Perinatal depression screening rates, correlates, and treatment recommendations in an obstetric population.

INTRODUCTION: The current study aimed to assess perinatal depression (PD) screening and treatment practices of obstetrical health care providers. METHOD: Retrospective record reviews (n = 557) evaluated the PD screening, referral, and treatment practices at an Obstetrician/Gynecology practice. This study assessed the frequency of screening for PD, rates of elevated Edinburgh Postnatal Depression Scale (EPDS) scores, treatment recommendations, demographic correlates, and predictors of elevated EPDS scores. RESULTS: PD screening completion rates were: 60.1% (intake), 35% (glucola test), and 85.5% (6-week follow-up). Rates of clinically elevated EPDS scores were: 18.21% (intake), 17.43% (glucola test), and 13.00% (6-week follow-up). Correlates of clinically elevated EPDS scores at intake and 6-week follow-up were history of depression, history of anxiety, and young age. History of depression and anxiety were associated with an increased likelihood of having a clinically significant EPDS score at intake. Intake EPDS score and history of depression were associated with an increased likelihood of having a clinically significant EPDS score at 6-week follow-up. DISCUSSION: Obstetric/gynecology providers should screen for perinatal depression at every obstetrical appointment. It is important to thoroughly assess history of depression and anxiety. Education and training for health care providers and perinatal women may improve the mental health experience of perinatal women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Association between depressive symptoms and adherence among adolescents living with HIV in the Republic of Congo: A cross sectional study.

The increasing availability of antiretroviral therapy (ART) worldwide is yet to result in decreasing HIV-related mortality among adolescents (10-19 years old) living with HIV (ALHIV) in part because of poor adherence. the poor adherence might itself be due to high level of depression. We assess the prevalence of depressive symptomatology and it's associated with adherence among ALHIV receiving ART care in Brazzaville and Pointe Noire, Republic of Congo (RoC).Adolescents aged 10 to 19 years, on antiretroviral therapy (ART), followed in the two Ambulatory Treatment Centers (ATC) in Brazzaville and Pointe Noire, RoC were included in this cross-sectional study. From April 19 to July 9, 2018, participants were administered face to face interviews using a standardized questionnaire that included the nine-item Patient Health Questionnaire (PHQ-9). Participants who reported failing to take their ART more than twice in the 7 days preceding the interview were classified as non-adherent. Bivariate and multivariable log-binomial models were used to estimate the prevalence ratio (PR) and 95% confidence interval (95%CI) assessing the strength of association between predictors and presence of depressive symptoms (PHQ-9 score ≥9).Overall, 135 adolescents represented 50% of ALHIV in active care at the 2 clinics were interviewed. Of those, 67 (50%) were male, 81 (60%) were 15 to 19 years old, 124 (95%) had been perinatally infected, and 71 (53%) knew their HIV status. Depressive symptoms were present in 52 (39%) participants and 78 (58%) were adherent. In univariate analyses, the prevalence of depressive symptoms was relative higher among participants who were not adherent compared to those who were (73% vs 33%; PR: 2.20 [95%CI: 1.42-3.41]). In multivariate analysis, after adjustment for report of been sexually active, alcohol drinking, age category (10-14 and 15-19), not in school, loss of both parents, the association between depression and adherence was strengthened (PR: 2.06 [95%CI: 1.23-3.45]).The prevalence of depressive symptoms in adolescents living with HIV is high and was strongly associated with poor adherence even after adjustment of potential confounders. Efforts to scale-up access to screening and management of depression among ALHIV in sub-Saharan is needed for them to realize the full of ART.

Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers.

OBJECTIVE: To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN: A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS: We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS: Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.

Lung function evolution in children with old and new type bronchopulmonary dysplasia: a retrospective cohort analysis.

