The opinions and experiences of Irish obstetric and gynaecology trainee doctors in relation to abortion services in Ireland.

INTRODUCTION: The provision of abortion services in the Republic of Ireland is legally restricted. Recent legislation that has been implemented allows for abortion if there is a real and substantial risk to the woman's life, but in general Irish women must travel abroad for abortion services. The aims of this study were to investigate the clinical experiences of Irish obstetric non-consultant hospital doctors (NCHDs) that work in this environment and to assess their attitudes towards termination of pregnancy (ToP). METHODS: We conducted an online cross-sectional descriptive survey of 184 Irish obstetric NCHDs. Quantitate and qualitative analysis was performed. RESULTS: There was a 28% response rate. 88% of respondents thought that ToP should be permitted for fatal fetal abnormality if the parents choose, 96% if the woman's health is severely affected and 86% in cases of rape and incest. Over 90% of respondents believed a woman's health suffers because of the need to travel abroad to undergo a ToP. Physical, psychological and social reasons were explored. The research also highlights that obstetric trainees are actively involved in the provision of preabortion and postabortion care. CONCLUSIONS: The clinical experiences and opinions of the respondents suggest that the current legal availability of abortion in Ireland is insufficient to guide best clinical practice and does not represent the views of those that provide obstetric care.

MRI Significantly Improves Disease Staging to Direct Surgical Planning for Abnormal Invasive Placentation: A Single Centre Experience.

OBJECTIVE: To describe the role of ultrasound and MRI in defining the extent of disease and guiding perioperative and surgical management of abnormal invasive placentation (AIP). METHODS: We conducted a review of 65 cases of invasive placentation diagnosed antenatally with use of ultrasound and/or MRI in a single tertiary centre between January 2000 and December 2014. Cases were assigned a grade based on the depth of invasion and location of invasion within the uterus as described in ultrasound and MRI reports. These grades were then compared with grades assigned using a combination of pathology and dictated surgical reports. RESULTS: Ultrasound correctly identified the presence of AIP in 91.9% of cases but was accurate in predicting the stage of invasion in only 38.7% of cases. Ultrasound identified only 6.3% of cases with parametrial involvement. MRI correctly identified the presence of AIP in 98.4% of cases and was accurate in predicting the stage of invasion in 61.3% of cases. MRI accurately detected parametrial involvement in 68.8% of cases. CONCLUSIONS: Our results suggest that all women with signs of AIP on ultrasound scanning should be referred for MRI to assess the extent of placental invasion adequately and consequently to allow for adequate perioperative and surgical planning for delivery.