Pregnancy complications in women with childhood sexual abuse experiences.

OBJECTIVE: Childhood sexual abuse (CSA) has an estimated prevalence of 20% and has a constantly growing list of known long-term consequences on physical as well as psychological health which may also influence obstetrical care attributed to it. However, scientific data on the association of CSA and pregnancy are sparse. Therefore, the study investigated pregnancy complications in women exposed to CSA. METHODS: The study was designed as a cohort study comparing 85 women exposed to CSA with 170 matched unexposed women. CSA was identified by interview using modified questions from Wyatt [Child Abuse Negl 9 (1985) 507-519]. Data on pregnancy complications were collected by questionnaire and based on entries in a booklet (Mutterpass) in which all relevant data on pregnancy are documented at each prenatal consultation for any women attending prenatal care in Germany. Statistical analysis was performed with chi square, Fisher's Exact Test, and multiple logistic regression analysis to control the association between CSA and pregnancy complications for confounders significant in univariate analysis, i.e., physical abuse, other adverse experiences during childhood, abuse during pregnancy, substance abuse, and occupation. RESULTS: Women exposed to CSA were significantly more often hospitalized during pregnancy (41.2%/19.4%; OR 2.91, CI 1.64-5.17). They presented more often complications such as premature contractions (38.8%/20%; OR 2.54 CI 1.43-4.51), cervical insufficiency (25.9%/9.4%; OR 3.36, CI 1.65-6.82), and premature birth (18.8%/8.2%; OR 2.58, CI 1.19-5.59). CONCLUSION: Therefore, health care providers should adapt prenatal care to the specific needs of women exposed to CSA.

[Obstetric outcome and behavior of women after transabdominal isthmocervical cerclage]. / Wyniki poloznicze i ocena zachowania kobiet po zalozonym szwie okreznym ciesni macicy z dojscia przezbrzusznego.

OBJECTIVES: The aim of this study was to evaluate the course of the life in women with preconception transabdominal cervicoisthmic cerclage. MATERIALS AND METHODS: The studied material consisted of 9 women with cervical incompetence treated with transabdominal cervicoisthmic cerclage in period 2001-2005 in II Department of Gynaecology and Obstetrics of Medical University in Lódz. We paid special attention to mental condition. RESULTS: In analysed group 7 women got pregnant. Actually 6 of them have children and 1 is in 32 weeks pregnant. CONCLUSIONS: 1. Women after repetitive abortion or premature delivery because of serious defect of cervical isthmus are likely to suffer from depression. 2. Management with transabdominal cervicoisthmic cerclage makes carrying pregnancy up to term possible. 3. Prophylactic transabdominal cervicoisthmic cerclage left after childbirth seriously improves feeling of this women. 4. Women with transabdominal cervicoisthmic cerclage left after birth don't complain about dysurical symptoms.

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.

Incompetencia cervical: diagnóstico y tratamiento

La incompetencia cervical es una causa relativamente poco frecuente de pérdida gestacional, que se considera se ha sobrediagnósticado, más sin embargo es una importante razón para aborto repetido en el segundo trimestre de la gestación. El diagnóstico debe sustentarse en los antecedentes obstétricos y tratar de evidenciar su existencia de forma preconcepcional para simultáneamente descartar otras causas de pérdidas repetidas. Alcanzada la gestación y de forma temprana debe realizarse cerclaje cervical, utilizando técnica de Shirodkar o McDonald, que se presentan iguales ratas de supervivencia fetal e iguales ratas de complicaciones. En nuestra experiencia hemos tenido buenos resultados con Técnica de McDonald y seda en forma de trenza, como material de sutura, pasando la rata de supervivencia fetal del 10 por ciento pre-cerclaje al 88 por ciento post-cerclaje. En aquellos pacientes en que no se pueden realizar cerclaje cervical, se recomienda cerclaje cérvico-istmico vía abdominal