Bronchopulmonary dysplasia (BPD) is one of the most important sequelae of premature birth. There is concern that in some patients, lung injuries early in life may have lifelong consequences. In this retrospective observational cohort study, lung function evolution in children with BPD was investigated from childhood to young adulthood. Data from 355 pulmonary function tests (PFT) in 24 patients were analyzed, with a median age at first PFT of 7.6 years and at last PFT 18.2 years. FEV1 and FEV1/FVC were below the 5th percentile in respectively 18 and 13/24 patients. Comparing first and last measurement, there was significant worsening in FEV1 from a mean of 71.3% pred (SD 18.3) to 66.7% pred (SD 21.7) (p < 0.05) and in FEV1/FVC from 85.4% pred (SD 15.2) to 79.8% pred (SD 17.3) (p = 0.01). Evaluation of the individual lung function changes with linear regression showed deterioration in FEV1, FVC, and FEV1/FVC in respectively 17, 13, and 17/24 patients. Total group analysis showed significant deterioration in FEV1 (- 0.7%/year, p = 0.002) and FEV1/FVC (- 0.5%/year, p = 0.01). None of the 11 patients born up to 1990 improved in FEV1 vs 7 of the 13 patients born after 1990 (p = 0.006).Conclusion: This points out to further deterioration of the lung function during childhood in this selected group of children with BPD.What is Known:• Data on longitudinal changes in lung function in children with BPD are scarce.What is New:• In children with BPD at the severe end of the disease spectrum, lung function does not improve over time. On the contrary, in two-thirds of the subjects studied FEV1and FEV1/FVC worsen over time.• Lung function evolution towards adulthood was somewhat more favorable in children born after 1990 compared with those born earlier, probably reflecting improvements in neonatal care in subjects with new type BPD.

Evidence-Based Practice: Improving the Quality of Perinatal Care.

BACKGROUND: For clinical research findings to improve the quality of care and outcomes for newborn infants and their families, they need to be implemented in policy and adopted in practice. METHODS: We describe the principles of effective dissemination and implementation of research findings and highlight examples of collaborative quality improvement strategies to ensure that guidelines, protocols, policies and practices reflect research-informed evidence. RESULTS: Passive dissemination of research findings is generally ineffective in driving change. Implementation strategies that use multi-faceted approaches acting on different barriers to change are better at driving improvements in the quality of care practices. These initiatives are increasingly embedded within regional, national and international networks of neonatal care centres that collaborate in conducting research, implementing its findings and auditing its uptake. Examples of successful network-based collaborative quality improvement programmes include efforts to increase use of evidence-based strategies to prevent hospital-acquired bloodstream infections, optimise surfactant replacement for preterm infants, reduce the incidence of bronchopulmonary dysplasia, improve antibiotic stewardship and promote the use of human milk to prevent necrotising enterocolitis in very-low-birth-weight infants. CONCLUSIONS: Effective dissemination and implementation are essential for research evidence to improve quality of care and outcomes for newborn infants and their families. Multifaceted initiatives within network-based collaborative quality improvement programmes facilitate continuous audit and benchmarking cycles to ensure equity of access to evidence-based care practices.

Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos / Avances en la asistencia al parto en Brasil: resultados preliminares de dos estudios evaluativos / Progress in childbirth care in Brazil: preliminary results of two evaluation studies

Resumo: Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.

