Relación entre características sociodemográficas, obstétricas y psicosociales con el desenlace del parto prematuro en un hospital de alta complejidad / Relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature delivery in a highly complex hospital

INTRODUCCIÓN: La prematuridad es un grave problema de salud pública por la morbilidad, la mortalidad y los costos a ella asociados. OBJETIVO: Evaluar la relación entre las características sociodemográficas, obstétricas y psicosociales con el desenlace de parto prematuro frente a partos de término en el Hospital Guillermo Grant Benavente de Concepción, Chile, entre el segundo semestre de 2016 y el primer semestre de 2017. MÉTODO: Estudio cuantitativo, observacional, de tipo caso-control. La muestra la constituyeron 84 mujeres con parto prematuro y 85 con parto de término. Se utilizó un cuestionario de elaboración propia y la escala de Evaluación Psicosocial Abreviada (EPsA). El estudio fue aprobado por el comité ético científico. Se realizó análisis bivariado, con un nivel de significancia a = 0,05. Los datos se analizaron con el software estadístico SPSS v.25.0. RESULTADOS: No hubo diferencias en los antecedentes sociodemográficos (edad, nivel socioeconómico, estado civil y escolaridad) entre ambos grupos. Solo las mujeres con parto prematuro mantenían en mayor porcentaje que las gestantes de término un trabajo remunerado (43,4% vs. 25,9%). El estado nutricional y el antecedente de parto prematuro previo no se asociaron a un nuevo parto antes de las 37 semanas. La interrupción por cesárea fue significativamente más frecuente en las gestaciones de pretérmino que en el grupo control (p = 0,0377). CONCLUSIONES: En la población estudiada, las características sociodemográficas de las gestantes no tuvieron relación con el desenlace prematuro de la gestación. Algunos factores biomédicos se relacionan significativamente con este riesgo. Es necesario evaluar la pertinencia de aplicar escalas psicosociales en esta población y enfocar los esfuerzos para promover el control preconcepcional en mujeres con antecedentes de parto prematuro o comorbilidad.

INTRODUCTION: Prematurity is a serious public health problem due to morbidity, mortality and associated costs. OBJECTIVE: To evaluate the relationship between sociodemographic, obstetric and psychosocial characteristics with the outcome of premature birth versus term births at the Guillermo Grant Benavente Hospital in Concepción, Chile, between the second semester of 2016 and the first semester of 2017. METHOD: Quantitative, observational case-control study. The sample consisted of 85 women with premature delivery and 85 with term delivery. A self-elaborated questionnaire and Abbreviated Psychosocial Assessment scale (EPsA) were used. The study was approved by the scientific ethics committee. Bivariate and multivariate analysis was performed, with a level of significance a = 0.05. The data were analyzed with the statistical software SPSS v.25.0. RESULTS: There were no differences between the sociodemographic antecedents (age, socioeconomic level, marital status and education) between both groups. Only women with preterm birth had a higher percentage of paid work than full-term pregnant women (43.4% vs. 25.9%). Nutritional status and a history of previous preterm birth were not associated with a new delivery before 37 weeks. Interruption by cesarean section was significantly more frequent in preterm pregnancies than in the control group (p = 0.0377). CONCLUSIONS: In the studied population, the sociodemographic characteristics of the pregnant women were not related to the premature outcome of pregnancy. Biomedical factors are significantly related to this risk. It is necessary to evaluate the relevance of applying psychosocial scales in this population and to focus efforts to promote preconception control in women with a history of preterm birth and/or comorbidities.

Impact of a medical mobile phone app (QUiPP) for predicting preterm birth on the anxiety and decisional conflicts faced by women in threatened preterm labour.

