Validacijsko istraživanje hrvatske verzije Edinburškog upitnika poslijeporođajne depresivnosti (EPDS)

Validation studies established different cut-off points for the Edinburgh Postnatal Depression Scale (EPDS) in different countries. The aim of this paper was to validate the Croatian EPDS against DSM-IV-TR for major and minor depression. A community sample of 272 women was followed from pregnancy to six weeks postpartum. They filled out the EPDS and STAI and were diagnosed using the SCID-I-RV. At the 8/9 cut-off score the sensitivity of the EPDS was 77.3% and its specificity was 82.4%. The principal component analysis with oblique rotation resulted in two correlated oblique factors, reflecting depressive and anxiety symptoms. Since the scree plot indicated that a one-factor solution would be appropriate, it is advised to treat the scale as one-dimensional. The Croatian version of the EPDS is a valid screening instrument and can be used by health practitioners for PPD screening.Istraživanja koja su se bavila validacijom Edinburškog upitnika poslijeporođajne depresivnosti (EPDS) utvrdila su različite kritične rezultate u različitim zemljama. Cilj ovog istraživanja bio je validirati hrvatsku verziju EPDS-a s obzirom na dijagnozu velike i male depresivne epizode prema DSM-IV-TR. U istraživanju su sudjelovale 272 žene koje su praćene od trudnoće do 6 tjedana nakon porođaja, kad su ispunile EPDS i Spielbergerov upitnik anksioznosti (STAI) te je proveden strukturirani klinički intervju (SCID-I-RV) s ciljem postavljanja dijagnoze depresije. Pri kritičnom rezultatu 8/9 osjetljivost EPDS-a je 77,3%, a specifičnost 82,4%. Metodom glavnih komponenti s kosokutnom rotacijom utvrđena su dva kosokutna faktora koji odražavaju depresivnost i anksioznost, a za koje se pokazalo da su u međusobnoj korelaciji. S obzirom na to da scree plot upućuje na postojanje jednog faktora, preporuča se koristiti upitnik kao jednodimenzionalni. Zaključno se može reći da se hrvatska verzija EPDS-a pokazala valjanim upitnikom za trijažu poslijeporođajne depresije te se preporuča za korištenje u kliničke i zdravstvene svrhe

The role of perceived stress and coping styles in development of prenatal anxiety

Prethodna istraživanja su pokazala da je pretporođajna anksioznost rizični faktor za razvoj afektivnih poremećaja nakon porođaja, a može imati utjecaja i na razvoj fetusa. Cilj ovog istraživanja bio je ispitati ulogu percipiranog stresa i stilova suočavanja u nastanku pretporođajne anksioznosti. Obuhvaćen je uzorak od 149 trudnica u posljednjem tromjesečju trudnoće koje su popunile Ljestvicu percipiranog stresa, revidirani Upitnik suočavanja sa stresom te Upitnik anksioznosti kao stanja i osobine ličnosti. Regresijska analiza je pokazala da su anksioznost kao osobina ličnosti, dob, komplikacije u trudnoći te razina percipiranog stresa značajni prediktori anksioznosti. S obzirom na povišen rizik za razvoj poslijeporođajne depresije kod anksioznih trudnica te moguć negativni utjecaj na dijete, naglašava se važnost adekvatnih intervencijskih postupaka u trudnoći.postpartum affective disorders and could also negatively affect fetal development. The aim of this study was to examine the role of perceived stress and coping styles in the development of prenatal anxiety. The sample consisted of 149 pregnant women in their last trimester of pregnancy. They filled out The Perceived Stress Scale, STAI, the revised version of COPE and the demographic information form. The regression analysis has shown that trait anxiety, age, complications during pregnancy and the level of perceived stress were the significant predictors of state anxiety. Considering the higher risk for postpartum depression in pregnant women with high anxiety levels and possible negative effects for the child, the importance of adequate intervention programs during pregnancy is emphasized