Resumen: El objetivo de este artículo es describir los primeros resultados de dos estudios evaluativos, uno sobre la Red Cigüeña y otro sobre el proyecto Parto Adecuado, denominados respectivamente como evaluación de la Red Cigüeña y Nacer Sano, e identificar posibles mejorías en comparación con el estudio Nacer en Brasil. Ambos estudios tienen un diseño transversal, realizados en 2017. El estudio evaluación de la Red Cigüeña incluyó todas las maternidades públicas (606) y mixtas implicadas en la Red Cigüeña y a un total de 10.675 puérperas. El estudio Nacer Sano incluyó una muestra de conveniencia de 12 hospitales privados y a un total de 4.798 mujeres. Los indicadores de atención al parto y nacimiento evaluados fueron: presencia de acompañante, atención por enfermera obstetra, cumplimentación de partograma, uso de métodos no farmacológicos, deambulación, alimentación, uso de catéter venoso periférico, analgesia, posición de la mujer para el parto, episiotomía y maniobra de Kristeler. Estos indicadores se compararon con los encontrados en Nacer en Brasil, un estudio a nivel nacional, realizado en 2011-2012, antes del inicio de los dos programas de intervención. Para las comparaciones utilizamos el test del chi-cuadrado para muestras independientes y nivel de confianza de un 95%. Hubo un aumento significativo del número de mujeres con acceso a la tecnología apropiada para el parto entre los años de 2011 y 2017 y una reducción de las prácticas consideradas perjudiciales. En el sector privado, se observó también una reducción en las tasas de cesárea y aumento de la edad gestacional al nacer. Los resultados de este estudio muestran que las políticas públicas bien dirigidas pueden cambiar el escenario de la atención al parto y nacimiento, promoviendo la reducción de desenlaces maternos y neonatales negativos.

Abstract: This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.

Pregnancy unshackled: Increasing equity through implementation of perinatal depression screening, shared decision making, and treatment for incarcerated women.

BACKGROUND: Perinatal depression (PD) is one of the most common medical complications of pregnancy. The prevalence of women in correctional settings has grown eight-fold in the last 30 years. A quarter of these women were either pregnant or within a year postpartum when entering custody. Recommendations to screen and treat all pregnant women for PD are being implemented nationwide. LOCAL PROBLEM: In 2016, 71% of pregnant women entering Milwaukee County Jail had minimal or no prenatal care and significant rates of high-risk medical and social risk factors. The jail system was not screening for PD. METHODS: The Plan-Do-Study-Act method of quality improvement (QI), with four rapid cycles, was utilized. Patient tracer interviews and refusal rates were collected for baseline data two months preceding implementation. Data was analyzed using run charts to evaluate the impact of interventions on outcomes. INTERVENTION: PD screening was implemented with the Edinburgh Perinatal Depression Scale, and if scored positive, the Healthwise shared decision-making tool was utilized for therapy options and treatment initiated. RESULTS: A total of 101 women were seen, 93 were offered screening, 76 were screened, 43 were positive, and 37 started treatment within the facility. That is, 46% to 57 % of this aggregate of women who screen positive for PD and a decrease in patient refusal rates was seen throughout the process. CONCLUSION: Rapid cycle QI was effective in standardizing PD screening and treatment. Replication of this project across correctional systems would help to bridge a gap of equitable care for incarcerated women.

Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys.

OBJECTIVE: To study trends in the main indicators of perinatal health, medical practices and risk factors in France since 1995. POPULATION AND METHOD: All live births during one week in 1995 (n=13,318), 2003 (n=14,737), 2010 (n=14,903) and 2016 (n=13,384). Data were from interviews of women in postpartum wards and from medical records and were compared between years. RESULTS: Between 1995 and 2016, maternal age and body mass index increased steadily. Pregnancies that occurred with use of contraception increased from 7.4% in 2010 to 9.3% in 2016. Smoking during pregnancy (16.6%) did not decrease since 2010. The frequency of more than three ultrasounds during pregnancy was 48.5% in 1995 and 74.7% in 2016. Deliveries in large public hospitals increased steadily. The caesarean section rate has been relatively stable since 2003 (20.4% in 2003, 21.1% in 2010 and 20.4% in 2016). The rate of induction of labour was 22% in 2010 and 2016. Overall, 83.8% of women had epidural analgesia/anaesthesia in 2016. Rates of pre-term birth in 2016 ranged from 7.5% among all live births to 6.0% among live born singletons; for singletons, this rate increased steadily from 1995 to 2016, whereas there was no clear trend for low birth weight. Exclusive breastfeeding decreased from 60.3% in 2010 to 52.2% in 2016. CONCLUSION: Routine national perinatal surveys highlight successful policies and recommendations but also point out some health indicators, practices, preventive behaviours and risk factors that need special attention.

