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Journal of Obstetrics and Gynaecology... May 2024
Topics: Humans; Female; Pregnancy; Granulomatous Mastitis; Adult; Pregnancy Complications
PubMed: 38452928
DOI: 10.1016/j.jogc.2024.102428 -
JAMA Apr 2024
Topics: Female; Humans; Infant, Newborn; Pregnancy; Depression; Depression, Postpartum; Mass Screening; Perinatal Care; Pregnancy Complications; Psychotherapy; Antidepressive Agents
PubMed: 38483381
DOI: 10.1001/jama.2024.0434 -
Radiographics : a Review Publication of... Apr 2024Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both...
Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Placenta; Cesarean Section; Puerperal Disorders; Hematoma
PubMed: 38547034
DOI: 10.1148/rg.230164 -
Rheumatology International Oct 2023Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for...
Idiopathic Granulomatous Mastitis (IGM) is an infrequent, benign breast disease that primarily affects women during their childbearing years and can be mistaken for breast cancer. This study aimed to review the clinical, radiological, and histopathological findings of patients with IGM in addition to management and outcome. Retrospective cross-sectional study of biopsy-confirmed IGM at an academic medical center and a private hospital in Amman, Jordan. Fifty-four patients were included, with a mean age of 37.0 ± 9.04 years, mostly presenting with a breast lump (n = 52, 96.3%) and breast pain (n = 45 patients, 84.9%). Approximately half of the patients (51.9%) were parous, and 50% had breastfed for an average duration of 30.37 ± 22.38 months. Most of the patients had either solitary or multiple abscesses on breast ultrasound. Histopathological analysis (n = 35) showed mostly either moderate inflammation (n = 16, 45.7%) or severe inflammation (n = 14, 40%). Two-thirds of the patients underwent surgical interventions at the time of diagnosis, mostly incision and drainage (n = 16, 29%) or surgical excision (n = 7, 13%), and no mastectomies were performed. The most common medical treatment included a combination of antibiotics, corticosteroids, and methotrexate (n = 21, 38.8%). After follow-up, 31 patients remained in remission, 3 experienced relapses, and 3 had a chronic course. The use of corticosteroids was significantly associated with remission (p = 0.035). The presentation and demographics of IGM patients in Jordan were consistent with the existing literature. Prospective research is needed to explore different treatment options and disease outcomes.
Topics: Female; Humans; Adult; Middle Aged; Granulomatous Mastitis; Retrospective Studies; Prospective Studies; Cross-Sectional Studies; Neoplasm Recurrence, Local; Adrenal Cortex Hormones; Inflammation; Immunoglobulin M
PubMed: 37347273
DOI: 10.1007/s00296-023-05375-6 -
Maternal and Child Health Journal Jul 2023Postpartum depression estimated prevalence in women is between 5 and 26% and it has adverse effects both on the mother, infant and her partner. Psychological treatments... (Review)
Review
OBJECTIVES
Postpartum depression estimated prevalence in women is between 5 and 26% and it has adverse effects both on the mother, infant and her partner. Psychological treatments have proved to be effective for women with mild-to-moderate symptoms. Whereas several systematic reviews have assessed the effects of different psychological interventions for postpartum depression, such as cognitive-behavioural therapy or interpersonal therapy, no review assessing psychodynamic therapy has been carried out. A systematic review was conducted to evaluate the efficacy of psychodynamic therapy for postpartum depression.
METHODS
Studies were identified using the following databases: PsycINFO, Psycarticles and Pubmed over January 2023. The requirements for the studies were the following: they had to be quantitative, available in English, including a psychodynamic intervention targeting treatment or prevention of postpartum depression which starts during pregnancy or within the first 12 months after giving birth. Case studies, qualitative studies or studies focused on improving parent-infant relationship or infant outcome were excluded from this research.
RESULTS
Seven trials including 521 women met the inclusion criteria. In summary, three randomized controlled trials and four longitudinal studies were found. The most frequently used assessment tool was EPDS, five were individual interventions and the other two were group interventions.
DISCUSSION
All studies reported the efficacy of psychodynamic interventions for postpartum depression, both in home and clinical settings and both in group and individual format. The limited number of trials, small sample sizes and lack of appropriate control groups were the main limitations.
CONCLUSIONS FOR PRACTICE
Psychodynamic therapy is probably efficient intervention for postpartum depression. Future research with strong methodological designs is needed to confirm these findings.
