Premature Childbirth Research Articles

24.M. Workshop: Deprived adolescent children access to health

Abstract Adolescence is a vulnerable phase in human development. The age of the mother is essential for normal pregnancy and delivery with a good outcome. Sixteen million of mainly deprived adolescents give birth each year, constituting 11% of all births world-wide. Maternal and newborn health is one of the key markers of health inequalities worldwide. It has been ranked as the third leading source of funding for health and reproductive health with an investment of US$ 12.6 billion between 2013 and 2015. This workshop with five panelists will raise the importance of using the right data for analysis and advocacy on improving preventive health program effectiveness targeting deprived minor adolescents globally, by highlighting the case of Roma adolescents' in Bulgaria. Moreover, the Bulgarian law does not allow an independent access to gynecologist for anyone below 16 years, which includes the most at risk children with no supportive formal guardians or parents. Sanofi Espoir Foundation's evaluation of a decade long investments on reducing health inequalities will highlight the importance of adjusting preventive health programming to specific needs of the excluded adolescents globally by emphasizing irregular outcomes and often no real and sustainable impacts, despite numerous stakeholders, significant amount of energy and money engaged. Additionally, presentation on Bangladesh comparing trends of perinatal mortality in two rural Areas of Matlab over nine years, and on Nepal focused health impacts of parental migration on left-behind adolescents will share magnitude of insufficient attention to addressing access to health of deprived adolescents, especially in connection to their sexual and reproductive health. There is also an insufficient adjustment of preventive health programming targeting excluded Roma adolescents in Europe due to an insufficient application of the UN CRC participation principle in these programming. An example of Bulgaria shows a disproportional disadvantaged experience of deprived Roma children particularly visible in relation to health. Adolescent girls of Roma origin are particularly vulnerable because they face the risks of premature pregnancy and childbirth and premature childbirth. The percentage of low birth weight infants is more than four times higher among Roma children which carries a range of grave health risks for children. More than half of Roma women between the ages of 20 to 24 years were married before the age of 18. Prevalence of teenage parenthood among Roma girls is higher and the immunization coverage among segregated Roma communities is far below recommended 90%. The perspectives of the children who are the most in need of preventive health services is very often missing in the design, implementation and monitoring of these, as these programming is predominantly done through schools, even though these children are frequently outside of educational systems especially in teenage years. Key messages Deprived adolescents out of schools should be included in all phases of health programming that is their immediate concern including planning, implementation and evaluation phase. Health laws limiting access to health for minors should be adjusted for children with disadvantaged socio-economic background.

