Presence Of Obstetric Complications Research Articles

Catatonia in the peripartum: A cohort study using electronic health records

BackgroundDue to limited existing literature available on the presentation and treatment of catatonia in the peripartum, this retrospective descriptive cohort study aimed to examine demographic data, catatonic features, diagnoses pre- and post-catatonic episodes, treatment and the presence of obstetric complications. MethodsIndividuals with catatonia were identified in a previous study using anonymised electronic healthcare records from a large mental health trust in South-East London. The presence of features from the Bush-Francis Catatonia Screening Instrument was coded by the investigators and longitudinal data were extracted from structured fields and free text. Results21 individuals were identified from the larger cohort, each of whom experienced one episode of catatonia in the postpartum period, and all had had an inpatient psychiatric admission. 13 patients (62 %) presented after their first pregnancy and 12 (57 %) experienced obstetric complications. 11 (53 %) attempted breastfeeding and 10 (48 %) received a diagnosis of a depressive disorder following the episode of catatonia. The majority presented with immobility or stupor, mutism, staring and withdrawal. All were treated with antipsychotics and 19 (90 %) received benzodiazepines. ConclusionsThis study suggests that signs and symptoms of catatonia during the peripartum are similar to other catatonic presentations. However, the postpartum may be a period of high risk for catatonia and obstetric factors, such as birth complications, may be relevant.

Determinants of perinatal mortality at tertiary hospitals in East Wollega, Western Ethiopia: a case-control study.

This study was performed to determine predisposing factors of perinatal mortality among deliveries at tertiary hospitals in East Wollega, Western Ethiopia. This institutional-based unmatched retrospective case-control study involved 810 samples (270 perinatal deaths and 540 controls) selected from the study hospitals. For each case, two controls were selected. Data were collected using a pretested structured questionnaire. Data were entered into EpiData Version 3.1 and exported to SPSS Version 25 for analysis. Descriptive analysis and logistic regression were performed. The adjusted odds ratio with 95% confidence interval was calculated, and statistical significance was declared at a P-value of <0.05. The statistical analysis revealed the following independent determinants of perinatal mortality: rural residence, lack of antenatal care, preterm delivery, induction of labor, presence of obstetric complications, breech presentation, shoulder presentation, low birth weight, congenital malformation, and not using a partograph. Given the determinant factors of perinatal mortality in the study area, health facilities are recommended to implement appropriate antenatal care, intrapartum care, and neonatal care to prevent perinatal mortality. They are also advised to use partographs and ensure better access to antenatal care facilities.

Pregnant Women Affected by COVID-19 in Veracruz, Mexico

Introduction: Currently, maternal-fetal vertical transmission has not been reliably demonstrated; however, it has been shown that when there is a maternal cytokine storm, it can severely affect the fetus, leading to risks of fetal brain development abnormalities and risks of autism spectrum disorders. Materials and Methods: In a descriptive and retrospective study carried out from June 2021 to June 2022, admitting pregnant patients over 18 years of age with a diagnosis of COVID-19 by positive antigen test or PCR-RT, previous symptoms and comorbidities are analysed, as well as the presence of obstetric complications. associated and the use of vaccines during pregnancy. Results: 58 pregnant women with an established diagnosis of COVID-19 are entered into the study; the average age is 28 years; regarding comorbidities; only 2 reported suffering from chronic hypertension and 10 are overweight/obese. 40 patients were reported during the 3rd wave of COVID (June to December 2021) dominated by the Delta variant and 18 patients during the 4th wave dominated by Omicron (January to June 2022). According to the gestation trimesters, the majority were in the first trimester with 32 patients (55%), in the second trimester with 18 patients (31%), and only 8 patients in the third trimester (14%). Only 10 patients (17%) presented obstetric events associated with acute COVID-19 infection, highlighting threatened abortion and threatened preterm labour. Conclusion: This cohort of pregnant patients with COVID-19 infection, remained free of serious disease thanks to vaccination, and being a young and healthy population, the importance of preventive vaccination in the gestation stage is of utmost relevance to avoid both serious maternal illness as well as poor fetal outcomes. Similarly, the virulence and pathogenicity of some strains over others are notorious.

