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Fierro G, Milan B, Buelli E, Bugada D, Casarotta E, Rizzo F, Ongaro L, Gritti P, Previdi F, Lorini FL. Sublingual sufentanil for patient-controlled analgesia during labor induction for pregnancy termination: an effective and well-tolerated approach. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:41. [PMID: 38973007 DOI: 10.1186/s44158-024-00177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy. METHODS We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating "not satisfied" to 5, denoting "completely satisfied"), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed. RESULTS The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine. CONCLUSIONS Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.
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Affiliation(s)
- Giulia Fierro
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
| | - Barbara Milan
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy.
| | - Elena Buelli
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
| | - Dario Bugada
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
| | - Erika Casarotta
- Department of Biomedical Sciences and Public Health, Università Politecnica Delle Marche, Via Tronto 10/a, Ancona, 60020, Italy
| | - Francesco Rizzo
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
| | - Laura Ongaro
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
| | - Paolo Gritti
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
| | - Fabio Previdi
- Department of Management, Information and Production Engineering, University of Bergamo, Viale G. Marconi 5, Dalmine, BG, 24044, Italy
| | - Ferdinando Luca Lorini
- Department of Emergency and Intensive Care, ASST Papa Giovanni XXIII, P.Za OMS, Bergamo, 24127, Italy
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Arora IH, Woscoboinik GG, Mokhtar S, Quagliarini B, Bartal A, Jagodnik KM, Barry RL, Edlow AG, Orr SP, Dekel S. A diagnostic questionnaire for childbirth related posttraumatic stress disorder: a validation study. Am J Obstet Gynecol 2024; 231:134.e1-134.e13. [PMID: 37981091 PMCID: PMC11175478 DOI: 10.1016/j.ajog.2023.11.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Labor and delivery can entail complications and severe maternal morbidities that threaten a woman's life or cause her to believe that her life is in danger. Women with these experiences are at risk for developing posttraumatic stress disorder. Postpartum posttraumatic stress disorder, or childbirth-related posttraumatic stress disorder, can become an enduring and debilitating condition. At present, validated tools for a rapid and efficient screen for childbirth-related posttraumatic stress disorder are lacking. OBJECTIVE We examined the diagnostic validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for detecting posttraumatic stress disorder among women who have had a traumatic childbirth. This Checklist assesses the 20 Diagnostic and Statistical Manual of Mental Disorders, posttraumatic stress disorder symptoms and is a commonly used patient-administrated screening instrument. Its diagnostic accuracy for detecting childbirth-related posttraumatic stress disorder is unknown. STUDY DESIGN The sample included 59 patients who reported a traumatic childbirth experience determined in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder criterion A for exposure involving a threat or potential threat to the life of the mother or infant, experienced or perceived, or physical injury. The majority (66%) of the participants were less than 1 year postpartum (for full sample: median, 4.67 months; mean, 1.5 years) and were recruited via the Mass General Brigham's online platform, during the postpartum unit hospitalization or after discharge. Patients were instructed to complete the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, concerning posttraumatic stress disorder symptoms related to childbirth. Other comorbid conditions (ie, depression and anxiety) were also assessed. They also underwent a clinician interview for posttraumatic stress disorder using the gold-standard Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A second administration of the Checklist was performed in a subgroup (n=43), altogether allowing an assessment of internal consistency, test-retest reliability, and convergent and diagnostic validity of the Checklist. The diagnostic accuracy of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in reference to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, was determined using the area under the receiver operating characteristic curve; an optimal cutoff score was identified using the Youden's J index. RESULTS One-third of the sample (35.59%) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for a posttraumatic stress disorder diagnosis stemming from childbirth. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, symptom severity score was strongly correlated with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, total score (ρ=0.82; P<.001). The area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.87-0.99), indicating excellent diagnostic performance of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A cutoff value of 28 optimized the sensitivity (0.81) and specificity (0.90) and correctly diagnosed 86% of women. A higher value (32) identified individuals with more severe posttraumatic stress disorder symptoms (specificity, 0.95), but with lower sensitivity (0.62). Checklist scores were also stable over time (intraclass correlation coefficient, 0.73), indicating good test-retest reliability. Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores were moderately correlated with the depression and anxiety symptom scores (Edinburgh Postnatal Depression Scale: ρ=0.58; P<.001 and the Brief Symptom Inventory, anxiety subscale: ρ=0.51; P<.001). CONCLUSION This study demonstrates the validity of the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as a screening tool for posttraumatic stress disorder among women who had a traumatic childbirth experience. The instrument may facilitate screening for childbirth-related posttraumatic stress disorder on a large scale and help identify women who might benefit from further diagnostics and services. Replication of the findings in larger, postpartum samples is needed.