BACKGROUND: The QUiPP app is a free, validated mobile phone application (app) that supports clinical decision-making for women in threatened preterm labour by providing an individualised risk of delivery within clinically important time points. Alongside generating a percentage risk score, the QUiPP app also provides the risk score in an infographic donut chart, allowing the clinician to communicate with the woman in an easy to understand format. Informing women of their risk status using the QUIPP app may help to reduce anxiety in women and decrease decisional conflict. METHOD: A subset of participants from the EQUIPTT study [REC Ref. 17/LO/1802] were asked to complete a questionnaire booklet which was used to evaluate decisional conflict and anxiety. Seven sites were randomised to the QUiPP app intervention (to use as a decision and communication tool) and six sites were randomised to the control (continued their normal practice). The first section of the questionnaire booklet was completed by the woman before her assessment, and the second section after. The pre and postassessment anxiety scores utilised the Visual Analogue Scale for Anxiety (Hornblow and Kidson, 1976). The Decisional Conflict Scale (O'Connor, 1995) measured decisional conflict post assessment. The data were then analysed to determine the impact of the QUiPP App on the anxiety and decisional conflicts faced by women in threatened preterm labour. RESULTS: Questionnaires were completed by 221 women from 12 of the potential 13 sites. After exclusions 202 questionnaires were included in the analysis. There was a significant reduction in difference between anxiety scores before and after clinical assessment. While there were reductions in anxiety and decisional conflict for women who were aware of the QUiPP app use, this failed to reach statistical significance. CONCLUSIONS: The QUiPP app has potential to reduce anxiety and decisional conflict in women who are aware that it is being used in their care. Additional work is required to ensure clinicians are aware of the QUiPP app and optimise using it as a communication tool when counselling women.

Effects of Relaxation-Focused Nursing Care in Women in Preterm Labor.

BACKGROUND: Threatened preterm labor is a common problem that causes women to be hospitalized. During this period, physical problems such as a decrease in muscle functions, edema and pain, and psychological problems such as anxiety and stress may develop. OBJECTIVE: This study aimed to investigate the effect of relaxation-focused nursing care state anxiety, cortisol, contraction severity, nursing care satisfaction, knowledge, and birth weeks on threatened preterm labor. METHOD: This study was a pre-post single-blind randomized controlled trial. The study was conducted with 66 women in the threatened preterm labor process, 33 in the intervention group and 33 in the control group. The intervention group received relaxation-focused nursing care, which comprises a 2-day program in four stages. The data were collected before and after the relaxation-focused nursing care, and after the birth. RESULTS: In the intervention group, state anxiety, cortisol level, and contraction severity were lower than those in the control group (p < .05). The knowledge level about threatened preterm labor, satisfaction from nursing care, and birth weeks were higher in the intervention group (p < .05). CONCLUSION: Relaxation-focused nursing care was found to reduce the state anxiety in women, improve the knowledge level about threatened preterm labor and birth weeks, and decrease the level of cortisol. Therefore, it is recommended to use relaxation-focused nursing care in threatened preterm labor.

Implementing Patient-Centered Trauma-Informed Care for the Perinatal Nurse.

Adverse childhood experiences and trauma significantly impact physical and mental health. Increased maternal perinatal depression/anxiety, preterm labor, and low birth weight, as well as infant morbidity and mortality, are some examples of the impact of trauma on perinatal health. Trauma-informed care begins with knowledge about trauma, the ability to recognize signs of a trauma response, responding to patients effectively, and resisting retraumatization. As holistic providers, perinatal nurses can create safe care environments, establish collaborative patient relationships based on trust, demonstrate compassion, offer patients options when possible to support patient autonomy, and provide resources for trauma survivors. This can prevent or reduce the negative impact of trauma and improve the health and well-being of infants, mothers, and future generations. This clinical article outlines key strategies for implementation of patient-centered trauma-informed perinatal nursing care.

Direct and Vicarious Racial Discrimination at Three Life Stages and Preterm Labor: Results from the African American Women's Heart & Health Study.

INTRODUCTION: Health disparities research has demonstrated a negative relationship between racial discrimination and African American women's maternal health outcomes. Yet, the relationship between racial discrimination and preterm labor, a key measure of maternal health, remains understudied. This study sought to examine the associations between preterm labor and direct and vicarious racial discrimination among African American women at three life stages: childhood, adolescence, and adulthood. METHODS: Logistic regression methods were used to analyze cross-sectional data from the African American Women's Heart & Health Study (AAWHHS; N = 173). The AAWHHS includes detailed maternal health information on a community sample of African American women residing in the San Francisco Bay Area. RESULTS: Findings indicated each unit increase in adolescent direct racial discrimination was associated with a 48% increase in the odds of preterm labor (OR: 1.480, 95% CI 1.002-2.187, p < 0.05) and each unit increase in childhood vicarious racial discrimination was associated with a 45% increase in the odds of preterm labor (OR: 1.453, 95% CI 1.010-2.092, p < 0.05) after adjusting for number of pregnancies and socioeconomic variables. DISCUSSION: This study provides evidence of an association between life-stage racial discrimination and preterm labor risk among African American women, underscoring a need to consider how both directly and vicariously experienced racial discrimination at different developmental periods impact racial disparities in birth outcomes.

