Residency program factors affecting ACVS board examination pass rates from 2017 to 2021: A survey of ACVS small animal surgery residency programs.

OBJECTIVE: To identify small animal surgery (SAS) residency program factors associated with board examination pass rates for the American College of Veterinary Surgeons (ACVS) board certification examinations. STUDY DESIGN: Online survey. SAMPLE POPULATION: Program directors of ACVS-registered SAS residency programs. METHODS: An online survey was distributed to eligible 2021 ACVS SAS residency program directors. Respondents provided program information and Phase I and Phase II board examination pass rate data from 2017 to 2021. Programs were grouped based on overall combined board examination pass rates as "excellent" (≥90%) versus "adequate" (<90%). Data were analyzed using recursive partitioning. RESULTS: Responses from 36 ACVS SAS residency programs (18 private practice [PP], 18 academic programs [AP]) were included. Pass rates were considered "excellent" for 17/36 programs (11/17 AP, 6/17 PP). The strongest indicator of "excellent" programs was most mentors participating in rounds >75% of the time. Of those, the second indicator of "excellent" programs was a soft tissue caseload of <7 surgeries/resident/week. If the soft tissue caseload was >7 surgeries/resident/week, a high orthopedic caseload (>9 surgeries/resident/week) was indicative of "excellent" programs. If most mentors were not participating in rounds >75% of the time, APs were more likely to be "excellent." CONCLUSION: SAS APs may have higher ACVS board examination pass rates. Mentor involvement, caseload, and residency practice type may influence board examination pass rates. CLINICAL IMPACT: ACVS SAS residency programs' board examination pass rates may improve by optimizing mentor involvement and caseload regardless of practice type.

Anatomical classification of feline congenital extrahepatic portosystemic shunts based on CT angiography: A SVSTS and VIRIES multi-institutional study in 231 cats.

The prevalence of anatomical-based subtypes of feline congenital extrahepatic portosystemic shunts (EHPSS) has not been completely elucidated. The goal of this study was to use CT angiography to create an anatomical-based nomenclature system for feline congenital EHPSS. Additionally, subjective portal perfusion scores were generated to determine if intrinsic portal vein development was associated with different shunt conformations or patient age at the time of CT. The SVSTS and VIRIES list services were used to recruit cases. Data collected included patient DOB, gender, breed, weight, CT date, and reported diagnosis. Shunts were classified based upon (1) the shunt portal vessel(s) of origin, (2) the shunt systemic vessel(s) of insertion, and (3) any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between 1 (poor/none) and 5 (good/normal) based on the caliber of the intrahepatic PVs. A total of 264 CT scans were submitted from 29 institutions. Due to exclusion criteria, 33 (13%) were removed, leaving 231 CT scans to be included. Twenty-five different EHPSS anatomies were identified with five classifications accounting for 78% of all shunts (LGP [53%], LGC-post [11%], LCG [7%], LGC-pre [4%], and PC [4%]). Shunt origin involved the left gastric vein in 75% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of CT scan (P = .002), breed (P < .001), and subjective portal perfusion score (P < .001). This refined anatomical classification system for feline EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for cats with these anomalies.

Does elastic taping on soles improve flexibility? A randomized controlled trial with equivalence test design.

BACKGROUND: Elastic taping that applies shear force affects joint movement. However, it remains uncertain whether elastic taping or stretching is more effective in improving flexibility. OBJECTIVE: We investigated whether elastic taping for flexibility improvement is comparable to traditional stretching. METHODS: In this randomized controlled trial, 64 university students were randomly allocated to two groups: elastic taping on the sole or 30 s of static stretching. The primary outcome measures were the straight leg raising angle, tested with an equivalence margin (± 9.61∘ on changes), and the fingertip-to-floor distance. Secondary outcomes were the hip flexor and knee extensor strength, two-step distance, adverse events, and pain intensity during the intervention, which were compared using conventional statistical methods. RESULTS: The mean differences in straight leg raising between the two groups after the interventions were not greater than the equivalence margin (mean [95% CI]: 1.4 [-6.9, 9.5]; equivalence margin, -9.61∘ to 9.61∘). There were no consistent differences between groups in terms of secondary outcomes except for pain intensity during the intervention (p> 0.05). Elastic taping did not induce pain. CONCLUSION: Elastic taping augments the flexibility-improving effect comparable to static stretching, based on an equivalence margin. Elastic taping of the sole appears to be an alternative method of improving flexibility.

