Perinatal Care Centers Research Articles

Perinatal findings of women with pregnancy related haemolytic uremic syndrome: a case series from a single Italian tertiary perinatal care centre

Perinatal findings of women with pregnancy related haemolytic uremic syndrome: a case series from a single Italian tertiary perinatal care centre

Ethical Attitudes and Handling in Prenatal Conflict Situations - A Survey among Obstetricians and Prenatal Diagnosticians in Germany

Various studies have shown that belonging to a professional group has an influence on ethical attitudes. The aim of this study was to assess and compare the attitudes and approaches of obstetrical specialists and prenatal diagnosticians in prenatal conflict situations. Explorative cross-sectional online survey among tertiary perinatal care centers and prenatal diagnosticians with DEGUM Level II/III in Germany. The questionnaire included questions on ethical attitudes in the perinatal context and a case presentation of a fetal hypoplastic left heart syndrome. The response rate was 57.1% (310/543). 55.5% of the respondents practiced both obstetrics and prenatal diagnostics, 24.5% exclusively prenatal diagnostics, and 14.2% purely obstetrics. 27% agreed with the statement "An uncertain prognosis justifies pregnancy termination". For complex fetal malformations joint interdisciplinary counseling was advocated by 98.3%. Addressing the option of postnatal palliative treatment in a case of a hypoplastic left heart syndrome was accepted by 84.3% across all professional groups, while mentioning fetocide was more frequently cited as an option by prenatal diagnosticians than by obstetricians (57.7% vs. 34.1%). Interdisciplinary prenatal parental counseling in complex fetal malformations is uniformly advocated by prenatal diagnosticians and obstetricians in Germany. However, different ethical attitudes appear among specialists groups with regard to the option of termination of pregnancy.

Newborn Hearing Screening - An Implementation Analysis.

Hearing impairment affects a small but significant percentage of newborns (0.1-0.4%). Newborn hearing screening (NHS) is recommended for early detection and treatment. The implementation of NHS can vary among countries. In this study, we present the methodology, organization, and technical requirements of NHS. This study analyzed results from a tertiary hospital, identified issues, and proposed solutions. In the studied region, there are five maternity hospitals and a perinatal intensive care center and in 2020, there were 5,864 live births. Screening is performed at three levels. The first screening is conducted on the 2nd-3rd day of a newborn's life in a maternity hospital, the first rescreening on the 3rd-6th week at a relevant ENT department, and the second rescreening on the 3rd-6th month of life at the regional screening center where the central database is also held. In the studied region, 5,793 out of 5,864 (98.79%) newborns received NHS in 2020. Of these, 120 (2.07%) were tested positive on their first screening. Ninety-four patients (78.3%) of those attended the ENT department for a first rescreening. Thirty-four patients (0.59% of total) were tested positive again and referred to the regional screening center. Out of the 27 patients who attended the second rescreening, four (0.07% of the total) were ultimately diagnosed with hearing impairment. Our study found that newborn hearing screening (NHS) in our region achieved a high compliance rate of 98.8% for initial screenings in 2020. However, challenges remain in the rescreening process due to data management issues, inter-regional cooperation, and public awareness. The recent implementation of mandatory screenings, updated guidelines, and a centralized database is expected to enhance the effectiveness of NHS. Further research is needed to evaluate these improvements.