Do lifetime anxiety disorders (anxiety liability) and pregnancy-related anxiety predict complications during pregnancy and delivery?

BACKGROUND: Evidence suggests that maternal anxiety is associated with adverse pregnancy and delivery outcomes, such as preterm birth, vaginal bleedings and low birth weight. AIMS: To examine the association of lifetime anxiety disorders and pregnancy-related anxiety and complications during pregnancy and delivery. STUDY DESIGN: Prospective-longitudinal study (MARI). SUBJECTS: N = 306 pregnant women who were investigated repeatedly during the peripartum period. OUTCOME MEASURES: Information on lifetime anxiety disorders was assessed using a dimensional score (lifetime anxiety liability index) based on the standardized Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy-related anxiety was surveyed with the Pregnancy and Childbirth Related Fears (PCF) questionnaire. Common pregnancy (e.g. vaginal bleedings) and delivery complications (e.g. labor induction) were assessed via medical records, interviews and questionnaires. RESULTS: The global tests on the association between lifetime anxiety liability and pregnancy complications and on the association between pregnancy-related anxiety and pregnancy/delivery complications revealed significant associations. Further analyses revealed associations of lifetime anxiety liability with preterm labor (OR = 1.6, 95% CI = 1.2-2.0) as well as pregnancy-related anxiety with vaginal bleedings (OR = 1.4, 95% CI = 1.0-1.8), preterm labor (OR = 1.3, 95% CI = 1.0-1.7), gestational diabetes (OR 0.5, 95% CI = 0.2-0.9), labor induction (OR = 1.5, 95% CI = 1.1-1.9) and use of labor medication (OR = 1.6, 95% CI = 1.2-2.0). After adjustment for maternal age, maternal body mass index, maternal smoking, socioeconomic status (occupation, household income) and social support (cohabitation), the associations between pregnancy-related anxiety and labor induction as well as use of labor medication remained significant. CONCLUSIONS: Pregnancy-related anxiety should be regularly assessed and, if necessary, treated during (early) pregnancy to minimize risks for complications during delivery.

Preterm labour decision-making and experiences of care for women and clinicians (QUIDS Qualitative): A qualitative exploration.

BACKGROUND: Minimising the risks of mortality, morbidities, and the costs associated with preterm birth is reliant on accurate prediction, appropriate decision-making and timely intervention. This study aimed to determine for the first time the decisional and informational requirements of women and clinicians during preterm labour diagnosis and intervention. A secondary objective was to explore their experiences. STUDY DESIGN: A qualitative, interpretive approach was used in three tertiary referral units in England and Scotland. Women with experience of or risk factors for preterm birth and clinicians with experience of caring for women in preterm labour took part in semi-structured interviews individually face-face or via telephone, or in a small focus-group. Data was analysed using a framework approach. RESULTS: Women and clinicians welcomed a more accurate tool for predicting preterm birth. Women wanted to be actively involved in their care, but desired different levels of control over decisions. Communication between women and clinicians influenced women's overall experiences and shaped clinicians' practice. Women found accessing care difficult, due to uncertainty about symptoms and gatekeepers to face-face care. The emotional impact of their experiences influenced family plans and subsequent pregnancies. Women's overall perception of their experience was influenced by their judgement of the care they received. CONCLUSIONS: Decision-making is complex and a tool to more accurately predict preterm birth than is currently available was valued. Further research is warranted to evaluate a tool in clinical practice and to improve services for women with symptoms of preterm labour attempting to gain access to face-face care. Trial Registration ISRCTN: 41598423 and CPMS:31277.

