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Competing Interests: None declared

Introduction The World Health Organisation has identified air pollution as the single biggest environmental threat to human health. There is growing evidence in the literature that air pollution is associated with negative outcomes in pregnancy. The purpose of this study was to measure pollution levels in the immediate surroundings of the three Dublin maternity hospitals by measuring fine particulate matter <2.5 micrometres (PM2.5). Methods Data pertaining to levels of PM2.5 at the three Dublin maternity hospitals were obtained from Pollutrack's records for the time period 25/6/2021-2/12/2021. Results were compared to the 2021 WHO Air Quality Guidelines. Results Average PM2.5 levels were 9μg/m³ around the National Maternity Hospital, 10μg/m³ around the Coombe Hospital and 13μg/m³ around the Rotunda Hospital. Levels were higher during the day, weekdays and in December. No matter when the PM2.5 levels were measured, results were higher than those recommended by the World Health Organisation's Air Quality Guideline. Discussion Air pollution levels across Ireland's capital city are higher than recommended by the WHO. This is concerning for the public and in particular for the pregnant population. Going forward, further research is required on the relationship between levels of air pollutants and adverse pregnancy outcomes in Dublin., Competing Interests: Mr. Gilles Delaunay is a staff member at Pollutrack SAS. No funding was received for this study.

Introduction Transgender people have specific healthcare needs and experience difficulty in accessing health services. Medical students should receive teaching on general and gynaecological healthcare issues in this population. Our aim was to assess medical students' knowledge of healthcare needs of transgender people before and after a newly implemented teaching session on transgender healthcare. Method A mixed-method study was carried out over a three month period in a university obstetric and gynaecology hospital in Dublin. A one-hour teaching session was developed and delivered to final year medical students. Students completed a survey before and after receiving the lecture. Results Seventy-one students completed the pre-lecture survey and forty-three completed the post-lecture survey. Pre-lecture, 64 students (90%) reported some-to-no understanding of healthcare issues of transgender people, and only 13 (18%) reported understanding gynaecological issues faced by transgender people. Post-lecture, 41 (95%) had a better understanding of health issues faced by this population and 40 (93%) had a better understanding of gynaecological health issues faced. Most students (81%) wanted further teaching on the topic. Conclusion A one-hour teaching session was effective at improving student knowledge of care of transgender people. This teaching could be expanded to all Irish medical schools. Going forward, the teaching could be adapted for post-graduate obstetric and gynaecology teaching., Competing Interests: The authors have no conflicts of interest to declare. No funding was received for this study.

Aims Screening for gestational diabetes mellitus (GDM) may be universal or selective based on risk factors. We audited selective screening with an Oral Glucose Tolerance Test (OGTT). Methods Clinical and laboratory details of the first 200 women who delivered a baby in 2017 were analysed. Results Based on national recommendations, 46.5% (n=93) had maternal risk factors (RF) and an additional 6.5% (n=13) had fetal RF. Nine women with RF, for unexplained reasons did not have their OGTT. Of the 95 who had their OGTT, the diagnosis of GDM was made in 27.4% (n=26). The diagnosis of GDM was made in an additional 8 women outside selective screening giving an overall incidence of 17.0%. Discussion More than half of the women needed to be screened selectively for GDM. Compliance with the national recommendations was incomplete and thus the diagnosis of GDM may be missed even in an academic setting., Competing Interests: None of the authors have any conflict of interest to declare.

Neural tube defects (NTD) are potentially preventable in two-thirds of cases by periconceptional maternal Folic Acid (FA) supplementation. A national audit for the years 2009-11 showed no decline in NTD rates over twenty years. The aim of this national audit was to determine trends/rates and inform revision of national FA supplementation and food fortification strategies. Of 274,732 live and stillbirths there were 121(42.0%) cases of anencephaly, 136(47.2%) cases of spina bifida and 31(10.8%) cases of encephalocoele giving a total of 288 and overall rate of 1.05/1000 compared with 1.04/1000 in 2009-11(NS). In the 184 women where the information was available, only 29.9%(n=55) reported starting FA before pregnancy. The number of cases diagnosed antenatally was 91%(n=262) and 53%(n=154) were live-born. This audit confirms that over a generation, healthcare interventions have not succeeded in decreasing the number of pregnancies in Ireland complicated by NTD, and that revised strategies need to be developed and implemented.

There is international consensus that smoking cessation in the first half of pregnancy improves foetal outcomes. We surveyed all 19 maternity units nationally about their antenatal smoking cessation practices. All units recorded details on maternal smoking at the first antenatal visit. Only one unit validated the self-reported smoking status of pregnant women using a carbon monoxide breath test. Twelve units (63%) recorded timing of smoking cessation. In all units women who reported smoking were given verbal cessation advice. This was supported by written advice in 12 units (63%), but only six units (32%) had all midwives trained to provide this advice. Only five units (26%) reported routinely revisiting smoking status later in pregnancy. Although smoking is an important modifiable risk factor for adverse pregnancy outcomes, smoking cessation services are inadequate in the Irish maternity services and there are variations in practices between hospitals.

In developed countries, caesarean section (CS) rates continue to escalate and in Ireland nearly one in three women are now delivered by CS. The purpose of this study was to compare the management of women after one previous CS in two large Dublin maternity hospitals with the management in two other well-resourced countries. Data were analysed for Dublin, Massachusetts in the United States, and Hesse in Germany. It was found that since 1990, the CS rate in Dublin has increased by much more than in the other areas. This increase may be explained by the precipitous fall in the vaginal birth after CS rate because the rates in Massachusetts and Hesse in 1990 were initially much lower. Changes in the clinical management of women with one previous CS are a major contributor to the rising CS rates and are likely to be an ongoing driver of CS rates unless clinical practices evolve.