Prediction of Urinary Tract Infection in Neonates with Unexplained Indirect Hyperbilirubinemia

Background: Neonates with urinary tract infection (UTI) are susceptible to higher rates of morbidity and mortality, specifically when presented with hyperbilirubinemia. Screening for UTIs in jaundiced neonates is a cost-effective strategy. The aims of this study were to investigate the pattern of UTI (prevalence, etiology, and susceptible antimicrobial agents) in neonates admitted to the NICU with unexplained indirect hyperbilirubinemia, as well as to identify early predictors of UTI in order to reduce the present morbidity and long-term consequences in NICU patients.&#x0D; . Methods: A cross-sectional hospital-based study that included 140 neonates diagnosed with unexplained indirect hyperbilirubinemia in the first 4 weeks of life. A questionnaire was applied to obtain demographic and clinical data. A number of laboratory parameters were assessed with clinical examination. Bacterial growth of 1 × 103 colony-forming units/mL of a single uropathogen was used to identify the existence of UTI. Multivariate analysis was used to identify the predicting factors of UTIs. Results: In the NICU group investigated, 25.7% of subjects had a culture-proved UTI. The most frequently isolated organism was Escherichia coli. Amikacin was the most common antibiotic that the isolates were susceptible to. In multivariable logistic regression analysis, a positive urine culture was statistically associated with an increase in WBCs (OR= 6.90, p= 0.001), pyuria (OR= 5.55, p= 0.001), small for gestational age (OR= 4.07, p= 0.021), prolonged phototherapy duration (OR= 3.50, p= 0.034), and the presence of obstetric complications (OR= 2.92, p= 0.001). Conclusion: UTI is substantially prevalent among neonates admitted to the NICU with unexplained indirect hyperbilirubinemia. The importance of routine UTI screening (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia was highlighted in this study, particularly in neonates with leukocytosis, pyuria, small for gestational age, prolonged phototherapy, and those born from mothers with a history of obstetric complications.&#x0D;

Premorbid of depressive youth at clinical high-risk for psychosis

IntroductionEarly detection of psychosis is a promising area in preventive psychiatry. The use of early intervention can prevent the first episode psychosis and improve outcomes.ObjectivesIdentification of premorbid features of depressive patients at clinical high risk for psychosis (CHR) comparing with depressive patients without CHR in order to improve early recognition of the psychotic process.Methods219 young depressive in-patients with CHR criteria for SOPS with attenuated positive and attenuated negative symptoms and 52 young depressive in-patients without CHR were examined. Presence of obstetric complications, neurodevelopmental deviance, neurological and psychiatric signs at the premorbid stage, and the level of premorbid functioning on the PAS were examined.ResultsIt has been established that depressive patients at CHR and without CHR had some obstetric complications (57.5% and 40.4%, respectively). Neurodevelopmental deviance in the first year of live was in 57.5% patients with CHR. At the age of 3-5 sleep disorders, ADHD and phobias were more common in patients at CHR than without it (58.8% and 32.7%, p=0.014). In pubertal, patients at CHR were more likely to show depression symptoms, obsessions, and aggression - 90.4% versus 76.9% (p=0.029). On the PAS scale, a decrease of the level of premorbid functioning has been observed in two groups of patients with and without CHR from the age of 12: from 12 to 15 years, 0.4 and 0.3 (p=0.004), from 16 to 18 years, 0.47 and 0.37 (p 0.001).ConclusionsPremorbid functioning were worst in patients with CHR, which indicates the possibility of early clinical detection of psychosis.DisclosureNo significant relationships.

Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis

Obstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.

Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood.

ObjectiveThis study was aimed at identifying differences in the prodromal symptoms and their duration, risk factors and markers of vulnerability in patients presenting a first episode mania (FEM) or psychosis (FEP) with onset in late adolescence or adulthood in order to guide tailored treatment strategies.MethodsPatients with a FEM or FEP underwent a clinical assessment. Prodromes were evaluated with the Bipolar Prodrome Symptom Scale‐Retrospective (BPSS‐R). Chi‐squared tests were conducted to assess specific prodromal symptoms, risk factors or markers of vulnerability between groups. Significant prodromal symptoms were entered in a stepwise forward logistic regression model. The probabilities of a gradual versus rapid onset pattern of the prodromes were computed with logistic regression models.ResultsThe total sample included 108 patients (FEM = 72, FEP = 36). Social isolation was associated with the prodromal stage of a FEP whilst Increased energy or goal‐directed activity with the prodrome to a FEM. Physically slowed down presented the most gradual onset whilst Increased energy presented the most rapid. The presence of obstetric complications and difficulties in writing and reading during childhood were risk factors for FEP. As for markers of vulnerability, impairment in premorbid adjustment was characteristic of FEP patients. No specific risk factor or marker of vulnerability was identified for FEM.ConclusionEarly characteristics differentiating FEP from FEM were identified. These findings might help shape early identification and preventive intervention programmes.

