Depressive symptoms and maternal psychological distress during early infancy: A pilot study in preterm as compared with term mother-infant dyads.

BACKGROUND: Preterm birth does not only affect infants but also represents an unexpected and traumatic event for parents. There are few reports on parenting stress during early infancy comparing preterm and term mothers, with the results being somewhat inconsistent. METHODS: As part of a longitudinal study, preterm mother-infant and term mother-infant dyads were enrolled. Dyads were assessed twice: during hospitalisation in the neonatal intensive care unit (NICU) and at 3 months of infant age (corrected age for preterm). Each mother completed a self-report set of psychological questionnaire in both time points. All the children underwent a neurological examination at 40 weeks post conceptional age and at 3 months (corrected age for preterm). RESULTS: 20 preterm and 20 term dyads were included. NICU mothers reported elevated postnatal depressive symptoms and high stress level, even if the preterm infants were with low perinatal risk and normal neurological examination. Comparing preterm infant with low perinatal risk and normal neurological examination with term-born children at 3 months, we found higher parental stress in term mothers than in preterm mothers. LIMITATIONS: This study was limited by a relatively small sample size; findings are preliminary and warrant further investigation in larger-scale study. CONCLUSIONS: Findings confirm that becoming a mother of a preterm infant is an event associated with emotional distress. These symptoms may resolve with time, and sometimes are independent of the infant's clinical severity. Assessing parental sources of stress and subsequent follow-up is essential to promote parental support, both for preterm and term mothers.

The Mother-Child Relationship during the First Months of Life: Preliminary Considerations in Preterm as Compared with Term Mother-Infant Dyads.

INTRODUCTION: From the prognostic perspective, the quality of the mother-child relationship during the first months of life has been variously associated with different factors such as the child's psychomotor/cognitive development and emotional-behavioral disorders. METHODS: The main aim of this study was to describe, at term age and 3 months of corrected age, the features and the prevalent patterns of the mother-child relationship in a group of 20 mother-preterm infant dyads and to compare them with those of a group of 20 mother-term infant dyads. RESULTS: A relatively high rate of inadequate dyadic synchrony was found in our sample of preterms at 40 weeks of gestational age (half of the sample analyzed). The quality of the dyadic relationship and the prevalent patterns of the mother-child relationship were found to differ between the two groups we studied; moreover, the subjects at risk of relational problems remained substantially the same during the first 3 months of life. DISCUSSION: These data underline that in preterm children, the first weeks of life, coinciding with their hospitalization, represent a crucial time for establishing a valid dyadic relationship and for considering and planning any preventive interventions; after all, the earlier the risk of relational problems becomes a real possibility, the more likely it is to negatively impact on a child's overall development.

Robotic single site staging in endometrial cancer: A multi-institution study.

OBJECTIVE: To evaluate the feasibility and the safety of robotic single site hysterectomy (RSSH) plus or less pelvic lymphadenectomy in FIGO stage I-II endometrial cancer. MATERIALS AND METHODS: We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients who underwent RSSH plus or less pelvic lymphadenectomy for clinical FIGO stage I or occult stage II endometrial carcinoma. RESULTS: From January 2012 to February 2015, 125 patients were included in our study. The median age of the patients was 59 years (range, 35-84 years) and the median body mass index was 27 kg/m(2) (range, 19-52 kg/m(2)). One patient was converted to vaginal surgery due to problems of hypercapnia. The median docking time, console time, and total operative time was 11 min (range, 4-40 min), 80 min (range, 20-240 min) and 122 min (range, 35-282 min), respectively. The median blood loss was 50 ml (range, 10-250 ml). No laparoscopic/laparotomic conversion was registered. Twenty one patients underwent pelvic lymphadenectomy (16.8%) and the median pelvic lymph nodes was 13 (range, 3-32). The median time to discharge was 2 days (range, 1-3 days). No intra-operative complications occurred, while we observed 10 (8%) early post-operative complications. CONCLUSION: RSSH plus or less pelvic lymphadenectomy is technically feasible, safe and reproducible and could be the treatment of choice for patients affected by FIGO stage I-II endometrial cancer. However, randomized controlled trials are needed to confirm these results.

Placental lesions associated with oligohydramnios in fetal growth restricted (FGR) pregnancies.

