Pregnancy and the perinatal period: The impact of attachment theory.

Ιn this study we aim to examine and integrate current literature and research on attachment theory and its expression on the specific field of obstetrics, the perinatal period. In medical settings in general, and in the field of obstetrics in specific, which is the clinical domain of the perinatal period, obstetricians, psychiatrists and psychologists frequently come across antenatal and postnatal concerns, psychological issues as well as psychiatric symptomatology stemming from closer observation of the women's difficulties or reported by women themselves. To our theoretical understanding, in order to better comprehend these psychosocial concerns and deliver timely and more effective personalized interventions to women in need, it is of paramount importance to thoroughly examine the perspective proposed by attachment theory, as it was first developed by child psychiatrist-psychoanalyst John Bowlby and the newest theoretical developments on the field that followed. Subtypes of attachment style are examined regarding their imprint on the benefits, as well as the difficulties and risks they place on women during each perinatal stage. "Insecurity" in attachment and significant relationships appears to render women more vulnerable in relation to psychopathology, according to the literature reviewed. As far as the psychopathological symptoms and disorders related to the perinatal period and their connection to attachment are concerned, the main disorders and symptomatology discussed in the literature appear to be perinatal depression, postpartum depression, perinatal anxiety and posttraumatic stress symptoms related to pregnancy and labor. At the same time, "security" attachment-wise, tangibly observed in couples with strong intramarital support, appears to offer a protective barrier against adversities by enabling securely attached women to remain calmer and make better use of their emotional and social resources throughout the challenging perinatal phase. Consequently, mothers-to-be become more eligible to overcome perinatal difficulties by the use of patterns of behavior that promote their well-being. Through the in-depth review of the current literature on attachment theory available and the tools of knowledge it equips us with, we attempted to assemble the real challenges and needs deriving from the demands that pregnancy, labor and the postpartum place on new mothers, as well as the way close relationships become affected by or, correspondingly, can be positively used in order to protect and shield women and their families from acknowledged stressful perinatal phases.

Trocar metastases in laparoscopic approach for gynecologic malignancies. A short review of the literature.

INTRODUCTION: Compared to laparotomy, laparoscopy has many benefits for patients, such as shorter recovery and lower morbidity rates. Port site metastases after laparoscopic approach in the treatment of gynecologic malignancies are uncommon. The purpose of this review is to identify and summarize possible risk factors for port-site metastases in patients undergoing laparoscopic surgery in the ambit of gynecologic oncology. DISCUSSION: The precise incidence of port-site metastases is not well known because many patients are not followed-up during the whole postoperative period. Possible risk factors that can increase the risk of port-site metastases can be the presence of large masses in the abdomen, especially in the presence of concomitant ascites and in patients treated for ovarian carcinomas. Different theories have been postulated in order to explain the development of port site metastases during laparoscopy for oncological patients. CONCLUSIONS: Patient selection is an essential factor that can influence the incidence of port site metastases in gynecological patients. Robust data regarding port site metastases in gynecologic oncology are needed.

A rare case report of squamous-cell carcinoma arising from mature cystic teratoma of ovary.

The most frequent ovarian germ cell tumors are mature cystic teratomas (MCTs), composing 10-25% of all ovarian neoplasms. MCTs have the potential of undergoing malignant transformation, typically in postmenopausal women, with a frequency of 0.17-3%, with squamous cell carcinoma being the most common malignant tumor arising from MCT. We present the rare clinical entity of a squamous cell carcinoma arising from a mature cystic teratoma in a 56-year-old premenopausal woman as well as diagnostic and therapeutic route followed.

Maternal and umbilical cord oxygen content and acid-base balance in relation to general, epidural or subarachnoid anesthesia for term elective cesarean section.

PURPOSE: To compare maternal and neonatal oxygenation and acid-base status after elective cesarean section (CS) under different anesthetic techniques. MATERIALS AND METHODS: Three hundred and eighty parturients undergoing elective cesarean section were randomly assigned to receive general (GA, n =140), epidural (EA, n = 117) or subarachnoid anesthesia (SA, n =123). Blood gases, oxygen content, and acid-base status parameters were measured in maternal artery and umbilical cord vessels. Neonatal Apgar scores were also recorded. RESULTS: Umbilical artery pH, HCO3-, and actual base excess (ABE) were significantly higher in the GA compared to SA group (p < 0.001, p < 0.05, andp < 0.05, respectively). Umbilical vein ABE was lower in the SA compared to GA and EA groups (p < 0.05). Oxygen content in maternal artery was higher in the GA and EA groups compared to the SA group (p < 0.05). Neonatal oxygen content in both cord vessels was higher in the GA group compared to EA and SA groups (p < 0.05). Umbilical venous-arterial difference of PO2, oxygen content, and Apgar scores did not differ significantly among groups. CONCLUSION: Neonatal oxygenation and acid-base status values were better preserved when GA was administered for elective CS compared to regional modalities. Apgar scores and neonatal outcomes were not affected by the anesthetic technique.

The presence of CD40, CD40L and ADAM8 among endometriotic patients.