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Affiliation(s)
- Isha Hemant Arora
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Georgia G Woscoboinik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Salma Mokhtar
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Beatrice Quagliarini
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alon Bartal
- The School of Business Administration, Bar-Ilan University, Ramat Gan, Israel
| | - Kathleen M Jagodnik
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA
| | - Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA; Harvard Medical School, Boston, MA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston MA
| | - Scott P Orr
- Department of Psychiatry, Harvard Medical School, Boston MA; Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Sharon Dekel
- Postpartum Traumatic Stress (Dekel) Laboratory, Division of Neuroscience, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston MA.
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Harper K, Bohecker L, Lewis T, Lee M, Edwards N, Celoria W, Moore D. Identifying Systemic Factors when Counseling Black Women of Christian Faith in the USA. JOURNAL OF RELIGION AND HEALTH 2023; 62:3414-3429. [PMID: 37133609 DOI: 10.1007/s10943-023-01824-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
When Black women of Christian faith in the USA receive secular help for psychological symptoms, their spiritual and religious communities often view the decision negatively. The women may feel shamed, ostracized, and condemned. They often experience emotional, physical, and spiritual trauma from the rejection that increases the frequency, duration, and intensity of their psychological symptoms. This article identifies specific community-based and systemic factors that exacerbate mental health issues in Black women of Christian faith. The authors discuss the influence of such factors on mental health and provide evidence-based practices for mental health clinicians working with Black women of Christian faith.
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Affiliation(s)
- Keyona Harper
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA.
| | - Lynn Bohecker
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
| | - Tamika Lewis
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
| | - Margaret Lee
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
| | - Nivischi Edwards
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
| | - Wendy Celoria
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
| | - Denise Moore
- Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
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Terada S, Fujiwara T, Sugawara J, Maeda K, Satoh S, Mitsuda N. Association of severe maternal morbidity with bonding impairment and self-harm ideation: A multicenter prospective cohort study. J Affect Disord 2023; 338:561-568. [PMID: 37385386 DOI: 10.1016/j.jad.2023.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Evidence on the association between severe maternal morbidity (SMM) and mother-infant bonding and self-harm ideation is limited. We aimed to examine these associations and the mediating effect of Neonatal Intensive Care Unit (NICU) admission at one-month postpartum. METHODS This multicenter, prospective cohort study was conducted in Japan (n = 5398). SMM included preeclampsia, eclampsia, severe postpartum hemorrhage, placental abruption, and a ruptured uterus. Lack of affection (LA) and Anger and Rejection (AR) were assessed using the Mother-Infant Bonding Scale (MIBS), and self-harm ideation was assessed using the 10th item of the Edinburgh Postnatal Depression Scale (EPDS). Linear and logistic regression models were used to examine the association between SMM and MIBS score and self-harm ideation. A structural equation model (SEM) was employed to examine the mediating effect of NICU admission on the association between SMM and mother-infant bonding and postpartum depressive symptoms. RESULTS Women with SMM had a 0.21 (95 % confidence interval [CI]: 0.03-0.40) point higher MIBS score and a decreasing trend in the risk of self-harm ideation (odds ratio 0.28, 95 % CI: 0.07-1.14) compared to those without SMM. SEM analysis revealed that SMM was associated with MIBS partially through NICU admission. LIMITATIONS EPDS scores during pregnancy could be an unmeasured confounder. CONCLUSIONS Women with SMM had higher MIBS scores, particularly on the LA subscale, which was partially mediated by NICU admission. Psychotherapy to support parent-infant relationships is necessary for women with SMM.
