Risk psychosocial factors associated with postpartum depression trajectories from birth to six months.

PURPOSE: The purpose of this study was to assess the trajectory of women's depressive symptoms during the first six months postpartum, identify risk factors (sociodemographic, obstetric and personality) associated with classes, and examine associations between classes and postpartum PTSD at two months and bonding at six months. METHODS: The final sample included 212 women who gave birth in the maternity wards of a large tertiary health center that were approached at 1-3 days, two months, and six months postpartum and completed a demographic questionnaire and measures of neuroticism (BFI) and postpartum depression (EPDS), postpartum PTSD (City Birth Trauma Scale) and bonding (PBQ). Obstetric data were taken from the medical files. RESULTS: Cluster analysis revealed three distinctive clusters: "stable-low" (64.2%), "transient-decreasing" (25.9%), and "stable-high" (9.9%). Neuroticism, general-related PTSD symptoms, and bonding were associated with differences between all trajectories. Birth-related PTSD symptoms were associated with differences between both stable-high and transient-decreasing trajectories and the stable-low trajectory. No obstetric or demographic variables were associated with differences between trajectories. CONCLUSION: We suggest that screening women for vulnerabilities such as high levels of neuroticism and offering treatment can alleviate the possible deleterious effects of high-symptom depression trajectories that may be associated with their vulnerability.

Gestational diabetes is driven by microbiota-induced inflammation months before diagnosis.

OBJECTIVE: Gestational diabetes mellitus (GDM) is a condition in which women without diabetes are diagnosed with glucose intolerance during pregnancy, typically in the second or third trimester. Early diagnosis, along with a better understanding of its pathophysiology during the first trimester of pregnancy, may be effective in reducing incidence and associated short-term and long-term morbidities. DESIGN: We comprehensively profiled the gut microbiome, metabolome, inflammatory cytokines, nutrition and clinical records of 394 women during the first trimester of pregnancy, before GDM diagnosis. We then built a model that can predict GDM onset weeks before it is typically diagnosed. Further, we demonstrated the role of the microbiome in disease using faecal microbiota transplant (FMT) of first trimester samples from pregnant women across three unique cohorts. RESULTS: We found elevated levels of proinflammatory cytokines in women who later developed GDM, decreased faecal short-chain fatty acids and altered microbiome. We next confirmed that differences in GDM-associated microbial composition during the first trimester drove inflammation and insulin resistance more than 10 weeks prior to GDM diagnosis using FMT experiments. Following these observations, we used a machine learning approach to predict GDM based on first trimester clinical, microbial and inflammatory markers with high accuracy. CONCLUSION: GDM onset can be identified in the first trimester of pregnancy, earlier than currently accepted. Furthermore, the gut microbiome appears to play a role in inflammation-induced GDM pathogenesis, with interleukin-6 as a potential contributor to pathogenesis. Potential GDM markers, including microbiota, can serve as targets for early diagnostics and therapeutic intervention leading to prevention.

Comparing spatial management tools to protect highly migratory shark species in the Eastern Mediterranean Sea hot spots.

Bycatch of non-target species is a pressing problem for ocean management. It is one of the most concerning issues related to human-wildlife interactions and it affects numerous species including sharks, seabirds, sea turtles, and many critically endangered marine mammals. This paper compares different policy tools for ocean closure management around a unique shark aggregation site in Israel's nearshore coastal waters. We provide a set of recommendations based on an optimal management approach that allows humans to enjoy marine recreational activities such as fishing, while maintaining safe conditions for these apex predators which are vital to the local marine ecosystem. To learn more about recreational fishers' derived benefits, we use a benefit transfer method. Our main conclusion is that dynamic time-area closures offer sustainable and effective management strategies. Since these closures are based on near real-time data, they might successfully preserve specific species in limited areas (i.e., small areas).

Hebrew validation of the postpartum bonding questionnaire: a study of mothers and fathers.

