Search Results (87)

Psychopathy in women remains understudied, particularly regarding the role of early relational experiences such as attachment. This systematic review aims to synthesize the current evidence on the association between attachment-related factors and psychopathic traits in women. A structured search following PRISMA guidelines across multidisciplinary databases (Scopus-Elsevier^®, ESBCO^®, Pubmed^®, Sage Publishing^®, B-On, and Web of Science-Core Collection^®) yielded 147 articles, of which eight met the inclusion criteria. The majority of the studies met three to four out of the five methodological quality criteria. Findings indicate that insecure attachment styles are differentially associated with psychopathy. Avoidant attachment is positively linked to callous-unemotional traits, whereas the role of anxious attachment appears more heterogeneous. Some studies associate it with higher levels of affective traits and secondary psychopathy, while others identify it as a negative predictor of callous-unemotional features in women. Avoidant attachment was also negatively correlated with empathy and positively related to maladaptive emotion regulation strategies, particularly among women with secondary psychopathic traits. Negative maternal parenting was associated with elevated psychopathic traits, whereas positive parental involvement acted as a protective factor. Additional predictors included early maladaptive schemas and childhood risk factors such as parental criminality and poor supervision. These findings highlight the relevance of early intervention and attachment-informed approaches in forensic risk assessment, trauma-informed care, and prevention programs targeting women with psychopathic traits. Full article

Background/Objectives: Infant feeding is critical for health and development, yet the influence of maternal psychosocial factors on its timing is not fully understood. While maternal adverse childhood experiences (ACEs) are known to affect perinatal outcomes, their impact on the specific timing of initiating formula and complementary foods remains under-investigated. We hypothesized that maternal ACEs are associated with delayed initiation of infant formula and complementary foods and that this association is mediated by postpartum depression (PPD). This study aimed to examine the link between maternal ACEs and delayed infant feeding, and to assess the mediating role of PPD using data from a large nationwide Japanese database. Methods: This cross-sectional study utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted between July and August 2021. The analysis included 3446 postpartum mothers. Maternal ACEs were assessed using a 9-item questionnaire, and a cumulative score was categorized as high (≥4 ACEs) versus low (0–3 ACEs). The primary outcomes were infant feeding behavior including breastfeeding, formula feeding and complementary foods. We used logistic regression analysis with inverse probability of treatment weighting (IPTW) to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A mediation analysis was conducted to evaluate the role of smoking, alcohol and PPD. Results: High ACE exposure (≥4) was present in 221 mothers (6.4%). A high maternal ACE score was significantly associated with delayed initiation of formula feeding (≥7 days) (Adjusted OR: 2.12, 95% CI: 1.12–4.01, p = 0.02) and late initiation of complementary foods (≥7 months) (Adjusted OR: 2.27, 95% CI: 1.38–5.01, p = 0.03); no significant associations were observed for ever/late/continued breastfeeding or ever/continued formula feeding. These associations attenuated to non-significance after adjusting for PPD. Conclusions: Maternal ACEs are associated with delayed initiation of complementary foods and formula, largely through PPD. Perinatal services should combine ACE/PPD screening with trauma-informed mental health and nutrition support to promote timely infant feeding. Full article

Background: Motor vehicle accidents account for the majority of abdominal trauma in pregnancy and can result in fetal morbidity and mortality. With advancing gestation, the fetus becomes more vulnerable to injury. Case presentation: A preterm neonate is born at 32 weeks’ gestation via cesarean section due to placental abruption after maternal motor vehicle accident. Initially, the infant presented with anemia, thrombocytopenia, and acute kidney injury in the setting of renal contusions. Results: Hyponatremia, acidosis, oliguria, and uremia progressed to frank anuric renal failure, requiring several months of hemodialysis before transition to peritoneal dialysis for chronic renal replacement therapy at home. Conclusions: Fetal renal injury resulting in postnatal renal failure is a rare but potentially devastating complication of blunt abdominal injury during pregnancy. Sonographic and laboratory evaluation of a neonate with suspected in utero injury after maternal motor vehicle accident is imperative, as is a high index of suspicion for neonatal renal injury. Full article

Refugee mothers are at heightened risk of developing negative family dynamics due to traumatic experiences and unstable living conditions, often impacting their children in lasting ways. This partially mixed, explanatory mixed-methods pilot study examines the potential of Drama Therapy as a psychosocial intervention to reduce harmful parenting behaviors and strengthen parent–child relationships. The study engaged 20 refugee mothers who participated in a three-session intervention based on Emunah’s five-phase model. Data collection included pre-intervention demographic information, two standardized psychological scales—The Child–Parent Relationship Scale and the Parent Anger Scale—and post-intervention focus group discussions. The findings indicate that the Drama Therapy Intervention (DTI) helped reduce parental anger and improve emotional regulation, leading to more positive interactions with children and decreased conflict within the family. Focus group insights revealed that the mothers’ ongoing and past traumas significantly shaped their emotional responses and parenting styles. This pilot study highlights the importance of addressing maternal mental health in post-displacement contexts. Although one cannot draw causal inferences of efficacy in the absence of a control group, the findings provide preliminary evidence that Drama Therapy can be an effective tool for reducing parental maltreatment and improving family relationships among refugee populations. Full article

