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Kieran O'Driscoll died recently at home in the loving care of his family. His wife, Ina, predeceased him by a few months.
Kieran believed that clinical research was an intrinsic part of good medical practice and spent his professional life accordingly.
His commitment to the labour ward and to the labouring women there resulted in many significant publications on the supervision of labour.
Both in 1920 in Kildare, where his father was a pharmacist and family doctor, he was educated at the nearby Clongowes Wood College and qualified in medicine with a first class honours degree from University College Dublin. He spent his initial postgraduate years at St Vincent's and the National Maternity Hospitals in Dublin. He undertook specialist training at the Women's Hospital in Liverpool and Queen Charlotte's in London, where he met his future Scottish wife, Robina (Ina). He took his MRCOG and MAO examinations in 1947 and became a consultant obstetrician and gynaecologist at the National Maternity Hospital (Holies Street) and at the Richmond Hospital in 1953.
Kieran's exceptional qualities will be remembered for many reasons. With a passionate-interest in the community aspects of reproductive medicine and recognising at that time the frequent tragedy of maternal death, he established specialised clinics and screening programmes, supervised jointly by physicians and obstetricians. Many joint papers on rheumatic heart disease, diabetes, and hypertension resulted, with a reduction in maternal mortality from these complications of pregnancy. With his anaesthetic colleagues he introduced central venous pressure monitoring in all cases where large amounts of blood were required and dramatically reduced the sequelae of renal failure, particularly in cases of abruptio placentae.
He established outreach clinics, thereby bringing the “hospital to the patient” and ensuring that joint antenatal care with family doctors was available without having to make the arduous journey to the city when transport was difficult.
He was a brilliant undergraduate teacher whose explicit dictates and definitions are often recalled with affection by students years later. He presented complex problems in the simplest terms. However, he will be best remembered for his original contributions to the detailed care of women in labour.
On election as master of the National Maternity Hospital in 1963 he became almost exclusively involved in the labour-delivery area of the hospital. Some years later there began a series of papers on “active management of labour.”
The regular routine attendance of the consultants in the labour ward ensuring all patients were reviewed every 4-6 hours, the emphasis on the difficulties in diagnosing actual labour, one to one skilled care for all mothers in labour, a simple precise partogram with a different colour for first-time mothers and for all other mothers, the safety of oxytocin in the primagravid uterus which was “immune to rupture” (whenever rupture of a primigravid uterus was discussed there were humorous references to the “black fox”), and the reduction in instrumental delivery and, above all, in prolonged labour were the bullet points of the programme. An intense detailed prenatal educational programme matched the labour programme as outlined. His trust in the skills of midwives and their appreciation of this trust resulted in a recognition that a skilled experienced midwife should be senior to resident doctors in the decision making pyramid.
Active Management of Labour, of which he was senior author and which is now in its fourth edition and in at least three languages, was not just another textbook in labour but was different in that each and every point made in the text was clearly illustrated by a corresponding partogram and in its current edition reflects experience in over 250 000 births at the National Maternity Hospital, of which more than a third were first time mothers. “Our era will be seen as one in which there occurred a revolution in intrapartum care centring in Dublin,” wrote a reviewer in the BMJ in 1980.
Kieran's numerous publications in labour attracted global attention, and he travelled extensively as visiting professor. Many present at such lectures will recall his precise delivery sprinkled with a keen sense of humour.
On completion of his mastership he was appointed to the chair of obstetrics and gynaecology at University College Dublin, having previously held the chair of clinical professor. He retired in 1984.
Kieran was a very private person who eschewed honours but as the only Irishman to be invited to deliver the Bartholomew Mosse Lecture in the Rotunda Hospital he felt as a prophet in his own country. He is survived by his six children, grandchildren, and brother, Diarmuid, also a retired gynaecologist, to whom we offer our sympathy.
Former professor of obstetrics and gynaecology University College Dublin (b 1920; q University College Dublin 1943; MRCOG, MAO), d 17 January 2007.