The Burden of Respiratory Disease in Very-Low-Birth-Weight Infants: Changes in Perinatal Care and Outcomes in a Decade in Spain.

BACKGROUND: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. OBJECTIVES: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). METHODS: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants <230 or >346 weeks of gestational age (GA) were excluded. RESULTS: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of "outborn" patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001). CONCLUSIONS: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.

Clínicas Perinatológicas Argentinas 2017 / Argentine Perinatologics Clinics 2017

En este número se reúne material sobre actualidad de la medicina perinatal, psicología perinatal, trato obstétrico inadecuado, y etiología de la rotura prematura de membranas durante el embarazo.

The impact of the implementation of the postpartum haemorrhage management guidelines at the first regional perinatal centre in Southern Kazakhstan.

BACKGROUND: Postpartum haemorrhage (PPH) remains one of the most common causes of maternal morbidity and mortality. Therefore, clearly written PPH management guidelines should be used in clinical practice. The aim of this study was to evaluate the effectiveness of the implementation of PPH management guidelines at the First Regional Perinatal Centre of Southern Kazakhstan (FRPC). METHODS: Between 2012 and 2013 an interventional study was performed whereby the PPH management guidelines were implemented at the FRPC. All of the deliveries that were complicated by PPH 8 months before and 8 months after the intervention were analysed. Prevalence and severity of PPH, and the change in prevention, diagnostics and management of PPH was evaluated and statistical analysis using the SPSS 22.0 was performed. RESULTS: There were in total 5404 and 5956 deliveries in the pre- and post-intervention periods, respectively. The rates of PPH and severe PPH decreased from 1.17 to 1.02 % (p = 0.94) and from 0.24 to 0.22 % (p = 0.94), respectively. Blood loss on average increased from 1055 to 1170 ml in the post-intervention period. The pharmacological treatment of postpartum haemorrhage with uterotonics was administered most frequently during both periods. After the implementation of the guidelines, the number of transfused units of packed red blood cells decreased from 4.76 to 2.48 units/case. In addition, the amount of transfused fresh frozen plasma decreased by 20 %. The number of conservative interventions and conservative operations increased from 7.9 to 52.7 % and from 3.9 to 48.6 %, respectively. The number of hysterectomies decreased from 23.7 % in pre-intervention to 8.1 % in the post-intervention period. CONCLUSIONS: The implementation of the PPH management guidelines had a positive effect on PPH prevention, diagnostics and management. It led to a more conservative aproach to the treatment of PPH. Therefore, clearly written PPH management guidelines, adapted for a particular hospital, should be developed and used in clinical practice.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Improvement in perinatal care for extremely premature infants in Denmark from 1994 to 2011.

INTRODUCTION: Major advances in perinatal care over the latest decades have increased the survival rate of extremely premature infants. Centralisation of perinatal care was implemented in Denmark from 1995. This study evaluates the effect of organisational changes of perinatal care on survival and morbidity of live-born infants with gestational ages (GA) of 22-28 weeks. METHODS: Three cohort studies were included from 1994-1995, 2003 and 2011. Data from live-born infants were extracted regarding risk factors, survival, bronchopulmonary dysplasia (BPD), cystic periventricular leukomalacia (cPVL) and intraventricular haemorrhage grade 3-4 (IVH 3-4). RESULTS: A total of 184, 83 and 127 infants were included from the cohorts. Delivery rates at level 3 Neonatal Intensive Care Unit (NICU) hospitals increased from 69% to 87%. Transfer rates to level 3 NICU almost doubled during the period. Survival rates were stationary, although a trend towards increased survival was observed for infants < 26 weeks. The frequency of infants receiving evidence-based treatment increased from 14% to 46%. IVH 3-4 rates were reduced from 21% to 12%, whereas BPD and cPVL rates did not change. Survival odds increased with higher gestational age and administration of surfactant. CONCLUSIONS: Centralisation of treatment of extremely premature infants has been implemented because more children are being born at highly specialised perinatal centres. Care improved as more infants received evidence-based treatment. IVH 3-4 rates declined. A trend towards increased survival was observed for infants with a GA < 26 weeks. FUNDING: none. TRIAL REGISTRATION: not relevant.