CLINICAL AND PARACLINICAL ASPECTS OF FORECASTING OF SEVERE FORMS OF HYPERBILIRUBINEMIA OF NEONATAL PERIOD

Modern clinical guidelines in neonatology consist list of risk groups of severe form of neonatal jaundice in newborns, but there is a lack of authenticityof clinical and paraclinical criteria’s, which could have allowed to forecast the severity ofpathological course and to define the predictors and early signs of dysfunction of hepatobiliary system for timely conducting of medical correction in neonatal period.
 Objective.To conduct the analysis of risk factors of somatic pathology, course of pregnancy andchildbirthof pregnant, clinical and paraclinical peculiarities of early neonatal adaptation of kids considering gestational age in time of birth for defining of risk groups of newborns with severe form ofhyperbilirubinemia.
 Materials and methods.Researched peculiarities of somatic anamnesis, gestational periods course and childbirth of 141 women, whose kids had clinical signs of neonatal jaundice. Main researched groups of newborns: I group includes mature newborns, whowere divided on two subgroups: subgroup IA (46 kids) – kids that had middle condition severity and subgroup IB (23 kids) – kids with severe condition. II (control) group consist of 72 healthy mature newborns. III group includes premature newborns with gestation period 34 – 37 weeks. Consequently, IIIA group consist of 28 newborns with middle condition severity, IIIB group – kids with severe general condition in neonatal period. IV group includes conditionally healthy newborns with defined gestation period. Criteria of excluding from research were: premature childbirth (gestation period < 34 weeks), infectious genesis jaundice (P36), confirmed congenital organic pathology of hepatobiliary system, in particular: anomaly of development of gallbladder, atresia of bile duct (Q44), congenital viral hepatitis (P53.3)
 Result and discussions. Maternity factors that complicate the pregnancy course and had an importance for severity of pathological course in kids, who had a clinical sign of hyperbilirubinemia in perinatal pathology: age of pregnant, especially in premature childbirth, infertility and uncontrolled misbirthof anamnesis, placental dysfunction,threat of premature birth in this pregnancy by rhesus factor. According to scale “Risk Score for Neonatal Hyperbilirubinemia” (2004), was distinguished some tendency of increasing of severity risk of hyperbilirubinemia in perinatal pathology of mature newborns, but that tendency didn’t exist in premature newborns. The most frequent clinical symptoms in newborns with hyperbilirubinemia in perinatal pathology were: hepatosplenomegaly, bowels dysfunction, hypoglycemia, anemic syndrome, combined hemorrhagic disorders. Indicators of biochemical blood’s spectrum of newborns showed increased level of general bilirubinserum, mainly for non-conjugate fraction, decreased level of general protein,albumin and glucose, possible increasing of AsAT activity in middle severity of condition, that tells about its activation, decreasing of indicator in severe condition; AsAT activity of premature newborns had a tendency of increasing in both middle and severe condition of newborns. AlAT indicator had a possible increasing of activity in correlation with increasing of conditions severity of mature newborns and decreased ferment reaction – in premature newborns. Сonclusions. 1. Estimation of probability of severe hyperbilirubinemia development in newbornshas to be complex, considering risk factors of pregnant and her somatic, obstetric and gynecological anamnesis, course of pregnancy and of childbirth and with conducting of marks estimation of factors according recommendations of «Risk Score for Neonatal Hyperbilirubinemia» (2004). 2. Important role for prevention of development of severe form of hyperbilirubinemia has estimation of risks in newborns, considering nature of perinatal pathology course, timely detectionof clinical symptoms, existentin disorders of metabolism and transport of bilirubin.

Roma origin as a factor for high level of adolescent fertility and abortion rate in European Union

Abstract Background Adolescence is a vulnerable phase in human development. Adolescent girls from Roma origin, especially younger girls, are particularly vulnerable because they face the risks of premature pregnancy and childbirth. The study aims to evaluate the association between Roma origin of mothers and prevalence of adolescent fertility and abortion rate in EU member states. Methods A correlational study was conducted and data on prevalence of adolescent fertility and abortion among adolescent girls (per 1000 live births) were extracted from European database “Health for all”. The means of variables in different countries were compared and Pearson’s correlation coefficients with share of Roma population were calculated. Data processing was performed by SPSS v.24. Results Increasing trend in premature childbirth has been observed in parallel with the increase of share of Roma population within countries, significantly more expressed in South-East member states. The mean adolescent live birth rate in the countries with highest proportion of Roma population was 5.6 times higher as compared to the mean for those with lowest proportion of Roma population. The highest level of proportion of live births to mothers aged less than 20 years was found in Romania (9.8%) and Bulgaria (9.5%). At the same tame proportion of Roma population in those countries is highest: Bulgaria (4.7%) and Romania (2.5%). The relation of adolescent fertility rate with share of Roma population shows significant positive correlation (r = 0.804, with 2-tailed significance p = 0.000). As far as the correlation of abortion among adolescent girls with the Roma origin is concerned, it is inverse and not significant. Conclusions Our results indicate significant correlation between share of Roma population and adolescent live birth in EU member states. A holistic approach is needed in which socio-economic development and education of Roma girls leads to further reduction of adolescent childbirth and abortions in EU. Key messages Adolescent girls from Roma origin in EU face the risks of premature pregnancy and childbirth more expressed in South-East member states and significant positive correlation for it was found. Bulgaria is the country with highest share of Roma population (4.7%) and in the second place according proportion of live births to mothers aged less than 20 years (9.5%) in the EU in 2015.

