bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of a structured follow‐up visit to a midwife on women with early miscarriage: a randomized study
Authors: ADOLFSSON ANNSOFIE , BERTERÖ CARINA , LARSSON PER‐GÖRAN
Published: December 2009

Background. Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow‐up visit to a midwife (group 1) at 21–28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow‐up visit to a midwife (group 2). Methods. We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post. Results. There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow‐up visit. Conclusions. A structured follow‐up visit did not, in comparison with a regular follow‐up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow‐up visits are not imperative for all women with early miscarriage.
Pregnancy risk increases from 41 weeks of gestation
Authors: Nakling Jakob , Backe Bjørn
Published: December 2009

Background. The aim of this study was to evaluate the mortality and morbidity of conservatively managed post‐term pregnancies (gestation 294 days and beyond). Materials and methods. This is a population‐based prospective study. The sample was comprised of all women (N=17 493) with a singleton pregnancy in one Norwegian county from 1989 to 1999, with a second‐trimester ultrasound examination and delivery after 37 completed gestational weeks. Results. One thousand three hundred and thirty‐six (7.6%) of the deliveries were post‐term. In this group, the increase in perinatal mortality reached borderline significance [relative risk (RR) 2.0; 95% confidence interval 0.9–4.6]. Perinatal morbidity expressed as Apgar score <7 at 5min (RR 2.0; 95% confidence interval 1.2–3.3), and transferal to neonatal intensive care unit (RR 1.6; 95% confidence interval 1.3–2.0) were significantly more frequent. However, RR for perinatal death calculated per 1000 ongoing pregnancies increased significantly from 0.2 in week 37–3.7 in week 42, using perinatal mortality in gestational week 41 as a reference. Conclusions Our results indicate that expectant management of post‐term pregnancies allowing pregnancies to continue up to week 43 carries a risk for perinatal mortality and morbidity. The risk increases already from gestational week 41. The guidelines for management of post‐term pregnancies should be revised.
The relationship between psychosocial profile, health practices, and pregnancy outcomes
Authors: NEGGERS YASMIN , GOLDENBERG ROBERT , CLIVER SUZANNE , HAUTH JOHN
Published: December 2009

Background. The influence of psychosocial factors such as stress, anxiety, depression, and self‐esteem on birth weight is controversial. A prospective study was conducted to evaluate the relationship between pregnancy outcomes, psychosocial profile, and maternal health practices. Methods. 3,149 low‐income, predominantly African‐American pregnant women participated in this study. A 28‐item psychosocial scale measured the constructs of negative and positive affect, self esteem, mastery, worry, and stress. Maternal health practices were assessed with 11 questions dealing with diet, exercise, and the use of preventive medical and dental services. Results. A low score on either scale indicated “poor” psychosocial or health practices status. Low birth weight, preterm delivery, and intrauterine growth retardation occurred in 10.9, 10.1 and 7.3% of the pregnant women respectively. In women with low psychosocial scores, the risk of both low birth weight and preterm delivery was 40% higher and the mean birth weight of infants was 51 g (p=0.02) lower as compared to women with high scores. Negative affect (a measure of depression) was the only factor significantly associated with both infant birth weight (β= − 71.2, p=0.001) and low birth weight (AOR = 1.4, 95% CI = 1.1–1.7). When data were stratified by body mass index, the adverse effect of negative affect scores on birth weight and low birth weight was present only in thin women. Health practice scores were not associated with any of the pregnancy outcomes. Conclusion. Thin women with a poor psychosocial profile and who are depressed during pregnancy are at increased risk of giving birth to low birth weight and preterm infants.
Longitudinal reference ranges for estimated fetal weight
Authors: JOHNSEN SYNNØVE LIAN , RASMUSSEN SVEIN , WILSGAARD TOM , SOLLIEN RITA , KISERUD TORVID
Published: December 2009

Objective. The aims of the present study were to establish reference ranges for the growth of estimated fetal weight (EFW) between gestational weeks 20 and 42 and to determine the effect of fetal and maternal factors. Methods. This prospective longitudinal study was based on 634 low‐risk pregnancies and a total of 1799 examinations. Gestational age was computed from last menstrual period. Head circumference, abdominal circumference, and femur length were measured using ultrasound, and EFW was calculated using the formula of Combs et al. The statistical analysis was based on regression analysis and multilevel modeling. Results. Intrauterine growth expressed by EFW showed a continuous pattern until term. Males were calculated to be 5% heavier than female fetuses at 20 gestational weeks and 3% at 40 weeks. Otherwise, the fetal and maternal effects on intrauterine growth correspond to a weight shift of 1.3% for breech/nonbreech, 2.5% for each increase in maternal height tertile, and −4% for smoking/nonsmoking. Maternal age higher than 34 years had a significant increased EFW of 4.5% compared with maternal age less than 24 years. Cephalic index in the third tertile had a 1.1% lower EFW compared with the first tertile. Maternal weight, body mass index, and parity did not influence the EFW. Terms for customization to individualize the growth patterns are presented. Conclusions. The present growth chart is recommended as robust reference ranges for assessing EFW and growth. Fetal and maternal variables can be added into the models to individualize the prediction of EFW.
Fetal gender and gestational‐age‐related incidence of pre‐eclampsia
Authors: ELSMÉN EMMA , Källén Karin , MARŠÁL KAREL , HELLSTRÖM‐WESTAS LENA
Published: December 2009

