This prospective study was carried out in a service hospital, with the aim to study the prevalence and incidence of depression in pregnancy and postpartum period. Eighty Four consecutive patients attending the antenatal outpatient in the Obstetrics & Gynaecology department in their last trimester of pregnancy were recruited for the study. They were assessed on Beck Depression Inventory thrice viz. during third trimester of pregnancy, within 3 days of delivery (early postpartum period) & within 4-8 weeks of delivery (late postpartum period).The prevalence of depression was 8.3%, 20% and 12.8% respectively at three ratings. The incidence was 16% and 10% in the early & late postpartum period respectively. Further analysis revealed that depression in pregnancy correlated significantly with depression in early postpartum period, but not with late postpartum period. Depression in early postpartum period correlated with depression in late postpartum period.These findings have implications for early detection and care of women at risk for developing depression.
Sood, Mamta; Sood, A.K.
We previously assessed the motivational properties of pups relative to those of cocaine in parturient female rats (dams) across the postpartum period and demonstrated that the larger subset of dams in early postpartum (PPD8) preferred the pup-associated chamber, whereas the majority of dams tested in late postpartum (PPD16) preferred the cocaine-associated chamber [Mattson, B.J., Williams, S., Rosenblatt, J.S., Morrell, J.I.
Michael P. Wansaw; Mariana Pereira; Joan I. Morrell
We previously assessed the motivational properties of pups relative to those of cocaine in parturient female rats (dams) across the postpartum period and demonstrated that the larger subset of dams in early postpartum (PPD8) preferred the pup-associated chamber, whereas the majority of dams tested in late postpartum (PPD16) preferred the cocaine-associated chamber [Mattson, B.J., Williams, S., Rosenblatt, J.S., Morrell, J.I. 2001. Comparison of two positive reinforcing stimuli: pups and cocaine throughout the postpartum period. Behav. Neurosci., 115, 683-694; Seip, K.M., Morrell, J.I. 2007. Increasing the incentive salience of cocaine challenges preference for pup- over cocaine-associated stimuli during early postpartum: place preference and locomotor analyses in the lactating female rat. Psychopharmacology 194, 309-319]. The present study uses a dual-choice conditioned place preference to ask how the progression of the postpartum period, including natural pup development, influences maternal motivation for pups. Preferences for cued chambers associated with pups that were age-matched to the postpartum stage of the dam in contrast to a stimulus with little incentive salience were higher during the early than the late postpartum, suggesting that the incentive salience of pups diminishes as the postpartum period progresses. Preferences of the early postpartum dams deprived of pups for 15 min, 2, 6, 12 or 22 hrs prior to conditioning and testing did not differ statistically but there was a trend of more pup preference after 22 hr deprivation; pup age was not an important factor in early postpartum. In marked contrast, late postpartum dams only exhibited robust pup-associated place preference when they were conditioned with young (4-7 day-old) pups or after a 22 hr period of deprivation from contemporaneous pups. Together these results suggest that both forces are at work in the mother-pup dyad, changes in the pups as they develop and changes in the physiological and endocrine state of the female as she progresses through the postpartum period. PMID:18457837
Wansaw, Michael P; Pereira, Mariana; Morrell, Joan I
Objective: The purpose of this study was to determine whether there is a shift in the timing of eclampsia in relation to delivery and whether traditional symptoms precede impending postpartum eclampsia. Study Design: A multicenter analysis of data from patients with eclampsia from March 1996 through February 2001 at the University of Cincinnati, the University of Tennessee, Memphis, and Central
Mark C. Chames; Jeffrey C. Livingston; Thomas S. Ivester; John R. Barton; Baha M. Sibai
Healthy mother–infant interactions are critical for the physical, cognitive, and psychological development of offspring. Such interactions rely on numerous factors, including a positive maternal emotional state. However, many postpartum women experience emotional dysregulation, often involving elevated anxiety. Neuroendocrine factors contributing to the onset of postpartum anxiety symptoms are mostly unknown, but irregularities in hypothalamic–pituitary–adrenal axis function, reduced prolactin and oxytocin
Joseph S. Lonstein
Research into psychiatric illnesses during pregnancy and the postpartum period has focused primarily on mood disorders and psychosis. However, recent reports suggest that during pregnancy and the postpartum period psychiatric patients run an increased risk of developing the symptoms of obsessive compulsive disorder (OCD) or if they already have these symptoms, the severity is likely to increase. We report two cases of OCD in pregnancy and in the postpartum period. In addition, we present a brief review of the literature that is currently available on this topic. PMID:22753187
de Pender, A M G; Lambregtse-van den Berg, M P; Raats, M E
In the majority of recent textbooks of obstetrics, a routine follow-up examination at the end of the postpartum period is\\u000a recommended. To date, no studies have been done in the Czech Republic addressing use of contraception and follow-up care in\\u000a the postpartum period. Questionnaires were sent to 672 participants who gave birth in the year 2008, inquiring about follow-up\\u000a examinations
Jozef Zahumensky; Jana Sykorova; Oldrich Sottner; Barbora Zmrhalova; Jiri Vojtech; Erika Menzlova; Ian Vasicka; Monika Dvorska; Katerina Maxova; Jaromir Vlacil; Helena Hrubantova; Michael Halaska
Hypertension affects 10% of pregnancies, many with underlying chronic hypertension, and approximately 1-2% will undergo a hypertensive crisis at some point during their lives. Hypertensive crisis includes hypertensive urgency and emergency; the American College of Obstetricians and Gynecologists describes a hypertensive emergency in pregnancy as persistent (lasting 15 min or more), acute-onset, severe hypertension, defined as systolic BP greater than 160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia. Pregnancy may be complicated by hypertensive crisis, with lower blood pressure threshold for end-organ damage than non-pregnant patients. Maternal assessment should include a thorough history. Fetal assessment should include heart rate tracing, ultrasound for growth and amniotic assessment, and Doppler evaluation if growth restriction is suspected. Initial management of hypertensive emergency (systolic BP >160 mmHg or diastolic BP >110 mmHg in the setting of pre-eclampsia or eclampsia) generally includes the rapid reduction of blood pressure through the use of intravenous antihypertensive medications, with goal systolic blood pressure between 140 mmHg and 150 mmHg and diastolic pressure between 90 mmHg and 100 mmHg. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, nifedipine, and, as a last resort, sodium nitroprusside. Among patients with hypertensive urgency, slower blood pressure reduction can be provided with oral agents. The objective of this article is to review the current understanding, diagnosis, and management of hypertensive crisis during pregnancy and the postpartum period. PMID:23916027
Too, Gloria T; Hill, James B
During the postpartum period, women frequently report increased fatigue, which, if severe, may interfere with maternal-child\\u000a bonding, delay a new mother’s return to her activities of daily living, and contribute to depression. Several studies have\\u000a sought to determine psychosocial contributions to fatigue during the postpartum period, but few evaluate any physiological\\u000a changes that may contribute to fatigue during this time.
Elizabeth J. Corwin; Ingrid Bozoky; Linda C. Pugh; Nancy Johnston
Nontraumatic hemothorax is a rare cause of postpartum respiratory distress. We present a case of massive spontaneous hemothorax, which presented during the immediate postpartum period and was initially treated as pulmonary embolism. Further investigation revealed a tiny lung nodule: although pulmonary arteriovenous malformation was considered, the imaging appearances tended to counter this interpretation. Eventually, in the absence of another cause for spontaneous hemothorax, on either clinical or imaging grounds, we diagnosed spontaneous arteriovenous malformation. Its management is discussed herein.
Doshi, Harikrishna M.; Robinson, Stuart; Chalhoub, Tony; Jack, Stuart; Denison, Alan; Gibson, George
Objective?To investigate potential predictive symptoms of late postpartum eclampsia (LPE). Study Design?Retrospective review of patients delivered at a single academic medical center and diagnosed with eclampsia greater than 48 hours postdelivery. Results?Among 19 patients with eclampsia, 5 (26%) patients with confirmed eclampsia seized greater than 48 hours after delivery. None of these patients showed evidence of preeclampsia intrapartum or immediately postpartum and none received intrapartum magnesium sulfate. Prior to seizure activity, 4 of 5 (80%) patients had increased blood pressure and 2 of 5 (40%) had central nervous system symptoms (headache and visual changes). Conclusion?Gestational hypertension (GHTN) may be a risk factor for LPE. Consideration of seizure prophylaxis for patients with GHTN may facilitate the prevention of LPE. PMID:23943702
Wolfe, Diana S; Williams, Shauna F; Ross, Michael G; Beall, Marie H; Apuzzio, Joseph J
The purpose of this study was to explore the cultural practices and beliefs of the Hmong in the postpartum period. Using the qualitative research method of in-depth interviewing, data were collected through semistructured interviews. A convenience sample of 52 childbearing Hmong women was interviewed with the help of Hmong interpreters. The interviews were audiotaped and transcribed for analysis. Data analysis revealed cultural practices and beliefs categories related to diet, rest period, appropriate clothing, breast feeding, and sex practices in the postpartum period. Implications for nursing include both cultural sensitivity and an understanding of such traditional practices, before suggesting or implementing any health-promotion activities. PMID:7633342
Summary The majority of women who quit smoking during pregnancy will resume smoking during the postpartum period. Little is known, however, about the predictors of postpartum relapses to smoking. Changes in mood and increases in concerns about weight are common during the postpartum period, and these factors may affect women’s postpartum smoking behavior. In this paper, we present a model
M. D. Levine; M. D. Marcus
Introduction. Eclampsia is the combination of preeclampsia and seizures. Approximately one-half of all cases of eclampsia occur postpartum. Thereby late onset postpartum eclampsia is defined by its onset more than 48 hours after delivery. Summary of Case. We report a postpartum eclampsia occurring 8 weeks after delivery, which is the latest onset ever described. The course was complicated by an intracerebral hemorrhage (ICH). Conclusion. A late onset postpartum eclampsia even several weeks after delivery should be considered as possible diagnosis, since early treatment initiation with magnesium sulphate and antihypertensive medication prevents severe complications and reduces mortality.
Minnerup, Jens; Kleffner, Ilka; Wersching, Heike; Zimmermann, Julian; Schabitz, Wolf-Rudiger; Niederstadt, Thomas; Dziewas, Rainer
Maternal behavior in rats undergoes considerable plasticity in parallel to the developmental stage of the pups, resulting in distinct patterns of maternal behavior and care at different postpartum time points. The medial preoptic area (mPOA) of the hypothalamus is one critical neural substrate underlying the onset and early expression of maternal behavior in rats but little is known about its specific functional role in the evolving expression of maternal behavior across the postpartum period. The present study uses a reversible local neural inactivation method to examine the role of the mPOA in the regulation of maternal behavior throughout the postpartum period, particularly extending into the late postpartum, a little examined period. This approach avoids the compensatory plasticity in CNS that occurs after permanent lesions, and allows the repeated testing of same individuals. Early (PPD7-8) and late (PPD 13-14) postpartum maternal behavior was evaluated in female rats following infusions of bupivacaine or vehicle into the mPOA or into control areas. As expected, mPOA inactivation severely but transiently disrupted early postpartum maternal behavior whereas infusion of vehicle or inactivation of adjacent control sites did not. Later in the postpartum period, however, transient mPOA inactivation facilitates the expression of maternal behaviors, highly contrasting the behavioral expression levels characteristic of late postpartum. Results strongly demonstrate that the mPOA is differentially engaged throughout postpartum in orchestrating appropriate maternal responses with the developmental stage of the pups.
Pereira, Mariana; Morrell, Joan I.
Unplanned, adverse events during labor or delivery may generate a negative response during the early postpartum period, resulting\\u000a in disruption of usual functioning and mood. High levels of maternal depressive symptoms are associated with parenting, infant\\u000a attachment, behavioral problems and cognition (Beck 2002). The purpose of this study was to examine the relationship of adverse events in labor or delivery
Diane F. Hunker; Thelma E. Patrick; Susan A. Albrecht; Katherine L. Wisner
We report the case of a 42-year-old patient with hypertrophic cardiomyopathy (HCM) who presented to the emergency department with severe shortness of breath one week following uneventful cesarean delivery. Thoracic CT ruled out pulmonary embolus and confirmed pulmonary edema. Asymmetric interventricular septal thickening was clearly identified, demonstrating that the heart may be evaluated even on a non-ECG gated study. Acute pulmonary edema in the postpartum period is an unusual clinical presentation of HCM.
Nguyen, Elsie T.; Crean, Andrew M.
This study evaluated the relationship between sleep quality in late pregnancy and recurrence of postpartum major depression (PPMD) through 28 weeks postpartum. The Pittsburgh Sleep Quality Index (PSQI) at 36 weeks gestation was assessed in 51 non-depressed women with a history of PPMD; recurrence was determined by the 21-item Hamilton Rating Scale for Depression and the Schedule for Affective Disorders
Michele L. Okun; Barbara H. Hanusa; Martica Hall; Katherine L. Wisner
Although difficult infant temperament has been associated with maternal postpartum anxiety and depressed mood in later infancy, the emergence of this association in the early postpartum period has not been explored. In a survey study of 296 mothers of healthy term newborns during the first postpartum month, the relationship of infant temperament with maternal anxiety and depressed mood was explored.
John R. Britton
The parental killing of children constitutes a complex phenomenon which has been reported across numerous cultures and throughout history. Children in the 1st year of life are at the highest risk of filicide. Types of filicide in the postpartum period include altruistic filicide, extended suicide, fatal child maltreatment, and neonaticide. Babies are murdered more frequently by mothers who are psychiatrically disturbed. With high frequency, depressive and psychotic symptoms are related to the newborn or to the maternity itself. The knowledge about maternal factors associated with filicide is not homogeneous. Sociodemographic characteristics are presented in relation to the different types of filicide. Risk constellations that may lead to a child's murder are described. PMID:17926015
Trautmann-Villalba, P; Hornstein, C
Because women in the childbearing years are vulnerable to mood and anxiety disorders, physi- cians in all patient care specialties need to be fa- miliar with the prevalence and course of these disorders, particularly during pregnancy and the postpartum period. Systematic prospective data are limited on the onset of mood and anxiety dis- orders during pregnancy and the postpartum pe-
Lori L. Altshuler; Victoria Hendrick; Lee S. Cohen
This study evaluated the relationship between sleep quality in late pregnancy and recurrence of postpartum major depression (PPMD) through 28 weeks postpartum. The Pittsburgh Sleep Quality Index (PSQI) at 36 weeks gestation was assessed in 51 non-depressed women with a history of PPMD; recurrence was determined by the 21-item Hamilton Rating Scale for Depression and the Schedule for Affective Disorders and Schizophrenia. Sleep quality in late pregnancy was not related to recurrence per se, but it was related to timing of recurrence (Kruskal-Wallace = 9.78, p = .008). Rapid recurrence (within 4 weeks post delivery) was preceded by fewer sleep complaints (mean PSQI for early recurrers = 4.8 vs. 7.3 for non-recurrers, p = .09). Recurrence after 4 weeks postpartum was preceded by more sleep complaints in late pregnancy (mean PSQI for late recurrers = 9.9 vs. 7.3 for non-recurrers, p = .02). Sleep quality in late pregnancy may help in identifying women at risk for a PPMD recurrence. PMID:19330583
Okun, Michele L; Hanusa, Barbara H; Hall, Martica; Wisner, Katherine L
Numerous studies have investigated the deleterious effects of maternal depression on child outcomes. Knowledge of characteristics of these mothers is incomplete, as most studies utilize small samples or limit investigation to the postpartum period. Utilizing data from a nationally representative sample of 7,211 fathers and mothers living in households with children aged 5-17 years who participated in the Medical Expenditure Panel Survey (MEPS) 2004-2006, the Patient Health Questionnaire-2 (PHQ-2) was used to assess parental depressive symptoms, the Short Form-12 (SF-12) was used to examine paternal and maternal physical health, and the Columbia Impairment Scale was used to measure child behavioral or emotional problems. In multivariate analyses, maternal unemployment (AOR 1.76, 95 % CI 1.31-2.35); living with smokers (AOR 1.82, 95 % CI 1.12-2.94); poor maternal physical health (AOR 2.31; 95 % CI 1.81-2.94); living with children with behavioral or emotional problems (AOR 2.95, 95 % CI 2.30-3.96); and paternal depressive symptoms (AOR 5.11, 95 % CI 1.97-13.25) each were independently associated with increased rates of maternal depressive symptoms. This paper is the first we are aware of to use a nationally representative sample to investigate characteristics associated with maternal depressive symptoms and found that maternal unemployment, living with smokers, poor maternal physical health, having children with behavioral or emotional problems, and paternal depressive symptoms are each independently associated with maternal depressive symptoms. In these data, paternal depressive symptoms are associated with the greatest risk of mothers exhibiting depressive symptoms, a finding that we believe has never before been shown. PMID:22878534
Rosenthal, David G; Learned, Nicole; Liu, Ying-Hua; Weitzman, Michael
Stroke in pregnancy and the puerperium is a rare but potentially devastating event. We present the case of a previously healthy woman who underwent a cesarean delivery and experienced a middle cerebral artery thrombosis in the immediate postpartum period that was subsequently lysed with intra-arterial urokinase. The patient made a complete neurologic recovery. To the best of our knowledge, this is the first reported case of successful intra-arterial thrombolysis for ischemic stroke in the postpartum period.
Mendez, Jose C. [Hospital Universitario Ramon y Cajal, Department of Neuroradiology (Spain)], E-mail: firstname.lastname@example.org; Masjuan, J.; Garcia, N.; Lecinana, M. de [Hospital Universitario Ramon y Cajal, Department of Neurology (Spain)
Three cases of stenosing tenosynovitis occurred three to six months postpartum. Childcare activities aggravated the symptoms of pain and swelling in both patients. In two cases, a specific method of carrying the child was implicated as the mechanism of injury. Although there was no evidence of generalized inflammatory arthritis, all patients had very low positive titres of anti-nuclear antibodies. While
James L Cosgrove; Dan A Welch; George S Richardson; John J Nicholas
Background Several studies have shown a prolonged or increased susceptibility to malaria in the post-partum period. A matched cohort study was conducted to evaluate prospectively the susceptibility to malaria of post-partum women in an area where P.falciparum and P.vivax are prevalent. Methods In an area of low seasonal malaria transmission on the Thai-Myanmar border pregnant women attending antenatal clinics were matched to a non-pregnant, non-post-partum control and followed up prospectively until 12 weeks after delivery. Results Post-partum women (n?=?744) experienced significantly less P.falciparum episodes than controls (hazard ratio (HR) 0.39 (95%CI 0.21–0.72) p?=?0.003) but significantly more P.vivax (HR 1.34 (1.05–1.72) p?=?0.018). The reduced risk of falciparum malaria was accounted for by reduced exposure, whereas a history of P.vivax infection during pregnancy was a strong risk factor for P.vivax in post-partum women (HR 13.98 (9.13–21.41), p<0.001). After controlling for effect modification by history of P.vivax, post-partum women were not more susceptible to P.vivax than controls (HR: 0.33 (0.21–0.51), p<0.001). Genotyping of pre-and post-partum infections (n??=??10) showed that each post-partum P.falciparum was a newly acquired infection. Conclusions In this area of low seasonal malaria transmission post-partum women were less likely to develop falciparum malaria but more likely to develop vivax malaria than controls. This was explained by reduced risk of exposure and increased risk of relapse, respectively. There was no evidence for altered susceptibility to malaria in the post-partum period. The treatment of vivax malaria during and immediately after pregnancy needs to be improved.
Boel, Machteld E.; Rijken, Marcus J.; Leenstra, Tjalling; Pyae Phyo, Aung; Pimanpanarak, Mupawjay; Keereecharoen, Naw Lily; Proux, Stephane; Laochan, Natthapon; Imwong, Mallika; Singhasivanon, Pratap; White, Nicholas J.; McGready, Rose; Nosten, Francois H.
Regulatory T cells (Treg cells) are an important area of investigation in human health and disease. In this study, the trajectory of percentage of Treg cells (defined as CD4+CD25+Foxp3+CD127? lymphocytes) was measured in the blood of 208 women during pregnancy and up to three additional times in the postpartum period (1, 6 and 12 months postpartum). Whether the trajectory was
Ganesa Wegienka; Suzanne Havstad; Kevin R. Bobbitt; Kimberley J. Woodcroft; Edward M. Zoratti; Dennis R. Ownby; Christine Cole Johnson
Abstract Objective To explore the association between healthcare provider advice about weight loss and physical activity in the postpartum period and weight retention and activity levels in women assessed at 3 months postpartum. Methods Using data from a prospective cohort study, we explored the association of advice with postpartum weight retention and activity levels in 688 women at 3 months postpartum. Data from home visits included anthropometric measurements and information collected from sociodemographic, health behavior, and psychosocial questionnaires. Weight retention was calculated as weight at 3 months postpartum minus prepregnancy weight; activity levels and advice were based on maternal self-report. Linear regression and Poisson regression were used to explore associations. Results The majority of the population was white (76%), had a greater than high school education (83%), and had an income >185% of the federal poverty level (81%). Women ranged in age from 17 to 48 years. Most women reported receiving no weight loss (89.1%) and no physical activity advice (77.4%) from a healthcare provider during the 3-month postpartum period. After adjustment, we found no association between provider advice and weight retention. When compared with those who reported no advice, following provider advice showed an association with recreational activity above the median (RR 1.50, 95% confidence interval [CI] 1.24, 1.80). Conclusions Provider advice may influence physical activity but may not be enough to help postpartum women lose pregnancy weight. Instead, women may benefit more from individualized counseling and follow-up beyond the usual 6-week postpartum visit.
Ferrari, Renee M.; Evenson, Kelly R.; Moos, Merry-K.; Melvin, Cathy L.; Herring, Amy H.
In two patients eclampsia started 9 days postpartum. Headache and visual disturbances preceded seizures but none of the classic pre-eclamptic signs oedema, proteinuria, and hypertension were present until shortly before seizure onset. Brain herniation (patient 1) and status epilepticus (patient 2) necessitated neurointensive care management. Brain MRI initially showed only frontal sulcal effacement in one patient but later showed white matter hyperintensities on T2 weighted images and a previously undescribed pattern of cortical-subcortical postgadolinium enhancement on T1 weighted images in both. Neurological deficits and MRI findings were reversed with therapy in both patients. It is concluded that late postpartum eclampsia can manifest without classic prodromi and that characteristic MRI findings may lag behind clinical manifestation.??
Veltkamp, R; Kupsch, A; Polasek, J; Yousry, T; Pfister, H
The potential harms of herbs to the pregnant mothers and their foetuses as well as the effect of herbs taken by nursing mothers on their babies remain largely unknown. Common perception is that herbal medicines ingestion during pregnancy and confinement period is a common practice among multi-racial Malaysian mothers. The purpose of this study was to explore the usage of herbal medicines during pregnancy and post-partum period among mothers who gave birth at a tertiary hospital in a metropolitan city of Malaysia. This cross sectional study was conducted between October and December 2010. The subjects were interviewed twice after giving birth: before hospital discharge and 6 to 8 weeks later. A total of 323 mothers were recruited for this study. The prevalence of herbs ingestion during pregnancy was 13.9%, with half of the users consuming it during the first trimester. A total of 163 (52.9%) mothers ingested herbs during the post-partum period. Significantly more Chinese (p=0.01) and Malay (p=0.04) mothers ingested herbs during pregnancy and post-partum period, respectively. Infants of mothers who ingested herbs had a higher rate of neonatal jaundice compared to infants of mothers who did not ingest herbs during the post-partum period (P=0.001). PMID:23629564
Teoh, C S; M H I, Aizul; W M, Wan Fatimah Suriyani; Ang, S H; M Z, Nurul Huda; M I, Nor Azlinl; J, Rohana
The findings from two studies, surveys of hospitals and community health units in Alberta, Canada, to determine the policies, procedures and content related to postpartum teaching are presented in this paper. While content covered was extensive the limited time available for teaching suggested that material would have to be presented at a superficial level, with little time for reinforcement. The average time for a home visit by the nurse was 7-12 days post-discharge and in some instances staff shortages precluded a second visit. The most frequent reason for follow-up visits in the community was problems with newborn feeding. Volunteer services in the community, such as the La Lêche League, were frequently not recommended to mothers by hospital nurses, so breastfeeding mothers were left without support at a critical time. While the study did not support the mother's contention in an earlier study that they did not receive information, the lack of opportunity for expansion and reinforcement of provided information would mitigate against adequate maternal education. PMID:1894461
Field, P A; Renfrew, M
The effect of maternal attempt to lose weight during the postpartum period on later child weight has not been explored. Among 1,044 mother–infant pairs in Project Viva, we estimated longitudinal associations of maternal attempt to lose weight during the postpartum period with child weight and adiposity at age 3 years and examined differences in associations by type of weight loss
Kendrin R. Sonneville; Sheryl L. Rifas-Shiman; Emily Oken; Karen E. Peterson; Steven L. Gortmaker; Matthew W. Gillman; Elsie M. Taveras
The relationship between fatigue and depression in the postpartum period has been of interest to researchers and clinicians. However, conceptual and measurement issues of how to best assess and clearly distinguish between fatigue and depressive symptoms have plagued this work. The aim of the current study was to assess the discriminant validity between fatigue and depression in a community sample
Rebecca Giallo; Catherine Wade; Amanda Cooklin; Natalie Rose
This study was aimed at identifying practices during the menstrual, partum and postpartum periods posing possible risk factors contributing towards secondary infertility in women of a selected popu- lation in Karachi, Pakistan. A matched case-control study was conducted from April 2003 to March 2004. Four hundred cases were selected from five infertility clinics affiliated with tertiary-care hospitals, and 400 age-matched
Tazeen Saeed Ali; Neelofar Sami; Ali Khan Khuwaja
A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal\\u000a veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed\\u000a to involve inferior vena cava and right ventricle. A diagnosis of Behçet’s disease was made on the clinical grounds of fever,\\u000a night sweats, and recurrent
Prashant Hiwarkar; Roberto Stasi; George Sutherland; Muriel Shannon
As well as having widespread effects on many aspects of mammalian physiology, the hormones of both the reproductive and stress axes can directly and indirectly influence behavior. Here we review possible mechanisms through which centrally active hormones of the female reproductive system and the hypothalamo-pituitary-adrenal stress axis may interact to influence behavior and mood states during the post-partum period. We
C. Sue Carter; Margaret Altemus; George Pchrousos
\\u000a \\u000a Background: Intracerebral hemorrhage (ICH) is one of the most common causes of maternal deaths related to the postpartum period. This\\u000a is a devastating form of stroke for which there is no available treatment. Although premenopausal females tend to have better\\u000a outcomes after most forms of brain injury, the effects of pregnancy and child birth lead to wide maternal physiological changes
Tim Lekic; Robert P. Ostrowski; Hidenori Suzuki; Anatol Manaenko; William Rolland; Nancy Fathali; Jiping Tang; John H. Zhang
Plasma levels of cocaine (COC) and two of its principle metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME) were determined by liquid chromatography–tandem mass spectrometry (LC/MS/MS) in samples collected up to 3 h after a subcutaneous injection of cocaine (10 mg/kg) on six different days between days 4 and 24 postpartum, a period of dramatic change in the endocrine state of the female rat. Locomotor activity was measured in the same animals during this period using automated animal activity monitors. Additional measures in males provide a link to existing literature. We found that plasma levels of cocaine and its metabolites, as well as their respective time courses, are remarkably uniform across the postpartum period in female rats, as are the effects of cocaine on locomotor activity. Data from males show accord with prior published values. COC and BE, but not EME levels, were higher in males, and the time courses of COC and BE levels after injection varied somewhat between postpartum females and males; however, neither baseline nor cocaine-induced locomotor activity differed between postpartum females and males. We conclude that in the postpartum rat, there are no significant differences in the peripheral processing or general accessibility of cocaine to the brain to activate motor systems across the postpartum period. These data are critical to our understanding of differences in the reward salience of cocaine across the postpartum period and in other adult rat models [Mattson BJ, Williams S, Rosenblatt JS, Morrell JI. Comparison of two positive reinforcing stimuli: pups and cocaine throughout the postpartum period. Behav Neurosci 2001;115:683–94, Mattson BJ, Williams SE, Rosenblatt JS, Morrell JI. Preferences for cocaine- or pup-associated chambers differentiate otherwise behaviorally identical postpartum maternal rats.
Wansaw, Michael P.; Lin, Shen-Nan; Morrell, Joan I.
The serum concentrations of the total thyroxine-binding globulin (TBGt), its pregnancy-associated molecular variant (TBG-1), thyroxine, progesterone, estradiol, and prolactin were measured by radioimmunoassay in the course of the postpartum period (0-40 days) in women. High serum TBG-1 concentrations (an average of 36% of the level observed at the time of delivery) were unexpectedly detected in the late postpartum period (days 36-40) when the concentrations of TBGt, thyroxine, estradiol and progesterone were within normal. The presence of TBG-1 in the maternal blood for a long time after delivery may be caused by estrogen-dependent synthesis and secretion rather than by its slow clearance from the blood. PMID:2127845
Sviridov, O V; Kiseleva, E E; Ermolenko, M N; Shilko, A N; Borodina, E I
Adjusting to the role of mother, a creative and joyous change for most women, combines with simultaneous physiological and psychological changes to develop into psychiatric problems in some women. Three common syndromes during the postpartum period are postpartum blues, postpartum depression, and postpartum psychosis. Any postpartum condition should be diagnosed rapidly to prevent short- and long-term disorders.
Misri, Shaila; Burgmann, Allan J.F.
In postpartum beef cows, GnRH-induced ovulation of small dominant follicles decreased pregnancy rates and increased late embryonic/fetal mortality; however, ovulatory follicle size had no apparent effect on the establishment or maintenance of pregnancy when ovulation occurred spontaneously. Further...
Where the non-human animal research investigating reproduction-induced cognitive reorganization has focused on neural plasticity and adaptive advantage in response to the demands associated with pregnancy and parenting, human studies have primarily concentrated on pregnancy-induced memory decline. The current review updates Henry and Rendell's 2007 meta-analysis, and examines cognitive reorganization as the result of reproductive experience from an adaptationist perspective. Investigations of pregnancy-induced cognitive change in human females may benefit by focusing on areas, such as social cognition, where a cognitive advantage would serve a protective function, and by extending the study duration beyond pregnancy into the postpartum period. PMID:23052608
Anderson, Marla V; Rutherford, Mel D
Clinical observations indicate that some autoimmune dis- eases, such as rheumatoid arthritis and multiple sclerosis, frequently remit during pregnancy but exacerbate, or have their onset, in the postpartum period. The immune basis for these phenomena is poorly understood. Recently, excessive production of IL-12 and TNF- was causally linked to rheu- matoid arthritis and multiple sclerosis. We studied 18 women with
ILIA J. ELENKOV; RONALD L. WILDER; VLADIMIR K. BAKALOV; AMREY A. LINK; MARIANA A. DIMITROV; SCOTT FISHER; MARIANNA CRANE; KEITH S. KANIK; GEORGE P. CHROUSOS
The prevalence of anaemia during pregnancy and post partum is according to the literature and many years clinical experience high. In the submitted work we investigated the incidence of sideropenic anaemia in women during the first three months after a spontaneous delivery, changes of clinical and laboratory indicators of anaemia during this period and the possible effect exerted by administration of iron and iron plus folic acid resp. Ninety pregnant women in the 35th to 39th week of pregnancy were at random divided into three equally sized groups and the following were assessed: haemogram, indicators of iron reserves, serum concentrations of folic acid, vitamin B12, erythropoetin and soluble transferrin receptor, liver tests, total protein + electrophoresis, acute stage proteins. In the first group (T) the women were given, starting on the 4th day after delivery 1 tablet of Tardyferon per day for two months. To the second group (F) for an equal period 1 tablet of Tardyferon Fol per day was administered. Women in the control group (K) had no medication. In the investigation women with medium and severe pregnancy anaemia were not included nor women taking during pregnancy or previously iron preparations or those treated in the past by blood transfusion. After spontaneous delivery (women who had Caesarean section or forceps delivery were eliminated from the study) the women were subjected to the same examinations as before delivery. These examinations were made on the fourth day after delivery and then after monthly intervals for a period of three months. At the same time the subjective condition of the mothers was evaluated after delivery, focused on the development of symptoms typical for anaemia and the possible effect of administered treatment. The investigation was completed by 60 women. During treatment no allergic or other serious side-reactions to the administered drugs calling for discontinuation of treatment were recorded. The results of the investigation proved that laboratory and clinical indicators of post-partum anaemia reached more quickly normal values in women treated with iron preparations. The authors did not detect a single and supreme marker of sideropenic anaemia in the early post-partum period. This is one of the reasons why the authors recommend iron administration to all women after spontaneous delivery. In the authors' opinion examination of the blood count on the fourth day and assessment of the serum ferritin concentration one month after a spontaneous delivery in selected mothers (e.g. after an above average peripartal blood loss) is desirable. Addition of folic acid to iron is of no special value during the post-partum period. Iron substitution in women after spontaneous delivery should be, with regard to the long persisting sideropenia, administered at least for three months. The dose of 80 mg elemental iron per day is sufficient for mild or medium post-partum anaemia. Addition of mucoprotease and ascorbic acid to iron preparations is useful because it increases the compliance of the patients and thus also its effectiveness. The preparation Tardyferon meets the above criteria and is therefore a good choice for the treatment of post-partum anaemia. PMID:10568044
Mára, M; Eretová, V; Zivný, J; Kvasnicka, J; Umlaufová, A; Márová, E
L-arginine is an amino acid which can alter pituitary function and increase blood flow to the reproductive tract. The objective was to determine the effect of supplementing 100g of L-arginine on plasma arginine concentrations, follicular dynamics and ovarian and uterine artery blood flow during the estrus that occurs subsequent to foaling. In Experiment 1, mares were fed 100g L-arginine for 1 day during the last 3 weeks of pregnancy and plasma samples taken for every hour for the first 4h and every other hour until 12h.L-arginine supplementation elevated plasma arginine concentrations from 1 to 8h post feeding; arginine peaked at 6h (arginine: 515±33?mol/L; control: 80±33?mol/L). In Experiment 2, mares received either 100g L-arginine or control diets beginning 21 d before the expected foaling date and continued for 30 d postpartum. The reproductive tract was evaluated by transrectal Doppler ultrasonography from Day 1 postpartum through Day 30. There were no differences in ovarian follicular dynamics, ovarian or uterine resistance indices between groups. Vascular perfusion of the F1 follicular wall was greater in L-arginine supplemented mares (37.3±2.6%) than controls (25.4±2.7%; P<0.05). L-arginine supplemented mares had a smaller uterine body and horns and accumulated less uterine fluid than controls (P<0.05). The combination of reducing uterine fluid accumulation, while not altering follicular development, raises the possible use of L-arginine supplementation as a breeding management tool during the postpartum period to increase reproductive success. PMID:23523236
Kelley, Dale E; Warren, Lori K; Mortensen, Christopher J
Although suicide is a leading cause of death among new mothers during the postpartum period, there has been limited research on self-harm in the postpartum period and associated risk factors. One potential risk factor for suicidality (completed suicides, suicide attempts, and suicide ideation including thoughts of self harm) during the postpartum period is postpartum depression (PPD). In this study of women who gave birth for the first time between 1 January 2007 and 31 December 2011, 5,267 (9.9% of all who delivered) active component service women and 10,301 (8.2%) dependent spouses received incident PPD diagnoses during the one year postpartum period; 213 (0.4%) service women and 221 (0.2%) dependent spouses were diagnosed with incident suicidality. After adjusting for the effects of other covariates, service women with PPD had 42.2 times the odds to be diagnosed with suicidality in the postpartum period compared to service women without PPD; dependent spouses with PPD had 14.5 times the odds compared to those without PPD. The findings of this report suggest that a history of mental disorders was common among service women and dependent spouses with PPD in the postpartum period, and, in turn, PPD was a strong predictor for suicidality in the postpartum period. These results emphasize the importance of PPD screening during the postpartum period. They also suggest that additional focused screening for suicidal behavior among those already diagnosed with PPD may be warranted. PMID:24093957
Do, Tai; Otto, Jean; Rohrbeck, Patricia
Women with gestational diabetes mellitus (GDM) have a substantial risk of subsequently developing type 2 diabetes. This risk may be mitigated by engaging in healthy eating, physical activity, and weight loss when indicated. Since postpartum depressive symptoms may impair a woman's ability to engage in lifestyle changes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent GDM. The participants are part of the baseline cohort of the TEAM GDM (Taking Early Action for Mothers with Gestational Diabetes Mellitus) study, a one-year randomized trial of a lifestyle intervention program for women with a recent history of GDM, conducted in Boston, Massachusetts between June 2010 and September 2012. We administered the Edinburgh Postnatal Depression Scale (EPDS) at 4-15 weeks postpartum to women whose most recent pregnancy was complicated by GDM (confirmed by laboratory data or medical record review). An EPDS score ?9 indicated depressive symptoms. We measured height and thyroid stimulating hormone, and administered a questionnaire to collect demographic data and information about breastfeeding and sleep. We calculated body mass index (BMI) using self-reported pre-pregnancy weight and measured height. We reviewed medical records to obtain data about medical history, including history of depression, mode of delivery, and insulin use during pregnancy. We conducted bivariable analyses to identify correlates of postpartum depressive symptoms, and then modeled the odds of postpartum depressive symptoms using multivariable logistic regression. Our study included 71 women (mean age 33 years ± 5; 59 % White, 28 % African-American, 13 % Asian, with 21 % identifying as Hispanic; mean pre-pregnancy BMI 30 kg/m(2) ± 6). Thirty-four percent of the women scored ?9 on the EPDS at the postpartum visit. In the best fit model, factors associated with depressive symptoms at 6 weeks postpartum included cesarean delivery (aOR 4.32, 95 % CI 1.46, 13.99) and gestational weight gain (aOR 1.21 [1.02, 1.46], for each additional 5 lbs gained). Use of insulin during pregnancy, breastfeeding, personal history of depression, and lack of a partner were not retained in the model. Identifying factors associated with postpartum depression in women with GDM is important since depression may interfere with lifestyle change efforts in the postpartum period. In this study, cesarean delivery and greater gestational weight gain were correlated with postpartum depressive symptoms among women with recent GDM (Clinicaltrials.gov NCT01158131). PMID:23124798
Nicklas, Jacinda M; Miller, Laura J; Zera, Chloe A; Davis, Roger B; Levkoff, Sue E; Seely, Ellen W
Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income women's experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Women's experiences indicated altered
Bobbie Sue Sterling; Eileen R. Fowles; Alexandra A. Garcia; Sandra K. Jenkins; Susan Wilkinson; Minseong Kim; Sunghun Kim; Lara Latimer; Lorraine O. Walker
Background Zuo yuezi is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of zuo yuezi from social, cultural and western medical perspectives. Methods We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional beliefs and their behaviour postpartum. We used a framework approach to identify main themes. We categorised reported behaviour against their probable effects on health, drawing on Western standards. Results Respondents reported that zuo yuezi was commonly practiced in urban and rural families to help the mother regain her strength and protect her future health. Zuo yuezi included: dietary precautions, such as eating more food and avoiding cold food; behavioural precautions, such as staying inside the home, avoiding housework and limiting visitors; hygiene precautions, such as restricting bathing and dental hygiene; and practices associated with infant feeding, including supplementary feeding and giving honeysuckle herb to the infant. Respondents reported that the main reasons for adhering to these practices were respect for tradition, and following the advice of elders. Categorised against Western medical standards, several zuo yuezi practices are beneficial, including eating more, eating protein rich food, avoiding housework, and daily vulval and perineal hygiene. A few are potentially harmful, including giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants supplementary feeds, although zuo yuezi emphasises breast feeding. Conclusion Zuo yuezi is an important ritual in Fujian. In medical terms, most practices are beneficial, and could be used by health staff to promote health in this period. Further research on reported potentially harmful practices, such as supplements to breast feeding, is needed.
