The healthy moms and babies app to prevent postpartum depression: analysis of user-profiles and dropout cases.

Introduction: Perinatal depression affects mothers, babies and society. Preventive interventions are needed, but face barriers to access. E-health interventions could be an effective and accessible option. To date, few studies have attempted to understand the use of mobile health (m-health) applications and why they are not more widely used. This study aims to understand the demographic characteristics of enrolled participants and examine dropout patterns through the Healthy Moms and Babies app. Methods: A longitudinal study was conducted with a sample of 511 women recruited between 2020 and 2022. Data were collected from the app, including sociodemographic information, the participant's progress through the modules of the app, and the permissions granted to use the app. Results: Out of the 511 women who completed the initial form to initiate participation, 279 downloaded the app and completed the evaluation. Results indicated that granting permission to be notified about the module's availability is related to an increase in the use of the first modules. Conclusion: This study shows the importance of establishing follow-ups in the use of mobile apps during the perinatal period.

Psychological, Psychosocial and Obstetric Differences between Spanish and Immigrant Mothers: Retrospective Observational Study.

This study analyzed the influence of psychological and psychosocial factors of pregnant women at an obstetric level. The possible differences between Spaniards and immigrants were studied. This was a retrospective observational study. The sample has been divided into two study cohorts, one consisting of Spanish pregnant women and one consisting of foreign pregnant women. Both completed the Revised Postpartum Depression Predictors Inventory and the Patient Health Questionnaire-9. A total of 15.9% of Spanish women and 23.2% of immigrants had depressive symptoms. Immigrants claim to have less support at the partner, family, and friendship levels than Spaniards. Moreover, 16.4% of Spaniards vs. 8.1% of immigrants had pregnancy complications; Cesarean section was performed in 16.2% of Spaniards vs. 7.9% of immigrants. A greater number of premature births were detected in immigrants than in Spaniards. Access to universal healthcare is a protective factor against socioeconomic and cultural conditions affecting the mental and obstetrical health of immigrants.

Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences.

BACKGROUND: Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention. AIMS: This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy. METHOD: A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed. RESULTS: The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found. LIMITATIONS: The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject. CONCLUSIONS: This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.

Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences

Abstract Background: Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention. Aims: This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy. Method: A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed. Results: The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found. Limitations: The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject. Conclusions: This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.

Catastrophic antiphospholipid syndrome during pregnancy.

Catastrophic antiphospholipid syndrome (CAPS) is an uncommon and the most severe form of antiphospholipid syndrome (APS). A 33-week pregnant patient with Klippel-Trenaunay syndrome, past SARS-CoV-2 infection and type I fetal growth restriction with shortening of the fetal long bone was diagnosed in our center with a probable CAPS. Cesarean section was performed four days after the diagnosis due to the torpid evolution of the patient. Clinical improvement was noted a few days later and the mother and baby were discharged within a week. We review the current literature on CAPS during pregnancy and provide an updated view.

The Psychometric Properties of the Patient Health Questionnaire-4 for Pregnant Women.

Background: Perinatal anxiety and depression are common complications during pregnancy. The purpose of this study was to examine the item characteristics, reliability, validity, and factorial structure of the four-item Patient Health Questionnaire-4 (PHQ-4) and to determine the associations between scale scores and sociodemographic factors in a sample of pregnant women from Spain. Method: A total of 845 pregnant women were recruited from two public hospitals in Spain between 2014 and 2016. Participants completed a self-report questionnaire that included Patient Health Questionnaire-4, including the two-item Patient Health Questionnaire and the two-item Generalized Anxiety Disorder Screener. Results: Exploratory and confirmatory factor analysis and scale inter-correlations between the PHQ-4 and PHQ-9 revealed that the PHQ-4 has a bivariate structure and adequately assesses the dimensions of antenatal anxiety and depression. Conclusion: The PHQ-4 is a reliable and valid instrument to screen for depression and anxiety during pregnancy. The PHQ-4 is an ultra-brief measure that can be used to screen for antenatal depression and anxiety to prevent the negative consequences associated with these mental health conditions among mothers and infants.

Prolapsed cervical myoma during pregnancy.

