Construct and content validity of the Greek version of the birth satisfaction scale (G-BSS).

Background: ‘Birth Satisfaction’ is a term that encompasses a woman’s evaluation of her birth experience. The term includes factors such as her appraisal of the quality of care she received, a personal assessment of how she coped, and her reconstructions of what happened on that particular day. Her accounts may be accurate or skewed, yet correspond with her reality of how events unfolded. Objective: To evaluate properties of an instrument designed to measure birth satisfaction in a Greek population of postnatal women. Study design: We assessed factor structure, internal consistency, divergent validity and known-groups discriminant validity of the 30-item Greek Birth Satisfaction Scale – Long Form (30-item G-BSS-LF) and its revised version the 10-item Greek-BSS-Revised (10-item-G-BSS-R), using survey data collected in Athens. Participants: A convenience sample of healthy Greek postnatal women (n = 162) aged 22–46 years who had delivered between 34 and 42 weeks’ gestation. Results: The 30-item-G-BSS-LF performed poorly in terms of factor structure. The short-form 10-item-G-BSS-R performed well in terms of measurement replication of the English equivalent version as a multidimensional instrument. The short-form 10-item-G-BSS-R comprises three subscales which measure distinct but correlated domains of: (1) quality of care provision (4 items), (2) women’s personal attributes (2 items), and (3) stress experienced during labour (4 items). Key conclusions: The 10-item-G-BSS-R is a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in Greek postnatal women.

Pancreatic and adrenal development and function in an ovine model of polycystic ovary syndrome.

Polycystic Ovary Syndrome (PCOS) is a complex disorder encompassing reproductive and metabolic dysfunction. Ovarian hyperandrogenism is an endocrine hallmark of human PCOS. In animal models, PCOS-like abnormalities can be recreated by in utero over-exposure to androgenic steroid hormones. This thesis investigated pancreatic and adrenal development and function in a unique model of PCOS. Fetal sheep were directly exposed (day 62 and day 82 of gestation) to steroidal excesses - androgen excess (testosterone propionate - TP), estrogen excess (diethylstilbestrol - DES) or glucocorticoid excess (dexamethasone - DEX). At d90 gestation there was elevated expression of genes involved in β- cell development and function: PDX-1 (P<0.001), and INS (P<0.05), INSR (P<0.05) driven by androgenic excess only in the female fetal pancreas. β- cell numbers (P<0.001) and in vitro insulin secretion (P<0.05) were also elevated in androgen exposed female fetuses. There was a significant increase in insulin secreting β-cell numbers (P<0.001) and in vivo insulin secretion (glucose stimulated) (P<0.01) in adult female offspring, specifically associated with prenatal androgen excess. At d90 gestation, female fetal adrenal gene expression was perturbed by fetal estrogenic exposure. Male fetal adrenal gene expression was altered more dramatically by fetal glucocorticoid exposure. In female adult offspring from androgen exposed pregnancies there was increased adrenal steroidogenic gene expression and in vivo testosterone secretion (P<0.01). This highlights that the adrenal glands may contribute towards excess androgen secretion in PCOS, but such effects might be secondary to other metabolic alterations driven by prenatal androgen exposure, such as excess insulin secretion Thus there may be dialogue between the pancreas and adrenal gland, programmed during early life, with implications for adult health Given both hyperinsulinaemia and hyperandrogenism are common features in PCOS, we suggest that their origins may be at least partially due to altered fetal steroidal environments, specifically excess androgenic stimulation

Imaging of activated complement using ultrasmall superparamagnetic iron oxide particles (USPIO) - conjugated vectors: an in vivo in utero non-invasive method to predict placental insufficiency and abnormal fetal brain development.

In the current study, we have developed a magnetic resonance imaging-based method for non-invasive detection of complement activation in placenta and foetal brain in vivo in utero. Using this method, we found that anti-complement C3-targeted ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles bind within the inflamed placenta and foetal brain cortical tissue, causing a shortening of the T2* relaxation time. We used two mouse models of pregnancy complications: a mouse model of obstetrics antiphospholipid syndrome (APS) and a mouse model of preterm birth (PTB). We found that detection of C3 deposition in the placenta in the APS model was associated with placental insufficiency characterised by increased oxidative stress, decreased vascular endothelial growth factor and placental growth factor levels and intrauterine growth restriction. We also found that foetal brain C3 deposition was associated with cortical axonal cytoarchitecture disruption and increased neurodegeneration in the mouse model of APS and in the PTB model. In the APS model, foetuses that showed increased C3 in their brains additionally expressed anxiety-related behaviour after birth. Importantly, USPIO did not affect pregnancy outcomes and liver function in the mother and the offspring, suggesting that this method may be useful for detecting complement activation in vivo in utero and predicting placental insufficiency and abnormal foetal neurodevelopment that leads to neuropsychiatric disorders.

G181(P) Evaluation of a new e-health intervention in neonatal care : perspectives of parents and health professionals.

Aim This paper will report findings from the first phase of an evaluation of a new e-health intervention designed to allow mothers to ‘see’ their baby in neonatal care (NNU) when they are not able to be with them. The intervention, MyLittleOne, involves a web-camera being placed over the incubator in NNU, which transmits a real-time video wirelessly to a coupled tablet device at the mother’s bedside. Guided by the MRC Framework for the Development and Evaluation of Healthcare Interventions (MRC, 2008), the aim was to explore parent and professional views of the technology and make recommendations for its future development, use and evaluation. Methods A qualitative approach was adopted, guided by a critical realist perspective (McEvoy and Richards, 2003). The study took place in a Level 3 NNU in Scotland. Participants were recruited purposively and included parents (n = 33) and a range of health professionals working in neonatal and postnatal care (n = 21). The data were collected during semi-structured individual, paired and small group interviews and were analysed thematically using NVivo v10. Results The majority of parents and professionals spoke positively about MyLittleOne. Perceptions were that: use of the technology assisted bonding and responsiveness; it promoted the recovery process following birth; and, for mothers who wished to breast-feed, being able to see their baby on the tablet device encouraged the ‘let-down’ reflex. An additional benefit was that siblings and others who may not be able to visit the NNU were able to see the baby. In contrast, for a small number of mothers, viewing their baby remotely appeared to increase their levels of anxiety. Switching off the camera during a medical procedure and back on after the procedure was completed was found to be problematic, at times and in different ways, for both parents and professionals. Conclusions Findings from this preliminary evaluation will guide future developments of the technology, including its use in family homes following the mother’s discharge. The findings will also inform the design of a feasibility study and subsequent RCT to assess the impact of MyLittleOne on a range of psychological indicators of postnatal adjustment.