Expansion of Health Insurance Coverage for Prenatal Care and Its Association with Low Birth Weight and Premature Birth

Purpose The purpose of this study was to investigate the relationship between the cost of medical care for pregnancy and childbirth and the birth outcome. Methods Using the Korean National Health Insurance Corporation cohort data, we compared the birth outcome of 2,198 subjects before policy (2005-2008) and after policy (2009-2012) costs related to pregnancy and childbirth. Results After the rate of application of the maternity care fee increased by 2.3%, the cesarean section rate increased by 15%. The incidence of low birth weight was significantly lower in women under 35 years of age, as well as in women over 35 years of age who had delivered a child through cesarean section. Conclusion After the policy implementation, the rates of low birth weight and premature childbirth decreased at all ages, for second or subsequent births. Considering the purpose of the pregnancy and childbirth care support policy, implemented to reduce the burden of medical expenses and to create a favorable environment for childbirth, it is necessary to expand coverage by converting nonpayment items, and to develop diverse and comprehensive policies that consider pregnant women’s characteristics. Key Words: Health policy, Program evaluation, Prenatal care, Low birth weight, Premature birth

Impact of Premature Childbirth on Parental Outcomes During Baby's NICU Stay and Beyond

Impact of Premature Childbirth on Parental Outcomes During Baby's NICU Stay and Beyond

HUBUNGAN USIA IBU HAMIL DENGAN KEJADIAN PERSALINAN PREMATUR DI RSUD PANEMBAHAN SENOPATI BANTUL YOGYAKARTA

Persalinan prematur menjadi masalah global yang terjadi di dunia, Indonesia menduduki posisi kelima tertinggi. Penyebab persalinan prematur multikompleks, salah satu faktornya adalah usia. Usia ibu beresiko (<20 dan >35 tahun), sedangkan usia tidak beresiko (20-35 tahun). Tujuan penelitian ini adalah mengetahui hubungan antara usia ibu hamil dengan kejadian persalinan prematur. Penelitian ini menggunakan desain deskriptif korelasi dengan pendekatan cross sectional. Pengambilan sampel menggunakan teknik purposive sampling dengan jumlah sampel yaitu 97 ibu hamil yang mengalami persalinan prematur. Peneliti menggunakan studi dokumentasi dari rekam medis RSUD Panembahan Senopati Bantul Yogyakarta selama periode bulan Januari-Desember 2018. Analisis data menggunakan uji Kendall-Tau. Menghasilkan nilai p value 0,046 (<0,05), yang menunjukan terdapat hubungan antara usia ibu hamil dengan kejadian persalinan prematur. Kesimpulan : Ada hubungan antara usia ibu hamil dengan kejadian persalinan prematur di RSUD Panembahan Senopati Bantul Yogyakarta.

Cellular immune response induced by surface immunogenic protein with AbISCO-100 adjuvant vaccination decreases group B Streptococcus vaginal colonization

Group B Streptococcus (GBS) represents one of the most common causes of bacterial infection in neonates; it is also associated with premature childbirth and stillbirth. A vaccine against GBS is needed, but no approved vaccines are yet available. The Surface Immunogenic Protein (SIP) of GBS is conserved in all serotypes and had been reported to be a good vaccine prototype in a mouse model of GBS infection. Also, we have previously shown that both subcutaneous and oral immunization with rSIP can induce an efficient immune response that decreases GBS vaginal colonization in mice. In this study, we show that a vaccine based on a mixture of rSIP and AbISCO-100 adjuvant reduces GBS vaginal colonization in mice and induces antibodies with opsonophagocytic activities. Moreover, the passive transfer of sera and total T-cells from mice immunized with rSIP mixed with AbISCO-100 to unvaccinated mice decreases vaginal GBS colonization in an infected mouse. This is the first report of cellular immunity associated with rSIP-based vaccine testing in a mouse model of GBS infection.

