Post-traumatic Stress Disorder Post Partum: The Impact of Birth on the Prevalence of Post-traumatic Stress Disorder (PTSD) in Multiparous Women.

Traumatic birth experiences may lead to serious psychological impairment. Recent studies show that a considerable number of women can develop post-traumatic stress disorder (PTSD), in some cases in a subsyndromal form. Until now, the possibility that postpartum psychological symptoms might be a continuum of a pre-existing disorder in pregnancy has rarely been considered. This study therefore aimed to evaluate the proportion of women who develop post-traumatic stress disorder as a result of childbirth. Materials and Methods: 56 multiparous women were recruited for the study. The diagnosis of PTSD was made according to the criteria for psychological disorders in the DSM-IV (Diagnostics and Statistical Manual of Mental Disorders). The data were collected in structured interviews in the 30th to 38th week of gestation and in the 6th week post partum. Results: Of the 56 women participating, 52 (93 %) completed the survey. Uncontrolled results showed that 21.15 % of the multiparous women met the full diagnostic PTSD criteria in the 6th week post partum. After the exclusion of all cases already characterised by all criteria or a subsyndromal form of PTSD caused by previous traumatisation, the PTSD rate was below 8 % at 6 weeks postpartum (= incidence rate of PTSD post partum). Conclusions: The present study is the first prospective longitudinal study to demonstrate the occurrence of full criteria PTSD in multiparous women as a result of childbirth after having excluded pre-existing PTSD. The results of our study show a high prevalence rate of PTSD during pregnancy. A number of women report all aspects of post-traumatic stress disorder as a result of childbirth.

[Diagnosis of premenstrual disorders]. / Diagnostik prämenstrueller Störungen - Deutschsprachige Fassung und Validierung der "Premenstrual Tension Syndrome Observer and Self-Rating Scale" (PMTS-O und -SR Scale) und der Visuellen Analogskala für prämenstruelle Störungen (VAS-PmS).

BACKGROUND AND OBJECTIVE: There is no valid method in the German literature for assessing premenstrual disorders. This study was undertaken to translate into German, validate and test the reliability of the "Premenstrual Syndrome Tension Observer/Self-Rating Scale" and the "Visual Analogue Scale for Premenstrual Disorders". PATIENTS AND METHODS: 55 patients diagnosed with premenstrual dysphoric disorder took part in the study. After fullfilling the inclusion criteria, sociodemographic and medical data were studied. The self-assessment by PMTS-SR and VAS-PmD was done two days premenstrual and nine days postmenstrual by all 55 patients. The objective assessment (done by a clinical interview and the PMTS-O as the reference standard) was obtained afterwards without knowing the self-assessment. RESULTS: The average age of the tested women was 35 years. The average increase of 85 % in premenstrual symptoms (PMTS-O and PMTS-SR scale) indicates a group with severe premenstrual disorders. The correlation coefficient between PMTS-O and PMTS-SR scale, pre- and postmenstrually, was 0.83 and 0.84, respectively (p < 0.0001 for both). The correlation coefficient between PMTS-O and VAS-PmD, pre- and postmenstrually, was 0.5 and 0.69, respectively (p < 0.0001 for both). This was calculated at 0.64 and 0.67, respectively (p < 0.0001 for both) between PMTS-SR and VAS-PmD. Reliability analysis for PMTS-O was, pre- and postmenstrually, 0.71 and 0.29, respectively, for PMTS-SR 0.77 and 0.78, respectively, and for VAS-PmD it was 0.79 and 0.87, respectively. CONCLUSIONS: The German version of the PMTS-O and the PMTS-SR scale are "application friendly" as well as proven to be a valid and reliable method for supporting the diagnosis, course of disease and research aspects concerning premenstrual disorders. Initially VAS-PmD should be used in combination with PMTS-O and PMTS-SR scale.

[Effect of the dopamine antagonist metoclopramide on uterine contraction]. / Einfluss des Dopaminantagonisten Metoclopramid auf die uterine Kontraktilität.