Raven, Joanna H; Chen, Qiyan; Tolhurst, Rachel J; Garner, Paul
Background: Factors affecting bone calcium deposition across pregnancy and lactation are not well characterized. Objective: The impact of maternal age, calcium intake, race-ethnicity, and vitamin D status on the rate of bone calcium deposition (VO+) was assessed across pregnancy and lactation. Design: Stable calcium isotopes were given to 46 women at pre- or early pregnancy (trimester 1), late pregnancy (trimester 3), and 3–10 wk postpartum. Three cohorts were included: 23 adolescents from Baltimore (MD), aged 16.5 ± 1.4 y (mean ± SD; Baltimore cohort); 13 adults from California, aged 29.5 ± 2.6 y (California cohort); and 10 adults from Brazil, aged 30.4 ± 4.0 y (Brazil cohort). The total exchangeable calcium pool, VO+, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D [1,25(OH)2D], parathyroid hormone, and calcium intake were evaluated. Results: At trimester 3, inverse associations between 1,25(OH)2D and VO+ were evident in the Baltimore (P = 0.059) and Brazil (P = 0.008) cohorts and in the whole group (P = 0.029); calcium intake was not a significant determinant of VO+ in any group during pregnancy. At postpartum, a significant positive association was evident between VO+ and calcium intake (P ? 0.002) and between VO+ and African ethnicity (P ? 0.004) in the whole group and within the Baltimore and Brazil cohorts. Conclusions: Elevated 1,25(OH)2D was associated with decreased rates of bone calcium deposition during late pregnancy, a finding that was particularly evident in pregnant adolescents and adult women with low calcium intakes. Higher dietary calcium intakes and African ethnicity were associated with elevated rates of bone calcium deposition in the postpartum period.
O'Brien, Kimberly O; Donangelo, Carmen M; Ritchie, Lorrene D; Gildengorin, Ginny; Abrams, Steve
The researchers' aims were to estimate the prevalence of postpartum depressive symptoms in Italy. Cross-sectional data from the survey, “Health and use of health care in Italy” were analyzed. The authors focused on 5,812 women, pregnant some time during five years before the survey. Multiple logistic regression was used to evaluate risk factors independently associated with postpartum depressive symptoms. Evaluation
Pamela Barbadoro; Giordano Cotichelli; Carlos Chiatti; Maria Luisa Simonetti; Anna Marigliano; Francesco Di Stanislao; Emilia Prospero
Summary Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is\\u000a experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum\\u000a fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they\\u000a have not yet identified a means
J. J. Runquist
Purpose Postpartum depression (PPD) stands out as an important health issue that affects not only the mother but her partner and the\\u000a entire family.\\u000a \\u000a \\u000a A few studies from Turkey have found the high prevalence for PPD. In the current study we aimed: (1) to report the prevalence\\u000a of postpartum depression among Turkish women in Manisa province; (2) description of the association
Ferda Özba?aran; Ayden Çoban; Mert Kucuk
Background The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively. Methods A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable. Results Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality. Conclusions There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.
Summary Objective: To identify depressive moods as measured by the Edinburgh Postnatal Depression Scale in late pregnancy and postpartum, explore\\u000a associated factors and assess changes in depressive moods.\\u000a \\u000a Methods: A cohort study of 610 pregnant Thai women was conducted. The self-reporting EPDS was completed at 36–40 weeks and at 6–8\\u000a weeks postpartum.\\u000a \\u000a \\u000a \\u000a Result: The prevalence of depressive moods (scores of 10
N. Limlomwongse; T. Liabsuetrakul
Studies carried out to support the existence of a critical period for language acquisition have concentrated mainly on the case of being in total deprivation from language contact, and in particular deprivation from auditory input in the entire time span before puberty. While arguing for a useful distinction between early and late critical…
Gheitury, Amer; Sahraee, Ahmad Hosein; Hoseini, Maryam
Late Antiquity as a period has a complex history with moments when the issues pertaining to it seem to intensify. One of these was without a doubt the aftermath of World War I and reached its apex in 1923 during the International Congress of Historical Sciences in Brussels. The tragic events that had shaken Europe had a deep impact on
|Studies carried out to support the existence of a critical period for language acquisition have concentrated mainly on the case of being in total deprivation from language contact, and in particular deprivation from auditory input in the entire time span before puberty. While arguing for a useful distinction between early and late critical…
Gheitury, Amer; Sahraee, Ahmad Hosein; Hoseini, Maryam
Summary \\u000a Objective: To study prevalence as well as risk factors for pregnancy and postpartum depression in a sample of adolescent and adult Portuguese\\u000a mothers.\\u000a \\u000a \\u000a Methods: The Edinburgh Postnatal Depression Scale (EPDS) was administered to 108 (54 adult and 54 adolescent) Portuguese women at\\u000a 24–36 weeks of pregnancy and at 2–3 months postpartum.\\u000a \\u000a \\u000a \\u000a \\u000a Results: Rates for EPDS > 12 are high
B. Figueiredo; A. Pacheco; R. Costa
The electrolyte composition of breast milk beyond 6 months postpartum has not been extensively examined, particularly chloride concentrations. A total of 140 samples of breast milk from 30 breast-feeding mothers were collected and analyzed. Mean mother's values ± standard error of sodium (141 ± 17 mg\\/L), potassium (480 ± 11 mg\\/L), and chloride (452 ± 32 mg\\/L) were found to
Robert P. Wack; Eric L. Lien; David Taft; John D. Roscelli
BACKGROUND: Zuo yuezi is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of zuo yuezi from social, cultural and western medical perspectives. METHODS: We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional
Joanna H Raven; Qiyan Chen; Rachel J Tolhurst; Paul Garner
|A prospective, longitudinal investigation was made of psychological aspects of pregnancy, birth, and the first year postpartum. The majority of participants were Caucasian (90 percent) and Chinese-Canadian (5 percent) men and women and their infant children. Adult participants completed a series of psychological and attitude measures selected to…
Bradley, Christine F.
After terrestrialization, the diversification of arthropods and vertebrates is thought to have occurred in two distinct phases, the first between the Silurian and the Frasnian stages (Late Devonian period) (425-385?million years (Myr) ago), and the second characterized by the emergence of numerous new major taxa, during the Late Carboniferous period (after 345?Myr ago). These two diversification periods bracket the depauperate vertebrate Romer's gap (360-345?Myr ago) and arthropod gap (385-325?Myr ago), which could be due to preservational artefact. Although a recent molecular dating has given an age of 390?Myr for the Holometabola, the record of hexapods during the Early-Middle Devonian (411.5-391?Myr ago, Pragian to Givetian stages) is exceptionally sparse and based on fragmentary remains, which hinders the timing of this diversification. Indeed, although Devonian Archaeognatha are problematic, the Pragian of Scotland has given some Collembola and the incomplete insect Rhyniognatha, with its diagnostic dicondylic, metapterygotan mandibles. The oldest, definitively winged insects are from the Serpukhovian stage (latest Early Carboniferous period). Here we report the first complete Late Devonian insect, which was probably a terrestrial species. Its 'orthopteroid' mandibles are of an omnivorous type, clearly not modified for a solely carnivorous diet. This discovery narrows the 45-Myr gap in the fossil record of Hexapoda, and demonstrates further a first Devonian phase of diversification for the Hexapoda, as in vertebrates, and suggests that the Pterygota diversified before and during Romer's gap. PMID:22859205
Garrouste, Romain; Clément, Gaël; Nel, Patricia; Engel, Michael S; Grandcolas, Philippe; D'Haese, Cyrille; Lagebro, Linda; Denayer, Julien; Gueriau, Pierre; Lafaite, Patrick; Olive, Sébastien; Prestianni, Cyrille; Nel, André
We report a case of a young woman, with a history of a miscarriage and a molar pregnancy, who developed headache and status epilepticus in postpartum day three. Posterior reversible encephalopathy syndrome (PRES) and cerebral venous and sinus thrombosis (CVST) can present with identical clinical picture; however, the imaging findings can help the clinician to make the correct diagnosis and initiate the appropriate treatment. Both PRES and CVST are medical emergencies and fully reversible entities especially when treatment initiation is immediate.
The study aims were to estimate the prevalence of Post-partum Depressive Symptoms (PDS) in Italy.Cross-sectional data from the survey “Health and use of health care in Italy” were analyzed. We focused on 5,812 women, pregnant some time during 5 years before the survey. Multiple logistic regression was used to evaluate risk factors independently associated with post partum depressive symptoms. Evaluation
Pamela Barbadoro; Giordano Cotichelli; Carlos Chiatti; Maria Luisa Simonetti; Anna Marigliano; Francesco Di Stanislao; Emilia Prospero
Influenza and pertussis prevention in young infants requires immunizing pregnant women and all caregivers (cocooning). We evaluated the knowledge and attitude of postpartum women about these two recommendations. A survey of predominantly Hispanic, underinsured, medically underserved postpartum women in Houston, Texas was performed during June 2010 through July 2012. 511 postpartum women [mean age 28.8 y (18-45); 94% Hispanic] with a mean of 3 children (1-12) participated. Ninety-one (17.8%) were first-time mothers. 496 (97.1%) received prenatal care; care was delayed in 24.3%. Only 313 (61.3%) received vaccine education while pregnant and 291 (57%) were immunized. Four hundred 74 women (93%) were willing to be immunized during pregnancy if recommended by their healthcare provider, (the most trusted information source for 62%). Immunization of infants or infant caregivers was discussed with 41% and 10% of mothers, respectively. 230 women (45%) had received influenza vaccine; most intended to (79%) or had already received (15%) tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. Preferred locations for cocooning were hospital or community clinics (97%). Insufficient knowledge (46.6%), cost (31.4%), lack of transportation (26%), work commitments (13.3%), and fear of needles (13.3%) were perceived barriers to cocooning. Level of formal education received by mothers had no effect on the quantity or quality of immunization education received during PNC or their attitude toward immunization. Immunization during pregnancy and cocooning, if recommended by providers, are acceptable in this high-risk population. Healthcare providers, as reported in infant studies, have the greatest influence on vaccine acceptance by pregnant and postpartum women. PMID:23782490
Rossmann Beel, Elizabeth; Rench, Marcia A; Montesinos, Diana P; Mayes, Betsy; Healy, C Mary
Introduction Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It affects predominantly young and middle aged women. Case presentation This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery. Conclusion Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention.
Properties of bioelectrical impedance analysis (BIA) reflect body-composition and may serve as stand-alone indicators of maternal health. Despite these potential roles, BIA properties during pregnancy and lactation in rural South Asian women have not been described previously, although pregnancy and infant health outcomes are often compromised. This paper reports the BIA properties among a large sample of pregnant and postpartum women of rural Bangladesh, aged 12-46 years, participating in a substudy of a community-based, placebo-controlled trial of vitamin A or beta-carotene supplementation. Anthropometry and single frequency (50 kHz) BIA were assessed in 1,435 women during the first trimester (?12 weeks gestation), in 1,237 women during the third trimester (32-36 weeks gestation), and in 1,141 women at 12-18 weeks postpartum. Resistance and reactance were recorded, and impedance and phase angle were calculated. Data were examined cross-sectionally to maximize sample-size at each timepoint, and the factors relating to BIA properties were explored. Women were typically young, primiparous and lacking formal education (22.2±6.3 years old, 42.2% primiparous, and 39.7% unschooled among the first trimester participants). Weight (kg), resistance (?), and reactance (?) were 42.1±5.7, 688±77, and 73±12 in the first trimester; 47.7±5.9, 646±77, and 64±12 in the third trimester; and 42.7±5.6, 699±79, and 72±12 postpartum respectively. Resistance declined with age and increased with body mass index. Resistance was higher than that observed in other, non-Asian pregnant populations, likely reflecting considerably smaller body-volume among Bangladeshi women. Resistance and reactance decreased in advanced stage of pregnancy as the rate of gain in weight increased, returning to the first trimester values by the three months postpartum. Normative distributions of BIA properties are presented for rural Bangladeshi women across a reproductive cycle that may be related to pregnancy outcomes and ultimately be used for assessing body-composition in this population.
Shaikh, Saijuddin; Ali, Hasmot; Labrique, Alain B.; Shamim, Abu Ahmed; Rashid, Mahbubur; Mehra, Sucheta; Christian, Parul; West, Keith P.
Spontaneous unilateral haematoma of the adrenal gland in post-partum is a rare event. We report a case in a 20 year-old woman without any medical history. The diagnosis could be suspected on upper abdominal pain and confirmed by sonography and CT-scan. There was no sign of endocrine dysfunction. Laboratory data were helpful to eliminate a phaeohromocytoma and histologic examination revealed only unilateral adrenal haemorrhage without tumour. Haematoma of the adrenal gland should be suspected in patients with upper abdominal pain without previous trauma, stress, or infection: however it occurs more frequently after severe stress and in association with other conditions. Surgery should be as conservative as possible. PMID:9033837
Badaoui, R; Thouvenin, T; Riboulot, M; Bachelet, Y; Ossart, M
Individuals with mood disorders are at higher risk for self-harm and suicidal ideation than other psychiatric group. However, the risk of self-harm and suicidal ideation after pregnancy for women with mood disorders is unknown. This investigation assessed the prevalence of thoughts of self-harm and suicidal ideation during the 1-year postpartum period in women with major depressive disorder or bipolar II disorder. Data were collected between June 2005 and March 2010 from a convenience sample of women participating in a study on the course of mood disorders during pregnancy and postpartum. Participant diagnosis was confirmed using the Structured Clinical Interview for DSM-IV. Thoughts of self-harm were assessed using the Edinburgh Postnatal Depression Scale item 10 and suicidal ideation was assessed using the Hamilton Depression Rating Scale item 3. During the 1-year postpartum period, 16.97 % reported thoughts of self-harm while 6.16 % reported suicidal ideation. Further, those reporting thoughts of self-harm or suicidal ideation postpartum also reported higher levels of depression and hypomanic symptoms. We found that a number of women in our sample of women with a diagnosed mood disorder report experiencing thoughts of self-harm and suicidal ideation during the postpartum. PMID:23784481
Pope, Carley J; Xie, Bin; Sharma, Verinder; Campbell, M Karen
An inductive qualitative approach was employed to explore women’s experiences of their body and mood during pregnancy and the postpartum. In?depth interviews were conducted with 20 perinatal women (n at late pregnancy=10; n in the early postpartum period=10). While most of the sample reported adapting positively to body changes experienced during pregnancy, the postpartum period was often associated with body
Abigail Clark; Helen Skouteris; Eleanor H. Wertheim; Susan J. Paxton; Jeannette Milgrom
Purpose The objective of this study is to investigate the association between women’s perceptions of their husband’s drinking behavior\\u000a and their health-related quality of life (HRQOL) in the postpartum period.\\u000a \\u000a \\u000a \\u000a Methods We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan\\u000a national birth register in 2005. A structured questionnaire to assess lifestyle risk behaviors and
Pei-Jen Chang; Li-Yao Wu; Yi Chun Chen; Chao-Hua Chuang; Wu-Shiun Hsieh; Shio-Jean Lin; Pau-Chung Chen
Pregnancy and newborn care rank among the top health care expenditures for health plans and employers. Traditionally treated as episodic conditions, maternity and newborn clinical management is most often reactive in nature, event driven, and not perceived as a continuum. Existing models of pure disease management are not suited for addressing this continuum because the condition of pregnancy is not a disease, is not chronic, and is self-limited. Wellness approaches may be applicable for prenatal care, but they fail to fully engage the complexities and intervention needed for high-risk pregnancies. Case management alone is too comprehensive to focus on the high volume of pregnancies, which must be screened and accommodated at the health plan level. Alternatively, the management of a pregnant population through a continuum starting with early prenatal care and commencing with newborn and maternal postpartum care is optimal. We describe a total maternal-newborn solution (TMNS) that considers pregnancy as a unique, high-volume condition with infrequent, but costly, complications that can benefit from primary and secondary preventive efforts to avoid or reduce the impact of complications in a cost-effective manner. A TMNS helps to improve the quality of care delivered as participants and their health care providers are encouraged to follow standardized clinical guidelines and monitored for compliance. A TMNS is made possible with the use of an enterprise information technology platform that provides a common infrastructure to track participant encounters and interventions and measure and report on maternal and newborn care delivered. Preliminary outcomes for the TMNS program prove it to be a promising approach for addressing the clinical and cost management of the pregnancy continuum. PMID:18564028
Fetterolf, Donald E; Stanziano, Gary; Istwan, Niki
Early postpartum discharge (EPD) programs could soon become normative for low-risk women in Canada. To meet new mothers' health care, educational, and psychosocial needs, EPD programs must reflect a deeper understanding of the immediate postpartum period. Structured teaching in hospital must be replaced by a fluid, individualistic approach to mother-infant care. Family physicians can play a vital role.
Midmer, Deana; Clemmens, Donna
Ovarian vein thrombosis is a rare occurrence in the postpartum period. Two cases of postpartum ovarian vein thrombosis are presented. The differential diagnosis is extensive because many diseases can present with similar symptoms. Early diagnosis is essential for appropriate treatment and prevention of the potential sequelae that can occur. Computerized tomography with contrast is the optimal imaging modality for the diagnosis. PMID:8285981
Chawla, K; Mond, D J; Lanzkowsky, L
A household survey was undertaken in Matlab, a rural area of Bangladesh, to estimate the costs incurred during pregnancy, delivery, and the postpartum period for women delivering at home and in a health facility. Those interviewed included 121 women who delivered at home, 120 who delivered in an ICDDR,B basic obstetric care (BEOC) facility, 27 who delivered in a public comprehensive obstetric care (CEOC) hospital, and 58 who delivered in private hospitals. There was no significant difference in total costs incurred by those delivering at home and those delivering in a BEOC facility. Costs for those delivering in CEOC facilities were over nine times greater than for those delivering in BEOC facilities. Costs of care during delivery were predominant. Antenatal and postnatal care added between 7% and 30% to the total cost. Services were more equitable at home and in a BEOC facility compared to services provided at CEOC facilities. The study highlights the regressive nature of the financing of CEOC services and the need for a financing strategy that covers both the costs of referral and BEOC care for those in need.
Sabina, Nazme; Blum, Lauren S.; Hoque, Mohammad Enamul; Ronsmans, Carine
This study analyses the evolution of liver disease in women with chronic hepatitis C during the third trimester of pregnancy and the post-partum period, as a natural model of immune modulation and reconstitution. Of the 122 mothers recruited to this study, 89 were HCV-RNA+ve/HIV-ve and 33 were HCV-RNA-ve/HIV-ve/HCVantibody+ve and all were tested during the third trimester of pregnancy, at delivery and post-delivery. The HCV-RNA+ve mothers were categorized as either Type-A (66%), with an increase in ALT levels in the post-partum period (>40 U/L; P<0.001) or as Type-B (34%), with no variation in ALT values. The Type-A mothers also presented a significant decrease in serum HCV-RNA levels in the post-delivery period (P<0.001) and this event was concomitant with an increase in Th1 cytokine levels (INF?, P?=?0.04; IL12, P?=?0.01 and IL2, P?=?0.01). On the other hand, the Type-B mothers and the HCV-RNA-ve women presented no variations in either of these parameters. However, they did present higher Th1 cytokine levels in the partum period (INF? and IL2, P<0.05) than both the Type-A and the HCV-RNA-ve women. Cytokine levels at the moment of delivery do not constitute a risk factor associated with HCV vertical transmission. It is concluded that differences in the ALT and HCV-RNA values observed in HCV-RNA+ve women in the postpartum period might be due to different ratios of Th1 cytokine production. In the Type-B women, the high partum levels of Th1 cytokines and the absence of post-partum variation in ALT and HCV-RNA levels may be related to permanent Th1 cytokine stimulation. PMID:24130726
Ruiz-Extremera, Angeles; Muñoz-Gámez, José Antonio; Abril-Molina, Ana; Salmerón-Ruiz, María Angustias; Muñoz-de-Rueda, Paloma; Pavón-Castillero, Esther José; Quiles-Pérez, Rosa; Carazo, Angel; Gila, Ana; Jimenez-Ruiz, Sergio Manuel; Casado, Jorge; Martín, Ana Belén; Sanjuán-Núñez, Laura; Ocete-Hita, Esther; Viota, Julián López; León, Josefa; Salmerón, Javier
This study analyses the evolution of liver disease in women with chronic hepatitis C during the third trimester of pregnancy and the post-partum period, as a natural model of immune modulation and reconstitution. Of the 122 mothers recruited to this study, 89 were HCV-RNA+ve/HIV-ve and 33 were HCV-RNA-ve/HIV-ve/HCVantibody+ve and all were tested during the third trimester of pregnancy, at delivery and post-delivery. The HCV-RNA+ve mothers were categorized as either Type-A (66%), with an increase in ALT levels in the post-partum period (>40 U/L; P<0.001) or as Type-B (34%), with no variation in ALT values. The Type-A mothers also presented a significant decrease in serum HCV-RNA levels in the post-delivery period (P<0.001) and this event was concomitant with an increase in Th1 cytokine levels (INF?, P?=?0.04; IL12, P?=?0.01 and IL2, P?=?0.01). On the other hand, the Type-B mothers and the HCV-RNA-ve women presented no variations in either of these parameters. However, they did present higher Th1 cytokine levels in the partum period (INF? and IL2, P<0.05) than both the Type-A and the HCV-RNA-ve women. Cytokine levels at the moment of delivery do not constitute a risk factor associated with HCV vertical transmission. It is concluded that differences in the ALT and HCV-RNA values observed in HCV-RNA+ve women in the postpartum period might be due to different ratios of Th1 cytokine production. In the Type-B women, the high partum levels of Th1 cytokines and the absence of post-partum variation in ALT and HCV-RNA levels may be related to permanent Th1 cytokine stimulation.
Ruiz-Extremera, Angeles; Munoz-Gamez, Jose Antonio; Abril-Molina, Ana; Salmeron-Ruiz, Maria Angustias; Munoz-de-Rueda, Paloma; Pavon-Castillero, Esther Jose; Quiles-Perez, Rosa; Carazo, Angel; Gila, Ana; Jimenez-Ruiz, Sergio Manuel; Casado, Jorge; Martin, Ana Belen; Sanjuan-Nunez, Laura; Ocete-Hita, Esther; Viota, Julian Lopez; Leon, Josefa; Salmeron, Javier
The serotonin (5-HT) system in the brain plays an important role in mood regulation. The postpartum period is considered a high-risk time for mood and anxiety disorders. We assessed changes in 5-HT levels in whole blood (as an indicator of brain 5-HT concentrations) and mood states before and after delivery in 28 healthy, lactating postpartum women. Mood states were evaluated using Profile of Mood States questionnaires (POMS). Measurements were done on the same day in early (first week) and late (third-fourth and sixth-seventh weeks) postpartum, and compared with those in the third trimester and in age-matched, healthy, non-pregnant women. Mean 5-HT concentrations were significantly higher and mean tension/anxiety scores of POMS were significantly lower in late (but not early) postpartum than in the third trimester or non-pregnant controls. 5-HT concentrations correlated with tension/anxiety in the third trimester and late postpartum, indicating an important role for the 5-HT system in the regulation of tension/anxiety in healthy postpartum women. The mechanism underlying the changes in the 5-HT system may be rapid inhibition induced by the marked decrease in estradiol after delivery and gradual excitation caused by lactation-induced brain oxytocin release during the postpartum period. PMID:23541877
Sekiyama, Tamami; Nakatani, Yasushi; Yu, Xinjun; Seki, Yoshinari; Sato-Suzuki, Ikuko; Arita, Hideho
Path analysis and logistic regression were used to model direct and indirect relationships among clinical periparturient (within 30 d after calving) retained placenta, metritis, veterinary-assisted dystocia, uncomplicated and complicated ketosis, left displaced abomasum, parturient paresis, mastitis, and estimated nutrient intakes (protein, calcium, phosphorus, energy; coded into terciles) in the last 3 wk of the dry period. Data were from 1,374 multiparous Holstein lactations for calvings from March 1981 through February 1982 in 31 commercial herds in central New York. Periparturient disorders occurred as a complex. Odds ratios for the multiplicative effects of parturient paresis on incidence of veterinary-assisted dystocia, retained placenta, complicated ketosis, and clinical mastitis were 7.2, 4.0, 23.6, and 5.4, respectively. Reproductive disorders were interrelated. Retained placenta, left displaced abomasum, and parturient paresis directly increased risk of complicated ketosis (odds ratios were 16.4, 53.5, and 23.6, respectively). Higher terciles of estimated energy intake in the last 3 wk of the dry period decreased risk of veterinary-assisted dystocia and left displaced abomasum, while higher terciles of estimated protein intake decreased risk of retained placenta and uncomplicated ketosis. Estimated nutrient intakes were directly related to subsequent metabolic disorders and directly and indirectly related (mediated by metabolic disorders) to reproductive disorders. The study suggests that feeding higher intakes (relative to National Research Council recommendations) of protein and energy in the last 3 week of the dry period may reduce the incidence of metabolic and reproductive disorders. Exact recommendations as to the amounts and types of feed cannot be made from our results. PMID:4067048
Curtis, C R; Erb, H N; Sniffen, C J; Smith, R D; Kronfeld, D S
Postpartum aortic dissection is a rare but lethal event. Until now, only a limited number of cases have been reported, and a comprehensive literature review from 1988 to 2012 yielded 27 cases. Postpartum aortic dissection occurred between Day 1 and Day 42 after delivery, either vaginally or by cesarean section. Pregnancy alone without underlying contributing risk factors and Marfan syndrome were the two main risk factors for postpartum aortic dissection, accounting for 44.4% and 40.7% of cases, respectively. Late presentation and delayed diagnosis may lead to sudden death. Improving prenatal and peripartum care is, therefore, crucial in preventing the development of aortic dissection. Prompt diagnosis and timely treatment of postpartum aortic dissection may prevent patient death. PMID:24075366
... find cures for tomorrow References Al-Safi Z, et al. Delayed postpartum preeclampsia and eclampsia. Obstetrics & Gynecology. ... Obstetrics and Gynecology. 2004;190:1464. Yancey LM, et al. Postpartum preeclampsia: Emergency department presentation and management. ...
... therapy if you have postpartum depression. Having good social support from family, friends, and coworkers may help reduce ... Having good social support from family, friends, and coworkers may ... seriousness of postpartum depression, but may not prevent it. ...
Obstetricians must be familiar with the diagnosis and treatment of postpartum depression (PPD), as they are the first contact physicians of most postpartum depressed women. Postpartum depression is particularly critical to treat as it has significant impact on the mother, the infant, and the family if left untreated. Clinicians should be able to identify the risk factors for depression in
Yesne Alici-Evcimen; Donna M. Sudak
Shorter sleep duration is linked to obesity, coronary artery disease, and diabetes. Whether sleep deprivation during the postpartum period affects maternal postpartum weight retention remains unknown. This study examined the association of sleep at 6 months postpartum with substantial postpartum weight retention (SPPWR), defined as 5 kg or more above pregravid weight at 1 year postpartum. The authors selected 940
Erica P. Gunderson; Sheryl L. Rifas-Shiman; Emily Oken; Janet W. Rich-Edwards; Ken P. Kleinman; Elsie M. Taveras; Matthew W. Gillman
Clinically normal Holstein-Friesian cows (n = 43) were used to establish a relationship between the evaluations of the uterine condition by vaginoscopy, Metricheck, endometrial cytology (EC) and ultrasonography (US) during post-partum period (pp), and subsequent reproductive performance. The uterine status of the selected cows was evaluated by EC, Metricheck, US and vaginoscopy on a weekly basis from the third week (W3) to the seventh week (W7) pp. The animals were bred after a voluntary waiting period of 45-60 days pp and diagnosed for pregnancy status at 45 days after breeding by US. First service conception rate (FSCR) of bred animals was 32.6% (14/43). There was no significant difference in polymorphonuclear leucocyte percentage between conceived and non-conceived cows during different weeks post-partum. First service conception rate in animals with normal vaginal discharge as detected by Metricheck was significantly low when compared to those of abnormal discharge during W3 (2.3% vs 30.3%; p?0.001) and W4 (4.7% vs 29.7%; p < 0.01) post-partum. Using US, the number of pregnant cows having fluid in uterus (FIU) during W6 (p?0.01) and W7 (p?0.001) post-partum was significantly lower (2/34, 4.7% and 1/43, 2.3%, respectively) than those that had no FIU (12/43, 27.9% and 13/43, 30.3%, respectively). Using vaginoscopy, FSCR in animals having abnormal discharge was significantly (p?0.01) low when compared to that of normal discharge (2.4% vs 30.2%) during W5 and W6 post-partum. In conclusion, Metricheck during W3 and W4 and detection of FIU by US and vaginoscopy during W6 and W7?pp can be used as good predictive tools to anticipate the future reproductive performance of dairy cattle. PMID:21707786
Senosy, W; Uchiza, M; Tameoka, N; Izaike, Y; Osawa, T
The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby’s
Helen I Lugina; Kyllike Christensson; Siriel Massawe; Lennarth Nystrom; Gunilla Lindmark
Bilateral peripeduncular (PPN) lesions made on the seventh postpartum day (L7) with either radiofrequency (RF) current or N-methyl-d,l-aspartic acid (NMDA)\\/phosphate buffered saline (PBS) reduced maternal aggression (MA) and partially inhibited lactation without producing significant deficits in other items of maternal behavior (MB). RF-PPN lesions did not interfere with prolactin secretion, which suggests that there was deficient oxytocinergic activity. The deficit
Elizabeth M. Factor; Anne D. Mayer; Jay S. Rosenblatt
Trachoma is an ancient disease that has survived until the present day and represents the most common cause of infectious blindness globally. This study reviews the main Greek medical sources of the period from the 1st to 7th century AD and presents the medical knowledge relating to trachoma, including its definition, clinical features, diagnosis, complications, and treatment. It was widely accepted that trachoma was a disease of the palpebral conjunctiva, and the different stages of trachoma were described in detail. However, it is unclear whether the stages of trichiasis and pannus were identified as trachoma complications. The extensive references to the treatment of trachoma during the Byzantine period provide a strong argument for the case that trachoma was one of the most serious and common eye diseases. Both surgical and pharmaceutical treatments were often applied at the same time. Occasionally, surgical treatment could be rather dramatic, involving the use of stiff fig leaves or a chisel. Nevertheless, the prognosis was always poor, and the disease developed over the years until it threatened the cornea. PMID:18033329
Trompoukis, Constantinos; Kourkoutas, Dimitrios
The aim of this study was to explore the lived experiences of postpartum depression among the Middle Eastern women living in Sydney, Australia. A phenomenologic research design was used to conduct in-depth, unstructured interviews with a purposive sample of 45 mothers who had experienced postpartum depression. The interviews were conducted in the mothers’ homes. Transcriptions of these interviews were analyzed
Violeta Lopez Nahas; Sharon Hillege; Nawal Amasheh
Impaired non-esterified fatty acid suppression to intravenous glucose during late pregnancy persists postpartum in gestational diabetes: a dominant role for decreased insulin secretion rather than insulin resistance
Aims\\/hypothesis Non-esterified fatty acids are implicated in the pathogenesis of gestational (GDM) and type 2 diabetes. We examined the relationship between NEFA dynamics, insulin resistance and beta cell dysfunction in women with GDM in late pregnancy and postpartum.Methods A total of 19 Caucasian women with GDM and 19 healthy pregnant women matched for BMI and age underwent an IVGTT in the third
K. A. McLachlan; R. Boston; F. P. Alford
Difficulties in the postpartum period detract from new parents' enjoyment of their child. Practical approaches to episiotomy care, timing of discharge from hospital, breast-feeding and drugs, bladder dysfunction, fever, depression, vaginal bleeding, contraception and the `postpartum check' assure continuing good health of the new mother. The art and science of medicine must be judiciously mixed with knowledge, compassion and reassurance.
Sugarman, Robert G.
... Postpartum Anxiety During Pregnancy & Postpartum Pregnancy or Postpartum OCD Postpartum Post-Traumatic Stress Disorder Postpartum Psychosis Useful ... hurt you. Another form of anxiety is Postpartum Obsessive Compulsive Disorder . Learn more about it here. Postpartum and antepartum ...