Background. Male fetal gender is associated with an overall increased risk of pre‐eclampsia. However, it was recently shown that the male: female birth ratio was decreased in pre‐eclampsia associated with preterm delivery. The reason for this discrepancy is not known. Objective. To investigate whether the fetal and newborn gender is associated with the incidence of antenatal maternal pregnancy complications, and to investigate if gender‐associated risk changes with gestational age at delivery. Methods. Population‐based study including 1,158,276 infants born in Sweden 1990–2001. Five maternal diagnosis groups (pre‐eclampsia, infection, preterm premature rupture of membranes, abruptio placentae, and polyhydramnios) were explored in relation to newborn infant gender and gestational age at delivery. Results. When all gestational ages were evaluated, male newborn gender was associated with increased odds ratios for all five diagnosis groups, and for preterm birth before 37 weeks gestation, M/F ratio 1.17. In very preterm births (gestational age below 32 weeks), male newborn gender was associated with a significantly lower risk for pre‐eclampsia (OR 0.88, 95%CI 0.80–0.97), and a marginally lower risk for polyhydramnios (OR 0.74, 95%CI 0.54–1.01). Conclusion. The fetal gender seems to affect the occurrence of pre‐eclampsia, and possibly also polyhydramnios. The finding could be due to an increased risk for spontaneous abortions in pregnancies with male fetuses, but could also be associated with the etiology of these conditions. Evaluation of antenatal pregnancy complications from a fetal/newborn gender perspective may contribute to new insights regarding their pathophysiological mechanisms.
Identifying hazardous alcohol consumption during pregnancy: implementing a research‐based model in real life
Authors: Göransson Mona , Magnusson Åsa , Heilig Markus
Published: December 2009

Aims. It has been repeatedly demonstrated that hazardous alcohol use during pregnancy is rarely detected in regular antenatal care, and that detection can be markedly improved using systematic screening. A major challenge is to translate research‐based strategies into regular antenatal care. Here, we examined whether a screening strategy using the Alcohol Use Disorder Test (AUDIT) and time‐line follow‐back (TLFB) could be implemented under naturalistic conditions and within available resources; and whether it would improve detection to the extent previously shown in a research context. Methods. Regular midwives at a large antenatal care clinic were randomized to receive brief training and then implement AUDIT and TLFB (“intervention”); or to a waiting‐list control group continuing to deliver regular care (“control”). In the intervention‐condition, AUDIT was used to collect data about alcohol use during the year preceding pregnancy, and TLFB to assess actual consumption during the first trimester. Data were collected from new admissions over 6 months. Results. Drop out was higher among patients of the intervention group than control midwives, 14% (23/162) versus 0% (0/153), and p<0.0001. A one‐day training session combined with continuous expert support was sufficient to implement systematic screening with AUDIT and TLFB largely within resources of regular antenatal care. The use of these instruments identified patients with hazardous consumption during the year preceding pregnancy i.e. AUDIT score 6 or higher (17%, 23/139), and patients with ongoing consumption exceeding 70 g/week and/or binge consumption according to TLFB (17%, 24/139), to a significantly higher degree than regular antenatal screening (0/162). The AUDIT‐ and TLFB‐positive populations overlapped partially, with 36/139 subjects screening positive with either of the instrument and 11/139 were positive for both. Conclusions. We confirm previous findings that alcohol use during pregnancy is more extensive in Sweden than has generally been realized. Systematic screening using AUDIT and TLFB detects hazardous use in a manner which regular antenatal care does not. This remains true under naturalistic conditions, following minimal training of regular antenatal care staff, and can be achieved with minimal resources. The proposed strategy appears attractive for broad implementation.
Use of pH/whiff test or QuickVue Advanced® pH and Amines test for the diagnosis of bacterial vaginosis and prevention of postabortion pelvic inflammatory disease
Authors: Charonis Georgios , Larsson P.‐G.
Published: December 2009

Background. Untreated bacterial vaginosis (BV) is a risk factor for postabortion pelvic inflammatory disease (PID). Methods. Eight hundred and eight women who requested therapeutic abortion were consecutively examined for the presence of BV, using either pH/whiff test or QuickVue Advanced® pH and Amines test. All patients who tested positive to BV were treated with clindamycin or metronidazole prior to abortion. Results. Based on the wet smear examination, the incidence of BV was 21.6%. Positive pH and whiff test had a sensitivity of 53%, specificity of 98% and Kappa index 0.59 (n=239). Values for QuickVue Advanced® pH and Amines test were 53%, 97%, and 0.58 respectively (n=508). The incidence of PID among all patients was 2.4% after pharmacological abortion and 4.9% after surgical abortion. Among the patients with microscopic presence of BV diagnosed positive by the pH/whiff test or QuickVue Advanced® pH and Amines test and treated with antibiotics, no PID occurred. Patients with negative pH/whiff test or QuickVue pH and amines test who consequently did not receive preoperative antibiotics, but who later demonstrated microscopic presence of BV, had an incidence of 14.3% (5/35) postoperative PID compared to women with normal lactobacilli flora 4.3% (10/234) (OR 3.73; 95% CI 1.21–9.21). Conclusions. Although the pH/whiff test and QuickVue pH and Amines test failed to ascertain BV in almost half of the participants later found to have BV, we found that preabortal screening and subsequent treatment of those who test clinically positive does lower the incidence of postabortion PID.
Increase of acetone emitted by urine in relation to ovulation
Authors: Smith David , Ismail Khaled M. K. , Diskin Ann M. , Chapman Gail , Magnay Julia L. , Španěl Patrik , O'Brien Shaughn
Published: December 2009