Prolapsed submucosal myomas during pregnancy are uncommon, and few cases of patients undergoing vaginal myomectomy during pregnancy have been reported. In our center, a 13 weeks pregnant patient with prolapsed cervical myoma was diagnosed. Because of intermittent vaginal bleeding, surgery was scheduled at 13 weeks and 5 days of pregnancy. A vaginal myomectomy was performed. The postoperative course was uneventful. Cervical leiomyomas and prolapsed submucosal leiomyomas in pregnancy are rare clinical entities, and the literature is comprised of only case reports. We reviewed the current literature in regard to prolapsed cervical leiomyomas in pregnancy and provide an updated vision of the literature.

The Prevalence and Risk Factors for Antenatal Depression Among Pregnant Immigrant and Native Women in Spain.

Introduction: The aim was to examine the risk factors of anternatal depression among immigrant and native pregnant women in Spain. Method: A total of 1,524 pregnant women completed the Patient Health Questionnaire and the Postpartum Depression Predictors Inventory-Revised form. Results: The native group reported a lower prevalence (15.2%) compared with immigrant group (25.8%). For immigrants, primiparity, moving, and perceived lack instrumental support from friends or emotional support from partners and family members were significant risk factors. Discussion: The study identified risk factors that can be used for preventive interventions during pregnancy. Significance: Screening and interventions for depression during pregnancy should take migration status into account to maximize effective health care. Also, health providers should consider how migration status can result in different risk factors that affect depression during pregnancy.

Preventing perinatal depression in Spain: a pilot evaluation of Mamás y Bebés.

Objective: This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of a cognitive-behavioural intervention to prevent perinatal depressive symptoms in pregnant women at high risk for perinatal depression in Spain. Background: Perinatal depression (PD) can negatively affect maternal and infant outcomes. Mamás y Bebés/The Mothers and Babies Course (MBC) is an evidence-based CBT intervention aimed at teaching women at high risk for depression mood regulation skills to prevent depression in the United States, including Spanish-speaking perinatal women in the United States. However, there is limited research on preventive interventions for PD in Spain. Method: Pregnant women screened for high risk for PD were recruited in their first trimester in an obstetrics clinic at two urban hospitals in Spain. In a non-experimental design, 30 women completed eight weekly group sessions of the MBC. The Patient Health Questionnaire was the main depression outcome at four time points: pre-intervention, post-intervention, and at 3 months and 6 months postpartum. Participants completed an evaluation questionnaire at the end of each session to assess the acceptability of the intervention. Results: The MBC was effective in reducing depressive symptoms from baseline to all three time points: post-intervention, 3 and 6 months postpartum. Attendance was high (76.7% attended all eight sessions). Mothers reported positive feedback from the participating in the MBC. Conclusion: This pilot study suggests that the intervention is feasible, acceptable, and provides promising evidence for reducing depressive symptoms in urban Spanish perinatal women. Larger and rigorous randomised trials are needed to confirm these findings.

Low levels of PAPP-A and perinatal complications / Niveles bajos de PAPP-A y complicaciones perinatales

Objective: the main objective was to assess the rate of occurrence of adverse perinatal events in patients with low levels of PAPP-A in the first trimester of pregnancy. The secondary objectives were to identify the route of delivery and mean gestational age at the end of pregnancy, identify the reasons for cesarean delivery, and conduct a follow-up protocol in patients with low PAPP-A. Material and methods: we performed a longitudinal, observational, prospective, descriptive, and analytical study of 450 pregnant women with PAPP-A <0.4 MoM between January 2009 and December 2015 at Hospital Clínico San Carlos. Results: obstetric complications were detected in 71.6% of pregnant women with PAPP-A <0.4 MoM. The main complication was gestational diabetes (37.7%), followed by hypertensive disorders (20%) and impaired fetal growth (11.6%). The mean gestational age at the end of pregnancy was 37 weeks. With regard to the route of delivery, 70% of patients had a vaginal delivery, while 30% of patients had a cesarean delivery. The 3 main reasons for cesarean delivery were elective cesarean (9%), suspected loss of fetal wellbeing (8.7%), and HELLP syndrome (4.9%). Conclusions: adverse events were very frequent in patients with low levels of PAPP-A (70%). Low PAPP-A could be used as a predictor of obstetric complications, since it is now determined in almost all pregnant women. Interpretation of PAPP-A findings could favor the progress of pregnancy, with no increased cost per patien