Revealing histamine-sensible activity of Wood umbilical cord serum in experiments with ring segments of arteries and umbilical cord vein and with myometrium strips of pregnant women

In experiments with 60 segments of arteries and 46 segments of the umbilical cord vein of 24 newborns and 35 strips of myometrium of 12 pregnant women, the effect of 100-fold dilutions of cord blood serum (SPK-1: 100) on the contractile effects of histamine (0.01, 0.1 and 1 ϻg l ml). SPK-1: - 100 increased the vasoconstrictor and uterostimulating effects of histamine.&#x0D; H1-histaminosensitizing activity of SPK-1: 100 and the efficiency of activation of H1-histamine receptors of myocytes of the arteries and umbilical cord veins are increased in the presence of obstetric complications. A conclusion was made about the content of endogenous sensitizer H1-histamine receptors (ESGR) in the fetal blood, the level of which increases in the presence of obstetric complications, as well as the possible role of histamine and ESGR in the regulation of fetoplacental blood circulation in conditions of normal and pathological conditions.

Lack of Support for the Genes by Early Environment Interaction Hypothesis in the Pathogenesis of Schizophrenia.

Ursini et al reported recently that the liability of schizophrenia explained by a polygenic risk score (PRS) derived from the variants most associated with schizophrenia was increased 5-fold in individuals who experienced complications during pregnancy or birth. Follow-up gene expression analysis showed that the genes mapping to the most associated genetic variants are highly expressed in placental tissues. If confirmed, these findings will have major implications in our understanding of the joint effect of genes and environment in the pathogenesis of schizophrenia. We examined the interplay between PRS and obstetric complications (OCs) in 5 independent samples (effective N = 2110). OCs were assessed with the full or modified Lewis-Murray scale, or with birth weight < 2.5 kg as a proxy. In a large cohort we tested whether the pathways from placenta-relevant variants in the original report were associated with case-control status. Unlike in the original study, we did not find significant effect of PRS on the presence of OCs in cases, nor a substantial difference in the association of PRS with case-control status in samples stratified by the presence of OCs. Furthermore, none of the PRS by OCs interactions were significant, nor were any of the biological pathways, examined in the Swedish cohort. Our study could not support the hypothesis of a mediating effect of placenta biology in the pathway from genes to schizophrenia. Methodology differences, in particular the different scales measuring OCs, as well as power constraints for interaction analyses in both studies, may explain this discrepancy.

Hair cortisol moderates the association between obstetric complications and child wellbeing

Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children’s behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome (“distress”), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children’s physiological set-up such as HPA-functioning.

688: Risk factors for preterm parturition syndrome in live births and stillbirths

Amongst stillbirths due to obstetric causes, there is significant overlap in spontaneous preterm birth phenotypes that can be characterized as preterm parturition syndrome (PPS). Our objective was to assess PPS in live births and to compare demographic and obstetric factors between live births and stillbirths. The Stillbirth Collaborative Research Network (SCRN) conducted a population-based, case-control study of stillbirths and live births from 2006-2008. This secondary analysis includes both stillbirths and live births with presence of PPS at delivery. PPS was defined as presence of one or more of the following: cervical insufficiency (CI), preterm labor (PTL), preterm premature rupture of membranes (PPROM), chorioamnionitis, or placental abruption. For women with PPS live births, we reported the total number of PPS factors present and the association between them (McNemar’s test). We then compared risk factors between women with live births and stillbirths with PPS. We also compared number of components of PPS and the presence of each individual component. Comparison analyses were weighted to account for oversampling of live births preterm deliveries in original study design. Of the 536 preterm live births, 394 (74%) involved one or more components of PPS. 38% of women with PPS had only one PPS factor, 62% had at least two factors, and 24% had three or more. Presence of obstetric complications if others are present and McNemar’s p-value represented in (Table 1). Women with PPS and stillbirth delivered at earlier gestational age (25.7 vs 34.3 weeks, p<0.001). Women with PPS and stillbirth were more likely to be non-Hispanic black (OR 2.3, 95% CI 1.4-3.8), to have BMI ≥35 (OR 2.9, 95% CI 1.5-5.4), and to have asthma (OR 2.1, 95% CI 1.02-4.3). PPS with stillbirth were also more likely than live births to have 3 (OR 4.5, 95% CI 2.6-8.0) and 4 (OR 5.6, 95% CI 2.2-14.5) factors of PPS present. Placental abruption was more common in stillbirths than live births with PPS (OR 2.3, 95% CI 1.2-4.5). Women with stillbirth have more components of PPS in their presentation. It is important to recognize PPS in stillbirths, as it may be an opportunity for intervention in subsequent pregnancies.