Mortuary rituals, specifically secondary mortuary practices with the socially sanctioned removal of all or some parts of the deceased, are a powerful means of social integration during periods of social, economic, or environmental change. Integrating ethnographic data on the social impact of secondary mortuary ceremonies with archaeological evidence from the Late Natufian and Prepottery Neolithic A periods of the south-central
BACKGROUND: Postpartum weight retention can contribute to obesity. There may be unique barriers to weight loss in this period. FINDINGS: Cases are presented for three postpartum women who declined to participate in a postpartum weight loss intervention. Despite their desire to engage in healthier behaviors, or partake in an intervention uniquely designed to promote healthy lifestyles for postpartum women, some
Lori Carter-Edwards; Truls Østbye; Lori A Bastian; Kimberly SH Yarnall; Katrina M Krause; Tia-Jane'l Simmons
Since many dairy cows calve during late summer, the objective was to determine if heat stress immediately post-partum would (1) alter metabolism, thus, increasing susceptibility to metabolic disorders, (2) affect lactation and/or (3) affect reproduction. Forty four cows, calving during late summer, were paired with one member of each pair stressed (HS) for the first 10 post-partum days in a hot barn. Controls (CC) were kept in a cooled section of the barn. Plasma drawn weekly for 7 weeks was analyzed in an autoanalyzer for calcium, inor. phosphorus, protein, glucose and cholesterol and by radioimmunoassay for cortisol and progesterone. Ovaries and uteri were palpated weekly. Rectal temperatures were significant higher for HS during the first 10 post-partum days. No significant effects on plasma constituents were observed during the 10-day treatment period. For the 7-week period, glucose and cholesterol were lower in HS, as were cyclic peaks of progesterone and cortisol. Both calcium and inorganic phosphorus remained clinically low for the 7 weeks, but no treatment effects were seen. Uteri of HS involuted more rapidly than the CC. Treatment did not affect reproductive efficiency. Lactation milk yields did not differ, but milk fat percent was lower in HS. Heat stress immediately post-partum altered lipid metabolism, but the animal's compensatory mechanisms prevented reduction in milk production or reproductive efficiency.
Fuquay, J. W.; Chapin, L. T.; Brown, W. H.
The early postpartum period is associated with increased risk for affective and psychotic disorders. Because maternal dopaminergic reward system function is altered with perinatal status, dopaminergic system dysregulation may be an important mechanism of postpartum psychiatric disorders. Subjects included were non-postpartum healthy (n=13), postpartum healthy (n=13), non-postpartum unipolar depressed (n=10), non-postpartum bipolar depressed (n=7), postpartum unipolar (n=13), and postpartum bipolar
Eydie L Moses-Kolko; Julie C Price; Katherine L Wisner; Barbara H Hanusa; Carolyn C Meltzer; Sarah L Berga; Anthony A Grace; Teresa Lanza di Scalea; Walter H Kaye; Carl Becker; Wayne C Drevets
Evidence of postpartum depression in Western culture has been widely documented in the literature. The conclusion reached by many researchers is that women are vulnerable to depression following childbirth to some extent. It has been suggested that postpartum depression is a culture-bound syndrome that develops because of lack of supportive rites and rituals surrounding childbirth. The present study was undertaken to explore postpartum depression in Hmong women living in the U.S. and the influence of cultural practices on postpartum depression. The results indicate that cultural beliefs and practices help the Hmong women adjust to the postpartum period. Whatever symptoms of depression they reported were related to living in a different culture and different environment, and using a language to which they were not accustomed. PMID:8850766
Stewart, S; Jambunathan, J
Research at San Bartolo has continued providing evidence of the use of ceremonial conduct to maintain social, political and spiritual order at the site. Evidence of such activities was found both through space and time, suggesting continuity in the cosmovision of San Bartolo along its entire development. While the amazing Late Preclassic period murals still narrate the histories of mythology
Jessica H. Craig
Daily determinations of FSH and prolactin in plasma were made for 10-12 weeks after parturition in ewes which lambed either in the middle of (December) or late in (February) the breeding season. Fluctuations in the plasma concentrations of FSH could not be related to the time after parturition or to the occurrence of otherwise of oestrus and ovulation. However, there was evidence of an increased secretion of prolactin post partum but only in those ewes which lambed in February. The lack of an elevated level of prolactin during the post-partum period in the December-lambing ewes was associated with an earlier return to oestrus by these animals. The suppression of prolactin concentrations by treatment with bromocriptine to undetectable values in the December-lambing ewes was not associated with an earlier return to oestrus. The removal of lambs at various times post partum from those ewes which lambed in February was not associated with any marked changes in prolactin secretion. The results suggest that when the plasma concentrations of prolactin are low post partum there is a greater likelihood of an earlier resumption of breeding activity in the ewe. PMID:6779003
Fitzgerald, B P; Cunningham, F J
C56 (activated "reactor") could be generated by adding zymosan to only nineteen out of the fifty serum samples obtained from southern Chinese women 3 to 5 days after a normal spontaneous delivery. As a group, post-partum sera showed a 25% increase in total haemolytic complement, an almost two-fold increase in haemolytic C5, C4 and C8 plus C9 activity, a 50% increase in antigenic C3 and haemolytic C2, C1 and factor B activity, a less than 20% increase in haemolytic C6 and C7 activity, and a 20% decrease in factor D and C1 inhibitor activity. Consequently, their C5:C7 ratios were significantly elevated. This finding supports, in part, the theory that the "reactor" state or ability to generate C56 depends on a relative excess of C56 over C7. However, comparison of the complement profile between sera with and those without "reactor" activity did not reveal any difference, except a greater elevation of C5 in the latter. It appears possible that a grossly excessive level of C5 may, in fact, be unfavourable to the generation of C56.
Mak, L W
Thirty multiparous lactating dairy cows were used in a randomized block design experiment to evaluate factors related to the degree of hypophagia from intraruminal infusion of propionate. Cows between 3 and 40 d postpartum at the start of the experiment were blocked by calving date and randomly assigned to treatment. Treatments were 1.0 mol/L propionic acid or 1.0 mol/L acetic acid adjusted to pH 6 with sodium hydroxide and infused at 0.5 mol of volatile fatty acid/h from 6h before feeding until 12h after feeding. Propionate infusion decreased dry matter intake by 20.0%, total metabolizable energy intake by 22.5%, and plasma ?-hydroxybutyrate concentration by 54.3% compared with acetate infusion. Effects of treatment on dry matter intake were related to concentration of acetyl coenzyme A (CoA) in the liver; hypophagic effects of propionate compared with acetate increased as liver acetyl CoA concentration increased. Hypophagic effects of propionate are greater for cows with elevated concentrations of acetyl CoA in the liver. PMID:22612960
Stocks, S E; Allen, M S
Effect of the amount of body condition loss from the dry to near calving periods on the subsequent body condition change, occurrence of postpartum diseases, metabolic parameters and reproductive performance in Holstein dairy cows
We investigated the effect of body condition loss from the dry to near calving periods on the subsequent body condition change, the occurrence of postpartum diseases, the serum metabolic parameters total cholesterol, triglyceride, glucose, and urea nitrogen and the number of days to first breeding after calving in Holstein dairy cows. Body condition scoring (using a 5-point scale with quarter-point
Ill-Hwa Kim; Gook-Hyun Suh
In ancient China, formal government institutions stretched to the county level. This system witnessed a radical transformation\\u000a during the late Qing and the Warlord period, with various types of township\\/village administrations mushrooming in many places\\u000a across the country to meet the requirements of institutional reform and the demands for modernization in local regions. These\\u000a township\\/village administrations can be divided into
Guangqi Wei; Haixiu Ding
The purpose of this study was to examine relationships among patterns of feminine attributes, self concept, perceived life satisfaction, and comfort in the mothering role for women during the developmental period of late pregnancy and the early postpartum period.^ Manifestations of change in a person's pattern are particularly evident during developmental phases. However, there is little empirical evidence to verify
SUZANNE HICKEY BROUSE
In spite of the difficulties in delivering PUFA to ruminants, studies have generally indicated that the PUFA of the omega-6 (linoleic acid) and omega-3 [?-linolenic acid; eicosapentaenoic (EPA), C20:5 omega-3; docosahexaenoic (DHA), C22:6 omega-3] families are the most beneficial to improving reproduction in cows. The objectives were to determine if a diet enriched in ?-linolenic acid (omega-3) or linoleic acid (omega-6) would influence milk production and composition, metabolic status, and reproductive performance in lactating dairy cows. High-yielding multiparous Holstein dairy cows (n = 120) with no overt clinical illnesses were blocked according to calving date and parity. Cows were assigned randomly to be fed 1) soybean whole roast (Soy, omega-6, n = 40) or 2) linseed (Lin, omega-3, n = 40) or 3) palm oil as a source of SFA (PO, n = 40) from calving until first heat after 40 d postpartum (dpp), and then half of the cows in each treatment group were switched to receive either Lin or SFA (PO) from first heat after d 40 to 120 dpp. Blood was collected from a subsample of cows. Blood was collected at 14 d intervals for 12 wk, starting on the day of calving. Results showed milk yield and DMI were not affected. Milk compositions were similar (P > 0.08) among diets, except concentration and yield of milk fat percentage, which was less in cows fed Lin (P < 0.05). Uterine involution in cows fed Soy occurred earlier (P < 0.05). Diets affected day to first estrus and day to first insemination in cows (P < 0.05). There were no differences among treatments for percent heat detection, percent pregnancy per first insemination, and percent conception per AI at estrus. Also, there is a trend of pregnancy by 120 d, which is 66.7% for the Lin group vs. 50.91% for the PO group (P < 0.08). Of the 4 pregnancy losses, 2 occurred in PO-PO group and 2 occurred in Soy-PO group, and none occurred in the other 4 treatments. In conclusion, our study showed feeding omega-6 fatty acids during 40 dpp could be a good treatment for early postpartum periods, and a shift to omega-3 fatty acids until 40 d after AI can be considered as a strategy for improving fertility in lactating dairy cows. PMID:23148256
Dirandeh, E; Towhidi, A; Zeinoaldini, S; Ganjkhanlou, M; Ansari Pirsaraei, Z; Fouladi-Nashta, A
The clinical course, prognostic factors, and management of 50 cases of late prosthetic valve endocarditis, occurring more than two months after valve replacement, were reviewed. Twenty nine cases that presented from 1971 to 1980 were compared with 21 cases that presented from 1981 to 1985. Apart from an appreciable decrease in the frequency of neurological complications between the first period (38%) and the second period (10%) no differences in clinical or bacteriological features were seen. Seventeen (59%) of the 29 cases in the earlier period and four (19%) of the 21 cases in the later period died. The rationale for antimicrobial treatment was similar during both periods. Cardiac surgery was performed in eight of 29 cases between 1971 and 1980 and in 11 of 21 between 1981 and 1985; the mean (SD) time between diagnosis of endocarditis and operation was 28 (19) days and 43 (44) days respectively. Six of the eight cases operated on in the first period died as did two of the 11 operated on in the second period. Twenty seven of the 29 cases presenting between 1971 and 1980 were treated with anticoagulants--either warfarin (15 of 27) or heparin sodium (12 of 27). Sixteen of the 21 cases presenting later were given anticoagulants and 15 of these cases were given heparin sodium. Control of anticoagulation was inadequate in nine of the 27 cases treated with anticoagulants during the first period and in only two of 16 treated during the second period. During the first treatment period neurological complications were more frequent when control of anticoagulation was inadequate.
Leport, C; Vilde, J L; Bricaire, F; Cohen, A; Pangon, B; Gaudebout, C; Valere, P E
Median sternotomy is the most common method of access to the heart and great vessels in cardiac surgical procedures. However, particularly in obese and diabetic patients, complications such as dehiscence, osteomyelitis, mediastinitis and superficial wound infection or fistula formation may be encountered. To overcome these complications, some alternative surgical techniques and surgical equipment are designed for sternal closure. ‘Nitinol thermoreactive clips’ is one of them. In this study, we report a patient with detachment of thermoreactive clips from sternum in the late postoperative period due to wrong measurement of distance between intercostal spaces.
Tavlasoglu, Murat; Kurkluoglu, Mustafa; Arslan, Zekeriya; Durukan, Ahmet Bar?s
The birth of a child requires adaptation and reorganization within the family system in order to accommodate the new family member and to allow the family to continue in its psychosocial development. Knowledge of the normative and transitional changes required at this stage of family life will enhance family practitioners' understanding of some of the common concerns and complaints related to them by various family members during the postpartum period. The Family FIRO model represents a helpful conceptual framework to increase the family physician's understanding of the issues of inclusion, control, and intimacy that are highlighted during the transition to parenthood. The authors briefly present this model and discuss its application to postpartum adjustment and its implications for health-care professionals.
Midmer, Deana; Talbot, Yves
Postpartum hemorrhage (PPH) is a very common obstetric emergency with high morbidity and mortality rates worldwide. Understanding its etiology is fundamental to effectively managing PPH in an acute setting. Active management of the third stage of labor is also a key component in its prevention. Management strategies include conservative measures (medications, uterine tamponade, and arterial embolization) as well as surgical interventions (arterial ligations, compression sutures, and hysterectomy). Creating a standardized PPH protocol and running simulation-based drills with a multidisciplinary team may also help decrease maternal morbidity and improve perinatal outcomes, although further studies are needed. PMID:22309588
Su, Cindy W
Summary The postpartum period is associated with an increased risk of developing obsessive-compulsive disorder (OCD) in women. Postpartum onset OCD is often undiagnosed and untreated resulting in serious consequences for the patient, her family and the newborn. The symptoms of postpartum onset OCD may consist of obsessional intrusive thoughts about harming the newborn without compulsions or with both obsessions and
M. Brandes; C. N. Soares; L. S. Cohen
Study was carried out to evaluate the heat stability and quality characteristics of buffalo colostrum during its transition to normal milk. A total of 140 postpartum milk samples of 20 buffaloes (in seven postpartum milking) were collected to observe the heat stability at boiling temperature during transition period. Gradual change (coagulation\\/precipitation) was observed up to sixth postpartum milking when heated
H. H. Arain; M. Khaskheli; M. A. Arain; A. H. Soomro; A. H. Nizamani
The objectives of this study were to investigate the effects of forage source [wheat straw (WS) or orchardgrass hay (OG)] and total amount of diet dry matter fed [ad libitum or restricted to 70% of predicted dry matter intake (DMI)] prepartum on postpartum performance. The study design was a 2×2 factorial design with 10 cows per treatment. Treatments were WS total mixed ration (TMR) ad libitum, OG TMR ad libitum, WS TMR restricted, and OG TMR restricted. The WS TMR (dry matter basis) contained 30% WS, 20.7% corn silage, 10.0% alfalfa hay, 18.2% ground corn, 16.8% soybean meal, and 4.3% molasses mineral mix (14.7% CP, 1.5 Mcal/kg of net energy for lactation, 37.0% neutral detergent fiber). The OG TMR contained 30% OG, 46.2% corn silage, 10.0% alfalfa hay, 9.5% soybean meal, and 4.3% molasses (14.2% CP, 1.5 Mcal/kg of net energy for lactation, 41.0% neutral detergent fiber). Cows received 1 lactation diet after calving (17.7% CP, 1.6 Mcal/kg of net energy for lactation, 27.3% neutral detergent fiber). Total diet DMI prepartum was higher for ad libitum than for restricted as designed, but forage source had no effect on DMI. Total tract apparent digestibilities of DM and NDF were greater for OG than for WS. Postpartum DMI expressed as a percentage of body weight for the first week of lactation was higher for ad libitum than for restricted diets. Postpartum DMI during the first 30 d of lactation was higher for OG than for WS, but no effect was observed for the amount fed prepartum. Milk yield during the first week of lactation was higher for OG than for WS; however, during the first 30 d, 3.5% fat-corrected milk yield and yield of milk fat were highest for OG TMR restricted and WS TMR ad libitum. Prepartum treatments had a limited effect on pre- and postpartum lipid metabolism; however, cows fed WS TMR ad libitum had the highest postpartum ?-hydroxybutyrate. Eating behavior was observed by 10-min video scans of 24-h video surveillance for 5d pre- and postpartum. Prepartum eating time and eating bouts tended to be greater by WS than for OG, and postpartum eating time per kilogram of neutral detergent fiber intake tended to be greater for WS than for OG. Results indicate that forage source and amount of DM fed prepartum affected postpartum performance and tended to alter the behavior of cows in tie-stall barns. PMID:23040018
Litherland, N B; Weich, W D; Hansen, W P; Linn, J G
Sauropod dinosaurs are one of the most conspicuous groups of Mesozoic terrestrial vertebrates. They show general trends towards an overall increase in size and elongation of the neck, by means of considerable elongation of the length of individual vertebrae and a cervical vertebra count that, in some cases, increases to 19 (ref. 1). The long neck is a particular hallmark of sauropod dinosaurs and is usually regarded as a key feeding adaptation. Here we describe a new dicraeosaurid sauropod, from the latest Jurassic period of Patagonia, that has a particularly short neck. With a neck that is about 40% shorter than in other known dicraeosaurs, this taxon demonstrates a trend opposite to that seen in most sauropods and indicates that the ecology of dicraeosaurids might have differed considerably from that of other sauropods. The new taxon indicates that there was a rapid radiation and dispersal of dicraeosaurids in the Late Jurassic of the Southern Hemisphere, after the separation of Gondwana from the northern continents by the late Middle Jurassic. PMID:15931221
Rauhut, Oliver W M; Remes, Kristian; Fechner, Regina; Cladera, Gerardo; Puerta, Pablo
Leiomyomata are common benign tumors of the uterus and female pelvis. Myomas have been reported in 25% of Caucasian American women and 50% of African-American women. The true incidence is unknown, but descriptions of 50% have been found at postmortem examinations. Considering the high incidence of uterine myomata in women of reproductive age, they are reported as complications in only 2% of pregnancies. Pyomyoma (suppurative leiomyoma) a rare complication results from infarction and infection of a leiomyoma. Without a strong clinical suspicion and surgical intervention, fatalities may occur. Since 1945, only 15 cases have been described in the literature, mostly in pregnant or postmenopausal women after ascending infection. This report documents a pyomyoma that presented as a postpartum enlargement of a previously known leiomyoma. This case is unique because the patient did not undergo a hysterectomy at the time of exploratory laparotomy. Six months after the procedure, normal cyclic bleeding was noted. Images Figure 1 Figure 2
Mason, Tina C.; Adair, Jamie; Lee, Yi Chun
Background Animal research demonstrates that pelvic sensory signaling at parturition initiates behavioral and emotional changes that are protective for mother and offspring. In contrast, research with humans has found no effect of cesarean delivery (i.e., procedure that blocks pelvic signaling) on mother's mental health. The lack of effect may reflect little consideration for the use of epidurals, another intervention that blocks pelvic signaling. The following study examines whether blocking pelvic signaling during delivery predicts postpartum depression symptomatology. Method Longitudinal mental health data were collected prospectively from 142 primiparous women who had a cesarean delivery and/or received epidural anesthesia (Intervention) or delivered vaginally without anesthesia (No-Intervention). Measurements began in late pregnancy and continued through the first postpartum year. Results Intervention mothers reported more depressive symptoms at the end of the first postpartum year compared to those in the No-Intervention group. This effect was independent of socio-cultural factors known to predict levels of depressive symptoms. Conclusion These results suggest that pelvic sensory signaling may help to prepare women for the postpartum period. Considering there are many factors influencing the mental health of mothers, the present finding suggest that populations vulnerable to postpartum depression should consider a delivery without intervention, when medically permissible.
Hayes, U.L.; Balaban, S.; Smith, J.Z.; Perry-Jenkins, M.; Powers, S.I.
Late preterm (LP) infants are defined as those born at 34-0/7 to 36-6/7 weeks' gestational age. LP infants were previously referred to as near term infants. The change in terminology resulted from the understanding that these infants are not fully mature and that the last 6 weeks of gestation represent a critical period of growth and development of the fetal brain and lungs, and of other systems. There is accumulating evidence of higher risks for health complications in these infants, including serious morbidity and a threefold higher infant mortality rate compared with term infants. This information is of critical importance because of its scientific merits and practical implications. However, it warrants a critical and balanced review, given the apparent overall uncomplicated outcome for the majority of LP infants. Others reviewed the characteristics of LP infants that predispose them to a higher risk of morbidity at the neonatal period. This review focuses on the long-term neurodevelopmental and respiratory outcomes, with the main aim to suggest putative prenatal, neonatal, developmental, and environmental causes for these increased morbidities. It demonstrates parallelism in the trajectories of pulmonary and neurologic development and evolution as a model for fetal and neonatal maturation. These may suggest the critical developmental time period as the common pathway that leads to the outcomes. Disruption in this pathway with potential long-term consequences in both systems may occur if the intrauterine milieu is disturbed. Finally, the review addresses the practical implications on perinatal and neonatal care during infancy and childhood. PMID:24062372
Kugelman, Amir; Colin, Andrew A
effect of simvastatin locally applied from a bioactive polymer coating of implants on osteoporotic fracture healing at late period. Methods:Femur fracture model was established on normal or osteotoporotic mature female SD rats, intramedullary stabilization was achieved with uncoated titanium Kirschnerwires in normal rats(group A),with polymer-only coated vs. polymer plus simvastatin coated titanium Kirschner wires in osteoporotic rats(group B and C, respectively).Femurs were harvested after 12 weeks, and underwent radiographic and histologic analysis, as well as immunohistochemical evaluation for BMP-2 expression. Results:Radiographic results demonstrated progressed callus in the simvastatin-treated groups compared to the uncoated group.The histologic analysis revealed a significantly processed callus with irregular-shaped newly formed bone trabeculae in simvastatin-treated group. Immunohistochemical evaluation showed markedly higher expression levels of B:MP-2 in simvastatin-treated group.Conclusions: The present study revealed a improved fracture healing under local application of simvastatin in osteoporotic rat,which might partially from upregulation of the B:MP-2 expression at fractured site.
Tian, Faming; Zhang, Liu; Kang, Yuchuan; Zhang, Junshan; Ao, Jiao; Yang, Fang
Much of the Galápagos Volcanic Province (GVP), consisting of the Cocos, Carnegie, Coiba and Malpelo aseismic ridges and related seamount provinces, remains poorly understood due to a lack of direct age and geochemical data. In recent years reconnaissance dredge/grab sampling of these submerged regions of the GVP provides some new insights that can be re-evaluated in the context of the three new cruises to the region in 2010. The distribution of 40Ar/39Ar basement ages [1-3] suggest that volcanism migrated time-progressively across GVP in broad regions of long-lived, possible concurrent, hotspot volcanism. Development of the GVP via such broad zones of overlapping volcanism leads to multiple phases of volcanism post-dating the onset of hotspot volcanism, similar to rejuvenescent volcanism that occurs million years after the main shield-building phase of mid-plate oceanic volcano, most notably along the Hawaiian-Emperor Seamount Chain. Evidence for rejuvenescent volcanism across the GVP provides an opportunity to evaluate this poorly understood process in a very different physical setting compared to the Hawaiian-Emperor Chain (mid-plate versus on/near spreading axis). Widespread episodes of coeval GVP volcanism show that the Galápagos hotspot influences broad regions of the lithosphere implying relative motion between the Cocos and Nazca plates and a broad Galápagos hotspot. The complex spreading history of the Cocos-Nazca spreading centre likely controlled the relative distribution of GVP volcanism between the Cocos and Nazca plates while creating lithosphere of variable age/thickness across the region . But recent age and geochemical studies of other hotspot systems show that lithosphere influenced in the past by hotspot activity is more likely to generate late-stage volcanism in response to changing patterns of stress in the lithosphere. Late stage volcanism across a broad Galápagos hotspot might therefore reflect periodic reorganisations of the Galápagos spreading centre.  Werner, D.R. et al., 1999. A drowned 14-m.y.-old Galápagos Archipelago off the coast of Costa Rica: implications for tectonic and evolutionary models. Geology 27.  Werner, D.R. et al., 2003. Geodynamic evolution of the Galápagos hot spot system (Central East Pacific) over the past 20 m.y. Constraints from morphology, geochemistry, and magnetic anomalies. Geochem. Geophys. Geosyst. 4, 1108.  O’Connor et al., 2007. Migration of widespread long-lived volcanism across the Galápagos Volcanic Province: Evidence for a broad hotspot melting anomaly? Earth Planet. Sci. Letts. 263.
O'Connor, J. M.; Hoernle, K.; Wijbrans, J. R.; Werner, R.; Hauff, S. F.; Stoffers, P.
Postpartum hemorrhage is one of the leading causes of maternal mortality worldwide. According to the time when postpartum hemorrhage develops, it is classified as (a) primary, or early, postpartum hemorrhage (within the first 24 hours after delivery) or (b) secondary, or late, postpartum hemorrhage (>24 hours to 6 weeks after delivery). Primary postpartum hemorrhage may be caused by uterine atony (75%-90% of cases), trauma of the lower portion of the genital tract, uterine rupture, uterine inversion, bladder flap hematoma, retention of blood clots or placental fragments, and coagulation disorders. Secondary postpartum hemorrhage may be caused by uterine subinvolution, coagulopathies, and abnormalities of the uterine vasculature. Extrauterine sources of bleeding include rectus sheath hematoma, direct arterial injuries, and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Severe postpartum hemorrhage is a life-threatening condition that is diagnosed on the basis of the findings from clinical examination, with or without ultrasonography. Computed tomography (CT) and magnetic resonance imaging are useful in the characterization of postpartum hemorrhage when medical treatment fails. Multidetector CT has an important role when intraabdominal bleeding is suspected and can be considered in cases of recurrent bleeding after embolization, as well as for the evaluation of postsurgical complications. A proposed clinical and CT imaging algorithm for postpartum hemorrhage is presented. A multidisciplinary approach to postpartum hemorrhage is essential to optimize the role of diagnostic and interventional radiology in obstetric hemorrhage, to avoid hysterectomy and thus preserve fertility. PMID:22977030
Sierra, Ana; Burrel, Marta; Sebastia, Carmen; Radosevic, Aleksandar; Barrufet, Marta; Albela, Sonia; Buñesch, Laura; Domingo, Montserrat A; Salvador, Rafael; Real, Isabel
Background: The advent of highly active antiretroviral therapy (HAART) in 1996 led to a decrease in the incidence of Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL), but not of other cancers, among people with HIV or AIDS (PWHA). It also led to marked increases in their life expectancy. Methods: We conducted a record-linkage study between the Swiss HIV Cohort Study and nine Swiss cantonal cancer registries. In total, 9429 PWHA provided 20?615, 17?690, and 15?410 person-years in the pre-, early-, and late-HAART periods, respectively. Standardised incidence ratios in PWHA vs the general population, as well as age-standardised, and age-specific incidence rates were computed for different periods. Results: Incidence of KS and NHL decreased by several fold between the pre- and early-HAART periods, and additionally declined from the early- to the late-HAART period. Incidence of cancers of the anus, liver, non-melanomatous skin, and Hodgkin's lymphoma increased in the early- compared with the pre-HAART period, but not during the late-HAART period. The incidence of all non-AIDS-defining cancers (NADCs) combined was similar in all periods, and approximately double that in the general population. Conclusions: Increases in the incidence of selected NADCs after the introduction of HAART were largely accounted for by the ageing of PWHA.
Franceschi, S; Lise, M; Clifford, G M; Rickenbach, M; Levi, F; Maspoli, M; Bouchardy, C; Dehler, S; Jundt, G; Ess, S; Bordoni, A; Konzelmann, I; Frick, H; Dal Maso, L; Elzi, L; Furrer, H; Calmy, A; Cavassini, M; Ledergerber, B; Keiser, O
We proposed that the higher incidence of sleep fragmentation, sympathovagal imbalance and baroreceptor reflex impairment during quiet sleep may play a critical role in late-sleep-related cardiovascular events. Polysomnographic recording was performed through wireless transmission using freely moving Wistar-Kyoto rats over 24 h. The low-frequency power of arterial pressure variability was quantified to provide an index of vascular sympathetic activity. Spontaneous baroreflex sensitivity was assessed by slope of arterial pressure-RR linear regression. As compared with early-light period (Zeitgeber time 0-6 h), rats during the late-light period (Zeitgeber time 6-12 h) showed lower accumulated quiet sleep time and higher paradoxical sleep time; furthermore, during quiet sleep, the rats showed a lower ?% of electroencephalogram, more incidents of interruptions, higher ?% and higher ?% of electroencephalogram, raised low-frequency power of arterial pressure variability value and lower baroreflex sensitivity parameters. During the light period, low-frequency power of arterial pressure variability during quiet sleep had a negative correlation with accumulated quiet sleep time and ?% of electroencephalogram, while it also had a positive correlation with ?% and ?% of electroencephalogram and interruption events. However, late-sleep-related raised sympathetic activity and sleep fragmentation diminished when an ?1-adrenoceptor antagonist was given to the rats. Our results suggest that the higher incidence of sleep fragmentation and sympathovagal imbalance during quiet sleep may play a critical role in late-sleep-related cardiovascular events. Such sleep fragmentation is coincident with an impairment of baroreflex sensitivity, and is mediated via ?1-adernoceptors. PMID:22957846
Kuo, Terry B J; Lai, Chun-Ting; Chen, Chun-Yu; Lee, Guo-She; Yang, Cheryl C H
|This research explores if poor grammaticality judgments of late (age of arrival greater than or equal to 12) second language learners often attributed to being beyond the critical period for language acquisition can be better explained by processing difficulties due to (1) low L2 working memory capacity, (2) poor L2 decoding, and/or (3)…
McDonald, Janet L.
A series of trials was conducted to determine the effect of extended periods of light on the growth, survival, feeding pattern and daily feed consumption of barramundi, Lates calcarifer, larvae and juveniles. Larvae 2–10 days old grew progressively faster under conditions of 8, 16 and 24 h light per day; survival rates did not differ between the treatments. Larvae 8–20
C. G. Barlow; M. G. Pearce; L. J. Rodgers; P. Clayton
This paper brings together previously published material and the writer's analysis of recently excavated material from Spirit Cave, northern Thailand, in order to synthesize a chronology and a more detailed reconstruction of Hoabinhian exploitative patterns during the late Pleistocene\\/ early Recent periods in Southeast Asia. Hoabinhian subsistence patterns are described as the broad spectrum exploitation of both plants and animals.
The quantity and quality of fresh organic matter (OM) formed by primary production in relation to phytoplankton community structure was calculated for the late summer-winter 2009/2010 in the northern Adriatic Sea (Mediterranean). Phytoplankton species, as a direct measure of fresh OM, chlorophyll a, the OM pool (DOC and POC) and lipids, including classes, were analyzed. Data for temperature, salinity and nutrients enabled deeper insight into the conditions that promoted fresh OM production and associated processes at two stations of different trophic status. Phytoplankton growth was controlled by bottom regenerated nutrients and to lesser extent by riverine nutrients. The phytoplankton community was mainly dominated by nanoplankton. Species of moderate carbon content Chaetoceros compressus, Asterionellopsis glacialis, Leptocylindrus danicus and Bacteriastrum jadranum dominated the microplankton fraction. Availability of orthophosphates was the key factor influencing fresh OM production. POC varied from 37-522 ?g l-1. Freshphyto POC, i.e. carbon fixed in phytoplankton cells, contributed 7-79% to the POC pool. The DOC (890-1560 ?g l-1) level decreased during the investigated period. Calculation of fresh DOC, i.e. carbon fixed during primary production and released as dissolved OM, revealed it as a minor part (0-2%) of the DOC pool. Lipid concentrations varied from 9.9-55.0 ?g l-1 and 20.0-40.2 ?g l-1 in the particulate and dissolved fractions, respectively. Nutrient limitation caused increased synthesis of lipids, among which energy reserve lipids triacylglycerols, which are further immobilized for the construction of glycolipids with increasing depletion of orthophosphates.
Mari?, Daniela; Frka, Sanja; Godrijan, Jelena; Tomaži?, Igor; Penezi?, Abra; Djakovac, Tamara; Vojvodi?, Vjero?ka; Precali, Robert; Gašparovi?, Blaženka
Postpartum depression and postpartum psychosis are serious mood disorders encountered by nurses working in a variety of settings. Postpartum depression refers to a nonpsychotic depressive episode, while postpartum psychosis refers to a manic or affective psychotic episode linked temporally with childbirth. The nursing profession plays a crucial role in the early identification and treatment of these postpartum mood disorders. This
Shelley Doucet; Cindy-Lee Dennis; Nicole Letourneau; Emma Robertson Blackmore
Summary This paper presents a review and discussion of eight self-report measures used to assess for depressive symptoms in the postpartum period. Because postpartum depression is a significant mental health problem, there is a need for reliable and valid screening instruments. Published psychometric data (e.g., reliability, sensitivity, specificity, positive predictive value, concurrent validity) of each self-report instrument are presented and
R. C. Boyd; H. N. Le; R. Somberg
The postpartum period is a time of increased risk of new-onset psychiatric illness, hospital admissions and out-patient psychiatric care for new mothers. Research into postpartum mood disorders has focused primarily on major depressive disorder, and has overlooked the study of bipolar disorder, particularly bipolar II disorder and bipolar disorder not otherwise specified. Failure to properly diagnose postpartum bipolar disorder may delay the initiation of appropriate treatment, lead to inappropriate treatment - thereby precipitating (hypo)mania, rapid cycling or a mixed episode - or result in polypharmacy and treatment refractoriness. The most serious consequence, however, is the high risk of infanticide and suicide among women with postpartum bipolar disorder. While no specific screening tools have been validated for postpartum mania or bipolar depression, symptoms of hypomania, atypical depression, a family history of bipolar disorder and a rapid onset of depressive symptoms following delivery may suggest a bipolar diathesis. In the absence of any pharmacological or psychotherapeutic treatments to guide clinical decision-making, it is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of non-postpartum bipolar depression, using medications that are compatible with lactation. PMID:20586688
Kelly, Erin; Sharma, Verinder
Recent evidence suggests that blindness enables visual circuits to contribute to language processing. We examined whether this dramatic functional plasticity has a sensitive period. BOLD fMRI signal was measured in congenitally blind, late blind (blindness onset 9-years-old or later) and sighted participants while they performed a sentence comprehension task. In a control condition, participants listened to backwards speech and made match/non-match to sample judgments. In both, congenitally and late blind participants BOLD signal increased in bilateral foveal-pericalcarine cortex during response preparation, irrespective of whether the stimulus was a sentence or backwards speech. However, only in congenitally blind people left occipital areas (pericalcarine, extrastriate, fusiform and lateral) responded more to sentences than backwards speech. We conclude that age of blindness onset constrains the non-visual functions of occipital cortex: while plasticity is present in both congenitally and late blind individuals, recruitment of visual circuits for language depends on blindness during childhood.
Bedny, Marina; Pascual-Leone, Alvaro; Dravida, Swethasri; Saxe, Rebecca
Study Objectives: Sleep disturbances cause neurobehavioral performance and daytime functioning impairments. Postpartum women experience high levels of sleep disturbance. Thus, the study objective was to describe and explore the relation between neurobehavioral performance and sleep among women during the early postpartum period. Design: Longitudinal field-based study. Participants: There were 70 primiparous women and nine nulliparous women in a control group. Interventions: None. Methods and Results: During their first 12 postpartum weeks, 70 primiparous women wore continuous wrist actigraphy to objectively monitor their sleep. Each morning they self-administered the psychomotor vigilance test (PVT) to index their neurobehavioral performance. Nine nulliparous women in a control group underwent the same protocol for 12 continuous weeks. Postpartum PVT mean reciprocal (1/RT) reaction time did not differ from that of women in the control group at postpartum week 2, but then worsened over time. Postpartum slowest 10% 1/RT PVT reaction time was significantly worse than that of women in the control group at all weeks. Despite improvements in postpartum sleep, neurobehavioral performance continued to worsen from week 2 through the end of the study. Across the first 12 postpartum weeks, PVT measures were more frequently associated with percent sleep compared with total sleep time, highlighting the deleterious consequences of sleep disruption on maternal daytime functioning throughout the early postpartum period. Conclusions: Worsened maternal neurobehavioral performance across the first 12 postpartum weeks may have been influenced by the cumulative effects of sleep disturbance. These results can inform future work to identify the particular sleep profiles that could be primary intervention targets to improve daytime functioning among postpartum women, and indicate need for further research on the effectiveness of family leave policies. The time when postpartum women return to control-level daytime functioning is unknown. Citation: Insana SP; Williams KB; Montgomery-Downs HE. Sleep disturbance and neurobehavioral performance among postpartum women. SLEEP 2013;36(1):73–81.