The impact of fetal surgical procedures on perinatal anxiety and depression

BackgroundPerinatal mental illness imparts a significant health burden to both patients and families. Many factors are hypothesized to increase the incidence of perinatal depression and anxiety in the fetal surgical population, including uncertain fetal prognosis and the inherent risks of surgery and preterm delivery. ObjectiveThe aim of this study was to determine the incidence and disease course of postpartum depression and anxiety in the fetal surgery population. Study DesignA retrospective chart review was conducted of fetal surgery patients delivering between November 2016 – November 2021 at an academic level IV perinatal health care center. Demographics and surgical, obstetric, and psychiatric diagnoses were abstracted. Standard descriptive analyses were performed. ResultsEligible patients were identified (n=119). Fetal surgery was performed at a mean gestational age of 22.8 weeks (SD: 4.11) weeks. Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. 28.6% (34/119) of patients carried the diagnosis of pre-existing depression or anxiety, with 55.9% (19/34) and 50.0% (17/34) of those on a baseline medication for depression or anxiety, respectively, prior to surgery. 27.1% (23/85) of patients without a history of anxiety or depression had new identification of one or both postpartum. Two patients experienced suicidal ideation postpartum.6.7% (8/119) and 10.1% (12/119) initiated a new psychiatric medication during or post-pregnancy, respectively. 16.0% (19/119) received a therapy referral. Among patients with baseline anxiety or depression, 58.8% (20/34) experienced an exacerbation postpartum with 26.5% (9/34) referred for therapy, and 26.5% (9/34) changing dose or medication for anxiety and 32.4% (11/34) for depression. 20.2% (24/119) of patients experienced new or worsening depression or anxiety after the standard 6-week postpartum visit. ConclusionAmong patients undergoing fetal surgery, a high incidence of postpartum depression and anxiety was identified, with most patients with pre-pregnancy anxiety or depression experiencing exacerbation postpartum. The timeframe to clinical presentation with depression or anxiety symptoms may be delayed beyond the traditional six-week postpartum period and into the first postpartum year. This observation could be attributed to de novo postpartum exacerbation or a lack of standardized treatment approaches earlier in the disease course or antepartum period. Understanding effective longitudinal supportive interventions is an essential next step.

Clinical features of women with thrombotic microangiopathy in pregnancy: A case series from a single Japanese tertiary perinatal care center.

Although perinatal thrombotic microangiopathy has become increasingly understood, the racial characteristics of patients with this condition remain unclear. Herein, we report the characteristics of patients with perinatal thrombotic microangiopathy at a single institution in Japan. We conducted a retrospective study over a 5-year period from January 1, 2017, to December 31, 2021, using the electronic medical records of pregnant women who delivered at the perinatal center of our hospital. We extracted the data of those who developed perinatal thrombotic microangiopathy and evaluated their characteristics at the time of disease onset, final diagnosis, and maternal and fetal outcomes. Of the 10 224 deliveries that occurred during the 5-year period, only seven patients (0.06%) had perinatal thrombotic microangiopathy. The median pre-pregnant body mass index was 18.65 kg/m2 (minimum 17.3 kg/m2 , maximum 20.7 kg/m2 ). More than half of the patients were conceived by in-vitro fertilization, and 42% these had twin deliveries. Four patients had a history of rheumatic disease. The other three patients without underlying diseases developed thrombotic microangiopathy with HELLP syndrome, and one patient transitioned to atypical hemolytic uremic syndrome. Based on low body mass index and in-vitro fertilization, which are characteristic of Japanese women, medical complications and twin pregnancies may be a risk for thrombotic microangiopathy. Additionally, depending on the cause of thrombotic microangiopathy, its timing and onset differed.

Differences in the incidence of obstetric complications depending on the extent and location of adenomyosis lesions

Objectives Although adenomyosis is reportedly associated with adverse pregnancy outcomes, clinical factors related to the high risk of obstetric complications are unclear. This study aimed to elucidate the characteristics of adenomyosis lesions associated with the increased incidence of obstetric complications based on imaging findings. Methods This was a retrospective, observational cohort study conducted in a tertiary perinatal care center. Eighty-eight singleton pregnant women with adenomyosis were included in the study. Based on magnetic resonance imaging or ultrasonography before and/or during pregnancy, patients were classified according to three types of image characteristics: the extent of adenomyosis lesion (focal type or diffuse type), location of the lesion (extrinsic type, intrinsic type, or indeterminate type), the positional relationship between the lesion and the placenta (placenta distant from adenomyosis or placenta over adenomyosis), and the incidence of obstetric complications were examined. Results Patients with diffuse type adenomyosis are significantly more likely to have spontaneous second-trimester miscarriage (diffuse type vs. focal type: 16.7 vs. 0%, p < .01), preterm premature rupture of membranes (19.4 vs. 1.9%, p < .01), and preeclampsia (25.0 vs. 7.7%, p = .02), as compared to those with focal type adenomyosis. In a comparison of the three location types, the incidence of placental malposition was higher in patients with the extrinsic type adenomyosis (extrinsic type vs. intrinsic type vs. indeterminate type: 20.0 vs. 6.7 vs. 2.3%, p = .03). Comparisons between the types of the placenta over or distant from adenomyosis lesion displayed no significant differences in the frequencies of obstetric complications. Conclusions We demonstrated that the frequency of obstetric complications related to adenomyosis varies depending on the extent and location of the lesion; patients with diffuse type adenomyosis have an increased risk of spontaneous second-trimester miscarriage, preterm premature rupture of membranes, and preeclampsia, while patients with extrinsic type adenomyosis have an increased risk of placental malposition. Imaging evaluation of adenomyosis prior to conception or early in pregnancy may be useful for the obstetrical risk assessment among patients with adenomyosis.

Maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in cervical cerclage- a Germany-wide survey on the current practice after dissemination of the German guideline.

To investigate the adherence of German perinatal specialist units and those of basic obstetric care to the national guideline we compared data from a nation-wide survey on the practice of maintenance tocolysis, tocolysis in preterm premature rupture of membranes and in the perioperative setting of cervical cerclage, and bedrest during and after tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth". A total of 632 obstetric clinics in Germany were approached and received a link to an online questionnaire. Data were descriptively analyzed by performing measures of frequency. To compare two or more groups Fisher's exact test was used. The response rate was 19%; 23 (19.2%) of respondents did not perform maintenance tocolysis, while 97 (80.8%) conducted maintenance tocolysis; 30 (25.0%) of obstetric units performed cervical cerclage without tocolysis and 90 (75.0%) combined cervical cerclage with tocolysis; 11(9.2%) of respondents did not use tocolytics in patients with preterm premature rupture of membranes, while 109 (90.8%) conducted tocolysis in these patients; 69 (57.5%) of obstetric units did not recommend bed rest during tocolysis, whereas 51 (42.5%) favored bedrest. Perinatal care centers of basic obstetric care recommend bed arrest during tocolysis statistically significant more often to their patients than those of higher perinatal care levels (53.6 vs. 32.8%, p=0.0269). The results of our survey are in accordance to others from different countries and reveal considerable discrepancies between evidence-based guideline recommendations and daily clinical practice.

周産期の危機的病態にVA–ECMOを導入し良好な結果を得た3例(Three peripartum patients in critical condition successfully treated with extracorporeal circulation)

要旨周産期において急激に循環虚脱へ陥った産科救急3例に対して体外循環を導入し良好な結果を得た。3例はそれぞれ肺血栓塞栓症による呼吸循環不全，羊水塞栓症による肺水腫，周産期心筋症による心不全であった。うち1例は帝王切開後の子宮出血が止まらないなかでvenoarterial extracorporeal membrane oxygenation（VA–ECMO）を使用し，子宮摘出術を行った。もう1例はVA–ECMO導入後に緊急帝王切開を行った。3例とも危機的病態であったにもかかわらず神経学的異常はほとんどなく母児ともに良好な転帰を得ることができたが，うち2例の体外循環は標準的な妊産婦の蘇生治療ではないため今後の症例の集積が待たれる。急変した妊産婦の救命ならびに神経学的転帰の改善のためには，カンファレンスやシミュレーションによる母体救命システムについての意思統一が有効である。さらには，地域の産婦人科医，周産期センターと救命救急センターが日頃から産科救急に柔軟に協働し，必要に応じて循環虚脱や重症呼吸不全に対して迅速に体外循環を導入できる体制が重要である。

Fetal outcomes with and without the use of sugammadex in pregnant patients undergoing non-obstetric surgery: a multicenter retrospective study