Programa de diagnóstico y tratamiento fetal. Estudio de cohorte sobre su efectividad en la evolución de neonatos con patologías quirúrgicas / Program for prenatal diagnosis and treatment: A cohort study on effectivity on the outcome of newborns with surgical pathologies

Introducción. El diagnóstico prenatal de las malformaciones congénitas (MC) permite optimizar el cuidado perinatal. Al Hospital Garrahan (HG) ingresan recién nacidos (RN) con MC para tratamiento quirúrgico. Desde el año 2008 funciona el programa de diagnostico y tratamiento fetal (PDTF) para optimizar el cuidado prenatal y perinatal de RN con MC. El objetivo del estudio es evaluar el impacto de la derivación prenatal en RN que ingresan a la unidad de cuidados intensivos neonatales (UCIN) del HG por MC seleccionadas. Población y Métodos: estudio observacional analítico y comparativo entre grupos, sobre condición de ingreso y evolución de RN con gastrosquisis (GTQ), mielomeningocele (MMC) y hernia diafragmática (HD) y grado de stress parental, según ingreso a UCIN por derivación prenatal o postnatal. Se realizó análisis bivariado, descriptivo y comparativo de indicadores generales y especiales de cuidado. Resultados: Se incluyeron 164 RN (44 con derivación prenatal a través del PDTF). Este grupo presentó: mejor control del embarazo (93% vs 66%, p: 0.04), menor edad gestacional al diagnóstico (24s vs 33s p=0.0006) y mayor tasa de cesárea electiva (95 vs 47%, p=0.0001). Los RN tuvieron menor necesidad de reanimación e ingresaron más tempranamente a la Unidad (mediana 4hs vs 10hs, p=0,004). Hubo menor stress parental en relación al hijo (17 vs 40%). Los RN con GTQ ingresaron mejor curados y se alimentaron por vía enteral más rápidamente. Conclusión: Los RN con MC derivados prenatalmente a través del PDTF, ingresan precozmente y presentaron mejores estrategias de cuidado que los ingresados por derivación habitual (AU)

Introduction. Prenatal diagnosis of congenital malformations (CM) improve perinatal care. At the Garrahan Hospital (GH) newborns (NB) with CM are admitted for surgical treatment. Since 2008 a program for prenatal diagnosis and treatment (PDT) has been in place to optimize prenatal and perinatal care of NB with CM. The aim of this study was to assess the impact of prenatal referral of NB that are admitted to the GH for selected CM. Population and Methods: An observational, analytical, and between-group comparative study was conducted on the status on admission and outcome in NB with gastroschisis (GS), myelomeningocele (MMC), and diaphragmatic hernia (DH) and degree of parental stress, according to NICU admission after prenatal or postnatal referral. Bivariate, descriptive and comparative analysis of general and specific markers of care was performed. Results: 164 NB were included (44 were prenatally referred through the PDT program). The latter group presented with better pregnancy control (93% vs 66%, p: 0.04), younger gestational age at diagnosis (24w vs 33w p=0.0006), and higher rate of elective cesarean section (95 vs 47%, p=0.0001). This group of NB needed less reanimation and were admitted to the NICU earlier (∑4hs vs 10hs, p=0.004). Parental child-related stress was less (17 vs 40%). NB with GS had a better surgical outcome and were started on enteral feeding earlier. Conclusion: NB with CM that were prenatally referred through the PDT program, were admitted earlier and could be managed with better strategies than those who were conventionally referred (AU)

Perinatal and background risk factors for childhood autism in central China.

