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.

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.

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)

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.

Cumulative psychosocial stress, coping resources, and preterm birth.

Preterm birth constitutes a significant international public health issue, with implications for child and family well-being. High levels of psychosocial stress and negative affect before and during pregnancy are contributing factors to shortened gestation and preterm birth. We developed a cumulative psychosocial stress variable and examined its association with early delivery controlling for known preterm birth risk factors and confounding environmental variables. We further examined this association among subgroups of women with different levels of coping resources. Utilizing the All Our Babies (AOB) study, an ongoing prospective pregnancy cohort study in Alberta, Canada (n = 3,021), multinomial logistic regression was adopted to examine the independent effect of cumulative psychosocial stress and preterm birth subgroups compared to term births. Stratified analyses according to categories of perceived social support and optimism were undertaken to examine differential effects among subgroups of women. Cumulative psychosocial stress was a statistically significant risk factor for late preterm birth (OR = 1.73; 95 % CI = 1.07, 2.81), but not for early preterm birth (OR = 2.44; 95 % CI = 0.95, 6.32), controlling for income, history of preterm birth, pregnancy complications, reproductive history, and smoking in pregnancy. Stratified analyses showed that cumulative psychosocial stress was a significant risk factor for preterm birth at <37 weeks gestation for women with low levels of social support (OR = 2.09; 95 % CI = 1.07, 4.07) or optimism (OR = 1.87; 95 % CI = 1.04, 3.37). Our analyses suggest that early vulnerability combined with current anxiety symptoms in pregnancy confers risk for preterm birth. Coping resources may mitigate the effect of cumulative psychosocial stress on the risk for early delivery.

Screening for symptoms of postpartum traumatic stress in a sample of mothers with preterm infants.

There are no established screening criteria to help identify mothers of premature infants who are at risk for symptoms of emotional distress. The current study, using data obtained from recruitment and screening in preparation for a randomized controlled trial, aimed to identify potential risk factors associated with symptoms of depression, anxiety and posttraumatic stress in a sample of mothers with premature infants hospitalized in a neonatal intensive care unit. One hundred, thirty-five mothers of preterm infants born at 26-34 weeks of gestation completed three self-report measures: the Stanford Acute Stress Reaction Questionnaire, the Beck Depression Inventory (2nd ed.), and the Beck Anxiety Inventory to determine their eligibility for inclusion in a treatment intervention study based on clinical cut-off scores for each measure. Maternal sociodemographic measures, including race, ethnicity, age, maternal pregnancy history, and measures of infant medical severity were not helpful in differentiating mothers who screened positive on one or more of the measures from those who screened negative. Programs to screen parents of premature infants for the presence of symptoms of posttraumatic stress, anxiety, and depression will need to adopt universal screening rather than profiling of potential high risk parents based on their sociodemographic characteristics or measures of their infant's medical severity.

Reproductive hormones and postpartum mood disturbances in Greek women.

AIM: Postpartum mood disturbances are common among Greek women, with postpartum depression (PPD) being as high as 19%. This study aimed to investigate whether sex steroid hormone levels affect the incidence of postpartum mood disturbances. MATERIALS AND METHODS: Fifty-seven women were evaluated for postpartum mood disturbances using the Postpartum Blues Questionnaire and the Edinburgh Postnatal Depression Scale on the 1st and 6th week. Serum estradiol, progesterone and testosterone concentrations were measured upon admission for delivery and daily until the fourth postpartum day. We then studied the association between hormone levels and the scores in the two psychometric scales. RESULTS: Testosterone was the only hormone that was marginally associated with psychometric scoring in simple regression analysis. (Postpartum Blues during days 1-4: b = 4.291, 95% C.I. -0.796 to 9.377 and p-value = 0.096). Women with lower testosterone drops had higher scores in Postpartum Blues Questionnaire. This association, however, lost statistical significance in the multivariable analysis after adjusting for pregnancy duration. In multiple regression analysis, only pregnancy duration had the most constant adverse effect on psychometric scores: The shorter the duration of pregnancy, the higher the scores for Postpartum Blues. (r = -0.39, p < 0.01). CONCLUSIONS: Our findings do not indicate an association between the occurrence of postpartum mood disorders and sex steroid hormone levels. Preterm labour may be associated with a higher risk of postpartum mood disturbances.

[Antepartum depression: prevalence, diagnosis and treatment]. / La dépression de l'antepartum: prévalence, diagnostic, traitement.

