The global epidemic of Zika virus has been a major public health problem affecting pregnant women and their infants. Zika virus causes a viral disease transmitted to humans mainly by the infected Aedes mosquito bite. The infection is not severe in most cases; however, there is evidence that infection during pregnancy may be associated with fetal genetic abnormalities (including microcephaly). In addition to microcephaly and other malformations, some specific lesions in the central nervous system have been reported. The aim of this systematic review was to determine the risk of developing microcephaly in infants whose mothers were infected with Zika virus in pregnancy. Epidemiological studies and case reports were incorporated in our review, finally including 15 articles from an initial pool of 355 related papers. Most studies have linked maternal infection during pregnancy to the development of neonatal microcephaly. The period considered most dangerous is the first trimester and the beginning or the whole of the second trimester. In order to understand the relationship between Zika virus and microcephaly in infants, a cohort study will be able to estimate the time from the onset of Zika infection and the full spectrum of adverse pregnancy outcomes.

A birth experience with cesarean section (CS) can be a cause of the development of post-traumatic stress disorder after a cesarean (PTSD-AC) or profile PTSD, for a percentage of women. So far, there is no data on the frequency of PTSD-AC in Greece and this syndrome is often associated with other mental disorders of the postpartum period. The purpose of this research is to associate the kind of CS with PTSD-AC for Greek mothers and the combination of factors that make them less resistant to trauma. A sample of ahundred and sixty-six mothers who gave birth with emergency cesarean section (EMCS) and elective cesarean section (ELCS) at a Greek University hospital have consented to participate in the two phases of the survey, in the 2nd day postpartum and a follow-up in the 6th week postpartum. Medical/demographic data and a life events checklist (LEC-5) with Criterion A and post-traumatic stress checklist (PCL-5) were used to diagnose PTSD and PTSD Profile. Out of166 mothers enrolled, 160 replied to the follow-up (96.4%), ELCS 97 (97%) and EMCS 63 (95%). Twenty (31.7%) EMCS had PTSD and nine (14.3%) had Profile. One (1%) ELCS had PTSD and 4 (4.1%) had Profile. This survey shows a high prevalence rate of PTSD after EMCS with additional risk factors of preterm labor, inclusion in the Neonatal Intensive Care Unit (NICU), a lack of breastfeeding, and a lack of support from the partner.

Background: Cesarean section (CS) rates have been increasing worldwide with different effects on maternal and neonatal health. Factors responsible for the growing trend of CSs, include maternal characteristics, medical insurance and convenient scheduling or financial incentives. Effective interventions and guidelines are required to reduce CS rates. Objective: The aim of this research was to investigate the factors contributing to CS rate increase and their correlation with international guidelines. Methods: The performed analysis included the available socio-demographic and medical information retrieved from the medical records and a related questionnaire in both emergency and elective CSs. Results: Out of the included 633 births, the cesarean delivery rate was 58%. Women with a previous CS showed higher percentages for Elective CS (66.1%) compared to Emergency CSs for the same reasons (8.9%). Furthermore, 23% of the patients underwent an Emergency CS because of failure of labor to progress while 18% of CSs were due to maternal desire. Conclusion: The high rates of CS in Greece demonstrate the lack of use of international obstetric protocols, national strategies, Cesarean Section audits and a significant shortage of midwives. A decrease in iatrogenic and non-iatrogenic factors leading to the primary CS will decrease CS rates.

