The postnatal effects of perineal trauma on maternal psychological and emotional wellbeing: A longitudinal study

OBJECTIVE

To examine the postnatal psychological health and parenting adjustment of primiparous women experiencing perineal trauma.

STUDY DESIGN

Longitudinal cohort study assessing body image, perceptions of traumatic birth, psychological distress, perineal pain, impact upon parental tasks and mother-infant bonding at 6-12 weeks (n = 103) and 6-10 months postnatally (n = 91). Primiparous women were recruited following vaginal birth and perineal suturing in a UK-based maternity hospital. al. Comparisons made according to the objective classification of perineal trauma experienced; 1st/2nd degree tear, episiotomy, and Obstetric Anal Sphincter Injuries (OASI).

RESULTS

At 6-12 weeks women with an episiotomy reported a more negative perception of their body image than those with OASI. Women with OASI or an episiotomy were more likely to have experienced birth as traumatic, and those with OASI reported more avoidance symptoms of post-traumatic stress and a greater negative impact on parenting tasks. At 6-10 months significantly more avoidance symptoms continued to be reported by those with OASI, whereas those with an episiotomy reported more anxiety related symptoms in general than those with OASI.

CONCLUSIONS

OASI, whilst associated with traumatic birth and some early parenting impacts, may not be linked to general negative psychological outcomes when specialist routine follow-up care is provided. Psychological impacts for women with episiotomy may merit further input than currently provided. Consideration should be given with regards to widening the access to postnatal perineal care by extending the criteria for specialist follow up beyond those sustaining OASI.

The effects of perineal trauma on immediate self-reported birth experience in first-time mothers

INTRODUCTION

Childbirth can sometimes be stressful or traumatic, and previous research has considered how birth complications and interventions may contribute to a negative birth experience. One of the most frequent complications during birth is trauma to the perineum. The aim of this study was to investigate whether different levels of perineal trauma were associated with differences in women's evaluation of their birth experience.

MATERIALS AND METHODS

As part of a longitudinal cohort study, the self-reported birth experiences of 202 primiparous women were compared based on the degree of perineal trauma they had experienced. Women who had given birth for the first time, vaginally and within the last 48 h in a large tertiary maternity unit in England were invited to take part. Data were collected from their hospital records with their consent and using the Childbirth Experience Questionnaire (CEQ), Experience of Birth Scale (EBS) and a perineal pain Visual Analogue Scale (VAS).

RESULTS

Women with an obstetric anal sphincter injury (OASI) or episiotomy reported a more negative overall birth experience and perceived themselves as having less ability to give birth compared to those with a 1st/2nd degree sutured tear. Those with an episiotomy also reported feeling less involved in decision making processes during their birth. Significant differences remained between the OASI and 1st/2nd degree tear groups when controlling for factors known to affect birth experience, highlighting severe perineal trauma as a potential contributor to more negative birth experience.

CONCLUSIONS

Perineal trauma may affect a woman's birth experience. Experiencing an episiotomy should not be overlooked as a potential contributor, especially during instrumental birth and in the absence of involved decision making. Further research is needed to disentangle the effects of episiotomy on birth experience, to explore the care needs of women with different degrees of perineal trauma and to explore how a negative birth experience may contribute to poor psychological health in the longer term.

Genome-Based Infection Tracking Reveals Dynamics of Clostridium difficile Transmission and Disease Recurrence

Whole-genome phylogeny and detailed patient movement data identified highly contagious super-spreading donors of Clostridium difficile and precisely identified recurrent cases; our approach could guide infection control and patient management to monitor the transmission of C. difficile within healthcare facilities.

Background. Accurate tracking of Clostridium difficile transmission within healthcare settings is key to its containment but is hindered by the lack of discriminatory power of standard genotyping methods. We describe a whole-genome phylogenetic-based method to track the transmission of individual clones in infected hospital patients from the epidemic C. difficile 027/ST1 lineage, and to distinguish between the 2 causes of recurrent disease, relapse (same strain), or reinfection (different strain).

