Alberto Moreno Zaconeta

DEPRESIÓN POSTPARTO: PREVALENCIA DE TEST DE RASTREO POSITIVO EN PUÉRPERAS DEL HOSPITAL UNIVERSITARIO DE BRASILIA, BRASIL

RESUMENCon la intencion de estimar la prevalencia de depresion postparto en mujeres atendidas en el HospitalUniversitario de Brasilia - Brasil, fue utilizada una version en portugues de la Escala de Depresion PostNatal de Edimburgo (EPDS). La escala fue aplicada a mujeres que se encontraban entre la octava ydecima segunda semana postparto, abordadas en los consultorios de Crecimiento y Desarrollo Pediatrico,donde llevaban a sus hijos para consulta pediatrica de rutina. Fue analizada la prevalencia de testpositivo, asi como la influencia de los antecedentes reproductivos y si el embarazo fue programado oaccidental. Un total de 123 mujeres respondieron la escala; 6 fueron excluidas por dejar uno o mas itemssin respuesta. Hubo una prevalencia de test positivo de 22,2%. La edad, paridad, antecedentes de abortoo embarazo accidental no fueron factores de riesgo estadisticamente significativos para el hallazgo detest positivo.PALABRAS CLAVE: Depresion postparto, EPDS, BrasilSUMMARYWith the aim of estimating the prevalence rate of postpartum depression in women assisted at theUniversity Hospital of Brasilia - Brazil, a portuguese version of the Edinburgh Postnatal Depression Scale(EPDS) was used. The scale was applied to women who were between the 8th and 12th postpartumweek, approached in the outpatient clinic of Pediatric Growth and Development, where they took theirchildren for routine pediatric consultation. The prevalence rate of positive test was analyzed, as well asthe influence of the reproductive antecedents and of the fact that the pregnancy has been planned oraccidental. A total of 123 women responded the scale, but 6 were excluded because one or more itemswere not answered. A prevalence rate of positive test of 22.2% was found. The age, parity, abortionantecedents or unplanned pregnancy were not statistically significant risk factors for positive test.KEY WORDS: Postpartum depression, EPDS, Brazil

Cerebrospinal Fluid CRH Levels in Late Pregnancy Are Not Associated With New-Onset Postpartum Depressive Symptoms.

CONTEXT CRH participates in the hypothalamic-pituitary-adrenal axis and in neural circuits involved in the pathophysiology of depression. During pregnancy, the placenta produces large amounts of CRH, and production ceases abruptly after delivery. The relationship between CRH in the cerebrospinal fluid (CSF) during pregnancy and peripartum mood disorders has not been investigated. OBJECTIVES The objectives were to determine whether there are differences in CSF CRH concentrations of pregnant and nonpregnant women and whether CSF CRH concentrations in late pregnancy are associated with the presence of depressive symptoms during pregnancy and in the early postpartum period. DESIGN This was a prospective cohort study conducted from January to April, 2011. SETTING The study was conducted in one public and two private hospitals in Brasilia, Brazil. PATIENTS Patients included 107 healthy pregnant women who underwent elective cesarean delivery and 22 nonpregnant healthy women who underwent spinal anesthesia for elective surgical sterilization. INTERVENTION CRH in CSF was measured in pregnant and nonpregnant women by ELISA. MAIN OUTCOME MEASURE The association between CSF CRH concentration at delivery and maternal depression assessed before cesarean section and postpartum (4 to 8 wk) with the Edinburgh Postnatal Depression Scale (EPDS), with a cutoff of ≥ 13. RESULTS CRH concentration in the CSF was significantly higher in pregnant (4.1 ± 0.51 log CRH) than in nonpregnant women (3.6 ± 0.26 log CRH) (P < .001). Depressive symptoms starting after delivery occurred in 5.6% of women. CRH concentration in CSF was not different between women without depressive symptoms and women showing such symptoms during pregnancy or in the postpartum period. CONCLUSION CRH concentration in the CSF was higher in pregnant women than in nonpregnant women. However, in this sample, CSF CRH in late pregnancy was not associated with new-onset depressive symptoms in the early postpartum period.

Depression with postpartum onset: a prospective cohort study in women undergoing elective cesarean section in Brasilia, Brazil

PURPOSE It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff >13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS Among the 107 women who completed the study, 11 (10.3%) had significant depressive symptoms during pregnancy and 12 (11.2%) during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04), a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002). The risk of depression was not influenced by age, parity or educational level. CONCLUSION Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers.