Objetivo: evaluar el porcentaje de aparición de eventos adversos perinatales en pacientes con PAPP-A baja en el primer trimestre del embarazo. En segundo plano, identificar la vía y edad gestacional media de finalización de la gestación. Establecer las causas de las cesáreas. Realizar un protocolo de seguimiento en pacientes con PAPP-A baja. Material y métodos: Estudio longitudinal, observacional, prospectivo, descriptivo y analítico. Se evaluó a 450 gestantes con PAPP-A < 0,4 MoM, en el periodo comprendido entre Enero 2009 y Diciembre 2015 en el Hospital Clínico San Carlos. Resultados: El 71,6 % de las gestantes con PAPP-A < 0,4 MoM presentaron complicaciones obstétricas. La principal complicación fué la diabetes gestacional (37,7%), en segundo lugar trastornos hipertensivos (20%) y en tercer lugar, alteraciones del crecimiento fetal (11,6 %). La edad media fin de gestación fueron las 37 semanas. Con respecto a la vía de parto, el 70% de las pacientes tuvieron un parto vaginal, mientras que el 30% terminaron la gestación mediante cesárea. Las tres principales causas de la cesárea fueron cesárea electiva (9%), sospecha de pérdida de bienestar fetal (8,7%) y síndrome Hellp (4,9%). Conclusiones: El porcentaje de eventos adversos en nuestras pacientes con PAPP-A baja fué elevado, presentándolos aproximadamente 7 de cada 10 gestantes. La PAPP-A baja se podría utilizar como predictor de complicaciones gestacionales, ya que se determina hoy en día en casi todas las gestantes, y su interpretación podría favorecer la evolución de la gestación, sin un aumento del coste por embarazada

Prevention and treatment of fetal cytomegalovirus infection with cytomegalovirus hyperimmune globulin: a multicenter study in Madrid.

INTRODUCTION: Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection. MATERIALS AND METHODS: A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009-2015, CMV-HIG (Cytotect® CP Biotest, Biotest) treatment was offered to all pregnant women with primary CMV infection and/or detection of CMV-DNA in amniotic fluid in participating centers. Women were divided into prevention and treatment groups (PG and TG, respectively). Those with primary CMV infection who had not undergone amniocentesis comprised the PG and received monthly CMV-HIG (100 UI/kg). If CMV-DNA was subsequently detected in amniotic fluid, one extra dose of CMV-HIG (200 UI/kg) was given 4 weeks after the last dose. Those women were considered to be part of the PG group despite detection of CMV-DNA in amniotic fluid. In the case of a negative result in CMV-DNA detection in amniotic fluid or if amniocentesis was not performed, monthly HIG was given up to the end of the pregnancy. RESULTS: Thirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38-40) and two children (5.5%) were premature (born at 28 and 34 weeks' gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3-1185; p = .007). DISCUSSION: Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.

The structure of the Patient Health Questionnaire-9 in pregnant women in Spain.

OBJECTIVE: To evaluate psychometric properties and the factor structure of the Spanish version of the Patient Health Questionnaire (PHQ-9) in pregnant women received care in an urban public hospital in Spain. RESEARCH DESIGN/SETTING: In a cross-sectional study, the reliability and factor structure were examined. Exploratory and confirmatory factor analyses were conducted to examine the latent structure of the PHQ-9 with a pregnant Spanish-speaking sample (n = 445) recruited during the first trimester in an obstetrics clinic in Madrid. MEASUREMENTS AND FINDINGS: The Spanish version of PHQ-9 had moderate internal consistency (α = 0.81). Exploratory factor analysis revealed a two-factor (cognitive-affective, somatic) and three-factor (cognitive-affective, somatic, pregnancy-related) structure of the PHQ-9, whereas confirmatory factor analyses support a three-factor model (cognitive-affective, somatic, pregnancy-related) as the best fit to the data. KEY CONCLUSIONS: The Spanish version of PHQ-9 is reliable and can be used to screen for depression during pregnancy. A three-factor model structure is adequate to evaluate the components and symptoms of depression for Spanish pregnant women. IMPLICATION FOR PRACTICE: Midwives can screen for depression during the PHQ-9 and can tailor interventions to minimize the adverse effects on mothers and infants, before and after birth.

[Psychometric properties of postpartum depression predictors inventory- revised- prenatal version in a sample of spanish pregnant women.] / Propiedades psicométricas del Postpartum Depression PredictorsIinventory- revised- versión prenatal en una muestra española de mujeres embarazadas.

