Biography
Dr Chris Fitzpatrick is a Graduate of University College Dublin (1983).

As part of his training in Obstetrics & Gynaecology he has worked in all three of the Dublin Maternity Hospitals. In 1991/1992 he completed a Fellowship in Urogynaecology and Urodynamics in the University of Michigan, Ann Abor, USA. He was appointed as Senior Registrar/Assistant Master in the Coombe Women & Infants University Hospital. in 1993 and subsequently as a Consultant in 1996.

Dr Fitzpatrick took up his position as Master of this Hospital on January 1st 2006. His special areas of interest include urogynaecology and pelvic floor dysfunction, labour ward management, medical education and clinicians in management.

Biography
Prof Deirdre Murphy is a clinical academic and an obstetrician with clinical expertise in high risk pregnancy and labour ward care. Her research interests are focused on maternal and neonatal health, intrapartum care and women’s experiences of childbirth and obstetric intervention. She has an international profile in the area of operative delivery. She has chaired the Guideline and Audit Committee of the RCOG which promotes the implementation of safe and effective practices in obstetrics and gynaecology. She has worked as Consultant Senior Lecturer in Maternal Medicine at the University of Bristol, Professor of Obstetrics and Gynaecology at the University of Dundee and is currently the Professor of Obstetrics at Trinity College Dublin.

Abstract
Obstetric care involves a close working relationship between obstetricians, midwives, neonatologists and anaesthetists. High quality antenatal, intrapartum and postnatal care can have a huge impact on health care outcomes for the mother and her child. A woman centred approach is essential in achieving safe outcomes alongside a rewarding birth experience.

Obstetric research takes many forms including laboratory-based studies, clinical trials, longitudinal studies and qualitative research addressing women’s experiences of pregnancy and childbirth. In addition systematic reviews synthesise the best available evidence and can be adapted into local practice guidelines. A number of initiatives being developed at the Coombe will be discussed. The role of pre-pregnancy counselling and early pregnancy advice in relation to medication exposure, recreational drug use and alcohol intake; a systematic review of outcomes following premature rupture of membranes at the threshold of viability is in progress; and a randomised controlled trial of approaches to minimise blood loss at caesarean section will be outlined.

The potentially seamless links between understanding the sources of morbidity both physical and psychological inherent in pregnancy and childbirth, the ability to apply this understanding to direct patient care and the implementation of a developing knowledge base into teaching and training provides the basis for woman-centred obstetric care.

Biography
Professor Michael Turner is the UCD Professor of Obstetrics and Gynaecology in the Coombe Women and Infants University Hospital and St Vincent’s University Hospital.

He trained in London and Dublin and has previously served as Master in the Coombe Women’s Hospital. His research interests include the relationship between maternal and fetal body composition and the clinical outcome of pregnancy.

Abstract
Obesity complicates about 1 in 5 pregnancies in Irish women. It is associated
with an increase in maternal complications before labour, during labour and after delivery. It is also associated with lifelong consequences for the mother and her offspring. In the past, the diagnosis of obesity was based usually on selfreporting of height and weight using the WHO Body Mass Index (BMI) classification. Selfreporting has been shown to be unreliable and BMI is only a surrogate measure for adiposity. Professor Turner will discuss the measurement of maternal adiposity and its clinical implications

Biography
Sean Daly graduated from Trinity College Dublin in 1988. He started work in St James Hospital and Wexford General Hospital before moving to the Rotunda Hospital to start his training in Obstetrics and Gynaecology in 1989. He was admitted as a member of the Royal College of Obstetricians and Gynaecologists in 1993. In 1994 he was appointed lecturer in the Royal College of Surgeon’s in Ireland and it was during this time that he performed work on folic acid which led to his MD thesis. He was appointed a fellow in maternal fetal medicine in Thomas Jefferson Hospital in 1996 and graduated from that programme two years later. In 1998 he was appointed Master of the Coombe Women & Infants University Hospital. He was admitted as a Fellow of the Royal College of Physicians in Ireland in 2003 and was elected to the Council of the College in 2007. He is widely published on Neural Tube Defects, Folic Acid as well as Preterm Labour. He was appointed Clinical Professor in Trinity College Dublin in 2007. He has served on the executive of the Institute of Obstetricians and Gynaecologists for seven years. Over the past 9 years he has been very involved in St Teresa’s Gardens initially as the head of the Community Forum and more recently as the Chairman of the Regeneration Board.

Abstract
Preterm delivery is the largest contributor to perinatal mortality in the developed world. The cause and mechanism for early delivery is not well understood.