Background/Objectives: Nipple trauma is a common challenge during the early postpartum period, often undermining maternal confidence and breastfeeding success. Although deep-learning-based image analysis offers the potential for objective and remote assessments, its feasibility in clinical practice has not been well examined. This study aimed to evaluate the feasibility and acceptability of a deep-learning-based nipple trauma assessment system and explore maternal perceptions of the intervention. Methods: A quasi-experimental study was conducted at a maternity hospital in Japan. Participants were assigned to intervention or control groups based on their delivery month. Mothers in the intervention group used a dedicated offline smartphone to photograph their nipples during hospitalization. Images were analyzed using a pretrained deep-learning model, and individualized feedback was delivered via a secure messaging platform. Self-administered questionnaires were collected at three points: late pregnancy, during hospitalization, and one month postpartum. Maternal experiences and satisfaction with breastfeeding were also assessed. Results: A total of 23 participants (intervention = 8 and control = 15) completed the study. The system functioned without technical errors, and no adverse events were reported. Most participants found the AI results useful, with 75% receiving high-confidence outputs (predicted class probability ≥ 60%). Participants expressed interest in real-time feedback and post-discharge use. Breastfeeding self-efficacy scores (BSES-SF) improved more in the intervention group (+9.8) than in the control group (+7.8). Conclusions: This study confirmed the feasibility and acceptability of a deep-learning-based nipple trauma assessment system during postpartum hospitalization. The system operated safely and was well received by participants. Future developments should prioritize real-time, remote functionality to support diverse maternal needs. Full article

There are a range of factors that influence alcohol use in pregnancy and create risk of fetal harm. However, limited research has articulated the multilevel nature of these influences and their entanglement. The purpose of this narrative review is to analyze the types of factors that influence alcohol use and consider what factors need to be addressed in future health promotion and intervention efforts. Six databases were searched using EBSCOhost articles published between January and December 2023 on alcohol use in pregnancy and Fetal Alcohol Spectrum Disorder (FASD) prevention. English-language articles were screened for relevance and a subset of articles exploring the prevalence, influences, and risk-factors associated with pregnancy were included for analysis. Thirty-two (n = 32) articles were included in the review and categorized into five key areas of influence on maternal alcohol use: (1) informational factors; (2) stress-related factors; (3) social determinant of health-related (SDoH) influences; (4) preconception- and prenatal-health-related factors; and (5) structural factors. Future efforts to reduce alcohol use in pregnancy should address these five categories of factors through non-judgmental, health-promoting, trauma-informed, harm-reduction-oriented, and culturally safe education, programming, and policy. Full article

Precipitous deliveries in the emergency department are one of the highest-acuity events that emergency providers manage. These deliveries can range from uncomplicated to wrought with difficulty. They require emergency care providers to manage intrapartum complications, such as nuchal cords, shoulder dystocia, and breech presentation, and maternal complications such as uterine atony, birth canal trauma, and postpartum hemorrhage. Delivery may additionally necessitate resuscitative hysterotomy or neonatal resuscitation. Our narrative review discusses preparatory practices, normal labor and delivery progression, and brief guidelines for managing complications of precipitous deliveries for emergency medicine providers. Full article

Background: Blunt abdominal trauma in pregnancy is a medical emergency with significant maternal-fetal morbidity and mortality. Although rare, intestinal ischemia can occur as a serious abdominal complication following trauma during pregnancy. Case presentation: A 41-year-old woman at 33 weeks and 6 days of gestation was involved in a car accident, as a passenger in the front seat of a vehicle that left the road and overturned. The initial examination revealed severe chest trauma but no immediate signs of abdominal injury. However, the patient’s condition worsened, showing delayed symptoms of gastrointestinal dysfunction, clinical deterioration, and labor onset. Complementary imaging studies did not reveal conclusive findings suggesting complications related to the blunt abdominal trauma. Following a multidisciplinary team’s decision to perform an emergency cesarean section in the maternal-fetal interest, intestinal ischemia secondary to a mesenteric tear was discovered, necessitating intestinal resection and end-to-end anastomosis. Conclusions: Despite being a rare condition often associated with diagnostic delays, in cases of sudden clinical deterioration or maternal hemodynamic instability, immediate multidisciplinary intervention is essential. This approach may allow the early detection of trauma-related complications, reducing potentially preventable deaths and achieving favorable maternal and neonatal outcomes. Full article