INTRODUCTION: Aim of the study was to investigate the association between placental pathology and oligohydramnios in pregnancies complicated by fetal growth restriction (FGR). METHODS: Placentas from 221 consecutive FGR pregnancies and 63 healthy controls were studied. Pathological lesions were described according to consensus nomenclature and standardized criteria; both elementary lesions and constellations of lesions (patterns) were considered. Statistics included analysis of linear trends and multinomial logistic regression. RESULTS: Amniotic fluid index (AFI) was normal in 56 (25.3%) FGR pregnancies, whereas mild, moderate and severe oligohydramnios were diagnosed in 32 (14.5%), 44 (19.9%) and 89 (40.3%) subjects, respectively. In FGR pregnancies, after adjustment for potential confounders, membrane meconium staining (chi-square = 28.6, p < 0.001), chronic villous hypoxia pattern (chi-square = 18.8, p < 0.001) and fetal thrombotic vasculopathy pattern (chi-square = 9.2, p = 0.002) were positively and linearly correlated to AFI decrease. Odds ratios of meconium and chronic villous hypoxia were 9.2 (95% CI = 2.6-32.9) and 4.2 (95% CI = 1.3-13.6) in FGR pregnancies with normal AFI and 25.2 (95% CI = 6.9-91.8) and 9.7 (95% CI = 3-31.5) in those with severe oligohydramnios (p = 0.005 and p = 0.023 compared to normal AFI, respectively). DISCUSSION: In FGR pregnancies, reduction of amniotic fluid volume is directly correlated to histological features of placental under-perfusion, meconium staining of membranes and fetal vascular damage. These findings support the clinical notion that in FGR pregnancies oligohydramnios is a risk factor of fetal hypoxia and possibly of increased adverse neonatal outcomes.

HPV infection and intraepithelial lesions: comparison between HIV positive and negative women.

INTRODUCTION: Human Papillomavirus infections have been shown to be crucial for the development of cervical intraepithelial neoplasia and subsequent cervical cancer. The aim of this study is to describe the prevalence of different genotypes of HPV, in a population of HIV-positive women, compared to the negative ones, and their oncogenic risk. PATIENTS AND METHOD: A case-control study comparing HPV genotype distribution between 93 HIV-seropositive and 186 HIV-seronegative women, matched for age and severity of cervical lesions, who attending colposcopic service of our departments for periodical Pap smear and HPV DNA full genotyping by SPF-10 LiPA assay. RESULTS: No significant difference was found in genotype distribution between HIV positive and HIV negative women. Only the prevalence of HPV56 was higher in HIV positive women (p=0,046). The rates of HPV 6, 11, 16 and 18 were similar in both groups. The likelihood of the detection of three or more HPV genotypes was significantly associated with CIN (OR=2.0; 95% CI=1.1-3.8; p= 0.026) but only marginally to HIV-positive serostatus (OR=1.68; 95% CI=0.89-3.16; p= 0.1). High grade cervical lesions are associated with high risk viruses like HPV 16 and 18 and with multiple cervical HPV infections. CONCLUSIONS: The tendency to treat HIV disease with high active antiretroviral therapy may reduce the impact of immunosuppression and make the course of such HPV infections more similar to that among women who are not HIVinfected. As in immunocompetent women, high oncogenic risk viral type and multiple infections are associated with a histologically proven cervical intraepithelial lesions.

Results of endovesical hyaluronic acid/chondroitin sulfate in the treatment of Interstitial Cystitis/Painful Bladder Syndrome.

OBJECTIVES: The aim of our study was to test the effect of a more viscous compound than existent hyaluronic acid formulation in helping to restore a defective glycosaminoglycan layer, and therefore in improving Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) symptoms when administered intravesically in IC/PBS patients. METHODS: A total of 23 female patients completed the study. Patients received endovesical administration of hyaluronic acid and chondroitin sulfate in normal saline, 40 ml, weekly for 12 weeks and then bi-weekly for 6 months, if there was initial response. RESULTS: After 12 weeks treatment both Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), pelvic pain and Urgency/Frequency Symptom Scale (PUF) showed a mean significant improvement, which was maintained thereafter. The average number of voidings and mean voiding volumes revealed significant improvement after the 12 weeks' treatment period, with a significant reduction and increase, respectively. Mean voiding volume increased from 143 ml to 191, which apparently was not reflected in a corresponding reduction of number of daily voids (from 15,5 to 14). VAS values decreased from 5,4 to 3,6 (pain) and from 6,0 to 3,5 (urgency) after the treatment cycle, showing a significant improvement. CONCLUSIONS: In our preliminary experience, the administration of intravesical hyaluronic acid plus chondroitine sulphate appears to be a safe and efficacious method of treatment in IC/PBS.