Toll-like receptor 9 (TLR9) senses CpG motifs in DNA. These are more common in bacterial and viral DNA and TLR9 has been shown to have an important role in the sensing of various pathogens during host defence. Recent studies have suggested that abnormal epigenetic changes in CpG-rich islands in fetal mammalian DNA might contribute to the high rate of early pregnancy loss. It is also well known that higher concentrations of free fetal DNA are found in mothers who deliver prematurely. We therefore wished to test the hypothesis that fetal DNA might be sensed by TLR9, and might provoke an inflammatory response, which in turn could lead to preterm labour and early pregnancy loss

Our investigations have shown that fetal DNA added to the Namalwa B cell line (which expresses high levels of TLR9) or PMBCs could rapidly activate NF-kappaB (as measured by increased I-kappaB degradation) and also p38 activation, both of which are typical TLR9 signals. We also found increased production of the pro-inflammatory cytokines IL6 and TNF. The effects of fetal DNA were more potent than either synthetic CpG –containing oligonucleotides, or adult DNA. We also found that chloroquin, which has been shown to inhibit TLR9 signalling, blocked the effect. Finally we have found that the effect of fetal DNA on cytokine induction is significantly reduced in TLR9-deficient bone marrow-derived macrophages. We have therefore made the novel observation that TLR-9 senses fetal DNA and
facilitates an inflammatory reaction. This may then contribute to preterm labour or early pregnancy loss.

Biography
Previous Appointments:
1997–1998 Visiting Professor, Cornell University Medical School, USA
1994-1997 Lecturer in Pathology, The University of Oxford,UK
1993-1994 Lecturer in Pathology, The University of Leeds, UK
1990-1992 Research Fellow, Health Research Board, University College Cork
1988-1989 Senior House Officer [Pathology], Cork University Hospital
1987-1988 Intern Cork University Hospital

Academic and Professional Qualifications:
DEd (TCD) commenced 2007 ongoing
FTCD 2005
MA University of Dublin 2004
FRCPath Royal College of Pathologists 2002
FFPathRCPI Royal College of Physicians Ireland 2001
DPhil University of Oxford 1996
MRCPath Royal College of Pathologists 1995
MD National University of Ireland 1993
MSc National University of Ireland 1991
BSc National University of Ireland 1989
MB, BCh, BAO National University of Ireland 1987

Publication Record:
Number of Publications in International Peer Reviewed Journals:
> 130 papers [incl. Nature, Nature Medicine, Lancet, Cancer Research, Annals
of Oncology, The Lancet etc.], > 200 published abstracts.
Number of Invited Reviews: 10
Number of Chapters in Books: 21
Books / Proceeding Edited: 3 (1 seated editor), 1 (under review) Total Funding: 22 million euros

Research Supervision [Key Performance Indicators]:
John O’Leary has supervised 13 PhD, 6 MD and 7 MSc students to completion since 1997. His research group currently hosts 22 PhD, 3MD and 2MSc students and attracts international research visitors. The laboratory adopts a ‘translational research’ approach in applying knowledge to improve disease prevention, detection, diagnosis and treatment.

The departmental research groups are:
[GROUP 1] Cervical Cancer Research Group
[GROUP 2] Ovarian cancer research group
[GROUP 3] Cancer stem cell group
[GROUP 4] Pregnancy transcriptomic and proteomics group [PREG consortium]
[GROUP 5] Prostate cancer group
[GROUP 6] Thyroid cancer group

Abstract
Genes, chromosomes and cancer:
In this talk, I will describe how basic scientific research can aid in discovery achieving a ‘bench to bedside’ translational medicine approach. The era of personalised molecular and proteomic medicine demands that novel diagnostic and therapeutic approaches are developed.

Our research laboratory focuses on six key areas
[defined as individual yet linked groups]:
[GROUP 1] Cervical Cancer Research Group
[GROUP 2] Ovarian cancer research group
[GROUP 3] Cancer stem cell group
[GROUP 4] Pregnancy transcriptomic and proteomics group [PREG consortium]
[GROUP 5] Prostate cancer group
[GROUP 6] Thyroid cancer group

I will describe our findings in relation to the discovery of new biomarkers of disease [e.g. p16, mcm2, 3, 57, geminin etc. in cervical cancer], formulation of novel biological networks [e.g. chemoresistance bio-pathways in ovarian cancer] and novel bio-discovery [e.g. cancer stemness].

In addition, I will describe our recent work in the area of pregnancy transcriptomics, proteomics and inflammatory signalling which has yielded important imformation in relation to the pathophysiology of pregnancy but also
offers potentially new therapeutic approaches to pregnancy–related diseases.

The final part of the talk will deal with developing novel devices [lab-on-achip] for bio-discovery and novel therapeutic formulation.

