Memory of childbirth in the second year: the long-term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers

OBJECTIVE: To assess the memory of various subdimensions of the birth experience in the second year postpartum, and to identify women in the first weeks postpartum at risk of developing a long-term negative memory. DESIGN, METHOD, OUTCOME MEASURES: New mothers' birth experience (BE) was assessed 48-96 hours postpartum (T1) by means of the SIL-Ger and the BBCI (perception of intranatal relationships); early postnatal adjustment (week 3 pp: T1(bis)) was also assessed. Then, four subgroups of women were defined by means of a cluster-analysis, integrating the T1/T1(bis) variables. To evaluate the memory of the BE, the SIL-Ger was again applied in the second year after childbirth (T2). First, the ratings of the SIL-Ger dimensions of T1 were compared to those at T2 in the whole sample. Then, the four subgroups were compared with respect to their ratings of the birth experience at T2 (correlations, ANOVAs and t-tests). RESULTS: In general, fulfillment, emotional adaptation, physical discomfort, and anxiety improve spontaneously over the first year postpartum, whereas in negative emotional experience, control, and time-going-slowly no shift over time is observed. However, women with a negative overall birth experience and a low level of perceived intranatal relationship at T1 run a high risk of retaining a negative memory in all of the seven subdimensions of the birth experience. CONCLUSIONS: Women at risk of developing a negative long-term memory of the BE can be identified at the time of early postpartum, when the overall birth experience and the perceived intranatal relationship are taken into account.

Post-traumatic symptoms after childbirth: what should we offer?

Most studies on post-traumatic stress symptoms after childbirth have focused on prevalence of and looked at etiological factors and predictors. While most authors agree that around 1.5% of the women develop post-traumatic stress disorder (PTSD) and significantly more present with post-traumatic stress symptoms, the studies still lack a proper diagnosis using diagnostic interviews to validate the enhanced stress scores found in questionnaires. Also, some relevant predicting factors such as pre-existing psychopathology and dissociation during labor have not been investigated so far. Mostly, however, research on counseling strategies for women with post-traumatic symptoms after childbirth has been neglected. While most women remain in a mother-child unit during the first days after birth, there is a unique opportunity to systematically assess birth experience in this setting and screen for women at risk for developing trauma symptoms. This article presents a multilevel counseling approach including postnatal counseling and counseling in a subsequent pregnancy.

Postpartum depressive symptoms in the first 17 months after childbirth: the impact of an emotionally supportive partnership

OBJECTIVES: This study investigates the impact on different postpartum depressive trajectories (i.e., "non depressive symptoms", "stable depressive symptoms", "deterioration" and "improvement") from 5-17 months after childbirth exerted by emotional support that mothers receive from their partners and emotional support they provide to their partners. METHODS: Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale 5 and 17 months after delivery in a sample of 293 mothers. Emotional support received from the partners was assessed among both mothers and partners. RESULTS: The initial level and the change in emotional support that mothers received from their partners were related to different trajectories of postpartum depressive symptoms. Mothers who were living in a partnership with low reciprocal emotional support showed a significantly higher risk of suffering from "stable depressive symptoms" than mothers who were living in a partnership with high reciprocal emotional support. CONCLUSIONS: An increased risk of persistent depressive symptoms beyond the early postpartum period was observed in mothers with poor reciprocal emotional support in the partnership. Further research is needed for a better understanding of the mothers persistent depressive symptoms after childbirth associated with reciprocity of emotional support in the partnership.

Cytochrome P450 Regulation by -Tocopherol in Pxr-Null and PXR-Humanized Mice

The pregnane X receptor (PXR) has been postulated to play a role in the metabolism of α-tocopherol owing to the up-regulation of hepatic cytochrome P450 (P450) 3A in human cell lines and murine models after α-tocopherol treatment. However, in vivo studies confirming the role of PXR in α-tocopherol metabolism in humans presents significant difficulties and has not been performed. PXR-humanized (hPXR), wild-type, and Pxr-null mouse models were used to determine whether α-tocopherol metabolism is influenced by species-specific differences in PXR function in vivo. No significant difference in the concentration of the major α-tocopherol metabolites was observed among the hPXR, wild-type, and Pxr-null mice through mass spectrometry-based metabolomics. Gene expression analysis revealed significantly increased expression of Cyp3a11 as well as several other P450s only in wild-type mice, suggesting species-specificity for α-tocopherol activation of PXR. Luciferase reporter assay confirmed activation of mouse PXR by α-tocopherol. Analysis of the Cyp2c family of genes revealed increased expression of Cyp2c29, Cyp2c37, and Cyp2c55 in wild-type, hPXR, and Pxr-null mice, which suggests PXR-independent induction of Cyp2c gene expression. This study revealed that α-tocopherol is a partial agonist of PXR and that PXR is necessary for Cyp3a induction by α-tocopherol. The implications of a novel role for α-tocopherol in Cyp2c gene regulation are also discussed.