[Perinatal transmission of HIV]. / Infezione perinatale da HIV.

Paediatric HIV infection is still the most important pandemic, despite the substantial reductions of mother to child transmission achieved in North America and Europe. The total number of people living with the human immunodeficiency virus (HIV) rose in 2004 to reach its highest level ever: an estimated 39.4 million people are living with the virus. This number has been rising in every region, compared with two years ago, with the steepest increases occurring in East Asia, in Eastern Europe and central Asia. Sub-Saharan Africa remains by far the worst-affected region, with 25,4 million people living with HIV at the end of 2004. The AIDS epidemic is affecting women and girls in increasing number in Africa; them make up almost 57% of all people infected with HIV, but became a striking 76% in Sub-Saharan area. This review will focus on the current knowledge available regarding the timing of HIV transmission and the subsequent implications for its prevention. Mother to child transmission can take place during pregnancy, labour, delivery and post-partum, through breastfeeding. Different factors may influence HIV transmission during each of these time periods, and hence interventions to reduce transmission during each of these periods may also require different preventive strategies. The risk of mother to child transmission of HIV infection can be substantially reduced from 15-20% without interventions to less than 2% with the use of antiretroviral therapy during pregnancy, during labour and in the neonatal period, with an elective caesarean section delivery and refraining from breastfeeding. Factors associated with an increased risk of perinatal HIV transmission include advanced maternal blood, prolonged duration of ruptured membranes, and increased quantity of HIV in maternal blood at delivery.

Rates of neonatal death and cerebral palsy associated with fetal growth restriction among very low birthweight infants. A temporal analysis.

OBJECTIVE: To assess whether changes over time in neonatal survival and infants' neurodevelopmental outcome among very low birthweight (VLBW) infants was correlated with the obstetric aetiology of VLBW. DESIGN: A cohort study of 773 VLBW infants. SETTING: A University hospital in Northern Italy. POPULATION: All the VLBW infants born over a 20-year period (1983-2002) at a single institution. METHODS: Evaluation of neonatal mortality and neurodevelopmental outcome of the surviving infants at 2 years of corrected age. Logistic regression analysis was used to compare the improvements of neonatal outcome associated with obstetric risk factors over time. MAIN OUTCOME MEASURES: The risk reduction of neonatal death or cerebral palsy associated with each obstetric category responsible for VLBW over time. RESULTS: The overall rates of neonatal mortality and cerebral palsy were 38.7% (43/111) and 17% (9/53) in the period 1983-87 and 13.7% (34/24) and 6.3% (13/205) in the period 1998-2002, respectively. The adjusted decrement per 5-year period was 33.1% (95% CI = 7.9-51.4) for neonatal death and 29.1% (95% CI = 25.3-32.7) for cerebral palsy, respectively. The adjusted rise in the rate of intact survival at 2 years of corrected age was 7.6% (95% CI = 3.1-12.3) per quinquennium. In logistic models with neonatal death or cerebral palsy as a combined outcome variable, and gestational age, corticosteroid use, surfactant use, and time of birth as explanatory variables, fetal growth restriction (P < 0.001) and pre-eclampsia (P= 0.011) interacted significantly with period of birth. The adjusted decrement in the rate of neonatal death or cerebral palsy as a combined variable was 27.5% per 5 years (95% CI = 13-39.6) in the overall population, 54.5% per 5 years (95% CI = 46.8-61.2) (P < 0.001 compared with overall population) among growth-restricted infants and 50.3% per 5 years (95% CI = 42.5-57.1) (P= 0.003 compared with overall population) in infants born to mothers with pre-eclampsia. CONCLUSIONS: Over a period of 20 years, the decrement in the rate of neonatal death or cerebral palsy was higher in growth-restricted fetuses than in other VLBW infants. This reduction was not obtained at the expense of an increased rate of neurodevelopmental impairments in surviving infants.