Biography
Dr Regan qualified with an honours degree from University College Galway in 1985 and trained initially in general medicine gaining Membership of the Royal College of Physicians in 1988. She then entered the speciality of obstetrics and gynaecology and was conferred as a member of the Royal College of Obstetrics and Gynaecology (UK) in 1991. Following a further period of training in general obstetrics and gynaecology she was awarded a Health Research Board Post Doctoral Fellowship in 1994. Her research investigated prostaglandin formation in hypertensive pregnancy and was conducted at the Department of Clinical Pharmacology at the Royal College of Surgeons in Ireland. She was awarded an MD degree for her thesis in 2001.

In 1996 she travelled to the USA to pursue a fellowship in Maternal Fetal Medicine at the University of Pennsylvania, Philadelphia, and is subspecialty trained in maternal fetal medicine. She has published widely on the role of low dose aspirin and oxidative stress in pre-eclampsia. She worked on faculty as a maternal fetal medicine specialist in the University of Pennsylvania until 1999 when she returned to Ireland. Dr Regan is currently a Consultant Senior Lecturer in the Royal College of Surgeon’s in Ireland and her clinical base is at the Coombe Women & Infants University Hospital where she has specific responsibility for high risk pregnancies.

Her current research interests include pre-eclampsia, preterm delivery and she currently holds a HRB grant to investigate the role of prostanoids and smoking in the pathogenesis of intrauterine growth restriction.

Abstract
Why babies are small

Intrauterine growth restriction (IUGR) is a major cause of fetal mortality and morbidity and has several possible aetiologies. Our research focuses on uteroplacental IUGR with particular reference to alterations in prostaglandin biosynthesis. In 2007 Dr Caoimhe Lynch completed a postdoctoral research fellowship, funded by the Health Research Board of Ireland. This research, conducted at the Coombe Women & Infants University Hospital and the Dept of Molecular and Cellular Therapeutics at the Royal College of Surgeons in Ireland provided novel information on thromboxane A2 formation in placental disease shedding new light on this disease process.

Hypothesis: The production of thromboxane A2 (TxA2) is altered in severe intrauterine growth restriction (IUGR).

Materials and Methods: Patients were enrolled prospectively following ultrasound examination for suspected IUGR defined as a fetal abdominal circumference of <5th centile for gestational age. Patients with IUGR and normal umbilical artery Dopplers (UAD) were identified (group1) and also those with abnormal umbilical artery Dopplers (group 2). A gestational age matched group of patients with normally grown fetuses were enrolled as controls (group 3). Patients underwent serial ultasound examination and maternal urine samples were collected at each timepoint. Urinary prostaglandin metabolites were quantified using high performance liquid chromatography tandem mass spectrometry (LC-MS-MS).

Results: In patients with IUGR and abnormal UAD thromboxane A2 formation was significantly reduced, suggesting impaired formation in these patients.

Conclusion: Abnormal eicosanoid formation is thought to be important in the pathogenesis of preeclampsia and IUGR. Low dose aspirin is often used in order to selectively inhibit thromboxane A2 formation in these conditions. Our study showed no evidence for increased formation of TxA2 in IUGR and does not support the use of low dose aspirin therapy in the management of IUGR.

Biography
Bridgette graduated from UCD in 1986. She trained in general medicine, obstetrics and gynaecology in Dublin subsequently trained in maternal medicine in Oxford. Bridgette then undertook Fetomaternal Research in Toronto. She was awarded MD in 1996. In 2001 Bridgette was appointed consultant at the CWIUH. She is also a MOET instructor.

Special Interests:
Maternal medicine, obstetric emergencies and severe maternal morbidity

Abstract
Severe Maternal Morbidity – Current Research
Data will be presented from the following ongoing research into severe maternal morbidity.

1. Audit of severe maternal morbidity
2. Retrospective study of massive obstetric haemorrhage in three Dublin maternity hospitals and risk factors for peripartum hysterectomy and end organ failure.
3. Prospective audit of massive obstetric haemorrhage at the Coombe Women & Infants Hospital. and the impact of obstetric haemorrhage drills on patient care and outcomes.
4. Audit of management of severe pre-eclampsia in the High Dependency Unit.
5. Safety of low molecular weight heparin in the prevention and treatment of thrombosis in pregnancy.

Biography
I was born 24/1 1975 in Teplice, Czech Republic. I am married and have 3 children. My education started at primary and then secondary school (grammar-school – 1989-1993) in Teplice. After leaving exam in 1993 I studied in Charles University Prague, 1st School of Medicine and graduated in 1999 (M.D.).