BackgroundThe influence of sugammadex exposure during pregnancy on progesterone withdrawal and miscarriage is unknown. We aimed to compare the fetal outcomes in pregnant patients who had undergone non-obstetric surgery with and without sugammadex. MethodsWe retrospectively reviewed the medical charts of pregnant women who underwent non-obstetric surgery at three tertiary perinatal care centers in Japan from January 2013 to December 2020. The women were divided into those who received general anesthesia with sugammadex (GA with SGX) and those who received general anesthesia without sugammadex (GA without SGX). We compared miscarriages and preterm births within four weeks after surgery. ResultsAmong the 124 women, 73 and 51 were included in the GA with SGX and GA without SGX groups, respectively. The two groups showed no differences in the rate of miscarriages or preterm births (3.0 % vs 4.3 %; odds ratio 1.42, 95 % confidence interval 0.19 to 10.47; P = 1.00). The SGX and no SGX groups were missing outcomes for 8.2 % and 7.8 % of cases, respectively. ConclusionsHaving GA with SGX or GA without SGX did not result in different rates of miscarriage or preterm birth within four weeks after the procedure. These findings do not exclude a potential association between sugammadex exposure during pregnancy and adverse pregnancy outcomes. Missing data may have obscured possible adverse outcomes from sugammadex exposure.

Perinatal deaths in Bursa Province, Turkey: an analysis by applying the International Classification of Diseases-perinatal mortality (ICD-PM) system

Objectives: The International Classification of Diseases for Perinatal Mortality (ICD-PM) system is a globally used classification based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Moreover, it focuses on the time of death and maternal conditions. Here, we analyzed perinatal deaths by using the ICD-PM system. Methods: This is a retrospective study, performed between January 1, 2020, and March 30, 2022, in Bursa. Perinatal characteristics and the causes of perinatal deaths were recorded. The perinatal deaths were classified according to the ICD-PM system and descriptives were given. Results: The majority of perinatal death cases (119 cases) occurred in the antepartum period. The leading cause of antepartum deaths was unspecified causes (62.2%) followed by fetal growth disorders (9.3%). A total of 63 (53.7%) mothers were healthy (M5) while 27 (22.7%) mothers had medical or surgical conditions (M4). Acute intrapartum events (33.4%) were the commonest cause of intrapartum deaths followed by unspecified causes (26.6%). When neonatal deaths were analyzed, low birth weight/prematurity constitute 59.6% of neonatal deaths. The largest proportion of mothers was healthy in the intrapartum (40%) while maternal complications of pregnancy (M2) was the most commonest classification for neonatal deaths. Conclusions: ICD-PM is a globally used system for classifying perinatal deaths. The time of perinatal death used in this system provides focus on interventions in perinatal care and it encourages comparison between perinatal care centers. We suggest that we might use resources truly to prevent perinatal deaths in our country by using this system.

Sexuality satisfaction 3 years after childbirth is better than men think

Sexual function and satisfaction in couples decreases after childbirth. Often communication problems play a central role in persisting sexual dysfunctions. The aim of this study was to evaluate sexual function of mothers of young children and to assess their partners’ perception of their sexuality. This cohort study is a postal survey using the Female Sexual Function Index (FSFI) questionnaire for women who gave birth at least 3 to 4 years ago in a perinatal health care centre in Germany. Additionally, the male partner got a modified FSFI questionnaire for evaluation of their perception of females’ sexuality. In all, 215 couples answered the questionnaire and were included in the study. The concordance of females’ and males’ answers was correlated with the females’ sexual function. The prevalence of women with potential female sexual dysfunction (FSFI < 26.55) was 24.3%. Besides, men seemed to underestimate their female partners’ sexual satisfaction. However, a good perception of men was associated with a good sexual function of women. Additionally, a child younger than three years was associated with a decreased sexual function in women and worse perception of men. This study helps to understand interactions between partners concerning females’ sexuality in couples with young children. Health care professionals should inform young parents about possible changes in sexuality after childbirth and encourage them to talk to each other about their sexual concerns and wishes to improve sexual and partnership satisfaction.

Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption-Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center.

Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.

Hypertensive disease, preterm birth, fetal growth restriction and chronic inflammatory disorders of the placenta: experiences in a single institution with a standardized protocol of investigation.