Stepwise in vitro affinity maturation of Vitaxin, an αvβ3-specific humanized mAb

A protein engineering strategy based on efficient and focused mutagenesis implemented by codon-based mutagenesis was developed. Vitaxin, a humanized version of the antiangiogenic antibody LM609 directed against a conformational epitope of the αvβ3 integrin complex, was used as a model system. Specifically, focused mutagenesis was used in a stepwise fashion to rapidly improve the affinity of the antigen binding fragment by greater than 90-fold. In the complete absence of structural information about the Vitaxin-αvβ3 interaction, phage-expressed antibody libraries for all six Ig heavy and light chain complementarity-determining regions were expressed and screened by a quantitative assay to identify variants with improved binding to αvβ3. The Vitaxin variants in these libraries each contained a single mutation, and all 20 amino acids were introduced at each complementarity-determining region residue, resulting in the expression of 2,336 unique clones. Multiple clones displaying 2- to 13-fold improved affinity were identified. Subsequent expression and screening of a library of 256 combinatorial variants of the optimal mutations identified from the primary libraries resulted in the identification of multiple clones displaying greater than 50-fold enhanced affinity. These variants inhibited ligand binding to receptor more potently as demonstrated by inhibition of cell adhesion and ligand competition assays. Because of the limited mutagenesis and combinatorial approach, Vitaxin variants with enhanced affinity were identified rapidly and required the synthesis of only 2,592 unique variants. The use of such small focused libraries obviates the need for phage affinity selection approaches typically used, permitting the use of functional assays and the engineering of proteins expressed in mammalian cell culture.

Validation of the Spanish version of mackey childbirth satisfaction rating scale

Background: The “Mackey Childbirth Satisfaction Rating Scale” (MCSRS) is a complete non-validated scale which includes the most important factors associated with maternal satisfaction. Our primary purpose was to describe the internal structure of the scale and validate the reliability and validity of concept of its Spanish version MCSRS-E. Methods: The MCSRS was translated into Spanish, back-translated and adapted to the Spanish population. It was then administered following a pilot test with women who met the study participant requirements. The scale structure was obtained by performing an exploratory factorial analysis using a sample of 304 women. The structures obtained were tested by conducting a confirmatory factorial analysis using a sample of 159 women. To test the validity of concept, the structure factors were correlated with expectations prior to childbirth experiences. McDonald’s omegas were calculated for each model to establish the reliability of each factor. The study was carried out at four University Hospitals; Alicante, Elche, Torrevieja and Vinalopo Salud of Elche. The inclusion criteria were women aged 18–45 years old who had just delivered a singleton live baby at 38–42 weeks through vaginal delivery. Women who had difficulty speaking and understanding Spanish were excluded. Results: The process generated 5 different possible internal structures in a nested model more consistent with the theory than other internal structures of the MCSRS applied hitherto. All of them had good levels of validation and reliability. Conclusions: This nested model to explain internal structure of MCSRS-E can accommodate different clinical practice scenarios better than the other structures applied to date, and it is a flexible tool which can be used to identify the aspects that should be changed to improve maternal satisfaction and hence maternal health.

The American vegetable practice, or, A new and improved guide to health. : Designed for the use of families. : In six parts. Part I. Concise view of the human body, with engraved and wood-cut illustrations. Part II. Glance at the old school practice of physic. Part III. Vegetable materia medica, with colored illustrations. Part IV. Compounds. Part V. Practice of medicine, based upon what are deemed correct physiological and pathological principles. Part VI. Guide for women, containing a simplified treatise on childbirth, with a description of the diseases peculiar to females and infants. /

Errata and advertisement for "New England Depot. D.L. Hale" at end of v. 2.

CDP571, a humanized monoclonal antibody to tumour necrosis factor-alpha, for steroid-dependent Crohn's disease: a randomized, double-blind, placebo-controlled trial

Background More than 50% of patients with Crohn's disease become either steroid resistant or dependent. Accordingly, development of new treatments for steroid-dependent Crohn's disease is a research priority. Aim To evaluate CDP571, a humanized antibody to tumour necrosis factor-α, for the treatment of steroid-dependent Crohn's disease. Methods Patients with steroid-dependent Crohn's disease (n = 271) were enrolled in a 36-week, double-blind, placebo-controlled trial. Steroid dependence was defined as use of prednisolone or prednisone (15–40 mg/day) or budesonide (9 mg/day) for ≥8 weeks, a previous failed attempt to decrease or discontinue steroids within 8 weeks of screening, and a Crohn's Disease Activity Index score of ≤150 points. Patients were randomized to receive intravenous CDP571 10 mg/kg or placebo 8-weekly through to week 32. Steroids were then tapered using a defined schedule. The primary efficacy endpoint was the percentage of patients with steroid sparing, defined as discontinuation of steroid therapy without a disease flare (Crohn's Disease Activity Index score ≥220 points) at week 36. Results Steroid sparing occurred in 53 of 181 (29.3%) CDP571 patients and 33 of 90 (36.7%) placebo patients (P = 0.24). Adverse events occurred at similar frequencies in both treatment groups. Conclusions CDP571 was ineffective for sparing steroids in patients with steroid-dependent Crohn's disease. CDP571 was well tolerated.

Urinary incontinence persisting after childbirth : extent, delivery history, and effects in a 12-year longitudinal cohort study

© 2015 Royal College of Obstetricians and Gynaecologists. Funded by •Wellbeing of Women/Royal College of Obstetricians and Gynaecologists •Health Research Council of New Zealand

Urinary incontinence persisting after childbirth : extent, delivery history, and effects in a 12-year longitudinal cohort study

© 2015 Royal College of Obstetricians and Gynaecologists. Funded by •Wellbeing of Women/Royal College of Obstetricians and Gynaecologists •Health Research Council of New Zealand