Background. Selected ion flow tube mass spectrometry allows trace gas quantification in exhaled breath and in the air/vapor above liquids (headspace) down to the 10 parts‐per‐billion level. During selected ion flow tube mass spectrometry investigation of the volatile compounds emitted by urine, high acetone levels were incidentally identified in the headspace of urine from healthy female volunteers around their mid‐cycle. Hence, this study was designed to measure urine headspace acetone levels throughout the menstrual cycle. Methods. Using selected ion flow tube mass spectrometry we measured daily urine headspace acetone concentrations of seven ovulating (group 1) and three postmenopausal volunteers (group 2). Results. A several‐fold increase in urine headspace acetone level was detected 2–3 days after the predicted day of ovulation in 5 of the 7 volunteers in group 1. No such rise was detected in group 2. Conclusion. This study provides the basis for future research to understand the reason for and the potential utility of this phenomenon.
Eclampsia in Dar es Salaam, Tanzania — incidence, outcome, and the role of antenatal care
Authors: Urassa David P. , Carlstedt Anders , Nyström Lennarth , Massawe Siriel N. , Lindmark Gunilla
Published: December 2009

Background In order to assess the effectiveness of antenatal care for prevention of eclampsia, a retrospective case‐control study was performed at the Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. All women with eclampsia seen at MNH during 1999–2000 and controls without eclampsia were included.

Methods. The study used a labor ward database and antenatal cards of eclamptic women and non‐eclamptic controls. For each of the 741 eclamptic women who delivered at MNH, two non‐eclamptic controls were chosen from the database. For 399 of the eclampsia cases and 420 non‐eclamptic controls, the antenatal records could be traced and compared.

Main outcome measures. Maternal and perinatal mortality, detection of antenatal risk factors, appropriate referrals, and incidence of eclampsia.

Results. Hospital and population‐based incidences of eclampsia were 200/10 000 and 67/10 000, respectively. The case‐fatality rate for eclampsia was 5.0% for women who delivered at MNH and 16% for those referred to MNH after being delivered elsewhere. The risk of low birth weight and perinatal death was significantly increased in eclamptic women (odds ratio = 6 and 10, respectively). The screening coverage for signs of pre‐eclampsia was >85%, except for proteinuria (33%). Fewer than 50% of the women who developed eclampsia had been referred from the ANC clinic and <10% were admitted to the antenatal ward at MNH before onset of eclamptic fits.

Conclusions. The current practice of antenatal care is insufficient as a prevention strategy for eclampsia in a low‐resource setting with high incidence of eclampsia.
Long‐term results of the tension‐free vaginal tape operation in an unselected group of 129 stress incontinent women
Authors: KUUVA NINA , NILSSON CARL GUSTAF
Published: December 2009

Background. This study was undertaken to examine the long‐term effects and effectiveness of the tension‐free vaginal tape (TVT) procedure in an unselected group of women. Method. One hundred and twenty‐nine stress urinary incontinent women (including primary, recurrent, mixed, and low pressure urethra cases) were studied prospectively and examined according to a strict protocol at a mean time of 6 years after their TVT operation. Cough and pad tests were used for objective evaluation, whereas visual analog scale and patients' verbal estimation were applied for subjective evaluation. Results. As assessed by the cough stress test and the pad test, 74 and 81% of the women were totally cured, respectively. Symptoms possibly indicating reduced urine flow were reported from 17% of the women and recurrent urinary tract infections from 9.3% of the women. The de novo urge rate was 4.7%. The tape was visualized in 3.1% of the women and necessitated resection in 1.6% of the cases due to subjective discomfort. No serious or unexpected adverse events were revealed. Conclusion. The TVT operation appears to be a safe and effective anti‐incontinence procedure in all female stress incontinence subgroups.
Childhood sexual abuse (CSA) experiences: an underestimated factor in perinatal care
Authors: Leeners B. , Neumaier‐Wagner P. , Quarg A.F. , Rath W.
Published: December 2009

