A multicentre study on the epidemiology of perinatal depression was conducted among Japanese women expecting the first baby (N = 290). The incidence rate of the onset of the DSM-III-R Major Depressive Episode during pregnancy (antenatal depression) and within 3 months after delivery (postnatal depression) were 5.6% and 5.0%, respectively. Women with antenatal depression were characterised by young age and negative attitude towards the current pregnancy, whereas women with postnatal depression were characterised by poor accommodation, dissatisfaction with sex of the newborn baby and with the emotional undermining. Antenatal depression was a major risk factor for postnatal depression.
Bleeding problems occurred about 1 week after delivery or at the time of induced abortion in the 6 women with vWD. Thus, such patients require special care during pregnancy.
A large hepatic cyst was diagnosed in a fetus at 29 weeks of gestation by puncture and aspiration performed under ultrasonographic guidance. This procedure was repeated five times at about 2-week intervals, with a total of 1,446 ml of cystic fluid aspirated. A healthy female infant was delivered vaginally at 40 weeks of gestation. Her Apgar score was 9 at 1 min, and she weighed 2,790 g. On the 14th postnatal day, the hepatic cyst was punctured percutaneously under ultrasonographic guidance, and 119 ml of yellow fluid was aspirated. The cyst was subsequently not visible on computed tomography at 9 months. Surgery was not indicated in this infant, and the cyst was also not detected at the age of 21 month. Thus, treatment in utero appeared to have obviated the need for surgery.
A 30 year old female was admitted twice during her pregnancy for genital bleeding. An ultrasonography at 19 weeks gestation showed several nodules on the chorionic plate. Cardiotocography during labor at 37 weeks gestation indicated a non-reactive pattern. A 2230 g infant girl was delivered soon after rupture of membranes with asphyxia and hydrops fetalis. The placenta weighed 600 g with a maximal thickness of 6 cm. Nodules occupied about one-third of the placenta and were diagnosed as placental hemangiomas. Postnatal examination revealed that the infant had disseminated intravascular coagulation and cardiac failure. This baby recovered after treatment in the intensive care unit, and was discharged home on the 52nd day of life.
The authors evaluated the hemostatic abnormalities occurring in the postoperative period of eight patients with malignant tumors and compared them with those occurring in the postoperative period of eight patients with benign tumors. Two of the patients with malignant tumor presented pulmonary embolism after operation. Plasma fibrinogen and fibrin degradation product levels in patients with malignant tumors were already high before operation and further increased significantly after operation. The plasma levels of D-dimer, thrombin-antithrombin complex, and free-tissue factor pathway inhibitor were increased in both groups after operation, but they were higher in patients with malignant tumors than in patients with benign tumors. The plasma levels of protein C and antithrombin were significantly decreased in both groups after operation. but they were significantly lower in patients with malignant tumors than in those with benign tumors. The decreased activity of protein C or antithrombin may be not only a risk factor of thrombotic disease, such as pulmonary embolism, but also the cause of thrombosis. In patients with malignant tumors, the operation time was significantly longer than that in patients with benign tumors. This long operative period might cause vascular endothelial cell injury which is reflected by the plasma levels of free-tissue factor pathway inhibitor, antithrombin, and protein C.
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