My paediatric training took place in Prague in three different hospitals (Institute for the Care of Mother and Child; Department of Paediatrics and Adolescent Medicine, General University Hospital in Prague; Motol Children’s University Hospital). Part of my training was short attachment in Georgetown University Hospital in ashington, D.C.. I finished the training by paediatric professional exam (attestation) in 2002. My neonatal training took place in Institute for the Care of Mother and Child in Prague (level III perinatal centre and ECMO centre). Parts of the training were short attachments in Great Ormond Street Hospital, London (including ECMO training) and King’s College Hospital in London. I finished the training by neonatal professional exam (attestation) in 2005. In 2005 I was appointed as Neonatologist and Head of ECMO centre in Institute for the Care of Mother and Child in Prague.

In 2006 and 2007 I worked as Neonatal Registrar in Our Lady’s Hospital for Sick Children in Crumlin and Coombe Women & Infants University Hospital. After 6 months in 2007 (July to December) as Neonatologist and leader of ECMO Centre back in Prague, I was appointed as temporary Consultant Neonatologist in Coombe Women & Infants University Hospital from January 2008.

Abstract
Superior Vena Cava Flow – Modern Marker of Perfusion in VLBW
Superior vena cava (SVC) flow assesses blood flow from the upper body, and may provide a reliable assessment of systemic blood flow. We aimed to assess the relationship between SVC flow in first 24 h and adverse outcome in very low birth weight (VLBW) infants and to assess the relationship between the clinical and biochemical parameters of perfusion and superior vena cava (SVC) flow in a prospective observational cohort study of very low birth weight (VLBW) infants. Newborns with congenital heart disease were excluded. Echocardiographic evaluation of SVC flow was performed in the first 24 h of life. The primary outcome was intraventricular haemorrhage (IVH) grade > II and/or early neonatal death. Capillary refill time (forehead, sternum and toe), mean blood pressure, urine output and serum lactate and cortisol concentrations were also measured simultaneously. Thirty-eight VLBW infants were examined. Eight patients (21%) had SVC flow less than 40 ml/kg/min. There was no difference between the cohorts in median birth weight (1.14 kg vs. 1.17 kg; p=0.76), gestational age (26.5 vs. 28.0 weeks; p=0.12) or hours of life at examination (18.5 h vs. 21 h; p=0.36). The incidence of primary outcome (IVH > grade II and/or early neonatal death)
was 50% and 6.7%, respectively (p=0.01). There was a poor correlation between the capillary refill time (in all sites), mean blood pressure, urine output and SVC flow. The correlation coefficient for the serum lactate concentration was r=−0.28, p=0.15. The median serum lactate concentration was 3.5 (range 2.8–8.5) vs. 2.7 (range 1.2–6.9) mmol/l (p=0.01) in low flow versus normal flow states.

21% of our VLBW infants had low SVC flow in the first 24 h, and this was associated with early neonatal death and/or severe IVH. Serum lactate concentrations are higher in low SVC flow states.

Biography
Acting Director of the Centre for Midwifery Education, Midwife Practice Development Co-Ordinator (2003-2007), Midwifery Tutor (1989-2003), Delivery Suite Clinical Manager and Staff Midwife (14 years), Member of An Bord Altranais (The Irish Nursing Board) (11 years), Member of Executive Council Irish Nurses Organisation (10 years). Nurse &Midwife Prescribing
Site Co-ordinator, Co-ordinator of IHF accredited CPR-BLS Programme.

Keen interest in Practice Development –Development and expansion of the role of the Midwife and Research Bio-pyschosocial needs of couples following miscarriage (1987), Audit of Perineal Tauma (1988-2007), and the mother – midwife relationship and in the History of the Coombe Women& Infants University Hospital.

Organisation of CWIUH Art Exhibition 2008,2006, Christmas Concerts (annual) & Fashion Shows.

Interests
Art, Golf and Theatre.

Abstract
The Role of the Centre for Midwifery Education
“The provision of continuing midwifery and nurse education and training programmes for staff in the Coombe Women & Infants University Hospital, National Maternity Hospital and Rotunda Hospital. General requirements for midwifery education in the Dublin catchment area are also catered for. The centre will also provide specialist programmes as required nationally. The education programmes include midwifery, neonatal and gynaecology and other related programmes”

This presentation will give an account of the setting up of the Hub Centre of the Centre for Midwifery Education in the CWIUH, its role, governance structure, education and training programmes provided. Plans for future development of the Centre will also be outlined.

Biography
Graduate of Queen’s University Belfast - Physiology 1977
Graduate of University College Dublin - Medicine 1977
Fellow of the Faculty of Anaesthetists RCSI 1990
Doctorate in Medicine UCD 1995
Consultant Anaesthetist Coombe Women & Infants University Hospital since 1995

Abstract
The Department of Perioperative Medicine’s research philosophy is to combine laboratory and clinical research with audit activity. The ultimate goal is to improve patient care and outcome. The presentation will outline some past and current research projects that endeavour to fulfil this philosophy.