English

Cesarean section is the most common major surgical procedure in obstetrics and gynecology in the world. Though advance in cesarean section technique, it still poses higher maternal morbidity and mortality than vaginal delivery. This study aimed to determine the magnitude of maternal complications (Including the presence of one of the intera-operative surgical complication or postoperative maternal complication; postoperative complication-is defined as the existence of one of the following; febrile morbidity, extended antibiotics treatment, extended hospital stay, wound infection (SSI), deep venous thrombosis (DVT), pneumonia, admission to Intensive Care Unit (ICU), drop in hemoglobin/hematocrit (HCT/HGB), blood transfusion, postpartum hemorrhage (PPH) maternal death in the Hospital) and associated obstetric factors among women who delivered by cesarean section at Arba-Minch General Hospital, Sothern Ethiopia Hospital based retrospective cohort study was conducted among women who delivered by cesarean section from July 8, 2013 to August 6, 2014 at Arba-Minch General Hospital. Demographic data, obstetric factors and occurrence of intra-operative and postoperative maternal complication during their hospital stay were collected using a pre-tested data collection format. SPSS version 20.0 was used for data analysis. A total of 416 mothers&rsquo; charts were reviewed. The mean (&plusmn;SD) age of the mothers was 25.72 (&plusmn;5.175 years). Emergency cesarean delivery accounted for 87% of all cesarean deliveries. Fetal distress, Cephalo Pelevic Disproportion (CPD), and obstructed labor accounted half of the indications for cesarean sections. Overall maternal complication rate was 38.2%. Living in rural setting (AOR, 1.4,95%CI:1.0,2.3), maternal age &ge; 30 years, (AOR=2.0,95%CI:1.1,3.8 ), presence of obstetric complications, (AOR=2.6,95%CI:1.4,4.7), operation done in second stage of labor, (AOR=2.5,95%CI:1.3,4.6), labor&ge;25 h (AOR=1.4,95%CI:1.0,2.4) &nbsp;and general anesthesia (AOR=2.456,95%CI:1.382,4.356) &nbsp;were found to have significant association with maternal complication. Maternal complication was found to be high. Timely management of labor before a woman develops obstetrics complication and use of appropriate anesthesia will reduce the occurrence of complications. &nbsp; Key words: Maternal complication, cesarean section (C/S), Ethiopia

A Case-Control Study of Hypoxic-Ischemic Encephalopathy in Newborn Infants at &gt;36 Weeks’ Gestation

Objective The purpose of this study was to determine risk factors that are associated with hypoxic ischemic encephalopathy (HIE). Study Design This was a case-control study that included newborn infants with HIE who were admitted to the hospital between January 2001 and December 2008. Two control newborn infants were chosen for each case. Logistic regression and classification and regression tree (CART) analysis that compared control infants and cases with grade 1 HIE and control infants and cases with grades 2 and 3 HIE was performed. Results Two hundred thirty-seven cases (newborn infants with grade 1 encephalopathy, 155; newborn infants with grade 2 encephalopathy, 61; newborn infants with grade 3 encephalopathy, 21) and 489 control infants were included. Variables that were associated independently with HIE included higher grade meconium, growth restriction, large head circumference, oligohydramnios, male sex, fetal bradycardia, maternal pyrexia and increased uterine contractility. CART analysis ranked high-grade meconium, oligohydramnios, and the presence of obstetric complications as the most discriminating variables and defined distinct risk groups with HIE rates that ranged from 0–86%. Conclusion CART analysis provides information to help identify the time at which intervention in labor may be of benefit.

