Loss of E-Cadherin Staining Continuity in the Trophoblastic Basal Membrane Correlates with Increased Resistance in Uterine Arteries and Proteinuria in Patients with Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH), especially when complicated with pre-eclampsia (PE), could be a life-threatening complication of pregnancy. Pre-eclampsia is one of the leading causes of perinatal morbidity and mortality in women. Pre-eclampsia is mainly characterized by hypertension and kidney damage with proteinuria. Abnormal placentation and altered structure of the placental barrier are believed to participate in the pathogenesis of pregnancy-induced hypertension, leading to PE. In the current study, we aimed to analyze the immunohistochemical expression pattern of E-cadherin and p120, two markers of epithelial–mesenchymal transition, in placental samples derived from a group of 55 patients with pregnancy-induced hypertension, including pre-eclampsia and 37 healthy pregnant controls. The results were correlated with the presence of an obtained early uterine artery flow notching during diastole on Doppler ultrasound. We observed a higher frequency of discontinuous E-cadherin staining in the basement membrane of syncytiotrophoblast in patients with PIH/PE compared to controls (p < 0.001, Fisher’s exact test). Moreover, the loss of continuity of E-cadherin expression correlated with the presence of a bilateral early diastolic notch on Doppler ultrasound (p < 0.001, Fisher’s exact test) and the presence of proteinuria (p = 0.013, Fisher’s exact test). These findings suggest that E-cadherin contributes to the integrity of the placental barrier, and its loss could be an immunohistochemical marker of PE.

Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues

OBJECTIVES

The purpose of the study was to identify factors increasing or decreasing the risk for postpartum blues.

MATERIAL AND METHODS

A total of 101 women in their first week postpartum were included in the study. The Edinburgh Postnatal Depression Scale, questions concerning their medical and social status, and psychological tests (the Personality Inventory NEO-FFI, The Mieczysław Plopa and Jan Rostowski Marriage Questionnaire, and the Berlin Social Support Scales) were used.

RESULTS

The probability of postpartum blues was detected in 16.8% of the respondents. The risk decreased with higher satisfaction with intimacy (OR = 0.81), partner similarity (OR = 0.78), and the overall satisfaction with the relationship (OR = 0.94), while higher disappointment elevated that risk (OR = 1.12). As far as social support is concerned, further inde-pendent factors included perceived available social support (OR = 0.31), perceived instrumental social support (OR = 0.24), need for support (OR = 2.74), and protective buffering support (OR = 3.41). High level of neuroticism as well as fear of childbirth increased the risk for postpartum blues (OR = 2.17 and OR = 1.30, respectively). High level of extraversion and better quality of sleep constituted protective factors (OR = 0.74 and OR = 0.60, respectively).

CONCLUSIONS

Maternal disappointment with marriage/relationship, neuroticism and introversion, poor quality of sleep, fear of childbirth, and seeking social support are among the factors signaling the need for careful observation for signs of possible postpartum mood disorders both, during hospitalization and the follow-up visits.

Early vesico-amniotic shunting - does it change the prognosis in fetal lower urinary tract obstruction diagnosed in the first trimester?

OBJECTIVES

The aim of the study was to assess the outcome of vesico-amniotic shunting performed before 16 weeks of pregnancy in fetuses with severe megacystis diagnosed in the first trimester of pregnancy.

MATERIAL AND METHODS

Between January 2008 and October 2012 severe megacystis with the bladder length > 15 mm was diagnosed in 17 fetuses. The procedure of early vesico-amniotic shunting (VAS) was offered to 8 patients with presumably isolated LUTO. The procedure of VAS was performed in 6 fetuses. Before the intervention one or two procedures of vesicocentesis and urine analysis were performed.

RESULTS

In all treated cases shunts provided urinary tract decompression. All babies were born prematurely, 2 of them died due to premaurity, 3 of them survived and have normal renal function at the age of 5-6 years. In 4/5 children accompanying malformations were later diagnosed, in 1 born prematurely neonate necropsy was not performed.

CONCLUSIONS

Our results suggest that early vesico-amniotic shunting in fetal LUTO is feasible and may potentially prevent not only pulmonary hypoplasia but also renal insufficiency. However, the rationale of the procedure needs further investigation due to a high risk of long-term morbidity and co-existing malformations in children Before offering the therapy detailed counseling of the parents about the possible pros and cons of the therapy is necessary.

Personality type, social support and other correlates of risk for affective disorders in early puerperium

OBJECTIVES

The purpose of this study was to assess the prevalence of risk for postpartum mood disorders in mothers during the early postnatal period and to search for coexisting conditions.

MATERIAL AND METHODS

We studied 546 women in the first week after delivery. The subjects filled out a questionnaire concerning their health, social and demographic status, the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire, the NEO-FFI Personality Inventory and the Berlin Social Support Scales.

RESULTS

Probable mood disorders affected 15.85% of these patients. The risk increased with a current cesarean section (ORa = 2.54), a higher level of neuroticism (ORa = 1.65), greater fear of childbirth (ORa = 1.18), a lower level of extraversion (ORa = 0.77) and greater need for social support (ORa = 2.68).

CONCLUSIONS

High level of neuroticism and introversion, as well as higher fear of delivery and the need of social support are among factors increasing the probability of mood disturbances in early postpartum period. A cesarean section might elevate the risk similarly. The mental health of such patients should be carefully examined.

Screening for maternal postpartum depression and associationswith personality traits and social support. A Polish follow-upstudy 4 weeks and 3 months after delivery

OBJECTIVES

To investigate the likelihood of postpartum depression and to explore maternal characteristics in terms of personality, social support and other medical and psychological data.

METHODS

A sample of 548 patients was investigated 4 weeks and 3 months after delivery. They responded to questionnaires containing sociodemographic questions: the EPDS (Edinburgh Postnatal Depression Scale), the PHQ-9 (Patient Health Questionnaire-9), theNEO-FFI (Personality Inventory), and the BSSS (Berlin Social Support Scales).

RESULTS

Probable depression any time during first 3 months postpartum was prevalent among 6.38% of women, based on the following criteria: EPDS > 12 points and PHQ-9 > 9 points. A score of EPDS > 9 in the first week after delivery (ORa = 4.16; CI 1.59-10.86), a history of hospitalisation during pregnancy (ORa = 3.51; CI 1.32-9.20), a high level of neuroticism (ORa = 1.37; CI 1.05-1.77), and high buffering-protective social support (ORa =2.56; 1.25-5.23) were significantly associated with depressive symptoms. Potential protective factors were initial breastfeeding (ORa = 0.31; CI 0.11-0.90) and high satisfaction with currently received social support (ORa=0.41;CI 0.22-0.79). The total dropout rate was 23%.

CONCLUSIONS

New mothers who are neurotic and who suffered from physical or mental problems during pregnancy and puerperium might experience depressive symptoms more easily. They would also protect those close to them from negative information about themselves. A lack of initial breastfeeding and unsatisfactory social support played a similar role.