Ultrasonographic Estimation of Fetal Weight – Residents Accuracy

The aim of this retrospective study was to evaluate the accuracy of gynecology and obstetrics residents when performing ultrasonographic estimation of fetal weight. The total of 400 ultrasonographic estimations of fetal weight and corresponding neonatal weight were collected and divided into 3 groups according to physicians’ experience (junior and senior residents, staff physicians). The accuracy of fetal weight estimation correlated positively with the level of physicians’ experience. The proportional difference between ultrasound estimation and actual birth weight varied from 8.45% to 6.88% (junior residents 8.45%, senior residents 6.95%, staff physicians 6.88%). The proportion of ultrasonograhic estimates that fell within 10% of birth weight varied from 59.09% to 79.21% (junior residents 59.09%, senior residents 78.44%, staff physicians 79.21%). Senior residents reach a highly acceptable accuracy in ultrasonographic estimation of fetal weight which is comparable to staff physicians

Development and validation of Pregnancy Concerns Scale

Anksioznost kao stanje i anksioznost specifična za trudnoću su povezani, ali ponešto različiti konstrukti, što zahtijeva da se anksioznost vezana uz trudnoću mjeri zasebnim instrumentima. Cilj ovog istraživanja bio je razviti i validirati novu mjeru - Ljestvicu zabrinutosti u trudnoći (LJZT), koja će mjeriti specifičnu zabrinutost, strahove i brige u trudnoći. U istraživanju su sudjelovale 384 trudnice u trećem tromjesečju trudnoće, koje su ispunile Ljestvicu zabrinutosti u trudnoći, Upitnik anksioznosti kao stanja i osobine (STAI), Ljestvicu intenziteta doživljenog stresa (PSS), Edinburšku ljestvicu poslijeporođajne depresivnosti (EPDS) te upitnik demografskih i opstetričkih podataka. Analizirana je pouzdanost, faktorska struktura, konvergentna i diskriminantna valjanost te osjetljivost i specifičnost Ljestvice. Konačna Ljestvica sastoji se od 16 čestica i 4 podljestvice: Zabrinutost za zdravlje ploda, Zabrinutost za vlastito zdravlje i porođaj, Zabrinutost za financije i bliske odnose te Zabrinutost za vlastiti izgled. Pouzdanost ukupne ljestvice je 0,80, a pri kritičnom rezultatu 5/6 osjetljivost Ljestvice je 80,8%, a specifičnost 50,4%. Analiza konvergentne valjanosti je pokazala da je Ljestvica neovisna mjera anksioznosti u trudnoći te da dobro razlikuje trudnice koje imaju i koje nemaju komplikacija u trudnoći. Zaključno, ljestvica ima visoku pouzdanost i konstruktnu valjanost sa zadovoljavajućim psihometrijskim karakteristikama.State anxiety and pregnancy-specific anxiety are related albeit distinct constructs. Therefore, pregnancy-specific anxiety should be assessed with pregnancy-specific measures. The aim of the study was to construct and validate a new scale, Pregnancy Concerns Scale (PCS) that measures specific worries, fears and concerns during pregnancy. Pregnant women in the third trimester of pregnancy (N = 384) completed the PCS, the State-Trait Anxiety Inventory (STAI), the Perceived Stress Scale (PSS), and the Edinburgh Postnatal Depression Scale (EPDS). Reliability, factor structure, convergent and discriminant validity, and scale sensitivity and specificity were analyzed. The final scale comprised 16 items and four subscales measuring Concerns about fetal health, Concerns about own health and childbirth, Concerns about financial issues and close relations, and Concerns about appearance. Reliability of the PCS total scale is 0.80. At a cut-off score of 5/6, sensitivity was 80.8% and specificity 50.4%. Convergent validity analysis showed the PCS to be an independent measure of pregnancyspecific anxiety that can discriminate between pregnant women with and without pregnancy complications. To conclude, the PCS has high reliability and construct validity, and satisfactory psychometric characteristics

Anksioznost u trudnoći i nakon porođaja: tijek, prediktori i komorbiditet s poslijeporođajnom depresijom

Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants’ medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not completely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.Prethodna istraživanja o peripartalnoj anksioznosti nisu dosljedna s obzirom na učestalost, tijek anksioznosti i komorbiditet s depresijom. Cilj ovoga istraživanja bio je: 1) ispitati tijek povišene anksioznosti u trudnoći, neposredno nakon porođaja i 6 tjedana nakon porođaja; 2) utvrditi komorbiditet anksioznosti i poslijeporođajne depresije (PD); 3) ispitati prediktore anksioznosti 6 tjedana nakon porođaja. Uzorak žena (N=272) s rezultatom nižim od kritičnog za kliničku depresiju u trudnoći praćen je u trećem tromjesečju trudnoće te 2 dana i 6 tjedana nakon porođaja. U svakoj točki mjerenja primijenjeni su upitnici anksioznosti, stresa, stresa specifičnog za trudnoću, načina suočavanja, socijalne potpore i depresivnosti. Opstetrički podaci prikupljeni su iz medicinske dokumentacije. Utvrđena je učestalost povišene anksioznosti od 35% u trudnoći, 17% neposredno nakon porođaja i 20% šest tjedana nakon porođaja, pri čemu je utvrđeno smanjenje razine anksioznosti nakon porođaja. Komorbiditet anksioznosti i PD-a je bio 75%. Anksioznost kao osobina i anksioznost kao stanje neposredno nakon porođaja značajni su prediktori anksioznosti šest tjedana nakon porođaja. Anksioznost je česta psihološka smetnja u peripartalnom razdoblju. Anksiozni simptomi se preklapaju s PD-om, ali ne u potpunosti, što upućuje na to da trijaža za poslijeporođajne mentalne teškoće mora uključivati i depresiju i anksioznost

Ultrazvučna analiza štitnjače u trudnoći

The aim of the study was to determine whether pregnancy induced ultrasonographically detectable changes of the thyroid gland. It is a very interesting clinical feature, because some parts of inland Croatia were an endemic goiter area before the implementation of the 1996 act on salt iodination. Sixty-six pregnant women with no history of thyroid disease were repeatedly examined by ultrasound during the course of pregnancy. The size and echostructure of the thyroid were estimated. The thyroid volume increased slightly during pregnancy, but mostly remained within the normal range for particular age. A significant thyroid volume enlargement was observed in third trimester as compared with either first trimester (p=0.02) or control group (p=0.01). Mild goiter of 16% was found in pregnant women in comparison to control group. Morning urine sample, thyroid hormone, TSH and thyroid antibodies were also analyzed in 89 women. Median urine iodine was 8.8 µg/dL. Sixty percent of pregnant women had an iodine concentration below 10 µg/dL. In four out of nine subjects with goiter, urinary iodine excretion was below 5 µg/dL. Elevated serum TSH concentration was recorded in three (3%) women; however, they were euthyroid at the time of the study. Results of the study supported the hypothesis that thyroid volume and thyroid function adapt to the physiologically increased iodine and energy demands. The possible goitrogenic effect of pregnancy could be prevented by an increased iodine intake by diet rich in iodine.U kontinentalnim dijelovima Hrvatske prije uvođenja novoga pravilnika o jodiranju soli 1996. godine zabilježena je endemska gušavost. Stoga je svrha ovoga istraživanja bila utvrditi postoji li i u kojoj mjeri gušavost, odnosno povećanje volumena štitnjaču trudnica sa zagrebačkog područja. Šezdeset šest zdravih trudnica u kojih prethodno nije postojala bolest štitnjače u više je navrata pregledano ultrazvukom, pri čem je određen volumen i ehostruktura štitnjače. Utvrđen je porast volumena štitnjače u sva tri trimestra trudnoće koji je, međutim, prelazio gornju granicu normalne veličine štitnjače (18 mL) i to uglavnom u trećem trimestru. Značajan porast veličine štitnjače ustanovljen je u trećem trimestru u odnosu na prvi trimestar (p=0,02) te na kontrolnu skupinu (p=0,01). Umjerena guša nađena je u 16% trudnica u odnosu na kontrolnu skupinu. U skupini od 89 trudnica određena je koncentracija joda u mokraći, koncentracija hormona štitnjače, TSH te tiroidna protutijela. Utvrđen je medijan koncentracije joda u mokraći od 8,8 µg/dL, a 60% trudnica imalo je koncentraciju nižu od 10 µg/dL. U četiri od devet trudnica s ustanovljenom gušom razina joda bila je ispod 5 µg/dL. Povišena razina TSH u serumu nađena je u 3% trudnica, ali uz normalne razine hormona štitnjače. Ovim smo ispitivanjem potvrdili očekivani porast volumena štitnjače u trudnoći kao posljedicu povećane potrebe za energijom i jodom. Stoga zaključujemo da se očekivani goitrogeni učinak trudnoće može spriječiti prehranom obogaćenom jodom