INFLUENCE OF THE TRANSFERRED SYPHILITIC INFECTION ON THE COURSE OF PREGNANCY, CHILDBIRTH AND THE STATE OF NEWBORNS

Introduction: The article presents information about the peculiarities of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis. The peculiarities of the state of newborn babies born from mothers who have suffered syphilis are described. To date, the incidence of syphilis in Ukraine has a clear tendency to decline, but still remains quite high. The maximum incidence of syphilis is observed in women aged 15-20 years. The combination of pregnancy and syphilitic infection in an anamnesis is an unfavorable factor in regard to high risk of perinatal complications, the frequency of which does not tend to decrease. The aim - study the features of the course of pregnancy and childbirth in women with a syphilitic infection in the anamnesis, the evaluation of the state of newborns. Materials and methods: A prospective examination of 57 healthy women and their newborns (control group) and 60 pregnant women with a history of syphilitic infection (the main group) had been conducted. All pregnant women had undergone ultrasound examination, including feto- and placentometry, an estimate of the amount of amniotic fluid. The effect of the transferred syphilis on the state of the newborn had been assessed in accordance with the results of the clinical examination of an anthropometric data, including an Apgar score. Results: It is stated that the incidence of latent (41,66%) and forms with a prolonged course (20,00%) of syphilitic infection. The threat of premature childbirth was almost 3,5 times higher than in women with syphilis, cases of an anemia in pregnant women - 2 times, hypertensive disorders of pregnant women were 2,4 times more common in women of the main group, fetal development retardation syndrome 6,4 times, while a greater percentage of this disorder was recorded among women in the main group who were ill with latent forms and suffered secondary recurrent syphilis (35%). In 20% of the cases, pregnancy in women with syphilis has been completed by the cesarean section, an abnormality of the contractile capacity of the uterus was significantly higher - 23,33%. The adaptive capacity of the newborns in the main group has been significantly lower, compared to the control group. Conclusions: Syphilitic infection in the anamnesis complicates the course of pregnancy with numerous pathological conditions. Syphilitic infection, borne before pregnancy, affects not only the course of pregnancy, but also the course of childbirth and the postpartum period. The pathological conditions in infants are due to a decrease in resistance to birth stress, early depletion of adaptive resources of newborns under the influence of a syphilitic infection of the mother. In children who have experienced chronic intrauterine hypoxia, the risk of hemorrhagic syndrome is significantly higher due to increased permeability of the vascular wall. Such children have a tendency to develop neurological disorders and respiratory system lesions.

ОЦЕНКА ФАКТОРОВ РИСКА СВЕРХРАННИХ ПРЕЖДЕВРЕМЕННЫХ РОДОВ

Objective: Assessment of the significance of possible etiological factors in the development of early-premature birth in the Udmurt Republic. Methods: The main monitoring group consisted of 94 women with extremely early premature birth, the comparison group – 94 women with spontaneous childbirth in time. The estimation of the significance of risk factors was carried out by means of determination of relative risk value (RR), which characterizes the relationship between exposure and pathology. The data obtained as a result of the research are processed by generally accepted methods of variation statistics. Results: The obtained data on the significant influence of the morphofunctional state of the placenta (chronic placental insufficiency, relative risk, RR=3.4), premature rupture of the fetal membranes (RR=3.9), cervical insufficiency (RR=23) for the development of early premature childbirth. The somatic history of women with extremely early premature birth is a pathology of the cardiovascular system (arterial hypertension, RR=5.7), liver and biliary tract (dyskinesia, RR=3.7), iron deficiency anemia (RR=5.0), what is important for the adequate development and functioning of the placenta. Conclusion: Premature birth still remains an important problem in obstetrics, neonatology, and pediatrics. Of the risk factors we have identified for the Udmurt Republic, the most important consider the cervical insufficiency, premature birth in the anamnesis, inflammatory processes of the cervix, etc. Pregravid preparation taking into account these risk factors, and also the correction of extragenital pathology, can help to reduce the incidence of early premature birth. Keywords: Premature birth, early premature birth, risk factors.