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Affiliation(s)
- Shuhei Terada
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Junichi Sugawara
- Graduate School of Medicine, Tohoku University, Miyagi, Japan; Suzuki Memorial Hospital, Miyagi, Japan
| | - Kazuhisa Maeda
- Department of Obstetrics and Gynecology, National Hospital Organizations: Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Shoji Satoh
- Maternal and Perinatal Care Center, Oita Prefectural Hospital, Oita, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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Ahrens KA, Palmsten K, Lipkind HS, Pfeiffer M, Gelsinger C, Ackerman-Banks C. Mental Health Within 24 Months After Delivery Among Women with Common Pregnancy Conditions. J Womens Health (Larchmt) 2023; 32:787-800. [PMID: 37192449 PMCID: PMC10354313 DOI: 10.1089/jwh.2022.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Objective: The aim of this study is to estimate the risk of a new mental health diagnosis within the first 24 months postpartum among women with common pregnancy conditions, overall and by rurality. Materials and Methods: This longitudinal population-based study used the Maine Health Data Organization's All-Payer Claims Data to estimate the cumulative risk of a new mental health disorder diagnosis in the first 24 months postpartum among women with deliveries during 2007-2019 and who did not have a mental health diagnosis before pregnancy. Cox models were used to estimate hazard ratios for common pregnancy conditions (prenatal depression, gestational diabetes [GDM], and hypertensive disorders of pregnancy [HDP]) on the new diagnosis of five mental health conditions, separately. Models were adjusted for maternal demographics and pregnancy characteristics. Results: Of the 123,125 deliveries, the cumulative risk of being diagnosed in the first 24 months postpartum with depression was 28%, anxiety 25%, bipolar disorder 3%, post-traumatic stress disorder 6%, and schizophrenia/psychotic disorder 1%. Women with prenatal depression were at higher risk of having a postpartum mental health diagnosis compared with women without prenatal depression (adjusted hazard ratios [aHRs] ranged from 2.5 [for anxiety] to 4.1 [for postpartum depression]). Risk of having postpartum depression was modestly higher among women with HDP, as was the risk of postpartum bipolar disorder among those with GDM. Findings were generally similar between women living in rural versus urban areas. Conclusions: Effective interventions to prevent, screen, and treat mental health conditions among women with pregnancy complications for an extended time postpartum are warranted.
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Affiliation(s)
- Katherine A. Ahrens
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Kristin Palmsten
- Pregnancy and Child Health Research Center, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mariah Pfeiffer
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Catherine Gelsinger
- Public Health Program, Muskie School of Public Service, University of Southern Maine, Portland, Maine, USA
| | - Christina Ackerman-Banks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
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Kroll-Desrosiers A, Kinney RL, Marteeny V, Mattocks KM. Exploring the Acceptability of Expanded Perinatal Depression Care Practices Among Women Veterans. J Gen Intern Med 2022; 37:762-769. [PMID: 36042083 PMCID: PMC9427169 DOI: 10.1007/s11606-022-07573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Veterans receive obstetrical care from community-based providers contracted through the Veterans Health Administration (VA); however, Veterans remain eligible for VA mental healthcare in the perinatal period. To date, few studies have focused specifically on the mental health needs of Veterans during the perinatal period. OBJECTIVE To examine the acceptability of more comprehensive perinatal mental healthcare screening and treatment in VA care, we explored pregnant and postpartum Veteran perspectives of United States Preventive Services Task Force (USPSTF) recommendations that aim to expand mental health counseling for the prevention and treatment of perinatal depression. DESIGN Semi-structured interviews with pregnant and postpartum Veterans enrolled in VA care, integrated with quantitative survey data. PARTICIPANTS Pregnant and postpartum Veterans (n=27) who had delivered infants or were due by February 2020. APPROACH Framework analysis with an inductive approach was utilized to understand our data, interpret and code our transcripts, and develop themes. KEY RESULTS Fewer than half (44%) of the women reported seeing a mental health provider at the beginning of their pregnancy. We found that Veterans support USPSTF recommendations in the VA, consider mental healthcare to be very important during the perinatal period, would like better access to mental healthcare resources and peer support networks, and suggest that perinatal depression screening could be more extensive. CONCLUSIONS These findings support the implementation of more comprehensive perinatal depression prevention policies and practices within VA care. Understanding the real-world feasibility and prevailing barriers to comprehensive perinatal depression care is needed to inform implementation of the USPSTF recommendations or a similar intervention tailored for VA care.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Rebecca L Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Valerie Marteeny
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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Kranenburg LW, Bijma HH, Eggink AJ, Knijff EM, Lambregtse-van den Berg MP. Implementing an Eye Movement and Desensitization Reprocessing Treatment-Program for Women With Posttraumatic Stress Disorder After Childbirth. Front Psychol 2022; 12:797901. [PMID: 35126248 PMCID: PMC8815617 DOI: 10.3389/fpsyg.2021.797901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing (EMDR) treatment-program for women with posttraumatic stress disorder (PTSD) after childbirth. Methods A prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used. Results Forty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%). Conclusion Implementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD.