Insana, Salvatore P.; Williams, Kayla B.; Montgomery-Downs, Hawley E.
The impact of stress on the health of postpartum mothers is poorly understood. Although the postpartum period increases risk for stress related diseases such as depression and autoimmune disorders, little qualitative research has focused on women’s perceptions of postpartum stressors.\\u000aA constant comparative content analysis using Atlas.Ti was done on data collected by Groer (NIH R01 NR05000“Influence of Lactation on
Nancy Gilbert Crist
Background Early diagnosis of HIV infection can prevent morbidity and mortality as well as reduce HIV transmission. The aim of the present study was to assess prevalence, describe trends and identify factors associated with late presentation of HIV infection in Barcelona (Spain) during the period 2001-09. Methods Demographic and epidemiological characteristics of cases reported to the Barcelona HIV surveillance system were analysed. Late presentation was defined for individuals with a CD4 count below 350 cells/ml upon HIV diagnosis or diagnosis of AIDS within 3 months of HIV diagnosis. Multivariate logistic regression were used to identify predictors of late presentation. Results Of the 2,938 newly diagnosed HIV-infected individuals, 2,507 (85,3%) had either a CD4 cell count or an AIDS diagnosis available. A total of 1,139 (55.6%) of the 2,507 studied cases over these nine years were late presenters varying from 48% among men who have sex with men to 70% among heterosexual men. The proportion of late presentation was 62.7% in 2001-2003, 51.9% in 2004-2005, 52.6% in 2006-2007 and 52.1% in 2008-2009. A decrease over time only was observed between 2001-2003 and 2004-2005 (p = 0.001) but remained constant thereafter (p = 0.9). Independent risk factors for late presentation were older age at diagnosis (p < 0.0001), use of injected drugs by men (p < 0.0001), being a heterosexual men (p < 0.0001), and being born in South America (p < 0.0001) or sub-Saharan Africa (p = 0.002). Conclusion Late presentation of HIV is still too frequent in all transmission groups in spite of a strong commitment with HIV prevention in our city. It is necessary to develop interventions that increase HIV testing and facilitate earlier entry into HIV care.
The majority of cases of Madelung deformity are caused by hereditary dyschondrosteosis at the wrist. The principal lesion in the ulnar zone of the distal radial physis retards growth asymmetrically, especially in late childhood. Resection of this zone and its replacement with autologous fat (Langenski?ld procedure, or physiolysis) restores growth and minimizes deformity. The resection of an abnormal ligament tethering
D VICKERS; G. NIELSEN
Sedimentary records of Lake Edward in Central Africa from the late Holocene era exhibit submillennial-scale periodicities\\u000a in magnesium (Mg) and stable isotope compositions of endogenic calcite. Using multitaper spectral analysis, Russell et al. (Geology\\u000a 31(8):677–680, 2003) detected a 725-yr cycle in the Mg data. We have analyzed the Mg data using a continuous wavelet transform and observed temporal\\u000a variations in the
Asok K. Sen
Blood samples were obtained from 12 Iranian fat-tailed sheep during 7 weeks pre-partum, at parturition and 7 weeks post-partum. The lipids measured were cholesterol, triglyceride, total lipid, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, and very low-density lipoprotein (VLDL)-cholesterol. The concentrations of cholesterol, triglyceride, HDL-cholesterol and VLDL-cholesterol during the 7 weeks pre-partum, at parturition and the 7 weeks post-partum were significantly different (P < 0.05). One week before parturition, the concentrations of cholesterol, triglyceride, HDL-cholesterol and VLDL-cholesterol were higher (P < 0.05) than at other periods. The lowest concentrations of these parameters were observed 2-3 weeks after parturition. In this study, significant positive correlations were observed between the time of sampling (pre-partum, parturition and post-partum) and serum cholesterol (r = 0.22; P < 0.01) and HDL-cholesterol (r = 0.25; P < 0.01). PMID:11913828
Nazifi, S; Saeb, M; Ghavami, S M
Introduction Loss of more than 500 mL of blood following childbirth is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries, with a 1% mortality rate worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract, and coagulation disorders. Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of high parity. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug interventions and of drug interventions to prevent primary postpartum haemorrhage? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: active management of the third stage of labour, carboprost injection, controlled cord traction, ergot compounds (ergometrine/methylergotamine), immediate breastfeeding, misoprostol (oral, rectal, sublingual, or vaginal), oxytocin, oxytocin plus ergometrine combinations, prostaglandin E2 compounds, and uterine massage.
Abstract Background and Methods Physical activity during postpartum is both a recommended and an essential contributor to maternal health. Understanding the beliefs, barriers, and enablers regarding physical activity during the postpartum period can more effectively tailor physical activity interventions. The objective of this study was to document self-reported beliefs, barriers, and enablers to physical activity among a cohort of women queried at 3 and 12 months postpartum. Five questions about beliefs and two open-ended questions about their main barriers and enablers regarding physical activity and exercise were asked of 667 women at 3 months postpartum. Among the sample, 530 women answered the same questions about barriers and enablers to physical activity at 12 months postpartum. Results Agreement on all five beliefs statements was high (?89%), indicating that women thought that exercise and physical activity were appropriate at 3 months postpartum, even if they continued to breastfeed. For the cohort, the most common barriers to physical activity at both 3 and 12 months postpartum were lack of time (47% and 51%, respectively) and issues with child care (26% and 22%, respectively). No barrier changed by more than 5% from 3 to 12 months postpartum. For the cohort, the most common enablers at 3 months postpartum were partner support (16%) and desire to feel better (14%). From 3 to 12 months postpartum, only one enabler changed by >5%; women reported baby reasons (e.g., baby older, healthier, not breastfeeding, more active) more often at 12 months than at 3 months postpartum (32% vs. 10%). Environmental/policy and organizational barriers and enablers were reported less often than intrapersonal or interpersonal barriers at both time points. Conclusions A number of barriers and enablers were identified for physical activity, most of which were consistent at 3 and 12 months postpartum. This study provides information to create more successful interventions to help women be physically active postpartum.
Aytur, Semra A.; Borodulin, Katja
Palaeobiogeographic analysis of Indian tetrapods during the Late Cretaceous-Early Tertiary time has recognized that both vicariance and geodispersal have played important roles in producing biogeographic congruence. The biogeographic patterns show oscillating cycles of geodispersal (Late Cretaceous), followed by congruent episodes of vicariance and geodispersal (Early Eocene), followed by another geodispersal event (Middle Eocene). New biogeographic synthesis suggests that the Late Cretaceous Indian tetrapod fauna is cosmopolitan with both Gondwanan and Laurasian elements. Throughout most of the Cretaceous, India was separated from the rest of Gondwana, but in the latest Cretaceous it reestablished contact with Africa through Kohistan-Dras (K-D) volcanic arc, and maintained biotic link with South America via Ninetyeast Ridge-Kerguelen-Antarctica corridor. These two geodispersal routes allowed exchanges of "pan-Gondwana" terrestrial tetrapods from Africa, South America, and Madagascar. During that time India also maintained biotic connections with Laurasia across the Neotethys via Kohistan-Dras Arc and Africa. During the Palaeocene, India, welded to the K-D Arc, rafted like a "Noah's Ark" as an island continent and underwent rapid cladogenesis because of allopatric speciation. Although the Palaeocene fossil record is blank, Early Eocene tetrapods contain both endemic and cosmopolitan elements, but Middle Eocene faunas have strong Asian character. India collided with Asia in Early and Middle Eocene time and established a new northeast corridor for faunal migration to facilitate the bidirectional "Great Asian Interchange" dispersals.
Chatterjee, Sankar; Scotese, Christopher
The objectives were to characterize postpartum endometrial cytology and to determine the prevalence of subclinical endometrial inflammation and its impact on reproduction in beef cows. Samples for endometrial cytology (low-volume uterine lavage) were obtained from 135 of 137 Angus cows (2-87d postpartum) in northern Minnesota, 26d before breeding started. Agreement between examiners for subjective inflammation scores was very high (kappa=0.971); the correlation between these scores and PMN counts was high (r=0.83; P<0.001), validating subjective categorization. The proportion of PMN and large mononuclear cells (principally macrophages) declined with postpartum interval (P<0.001), whereas small mononuclear cells were consistently present (and not significantly affected by postpartum interval). Pregnancy rate to fixed-time AI was 29% and overall pregnancy rate was 89%. There was no association between cell type and ultimate pregnancy status or day of conception (P>0.10). Although inflammation later in the postpartum period apparently impaired subsequent reproduction in dairy cows, in cows >50 d postpartum at sample collection in the present study, no cytological parameter significantly predicted final pregnancy status or day of conception. Previous twinning increased the risk of subclinical endometritis (P=0.02), but not the probability of becoming pregnant (P=0.14). In conclusion, we inferred that beef cows had the ability to clear uterine inflammation after resumption of ovarian cyclicity. PMID:18992934
Santos, N R; Lamb, G C; Brown, D R; Gilbert, R O
A longitudinal study was conducted to examine the relationship between lameness and delayed ovarian cy- clicity during the first 60 d postpartum and days to first luteal activity during the first 300 d postpartum in Holstein cows. Two hundred thirty-eight cows from a 600-cow dairy that calved during a 12-mo period were used. Cows were classified into 1 of 6
E. J. Garbarino; J. A. Hernandez; J. K. Shearer; C. A. Risco; W. W. Thatcher
Separate research areas indicate that sleep quality, mood, and relationship satisfaction decline among couples during the postpartum period. Furthermore, accurate partner perceptions are associated with positive relationship qualities. In this study, 21 first-time postpartum mother–father dyads, contributed 1 week of continuous wrist actigraphy along with concurrent subjective Palm Pilot monitoring to provide objective and subjective sleep measures. Parents also reported
Salvatore P. Insana; Chelsea R. Costello; Hawley E. Montgomery-Downs
Mothers have inadequate information about what to expect in the postpartum period in terms of their own health. Understanding common patterns of postpartum health may be particularly important for mothers of preterm low birthweight infants, so that they can plan how to optimize their own health as they care for their vulnerable infants. The purpose of this study was to
Susan Gennaro; Joan Rosen Bloch
Laboratory methods give more accurate measurement of blood loss in the postpartum period than visual estimation. In order to evaluate a laboratory method used to quantify blood loss postpartum, blood lost at gynecological operations was collected in a measuring bottle. The measured amount of blood (50–1,000 ml) was then poured onto absorbent paper towels and sanitary pads, in order to
S. Chua; L. M. Ho; K. Vanaja; L. Nordstrom; A. C. Roy; S. Arulkumaran
Paintings and drawings by Lucas Moser, Leonardo da Vinci, Albrecht Dürer, and Jacob Cornelisz van Oostsanen suggest that they employed people who had had cleft lips operated on as models for their works of art. Created between 1431 and 1520, the portraits show diagnostic facial profiles with a curved nasal dorsum, short columella, maxillary retrusion, and pseudoprogenia. The first medical illustration of cleft lip surgery was published in 1564 by Ambroise Paré. It was therefore late Gothic and Renaissance artists who depicted the conspicuous signs of surgically treated patients with cleft lip more than 130 years before the surgeons. PMID:11286447
Pirsig, W; Haase, S; Palm, F
Postpartum weight retention plays an important role in the pathway leading to obesity among women of childbearing age. The objective of this study was to examine predictors of moderate (1–10 pounds) and high (>10 pounds) postpartum weight retention using data from a prospective pregnancy cohort that followed women into the postpartum period; n = 688 and 550 women at 3
Anna Maria Siega-Riz; Amy H. Herring; Kathryn Carrier; Kelly R. Evenson; Nancy Dole; Andrea Deierlein
|Only recently has the research on postpartum depression dealt with the disorder's effects on child development. This book explores the impact of postpartum depression on mother-infant interaction and child development, its treatment, and postpartum psychosis. The chapters are: (1) "The Nature of Postpartum Depressive Disorders" (Michael O'Hara);…
Murray, Lynne, Ed.; Cooper, Peter J., Ed.
The immigrant population in Taiwan has increased significantly over the past decade, and immigrants now comprise a significant proportion of the women in Taiwan receiving maternal care. Postpartum stress and depression are important physical and mental health issues. This article used a systemic review of published articles to understand the general incidence of postpartum depression amongst immigrant women. Articles reviewed included those published in MEDLINE, PubMed, Proquest and CEPS in either English or Chinese. A systematic literature review of 20 identified original research papers was conducted to explore postpartum depression in immigrant women. One article addressed the experience of healthcare providers responsible to care for immigrant women suffering from postpartum depression. Other articles discussed factors of influence on postpartum depression in immigrant women or related experiences. Results show that immigrant women have a higher incidence of postpartum depression than the overall population. This incidence is even higher amongst immigrant women from minority groups. In addition to socioeconomic influence factors, social support and acculturation abilities were also found to be significant predictive factors of postpartum depression in immigrant women in Taiwan. PMID:20127631
Lee, Li-Chun; Chen, Jih-Yuan; Chen, Chung-Hey
Objective While the majority of women quit smoking either before or during pregnancy, 60 to 80% relapse in the postpartum period. The objective of this research was to examine postpartum women who quit smoking during their pregnancies and to determine the predictive factors for relapse in the postpartum period by identifying different subgroups that predict risk of relapse. Method One hundred forty four postpartum women who were abstinent at the time of delivery were recruited. Data regarding the Acquisition Stage of Change, Decisional Balance and Situational Temptations to Smoke were assessed in the immediate postpartum period. Based on their intention to remain abstinent, 121 women identified in the acquisition-Precontemplation (aPC) group comprised the study sample. Smoking status was assessed again at 2-months postpartum Results A cluster analysis was performed to idenitfy subgroups of the acquisition-Precontemplation (aPC) group. Four subgroups were identified and were labeled Most Protected, Ambivalent, Risk Denial, and High Risk. Logistic regression was performed to establish external validity of the clusters. The clusters and exclusive breastfeeding were the only statistically significant variables associated with relapse at 2-months postpartum. Conclusions The results confirmed the clusters identified in previous prevention research with both adolescents and postpartum women, The cluster profiles can serve to guide the development of a tailored intervention program.
Simonelli, Mary Colleen; Velicer, Wayne F
We screened automated ambulatory medical records, hospital and emergency room claims, and pharmacy records of 2,826 health maintenance organization (HMO) members who gave birth over a 30-month period. Full-text ambulatory records were reviewed for the 30-day postpartum period to confirm infection status for a weighted sample of cases. The overall postpartum infection rate was 6.0%, with rates of 7.4% following cesarean section and 5.5% following vaginal delivery. Rehospitalization; cesarean delivery; antistaphylococcal antibiotics; diagnosis codes for mastitis, endometritis, and wound infection; and ambulatory blood or wound cultures were important predictors of infection. Use of automated information routinely collected by HMOs and insurers allows efficient identification of postpartum infections not detected by conventional surveillance.
Yokoe, D. S.; Christiansen, C. L.; Johnson, R.; Sands, K. E.; Livingston, J.; Shtatland, E. S.; Platt, R.
A five-and-a-half-year-old girl started experiencing progressive left hemiparesis at age two and a half years. At age five years and four months she started presenting clusters of asymmetric periodic epileptic spasms with no hypsarrhythmia. The ictal EEG showed periodic, constant and stereotyped complexes. Serial brain imaging revealed progressive atrophy of the right hemisphere with increased T2 signal on MRI. She underwent a right hemispherotomy, and histological examination showed signs of inflammation and features of focal cortical dysplasia (FCD). She has been seizure-free for 16 months. This case is unique in the following aspects: the presence of typical Rasmussen encephalitis features of progressive unilateral brain involvement without seizures, a delay of almost three years prior to seizure onset; an atypical seizure type presentation with periodic epileptic spasms and the presence of FCD associated with inflammatory changes. [Published with video sequences]. PMID:21896424
Ferrari, Taíssa P F; Hamad, Ana P A; Caboclo, Luís Otávio S F; Centeno, Ricardo S; Zaninotto, Ana Luiza; Scattolin, Monica; Carrete Junior, Henrique; Lancellotti, Carmem L P; Yacubian, Elza Márcia T
It is during this period that human activity can begin to be identified, which at this time depended upon hunting and gathering. The landscape is densely wooded with birch and hazel on the upland fells and oak and lime predominating in the lowland, along with elm and pine. There are a small number of clearances within the forest that have
A Late Devonian polymictic diamictite extends for more than 400??km from northeastern Pennsylvania across western Maryland and into east-central West Virginia. The matrix-supported, unbedded, locally sheared diamictite contains subangular to rounded clasts up to 2??m in diameter. The mostly rounded clasts are both locally derived and exotic; some exhibit striations, faceting, and polish. The diamictite commonly is overlain by laminated siltstone/mudstone facies associations (laminites). The laminites contain isolated clasts ranging in size from sand and pebbles to boulders, some of which are striated. The diamictite/laminite sequence is capped by massive, coarse-grained, pebbly sandstone that is trough cross-bedded. A stratigraphic change from red, calcic paleo-Vertisols in strata below the diamictite to non-calcic paleo-Spodosols and coal beds at and above the diamictite interval suggests that the climate became much wetter during deposition of the diamictite. The diamictite deposit is contemporaneous with regressive facies that reflect fluvial incision during the Late Devonian of the Appalachian basin. These deposits record a Late Devonian episode of climatic cooling so extreme that it produced glaciation in the Appalachian basin. Evidence for this episode of climatic cooling is preserved as the interpreted glacial deposits of diamictite, overlain by glaciolacustrine varves containing dropstones, and capped by sandstone interpreted as braided stream outwash. The Appalachian glacigenic deposits are contemporaneous with glacial deposits in South America, and suggest that Late Devonian climatic cooling was global. This period of dramatic global cooling may represent the end of the mid-Paleozoic warm interval that began in the Middle Silurian. ?? 2008 Elsevier B.V. All rights reserved.
Brezinski, D. K.; Cecil, C. B.; Skema, V. W.; Stamm, R.
Background The objective was to examine the course and longitudinal associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in mothers over the postpartum 2 years. Method Using a prospective naturalistic design, 296 mothers recruited from a large community pool were assessed for GAD and MDD at 3, 6, 10, 14, and 24 months postpartum. Structured clinical interviews were used for diagnoses, and symptoms were assessed using self-report questionnaires. Logistic regression analyses were used to examine diagnostic stability and longitudinal relations, and latent variable modeling was employed to examine change in symptoms. Results MDD without co-occurring GAD, GAD without co-occurring MDD, and co-occurring GAD and MDD, displayed significant stability during the postpartum period. Whereas MDD did not predict subsequent GAD, GAD predicted subsequent MDD (in the form of GAD + MDD). Those with GAD + MDD at 3 months postpartum were significantly less likely to be diagnosis free during the follow-up period than those in other diagnostic categories. At the symptom level, symptoms of GAD were more trait-like than those of depression. Conclusions Postpartum GAD and MDD are relatively stable conditions, and GAD is a risk factor for MDD but not vice versa. Given the tendency of MDD and GAD to be persistent, especially when comorbid, and the increased risk for MDD in mothers with GAD, as well as the potential negative effects of cumulative exposure to maternal depression and anxiety on child development, the present findings clearly highlight the need for screening and treatment of GAD in addition to MDD during the postpartum period.
Prenoveau, Jason; Craske, Michelle; Counsell, Nicholas; West, Valerie; Davies, Beverley; Cooper, Peter; Rapa, Elizabeth; Stein, Alan
Although many women experience sexual problems in the postpartum period, research in this subject is under-explored. Embarrassment and preoccupation with the newborn are some of the reasons why many women do not seek help. Furthermore, there is a lack of professional awareness and expertise and recognition that a prerequisite in the definition of sexual dysfunction is that it must cause
Zeelha Abdool; Ranee Thakar; Abdul H. Sultan
Samples of induced sputum from 187 individuals were used to estimate the bronchopulmonary immunity status after a prolonged radiation exposure (120 individuals who are the Mayak main plant workers were exposed to combined internal a-radiation due to incorporated plutonium (239Pu) and external y-radiation during their career). The control group included 67 Ozersk residents of a corresponding age and gender, without any occupational exposure, who were examined at the same period. The immune system is the most important component in homeostasis. In occupational workers, the status of the systemic and bronchopulmonary immunity after 30-55 years of career was estimated by the level of regulatory proteins in the samples of blood and the induced sputum supernatant stored at low temperatures in freezers of the Radiobiological human tissue Repository, SUBI (interleukins IL-1beta, IFN-gamma, IL-12+p70, IL-15, IL-17A and growth factors EGF, TGF-beta1, FGF and PDGF-AA), as well as by the content of effector and regulatory lymphocytes in blood. After the examination period, each registrant was provided with dosimetry data: 239Pu body burden was from 0.03 kBq to 11.89 kBq, the absorbed dose to the lung from incorporated radionuclide - from 0.01 Gy to 1.38 Gy, and accumulated doses of external y-radiation during the occupational career - from 0.02 Gy to 7.91 Gy. In the case of the prolonged combined radiation, the tensioned mode of immunity cell link functioning and the increase of activated lymphocyte forms were detected. Comparison of correlation coefficients between the content oflymphocytes, the level ofinterleukins and growth factors and the dose load allowed us to find relation of these ratios to the type of exposure, Pu body burden, the absorbed 239Pu dose to the lung and the accumulated external dose. The reduced concentration of the main growth factors in the group of Mayak workers is the evidence for the declined control function of proteins and immunodeficiency. The analysis of the regulatory proteins content in blood and sputum following occupational exposure allowed us to find specific features of the protein expression in support of the local and systemic immune homeostasis. PMID:23516889
Pavlova, O S; Kirillova, E N; Luk'ianova, T V; Oslina, D S; Ryzhov, V P
This longitudinal study examined depression symptoms among pregnant, low-income, urban Latinas, primarily Puerto Ricans and Dominicans, receiving obstetrical services in community health centers. In all, 106 women were interviewed in late pregnancy, 47 were interviewed again 2 to 3 weeks postpartum, and 42 three months postpartum. Elevated levels of depressive symptoms were evident in 53% of the original sample. Across
Luis H. Zayas; Katherine R. B. Jankowski; M. Diane McKee
OBJECTIVE: The purpose of this study was to examine the effects of feelings about pregnancy and consideration of abortion on late initiation of prenatal care and postpartum appointment.STUDY DESIGN: A descriptive study was conducted in a tertiary clinic in Detroit using a convenience sample comprised of 518 low-income pregnant and postpartum women with a large number of unintended pregnancies. A
Tara McComb Hulsey; Marilyn Laken; Virginia Miller; Joel Ager
The purpose of this study is to analyze health at the transition from the Late Antique (LA) to the Early Medieval (EM) period in Croatia. Results of the analyses of skeletal remains are compared with historical and archaeological data to test the hypothesis that the transition was catastrophic. An additional objective is to determine whether the transition was a uniform process, or differentially affected the past inhabitants of Croatia because of various local considerations. To accomplish this, four markers of health: cribra orbitalia, linear enamel hypoplasia, nonspecific periostitis, and trauma were compared in 981 skeletons: 477 from nine urban LA sites, and 504 from six rural EM sites. Data were collected by sex and age for individual, and for co-occurrences of various features. Because continental and Adriatic Croatia has different ecological features, data were specifically tabulated for the two regions. Comparisons between the continental and Adriatic regions of the LA series showed no significant differences in the frequencies of the analyzed markers of stress. Comparisons between the LA and EM series showed similar frequencies in continental Croatia--suggesting no significant discontinuity of living conditions, and a significant increase of cribra orbitalia, periostitis, and trauma frequencies during the EM period in Adriatic Croatia. The deterioration of living conditions primarily affected subadults and males. These data suggest that the transition from the LA to the EM period in Croatia was not a uniform process, but differentially affected population biology most likely because of local cultural, socio-economical or political considerations. PMID:18383158
Purpose: This study was conducted to develop a postpartum care program and to evaluate the effects of the program on postpartum activity and postpartum discomfort in primiparous women. Methods: For this control group quasi-experimental study, primiparous women who had a normal delivery at OBGYN clinics in G-city and then went home with assistance from their mothers participated from April 10
Two hundred and sixty-nine (5.4%) of the 4,998 patients who delivered in Westmead Hospital, New South Wales in 1985 had immediate postpartum complications. This analysis was compared with figures from a major institution in another state of Australia. Early detection and prompt management without procrastination was the key to a successful outcome in the fourth stage of labour (i.e. within 24 hours of delivery). Nearly three-quarters of the complications were due to postpartum haemorrhage (PPH). The contributory factors are analysed and discussed. Reappraisal of the indications for induction of labour, epidural analgesia and forceps delivery is necessary to reduce the incidence of postpartum haemorrhage. The study reinforces the need for undiminished vigilance in the fourth stage of labour even if the first 3 stages are uncomplicated. PMID:2346452
St George, L; Crandon, A J
Background Saliva has been advocated as an alternative to serum or plasma for steroid monitoring. Little normative information is available concerning expected concentrations of the major reproductive steroids in saliva during pregnancy and the extended postpartum. Methods Matched serum and saliva specimens controlled for time of day and collected less than 30?minutes apart were obtained in 28 women with normal singleton pregnancies between 32 and 38?weeks of gestation and in 43 women during the first six months postpartum. Concentrations of six steroids (estriol, estradiol, progesterone, testosterone, cortisol, dehydroepiandrosterone) were quantified in saliva by enzyme immunoassay. Results For most of the steroids examined, concentrations in antepartum saliva showed linear increases near end of gestation, suggesting an increase in the bioavailable hormone component. Observed concentrations were in agreement with the limited data available from previous reports. Modal concentrations of the ovarian steroids were undetectable in postpartum saliva and, when detectable in individual women, approximated early follicular phase values. Only low to moderate correlations between the serum and salivary concentrations were found, suggesting that during the peripartum period saliva provides information that is not redundant to serum. Conclusions Low correlations in the late antepartum may be due to differential rates of change in the total and bioavailable fractions of the circulating steroid in the final weeks of the third trimester as a consequence of dynamic changes in carrier proteins such as corticosteroid binding globulin.
We screened automated ambulatory medical records, hospital and emer- gency room claims, and pharmacy records of 2,826 health maintenance organization (HMO) members who gave birth over a 30-month period. Full- text ambulatory records were reviewed for the 30-day postpartum period to confirm infection status for a weighted sample of cases. The overall post- partum infection rate was 6.0%, with rates
Deborah S. Yokoe; Cindy L. Christiansen; Ruth Johnson; Kenneth E. Sands; James Livingston; Ernest S. Shtatland; Richard Platt
Factors influencing operative mortality and late survival of 549 patients undergoing a first reoperation for prosthetic valve failure during the interval from 1966 to 1992 were analyzed; 347 patients had reoperation on a mitral prosthesis, 173 on an aortic prosthesis and 29 on both aortic and mitral prostheses. Univariate analysis showed that hospital mortality was higher in patients in functional class IV compared with those in class II-III (35% vs. 8%, p < 0.001), in those who required emergency reoperation (57% vs. 11%, p < 0.001), in those reoperated for endocarditis (59%) or valve thrombosis (43%) compared with those reoperated for structural valve deterioration (9%, p < 0.001), and in those with a failing mechanical prosthesis compared to patients with a bioprosthesis (21% vs. 10%, p < 0.05). Furthermore, operative mortality decreased from 41% in the period from 1966 to 1977, to 12% from 1977 to 1983 and to 8% from 1984 to 1992 (p < 0.001). Hospital survivors were followed from 0.1 to 22 years (mean follow-up 11 +/- 5 years) with an overall actuarial survival at 15 years of 24 +/- 5%. At 15 years actuarial survival is 24 +/- 5% for patients in preoperative functional class II-III and 20 +/- 6% for those in functional class IV (p < 0.05). It is concluded that in prosthetic valve recipients both early and late outcome is greatly influenced by preoperative clinical status. Increasing surgical experience, better myocardial protection and patient management have contributed to reducing the operative risk. More accurate patient follow up and possibly earlier reoperation might also improve the long term outcome. PMID:8162223
Bortolotti, U; Milano, A; Mossuto, E; Mazzaro, E; Thiene, G; Casarotto, D
BACKGROUND: The research on Postpartum Depression (PPD) to date suggests that there is a knowledge gap regarding women's perception of their partners' role as carer and care activities they perform. Therefore, the purpose of this study was to describe women's understanding of their partners' or husbands' involvement in the midst of PPD. METHODS: This study used interview data from a
Phyllis Montgomery; Pat Bailey; Sheri Johnson Purdon; Susan J Snelling; Carol Kauppi
Postpartum blues, postpartum neurotic depression and puerperal psychoses have distinct clinical features; they affect women in all social classes and in all cultures, and despite numerous studies they have not been linked definitively with any biologic or psychosocial variables. The only possible exception is puerperal psychosis, which emerges much more often in women with a personal or family history of a bipolar affective disorder than in women without, a finding that probably explains the reluctance of some researchers to recognize puerperal psychotic episodes as distinct from psychotic episodes at other times. If postpartum blues last longer than 2 weeks and are disabling they are classified as neurotic depression and warrant treatment, often requiring both psychosocial approaches and psychotropic drug therapy. Antidepressants, major tranquillizers, electroconvulsive therapy and lithium have proved effective in the treatment of postpartum psychoses, depending on the symptoms. Both lithium and diazepam have been reported to cause deleterious side effects on breast-fed infants, and as the side effects of other psychotropic drugs given to a nursing mother are imperfectly understood, bottle feeding seems prudent.
Robinson, G E; Stewart, D E
The number of incarcerated women in the United States is steadily increasing with 9% giving birth while serving time. Mothers and babies are routinely separated immediately and during most of the postpartum period. This qualitative study examines the impact of this policy by exploring the nature and meaning of the mother-infant bonding experience when the mothers know separation is coming. Twelve incarcerated postpartum mothers were interviewed during the early postpartum period about their antepartum and postpartum relationships with their babies. Qualitative data analysis produced four relational themes: (a) "a love connection," (b) "everything was great until I birthed," (c) "feeling empty and missing a part of me," and (d) "I don't try to think too far in advance." Results of this qualitative study provide information to professionals exploring gender-sensitive prison policies for the growing female population. PMID:20022914
Chambers, Angelina N
In thinking about a title for this chapter, the word periodicity came to mind. I was sure this had some kind of pop culture reference. After discussing this with my wife, we figured I was thinking of synchronicity, which is a reference to music by the band, The Police. Looking the word Periodicity up on the internet, I found that I was, in fact, a science geek and had not made a hip reference. Periodicity refers mainly to the Periodic Table, which is a focus of this chapter. No music, just science.
Robertson, William C.
The purpose of this study was to examine the association of short sleep duration among women in the first year postpartum with adiposity and cardiometabolic status at 3 years postpartum. We studied 586 women in Project Viva, a prospective cohort. At 6 months and 1 year postpartum, women reported the number of hours they slept in a 24-h period, from which we calculated a weighted average of daily sleep. We used multivariable regression analyses to predict the independent effects of short sleep duration (?5 h/day vs. >5 h/day) on adiposity, glucose metabolism, lipid metabolism, and adipokines at 3 years postpartum. Women's mean (s.d.) hours of daily sleep in the first year postpartum was 6.7 (0.97) h. After adjusting for age, race/ethnicity, education, parity, prepregnancy BMI, and excessive gestational weight gain, we found that postpartum sleep ?5 h/day was associated with higher postpartum weight retention (? 1.50 kg; 95% confidence interval (CI): 0.02, 2.86), higher subscapular + triceps skinfold thickness (? 3.94 mm; 95% CI: 1.27, 6.60) and higher waist circumference (? 3.10 cm; 95% CI: 1.25, 4.94) at 3 years postpartum. We did not observe associations of short sleep duration with measures of cardiometabolic status at 3 years postpartum. In conclusion, short sleep duration in the first year postpartum is associated with higher adiposity at 3 years postpartum. PMID:20489690
Taveras, Elsie M; Rifas-Shiman, Sheryl L; Rich-Edwards, Janet W; Gunderson, Erica P; Stuebe, Alison M; Mantzoros, Christos S
Background During the postpartum period, some women might be under a considerable amount of stress and at increased risk for onset or exacerbation of obsessive–compulsive disorder (OCD). Little is known about the stress response correlates during the postpartum period and in patients with OCD. This study aimed to examine the cerebral, psychologic and endocrine correlates of the stress response in patients with OCD and during the postpartum period. Methods Women with postpartum OCD, healthy postpartum women and healthy mothers past the postpartum period underwent functional magnetic resonance imaging while facing a reliable psychosocial stressor (the Montreal Imaging Stress Task). Stress-related psychologic and endocrine responses (i.e., cortisol) were obtained. Results We enrolled 12 women with postpartum OCD, 16 healthy postpartum women and 11 healthy mothers past the postpartum period in our study. Compared with healthy postpartum counterparts, postpartum women with OCD had a heightened self-reported and endocrine stress response associated with a distinct brain activation pattern in response to psychosocial stress involving the orbitofrontal and temporal cortices. Moreover, compared with mothers assessed in a period of time beyond the postpartum period, healthy postpartum women did not differ in psychologic and cortisol response to stress, but recruited different brain regions, such as the dorsolateral pre-frontal cortex and the anterior cingulate cortex, during exposure to stress. Limitations Potential confounding factors, such as medication use, breastfeeding, parity and personality factors, may have modulated the stress-related endocrine response and could not be assessed in this study. Conclusion Obsessive–compulsive disorder and the postpartum period differentially influence the brain circuitry underlying psychosocial stress as well as the psychologic and endocrine responses.
Lord, Catherine; Steiner, Meir; Soares, Claudio N.; Carew, Caitlin L.; Hall, Geoffrey B.
Similar to biological mothers during the postpartum period, women who adopt children experience increased stress and life\\u000a changes that may put them at risk for developing depression and anxiety. The purpose of the current study was to compare levels\\u000a of depression and anxiety symptoms between postpartum and adoptive women and, among adoptive women, to examine associations\\u000a between specific stressors and
Sarah L. Mott; Crystal Edler Schiller; Jenny Gringer Richards; Michael W. O’Hara; Scott Stuart
Tubal sterilization is a highly effective, permanent, and safe method of contraception. Many women who desire postpartum sterilization do not obtain the procedure due to barriers. We performed a retrospective cohort study examining patients from a single obstetrics practice who delivered between 1/1/07 and 6/30/07 at Women and Infants Hospital in Providence, RI. During the study period, 626 women in the practice delivered. Of these subjects, 87 (14%) desired postpartum sterilization. Of these 87, 45 (51.7%) underwent sterilization as planned. In multivariable analysis controlling for age, BMI, delivery mode and marital status, older age (OR 2.15, 95% CI 1.12, 4.12, p=0.02) and cesarean delivery (OR 19.65, 95% CI 3.75, 103.1, p < 0.001) were associated with completion of postpartum sterilization and being married (OR 0.10, 95% CI 0.02, 0.56, p=0.009) and having a higher BMI (OR 0.60, 95% CI 0.39, 0.91, p=0.02) were associated with incompletion. Only half of women who request postpartum sterilization antenatally end up obtaining the procedure. PMID:23641425
Boardman, Lori A; Desimone, Michael; Allen, Rebecca H
One hundred and fifty-nine women were measured for depressive and anxiety symptoms from late pregnancy through to 12 months\\u000a postpartum. Partial correlations revealed stability of depressive and anxiety symptoms across time. Depressive symptoms did\\u000a not predict anxiety at any time point. Anxiety predicted increases in depressive symptoms from late pregnancy to early postpartum,\\u000a but not from early postpartum to mid postpartum.