Dogs ≥ five years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone.

OBJECTIVE: To determine the outcome in dogs diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical attenuation would have a longer survival time than dogs undergoing medical management only. ANIMALS: 351 dogs definitively diagnosed with EHPSS at ≥ 5 years of age. PROCEDURES: Medical records from 2009 to 2019 at 16 veterinary teaching hospitals were evaluated. Data collected included signalment, clinical signs at diagnosis, clinicopathologic data, surgical and medical treatments, shunt morphology, clinical signs and medical treatments at 6 to 12 months after diagnosis, and survival time. RESULTS: 351 dogs (M, 119 [33.9%]; S, 232 [66.1%]) were included in the study. Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years). Continued clinical signs at 6 to 12 months after diagnosis were more common with medical management (M, 40% [33/88]; S, 14% [21/155]). Continued medical treatments at 6 to 12 months after diagnosis were more common in the medical management group (M, 78% [69/88]; S, 34% [53/155]). Perioperative mortality rate was 7.3%. CLINICAL RELEVANCE: Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and fewer clinical signs with surgical attenuation, compared with medical management. Older dogs have similar surgical mortality rates to dogs of all ages after surgical EHPSS attenuation.

Evaluation of outcomes following subtotal colectomy for the treatment of idiopathic megacolon in cats.

OBJECTIVE: To evaluate outcomes in cats undergoing subtotal colectomy for the treatment of idiopathic megacolon and to determine whether removal versus nonremoval of the ileocecocolic junction (ICJ) was associated with differences in outcome. ANIMALS: 166 client-owned cats. PROCEDURES: For this retrospective cohort study, medical records databases of 18 participating veterinary hospitals were searched to identify records of cats with idiopathic megacolon treated by subtotal colectomy from January 2000 to December 2018. Data collection included perioperative and surgical variables, complications, outcome, and owner perception of the procedure. Data were analyzed for associations with outcomes of interest, and Kaplan-Meier survival time analysis was performed. RESULTS: Major perioperative complications occurred in 9.9% (15/151) of cats, and 14% (12/87) of cats died as a direct result of treatment or complications of megacolon. The median survival time was not reached. Cats with (vs without) a body condition score < 4/9 (hazard ratio [HR], 5.97), preexisting heart disease (HR, 3.21), major perioperative complications (HR, 27.8), or long-term postoperative liquid feces (HR, 10.4) had greater hazard of shorter survival time. Constipation recurrence occurred in 32% (24/74) of cats at a median time of 344 days and was not associated with retention versus removal of the ICJ; however, ICJ removal was associated with long-term liquid feces (OR, 3.45), and a fair or poor outcome on owner assessment (OR, 3.6). CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that subtotal colectomy was associated with long survival times and a high rate of owner satisfaction. Removal of the ICJ was associated with less favorable outcomes in cats of the present study.

Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions.

OBJECTIVE: To describe perioperative characteristics and outcomes of dogs surgically treated for intestinal intussusception. STUDY DESIGN: Multi-institutional, retrospective study. ANIMALS: One hundred fifty-three client-owned dogs with intestinal intussusception. METHODS: Dogs were included when they had undergone surgical treatment of a confirmed intestinal intussusception. Medical records were reviewed for demographics and clinical data, including surgical complications (graded 1-4). Follow-up was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]). Most cases had no identifiable cause (104/155 [67%]). Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA. Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction. The median duration of follow-up after discharge was 334 days (interquartile range, 15-990; range, 1-3302). Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events. Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively. Fourteen-day postoperative mortality rate was 6%. CONCLUSION: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications. CLINICAL SIGNIFICANCE: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered.

Characteristics and long-term outcomes of dogs with gastroesophageal intussusception.