Clinical and molecular research data are still insufficient to determine the onset, etiology and progression of endometriosis. Recently, a number of studies have been investigating the role of the inflammatory-immune factor. The role of inflammation in tissue infiltration and staging of endometriosis is limited. The aim of this study is to investigate the presence of CD40, CD40L and ADAM8 among endometriotic patients. These three markers of inflammation were measured in the serum of each of 76 women participating in the study. Twenty-nine (29) women, of mean age 36.9, (±9.2 SD) years free of endometriosis served as the control group. Of the endometriotic women 15 had a stage I-II and 32 stage III-IV disease. We undertook the present investigation expecting that an increased expression of CD40, CD40L and ADAM8 would testify to the inflammatory-autoimmune character of endometriosis. No difference in the levels of CD40, ADAM 8, CD40L was detected between the two groups. The stage of endometriosis did not affect CD40, ADAM 8, CD40L serum concentrations. A difficulty in our study is the lack of data with which to compare our results. Further investigation is needed to elucidate the role of these inflammatory markers in endometriosis.

Obstetric hysterectomy: a review of cases over 16 years.

Emergency peripartum hysterectomy (EPH), is performed when life-threatening obstetric conditions occur. The authors attempt to assess the incidence of EPH as well as to investigate risk factors and patients' characteristics. A retrospective study of all cases of EPH performed at the 2nd Department of Obstetrics and Gynecology, Medical School of Athens University, from 1994 to 2009 has been conducted. Data were abstracted from individual medical charts and laboratory records. Among 16,182 deliveries, 15 EPH were performed (0.92 per 1,000 deliveries). Indication was uncontrollable haemorrhage due to placenta accreta (73.3%) or uterine atony (26.6%). Incidence of 1.54 EPHs per 1,000 caesarean sections and 0.51 per 1,000 vaginal deliveries, were noted. Morbidity rate was 46.6%. One (6.6%) mother died because of pulmonary embolism. In conclusion, peripartum hysterectomy is a severe but life-saving procedure. Caesarean section increases the risk of EPH. Obstetricians should always be prepared to confront this emergency situation.

Perinatal mortality in diabetic pregnancy.

Perinatal mortality rate (PMR) is one of the most important perinatal health indicators. PMR in diabetic pregnancies varies throughout the world and is higher than the background PMR. The prevalence of pregestational diabetes is increasing and is associated with an elevated risk of congenital malformations, macrosomia, preeclampsia, and preterm delivery. The incidence of PMR in preexisting diabetes mellitus ranges considerably, with congenital abnormalities and preterm labor the main factors contributing to the higher PMR. Women with gestational diabetes mellitus or impaired glucose tolerance are a mixed group that may have low to a high PMR, especially if they require insulin in their pregnancy. All the known diabetic women should plan their pregnancies and optimize glycemic control periconceptually and throughout pregnancy, as this reduces the frequency of congenital abnormalities, obstetric complications, and perinatal mortality.

Maternal serum levels of TNF-alpha and IL-6 long after delivery in preeclamptic and normotensive pregnant women.

AIM: To evaluate maternal TNF-alpha and IL-6 plasma levels in normotensive pregnant women, women with preeclampsia, and to examine the temporal changes in their levels from the antepartum to the postpartum period correlated with the regression of preeclampsia. METHOD: A prospective study was performed in the 2nd Department of Obstetrics and Gynecology, University of Athens. Blood samples were obtained: (1) antepartum at the time of clinical diagnosis of the syndrome, 2. 12-14 weeks postpartum. RESULTS: No statistically significant differences were found in IL-6 levels, whereas a difference was found in TNF-alpha levels between preeclamptic and controls in antepartum period (0.80 pg/ml versus 0.60 pg/ml, P : .04). Long after delivery, TNF-alpha levels were significantly higher in preeclamptic compared to normotensive controls (0.86 pg/ml versus 0.60 pg/ml, P : .004). No difference was observed in TNF-alpha before and after delivery in both groups. No difference was noticed in IL-6 levels in women of normotensive group long after delivery compared to that before delivery. Long after delivery IL-6 levels were statistically significant higher in preeclamptic women compared to normal controls (3.53 ± 0.52 pg/ml versus 1.69 ± 0.48 pg/ml, P : .02). CONCLUSION: Preeclamptic women remain under a status of increased inflammatory stress up to 12-14 weeks postpartum despite the fact that all the other signs of preeclampsia are resolved.

Human papilloma virus in adolescence.

Human papilloma virus (HPV) is one of the most widespread sexually transmitted diseases especially in adolescence. The majority of the infections are self-sustained by the immune system. However, HPV may lead to genital warts, cervical dysplasia and cervical cancer. Sexually active adolescent females should be encouraged to obtain gynecologic screening for HPV and be well informed about HPV and the risks associated with this infection. All the efforts are now focused on the vaccines that are being developed to reduce the morbidity and mortality associated with HPV infection if administered in time.

Breast pain and mammographic density increase as a consequence of raloxifene therapy.

A 55-yr-old post-menopausal woman with osteopenia and no history of breast disease is presented. She was placed on raloxifene HCl 60 mg and soon after developed severe breast pain. The follow-up mammogram, performed prematurely at 6 months, showed a marked increase in breast density. Therapy was accordingly stopped and mastodynia subsided. The patient's mammogram regressed to pre-treatment status after 6 months off-therapy.