Relationship between placental corticotropin-releasing hormone and postpartum depression: can defining what "postpartum depression" means make a difference?

Glynn and Sandman (1) described that increased levels of placental corticotropin-releasing hormone (pCRH) at midpregnancy are associated with increased risk of developing depressive symptoms at 3 months postpartum. Previous studies have also addressed the association between pCRH during pregnancy and the risk of postpartum depression (PPD), but with conflicting results (2–5). Glynn and Sandman, as well as the authors from previous studies, have defined PPD based on the presence of depressive symptoms on the postpartum period, whether or not the onset of symptoms was during pregnancy. We are concerned that this may not be the most appropriate strategy to define PPD and believe that this might have influenced their results. Not distinguishing women with depressive symptoms during and after pregnancy from those with depressive symptoms exclusively after pregnancy might have influenced the results because there is evidence that antenatal depression and PPD have different underlying physiopathological mechanisms, including differences in hypothalamus-pituitary-adrenal (HPA) axis function (6). According to Kammerer et al. (6), pCRH-induced HPA axis hyperactivity could contribute to antenatal depression, whereas HPA hypoactivity typically seen in the postpartum period resulting from the abrupt fall in pCRH levels could underlie PPD. We therefore believe that the role of pCRH in the development of PPD would be best addressed by assessing women with depressive symptoms with onset exclusively in the postpartum period. Distinguishing the latter from women whose symptoms were already present during pregnancy would possibly bring new insights into HPA axis involvement in PPD.

Pregnancy-induced growth of a spinal hemangioblastoma: presumed mechanisms and their implications for therapeutic approaches

Hemangioblastomas are benign tumors of the central nervous system (CNS) that may occur either sporadically or as part of von Hippel–Lindau (VHL) disease, in which they coexist with a series of other tumors outside the CNS. Because of their low mitosis rate, hemangioblastomas usually have slow-growing and late manifestations, but may cause sudden neurological symptoms if tumor hemorrhage occurs. Few studies have evaluated the impact of pregnancy on the evolution of hemangioblastomas. Some authors have reported tumor growth in women with VHL disease, but no such association was observed by others. The influence of pregnancy on sporadic hemangioblastomas remains largely unexplored. We report here the case of a pregnant woman whose first manifestation of sporadic spinal hemangioblastoma was life-threatening, rapidly progressive dysautonomia. In addition, we discuss the role of pregnancy in the triggering of symptoms, as well as the possibility of medically indicated delivery for the management of these tumors.

Abdominopelvic tuberculosis mimicking malignant ovarian tumor

A 32-year-old woman was referred to the Gynecologic Oncology service with history of abdominal pain and weight loss of 10Kg in the last six months. An ultrasound performed a few days before had shown enlarged ovaries, ascites and omental and peritoneum thickening. CA125 level was 1986IU/mL (N<200IU/mL). Considering the diagnosis of ovarian and peritoneal cancer, an exploratory laparotomy was performed. During surgery, there was no evidence of ovarian tumor, instead, diffuse nodules, edema and significant hyperemia were seen in the uterus, tubes, peritoneum and omentum (Figures 1 and 2). Intra-operative frozen section consultation showed a chronic granulomatous inflammatory process, with giant multinucleated cells. After tissue and peritoneal fluid samples collection, the abdomen was closed without any other intervention. Both, ascitic fluid Adenosine Deaminase levels and histopathological tissue analysis were suggestive of tuberculosis (Figure 3). Staining methods searching for Alcohol and Acid Fast Bacilli and for fungi were negative (Figures 4 and 5). The patient was treated for tuberculosis with complete symptoms recovery.

Lactation Induction in a Commissioned Mother by Surrogacy: Effects on Prolactin Levels, Milk Secretion and Mother Satisfaction

Case report of a 39-year-old intended mother of a surrogate pregnancy who underwent induction of lactation by sequential exposure to galactagogue drugs (metoclopramide and domperidone), nipple mechanical stimulation with an electric pump, and suction by the newborn. The study aimed to analyze the effect of each step of the protocol on serum prolactin levels, milk secretion and mother satisfaction, in the set of surrogacy. Serum prolactin levels and milk production had no significant changes. Nevertheless, the mother was able to breastfeed for four weeks, and expressed great satisfaction with the experience. As a conclusion, within the context of a surrogate pregnancy, breastfeeding seems to bring emotional benefits not necessarily related to an increase in milk production.