Chronic inflammatory disorders of the placenta, in particular villitis of unknown etiology (VUE), chronic deciduitis (CD), chronic chorioamnionitis (CC), chronic histiocytic intervillositis (CHI), and eosinophilic/T-cell chorionic vasculitis (ETCV) can exclusively be diagnosed histologically. Using a standardized procedure for submission and pathological-anatomical examination of placentas in a single perinatal care center, we analyzed the association of chronic placental lesions to perinatal complications. We reviewed all singleton placentas and miscarriages that were examined histologically over a period of ten years after having implemented a standardized protocol for placental submission in our hospital. Cases with chronic inflammatory lesions were identified, and clinical data were analyzed and compared with a focus on preterm birth, hypertensive disorders, and fetal growth restriction and/or fetal demise. In 174 placentas, at least one of the chronic inflammatory entities was diagnosed. CD was the most frequent disorder (n = 95), and had strong associations with preterm birth (47.3% of all cases with CD) and intrauterine fetal demise. VUE (n = 74) was exclusively diagnosed in the third trimester. This disorder was associated with a birth weight below the 10th percentile (45% of the cases) and hypertensive disease in pregnancy. Miscarriage and intrauterine fetal demise were associated with CHI (in 66.7% of cases, n = 18). Chronic inflammatory disorders are frequently observed and contribute to major obstetric and perinatal complications. Further studies are needed to get a better picture of the connection between adverse obstetric outcomes and chronic inflammation to aid in the better counseling of patients.

A Review of Cordocentesis: Percutaneous Umbilical Cord Blood Sampling.

We discuss the current indications, technical variation and procedure-related complications of percutaneous umbilical cord blood sampling (PUBS). The term PUBS is commonly used in the United States. Cordocentesis and funipuncture are equivalent terms. A needle guided by ultrasound is introduced into a blood vessel (usually the vein) of the umbilical cord to collect fetal specimen in PUBS.We conducted a literature search in PubMed indexed journals and analyzed all related articles on PUBS and cordocentesis. We chose this subject because it is a relatively new but convenient method that has both diagnostic and therapeutic value in fetal medicine. At present the only procedure that provides direct access to fetal circulation is PUBS. The most common clinical indication for PUBS is suspected fetal anemia. Other major indications for PUBS are the diagnosis of congenital infections, cytogenetic analysis, metabolic disorders, fetal growth restriction and hematologic disorders. Therapeutic applications of cordocentesis or puncture of the umbilical cord are in utero transfusions for rhesus alloimmunization and medication administration. PUBS also provides a direct assessment of fetal thyroid function diagnosing fetal thyroid disorders and helps administer therapy in utero. Literature demonstrates a low incidence of complications associated with percutaneous umbilical blood sampling. For PUBS, the true complication rate related to the method of sampling remains unclear. A few cases reported complications conducted PUBS for therapeutic purposes which naturally has a higher accident rate compared to diagnostic purposes. Although life-threatening complications are rare, there are potential risks that include bleeding from the puncture site, fetal bradycardia, vertical transmission of maternal infection. Therefore, PUBS should be performed at perinatal care centers by experienced physicians and the best time is between 17 to 40 weeks of gestation. There are three methods used to approach the umbilical cord that includes direct, indirect and free puncture. Anteriorly placed placenta allows an easier approach to the umbilical cord. The danger of abruption of placenta must be kept in mind while using this technique. The number of punctures should be limited to a maximum of 3 to reduce complications. According to a case series report, the mean time required for the procedure was 4 minutes with a fall in duration seen with increased experience.In conclusion, percutaneous blood sampling allows direct access to fetal circulation thus opening up new areas of prenatal diagnosis and therapy. PUBS is now a well-codified procedure. It is clear from our literature review that risks directly related to the technique are small. The indication of the procedure must be carefully chosen as the risk of complications of umbilical cord puncture is directly related to the severity of the condition. Complications such as bleeding and hematoma formation are related to duration and number of punctures which are operator-dependent. Thus, only highly trained personnel should conduct the procedure. The list of indications is extensive and growing. Nevertheless, this technique shows potential to open up new realms in the area of fetal medicine.

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Noteworthy Professional News.