OBJECTIVE: To determine long-term outcomes and factors associated with those outcomes in dogs with gastroesophageal intussusception (GEI). ANIMALS: 36 dogs with GEI evaluated at 16 veterinary hospitals from January 2000 through January 2018. PROCEDURES: Medical records of included dogs were reviewed to collect information regarding signalment, clinical signs, physical examination findings, blood work and diagnostic imaging results, surgical findings, and outcome. Factors were evaluated for associations with various outcomes. RESULTS: Median age of dogs with GEI was 13.2 months, and males (72% [26/36]) and German Shepherd Dogs (33% [12/36]) were most common. Vomiting (67% [24/36]) and regurgitation (33% [12/36]) were the most common clinical signs. Ten of 36 (28%) dogs were euthanized without treatment, and 26 (72%) underwent treatment (25 surgically and 1 endoscopically). Twenty-three of the 26 (88%) treated dogs survived to discharge; median survival time was 995 days. At last follow-up, 15 of the 23 (65%) surviving dogs remained alive and 8 (35%) had died for reasons related to persistent regurgitation (n = 6) or reasons unrelated to GEI (2). Of the 10 dogs for which owners were contacted, 7 had persistent regurgitation, the severity of which was reduced through managed feedings. Dogs with acute (≤ 7 days) clinical signs or a previous diagnosis of megaesophagus were more likely to have persistent regurgitation than were dogs without these factors. CONCLUSIONS AND CLINICAL RELEVANCE: Treatment should be considered for dogs with GEI given the high rate of survival to discharge and median survival time. Although persistent regurgitation was common after treatment, a satisfactory outcome was possible with medical management, including managed feedings and medications.

Outcome after surgical and conservative treatments of canine peritoneopericardial diaphragmatic hernia: A multi-institutional study of 128 dogs.

OBJECTIVE: To compare demographics and disease characteristics in dogs in which peritoneopericardial diaphragmatic hernia (PPDH) had been diagnosed and report outcomes after surgical treatment (ST) or conservative treatment (CT). STUDY DESIGN: Retrospective study. SAMPLE POPULATION: One hundred twenty-eight dogs (91 ST, 37 CT) in which PPDH had been diagnosed. METHODS: Medical records were reviewed for demographics, perioperative findings, and outcomes. Follow-up was obtained via telephone interview and email correspondence with owners and referring veterinarians. Baseline variables were compared between treatment groups. RESULTS: Dogs treated surgically were younger (P < .001), more likely to be sexually intact (P = .002), more likely to have clinical signs from PPDH vs an incidental diagnosis (P < .001), and more likely to have other congenital abnormalities (P = .003) compared with dogs treated conservatively. Ninety-seven percent of ST dogs were discharged from hospitals. Intraoperative and postoperative complications were reported in 22% and 41% of dogs, respectively, although most complications were classified as low grade (75% and 83%, respectively). Follow-up was available in 87 dogs, at a median of 1062 days. Hernia recurrence was not reported in any surgically treated dog. The deaths of nine dogs (five ST, four CT) could be attributed to PPDH, and long median survival times were observed in both the ST and CT groups (8.2 and 5 years, respectively). CONCLUSION: Preoperative characteristics differed between dogs treated conservatively vs surgically. Surgical treatment was associated with low operative mortality, and both ST and CT dogs had good long-term survival. CLINICAL SIGNIFICANCE: A diagnosis of PPDH can confer a good long-term prognosis for both ST and CT dogs.

Metastatic Cardiac Hemangiosarcoma in a 6 Year Old Wheaten Terrier Mix.

A 6 year old Wheaten Terrier mix with a history of collapse and lethargy was referred for evaluation of pericardial effusion. The echocardiogram identified pericardial effusion and a right auricular mass. No sign of metastasis was noted at this time in thoracic radiographs and abdominal ultrasounds. The patient underwent the right auriculectomy via right lateral thoracotomy. Several metastatic masses were located in the visceral aspect of the pericardium at the time of surgery and were all excised. The right auricular mass and pericardial masses were diagnosed as hemangiosarcoma with a sign of metastasis. The patient recovered from surgery uneventfully and was discharged the sixth day after surgery. The patient received doxorubicin followed by cyclophosphamide, piroxicam and Coriolus versicolor extract postoperatively. Pulmonary metastases were noted 229 days and the dog was euthanized 318 days after surgery. No clinical signs were noted until 309 days postoperatively.

Fine-needle aspiration of cutaneous, subcutaneous, and intracavitary masses in dogs and cats using 22- vs 25-gauge needles.

