Journal of Psychosomatic Obstetrics & Gynecology最新文献

Background: Differential experiences of psychosocial stress during pregnancy may contribute to racial inequities in adverse pregnancy outcomes in the US. Valid and unbiased measurement scales are needed to assess the effect of psychosocial stress on pregnancy outcomes, however, the numerous modified scales implemented to measure stress are not always validated.

Methods: The construct validity and measurement invariance of maternal stress among Medicaid-covered pregnant women (N = 1,632) were examined. Model fit estimates of three confirmatory factor analysis (CFA) models were compared to determine the appropriate measurement structure. Multiple-group CFA assessed measurement invariance across Black or African American women (51.7%) and women of all other races.

Results: Robust estimates of model fit supported a hierarchical CFA model composed of four latent domains of stress. Standardized factor loadings of three of these latent domains-external stress, perceived stress, and enhancers of stress- indicated positive correlations with a second-order latent factor for overall maternal stress, whereas the fourth domain, buffers of stress, had a negative association. Multiple-group CFA demonstrated strong measurement invariance.

Conclusions: Among Medicaid-covered pregnant women, measures for psychosocial stress were unbiased across two subgroups of maternal race/ethnicity. These findings support the construct validity of overall maternal stress underlying the common variability among four latent domains of stress.

Purpose: Subjective social status (SSS), perceived social standing relative to others, has been associated with health status, independent of objective socioeconomic status (SES). Few studies have examined the relationship of prenatal maternal SSS with birth outcomes. We evaluated the association of SSS in pregnancy with low birth weight (LBW) and high birth weight (HBW).

Methods: A total of 378 pregnant women rated their SSS from 1 (low) to 10 (high) compared to others in the United States (SSS-US) and compared to their community (SSS-Comm). Multivariable logistic regression was used to examine the relationship between SSS and odds of LBW or HBW.

Results: Higher SSS-US was associated with lower odds of HBW in unadjusted models (OR 0.76, 95% CI 0.60-0.96; p < 0.05); this relationship persisted after controlling for objective SES, health, and demographic factors (OR 0.73, 95% CI 0.53-0.99; p < 0.05). Neither SSS measure was associated with LBW.

Conclusions: Pregnant women who view themselves as having lower status than others in the US have greater odds of HBW, over and above the influence of factors known to be associated with birth weight. SSS, a brief and non-stigmatizing measure, might help identify women at elevated social risk for adverse birth outcomes.

Objective: The prognosis for ovarian cancer patients remains poor. A key to maximizing survival rates is early detection and treatment. This requires an accurate prediction of malignancy. Our study seeks to improve the accuracy of prediction by focusing on early subjective assessment of malignancy. We therefore investigated the assessment of patients themselves in comparison to the assessment of physicians.

Methods: One thousand three hundred and thirty patients participated in a prospective and multicenter study in six hospitals in Berlin. Using univariate analysis and multivariate logistic regression models, we measured the accuracy of the early subjective assessment in comparison to the final histological outcome. Moreover, we investigated factors related to the assessment of patients and physicians.

Results: The patients' assessment of malignancy is remarkably accurate. With a positive predictive value of 58%, the majority of patients correctly assessed a pelvic mass as malignant. With more information available, physicians achieved only a slightly more accurate prediction of 63%.

Conclusions: For the first time, our study considered subjective factors in the diagnostic process of pelvic masses. This paper demonstrates that the patients' personal assessment should be taken seriously as it can provide a significant contribution to earlier diagnosis and thus improved therapy and overall prognosis.

Background: Women are nearly twice as likely as men to suffer from depression throughout the life span. In particular, reproductive transition phases mark a period of vulnerability for female mood disorders. The life events of being pregnant and giving birth harbor multiple psychological and physiological challenges, and a lack of adjustment to these events can result in mood swings and depression. The purpose of this review is to provide an overview of the symptomatology of postpartum depression (PPD), including tools that have been used to assess PPD, and potential phenomenological differences to major depression during other life phases.

Methods: A systematic literature search in the databases PubMed, Cochrane Library and PsycINFO was conducted with the keywords "postpartum depression" and "symptomatology". A total of 33 studies fulfilled the chosen criteria and were selected for the review.