400 The risk of postpartum glucose intolerance in lean japanese women with gestational diabetes

Although East Asian populations, including the Japanese, are the leanest populations in the world, the prevalence of diabetes in this population tends to be much higher than that in more obese populations. We investigated the risk of developing diabetes during the early postpartum period in lean Japanese women with gestational diabetes (GDM) compared with normal and obese women with GDM. In this retrospective cohort study, we included singleton pregnant women with GDM in a tertiary perinatal care center in Japan. We defined diabetes and impaired glucose tolerance as abnormal glucose tolerance (AGT) at the first postpartum oral glucose tolerance test (OGTT) at 6-9 weeks postpartum, and we then compared the prevalence of AGT between lean (prepregnancy body mass index [BMI] <18.5) and normal (18.5-24.9) and obese (≥25) women. We also compared the insulinogenic index (IGI) and homeostasis model of assessment (HOMA)-β as an index of insulin secretion and the HOMA-insulin resistance (IR) as an index of IR. We included 531 women with GDM, and 55 (10%), 330 (62%) and 146 (28%) were considered lean, normal and obese, respectively. The prevalence of AGT was 36% in the lean group, which was similar to that in the obese group (36%) and significantly higher than that in the normal group (p<0.05). In the lean group, the IGI (0.44±0.35 vs. 0.73±0.57, p<0.005), HOMA-β (55±23 vs. 102±73, p<0.0001) and HOMA-IR (0.72±0.35 vs. 1.81±1.57, p<0.0001) were significantly lower than those in the obese group. Lean Japanese women with GDM were characterized as having pancreas β-cell dysfunction rather than IR and were at a high risk of developing AGT during the early postpartum period, similar to obese women. Such women should be followed up as a high-risk group, similar to obese women.

399 Simple basal insulin regimen in women with mild gestational diabetes

Approximately 30% to 40% of women with gestational diabetes (GDM) receive insulin therapy, and the multiple daily insulin injection (MDI) regimen with a combination of basal and prandial insulin is generally used, as in cases of prepregnancy diabetes. We developed a simple insulin injection (SII) regimen, in which one or two injected doses of basal insulin are used, for women with mild GDM who require insulin therapy. The present study explored whether or not the SII regimen is as effective as the MDI regimen in preventing fetal macrosomia in women with mild GDM. In this retrospective study, we included singleton pregnant women with GDM in a tertiary perinatal care center. Insulin therapy was indicated if glucose control did not reach the target values under diet therapy. At the beginning of the insulin therapy, we used one daily injection of NPH insulin (10 to 20 units) before breakfast and added another injection of NPH insulin at bedtime, if necessary. If the control still did not reach the target values, we switched to an MDI regimen with additional prandial insulin aspart injection. We compared the glucose control levels, gestational weight gain (GWG), and perinatal outcomes between the diet-alone, SII, and MDI groups. Among 397 women with GDM, 66%, 15%, and 19% were in the diet-alone, SII, and MDI groups, respectively. There were no significant differences in the glucose control, maternal GWG, or perinatal outcomes among the groups (Table). Among the 34% of women with GDM requiring insulin therapy, 44% had a well-controlled condition with the SII regimen without any increase in the GWG or adverse perinatal outcomes. In women with mild GDM requiring insulin therapy, nearly half can maintain good control with this simpler insulin regimen.

