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In 2015, Cold Coagulation was introduced as a treatment for cervical intraepithelial neoplasia (CIN) at our colposcopy clinic. We reviewed the 6-month follow up data of the first 200 women who underwent Cold Coagulation using cytology and HPV status as tests of cure (TOC). A random sample of 200 patients treated by Large Loop Excision of the Transformation Zone (LLETZ) during the same period was used to compare treatment outcome. Six months following treatment,173 (86.5%) of the women treated by CC and 167 (83.5%) treated by LLETZ had negative cytology. (x2= P0.05). 148 (74%) treated by Cold Coagulation and 166 (83%) treated by LLETZ were HPV negative (x2= P0.05). One hundred and thirty-nine (70%) women treated by Cold Coagulation and 152 (76%) treated with LLETZ had normal cytology and were HPV negative. This audit of our initial experience supports the observation that Cold Coagulation is as effective as LLETZ in the management of CIN when cervical cytology is used as a test of cure.

A 20-year old parturient with moderate to severe cystic fibrosis presented for an Elective Caesarean Delivery at 31 weeks gestation due to intra-uterine growth retardation and persistent maternal weight loss. The procedure was successfully performed using a combined spinal-epidural anaesthetic technique. A review of the literature is presented and the anaesthetic implications of pregnancy in cystic fibrosis patients are discussed.

This was a questionnaire-based study of 151 postnatal women. We found 42% of women were smokers prior to pregnancy and only 37% of these women succeeded in quitting smoking during pregnancy. Success in quitting was significantly related to the number of cigarettes smoked (p0.05). However, 71% of pregnant smokers were aware of the associated risks. Alcohol was consumed by 89% of women and 10% admitted to binge drinking during pregnancy. Only 44% of the study group were aware of the associated risks of alcohol. We propose that we need to change our social acceptance of these behaviours before pregnancy, and provide support to those women during pregnancy.

Ovarian cancer is the most lethal gynecological malignancy. Many patients present at an advanced stage as the symptoms of early stage disease can be vague. AIM We evaluated the demographics, treatment regimens and survival rates of ovarian cancer patients attending Beaumont Hospital Dublin over a nine year period. A retrospective chart review of ovarian cancer patients attending Beaumont Hospital between 11/10/94 and 30/6/3 was performed. Patients were selected from pathology records. Patients with borderline histology and those who died of unrelated causes were excluded. 31% of individuals presented with distension as their only clinical sign. 20% presented with a mass as their only clinical sign. The most common cell type was papillary serous adenocarcinoma in two thirds of cases. 54% presented with advanced disease [stage IIl-IV]. Treatment involved surgical clearance or debulking +/- chemotherapy. 5 year survival for Stage I was 95% versus 19% for Stage IlI. This highlights the importance of early diagnosis.

The best practice for the delivery of a term breech in singleton and twin pregnancies is still controversial. We sought the opinions of obstetricians working in Ireland. A questionnaire was used to address the management of the obstetrician's "own hypothetical pregnancy" in three different scenarios. We also inquired about factors which might influence the decision on mode of delivery. The response rate was 104/174 (60%). In the scenario of a singleton fetus presenting by the breech in a nulliparous woman, 15/84 (18%) of obstetricians would chose a spontaneous vaginal delivery compared to 40/80 (50%) for a multiparous woman (p0.01). In the scenario of a second twin in breech presentation (nulliparous and multiparous), 75/93 (81%) would choose a spontaneous vaginal delivery. When asked about a singleton cephalic presentation, 85/91 (93%) would choose a spontaneous vaginal delivery. These decisions were influenced by concerns about perinatal morbidity [91/100 (91%)], published evidence [73/98 (75%)], the delivery doctor's inexperience [56/94 (60%)], but not by gender. Our study indicates that obstetricians in Ireland consider that there is a role for vaginal breech delivery in selected scenarios.