BACKGROUND: Because of its activity on the gastro-intestinal tract metoclopramide is used also in pregnancy, though nothing is known about its effect on the pregnant uterus. Therefore it was of interest to look after a change in uterine activity after the application of metoclopramide in a clinical relevant dose. MATERIALS AND METHODS: 24 strips from pregnant uteri were removed during a cesarean section, brought into an organ chamber and changes of spontaneous activity after the application of metoclopramide were measured. RESULTS: A highly significant decrease of uterine activity was observed. CONCLUSIONS: It was demonstrated that metoclopramide, in contrast to stomach and ureter, exerts not a tonifying but a relaxant effect on the uterus.

Multiple blue nevi of the vagina. A case report.

BACKGROUND: Melanotic lesions of the vagina are very rare; clinically, most are suspected to be malignant melanomas. Occasional benign cases, however, require differential diagnostic consideration. We report a case of multiple (benign) blue nevi of the vagina. CASE: A 51-year-old woman presented with bluish black macules irregularly distributed throughout the vagina. Biopsies revealed pigmented cells in the dermis that proved to be melanocytes. The patient received no therapy. The lesions remained unchanged in the follow-up period. CONCLUSION: Multiple blue nevi could be a differential diagnosis for malignant melanoma of the vagina. Our patient showed no malignant transformation over a 29-year period. Therapy for blue nevi in the vagina does not require complete excision.

Neopterin is an independent prognostic variable in females with breast cancer.

BACKGROUND: Neopterin, produced by human monocytes/macrophages upon stimulation by interferon-gamma, is a sensitive marker for monitoring Th1-cell immune response in humans. In malignant diseases, the frequency of increases in neopterin in the serum and urine of patients depends on tumor stage and type. METHODS: In a retrospective study comprising 129 females with breast cancer, urinary neopterin/creatinine ratios were measured at the time of diagnosis. Tumor characteristics were determined concomitantly. RESULTS: Urinary neopterin was increased in 18% of the patients. It did not correlate with tumor size or lymph node status, but it was influenced by the presence of distant metastases (P <0.05) and by tumor differentiation (P = 0.01). When product-limit estimates were calculated after follow-up for up to 13 years (median follow-up, 56 months), the presence of distant metastases (P <0.001), neopterin (P <0.001), tumor size (P = 0.001), and lymph node status (P <0.01) were significant predictors of survival. By multivariate analysis, a combination of the variables presence of distant metastases (P <0. 001), neopterin (P <0.01), and lymph node status (P <0.05) was found to jointly predict survival. In lymph node-negative patients without distant metastases, the relative risk of death associated with increased neopterin concentrations was 2.5 compared with patients with neopterin concentrations within the reference interval. CONCLUSION: Urinary neopterin provides additional prognostic information in patients with breast cancer.

Early postnatal depressive mood: associations with obstetric and psychosocial factors.

The central purpose of this investigation was to detect incidence and influencing factors on early postnatal depressive mood in a large hospital sample. By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, and obstetric and psychologic variables. The Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive mood of our patients. The interview was carried out on 1250 women at two postnatal wards 5 days after delivery. According to the results of the German validation of the EPDS, where a cutoff of 9/10 indicates at least mild depressive disorder, the whole sample was divided into group A (EPDS score < or = 9; n = 996, 79.7%) and group B (EPDS score > or = 10; n = 254, 20.3%). Early postnatal depressive mood, as assessed by the EPDS, appeared with 20% of all women taking part in our investigation on the fifth postnatal day. Subjective measurements such as high childbirth burden, elevated trait anxiety, low life satisfaction and lower social class, and low birth weight of the infant seem to be of predominant relevance for early postnatal depressive mood.

Retinoic acid modulates prolactin receptor expression and prolactin-induced STAT-5 activation in breast cancer cells in vitro.

