Practices for predicting and preventing preterm birth in Ireland: a national survey.

Background: Preterm birth can result in adverse outcomes for the neonate and/or his/her family. The accurate prediction and prevention of preterm birth is paramount. This study describes and critically analyses practices for predicting and preventing preterm birth in Ireland.

Active versus expectant management for women in the third stage of labour.

Background: Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality in low-income countries.

Improving quality and safety in maternity care: the contribution of midwife-led care.

This article draws on findings from a recent Cochrane systematic review of midwife-led care and discusses its contribution to the safety and quality of women's care in the domains of safety, effectiveness, woman-centeredness, and efficiency. According to the Cochrane review, women who received models of midwife-led care were nearly eight times more likely to be attended at birth by a known midwife, were 21% less likely to experience fetal loss before 24 weeks' gestation, 19% less likely to have regional analgesia, 14% less likely to have instrumental birth, 18% less likely to have an episiotomy, and significantly more likely to have a spontaneous vaginal birth, initiate breastfeeding, and feel in control. In addition to normalizing and humanizing birth, the contribution of midwife-led care to the quality and safety of health care is substantial.

Antenatal cardiotocography for fetal assessment.

Background: Cardiotocography (CTG) is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. CTG is widely used in pregnancy as a method of assessing fetal well-being, predominantly in pregnancies with increased risk of complications.

Objectives: To assess the effectiveness of antenatal CTG (both traditional and computerised assessments) in improving outcomes for mothers and babies during and after pregnancy.

Psychosocial interventions for the prevention of disability following traumatic physical injury.

Background: Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning.

Objectives: To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury.

Search Strategy: The search was not restricted by date, language or publication status.

A systematic review and quality assessment of systematic reviews of randomised trials of interventions for preventing and treating preterm birth.

The aim of this paper is to identify reviews of interventions for preventing and treating preterm birth so that these could be appraised and the findings from good quality reviews highlighted. Reviews, rather than individual studies, are the basis for this systematic review because of the proliferation of reviews and the benefits of a single, consistent appraisal and assessment of evidence from these reviews rather than further attempts to find and appraise the many individual studies in the literature. Our systematic review consists of a description of five interventions for preventing and treating preterm birth; antibiotics, cervical cerclage, bed rest, progesterone, and tocolytic therapy, for which at least one relevant review was found.

Midwife-led versus other models of care for childbearing women.

Background: Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led and other models of care.

Objectives: To compare midwife-led models of care with other models of care for childbearing women and their infants.

Biophysical profile for fetal assessment in high risk pregnancies.

Background: A biophysical profile (BPP) includes ultrasound monitoring of fetal movements, fetal tone and fetal breathing, ultrasound assessment of liquor volume with or without assessment of the fetal heart rate. The BPP is performed in an effort to identify babies that may be at risk of poor pregnancy outcome, so that additional assessments of wellbeing may be performed, or labour may be induced or a caesarean section performed to expedite birth.

Objectives: To assess the effects of the BPP when compared with conventional monitoring (CTG only or MBPP) on pregnancy outcome in high-risk pregnancies.

Women's experiences of labour and birth: an evolutionary concept analysis.

Aim: the aim of this paper is to identify the core attributes of the experience of labour and birth.

Methods: a literature search was conducted using a variety of online databases for the years 1990-2005. A thematic analysis of a random sample of 62 of these papers identified the main characteristics of the experience of childbirth.

Educating advanced midwife practitioners: a collaborative venture.

Aim: To describe the collaborative development of an MSc course preparing Ireland's first advanced midwife practitioners.

Background: Ireland has 55 advanced nurse practitioner posts, but, as yet, no advanced midwife practitioners.

Methods: A consultative, collaborative process involving 38 midwives across Ireland generated the philosophy, aims and content of the course.

Ultrasound screening for fetal abnormality in Ireland: a national survey.

Background: Since 1997, the RCOG have recommended that ultrasound screening for fetal abnormality in pregnancy should be offered to all women.

Aim: This study describes the practices and service provision of ultrasound screening for fetal abnormality in Ireland.

Methods: A national survey of all maternity units providing an obstetric ultrasound service (n = 21) was undertaken.

Evaluating maternity care: a core set of outcome measures.

Background: Comparing the relative effectiveness of interventions on specific outcomes across trials can be problematic due to differences in the choice and definitions of outcome measures used by researchers. We sought to identify a minimum set of outcome measures for evaluating models of maternity care from the perspective of key stakeholders.

Methods: A 3-round, electronic Delphi survey design was used.

A systematic review and quality assessment of systematic reviews of fetal fibronectin and transvaginal length for predicting preterm birth.

This systematic review aims to identify reviews of fetal fibronectin and transvaginal cervical length for predicting preterm birth, so that these could be appraised and the findings from good quality reviews highlighted. Reviews, rather than individual studies, are the basis for this systematic review because of the proliferation of reviews and the benefits of a single, consistent appraisal and assessment of evidence from these reviews, rather than further attempts to find and appraise the many individual studies in the literature. Potentially eligible reviews were sought primarily through searches of the electronic databases MEDLINE (1966-2005), EMBASE (1980-2005), CINHAL (1982-2005), Science Citation Index (1970-2005) and The Cochrane Library (Issue 3, 2005).

The use of intrapartum electronic fetal heart rate monitoring: a national survey.

This study describes the use of intrapartum electronic fetal monitoring in Ireland. Electronic fetal monitoring (EFM) has become routine in the assessment of fetal wellbeing during labour. Current evidence indicates that the routine use of EFM leads to an increased caesarean section and operative vaginal delivery rate and a reduction in the rate of neonatal seizures.

Unexpected diagnosis of fetal abnormality: women's encounters with caregivers.

Background: It is acknowledged that health professionals have difficulty with breaking bad news. However, relatively little research has been conducted on the experiences of women who have had a fetal anomaly detected at the routine pregnancy ultrasound examination. The study objective was to explore women's experiences of encounters with caregivers after the diagnosis of fetal anomaly at the routine second trimester ultrasound scan.

Ultrasound screening: how effective is the service?

This study describes the standards, training and audit systems in units offering ultrasound screening services in Ireland. A national survey of 21 of all maternity units offering an obstetric ultrasound service in Ireland was undertaken. The questionnaire used was designed by the UK Screening committee and sought information on nine key areas associated with service provision including protocols for screening, the antenatal ultrasound package available and management following the identification of a fetal abnormality.