Background. Childhood sexual abuse can have several negative consequences on pregnancy, birth, and the early neonatal period. However, most obstetricians are not aware if their patients have a history of childhood sexual abuse. We therefore investigated childhood sexual abuse experiences in 226 women three to eight months after delivery of a healthy child. Methods. 415 women were approached to answer a self‐administered questionnaire including obstetrical questions and questions focusing on abuse experiences. 320 women agreed to participate, 226 (69.1% of the women fulfilling inclusion criteria) of which returned a completed questionnaire. Sexual abuse was explored using a modified version of a questionnaire developed by Wyatt. The complete questionnaire was designed in cooperation with the German “Frauennotruf”, a society providing care for victims of sexual abuse. Results. The prevalence of childhood sexual abuse was a minimum of 11.5% and a maximum of 14.6% if women who were not sure about such experiences during their childhood were included. Another 1.3% of the women had experienced sexual abuse as an adult. Lifetime sexual abuse prevalence was 12.8% and 15.9%, respectively. Of the women with an experience of childhood sexual abuse, 42.3% mentioned an ongoing abuse situation for at least six months. Conclusions. As approximately every 9th woman presenting for obstetrical care has experienced childhood sexual abuse, and as those experiences may have a negative impact on fetal and maternal well‐being, adequate counseling models should be offered to victims of sexual abuse.
Increased sexual risk taking behavior among Swedish female university students: repeated cross‐sectional surveys
Authors: Larsson Margareta , Tydén Tanja
Published: December 2009

Background. The aim of this study was to perform a repeated cross‐sectional study of female university students’ sexual and contraceptive behavior, as well as experiences of pornography and sexual harassment and compare the findings with those from earlier studies. Methods. Waiting‐room questionnaires to female university students (n=315) visiting a Student Health Centre in Sweden. Similar investigations had been performed earlier, which enabled comparisons. Results. Almost all women (98%) had experienced intercourse and giving oral sex (94%). Condoms were most often used at first intercourse (72%) and combined oral contraceptives at latest intercourse (67%). The ever use of emergency contraceptive pills had increased from 22% to 52% over five years and there was a tendency towards more risk‐taking behavior with more sexual partners (mean 5.4 in 1999 and mean 7.4 in 2004), more experience of first‐date intercourse without a condom (37–45%), and more self‐reported sexually transmitted infections (14–21%). The proportion of women who had undergone an abortion remained stable (6%) and fewer women reported ever being sexually harassed in 2004 compared to 1999. Conclusions. In conclusion, contraceptive use remained stable over time, but there was a trend towards more risky sexual behavior with more sexual partners, more unprotected first‐date intercourse, and more self‐reported sexually transmitted infections. Induced abortions, however, had not increased, but the use of emergency contraceptive pills had more than doubled in the five years between 1999 and 2004.
Prognosis of women with pelvic pain during pregnancy: a long‐term follow‐up study
Authors: Röst Cecile C.M. , Jacqueline J. , Kaiser A. , Verhagen Arianne P. , Koes Bart W.
Published: December 2009

Study design. A follow‐up study of women with pelvic pain during pregnancy. Objectives. To evaluate prognostic factors for pelvic pain. Methods. Out of a cohort of 870 pelvic pain patients, 598 women, who delivered less than 42 months prior to the follow‐up measurement, were selected for follow‐up. Results. Data of 430 women were available for analysis with a mean follow‐up duration of 18 months postpartum. Forty‐three women still experienced moderate or severe pain and were seriously hindered in more than one activity. At intake symptomatic women experienced a higher overall severity of complaints, more walking deficiencies, and mentioned prepregnancy back pain more often and reported labor lasting longer than 18 h 2.5 times more often than asymptomatic women. Explained variance of these factors is small. Conclusions. Mean 18 months postpartum a small group had moderate or severe pain. Prepregnancy back pain, severity of complaints, and number of walking deficiencies at primary referral as well as duration of labor showed a significant relation with symptoms.
Optimal treatment of premature ovarian failure after treatment for Hodgkin's lymphoma is often withheld
Authors: Verschuuren Sylvia I. , Schaap Jiska J. , van't Veer Mars B. , Stijnen Theo , Burger Curt W. , Ansink Anca C.
Published: December 2009

Background. The purpose of this study is to determine: 1. the effect of treatment for Hodgkin's lymphoma on ovarian function, and 2. the interventions to relieve postmenopausal symptoms. Methods. Seventy‐seven consecutive patients treated between 1989 and 2003 in the Rotterdam region for Hodgkin's lymphoma stages I and II were approached for this study. A questionnaire consisting of 45 questions was carried out to evaluate premature menopausal symptoms, hormonal replacement therapy and use of contraception, menstrual cycle, and subsequent pregnancies. Results. After informed consent 67 patients were willing to participate in the study and 66 patients filled in a questionnaire. After antitumor treatment 13 patients developed treatment‐related premature ovarian failure, 35 patients had a spontaneous cycle, and 18 patients could not be classified as they used hormonal contraception. Women who developed treatment‐related premature ovarian failure had a significantly higher mean age at the start of treatment for Hodgkin's lymphoma than women who remained premenopausal (p<0.002). Only 6 of these 13 women (46%) received hormonal substitution. In all, 21 women conceived after antitumor treatment, and 28 children were born. All pregnancies were the result of spontaneous conception. Conclusions. The effect of antitumor treatment for Hodgkin's lymphoma on ovarian function is age dependent (odds ratio of 1.18 per year). There is a striking inconsistency regarding the management of ovarian protection before and during antitumor treatment. Premenopausal women who undergo therapy for Hodgkin's lymphoma should be offered hormonal substitution therapy after loss of ovarian function.
Newborns of pre‐eclamptic women: a biochemical difference present in utero
Authors: OPHIR ELLA , DOURLESHTER GREGORY , HIRSH YAEL , FAIT VLADIMIR , GERMAN LEONID , BORNSTEIN JACOB
Published: December 2009