Background/Objectives: Perineal obstetrical trauma sustained during vaginal delivery has a profound impact on female quality of life. The aim of the cross-sectional study was to analyze the association between active bacterial cervical infection and group B Streptococcus (GBS) rectovaginal colonization in the 35th–37th weeks of pregnancy with the degree of delivery perineal trauma. Methods: The study included 778 women after vaginal delivery. Maternal characteristics, including age, concomitant diseases, parity, obstetrical history, and cervical swab results conducted at admission and rectovaginal bacterial swabs at the 35th–37th weeks of pregnancy, were analyzed. The rates of perineal tears were compared between the physiological and pathological cervical swab groups and between the GBS-positive and GBS-negative colonization groups. Results: At admission to delivery, active cervical infection was diagnosed in 269 (35.9%) women. After vaginal delivery, 361 (49.3%) women had an intact perineum, and 288 (39.3%), 78 (10.7%), 4 (0.6%), and 1 (0.1%) had 1st–4th-degree perineal tears, respectively. Statistical analyses of the logistic regression model found that GBS colonization at the 35th–37th weeks of pregnancy (OR 1.56, p = 0.035) and pathological flora at admission (OR 1.54, p = 0.019) were associated with perineal tears. A higher vaginal parity was found to be a protective factor (OR 0.49, p < 0.000). Conclusions: High birthweight, longer second stage of labor duration, and primiparity were associated with increased rates of perineal trauma. Active cervical infection at admission and GBS colonization at the 35th–37th weeks of pregnancy were found to be risk factors for perineal tears. A protective factor for an intact perineum was a higher number of prior vaginal deliveries. Full article

This study aims to illustrate the impact of accumulated traumatic experiences in adolescence and to evaluate the potential of brief focal psychotherapy (BFP) as a treatment approach for complex trauma. We present the case of a 14-year-old boy who experienced vicarious gender-based violence, child abuse, early maternal separation without alternative secure attachment figures, and forced sudden migration. The patient exhibited symptoms consistent with post-traumatic stress disorder (PTSD) and complex trauma. The culturally sensitive intervention, delivered at a public child and adolescent mental health center, consisted of twenty weekly individual sessions of 45 min each, complemented by three 45 min psychoeducation sessions with the caregiver. The assessment was conducted using a multitrait and multi-informant approach, systematically gathering information across multiple domains of functioning (emotional–behavioral, physical, cognitive, self-perception, and relational) and from different sources (the adolescent, his mother, and the clinician) through clinical interviews, projective techniques, and parental feedback. The primary therapeutic focus was the establishment of a secure therapeutic alliance to facilitate emotional exploration and trauma processing. Following treatment, the patient demonstrated significant improvements in emotional regulation, family relationships, and school performance, as measured by both self-report and parental observations. This case highlights the potential of BFP in addressing complex trauma in adolescents, particularly during a developmental stage marked by increased vulnerability to the effects of chronic trauma exposure. The findings suggest that BFP can effectively reduce both acute symptomatology and broader psychosocial consequences associated with prolonged and cumulative trauma. Further research, particularly controlled studies and longitudinal follow-ups, is needed to refine and optimize the use of BFP by mental health professionals working with adolescents affected by complex trauma. Full article

Early caregiving can evoke feelings of helplessness in mothers that are potentially associated with disintegrative responses, i.e., intrusive thoughts and dissociative experiences in the context of infant care. Given the associated increase in stress and exposure to life-threatening dangers, crises such as pandemics and wars may intensify these responses, but this has not previously been tested. Objectives: This cross-sectional study aimed to (1) examine maternal disintegrative responses across three contexts—a high-intensity phase of the COVID-19 pandemic, a subsequent low-intensity pandemic period, and the Israel–Hamas war—and (2) compare the two crisis periods in terms of trauma-related exposure, a damaged experience of childbirth and childcare, and their links to disintegrative responses. Method: This study had two parts and was conducted among Israeli mothers. Part 1 involved 1416 mothers across three groups: high-intensity pandemic (N = 637), low-intensity pandemic (N = 360), and war (N = 419). Part 2 involved a subsample from Part 1 comparing the 1056 mothers from the high-intensity pandemic and war groups. All the participants completed questionnaires assessing maternal disintegrative responses, trauma-related exposure, and a damaged experience of childbirth and childcare. The analyses included ANOVA and mediation models, controlling for maternal characteristics. Results: Intrusive thoughts and dissociative experiences were significantly higher during both the high-intensity pandemic and war periods compared to the low-intensity pandemic period. Trauma exposure indirectly predicted intrusive thoughts and dissociative experiences through a damaged experience of childbirth and childcare, particularly during war. Conclusions: The findings indicate that maternal disintegrative responses were higher during high-intensity crisis contexts, with the highest levels reported by mothers during the war. Trauma exposure and a damaged experience of childbirth and childcare were associated with more intrusive thoughts and dissociative experiences, underscoring the need for targeted support to protect maternal well-being and caregiving during crises. Full article