STATUS OF MEDICAL CARE FOR NEWBORNS IN UKRAINE

Introduction. In the context of continuing depopulation, and low birth rate, the formation and preservation of newborn generations’ health is the most important medical and social task and one of the main activities of the Ministry of Health of Ukraine and local health care institutions.&#x0D; The aim of the study was to analyze and evaluate the effectiveness of medical care for newborns in Ukraine and its impact on the main indicators of newborns’ health.&#x0D; Materials and research methods. A retrospective analysis and assessment of the dynamics of neonatal care in Ukraine was carried out according to state and industry statistics, perinatal audit according to the method of WHO “MATRIX - BABIES” for the period 2001-2019, monitoring and evaluation of the regionalization of perinatal care (for 2014-2017). Methods of a systematic approach, bibliographic, statistical data processing, and graphic representation were applied.&#x0D; Results of the study: the study showed that during the period of the research a number of newborns born in the facilities of the Ministry of Health of Ukraine decreased from 387900 in 2000 to 294100 in 2019, with a negative trend in the generalized objective criterion of the generation’s health and socio-economic well-being of the population - frequency of premature newborns with low birth weight including those with extremely low birth weight. At the same time, the frequency of newborns with congenital diseases or those who got sick after birth, decreased from 280.8 per 1000 live births in 2000 to 172.14 in 2019 with the wave-like nature of its dynamics.&#x0D; The existing state system of three-level neonatal care integrated into the perinatal service makes it possible to provide basic, qualified and highly qualified specialized medical care for newborns at all stages of its provision. During the observation period, the provision of newborns with pediatrician-neonatologists increased from 4.58 per 1000 live births to 5.34, and with hospital beds for premature and sick newborns - from 5.62 to 6.91, respectively.&#x0D; A slight increasing trend of significant criterion of newborns’ health condition was achieved (99.36% in 2001 vs 99.7% in 2019) along with the activities of the neonatological service in survival of newborns in the first 168 hours of life mainly due to a 2.6-fold increase in the survival of newborns with a birth weight of 500-999g. Sufficient efficiency of medical care for newborns was confirmed by a positive trend in early neonatal mortality from 4.71 ‰ in 2000 to 3.04 ‰ in 2019 and neonatal mortality from 6.65 ‰ to 4.57 ‰, respectively.&#x0D; At the same time, the increase of newborns’ incidence with diseases that have a direct impact on the development of chronic and disabling diseases is a cause for concern: cases of congenital pneumonia increased from 3.18 ‰ in 2000 to 5.46 ‰ in 2019, of neonatal sepsis - from 0.09 ‰ to 0.74 ‰, respectively. Also other disorders of newborns’ cerebral status increased from 18.5 ‰ in 2010 to 28.5 ‰, and neonatal jaundice - from 31.11 ‰ in 2015 to 43.65 ‰.&#x0D; An excess in 1.5 times of the standard recommended by the WHO of the proportional indicator of early neonatal mortality was revealed among infants weighing more than 1500 g. The excess of the real indicator of early neonatal mortality over the actual one was 2.2-2.3 times, which meant underestimation of the total rate of neonatal and infant mortality.&#x0D; Conclusions. Further improvement of the effectiveness of neonatal care and the decrease of early neonatal and neonatal mortality levels requires continued regionalization of perinatal care, completion of the perinatal care centers of the third level, revision and provision of patient routes, development and provision of state-guaranteed medical services/standards (such as a standard of child’s safety, safety of pregnant and postpartum woman), the reliability of determining body weight at birth, criteria for live birth and stillbirth, the introduction of follow-up monitoring of low-birth-weight newborns, the formation of a unified system for monitoring the activities of the maternal and child health services.

Does Birth-Related Trauma Last? Prevalence and Risk Factors for Posttraumatic Stress in Mothers and Fathers of VLBW Preterm and Term Born Children 5 Years After Birth.

Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4–6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study “Hamburg study of VLBW and full-term infant development” (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.

Translation and Psychometric Analysis of the Japanese Version of the Perceived Maternal Parenting Self-Efficacy Scale

ObjectiveTo translate the Perceived Maternal Parenting Self-Efficacy (PMP S-E) scale to Japanese and test its psychometric properties among Japanese mothers of low-birth-weight (LBW) infants. DesignDescriptive psychometric study. SettingNICUs in two regional perinatal care centers in the Kinki region of Japan. ParticipantsSeventy-nine Japanese mothers of LBW infants hospitalized in NICUs. MethodsFirst, we translated the PMP S-E scale into Japanese and assessed its face and content validity. Second, we assessed the internal consistency, test–retest reliability, and criterion-related and construct validity of the Japanese version of the PMP S-E (JPMP S-E) with data from Japanese mothers of LBW infants. ResultsThe JPMP S-E mean score was 53.0 (SD = 7.1); the total scores ranged from 38 to 68. The intraclass correlation coefficient of test–retest reliability was .75, and Cronbach’s alpha coefficient was .90. With regard to criterion-related validity, we found a significant positive correlation between the JPMP S-E and the Maternal Attachment Inventory Japanese version (r = .45, p < .001), but no correlation existed between the JPMP S-E and the General Self-Efficacy Scale (r = .21, p = .06). We evaluated construct validity using confirmatory factor analysis to assess whether the model fit the previously determined structure of the PMP S-E. The model fit was moderate in the confirmatory factor analysis (comparative fit index = .63, goodness-of-fit index = .63, root mean square error of approximation = .15). ConclusionWe found adequate estimates of reliability and moderate indicators of validity for the JPMP S-E, which support the use of the tool for clinical and research purposes.