Background. Offspring exposed to pre‐eclampsia in utero had higher systolic blood pressure, and were more obese during adolescence. We hypothesized that metabolic changes, a marker of cardiovascular disease, may be affected by intrauterine exposure to pre‐eclampsia. Methods. Blood samples were collected from cord blood of 36 newborns who were exposed to pre‐eclampsia in utero and their mothers, and of 35 newborns and their mothers with noncomplicated pregnancies. Serum levels of lipids, homocysteine, and fibrinogen were determined in all samples. Results. Fetuses exposed to pre‐eclampsia in utero had lower birth weight, smaller abdominal circumference (p<0.002; p<0.03 respectively) and higher levels of low‐density lipoprotein, homocysteine, and fibrinogen (p<0.01; p<0.001; p<0.001, respectively), compared with fetuses of normotensive, pregnancies. A significant correlation existed between maternal homocysteine concentration and that of newborn infants (r = 0.539; p<0.001) and between maternal low‐density lipoprotein and newborn homocysteine (r = 0.36; p<0.03). Significant negative correlations were found between abdominal circumference of newborns and cord blood concentration of fibrinogen (r = − 0.52; p<0.001) and low‐density lipoprotein (r = − 0.42; p<0.001). Maternal plasma homocysteine, low‐density lipoprotein, and triglyceride were significantly higher, while high‐density lipoprotein was significantly lower in pregnancies with pre‐eclampsia as compared with the uncomplicated pregnancy group (p<0.001 for all). Cord blood level of low‐density lipoprotein and fibrinogen were best predicted by abdominal circumference of newborn, though maternal level of homocysteine was the most powerful independent predictor of cord homocysteine. Conclusion. Intrauterine exposure to pre‐eclampsia was associated with untoward effects on biochemical risk factor markers for cardiovascular disease. Our findings suggest that the cardiovascular risk of newborns of pre‐eclamptic mothers may begin in utero.
Geographical variation in neonatal phenotype
Authors: Leary Sam , Fall Caroline , Osmond Clive , Lovel Hermione , Campbell Doris , Eriksson Johan , Forrester Terrence , Godfrey Keith , Hill Jacqui , Jie Mi , Law Catherine , Newby Rachel , Robinson Sian , Yajnik Chittaranjan
Published: December 2009

Background. Recent studies have shown associations between size and body proportions at birth and health outcomes throughout the life cycle, but there are few data on how neonatal phenotype varies in different populations around the world. Methods. Data from the UK, Finland, India, Sri Lanka, China, DR Congo, Nigeria, and Jamaica (n=22,067) were used to characterize geographical differences in phenotype in singleton, live‐born newborns. Measurements included birth weight, placental weight, length, head, chest, abdominal and arm circumferences, and skinfolds. Results. Neonates in Europe were the largest, followed by Jamaica, East Asia (China), then Africa and South Asia. Birth weight varied widely (mean values 2,730–3,570 g), but in contrast, head circumference was similar in all except China (markedly smaller). The main difference in body proportions between populations was the head to length ratio, with small heads relative to length in China and large heads relative to length in South Asia and Africa. Conclusions. These marked geographical differences in neonatal phenotype need to be considered when investigating determinants of fetal growth, and optimal phenotype for short‐term and long‐term outcomes.
The prevalence of depressive symptoms in the postnatal period in Lalitpur district, Nepal
Authors: DØRHEIM HO‐YEN SIGNE , TSCHUDI BONDEVIK GUNNAR , EBERHARD‐GRAN MALIN , BJORVATN BJØRN
Published: December 2009

Background. Mental disorders are highly prevalent across different cultures and are often associated with serious role impairment. In developing countries, more than three‐quarters of people with serious mental disease do not receive any treatment. Identifying and treating maternal depression is important also in Nepal, where suicide is the second largest cause of deaths among women of reproductive age. The emotional, cognitive, and physical development of the infant is also negatively influenced by maternal depression.

Objectives. The aim of this study was to estimate the prevalence of depressive symptoms among mothers 5–10 weeks after delivery in a clinical, a rural, and an urban population in Lalitpur district, Nepal.

Methods. A total of 426 postnatal women were included in a cross‐sectional structured interview study of mental health. Depressive symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS), and mental distress by the Self Report Questionnaire‐20 (SRQ‐20).

Results. The overall prevalence of depressive symptoms in the postnatal period (defined as EPDS > 12) was 4.9% (95% CI 2.9–7.0). The prevalence of mental distress (defined as SRQ‐20 > 10) was 3.1% (95% CI 1.4–4.7). There were no significant differences in prevalences among the three populations studied.

Conclusions. The prevalence of depressive symptoms in the postnatal period was lower than previously reported from Nepal. The value of possible protective and precipitating factors needs to be explored.
Differences within couples’ experience of their hospital care and well‐being three months after experiencing a stillbirth
Authors: SÄFLUND KARIN , WREDLING REGINA
Published: December 2009

Background. The present study aimed to investigate possible differences, within the couple, in their encounter with their stillborn child and the assistance of caregivers during the event and to evaluate the parents’ psychological well‐being three months after the stillbirth.

