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Aim: To quantify associations of anxiety and depression during pregnancy with differential cord blood DNA methylation of the glucorticoid receptor ( NR3C1). Materials & methods: Pregnancy anxiety, trait anxiety and depressive symptoms were collected using the Pregnancy Related Anxiety Scale, State-Trait Anxiety Index and Edinburgh Postnatal Depression Scale, respectively. NR3C1 methylation was determined at four methylation sites. Results: DNA methylation of CpG 1 in the NR3C1 CpG island shore was higher in infants born to women with high pregnancy anxiety (β 2.54, 95% CI: 0.49–4.58) and trait anxiety (β 1.68, 95% CI: 0.14–3.22). No significant association was found between depressive symptoms and NR3C1 methylation. Conclusion: We found that maternal anxiety was associated with increased NR3C1 CpG island shore methylation.

Objective: Our objective was to compare women with and without invasive placentation for whom the massive transfusion protocol (MTP) was activated. In addition, we evaluated the differences in clinical management and blood product utilization between the two groups and described the activation of MTP over time.Study Design: This is a retrospective cohort study of women for whom the MTP was activated from January 2012 through July 2016. Two groups were compared, those with invasive placentation (accreta, increta, percreta) and those without. Results:We identified 87 women for whom the MTP was activated, the majority (62.1%) did not have invasive placentation. Women with invasive placentation were more likely to have had a prior cesarean delivery and placenta previa (both p<0.001). Women with invasive placentation were more likely to undergo hysterectomy, experience more blood loss, and receive cell salvage (all p≤0.04). Blood product utilization was similar between the two groups, with the exception of cell-salvage, which was more commonly used for women with invasive placentation. The proportion of deliveries necessitating MTP activation ranged from 1.4 to 2.6 per 1000 deliveries. Conclusion:Invasive placentation accounts for less than half of cases complicated by activation of an MTP. Cases with invasive placentation were more likely to result in a vertical uterine and skin incision or a hysterectomy. With the exception of cell-salvage, blood product utilization was similar.

INTRODUCTION: Postpartum pelvic floor dysfunction (PFD) is associated with reduced quality of life; however, patient education regarding PFD is limited. The purpose of this study was to evaluate impact of PFD education and pelvic floor physical therapy (PFPT) referral on patient satisfaction with postpartum care. METHODS: This randomized controlled trial included 160 postpartum patients recruited during their delivery admission between November 2020 and June 2021. Patients were randomized to receive postpartum PFD education materials and PFPT referral (n=80) or to receive standard postpartum teaching (n=80). The Client Satisfaction Questionnaire (CSQ-8) was used to assess patient satisfaction at 12 weeks postpartum. RESULTS: In total, 131 (81.87%) participants completed the questionnaire. The groups were well matched in terms of demographics, comorbidities, and delivery type. In total, 60 of 131 (45.8%) reported PFD symptoms. Overall satisfaction did not differ between groups (27.43 vs. 28.31 out of 32, P=.28). Significantly more patients in the intervention group felt that they received enough PFD education and support (47.1% vs. 27.0%, P=.017). Of those who read the educational materials (48 of 68, 70.6%), 89.6% found them helpful, and 100% thought all patients should receive PFD education. Most common obstacles to attending PFPT included lack of interest, time commitment, and childcare. CONCLUSION: Our study demonstrates that while providing PFD education and PFPT referral does not lead to increased patient satisfaction, patients do find these resources helpful. Postpartum PFD is prevalent; however, few patients attend PFPT despite referrals. We identify specific barriers to attending PFPT which are targets for future studies on patient satisfaction.

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