OBJECTIVE: The Postpartum Bonding Questionnaire (PBQ) is a self-report questionnaire designed to screen disorders of the mother-infant relationship. The PBQ was adapted to several countries, though there is no agreement on the accepted number of items and factors. This study aimed to assess the validity and reliability of the Hebrew version for both mothers and fathers. METHODS: Participants (602 mothers and 144 fathers) from two separate samples were randomly recruited in the maternity ward of a large tertiary health centre. The mothers' samples were combined and redivided to form subsamples A and B. At T1 (1-4 days postpartum), the participants completed demographic questionnaire in person the PBQ and the Edinburgh Postpartum Depression Scale (EPDS) were administered online at T2 (8-12 weeks postpartum). The PBQ was also administrated at T3 (six-months). RESULTS: EFA on subsample A resulted in a two-factor structure, which was tested using CFA on subsample B. The model's fit was very good; χ(35)2 = 83.68, p < .001, CFI = .97, TLI = .91, RMSEA = .07, SRMR = .03. Additional reliability and validity analyses showed a very good fit for mothers. Scalar measurement invariance across mothers and fathers yielded satisfactory results. CFA among fathers, revealed adequate goodness of fit; χ2/df = 87.65/46, p < .001, CFI = .95, TLI = .89, RMSEA = .08, SRMR = .05. CONCLUSIONS: The Hebrew version of the PBQ demonstrated satisfactory validity for both mothers and fathers. The revised version, with 14 items, measures bonding as a continuum rather than measuring bonding disorders like the original version. These findings emphasise the importance of validating the scale in different cultural contexts.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD.

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1-4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8-10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

Acute Adnexal Torsion: Is Immediate Surgical Intervention Associated with a Better Outcome?

OBJECTIVES: We aimed to investigate whether surgery for adnexal detorsion within 6 h from admission to the hospital was associated with less adnexal ischemia. DESIGN: This is a retrospective cohort study. PARTICIPANTS/MATERIALS, SETTING, AND METHODS: This retrospective study was conducted at two university-affiliated medical centers and assessed women aged 18-45 years with adnexal torsion who were hospitalized within 12 h from the pain onset and underwent surgery for detorsion within 24 h. The study group was divided into 2 groups: early, surgical intervention within less than 6 h and late, surgical intervention between 6 and 24 h. The primary outcome was the rate of macroscopic appearance of ischemic adnexa. RESULTS: Two hundred and twenty women fulfilled the inclusion criteria. In 101 women, the adnexa with the torsion appeared macroscopically ischemic. There was no difference in ischemic adnexa between the early and late intervention groups (48% vs. 40%; p = 0.269). No significant association was found between the physical examination or ultrasonographic findings and the rate of ischemic adnexa within each group. LIMITATIONS: The main limitations of our study are its retrospective nature. Much of the clinical and ultrasonographic data are subjective and operator-dependent. The decision to operate may vary from one surgeon to another. CONCLUSION: Immediate surgical intervention in patients with adnexal torsion is not associated with a lower rate of adnexal ischemia. These findings suggest that in acute adnexal torsion, there is a wider time window for a thorough evaluation before surgery.

The effect of stillbirth and late termination of pregnancy on the emergence of post-traumatic symptoms among attending medical personnel.