Results: Within the studies, 22 different tools were used to assess depressive symptoms throughout pregnancy and the postpartum period. A total of 29 questionnaires or interviews were applied to detect additional psychopathological symptoms present in the perinatal period, such as anxiety. Most studies that included a control group of non-perinatal women concluded that postpartum depression is nosologically distinct from depression occurring at other stages of female life.

Discussion: Somatic symptoms in the puerperium contribute to psychopathological burden and might result in diverse clinical representations of postpartum depression. Anxiety frequently co-occurs with depression during the perinatal period. However, the diversity of screening instruments for postpartum depression does not allow for general conclusions to be drawn about similarities or differences in the psychopathological profiles of postpartum women with depression and women with depression at other stages of life.

Purpose: The aim of this study is to understand the motives behind CS requests in nulliparous women in their late pregnancy better and to investigate if specific personality traits affect the maternal decision on mode of delivery.

Material and method: This prospective study was conducted with 70 healthy, nulliparous parturient with singleton pregnancies. Women at their 28-32. weeks of gestation were asked to fill a socio-demographic data form and the questionnaires; Personality Belief Questionnaire - Short Form (PBQ-SF) and The Childbirth Attitudes Questionnaire (CAQ). After delivery, all the results of pre-filled questionnaires and women's mode of delivery were analyzed and compared.

Results: There were significant differences in personality types; dependent (p = 0.033), passive-aggressive (p = 0.031), obsessive-compulsive (p = 0.001), antisocial (p = 0.014), narcissistic (p = 0.014) and borderline (p = 0.014) between vaginal delivery and CS groups. The CAQ scores of the mothers who requested CS were significantly higher (p:0.007). Weak but significant positive relation was found between total CAQ scores and avoidant (p = 0.022), dependent (p = 0.034), passive-aggressive (p = 0.040), narcissistic (p = 0,006), schizoid (p = 0.007), paranoid (p = 0.007) and borderline (p = 0.007) personality types.

Conclusion: This is the first study that investigates the relationship between mode of delivery and personality traits according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and cognitive behavioral perspective in the literature. These personality traits can be carried at a level that is not clinically significant to create an obvious pathology, yet they might play a role as the motives behind the apparent reasons for women who request CS. Understanding women's motives and attitudes for childbirth during their pregnancy may help healthcare providers to tailor women's approach to childbirth to avoid unnecessary CS.

Purpose: Endometriosis is a chronic, inflammatory condition. The aim was to describe the self-reported disease characteristics and factors associated with the use of different treatment modalities among women with surgically diagnosed endometriosis.

Method: A cross-sectional online survey featuring 58 fixed-response items measuring disease characteristics, self-efficacy, health service usage, and treatment approaches was conducted. Logistic regression was used to explore the factors associated with different treatment modalities.

Results: Complete data were available from 620 respondents. Average delay to diagnosis was 6.4 years. Despite medical and surgical intervention, 65.8% reported dysmenorrhea and 61.1% reported dyspareunia, and 82.7% reported chronic pelvic pain in the last 3 months. Respondents had consulted an average of three different health practitioner specialties in the previous 12 months for their endometriosis.

Discussion: A chronic disease management plan (CDMP) may be a useful mechanism to coordinate multidisciplinary care among women who experience ongoing symptoms.

Aim: This study aims to understand the essence of perinatal nurses' experiences, thoughts, and feelings on compassion satisfaction and compassion fatigue.

Methods: The descriptive phenomenological design was used in this study. Data were collected at in-depth interviews with 16 perinatal nurses. The thematic analysis method was used in data analysis.

Results: Five main themes and 14 subthemes were determined. The first theme 'Compassionate Caring Behaviors' has four subthemes: affectionate behaviors, responsiveness to women' needs, and authentic informing. The theme of 'Gains of Compassionate Care' has two subthemes: easier with same-sex patients and achieving moral satisfaction. The theme of 'The Other Side of Care' contained the subthemes not being understood, challenging care moments, specific nursing expectations, and a demanding work environment. The theme of "Relieving Burden of Care' has three subthemes trying to understand, taking deliberate breaks in communication, and coping with the experience. The last theme 'Cost of Caring: Compassion Fatigue' has two subthemes: avoiding women and multidimensional fatigue.

