Pregnancies with decreased fetal movements : risk factors and strategies for mitigation of poor neonatal outcomes

Background and aims: The most feared complication of pregnancy is stillbirth. Globally there are 2.6 million stillbirths annually with more than 7000 deaths a day. Pregnancies with reduced fetal movements have a higher risk of stillbirth and growth restriction. In this thesis, we aimed to identify risk factors that are associated with poor neonatal outcome in the group of women with reduced fetal movements; to identify preventable stillbirths through an audit process; to investigate the intrauterine milieu and the existence of a placental microbiome in full-term pregnancies; to investigate if ultrasound and angiogenic markers can be used as predictors of the neonatal outcome in pregnancies with reduced fetal movement. Methods: Study I was a retrospective cohort study were all women with pregnancies who attended health care for decreased fetal movements at Soder Hospital were included. A composite neonatal outcome was constructed and the risk factors for poor neonatal outcome were analyzed for this group. Study II was a retrospective cohort study conducted as an audit by a multidisciplinary team. All stillbirths in Stockholm 2017 were included and the intention was to investigate the preventable deaths and standard of care. Study III investigated the potential presence of a placental microbiome in full-term pregnancies in pregnancies with pre-labor cesarean deliveries and in vaginal deliveries. Study IV was a pilot study in which it was investigated if the cerebroplacental ratio, the flow in the uterine artery and angiogenic factors could be used as predictors of poor neonatal outcome. Results: There was an increased risk of having an Apgar ≤7 at 5’ (RR 1.56, 95% CI 1.25-1.96), pH ≤ 7.10 (RR 1.34 CI 95% 1.12-1.61) and stillbirth (RR 5.53, CI 95% 2.81-10.85) in the RFM group compared with pregnancies without RFM. 30% of the stillbirth analyzed by the audit were assessed as preventable/possible preventable. The non-Swedish speaking women were overrepresented in this group. When adding a Doppler examination to standard care for RFM there was a significant increase in the obstetrical intervention rate without improvement of the neonatal outcome. The predictive model for composite neonatal outcome based on additional Doppler angiogenic factors and parity had an AUC of 0.89 (95% CI 0.81–0.97). Conclusion: The highest risk of having a poor neonatal outcome were the small for gestational babies (SGA) and the IVF pregnancies in the group of pregnancies with RFM. The audit process of stillbirth identified preventable deaths, delays in the health care system and cases with substandard care. This leads us to the conclusion that national audits can further improve the care for these patients and can possibly help us to reduce the rate of stillbirths. Non-Swedish women have a higher risk of stillbirth and those not speaking the language need individualized antenatal care. The angiogenic factors can be useful predictors of the neonatal outcome, but larger studies are needed. There is no evidence for a placental microbiome in human pregnancies at term

Parental rejection perceived in the childhood and its role in the development of depressive disturbances in the adulthood

Catedra Psihiatrie, Narcologie şi Psihologie Medicală USMF „Nicolae Testemiţanu”In this article the parental rejection perceived in the childhood by the depressive patients is studied. 21 patients with diagnosis of affective disturbances (chapters F.30-F.39 from ICD-10) were included in experimental group. The correlation between parental rejection perceived in the childhood and development of pathological symptoms in adulthood was estimated, using comparison of Hamilton scale score and scores of PAQ and PARQ questionnaires. The role of hostile/aggressive parenting as etiological factor in the development of depressive disturbances in the adulthood is estimated. În articol sunt prezentate rezultatele studiului consecinţelor fenomenului respingerii părinteşti, percepute în copilărie de pacienţii cu tulburărilor depresive. A fost studiat lotul de 21 pacienţi care conform clasificării ICD – 10 au cifrul F.30 - F.39. Estimarea corelaţiei intre respingerea părintească percepută în copilărie şi dezvoltarea simptoamelor patologice la adulţi sa efectuat prin comparare scorului obţinut prin completarea scalei Hamilton şi scalelor chestionarelor PARQ şi PAQ. Rolul stilului ostil/agresiv în educaţie este apreciat ca un factor etiologic în dezvoltarea tulburărilor depresive în vârsta adultă

Psychopathological traits of the personality of patient with mood disorder

Catedra Psihiatrie, Narcologie şi Psihologie Medicală USMF „Nicolae Testemiţanu”In this article was analyzed the pathological structure of the personality of the patients with mood disorder. Using the instrument to asses the patient’s perception of him/herself were evaluated behavioral dispositions typical for the patients and their connection to pathological traits of character. It was shown that high level of the pathological traits of personality correlates with the poor psychological adjustment. Respondents with the high level of psychopathological changes have the tendency to falsify the information, especially those with aggressive behavior. În articol s-a analizat structura patologică a personalităţii pacientului cu tulburarea a sferei emotive. Prin folosirea instrumentului de autoestimare au fost evaluate înclinaţii comportamentale caracteristice pacienţilor şi legatura lor cu trăsături patologice de caracter. S-a demonstrat că nivelul înalt trăsături patologice de personalitate corelează cu ajustarea psihologică scăzută. Respondenţii cu nivel înalt de schimbări psihopatologice au tendinţa de a denatura informaţia redată, mai ales respondenţii cu manifestări de agresivitate în compotament

CRIMINAL SECURITY POLICIES IN THE REPUBLIC OF MOLDOVA

The article addresses the main post soviet problems in the sphere of criminal activity, from the political point of view. It runs from the arduous task of the country to build a democratic nation and a market based economy as it faces ethnic conflicts and social hardships accompanied by economic and political transformation to the present situation of a halt in transition to a European future. It also presents a compared analysis on criminal situation during every political power’s period of government

Pathological particularities of personality in patients which suffer from affective disorders or chronuic alcoholism

Catedra Psihiatrie, Narcologie şi Psihologie Medicală, USMF „Nicolae Testemiţanu”, IMSP Spitalul de Psihiatrie, secţia Nr.3, BălţiThe article presents results of analysis of the pathological personality traits of patients with affective disorders and patients with chronic alcoholism. The most important clinical features and the common pathological traits have been elucidated to assess psychotherapeutic possibilities in the complex treatment of patients În articol sunt prezentate rezultatele analizei trăsăturilor patologice a personalităţii pacienţilor ce suferă de tulburări afective şi pacienţilor cu alcoholism cronic. Au fost elucidate cele mai importante trăsături la nivel clinic şi trăsăturile patologice comune pentru aprecierea posibilităţilor psihoterapeutice în tratamentul complex a pacienţilor