[Impact of Uncertainty on the Anxiety of Hospitalized Pregnant Women Diagnosed with Preterm Labor: Focusing on Mediating Effect of Uncertainty Appraisal and Coping Style].

PURPOSE: This study aimed to test the mediating effect of uncertainty appraisal and coping style in the relation between uncertainty and anxiety in hospitalized pregnant women diagnosed with preterm labor. METHODS: The participants were 105 pregnant women diagnosed with preterm labor in hospitals in Korea. Data were collected from July to October 2017. The measurements included the Uncertainty in Illness Scale, Uncertainty Appraisal Scale, Coping Style Scale, and State Anxiety Inventory. Data were analyzed using descriptive statistics, an independent t-test, correlation, and multiple regression following the Baron and Kenny method and Sobel test for mediation. RESULTS: The mean score for anxiety was 2.29 out of 4.00 points and for uncertainty it was 2.46 out of 5.00 points. There were significant correlations among uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, problem-focused coping, emotion-focused coping, and anxiety. Uncertainty danger appraisal (ß=.64, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=4.54, p<.001). Uncertainty opportunity appraisal (ß=-.45, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=3.28, p<.001). Emotion-focused coping (ß=-.23, p=.021) had a partial mediating effect in the relation between uncertainty and anxiety (Z=2.02, p=.044). CONCLUSION: Nursing intervention programs focusing on managing uncertainty appraisal and improving emotion-focused coping are highly recommended to decrease anxiety in hospitalized pregnant women diagnosed with preterm labor.

Threatened preterm labour: Women's experiences of risk and care management: A qualitative study.

BACKGROUND: Preterm birth is a major cause of neonatal death and severe morbidity, so pregnant women experiencing symptoms of threatened preterm labour may be very anxious. The risk assessment and management that follows recognition of threatened preterm labour has the potential to either increase or decrease this anxiety. The aim of this study was to explore women's experience of threatened preterm labour, risk assessment and management in order to identify potential improvements in practice. DESIGN: One-to-one semi-structured interviews with 19 women who experienced assessment for threatened preterm labour took place between March 2015 and January 2017. A purposive sample approach was employed to ensure participants from different risk and demographic backgrounds were recruited at an inner city UK NHS hospital. Interviews were recorded and transcribed. Data was managed with NVivo software and analysed using the Framework Approach. A public and patient involvement panel contributed to the design, analysis and interpretation of the findings. FINDINGS: Data saturation was achieved after 19 interviews. 11 women were low risk and 8 were high risk for preterm birth. All high risk women had experience of being supported by a specialist preterm team. Four main themes emerged: (i) coping with uncertainty; (ii) dealing with conflicts; (iii) aspects of care and (iv) interactions with professionals. Both low and high risk women experiencing TPTL struggle to cope with the uncertainty of this unpredictable state. The healthcare management they receive can both help and hinder their ability to cope with this extremely stressful experience. High risk women were less likely to receive conflicting advice. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Clinicians should acknowledge uncertainty, minimize conflicting information and advice, and promote continuity of care models for all women, including those attending high risk clinics and in the ward environment.

Prevalência do transtorno de estresse pós-traumático em mães de recém-nascidos prematuros: atualização / Prevalence of post traumatic stress disorder in preterm infants's mothers: update

O Transtorno do Estresse Pós-Traumático (TEPT) é um agravo mental que pode ocorrer em resposta a eventos traumáticos na vida do indivíduo. Alguns estudos apontam que há relação do transtorno do estresse pós-traumático após o parto, quando este é considerado como parto de risco. O objetivo deste artigo é fornecer uma atualização da literatura sobre a prevalência do Transtorno de Estresse Pós-Traumático em mulheres que tiveram parto pré-termo. Para a identificação dos estudos, foram consultadas as bases de dados PubMed/Medline, Ibecs e Lilacs. Para os resultados da busca, a seleção inicial ocorreu pela leitura dos títulos encontrados, sendo descartados aqueles não tinham relação com o tema e período selecionados. O total de 18 estudos cumpriu com os critérios de inclusão deste artigo. A prevalência encontrada do Transtorno do Estresse Pós-Traumático após o parto foi entre 1,3% e 12,5%, e de 28% nos grupos de risco, como as mães de prematuros. O presente artigo de atualização aponta que há possível correlação entre o Transtorno do Estresse Pós-Traumático e o nascimento prematuro.(AU)

