Topics in contemporary psychiatric practice: Compliance in major psychoses

Objective. While there is a recommendation to screen for postpartum depression (PPD), there are worries about the validity of instruments other than the Edinburgh Postnatal Depression Scale; little is known about the construct validity of one of the most used screening instruments, the Beck Depression Inventory, in this period. Methods. This study evaluated the validity and reliability of the BDI in a population-based sample of women and their spouses (n=772) in the postpartum. Additionally, we compared factor scores within the couple. Results. Exploratory factor analysis demonstrated a two-factor solution (depressive symptoms and somatic symptoms), accounting for 44.01% of the total variance. Internal consistency was good (Cronbach's α=0.90). Women had higher scores than their partners in both factors (P<0.001), but not a higher proportion of the total score attributable to somatic symptoms. Conclusion. With little factor variance between women and men, and a similar proportion of somatic symptoms, these results should be taken to reinforce the validity of the BDI in the postpartum.     

A Novel Approach to Detecting Postpartum Hemorrhage Using Contrast-Enhanced Ultrasound

The aim of this study was to estimate the efficacy of contrast-enhanced ultrasound (CEUS) in detecting postpartum hemorrhage (PPH) after cesarean section. This is the first study of CEUS in obstetric hemorrhage. A total of 37 patients, operated at Nagoya University Hospital, underwent CEUS. We evaluated the findings of CEUS, which were qualitatively defined as positive when pooling or leakage of contrast agent was observed in the uterine cavity, by measuring the amount of bleeding during the first 4 h after cesarean section. The time–intensity curve patterns of leaked contrast agents were also analyzed for quantitative prediction of the amount of blood loss. Significant differences between the excessive hemorrhage (N = 7) and non-excessive hemorrhage groups (N = 30) were noted in the occurrence of positive CEUS (p = 0.011). Additionally, mean postpartum blood loss markedly increased in patients with a positive CEUS (p = 0.002). From a quantitative perspective, the time until leakage of contrast agents was detected correlated with the amount of bleeding, but the other characteristics of the time–intensity curve pattern did not provide valuable information. In conclusion, CEUS, which enables bedside assessment and rapid diagnosis, is a promising strategy for the detection of PPH.     

产后抑郁与分娩前后血清同型半胱氨酸、雌二醇水平变化的相关性分析

目的分析产后抑郁与分娩前后血清同型半胱氨酸(Hcy)、雌二醇(E2)水平变化的相关性。方法选取我院2018年7月至2019年7月收治的120例初产妇,在分娩后7天时采用爱丁堡产后抑郁量表(EPDS)评估产妇的抑郁状态,根据评估结果分为产后抑郁组(n=15)和非抑郁组(n=105)。比较两组产妇的一般资料及分娩前、分娩后7天的血清Hcy、 E2水平,分析EPDS评分与血清Hcy、 E2水平的相关性。结果 120例产妇中,有15例(12.5%)发生产后抑郁。产后抑郁组的受教育程度显著低于非抑郁组(P <0.05)。分娩前,两组的血清Hcy、 E2水平比较无统计学差异(P>0.05);分娩后7天,产后抑郁组的血清Hcy水平显著高于非抑郁组,血清E2水平显著低于非抑郁组(P均<0.05)。EPDS评分与分娩后血清Hcy水平呈正相关(r=0.233, P <0.05),与分娩后血清E2水平呈负相关(r=-0.691, P <0.05)。结论分娩后血清Hcy水平升高、 E2水平降低可能是产后抑郁的危险因素,检测分娩后Hcy、 E2水平有助于产后抑郁症的预测。     

Postpartum gangrene of three limbs complicating inotrope therapy: A case report

BackgroundSymmetrical peripheral gangrene (SPG) is an uncommon but devastating complication in critically ill patients with a high mortality. It is seldom seen in pregnancy and postpartum period.Case presentationWe hereby report a 27-year-old woman diagnosed of having postpartum hemorrhagic shock. The patient developed symmetrical peripheral gangrene triggered possibly by sepsis and inotropes. The patient presented with consciousness disturbance and hemodynamically unstable condition. Owing to the unstable hemodynamic status, inotropic agents with maximum dose of dopamine at 17 mcg/kg/min and norepinephrine of 8 mcg/kg/min were used. On the 4th day of admission, the patient developed gangrene and compartmental syndrome in the limbs. However, even with the dose of inotropic agents tapered, the gangrene did not resolve. So, multiple amputations and fasciotomy were done. Patient also developed acute kidney injury with anuria, thus necessitating hemodialysis treatment.ConclusionAlthough postpartum hemorrhagic shock is of high risk for sepsis and use of inotropes is common, occurrence of peripheral gangrene is rare. A high index of suspicion for the diagnosis and timely intervention will prevent irreparable damage and loss of limb.     