The purpose of this paper was to assess the impact and the post-traumatic potential of late termination of pregnancy (TOP) and stillbirth on medical staff and characterise personal attributes that modulate these possible outcomes. Fifty-one participants involved in the treatment of women undergoing late TOPs and stillbirths answered questionnaires including demographics, Neuroticism subscale of the Big Five Inventory (BFI), Life Orientation Test-Revised (LOT-R), Posttraumatic Diagnostic Scale (PDS), Brief Symptom Inventory (BSI-18) and questions regarding exposure to stillbirths and late TOPs. None of the participants met the full post-traumatic stress disorder (PTSD) criteria. A correlation with a marginal significance was found between the number of TOP's/stillbirths attended during the past year and traumatic symptoms. Neuroticism moderated the association between presence in TOP's/stillbirths and post-traumatic symptoms among those who attended this event over the past month. According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP's/stillbirths. Impact StatementWhat is already known on this subject? There is a very little research on the ways in which medical personnel respond to Stillbirths, late miscarriages and terminations of pregnancy (TOP) of their patients and on the possible effect of their personality traits in this response.What do the results of this study add? According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP's/stillbirths.What are the implications of these findings for clinical practice and/or further research? Further studies are warranted to better assess the impact of exposure to traumatic events in general and on the effect of late TOP and stillbirths in particular, on medical personnel and to identify interventions that may prevent posttraumatic symptoms among staff members when they happen.

COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum.

BACKGROUND: The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase. METHODS: Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4. RESULTS: Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12). DISCUSSION: The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.

The associations between insecure attachment, rooming-in, and postpartum depression: A 2 months' longitudinal study.

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming-in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming-in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1-4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming-in conditions. In addition, women in partial rooming-in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming-in women. A situational factor such as full rooming-in, which occurs at a critical time point for the mother-infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming-in, can be personalized and thus beneficial in moderating personal risk factors for PPD.

La depresión posterior al parto (PPD) es la complicación más común de dar a luz y estudios recientes han intentado examinar los factores de riesgo asociados con el parto. La hipótesis del principal estudio fue que un factor situacional de protección en un período temporal sensible (permitirle a la madre mantener a su bebé con ella en el mismo cuarto después del parto) moderaría las asociaciones entre las dimensiones de afectividad insegura y PPD. Trescientas doce mujeres, en situación completa o parcial de tener a su bebé en el mismo cuarto, participaron en un estudio longitudinal en la sala de partos de un centro terciario de cuidado de salud. Del primer al cuarto día después del parto, se administró un cuestionario demográfico y la Escala de Experiencias en Relaciones Cercanas; la Escala de Edimburgo de Depresión Postnatal se administró a los dos meses posteriores al parto. Significativamente se asoció la PPD tanto con las dimensiones de afectividad de tipo ansiosas como las evasivas, pero no con las condiciones de compartir el mismo cuarto. Adicionalmente, las mujeres en situaciones parciales de compartir el mismo cuarto mostraron una correlación positiva entre las dimensiones de afectividad insegura y PPD, mientras que tal correlación no se encontró en el caso de las mujeres en situaciones de compartir el cuarto completamente. Un factor situacional tal como el compartir el cuarto completamente, lo cual ocurre en un punto temporal crítico para la relación madre-infante, puede moderar la asociación entre las dimensiones de afectividad maternas evasivas o ansiosas y los niveles de PPD de la madre. Las prácticas del período posterior al parto, tales como el compartir el cuarto, pueden ser personalizadas y por tanto beneficiosas en cuanto a moderar los factores personales de riesgo de PPD.

La dépression postpartum (DPP) est la complication la plus commune de la maternité et les études récentes ont essayé d'examiner les facteurs de risque qui y sont liés. L'hypothèse principale de cette étude était qu'un facteur protecteur situationnel à une période sensible (rooming-in total postpartum) modérerait les liens entre les dimensions d'attachement insécure et la DPP. Trois cent douze femmes, soit en rooming-in partiel ou total, ont participé à une étude longitudinale à la maternité d'un centre de santé tertiaire. Un questionnaire démographique et l'Echelle d'Expériences dans les Relations Proches ont été donnés à 1-4 jours postpartum, l'Echelle de Dépression Postnatale d'Edinbourg à deux mois postpartum. La DPP a été liée de manière importante à des dimensions d'attachement à la fois anxieux et évitant, mais pas avec les conditions de rooming-in. De plus, les femmes en rooming-in partiel ont fait preuve d'une corrélation positive entre les dimensions de l'attachement insécure et la DPP, alors qu'aucune corrélation n'a été trouvée pour les femmes du groupe rooming-in. Un facteur situationnel telle que le rooming-in total, qui se passe à un moment critique pour la relation mère-bébé, peut modérer le lien entre les dimensions d'attachement évitant maternel et de l'attachement anxieux et les niveaux de DPP de la mère. Les pratiques postpartum, tel que le rooming-in, peuvent être personnalisées et donc s'avérer être un bénéfice pour la modération de facteurs de risque personnel pour la DPP.