Two recent papers demonstrate that prolactin plays an important role in the induction and progression of mammary tumours. Retinoids have been shown to be potent inhibitors of breast carcinogenesis. We studied expression of prolactin receptor mRNA in human breast cancer cell lines MCF-7, SKBR-3, T47D and BT-20 treated with and without retinoids using Northern blot and a quantitative polymerase chain reaction (PCR) method. In all cell lines, all-trans- and 9-cis-retinoic acid, as well as the retinoic acid receptor gamma (RAR-gamma) selective agonists CD2325 and CD437 (1 microM), were able to down-regulate prolactin receptor. After 1 h, a significant reduction was detectable and maximal effect was achieved after 24 h of treatment. Pretreatment with retinoic acid also reduced the prolactin-/prolactin receptor-dependent signal transduction and activation of transcription 5 (STAT-5) activation in T47D cells. Cycloheximide failed to abrogate the retinoic acid-induced decline in prolactin receptor mRNA levels, indicating that this effect was not dependent upon continuing protein synthesis. Similarly, no change in the stability of prolactin receptor mRNA was observed during 12 h of retinoic acid treatment. In conclusion, our results demonstrate that retinoids are able to inhibit the expression of prolactin receptor message, which encodes an important growth factor receptor in breast cancer cells. This action could be responsible for the anti-tumour effects of retinoids.

[Coping with anger and the premenstrual syndrome]. / Argerbewältigung und prämenstruelles Syndrom.

OBJECTIVE: Investigations in recent years confirm the importance of "anger coping-behaviour" for women suffering from different diseases such as migraine, high blood pressure and coronary heart disease. The hypothesis for this investigation was that "anger-in" coping (anger-suppression) is a possible causal factor in the premenstrual syndrome. METHODS: Data analysis was undertaken on 38 patients (average age 32 years) fulfilling the inclusion criteria. The Menstrual Distress Questionnaire (MDQ) was used for measuring the intensity of premenstrual symptoms. As a result of a cluster analysis of MDQ scores, the 38 patients were divided into 3 subgroups (group 1: mild symptoms, n = 16; group 2: moderate symptoms, n = 10; groups 3: severe symptoms, n = 12). The 3 groups were compared by using different questionnaires regarding the variables anger, attitudes to menarche and menstrual bleeding, anxiety and depression. Additionally, sociodemographic data were obtained and a daily record taken for 2 days premenstrually and 5 day postmenstrually of subjective replies to a standardized protocol. RESULTS: Contrary to our expectations the results showed no significant differences for "anger coping" between the 3 subgroups. Increased daily stress (professional and familial double load) statistically significantly influenced the intensity of premenstrual symptoms. Additional significant factors were a general tendency towards somatization disorder, a negative attitude toward menarche and menstrual bleeding, as well as a tendency to depressive mood in patients with severe premenstrual symptoms. CONCLUSION: Emotional disorders (anger, anxiety) showed less influence on the premenstrual syndrome in the investigated women than daily stress and medical anamnesis.

Childbirth as a biological model for stress? Associations with endocrine and obstetric factors.

OBJECTIVE: The aims of this investigation were to measure corticotropin-releasing hormone (CRH), corticotropin (ACTH) and cortisol before, during and after delivery searching for an endocrine intercorrelation of the hypothalamic-pituitary-adrenal (HPA) axis and to correlate these findings with obstetrical variables. METHODS: Blood was sampled from 50 women with singleton pregnancies at term without uterine contractions, during delivery (after full cervical dilatation) and on the 4th postnatal day. Hormones were measured by radioimmunoassay (RIA). The correlation between obstetric variables, sociodemographic and endocrine data were evaluated using the Spearman rank coefficient. Group comparisons for continuous variables were calculated using the Mann-Whitney U test and Kruskal-Wallis test. RESULTS: Maternal plasma ACTH and cortisol increased significantly during labor, declining toward the 4th postnatal day (p < 0.001) and showing a significant intercorrelation (p < 0.01). Compared to women without uterine contractions CRH rose during labor (p < 0.05) and decreased rapidly to the 4th postnatal day (p < 0.001). No correlations between CRH and ACTH or cortisol were observed. None of the obstetrical variables (parity, newborn's weight, duration of delivery) revealed any significant correlation with ACTH. Analgetic medication (pethidine hydrochloride) was not able to influence the endocrine response to labor stress. CONCLUSIONS: Stressful experience during childbirth has an impact on endocrine response. However, this is not fully evident along the HPA axis in a simple biological model with monocausal dependencies. This 'biological stress model' is not sensitive enough to detect different childbirth conditions and the hormones in the maternal compartment have partially fetal (placental) origin.