A case-control study of hypoxic-ischemic encephalopathy in newborn infants at >36 weeks gestation

The purpose of this study was to determine risk factors that are associated with hypoxic ischemic encephalopathy (HIE). This was a case-control study that included newborn infants with HIE who were admitted to the hospital between January 2001 and December 2008. Two control newborn infants were chosen for each case. Logistic regression and classification and regression tree (CART) analysis that compared control infants and cases with grade 1 HIE and control infants and cases with grades 2 and 3 HIE was performed. Two hundred thirty-seven cases (newborn infants with grade 1 encephalopathy, 155; newborn infants with grade 2 encephalopathy, 61; newborn infants with grade 3 encephalopathy, 21) and 489 control infants were included. Variables that were associated independently with HIE included higher grade meconium, growth restriction, large head circumference, oligohydramnios, male sex, fetal bradycardia, maternal pyrexia and increased uterine contractility. CART analysis ranked high-grade meconium, oligohydramnios, and the presence of obstetric complications as the most discriminating variables and defined distinct risk groups with HIE rates that ranged from 0-86%. CART analysis provides information to help identify the time at which intervention in labor may be of benefit.

Obstetric Complications in Adults with ADHD: A Retrospective Cohort Study

Obstetric complications have been associated with a number of mental disorders. In this study, we investigate how obstetric complications relate with clinically significant determinants of adult attention deficit hyperactivity disorder (ADHD), such as gender, age of diagnosis, psychiatric co morbidity, severity of symptomatology and general functioning. Presence of obstetric complications as reported in the psychiatric history of 64 patients in transition from adolescence to adulthood referred to the Yorkshire service for adults with ADHD between June 2009 and October 2010 were recorded. The presence or not of these complications was examined as a factor determining a number of clinically significant variables, such as gender, age at first diagnosis, psychiatric comorbidity, severity of symptomatology (measured with Conners Adult ADHD Rating Scale (CAARS)) and general functioning (measured using the DSM-IV General Assessment of Functioning (GAF) index). Obstetric complications were not associated with any of the variables examined. Adults with ADHD in transition to adult services were highly symptomatic and disabled with a mean Conner’s score (n = 56) of 30.5 (SD = 12.8) and the most common frequency of the GAF score (n = 55) on the 60–51 range. Although it has been reported that environmental factors are associated with ADHD, the presence or absence of obstetric complications in an adult ADHD population was not associated with a number of proxy measures clinically associated with organic aetiology in mental health conditions. Future research on etiology and etiopathology should focus on prenatal and genetic factors instead.

Factors influencing maternal length of stay after giving birth in a UK hospital and the impact of those factors on bed occupancy

SummaryOn average, the length of time women remain in hospital after giving birth in the UK has deceased in recent years but most women are nevertheless admitted to a postnatal ward after childbirth. In this unique, prospective, observational study, we drew upon the expertise of caregivers on postnatal wards to reveal a wide range of obstetric, medical, neonatal and social problems that can lead to prolonged hospital stay. A woman's stay was likely to be increased by the greatest amount if her baby required specialised care but bed occupancy was more strongly influenced by the presence of obstetric complications because these were common. In this paper, we describe inpatient postnatal activity in detail and make recommendations for the safe and effective development of postnatal services.

Effects of antepartum electronic fetal monitoring on maternal emotional state

To evaluate the emotional state of pregnant women undergoing computerised cardiotocography (cCTG). A questionnaire including questions about socio-demographic background, personal obstetric history and physician-patient relationship was given to 204 pregnant women about to undergo cCTG. The Edinburgh Post-natal Depression Scale (EPDS) was used to assess patients' mood state before CTG, while the Spielberger State-Trait Anxiety Inventory (STAI) was used to evaluate anxiety levels before and after this examination. Mean STAI T-anxiety score did not differ before and after CTG (p=0.38), but higher levels of basal anxiety were found in women who had undergone only occasional prenatal controls (p=0.04), as well as smokers (p=0.01), and women preferring a vaginal delivery (p=0.01). The mean STAI S-anxiety score of 43.6+/-4.03 before the cardiotographic examination, increased to 45.2+/-5.4 after this test with a statistically significant difference (p=0.0001). This increase was found to be correlated with the presence of obstetric complications during the current pregnancy (p=0.036) and a lower number of fetal active movements (p=0.029). Based on the EPDS, 22 patients (14.1%) were found to be depressed, but this condition was not correlated with significant increases in anxiety levels. Anxiety levels in pregnant women who undergo routine CTG are increased, and this emotional reaction seems to be influenced by the perception of fetal movement during the examination, and is more evident in pregnancies affected by obstetric complications.