The Post-traumatic stress disorder (PTSD) is a mental illness that can occur in response to traumatic events in an individual's life. Some studies indicate that there is a relationship between PTSD after childbirth, when it is considered as risk childbirth. The aim of this article is to provide an update of the literature about the prevalence of Post Traumatic Stress Disorder and Prematurity. To identify the studies, the PubMed / Medline, Ibecs and Lilacs databases were consulted. For the search results, the initial selection occurred by reading the titles found, being discarded those that had no relation with the theme and period selected. In the total 18 studies met the inclusion criteria of this article. The prevalence of posttraumatic stress disorder after childbirth was between 1,3 and 12.5%, and 28% in the risk groups, such as mothers of premature infants. The present update article points out that there is a possible correlation between posttraumatic stress disorder and premature birth.(AU)

Antenatal depression among women hospitalized due to threatened preterm labor in a high-risk pregnancy unit in Greece.

PURPOSE: Estimates for the prevalence of antenatal depression vary widely across different studies and especially concerning high-risk pregnancies. Threatened preterm labor is the most common indication for antenatal obstetric hospitalization. The aim of this study was to screen for depressive symptoms among pregnant women hospitalized in a high-risk pregnancy unit due to threatened preterm labor and also to investigate possible associated risk factors. MATERIALS AND METHODS: A total of 103 pregnant women admitted at >24 and <36 gestational weeks were eligible to participate in the study. The Greek version of the Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms on admission. A cutoff score of >13 was considered as indicative of depression. Possible associated risk factors were also investigated. RESULTS: The prevalence of antenatal depression (score >13) was 24.3% (n = 25). In the multivariate analysis, antenatal depression was significantly correlated with thoughts of abortion (OR: 6.208; 95% CI: 1.141-33.765). CONCLUSIONS: About one quarter of the pregnant women hospitalized in the HRPU due to threatened preterm labor were depressed based on the EPDS. Thoughts of abortion were associated with a sixfold increase in the risk of depression, while no associations were found between antenatal depression and other sociodemographic and obstetric parameters.

Antenatal consultations for preterm labour: how are future mothers reassured?

OBJECTIVE: To evaluate whether the antenatal consultation for preterm labour worries or reassures women, and to identify factors contributing to these feelings. DESIGN: This is a prospective survey study from April 2012 to September 2013. This mixed-methodology tool was co-constructed with patients and first tested in a single-centre pilot study. SETTING: Three university-affiliated, tertiary care, high-risk obstetrics inpatient units in Quebec, Canada. PARTICIPANTS: Women hospitalised with threatened preterm labour between 26 and 32 weeks' gestational age completed the survey within 72 hours of an antenatal consultation by neonatology. 341 women were invited to participate and 226 mothers completed the survey (72% response rate), at a median gestational age of 30 weeks. MAIN OUTCOME MEASURES: Participant worry, reassurance and change in perception after the antenatal consultation were the main outcome measures. Multivariable logistic regression was used to identify factors associated with these outcomes. RESULTS: 23% of participants were worried by the consultation, and 87% were reassured by it. Lower gestational age and higher maternal education were associated with feeling worried (adjusted OR=0.83, 95% CI 0.70 to 0.99; and adjusted OR=2.15, 95% CI 1.04 to 4.44, respectively). Longer consultations were associated with reassurance (adjusted OR=8.21, 95% CI 2.67 to 25.26). Women were reassured by (1) feeling well informed about prematurity with optimistic outlooks, and (2) a trusting and reassuring expert neonatology team. High-quality interactions with neonatologists were associated with reassurance, while poorer communications were associated with feelings of worry. CONCLUSIONS: To be reassuring, neonatologists should strive to establish a trusting relationship with mothers, in which realistic and clear, but optimistic, information is offered.

Efficacy of an internet-based cognitive behavioral stress management training in women with idiopathic preterm labor: A randomized controlled intervention study.