OBJECTIVE: Prenatal depression is a major public health problem, therefore predicting and preventing it is a relevant objective for public health agendas. Consequently, it is important to have adequate screening tools to detect risk factors associated with prenatal depression. The aim of this study was to evaluate the psychometric properties reliability and factor structure of the Spanish version of the Postpartum Depression Predictors Inventory- Revised- Prenatal Version (PDI-R) in pregnant women who attend prenatal care in an urban hospital in Spain. METHODS: The sample was formed of 445 women receiving prenatal care in an obstetrics clinic in an urban public hospital in Madrid, Spain. The internal consistency of PDPI-R was assessed by measuring Cronbach's Alfa index, calculating the COR curve and percentiles for this sample. RESULTS: The PDPI-R showed good internal consistency in this sample (Cronbach's Alfa = 0,855). The area under the COR curve is 0,84 p≤0,001. Sensibility and specificity values were 62,3% and 69,5% respectively, and the cut-off point with greatest sensibility and specificity was 4. CONCLUSIONS: The PDPI-R is reliable and can be used to screen for risk factor for depression during pregnancy.

OBJETIVO: La depresión postparto es un importante problema de salud pública por lo que su predicción y prevención es un objetivo relevante de las agendas de salud pública. Para ello es importante disponer de herramientas de cribado de los factores de riesgo asociados a la depresión post-parto. El objetivo de este trabajo fue evaluar las propiedades psicométricas del Inventario Predictor de la Depresión Postparto-Versión Revisada-Prenatal (PDI-R) en su versión en lengua española en relación con la fiabilidad de sus puntuaciones en mujeres embarazadas que acuden a la atención prenatal en un hospital urbano de España y en cuanto a su estructura factorial. METODOS: Se dispuso de una muestra de 445 mujeres que reciben atención prenatal en una clínica de obstetricia en un hospital público urbano de Madrid, España. En esta muestra se analizó la consistencia interna del PDI-R mediante el coeficiente alfa de Cronbach además de realizar un análisis de curva ROC y percentiles de la muestra. RESULTADOS: Los resultados del PDPI-R en esta muestra indicaron satisfactorios valores de consistencia interna (alfa de Cronbach = 0,855). El área bajo la curva del PDPI-R fue de 0,84 p≤0,001. Con el punto de corte de 4 la sensibilidad y especificidad fueron de 62,3% y 69,5% respectivamente. CONCLUSIONES: El PDPI-R es adecuado y puede utilizarse para detectar el factor de riesgo de depresión durante el embarazo.

Depresión perinatal: rentabilidad y expectativas de la intervención preventiva / Perinatal depression: Profitability and expectations of preventive intervention

No disponible

[PHQ-2 as First Screening Instrument of Prenatal Depression in Primary Health Care, Spain]. / PHQ-2 como primer instrumento de cribado de la depresión prenatal.

OBJECTIVE: Prenatal depression is a major public health problem that is barely treated. Based on existing literature, depression during this period is associated with negative consequences for the mother and the baby. Therefore it is important to make an adequate screening in this population. The aim of this study was to determine the discriminant validity and cut-off of the Patient Health Questionnaire (PHQ-2) as a screening tool to identify the depression in pregnant women living in Spain. METHODS: The sample included 1,019 female participants, aged between 19 and 45 years, who participated voluntarily, and received prenatal care during the first trimester. Participants completed a sociodemographic questionnaire, PHQ-2 andPHQ-9. The research has been developed within the Obstetrics and Gynecology department at two public hospitals in two different Spanish Regions. The research was conducted between 2014 and 2016 performing a ROC curve analysis to determine the discriminative capacity and cut-off for PHQ-2. RESULTS: 11,1 % out of 1019 participants were diagnosed with depression. The area under the curve of PHQ-2 was 0,84 p smaller than 0,001. With the cutoff 2 the sensitivity and specificity of 85,4 % and 79,5% respectively. CONCLUSIONS: A score Equal or greater than 2 is an appropriate cut-off in PHQ-2 to detect depression during pregnancy. The use of PHQ-2 could precede PHQ-9 as a brief screening tool for antenatal depression in obstetric settings.