Objective: This paper presents the first Greek empirical research on bioethical neonatal issues. The study goals were: 1) to document and measure the attitude of Greek healthcare professionals' working in NICUs towards the value of human life (intrinsic value vs. quality of life) as ethical decision making guiding principle in the provision of intensive treatment to extremely/very preterm babies and 2) to investigate the socio-cultural and other parameters which form this attitude. Methods:Questionnaires developed for the EURONIC project and implemented in research in 11 countries were culturally adjusted to the Greek NICU context. Healthcare professionals (n=495) who were employed in Greek NICUs (May 2009-May 2011 and met inclusion criteria were invited to participate. Of those 251 (98 midwives, 82 nurses and 71 doctors) completed a structured, self-administered, anonymous questionnaire (response rate 50.7%). Results:The reported attitude score (total sample mean attitude score=3.09) indicates that Greek healthcare professionals tend to support the intrinsic value of human life position. Gender (p<0.05), the importance placed on religion (p<0.05) and profession specialization (p<0.01) were found to influence their attitude in statistically significant ways. Specifically, men, professionals who consider religion as being important in their life and midwives and nurses tend to be more supportive of the intrinsic value of life position. NICUs' equipment and personnel, the cost of neonatal healthcare provision, and the burden of disability on the neonate's family have not been found to influence healthcare professionals' attitude in statistically significant ways. Conclusion:Compared to the findings from other countries in which the EURONIC research was implemented, Greek healthcare professionals appear to hold a rather vitalistic approach and follow the intrinsic value of human life position as their ethical decision-making guiding principle. Socio-cultural and professional characteristics explain ethical decision making differences among healthcare professionals.

Research has highlighted the wide impact of intimate partner violence (IPV) and the public health role of community health professionals in detection of victimized women. The purpose of this study was to identify postpartum emotional and physical abuse and to validate the Greek version of the Women Abuse Screening Tool (WAST) along with its sensitivity and specificity. Five hundred seventy-nine mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of two public hospitals in Athens, Greece. Participants were randomly selected by clinic or shift. The WAST and the Partner Violence Screen (PVS) surveys were administered in random order to the mothers from September 2007 to January 2008. The WAST was compared with the PVS as a criterion standard. Agreement between the screening instruments was examined. The psychometric measurements that were performed included: two independent sample t tests, reliability coefficients, explanatory factor analysis using a Varimax rotation, and Principal Components Method. Confirmatory analysis-also called structural equation modeling-of principal components was conducted by Linear Structural Relations. A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. Two hundred four (35.6%) of the mothers screened were identified as experiencing IPV. Scores on the WAST correlated well with those on the PVS; the internal consistency of the WAST Greek version-tested using Cronbach's alpha coefficient-was found to be 0.926 and that of Guttman's split-half coefficient was 0.924. Our findings confirm the multidimensionality of the WAST, demonstrating a two-factor structure. The area under ROC curve (AUC) was found to be 0.824, and the logistic estimate for the threshold score of 0/1 fitted the model sensitivity at 99.7% and model specificity at 64.4%. Our data confirm the validity of the Greek version of the WAST in identifying IPV. The validated Greek WAST scale could be used for screening purposes in both clinical practice and research.

An emergency cesarean delivery can be a traumatic childbirth experience for a woman and a risk factor for postpartum psychosis, especially in a patient with a history of bipolar disorder. This article describes the case of a pregnant woman with an unknown history of bipolar disorder who developed an acute psychotic reaction during the procedure of an emergency caesarian section and switched to mania. The purpose of this case study is for perinatal health care professionals to identify suspicious symptoms and promptly refer to psychiatric services so as to ensure the mother’s and the newborn’s safety. This case study highlights the importance of assessing women with bipolar disorder or a previous psychotic episode for the risk of psychiatric complications in pregnancy and after childbirth. Midwifery education on perinatal mental health is crucial for the detection of suspicious symptoms and early referral to a specialist.

This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women’s history and two psychometric tools—the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points—were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. Results: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). Conclusions: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period.

This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to withhold or withdraw neonatal intensive care (p < 0.05). Conclusions: Our research shows that Greek NICU physicians report considerably lower levels of ethical decision-making regarding preterm and ill newborns compared to their counterparts in other European countries. Clinical practices and attitudes towards ethical decision-making appear to be influenced mainly by the Greek physicians’ values.