A major study of 50,000 pregnancies in eight hospitals throughout Ireland hopes to discover the link between low-weight foetuses and stillbirth. David Labanyi reports
A major All-Ireland research programme to identify foetuses that are not growing properly in an effort to reduce the number of stillbirths will begin in April. The project will assess more than 50,000 pregnancies in eight hospitals during the next five years. It will focus on the 3 per cent of pregnancies where the foetus does not grow properly.
Prof Fergal Malone, head of the Department of Obstetrics and Gynaecology at the Royal College of Surgeons in Ireland and Rotunda Hospital, is the principal investigator on the study and says the causes of stillbirth have not yet received significant research attention.
"There are five to eight stillbirths per thousand. But no one really knows how many of these deaths are preventable or are the result of not developing properly. More than 10 per cent of all pregnancies measure on the low side in terms of weight and for about 3 per cent that is because the baby is not growing very well.
"What we are hoping to achieve is an improvement in our diagnoses of foetuses that are not growing well and figure out when is the best time to intervene, if needs be," he says.
Even when they go full term, some low-weight pregnancies can lead to difficulties in later life, including mental retardation. The researchers hope to investigate any link between low-weight pregnancies and later mental retardation and the research teams will follow the development of the infants in the research group for three years. "We plan to follow the babies from low-weight pregnancies for a couple of years because you can't really tell whether a child has mental retardation at birth," says Malone.
Dedicated ultrasound machines have been provided at each of the eight hospital sites as part of a €4-million funding provision from the Health Research Board.
Malone returned to Ireland from America to take up his post last year. He says the use of multiple research sites mirror the US approach when taking on research projects too large for any one centre. "Our network will have a huge patient base and that makes it very attractive for researchers."
Malone has won two awards from the US Society for Foetal Medicine for his work in screening for foetal abnormalities such as congenital heart disease and Down's syndrome. By combining a special form of ultrasound scan and a blood test in the 11th or 12th week of pregnancy, Malone's research team says it has significantly improved the identification of such conditions.
However, having access to detailed information revealing a severe congenital birth defect at that early stage of pregnancy raises a moral question for parents.
"I have patients coming into me being faced with the reality of their baby having a lethal abnormality. In those cases we offer counselling and we can offer them the opportunity to meet parents who have had children with a similar condition.
"Many continue with the pregnancy, but there have been cases where the patient has decided to go to another jurisdiction to terminate the pregnancy. We can all talk about this in the abstract but we have found that many parents react very differently from previously held views when the reality of a serious congenital abnormality sinks in."
Having spent many years working abroad, Malone is well placed to comment on the standard of obstetric care in the State. He describes the sector in Ireland as "extremely advanced" but with one clear weakness. "Where we fell down in the past was not having easy access to the latest equipment. And sometimes even when the equipment was there, the demand can mean it had to be effectively rationed.
"The strength of this new research programme is that it will provide dedicated ultrasound equipment throughout Ireland that can be protected for research uses."
Medico-legal claims in obstetrics cases are "a thorny issue", says Malone, in part because as medical expertise increases there is less tolerance for when things go wrong.
"When something goes wrong the normal reaction is to lash out and that may be why people go the medical legal route. However, when the care falls short of expected standards then patients deserve compensation."
The hospitals taking part are: The Rotunda Hospital, Dublin; Coombe Women's Hospital, Dublin; the National Maternity Hospital, Dublin; Our Lady of Lourdes Hospital, Drogheda; Cork University Maternity Hospitals, Cork; University College Hospital, Galway; Limerick Regional Hospital, Limerick; Royal Hospitals, Belfast.