Chloasma – The Mask of Pregnancy

Chloasma is a required hypermelanosis of sun-exposed areas occurred during pregnancy and it can affect 50–70% of pregnant women. It presents as symmetric hyperpigmented macules, which can confluent or punctuate. The most common locations are the cheeks, the upper lip, the chin and the forehead. The exact mechanism by which pregnancy affects the process of melanogenesis is unknown. Estrogen, progesterone, and melanocyte-stimulating hormone (MSH) levels are normally increased during the third trimester of pregnancy. However, nulliparous patients with chloasma have no increased levels of estrogen or MSH. In addition, the occurrence of melasma with estrogen- and progesterone-containing oral contraceptive pills has been reported. The observation that postmenopausal woman who are given progesterone develop melasma, while those who are given only estrogen do not, implicates progesterone as playing a critical role in the development of melasma. UV-B, UV-A, and visible light are all capable of stimulating melanogenesis. The condition is self-limited; however spontaneous resolution is time-consuming and may take months to resolve normal pigmentation. Therefore, it is worthwhile to prevent the onset of chloasma, by strict photoprotection. Prudent measures to avoid sun exposure include hats and other forms of shade combined with the application of a broad-spectrum sunscreen at least daily. Sunscreens containing physical blockers, such as titanium dioxide and zinc oxide, are preferred over chemical blockers because of their broader protection. Chloasma can be difficult to treat. Quick fixes with destructive modalities (eg, cryotherapy, medium-depth chemical peels, lasers) yield unpredictable results and are associated with a number of potential adverse effects. The mainstay of treatment remains topical depigmenting agents. Hydroquinone (HQ) is most commonly used

UTJECAJ SPOLA FETUSA I PUŠENJA TE RODNOSTI MAJKE NA AFP I SLOBODNI beta-HCG U PLODOVOJ VODI UREDNIH TRUDNOĆA DRUGOG TROMJESEČJA

Objective. The aim is to investigate the influence of mother’s smoking and parity and fetal sex on AFP and free beta-hCG in amniotic fluid and to examine the correlation between maternal serum and amniotic fluid marker concentrations. Methods. The study was performed on 233 second-trimester amniotic fluid samples. In 75 women, blood sample was taken immediately before amniocentesis too. All pregnancies were singleton with normal fetal karyotype and outcome. Concentrations of AFP and free beta-hCG were determined by fluoroimmunoassay and converted to MoM, according to medians for unaffected pregnancies of the corresponding gestational age. Results. In smoking women, amniotic fluid free beta-hCG was significantly lower than in non-smoking ones (p=0.033), though AFP was not significantly different in regard to smoking habits (p=0.113). Significantly higher amniotic fluid free beta-hCG (p0,05 za oba biljega). Statistički značajna korelacija utvrđena je za koncentracije AFP (r=0,61; p<0,001) i slobodnog beta-hCG (r=0,35; p<0,002) između seruma i plodove vode. Zaključak. Rezultati ovog istraživanja potvrđuju utjecaj spola fetusa na vrijednosti slobodnog beta-hCG i AFP u plodovoj vodi kao i negativan utjecaj pušenja na razinu slobodnog beta-hCG. Promjene su istovjetne onima u serumu. Utjecaj pariteta na ispitivane biljege u plodovoj vodi nije potvrđen, moguće zbog nedovoljnog broja uzoraka

