Objective The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored.Design A prospective longitudinal study.Setting Pregnant women in Linköping and Kalmar, Sweden.Population A total of 1224 women were assessed in pregnancy, week 12-20 and 32, as well as 1 month postpartum.Methods Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records.Main outcome measures Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV)) and depression (Beck's depression inventory).Results One month postpartum, 12 (1.3%) women had posttraumatic stress (met symptom criteria B, C, and D for posttraumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR = 16.3), severe fear of childbirth (OR = 6.2), and 'pre'-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR = 12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors.Conclusions Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

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Uterine adrenergic and cholinergic nerves were examined histochemically and chemically in combination with surgical denervation. There was a clear regional variation with a greater number of axon terminals in the tubal end of the uterine horn and in the cervix compared to the remainder (major part) of the uterine horn. No cholinergic nerves were found in the uterus but were abundant around the uterine artery and its primary ramifications. Clusters of ganglion cells were located near the cervix: the majority were acetylcholinesterase positive, whereas the remainder stored catecholamines. Unexpectedly, the suspensory ligament (connecting the tubal end of the uterine horn with the two lower ribs) was found to contain an extensive number of adrenergic nerves. The major part of the uterine horns, as well as the cervix, was innervated mainly from two sources contributing almost equally: the paracervical ganglia (short adrenergic neurons) and postganglionic fibers running in the hypogastric nerves. A restricted area at the tubal end of the uterus received most of its via the suspensory ligament.

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Pregnancy is accompanied by a reduction in uterine noradrenaline, and the study was undertaken to investigate associated structural and functional integrity of the sympathetic nerves in the organ. The formaldehyde-induced fluorescence of adrenergic nerves was studied in different uterine regions before and after in vitro incubation or injection with alpha-methyl-noradrenaline in pregnant and puerperal guinea-pig uterus at 6 time periods, from early pregnancy (about 20 days post coitum) to 3 months post partum. The changes were related to the position of the fetuses, which were often present in only one of the two uterine horns. There was a drastic loss of fluorescent adrenergic nerves in myometrial tissue from horns distended by fetuses. Attempts to restore this fluorescence by incubation or injection with alpha-methyl-noradrenaline were essentially ineffective. Tissues from uterine regions outside (and not distended by) fetuses (in the case of early pregnancy), from horns devoid of fetuses (in the case of unilateral pregnancy), and from the cervix also lost their noradrenaline-fluorescent nerves, but this occurred at a much later stage of pregnancy. After treatment with alpha-methyl-noradrenaline, a fluorescent plexus of sympathetic nerves could be restored to a considerable extent in these latter tissues. In puerperal animals the horn that had been devoid of fetuses regained its endogenous fluorescence much faster, and the uptake of alpha-methyl-noradrenaline was more efficient, than in the horn which had contained fetuses. In this latter horn clear signs of restoration of endogenous adrenergic fluorescence and a clear uptake capacity was not found until 3 months after delivery. In the tubal end of the uterus, the reduction in the number of fluorescent nerves was only insignificant, and the region thus clearly differed from the rest of the uterus. It is concluded that (1) there are clear regional differences with regard to the disappearance of the noradrenaline transmitter in the uterus, (2) this disappearance in early pregnancy is related to the position of the conceptus, and (3) the changes involve de- and regenerative phenomena as well as alterations in transmitter levels of intact neurons.

In the guinea pig myometrium, the adrenergic nerves selectively demonstrated at the ultrastructural level after treatment with 5-OH-DA, show varying degree of degeneration during pregnancy. The changes are more extensive in a late gestational stage (40-45 days) than in an early one (20-25 days), and are particularly evident in the uterus overlying the conceptus as compared to the regions between the fetuses. Scattered degenerative changes were also observed in myometrial specimens from virgin animals, but probably reflect the normal continuous turnover of axons.

Progesteroneand estradiol-1 713 concentrations were determined in peripheral plasma, uterine, ovarian and placental tissues in nonpregnant (diestrous) and pregnant (mid-and fullterm) guinea

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