Methods. Twenty‐two couples, who experienced a stillbirth, participated in the study. A study‐specific questionnaire and a previously evaluated well‐being questionnaire were used to assess the parents’ psychological condition. Chi‐square analysis, Wilcoxon's signed rank test, Student's paired t‐test, and Spearman's rank correlation coefficient were used to detect differences within the couples.

Results. The parents had feelings of fear when they conceptualized the stillborn child, but with support from staff all but one couple held their child. The fathers had the same strong feelings of warmth, pride, tenderness, and grief as the mothers when they held the child. Most parents reported that the staff had treated them with understanding during the delivery. Three months after the event the mothers scored significantly higher on Negative Well‐being, lower on Positive Well‐being, and lower on General Well‐being than the fathers. A majority of the mothers, but no fathers, were on sick leave three months after the event.

Conclusions. Our study suggests that mothers and fathers need to be emotionally supported in the encounter with their stillborn child. The mothers’ scoring of lower well‐being may be due to a stronger antenatal attachment to the child. This should, however, be a subject of further studies.
Urine albumin/creatinine ratio for the assessment of albuminuria in pregnancy hypertension
Authors: NISELL HENRY , TRYGG MARIA , BÄCK RUNE
Published: December 2009

Background. An accurate method to assess albuminuria in pregnancy is mandatory to diagnose pre‐eclampsia. Twenty‐four‐hour urine collection is still the only universally accepted method. This is, however, a cumbersome and inconvenient method. Therefore, the present study aimed at assessing the accuracy of a spot urine albumin/creatinine ratio in pregnant women with hypertension. Material and methods. In 54 pregnant women with blood pressure ≥140/90 mmHg, 24‐h albumin excretion and subsequent albumin/creatinine ratio on morning spot urine were analyzed in the individual patients. Altogether 75 paired samples were included. Receiver operating characteristic curves, relating different albumin/creatinine ratio cut‐off values to 24‐h albumin excretion >300 mg were constructed. Correlations were assessed by Spearman rank correlation tests. Results. The area under the receiver operating characteristic curve was 0.985. At the optimal cut‐off albumin/creatinine ratio value of 27 mg/mmol the sensitivity, specificity, positive and negative predictive value for detecting albuminuria >300 mg/24 h were: 95, 100, 100 and 86% respectively. There was a close correlation between albumin/creatinine ratio and 24‐h albumin excretion values (r = 0.95; p<0.001). Conclusions. It is suggested that in most cases the more cumbersome 24‐h urine collection can be replaced by the more convenient albumin/creatinine ratio on spot urine.
Emotional well‐being and predictors of birth‐anxiety, self‐efficacy, and psychosocial adaptation in healthy pregnant women
Authors: SIEBER SANDRA , GERMANN NICOLE , BARBIR ALINE , EHLERT ULRIKE
Published: December 2009

Background. A broad body of studies have shown that emotional well‐being during pregnancy influences birth outcome and postpartum mood state, but few longitudinal studies have examined the extent of changes of emotional well‐being during late pregnancy. Furthermore, up to now it has remained unclear which factors are predictive for emotional well‐being during pregnancy. This prospective longitudinal study has two main aims. First of all, possibly occurring changes of birth anxiety, self‐efficacy for labor and delivery, and psychosocial adaptation to pregnancy in primiparous healthy women during the final trimenon will be described. Second, predictors of these assessed constructs during the final trimenon as well as the extent of these constructs as predictors for the psychological status postpartum will be shown. Methods. A prospective longitudinal study was conducted with 61 pregnant women recruited from childbirth classes. Results. The results showed significant changes in emotional well‐being – measured by birth anxiety, self‐efficacy for labor and delivery, and psychosocial adaptation to pregnancy – during the final trimenon: the women were more confident in their ability to cope with labor and delivery. Birth anxiety did not change significantly during the final trimenon. Regression analyses revealed different psychosocial predictor variables for emotional well‐being during late pregnancy. The predictive factor for an unfavorable psychological status postpartum was birth anxiety. Conclusions. The results of this study suggest that the importance of discovering psychosocial problems of pregnant woman early in pregnancy could be imperative in preventing psychosocial problems later in pregnancy as well as postpartum.
Obstetric anal sphincter rupture in older primiparous women: a case–control study
Authors: DAHL CHRISTIAN , KJØLHEDE PREBEN
Published: December 2009

Objective. To determine if maternal age (35 years of age or older) in primiparous women is a risk factor for the development of obstetric anal sphincter rupture (OASR) and to identify obstetric factors associated with it. Material and methods. This is a retrospective case–control study. The study population was made up of the 5,345 primiparous women aged 24–45 years who delivered vaginally with singleton live‐born neonates during 1990–99 at the Department of Obstetrics and Gynecology, Linköping University Hospital, Sweden. As cases the 327 primiparous women aged 35–45 years at delivery were selected. For each case two primiparous controls ten years younger were selected, matched for gestational age and year of delivery, in all 654 controls. Maternal, obstetrical, and neonatal data were obtained from the delivery records. Obstetric factors for the development of OASR were assessed with multivariate logistic regression analysis. Results. No significant association was found between the primiparous age category and OASR. Vacuum extraction, forceps delivery, and the head circumference of the neonate were found to be independent risk factors for OASR, while the use of mediolateral episiotomy or epidural analgesia were independent protective factors for developing OASR. Conclusions. Primiparous women, 35 years of age or older, do not seem to have a greater risk of OASR than younger primiparous women. Risk factors for OASR are instrumental vaginal delivery and the size of the neonate. Mediolateral episiotomy and epidural analgesia seem to reduce the risk for OASR.
Association between urinary tract infection and postmicturition wiping habit
Authors: PERSAD SUNIL , WATERMEYER SEAN , GRIFFITHS ANTHONY , CHERIAN BINA , EVANS JANET
Published: December 2009

