C Stern

The impact of resilience on psychological outcomes in women after preeclampsia: an observational cohort study

BackgroundPreeclampsia is a frequent obstetric complication which affects the mother`s and the fetus’s health and can be life threatening. It also has an impact on psychological outcomes. There may be protective variables such as resilience shielding against psychosocial distress in women experiencing these pregnancy complications. The aim of this study was to examine differences in resilience in terms of quality of life, depression and post-traumatic stress symptoms in women after preeclampsia.MethodsFour international validated questionnaires were used to measure the psychological outcomes (Medical Outcome Study Short-Form SF12, Edinburgh Postnatal Depression Scale EPDS, Resilience Scale RS13, Impact of Event Scale IES-R). Statistical analyses were performed using independent-samples t-test and chi-square test.Results67 women with previous preeclampsia returned the questionnaires. Women with high resilience showed significantly less depression (p = 0.001) and better mental quality of life (p = 0.002) compared to women with low resilience. No group differences were found on the medical and socio-demographic characteristics.ConclusionsResilience has an important impact on the psychological outcomes in women after preeclampsia. A screening for resilience, depression and quality of life may be appropriate to identify these women.

Gestational diabetes: women's concerns, mood state, quality of life and treatment satisfaction

Objective: The aim of this observational cohort study was to explore concerns, mood state, quality of life (QoL) and treatment satisfaction of women treated for gestational diabetes (GDM). Methods:Twenty-seven diet-treated and 18 insulin-treated women participated in a semi-structured interview and completed a series of three different questionnaires. Results: Qualitative analysis identified “the baby’s health” as dominant concern, but also as main motivational treatment factor. Treatment satisfaction was generally high and further increased, whereas QoL and mood state significantly dropped over time. Conclusions: Acknowledgment of women’s concerns and precise information may improve treatment compliance and outcome.

A case of a transient enlargement of the intracranial translucency

On the basis of the first description of the intracranial translucency (IT) as a marker for spina bifida, we started to measure the IT during the first trimester scan. In a fetus of a 28-year old healthy primigravida with no family history of neuroanatomical malformations, an abnormal IT was detected. She was referred to our unit at a gestational age of 12weeks and 3days for 11–13weeks scan. Transabdominal and transvaginal ultrasound examination revealed a fetus with a crown–rump length (CRL) of 61mm. The nuchal translucency was 1.6mm, and the combined screening revealed a calculated risk for Down syndrome of 1 : 27414. However, the IT measured was enlarged and the anterior posterior diameter was 4.7mm (Figure 1). The fetus showed no other structural abnormalities. A follow-up scan after 2weeks showed a fetus with a CRL of 91mm and a normal IT with an anteroposterior-diameter of 3.4mm (Figure 2). A repeat sonographic examination at 29weeks showed normal intracranial structures with a normal size and position of the vermis and a normal size of the cisterna magna. We concluded that this temporary enlargement of the fourth ventricle as a solitary finding might represent a normal variant. Knowledge of the embryological steps of cerebral development helps to understand the time of damage and consequences for further development. During embryologic development, the roof plate of the rhombencephalon (fourth ventricle) is divided by the plica choroidea; the superior part is called area membranacea superior, whereas the inferior part is called area membranacea inferior. The area membranacea inferior forms a small diverticulum called Blake’s pouch (BP), which fenestrates at 7 to 8weeks leaving a connection between the intraventricular space and the subarachnoid space. This median aperture is the foramen Magendie. A non-perforation of the area membranacea inferior results in the formation of a BP cyst. The extent of alteration depends on the degree of dilatation of the pouch, which in turn depends on the timing of Figure 1 Fetus at 12weeks and 3days, crown–rump length (CRL) 61mm, intracranial translucency (IT) 4.7mm (transvaginal approach) Figure 2 Fetus at 14weeks and 3days, crown–rump length (CRL) 91mm, intracranial translucency (IT) 3.4mm (transabdominal approach)

Angiogenic factors in pregnancies of women with antiphospholipid syndrome and systemic lupus erythematosus

OBJECTIVES An imbalance of angiogenic placental factors such as endoglin, soluble fms-like tyrosine kinase 1(sFlt-1) and placental growth factor (PlGF) has been implicated in the pathophysiology of preeclampsia. This study aimed to evaluate serum levels of sFlt-1, PlGF and endoglin in women with primary and secondary antiphospholipid Syndrome (APS) and systemic lupus erythematosus (SLE) longitudinally through pregnancy. MATERIAL AND METHODS Serum levels of sFlt-1, PlGF and endoglin were measured prospectively at 4-week intervals (from gestational weeks 12-36) in 17 women with primary APS (PAPS), 18 women with secondary APS (SAPS), and 23 women with SLE. RESULTS 6/17 (35%) of women with PAPS, 3/18 (17%) of women with SAPS, and 2/23 (9%) of women with SLE developed early-onset preeclampsia. Women who developed preeclampsia had significantly higher mean sFlt-1 and endoglin levels, higher sFlt-1/PlGF ratios, and lower mean PlGF-levels than women who did not. These changes became statistically significant at 12 weeks for sFlt-1, PlGF and endoglin. DISCUSSION Endoglin, sFlt-1 and PlGF are potential early screening parameters for the development of preeclampsia in pregnant women with autoimmune diseases like APS and SLE.

Comparison of two-risk assessment algorithms for preeclampsia in first trimester with consecutive intake of low-dose aspirin in the high-risk group – an observational study

Abstract We analyzed outcome of women screened for preeclampsia with two different multifactorial risk algorithms (Predictor®Software by PerkinElmer, PerkinElmer, Waltham, MA; PERK-group: n = 214 and Viewpoint® by GE Healthcare, Dornstadt, Germany; VIEW-group: n = 209) in first trimester. Women at high risk for developing preeclampsia were advised to take low-dose acetylsalicylic acid (LDA). Screening positive rates for early onset preeclampsia differed significantly between the two groups (7.9% versus 26.3%; p = 0.000). According the clinical use of screening test criteria, LDA was prescribed in 63 (29.4%) women in the PE-group and 55 (26.3%) in the VP-group (p = 0.516). There were no differences in onset of preeclampsia [4 (1.9%) versus 6 (2.9%); p = 0.540]. No early or severe preeclampsia occurred in the whole population.