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Affiliation(s)
- Leonieke W. Kranenburg
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- *Correspondence: Leonieke W. Kranenburg,
| | - Hilmar H. Bijma
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Alex J. Eggink
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Esther M. Knijff
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mijke P. Lambregtse-van den Berg
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
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A way forward in the maternal mortality crisis: addressing maternal health disparities and mental health. Arch Womens Ment Health 2021; 24:823-830. [PMID: 34427773 DOI: 10.1007/s00737-021-01161-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
Our objective was to review the role of maternal health disparities and mental health in the maternal mortality crisis in the USA, and discuss how perinatal care quality improvement in these areas is a critical lever for reducing maternal death. This paper summarizes content from a plenary talk delivered at the 2020 Biennial Meeting of the International Marcé Society for Perinatal Mental Health, in commemoration of the Society's 40th anniversary. The talk synthesized literature on two characteristics of the maternal mortality crisis in the US: (1) wide racial and ethnic disparities in maternal mortality and severe morbidity and (2) the impact of mental health and substance use disorders on maternal death, and introduced a framework for how health care quality gaps contribute to both of these issues. The US remains an outlier among similar nations in its alarmingly high rates of maternal mortality. Achieving significant progress on this measure will require confronting longstanding racial and ethnic disparities that exist throughout the pregnancy-postpartum continuum, as well as addressing the under-reported issue of maternal self-harm. Suicide and overdose are leading but under-recognized causes of death among pregnant and postpartum women in some states. Health care delivery failures, including inadequate risk assessment, care coordination, and communication, are identified in the literature on drivers of maternal health disparities and self-harm. Many of the same steps to improve quality of perinatal care can help to reduce health disparities and address the essential role of mental health in maternal well-being.
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von Rosen IEW, Shiekh RM, Mchome B, Chunsen W, Khan KS, Rasch V, Linde DS. Quality of life after maternal near miss: A systematic review. Acta Obstet Gynecol Scand 2021; 100:704-714. [PMID: 33599289 DOI: 10.1111/aogs.14128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Maternal near miss is a major global health issue; approximately 7 million women worldwide experience it each year. Maternal near miss can have several different health consequences and can affect the women's quality of life, yet little is known about the size and magnitude of this association. The aim of this study was to assess the evidence of the association between women who have experienced maternal near miss and quality of life and women who had an uncomplicated pregnancy and delivery. MATERIAL AND METHODS Cochrane library, Embase, CINAHL, Web of Science, MEDLINE, Scopus and PubMed were searched for published studies. Studies were selected according to the PECO model (population, exposure, control and outcome) and were included if they investigated quality of life as an outcome after maternal near miss among women of all ages with no limitation on country or time (up to June 2020). Maternal near miss was defined as a life-threatening condition arising from complications related to pregnancy and/or childbirth. The quality of the studies was assessed according to the Newcastle-Ottawa scale and a Forest plot was constructed based on quality of life outcomes and study quality. PROSPERO registration number: CRD42020169232. RESULTS Fifteen studies were included in the review with a total of 31 558 women. Quality of life was reported in various ways, and 25 different confounders were controlled for. Compared with women who did not experience maternal near miss, women exposed to maternal near miss had an overall lower quality of life (n = 2/2), had poorer mental (n = 6/10) and social health (n = 2/3), and maternal near miss had negative economic consequences (n = 4/4). Maternal near miss was not associated with sexual dysfunction (n = 1/5). Ten of 15 studies were assessed as being of poor quality. CONCLUSIONS Evidence shows that maternal near miss is negatively associated with various aspects of quality of life. This highlights the importance of addressing the adverse effects associated with maternal near miss and follow up maternal near miss after discharge. Quality of life is a multidimensional concept that is assessed in various ways, and the literature on the field is heterogeneous. More high-quality studies are needed.
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Affiliation(s)
- Ida E W von Rosen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Rayan M Shiekh
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Wu Chunsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, CIBER of Epidemiology and Public Health (CIBERESP), Granada, Spain
| | - Vibeke Rasch
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ditte S Linde
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
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