SIGNIFICANCE
What is already known on this subject? Several systematic reviews have assessed the effects of different psychological interventions for postpartum depression, but no review assessing psychodynamic therapy has been carried out. What this study adds? A systematic review was conducted to evaluate the efficacy of psychodynamic therapy for postpartumdepression. This makes the systematic review a unique contribution to the literature.
Topics: Infant; Pregnancy; Female; Humans; Depression, Postpartum; Psychotherapy, Psychodynamic; Cognitive Behavioral Therapy; Behavior Therapy; Parturition
PubMed: 37029894
DOI: 10.1007/s10995-023-03655-y -
Medicine, Health Care, and Philosophy Dec 2023Semmelweis' discovery of the etiology of childbed fever has long attracted the attention of historians of medicine and biographers. In recent years it has also become of...
Semmelweis' discovery of the etiology of childbed fever has long attracted the attention of historians of medicine and biographers. In recent years it has also become of increasing interest to philosophers. In this paper I discuss the interpretation of Semmelweis' methodology from the viewpoint of the inference to the best explanation and argue that Popperian methodology is better at capturing the dynamics of the growth of knowledge. Furthermore, I criticize the attempts to explain the failure of Semmelweis to have his discovery accepted on the basis of the Kuhnian concept of paradigms, and warn that this view may endorse dogmatism as the norm The Kuhnian position also raises the problem of the authoritarian nature of scientific institutions which defend a paradigm against unorthodox, rebellious views, such as in the case of Semmelweis. Popperian philosophy is seen as a challenge to promote a link between an open society and open science with its main aim being to cherish a free critical spirit.
Topics: Pregnancy; Female; Humans; Puerperal Infection; Medicine; Knowledge
PubMed: 37584837
DOI: 10.1007/s11019-023-10167-7 -
Environmental Science and Pollution... Sep 2023Exposure to endocrine-disrupting chemicals (EDCs) can promote infant neurodevelopmental impairment and maternal postpartum depression (PPD). However, the associations...
Effects of postnatal exposure to phthalate, bisphenol a, triclosan, parabens, and per- and poly-fluoroalkyl substances on maternal postpartum depression and infant neurodevelopment: a korean mother-infant pair cohort study.
Exposure to endocrine-disrupting chemicals (EDCs) can promote infant neurodevelopmental impairment and maternal postpartum depression (PPD). However, the associations between lactation exposure to EDCs, maternal PPD, and infant neurodevelopment are unclear. Hence, we investigated these relationships in infants aged 36-42 months. We recruited 221 Korean mothers and analyzed 29 EDCs. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal PPD. Bayley scales of infant development; the Swanson, Nolan, and Pelham rating scale (SNAP); and the Child Behavior Checklist (CBCL) were used to assess neurodevelopment in infants exposed to the top 30% of EDC over three years. Multiple regression analyses were adjusted for maternal age, pre-pregnancy body mass index, education, income, employment, residence, and infant age and sex. The rates of infants with clinically abnormal diagnoses on neurologic developmental tests (Balyey, SNAP, and CBCL scales) ranged from 7.7 to 38.5% in this study, with the motor and hyperactivity/impulsivity areas scoring the highest among 65 boys and girls. Mono-2-ethylhexyl phthalate (MEHP) and mono-isononyl phthalate (MiNP) levels in breast milk significantly correlated with infant inattention and hyperactivity. Perfluorononanoic acid (PFNA) and perfluorooctyl sulfonate (PFOS) levels correlated significantly with motor development of BSID-III and total CBCL score which mean infant might have lower developmental status. EDC concentrations in breast milk were not associated with maternal PPD. Overall, lactational exposure to EDCs during the postpartum period can exert a negative effect on maternal PPD and infant neurodevelopment.
Topics: Male; Child; Female; Pregnancy; Humans; Infant; Mothers; Cohort Studies; Triclosan; Parabens; Depression, Postpartum; Endocrine Disruptors; Republic of Korea; Prenatal Exposure Delayed Effects
PubMed: 37572253
DOI: 10.1007/s11356-023-29292-0 -
The association between adverse childhood experiences and perinatal depression symptom trajectories.American Journal of Obstetrics &... Aug 2023Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this...
BACKGROUND
Having a history of adverse childhood experiences is associated with an increased risk for treatment-resistant depression in the general population. Whether this relationship is true in the perinatal context is unknown.