Perinatal and background risk factors for autism were identified in a cohort of autistic children in Zhengzhou, China, to formulate preventative and treatment strategies for high-risk families. In this case-control study, children were screened for suspected autism using the Autism Behavior Checklist (ABC) and diagnosed according to DSM-IV and the Childhood Autism Rating Scale (CARS). We collected perinatal histories and clinical data of 286 confirmed autistic children treated at the Third Affiliated Hospital Children׳s Psychological Clinic of Zhengzhou University from 2011 to 2013. The control group consisted of 286 healthy children from area kindergartens. Maternal age>30 years, parental introversion as measured by the Eysenck Personality Questionnaire, low level of parental education, smoking, abortion threat, pregnancy complications, maternal illness during pregnancy, maternal mental health, family history of mental illness, neonatal jaundice, birth asphyxia, premature rupture of the fetal membrane, and gestational age<37 weeks were significantly higher in the autism group. These factors were significantly correlated with behavioral symptoms as measured by ABC scores (Kendall rank correlation). Birth asphyxia, neonatal jaundice, maternal age, parental introversion, family history of mental illness, abortion threat, premature delivery, and smoking were identified as independent risk factors by multivariate logistic regression.

Depression screening and patient outcomes in pregnancy or postpartum: a systematic review.

OBJECTIVE: Clinical practice guidelines disagree on whether health care professionals should screen women for depression during pregnancy or postpartum. The objective of this systematic review was to determine whether depression screening improves depression outcomes among women during pregnancy or the postpartum period. METHODS: Searches included the CINAHL, EMBASE, ISI, MEDLINE, and PsycINFO databases through April 1, 2013; manual journal searches; reference list reviews; citation tracking of included articles; and trial registry reviews. RCTs in any language that compared depression outcomes between women during pregnancy or postpartum randomized to undergo depression screening versus women not screened were eligible. RESULTS: There were 9,242 unique titles/abstracts and 15 full-text articles reviewed. Only 1 RCT of screening postpartum was included, but none during pregnancy. The eligible postpartum study evaluated screening in mothers in Hong Kong with 2-month-old babies (N=462) and reported a standardized mean difference for symptoms of depression at 6 months postpartum of 0.34 (95% confidence interval=0.15 to 0.52, P<0.001). Standardized mean difference per 44 additional women treated in the intervention trial arm compared to the non-screening arm was approximately 1.8. Risk of bias was high, however, because the status of outcome measures was changed post-hoc and because the reported effect size per woman treated was 6-7 times the effect sizes reported in comparable depression care interventions. CONCLUSION: There is currently no evidence from any well-designed and conducted RCT that screening for depression would benefit women in pregnancy or postpartum. Existing guidelines that recommend depression screening during pregnancy or postpartum should be re-considered.

Unexpected diagnosis of fetal malformations: therapeutic itineraries / O diagnóstico inesperado de malformações fetais: itinerários terapêuticos

Ultrasonography was a technological breakthrough for obstetrics, allowing visualization of fetal structures. However, the lack of a systematic approach to obstetric ultrasound examinations causes in Brazil, pregnant women do the exam on their own, which can sometimes lead to unexpected diagnosis of fetal malformation. In order to describe the reaction of women when surprised by the diagnosis of fetal malformation and therapeutic itineraries that follow, we conducted a study with nine pregnant women after ultrasound confirmation of fetal malformation. Through semi-structured interviews and content analysis of the narratives, the following categories were identified: motivation to perform ultrasonography; care at the referral; and coping strategies from the confirmation of fetal malformation. The interviews revealed failure to comply with the correct sequence of the prenatal care process. Definition of suitable moment for ultrasound test and guidance at each stage of pregnancy now represent a challenge for the improvement of perinatal care...

