Sibil Tschudin

Correlates of fertility issues in an Internet survey of cancer survivors

Purpose. The objectives of this study were (1) to determine what young cancer survivors know about the effect of their cancer on fertility, how fertility difficulties affected their lives and whether they would opt for fertility preservation (FP) and (2) to assess the sources of information and the helpfulness of them. Methods. Women of at least 18 years with cancer affecting reproductive function were recruited from eight cancer websites for this online survey. The Cancer and Fertility Survey (CFS) contained items from validated inventories and items to assess fertility issues in cancer patients. Quantitative analyses (t-tests, χ2, analysis of variance) and thematic analysis of free text data were performed. Results. Of the 80 participating women, 68.1% rated the risk of infertility as high. The mean number of professionals consulted was 3.56 (SD = 2.7), but 20% of women had not discussed fertility with any professional. The weighted mean helpfulness index was the highest for spouses and oncologists. Strength of positive attitudes towards FP was significantly greater than that of negative attitudes. Conclusion. The need to discuss fertility is high among women searching for information on cancer websites. Options to preserve fertility were positively viewed but the actual use may be limited by concerns about safety.

Post-traumatic symptoms after childbirth: what should we offer?

Most studies on post-traumatic stress symptoms after childbirth have focused on prevalence of and looked at etiological factors and predictors. While most authors agree that around 1.5% of the women develop post-traumatic stress disorder (PTSD) and significantly more present with post-traumatic stress symptoms, the studies still lack a proper diagnosis using diagnostic interviews to validate the enhanced stress scores found in questionnaires. Also, some relevant predicting factors such as pre-existing psychopathology and dissociation during labor have not been investigated so far. Mostly, however, research on counseling strategies for women with post-traumatic symptoms after childbirth has been neglected. While most women remain in a mother–child unit during the first days after birth, there is a unique opportunity to systematically assess birth experience in this setting and screen for women at risk for developing trauma symptoms. This article presents a multilevel counseling approach including postnatal counseling and counseling in a subsequent pregnancy.

Previous birth experience and birth anxiety: predictors of caesarean section on demand?

Objective. The purpose of this study was to investigate pregnant womens intentions for opting for caesarean section (CS), their experiences regarding previous births and their expectations for subsequent delivery. Our objectives were to identify medical and psychological predictors pertaining to the decision for CS on demand. Design. The cross-sectional survey was conducted at two study centres over a three-month period including German speaking women at any time of pregnancy and consisted of an anonymous structured questionnaire. Logistic regression was computed to investigate the predictive value of medical variables, birth experience and birth anxiety on the demand for CS. Results. Nineteen of 201 participants preferred to deliver by CS on demand and 15 felt uncertain about their decision. How the preceding delivery had been experienced was significantly better in the vaginal delivery (VD)-group (women not considering CS on demand) than in the CS-group (good experience in 81.7% and 52.0% respectively, p = 0.007). A negative previous birth experience and a preceding CS were predictors for the wish to deliver by CS. Conclusions. As negative birth experience predicts the wish for a CS, specific supportive care during first pregnancy could play a pivotal role in making this decision.

Risk factors for unfavorable pregnancy outcome in women with adverse childhood experiences

Abstract Aims: To explore the association between childhood sexual abuse (CSA), physical abuse, as well as other adverse childhood experiences (ACE), and different obstetrical risk factors/behaviors. Methods: In this cohort study, obstetrical risk factors and perinatal outcome in 85 women exposed to CSA were compared to 170 matched unexposed women. CSA, physical abuse, and ACE were explored by face-to-face interviews and by questionnaire. Data on perinatal outcome were extracted from medical charts. Fisher’s exact, χ2-test, and multiple logistic regression were used for statistical analysis. Results: During pregnancy women with CSA experiences were significantly more often smoking (31.7%/9.4%; P<0.0001), had partners abusing drugs (10.6%/1.2%; P<0.0005), experienced physical (16.5%/0; P<0.0001), sexual (12.9%/0; P<0.0001), and emotional abuse (44.7%/1.7%; P<0.0001), reported depression (24.7%/1.8%; P<0.0001), and suicidal ideation (10.6%/0; P<0.0001) than women without CSA experiences. Differences in risk factors were more often correlated with physical than with sexual abuse during childhood. The probability for premature delivery was associated with CSA, physical abuse and ACE as well as with several of the risk factors investigated. Conclusion: Women with CSA, physical, and ACE present with a variety of abuse-associated obstetrical risk factors and an increased risk for premature delivery. Therefore, all types of abusive and other ACE should be considered in prenatal care.

Prenatal care in adult women exposed to childhood sexual abuse

Abstract Aims: Several case reports show a negative impact of childhood sexual abuse (CSA) on prenatal care. The study aimed to systematically investigate this association in a larger study group. Methods: CSA was investigated by face-to-face interviews and by a modified questionnaire developed by Wyatt. All study participants completed a self-administered questionnaire designed to investigate the consequences of CSA on prenatal care during adulthood. Data from 85 women after CSA were compared to those of 170 matched women without such experiences. Results: Women exposed to CSA had fewer than five prenatal consultations more often than unexposed women (26%/7%; P<0.0001). Of the 85 women with a positive history for CSA, 9.4% had been asked for such antecedents, 36.5% had intense memories on original abuse situations during pregnancy, 56.6% mentioned specific consequences of CSA on prenatal care and 61.2% were satisfied with obstetrical support. Exposed women (62.4%) felt significantly less prepared for labor than unexposed women (75.9%) (P<0.0001). Conclusions: CSA experiences are associated with impaired prenatal care. These results underscore the compelling need to improve prenatal care in women exposed to CSA through better education of obstetricians regarding the effects of CSA and in their ability to provide empathetic professional support.

