Relation of outbursts of anger and the acute risk of placental abruption: A case-crossover study.

BACKGROUND: Roughly, a fourth of all placental abruption cases have an acute aetiologic underpinning, but the causes of acute abruption are poorly understood. Studies indicate that symptoms of stress, depression, and anxiety during pregnancy may be associated with a higher risk of abruption. OBJECTIVE: We examined the rate of abruption in the 2 hours immediately following outbursts of anger. METHODS: In a multicentre case-crossover study, we interviewed 663 women diagnosed with placental abruption admitted to one of the seven Peruvian hospitals between January 2013 and August 2015. We asked women about outbursts of anger before symptom onset and compared this with their usual frequency of anger during the week before abruption. RESULTS: The rate of abruption was 2.83-fold (95% confidence interval [CI] 1.85, 4.33) higher in the 2 hours following an outburst of anger compared with other times. The rate ratio (RR) was lower for women who completed technical school or university (RR 1.38, 95% CI 0.52, 3.69) compared to women with secondary school education or less (RR 3.73, 95% CI 2.32, 5.99, P-homogeneity = .07). There was no evidence that the association between anger episodes and abruption varied by hypertensive disorders of pregnancy (ie preeclampsia/ eclampsia) or antepartum depressive symptoms. CONCLUSION: There was a higher rate of abruption in the 2 hours following outbursts of anger compared with other times, providing potential clues to the aetiologic mechanisms of abruption of acute onset.

Risk of placental abruption in relation to maternal depressive, anxiety and stress symptoms.

BACKGROUND: Little is known about the influence of psychiatric factors on the etiology of placental abruption (PA), an obstetrical condition that complicates 1-2% of pregnancies. We examined the risk of PA in relation to maternal psychiatric symptoms during pregnancy. METHODS: This case-control study included 373 PA cases and 368 controls delivered at five medical centers in Lima, Peru. Depressive, anxiety and stress symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). Multivariable logistic regression models were fit to calculate odds ratios (aOR) and 95% confidence intervals (CI) adjusted for confounders. RESULTS: Depressive symptoms of increasing severity (using the DASS depression subscale) was associated with PA (p for trend=0.02). Compared with women with no depressive symptoms, the aOR (95%CI) for PA associated with each level of severity of depression symptoms based on the DASS assessment were as follows: mild 1.84 (0.91-3.74); moderate 1.25 (0.67-2.33); and severe 4.68 (0.98-22.4). The corresponding ORs for mild, moderate, and moderately severe depressive symptoms based on the PHQ assessment were 1.10 (0.79-1.54), 3.31 (1.45-7.57), and 5.01 (1.06-23.6), respectively. A positive gradient was observed for the odds of PA with severity of anxiety (p for trend=0.002) and stress symptoms (p for trend=0.002). LIMITATIONS: These cross-sectionally collected data may be subject to recall bias. CONCLUSIONS: Maternal psychiatric disorders may be associated with an increased occurrence of AP. Larger studies that allow for more precise evaluations of maternal psychiatric health in relation to PA risk are warranted.

Intervilosite crónica masiva da placenta / Intervilositis crónica masiva de placenta / Massive chronic intervillositis of placeta

A intervilosite crónica massiva é uma patologia raras vezes diagnosticada na placenta, com uma incidência inferior a 0.5%. O exame histológico da placenta mostra uma infiltração massiva do espaço intervilositário por células inflamatórias, sem lesões de vilite crónica associadas. Estas alterações vão comprometer a função placentar originando um compromisso fetal que se manifesta sob a forma de atraso de crescimento fetal intra-uterino, parto pré-termo ou morte fetal. Descreve-se um caso clínico, ilustrativo deste tipo de patologia, referente a uma mulher de 31 anos, II gesta, O para, com antecedentes de morte fetal intra-uterina às 13 semanas de gestação em gravidez anterior, tendo registado na actual gravidez um valor elevado de alfa-feto-proteína às 16 semanas de gestação e morte fetal intra-uterina inesperada às 18 semanas. O exame histológico da placenta demonstrou a presença de uma intervilosite crónica massiva. Este caso realça, ainda, o valor do exame anátomo-patológico da placenta em todos os casos de morte fetal in-trauterina, e a sua importância para o diagnóstico da etiopatogenia e prognóstico de futuras gestações (AU)