Women's preferences for mode of second birth-A prospective study of two Israeli birth cohorts.

INTRODUCTION: Various biopsychosocial factors affect women's preferences with respect to mode of birth, but they are usually not examined simultaneously and prospectively. In the current study, we assessed the contribution of personal characteristics of first-time mothers, their prior prenatal perceptions, events during birth, and subjective birth experiences, on their preference about mode of second birth. METHODS: This was a secondary analysis of two prospective birth cohort studies. Participants included 832 primiparous women recruited mostly from women's health centers in Israel, and through natural birth communities and cesarean birth websites. Women completed questionnaires prenatally and were followed up at 6-8 weeks postpartum to understand their preferences for a second birth. RESULTS: Regression models indicated that after vaginal first birth, being less religious, believing that birth is a medical process, and having a negative experience increased the odds of preferring primary cesarean for the second birth. After cesarean birth, being more religious, having higher education, conceiving spontaneously, having a more negative birth experience, and perceiving better treatment from the staff during birth contributed to preferring vaginal birth for the second birth. CONCLUSIONS: Religiosity is central to women's preferences, probably because of its association with the desire to have many children. Modifiable factors, such as women's beliefs about the nature of birth, their overall birth experience, and their perceived treatment from the staff, could influence the uptake of having vaginal births. Intrapartum care that is empathic and encouraging, along with education about modes of birth, could help decrease cesarean birth rates.

Risk factors and maternal outcomes following preterm premature rupture of membrane in the second trimester of gestation.

PURPOSE: To characterize the population of women who underwent mid-trimester preterm premature rupture of membrane (PPROM) in a country where mid-trimester abortions are legal and available. METHODS: A retrospective cross-sectional cohort study was conducted at a tertiary referral hospital, during 2013-2016. Mid-trimester defined as gestational age 13 + 0 to 23 + 6 weeks. Rupture of membrane was defined by documentation of fluid passing through the cervix on sterile speculum examination, and a positive Nitrazine (Bristol-Myers Squibb, Princeton, NJ) or erning test. All records were evaluated for medical history, laboratory data, postnatal examination, and autopsy findings, and a database was constructed. RESULTS: A total of 61 women were hospitalized for mid-trimester PPROM during the study period. Mean maternal age was 32 ± 5.98, range 20-45 years old. The majority (50, 82%) of patients decided to terminate their pregnancy before reaching the limit of viability at 24 weeks gestation. The overall prognosis of pregnancies reaching term was better than expected, with six (9.8%) patients delivering live babies and four of them born at term (36 ± 5 to 40 ± 6 weeks gestation), all after PPROM following amniocentesis or selective fetal reduction. A total of 60% of women with hypothyroidism had unbalanced TSH levels above 4.0 mIU/L prior to their pregnancy. A notable number of women (15, 24.6%) had PPROM following a pregnancy achieved by assisted reproductive technology (ART). CONCLUSIONS: Most women with diagnosed mid-trimester PPROM opted for pregnancy termination before the limit of viability when granted the choice. Possible risk factors for early PPROM are unbalanced hypothyroidism and ART. PPROM following amniocentesis can in some cases reseal and reach term, suggesting conservative treatment is a reasonable management for those cases.

Testing a biopsychosocial model of the basic birth beliefs.