Urinary tract infections are common in pregnancy. In pregnancy urinary tract infections have an associated risk of premature labour. This study looks at the incidence of urinary tract infections and the method of perineal hygiene used after urination. Wiping back to front is associated with a greater risk of developing urinary tract infection than wiping front to back.
Static and dynamic MRI features of the levator ani and correlation with severity of genital prolapse
Authors: ANSQUER YAN , FERNANDEZ PEDRO , CHAPRON CHARLES , FREY CATHERINE , BENNIS MALIKA , ROY CARINE , SALOMON LAURENCE , MANDELBROT LAURENT , CARBONNE BRUNO
Published: December 2009

Background. To describe the static and dynamic MRI features of the levator ani, and evaluate whether they are associated with the MRI evaluation of the severity of genital prolapse. Methods. Static and dynamic MRI of 40 patients, referred for evaluation prior to genital prolapse surgery, were reviewed retrospectively. Prolapse severity was evaluated on MRI at maximal straining by descent of the bladder neck under the pubococcygeal line for the anterior compartment, by descent of the uterine cervix under the pubococcygeal line for the middle compartment, and by anterior bulging of the rectum for the posterior compartment. For evaluation of the levator ani, the following parameters were recorded: (1) at rest: thinning or defects in both puborectalis and iliococcygeus muscles, (2) at rest and at straining: urogenital hiatus length and width, M line, iliococcygeal and levator plate angles. The levator ani features were tested for potential associations with the MRI evaluation of prolapse severity. Results. Bladder neck descent at straining was correlated with the levator plate angle at rest (p = 0.001), and with the hiatus length at rest (p = 0.02), and at straining (p = 0.008). Uterine cervix descent at straining was correlated with the hiatus length (p = 0.0005), and width (p = 0.014) at straining, M line (p = 0.002) and levator plate angle (p = 0.007) at straining, whereas anterior rectal bulging at straining was paradoxically inversely correlated with the hiatus width at rest (p = 0.04). Conclusion. In a population of women with genital prolapse, MRI evaluation of the levator ani was associated with MRI evaluation of the severity of genital prolapse.
Informed consent: attitudes, knowledge and information concerning prenatal examinations
Authors: DAHL KATJA , KESMODEL ULRIK , HVIDMAN LONE , OLESEN FREDE
Published: December 2009

Background. Providing women with information enabling an informed consent to prenatal examinations has been widely recommended. Objective. The primary purpose of this review is to summarise the current knowledge of the pregnant woman's expectations and attitudes concerning prenatal examinations, as well as the knowledge possessed by pregnant women undergoing prenatal examinations. Second, we explore their reasons for accepting or declining available screening tests. Results. More than 90% of the pregnant women expressed a positive attitude toward screening procedures in pregnancy. Most often (70–96%), the pregnant women were found knowledgeable about the procedural and practical aspects, but were more seldom (31–81%) able to correctly identify the purpose of tracing fetal malformations. Some 29–65% were not familiar with the existence of a false negative result, and 30–43% were found unaware of the possibility of a false positive result. The risk of miscarriage in relation to amniocentetesis [AC] is unknown to 11–53%. Uptake rates are associated with attitudes toward prenatal examinations, but no knowledge of the test offered. A total of 88% considered their health care provider an important source of information, and 57% stated that this information has influenced their decision. Conclusions. Pregnant women favor prenatal examinations, but the choice of participation does not seem to be based on insight to enable full informed consent. Health care providers are perceived as an essential source of information.
Use of preoperative serum CA‐125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer
Authors: HOON CHUNG HYUN , WEON KIM JAE , PARK NOH‐HYUN , SONG YONG‐SANG , KANG SOON‐BEOM , LEE HYO‐PYO
Published: December 2009

Background. The purpose of this study was to evaluate the predictive value of preoperative serum CA‐125 levels in the assessment of disease extent and clinical outcome of endometrial cancer. Method. This retrospective study evaluated 92 women with pathologically proven endometrial carcinoma scheduled for treatment that had preoperative serum CA‐125 levels between January 1999 and February 2006. The association of preoperative serum CA‐125 with a variety of histopathologic factors was evaluated. Statistical analysis was performed using φ2/Fisher's exact test and a logistic regression. Survival was studied with the Kaplan–Meier method and Cox regression models. Results. Elevated serum CA‐125 levels were significantly correlated with advanced‐stage disease (p<0.001), lymph node metastases (p<0.001), increased depth of myometrial invasion (p = 0.001), and positive peritoneal cytology (p = 0.026). Multivariate analyses using logistic regression showed that lymph node metastases had the most significant effect on the elevation of preoperative serum CA‐125 levels (p = 0.004). Patients with a serum CA‐125 ≤28.5 U/ml had a significantly better five‐year disease‐free survival than those with an elevated level in this study: 85.6% versus 60.0% (p = 0.004). Conclusions. The preoperative serum CA‐125 level appears to be a significant independent predictor of lymph node metastasis and prognosis after surgical intervention. Therefore, preoperative serum CA‐125 may be a useful tool, in the clinical setting, for optimal individualized patient management.
Shrinking the Kimberley: Remote Area Psychiatry in Australia
Authors: McLaren N.
Published: December 2009