OBJECTIVE: This randomized controlled trial aimed at evaluating the efficacy of an internet-based cognitive behavioral stress management program (IB-CBSM) for pregnant women with preterm labor (PTL) on birth outcome and stress-related psychological and biological parameters. METHODS: 93 pregnant women with PTL (gestational age 18-32) were assigned to either the IB-CBSM (n=50) or a control group (CG) based on distraction (n=43). Participants in both groups worked through six weekly modules. Birth outcome measures included gestational age, neonatal weight and length at birth and the rate of preterm birth (PTB). Questionnaires assessed psychological wellbeing and the activity of the HPA-axis was measured with the cortisol awakening reaction (CAR), both before (T1) and after the intervention (T2). RESULTS: Birth outcome and psychological wellbeing did not differ between IB-CBSM and CG. However, psychological wellbeing was higher after both interventions (PSS: ηp2=0.455, STAIX1: ηp2=0.455, STAIX2: ηp2=0.936, PRAT: ηp2=0.465, EPDS: ηp2=0.856). Cortisol levels were stable and did not alter differently between groups from T1 to T2. Higher cortisol levels were associated with lower gestational age at birth, whereas no significant correlations were found between weight and length at birth. CONCLUSIONS: Although there were no significant differences between the two groups and birth outcome, psychological and biological parameters, both interventions (CBSM and CG) showed equivalent effects and proved to be beneficial with regard to psychosocial distress and well-being. Further research is needed to investigate CBSM and distraction interventions for pregnant women at risk for PTB together with a non-intervention control condition.

Parto prematuro y asociación con percepción materna de apoyo social insuficiente / Preterm birth and association with maternal perception of insufficient social support

En Puerto Montt (Chile) el parto prematuro presentó una frecuencia de 8,6% el 2014. Se diseñó estudio para evaluar el apoyo social en embarazadas y su asociación con prevalencia de parto prematuro. MATERIAL Y MÉTODO: Estudio casos controles. Medición con escala MOS de apoyo social validada. Muestra de 355 mujeres. Análisis estratificado según variables de control y modelación de datos con regresión logística multivariada RESULTADOS: No hubo diferencia en la media del puntaje MOS entre mujeres con parto prematuro y las con parto a término (p=0,4243). Se definió apoyo social insuficiente (ASI) un puntaje menor o igual a 84. 57,2% de los casos y 49,6% de los controles tuvo ASI respectivamente. Hubo asociación entre prematuridad, educación superior e ingreso familiar sobre $1.000.000 de pesos chilenos (p<0,05). Las variables de salud materno fetal presentaron asociación con prematuridad y ASI (ORa 1,73; IC95% 0,98 - 3,06). El modelo con prematuridad y dimensión interacción social positiva de la escala MOS, mostró fuerte asociación (ORa 2,51: IC95% 1,30 - 4,89). CONCLUSIONES: Encontramos diferencia no significativa en media puntaje MOS. La interacción social positiva es la dimensión de la encuesta MOS que se asoció a prematuridad. Debe validarse escala MOS en embarazo o crear nueva escala de medición. La asociación entre con educación superior e ingreso familiar mayor a $1.000.000 CPL perfila un segmento de riesgo social distinto. La pesquisa de percepción de ASI puede ser útil para planificar intervenciones en el ámbito psicosocial, especialmente en la hospitalizada con patología de alto riesgo obstétrico.

In Puerto Montt (Chile), preterm birth presented a frequency of 8.6% in 2014. A study was designed to evaluate social support in pregnant women and its association with preterm birth prevalence. MATERIAL AND METHODS: Case - control study. Measurement with MOS scale of validated social support. Sample of 355 women. Stratified analysis according to variables of control and data modeling with multivariate logistic regression RESULTS: There was no difference in mean MOS score between women with preterm birth and those with term delivery (p = 0.4243). Insufficient social support (ASI) was defined as a score of less than or equal to 84. 57.2% of the cases and 49.6% of the controls had ASI respectively. There was an association between prematurity, higher education and family income over $ 1,000,000 of Chilean pesos (p <0.05). Maternal fetal health variables had an association with prematurity and ASI (OR 1.73, 95% CI 0.98 - 3.06). The model with prematurity and positive social interaction dimension of the MOS scale showed strong association (ORa 2.51: 95% CI 1.30-4.89). CONCLUSIONS: We found no significant difference in mean MOS score. Positive social interaction is the dimension of the MOS survey that was associated with prematurity. The MOS scale should be validated during pregnancy or a new measurement scale should be created especially for it. The association between higher education and family income over $ 1,000,000 CPL profiles a distinct social risk segment. The ASI perception survey may be useful for planning interventions in the psychosocial field, especially in the hospitalized with high obstetric risk.