BACKGROUND: Fine-needle aspiration (FNA) is a common procedure as a diagnostic tool in veterinary medicine. However, it is unclear whether the gauge of the needle affects the quality of cytology. OBJECTIVE: This study compared the quality of cytologic samples obtained via FNA using 22- or 25-gauge needles. METHODS: Fine-needle aspiration was performed on 50 masses (cutaneous, subcutaneous, or intracavitary) obtained from client-owned animals. The size of the needle was randomly assigned using either of the following two sequences: 22-25-22 gauge or 25-22-25 gauge. Samples were evaluated by two board-certified clinical pathologists to assess cellularity, blood contamination, amount of cellular debris, degree of cellular trauma, and the overall ability to make a diagnosis for each sample. RESULTS: No significant difference was detected between the 22- and 25-gauge needle samples for cellularity, whereas a significant difference was present for blood contamination, amount of cellular debris, and degree of cellular trauma. The overall ability to make a diagnosis was not significantly affected by the needle gauge. The degree of cellular trauma was significantly increased in intracavitary samples. CONCLUSIONS AND CLINICAL RELEVANCE: Needle gauge is a contributing factor to FNA sample quality. However, it did not affect the overall ability to make a diagnosis. Samples obtained using 25-gauge needles resulted in less blood contamination yet increased cellular trauma compared to 22-gauge needle samples.

Antibacterial Efficacy of Several Surgical Hand Preparation Products Used by Veterinary Students.

OBJECTIVE: To compare the antibacterial efficacy of different surgical hand antisepsis protocols used by veterinary students. STUDY DESIGN: Prospective, randomized, controlled study. STUDY POPULATION: Third year veterinary students (n=45). METHODS: The participants were randomly assigned to 4 of the following 12 hand preparation product/time combinations: nonabrasive hand scrub method with 4% chlorhexidine gluconate (CH); hand rub with a mixture of 30% 1-propanol and 45% 2-propanol solution (MPS), 70% 2-propanol solution (IPS), or 61% ethanol solution with 1% chlorhexidine gluconate (ES/CH), with a contact time of 1.5, 3, or 5 minutes. Antibacterial efficacy was assessed after surgical hand preparation and at the end of surgery. Log reductions of total bacterial colony forming unit (CFU)/mL and positive aerobic culture rates were compared using multivariable analysis of variance and multivariable logistic regression, respectively. RESULTS: After surgical hand preparation, CH and ES/CH provided significantly higher log CFU reduction and lower positive culture rate for Gram-positive and spore-forming bacteria compared to MPS and IPS. Increase in contact time did not provide significant improvement in bacterial reduction. At the end of surgery, ES/CH provided significantly higher log CFU reduction compared to IPS and lower positive culture rate for Gram-positive bacteria compared to CH, MPS, and IPS. Increase in contact time significantly improved log CFU reduction in ES/CH and MPS groups. CONCLUSION: In our population of veterinary students ES/CH hand rubs or CH scrubs were more effective in reducing bacterial CFU during surgical hand preparation than MPS or IPS.

Warfarin therapy in a dog with acute arterial thrombosis and pyometra.

This report describes the presentation of acute arterial thrombosis causing triparesis in a 6-year-old female Chihuahua with pyometra and its successful management in combination with warfarin therapy. This is the first case report of a dog with arterial thrombosis associated with pyometra.

Traitement à la warfarine chez un chien atteint d'une thrombose artérielle aiguë et de pyométrite. Ce rapport décrit la présentation d'une thrombose artérielle aiguë causant la triparésie chez une chienne Chihuahua âgée de 6 ans atteinte de pyométrite et sa gestion réussie en combinaison avec un traitement à la warfarine. C'est le premier rapport de cas d'un chien atteint d'une thrombose artérielle associée à la pyométrite.(Traduit par Isabelle Vallières).

Bioprosthesis valve replacement in dogs with congenital tricuspid valve dysplasia: technique and outcome.

OBJECTIVE: To describe the surgical technique and report outcome of dogs undergoing bioprosthesis valve replacement for severe tricuspid regurgitation (TR) secondary to congenital tricuspid valve dysplasia (TVD). ANIMALS, MATERIALS AND METHODS: Twelve client-owned dogs (19-43 kg) with TVD underwent tricuspid valve replacement with a bovine pericardial or porcine aortic bioprosthesis with the aid of cardiopulmonary bypass. Anticoagulation with warfarin was maintained for 3 months after surgery and then discontinued. RESULTS: Ten of 12 (83.3%) dogs survived surgery and were discharged from the hospital. Seven dogs were alive with complete resolution of TR for a median period of 48 months (range 1-66 months) after surgery. Two dogs underwent euthanasia because of bioprosthesis failure due to inflammatory pannus at 10 and 13 months after surgery. Two dogs experienced valve thrombosis that was resolved by tissue plasminogen activator. One dog developed suspected endocarditis after surgery that was resolved with antibiotics. Serious cardiac complications included atrial fibrillation and flutter, right-to-left shunt through an uncorrected patent foramen ovale, complete atrioventricular block, and sudden cardiac arrest. Postoperative atrial fibrillation or flutter did not occur in 7 dogs treated prophylactically with oral amiodarone before surgery. CONCLUSIONS: Curative intermediate-term outcomes are possible in dogs undergoing open tricuspid valve replacement with a bioprosthesis. Prosthesis-related complications include inflammatory pannus, thrombosis, and endocarditis. Postoperative atrial fibrillation or flutter can be reduced or prevented by prophylactic preoperative treatment with amiodarone. Several identified complications are avoidable or can be reduced with increased awareness and experience with these techniques.