Karen M. Moss; Helen Skouteris; Eleanor H. Wertheim; Susan J. Paxton; Jeannette Milgrom
Multiproxy analysis (pollen, diatom, charcoal) on a 6 m core from Lago Verde (Sierra de Los Tuxtlas), shows evidences of environmental\\u000a changes and human impact on the evergreen rainforest on the tropical lowlands of eastern Mexico during the last ca. 2,800 years.\\u000a Prehistoric human occupation is recorded since the late Formative throughout the middle Classic (250 b.c.–ca. a.d. 800) by the presence
Socorro Lozano-García; Margarita Caballero; Beatriz Ortega; Susana Sosa; Alejandro Rodríguez; Peter Schaaf
The late Iron Age human remains from the British hillfort of Maiden Castle are frequently cited within the archaeological and bioarchaeological literature as providing evidence for con?ict. This interpretation is based on osteological work undertaken in the late 1930s. In order to test the validity of using this sample in conflict research, the authors undertook a detailed analysis of the
Rebecca C. Redfern; Andrew T. Chamberlain
Sarcoidosis is a multisystemic disease of unknown etiology, characterized by granulomatous inflammation. It typically presents between the ages of 20 to 40 years old. An estimated 0.02% to 0.05% of pregnancies occur in patients with sarcoidosis. Although fetal loss has been reported in mothers with sarcoidosis, limited studies do not suggest an in- crease risk of fetal or neonatal complications.
Bobbak Vahid; Neil Mushlin; Sandra Weibel
This paper describes the 3D modelling of Pinchango Alto, Peru, based on a combination of image and range data. Digital photogrammetry and laser scanning allow archaeological sites to be recorded efficiently and in detail even under unfavourable conditions. In 2004 we documented Pinchango Alto, a typical site of the hitherto poorly studied Late Intermediate Period on the south coast of
Karsten Lambers; Henri Eisenbeiss; Martin Sauerbier; Denise Kupferschmidt; Thomas Gaisecker; Soheil Sotoodeh; Thomas Hanusch
This study was conducted using Orem's self-care model to investigate its impact on the reduction and prevention of women's postpartum complications. One group of 63 women was included in the study in which a pretest and posttest quasi-experimental method was used. For analysis of the data, descriptive statistics, dependent groups t test, and McNemar test were applied, 24 different nursing diagnoses were made. Self-care agency pretest mean score was 97.13 ± 17.20, posttest mean score was 114.44 ± 13.72, and the difference was statistically significant (p < .001). The study found that the care given to women in the postpartum period using Orem's self-care model prevented postpartum complications and increased the self-care agency of postpartum women. PMID:24085674
Nazik, Evsen; Eryilmaz, Gülsen
Abstract Background Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women. This paper presents the design, rationale, and baseline participant characteristics of a randomized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese. Methods Active Mothers Postpartum (AMP) is based on the rationale that the birth of a child can be a teachable moment. AMP's primary objectives are to promote and sustain a reduction in body mass index (BMI) up to 2 years postpartum via changes in diet and exercise behavior, with a secondary aim to assess racial differences in these outcomes. Women in the intervention arm participate in ten physical activity group sessions, eight healthy eating classes, and six telephone counseling sessions over a 9-month period. They also receive motivational tools, including a workbook with recipes and exercises, a pedometer, and a sport stroller. Results Four hundred fifty women aged ?18 (mean 30.9), with a BMI ??25 kg/m2 (mean 33.0) at baseline (6 weeks postpartum) were enrolled; 45% of the final sample are black and 53% are white. Baseline characteristics by study arm and by race are presented. Conclusions Our intervention is designed to be disseminated broadly to benefit the public health. Behavior change interventions based on principles of social cognitive theory, stage of readiness, and other models that coincide with a teachable moment, such as the birth of a child, could be important motivators for postpartum weight loss.
Krause, Katrina M.; Brouwer, Rebecca J. N.; Lovelady, Cheryl A.; Morey, Miriam C.; Bastian, Lori A.; Peterson, Bercedis L.; Swamy, Geeta K.; Chowdhary, Jaspreet; McBride, Colleen M.
Purpose Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty. Methods A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information. Results A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors). Conclusion Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally.
Perera, C; Jhanji, V; Lamoureux, E; Pollock, G; Favilla, I; Vajpayee, R B
This study was designed to examine women's experiences of weight loss during the postpartum period. Understanding women's positive and negative experiences can assist health care providers to successfully intervene in helping women lose weight following pregnancy and avoid long-term weight gain and obesity development. Design: Phenomenology, according to Husserl's perspective. Setting: Private location of the women's choosing. Participants: Twenty-six women, who ranged in age from 25 to 35 years, and had given birth within the last 5 years, were interviewed regarding their experiences with postpartum weight loss. The majority of the sample was Caucasian. Interviews were transcribed and themes were identified from each of the interviews. Comparisons were made between interviews to identify common experiences between women. Data were analyzed according to the Giorgi method. The women in the study had a wide range of experiences. Themes that emerged from the interviews related to women's challenges with return to prepregnancy weight. These included: time and motivation issues, the need for support, and weight and other struggles. This study provides a look inside the lives of women faced with the reality of losing weight after childbirth. Losing weight after delivery is multi-faceted and influenced by many factors. Interventions to assist women with weight loss should target the challenges described in this paper. When effective strategies are developed, education can be done during pregnancy to prepare for the postpartum period. Ultimately, future research efforts can help us to eliminate pregnancy as a risk factor for obesity in women. PMID:20844941
Montgomery, Kristen S; Bushee, Tracy D; Phillips, Jennifer D; Kirkpatrick, Terrie; Catledge, Courtney; Braveboy, Kristin; O'Rourke, Carol; Patel, Neema; Prophet, Malshundria; Cooper, Anita; Mosley, Lori; Parker, Christie; Douglas, Gaye M
Evidence of postpartum depression in Western culture has been widely documented in the literature. The conclusion reached by many researchers is that women are vulnerable to depression following childbirth to some extent. It has been suggested that postpartum depression is a culture?bound syndrome that develops because of lack of supportive rites and rituals surrounding childbirth. The present study was undertaken
Stephanie Stewart; Jaya Jambunathan
A variety of explanations have been suggested to explain postpartum depression in women, including biological, psychological, social and cultural forces (Fossey, Papiernik & Bydlowski, 1987; O'Hara & Swain, 1996). This paper goes beyond biological explanations to explore psychosocial influences such as the cultural experience of giving birth, maternal expectations and the role of social support. Postpartum depression rates in Germany
Tracie Merritt; Sara Kuppin; Michelle Wolper; Bruce B. Downs
Similar to biological mothers during the postpartum period, women who adopt children experience increased stress and life changes that may put them at risk for developing depression and anxiety. The purpose of the current study was to compare levels of depression and anxiety symptoms between postpartum and adoptive women and, among adoptive women, to examine associations between specific stressors and depressive symptoms. Data from adoptive mothers (n=147), recruited from Holt International, were compared to existing data from postpartum women (n=147). Differences in the level of depression and anxiety symptoms as measured by the Inventory of Depression and Anxiety Symptoms among postpartum and adoptive women were examined. Associations between specific stressors and depressive symptoms were examined among adoptive mothers. Postpartum and adoptive women had comparable levels of depressive symptoms, but adoptive women reported greater well-being and less anxiety than postpartum women. Stressors (e.g., sleep deprivation, history of infertility, past psychological disorder, and less marital satisfaction) were all significantly associated with depressive symptoms among adoptive women. The level of depressive symptoms was not significantly different between the two groups. In contrast, adoptive women experienced significantly fewer symptoms of anxiety and experienced greater well-being. Additionally, adoptive mothers experienced more depressive symptoms during the year following adoption when the stressors were present. Thus, women with these characteristics should be routinely screened for depression and anxiety.
Schiller, Crystal Edler; Richards, Jenny Gringer; O'Hara, Michael W.; Stuart, Scott
Urine was collected from 55 cows via indwelling urinary catheters for periods of 12 h on different days (28 days prepartum to 60 days postpartum). Ex- cretion of urinary creatinine (mg\\/h per kg bodyweight) among Holsteins increased from .94 on day 28 prepartum to 1.14 on day .5 postpartum and then decreased to .82 on days 30 to 45 of
R. E. Erb; A. H. Surve; R. D. Randel; H. A. Garverick
The objectives of this study were to relate energy balance and metabolic hormones during the early postpartum period in dairy cows with dominant folli- cle development before first ovulation and to evaluate the effects of prilled lipid on follicular development during the first follicular wave after parturition and the postpartum anovulatory interval. At parturition, 42 cows received a control diet
S. W. Beam; W. R. Butler
|Objective: We examined the course and predictors of postpartum depression in the 18 months following interpersonal psychotherapy (IPT). Method: We enrolled 120 community women with major depression in a 12-week randomized trial of individual IPT during the postpartum period (O'Hara, Stuart, Gorman, & Wenzel, 2000). At 6, 12, and 18 months…
Nylen, Kimberly J.; O'Hara, Michael W.; Brock, Rebecca; Moel, Joy; Gorman, Laura; Stuart, Scott
Prolonged postpartum acyclicity (absence of ovarian cyclic activity) and anestrum (absence of overt estrous signs) are major sources of economic loss to buffalo breeders. Studies on the epidemiology of these two problems are highly recommended to achieve successful control. Review of the available literature on controlled studies in dairy buffaloes revealed that first ovulation as detected by rectal palpation and progesterone analysis occurred between 28-71 and 24-55 days, respectively, after calving. Postpartum estrus in the same studies occurred between 44 and 87 days. Reports concerned with data compiled from breeding records of research stations, breeding farms and small holders where estrus is a subjective measure, gave much longer periods. Also data from Egypt, India and Pakistan indicate that only 34-49% of buffaloes showed estrus during the first 90 days after calving and 31-42% remained anestrus for more than 150 days. In swamp buffaloes both postpartum ovulation and estrus are more delayed than in dairy buffaloes. The role of suckling, nutrition, body condition score at calving, milk yield, parity, season of calving and other minor factors were discussed. First postpartum ovulation is frequently followed by one or more short estrous cycles (<18 days). Long anovulatory and anestrous periods due to prolonged inter-luteal phase were reported to occur after short cycles. Also long anestrous periods due to cessation of cyclic activity (true anestrus) for 3 or more weeks and prolonged luteal activity for 28 days or more were described to occur in about 25 and 8-11% of the buffaloes, respectively, after the first or second ovulation. These cycle irregularities certainly impose difficulties on estrus detection programs in postpartum buffaloes. Four main forms of anestrus i.e. true anestrus (inactive ovaries and small and medium sized anovulatory follicles), subestrus, prolonged luteal activity and ovarian cysts in addition to pregnancy are reviewed in this article. Differentiation between true anestrus and subestrus is particularly important in buffaloes because of their weak estrous signs. However, the accuracy of a single rectal palpation of the ovaries is limited with an overestimation of the frequency of true anestrus due to misdiagnosis of the corpus luteum. The possible causes are discussed. PMID:16621354
El-Wishy, A B
The solid planets assembled 4.57 Gyr ago during a period of less than 100 Myr, but the bulk of the impact craters we see on the inner planets formed much later, in a narrow time interval between 3.8 and 3.9 Gyr ago, during the so-called late heavy bombardment (LHB). It is not certain what caused the LHB, and it has not been well known whether the impactors were comets or asteroids, but our present study lend support to the idea that it was comets. Due to the Earth's higher gravity, the impactors will have hit the Earth with ˜twice the energy density that they hit the Moon, and the bombardment will have continued on Earth longer than on the Moon. All solid surface of the Earth will have been completely covered with craters by the end of the LHB. However, almost nothing of the Earth's crust from even the end of this epoch, is preserved today. One of the very few remnants, though, is exposed as the Isua greenstone belt (IGB) and nearby areas in Western Greenland. During a field expedition to Isua, we sampled three types of metasedimentary rocks, deposited ˜3.8 billion years ago, that contain information about the sedimentary river load from larger areas of surrounding land surfaces (mica-schist and turbidites) and of the contemporaneous seawater (BIF). Our samples show evidence of the LHB impacts that took place on Earth, by an average of a seven times enrichment (150 ppt) in iridium compared to present-day ocean crust (20 ppt). The clastic sediments show slightly higher enrichment than the chemical sediments, which may be due to contamination from admixtures of mafic (proto-crustal) sources. We show that this enrichment is in agreement with the lunar cratering rate and a corresponding extraterrestrial LHB contribution to the Earth's Hadean-Eoarchean crust, provided the bulk of the influx was cometary (i.e., of high velocity and low in CI abundance), but not if the impactors were meteorites (i.e. had velocities and abundances similar to present-day Earth-crossing asteroids). Our study is a first direct indication of the nature of the LHB impactors, and the first to find an agreement between the LHB lunar cratering rate and the Earth's early geochemical record (and the corresponding lunar record). The LHB comets that delivered the iridium we see at Isua will at the same time have delivered the equivalent of a ˜1 km deep ocean, and we explain why one should expect a cometary ocean to become roughly the size of the Earth's present-day ocean, not only in terms of depth but also in terms of the surface area it covers. The total impacting mass on the Earth during the LHB will have been ˜1000 tons/m 2.
Gråe Jørgensen, Uffe; Appel, Peter W. U.; Hatsukawa, Yuichi; Frei, Robert; Oshima, Masumi; Toh, Yosuke; Kimura, Atsushi
Evidence of a multi-centennial scale dry period between ˜2800 and 1850 cal yr BP is documented by pollen, mollusks, diatoms, and sediment in spring sediments from Stonehouse Meadow in Spring Valley, eastern central Nevada, U.S. We refer to this period as the Late Holocene Dry Period. Based on sediment recovered, Stonehouse Meadow was either absent or severely restricted in size at ˜8000 cal yr BP. Beginning ˜7500 cal yr BP, the meadow became established and persisted to ˜3000 cal yr BP when it began to dry. Comparison of the timing of this late Holocene drought record to multiple records extending from the eastern Sierra Nevada across the central Great Basin to the Great Salt Lake support the interpretation that this dry period was regional. The beginning and ending dates vary among sites, but all sites record multiple centuries of dry climate between 2500 and 1900 cal yr BP. This duration makes it the longest persistent dry period within the late Holocene. In contrast, sites in the northern Great Basin record either no clear evidence of drought, or have wetter than average climate during this period, suggesting that the northern boundary between wet and dry climates may have been between about 40° and 42° N latitude. This dry in the southwest and wet in the northwest precipitation pattern across the Great Basin is supported by large-scale spatial climate pattern hypotheses involving ENSO, PDO, AMO, and the position of the Aleutian Low and North Pacific High, particularly during winter.
Mensing, Scott A.; Sharpe, Saxon E.; Tunno, Irene; Sada, Don W.; Thomas, Jim M.; Starratt, Scott; Smith, Jeremy
Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.
During December 1992 to October 1994, in Texas, clinical researchers conducted a prospective case control study (15 cases receiving Norplant immediately postpartum vs. 6 controls undergoing bilateral tubal ligation immediately postpartum) to determine the safety and efficacy of inserting the contraceptive implant Norplant (6 capsules inserted subdermally, each containing 35 mg levonorgestrel) immediately postpartum. They followed the cases and the controls for three months. The study subjects were 18-35 years old, received prenatal care at one of the Department of Obstetrics and Gynecology's (Texas Tech University Health Sciences Center) community clinics, had an uncomplicated term pregnancy and normal spontaneous vaginal delivery, and did not breast feed. They tended to be poor. During the first week after Norplant insertion, serum levonorgestrel levels peaked at about 2000 pg/ml, then fell abruptly until about the eighth week to about 250 pg/ml. This lower levonorgestrel level concerned the researchers because it is just slightly higher than levels associated with pregnancy. They were also concerned about the possibility of Norplant inducing a hypoestrogenic state in postpartum women. The Norplant group was more likely than the tubal ligation group to experience irregular bleeding (p 0.01), headaches (p 0.01), hair loss (p 0.05), and abdominal discomfort (p 0.05). The various serum metabolic biomarkers, serum electrolytes, and blood components fell into the normal range in both groups. The serum estradiol, progesterone, and urinary steroid biomarkers suggested that the Norplant group experienced very suppressed steroid secretion throughout the three month study period, while the controls had normal postpartum ovarian activity. Thus, ovarian activity was absent in the Norplant group. These findings suggest that postpartum insertion of Norplant is safe and effective. Yet further clinical evaluation is needed to address concerns about the long-term hypoestrogenic state and contraceptive efficacy beyond the three month postpartum period. PMID:8752609
Molland, J R; Morehead, D B; Baldwin, D M; Castracane, V D; Lasley, B; Bergquist, C A
ÖZET Postpartum depresyon, doumdan sonra ilk y›l içinde görülen bir duygudurum bozukluudur. Postpartum depresyonda kendine veya bebeine zarar verme ve intihar riski görülebilir. Postpartum depresyonun erken tan›lanmas› ve tedavi edilmesi ciddi depresyonun geliflmesini azalt- mak için önemlidir. Hemflireler\\/ebeler depresif kad›na daha fazla yard›m etmek ve daha fazla bilgi vermek için, doru sorular› sorarak postpartum depresyonun deerlendirmesine yard›mc› olabilir- ler. Postpartum
The purpose of this study was to examine the association of short sleep duration among women in the first year postpartum with inflammation at 3 years postpartum. We studied 479 women in Project Viva, a prospective cohort. At 6 months and 1 year postpartum, women reported the number of hours they slept in a 24-hour period, from which we calculated a weighted average of daily sleep. We used multivariable median regression analyses to predict the independent effects of short sleep duration (?5 vs >5 h/d) on markers of inflammation, for example, interleukin 6 (IL-6) and C-reactive protein at 3 years postpartum. Women's mean (SD) hours of daily sleep in the first year postpartum was 6.7 (0.96) hours. After adjusting for age, race/ethnicity, education, parity, pre-pregnancy body mass index, excessive gestational weight gain, and gestational age at delivery, we found that postpartum sleep ?5 h/d was associated with elevated IL-6 (?, 0.25 pg/mL; 95% confidence interval, 0.14-0.43) compared with >5 h/d. Although postpartum sleep ?5 h/d appeared to also be associated with elevated C-reactive protein (? 0.15 mg/dL; 95% confidence interval, -0.08 to 0.52), these results did not reach statistical significance. Short sleep duration in the first year postpartum is associated with elevated levels of the proinflammatory marker, IL-6, at 3 years postpartum. PMID:21040938
Taveras, Elsie M; Rifas-Shiman, Sheryl L; Rich-Edwards, Janet W; Mantzoros, Christos S
Laboratory methods give more accurate measurement of blood loss in the postpartum period than visual estimation. In order to evaluate a laboratory method used to quantify blood loss postpartum, blood lost at gynecological operations was collected in a measuring bottle. The measured amount of blood (50-1,000 ml) was then poured onto absorbent paper towels and sanitary pads, in order to mimic conditions when measuring blood loss in clinical trials in the postpartum period. The amount of blood absorbed onto the absorbent paper and sanitary pads was measured by a rapid method of automatic extraction and photometric measurement of alkaline hematin. The study shows that the method provides a reliable and accurate means of measuring blood loss. The error in each case was less than 10% with an intraclass correlation coefficient of almost 1. PMID:9692338
Chua, S; Ho, L M; Vanaja, K; Nordstrom, L; Roy, A C; Arulkumaran, S
Variations in the plasma concentration of levetiracetam during pregnancy and postpartum were prospectively monitored in five women to investigate their potential implications in epilepsy management and child outcome. Under unchanged levetiracetam dosages, the mean concentrations of levetiracetam during the third trimester were 62% of the baseline late (12 month) postpartum levels, but only 47% of the baseline early postpartum (2 month) levetiracetam levels. In dual therapy with lamotrigine, baseline late postpartum levetiracetam clearance was 63.2%, whereas in early postpartum it was 45% of the maximal second-trimester clearance. However, the number of seizures remained unchanged once lamotrigine dose was increased. No woman had adverse effects during the puerperium. The mean umbilical cord/maternal plasma concentration ratio was 1.21. None of the newborns had malformations, with the anthropometric data being normal for their gestational age. The decline in gestational levetiracetam plasma concentration does not seem to be hazardous, but differs according to whether early or late postpartum levels are chosen as baseline levels. PMID:19362602
López-Fraile, Isabel P; Cid, Antonio Oliveros; Juste, Antonio Oliveros; Modrego, Pedro J
A 36-year-old female started having postpartum vaginal bleeding after normal vaginal delivery. She underwent hysterectomy for persistent bleeding and was referred to our institution. An elevation of PTT and normal PT made us suspect postpartum acquired hemophilia (PAH), and it was confirmed by low factor VIII activity levels and an elevated factor VIII inhibitor. Hemostasis was achieved with recombinant factor VII concentrates and desmopressin, and factor eradication was achieved with cytoxan, methylprednisolone, and plasmapheresis.
Seethala, Srikanth; Enderton, Elizabeth; Corral, Javier
A 36-year-old female started having postpartum vaginal bleeding after normal vaginal delivery. She underwent hysterectomy for persistent bleeding and was referred to our institution. An elevation of PTT and normal PT made us suspect postpartum acquired hemophilia (PAH), and it was confirmed by low factor VIII activity levels and an elevated factor VIII inhibitor. Hemostasis was achieved with recombinant factor VII concentrates and desmopressin, and factor eradication was achieved with cytoxan, methylprednisolone, and plasmapheresis. PMID:23533849
Seethala, Srikanth; Gaur, Sumit; Enderton, Elizabeth; Corral, Javier
Background Recent studies have displayed increased interest in examining the relationship between personality traits and the onset, treatment response patterns, and relapse of depression. This study aimed to examine whether or not harm avoidance (HA) was a risk factor for postpartum depression measured by the Edinburgh Postnatal Depression Scale (EPDS) and the state dependency of HA. Methods Pregnant women (n=460; mean age 31.9±4.2 years) who participated in a prenatal program completed the EPDS as a measure of depressive state and the Temperament and Character Inventory (TCI) as a measure of HA during three periods: early pregnancy (T1), late pregnancy (around 36 weeks), and 1 month postpartum (T2). Changes in EPDS and HA scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group. Results There was no significant difference in the level of HA between the ND and PD groups at T1. In the ND group, EPDS and HA scores did not change significantly from T1 to T2. In the PD group, both scores increased significantly from T1 to T2 (EPDS, p<0.0001; HA, p<0.048). In the ND and PD groups, a significant positive correlation was observed in changes in EPDS and HA scores from T1 to T2 (r=0.31, p=0.002). Conclusions These results suggest that HA cannot be considered a risk factor for the development of postpartum depression measured by EPDS. Furthermore, HA may be state dependent.
Okada, Takashi; Murase, Satomi; Aleksic, Branko; Hayakawa, Norika; Shiino, Tomoko; Nakamura, Yukako; Tamaji, Ai; Ishikawa, Naoko; Ohoka, Harue; Usui, Hinako; Banno, Naomi; Morita, Tokiko; Goto, Setsuko; Kanai, Atsuko; Masuda, Tomoko; Ozaki, Norio
The authors report two cases of post-partum cortical renal necrosis. The diagnosis was made on clinical and biological criteria (severe, prolonged oliguria, the signs of intra-vascular coagulation defects, a rise in L.D.H. and anaemia with micro-angiopathy. It is confirmed by selective renal arteriography and renal punch-biopsy. There is a threefold method of treatment: --of the kidney condition by repeated haemodialysis and diuretics; --antihypertensive treatment; --treatment aimed at the aetiological pathology (heparin, anti-platelet aggregation and fresh plasma). Functional recovery of the kidney was obtained in both cases (after an interval of 1 year and an interval of 1 1/2 year). The authors review the diagnostic, physiopathological, morphological and therapeutic elements in the condition of cortical renal necrosis. PMID:7161455
Hiault, C; Dequiedt, P; Benoit, O; Dognin, C; Monnier, J C; Cotteel, M; Puech, F; Leroy, J L; Tacquet, A; Delecour, M
We have examined the responsiveness of dopamine sensitive neurones in the postpartum period in woman with a history of major depression who are at high risk of experiencing a recurrence of illness in the postpartum period. Fourteen women were assessed at 36 weeks of pregnancy and during the 3 months following delivery, using the Schedule for Affective Disorders and Schizophrenia,
R. J. Mc Ivor; R. A. Davies; A. Wieck; M. N. Marks; N. Brown; I. C. Campbell; S. A. Checkley; R. Kumar
Abstract Adherence to antiretrovirals by pregnant women (and postpartum women if breastfeeding) is crucial to effectively decrease maternal viral load and decrease the risk of mother-to-child transmission of HIV. Our objectives were to describe self-reported adherence to antiretrovirals during the antepartum (after 22 weeks of pregnancy) and postpartum periods (6–12 weeks and 6 months), and identify predictors of adherence among HIV-infected women enrolled and followed in a prospective cohort study from June 2008 to June 2010 at multiple sites in Latin America. Adherence was evaluated using the number of missed and expected doses during the 3 days before the study visit. At the pre-delivery visit, 340 of 376 women (90%) reported perfect adherence. This rate significantly decreased by 6–12 weeks (171/214 [80%]) and 6 months postpartum (163/199 [82%], p<0.01). The odds for less than perfect adherence at the pre-delivery visit was significantly higher for pregnant women with current tobacco use (odds ratio [OR]=2.9, 95% confidence interval [CI]: 1.46–6.14; p=0.0029). At 6–12 weeks postpartum, the probability of non-perfect adherence increased by 6% for each 1 year increase in age (OR=1.06, 95% CI: 1.00–1.12, p=0.0497). At 6 months postpartum, the odds of nonperfect adherence was higher for those who were currently using alcohol (OR=3.04, 95% CI: 1.34–6.90; p=0.0079). Although a self-report measure of adherence based on only 3 days may lead to overestimation of actual adherence over time, women with perfect adherence had lower viral loads and higher CD4 counts. Adherence to antiretrovirals decreased significantly postpartum. Interventions should target women at high risk for lower adherence during pregnancy and postpartum, including tobacco and alcohol users.
Harris, D. Robert; Kakehasi, Fabiana; Haberer, Jessica E.; Cahn, Pedro; Losso, Marcelo; Teles, Elizabete; Pilotto, Jose H.; Hofer, Cristina B.; Read, Jennifer S.
Background Guatemala has the third highest level of maternal mortality in Latin America. Postpartum haemorrhage is the main cause of maternal mortality. In rural Guatemala, most women rely on Traditional Birth Attendants (TBAs) during labour, delivery, and the postpartum period. Little is known about current postpartum practices that may contribute to uterine involution provided by Mam- and Spanish-speaking TBAs in the Western Highlands of Guatemala. Methods a qualitative study was conducted with 39 women who participated in five focus groups in the San Marcos Department of Guatemala. Questions regarding postpartum practices were discussed during four focus groups of TBAs and one group of auxiliary nurses. Results three postpartum practices believed to aid postpartum uterine involution were identified: use of the chuj (Mam) (Spanish, temazcal), a traditional wood-fired sauna-bath used by Mam-speaking women; herbal baths and teas; and administration of biomedicines. Conclusions TBAs provide the majority of care to women during childbirth and the postpartum period and have developed a set of practices to prevent and treat postpartum haemorrhage. Integration of these practices may prove an effective method to reduce maternal morbidity and mortality in the Western Highlands of Guatemala.
Radoff, K.A.; Thompson, Lisa M.; Bly, KC; Romero, Carolina
This study was conducted to investigate in early postpartum suckled beef cows with and without FSH pre-stimulation: (i) the influence of the postpartum period on the number and quality of oocytes recovered by ovum pick-up (OPU), (ii) the overall efficiency of the OPU\\/IVP embryos from days 30 to 80 postpartum and (iii) if repeated OPU negatively affect fertility following a
J. F. Aller; N. C. Mucci; G. G. Kaiser; G. Ríos; S. S. Callejas; R. H. Alberio
Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.
Fitelson, Elizabeth; Kim, Sarah; Baker, Allison Scott; Leight, Kristin
[Comparison of dysrhythmias in women with hypertension in the period of premenopause and in late fertile period with altered hormonal background in dependence on the variant of left ventricular modeling].
We carried out 24 hour Holter ECG monitoring in 106 women with hypertension in the period of premenopause and in late fertile period with altered hormonal background. Comparative analysis of character and structure of dysrhythmias showed that supraventricular premature beats including rapid and allorhythmic extrasystoles were more often registered among premenopausal women than among patients in fertile period. Same tendencies took place concerning frequency of ventricular rhythm disturbances (in most cases I grade II-IV ventricular extrasystoles). Comparative analysis of dysrhythmias in premenopausal and fertile hypertensive women with normal left ventricular geometry and with hypertrophic type of remodeling showed that both supraventricular and ventricular rhythm disturbances were significantly more often registered in hypertrophic variants of left ventricular remodeling, especially in premenopausal women. PMID:20459402
Khabibulina, M M; Iordanidi, Ia S; Grishina, I F; Andreev, A N
Minority adolescent mothers (N = 375) were interviewed during the prepartum (or early postpartum) period and approximately 1 year later (N = 186) regarding their maternal and romantic relationships, depressive symptomatology, and negative life events. Over time, adolescents reported that male partners provided more support than did mothers and that partners' support was equally important to mothers' support. Further, while
Christina B. Gee; Jean E. Rhodes
In response to the concept that a good postpartum program should begin prenatally, this study was designed to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of contraceptive usage, and pregnancy rates during the first year after childbirth. Over 500 women attending antenatal clinics in each of three
K. B. Smith; Z. M. van der Spuy; L. Cheng; R. Elton; A. F. Glasier
Objective: To determine the risk of occurrence and recurrence of postpartum haemorrhage (excessive bleeding after childbirth) among women having at least two consecutive pregnancies. Design and setting: Population-based study using longitudinally linked hospital discharge and birth records from New South Wales for the period 1 January 1994 to 31 December 2002. Participants: All 125 295 women having at least a
Jane B Ford; Christine L Roberts; Jane C Bell; Charles S Algert; Jonathan M Morris
This study was designed to examine the relationship between gender role orientation and psychological adjustment during pregnancy and the postpartum period in a large sample of French-speaking Caucasian mothers. Gender role was assessed with the Bem Sex Role Inventory, which classifies subjects into four categories: androgynous, masculine, feminine, and undifferentiated. A discriminant analysis showed a relationship between androgyny and the
Marc Berthiaume; Hélène David; Jean-François Saucier; François Borgeat
Twenty-four women with children 5 years old or younger were interviewed regarding their experiences in losing weight during the postpartum period. Phenomenological interviews were conducted according to Husserl's perspective. Women who participated in the study revealed the issues related to postpartum weight loss: weight struggles, exercise, breast-feeding, eating, and pregnancy contributions to weight gain. The overall theme that resulted from these in-depth interviews was that women struggle to balance their successes and setbacks in losing weight during the postpartum period. PMID:23175169
Montgomery, Kristen S; Best, Melissa; Aniello, Tracy B; Phillips, Jennifer D; Hatmaker-Flanigan, Elizabeth
A quasi-experimental design was used to compare postpartum perineometer readings of an experimental group of 32 women receiving a prenatal teaching program for the use of Kegel exercises with a control group of 30 women for whom the instructional program was omitted. All subjects received postpartum instruction from a pre-existing program presented by hospital staff. Significantly higher mean postpartum perineometer readings (t = 4.07; P less than .01) were found for the experimental group than for the control group, which supported the hypothesis that women who are offered the prenatal program for the use of Kegel exercises during the third trimester of pregnancy and are instructed on Kegel exercises by the staff during the hospitalized postpartum period will have significantly higher readings on the perineometer at the postpartum visit than those women for whom the prenatal program is omitted. PMID:6558247
Henderson, J S
Abstract Background The postpartum period may be critical for the development of midlife obesity. Identifying factors associated with postpartum weight change could aid in targeting women for healthy lifestyle interventions. Methods Data from Active Mothers Postpartum (AMP), a study of overweight and obese postpartum women (n=450), were analyzed to determine the effect of baseline characteristics, breastfeeding, diet, physical activity, and contraception on weight change from 6 weeks to 12, 18, and 24 months postpartum. The repeated measures mixed model was used to test the association of these effects with weight change. Results Although mean weight loss was modest (0.49 kg by 24 months), the range of weight change was striking (+21.5?kg to ?24.5?kg, standard deviation [SD] 7.4). Controlling only for baseline weight, weight loss was associated with breastfeeding, hormonal contraception, lower junk food and greater healthy food intake, and greater physical activity. Only junk food intake and physical activity were significant after controlling for all other predictors. Conclusions Eating less healthy foods and being less physically active put overweight and obese women at risk of gaining more weight after a pregnancy.
Peterson, Bercedis L.; Krause, Katrina M.; Swamy, Geeta K.; Lovelady, Cheryl A.
The early postpartum period is associated with increased risk for affective and psychotic disorders. Because maternal dopaminergic reward system function is altered with perinatal status, dopaminergic system dysregulation may be an important mechanism of postpartum psychiatric disorders. Subjects included were non-postpartum healthy (n=13), postpartum healthy (n=13), non-postpartum unipolar depressed (n=10), non-postpartum bipolar depressed (n=7), postpartum unipolar (n=13), and postpartum bipolar depressed (n=7) women. Subjects underwent 60?min of [11C]raclopride–positron emission tomography imaging to determine the nondisplaceable striatal D2/3 receptor binding potential (BPND). Postpartum status and unipolar depression were associated with lower striatal D2/3 receptor BPND in the whole striatum (p=0.05 and p=0.02, respectively) that reached a maximum of 7–8% in anteroventral striatum for postpartum status (p=0.02). Unipolar depression showed a nonsignificant trend toward being associated with 5% lower BPND in dorsal striatum (p=0.06). D2/3 receptor BPND did not differ significantly between unipolar depressed and healthy postpartum women or between bipolar and healthy subjects; however, D2/3 receptor BPND was higher in dorsal striatal regions in bipolar relative to unipolar depressives (p=0.02). In conclusion, lower striatal D2/3 receptor BPND in postpartum and unipolar depressed women, primarily in ventral striatum, and higher dorsal striatal D2/3 receptor BPND in bipolar relative to unipolar depressives reveal a potential role for the dopamine (DA) system in the physiology of these states. Further studies delineating the mechanisms underlying these differences in D2/3 receptor BPND, including study of DA system responsivity to rewarding stimuli, and increasing power to assess unipolar vs bipolar-related differences, are needed to better understand the affective role of the DA system in postpartum and depressed women.
Moses-Kolko, Eydie L; Price, Julie C; Wisner, Katherine L; Hanusa, Barbara H; Meltzer, Carolyn C; Berga, Sarah L; Grace, Anthony A; di Scalea, Teresa Lanza; Kaye, Walter H; Becker, Carl; Drevets, Wayne C
This article reviews the risk factors, pathogenesis, treatment, and prevention of postpartum depression. Postpartum depression\\u000a is common and occurs in up to 18% of newly delivered mothers. Though the hormonal changes occurring after childbirth are believed\\u000a to play a role in postpartum depression, no hormonal etiology has been identified. Estrogen appears somewhat helpful for postpartum\\u000a depression, but its use is
Deborah Lynne Flores; Victoria C. Hendrick
The objective of this study was to examine which factors during pregnancy and postpartum predict pelvic girdle pain (PGP) at 12 weeks postpartum among working women. A total of 548 Dutch pregnant employees were recruited in 15 companies, mainly health care, child care, and supermarkets. The definition of PGP was any pain felt in the pelvic girdle region at 12 weeks postpartum. Participants received questionnaires at 30 weeks of pregnancy and at 6 and 12 weeks postpartum with demographic, work-related, pregnancy-related, fatigue, psychosocial, PGP-related and delivery-related questions. Univariate and multiple logistic regression analyses were performed. Almost half of the women experienced pain in their pelvic girdle at 12 weeks postpartum. However, the level of pain and the degree of disability due to postpartum PGP was low. Pregnancy-related predictors for PGP at 12 weeks were history of low back pain, higher somatisation, more than 8 hours of sleep or rest per day, and uncomfortable postures at work. The pregnancy and postpartum-related predictors were: more disability at 6 weeks, having PGP at 6 weeks, higher mean pain at 6 weeks, higher somatisation during pregnancy and at 6 weeks postpartum, higher birth weight of the baby, uncomfortable postures at work and number of days of bed rest. Based on these results, it is concluded that extra attention should be given to women who experience PGP during pregnancy to prevent serious PGP during late pregnancy and postpartum. More research is needed to confirm the roles of hours of sleep, somatisation, and bed rest in relation to PGP. PMID:23137900
Stomp-van den Berg, Suzanne G M; Hendriksen, Ingrid J M; Bruinvels, David J; Twisk, Jos W R; van Mechelen, Willem; van Poppel, Mireille N M
Objective: The goal of this study was to describe the frequency of postpartum fecal incontinence and to examine associated delivery events in a group of women participating in a validation study of a postpartum fecal incontinence survey. Study Design: A self-administered survey of fecal incontinence symptoms and delivery events was administered to 50 women seen for their 6-week postpartum appointments.
