Hans Skari

Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth—a prospective population-based study of mothers and fathers

Objective To compare maternal and paternal psychological responses following birth of a healthy baby; and to explore predictors of parental psychological distress.

Acute maternal social dysfunction, health perception and psychological distress after ultrasonographic detection of a fetal structural anomaly

Please cite this paper as: Kaasen A, Helbig A, Malt U, Næs T, Skari H, Haugen G. Acute maternal social dysfunction, health perception and psychological distress after ultrasonographic detection of a fetal structural anomaly. BJOG 2010;117:1127–1138.

Parenting stress and emotional wellbeing in mothers and fathers of preschool children

Aims: The aims of the study were to compare parenting stress and emotional wellbeing in mothers and fathers of preschool children, to look for predictors of different aspects of parenting stress in mothers and fathers, and to discriminate parenting stress from psychological distress and anxiety. Methods: We studied 256 mothers and 204 fathers of children aged 1–7 years. The Swedish Parenthood Stress Questionnaire (SPSQ) assesses stress related to parenting. Emotional wellbeing was defined by the General Health Questionnaire-28 (GHQ-28) and the State Anxiety Inventory (STAI-X1) that measures psychological distress and anxiety, respectively. Results: Fathers reported significantly more social isolation than mothers (P < 0.001). On all other parameters mothers, had higher scores, representing more stress and less wellbeing than fathers. Anxiety and psychological stress were strong predictors of parental stress in both mothers and fathers. Furthermore, maternal parental stress was predicted by birth of subsequent children and younger child age. Higher educational attainment predicted increased role restriction in fathers and more health problems in mothers. A principal component analysis (PCA) of the SPSQ, GHQ-28, and STAI-X1 showed that all endpoints of the analysis are positively correlated. Conclusions: Fathers reported significantly more social isolation, but less role restriction, incompetence and state anxiety than mothers. The SPSQ together with GHQ-28 and STAI-X1 allow a targeted screening aimed at contrasting parents who experience reduced emotional wellbeing with those who struggle with stress directly related to their parenting role.

Long-term parental psychological distress among parents of children with a malformation—A prospective longitudinal study†

We previously reported that prenatal diagnosis of malformations is associated with increased parental psychological distress after birth compared to distress in parents with postnatal diagnosis. We have now extended our earlier study to include a long‐term follow‐up of mothers and fathers 9 years after birth. Psychological responses were measured by General Health Questionnaire (GHQ‐28), State Anxiety Inventory (STAI‐X1), and Impact of Event Scale (IES) in 118 mothers and 100 fathers of 124 children with malformations 0–7 days (T1), 6 weeks (T2), 6 months (T3), and 9 years postpartum (T4). At T4 we observed no significant differences in psychological responses comparing parents with and without prenatal foreknowledge of their childs malformation. At T4 30.2% and 27.8% of the parents reported clinically important psychological distress and clinically important state anxiety, respectively. Intrusive stress decreased from T1 to T3, but increased significantly from T3 to T4. At T4 25.6% of the parents reported severe intrusive stress, with a higher proportion among mothers than fathers (32.8% vs. 17.2%, P = 0.029). In the multivariate analysis, unemployment predicted clinically important psychological distress at T4, whereas, clinically important state anxiety at T4 was predicted by low educational level. This study shows that prenatal diagnosis is associated with significantly increased psychological distress in the acute postnatal phase. However, there was no long‐term increase in psychological distress among parents with prenatal foreknowledge of their childs malformation. The significantly increased intrusive stress at 9‐year follow‐up might reflect long‐term challenges related to having a child with a malformation.

Consequences of prenatal ultrasound diagnosis, A preliminary report on neonates with congenital malformations

OBJECTIVE The aim of the present study was to examine the sensitivity of prenatal ultrasound diagnosis in neonates referred for surgery, and to test whether a prenatal versus postnatal diagnosis influenced mode of delivery and neonatal outcome of these infants. PATIENTS Thirty-six consecutive neonates with congenital diaphragmatic hernia, abdominal wall defects, bladder exstrophy and meningomyelocele were included. RESULTS The sensitivity of prenatal ultrasound for diagnosis of the congenital malformations was 7/36 (19%) at 17-18th week of gestation, and overall 13/36 (36%). Overall sensitivity was 2/8 in neonates with congenital diaphragmatic hernia, 6/12 in neonates with abdominal wall defects, 5/13 in neonates with meningomyelocele, whereas none of three cases with bladder exstrophy were detected prenatally. No significant improvement in neonatal morbidity was found comparing the prenatally and postnatally diagnosed groups. The neonatal survival rate was 10/13 (77%) in the prenatally diagnosed group and 22/23 (96%) in the postnatally diagnosed group (p=0.12). CONCLUSIONS The sensitivity of prenatal ultrasound in diagnosing the congenital malformations under study in a low risk population was 19% at 17-18th week of gestation and 36% throughout the pregnancy. Prenatal diagnosis altered management of labor, but caused no improvement in neonatal outcome.

Psychological distress in mothers and fathers of preschool children: a 5-year follow-up study after birth

Objective  Maternal and paternal psychological distress influence children’s development and health beyond the perinatal period. The aim of our study was to describe psychological health during a 5‐year period in parents of preschool children. Secondarily, we wanted to explore differences between mothers and fathers and identify predictors for increased psychological distress in parents.

