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At the forefront of maternity care and research in Ireland

By Dermot - 05th May 2017

While many of Ireland’s medical graduates choose to move overseas, this country has been fortunate to welcome several experienced clinicians from abroad.

Consultant Obstetrician and Gynaecologist at Cork University Maternity Hospital (CUMH), Prof Louise Kenny, is undoubtedly one such clinician, having established the world-class Irish Centre for Foetal and Neonatal Translational Research (INFANT) in Cork in 2013.

The centre employs more than 100 staff and has placed Ireland firmly on the map as a world leader in perinatal research.

Graduating in medicine from the University of Liverpool in 1993, Prof Kenny moved to Cork in 2006 to take up a role in the development of the Anu Research Centre at CUMH.

As Professor of Obstetrics at University College Cork (UCC), Prof Kenny quickly became immersed in teaching, research and practical work, both locally and nationally.

Her move to Cork coincided with much change in maternity and acute services in the city, with the new CUMH opening in 2007.

Prof Kenny has won various honours and awards for her work and, as Director of the INFANT centre, continues to strive to improve outcomes for mothers and babies.

The centre is the brainchild of Prof Kenny and Professor of Neonatal Physiology at UCC, Prof Geraldine Boylan. It aims to improve health outcomes for mothers and babies through perinatal research. It has an active grant portfolio of over €30 million.

<h3 class=”subheadMIstyles”>Pre-eclampsia</h3>

Prof Kenny specialises in managing high-risk pregnancies and has a particular interest in pre-eclampsia, which is a leading cause of death among mothers and babies internationally.

The complication, which usually occurs in late pregnancy, causes 70,000 deaths in women and over 500,000 infant deaths worldwide annually.

Yet, despite these shocking statistics, awareness remains poor. Efforts to change this are underway, however, as iconic buildings around the world will light up in orange for the inaugural World Pre-eclampsia Day on 22 May.

Speaking to the <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>), Prof Kenny noted that the event aims to raise much-needed awareness about the incurable condition.

Cork City Hall and UCC will light up as well as Trinity College Dublin (TCD) and the Rotunda Hospital, Dublin.

The event will also be celebrated in the UK, US, Norway, Canada, Brazil, Germany and New Zealand.

As well as campaigning to improve awareness of pre-eclampsia, Prof Kenny sits on numerous committees, including the International Society for the Study of Hypertension in Pregnancy, a specialist society that represents researchers and clinicians that work in pre-eclampsia across the world.

“The great thing about doing what I do is there is no such thing as a typical day. The good thing about being a clinical academic is that, in any one day, I can do research, teaching, deliver a baby, or provide care for a really sick mum. It’s the variety that I like,” Prof Kenny explained.

“Roughly speaking, I spend about 50 per cent of my time providing clinical care. I specialise in high-risk obstetrics, so I mainly see mums who enter pregnancy with medical issues or mums who have had previously poor pregnancy outcomes.”

<h3 class=”subheadMIstyles”>Research studies</h3>

One of the 25 programmes underway at the INFANT centre – the IMPROVED study – focuses on complications in late pregnancy including pre-eclampsia, foetal growth restriction and spontaneous preterm birth.

The study aims to develop a clinically robust predictive test for pre-eclampsia and is titled <em>Personalised medicine for pregnant women: novel metabolomic and proteomic biomarkers to detect pre-eclampsia and improve outcome</em> (<em>Improved Pregnancy Outcomes by Early Detection</em>).

“We will shortly be recruiting our 4,000th patient, 1,500 of which will have been recruited in Cork. The other 2,500 were recruited across Europe and across the UK, Sweden and the Netherlands,” Prof Kenny revealed.

“We’re hoping to close the study out this year. Overall, it’s gone exceptionally well.”

The study began in 2012 and has a budget of €7.8 million. Clinical information and blood samples are being taken from pregnant women at 11, 15, 20 and 34 weeks.

“It will be the end of this year or early next year before we have results,” Prof Kenny added.

If successful, the test could dramatically reduce mortality among mothers and babies and provide massive healthcare cost savings.

Another study that could have a significant impact on mothers who develop pre-eclampsia is the Parrot Study, Prof Kenny outlined.

“The other thing we’re launching very soon, within the next month, is a large multicentre trial across the whole of Ireland, called the Parrot study, which is a diagnostic test for pre-eclampsia, rather than a screening test; this is a blood test that tells us whether or not a woman has pre-eclampsia within 15 minutes.”