Wendy Hall; Karen McCracken; Patricia Osterweil; Jeanne-Marie Guise
Maternal iron status is thought to be related to postpartum depressive symptoms. The purpose of the present study was to evaluate the relationship between pre- and postnatal maternal iron status and depressive symptoms in pilot (n = 137) and confirmatory (n = 567) samples of Chinese women. Iron status was evaluated at mid- and late pregnancy and 3 days postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal postpartum depression 24-48 hours after delivery and 6 weeks later. In the pilot sample, correlations between early- and late-pregnancy maternal Hb and EPDS scores at 6 weeks were r = 0.07 and -0.01, respectively (nonsignificant). In the confirmatory sample, the correlations between maternal iron measures (Hb, MCV, ZPP, ferritin, sTfR, and sTfR Index) in mid- or late pregnancy or 3 days postpartum and EPDS scores shortly after delivery or at 6 weeks were also low (r values 0.10). EPDS scores in anemic and nonanemic mothers did not differ, regardless of sample or timing of maternal iron status assessment. In addition, women with or without possible PPD were similar in iron status in both samples. Thus, there was no relationship between maternal iron status and postpartum depression in these samples. PMID:22900184
Armony-Sivan, Rinat; Shao, Jie; Li, Ming; Zhao, Gengli; Zhao, Zhengyan; Xu, Guobing; Zhou, Min; Zhan, Jianying; Bian, Yang; Ji, Chai; Li, Xing; Jiang, Yaping; Zhang, Zhixiang; Richards, Blair J; Tardif, Twila; Lozoff, Betsy
Maternal iron status is thought to be related to postpartum depressive symptoms. The purpose of the present study was to evaluate the relationship between pre- and postnatal maternal iron status and depressive symptoms in pilot (n = 137) and confirmatory (n = 567) samples of Chinese women. Iron status was evaluated at mid- and late pregnancy and 3 days postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal postpartum depression 24–48 hours after delivery and 6 weeks later. In the pilot sample, correlations between early- and late-pregnancy maternal Hb and EPDS scores at 6 weeks were r = 0.07 and ?0.01, respectively (nonsignificant). In the confirmatory sample, the correlations between maternal iron measures (Hb, MCV, ZPP, ferritin, sTfR, and sTfR Index) in mid- or late pregnancy or 3 days postpartum and EPDS scores shortly after delivery or at 6 weeks were also low (r values 0.10). EPDS scores in anemic and nonanemic mothers did not differ, regardless of sample or timing of maternal iron status assessment. In addition, women with or without possible PPD were similar in iron status in both samples. Thus, there was no relationship between maternal iron status and postpartum depression in these samples.
Armony-Sivan, Rinat; Shao, Jie; Li, Ming; Zhao, Gengli; Zhao, Zhengyan; Xu, Guobing; Zhou, Min; Zhan, Jianying; Bian, Yang; Ji, Chai; Li, Xing; Jiang, Yaping; Zhang, Zhixiang; Richards, Blair J.; Tardif, Twila; Lozoff, Betsy
BACKGROUND: In many Southeast Asian cultures the activities and diet during the postpartum period are culturally dictated and a period of confinement is observed. Plants play an important role in recovery during the postpartum period in diet, traditional medicine, steam bath and mother roasting (where mother and child placed on a bed above a brazier with charcoal embers on which
Hugo de Boer; Vichith Lamxay
Postpartum depression (PPD) is the most common medical complication of childbearing. Universal screening maximizes the likelihood of prompt identification of PPD. Obstetrician-gynecologists routinely evaluate postpartum women for a general health examination and review of family planning options at approximately 6 weeks after birth; therefore, they are well-positioned to identify PPD. In this paper, we review the diagnostic criteria for postpartum depressive disorders and clinical risk factors predictive of PPD. We examine depression screening tools, appropriate cut-points associated with positive screens, the optimal timing for screening and the acceptability of depression screening in obstetrical settings. Lastly, we explore how to manage patients who screen positive for depression and treatment options for women with PPD.
Sit, Dorothy K.; Wisner, Katherine L.
Dietary fat intake is extremely low in most communities with vitamin A deficiency. However, its role in vitamin A status of pregnant and lactating women is poorly understood. The aim of the study was to examine the effect of supplementing women with fat from mid-/late pregnancy until six months postpartum on their vitamin A status and that of their infants. Women recruited at 5-7 months of gestation were supplemented daily with 20 mL of soybean-oil (n=248) until six months postpartum or received no supplement (n=251). Dietary fat intake was assessed by 24-hour dietary recall at enrollment and at 1, 3 and 6 months postpartum. Concentrations of maternal plasma retinol, ?-carotene, and lutein were measured at enrollment and at 1, 3 and 6 months postpartum, and those of infants at six months postpartum. Concentration of breastmilk retinol was measured at 1, 3 and 6 months postpartum. The change in concentration of plasma retinol at three months postpartum compared to pregnancy was significantly higher in the supplemented compared to the control women (+0.04 vs -0.07 ?mol/L respectively; p<0.05). Concentrations of plasma ?-carotene and lutein declined in both the groups during the postpartum period but the decline was significantly less in the supplemented than in the control women at one month (?-carotene -0.07 vs -0.13 ?mol/L, p<0.05); lutein -0.26 vs -0.49 ?mol/L, p<0.05) and three months (?-carotene -0.04 vs -0.08 ?mol/L, p<0.05; lutein -0.31 vs -0.47 ?mol/L, p<0.05). Concentration of breastmilk retinol was also significantly greater in the supplemented group at three months postpartum than in the controls (0.68±0.35 vs 0.55±0.34 ?mol/L respectively, p<0.03). Concentrations of infants’ plasma retinol, ?-carotene, and lutein, measured at six months of age, did not differ between the groups. Fat supplementation during pregnancy and lactation in women with a very low intake of dietary fat has beneficial effects on maternal postpartum vitamin A status.
van Raaij, Joop M.A.; Hautvast, Joseph G.A.J.; Yunus, M.; Wahed, M.A.; Fuchs, G.J.
This longitudinal study explores the relationship of postpartum depression (PPD) and marital dysfunction on infant outcomes from birth to 2 1/2 years of age among middle-class, postpartum women. Participants were recruited during the prenatal period. Twelve mothers completed the study throughout a 2 1/2-year period. Questionnaires, semistructured interviews, and observations were used to collect data. Content analysis of the interviews (Morse & Field, 1995) was conducted and thematic patterns were identified. Clinical PPD and marital dysfunction (defined as little or no support or closeness, or verbal, emotional or physical abuse) characterized nearly one in three mothers. Four themes describing the women's postpartum progression were identified: stress, isolation, resentment, and eventual adjustment by creating a new normal. No major developmental delays or behavioral problems were found among the infants. Eight of the 12 mothers who were initially identified as breastfeeding nursed their infants for 6–18 months. Regardless of financial and educational advantages, mothers in the study experienced depression and marital dysfunction. These findings support other studies that confirm the lack of association of PPD with social class or marital status. Childbirth educators and other health care professionals are encouraged to continue providing expectant families with anticipatory education and community resources in order to increase awareness of mental health and marital risks during the postpartum transition.
Roux, Gayle; Anderson, Cheryl; Roan, Chris
The sediments of the Galician continental margin (NW Spain) exhibit great but variable degrees of early diagenetic dissolution of magnetic minerals. This process completely erases any detrital magnetic signal at time-scales that range from about 1,000 years to less than 50 years in the highly productive estuarine-like environment of the Galician Rias Baixas. The more open marine conditions encountered in the adjoining continental shelf exhibit however a significantly different behavior. The singular balance between early diagenetic dissolution and lower sedimentation rates allows partial and variable preservation of the also variable detritally controlled magnetic inputs. In this context it is possible to reconstruct the recent environmental history of the area attending to the changes in the concentration of magnetically-interesting iron oxides. High-resolution magnetic and geochemical measurements carried out in 6 cores from the continental self evidenced the occurrence of correlatable peaks of magnetic mineral concentration that were interpreted as periods of enhanced detrital input. Magnetically depleted sediments were related to lower detrital input and/or to enhanced productivity that intensified the reductive conditions. The magnetic concentration peaks occurred within the Medieval (MWP) and Roman Warm Periods. Similar concentrations of hematite in the MWP and the RWP suggest that the lower concentration-dependent magnetic properties in the RWP are most likely caused by a greater degree of dissolution of magnetic detrital oxides due to a longer exposure to reducing conditions. These features could be traced over all the studied area, despite the great heterogeneity of the shelf sediments. This highlights the potential of magnetic properties as proxies of paleoenvironmental conditions in areas of similar complexity. This approach can be used as a rapid and cost-effective tool to screen large areas in the search for suitable settings for more precise, but time-consuming analysis, as well to extrapolate results through correlation of the appropriate magnetic features. We thank Prof. T. von Dobeneck and Dr. M. Dekkers for their kind support and advice during the stays of K. Mohamed in Bremen and Utrecht. The research of K. Mohamed in Bremen was funded by the EU Paleostudies program.
Mohamed, K.; Rey, D.; Rubio, B.; Vilas, F.
Objective Periodic limb movements in sleep (PLMS) show a time-of-night pattern, with most movements at the beginning of the night. Our study aimed to determine whether this pattern is due to an endogenous circadian rhythm, like that in the related movement disorder Restless Legs Syndrome (RLS). Methods Four healthy older adults with a screening PLMI> 20 were studied in an inpatient forced desynchrony protocol with an imposed sleep-wake cycle of 20 hours for twelve “nights,” allowing separation of circadian and sleep homeostatic influences on leg movements. We recorded sleep polysomnographically throughout each scheduled episode, including left and right anterior tibialis EMG. Results PLMS in Stage 2 showed both a significant time-within-sleep pattern and a significant circadian rhythm. The circadian rhythm in PLMS peaked at the circadian phases when usual sleep onset occurs, preceding the evening rise in melatonin secretion. Conclusions In our subjects, the circadian pattern of PLMs expression was very similar to that previously reported in patients with RLS. This evidence for a circadian rhythm in PLMS has implications for treatment and provides direction for future studies of the pathophysiology of this movement disorder.
Duffy, Jeanne F.; Lowe, Alex S.W.; Silva, Edward J.; Winkelman, John W.
The current study examined concurrent and longitudinal relations between maternal negative affective behavior and child negative emotional expression in preschool age children with (n = 96) or without (n = 126) an early developmental risk, as well as the predictions of later behavior problems. Maternal negative affective behavior, child externalizing emotional expression, and child internalizing emotional expression were observed during a number of lab tasks at child ages 4 and 5, and child externalizing and internalizing behavior problems were assessed via maternal questionnaire at age 6. Path analyses using structural equation modeling were utilized to test the relations among the variables at ages 4, 5, and 6. A parent-driven model of emotion socialization emerged, wherein stronger relations were found among maternal negative affect and child externalizing emotions and behaviors than among maternal negative affect and child internalizing emotions and behaviors. Early child risk did not appear to alter the overall emotion socialization process, although higher levels of maternal and child negativity were observed for the children with a developmental risk. Results underscore the complexity of emotion socialization processes throughout the preschool period.
According to a recent evolutionary life history model of development proposed by Ellis, Figueredo, Brumbach, and Schlomer (2009), growing up in harsh versus unpredictable environments should have unique effects on life history strategies in adulthood. Using data from the Minnesota Longitudinal Study of Risk and Adaptation, we tested how harshness and unpredictability experienced in early childhood (age 0-5) versus in later childhood (age 6-16) uniquely predicted sexual and risky behavior at age 23. Findings showed that the strongest predictor of both sexual and risky behavior was an unpredictable environment between ages 0 and 5. Individuals exposed to more unpredictable, rapidly changing environments during the first 5 years of life displayed a faster life history strategy at age 23 by having more sexual partners, engaging in more aggressive and delinquent behaviors, and being more likely to be associated with criminal activities. In contrast, exposure to either harsh environments or experiencing unpredictability in later childhood (age 6-16) was, for the most part, not significantly related to these outcomes at age 23. Viewed together, these findings show that unpredictable rather than merely harsh childhood environments exert unique effects on risky behavior later in life consistent with a faster life history strategy. The findings also suggest that there is a developmentally sensitive period for assessing environmental unpredictability during the first 5 years of life. PMID:22329381
Simpson, Jeffry A; Griskevicius, Vladas; Kuo, Sally I-Chun; Sung, Sooyeon; Collins, W Andrew
Pregnant Swiss albino mice were exposed to 0.3, 0.5, 1.0, or 1.5 Gy of gamma radiation on day 17 of gestation. Sham-exposed controls were examined for comparison. Exposed mice as well as controls were left to complete gestation and parturition. Pups were observed up to age 6 weeks; appearance of physiological markers (pinna detachment, eye opening, fur development, vaginal opening, and testes descent), postnatal mortality, body weight, body length, head length, head width, and tail length were recorded. A significant delay in fur development was observed at 0.3 Gy and in other physiological markers at doses above 0.3 Gy, while a significant increase in mortality and growth retardation occurred only at 1.0 and 1.5 Gy. Although congenital anomalies such as syndactyly and bent tail were observed at doses of 0.5-1.5 Gy, only syndactyly showed a statistically significant increase in frequency. A statistically significant lower body weight was observed during the first week of postnatal life, but body weights increased to normal levels by the second week in animals exposed to doses less than 1.0 Gy. At higher doses, low body weight persisted throughout the postnatal period. Head length and tail length showed a significant decrease from controls at 0.5-1.5 Gy, and the effect was evident from birth to age 6 weeks. But a similar effect on body length and head width was noticed only at 1.0 and 1.5 Gy. These studies indicate that even in the absence of any major morphological changes, normal development of physiological landmarks and postnatal growth can be impaired by fetal irradiation at 17 days p.c. (post coitus). Morphological changes appear to have a threshold between 0.3-0.5 Gy, while physiological marker effects may occur with a lower threshold. PMID:10194803
Hossain, M; Devi, P U; Bisht, K S
The purpose of this study was to assess nutrition knowledge during early and late postpartum in a sample of low-income and minority women, and to determine if that knowledge had any relationship to weight retention at 1-year postpartum. A questionnaire was developed and validated in a sample of 151 low-income new mothers. This instrument was then administered to a separate
Henry Nuss; Jeanne Freeland-Graves; Kristine Clarke; Deborah Klohe-Lehman; Tracey J. Milani
|Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation…
Birkeland, Robyn; Thompson, J. Kevin; Phares, Vicky
|Within the framework of the social stress and behavioral theories of depression, this study investigated the hypothesis that postpartum depression is a function of disruption of parents' prepartum functioning by the subsequent demands of infant caretaking. Seventy-eight primiparous married couples (N=156, 78 men and 78 women) volunteered to…
Atkinson, A. Kathleen; Rickel, Annette U.
Parity is associated with weight retention and has long-lasting and detrimental effects on the health of women. Previous studies have shown that increasing parity was independently associated with an increased prevalence of metabolic syndrome. Postpartum weight is made up of several components including uterine and mammary tissues, body water (intracellular (ICW) and extracellular water (ECW)), and fat. These components change
Geum Joon Cho; Hyo Jin Yoon; Eung-Ju Kim; Min-Jeong Oh; Hong-Seog Seo; Hai-Joong Kim
Objective The objective is to provide an overview of the clinical features, prognosis, differential diagnosis, evaluation, and treatment of postpartum psychosis. Methods The authors searched Medline (1966–2005), PsycInfo (1974–2005), Toxnet, and PubMed databases using the key words postpartum psychosis, depression, bipolar disorder, schizophrenia, organic psychosis, pharmacotherapy, psychotherapy, and electroconvulsive therapy. A clinical case is used to facilitate the discussion. Results The onset of puerperal psychosis occurs in the first 1–4 weeks after childbirth. The data suggest that postpartum psychosis is an overt presentation of bipolar disorder that is timed to coincide with tremendous hormonal shifts after delivery. The patient develops frank psychosis, cognitive impairment, and grossly disorganized behavior that represent a complete change from previous functioning. These perturbations, in combination with lapsed insight into her illness and symptoms, can lead to devastating consequences in which the safety and well-being of the affected mother and her offspring are jeopardized. Therefore, careful and repeated assessment of the mothers’ symptoms, safety, and functional capacity is imperative. Treatment is dictated by the underlying diagnosis, bipolar disorder, and guided by the symptom acuity, patient’s response to past treatments, drug tolerability, and breastfeeding preference. The somatic therapies include antimanic agents, atypical antipsychotic medications, and ECT. Estrogen prophylaxis remains purely investigational. Conclusions The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment and to allow for quick, full recovery, prevention of future episodes, and reduction of risk to the mother and her children and family.
SIT, DOROTHY; ROTHSCHILD, ANTHONY J.; WISNER, KATHERINE L.
Postpartum uterine infections results from uterine contamination with bacteria during parturition. The prevalence of uterine infections varies considerably among studies. Uterine infection implies adherence of pathogenic organisms to the mucosa, colonization or penetration of the epithelium, and/or release of bacterial toxins that lead to establishment of uterine disease. The development of uterine disease depends on the immune response of the cow, as well as the species and number (load or challenge) of bacteria. The postpartum uterus has a disrupted surface epithelium in contact with fluid and tissue debris that can support bacterial growth. A variety of species of bacteria, both Gram-positive and Gram-negative aerobes and anaerobes, can be isolated from the early postpartum uterus. Most of these are environmental contaminants that are gradually eliminated during the first 6 weeks postpartum. A normal postpartum cow resolves uterine infection by rapid involution of the uterus and cervix, discharge of uterine content, and mobilization of natural host defenses, including mucus, antibodies and phagocytic cells. Clinical signs of uterine infection vary with the virulence of the causative organisms and the presence of factors that predispose to the disease. The treatment of endometritis and metritis in bovine should be directed towards improving fertility. The antibiotic should be active against the main uterine pathogens and should maintain its activity in the environment of the uterus. Also, should not inhibit the normal defense mechanisms and should be well tolerated and not induce irritation in the endometrium. Effective use of hormones in uterine infection requires knowledge of both normal reproductive endocrinology and the therapeutic characteristics of available hormonal preparations. PMID:18280065
Azawi, O I
The purpose of this study was to predict women’s minor psychiatric morbidity after they had childbirth as measured repeatedly\\u000a at the first, the third, and the fifth weeks of the postpartum period. The Chinese Health Questionnaire, the Postpartum Stress\\u000a Scale, the Zung’s Self-rating Depression Scale and Anxiety Scale, and the Social Support Scale were used at the three points\\u000a of
This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the pre-natal-postpartum period. It also analyzes the patterns of service utilization for
Dayoung Song; Roberta G. Sands; Yin-Ling Irene Wong
Objective To determine if there is a socioeconomic status (SES) gradient in postpartum weight retention in women living in the UK,\\u000a and examine SES differences in weight-related attitudes and practices in the postpartum period. Methods Women (n = 2745) who had full-term live births between July and December 1999 in four London hospitals were eligible to participate\\u000a in this self-report postal questionnaire
Vanessa A. Shrewsbury; Kathryn A. Robb; Chris Power; Jane Wardle
The present study explored changes in mental health and functional status from pregnancy to 2 months postpartum in a sample of 106 childbearing immigrant women. Three sets of variables were examined in relation to postpartum depressive symptomatology: (1) prenatal depression, worries, and somatic symptoms; (2) social relationships (marital quality and social support), and (3) factors related to migration (premigration stress and length of stay in the host country). We found that 37.7% of the women in this community sample scored above the cutpoint of 12 on the Edinburgh Postnatal Depression Scale; prenatal depressive and somatic symptoms, as well as marital quality, were the best predictors of postpartum depressive symptomatology. An examination of differing trajectories from pregnancy to the postpartum period suggests that women with relatively few somatic complaints, low levels of perinatal stress, and satisfactory marital relations were less likely to exhibit mental health problems during pregnancy and postpartum. Women who were not depressed prenatally but reported postpartum depressive symptomatology exhibited several predisposing risk factors during pregnancy: many somatic complaints, high perinatal anxiety, and premigration stress. Women who were depressed during pregnancy but not postpartum reported improved physical function after childbirth. The implications of these findings for screening childbearing immigrant women are discussed. PMID:18270652
Zelkowitz, P; Saucier, J-F; Wang, T; Katofsky, L; Valenzuela, M; Westreich, R
During the postpartum period, women experience significant changes in their neuroendocrine profiles and social behavior compared to before pregnancy. A common experience with motherhood is a decrease in sexual desire. Although the lifestyle and peripheral physiological changes associated with parturition might decrease a woman's sexual interest, we hypothesized that there are also hormone-mediated changes in women's neural response to sexual and infant stimuli with altered reproductive priorities. We predicted that amygdala activation to sexually arousing stimuli would be suppressed in postpartum versus nulliparous women, and altered with intranasal oxytocin administration. To test this, we measured amygdala activation using fMRI in response to sexually arousing pictures, infant pictures, and neutral pictures in 29 postpartum and 30 nulliparous women. Half of the women received a dose of exogenous oxytocin before scanning. As predicted, nulliparous women subjectively rated sexual pictures to be more arousing, and infant pictures to be less arousing, than did postpartum women. However, nulliparous women receiving the nasal oxytocin spray rated the infant photos as arousing as did postpartum women. Right amygdala activation was lower in postpartum versus nulliparous women in response to sexual, infant, and neutral images, suggesting a generalized decrease in right amygdala responsiveness to arousing images with parturition. There was no difference in right amygdala activation with nasal spray application. Postpartum women therefore appear to experience a decrease in sexual interest possibly as a feature of a more generalized decrease in amygdala responsiveness to arousing stimuli. PMID:23085496
Rupp, Heather A; James, Thomas W; Ketterson, Ellen D; Sengelaub, Dale R; Ditzen, Beate; Heiman, Julia R
Post-partum amenorrhea is an important event for females' reproductive life and their health. It is the time period between the end of pregnancy and the resumption of menstruation after delivery, and it is considered to be the temporary infecundable period of women's reproductive life-span. The main aim of this article is to examine the differentials of post-partum amenorrhea by using current status reporting data according to the characteristics of the mother and her child. The data are utilized from a sample survey of Palpa and Rupandehi districts of western rural Nepal. A life-table based technique of survival analysis has been used. Important summary measures have been computed in order to see the differentials of duration of post-partum amenorrhea. The study revealed that parity of mothers, age of mothers, breast-feeding practices and survival status of the child were found to be the main differentials of the duration of post-partum amenorrhea. Amenorrhea period was found shorter for lower parity and younger mothers. Amenorrheic period was found to be increased with increased birth-interval and duration of breast-feeding practices. A strong positive association was found between the duration of post-partum amenorrhea and breast-feeding. The study also revealed that an inverse association was found between the duration of post-partum amenorrhea and socio-economic status of mothers. The survival status of the child showed a strong effect for the timing of amenorrhea. This study investigated the important differentials of amenorrhea by using current status reporting data according to the characteristics of mother and her child. The estimated values of mean, median and trimean duration of amenorrhea were compared. For instance, trimean of amenorrheic period was found to be 9.6 months while median was 8.4 months and mean was 10.4 months. This finding indicates that the trimean provided the most consistent and best estimates of the duration of amenorrhea than other averages. The trimean is the best measure if the data contain censored and open-ended class interval. Parity, age of mothers, survival status of child, breast-feeding practices and socio-economic status of mothers were found to be the main influencing factors for the timing of amenorrhea among rural Nepalese mothers. Although the coverage of the present study is limited to small areas as well as to a small sample size, it is expected that the findings may help in designing appropriate policies and programs for improving mothers' and children's health as well as for reducing the existing fertility level of a country. PMID:18094740
Aryal, T R
Based on the crop trial data during 1981-2009 at 57 agricultural experimental stations across the North Eastern China Plain (NECP) and the middle and lower reaches of Yangtze River (MLRYR), we investigated how major climate variables had changed and how the climate change had affected crop growth and yield in a setting in which agronomic management practices were taken based on actual weather. We found a significant warming trend during rice growing season, and a general decreasing trend in solar radiation (SRD) in the MLRYR during 1981-2009. Rice transplanting, heading, and maturity dates were generally advanced, but the heading and maturity dates of single rice in the MLRYR (YZ_SR) and NECP (NE_SR) were delayed. Climate warming had a negative impact on growth period lengths at about 80% of the investigated stations. Nevertheless, the actual growth period lengths of YZ_SR and NE_SR, as well as the actual length of reproductive growth period (RGP) of early rice in the MLRYR (YZ_ER), were generally prolonged due to adoption of cultivars with longer growth period to obtain higher yield. In contrast, the actual growth period length of late rice in the MLRYR (YZ_LR) was shortened by both climate warming and adoption of early mature cultivars to prevent cold damage and obtain higher yield. During 1981-2009, climate warming and decrease in SRD changed the yield of YZ_ER by -0.59 to 2.4%; climate warming during RGP increased the yield of YZ_LR by 8.38-9.56%; climate warming and decrease in SRD jointly reduced yield of YZ_SR by 7.14-9.68%; climate warming and increase in SRD jointly increased the yield of NE_SR by 1.01-3.29%. Our study suggests that rice production in China has been affected by climate change, yet at the same time changes in varieties continue to be the major factor driving yield and growing period trends. PMID:23661287
Tao, Fulu; Zhang, Zhao; Shi, Wenjiao; Liu, Yujie; Xiao, Dengpan; Zhang, Shuai; Zhu, Zhu; Wang, Meng; Liu, Fengshan
Background Symmetrical peripheral gangrene is usually associated with underlying medical problems and it is seldom seen in pregnancy. Sepsis though common in a setting of delivery by unskilled midwife is rarely accompanied by symmetrical gangrene. Case Presentation We report a case of symmetrical peripheral gangrene which occurred in the winter, triggered possibly by sepsis and a single dose of ergot. A high index of suspicion, early diagnosis and intervention with appropriate measures will result in favorable outcome in such cases. Conclusion Although postpartum period is of high risk for sepsis and use of ergot alkaloids is common in labor but occurrence of peripheral symmetrical gangrene is rare. A high index of suspicion for the diagnosis and timely intervention will prevent irreparable damage and loss of limb.
Sharma, Lipi; Mehta, Sumita; Rajaram, Shalini; Aggarwal, Rachna; Gupta, Sanjay; Goel, Neerja
Pregnancy and childbirth bring many changes to the health and well-being of new mothers. Postpartum sexual health is a common concern that is often not discussed during prenatal or postpartum care and has received little attention from either clinicians or researchers. In this article, we review current theories of female sexual response, the epidemiology of postpartum sexual dysfunction, and the use of screening tools to identify women with sexual health concerns. Specifically, we present a review of published data regarding the effect of mode of delivery, perineal lacerations, postpartum depression, and breastfeeding on postpartum sexual activity and function. Finally, suggestions for how to screen for and approach the treatment of postpartum sexual problems are presented. PMID:22353966
Leeman, Lawrence M; Rogers, Rebecca G
Postpartum hemorrhage is defined by bleeding > 500 mL through the vagina. It is one of the obstetrical complications that obstetricians fear most. It is the leading cause of maternal mortality in the world, especially in developing countries. The reference treatments in France are parenteral oxytocin and sulprostone. Sulprostone involves sometimes fatal side effects, and must be administered only in appropriate health care facilities. It also has the major disadvantage of requiring refrigeration. Misoprostol has uterotonic properties that have led to its occasional off-label use in the treatment of postpartum hemorrhage, by rectal or sublingual administration, as an alternative to sulprostone. A careful review of the literature on this particular use of misoprostol is essential. PMID:17643941
Godard, Clémence; Berhoune, Malik; Bertrand, Eric; Schlatter, Joël; Chiadmi, Fouad; Toledano, Audrey; Cisternino, Salvatore; Fontan, Jean-Eudes
Sleep fragmentation and disruption during the normal physiological changes of pregnancy are as significant as some medical\\u000a diseases. Sleep disorders during pregnancy are an even further complication. These changes, which persist not only over the\\u000a course of the pregnancy, but also into the postpartum period, are significant enough to affect quality of life. Measures specific\\u000a to the quality of life
Magdie Kohn; Brian James Murray
This study was designed to examine women’s experiences of weight loss during the postpartum period. Understanding women’s\\u000a positive and negative experiences can assist health care providers to successfully intervene in helping women lose weight\\u000a following pregnancy and avoid long-term weight gain and obesity development. Design: Phenomenology, according to Husserl’s\\u000a perspective. Setting: Private location of the women’s choosing. Participants: Twenty-six women,
Kristen S. MontgomeryTracy; Tracy D. Bushee; Jennifer D. Phillips; Terrie Kirkpatrick; Courtney Catledge; Kristin Braveboy; Carol O’Rourke; Neema Patel; Malshundria Prophet; Anita Cooper; Lori Mosley; Christie Parker; Gaye M. Douglas
This study aimed at estimating the prevalence of postpartum depression (PPD) according to postpartum periods and sub-groups\\u000a in public primary health care settings in Rio de Janeiro, Brazil. A cross-sectional survey was carried out in five primary\\u000a health care units and included 811 participants randomly selected among mothers of children up to five postpartum months.\\u000a Women were classified as depressed
Gustavo Lobato; Claudia L. Moraes; Alessandra S. Dias; Michael E. Reichenheim
Background: Using population-based data from the Pregnancy Risk Assessment Monitoring System (PRAMS), this study examines the prevalence and intensity of smoking before, during, and after pregnancy, and identifies correlates of postpartum smoking relapse.Methods: Women who delivered live births in 1996 responded to a mailed questionnaire approximately 2 to 6 months after delivery (N =17,378). Data from 10 states participating in
Suzan L. Carmichael; Indu B. Ahluwalia
This report describes the clinical findings and outcome of a patient suffering from septic postpartum ovarian vein thrombosis. Treatment modalities are well described and range from hysterectomy and thrombectomy to the use of vena cava filters in combination with anticoagulation and antibiotics. Defervescence with a combination infusion of tissue plasminogen and heparin were used. This treatment approach has been found particularly successful in cases of ilio-femoral, hepatic, renal and vena caval thromboses. PMID:12370730
Rajab, Khalil E; Malik, Neelam; Skirman, Jonathan H
Death from haemorrhage occurs in 5.5 per million maternities in the UK. Sadly, this figure has not fallen since the 1985–1987 triennium and care remains sub-standard in 66% of cases. While various risk factors can be identified for post-partum haemorrhage, further improvements in care can only occur with dissemination of good practice and adoption of local protocols designed to deliver
S. Macphail; J. Fitzgerald
Aims(1) To see how well are we performing in this area, (2) To suggest changes to improve the standard of patient care.BackgroundIntrapartum and postpartum bladder care are of great clinical importance. Overdistension of the bladder can cause permanent damage of the bladder. If voiding difficulties are recognised and treated early, both short and long-term morbidity may be prevented. Currently, there
A Yulia; S Mackenzie
A life table analysis is made of the duration of breast-feeding and post-partum amenorrhoea in Orissa, India, taking one variable at a time using data from a baseline survey of fertility and mortality (BSFM) conducted on the lines of the World Fertility Survey. Then a multivariate (proportional hazard) analysis showed that socioeconomic factors including residence, caste status and education influence the breast-feeding and post-partum amenorrhoea periods. There was no effect of maternal age on the length of breast-feeding, but mean length of post-partum amenorrhoea varied with age. The durations of breast-feeding and post-partum amenorrhoea are strongly related. PMID:2768294
Srinivasan, K; Pathak, K B; Pandey, A
This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the prenatal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services. Medicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatric diagnosis, during pregnancy and the postpartum period. About 10% of the women used mental health services during the study period. Women were more likely to use services if they were Caucasian, had a number of chronic diseases, had a number of pregnancy complications, and smoked. Among users, the same proportion (ca. 6%) used services during pregnancy and postpartum, with the average number of outpatient visits slightly higher during pregnancy than during the postpartum period. Most outpatient services (86%) were delivered in the specialty sector. Most women who used mental health services (84%) were diagnosed with minor psychiatric disorders including minor depression and anxiety disorders. Women who used services during the postpartum only were more likely to be diagnosed with major depression, whereas women who used services throughout the perinatal period were more likely to be diagnosed with severe mental disorders. Health providers can use information generated in this study to identify women who are likely to have a need for mental health services. PMID:15002880
Song, Dayoung; Sands, Roberta G; Wong, Yin-Ling Irene
Postpartum weight retention plays an important role in the pathway leading to obesity among women of childbearing age. The objective of this study was to examine predictors of moderate (1–10 pounds) and high (>10 pounds) postpartum weight retention using data from a prospective pregnancy cohort that followed women into the postpartum period; n=688 and 550 women at 3 and 12 months, respectively. Analysis included descriptive statistics and predictive modeling using log-binomial techniques. The average weight retained at 3 and 12 months postpartum in this population was 9.4 lbs (SD=11.4) and 5.7 lbs (SD=13.2) respectively. At 3- months postpartum, prepregnancy weight, gestational weight gain, and hours slept during the night were associated with moderate or high weight retention while having an infant hospitalized after going home and scoring in the upper 75th percentile of the eating attitudes test were associated only with high weight retention. At 12- months postpartum, prepregnancy weight, gestational weight gain and maternal education were associated with moderate weight retention and gestational weight gain, maternal age, race, employment status, and having an infant hospitalized at birth were associated with high weight retention. The results of this study illustrate the importance of prepregnancy weight and gestational weight gain in predicting postpartum weight retention. Furthermore, given the lack of successful intervention studies that exist to date to help women lose weight in the postpartum period, the results of this study may help to inform future interventions that focus on such aspects as hours of sleep, dealing with stress associated with a hospitalized infant, and non-clinical eating disorder symptomatology.
Siega-Riz, Anna Maria; Herring, Amy H.; Carrier, Kathryn; Evenson, Kelly R.; Dole, Nancy; Deierlein, Andrea
Lake Michigan contains numerous former embayments into glacial deposits or bedrock. Many of the embayments contain dunes, spits, and captured lakes, but others contain arcuate strandplains of beach ridges. The strandplains are a geologic record of shoreline behavior and lake-level variation throughout the late Holocene. The larger strandplains show similar long-term patterns of beach-ridge development. The similar patterns are expected because variations in lake level are a primary control on shoreline behavior, and all embayments would have experienced relatively the same lake-level changes. Some variations in the long-term pattern of shoreline development do occur between strandplains. These dissimilarities are primarily a function of different rates of sediment supply to the shoreline of each embayment. Beach-ridge development within embayments can be represented on a rate of water level change versus rate of sediment supply diagram (Curray diagram) as three superimposed ovals on the positive rate of sediment supply side of the diagram. The three stacked ovals represent the three quasi-periodic lake-level variations defined by Thompson (1992) and show the position of the shoreline for a given time within the Curray diagram fields. For shorelines with a high rate of sediment supply, only the 30-year quasi-periodic variation would reach the aggradation line. For shorelines having significantly less sediment supply, rising lake level on the 150- and 600-year variations would force the 30-year oval across the aggradation line and well into the depositional and possibly the erosional transgression fields. Under these conditions erosion would occur that may remove, stack, or at least prevent one or more beach ridges from being developed.
