The perinatal transition is characterized by acute changes in cardiac loading. Compared to normal newborn combined cardiac output (CCO), single right ventricular (RV) output of neonates with ...hypoplastic left heart syndrome (HLHS) is markedly greater. We sought to examine the mechanisms of cardiac adaptation which facilitate this perinatal transition from late fetal to early neonatal life in HLHS.
Prospectively recruited pregnancies complicated by fetal HLHS (n=35) and health controls (Ctrl, n=17) underwent serial echocardiography in late gestation (38±1weeks) and 6, 24 and 48 hours after birth. Cardiac function was assessed using conventional, tissue Doppler and speckle tracking echocardiography.
Term HLHS fetuses had an RV output (RVCO) comparable to Ctrl CCO via higher stroke volume (SV). Compared to both left ventricular (LV) and RV indices of Ctrls, they exhibited a globular and dilated RV with reduced relative wall thickness (RWT) RWT: 0.40±0.08 vs. 0.49±0.10, p<0.01, increased Tei index’ HLHS vs. Ctrl LV/Ctrl RV: sphericity index (SI): 0.9±0.25 vs. 0.5±0.10/0.6±0.11, RV area index: 28±6cm2/m2 vs. 15±3cm2/m2/17±5cm2/m2, Tei index’: 0.65±0.11 vs. 0.43±0.07/0.45±0.09, all p<0.0001. HLHS neonates generated elevated RVCO compared to Ctrl CCO via higher heart rate and SV, with further RV dilatation, increased longitudinal systolic strain at 48h -17±4% vs. -14±3%/-14±5% with reduced circumferential and rotational myocardial deformation and altered diastolic function. HLHS neonates also demonstrated right atrial (RA) enlargement with increased longitudinal strain: 6h (33±12% vs. 26±6%), 24h (37±15% vs. 26±13%), 48h (38±11% vs. 24±13%), p<0.0001.
Term HLHS fetuses exhibit altered RV geometry and RV systolic and diastolic functional parameters. After birth, further alterations in these cardiac parameters likely reflect adaptation to acutely altered RV loading from increasing cardiac output and pulmonary artery flow demands.
•HLHS fetuses exhibit significant RV remodeling and altered myocardial function.•Persistence/progression of these cardiac alterations in HLHS neonate.•Fetal HLHS increased cardiac output is entirely stroke volume derived.•Neonatal HLHS cardiac output is driven by stroke volume and heart rate.•HLHS perinatal strategy balancing SVR reduction with PVR increase might be optimal.
Objective: This study aimed to investigate the actual situation of perinatal depression and related factors considering the social impact of COVID-19.Method: This was a cross-sectional study using an ...online self-administered questionnaire in October 2020, and responses were obtained from 739 pregnant women and 1,603 mothers less than a year postpartum.Results: Regarding the experience of crises related to the Coronavirus disease 2019 (COVID-19) pandemic, “experiencing criticism for taking the child to public places” was found to be 18.1%, “reduced income” was 38.0%, and “fear of COVID-19 illness” was 77.2%. The logistic regression analysis showed that factors associated with the high risk of perinatal depression were ‘history of mental disorders’, ‘academic background’, ‘maternal and infant health condition’ and ‘social impact of COVID-19, varied depending on timing and delivery history.Conclusion: Depression among pregnant women and mothers increased in the COVID-19 pandemic, and it suggested the need for care considering the social impact of COVID-19.
Objective: this study aims to characterize the help-seeking behaviours of women who were screened positive for perinatal depression, to investigate its sociodemographic and clinical correlates, and ...to characterize the perceived barriers that prevent women from seeking professional help. Design: cross-sectional internet survey. Setting: participants were recruited through advertisements published in pamphlets and posted on social media websites (e.g., Facebook) and websites and forums that focused on pregnancy and childbirth. Participants: 656 women (currently pregnant or who had a baby during the last 12 months) completed the survey. Measurements: participants were assessed with the Edinburgh Postpartum Depression Scale, and were questioned about sociodemographic and clinical data, help-seeking behaviours and perceived barriers to help-seeking. Findings: different pathways of help-seeking were found, with only 13.6% of women with a perinatal depression seeking help for their emotional problems. Married women, currently pregnant women, and women without history of psychological problems had a higher likelihood of not engaging in any type of help-seeking behaviour. The majority of women who had not sought professional assistance identified several barriers to help-seeking, particularly knowledge barriers. Key conclusions: strategies to increase women's help-seeking behaviours should be implemented, namely improving mental health literacy, introducing screening procedures for mental health problems in pre/postnatal health care settings, and offering women innovative opportunities (e.g., web-based tools) that allow them to overcome the practical barriers to help-seeking. References
Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following ...childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers' mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well.
Perinatal oxidative stress (OS) is involved in the physiopathology of many pregnancy-related disorders and is largely responsible for cellular, tissue and organ damage that occur in the perinatal ...period especially in preterm infants, leading to the so-called “free-radicals related diseases of the newborn”. Reliable biomarkers of lipid, protein, DNA oxidation and antioxidant power in the perinatal period have been demonstrated to show specificity for the disease, to have prognostic power or to correlate with disease activity. Yet potential clinical applications of oxidative stress biomarkers in neonatology are still under study. Overcoming the technical and economic difficulties that preclude the use of OS biomarkers in the clinical practice is a challenge that needs to be overcome to identify high-risk subjects and to predict their short- and long-term outcome. Cord blood, urine and saliva represent valid and ethically acceptable biological samples for investigations in the perinatal period.
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Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and ...preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy.
To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the ...antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% 95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592 and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.
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