The Edinburg postpartum depression scale (EPDS) is a valuable tool to screen for perinatal depression. Recognizing depression after diagnosis of fetal anomaly is important to protect mother and baby from adverse outcomes. Our objective is to assess the impact of fetal intervention (FI) on mothers diagnosed with fetal anomaly. STUDY DESIGN: Retrospective review of patients with confirmed fetal anomaly receiving prenatal care at our center from January 2018 to January 2020. FI was offered for open neural tube defects, fetal anemia, congenital diaphragmatic hernia, pleural effusion, bladder obstruction, and twin-twin transfusion syndrome. EPDS surveys were administered during perinatal care. Patients were separated into two groups: Fetal anomaly-intervention (FA-FI) and no intervention (FA-non FI). Women with elevated EPDS scores (! 10) or indication for assessment were referred to psychiatry. Fisher's exact test and logistic regression analyses were performed, with statistical significance defined as p<0.05. RESULTS: 462 patients met criteria, 77 in the FA-FI and 385 in the FA-non FI group. There was no significant difference in mean EPDS scores between FA-FI and FA-non FI, antenatal [5.48 (AE4.60), 5.95 (AE5.53), p ¼ 0.25] or postnatal [6.44 (AE4.56), 6.62 (AE5.93), p ¼ 0.39]. However, women with a diagnosis of cardiac anomaly who underwent FI had greater antenatal EPDS scores [7.75 (AE1.50) vs. 5.49 (AE5.21), p ¼ 0.02]. Positive psychiatric history was a significant predictor of depression (p < 0.0001). Neither intervention (p ¼ 0.24) nor anomaly (p ¼ 0.43) were predictive of depression. The FAnon FI group had a higher EPDS score in the postnatal period in patients followed and treated by psychiatry [8.29 (AE4.60) vs 12.18 (AE5.97), p ¼ 0.007; 6.33 (AE3.33) vs 10.58 (AE4.49), p ¼ 0.01]. CONCLUSION: Type of anomaly or need for intervention were not predictive of depression in the perinatal period. The greatest predictor of depression is a history of a pre-existing psychiatric disorder. For patients with fetal anomaly, not receiving FI, depression presents in the postnatal period during psychiatric treatment.
D)(Fig 1). We tested the hypothesis that measurable SA function differs between races. STUDY DESIGN: In an IRB-approved prospective longitudinal observational study, we defined a supernormal population (parity¼0, no co-morbidities or pregnancy complications) to control covariables. S and D were quantified in all trimesters, with a compound ultrasound technique: In B-flow mode, STIC/4D image blocks of individual SA were acquired systematically in the placental bed. S and D diameters were measured via M-Mode. At the first trimester visit, serum analytes (PAPP-A, PlGF, AFP) were obtained. At each visit, BMI, mean arterial blood pressure, mean uterine artery-PI, gestational age (GA), race and age were recorded. Quality control included formal training, written criteria for image acceptance and screening of every image by senior study personnel, all blinded to patient characteristics/outcome. Longitudinal analysis utilized a linear mixed-effects model with random intercept and random slope. RESULTS: A total of 645 SA were measured serially in 43 women (15 each) at 11-32 weeks. Women self-assigned race as Black ( 24), White (14) or Asian (5). S and D diameters rose with GA (p<0.001 for both). S was significantly higher in W than B and A (Fig 2 ) The model showed significant interaction between S and PAPP-A (p<0.0001).
CONCLUSION:The study shows B-flow/M-mode can detect and quantify SA remodeling and illustrates the normal loss of mural tone of these vessels as pregnancy advances. Even when pregnancy outcome is normal, black women show less remodeling, a potential clue to their liability for placental dysfunction across pregnancy and the puerperium.
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