[Multiple Factors in the Second Trimester of Pregnancy on Preterm Labor Symptoms and Preterm Birth].

PURPOSE: The aim of this study was to determine the influence of various factors on preterm labor symptoms (PLS) and preterm birth (PB). METHODS: This prospective cohort study included 193 women in the second stage of pregnancy. Multiple characteristics including body mass index (BMI), smoking, and pregnancy complications were collected through a self-report questionnaire. Pregnancy stress and PLS were each measured with a related scale. Cervical length and birth outcome were evaluated from medical charts. Multiple regression was used to predict PLS and logistic regression was used to predict PB. RESULTS: Multiple regression showed smoking experience, pregnancy complications and pregnancy specific stress were predictors of PLS and accounted for 19.2% of the total variation. Logistic regression showed predictors of PB to be twins (OR=13.68, CI=3.72~50.33, p<.001), shorter cervix (<25mm) (OR=5.63, CI=1.29~24.54, p<.05), BMI >25 (kg/m²) (OR=3.50, CI=1.35~9.04, p<.01) and a previous PB (OR=4.15, CI=1.07~16.03, p<.05). CONCLUSION: The results of this study show that the multiple factors affect stage II pregnant women can result in PLS or PB. And preterm labor may predict PB. These findings highlight differences in predicting variables for pretrm labor and for PB. Future research is needed to develop a screening tool to predict the risk of preterm birth in pregnant women.

The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China.

BACKGROUND: Threatened premature labor (TPL) is a severe obstetric complication which affects the mental and physical health of both the mother and fetus. Family resilience may have protective role against psychological distress in women experiencing these pregnancy complications. There may be resilience related risk factors in TPL women, and interplays may exist among psychological variables and within couples. This study aims to examine psychological outcomes influenced by different levels of resilience, and explore psychological interactions in TPL women, spouses, and between women and spouses. METHODS: Six validated questionnaires were used to measure the psychological outcomes (Connor-Davidson resilience scale CD-RISC, Edinburgh postnatal depression scale EPDS, positive and negative affect scale PANAS, pregnancy pressure scale PPS, simplified coping style questionnaire SCSQ, social support rating scale SSRS) in 126 TPL women hospitalized in three tertiary hospitals and 104 spouses in Southwest China. RESULTS: Low resilient women had significantly more complicated placenta praevia, longer pediatric observation, more pressure than high resilient women. They also had significantly less active coping and positive affect, more negative affect and depression compared to high resilient women and their spouses. Although the socio-demographic characteristics of both TPL women and spouses and psychometric parameters of spouses had no significant differences, the prevalence rates of depression in spouses were notable. Compared with spouses, TPL women had a more complex interaction among these psychometric factors, with women's resilience negatively associated with their partners' negative affect, and their pressure positively correlated with pressure and negative affect of spouses. CONCLUSIONS: Pregnancy complicated with placenta praevia and pediatric observation may be risk factors for resilience of women with TPL. Maternal resilience has an important impact on the psychological outcomes in TPL women. A screening for resilience, depression and other psychological outcomes in couples with TPL and early psychological intervention of low resilient couples may be appropriate to promote resilience and well-being of these families.

Focusing on relationships, not information, respects autonomy during antenatal consultations.