[Effect of interleukin 6 on uterine contractility in the human in vivo]. / Der Einfluss von Interleukin-6 auf die uterine Kontraktilität beim Menschen in vivo.

The influence on uterine contractility of inflammatory cytokines like interleukin-6 is widely unknown. We were able to demonstrate in 16 human myometrial strips obtained during caesarean section in the organ chamber a highly significant (P < 0.001) increase of the activity of uterine strips after addition of IL-6. This further emphasizes the importance of subclinical infections for the etiology of so called idiopathic preterm labour.

[Induction of uterine contractions by Shigella]. / Induktion uteriner Kontraktionen durch Shigellen.

The uterus-contracting properties of Shigellae in a clinically relevant dose of 10(5) organisms per ml was investigated in 17 uterine strips which where dissected during caesarean section from the lower uterine segment. A highly significant (p < 0.001) increase in uterine activity was observed.

[German language version and validation of the Edinburgh postnatal depression scale]. / Deutschsprachige Fassung und Validierung der "Edinburgh postnatal depression scale".

BACKGROUND AND OBJECTIVE: There is no valid method in the German literature for assessing postpartum depressive disorders. This study was undertaken to translate into German, validate and test the reliability of the Edinburgh postnatal depression scale (EPDS). PATIENTS AND METHODS: Randomly selected women after childbirth (n = 110) underwent (on the fourth postpartum day) a semistructured interview after first having answered the translated EPDS questionnaire. The diagnosis of depressive disorder was made according to the the criteria for psychological disorders in the ICD-10. For validation the results of the EPDS were compared with the clinical diagnosis of depression. The calculation of sensitivity, specificity and positive prognostic value was related to the respective EPDS results. In addition the EPDS data were analyses as to their reliability. RESULTS: The average age of the tested women was 28.6 years; 72% were married and 45% were primiparae. For an EPDS total score threshold value of 9.5 the sensitivity was 0.96, the specificity 1.0, and a positive prognostic value of 1.0. In the reliability analysis for EPDS the Guttmann split-half reliability was 0.82 and the alpha-coefficient 0.81. CONCLUSIONS: The German version of the EPDS with ten questions is an "application friendly" as well as proven to be a valid and reliable method for supporting the diagnosis of postpartum depressive disorder. It is suitable for both clinical and research use.

[Prevalence of depressive disorders in early puerperium]. / [Prävalenz depressiver Störungen im frühen Wochenbett]

OBJECTIVE: The aims of this investigation were to detect the prevalence and influencing factors of early postpartal depressive disorders in a large hospital sample. METHODS: By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, obstetric and psychological variables. The German version of the Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive disorder of our patients. The interview was carried out on 1,250 women at the maternity ward 5 days after delivery. RESULTS: According to the results of the German validation of the EPDS, 254 (20.3%) women at the maternity ward had an at least mild depressive disorder. A comparison between nondepressed women (n = 996, 79.7%) and depressed women (n = 254, 20.3%) revealed the following risk factors for the development of an early postpartal depressive disorder: higher subjective burden of childbirth, higher trait anxiety, poorer couple compatibility, lower job satisfaction and lower social status. Of all the obstetric variables previous abortions, elevated pregnancy risks, low weight of the newborn at delivery and cesarean section were of significant influence. CONCLUSIONS: Early postpartal depressive disorder appears in 20% of all women 5 days after delivery. According to previous studies this group seems to be at highest risk for developing a later postpartum depression. Considering the psychosocial and obstetric risk factors, preventive psychotherapeutic interventions at the maternity ward are indicated.

Spontaneous abortion and psychosomatics. A prospective study on the impact of psychological factors as a cause for recurrent spontaneous abortion.