A ultrassonografia representou um avanço tecnológico para a obstetrícia, por permitir a visualização das estruturas fetais. Entretanto, a falta de uma abordagem sistemática para os exames de ultrassom obstétrico faz com que, no Brasil, mulheres grávidas façam o exame por iniciativa própria, o que às vezes pode levar a um diagnóstico inesperado de malformação fetal. Com o objetivo de descrever a reação das mulheres quando surpreendidas pelo diagnóstico de malformação fetal e os itinerários terapêuticos que se sucedem, foi realizado estudo com nove gestantes, após a confirmação ultrassonográfica de malformação fetal. Através de entrevistas semiestruturadas e análise de conteúdo das narrativas, foram identificadas as seguintes categorias: motivação para realizar ultrassonografia; atendimento na unidade de referência; e estratégias de enfrentamento a partir da confirmação de malformação fetal. As entrevistas revelaram uma falha em cumprir com a sequência correta do processo de cuidado pré-natal. A definição do momento adequado para o teste de ultrassom e orientação em cada etapa da gravidez representam um desafio para a melhoria da assistência perinatal...

Perinatal influences on the development of asthma and atopy in childhood.

BACKGROUND: In most children with asthma and atopy, onset of disease occurs early in life, indicating a crucial role of in utero and early childhood environment. However, only a small part of this burden of disease established early in life has been explained. OBJECTIVE: To examine the effects of early environmental exposures on the development of asthma and atopy within the setting of an affluent urban population. METHODS: The authors followed 526 German children from birth to 5 years of age. Parental interviews in pregnancy and then yearly assessed the health of the child and environmental characteristics. Endotoxin and allergens in house dust were measured at 3 months. Atopic sensitization was assessed at 1 and 5 years. RESULTS: In atopic mothers, acute atopic symptoms during pregnancy were associated with increased risk of early atopic dermatitis (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI] 1.00-3.02) and allergic rhinitis at 5 years (aOR 2.11, 95% CI 1.01-4.41). Further, maternal illnesses during pregnancy (ie, repeated common colds) increased the risk of asthma at 5 years (aOR 2.31, 95% CI 1.12-4.78). Endotoxin in the child's mattress was inversely associated with atopic sensitization (aOR 0.79, 95% CI 0.64-0.97) and asthma (aOR 0.71, 95% CI 0.55-0.93). A contrasting effect of early endotoxin and mite exposure was observed for mite sensitization: mite exposure increased the risk of mite sensitization at 5 years (aOR 1.30, 95% CI 1.11-1.53), whereas endotoxin exposure was inversely associated with mite sensitization (aOR 0.73, 95% CI 0.57-0.95). CONCLUSION: Factors affecting the in utero environment, such as maternal atopy and infections, and bacterial exposure in pregnancy or early life may act as immunomodulators enhancing or inhibiting the development of asthma and atopy in childhood.

Morbilidad materna: hospitalización ante-parto / Maternal morbidity: ante partum hospitalization

Determinar la incidencia de admisiones antenatales en gestantes portadoras de enfermedades severas que implican un tratamiento intrahospitalario, revelando así la morbilidad materna, además de conocer sus repercusiones perinatales. Estudio observacional, descriptivo, analítico realizado durante el trienio 2008-2010. Hubo 5 815 nacimientos, 1 033 admisiones antenatales, 230 neonatos con morbilidad neonatal y 34 muertes feto-neonatales. Las embarazadas debían tener 20 semanas o más de gestación, hospitalizadas 2 días o más, fueron dadas de alta sin parir y luego regresaron para su asistencia obstétrica definitiva. Departamento de Obstetricia y Ginecología, Hospital "Dr. Adolfo Prince Lara", Departamento Clínico Integral de la Costa, Universidad de Carabobo. Puerto Cabello. Hubo una incidencia de 17,76 pacientes hospitalizadas antenatalmente por cada 100 nacimientos o 1 cada 5,6 nacimientos. Las patologías más frecuentes fueron las propias del embarazo (57,41 por ciento): la amenaza de parto prematuro (18,20 por ciento), preeclampsia (9,78 por ciento), hemorragia placentaria (6,68 por ciento), oligohidramnios (6,58 por ciento) y anemia (5,52 por ciento). Las patologías asociadas al embarazo (33,98 por ciento): infección urinaria (14,13 por ciento) y diabetes(9,49 por ciento) La morbilidad neonatal global fue 22,26 por ciento, aportada principalmente por patologías propias del embarazo: amenaza parto pretérmino (20,43 por ciento), preeclampsia (13,04 por ciento), y hemorragia placentaria (10 por ciento); de las asociadas: infección urinaria 14,35 por ciento y diabetes 14,35 por ciento. La mortalidad feto-neonatal fue de 3,3 por ciento, contribuyendo predominante prematurez y malformación fetal (29,41 por ciento), preeclampsia (26,47 por ciento), el desprendimiento prematuro de placenta y la placenta previa (17,65 por ciento). Hubo una incidencia elevada de admisiones antenatales, causadas por entidades que obligan a un diagnóstico precoz...