OBJETIVO: La depresión prenatal es un importante problema de salud pública que apenas recibe tratamiento. La depresión durante este período está asociada con consecuencias negativas tanto para la madre como para el bebé. Por ello, es importante realizar un cribado adecuado en mujeres embarazadas. El objetivo del presente estudio fue conocer la capacidad discriminativa y el punto de corte del cuestionario PHQ-2 como primer instrumento de cribado para identificar la depresión en mujeres embarazadas que viven en España. METODOS: Participaron voluntariamente 1.019 mujeres, de edad comprendida entre los 19 y los 45 años, que acudieron a revisión obstétrica en el primer trimestre del embarazo. Las participantes completaron un cuestionario sociodemográfico y los cuestionarios PHQ9 y PHQ2. La investigación fue desarrollada en dos hospitales públicos de dos comunidades autónomas diferentes. Se llevó a cabo entre los años 2014 y 2016. Se realizó un análisis con curva ROC para determinar la capacidad discriminativa y el punto de corte del PHQ-2. RESULTADOS: De las 1.019 participantes el 11,1% fueron diagnosticadas de depresión. El área bajo la curva del PHQ2 fue de 0,84 p menor que 0,001. Con el punto de corte de 2 la sensibilidad y especificidad fueron de 85,4% y 79,5% respectivamente. CONCLUSIONES: La puntuación de corte mayor o igual 2 es adecuada para la discriminación de la depresión durante el embarazo mediante el cuestionario PHQ2 y podría servir como cribado previo al PHQ-9.

Propiedades psicométricas del Postpartum Depression Predictors Inventory-Revised- versión prenatal en una muestra española de mujeres embarazadas / Psychometric properties of postpartum depression predictors inventory- revised- prenatal version in a sample of spanish pregnant women

Fundamentos: La depresión postparto es un importante problema de salud pública por lo que su predicción y prevención es un objetivo relevante de las agendas de salud pública. Para ello es importante disponer de herramientas de cribado de los factores de riesgo asociados a la depresión post-parto. El objetivo de este trabajo fue evaluar las propiedades psicométricas del Inventario Predictor de la Depresión Postparto-Versión Revisada-Prenatal (PDI-R) en su versión en lengua española en relación con la fiabilidad de sus puntuaciones en mujeres embarazadas que acuden a la atención prenatal en un hospital urbano de España y en cuanto a su estructura factorial. Métodos: Se dispuso de una muestra de 445 mujeres que reciben atención prenatal en una clínica de obstetricia en un hospital público urbano de Madrid, España. En esta muestra se analizó la consistencia interna del PDI-R mediante el coeficiente alfa de Cronbach además de realizar un análisis de curva ROC y percentiles de la muestra. Resultados: Los resultados del PDPI-R en esta muestra indicaron satisfactorios valores de consistencia interna (alfa de Cronbach = 0,855). El área bajo la curva del PDPI-R fue de 0,84 p<0,001. Con el punto de corte de 4 la sensibilidad y especificidad fueron de 62,3% y 69,5% respectivamente. Conclusión: El PDPI-R es adecuado y puede utilizarse para detectar el factor de riesgo de depresión durante el embarazo (AU)

Background: Prenatal depression is a major public health problem, therefore predicting and preventing it is a relevant objective for public health agendas. Consequently, it is important to have adequate screening tools to detect risk factors associated with prenatal depression. The aim of this study was to evaluate the psychometric properties reliability and factor structure of the Spanish version of the Postpartum Depression Predictors Inventory- Revised- Prenatal Version (PDI-R) in pregnant women who attend prenatal care in an urban hospital in Spain. Methods: The sample was formed of 445 women receiving prenatal care in an obstetrics clinic in an urban public hospital in Madrid, Spain. The internal consistency of PDPI-R was assessed by measuring Cronbach’s Alfa index, calculating the COR curve and percentiles for this sample. Results: The PDPI-R showed good internal consistency in this sample (Cronbach’s Alfa = 0,855). The area under the COR curve is 0,84 p<0,001. Sensibility and specificity values were 62,3% and 69,5% respectively, and the cut-off point with greatest sensibility and specificity was 4. Conclusion: The PDPI-R is reliable and can be used to screen for risk factor for depression during pregnancy (AU)

PHQ-2 como primer instrumento de cribado de la depresión prenatal / PHQ-2 as frst screening insstrument of prenatal depression in primary healtg care, Spain

