ABSTRACT
BACKGROUND: Baby blues, a mood alteration, occurs in 30 to 80 % of the women during the first two weeks after childbirth. We evaluated if the frequency of baby blues can be influenced by oral and written information about these mood alterations. We wanted to find out whether information about postpartum depression could make these woman realize their own possible depression and therefore seek professional help more rapidly. PATIENTS AND METHODS: In a prospective randomized study German-speaking women were randomized on the second or third day after childbirth in our institution into an "information group" and a "control group". The first group was given oral and written information about baby blues and postpartum depression. Both groups were evaluated by Edinburgh Postpartum Depression Scale (EPDS) translated into German 3 days, 6 weeks and 3 months postpartum, by a visual-analogue questionnaire covering the first 6 weeks and by a self-report covering the whole period postpartum after 3 months. RESULTS: We obtained valuable information from 169 women. Only 12 (15 %) women of the "information group" experienced a baby blues vs. 25 (29 %) of the "control group" (RR 0.55, P = 0,027, CI 0.28 - 0.93). Concerning postpartum depression, no significant difference could be seen. The percentage of scores above 11 in the EPDS around birth was 8.5 % vs. 9.3 % in the information vs. control group. 6 weeks after birth the percentages were 7.5 vs. 7.1 % and 12 weeks after birth they were 7.3 % vs. 8.0 %. Of the women considering themselves as depressive by self evaluation 3 months postpartum, only a few sought help from a specialist: 7 of 13 in the Information vs. 4 of 14 in the control group. The difference is not statistically significant. CONCLUSION: We conclude that oral and written information about baby blues given postpartum can be an effective instrument to lower its frequency. No difference in postpartum depression could be registered - either in prevalence or in seeking professional help.
Subject(s)
Depression, Postpartum/epidemiology , Depression, Postpartum/prevention & control , Patient Education as Topic/statistics & numerical data , Risk Assessment/methods , Self-Assessment , Adolescent , Adult , Data Collection , Depression, Postpartum/diagnosis , Female , Germany/epidemiology , Humans , Middle Aged , Pregnancy , Psychiatric Status Rating Scales , Risk FactorsABSTRACT
BACKGROUND: Breast abscesses have usually been treated by incision and drainage. During the past 10 years conservative treatment with repeated ultrasound-guided drainage to evacuate the abscess combined with antibiotic treatment has become a valuable alternative. PATIENTS AND METHODS: From 1991 to 2003 the authors treated 17 patients with puerperal abscess with this method. Under local anesthesia with ultrasound guidance a thick needle (preferably a Venflon) is introduced into the cavity. The procedure is repeated every two or three days until the ultrasound image demonstrates a diameter of the cavity of 1.5 cm or less. The oral antibiotic treatment lasts for 6 to 10 days. RESULTS: In 7 cases only one puncture was needed, 5 cases needed 2 punctures while 4 women needed 3 or more punctures (up to 5). In 16 cases an open drainage could be avoided. One patient wanted to discontinue the conservative treatment after the first puncture and requested the surgical drainage. CONCLUSIONS: Conservative therapy with ultrasound-guided drainage of puerperal breast abscesses can therefore be recommended as a standard treatment.
Subject(s)
Abscess/diagnostic imaging , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Drainage/methods , Mastitis/diagnostic imaging , Mastitis/therapy , Abscess/drug therapy , Abscess/surgery , Combined Modality Therapy , Female , Humans , Mastitis/drug therapy , Mastitis/surgery , Puerperal Disorders/diagnostic imaging , Puerperal Disorders/drug therapy , Puerperal Disorders/surgery , Puerperal Disorders/therapy , Surgery, Computer-Assisted/methods , Treatment Outcome , UltrasonographyABSTRACT
BACKGROUND: Perinatal neonatal mortality is increased where there is a maternal history of cesarean section (0.45 vs. 0.31 % in deliveries after previous vaginal delivery). In this study we have analyzed the causes of the perinatal deaths. PATIENTS AND METHODS: The increased risk was found by analyzing the database of the Swiss Working Group of Obstetric and Gynecological Institutions with its 29 046 deliveries with a history of previous cesarean section between 1983 and 1996. In this time period 130 perinatal neonatal deaths in deliveries after previous cesarean were recorded. RESULTS: The cause of death could be established in 124 cases. In the 42 term deliveries the causes of death were the following: malformations 20, uterine rupture 5, placental abruption 5, respiratory distress syndrome 5, and other causes 7. In the 82 preterm deliveries: prematurity caused by premature contractions/rupture of membranes 38, malformations 12, chorioamnionitis 12, placental abruption 9, severe growth retardation 4, complications of placenta praevia 2, uterine rupture 1, other causes 4. DISCUSSION: Preterm deliveries are more frequent (in births) after a previous c/s (7.75 vs. 5.55 % in multiparous mothers without previous cesarean) - not because of a higher frequency of preterm labor or premature rupture of membranes, but because of placental abruption, chorioamnionitis, placental insufficiency and severe growth retardation. Although some of the neonatal deaths are linked to the previous cesarean delivery, perinatal death after previous cesarean is a very rare event. A recommendation to routinely perform a repeat cesarean instead of a trial of labor seems not appropriate.
Subject(s)
Cause of Death , Infant, Premature, Diseases/mortality , Vaginal Birth after Cesarean/mortality , Cesarean Section, Repeat/mortality , Female , Humans , Infant, Newborn , Male , Pregnancy , Risk , Switzerland/epidemiologyABSTRACT
Symptoms of autonomic hyperreflexia in patients with complete and incomplete paraplegia above D 7 can be caused by almost any stimulus in the abdominal area or in the lower extremities, specifically during parturition by the uterine contractions. The symptoms vary from pilo-erection and outbreaks of sweating to serious blood pressure crises and cerebrovascular accidents. Epidural anaesthesia and general anaesthesia are effective as therapy and also as prophylaxis. Frequent complications are anemia and urinary tract infections. Changes in bladder function as a result of pregnancy and childbirth were observed. Paraplegic expectant mothers experience premature labour pains more frequently than do others, and this implies the necessity for earlier clinical surveillance up to the time of delivery. The secondary uterine inertia frequently requires an operative termination of the birth. The perception of labour pains is clearly possible also with lesions above D 10.