Background/Objectives: Mothers of infants admitted to the neonatal intensive care unit (NICU) experience significant stress, which can have lasting effects on mental health and parent–infant bonding. This mixed-methods study aimed to explore maternal stress response, coping, and resilience by examining physiological stress markers and maternal narratives. Methods: A total of 28 mothers who had an infant hospitalized in the NICU within the past three years participated in a two-hour laboratory session, which included stress induction using the Trier Social Stress Test (TSST). Salivary cortisol (sCort) and heart rate variability (HRV) were measured to assess physiological responses. Results: Qualitative analysis of maternal narratives identified two distinct response patterns: an anger/trauma (AT) group (n = 7) and a gratitude/optimism (GO) group (n = 6), with the remaining 15 mothers classified as a mixed (M) group. GO mothers exhibited significantly higher cortisol reactivity during recovery compared to AT mothers (p < 0.01). While GO mothers had higher baseline HF-HRV, no significant between-group differences were found in HRV responses. Conclusions: Findings suggest that maternal perception of NICU experiences is associated with distinct physiological stress response patterns, highlighting the importance of stress appraisal and coping in maternal well-being. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Background: This study investigated the pathways through which various psychological problems occurring across the perinatal period influence mother–child bonding within the first 18 months postpartum, with a particular focus on the relationship between perinatal and postpartum depression and childbirth-related posttraumatic stress symptomatology. Methods: A multi-stage longitudinal design included three assessment points: recruitment and initial assessment in the third trimester of pregnancy (T1), a second assessment at 8 months postpartum (T2), and a final assessment at 18 months postpartum (T3). A total of N = 51 mothers completed all three waves (total follow-up period per participant: approximately 21 months). Sociodemographic data were collected, and all assessments were completed online. Results: Our findings revealed significant indirect effects, linking higher levels of perinatal depressive symptoms in the third trimester with mother–child bonding difficulties at 18 months postpartum. This association was mediated by both greater childbirth-related posttraumatic stress symptoms and elevated postpartum depressive symptoms at 8 months. Conclusions: These preliminary results highlight how complex perinatal factors at different stages (i.e., during pregnancy and early postpartum) influence mother–child bonding at 18 months postpartum. Understanding these pathways is essential in order to inform targeted interventions and to promote optimal maternal mental health and bonding outcomes. Full article

Background: Antimicrobial resistance (AMR) is a global threat in the public healthcare sector. The emergence of carbapenem-resistant Enterobacterales (CRE) has become a serious public health threat in South Africa. The spread of CRE has led to the use of colistin for treating severe infections. Colistin is a cationic, lipopeptide antibacterial agent that is effective against most Gram-negative bacteria through its disruption of the bacterial cell membrane. This study aims to determine the colistin resistance (MIC) and mobile colistin resistance (mcr-1) gene in clinical isolates from healthcare facilities in Mthatha and its surrounding areas. Methods: Fifty-three CRE isolates were collected from health facilities between January 2019 and June 2021 and stored in skim milk 10% and 5% inositol broth. The carbapenemase confirmatory test involved a RESIST-4 O.K.N.V assay (Coris BioConcept, Gembloux, Belgium), which was conducted following manufacturer protocol. Broth microdilution was performed according to the ISO standard method (20776-1) using A ComAspTM colistin 0.25–16 μg/mL MIC Broth. Conventional polymerase reaction (PCR) was performed for the detection of mcr-1. Results: N = 53 (100%) isolates were used. A total of 53% were defined as Klebsiella pneumoniae, Escherichia coli constituted 8%, Enterobacter cloacae 8%, Serratia marcescens 8%, Serratia fonticola 2%, Enterobacter aerogenes 2%, Klebsiella oxytoca 2%, Citrobacter koseri 2%, and Citrobacter freundii 2%. The specimens were from the following wards: Pediatric and Neonatal 38%, Medical 30%, Gynecology, Labour, and Maternity 11%, OPD and A&E 11%, ENT 4%, and Others—Male TB ward, Trauma, and adult ICU 6%. In total, 13% of the isolates were resistant and 86% were sensitive to colistin. The common CRE genes detected were OXA-48 at 47%, NDM at 13%, VIM at 1%, and a combination of OXA-48 and NDM at 5%. Of the isolates, 66% were positive for the production of carbapenamase. In this study, we found that all N = 53 (100%) isolates did not have the mobile colistin resistance gene (mcr-1). Conclusions: Antimicrobial resistance is associated with the emergence of carbapenemases genes. Increasing resistance to colistin in clinical settings can lead to difficulties in treating CRE infections, which may lead to clinical failure. In our study, 13% of isolates were phenotypically resistant to colistin. Full article