Fundamentos: La depresión prenatal es un importante problema de salud pública que apenas recibe tratamiento. La depresión durante este período está asociada con consecuencias negativas tanto para la madre como para el bebé. Por ello, es importante realizar un cribado adecuado en mujeres embarazadas. El objetivo del presente estudio fue conocer la capacidad discriminativa y el punto de corte del cuestionario PHQ-2 como primer instrumento de cribado para identificar la depresión en mujeres embarazadas que viven en España. Método: Participaron voluntariamente 1.019 mujeres, de edad comprendida entre los 19 y los 45 años, que acudieron a revisión obstétrica en el primer trimestre del embarazo. Las participantes completaron un cuestionario sociodemográfico y los cuestionarios PHQ9 y PHQ2. La investigación fue desarrollada en dos hospitales públicos de dos comunidades autónomas diferentes. Se llevó a cabo entre los años 2014 y 2016. Se realizó un análisis con curva ROC para determinar la capacidad discriminativa y el punto de corte del PHQ-2. Resultados: De las 1.019 participantes el 11,1% fueron diagnosticadas de depresión. El área bajo la curva del PHQ2 fue de 0,84 p<0,001. Con el punto de corte de 2 la sensibilidad y especificidad fueron de 85,4% y 79,5% respectivamente. Conclusiones: La puntuación de corte ≥2 es adecuada para la discriminación de la depresión durante el embarazo mediante el cuestionario PHQ2 y podría servir como cribado previo al PHQ-9 (AU)

Background: Prenatal depression is a major public health problem that is barely treated. Based on existing literature, depression during this period is associated with negative consequences for the mother and the baby. Therefore it is important to make an adequate screening in this population. The aim of this study was to determine the discriminant validity and cut-off of the Patient Health Questionnaire (PHQ-2) as a screening tool to identify the depression in pregnant women living in Spain. Method: The sample included 1,019 female participants, aged between 19 and 45 years, who participated voluntarily, and received prenatal care during the first trimester. Participants completed a sociodemographic questionnaire, PHQ-2 and PHQ-9. The research has been developed within the Obstetrics and Gynecology department at two public hospitals in two different Spanish Regions. The research was conducted between 2014 and 2016 performing a ROC curve analysis to determine the discriminative capacity and cut-off for PHQ-2. Results: 11,1 % out of 1019 participants were diagnosed with depression. The area under the curve of PHQ-2 was 0,84 p <0,001. With the cutoff 2 the sensitivity and specificity of 85,4 % and 79,5% respectively. Conclusions: A score ≥2 is an appropriate cut-off in PHQ-2 to detect depression during pregnancy. The use of PHQ-2 could precede PHQ-9 as a brief screening tool for antenatal depression in obstetric settings (AU)

Eclampsia y encefalopatía posterior reversible / Eclampsia and posterior reversible encephalopathy syndrome

La eclampsia, síndrome clínico definido clásicamente por la aparición de convulsiones y/o coma en gestantes con hipertensión y proteinuria, se presenta frecuentemente como un síndrome de encefalopatía posterior reversible (PRES), entidad clínico radiólogica caracterizada por cefalea, alteraciones visuales, convulsiones y/o alteración de conciencia, junto a un patrón radiológico de edema cerebral vasogénico reversible localizado en territorio posterior. Discutimos dos casos de gestantes pretérmino que ingresaron en el Servicio de Urgencias de nuestro hospital tras debutar en su domicilio con cefalea y status epiléptico, sin antecedentes de enfermedad hipertensiva del embarazo ni proteinuria. Ambas presentaron en las pruebas de neuroimagen, criterios de síndrome de encefalopatía posterior reversible (PRES), lo que facilitó el diagnóstico diferencial y la toma de decisiones terapéuticas. Dada la estrecha asociación entre eclampsia y síndrome de encefalopatía posterior reversible (PRES), los estudios de neuroimagen constituyen una herramienta valiosa para el diagnóstico y tratamiento oportuno de estas pacientes, favoreciendo su recuperación neurológica completa sin secuelas posteriores(AU)