Thompson, T.A.; Baedke, S.J. (Indiana Univ., Bloomington, IN (United States). Indiana Geological Survey)
A study, based on the social learning theory model and designed to assess the effect of a postpartum educational program on mothers' use of infant car seats at the time of discharge was conducted. The control group consisted of data for 92 mothers obtained by recording their behavior at the time of discharge regarding their use of infant car seats and eight other related measures. The postpartum study group (90) was shown an educational slide/audio tape presentation followed by a question-and-answer period and demonstration of car seats. They were also given a shoppers' guide and a pamphlet of facts and pictures of car seats. Statistical significance was obtained on several measures. PMID:6560047
Goebel, J B; Copps, T J; Sulayman, R F
Paternal postpartum depression (PPD) is a clinically significant problem for families that is currently underscreened, underdiagnosed, and undertreated. Maternal PPD is a well-known condition and has been extensively researched. In comparison, PPD in fathers and its potential effects on the family are not widely recognized. Studies have shown the importance of optimal mental health in fathers during the postpartum period. Negative effects of paternal PPD affect marital/partner relationships, infant bonding, and child development. To promote optimal health for parents and children, pediatric nurse practitioners must stay up to date on this topic. This article discusses the relationship of paternal PPD to maternal PPD; the consequences, signs, and symptoms; and the pediatric nurse practitioner's role in assessing and managing paternal PPD. PMID:23182851
Musser, Anna K; Ahmed, Azza H; Foli, Karen J; Coddington, Jennifer A
A case report is presented of supraventricular tachycardia (SVT) associated with metoclopramide administration in the early postpartum period in a 37-year-old woman. The patient was scheduled for elective laparoscopic tubal ligation 4 hours after an uncomplicated spontaneous vaginal delivery. The preoperative evaluation revealed that the patient's only significant past medical history was a total of 4 spontaneous vaginal deliveries. A review of systems was noncontributory, and the patient denied any untoward effects from drugs. Metoclopramide, 10 mg, was administered intravenously to facilitate gastric emptying and as an anti-emetic. Within 1 minute, the heart rate rose to 170 bpm. She was in no distress, being unaware of any change in her status. Arterial blood pressure remained in the 130-140 mmHg (systolic) range throughout the ensuing period. Various approaches, i.e., valsalva, carotid sinus massage, ocular pressure, were used to increase vagal tone without a decrease in the heart rate. After determining that the PR interval was grossly normal, she received 2 boluses of verapamil (10 mg intravenously) over a 10-minute period without change in heart rate. She then was given alphaprodine and droperidol for sedation. The patient then was administered Digoxin approximately 20 minutes after the administration of metoclopramide. This was followed by a gradual decrease in her heart rate to 130 bpm over the next 5 minutes. The patient was transferred to a telemetry unit for a 24-hour period, where her arterial blood pressure remained stable and her heart rate was noted to be in the 90-110 range. 12-lead EKG revealed sinus tachycardia with "nonspecific" ST changes. PR, QRS, and QTC intervals were within normal limits. Chest radiograph was without pathology. The patient was reinterviewed on several occasions and continued to deny a history of SVT, palpitations, syncope, or any other cardiac symptomatology. 2 days following the initial episode, she underwent successful laparoscopic tubal ligation under spinal anesthesia and sedation. In sum, a stable postpartum patient without history of SVT or evidence of structural heart disorder developed SVT immediately following metoclopramide administration. This may be because of the cardioactive properties of metoclopramide or to an underlying predisposition from her peripartum state, or a combination of factors. PMID:3337365
Bevacqua, B K
The authors reported the results from a retrospective investigation of 10121 deliveries for a three-year period (1981-1983) as well as from a prospective study of 6239 child-births during a three-year period after a 20-year-long time lag, i.e., in 2000-2002. The cases with early post-partum hemorrhages (EPH) and with accomplished laparotomy were examined. The causes for EPH, the obstetric therapeutic measures and manipulations prior to the laparotomy as well as the surgical interventions after opening the abdomen were considered. The authors emphasized that 20 years ago three uteri only could be "saved" by means of ligation of the uterine vessels. A hysterectomy was carried out in 21 cases with massive EPH after the laparotomy. After two decades the situation changed dramatically. The hysterectomies amounted to only 22.22% of the cases (n = 4) while in the rest females (n = 14) the copying of the massive hemorrhages was performed by means either of stepwise ligation of the uterine vessels, or of ligation of the hypogastric ones in 3 cases with additional vaginal lacerations. It was outlined that mother's mortality rate was zero during these two periods. The conclusion has been drawn that the ligation of the uterine vessels represents an alternative to the hysterectomy when copying the EPH and preserves the child-bearing functions of some females because of the subsequent vascular recanalization. PMID:15168647
Tsvetkov, Ts; Kozovski, G; Tsvetkov, K; Petkova, U; Minkov, R
Cheap and simple interventions that are intended to minimize postpartum hemorrhage are of major public health concern. We report a case of postpartum hemorrhage in which conservative interventions had failed. The use of a chitosan-covered gauze that originally was developed for combat trauma allowed us to achieve hemostasis, and a seemingly inevitable hysterectomy was avoided. PMID:22011588
Schmid, Bernd C; Rezniczek, Günther A; Rolf, Norbert; Maul, Holger
Background: Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic.Aim:: To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother.Methods: Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened
I Akman; K Kus?c?u; N O?zdemir; Z Yurdakul; M Solakoglu; L Orhan; A Karabekiroglu; E O?zek
Background: We describe our experience with sonographic diagnosis of ovarian vein thrombosis, an uncommon but dangerous postpartum complication. Methods: We retrospectively reviewed the medical records of seven patients in our institution who developed postpartum ovarian vein thrombophlebitis within the past 5 years. Results: In all cases the diagnosis was made by ultrasound, which showed tubular hypoechoic masses lateral to the
I. Hadas-Halpern; M. Patlas; D. Fisher
Objective To evaluate the efficacy of an integrated multiple risk intervention delivered mainly during pregnancy, in reducing such risks (smoking, environmental tobacco smoke exposure, depression and intimate partner violence) postpartum. Design Data from this randomized controlled trial were collected prenatally and on average 10 weeks postpartum in six prenatal care sites in the District of Columbia. African Americans were screened, recruited and randomly assigned to the behavioral intervention or usual care. Clinic-based, individually tailored counseling was delivered to intervention women. The outcome measures were number of reisks reported postpartum and reduction of these risks between baseline and postpartum. Results The intervention was effective in significantly reducing the number of risks reported in the postpartum period. In Bivariate analyses, the intervention group was more successful in resolving all risks (47% compared with 35%, p=0.007), number needed to treat=9, 95% confidence interval [CI] 5-31) and in resolving some risks (63% compared with 54%, p=0.009), number needed to treat=11, 95% CI 7-43) as compared with the usual care group. In logistical regression analyses, women in the intervention group were more likely to resolve all risks (OR=1.86, 95% CI: 1.25-2.75) and in resolving at least one risk (OR=1.6, 95% CI: 1.15-2.22). Conclusions An integrated multiple risk factor intervention addressing psychosocial and behavioral risks delivered mainly during pregnancy can have beneficial effects in risk reduction postpartum.
El-Mohandes, Ayman A.E.; Kiely, Michele; Joseph, Jill G.; Subramanian, Siva; Johnson, Allan A.; Blake, Susn M.; Gantz, Marie G.; El-Khorazaty, M. Nabil
This study was aimed to determine the beliefs among Jordanian women regarding 10 selected postpartum behaviours. Following Human Subjects approval, a descriptive quantitative questionnaire was administered to 40 postpartum women, 20 from two rural communities and 20 from two urban communities. The majority believed, incorrectly, in prolonged bed rest, that the baby's exhalation on the mother's breast can lead to infection, that kofaleyas (tightly secured wraps around the baby) do not harm newborns, that observation by others while nursing might 'steal' the mother's milk, and that a belt around the mother's abdomen will tighten muscles. The majority correctly believed that dieting affects breast-feeding. Most postpartum women could benefit from increased education about postpartum practices. Educational programmes can help women differentiate between helpful postpartum practices and those which might have adverse effects on the health of a mother and her newborn. PMID:17883715
Jarrah, Samiha; Bond, A Elaine
Postpartum depression is the most common complication of pregnancy, affecting 10% to 15% of women. This condition continues to be underdiagnosed and undertreated despite increased awareness. Several risk factors have been identified including anxiety or depression during pregnancy, a history of depression, as well as increased life stressors. Treatment for depression has been found to be effective and generally safe during pregnancy and while breastfeeding. The risks and benefits of treatment must be carefully evaluated and balanced with the risk of no treatment. Careful screening may assist physicians for more timely diagnosis and intervention. PMID:22828111
|Objective: This study examines the association between maternal childhood maltreatment and psychopathology and aggression in intimate relationships during pregnancy and the postpartum period. Method: Forty-four pregnant women who were recruited from an obstetric clinic and local advertising periodical completed questionnaires about childhood…
Lang, Ariel J.; Rodgers, Carie S.; Lebeck, Meredith M.
Pregnant women diagnosed with major depression were given 12 weeks of twice per week massage therapy by their significant other or only standard treatment as a control group. The massage therapy group women versus the control group women not only had reduced depression by the end of the therapy period, but they also had reduced depression and cortisol levels during the postpartum period. Their newborns were also less likely to be born prematurely and low birthweight, and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales. PMID:19646762
Field, Tiffany; Diego, Miguel; Hernandez-Reif, Maria; Deeds, Osvelia; Figueiredo, Barbara
To achieve the improved maternal and child outcomes of birth spacing, family planning in the postpartum period is essential. The objective of this study is to determine the perceptions regarding programmatic aspects of postpartum family planning by key informants in 17 countries determined to have high unmet need for postpartum family planning. We present interim data from structured interviews of key informants in Kenya and Ethiopia. Important themes included the need for documentation of contraceptive use to aid in commodity assessment and delivery, need for additional informational materials, and challenges of delivering services to those women who deliver away from a health care facility. PMID:24069767
Sonalkar, Sarita; Mody, Sheila; Phillips, Sharon; Gaffield, Mary E
Purpose This paper reports on secondary results from the Healthy Moms Study, a clinical trial to test the efficacy of brief intervention on reducing alcohol use and alcohol-related harms in postpartum women. Study Design and Methods Data from a randomized clinical trial conducted between 2002 and 2005 with a sample of Wisconsin women was analyzed. This report presents comparison data on depressive symptomatology between postpartum women drinking above recommended levels who received a brief alcohol intervention and those who received no intervention. Results At six month follow-up, there was a significant reduction in mean depression scores compared to baseline in the women who received the alcohol intervention (p <.001). There was not a significant reduction in depressive symptomatology in the control group. Mean level of depression at six months was significantly predicted by baseline depression and the intervention (p=.018). Alcohol use at either baseline or follow-up was not a predictive factor in determining mean depressive symptomatology. Clinical Implications The results of the Healthy Moms Study support the importance of both alcohol and depression screening during the postpartum period. Brief alcohol intervention during this time may also positively affect depressive symptomatology.
Wilton, Georgiana; Moberg, D. Paul; Fleming, Michael F.
Background Pregnancy may contribute to overweight and obesity. Purpose The primary objective of Active Mothers Postpartum was to promote a reduction in BMI through 24-months postpartum via sustainable lifestyle changes. Design Behavioral intervention RCT to enhance postpartum weight loss. Setting/participants A total of 450 overweight or obese women, enrolled 6-weeks postpartum, were recruited through obstetrics clinics and community posters in the Durham NC area. Intervention Intervention participants were offered eight healthy-eating classes, ten physical-activity classes, and six telephone-counseling sessions over 9 months. Main outcome measures Changes from baseline (6-weeks postpartum) to 1-month post-intervention (12-months postpartum) in: (1) diet (caloric intake, calories from fat, intake of certain foods); (2) physical activity (self-reported physical activity, television time); and (3) weight (collected 2004–2007, analyzed 2007–2008). Results Mean weight loss was 0.90 kg (±5.1 kg) in the intervention group and 0.36 kg (±4.9 kg) in the control group; this difference was not significant. There were also no significant group differences in improvement of diet or increased physical activity. In secondary analyses, there was a positive bivariate relationship between classes attended and weight loss (p=0.01). Conclusions There were no significant differences among the arms in diet, physical activity, or weight change. Home-based interventions via mail, telephone, or Internet/e-mail may be more feasible and successful in this population. The postpartum period is an important phase in women’s lives with regard to weight retention, but engaging them during this busy period remains a challenge.
?stbye, Truls; Krause, Katrina M.; Lovelady, Cheryl A.; Morey, Miriam C.; Bastian, Lori A.; Peterson, Bercedis L.; Swamy, Geeta K.; Brouwer, Rebecca J.N.; McBride, Colleen M.
Objective To describe the perceptions of a United States cohort of experienced birth doulas who were among the first in the country to be trained to provide postpartum support. Design A qualitative, longitudinal study using ethnographic methods; participant observation and semi-structured interviews. Setting Midwestern, urban, US; postpartum homecare over three months Participants Four postpartum doulas; 13 families Measurements Participant observation during six postpartum home visits per family; thirteen semi-structured interviews with doulas at the completion of each family’s care; four summative interviews with doulas at the end of the study. Findings When describing their postpartum practice, four themes emerged: supporting women, taking the mother’s perspective, empowering women, and empowering families. When speaking of the motivations three themes emerged: being “called” to practice, interest in preventing negative experiences, and career development. Key conclusions and implications for practice In the US, new mothers see midwives and physicians sporadically after discharge from the hospital. Postpartum doulas fill this gap in continuity of care by providing support for families as they transition to life with their new infant. Understanding the beliefs, values, and practices of these important paraprofessionals will help midwives effectively integrate postpartum doula care into the care of women and infants.
McComish, Judith Fry; Visger, Joan M.; Rowland, Carolynn A.; Kelleher, Jacqueline
This special feature focuses on the care of mothers and infants during the postpartum period. Postpartum care should include prevention, early detection and treatment of complications and disease, and provision of advice. Most maternal mortality is due to postpartum hemorrhage within 4 hours of delivery, especially among anemic women. The uterus should be well contracted, and blood loss should be minimal. Sepsis, as indicated by fever, should be treated with antibiotics, but preventive measures include cleanliness and hygiene at delivery. Infections are more likely after cesarean section, prolonged labor, and early rupture of membranes. Handwashing prevents infection. Women should be encouraged to pass urine in the first 12 hours after delivery. Bathing frequently relieves painful episiotomy. 85% of neonatal deaths are due to preterm birth and low birth weight. Keeping the baby warm helps prevent low body temperature and infections. Parents need social support in adjusting to congenital defects. Infants with infections should be recognized on time, managed correctly, and referred to a district hospital. Breast feeding should start immediately or within the first hour of birth. Mothers need adequate rest and a nutritious diet. Breast tenderness is common during the first 4 days after delivery. Breast feeding on demand and proper hygiene helps to prevent infections and breast tenderness. Postpartum depression requires support from families and expert advice. Exclusive breast feeding inhibits ovulation until menstruation returns. Family planning may begin during lactation with a progestin-only pill, IUD, or diaphragm. HIV-positive mothers should discontinue breast feeding and take extreme care to mix formula with clean water. Mothers should be immunized with two doses of tetanus toxoid. Pregnant mothers need iodized oil and vitamin A supplements. Reproductive tract infections should be treated. PMID:12321360
Background The majority of women who quit smoking as a result of pregnancy will resume smoking during the first 6 months postpartum. Evidence suggests that changes in depressive symptoms, perceived stress, and concerns about weight may relate to postpartum smoking relapse. Purpose This study was designed to prospectively evaluate the relationship of mood and weight concerns to postpartum smoking among women who quit smoking during pregnancy. Methods Pregnant women who had quit smoking (N = 183) were recruited between February 2003 and November 2006. Women completed assessments of mood (depressive symptoms, perceived stress, positive and negative affect) and weight concerns during the third trimester of pregnancy, and at 6, 12, and 24 weeks postpartum. Self-reported smoking status was verified by expired-air carbon monoxide and salivary cotinine at each assessment. Cox regression analyses in which mood and weight concerns were treated as time dependent covariates were conducted in 2007 and 2009. Results By 24 weeks postpartum, 65% of women had resumed smoking. Smoking-related weight concerns increased risk of relapse, and positive affect and self-efficacy for weight management without smoking decreased risk of relapse postpartum. Moreover, after controlling for variables previously related to postpartum relapse, weight concerns remained significantly related to smoking relapse. Conclusions Smoking-related weight concerns and positive affect increase the likelihood that a woman will resume smoking postpartum. Moreover, weight concerns appear to be salient even in the context of other factors shown to affect postpartum smoking. This study suggests that interventions may need to address women’s weight concerns and mood to help sustain smoking abstinence after childbirth.
Levine, Michele D.; Marcus, Marsha D.; Kalarchian, Melissa A.; Houck, Patricia R.; Cheng, Yu
Background\\/Objectives:Pregnancy is a life stage where excess weight gain may occur and the postpartum period is often characterised by weight retention. The aim of the current study was to evaluate the feasibility of undertaking a randomised controlled trial of a weight loss intervention (WeighWell) in postpartum women living in areas of social disadvantage.Subjects\\/Methods:The study aimed to recruit 60 women who
A M Craigie; M Macleod; K L Barton; S Treweek; A S Anderson
A balloon tamponade catheter for controlling uterine postpartum hemorrhage has an elongated body with a balloon at a marginal distal end of the elongated body for insertion into the uterus. The balloon preferably has a pear-shaped appearance. The balloon may have a first hemisphere that is located on the catheter distal to second, smaller hemisphere. The first hemisphere has a plane of maximum diameter that is larger than the second hemisphere's plane of maximum diameter. Between the two planes of maximum diameter, the balloon comprises a transition section. In some cases, the transition section bows inward towards the elongated body when the balloon is uninflated and/or inflated. Additionally, the elongated body preferably does not extend distally past the distal end of the first hemisphere.
In this report we evaluated the action of conjugated equine estrogens (CEE) on vaginal symptoms, cytology, pH, and flora in late postmenopausal women without any previous hormone therapy. The study was a randomized, double-blind, placebo-controlled trial with 48 late postmenopausal women who received placebo or unopposed CEE (0.625mg/day of CEE orally) during three months of treatment. Vaginal and sexual complaints were evaluated through daily diary cards. We analyzed vaginal changes through cytology and pH measurements. After three months of treatment, 20% of placebo-treated patients and 80% of the CEE-treated patients reported improvement in vaginal dryness and irritation. In the latter group, the vaginal cells and Lactobacillus increased and the vaginal pH decreased, without other changes in sexual complaints. We concluded that estrogen ameliorated the genital tract of late postmenopausal women without any previous hormone therapy. PMID:16903243
Galhardo, C L; Soares, J M; Simões, R S; Haidar, M A; Rodrigues de Lima, G; Baracat, E C
Since motivation for family planning is extremely high after delivery or abortion, women should be consulted about the use of contraception within 3 months postpartum. The International Postpartum Family Planning Program began in 1966 and now provides family planning information and services in 26 urban hospitals in 15 countries for women of low socioeconomic status. In the first 2 years, 236,000 acceptors were enrolled in the program out of an estimated target in developing countries of 1,870,000 women. Home visit follow up surveys found that 82% were continuing some method of contraception 18 months after initial acceptance. The cost has been $3.20 per acceptor. The rates of postpartum return visits have increased since the initiation of the postpartum family planning program. The Population Council is now extending the program to other countries of the developing world to work in rural as well as in urban areas. PMID:12177898
Zatuchni, G I
Pregnant and postpartum soldiers have unique needs that require adjustments in the demands placed on them in a military environment. This prospective cohort study was undertaken to examine the effects of pregnancy on the health, fitness and nutritional st...
J. Dettori K. A. Westphal A. Pusateri A. Cline P. Smith
Eating disorders are most often diagnosed during the childbearing years. Pregnancy and postpartum issues for women with eating\\u000a disorders are discussed with regard to symptoms, complications, course of pregnancy, delivery, breast-feeding, and postpartum\\u000a depression (PPD). Research findings indicate that women with eating disorders during pregnancy may be at risk for a variety\\u000a of pregnancy and obstetric complications. Moreover, there appears
Debra L. Franko
ObjectiveWe investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight.MethodsWe performed a prospective cohort study, including 21 121 mother-child-dyads from the Danish National Birth Cohort (DNBC). Maternal distress was measured 6 months postpartum by 9 items covering anxiety, depression and stress. Outcome was childhood overweight at 7-years-of age. Multiple logistic regression analyses were performed and
Teresa A. Ajslev; Camilla S. Andersen; Katja G. Ingstrup; Ellen A. Nohr; Thorkild I. A. Sørensen; Ian Lanza
It is generally thought that adult mammalian cardiomyocytes compensate for an increased workload by hypertrophy, whereas fetal myocardium grows by cellular proliferation. We analyzed the response of late-fetal rat hearts upon an increased workload imposed by premature constriction of the ductus arteriosus with indomethacin. Initially the fetal heart responds by proliferative growth, as both wet weight and labeling index (bromodeoxyuridine
Maurice J. B. van den Hoff; Ronald H. Lekanne Deprez; Jan M. Ruijter; Piet A. J. de Boer; Sabina Tesink-Taekema; Anita A. Buffing; Wouter H. Lamers; Antoon F. M. Moorman
We report the case of a 29-year-old female who had developed a postpartum cerebral angiopathy (PCA) complicated by an intracerebral haematoma and convulsions, after a postpartum haemorrhage with sulprostone and norepinephrine infusion. PCA is an under diagnosed neurovascular pathology, responsible of reversible and non-specific symptoms. However, it can be complicated by haemorrhagic or ischemic stroke with vital or functional risks. As PCA is favored by vasoactive treatments, their administration in peripartum period, when it is imperative, should be strictly controlled. PMID:22154454
Ruzic, Y; Tran-Van, D; Omarjee, A; Boukerrou, M; Winer, A
Chinese women (N = 102) who had migrated to Sydney, Australia, were interviewed about traditional cultural practices they had followed in the first six weeks of the postpartum period. The majority (90.2%) of these women had adhered to some form of practice, with the most frequent being eating warm ('yang') food (78%), following confinement for one month (55%), and using
Stephen Matthey; Paula Panasetis; Bryanne Barnett
Postural orthostatic tachycardia syndrome (POTS) commonly affects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS.
Kanjwal, Khalil; Karabin, Beverly; Kanjwal, Yousuf; Grubb, Blair P.
Objective: Recommendations by most national advisory committees on immunization include evaluating all pregnant women for chronic hepatitis B virus infection and immunity to rubella. It is recommended that all pregnant women be screened for hepatitis B surface antigen during an early prenatal visit and that rubella vaccine be administered in the postpartum period to women not known to be immune.
Sue K. Bath; James A. Singleton; Raymond A. Strikas; John M. Stevenson; Linda L. McDonald; Walter W. Williams
An ethnographic approach was used to explore the cultural practices of Hong Kong Chinese women during the postpartum period. Seven multiparous women were interviewed and asked to reflect on their self?care practices within the family home during the month after the birth of their first child. Content analysis was applied to the interviews and major categories identified: good food and
Eleanor Holroyd; Fung Kim Lai Katie; Lam Siu Chun; Sin Wai Ha
BACKGROUND: This study explored the impact of a multiple IVF birth on maternal mental health in the early post- partum period. METHODS: A prospective study of 207 women who had conceived following IVF treatment and fol- lowed up at 6 weeks post-partum. Mothers rated their mood using the Edinburgh postnatal depression scale (EPDS) and their baby's behaviour using the Unsettled
C. Sheard; S. Cox; M. Oates; G. Ndukwe; C. Glazebrook
Spontaneous coronary artery dissection is a rare but potentially life-threatening event associated with the peripartum period. We present a case of postpartum multivessel spontaneous coronary artery dissection diagnosed by conventional angiography and monitored with computed tomographic coronary angiography. The patient was initially managed medically and later received a coronary stent.
Schroder, Catherine; Stoler, Robert C.; Branning, George B.
India is a multicultural, multiethnic, pluralistic society with enormous socioeconomic disparities, and it is a formidable task to provide affordable and effective mental health care, especially to the remote rural corners of the country. The unfortunate aspect of the Indian mental health scenario is that there exists very poor awareness of the maternal health risks of the postpartum period. It
Lentiviral transmission by transfer of infected colostrum and/or milk is considered to be highly efficient. In this study, postpartum transmission of ovine progressive pneumonia virus (OPPV) from 10 naturally infected ewes to their 23 lambs was followed from the perinatal period throughout a four y...
Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children's development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children's developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children's milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children's development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children's language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children's development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children's development.
Tofail, F.; Hilaly, A.; Mehrin, F.; Shiraji, S.; Banu, S.; Huda, S.N.
Low-back pain is a common complaint during pregnancy and the post-partum period, and it may be due to a variety of conditions. Among these, a frequently overlooked cause is a sacral fracture. We report the case of a 37 year old woman, suffering from post-partum low-back pain which had not responded to treatment. Though rare, a sacral stress fracture must be considered in cases of prolonged low-back or sacral pain in pregnant or post-partum women. Plain radiographs are frequently inconclusive and MRI is the imaging technique of choice. Capacitive coupling electric fields (CCEF) seemed to be effective in treating pain and in reducing the patient's recovery time. PMID:23948818
Sansone, Valerio; McCleery, Jocelyn; Bonora, Cristina
Women with gestational diabetes mellitus require a continuum of care before, during, and after pregnancy for optimal management of hyperglycemia. Postpartum education and lifestyle modification should begin during pregnancy, and should continue during the postpartum period. Women should receive education on the long-term risk of type 2 diabetes mellitus, and should be encouraged to breastfeed, engage in regular physical activity, and select a highly effective contraceptive method in preparation for subsequent pregnancy. Postpartum women with gestational diabetes mellitus should be empowered to take ownership of their own health, including knowledge of health indicators such as weight, waist circumference hemoglobin A1C levels, and fasting and postprandial blood glucose levels. PMID:24036480
Castorino, Kristin; Jovanovi?, Lois
We report here on stable carbon and nitrogen isotope measurements of human and faunal bone collagen from the Iron Age, Viking Age, and Late Medieval site of Newark Bay, Orkney, Scotland. We found a wide range of results for humans in both ?13C (?15.4‰ to ?20.3‰) and ?15N (8.6‰–15.6‰) values. The enriched carbon and nitrogen values indicate the consumption of
M. P. Richards; B. T. Fuller; T. I. Molleson
We report here on stable carbon and nitrogen isotope measurements of human and faunal bone collagen from the Iron Age, Viking Age, and Late Medieval site of Newark Bay, Orkney, Scotland. We found a wide range of results for humans in both d13C (15.4& to 20.3&) and d15N (8.6&e15.6&) values. The enriched carbon and nitrogen values indicate the consumption of
M. P. Richards; B. T. Fuller; T. I. Molleson
The cycle of chronic cocaine (CC) use and withdrawal results in increased anxiety, depression and disrupted stress-responsiveness. Oxytocin and corticosterone (CORT) interact to mediate hormonal stress responses and can be altered by cocaine use. These neuroendocrine signals play important regulatory roles in a variety of social behaviours, specifically during the postpartum period, and are sensitive to disruption by CC exposure in both clinical settings and preclinical models. To determine whether CC exposure during pregnancy affected behavioural and hormonal stress response in the early postpartum period in a rodent model, Sprague-Dawley rats were administered cocaine daily (30 mg/kg) throughout gestation (days 1–20). Open field test (OFT) and forced swim test (FST) behaviours were measured on postpartum day 5. Plasma CORT concentrations were measured prior to and following testing throughout the test day, while plasma and brain oxytocin concentrations were measured post-testing only. Results indicated increased CORT response following the OFT in CC-treated dams (p? 0.05). CC-treated dams also exhibited altered FST behaviour (p? 0.05), suggesting abnormal stress responsiveness. Peripheral, but not central, oxytocin levels were increased by cocaine treatment (p? 0.05). Peripheral oxytocin and CORT increased following the FST regardless of treatment condition (p? 0.05). Changes in stress-responsiveness, both behaviourally and hormonally may underlie some deficits in maternal behaviour, thus a clearer understanding of CC’s effect on the stress response system may potentially lead to treatment interventions which could be relevant to clinical populations. Additionally, these results indicate that CC treatment can have long-lasting effects on peripheral oxytocin regulation in rats, similar to changes observed in persistent social behaviour and stress-response deficits in clinical populations.
Williams, Sarah K.; Barber, John S.; Jamieson-Drake, Abigail W.; Enns, Jordan A.; Townsend, Leah B.; Walker, Cheryl H.; Johns, Josephine M.
Background Postpartum weight retention affects many women and increases the risk of becoming overweight. The research objective was to study modifiable factors contributing to weight change at one year postpartum. Methods In this prospective cohort, postpartum behavior, such as physical activity, sedentary behavior, sleep, and intake of total energy, total fat and saturated fatty acids of 118 Dutch women were assessed in 2003/2004 by self-report at 6 weeks, 6 and 12 months postpartum. Mean postpartum scores were computed for the behavioral measures. In linear regression models it was determined which factors were associated with average weight change from before pregnancy to one year postpartum. Furthermore, factors associated with substantial postpartum weight retention (? 5 kg) were also studied in logistic regression models. Results At one year postpartum, the average weight of participants had increased by 0.9 kg (SD 4.4). Moreover, 20% of the women retained ? 5 kg. Women who perceived themselves more physically active than others were almost ten times less likely to retain ? 5 kg than women who perceived themselves equally active (OR = 0.11, 95%CI: 0.02 - 0.66). Exceeding the guideline for saturated fatty acid intake (OR = 3.40, 95%CI: 1.04 - 11.11), total gestational weight gain (OR = 1.14/kg, 95%CI: 1.01 - 1.27), and not having completed post high school education (OR = 5.13, 95%CI: 1.66 - 15.90) increased the odds of retaining ? 5 kg. Conclusions Since one in five women had substantial weight retention postpartum, effective interventions for the prevention of weight retention are much needed. Future studies should evaluate whether interventions focusing on the identified modifiable postpartum factors are successful in reducing weight retention after childbirth.
Bipolar disorder is a significant mental health problem among perinatal women; however, little attention has been devoted\\u000a to methods of screening for bipolar disorder during this phase of women’s life cycle. There is a need for reliable and valid\\u000a screening instruments for perinatal women. This paper presents a review of 11 self-report measures used to screen bipolar\\u000a disorder in the
Cheryl Ann Chessick; Sona Dimidjian
Background Realizing the importance of regular physical activity, particularly in the prevention of chronic diseases and unhealthy weight gain, it is important to study how physical activity changes during and after pregnancy using prospective study designs. The aim of this study was to describe the mode, duration, intensity, and changes in physical activity during pregnancy through one year postpartum among a cohort of women. Methods This study was part of the third Pregnancy, Infection and Nutrition Postpartum Study at the University of North Carolina Hospitals. A cohort of 471 women was followed at 17-22 and 27-30 weeks' gestation and at 3 and 12 months postpartum. The participants reported the mode, frequency, duration, and intensity of all physical activities that increased their breathing and heart rate in the past week. Results Overall physical activity for the cohort decreased from 17-22 weeks to 27-30 weeks of gestation, but rebounded up at 3 months postpartum and remained stable at 12 months postpartum. The mean MET h/wk values for each time point were 24.7 (standard deviation, SD 26.8), 19.1 (SD 18.9), 25.7 (SD 29.3), and 26.7 (SD 31.5). In postpartum, women reported more care-giving and recreational activity and less indoor household activity, as compared to their activity level during pregnancy. Conclusion For health benefits and weight management, health care professionals are encouraged to provide pregnant and postpartum women with information on recommendations of physical activity, particularly regarding the minimum duration and intensity level.
The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia--7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after delivery in a low-resource setting. Health programmes should invest to ensure that all women receive early postpartum visits after delivery at home and after discharge from institution to detect and manage maternal morbidity. Further, health programmes should also ensure that women are properly screened for complications before their discharge from hospitals after delivery. PMID:22838163
The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007–December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia—7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women—9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after delivery in a low-resource setting. Health programmes should invest to ensure that all women receive early postpartum visits after delivery at home and after discharge from institution to detect and manage maternal morbidity. Further, health programmes should also ensure that women are properly screened for complications before their discharge from hospitals after delivery.
Summary ¶The efficacy of psychotherapeutic interventions for the acute treatment of postpartum depression is strongly supported by empirical data, which suggest that counseling is of benefit as a stand-alone treatment for postpartum depression. Given the paucity of treatment trials using medication for postpartum depression, and the fact that psychotherapeutic interventions do not confer any “exposure” risks to breastfeeding infants, the
S. Stuart; M. W. O’Hara; L. L. Gorman
Various types of puerperal depressions, symptoms exhibited, and factors that predispose women to develop postpartum depression are reviewed. A case example of a woman who experienced a postpartum depression is discussed. A prenatal checklist is presented to assist clinicians working in obstetrics in evaluating the risk of postpartum depression in their various clients. PMID:6560048
Petrick, J M
BACKGROUND: Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in
Ann Rudman; Ulla Waldenström
Objectives The aim of this article was to determine risk factors for postpartum depression in low-socioeconomic level women during the\\u000a first postpartum year and to determine the relationship between postpartum depression symptoms and social support.\\u000a \\u000a \\u000a \\u000a \\u000a Methods This is a cross-sectional study. Data were collected through administration of a questionnaire, the Edinburgh Postnatal Depression\\u000a Scale (EPDS) and the Multidimensional Scale of Perceived Social
Yurdagül Ya?mur; Ne?e Ulukoca
Background Postpartum weight retention affects many women and increases the risk of becoming overweight. The research objective was to\\u000a study modifiable factors contributing to weight change at one year postpartum.\\u000a \\u000a \\u000a \\u000a \\u000a Methods In this prospective cohort, postpartum behavior, such as physical activity, sedentary behavior, sleep, and intake of total\\u000a energy, total fat and saturated fatty acids of 118 Dutch women were assessed in
Ellen Althuizen; Mireille NM van Poppel; Jeanne H de Vries; Jacob C Seidell; Willem van Mechelen
Background The relationship between perceived rearing and the postpartum depressive state remains unclear. We aimed to examine whether perceived rearing is a risk factor for postpartum depression as measured by the Edinburgh Postnatal Depression Scale (EPDS), and whether the score of perceived rearing is affected by depressive mood (the state dependency of perceived rearing). Methods Pregnant women (n?=?448, mean age 31.8±4.2 years) completed the EPDS as a measure of depressive state in early pregnancy (T1), late pregnancy (around 36 weeks), and at 1 month postpartum (T2), and the Parental Bonding Instrument (PBI) at T1 as a measure of perceived rearing. Changes in the EPDS and the PBI scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group. Results There were no significant differences in any PBI category for perceived rearing between the ND and PD groups at T1. EPDS scores did not change significantly from T1 to T2 in the ND group but increased significantly in the PD group. The PBI maternal care score increased significantly in the ND group (p<0.01), while decreasing in the PD group (p<0.05). Additionally, in both the ND and PD groups, significant negative correlation was observed regarding change in the EPDS and PBI maternal care scores from T1 to T2 (r?=??0.28, p?=?0.013). Conclusions The present study suggests that perceived rearing is not a strong risk factor for postpartum depression as measured by the EPDS. Furthermore, the results indicated the state dependency of the PBI maternal care score.