BACKGROUND: Women perceive what birth is even before they are pregnant for the first time. Part of this conceptualization is the basic belief about birth as a medical and natural process. These two separate beliefs are pivotal in the decision-making process about labor and birth. Adapting Engel's biopsychosocial framework, we explored the importance of a wide range of factors which may contribute to these beliefs among first-time mothers. METHOD: This observational study included 413 primiparae ≥24 weeks' gestation, recruited in medical centers and in natural birth communities in Israel. The women completed a questionnaire which included the Birth Beliefs Scale and a variety of biopsychosocial characteristics such as obstetric history, birth environment, optimism, health-related anxiety, and maternal expectations. RESULTS: Psychological dispositions were more related to the birth beliefs than the social or biomedical factors. Sociodemographic characteristics and birth environment were only marginally related to the birth beliefs. The basic belief that birth is a natural process was positively related to optimism and to conceiving spontaneously. Beliefs that birth is a medical process were related to pessimism, health-related anxiety, and to expectations that an infant's behavior reflects mothering. Expectations about motherhood as being naturally fulfilling were positively related to both beliefs. CONCLUSION: Psychological factors seem to be most influential in the conceptualization of the beliefs. It is important to recognize how women interpret the messages they receive about birth which, together with their obstetric experience, shape their beliefs. Future studies are recommended to understand the evolution of these beliefs, especially within diverse cultures.

Mode of delivery, childbirth experience and postpartum sexuality.

PURPOSE: Although childbirth has been studied extensively with regard to postpartum sexuality, the association between the psychological aspects of childbirth and postpartum sexuality has rarely been examined. This research is aimed at studying the possible association of mode of delivery, childbirth experience, sexual functioning, and sexual satisfaction. METHODS: Three hundred seventy-six primiparous and nulliparous women completed this web-based survey 100-390 days postpartum. The participants completed a socio-demographic and delivery details questionnaire, the Childbirth Perception Questionnaire (CPQ), the Index of Sexual Satisfaction (ISS) and the Sexual Function Questionnaire's Medical Impact Scale (SFQ-MIS). RESULTS: Structural equation modeling showed that there are indirect effects of mode of delivery on sexual functioning and sexual satisfaction through childbirth experience. Specific significant indirect paths were found: mode of delivery to sexual functioning through childbirth experience [B = - 0.26, p = 0.023, 95% CI = (- 0.40, - 0.10)] and from mode of delivery to sexual satisfaction through childbirth experience [B = 0.11, p = 0.013, 95% CI = (0.05, 0.21)]. No significant direct effects were found between mode of delivery and sexual functioning or sexual satisfaction. CONCLUSIONS: The results point to the association of the psychological experience of childbirth, sexual functioning and sexual satisfaction. In addition, we found a possible indirect link between mode of delivery and postpartum sexuality. It can be concluded that the psychological factors associated with childbirth are important to the understanding of postpartum sexuality.

Simple Hysterectomy for Residual Cervical Intraepithelial Neoplasm.

OBJECTIVE: Many patients undergo hysterectomy for the treatment of cervical dysplasia. Factors that correlate with residual high-grade squamous intraepithelial lesions (HGSIL) at hysterectomy are not clear. We set out to determine preoperative features that may predict residual disease for patients treated for cervical dysplasia. MATERIALS AND METHODS: A retrospective database was reviewed for women who underwent simple hysterectomy for HGSIL between 1990 and 2013. Clinical data included age, history of dysplasia, initial treatment, follow-up colposcopy, indications for surgery, time elapsed between initial treatments, and pathology findings after hysterectomy. Significant residual disease was defined as HGSIL or cervical carcinoma. Statistical analyses were performed with the SPSS, independent Student t test, and Pearson χ test. Significance was set at p < .05. RESULTS: Eighty-three women met the study criteria. The indication for hysterectomy was residual histological finding at conization pathology in 30 women and patients' request in 53 women. Residual disease was found in 42 hysterectomy specimens: in 16 of 30 with residual histological finding and in 26 of the 53 patients' request. Reason for the hysterectomy was not statistically significant for residual disease (p = .708). Median age of patients with residual disease was 46.5 years versus 44.1 years for those without residua (p = .02). Postmenopausal patients had a higher rate of residual disease, 12 (32.4%) of the 28 premenopausal patients and 25 (67.6%) of the 54 postmenopausal patients (p = .04). Conization margin status was not associated with residual disease (p = .878). CONCLUSIONS: Older women and those in menopause are at significantly higher risk of residual disease at hysterectomy.