To determine the incidence of antenatal admissions in pregnant women carrying a severe illness involving hospital management, revealing maternal morbidity, in addition to knowing their impact perinatal outcomes. An observational, descriptive, analytical study, made during the 2008-2010 period. There were 5 815 births, 1 033 antenatal admissions, 230 infants with neonatal morbidity and 34 fetal and neonataldeaths. Pregnant women should take 20 weeks or more gestation, hospitalized 2 days or more, were discharged without giving birth and then returned for final delivery care. Department of Obstetrics and Gynecology, Hospital "Dr. Adolfo Prince Lara". Departamento Clinico de la Costa. University of Carabobo. Puerto Cabello, Estado Carabobo, Venezuela. There was an incidence of patients hospitalized antenatally 17.76 per 100 births or 1 in 5.6 children. The most frequent pathologies were typical of pregnancy (57.41 percent): preterm delivery threatens (18.20 percent), pre-eclampsia (9.78 percent), placental hemorrhage (6.68 percent), oligohydramnios (6.58 percent) and anemia (5.52 percent). Pregnancy-associated pathologies (33.98 percent): urinary tract infection (14.13 percent) and diabetes (9.49 percent). Neonatal morbidity rate was 22.26 percent, contributed mainly by pathologies of pregnancy: preterm delivery threatens (20.43 percent), pre-eclampsia (13.04 percent), and placental hemorrhage (10 percent), associated: urinary tract infection 14.35 percent and diabetes 14.35 percent. Feto-neonatal mortality was 3.3 percent, contributing predominant: prematurity and fetal malformation (29.41 percent), pre-eclampsia (26.47 percent), abruptio placenta and placenta previous (17.65 percent). There was a high incidence of antenatal admissions caused by entities that require early diagnosis and better management in order to lessen the economic impact and the serious repercussions hospital perinatal evidenced

Trends in perinatal health in France from 1995 to 2010. Results from the French National Perinatal Surveys.

OBJECTIVE: To study trends in the main indicators of health, medical practices and risk factors in France. POPULATION AND METHOD: We collected data from samples of all births in France during one week in 1995 (n=13318), 1998 (n=13718), 2003 (n=14737) and 2010 (n=14903) and have compared them. RESULTS: Between 1995 and 2010, maternal age and body mass index increased steadily, but tobacco use decreased. In 2010, 39.4% of pregnant women had a visit with a midwife in a maternity unit, versus 26.6% in 2003. Deliveries occurred in large public hospitals more and more frequently. The increase in caesarean sections was no longer significant between 2003 and 2010. In general, medical decisions during pregnancy and delivery were closer to professional recommendations in 2010 than in earlier years. Live births before 37 weeks increased steadily from 5.4% in 1995 to 6.6% in 2010, but the proportion of birth weights below 2500g or the 10th percentile stopped increasing after 2003. CONCLUSION: Routine national perinatal surveys highlight major trends in maternal characteristics, obstetric practices, organisation of services, and perinatal health.