Prenatal ultrasound diagnosis of congenital diaphragmatic hernia and meningomyelocele: a case report with literature review

In the English language medical literature since 1975 the combination of congenital diaphragmatic hernia (CDH) and meningomyelocele (MMC) has been reported in only 17 patients (1–6). Population-based studies on CDH have reported serious associated malformations in 28%–47% of patients (3, 7–9). Prenatal diagnosis of the constellation of a CDH, MMC, and hydrocephalus has, to our knowledge, not been reported in the English language medical literature as identified by Medline, Embase, and additional hand-search of references.

Initial experience with percutaneous endoscopic gastrostomy with T-fastener fixation in pediatric patients

Background and study aims  Insertion of a percutaneous endoscopic gastrostomy (PEG) with push-through technique and T-fastener fixation (PEG-T) has recently been introduced in pediatric patients. The T-fasteners allow a primary insertion of a balloon gastrostomy. Due to limited data on the results of this technique in children, we have investigated peri- and postoperative outcomes after implementation of PEG-T in our department. Patients and methods  This retrospective chart review included all patients below 18 years who underwent PEG-T placement from 2010 to 2014. Main outcomes were 30-day postoperative complications and late gastrostomy-related complications. Results  In total, 87 patients were included, and median follow-up time was 2.4 years (1 month – 4.9 years). Median age and weight at PEG-T insertion were 1.9 years (9.4 months – 16.4 years) and 10.4 kg (5.4 – 33.0 kg), respectively. Median operation time was 28 minutes (10 – 65 minutes), and 6 surgeons and 3 endoscopists performed the procedures. During the first 30 days, 54 complications occurred in 41 patients (47 %). Most common were peristomal infections treated with either local antibiotics in 11 patients (13 %) or systemic antibiotics in 11 other patients (13 %). 9 patients (10 %) experienced tube dislodgment. Late gastrostomy-related complications occurred in 33 patients (38 %). The T-fasteners caused early and late complications in 9 (10 %) and 11 patients (13 %), respectively. Of these, 4 patients (5 %) had subcutaneously migrated T-fasteners which were removed under general anesthesia. Conclusion  We found a high rate of complications after PEG-T. In particular, problems with the T-fasteners and tube dislodgment occurred frequently after PEG-T insertion.

OP12.01: Ultrasonographic detection of fetal malformation and parental longitudinal psychological stress responses

Objectives: Treatment strategies of fetal heart beat (FHB)-positive Caesarean scar pregnancy (CSP) depend on the medical environment, social environment and gross domestic product. This study aimed to identify the most appropriate strategies by reviewing strategies that were addressed in previous studies in our country. Methods: We searched articles in these 5 years using the key word ”Caesarean scar pregnancy” from our national medical journal article retrieval system. We searched 38 articles. In these articles, we omitted articles in which the subject of the article was not FHB-positive CSP. We finally included 20 articles and reviewed them. We reviewed the treatment techniques and their order and combination as treatment strategies. Results: FHB-positive CSP cases were treated with 10 different treatment techniques. These treatments were (1) feticide (10 articles), (2) general administration of methotrexate (MTX) (10 articles), (3) local administration of MTX (5 articles), (4) misoprostol (1 article), (5) Transarterial embolisation (TAE) (5 articles), (6) laparoscopic blood vessel clipping (1 article), (7) vaginal CSP resection (7 articles), (8) laparoscopic CSP resection (2 articles), (9) hysteroscopic CSP resection (1 article), and (10) hysterectomy (2 articles). Feticide was performed in 50% (10/20) of articles. General MTX, local MTX, and misoprostol were drug therapies. TAE and laparoscopic blood vessel clipping decreased blood supply. Operative (vaginal, laparoscopic, hysteroscopic, and abdominal resection) CSP resection was performed in 12 of 20 (60%) articles. Treatment of CSP was achieved by a combination of some techniques, such as feticide, drug therapy, blood supply-decreasing techniques, and operative CSP resection, in this order. Conclusions: Feticide was considered necessary in 50% of articles. CSP resection was performed in 60% of articles. Treatment of CSP was achieved by a combination of some techniques, such as feticide, drug therapy, decreasing blood supply, and operative CSP resection. OP12: SCREENING

Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study

In this longitudinal prospective observational study performed at a tertiary perinatal referral centre, we aimed to assess maternal distress in pregnancy in women with ultrasound findings of fetal anomaly and compare this with distress in pregnant women with normal ultrasound findings. Pregnant women with a structural fetal anomaly (n = 48) and normal ultrasound (n = 105) were included. We administered self-report questionnaires (General Health Questionnaire-28, Impact of Event Scale-22 [IES], and Edinburgh Postnatal Depression Scale) a few days following ultrasound detection of a fetal anomaly or a normal ultrasound (T1), 3 weeks post-ultrasound (T2), and at 30 (T3) and 36 weeks gestation (T4). Social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression) were the main outcome measures. The median gestational age at T1 was 20 and 19 weeks in the group with and without fetal anomaly, respectively. In the fetal anomaly group, all psychological distress scores were highest at T1. In the group with a normal scan, distress scores were stable throughout pregnancy. At all assessments, the fetal anomaly group scored significantly higher (especially on depression-related questions) compared to the normal scan group, except on the IES Intrusion and Arousal subscales at T4, although with large individual differences. In conclusion, women with a known fetal anomaly initially had high stress scores, which gradually decreased, resembling those in women with a normal pregnancy. Psychological stress levels were stable and low during the latter half of gestation in women with a normal pregnancy.