Psychological management of pregnancy-related breast cancer.

The comprehensive care of a pregnant patient in whom breast cancer is diagnosed presents a challenge to the biomedical and psychological competence of the medical team. Illustrated by a case presentation the different phases of psychological care are delineated and discussed: the confrontation with the diagnosis of a life-threatening disease in a situation in which the beginning of a future life is celebrated. Special attention is given to breaking bad news, the establishment of a stable and trustful physician-patient relationship, communicating risk and to the extremely difficult decision-making process regarding termination or continuation of pregnancy (shared decision-making). The delicate balance between oncological care for the mother with a high-risk disease and a high-risk pregnancy and neonatal care for the foetus is outlined, including regular talks about emotions and concerns.

Psychosomatics in obstetrics and gynecology – evaluation of a compulsory standardized teaching program

Abstract Objective: This observational study was aimed at assessing the effect of case supervision in small groups over a two-year period as part of a standardized psychosomatic basic training for future obstetrician-gynecologists from the physicians’ perspective. Methods: The supervised groups were evaluated by questionnaires distributed to all 128 candidates at the beginning (T1), at half time (T2) and at the end of the course (T3). Aside from a validated battery of questions on self-efficacy, items included self-estimated psychosomatic competence, professional satisfaction as well as a validation of the training program. Results: The training program was associated with a significant increase of self-reported psychosomatic competence (55.0/68.9, p = 0.000) and self-efficacy (2.4/2.8, p = 0.0011). While major changes occurred at the end of the first year of the supervised groups, no further enhancement could be demonstrated throughout the second year. A total of 44 (88%) study participants who answered at T3 considered the training program as helpful. Conclusions: The presented teaching program – more precisely the supervised groups – seemed to be effective in increasing self-estimated psychosomatic competence and self-efficacy in future specialists for obstetrics and gynecology. It may serve as a model for the systematic integration of standardized psychosomatic basic training into the education of obstetrician-gynecologists.

Knowledge about and attitude towards fertility preservation in young female cancer patients: a cross-sectional online survey

Abstract Recent advances in cancer therapy have resulted in an increased number of long-term cancer survivors. However, because of their treatment, women might be confronted with impaired fertility. The options of fertility preservation (FP) techniques are increasing. The goal of this study was to assess knowledge about, and attitudes towards, fertility preservation in young female cancer patients. A cross-sectional online survey was conducted including 155 former female cancer patients from English and German speaking countries. The survey consists of questions about attitude towards, and knowledge about, fertility preservation. Results show that knowledge about fertility preservation was limited among participants. Positive attitudes towards fertility preservation significantly outweighed negative attitudes. Knowledge and attitude did not differ according to language or different healthcare systems. Confidence of knowledge was significantly higher in women who underwent any FP procedure compared to those who did not. Greater emphasis should be placed on counselling opportunities, the provision of adequate information and supporting material. A better understanding of these issues will hopefully enhance patients’ decision-making about FP options and assist the development of strategies to improve quality of care.

Addressing decisional conflict about fertility preservation: helping young female cancer survivors’ family planning decisions

Background Health professionals are challenged by a growing number of young long-term cancer survivors with their specific needs with regard to family planning. This study aimed at assessing decisional conflict (DC) in young female cancer patients regarding fertility preservation, identifying demographic, fertility and fertility preservation related factors, which may affect DC, and assessing the helpfulness of various decision-supports. Methods A retrospective, cross-sectional, web-based survey via an online questionnaire available in three languages with specific items concerning cancer, fertility, fertility preservation and the validated Decisional Conflict Scale targeted at current or former female cancer patients aged 18–45 years, with cancer types or treatment potentially affecting reproductive function. Results The 155 participating women showed considerable DC, especially with regard to missing information and support. DC was significantly lower in patients when the risk of infertility was discussed with a health professional, when they had undergone any procedure to preserve fertility, and when they had a university education. A longer time interval since cancer diagnosis was associated with higher DC. The most helpful decision-support tools were specialised websites and leaflets. Conclusions Young female cancer patients’ DC with regard to fertility preservation is very high. Information and support seem to be deficient. More information through standardised information tools might be an effective strategy to lower their DC at the time when treatment decisions need to be taken, and to improve their reproductive health after they have overcome cancer in the future.

The development of partnership after hypertensive diseases in pregnancy

Abstract Objective: Hypertensive diseases in pregnancy (HDP) occur in 5–8% of all pregnancies and represent one of the most important causes of maternal and fetal morbidity. Even after a normal pregnancy/delivery adaptation to parenthood is a major challenge. However, a successful adjustment is important for future family health. As pregnancy complications may put additional strain on early parenthood, the current study investigated satisfaction with partnership including factors which determine (dis)satisfaction as well as separation rates after pregnancies complicated by HDP. Methods: A total of 737 women after HDP and 624 matched-control women completed a self-administered questionnaire on psycho-social factors in the development of HDP. Free-text answers on satisfaction with partnership were analyzed by conceptual analysis. Results: Women with HDP were significantly less often satisfied with their partnership than control women (76%/81.1%; p < 0.05). Women with preeclampsia were at higher risk for an unsatisfactory relationship than those with other manifestations of HDP. Common interests and aims could be identified as the most important reasons for a satisfying marital relationship in women with and without a diagnosis of HDP. Conclusion: HDP represent an additional challenge in family adjustment. Adapted perinatal psycho-social support may help to facilitate the start into family life.