A group of 36 patients who had had at least two consecutive spontaneous abortions and who desired to have children was subjected to a psychosomatic investigation before a biomedical diagnostic screening programme was started. A semi-structured interview regarding sociodemographic data, current relationship, social support, education, occupation and medical anamnesis was carried out. In addition, all women completed four standardized questionnaires on the topics of anxiety, somatization disorder, life satisfaction and depression. A control group of 36 women, matched for age and occupation, was subjected to the same psychosomatic investigation. The findings of the diagnostic screening programme showed that 16 women had abortions because of physical abnormality, and 15 women had no physically confirmed cause (in five women, the investigations were not completed). Following recurrent spontaneous abortion, 18 women had a successful pregnancy within 2 years, and 18 women were still childless. The comparison between patients and the control group revealed that patients with recurrent abortion were significantly more satisfied with their life quality regarding leisure time, financial situation and occupation. No significant differences were observed in any other variables. Patients who suffered spontaneous abortions due to a physical disorder showed partner relationship of longer duration, and more frequent miscarriages. Women with successful pregnancy within 2 years after recurrent miscarriage were significantly younger and had fewer physically related abortions compared with women who remained childless. In summary, psychological factors seem to be of subordinate importance as a cause for recurrent spontaneous abortion. Moreover, physical abnormalities in the reproductive system have a predominant impact on the prediction of a future successful pregnancy.

[10 years after Chernobyl--radioactivity of mother's milk-- measurements from Tirol, Tibet and Nepal]. / 10 Jahre nach Tschernobyl--Strahlenbelastung der Muttermilch--Messungen aus Tirol, Tibet und Nepal.

10 years after the Chernobyl disaster gamma radioactivity from Cs-137 was determined in 53 breast milk samples from Tyrol, as well as 9 samples from Tibet and 2 from Nepal by means of a gamma-spectrometer with a germanium detector. In contrast to the values obtained within a few days, and again 1 year after the nuclear plant catastrophe, all samples from Tyrol showed gamma radioactivity levels (median 0.07 nCi/l; range 0.02-0.20 nCi/l) which were now below the limit laid down for baby food in Austria (0.3 nCi/l-11.1 Bq). The samples from Tibet and Nepal registered a slightly higher level of gamma radioactivity (median 0.16 nCi/l; range 0.16-0.41 nCi/l).

Tissue polypeptide antigen during parturition and puerperium.

The tumour and cytoskeleton protein tissue polypeptide antigen (TPA) was determined in maternal serum taken during the second stage of labour and on the 4th postpartum day. Pregnant women at term (weeks 38-42) served as a control group. TPA levels of women during parturition (median 169 U/l) were higher than those of the control group (median 108.5 U/l) and those of women on the 4th postpartum day (median 66.5 U/l); p < 0.0001 in each case. The correlation between duration of labour and TPA concentration was positive and significant (rs = 0.3; p = 0.03). A significant negative correlation was found between placental weight and maternal serum TPA levels during parturition (rs = -0.3; p = 0.03). The decline of TPA after delivery indicated a serum half-life for TPA of less than 4 days.

[Effect of dopamine on uterine contraction]. / Wirkung von Dopamin auf die uterine Kontraktilität.

The influence of dopamine on the central nervous system and on the circulation in humans is broadly investigated. As many biogene amines have an effect on the uterus too, this fact was investigated for dopamine. A highly significant (p < 0.001) increase of uterine strips activity could be observed after the application of dopamine 10(-6)M.

[Effect of the calcium antagonist amlodipine on non-vascular smooth muscle exemplified by the uterus]. / Die Wirkung des Kalziumantagonisten Amlodipin an nichtvaskulärer, glatter Muskulatur am Beispiel des Uterus.

The effect of amlodipine, a recently developed calciumantagonist on 21 uterine strips was investigated. Uterine activity, expressed by the area under the curve was depressed from 504 (51 to 1056) mm2 to 0 (0 to 130) 10 min after the application of amlodipine. After 20 and 60 min, the values were 0 (0 to 1310) and 0 (0 to 317) (median, 10th and 90th percentile). The decrease of uterine activity was highly significant (p < 0.0001). In summary, amlodipine exhibits a prompt and excellent relaxation on the spontaneous contractions of uterine strips.