INTRODUCTION: The occurrence of depression during pregnancy is a frequent situation that must be distinguished from postpartum depression. It raises many questions regarding its complications and therapeutic options. OBJECTIVES: To provide a systematic review of available data on prevalence, risk factors, and adverse outcomes of antepartum depression, as well as on screening tools and treatments currently available. METHODS: Studies, reviews, and meta-analyses were searched through the Pubmed and Embase databases. Articles related to postpartum depression or specifically focusing on bipolar disorder were excluded. EPIDEMIOLOGY: Prevalence is estimated between 5 and 15%. Risk factors, in addition to those of any depression, are an ambivalent attitude towards pregnancy, previous miscarriages, and medically-assisted or complicated pregnancies. Diagnosis and screening: No specific tool has yet been designed to diagnose or screen antepartum depression, but some scales (EPDS, PRIME-MD PHQ) have been validated. Adverse outcomes: For the mother, adverse outcomes are those of any depression, in addition to an increased risk of delivery complications and of postpartum depression. For the child, there is an increased risk for preterm birth, low birth-weight, and possibly sudden death. TREATMENTS: - Tricyclic antidepressants are widely described as safe during pregnancy. SSRIs show much reassuring data, even though recent studies have raised concerns about cardiac malformations and persistent pulmonary hypertension of the newborn. Electroconvulsive therapy is only indicated in the most severe cases but appears secure under specific safety measures. Most psychotherapies have not been specifically assessed during pregnancy. Other treatments (bright light therapy, rTMS…) have shown some promising but not robust results. CONCLUSION: Antepartum depression is frequent, and potentially severe if not treated. Validation of specific screening tools is warranted. Pharmacological treatment should not be postponed in cases of severe depression. Regarding moderate depressions, it appears reasonable to turn to non-pharmacological treatments, primarily psychotherapies, which therefore should be more thoroughly studied.

A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.

CONTEXT: Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). OBJECTIVE: To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. DATA SOURCES AND STUDY SELECTION: We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria. DATA EXTRACTION: Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. DATA SYNTHESIS: Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. CONCLUSIONS: Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.

Fatores de risco associados ao parto pré-termo em hospital de referência de Santa Catarina / Risk factors associated with pre-term labors in a reference hospital in Santa Catarina

Introdução: O parto pré-termo é um dos grandes problemas de saúde pública, que pouco evoluiu com o avanço da medicina, contribuindo com elevados números para a morbimortalidade infantil. Estudos epidemiológicos têm evidenciado o papel de diversos fatores de risco para a prematuridade, desde pré-natais, ginecológicos, sociais e maternos como raça, idade da mãe, fumo, estado civil, tipo de ocupação. O objetivo deste estudo foi relacionar exposição materna aos fatores de risco para partos pré-termo no Hospital Nossa Senhora da Conceição, em Tubarão (SC), no período de junho a novembro de 2008. Metodologia: Estudo caso-controle. Foram incluídas 192 puérperas que tiveram parto pré-termo como casos e com parto a termo como controles 2:1. Para verificar a associação dos fatores estudados à prematuridade, realizou-se a análise de regressão logística múltipla através do programa SPSS 8.0 e foram considerados fatores de risco as razões de chance (OR) >1.0 com intervalo de confiança de 95% significativo. Resultados: Após análise de regressão logística, os seguintes itens apresentaram associação com parto prematuro independente do efeito das outras variáveis: ausência de companheiro fixo (OR 7,92), parto pré-termo anterior (OR 11,68), infecção urinária na gestação (OR 4,12), pielonefrite (OR 65,71), vaginose na gestação (OR 21,83), intercorrências na gestação (OR 28,98), sangramento na gestação (OR 14,29) e gestação gemelar (OR 10,85). Conclusão: Ausência de companheiro fixo, parto pré-termo anterior, infecção urinária na gestação, pielonefrite, vaginose bacteriana na gestação, intercorrências gestacionais, sangramento durante a primeira metade da gestação e gestação gemelar são fatores de risco estatisticamente significantes para parto pré-termo.

Introduction: Pre-term labor is a major problem of public health that has been little improved by the advances in medicine and has contributed to increase the infant morbidity/mortality rates. Epidemiological surveys have evidenced the role of many prenatal, gynecological and social risk factors in prematurity, as well as maternal risk factors like mother’s race, age, smoking, marital status, and occupation type. The aim of this study was to investigate maternal exposure to risk factors for pre-term labor in the Hospital Nossa Senhora da Conceição in Tubarão (SC) in the Jun-Nov 2008 period. Methods: A case control study. A total of 192 mothers were included, those who had pre-term labor as cases and those who had term labor as controls (2:1). The studied factors’ association with prematurity was calculated by multiple logistic regression using software SPSS 8.0. An odds ratio (OR) >1.0 was considered as risk factor, with confidence interval of 95% as significant. Results: The logistic regression showed that the following items were associated with pre-term labor independently of the effect of other variables: Absence of a steady partner (OR 7.92), previous pre-term labor (OR 11.68), urinary infection during pregnancy (OR 4.12), pyelonephritis (OR 65.71), vaginosis during pregnancy (OR 21.83), intercurrences during gestation (OR 28.98), gestational bleeding (OR 14.29) and twin pregnancy (OR 10.85). Conclusion: Lack of a steady partner, previous pre-term labor, urinary infection during pregnancy, bacterial vaginosis during pregnancy, gestational intercurrences, early gestational bleeding, and twin pregnancy are statistically significant factors for preterm labor.