Eclampsia, a clinical syndrome classically defined by the occurrence of seizures and/or coma in pregnant women with hypertension and proteinuria, is often presented as a posterior reversible encephalopathy syndrome (PRES), a clinical-radiological entity characterized by headache, visual disturbances, seizures and/or alteration of consciousness, besides a radiological pattern of reversible vasogenic cerebral edema located in posterior territory. We discuss two cases of preterm pregnant women admitted to the Emergency Department of our hospital after debuting at their home with headache and status epilepticus, with no history of hypertensive disease of pregnancy or proteinuria. Both presented in neuroimaging criteria for posterior reversible encephalopathy syndrome (PRES), which facilitated the differential diagnosis and therapeutic decision making. Given the close association between eclampsia and posterior reversible encephalopathy syndrome (PRES), neuroimaging studies are a valuable tool for the diagnosis and treatment of these patients, favouring complete neurological recovery without sequelae(AU)

Gestación en paciente con anemia de Cooley / Pregnancy in patients with Cooley anemia

Los síndromes talasémicos son trastornos hereditarios de la biosíntesis de la globina alfa o la beta. La disponibilidad reducida de globina disminuye la producción de tetrámeros de hemoglobina, lo que da lugar a hipocromía y microcitosis. Se produce una acumulación desequilibrada de subunidades alfa o beta porque las síntesis de las globinas no afectadas continúan a una velocidad normal. La acumulación desequilibrada de cadenas domina el fenotipo clínico. La gravedad clínica varía mucho, dependiendo del grado de trastorno de la síntesis de la globina afectada, de la síntesis alterada de otras cadenas de globina y de la herencia simultánea de otros alelos anormales de la globina. La incidencia de estos síndromes durante el embarazo en todas las razas es de uno en 300 a 500 (AU)

Thalassemia syndromes are inherited disorders of alpha- or beta-globin biosynthesis. The reduced availability of globin decreases the production of hemoglobin tetramers, giving rise to hypochromia and microcytosis. There is unbalanced accumulation of alpha or beta subunits because the synthesis of unaffected globins continues at a normal speed. This unbalanced accumulation dominates the clinical phenotype. The clinical severity varies widely, depending on the degree of disorder of the synthesis of the affected globin, the altered synthesis of other globin chains and simultaneous inheritance of other abnormal globin alleles. The incidence of these syndromes during pregnancy in all races is one in 300 to 500 (AU)

Mortalidad perinatal en el Hospital Clínico San Carlos de Madrid / Perinatal mortality in the San Carlos Hospital of Madrid

Objetivo: Comparar las tasas de mortalidad perinatal del Hospital Clínico San Carlos entre los períodos 1995-1999 y 2000-2004.Material y métodos: Estudio retrospectivo de la mortalidad perinatal del quinquenio 2000-2004, empleando la clasificación internacional de la Federación Internacional de Ginecología y Obstetricia. Se recopiló un total de 157 casos y se estudiaron la mortalidad según el tipo de parto, así como los resultados de los estudios anatomopatológicos post mórtem realizados.Resultados: La mortalidad perinatal ampliada (MPNA) fue de 10,68/1.000 nacidos y la mortalidad perinatal estándar (MPNE) de 4,82‰, sobre un total de 14.261 partos, con 14.508 recién nacidos de500 g o más de peso. Las tasas de MPNA y MPNE corregidas fueron de 10,2 y 4,34/1.000 nacidos, respectivamente.Conclusiones: La mortalidad perinatal ha disminuido de forma drástica, de 13,6‰ nacidos en el período 1995-1999 a un 10,68‰ en el período estudiado. Los mejores resultados se obtuvieron en el año 2002 (6,63‰ nacidos vivos) (AU)

Objective: To compare perinatal mortality in San Carlos Clinic Hospital of Madrid during the period 2000-2004 with the period 1995-1999.Material and methods: We performed a retrospective study of perinatal deaths during the period 2000-2004, using the international FIGO classification. A total of 157 cases were collected. Mortality was studied by type of childbirth, and the histopathology results of the autopsies.Results: Extended perinatal mortality is 10.68 per thousand and standard perinatal mortality is 4.48%, in a total of 14,261 childbirths, with 14,508 newborns of 500 g. or more in weight. Corrected extended and standard perinatal mortality are 10.2% and 4.34%, respectively.Conclusions: Perinatal mortality is decreasing significantly, from 13.6% during 1995-1999 to 10.68% in 2000-2004. The best results were obtained in 2002 (6.63% newborns) (AU)