Personal Growth 4 Years After Premature Childbirth: The Role of Change in Maternal Mental Health

Using a longitudinal design, the current study aimed to extend previous research by exploring three questions concerning the mechanism underlying the process of mothers’ personal growth in the aftermath of a premature birth: Are the positive changes reported previously by women who gave birth prematurely long-lasting and salient 4 years post-partum? Does the degree of change in maternal mental health over time predict personal growth 4 years after childbirth? Does the change in maternal mental health mediate between premature birth and personal growth 4 years later? Mental health was examined in four assessment waves: 1 month, and 1, 2, and 4 years after childbirth. Personal growth was tapped in the last wave. Data were collected from 561 Israeli mothers. The findings reveal that mothers who gave birth prematurely report higher personal growth 4 years after childbirth than mothers who delivered at full-term. Moreover, higher initial mental health and greater improvement in mental health over time predicted higher personal growth. In addition, the higher personal growth shown by women who gave birth prematurely was explained by their greater improvement in mental health over time than women who delivered at full-term. Finally, more highly educated and multiparous women reported an increase in mental health over time, which, in turn was associated with higher personal growth. Theoretical and clinical implications are discussed.

Kisspeptin and Metabolism: The Brain and Beyond.

Apart from the well-established role of kisspeptin (Kp) in the regulation of reproductive functions, recent data described its action in the control of metabolism. Of particular interest for the review is the population of Kp neurons localized in the arcuate nucleus (ARC) of the hypothalamus, the site of the brain where reproductive and metabolic cross talk occurs. However, within the hypothalamus Kp does not work alone, but rather interacts with other neuropeptides, e.g., neurokinin B, dynorphin A, proopiomelanocortin, the cocaine- and amphetamine-regulated transcript, agouti-related peptide, and neuropeptide Y. Beyond the brain, Kp is expressed in peripheral tissues involved in metabolic functions. In this review, we will mainly focus on the local action of this peptide in peripheral organs such as the pancreas, liver, and the adipose tissue. We will concentrate on dysregulation of the Kp system in cases of metabolic imbalance, e.g., obesity and diabetes. Importantly, these patients besides metabolic health problems often suffer from disruptions of the reproductive system, manifested by abnormalities in menstrual cycles, premature child birth, miscarriages in women, decreased testosterone levels and spermatogenesis in men, hypogonadism, and infertility. We will review the evidence from animal models and clinical data indicating that Kp could serve as a promising agent with clinical applications in regulation of reproductive problems in individuals with obesity and diabetes. Finally, emerging data indicate a role of Kp in regulation of insulin secretion, potentially leading to development of further therapeutic uses of this peptide to treat metabolic problems in patients with these lifestyle diseases.

Perinatal Dissociation and Post-traumatic Stress Disorder among Mothers of Preterm Infants: A Comparative Study

Preterm delivery is a particularly challenging experience that can be experienced by mothers as a traumatic event, causing dissociative reactions and authentic post-traumatic stress disorder (PTSD). In this work, we proposed to study the prevalence of perinatal dissociation and PTSD in mothers of preterm babies compared to a control group of mothers of term babies and to identify factors that may contribute to the occurrence of perinatal dissociation and PTSD following premature childbirth. We conducted a cross-sectional and comparative study, including 97 mothers of premature babies and 80 controls. We used the Perinatal Posttraumatic Stress Disorder Questionnaire to screen for PTSD, the peri-traumatic dissociation questionnaire to measure the level of perinatal dissociation, and the Perinatal Risk Inventory to assess perinatal risk. Compared to mothers of term infants, mothers of preterm infants had significantly higher rates of peri-traumatic dissociation and PTSD. Our results are consistent with previous studies, and add additional credit to the traumatic nature of preterm delivery. Setting up specific support modalities seems essential in the case of premature births in order to ensure a better quality of mother-child interactions and optimal development of the child.