Obstetric complications in patients with schizophrenia and their unaffected siblings

Objective.– We sought to explore whether obstetric complications (OCs) are more likely to occur in the presence of familial/genetic susceptibility for schizophrenia or whether they themselves represent an independent environmental risk factor for schizophrenia. Methods.– The presence of OCs was assessed through maternal interview on 216 subjects, comprising 36 patients with schizophrenia from multiply affected families, 38 of their unaffected siblings, 31 schizophrenic patients with no family history of psychosis, 51 of their unaffected siblings and 60 normal comparison subjects. We examined the familiality of OCs and whether OCs were commoner in the patient and sibling groups than in the control group. Results.– OCs tended to cluster within families, especially in multiply affected families. Patients with schizophrenia, especially those from multiply affected families, had a significantly higher rate of OCs compared to normal comparison subjects, but there was no evidence for an elevated rate of OCs in unaffected siblings. Conclusion.– Our data provides little evidence for a link between OCs and genetic susceptibility to schizophrenia. If high rates of OCs are related to schizophrenia genes, this relationship is weak and will only be detected by very large sample sizes.

Does risperidone act better in schizophrenic patients who have a family or obstetric history?

Purpose: The aim of the study was to assess the effect of treatment with risperidone on psychopathological symptoms and cognitive deficits in schizophrenic patients, in relation to family history, obstetric complications and duration of the illness. Methods: Fifty schizophrenic inpatients (29 males, 21 females), aged 16–50 (mean 28 years), with duration of the illness 1–15 (mean 4 years) who successfully completed a 3-month risperidone treatment were included into the study. Family history of psychiatric illness and the presence of obstetric complications were estimated by a semistructured questionnaire. Schizophrenic symptoms were assessed using the Positive and Negative Symptoms Scale (PANSS). Cognitive abilities were measured by neuropsychological “frontal lobe” tests: Trail Making Test (TMT), part B, Stroop Color Word Interference Test, part B, and Wisconsin Card Sorting Test (WCST). The clinical and neuropsychological evaluation was performed before and after 3 months of risperidone treatment, in doses 2–6 mg (mean 4.2 mg/day). Results: Before treatment, patients with family history had significantly higher intensity of negative symptoms, and obtained worse results on WCST perseverative errors (PE) and correct categories (CC). These measures were also impaired in subjects with obstetric complications. Additionally, in patients with obstetric complications, total and general PANSS psychopathology was higher and the results of Stroop B were worse. After a 3-month treatment with risperidone, no difference between respective groups was observed both in psychopathology and in neuropsychological tests. Patients with obstetric complications had higher degree of improvement on positive and negative symptoms and on TMT-B than the remaining ones. Patients with longer duration of the illness had less improvement on positive symptoms with risperidone treatment. Conclusions: The results of this study show that treatment with risperidone results in better compensation of psychopathological (negative symptoms) and neuropsychological (working memory) deficits in patients who have a family history and/or obstetric complications. This may be due to a favourable effect of risperidone on the prefrontal cortex dysfunction mediating these deficits.

Perinatal transmission of HIV and diagnosis of HIV infection in infants: a review.

Paediatric HIV infection has become a major burden on families, communities and health services worldwide. The vast majority of children now acquire HIV as a result of mother to infant (vertical) transmission. Recent major advances have occurred following the greater understanding of the risk factors for perinatal transmission and the role of antiretroviral therapy in preventing transmission. Now that interruption of vertical transmission is possible, early identification of HIV-infected pregnant women is critical. As of June 1997, HIV infection has been diagnosed in 37 children under 15 yrs of age in the Republic of Ireland; 32 as a result of maternal to infant transmission. The exact timing of HIV transmission during pregnancy is unclear but it is estimated that 60-70 per cent of infants may be infected at the time of delivery with approximately 30 per cent infected earlier in gestation. Vertical transmission rates vary from 15-40 per cent in different global areas. Antenatal and perinatal zidovudine treatment can reduce this rate by 60-70 per cent. Risk factors for the vertical transmission of HIV-1 are multifactorial. These factors include maternal disease status, in particular maternal viral load, route of delivery, duration of membrane rupture, presence of obstetric complications and infant feeding practices. Definitive diagnosis of HIV infection in infancy has been difficult in the past. Direct viral detection methods now allow the reliable diagnosis of HIV infection in the first few months of life. The most effective intervention to reduce perinatal HIV infection will be the better identification of HIV positive pregnant women with the subsequent introduction of measures to interrupt vertical transmission of HIV.