The peripartum period involvement in the development of post-partum depression. A prospective cohort study.

PURPOSE: This study explores postpartum depression (PPD) in women who screened negative in mid-pregnancy to assess the impact of the peripartum period on the development of depressive symptoms. METHODS: A prospective cohort study was carried out in two facilities in Argentina. The Edinburgh postnatal depression scale (EPDS) scale was applied to pregnant women between weeks 20-24 gestation, and those screening negative (<10) were included in the cohort. Participants were followed up until the 4th week postpartum, when the EPDS was repeated. If positive, a semi-structured clinical interview was applied (MINI) to define the diagnosis. RESULTS: A total of 112 pregnant women were eligible for the follow-up. At the 4th week postpartum, 14 women (12.5%, CI 95% 7.0; 20.1) screened positive using a cutoff point of 10 or more in the EPDS. Of those screened positive in the EPDS, two participants (1.8%, CI 95% 0.2-6.3) had a Major Depressive Disorder. Newborn admission to the Intensive Care Unit, hospitalization of the newborn after discharge, abuse during childbirth, and lack of company during labor were identified as peripartum risk factors. CONCLUSIONS: This study reinforces the relevance of women and newborn mental health care during the hospitalization process surrounding peripartum. The women and newborn hospitalization process should be better explored to understand the contribution to PPD and design and test strategies to alleviate the impact of maternal depression.

Odon device for instrumental vaginal deliveries: results of a medical device pilot clinical study.

BACKGROUND: A prolonged and complicated second stage of labour is associated with serious perinatal complications. The Odon device is an innovation intended to perform instrumental vaginal delivery presently under development. We present an evaluation of the feasibility and safety of delivery with early prototypes of this device from an early terminated clinical study. METHODS: Hospital-based, multi-phased, open-label, pilot clinical study with no control group in tertiary hospitals in Argentina and South Africa. Multiparous and nulliparous women, with uncomplicated singleton pregnancies, were enrolled during the third trimester of pregnancy. Delivery with Odon device was attempted under non-emergency conditions during the second stage of labour. The feasibility outcome was delivery with the Odon device defined as successful expulsion of the fetal head after one-time application of the device. RESULTS: Of the 49 women enrolled, the Odon device was inserted successfully in 46 (93%), and successful Odon device delivery as defined above was achieved in 35 (71%) women. Vaginal, first and second degree perineal tears occurred in 29 (59%) women. Four women had cervical tears. No third or fourth degree perineal tears were observed. All neonates were born alive and vigorous. No adverse maternal or infant outcomes were observed at 6-weeks follow-up for all dyads, and at 1 year for the first 30 dyads. CONCLUSIONS: Delivery using the Odon device is feasible. Observed genital tears could be due to the device or the process of delivery and assessment bias. Evaluating the effectiveness and safety of the further developed prototype of the BD Odon Device™ will require a randomized-controlled trial. TRIAL REGISTRATION: ANZCTR ACTRN12613000141741 Registered 06 February 2013. Retrospectively registered.

Depresion durante el período perinatal en dos maternidades de Argentina / Depression during the perinatal period in two maternity hospitals in Argentina

INTRODUCCIÓN La depresión es uno de los trastornos mentales más frecuente en todo el mundo; según la Organización Mundial de la Salud (OMS) afecta a unos 350 millones de personas. Durante el período perinatal los valores de depresión son aún más elevados, transformando a la misma en un objetivo prioritario en salud pública debido a las consecuencias que origina sobre la salud materna y del recién nacido. Hasta el momento todos los trabajos de depresión perinatal en Argentina se han focalizado en la depresión postparto y no se ha explorado la depresión durante el embarazo. OBJETIVOS Estimar la prevalencia de síntomas de depresión perinatal usando la Escala de Depresión Postparto de Edimburgo (Edinburgh Pospartum Depression Scale, EPDS) y la prevalencia de Trastornos Afectivos realizando para esto una evaluación con una entrevista diagnóstica semiestructurada (Entrevista Neuropsiquiátrica Internacional MINI, MINI International Neuropsychiatric Interview) en mujeres de dos maternidades de Argentina. Asimismo se espera poder describir los factores de riesgo asociados a los síntomas depresivos durante el embarazo. Por último, se evaluará la relación entre los síntomas depresivos durante el embarazo, la frecuencia de complicaciones perinatales y los síntomas depresivos durante el puerperio. MATERIALES Y MÉTODOS Se realizó un estudio de cohorte en dos maternidades de Argentina, una pública en Tucumán y otra privada de la Ciudad de Buenos Aires. RESULTADOS Se tamizaron un total de 1212 mujeres entre la semana 20 y 24 de gestación, 891 en Tucumán y 321 en CEMIC. De estas mujeres fueron elegibles 208 (23.3%) y se evaluaron 205 en Tucumán y en CEMIC fueron elegibles y se evaluaron 186 (57.9%). En Tucumán, del total de 205 mujeres, 104 (50.7%) fueron tamizadas positivas en la Escala de Edimburgo usando un punto de corte de 10 o más. En CEMIC, del total de 186 mujeres, un total de 30 mujeres (16.1%) fueron tamizadas positivas en la Escala de Edimburgo usando un punto de corte de 10 o más. En Tucumán encontramos que las mujeres con síntomas de depresión tuvieron mayores complicaciones perinatales entre ellas sufrimiento fetal 9.77 (0.98 a 96.95), amenaza de aborto 2.38 (0.51 a 11.14) y muerte fetal 3.2 (0.43 a 23.56), mientras que en CEMIC no se encontraron diferencias