Policy statements regarding antenatal consultations for preterm labour are guided by physicians' concerns for upholding the legal doctrine of informed consent, through the provision of standardised homogeneous medical information. This approach, led by classical in-control conceptions of patient autonomy, conceives moral agents as rational, independent, self-sufficient decision-makers. Recent studies on these antenatal consultations have explored patients' perspectives, and these differ from guidelines' suggestions. Relational autonomy - which understands moral agents as rational, emotional, creative and interdependent - resonates impressively with these new data. CONCLUSION: A model for antenatal consultations is proposed. This approach encourages clinicians to explore individual patients' lived experiences and engage in trusting empowering relationships. Moreover, it calls on physicians to enhance patients' relational autonomy by becoming advocates for their patients within healthcare institutions and professional organisations, while calling for broadscale policy changes to encourage further funding and support in investigations of the patient's voice.

Stress experienced by women after premature labor is conditioned by their personality.

OBJECTIVES: The aim of the study was to analyze a possible correlation between personality traits and the level of stress experienced by women after premature labor. MATERIAL AND METHODS: The analysis was carried out on the basis of a study conducted in 96 women after premature labor. The following tools were used: Personality Inventory NEO-FFI, Parental Stressor Scale: NICU (SSR:OITN), and personal data questionnaire. It was an exploratory study since the SSR:OITN method is only applied to find out the characteristic features of stress induced by prematurity, and, therefore, it cannot be applied to study the control sample (i.e. women who delivered at term). RESULTS: The obtained results revealed significant correlations between the level and structure of stress connected with premature labor and personality traits. The general level of stress and all its components (infant's clinical characteristics and medical procedures, personal and interpersonal problems as well as parental competence) correlated positively with Neuroticism. Negative correlations between the general level of stress together with its parental competence factor and Extraversion and Openness to experience were found. Agreeableness correlated negatively with parental competence stress. No correlation between the level of stress and Conscientiousness was observed. CONCLUSIONS: Our findings shed new light on how women after premature labor experience stress, and suggested an ef-fective medical-psychological-therapeutic support aiming at reducing the level of trauma. The SSR:OITN Scale is proposed as one of the basic methods used to diagnose difficulties experienced by the investigated women.

Neonatal Outcomes in Women With Untreated Antenatal Depression Compared With Women Without Depression: A Systematic Review and Meta-analysis.

IMPORTANCE: Despite the prevalence of antenatal depression and the fact that only one-third of pregnant women with depression consider it acceptable to take antidepressants, the effect of untreated depression on neonatal outcomes remains to be addressed thoroughly. OBJECTIVE: To undertake a systematic review and meta-analysis to understand the effect of untreated depression on neonatal outcomes. DATA SOURCES: We executed our search strategy, with emphasis on its exhaustiveness, in MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, and Web of Science. The search was conducted in July, 2015. STUDY SELECTION: We included randomized and nonrandomized studies that examined neonatal outcomes in women with depression receiving neither pharmacological nor nonpharmacological treatment compared with women without depression. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles and abstracts, assessed full-text articles, extracted data, and assessed their quality using a modified version of the Newcastle-Ottawa Scale. We pooled data using random-effects meta-analyses, quantified heterogeneity using the I2 statistic, and explored it with subgroup analyses by type of assessment of depression, severity, reported conflicts of interest, and study quality. MAIN OUTCOMES AND MEASURES: Primary outcomes were preterm birth before 37 weeks and before 32 weeks, small and large for gestational age, low birth weight, and neonatal intensive care unit admission. RESULTS: Of the 6646 titles initially identified, 23 studies met inclusion criteria, all observational, with a total of 25 663 women. Untreated depression was associated with significantly increased risks of preterm birth (odds ratio [OR], 1.56; 95% CI, 1.25-1.94; 14 studies; I2, 39%) and low birth weight (OR, 1.96; 95% CI, 1.24-3.10; 8 studies; I2, 48%), with a trend toward higher risks for exposure to more severe depression. While the odds of preterm birth more than doubled in studies reporting conflicts of interest (OR, 2.50; 95% CI, 1.70-3.67; 5 studies; I2, 0%), studies not reporting such conflicts showed more moderate results (OR, 1.34; 95% CI, 1.08-1.66; 9 studies; I2, 30%). CONCLUSIONS AND RELEVANCE: Our results contrast with what is, to our knowledge, the only previous systematic review that examined the question of untreated depression because we found significant risks of 2 key perinatal outcomes, preterm birth and low birth weight. These are important results for pregnant women and clinicians to take into account in the decision-making process around depression treatment.