不同方法应用欣母沛预防剖宫产产后出血的疗效比较

目的：探讨肌注与宫体注射欣母沛两种方法预防剖宫产产后出血的疗效。方法：78例剖宫产产妇分别予以肌肉及宫体注射欣母沛,观察两组患者的出血量、临床疗效、不良情绪以及生活质量。结果：两组术后2 h出血量比较差异无统计学意义（P〉0.05）;术后24 h出血量比较,观察组优于对照组,差异具有统计学意义（P〈0.05）。观察组有效率为82.05%,对照组为79.49%,两组比较差异无统计学意义（P〉0.05）。观察组产妇的HAMD、HAMA总分及各因子得分均低于对照组,差异具有统计学意义（P〈0.05）。患者均无失访现象,观察组患者的生活质量指标PF、RP、RE得分均高于对照组,差异具有统计学意义（P〈0.01）。结论：两种方法对于预防剖宫产产后出血效果相当,但肌肉注射欣母沛对于降低24 h内产妇出血效果更佳,且更利于改善产妇的不良情绪,提高生活质量。     

自我管理在产后抑郁症高危产妇中的应用及疗效评价

目的针对高危产妇且在产后出现抑郁症的患者展开自我管理培训,旨在优化临床护理与管理模式,减少高危产妇在产后由于抑郁引发的危险。方法 选取花都区人民医院在2011年10月至2013年10月这2年内收治的高危产妇共126例,选取的患者均存在产后抑郁情况。将患者随机分为对照组(63例)及观察组(63例)。对照组采用常规临床管理方式,观察组采用自我管理干预方式,帮助产妇进行自我管理。对比两组患者精神状况在管理前后变化情况,了解让患者自我管理相对于常规管理模式在患者精神状态优化方面的效果。结果观察组患者产后抑郁症状减轻效果明显优于对照组患者,在SSRS量表以及SCL-90量表评定上分数更低,说明精神状况更好。两组患者管理效果存在显著差异性(P<0.05),具有统计学意义。结论帮助患者进行自我管理能够有效让患者自行控制情绪,减少产后抑郁程度,并降低抑郁情绪对产后恢复造成的不良影响。因此在临床护理与管理中使用自我管理存在推广价值。     

Influence of intra- and extrauterine factors on infant sleep in the first 6 months of life

ObjectiveInfant sleep problems can affect the child's health. Maternal characteristics have been associated with the quality of infant sleep, but few studies have investigated the impact of intrauterine conditions. The aim of the study was to evaluate the association between adverse intrauterine environments (maternal smoking, hypertension, diabetes, and intrauterine growth restriction) and extrauterine factors on infant sleep in the first 6 months of life.MethodsProspective cohort study, including singleton and at-term infants. Mothers were interviewed after delivery and at 30 days, 3 months, and 6 months of life. Socioeconomic, breastfeeding, and sleep data were self-reported by mothers using semi-structured interviews. Maternal stress (Perceived Stress Scale) and postpartum depression symptoms (Edinburgh Postpartum Depression Scale) were assessed.ResultsThere was no statistically significant association between intrauterine environments and the sleep of infants of the 359 mother–child dyads investigated. Total infant sleep time decreased from approximately 13–11 h from 30 days to 6 months of age (p < 0.001) and the longest period of uninterrupted sleep increased from approximately 4–6 h during the same period (p < 0.001). Breastfed infants slept longer in 24-h periods in the first month, but they woke up more often throughout the night when compared to infants receiving formula. Mothers with depressive symptoms reported increased sleep latency time.ConclusionsAdverse intrauterine environments did not significantly affect sleep measures in the first 6 months of life. Maternal characteristics and practices, however, were associated with infant sleep, suggesting that environmental factors significantly contribute to sleep quality early in life.     

卡前列素氨丁三醇治疗产后出血的效果分析

目的：探讨卡前列素氨丁三醇治疗产后出血的临床疗效。方法：选取本院2011年3月-2014年1月收入院的61例产后出血患者，随机分为观察组31例和对照组30例，观察组患者采取卡前列素氨丁三醇治疗，对照组患者采取米索前列醇联合缩宫素治疗。对比两组患者治疗后2h出血量、止血时间、不良反应的发生率和临床疗效情况。结果：观察组患者治疗后2h出血量少于对照组，止血时间明显短于对照组，不良反应的发生率低于对照组，差异均有统计学意义（P〈0.05）；观察组治疗的总有效率（93.55%）显著高于对照组（83.33%），差异具有统计学上意义（P〈0.05）。结论：对于产后出血的孕妇使用卡前列素氨丁三醇治疗，止血快，出血少，效果显著。