Methods. We monitored patients with C. difficile infection in a UK hospital over a 2-year period. We performed whole-genome sequencing and phylogenetic analysis of 108 strains isolated from symptomatic patients. High-resolution phylogeny was integrated with in-hospital transfers and contact data to create an infection network linking individual patients and specific hospital wards.

Results. Epidemic C. difficile 027/ST1 caused the majority of infections during our sampling period. Integration of whole-genome single nucleotide polymorphism (SNP) phylogenetic analysis, which accurately discriminated between 27 distinct SNP genotypes, with patient movement and contact data identified 32 plausible transmission events, including ward-based contamination (66%) or direct donor–recipient contact (34%). Highly contagious donors were identified who contributed to the persistence of clones within distinct hospital wards and the spread of clones between wards, especially in areas of intense turnover. Recurrent cases were identified between 4 and 26 weeks, highlighting the limitation of the standard <8-week cutoff used for patient diagnosis and management.

Conclusions. Genome-based infection tracking to monitor the persistence and spread of C. difficile within healthcare facilities could inform infection control and patient management.

The N170 observed 'in the wild': robust event-related potentials to faces in cluttered dynamic visual scenes

As a social species in a constantly changing environment, humans rely heavily on the informational richness and communicative capacity of the face. Thus, understanding how the brain processes information about faces in real-time is of paramount importance. The N170 is a high-temporal resolution electrophysiological index of the brain's early response to visual stimuli that is reliably elicited in carefully controlled laboratory-based studies. Although the N170 has often been reported to be of greatest amplitude to faces, there has been debate regarding whether this effect might be an artefact of certain aspects of the controlled experimental stimulation schedules and materials. To investigate whether the N170 can be identified in more realistic conditions with highly variable and cluttered visual images and accompanying auditory stimuli we recorded EEG 'in the wild', while participants watched pop videos. Scene-cuts to faces generated a clear N170 response, and this was larger than the N170 to transitions where the videos cut to non-face stimuli. Within participants, wild-type face N170 amplitudes were moderately correlated to those observed in a typical laboratory experiment. Thus, we demonstrate that the face N170 is a robust and ecologically valid phenomenon and not an artefact arising as an unintended consequence of some property of the more typical laboratory paradigm.

Aflatoxigenesis induced in Aspergillus flavus by oxidative stress and reduction by phenolic antioxidants from tree nuts

Almonds, pistachios, and walnuts grown in California have an aggregate value of over $3.3 billion, with a large proportion of the crop being exported. Mycotoxin contamination affects this value, because importing nations, and in particular the European Community (EC), apply strict regulatory levels for aflatoxins, formed by infection of the product by Aspergillus species. Conformance with such limits can best be achieved by capitalising on natural resistance factors inherent to the nuts. Differential resistance of tree nut species to aflatoxin formation, with walnuts being least susceptible, led to research which established that the hydrolysable tannins in walnut pellicle were responsible for this effect. This observation has now been extended to show that the addition to Aspergillus flavus growth media of natural antioxidants present in tree nuts, such as hydrolysable tannins, flavonoids and phenolic acids, decrease maximum aflatoxin by as much as 99.8%. There is evidence that aflatoxin formation is exacerbated by oxidative stress on the fungus and therefore compounds capable of relieving such stress should limit aflatoxin accumulation. The addition of tertiary-butyl hydroperoxide to the media induced oxidative stress in A. flavus and stimulated peak aflatoxin production with high levels being maintained, rather than declining as in control samples. Aflatoxin formation was significantly inhibited by incorporation into the media of the antioxidant, tannic acid. A similar effect was seen for drought-stressed cultures, with increased aflatoxigenesis being reduced in the presence of gallic or caffeic acids. Increasing antioxidant natural products in tree nuts may restrict the ability of A. flavus to biosynthesise aflatoxins, thus achieving conformity with regulatory limits.

Vancomycin-resistant enterococci: implications for infection control

The incidence of vancomycin-resistant enterococci (VRE) infection is increasing. Immunosuppressed individuals are particularly vulnerable to infection with VRE. Strict attention to infection control measures is important in preventing the spread of multiresistant organisms.