Adverse obstetric and neonatal outcomes in women with severe mental illness: to what extent can they be prevented?

BACKGROUND: Women with schizophrenia and bipolar disorder are at a higher risk of obstetric and neonatal complications. The aim of this study was to better understand the factors that may influence these adverse outcomes. METHOD: We examined obstetric and neonatal outcomes of pregnant women with schizophrenia and bipolar disorder and factors possibly influencing these outcomes. A retrospective review of the medical history of 112 women with a DSM-IV diagnosis of schizophrenia or bipolar disorder was undertaken. Data for controls were extracted from the hospital's electronic birth record data. RESULTS: Women with schizophrenia and bipolar disorder presented later for their first antenatal visit and had higher rates of smoking and illicit drug use than the control group. They also had higher rates of pre-eclampsia and gestational diabetes. Their infants were less likely to have Apgar scores 8-10 at both 1 and 5minutes and were more likely to be admitted to special care/neonatal intensive care nursery than the infants of controls. The rate of pre-term birth was significantly increased in the women with schizophrenia and bipolar disorder. Pre-term birth and admission to special care/neonatal intensive care were predicted by smoking and illicit drug use. CONCLUSION: These data point to potentially modifiable factors as significant contributors to the high rate of adverse obstetric and neonatal outcomes in women with mental illness. Comprehensive management of women with mental illness prior to, during pregnancy and in the postnatal period may have long-term benefits for their offspring.

Correlates of Chlamydia trachomatis infection in a primary care sentinel surveillance network.

BACKGROUND: Chlamydia is the most commonly notified infection in Australia. Prevention strategies should be informed by routine data on at-risk populations. METHODS: We calculated chlamydia positivity and correlates of infection using multivariable logistic regression for data collected between April 2006 and June 2009. RESULTS: Chlamydia positivity was 5.6% in 12233 females, 7.7% in 10316 heterosexual males and 6.2% in 7872 men who have sex with men (MSM). Correlates of chlamydia positivity among females included younger age (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.92-2.69), being born overseas (OR 1.50, 95% CI 1.25-1.82), multiple sex partners in the past year (OR 1.72, 95% CI 1.40-2.11) and inconsistent condom use with regular sex partners (OR 3.44 ,95% CI 1.65-7.20). Sex work was protective for females (OR 0.68, 95% CI 0.53-0.86). Among heterosexual males, correlates of positivity were younger age (OR 1.87, 95% CI 1.62-2.17), being born overseas (OR 1.35, 95% CI 1.16-1.58), symptoms at the time of testing (OR 1.64, 95% CI 1.40-1.92) and multiple sex partners in the past year (OR 1.83, 95% CI 1.46-2.30). Correlates of positivity among MSM were being born overseas (OR 1.23, 95% CI 1.00-1.51), being HIV-positive (OR 1.80, 95%CI 1.32-2.47), and reporting six or more anal sex partners in the past 6 months (OR 4.45, 95% CI 1.37-14.5). CONCLUSIONS: Our analysis identified subgroups at the highest risk of chlamydia in Victoria. These estimates will provide important baseline information to measure the impact of chlamydia control strategies.

A new perspective on VBAC: a retrospective cohort study.

BACKGROUND: Previous studies assessing the safety of vaginal birth after caesarean section (VBAC) have compared VBAC to elective repeat caesarean section (ERCS), despite the fact that the risks posed by each are considerably different. Explaining the complications of VBAC in a way that is meaningful to women can be challenging, and thus a comparison to a similar group of women who have also not undergone previous vaginal delivery may be a more relevant comparison. RESEARCH QUESTION: When counselling women undergoing planned VBAC, should a comparison of outcomes be made to women undergoing ERCS, or is a comparison to other nulliparous women undergoing vaginal birth a more valid comparison in terms of risk outcomes? PARTICIPANTS AND METHODS: A retrospective cohort study was undertaken comprising a consecutive cohort of 21,389 women who delivered, stratified by Robson's criteria into Robson groups 1-5. Those in Robson groups 6-10 were not included. Demographic data and maternal/neonatal outcomes were reviewed, with main outcome measures comprising uterine rupture, post-partum haemorrhage (PPH), 3rd/4th degree tears and neonatal morbidity. RESULTS: There was no increase in PPH, vaginal tears or neonatal complications in the VBAC group when compared to Robson groups 1 and 2 (nulliparous women in spontaneous or induced labour, respectively). Uterine rupture rates were low in all groups, with no correlation identified. DISCUSSION: The maternal and neonatal morbidity associated with VBAC is comparable to primiparous women undergoing a vaginal birth. CONCLUSION: In demonstrating the low relative morbidity in this comparison, these outcomes may aid in counselling women faced with the choice of VBAC versus ERCS.

Hyperemesis gravidarum--assessment and management.

BACKGROUND: Nausea and vomiting are common symptoms in early pregnancy. In most women the condition is mild and self limiting. A small percentage of women experience severe nausea and vomiting. This is known as hyperemesis gravidarum. Outcomes have improved with intravenous rehydration therapy. Consequences include decreased quality of life, time off work and secondary depression. OBJECTIVE: This article outlines the aetiology, outcomes, history and examination of women with hyperemesis gravidarum. Treatment modalities are discussed together with evidence regarding use. DISCUSSION: It is important to exclude other causes of nausea and vomiting such as urinary tract infection and thyrotoxicosis. Assessment of severity by checking for ketones is important as severity determines management. Management will include rehydration (intravenous or oral). Evidence is lacking regarding dietary and lifestyle recommendations but some women find them useful. Pyridoxine and metoclopramide (category A) are first line in treatment of hyperemesis gravidarum followed by prochlorperazine (category C), prednisolone (category A), promethazine (category C) and ondansetron (category B1). Benefit has been reported with the use of ginger. Evidence is mixed regarding acupressure and acupuncture.