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2 results

  • Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother–child cohort in Crete, Greece

  • K. Koutra, M. Vassilaki, V. Georgiou, A. Koutis, P. Bitsios, M. Kogevinas, L. Chatzi
  • Journal:
    Epidemiology and Psychiatric Sciences / Volume 27 / Issue 3 / June 2018
    Published online by Cambridge University Press:
    22 December 2016, pp. 244-255
  • Aims.

    Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum.

    Methods.

    A total of 1037 women who enrolled in the Rhea mother–child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders.

    Results.

    The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (β coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (β coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother.

    Conclusions.

    We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.

  • Chapter 15 - Intrapartum and Postpartum: Legal Commentary II

  • from Part II - INTRAPARTUM AND POSTPARTUM
  • John Patrick O'Grady, Tufts University, Massachusetts, Martin L. Gimovsky, Lucy A. Bayer-Zwirello, Kevin Giordano
  • Book:
    Operative Obstetrics
    Published online:
    07 May 2010
    Print publication:
    04 August 2008, pp 370-392

  • Summary

    Pregnancy, labor, and delivery are associated with major physiologic changes that can decrease maternal reserves. Consequently, various techniques of analgesia and anesthesia can have profound effects on maternal physiology. Furthermore, obstetric pain management and operative obstetric anesthesia are recognized as secondary causes of neonatal respiratory depression. Improper management of labor is the common claim in obstetrical malpractice cases. Malpresentation and/or dystocia are some of the most fertile areas for medical negligence lawsuits. The clinician must be fully aware of the general predisposing factors to complications in the third stage of labor. Common postpartum complications include urinary tract problems, such as infections, urine retention, or incontinence. Obstetricians have long recognized the excessive perinatal morbidity and mortality associated with the breech-presenting fetus. Multiple gestations often pose intrapartum management problems. Emphasizing the shoulder dystocia was a true obstetric emergency, and greater emphasis was placed on team approach, including neonatal resuscitation.