Perinatal dissociation during premature childbirth: A comparative study

Premature childbirth is sometimes perceived as a painful and traumatic experience, in which mothers can manifest dissociative symptoms. Our study aims to evaluate dissociative symptoms during premature childbirth compared with full-term delivery and to identify predictors of perinatal dissociation. We conducted a cross-sectional, descriptive and analytical study, including 97 mothers of premature infants who presented to the outpatient unit of neonatology at the UH Hedi Chaker of Sfax in Tunisia. For each mother, we collected sociodemographic and obstetric data. We used the peritraumatic dissociative experiences questionnaire (PDEQ) for screening dissociative symptoms during labor. We assessed severity of prematurity by the perinatal risk inventory (PERI). Responses were compared with a control group of 80 mothers of full-term infants. Average age of mothers was 30.2 years. Average gestational age was 32.82 weeks. Pregnancies were single (83.5%) or twins. 77.3% of mothers gave birth by caesarean section. Prematurity was unexpected by 56.7% of them. According to the PERI, 47.4% of newborns were considered as high-risk preterm infants (PERI ≥ 4). The average score of PDEQ was 16. The prevalence of perinatal dissociation for this sample (20.6%) was significantly higher compared with the control group (P = 0.014). It was also correlated to unexpected prematurity (P < 0.001) and a PERI score ≥ 4 (P = 0,023). Our results show that perinatal dissociation is more frequently occurring in preterm childbirth, especially when prematurity is severe and unexpected. Early interventions providing adequate information and support during delivery for mothers at risk of developing perinatal dissociation can alleviate such distress and prevent the development of subsequent post-traumatic stress disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Collodion Baby: Case Report

The purpose of this work is to analyse the present data concerning epidemiological aspects, therapeutic possibilities as well as prenatal diagnosis of collodion baby. We report the case a woman, having a case index in the family and that consulted for a threat of premature childbirth to 29 weeks of amenorrhoea. Following have been marked by a premature childbirth of masculine sex newborn, presenting dermatological lesions typical of collodion baby, whose evolution was quickly fatal since first hours of life. Collodion baby is a severe form of congenital ichthyosis presents at birth. The clinical table is often characteristic. The prognosis depends on the management in the early neonatal period. This disorder usually evolves into a nonbullous congenital ichthyosiform erythroderma. Thanks to techniques of molecular biology, the prenatal diagnosis is given back possible since the 10-12 weeks of amenorrhoea, permitting a genetic counseling.

Premature childbirth: pregnant women's characteristics of a population in the South area of São Paulo

Abstract Objectives: to identify the characteristics of pregnant women who had premature child-birth (PPT) in the South region of São Paulo city. Methods: a cross-sectional observational study with a data collection of 122 medical files on pregnant women who had PPT in 2013. The collected data were analyzed by a statistical package, Graphpad Prism 6. As for the variables that were shown to be significant in the multivariate regression, an analysis was performed in a dichotomous form by odds ratio. Results: the mean age of the pregnant women was 24.9 years old. Of the 122 pregnant women, 34.4% were included in the age group considered to be at risk by the Ministry of Health. The predominant race was mixed (46.2%). 41.8% were high school graduates. Regarding to personal background, the history on urinary infection was mostly mentioned (37.5%). In relation to family history regarding clinical conditions, 43% had diabetes history and 61% had hypertension. As for gynecological history, 37.5% reported having dysmenorrhea during menstrual cycles. Multivariate analysis was performed and found that particularly hypertension and dysmenorrhea were the most significant. Conclusions: Regarding to women´s risk factors for premature childbirth, the most determining factor was dysmenorrhea, followed by hypertension.

Exploring the Meaning of the Lived-experience of Medicalized Premature Childbirth

Exploring the Meaning of the Lived-experience of Medicalized Premature Childbirth

Prevalence of colonization by Streptococcus agalactiae among pregnant women in Bukavu, Democratic Republic of the Congo.

Maternal vaginal colonization by Streptococcus agalactiae (GBS) has an important impact on neonatal health but has not been studied in the Democratic Republic of Congo. The aim of this study was to determine its frequency and influencing factors. Vaginal samples (n = 509) for bacteriological analysis were collected from women in Bukavu, eastern DR Congo, during their third trimester of pregnancy, along with information about age, education and socio-economic status, and medical and obstetric-gynecological history. The overall GBS colonization rate was 20%. Colonization was significantly associated with low education, history of urinary infection during the pregnancy, history of premature childbirth or abortion, and HIV-positive serology, but was not significantly associated with socio-economic level or parity. The GBS colonization rate is similar to that found elsewhere on the continent. Further studies, with follow-up of neonates of infected mothers and evaluation of prevention/treatment strategies, are needed.