Conclusion: This study concluded that perinatal nurses were satisfied with compassionate care, caring for same-sex patients, and achieving moral satisfaction increased their compassion satisfaction while witnessing challenging care moments such as fetal loss, and a demanding work environment triggered compassion fatigue.

Objective: To assess the influence of surgical approach, complications and patient characteristics and their postoperative functional outcomes on (sexual) quality of life (QoL) in patients with deep endometriosis (DE) with bowel involvement.

Methods: Retrospective cohort study on patients surgically treated for DE in a Dutch tertiary referral hospital. Data are based on surgical records and questionnaires covering current postoperative bowel function and (sexual) QoL.

Results: Postoperative functional score outcomes: constipation, fecal incontinence and Low Anterior Resection Syndrome (LARS) did not differ between patients treated with rectal shaving or segmental resection. Thirty percent of women treated with rectal shaving experienced LARS-like symptoms as well. Women who underwent segmental resection had a worse sexual QoL compared to patients managed by shaving. Patients who suffered from complications had a worse postoperative QoL. A higher postoperative constipation score was correlated with a significantly higher pain score and a lower overall and sexual QoL. LARS-score was correlated with a worsened sexual QoL.

Conclusion: Women who underwent surgery for deep endometriosis rated their overall QoL as lower when a complication occurred. Segmental resection resulted in a lower sexual QoL compared to shaving. We showed that a higher LARS-score correlates with a lower sexual QOL, and postoperative constipation with more pain and a lower overall and sexual QoL. Interestingly, after using the shaving technique one-third of the patients experienced LARS-like symptoms as well.

Background: Knowledge of the associations between obesity and cesarean delivery (CD) is limited by previous research that does not separate the highest BMI classes.

Methods: We identified 25,604 pregnancies in retrospective electronic medical records at an inner-city academic hospital between 2000 and 2015. We examined the association between BMI at pre-pregnancy and delivery, as well as gestational weight gain (GWG), and rates of CD, gestational diabetes mellitus (GD), and pregnancy-induced hypertension (PIH) using logistic regression and chi-square.

Results: CD increased with each increase in delivery BMI class [X² (7, N = 25,604) =151.40, p < .0001]. GD and PIH also significantly increased across each BMI class. Each increasing BMI class predicted 1.21 times greater odds of CD even after adjusting for maternal age, year of birth, GD, and PIH [OR = 1.21 (95% CI, 1.07-1.37)]. As compared with the IOM recommended GWG, less weight gain offered mitigation of CD and GD, though less than the recommended GWG for women who were obese pre-pregnancy also increased odds of preterm birth, low birth weight, and stillbirth.

Conclusions: Increasing BMI is associated with increasing rates of adverse obstetric outcomes. There exists a "dose-dependent" effect of BMI on CD and limiting GWG may be associated with mitigated risk for this outcome, but increased risk for offspring adverse birth outcomes.

Background: Upwards of one in seven individuals experience perinatal depression and many individuals cannot access treatment. In response, perinatal depression is increasingly being managed in the obstetric setting. This study aimed to characterize the experiences of clinicians and clinician assistants to inform the extent to which clinician assistants can help address depression in obstetric settings.

Methods: This cross-sectional analysis used data from an ongoing cluster randomized control trial: The PRogram In Support of Moms (PRISM). Participants included clinicians (physicians, certified nurse midwives, nurse practitioners) and clinician assistants (medical assistants, nursing assistants). Baseline data regarding practices and attitudes of clinicians and clinician assistants toward addressing depression in the obstetric setting were described. Logistic regressions were used to examine the association of clinician time to complete work and depression management.

Results: Clinician assistants experienced significantly fewer time constraints than did clinicians. However, having adequate time to complete work was not significantly associated with increased depression management in clinicians. Clinician assistants reported feeling that addressing depression is an important part of their job, despite variation in doing so.

Conclusion: Clinician assistants are interacting with perinatal women extensively and are a vital part of obstetric care workflows. Clinician assistants report that they want to address depression and have time to do so. Thus, clinician assistants may be poised to help address the mental health needs of perinatal individuals.