Diagnosis of deep pelvic masses on a gynaecology service: Trans-vaginal ultrasound-guided needle aspiration of pelvic solid and cystic lesions.

OBJECTIVES: Women with undiagnosed pelvic lesions are often referred for evaluation and treatment. Transvaginal ultrasound-guided fine needle aspiration (TVUS-FNA) biopsy can assist in making management decisions. We describe our experience with this modality. METHODS: We performed a retrospective chart review of all women who had a TVUS-FNA biopsy between January 2004 and December 2014. Charts were reviewed for clinicopathologic information. The pathologic results of the TVUS-FNA were compared with the final diagnosis. RESULTS: Fifty-nine women underwent TVUS-FNA; the median age was 66 years (range 27-85). Thirty-three lesions were evaluated by fine-needle aspiration biopsy of the solid structure and 26 by aspiration of fluid for cytology. Pathologic feasibility rate was 88% (52/59). Of those with evaluable tissue, the sensitivity of the procedure was 100% and the specificity 92%. Considering the seven inconclusive results, the procedure had sensitivity of 88% (29/33) and specificity of 88% (23/26). Overall accuracy of TVUS-FNA for this patient cohort was 85%. No patient characteristics were found to distinguish between accurate and inaccurate or inconclusive TVUS-FNA result. No complications were noted. CONCLUSIONS: TVUS-FNA offers an excellent modality for the diagnosis and management of deep pelvic lesions otherwise not amenable for histologic evaluation.

Structured hands-on workshop decreases the over-detection rate of obstetrical anal sphincter injuries.

PURPOSE: The purpose of this study was to assess the effect of a structured hands-on workshop on the detection rate of obstetric anal sphincter injuries. METHODS: All physicians attending the delivery ward in our institution participated in a structured obstetric anal sphincter injury hands-on workshop developed by Dr. Ranee Thakar and Dr. Abdul Sultan which demonstrated proper identification and techniques for obstetric anal sphincter injury detection and repair. We retrospectively reviewed the electronic records of all singleton-pregnancy women who delivered vaginally (vertex presentation) during the 2 years prior to and 1 year following the workshop to assess the workshop's effect on the rate of detection of obstetric anal sphincter injuries. RESULTS: Overall, 20,484 women met the inclusion criteria during the study period and were eligible for final analysis. There were no significant differences in patient's characteristics between the groups. Women in the pre-workshop group had a higher rate of obstetric anal sphincter injuries than the post-workshop group (0.4 vs. 0.2 %, p = 0.005). On multivariate analysis, factors independently associated with a decreased risk for obstetric anal sphincter injuries were deliveries in the post-workshop period (odds ratio 0.43, 95 % confidence interval 0.24-0.79, p = 0.006), parity (odds ratio 0.37, 95 % confidence interval 0.25-0.54, p < 0.001), and spontaneous vaginal delivery (odds ratio 0.43, 95 % confidence interval 0.26-0.71, p = 0.001). CONCLUSIONS: A proper detection of obstetric anal sphincter injuries may depend on the experience of the assessor. A structured hands-on workshop is important to avoid over diagnosis third-degree perineal tears.

Factors Affecting Adnexal Torsion Direction: A Retrospective Cohort Study.