Tissue-gel electrophoresis enhances antigen removal from porcine aortic valve and bovine pericardium.

BACKGROUND AND AIM OF THE STUDY: A tissue-engineered heart valve could provide a living prosthesis with characteristics of an ideal valve replacement. One approach to scaffolding a tissue-engineered heart valve is through the 'decellularization' of xenogeneic tissues. Concerns regarding the completeness of antigen removal associated with current detergent-based decellularization treatments have been raised. The study aim was to evaluate antigen removal from candidate xenogeneic bioscaffolds using a novel tissue-gel electrophoresis (TGE) method. METHODS: Porcine aortic valve (PAV) conduit and bovine pericardium (BP) were treated sequentially with hypotonic lysis, sodium dodecyl sulfate (SDS), and TGE. The completeness of antigen removal was evaluated by immunoblot analysis of extractable soluble proteins using rabbit anti-PAV or anti-BP serum. Tissues were also evaluated by hematoxylin and eosin histology. RESULTS: TGE enhanced antigen removal from both the PAV and BP. The effects of TGE were shown to depend on the SDS concentration and voltage (60 versus 120 V), but to be independent of time after 4 h. The effects of TGE were detectable both before and after 96 h aqueous washout. Treatment with 1.0% SDS with TGE (120 V for 4 h) resulted in complete acellularity and no detectable soluble protein antigens from the PAV conduit. CONCLUSION: TGE is a promising adjunctive decellularization method for generating non-immunoreactive bioscaffolds from xenogeneic tissues.

Immunoblot detection of soluble protein antigens from sodium dodecyl sulfate- and sodium deoxycholate-treated candidate bioscaffold tissues.

BACKGROUND AND AIMS OF THE STUDY: The detergent-based 'decellularization' of xenogeneic tissues is one approach to scaffolding a tissue-engineered heart valve construct; however, concern persists regarding the immunogenicity of decellularized xenogeneic bioscaffolds. The study aims were to: (i) develop a sensitive and robust immunoblot-based assay for the detection of soluble protein antigens in xenogeneic bioscaffolds; and (ii) evaluate the completeness of protein antigen removal from sodium dodecyl sulfate (SDS)- or sodium deoxycholate (SD)-treated bovine pericardium (BP) or porcine aortic valve (PAV) conduit. METHODS: Homogenized BP or PAV were injected into rabbits to generate immune serum towards these tissues. Soluble proteins were extracted from untreated BP and PAV. Immunoblot analyses of the extracts were performed using pre-immune and 14-, 28-, 42-, 56- and 70-day post-immune serum. BP and PAV were treated sequentially with 4 h hypotonic lysis; with 0, 0.01, 0.025, 0.05, 0.1, 0.25 or 0.5% SDS or SD for 24 h; and with 96 h of aqueous wash-out. Immunoblot analyses of protein extracts from treated tissues were performed using 70-day post-immune rabbit serum. RESULTS: Immunoblot analysis of untreated BP or PAV with pre-immune serum showed no immune banding. The immune banding density increased progressively when immunoblots were performed with 14-day through 70-day post-immune serum. The immunoblot analysis of treated BP and PAV showed that soluble protein antigen removal from SDS- or SD-treated tissues was incomplete. CONCLUSION: Immunoblot analysis is a sensitive and robust assay for detecting soluble protein xenogeneic antigens after the decellularization of xenogeneic bioscaffolds. Under the study conditions, hypotonic lysis, SDS or SD detergent treatment, and aqueous wash-out-based decellularization of bovine pericardium and porcine aortic valve conduit did not completely remove detectable protein antigens.