OBJECTIVE
This study aimed to examine the association between adverse childhood experiences and the trajectories of antenatal and postpartum depression among people enrolled in a perinatal collaborative care program for mental healthcare.
STUDY DESIGN
This retrospective cohort study included all pregnant and postpartum people who were referred to and enrolled in a perinatal collaborative care program for mental healthcare and who delivered at a single, quaternary care institution between March 2016 and March 2021. Individuals referred to the collaborative care program were linked with a care manager and had access to evidence-based mental health treatment such as a psychiatric consult, pharmacotherapy, and psychotherapy. All individuals enrolled in the collaborative care program underwent adverse childhood experience screens at intake. A score of >3 on the validated Adverse Childhood Experiences Questionnaire was defined as a high adverse childhood experience score. Depression symptom monitoring occurred via electronic Patient Health Questionaire-9 screening every 2 to 4 weeks, and escalation of care was recommended for those without evidence of improvement. Antenatal depression trajectories were determined by comparing the earliest available prenatal Patient Health Questionaire-9 score closest to the time of referral to collaborative care with the latest Patient Health Questionaire-9 score before delivery. Postpartum trajectories were determined by comparing the earliest postpartum Patient Health Questionaire-9 score after delivery with the latest score before 12 weeks' postpartum. Depression trajectories were categorized as improved, stable, or worsened based on whether the Patient Health Questionaire-9 scores changed by at least 2 standard deviations (ie, 5 points on the Patient Health Questionaire-9 scale). Bivariable and multivariable analyses were performed.
RESULTS
Of the 1270 people who met the inclusion criteria, 294 (23.1%) reported a high adverse childhood experience score. Those with a high adverse childhood experience score were more likely to experience a worsened antenatal depression trajectory than those with a low adverse childhood experience score (10.3% vs 4.3%; P=.008). This association persisted after adjusting for potential confounders (adjusted odds ratio, 2.39; 95% confidence interval, 1.05-5.46). There was no significant difference in the postpartum depression trajectories between those with a high and those with a low adverse childhood experience score.
CONCLUSION
Having a high adverse childhood experience score is associated with a worsened antenatal depression trajectory for those enrolled in a collaborative care program. Given its high prevalence, future research should evaluate effective modalities of perinatal depression prevention and treatment specific for pregnant people with a history of adverse childhood experiences.
Topics: Humans; Female; Pregnancy; Depression, Postpartum; Depression; Adverse Childhood Experiences; Retrospective Studies; Postpartum Period
PubMed: 37247667
DOI: 10.1016/j.ajogmf.2023.101039 -
Revista Da Associacao Medica Brasileira... 2023
Topics: Female; Humans; Psychotic Disorders; Puerperal Disorders
PubMed: 37556644
DOI: 10.1590/1806-9282.2023S125 -
Preventing Chronic Disease Nov 2023Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later...
INTRODUCTION
Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later (9-10 months) postpartum period.
METHODS
We analyzed data from the 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) linked with data from a telephone follow-up survey administered to PRAMS respondents 9 to 10 months postpartum in 7 states (N = 1,954). We estimated the prevalence of postpartum depressive symptoms (PDS) at 9 to 10 months overall and by sociodemographic characteristics, prior depression (before or during pregnancy), PDS at 2 to 6 months, and other mental health characteristics. We used unadjusted prevalence ratios (PRs) to examine associations between those characteristics and PDS at 9 to 10 months. We also examined prevalence and associations with PDS at both time periods.
RESULTS
Prevalence of PDS at 9 to 10 months was 7.2%. Of those with PDS at 9 to 10 months, 57.4% had not reported depressive symptoms at 2 to 6 months. Prevalence of PDS at 9 to 10 months was associated with having Medicaid insurance postpartum (PR = 2.34; P = .001), prior depression (PR = 4.03; P <.001), and current postpartum anxiety (PR = 3.58; P <.001). Prevalence of PDS at both time periods was 3.1%. Of those with PDS at both time periods, 68.5% had prior depression.
CONCLUSION
Nearly 3 in 5 women with PDS at 9 to 10 months did not report PDS at 2 to 6 months. Screening for depression throughout the first postpartum year can identify women who are not symptomatic early in the postpartum period but later develop symptoms.
Topics: Pregnancy; United States; Female; Humans; Depression; Postpartum Period; Depression, Postpartum; Risk Assessment; Prevalence
PubMed: 37943725
DOI: 10.5888/pcd20.230107