Los estresores psicosociales se asocian a síndrome hipertensivo del embarazo y/o síntomas de parto prematuro en el embarazo adolescente / Psychosocial stress are associated to hypertensive syndrome and/or symptoms of preterm birth in the adolescent pregnancy

Objetivo: Identificar factores de apoyo y estrés psicosocial en adolescentes embarazadas y establecer la asociación entre estos factores y la presencia o ausencia de síndrome hipertensivo del embarazo (SHE) y/o síntoma de parto prematuro (SPP). Método: Estudio analítico de casos y controles. La muestra estuvo conformada por 146 puérperas adolescentes estratificadas en dos grupos, con y sin SHE y/o SPP durante su gestación. Para describir las variables se realizó un análisis exploratorio de datos utilizando medianas. Para comparar estos valores medios se aplicó la prueba de Mann-Whitney y para el análisis inferencial la prueba X² o Coeficiente V de Cramer. Para determinar el riesgo de presentar el SHE y/o SPP se calculó Odds Ratio. Resultados: Los estresores psicosociales asociados a la presencia de SHE y/o SPP fueron: problemas económicos (OR: 2,46 [1,20 - 5,80]), presencia de agresión psicológica familiar (OR: 4,65 [1,99 -11,30]), presencia de algún evento estresante y/o depresión (OR: 2,84 [1,36 - 5,98]), presencia de alguna enfermedad y/o hospitalización de un familiar de la adolescente (OR: 6,07 [1,85 - 25,68]), y presencia de violencia al interior del hogar (OR: 4,65 [1,95 -11,69]). El apoyo familiar se asocia con ausencia de SHE y/o SPP (p<0,001). Conclusiones: Los estresores psicosociales familiares se asocian a la presencia de SHE y/o SPP, mientras que el apoyo familiar es un factor protector de estas patologías.

Objective: To identify support and stress psychosocial factors in pregnant adolescents and to establish association between those factors and the presence or absence of hypertensive syndrome of pregnancy (HSP) and/or symptoms of preterm birth (SPB). Method: Case-control study. The sample consisted of 146 puerperal adolescent women stratified in two groups: with and without HSP and/or SPB during gestation. In order to describe the variables, an exploratory analysis of data was carried out using median. To compare these mean values, Mann-Whitney test was applied. For the analysis of the inferential variables X² test or Cramer's V coefficient was applied. To determine the risk of HSP and/or SPB, the Odds Ratio (OR) was calculated. Results: Psychosocial stressors associated with the presence of HSP and/or SPB are: economic problems (OR: 2.46 [1.20 - 5.80]), presence of family psychological aggression (OR: 4.65 [ 1.99 - 11.30]), presence of a stressful event and/or depression (OR: 2.84 [1.36 - 5.98]), presence of disease and/or hospitalization of a relative of the teenager (OR: 6.07 [1.85 - 25.68]), and presence of violence within the home (OR: 4.65 [1.95 -11.69]). The family support is associated with the absence of HSP and/or SPB (p<0.001). Conclusions: Family psychosocial stressors are mainly associated with the presence of HSP and/or SPB, meanwhile family support is a protective factor for these pathologies.

Percepção materna com o nascimento prematuro e vivência da gravidez com pré-eclampsia / Maternal perception of premature birth and the experience of pre-eclampsia pregnancy

OBJETIVO: Analisar a vivência materna diante de gravidez com pré-eclampsia e com recém-nascido prematuro hospitalizado em unidade de terapia intensiva neonatal. MÉTODOS: Estudo qualitativo com a utilização da técnica do grupo focal, realizado com 28 mulheres em maternidade referência para gestações de risco no Rio Grande do Norte, em 2004. As mães incluídas tiveram gravidez com pré-eclampsia e parto pré-termo e conseqüente internação do recém-nascido em Unidade de Terapia Intensiva Neonatal. Os dados foram analisados por meio da técnica análise de conteúdo temática categorial, abordando três núcleos temáticos: informações sobre a pré-eclampsia no pré-natal; vivências com o recém-nascido pré-termo; e a percepção das usuárias sobre o atendimento dos profissionais. RESULTADOS: Os relatos maternos evidenciaram o desconhecimento das participantes sobre a pré-eclampsia e sua associação com a prematuridade. Foram detectadas dificuldades inerentes à definição do papel materno nos cuidados com o filho, acentuadas pelas falhas na relação entre os profissionais de saúde e os usuários. CONCLUSÕES: Parte das dificuldades vividas pelas mães no contexto da pré-eclampsia e da prematuridade foram agravadas pela ausência de informação ou inadequação para o entendimento das usuárias. Os resultados mostram que dificuldades vividas por mães no contexto da pré-eclampsia e da prematuridade são agravadas pela ausência de informação ou inadequação para o seu entendimento.

