise definition of significant bacteriuria in these women is critical. The traditional definition of 'significant' bacteriuria is >10(5) colony-forming units/ml which was described 50 years ago by a renal physician whose primary interest was the prevent...

Recently published randomized trials examining skin closure technique on postcesarean wound complications have produced conflicting results. We performed a metaanalysis of trials comparing staples and subcuticular sutures for skin closure at cesarean section (CS). Pooled outcome measures were calculated using random effects models. Primary outcomes...

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Fetal or neonatal urinary ascites is a rare phenomenon, particularly when secondary to rupture of a neuropathic bladder in a fetus with meningomyelocele. To date, all similar cases have only been diagnosed in the neonatal period. We report a case of urinary ascites secondary to rupture of a neuropathic bladder, which was successfully diagnosed via...

Adenosine triphosphate released from urothelium during stretch stimulates afferent nerves and conveys information on bladder fullness. We measured adenosine triphosphate released during cystometric bladder filling in women with idiopathic detrusor overactivity and stress incontinence (controls), and assessed whether the level of released adenosine...

Cesarean section is the most common surgical procedure performed on US women, and rates of cesarean delivery continue to increase. Recent studies on operative technique in cesarean section have contributed significantly to our knowledge of antibiotic prophylaxis, bladder flap formation, management of the uterine repair and closure of the peritoneum...

The Ovarian Vein Syndrome was first reported in 1964, yet its existence as a true pathophysiological entity remains controversial. It may present as an acute or chronic disease, typically affecting young, multiparous women. This review discusses the literature to date on this poorly recognised cause of ureteric obstruction and pelvic pain, includin...

The previous studies of monochorionic monoamniotic (MCMA) twins reported perinatal mortality rates as high as 70-80%. The recent trends have been towards significantly improved outcomes, though results from all studies have not been consistent. A retrospective cohort analysis of all MCMA pregnancies > or =20 weeks delivered in a single university i...

Cesarean section delivery is a commonly performed surgical procedure, and rates of cesarean delivery are increasing. Previous randomized trials that compared extraabdominal and intraabdominal uterine repair at cesarean section delivery have yielded conflicting results. We conducted a metaanalysis of published randomized controlled trials that addre...

Hysterectomy is a very common gynaecological procedure. The vaginal route is considered preferable for hysterectomy, although the ideal route for women unsuitable for the vaginal approach remains unclear. We performed a meta-analysis of published randomised controlled trials to compare outcomes in total abdominal hysterectomy (TAH) and total laparo...

ATP is an important signalling molecule whose release from the bladder urothelium in response to stretch is thought to stimulate afferent nerves and thus convey information about bladder fullness (and the sensation of urgency). Our aim was to measure the release of ATP during urodynamic filling of bladders of women with idiopathic detrusor overacti...

To examine etiological factors contributing to cases of intrauterine fetal demise in term pregnancies over a 10-year period. This was a retrospective cohort analysis of 29 908 term (37(+0) to 41(+6) weeks gestation) infants delivering in a single tertiary-referral university institution over the 10-year period from 1996 to 2005. Cases of stillbirth...

Is better than diastolic or systolic pressures in low risk women, but is still only moderately effective

Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnant women. The benefits of a laparoscopic over an open approach to appendicectomy are well established in the non-pregnant population. Data on the optimal surgical approach to acute appendicitis in pregnant women are conflicting. A systematic review of...

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This study was undertaken to analyze trends in intrapartum fetal death and rates of perinatal autopsy over a 25-year period in Dublin, Ireland. A retrospective multicenter analysis of 508,342 nonanomalous infants 500 g or more, delivering in 3 tertiary-referral university institutions between 1979-2003. There has been a significant downward trend i...

Unlabelled: Uterine rupture is a catastrophic obstetric complication, associated with high rates of perinatal morbidity and mortality. The most common risk factor is previous uterine surgery, and most cases of uterine rupture occur in women with a previous cesarean delivery. Traditionally, the primigravid uterus has been considered almost immune t...

Fetal macrosomia (birth weight >/=4,500 g) is known to increase a number of adverse maternal and perinatal outcomes. Although there is a clear association between maternal diabetes mellitus and fetal macrosomia, the majority of macrosomic infants are born to non-diabetic mothers. We wished to determine the recurrence rate of macrosomia in non-diabe...

Unlabelled: Lyme disease is the most common vector-borne disease in the United States. A number of other spirochetal diseases, if contracted in pregnancy, have been shown to cause fetal harm and there is concern over a similar effect with gestational borreliosis. Previously published individual case reports have suggested a possible association be...

Uterine rupture is a catastrophic obstetric complication. The main risk factor is a scarred uterus, usually secondary to a previous cesarean delivery. Uterine rupture in a primigravid woman is a very rare event. A 33-year-old primigravida presented at term with severe abdominal pain, signs of hemodynamic instability, and fetal bradycardia. She was...

Our aim was to estimate the obstetric outcome of second delivery in women with normal glucose tolerance whose first fetus was macrosomic (fetal weight >/= 4,500 g). Primiparas delivering a macrosomic infant during the years 1997-2000 were identified from a hospital computer database, and the obstetric outcome of a second delivery was analyzed up un...

Many cases of histologically distinct renal tumors occurring coincidentally in the same patient have been reported. We report the first case of a benign oncocytoma and a urothelial carcinoma occurring synchronously in the same kidney in a man who underwent radical nephrectomy for a suspicious renal mass. The patient subsequently underwent distal ur...