Workload pressures and poor infrastructure at Dublin's Rotunda Hospital are putting patients at risk, according to its Master, Dr Sam Coulter-Smith.

Writing in the hospital's latest annual report, Dr Coulter-Smith said the current level of activity was unsustainable, particularly when simultaneous emergencies occurred, and it was a credit to the Rotunda frontline staff that safety levels were being maintained in spite of this.

He said the HSE and Department of Health had been notified on multiple occasions of the intolerably high levels of activity and the clinical risks that arose as a result.

According to its latest annual report, 2012 was the busiest year in the history of the country's oldest maternity hospital, with 11,000 women booked for maternity care, and 8,845 mothers delivered of 9,041 babies. Forty two deliveries took place over one 24-hour period last year.

The report points out that the Rotunda is critically short of operating theatres, delivery rooms and pre- and postnatal inpatient facilities, and its outpatient departments are too small to deal safely with the throughput of mothers and babies.

Dr Coulter Smith said the decision made late last year to site the national children's hospital at St James's had been extremely disappointing for the Rotunda.

It had been expected that the Rotunda would eventually move to a new building on the nearby Mater site, which was the original choice of location for the children's hospital.

Dr Coulter-Smith said the Rotunda would now work with the health authorities to try to alleviate its infrastructure problems, and provide facilities to deal with the huge increase in activity in the past five to six years.

He said the current midwife to patient ratio was completely inappropriate for any busy major hospital and this needed to be addressed.

According to the report, an action plan is required to address the Rotunda's capacity issues, and discussions had begun with Dublin City Council and the HSE to allow the hospital to develop its services.

It says the hospital applied for planning permission for a redesign of some parts of the existing site, but ultimately it was asked to withdraw the application until discussions were held on the future of the Rotunda and Parnell Square.

A number of off-site locations for hospital facilities were assessed to relieve pressure on the main hospital site , but it was decided that these would be too expensive to develop, and a solution is still being sought for the Rotunda's capacity problems.

The report also points out that the linking of the Rotunda with Beaumont and Connolly Hospitals in the new hospital groups system, rather than maintaining its historical link with the Mater, has many implications for future service delivery.

The Rotunda Hospital has occupied its current building on Parnell Square since 1757.