La intervilositis crónica masiva es una patología de la placenta, raras veces diagnosticada, con una incidencia inferior al 0,5 0/0. El examen histológico de la placenta muestra una inflamación masiva del espacio intervillositario, por células inflamatorias, sin lesiones de vellosidades crónicas asociadas. Estas alteraciones van a comprometer la función placentaria, originando un compromiso fetal que se manifiesta en una forma de retraso del crecimiento intrauterino, parto pretérmino o muerte fetal. Se describe un caso clínico ilustrativo de este tipo de patología, referente a una mujer de 31 años, secundigestante y primípara, con antecedentes de muerte fetal intrauterina a las 13 semanas de gestación en el embarazo anterior. En este embarazo se registra un valor elevado de la alfa-fetoproteína a las 16 semanas y muerte inesperada a las 18 semanas de embarazo. El examen histológico de la placenta demostró una intervillositis crónica masiva. Este caso realza el valor del examen histológico de la placenta en todos casos de muerte fetal intrauterina y su importancia en el diagnóstico de la etiopatogenia y pronóstico de futuras gestaciones (AU)

Massive chronic intervillositis (MCI) is an infrequently recognized placental lesion which is reported in less than 0.5 0/0 of cases. MCI is characterized by prominent inflammatory infiltrate in the intervillous space in the absence of significant chronic villitis. MCI has been associated with poor pregnancy outcome, including intrauterine growth restriction, preterm delivery and intrauterine fetal death. We report such a case of a 31-year-old woman, gravida 2, para 0, with a past history of one intrauterine fetal death at 13 weeks pregnancy, who became pregnant, and an elevated maternal serum alpha-fetoprotein was noted at 16 weeks gestation. The intrauterine fetal death was diagnosed at 18 weeks gestation. Histological examination of the placenta demonstrated the presence of MCI. This case also underlines the importance of the routine histopathological examination of the placenta in all cases of intrauterine fetal death, in view of its importance in aetiological diagnostic and prognostic information for future pregnancy (AU)

Dysphoria among high-risk pregnant hospitalized women on bed rest: a longitudinal study.

BACKGROUND: While approximately 700,000 women experience pregnancy complications and are treated with bed rest in the hospital each year, little is known about negative affect in these women. OBJECTIVES: The study purpose was to describe dysphoria, a composite of symptoms of negative affect across the antepartum and postpartum and to identify the relationship between dysphoria and the length of pre-admission home bed rest, hospital bed rest, and maternal and fetal/neonatal indices of risk. METHODS: The convenience sample for this longitudinal repeated measures study consisted of 63 high-risk pregnant women admitted on antepartum bed rest to one of three university-affiliated hospitals. Women were included if they were diagnosed with (a) preterm labor, (b) premature rupture of membranes, (c) incompetent cervix, (d) placenta previa, (e) placental abruption or multiple gestation, and (f) did not have a psychiatric disorder. The Multiple Affect Adjective Checklist-Revised (MAACL-R) was used to assess dysphoria. Obstetric risk status was assessed by both the Hobel and Creasy Risk Assessment tools. RESULTS: Dysphoria was highest upon hospital admission and decreased significantly across time (F (5) = 23.58, p <.001). Positive Affect-Sensation Seeking significantly increased across time (F (5) = 53.16, p <.001). Dysphoria scores were significantly greater for those with highest Hobel obstetric risk scores (F (1, 60) = 4.53, p =.037). Antepartum dysphoria was not correlated with gestational age upon hospital admission, length of bed rest, or Creasy risk status. However, gestational age at birth was significantly correlated with postpartum dysphoria. DISCUSSION: The stimulus for antepartum dysphoria is unclear. However, postpartum dysphoria appears to be related to indicators of the infant's state of health at birth.