BONDING E PREMATURIDADE: ESTUDO EXPLORATÓRIO SOBRE O ENVOLVIMENTO PATERNO EM CONTEXTO HOSPITALAR

The father's role in the modern family has been less studied and is poorly defined in the literature. Through an interview and qualitative analysis, we intend to explore paternal involvement in the context of hospitalization due to premature childbirth. This is exploratory and transversal study. We used semi-structured interviews to evaluate the emotional involvement of five parents with their children. Content analysis was used to analyse the interviews. The results revealed there are favourable conditions to make paternal involvement possible and beneficial for both father and child. The involvement appeared to be multidimensional and was subsequently classified as positive in this research. These fathers considered that early involvement/bonding with the premature baby was crucial for the future of their relationship. The condition of hospitalization for preterm birth seems to be a situation that, although hard and anxiogenic, also offers possibilities for contact and father involvement with the new-born. Key- words - bonding, content analysis, early relationship, fatherhood, paternal involvement, prematurity.

Antenatal psychosomatic programming to reduce postpartum depression risk and improve childbirth outcomes: a randomized controlled trial in Spain and France

BackgroundPostpartum depression (PPD) and poor childbirth outcomes are associated with poverty; these variables should be addressed by an adapted approach. The aim of this research was to evaluate the impact of an antenatal programme based on a novel psychosomatic approach to pregnancy and delivery, regarding the risk of PPD and childbirth outcomes in disadvantaged women.MethodsA multi-centre, randomized, controlled trial comparing a novel to standard antenatal programme. Primary outcome was depressive symptoms (using EPDS) and secondary outcome was preterm childbirth (fewer 37 weeks). The sample comprised 184 couples in which the women were identified to be at PPD risk by validated interview. The study was conducted in three public hospitals with comparable standards of perinatal care. Women were randomly distributed in to an experimental group (EG) or a control group (CG), and evaluated twice: during pregnancy (T1) and four weeks post-partum (T2). At T2, the variables were compared using the chi square test. Data analysis was based on intention to treat. The novel programme used the Tourné psychosomatic approach focusing on body awareness sensations, construction of an individualized childbirth model, and attachment. The 10 group antenatal sessions each lasted two hours, with one telephone conversation between sessions. In the control group, the participants choose the standard model of antenatal education, i.e., 8 to 10 two-hour sessions focused on childbirth by obstetrical prophylaxis.ResultsA difference of 11.2% was noted in postpartum percentages of PPD risk (EPDS ≥ 12): 34.3% (24) in EG and 45.5% (27) in CG (p = 0.26). The number of depressive symptoms among EG women decreased at T2 (intragroup p = 0.01). Premature childbirth was four times less in EG women: three (4.4%) compared to 13 (22.4%) among CG women (p = 0.003). Birth weight was higher in EG women (p = 0.01).ConclusionsThe decrease of depressive symptoms in women was not conclusive. However, because birth weight was higher and the rate of preterm childbirth was lower in the EG, our results suggest that the psychosomatic approach may be more helpful to the target population than the standard antenatal programs.

Prise en charge des patientes ayant un antécédent d’avortement tardif ou d’accouchement très prématuré

Patients have a very late abortion or premature delivery in 2–3 % of pregnancies. Management in a subsequent pregnancy should seek an infection, a fetal cause (aneuploidy, malformation syndrome, intrauterine death) or vascular pathology (preeclampsia, IUGR, intrauterine death). In women with a late abortion or very premature childbirth history, several preventive treatments of prematurity are now available. The main cause of prematurity is ascending infection from the vagina. Cerclage or pessary is designed to better isolate the uterine cavity. Their effectiveness has been validated in patients for whom the repeated measurement of cervical length by transvaginal ultrasound shows a cervical length <25mm. Early pregnancy vaginosis and treatment with Dalacin® seem to significantly reduce the risk of prematurity. Finally, the routine administration of intramuscular or vaginal progesterone at the beginning of the 2nd quarter also proved effective in several randomized studies.