In recent years the numbers of immigrants attending maternity hospitals has risen. The amount of antenatal care these women receive varies widely. Analysis was performed of deliveries to immigrant women in the Rotunda Hospital in 2002. Women were sub-divided depending on antenatal care received in Ireland. Women who received no antenatal care were 'unbooked', those who attended the hospital two to 28 days before delivery were 'late bookers'. The remaining women were 'booked'. There were 1,954 deliveries to immigrant women; 1,1 73 (60%) 'booked', 391 (20%) 'late bookers' and 390 (20%) 'unbooked'. 'Unbooked' women had a higher rate of spontaneous vertex delivery (63%) (p0.01). 'Late bookers' had a higher rate of caesarean section (27.6%) (p0.01). The 'late bookers' infants were more likely to be preterm, low birth weight and had a higher rate of neonatal ICU (NICU) admissions (p0.01). This study has identified 'late booker' immigrants as a high-risk group.

In 1998 the International Continence Society (ICS) developed a set of recommendations for the diagnostic evaluation and treatment of urinary incontinence. The aim of this study was to determine to what extent current clinical practice in the Republic of Ireland correlated with the ICS recommendations. We personally interviewed 100 gynaecologists at units around Ireland. Participants were presented with two clinical scenarios, one described a patient with predominantly genuine stress incontinence, the other described a patient with an overactive bladder. Ninety-five (95%) requested a midstream urine sample for culture and sensitivity, and 74 (74%) considered urodynamics an appropriate initial investigation for a woman with stress incontinence. Physiotherapy was recommended as a first line treatment for stress incontinence by 76 (76%). Burch colposuspension, chosen by 55 (55%), was the most common first line surgical procedure. Other first line surgical procedures were TVT [31(31%)] Marshall-Marchetti-Krants procedure [5(5%)], anterior colporrhaphy [4 (4%)] and a variety of other procedures [5 (5%)]. When considering the initial investigation for a woman with an overactive bladder, 95 (95%) asked for a midstream urine sample for culture and sensitivity and 85 (85%) requested urodynamic investigations. Initial management of this condition included anticholinergic therapy alone [57 (57%)], anticholinergic therapy combined with bladder retraining [36 (36%)], bladder retraining alone [5 (5%)], and cystoscopy and bladder distension 2 (2%). Seventy-six (76%) felt that cystoscopy was an appropriate investigation for a woman with symptoms of an overactive bladder who has failed to respond to initial therapy. The study reveals a significant degree of diversity in the evaluation and management of patients who present with symptoms of urinary incontinence. It also highlights a number of areas where current clinical practice deviates from the recommendations of the ICS. In particular, there is a high and inappropriate use of urodynamics in the initial management of these patients.

Thromboembolism is a major cause of maternal mortality. Pregnancy is associated with an increased risk of thromboembolic diseases, with an even greater risk in women undergoing caesarean section. Since the introduction of the RCOG guidelines in 1995 on thromboprophylaxis for women undergoing caesarean section, there has been a significant reduction in the number of women dying from pulmonary embolism in the UK. The aims of our study was to conduct an audit cycle to assess our compliance with RCOG guidelines for thromboprophylaxis in women undergoing caesarean section to introduce changes in practice based on the observations of this audit, and to re-audit our practice to assess the effect of the changes. A retrospective audit of 100 women undergoing caesarean section was done in the Rotunda Hospital in June 2001. Changes in practice were introduced based on the findings of this audit. Obstetricians were asked to complete a checklist pre-operatively and to assign the patients a risk category-low, moderate or high. Prophylaxis was prescribed based on this risk assessment. Following the introduction of this change in practice, we re-audited 100 women delivered by caesarean section in June 2002. In the first audit, risk assessment was as follows: 20 low, 75 moderate and 5 high. Twenty-one of 75 (28%) of moderate risk patients in the first audit received appropriate prophylaxis. In the re-audit, risk assessment was as follows: 33 low, 66 moderate and 1 high. Following the introduction of new clinical practice, 45 of 66 (68%) of those in the moderate risk group received appropriate prophylaxis. All women in the low risk groups received appropriate prophylaxis in both audits. Our audit cycle of thromboprophylaxis in women undergoing caesarean section has demonstrated that the introduction of new clinical practice resulted in greater compliance with the RCOG guidelines, but further improvement could be achieved. These observations are discussed and recommendations are made to further improve compliance with RCOG guidelines.