The Kimberley, the northernmost region of Western Australia, is still largely an empty wilderness. About twice the size of Victoria, it has a permanent population of some 22,000. Since 1987, the Health Department of WA has provided a psychiatric service to the region, but the practice of psychiatry in such a vast and remote area has proven to be very different from that in larger centres. This paper summarises three years' clinical experience in the region.
A Survey of Psychiatric Services for Elderly People in Australia
Authors: Snowdon John , Ames David , Chiu Edmond , Wattis John
Published: December 2009

In 1992 a postal questionnaire identified 107 psychiatrists in Australia who, for a significant proportion of their time, were providing psychiatric services to elderly people. Only 18% were female. There were 34 psychiatrists working full-time in psychiatry of old age in the public health system. Twenty-three multidisciplinary catchment area psychiatric services for elderly people were identified, but staff to population ratios varied considerably. The ratio of psychiatrists to elderly was 1:30,000 — similar to the ratio in a large part of Britain seven years previously. Psychogeriatricians are involved in a broad range of teaching and research activities. The mean number of non-medical staff in a catchment area psychogeriatric service should be increased.
Queensland's Geographical Maldistribution of Psychiatrists and Queensland Health's Response
Authors: Emmerson Brett , Brown Peggy , Whiteford Harvey
Published: December 2009

There is a major geographical maldistribution and shortage of psychiatrists throughout Queensland. In June 1992, 48 psychiatrists worked outside of Brisbane where 66% of the population reside, while 172 psychiatrists worked in the metropolitan area. The reasons for and the effects of the maldistribution are discussed. Since 1991, Queensland Health has developed a number of key strategies to attract and retain psychiatrists in our non-metropolitan areas. These strategies are outlined. Between July 1992 and December 1993, 14 new full time psychiatrists were recruited. The results of these strategies are encouraging.
Acute Psychiatric Beds: Distribution and Staffing in NSW and ACT
Authors: Rosenman Stephen
Published: December 2009

This study examined the availability and staffing of acute psychiatry beds in NSW and ACT. “Gazetted” acute psychiatry hospitals (which take compulsory admissions under mental health law) were polled directly for bed numbers, occupancy and staffing for the year 1990–1991. The NSW Department of Health provided beds numbers for non-gazetted and private hospitals. Four analyses sequentially reallocated beds according to the origin of patients to estimate acute bed availability and use by regional populations. Socio-demographic determinants of acute admission rates were measured.

Acute “gazetted” beds averaged 13.2 per 100,000 population but ranged from 6.9 to 49.1 per 100,000 when cross-regional flows were considered. “Non-gazetted” beds raised the provision to 15.5 per 100,000 and private beds raised provision further to 24.5 per 100,000. Inner metropolitan provision was higher than rural or provincial provision. The only determinant of the admission rate to gazetted beds was the number of available beds. Bed availability did not affect either bed occupancy or referral of patients to remote hospitals. Nursing staffing of gazetted units was reasonably uniform, although smaller units had significantly more nurses per bed. Medical staffing was highly variable and appears determined by staff availability.

The average provision of acute psychiatric beds approximates lowest levels seen in international models for psychiatric services. Average occupancy rates suggest that there is not an overall shortfall of acute psychiatric beds, but uneven bed distribution creates barriers to access. Referral of patients to remote hospitals is not related to actual bed provision in the regions, but appears to reflect attitudes to ensuring local care. Recommendations about current de facto standards are made. Current average nursing and medical staffing standards are reported.
Drug Use, Binge Drinking and Attempted Suicide among Homeless and Potentially Homeless Youth
Authors: Sibthorpe Beverly , Drinkwater Jane , Gardner Karen , Bammer Gabriele
Published: December 2009

In order to assess the need for drug-related services for at-risk youth, a survey was conducted among young people aged 12–17 years who, owing to severe family discord, were currently living away from home (homeless) or had experienced periods away from home in the past 12 months (potentially homeless). Prevalence of use and of potentially harmful levels of use of alcohol and other licit and illicit drugs were higher than in a comparative population. Of the 155 people interviewed, 54% reported past physical abuse, 28% reported past sexual abuse, and 73% had a family alcohol or other drug history. Of the total, 62% had been in a youth refuge at some time in the past 12 months. Twenty four per cent had been to hospital as a result of alcohol or other drug use and 45% had attempted suicide. Female sex and an interaction between sexual abuse and binge drinking predicted suicide attempts. This study points to the need for a comprehensive approach to interventions for troubled youth which gives greater recognition to mental health issues related to family circumstances, including abuse.