A case-control study of membrane cofactor protein mutations in two populations of patients with early pregnancy loss

Mouse models have demonstrated a strong link between complement activation and pregnancy loss. The purpose of this study was to assess if mutations or polymorphisms in the complement regulatory gene membrane cofactor protein (MCP) are associated with recurrent miscarriage (RM) or sporadic fetal loss (FL). This was a case-control study comprising two different populations of cases and controls: subjects with recurrent miscarriage (RM) and controls and maternal-fetal pairs with early fetal loss (at 10-20 weeks' gestation) and controls. In the RM cases and controls, we studied maternal DNA extracted from either whole blood or saliva samples. In the FL cases and controls, fetal DNA was obtained from evacuated products of conception (cases) or cord blood (controls). Exons from the MCP gene, previously identified as having functional mutations, were amplified with flanking primers, purified, and sequenced. Sequences were analyzed against the published reference sequence, the presence of known mutations and polymorphisms and novel polymorphisms. We enrolled and obtained maternal DNA from 75 women with RM and 115 controls. In the FL group, we identified 33 cases and 37 controls. We detected the previously described A304V variant, but neither genotype nor allele frequencies differed significantly between cases and controls in any of the populations (RM, FL (maternal) or FL (fetal)). Although other variants and mutations in MCP were identified, no significant differences were found between the groups. Thus, we conclude that the A304V mutation in the MCP gene is not strongly associated with RM or FL.     

Identifying and supporting women with psychosocial issues during the postnatal period: evaluating an educational intervention for midwives using a before-and-after survey

Objective

women experience a range of psychosocial issues during pregnancy, childbirth and the postnatal period. A review of hospital postnatal care in Australia found that many midwives who provide postnatal care find dealing with psychosocial issues a challenge, further complicated by heavy workloads that reduce the opportunity for quality interactions between midwives and women. This study aimed to evaluate an advanced communication skills education package for midwives caring for women during the postnatal period.

Design

a before-and-after survey design was used. Midwives attended seven sessions over a six-month period in 2006 and completed a survey before and after the sessions to evaluate the programme. Surveys included items about communication skills, willingness to change, learning style, and knowledge of and attitudes towards psychosocial issues.

Setting

the programme was implemented at two sites in Victoria, Australia: a tertiary metropolitan referral hospital and a regional hospital.

Participants

25 midwives participated in the study.

Findings

21 of the 25 participating midwives (84%) completed both the pre and post survey. Following the educational intervention, participants were more likely to feel competent at identifying women in an abusive relationship (p=0.002); encouraging women to talk about any psychosocial issues (p=0.02); actively encouraging women to talk about things on their mind (p=0.01); and encouraging women to talk about how they are really feeling (p=0.02). Participants also felt more confident in their knowledge of psychosocial issues (p=0.01) and in supporting women experiencing psychosocial issues in the early postnatal period (p=0.02). Participants were very positive about the programme.

Key conclusions and implications for practice

the advanced communication programme, implemented for the first time in the postnatal setting, increased the self-reported comfort and competency of midwives to identify and care for women with psychosocial issues during the postnatal period. The effect of this approach should now be evaluated in terms of women’s outcomes.     

Predictors of client engagement and attrition in home-based child maltreatment prevention services

High rates of program attrition in home-based family support and child maltreatment prevention services are common. Researchexamining factors related to family engagement (i.e., enrollment and completion rates) may help program developers increase theimpact of child abuse prevention services by reducing attrition. The present study examined the relative influence of provider,program, and individual factors from the Integrated Theory of Parent Involvement (ITPI) as well as maternal and family demo-graphic and risk variables in predicting service enrollment and completion in a home-based child maltreatment prevention service(SafeCaret) and a standard community care program (Services as Usual [SAU]). Participants were 398 female caregivers ofchildren ages 5 and below. Support was found for the primary role of program and provider factors in client enrollment andcompletion of services. Specifically, participants in SafeCaret were 4 times more likely to enroll in services and 8.5 times morelikely to complete services than those in SAU. Family risk variables including intimate partner psychological aggression, substanceabuse, and depression were also significant predictors. Recommended next steps include integration of risk-related factors in theITPI framework and disentangling specific provider and program factors related to service engagement.     

Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia

Aims: To investigate factors associated with health service use by women and their infants in Victoria, Australia. Methods: Cross‐sectional screening survey of 875 women with 4‐month‐old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self‐report instrument assessed socio‐demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post‐partum. Results: Mothers and their infants used on average 2.8 different health services in the first 4 months post‐partum (range 0–8). After adjustment for other factors, high health service use (defined as >3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one‐point increase on the unsettled infant behaviour measure was associated with an 8% (2–14%) increase in the use of >3 services, 9% (3–16%) in use of emergency departments, 7% (2–13%) in use of telephone helplines and 9% (3–14%) of parenting services. Poorer maternal mental health was also implicated with a one‐point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4–8%) increase in the likelihood of using more than three services. Conclusions: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health‐care capacity might be required.     

Risk factors and management of deep venous thrombosis in children following post-surgical hypopituitarism in craniopharyngioma

Post‐operative hypopituitarism following craniopharyngioma (CP) surgery is treated by replacement of various hormones. The risk of deep venous thrombosis (DVT) following CP surgery and initiation of hormones has not been well studied and recognized. We present three patients with DVT who had family history of DVT and procoagulant risk factors such as inherited thrombophilia and elevated Von Willebrand factor levels due to treatment with desmopressin. We discuss the individualized management of anticoagulation and the dilemma of starting estrogen and progesterone replacement therapy in them. Pediatr Blood Cancer 2011;57:175–177. © 2011 Wiley‐Liss, Inc.