AIMS: To investigate a trend for adnexal torsion direction and factors that may be associated with direction. METHODS: We retrospectively reviewed the medical files of all women who underwent exploratory laparoscopy for suspected ovarian torsion in our center from August 2010 to December 2012. RESULTS: Fifty-five women had laparoscopically proven torsion. Medial rotation, defined as clockwise rotation of the left adnexa or counterclockwise rotation of the right adnexa, with the proximal (lateral) segment of the infundibulopelvic ligament serving as the referral point was noted in most cases (n = 47, 85.5%). There was no statistically significant difference between the medial and lateral rotation groups. However, the proportion of pregnant women and mean parity were significantly higher in the lateral compared to the medial rotation group: 62.5 vs. 19.1%, p = 0.009 and 1.1 ± 1.2 vs. 0.1 ± 0.4, p < 0.001. Medial torsion was present in 64.3% of pregnant women vs. 92.7% of nonpregnant women, p = 0.009. CONCLUSION: The direction of ovarian or adnexal torsion is usually medially rotated, opposite to the psoas muscles and the great blood vessels on the same side. However, surgeons should be aware of an increased rate of lateral rotation among pregnant women.

The Use of a Novel Optical Algorithm in the Diagnosis of Cervical Pre-Invasive Pathology - A Preliminary Proof of Principal Study.

OBJECTIVE: To develop a novel optical probe monitoring cervical tissues in real-time and to compare the new imaging technique to actual cervical pathologic findings on resected cone biopsy specimens. METHODS: A loop electro-excisional procedure was performed on 15 women with a biopsy diagnosis of dysplasia. The conization specimen was then assessed with the novel optical system and results recorded. The 'normal' and 'abnormal' areas were tested by the optical setup at several points. Extracted parameters were used as the input of the classifier function of a logistic regression algorithm model to assess for system accuracy vs. clinical examination. RESULTS: Ninety-seven samples were taken - forty-five samples from 'abnormal zones' and 42 samples from 'normal zones', as defined by the surgeon. The pathologist diagnosed 58 samples as dysplastic and 39 samples as normal. The novel optical method predicted 58 sample points as abnormal and 39 points as normal. The sensitivity of the system was 90% with a specificity of 77%. The probability of correct differentiation of dysplastic cervical tissue from normal cervical tissue was 85%. CONCLUSIONS: The optical probe and the algorithms of image processing in combination with the logistic regression algorithm correlated well with pathology results for cervical dysplasia ex-vivo.

Personality, preterm labor contractions, and psychological consequences.

PURPOSE: Research of psychological factors associated with imminent preterm labor (PTL) is sparse, compared with considerable research of preterm birth. We explored state and trait psychological variables associated with PTL, both pre- and postpartum. METHODS: During 2012-2014, 56 women hospitalized due to PTL, and 33 pregnant women without PTL, responded during gestational week 20-33, to a demographic questionnaire, the Big-Five Inventory (BFI), the Brief Symptom Inventory (BSI), the Fear of Childbirth Questionnaire, and the Maternal-Fetal Attachment Inventory (MFAS). At 4-6 weeks postpartum, 35 and 23 of the women in the respective groups responded online to the Edinburgh Postnatal Depression Scale (EPDS) and the Mother to Infant Bonding Scale (MIBS). RESULTS: Compared to women without PTL, women with PTL scored higher on neuroticism, openness to experience, and MFAS (p < 0.01 each), scored lower on consciousness and agreeableness (p < 0.01 each), and showed greater fear of childbirth (p < 0.05). Significant differences were not found in the postpartum variables of EPDS and MIBS. In the PTL group, MFAS (ß = 0.36, p < 0.01), but not fear of childbirth (ß = 0.08, p = NS), remained higher, after controlling for demographic variables and neuroticism. CONCLUSIONS: PTL was associated with personality variables, but not with psychological consequences, other than elevated prepartum attachment to the fetus.