An increasingly common question posed by patients antenatally is whether air travel can be considered safe in pregnancy. The aim of this study was to assess whether any agreed standards or policies exist between airlines with respect to flying in pregnancy. Sixty-eight international airlines were surveyed, of whom seventeen (25%) replied. Three of seventeen (17.5%) airlines applied no restrictions at all to pregnant passengers; the remainder applied restrictions to air travel with varying gestations (28 to 36 weeks). A full delivery kit was carried by 5/17 airlines (29%), and some form of training in the management of a delivery was provided to the cabin crew in 12/17 airlines (70%). Experience of in-flight obstetric emergencies was reported by 11/17 airlines (65%). This study highlights a lack of consensus regarding restrictions on air travel in pregnancy. The low response rate also suggests an unwillingness on the part of the airline industry to openly declare their policy on this issue.

To assess the acceptability of antenatal HIV testing. A questionnaire based study. Obstetric outpatient clinic at the Portiuncula Hospital, Galway, Ireland. Women attending the antenatal clinic between May and November 2000. The participating women received pamphlets explaining HIV testing in pregnancy before completing the questionnaire. The questions included assessment of their views towards prenatal HIV testing, perceived benefits and acceptability. Seven hundred and forty-eight questionnaires were distributed. Of these 715 (96%) completed questionnaires were returned out of which 32 (4.5%) were discarded because they were improperly completed. 683 (96%) correctly completed questionnaires were analysed. 650 (95.2%) women agreed that prenatal HIV testing was a good idea and that test was necessary, 17 (2.5%) said test was not a good idea, 30 (4.4%) said test was unnecessary and 16 (2.3%) and 3 (0.4%) women were unsure whether or not test was a good idea and necessary respectively. Three hundred and sixty two (53%) women were of the opinion that prenatal HIV testing was of benefit to the mother and her baby; 301 (44%) to the mother, baby and the health workers; 14 (2%) to the baby; and 3 (0.4%) only to the mother. Only 3 (0.4%) women reported that prenatal HIV testing was of no benefit. The majority of the women, 436 (63.8%) had second level education, 202 (29.6%) received third level and 45 (6.6%) had only primary education. Antenatal HIV testing is acceptable to the majority of the obstetric population studied.

A structured computer-coded questionnaire was administered to 120 consecutive teenage mothers attending a public adolescent antenatal clinic in order to examine their sociodemographic characteristics and sexual behaviour. The mean age of teenagers attending the clinic was 17.7 years (range: 14-19); only 5 (4.1%) were under 16 years. The mean gestation at booking was 16.4 weeks (range: 6.34); 90 (75%) had unreliable menstrual dates; 29 (24.2%) were over 20 weeks, 18 (68.9%) of these saying that they were afraid to attend hospital earlier. Ninety seven (80.8%) said that they had just one sexual partner to date and 105 (87.5%) said that they were involved in a continuing relationship with the father of the baby. Conception occurred within the first year of the relationship in 110 (91.6%). One hundred and seventeen (88.2%) were from social classes III-V, 15 (12.5%) were still at secondary school and 59 (49.2%) were unemployed. Of the 105 (87.5%) who had left school 80% had not sat the Leaving Certificate and 10% had not undertaken any state examinations. Sixty seven (55.8%) continued to smoke and 29 (24.2%) to drink alcohol during pregnancy. Sixty two mothers (51.7%) had used contraception in the past; only 33 (27.5%) had used it always. The age of first coitus, fertility awareness and the use of contraception were significantly influenced by social class and education. This study highlights the necessity for early commencement of sexual education programmes.

In order to determine which formula most accurately predicts weight in Irish infants we performed a prospective study on 162 mothers within one week of delivery. Actual weights were compared with estimated weights derived from the formulae of Shepard; Hadlock; Birnholtz; Deter and Campbell. Overall the Deter formula gave the closest approximation of birth weight. All the formulae became increasingly inaccurate in the larger infants i.e. > 4 kg. However in infants of average weight the Campbell formula, which is based on a single measurement (A.C), is as good as any.

The value of population screening for cervical cancer has recently been questioned. The purpose of this study was to examine the cytological screening history in 100 consecutive patients undergoing Wertheim's hysterectomy for early invasive cervical cancer. Twenty three per cent of the patients were never screened; the screening history was unavailable in 11%; the patient was referred appropriately in 21%; there was a delay in referral for gynaecological assessment in 21%; the patient's previous cervical smear before referral was normal in 24%. If population screening in Ireland is to have an impact on mortality from cervical cancer, the results of this study indicate that greater attention needs to be given not only to extending the number of women screened, but also to increasing the frequency of screening and to improving the clinical response to an abnormal smear.

This study examined the contraceptive practices of 100 patients referred for colposcopy because of an abnormal cervical smear. At presentation 49% were using oral contraception but 94% had taken the pill at some time. Eight of the 10 patients using barrier methods were relying on condoms: in at least seven of the eight cases an abnormal cervical smear preceded condom usage. Thus, the method of contraception used when cervical neoplasia develops may differ from the method used when the patient presents for colposcopy. Although consistent with previous studies suggesting that the incidence of cervical neoplasia is increased in women using oral contraception, the risk of neoplasia is more likely to be explained by the degree of exposure of the cervix to an infectious carcinogen or to the immunosuppressive effects of seminal plasma. We suggest that future studies of the epidemiology and natural history of cervical neoplasia should include a detailed contraceptive history.