Constipation in the paediatric population is common and encompasses a spectrum of organic and functional pathology which differ from that of the adult population. Recently an expert group published a comprehensive system of classification of childhood functional gastrointestinal disorders that may have useful clinical application. We present the case of an adolescent schoolgirl with severe constipation with extreme anorectal, urological and neurological sequelae who displayed inappropriate behavioral response to her condition. The patient appeared inappropriately unmotivated and undisturbed by the severity of her constipation. This abnormal psychological habituation and adaptation to an abnormal bowel habit perpetuated the constipation. In addition, we examined the role of recent advances in anorectal investigation techniques and treatment in the context of the recent guidelines issued by the American Gastroenterological Association

195 Women attending the antenatal clinics at the hospital were interviewed, about their attitudes to home birth using a standardised questionnaire. One hundred and seventy one women (88%) said that they would not favour a home birth in a subsequent delivery, 19 (9.5%) said that they would consider a home birth in a subsequent pregnancy and the remaining 5 (2.5%) were unsure. Although the majority of women attending the Rotunda Hospital would not consider a home birth, approximately 10% of the sample population would consider this in their next pregnancy. This pilot study indicates that there may be a demand for home birth in patients attending our hospital and further evaluation of this need is warranted.

The primary aim of this study was to investigate obstetric outcomes in teenagers delivered in the Rotunda Hospital and to identify whether younger teenagers have a poorer obstetric outcome. Delivery record details were recorded from the years 1992-96. These included the number of teenage mothers, maternal age, parity, gestation, mode of delivery, birth weight and Apgar scores. Teenagers were classified into those aged under 17 years and those aged 17 and over. Overall 2,228 teenage mothers were delivered in the Rotunda hospital, representing 17.2% of the total teenage population delivered in Ireland during the study period. Ten percent of mothers were under 17 years; 10.6% were multiparous with 2.6% of these under 17 years. There was a significant difference in the preterm delivery rate when the teenagers were compared as a whole with matched controls aged 20-24 years (p = 0.0411). However this did not translate into a poorer neonatal outcome as on average only 5% of babies were low birth weight and only 3% had Apgar scores3. Overall 70.2% of deliveries were spontaneous, 20.2% were instrumental. Less than 10% of deliveries were by caesarean section. However the rate of caesarean section increased with age from 14 (5.7%) to 19 (13.5%) years and this trend was statistically significant (p = 0.013). In conclusion, this study does not support the view that younger teenage mothers have a poorer obstetric and neonatal outcome. It has also been shown that there has been a large increase in the number of multiparous patients in this teenage population.To assess the effect of young maternal age on pregnancy outcomes, the records of 2228 adolescents 14-19 years of age who delivered at the Rotunda Hospital in Dublin, Ireland, during 1992-96 were reviewed. This series represented 17.2% of adolescent pregnancies in Ireland during the study period. 224 women (10.1%) were 14-17 years of age. 10.5% of adolescent mothers were multiparous. Spontaneous vaginal deliveries occurred in 71.25% of 14-16 year olds and in 69.1% of 17-19 year olds. The rate of preterm delivery among teenagers was 13.8% (15.8% in 14-16 year olds and 14.7% in those 17-19 years old)--significantly higher than the 10.2% rate among women 20-24 years old. However, adverse pregnancy outcomes such as low birth weight and low Apgar scores were not significantly more frequent among teenage mothers. These findings fail to provide support for the view that teenagers have poorer obstetric and neonatal outcomes than adult mothers do.

Gemeprost (Cervagem), a synthetic PGE1 prostaglandin analogue was used to induce labour in 20 patients with second trimester intra uterine fetal death. The mean induction abortion interval was 13.8 hours; 17 of the 20 patients delivered within 24 hours. In 17 cases the placenta was retained and the uterus was evacuated under general anaesthesia. Nausea was noted in five (25%) patients, vomiting in two (10%) and diarrhoea in three (15%). No serious side-effects were encountered.