Heterotopic implantation of a porcine bioprosthetic heart valve in a dog with aortic valve endocarditis.

CASE DESCRIPTION: A 5-year-old male German Shepherd Dog was evaluated because of a 5-month history of progressive lethargy, weight loss, and heart failure. CLINICAL FINDINGS: On physical examination, bounding femoral pulses and systolic and diastolic murmurs were detected. Echocardiography revealed severe aortic valve insufficiency (AVI) and a large vegetative lesion on the aortic valve consistent with aortic valve endocarditis. The AVI velocity profile half-time was 130 milliseconds; the calculated peak systolic pressure gradient across the aortic valve was 64 mm Hg. Left ventricular diameter during diastole was 63.6 mm (predicted range, 40.2 to 42 mm) and during systole was 42.9 mm (predicted range, 25.4 to 27 mm). Systolic, diastolic, and mean arterial blood pressures were 120, 43, and 65 mm Hg, respectively. TREATMENT AND OUTCOME: To palliate severe AVI, the descending aorta was occluded (duration, 16.75 minutes) and heterotopic implantation of a porcine bioprosthetic heart valve in that vessel was performed. After surgery, systolic, diastolic, and mean arterial blood pressures were 115, 30, and 61 mm Hg, respectively, in the forelimb and 110, 62, and 77 mm Hg, respectively, in the hind limb. Within 6 months, the AVI velocity profile half-time had increased to 210 milliseconds, indicating diminished severity of AVI. After 24 months, the dog was able to engage in vigorous exercise; no pulmonary edema had developed since surgery. CLINICAL RELEVANCE: Heterotopic bioprosthetic heart valve implantation into the descending aorta during brief aortic occlusion appears feasible in dogs and may provide substantial palliation for dogs with severe AVI.

[Support for the family from infancy].

A rising tendency has been reported for child abuse in our country in recent years, and the need to provide support for child-care capabilities in the home has been raised. In this context, attention has turned to the mother-child relationship and the mother's mental health from early on, in pregnancy and the antenatal period. In particular, it has become clear that the incidence of post-partum maternity blues and puerperal depression is higher than hitherto believed, drawing focus upon the effects of the mother's depression on the mother-child relationship. This report outlines the research and clinical intervention we have been undertaking for the mother's depression in pregnancy and the puerperium in relation to maternal attachment. 1) Results from studies in the puerperium on a group of mothers with children admitted to the NICU and a control group of mothers, and a 1-year follow-up study on the control group of mothers have revealed a relationship between a mother's depression and maternal attachment in the puerperium with depression and maternal attachment after 1 year, indicating the importance of focusing on the mother's depression and maternal attachment from the puerperium in thinking about maternal mental health and the mother-child relationship. 2) We have been attempting clinical intervention for the mother's psychological problems through the obstetric clinic, obstetric ward, and NICU, since 1998. The number of subjects, interviews, interview content, and other such data are reported. 3) A borderline personality disorder case we have been involved with clinically from age 19 is presented, for discussion of problems arising in the mother-child relationship from pregnancy through the child-rearing years.

Antenatal depression and maternal-fetal attachment.

BACKGROUND: In recent years, attention has been turned to maternal mental health in relation to the mother-child relationship accompanying a widening in focus, i.e. taking into account not only the puerperium, but also the stage of pregnancy. This applies to studies that have revealed a connection between depression and maternal attachment in the postpartum period and late pregnancy. This study, however, was designed to evaluate the maternal-fetal relationship in the first and second trimesters, being the first one to address this issue in these early stages. SAMPLING AND METHODS: Zung's Self-Rating Depression Scale (ZSDS), the original Antenatal Maternal Attachment Scale (AMAS), and a questionnaire addressing peripheral factors were given to 216 pregnant women (3-6 months of gestation) who visited the Nagoya University Hospital between September 1998 and June 2001. RESULTS: Contrary to reports on the latter stages of pregnancy, no direct association was observed between depression in mothers and maternal-fetal attachment before fetal movement was perceived. CONCLUSION: However, education, form of employment, planning of pregnancy, and premenstrual mood changes were found to be associated with the ZSDS score (mean: 41.9), while form of employment, feelings regarding pregnancy, and sources of support were extracted as factors associated with the AMAS, which are of interest in terms of the subsequent association between depression and maternal-fetal attachment in the peri- and postnatal periods.