That Health Research Board (HRB) study will begin in the three main maternity hospitals in Dublin and in Galway, Limerick, Cork and Belfast within the next month. Over two years, some 4,000 women will take part in the study.

“We’ve been working with the company who made the test for some time but this is the first time, to our knowledge, that it’s been trialed in real life…. Doctors and patients will know [the latter] are having the test and patients and clinicians will have the results to work with and examine what happens in the real world when clinicians have knowledge of this blood test,” Prof Kenny noted.

Meanwhile, researchers at the INFANT centre regularly collaborate with colleagues abroad on various research projects.

The 111 Project is one such prestigious project and is a partnership with Chongqing Medical University in China, looking at improving pregnancy and advancing the knowledge of pregnancy-related diseases.

Prof Kenny will lead the team on biomarker discovery and recently launched the project in China.

“In addition to the Chinese project, we’re also working with colleagues in Tanzania in Africa. The reason for that is that most of the innovations we’re developing will have maximum effect only if they translate to low resource settings,” Prof Kenny outlined.

“Our engineers and scientists are working with their colleagues in Tanzania to ensure anything we develop can be road tested, as it were, in a low resource setting where the majority of the mums and babies live and die of the conditions that we’re interested in.”

<h3 class=”subheadMIstyles”>National Maternity Strategy</h3>

All of these fascinating projects will ultimately help to improve the health of women and their babies in Ireland and abroad.

But, as Prof Kenny is well aware, Ireland’s maternity services also require much examination and improvement.

The National Maternity Strategy, launched in January 2016, aims to deliver better healthcare for women and babies but an implementation plan has yet to be published.

According to Prof Kenny, the strategy is a perfect blueprint for how to modernise maternity services in Ireland and ensure equity across the field.

“The maternity strategy is wonderful. If we had everything in the strategy we would be extremely happy. The issue is that a strategy without resource and implementation is really just a report sitting on the shelf. Having a strategy is one thing, but it does need to be resourced, implemented and audited. It’s not enough to say we have what we need. We need to make sure that the standards are kept.”

Prof Kenny and other clinicians have been campaigning for foetal anomaly scans to be made universally available for women across Ireland.

“We have this difficult situation where we’re doing pioneering, world-leading research but we can’t offer uniform anatomy scans across the country, which is a real disparity and paradox,” Prof Kenny noted.

But things may be about to change following a commitment from Minister for Health Simon Harris to deliver greater funding.

“Several colleagues were in Dublin to meet with the Minister for Health… and he announced that our ‘five point plan’ to fix the gynaecology waiting list and inequity on access to ultrasound was going to be funded in full in a phased fashion.

“We’re looking forward to recruiting new consultants and to rolling out uniform anatomy scans, certainly across the south/south-west region. We’ll be keeping the pressure up to make sure that actually does happen. It’s unacceptable in 2017 that we have this issue and we’re still needing to discuss this.”

The South/South West Hospital Group has also been fortunate to have Prof John Higgins appointed as Clinical Director for Maternity Services, Prof Kenny noted, adding that maternity services in the Hospital Group have been awarded a delegation of the budget as well as having its own governance.

<h3 class=”subheadMIstyles”>Gestational diabetes</h3>

These developments are welcome as there is much work to do to ameliorate services, particularly for women with gestational diabetes.

Uncontrolled gestational diabetes can lead to premature birth, pre-eclampsia, stillbirth, miscarriage and placental abruption and the condition has increased dramatically in Ireland in recent years.

Gestational diabetes is the most common medical disorder in pregnancy and affects about 12 per cent of women.

Guidelines for the management of diabetes in pregnancy are in place, but are not being met due to inadequate resources and staffing in maternity hospitals to treat women with the condition.

“We were never adequately resourced to cope with gestational diabetes even back 10 years ago when the maternity hospital opened. We had a plan but unfortunately we didn’t have the people and resources in place,” Prof Kenny said.

“In Ireland, there’s been an epidemic of diabetes, which is really putting stress on the service from several angles. Firstly, the actual number of women arriving in the antenatal clinic with diabetes is going up, predominantly type 2 diabetes, but also the number of women developing gestational diabetes is increasing,” Prof Kenny explained.

“There’s compelling evidence worldwide that we should be performing universal screening for diabetes because, undoubtedly, if we do risk factor-based screening then we miss many women and babies who have this pregnancy complication. But at the moment we’re struggling to take care of the women that we know about, so the resources would need to increase significantly if we were to roll-out universal screening.”

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