THE INFLUENCE OF FETAL SEX AND MOTHER’S SMOKING AND PARITY ON AFP AND FREE beta-HCG CONCENTRATIONS IN AMNIOTIC FLUID OF UNAFFECTED SECOND TRIMESTER PREGNANCIES

Cilj istraživanja. (1) Ispitati utjecaj pušenja i rodnosti (pariteta) majke i spola fetusa na razinu alfa-fetoproteina (AFP) i slobodne beta-podjedinice humanog korionskog gonadotropina (slobodni beta-hCG) u plodovoj vodi urednih trudnoća. (2) Ispitati korelacije između serumskih vrijednosti AFP i slobodnog beta-hCG i vrijednosti spomenutih biljega u plodovoj vodi. Ispitanice i metode. Ispitivanje je provedeno na 233 uzorka plodove vode koji su dobiveni amniocentezom u drugom tromjesečju trudnoće. U 75 slučajeva uzet je i uzorak krvi neposredno prije amniocenteze. Sve su trudnoće bile jednoplodne, urednog tijeka i ishoda, a kariotip ploda bio je uredan. Koncentracije AFP i slobodnog beta-hCG određivane su fluoroimunometrijskom metodom i izražene u multiples of median (MoM) za odgovarajući tjedan trudnoće. Rezultati. U plodovoj vodi trudnica pušačica utvrđena je statistički značajno niža razina slobodnog beta-hCG nego u nepušačica (p=0,033). Utjecaj pušenja na razinu AFP u plodovoj vodi nije utvrđen (p=0,113). Nasuprot tomu, spol fetusa je značajno utjecao na razinu slobodnog beta-hCG i AFP u plodovoj vodi: razina slobodnog beta-hCG je bila statistički značajno viša, a AFP značajno niža ako je fetus bio ženskog spola (p0,05 za oba biljega). Statistički značajna korelacija utvrđena je za koncentracije AFP (r=0,61; p<0,001) i slobodnog beta-hCG (r=0,35; p<0,002) između seruma i plodove vode. Zaključak. Rezultati ovog istraživanja potvrđuju utjecaj spola fetusa na vrijednosti slobodnog beta-hCG i AFP u plodovoj vodi kao i negativan utjecaj pušenja na razinu slobodnog beta-hCG. Promjene su istovjetne onima u serumu. Utjecaj pariteta na ispitivane biljege u plodovoj vodi nije potvrđen, moguće zbog nedovoljnog broja uzoraka.Objective. The aim is to investigate the influence of mother’s smoking and parity and fetal sex on AFP and free beta-hCG in amniotic fluid and to examine the correlation between maternal serum and amniotic fluid marker concentrations. Methods. The study was performed on 233 second-trimester amniotic fluid samples. In 75 women, blood sample was taken immediately before amniocentesis too. All pregnancies were singleton with normal fetal karyotype and outcome. Concentrations of AFP and free beta-hCG were determined by fluoroimmunoassay and converted to MoM, according to medians for unaffected pregnancies of the corresponding gestational age. Results. In smoking women, amniotic fluid free beta-hCG was significantly lower than in non-smoking ones (p=0.033), though AFP was not significantly different in regard to smoking habits (p=0.113). Significantly higher amniotic fluid free beta-hCG (p<0.001) and lower AFP (p=0.015) were found in female, in comparison to fetal male gender. No significant change according to parity, neither for free beta-hCG, nor for AFP was observed (p=0.094 and p=0.376, respectively). Significant correlation of AFP to free beta-hCG was found between serum and amniotic fluid samples (r=0.61, p<0.001 and r=0.35, p<0.002, respectively). Conclusions. Our results confirmed the influence of fetal sex on amniotic fluid AFP and free beta-hCG and negative influence of smoking on free beta-hCG as well as on maternal serum AFP and free beta-hCG concentrations. More data should be available to determine the impact of parity on examined amniotic fluid markers