OBJECTIVE: To analyze maternal experiences of preeclampsia pregnancy with premature birth at a neonatal intensive care unit. METHODS: A qualitative study using the focus group technique was conducted with 28 women in a facility specialized in high-risk pregnancies in the state of Rio Grande do Norte, Northeastern Brazil, in 2004. Mothers included had had preeclampsia during pregnancy and a preterm delivery with consequent hospitalization of their baby at a neonatal intensive care unit. The data were analyzed using thematic content analysis of three thematic nuclei subjects: information about preeclampsia during prenatal care; experiences with the preterm newborn, and their perception of neonatal intensive care unit professionals' attitudes. RESULTS: Maternal reports showed subjects' lack of knowledge with regard to preeclampsia and its association with prematurity. Difficulties inherent to the maternal role of caring for the child in the neonatal intensive care unit were identified, accentuated by communication flaws between health professionals and users. CONCLUSIONS: Some difficulties experienced by the mothers, in the context of preeclampsia and prematurity, were aggravated by lack or inadequacy of information provided to the users.

Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor.

This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.

[Psychosocial environment and premature birth]. / Environnement psychosocial et naissance prématurée.

For about twenty years, prematurity has been the subject of many preventive actions. In spite of the elaboration of different screening programmes, preterm deliveries rate doesn't decrease. Some somatic risk factors are now known and are the subject of an unconditional screening in prenatal consultation. However we consider that the etiology of many preterm deliveries remain unknown and 55% of preterm cases could be idiopathic without any explanation of pathological order. The clinical observation suggests the existence of a link between preterm delivery and the psychosocial environment of the pregnant woman. According to that suggestion, they are now making a study in the university obstetrical service of the CHR Citadelle (Liège). The first part of the research has enabled to identify different risk factors such as: illegitimate pregnancy, future mother living alone, unemployed husband, no wage, stress, earlier miscarriage, social isolation, less than 2 years between 2 babies, bad satisfying pregnancy on a psychological and/or physical point of view. According to the study and literature results, a psychosocial risk screening overview has been elaborated. It would permit to identify the cases leading surely to a preterm delivery. That study is financed by a convention between the "Ministère de la Culture et des Affaires sociales de la Communauté française".

[Intrauterine growth retardation and premature delivery. The effect of smoking and psychosocial factors]. / Intrauterin vaeksthaemning og praematur fødsel. Effekten af rygning og psykosociale faktorer.

The purpose of the study is to investigate the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol and smoking on intrauterine growth retardation and premature delivery. At a Copenhagen university hospital 2432 consecutive Danish-speaking women in 20th week of pregnancy completed a questionnaire including the General Health Questionnaire and Severity of Psychosocial Stressor Scale and questions about social network, education, smoking and drinking habits. In 212 cases (8.7%) the women delivered before day 259 of gestation. In a multiple logistic regression model, pre-term delivery proved to be associated with psychosocial stress and poor school education. In 152 cases (6.3%) infants had a birth weight below the defined 10th percentile. In a multiple logistic regression model, IUGR was associated with smoking. In preventive programmes, such as anti-smoking campaigns, it should be kept in mind that women who smoke are also the least educated and have the poorest support from a social network.

Parto pré-termo: análise dos aspectos psicológicos / Pre-term birth: analisys of psychological aspects

Este estudo teve como objetivo analisar qualitativamente os fatores psicológicos associados ao parto pré-termo. Foram estudados vinte pacientes, assistidas no Departamento de Obstetrícia e Ginecologia da Santa Casa de Sao Paulo, no período de setembro de 1994 a junho de 1995, nas quais nao foi possível a identificaçao de fator causal de parto pré-termo. Como instrumento de pesquisa, foram utilizados um questionário e a prova gráfica do Desenho da Figura Humana de Karen Machover. Dificuldade em identificar-se com o papel de mae, adaptaçao emocional insuficiente à maternidade, dificuldade em lidar com situaçoes de estresse, as quais refletiram um aumento no nível de ansiedade, foram aspectos que apresentaram significativa associaçao nos casos estudados. A realizaçao sistemática de pré-natal e a falta de intercorrências clínicas foram elevadas, reafirmando que o cuidado pré-natal merece ser ampliado, isto é, prestar assistência nao só médico-obstétrica, mas também psicológica.