Okada, Takashi; Murase, Satomi; Aleksic, Branko; Furumura, Kaori; Shiino, Tomoko; Nakamura, Yukako; Tamaji, Ai; Ishikawa, Naoko; Ohoka, Harue; Usui, Hinako; Banno, Naomi; Morita, Tokiko; Goto, Setsuko; Kanai, Atsuko; Masuda, Tomoko; Ozaki, Norio
Objectives: To describe the characteristics and risk factors of women with only third-trimester (late) or no prenatal care. Methods: A statewide postpartum survey was conducted that included 6364 low-income women delivering in California hospitals in 1994 and 1995. Results: The following factors appeared most important, considering both prevalence and association with late or no care: poverty, being uninsured, multiparity, being
Melissa Nothnagle; Kristen Marchi; Susan Egerter; Paula Braveman
Purpose Mental health problems disproportionately affect women, particularly during childbearing years. However, there is a paucity of research on the determinants of postpartum mental health problems using representative US populations. Taking a life course perspective, we determined the potential risk factors for postpartum mental health problems, with a particular focus on the role of mental health before and during pregnancy. Methods We examined data on 1,863 mothers from eleven panels of the 1996-2006 Medical Expenditure Panel Survey (MEPS). Poor postpartum mental health was defined using self-reports of mental health conditions, symptoms of mental health conditions, or global mental health ratings of “fair” or “poor.” Results 9.5% of women reported experiencing postpartum mental health problems, with over half of these women reporting a history of poor mental health. Poor pre-pregnancy mental health and poor antepartum mental health both independently increased the odds of having postpartum mental health problems. Staged multivariate analyses revealed that poor antepartum mental health attenuated the relationship between pre-pregnancy and postpartum mental health problems. Additionally, significant disparities exist in women's report of postpartum mental health status. Conclusions While poor antepartum mental health is the strongest predictor of postpartum mental health problems, pre-pregnancy mental health is also important. Accordingly, health care providers should identify, treat, and follow women with a history of poor mental health, as they are particularly susceptible to postpartum mental health problems. This will ensure that women and their children are in the best possible health and mental health during the postpartum period and beyond.
Witt, Whitney P.; Wisk, Lauren E.; Cheng, Erika R.; Hampton, John M.; Creswell, Paul; Hagen, Erika W.; Spear, Hilary A.; Maddox, Torsheika; DeLeire, Thomas
We have examined the responsiveness of dopamine sensitive neurones in the postpartum period in woman with a history of major depression who are at high risk of experiencing a recurrence of illness in the postpartum period. Fourteen women were assessed at 36 weeks of pregnancy and during the 3 months following delivery, using the Schedule for Affective Disorders and Schizophrenia, including its change version. They were not depressed at initial assessment. Five of the 14 women went on to experience a postpartum relapse (2 major depressive disorder, 2 generalised anxiety disorder, 1 panic disorder). On the fourth day postpartum, i.e., before relapse, the growth hormone response to the dopamine agonist apomorphine was measured as an index of the functional state of hypothalamic dopamine D2 receptors. Women who subsequently relapsed had a significantly greater growth hormone response to apomorphine than those who remained well. This was particularly marked in women with anxiety/panic. The development of increased sensitivity of hypothalamic dopamine D2 receptors in the postpartum period appears to predict the onset of depressive and anxiety disorders. PMID:8897112
Mc Ivor, R J; Davies, R A; Wieck, A; Marks, M N; Brown, N; Campbell, I C; Checkley, S A; Kumar, R
The first cell cycle of Adiantum spores, which is induced by red light (R), was studied with regard to its temporal dependence on Pfr (the active form of phytochrome) and Ca2+. Responses were quantified with increases of the spore content of DNA, thus limiting the investigation to the reactions taking place before the S phase of the cell cycle (i.e. during G0/G1/S transitions). Spores hydrated for more than 2 days in the standard medium (includes 1 millimolar free Ca2+) showed, after stimulation with a saturating R pulse, an increase of DNA beginning at about 25 hours and saturating at about 55 hours. Reversal by far-red light of the inductive effect of R was used to examine the temporal requirement for Pfr. Spores became dependent on the supply of external Ca2+ when incubated in a low Ca medium (32 nanomolar free Ca2+ with 10 millimolar EGTA); this culture condition was used, after observing that the DNA increase occurs similarly if Ca2+ is supplied after the R pulse, to examine the temporal requirement for external Ca2+. It was concluded that the G1 phase of the spore is separated into three subphases: (a) the Pfr-dependent period which immediately follows the R pulse and varies among individual spores from a few to about 25 hours, (b) the Ca2+-dependent period (about 10 hours) which occurs immediately before the S phase, and (c) a gap (15-20 hours) between the two periods. In the Ca2+-dependent period, spores require the presence of extracellular Ca2+. This period occurs only during a determined time after the R pulse, and the competence of spores to enter the S phase is lost sharply if external Ca2+ is not available continuously during this period.
Iino, Moritoshi; Endo, Masami; Wada, Masamitsu
Women who have had gestational diabetes mellitus must be monitored in the immediate postpartum period to ensure that blood glucose levels return to normal without further treatment. In the few studies performed specifically in these women, those that breastfed did not have a different metabolic profile, at least during the period of breastfeeding; the metabolic profiles of children born to women that had gestational diabetes and that breastfed also did not differ from those that were not breastfed. The choice of contraception must mainly take into consideration the associated risk factors. The studies, even if few have specifically focused on women with a history of gestational diabetes, have not demonstrated a significant disturbance of glucose metabolism while using hormonal contraception, whether combined oral oestrogen/progestogen or progestogen-only contraception. However, the presence of obesity, hypertension, or dyslipidaemia must direct the choice of contraception towards one without cardiovascular consequences. In these cases, the intrauterine device is an excellent choice. PMID:21163421
Background Spontaneous coronary and vertebral artery dissections are rare events occurring most commonly in otherwise healthy women during pregnancy or the post-partum period. Case presentation This report describes a 35-year-old female who presented with an acute inferior ST elevation myocardial infarction 7 months post-partum secondary to spontaneous dissection of the left obtuse marginal coronary artery. Despite appropriate medical therapy with dual anti-platelet therapy, the patient presented four weeks later with a spontaneous dissection of the right vertebral artery. Conclusion We review the presentation, diagnosis, and management of spontaneous dissections of the vasculature in the peri-partum period.
A relatively high amount of hyena Crocuta crocuta spelaea (Goldfuss, 1823) remains at the Palaeolithic archaeological cave site Balve Cave (Sauerland Karst, NW Germany) and many chewed prey bones indicate periodic repeated use by hyenas. They reared their cubs and imported many prey remains. Most probably, Ice Age spotted hyenas occupied the Balve Cave for only a few years but
Cajus Godehard Diedrich
This study determined changes in plasma amino acid concentration in late-gestating (beginning 58 ± 1.02 days prior to calving), primiparous, winter-grazing range heifers receiving wheat middling-based supplement without (CON) or with rumen-protected methionine (MET) to provide 15 g DL-MET each day. Plasma was collected on days -2 and 0 (start of MET supplementation just prior to individually receiving supplement at 0700 hours). Plasma was sampled again on days 40, 42 and 44 prior to supplementation at 0700 and 1100 hours (4 h after receiving daily supplement). Data were analyzed with cow as the experimental unit. Continuous variables were analyzed by the main effects of treatment, date, or time and their interaction when appropriate. Comparable BW (P = 0.32) and BCS (P = 0.83) over the 44-day metabolism trial were found between both CON- and MET-fed heifers. MET-supplemented heifers had greater (P < 0.01) plasma concentrations of methionine indicating that the rumen-protection technology successfully delivered methionine to the small intestine. Supplementation with rumen-protected DL-MET caused a significant supplement × date interaction for glutamine (P = 0.03), glycine (P = 0.02), methionine (P < 0.01), and serine (P = 0.05). In addition, trends for supplement × date interactions were detected for leucine (P = 0.07), threonine (P = 0.09), valine (P = 0.08), total amino acids (TAA; P = 0.08), non essential amino acids (NEAA; P = 0.08), branched chain amino acids (BCAA; P = 0.08), and glucogenic amino acids (GLUCO; P = 0.08). These results suggest that the BCAA (leucine and valine) were utilized more efficiently with MET supplemented heifers compared to CON supplemented heifers. Plasma AA concentrations for glutamic acid (P < 0.01), histidine (P = 0.01), tyrosine (P < 0.01), and EAA (P < 0.01), all decreased throughout the study. These results further confirm methionine is a limiting amino acid in forage fed late-gestating heifers and further suggests the limitation when grazing dormant range forages as shown by improved utilization of other plasma amino acids when supplemental methionine was provided. PMID:22555648
Waterman, Richard C; Ujazdowski, Valerie L; Petersen, Mark K
While contemporary diagnostic nosology characterizes postpartum depression (PPD) as a specifier of a major depressive disorder\\u000a (MDD), this classification continues to be questioned. Functional magnetic resonance imaging (fMRI) holds the promise of helping\\u000a to characterize the neuroanatomical dysfunction associated with dysregulated emotion after childbirth. Twenty postpartum women\\u000a underwent fMRI in the presence of emotionally valenced stimuli. The observation of relative
Michael E. Silverman; Holly Loudon; Xun Liu; Casey Mauro; Gila Leiter; Martin A. Goldstein
The authors describe the case of a 28-year-old patient who died from an extensive intracerebral haemorrhage due to disseminated intravascular coagulation (DIC) which occurred a few days after delivery. Access to an emergency department of gynaecology on three separate occasions in the three days preceding hospitalization made judicial evaluation of the case necessary. The case was studied with a methodological approach based on the following steps: (1) examination of clinical records; (2) autopsy; (3) study of the placenta; (4) anatomo-histopathological observations concerning particular organs and structures potentially involved in postpartum maternal death; and (5) evaluation of physicians' behaviour, in the light of necroscopic findings and a review of the literature. The causes of death most frequently described in the postpartum period were excluded; a mediastinal nodular sclerosing Hodgkin's lymphoma with transdiaphragmatic diffusion, not diagnosed in life, was demonstrated. The cause of death was identified as intracerebral haemorrhage following DIC, Hodgkin's disease and recent delivery by caesarean section. Analysis of the physicians' conduct, together with a review of the literature, revealed a medical error. However, no causal relationship between the error and the death of the patient was considered to exist. The interest of the case lies in the unusual cause of DIC discussed in relation to a hypothesis of obstetric-gynaecological liability. PMID:22438507
Di Pietra, Laura; Gardiman, Marina; Terranova, Claudio
Postpartum thyroid dysfunction (PPTD) is a common disorder which causes considerable morbidity in affected women. The availability of effective treatment for hypothyroid PPTD, the occurrence of the disease in subsequent pregnancies and the need to identify subjects who develop long term hypothyroidism, has prompted discussion about screening for this disorder. There is currently no consensus about screening as investigations hitherto have been variable in their design, definitions and assay frequency and methodology. There is also a lack of consensus about a suitable screening tool although thyroid peroxidase antibody (TPOAb) is a leading contender. We present data about the use of TPOAb in early pregnancy and its value as a screening tool. Although its positive predictive value is moderate, its sensitivity and specificity when used in early pregnancy are comparable or better compared to other times during pregnancy and the postpartum period. Recent studies have also confirmed this strategy to be cost effective and to compare favourably with other screening strategies. We also explore the advantages of universal screening.
Adlan, Mohamed A.; Premawardhana, Lakdasa D.
Although a direct interdependence exists between the ovarian steroids, estrogen and progesterone, the exact role of these two hormones during pregnancy, especially late pregnancy, is not completely understood. Investigations have been conducted to determine whether the circulating levels of progesterone and estrogen or changes in the ratio of progesterone/estrogen in relation to the concentration of uterine estrogen receptors are associated with triggering parturition. Ninety-day old female rats were sacrificed at gestation days 14, 16, 18, 20 and two days post-partum. The plasma levels of estradiol and progesterone were measured by solid-phase radioimmunoassay. Uterine cytosol was subjected to a charcoal binding assay to determine the concentration of estrogen receptors. Our findings demonstrate that there is a significant drop in both plasma progesterone and estradiol during late pregnancy. Also indicated is a significant increase in uterine estrogen receptors throughout late pregnancy. Finally, during this period there is a direct correlation between the shift in the progesterone/estrogen ratio and the increase in the concentration of uterine estrogen receptors in late pregnancy.
Cathey, T.M.; Chung, Kyung W. (Univ. of Oklahoma, Oklahoma City (USA))
Distinct challenges face psychiatric-mental health nurses who treat a growing population of ethnically, racially, and culturally diverse patients. Nurses must be educated about the cultural beliefs and health practices within specific patient populations to provide comprehensive health care to patients. The purpose of this article is to educate nurses on postpartum depression among immigrant Muslim women.
Julia Fonte; Sara Horton-Deutsch
The association between breastfeeding patterns and resumption of postpartum menstruation was examined in rural Guatemalan women from the INCAP longitudinal study (1969-1977). It was distinguished among women who experienced infant mortality before menses resumed, women who weaned before menses resumed, and women who had return of menses while still breastfeeding. Weaning and infant mortality before menses resumes are significant risk
Guido Pinto Aguirre; Robert E. Jones
OBJECTIVE: A continuous rise in the rate of cesarean delivery has been reported in many countries during the past decades. This trend has prompted the emergence of a controversial debate on the risks and benefits associ- ated with cesarean delivery. Our objective was to pro- vide a valid estimate of the risk of postpartum maternal death directly associated with cesarean
Catherine Deneux-Tharaux; Elodie Carmona; Marie-Hélene Bouvier-Colle; Gérard Bréart
It is estimated approximately 9% of Army women are pregnant at any one time. Shortly after delivery, postpartum soldiers are expected to return to full duty, meet body fat standards and pass the APFT. It has never been determined when prepregnancy work ca...
Postpartum neurological complications occur in up to 1% of deliveries. Often prior anesthetic procedures are blamed, with medicolegal implications. We de- scribe a young woman who presented with postpar- tum foot drop diagnosed as an iatrogenic L5 root le- sion after uncomplicated epidural anesthesia. After neurological assessment some 5 mo later she tested positive for the common hereditary neuropathy with
DAVID J. BIRNBACH
Coincident with the processes that led to the development of agriculture and animal domestication, human and animal representations\\u000a in clay, stone, and plaster were important constituents of the archaeological record across much of the eastern Mediterranean\\u000a region. The bulk of the evidence comes from the Pre-Pottery Neolithic B (PPNB) period, but there are also important findings\\u000a from PPNA and the
Gary O. Rollefson
Objective: To evaluate postpartum uterine artery (UtA) velocimetry in patients following severe preeclampsia (PET) as compared with normotensive controls. Study Design: Postpartum UtA velocimetry was obtained prospectively during the early postpartum period. The right and left UtA pulsatility index (PI) was measured and the presence of an early diastolic notch was noted. For categorical variables, the ?2 test or Fisher exact was used as appropriate and for continuous variables the t-test was used. The p value <0.05 was considered statistically significant. Results: Thirty-one patients following severe PET and 52 normotensive controls were included in the study. Following severe PET, higher rates of intrauterine growth restriction, cesarean delivery, preterm delivery and accordingly lower neonatal birth weight were noted. Postpartum UtA velocimetry measurements were performed on average 51.2?h after delivery (range 8-169). Right and left UtA PI was comparable between patients following severe PET and controls. The presence of unilateral and bilateral early diastolic notches were significantly higher in patients following severe PET. Conclusions: The pathophysiology of uterine involution and the physiologic return of the uterine arteries to the non-pregnant state may be different following severe PET. PMID:23957256
Weintraub, Adi Y; Aricha-Tamir, Barak; Steiner, Naama; Hamou, Bat-El; Baron, Joel; Hershkovitz, Reli
This study discovers, describes, and explains the personal experiences, perceptions, and care meanings of Jordanian women who have suffered postpartum depression. Most postpartum cases often are misdiagnosed as exclusively psychological and untreated by health care professionals without consideration to the cultural meanings of this problem. Understanding the experiences of these women is important, as their expressions often are contextually and culturally influenced. Using Leininger's Theory of Culture Care Diversity and Universality, a purposive sample of 22 Jordanian women diagnosed with postpartum depression, living in Sydney, were interviewed. The ethnonursing research method and data analysis procedures were used. Results revealed that Jordanian mothers experienced severe loss of control over emotions of loneliness, hopelessness, and feelings of being a bad mother. Three major themes focusing on the care meanings and experiences of Jordanian women are discussed: (a) Care means strong family support and kinship during the postpartum period, (b) care is carrying out and fulfilling traditional gender roles as mother and wife, and (c) care is preservation of Jordanian childbearing customs as expressed in the celebration of the birth of the baby. PMID:10476151
Nahas, V; Amasheh, N
Purpose To examine the efficacy of cognitive-behavioral therapy (CBT) for the prevention of postpartum depression (PPD) in "at risk" women. Materials and Methods We recruited 927 pregnant women in 6 obstetric and gynecology clinics and screened them using Beck Depression Inventory (BDI). Ninety-nine of the screened women who had significantly high scores in BDI (a score above 16) were selected for the study. They were contacted through by telephone, and 27 who had consented to participate in the study were interviewed via SCID-IV-I. Twenty-seven eligible women were randomly assigned to the CBT intervention (n = 15) and control condition (n = 12). All participants were required to complete written questionnaires, assessing demographic characteristics, depressive symptoms, negative thoughts, dyadic communication satisfaction, and global marital satisfaction prior to treatment and approximately 1 month postpartum. The 15 women in the CBT condition received 9 bi-weekly 1-hour individual CBT sessions, targeting and modifying negative patterns of thinking and behaviors occurring in the context of the dyadic relationship. Results The analysis of covariance (ANCOVA) showed that there were significant differences in all postpartum measures between the 2 groups, indicating that our antenatal intervention with CBT was effective in reducing depressive symptoms and improving marital satisfaction, which lasted until the postpartum period. Conclusion Our pilot study has provided preliminary empirical evidence that antenatal CBT intervention can be an effective preventive treatment for PPD. Further study in this direction was suggested.
Kwon, Jung Hye; Lee, Jeong Jae
Postpartum uterine infections, endometrial histology and resumption of ovarian activity in cows were studied in 2 Estonian dairy herds with different herd sizes, milk yields and management systems. Ten cows at Farm A and 5 cows at Farm B were studied in the experiment. All cows in the study had normal calving performance. Endometrial biopsies for bacteriological and histological examinations were collected once a week starting on the second week postpartum and continuing for 7 weeks postpartum. Milk progesterone samples were collected twice a week during the whole study period. In both herds, the uterine flora contained mainly facultative anaerobic bacteria (Streptococcus spp., E. coli, Staphylococcus spp., Proteus vulgaris). Among obligate anaerobic bacteria only Bacteroides spp. were found. After 7 weeks of collection at farm A, a bacterial uterine flora still persisted in 2 of the cows. At farm B, on the other hand, bacterial elimination was complete after 6 weeks. Presence of inflammatory cells in uterine histology specimens remained higher at the end of collection and resumption of ovarian activity was delayed at farm A. After 7 weeks postpartum, only 6 of the 10 cows at farm A had resumed ovarian cyclicity, while at farm B the first oestrous cycle had occurred in all cows. The study showed that differences regarding uterine infections and their clearance occurred between farms and, despite these differences, cows with normal calving performance will effectively recover without any treatment. PMID:9926456
Kask, K; Kindahl, H; Gustafsson, H
Objectives Neglecting the presence of unobserved heterogeneity in survival analysis models has been showed to potentially lead to underestimating the effect of the covariates included in the analysis. This study aimed to investigate the role of unobserved heterogeneity of frailty on the estimation of mortality differentials from age 50 on by education level. Design Longitudinal mortality follow-up of the census-based Turin population linked with the city registry office. Setting Italian North-Western city of Turin, observation window 1971–2007. Population 391?170 men and 456?216 women followed from age 50. Primary outcome measures Mortality rate ratios obtained from survival analysis regression. Models were estimated with and without the component of unobserved heterogeneity of frailty and controlling for mortality improvement over time from both cohort and period perspectives. Results In the majority of cases, the models without frailty estimated a smaller educational gradient than the models with frailty. Conclusions The results draw the attention of the potential underestimation of the mortality inequalities by socioeconomic levels in survival analysis models when not controlling for unobserved heterogeneity of frailty.
Zarulli, Virginia; Marinacci, Chiara; Costa, Giuseppe; Caselli, Graziella
The species composition, cell concentration ( N), and biomass ( B) of the phytoplankton, as well as the chlorophyll a (Chl a) concentration, primary production ( PP), and the concentrations of the dissolved inorganic micronutrients (phosphorus, silica, nitrogen as nitrite), were estimated for Kandalaksha Bay (KB), Dvina Bay (DB), and the basin (Bas) of the White Sea in August of 2004. The micronutrient concentrations were lower compared to the average long-term values for the summer period. The Chl a concentration varies from 0.9 to 2.0 mg/m3 for most of the studied areas, reaching up to 7.5 mg/m3 in the Northern Dvina River estuary. The surface water layer of the DB was the most productive area, where the PP reached up to 270-375 mg C/(m3 day). The phytoplankton biomass varied from 11 to 205 mg C/m3 with the highest values observed in the Bas and DB. Three groups of stations were defined during the analysis of the phytoplankton's species composition similarity. The dinoflagellates Dinophysis norvegica and Ceratium fusus were particular to the phytoplankton assemblages in the KB; the diatom Ditylum brightwellii was particular to the upper and central parts of the DB. These three phytoplankton species were less abundant in the Bas.
Ilyash, L. V.; Radchenko, I. G.; Kuznetsov, L. L.; Lisitzyn, A. P.; Martynova, D. M.; Novigatskiy, A. N.; Chul'Tsova, A. L.
Objectives Whether postpartum visits by trained community health workers (CHW), reduce newborn breastfeeding problems. Methods CHWs made antenatal and postpartum home visits promoting newborn care practices including breastfeeding. CHWs assessed neonates for adequacy of breastfeeding and provided hands on support to mothers to establish breastfeeding. History and observation data of 3,495 neonates were analyzed to assess effects of CHW visitation on feeding problems. Results Inappropriate breastfeeding position and attachment were the predominant problems (12% –15%). 6% of newborns who received home visit by CHWs within 3 days had feeding difficulties, compared to 34% of those who did not (OR: 7.66, 95% CI: 6.03–9.71, p=0.00). Latter group was 11.4 times (95% CI: (6.7–19.3, p=0.00) more likely to have feeding problems as late as day 6–7, than the former. Conclusions Counselling and hands on support on breastfeeding techniques by trained workers within first 3 days of birth, should be part of community based postpartum interventions.
Mannan, Ishtiaq; Rahman, Syed Moshfiqur; Sania, Ayesha; Seraji, Habibur R; Arifeen, Shams El; Winch, Peter; Darmstadt, Gary L; Baqui, Abdullah
Le volvulus du sigmoïde compliquant la grossesse est une complication rare avec moins de 80 cas rapportés dans la littérature. Nous rapportons un cas de volvulus du sigmoïde compliquant les suites de couches. Une primigeste de 29-ans s'est présenté avec une douleur abdominale à J3 du post-partum. Une laparotomie exploratrice a révélé un volvulus, nécrosé, du côlon sigmoïde très distendu. Dans notre cas. Le Volvulus du sigmoïde est susceptible d'avoir été précipité par le changement rapide de la taille de l'utérus après l'accouchement. La mobilité colique associée à une distorsion du côlon sigmoïde, doit être gardé à l'esprit chez les patients qui présentent des douleurs abdominales lors du post-partum. Cet article se propose à travers un cas clinique de revoir les données de la littérature et d'engager les principes généraux de prise en charge et de traitement.
Moussaid, Ihsane; Haddad, Wafaa; Salmi, Said; Elyoussoufi, Smail; Miguil, Mohamed; Serbouti, Sihame; Boufettal, Houssine; Samouh, Naima; Berrada, Saad
Little is known about how maternal sleep disturbances in the postpartum period affect mother-infant interaction. The study was designed to assess if less maternal sleep disturbance and less fatigue were associated with more positive mother-child interaction, independent of maternal depression symptoms. Twenty-three mothers completed one week of actigraphy and self-report measures of fatigue and depression symptoms. To determine the quality
Cynthia R. Ronzio; Edward Huntley; Maureen Monaghan
During a 12-month period 170 women received early postpartum rubella vaccination. An injectable “depot” progestogen was given to each of these patients for contraceptive purposes at the same time as the vaccine was administered. Subsequent observations showed that the progestogen was effective as a contraceptive in this context and that it did not appear to affect the immune response of the patients to the vaccine.
Sharp, David S.; Macdonald, Helen
Light and electron microscopy and morphometry of rat myometrium revealed 5 morphological types of myometrial smooth muscle\\u000a cells. Quantitative evaluation of all cytotypes was performed in nonpregnant animals, during normal pregnancy, and during\\u000a the early postpartum period. Transformation of some cells with nonvacuolated cytoplasm and clear nuclei (type 1) into type\\u000a 3 cells (with small vacuoles in the cytoplasm), type
V. A. Shkurupiy; E. V. Dubinin; N. N. Dubinina
Background Meta-analyses of postpartum blood loss and the effect of uterotonics are biased by visually estimated blood loss. Objectives To conduct a systematic review of measured postpartum blood loss with and without prophylactic uterotonics for prevention of postpartum haemorrhage (PPH). Search strategy We searched Medline and PubMed terms (labour stage, third) AND (ergonovine, ergonovine tartrate, methylergonovine, oxytocin, oxytocics or misoprostol) AND (postpartum haemorrhage or haemorrhage) and Cochrane reviews without any language restriction. Selection criteria Refereed publications in the period 1988–2007 reporting mean postpartum blood loss, PPH (?500 ml) or severe PPH (?1000 ml) following vaginal births. Data collection and analysis Raw data were abstracted into Excel by one author and then reviewed by a co-author. Data were transferred to SPSS 17.0, and copied into RevMan 5.0 to perform random effects meta-analysis. Main results The distribution of average blood loss (29 studies) is similar with any prophylactic uterotonic, and is lower than without prophylaxis. Compared with no uterotonic, oxytocin and misoprostol have lower PPH (OR 0.43, 95% CI 0.23–0.81; OR 0.73, 95% CI 0.50–1.08, respectively) and severe PPH rates (OR 0.61, 95% CI 0.29–1.29; OR 0.74, 95% CI 0.52–1.04, respectively). Oxytocin has lower PPH (OR 0.65, 95% CI 0.60–0.70) and severe PPH (OR 0.71, 95% CI 0.56–0.91) rates than misoprostol, but not in developing countries. Conclusion Oxytocin is superior to misoprostol in hospitals. Misoprostol substantially lowers PPH and severe PPH. A sound assessment of the relative merits of the two drugs is needed in rural areas of developing countries, where most PPH deaths occur.
Sloan, NL; Durocher, J; Aldrich, T; Blum, J; Winikoff, B
Postpartum depression (PPD) affects up to 1 in 8 women. The early postpartum period is characterized by a downward physiological shift from relatively elevated levels of sex steroids during pregnancy to diminished levels after parturition. Sex steroids influence functional brain connectivity in healthy non-puerperal subjects. This study tests the hypothesis that PPD is associated with attenuation of resting-state functional connectivity (rs-fc) within corticolimbic regions implicated in depression and alterations in neuroactive steroid concentrations as compared to healthy postpartum women. Subjects (n = 32) were prospectively evaluated during pregnancy and in the postpartum with repeated plasma neuroactive steroid measurements and mood and psychosocial assessments. Healthy comparison subjects (HCS) and medication-free subjects with unipolar PPD (PPD) were examined using functional magnetic resonance imaging (fMRI) within 9 weeks of delivery. We performed rs-fc analysis with seeds placed in the anterior cingulate cortex (ACC), and bilateral amygdala (AMYG), hippocampi (HIPP) and dorsolateral prefrontal cortices (DLPFCs). Postpartum rs-fc and perinatal neuroactive steroid plasma concentrations, quantified by liquid chromatography/mass spectrometry, were compared between groups. PPD subjects showed attenuation of connectivity for each of the tested regions (i.e. ACC, AMYG, HIPP and DLPFC) and between corticocortical and corticolimbic regions vs. HCS. Perinatal concentrations of pregnanolone, allopregnanolone and pregnenolone were not different between groups. This is the first report of a disruption in the rs-fc patterns in medication-free subjects with PPD. This disruption may contribute to the development of PPD, at a time of falling neuroactive steroid concentrations. PMID:23499388
Deligiannidis, Kristina M; Sikoglu, Elif M; Shaffer, Scott A; Frederick, Blaise; Svenson, Abby E; Kopoyan, Andre; Kosma, Chelsea A; Rothschild, Anthony J; Moore, Constance M
Objective: To describe gestational weight gain during pregnancy, adherence to Health Canada 2010 Gestational Weight Gain Guidelines, and the effects of weight gain on postpartum weight retention in women with different pre-pregnancy body mass indices. Method: Body weight data were collected from women during pregnancy and in the early postpartum period as part of this prospective cohort study; analyses are presented for the first 600 women recruited. Multilinear regression was used to assess associations between pre-pregnancy BMI, total gestational weight gain, and postpartum weight retention. Multinomial regression was used to assess adherence to guidelines for total weight gain and rates of weekly weight gain. Results: Women who gained above recommendations were more likely to be overweight (OR 5.5; 95% CI 2.7 to 10.9, P < 0.001) or obese (OR 6.5; 95% CI 2.5 to 16.5, P < 0.001) before pregnancy, to have a history of smoking (OR 1.96; 95% CI 1.18 to 3.26, P = 0.01), or to be nulliparous (OR 2.23; 95% CI 0.99 to 5.05, P = 0.054). Women who gained weight above recommendations (P < 0.001) and women with low income (P < 0.01) were more likely to retain higher body weight at three months postpartum. Seventy-one percent of participants exceeded recommended rates of weekly weight gain; average weekly weight gain of these women was 0.65 ± 0.17 kg. Conclusion: Pre-pregnancy BMI is a significant predictor of excessive weight gain in pregnancy. Higher gestational weight gain predisposes women to higher postpartum weight retention across all BMI categories. Future studies are warranted to design tools and intervention programs to monitor weight gain during pregnancy. PMID:22742482
Begum, Fatheema; Colman, Ian; McCargar, Linda J; Bell, Rhonda C
During pregnancy, fetal cells cross into the maternal organs where they reside postpartum. Evidence from multiple laboratories suggests that these microchimeric fetal cells contribute to maternal tissue repair after injury. In mouse models, most injury experiments are performed during pregnancy; however, in a clinical setting most injuries or diseases occur postpartum. Therefore, experiments using animal models should be designed to address questions in the time period following delivery. In order to provide a baseline for such experiments, we analyzed the natural history of fetal cells in the postpartum maternal organs. Female C57BL/6J mice were mated to males homozygous for the enhanced green fluorescent protein gene. Fetal cells in the maternal lungs and bone marrow were identified by their green fluorescence using in a high-speed flow cytometer and their counts were compared between the lung and bone marrow. Spearman correlation analysis was used to identify relationships between the duration of time postpartum and the cell counts and ratio of live and dead cells. Our results show that fetal cells persist in these organs until at least three months postpartum in healthy female mice. We show a two-stage decline, with an initial two and a half-week rapid clearance followed by a trend of gradual decrease. Additionally, an increase in the ratio of live to dead cells within the lung over time suggests that these cells may replicate in vivo. The results presented here will inform the design of future experiments and may have implications for women’s health.
Pritchard, Stephanie; Peter, Inga; Johnson, Kirby L.; Bianchi, Diana W.
OBJECTIVE The determinants of anemia during both pregnancy and postpartum recovery remain incompletely understood in sub-Saharan African women. SUBJECTS/METHODS In a prospective cohort study among pregnant women, we assessed dietary, biochemical, anthropometric, infectious and sociodemographic factors at baseline. In multivariate Cox proportional hazards models, we examined predictors of incident anemia (hemoglobin <11 g/dl) and iron deficiency anemia (anemia plus mean corpuscular volume <80 fL), and recovery from anemia and iron deficiency anemia through 18 months postpartum at antenatal clinics in Dar es Salaam, Tanzania between 2001 and 2005. A total of 2364 non-anemic pregnant women and 4884 anemic women were enrolled between 12 and 27 weeks of gestation. RESULTS In total, 292 women developed anemia during the postpartum period and 165 developed iron deficiency anemia, whereas 2982 recovered from baseline anemia and 2044 from iron deficiency anemia. Risk factors for postpartum anemia were delivery complications (RR 1.6, 95% confidence interval (CI) 1.13, 2.22) and low postpartum CD4 cell count (RR 1.73, 95% CI 0.96, 3.17). Iron/folate supplementation during pregnancy had a protective relationship with the incidence of iron deficiency anemia. Absence of delivery complications, education status and iron/folate supplementation were positively associated with time to recovery from iron deficiency. CONCLUSION Maternal nutritional status during pregnancy, prenatal iron/folate supplementation, perinatal care, and prevention and management of infections, such as malaria, are modifiable risk factors for the occurrence of, and recovery from, anemia.
Petraro, P; Duggan, C; Urassa, W; Msamanga, G; Makubi, A; Spiegelman, D; Fawzi, WW
Background Whilst the prevalence and correlates of postpartum depression are well established, far less is known about postpartum anxiety. Studies have described the association between socio-demographic factors and postpartum depression, yet few have explored the association between stressors in women's lives around the time of having a baby and maternal psychological morbidity. This study aimed to describe the population prevalence of postpartum depression, anxiety, co-morbid anxiety and depression and social health issues; and to examine the association between postpartum psychological and social health issues experienced in the six months following birth. Methods Population-based survey of all women who gave birth in Victoria and South Australia in September/October 2007. Women were mailed the survey questionnaire six months following birth. Anxiety and depression were measured using the Depression Anxiety Stress Scales (DASS-21). Results Questionnaires were completed by 4,366 women. At six months postpartum the proportion of women scoring above the 'normal' range on the DASS-21 was 12.7% for anxiety,17.4% for depression, and 8.1% for co-morbid depression and anxiety. Nearly half the sample reported experiencing stressful life events or social health issues in the six months following birth, with 38.3% reporting one to two and 8.8% reporting three or more social health issues. Women reporting three or more social health issues were significantly more likely to experience postnatal anxiety (Adj OR = 4.12, 95% CI 3.0-5.5) or depression (Adj OR = 5.11, 95% CI = 3.9-6.7) and co-morbid anxiety and depression (Adj OR = 5.41, 95% CI 3.8-7.6) than women who did not report social health issues. Conclusions Health care providers including midwives, nurses, medical practitioners and community health workers need to be alert to women's social circumstances and life events experienced in the perinatal period and the interplay between social and emotional health. Usual management for postpartum mental health issues including Cognitive Behavioural Therapy and pharmacological approaches may not be effective if social health issues are not addressed. Coordinated and integrated perinatal care that is responsive to women's social health may lead to improvements in women's emotional wellbeing following birth.
CONTEXT Psychiatric disorders and substance use during pregnancy are associated with adverse outcomes for mothers and their offspring. Information about the epidemiology of psychiatric disorders and substance use in this population is lacking. OBJECTIVE To examine sociodemographic correlates, rates of DSM-IV Axis I psychiatric disorders, substance use and treatment-seeking among past-year pregnant and postpartum women in the United States. DESIGN, SETTING, AND PARTICIPANTS Face-to-face interviews were conducted in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). MAIN OUTCOME MEASURES Prevalence of 12-month DSM-IV Axis I psychiatric disorders, substance use, and treatment seeking. RESULTS There were no significant differences in the 12-month prevalence of psychiatric disorders between past-year pregnant (25.3%), postpartum women (27.5%), and non-pregnant women of child-bearing age (30.1%), except for the significantly higher prevalence of major depressive disorder in postpartum women (9.3%) than in non-pregnant women (8.1%) (OR 1.59, 95% CI=1.15–2.20). Past-year pregnant and postpartum women had significantly lower rates of alcohol use disorders, and any substance use, except illicit drug use, than non-pregnant women. Age, marital status, health status, stressful life events, and history of traumatic experiences were all significantly associated with higher risk of psychopathology in pregnant and postpartum women. Most women with a current psychiatric disorder did not receive any mental health care in the 12-months prior to the survey regardless of pregnancy status. CONCLUSIONS Pregnancy per se is not associated with increased risk of mental disorders, though the risk of major depressive disorder may be increased during the postpartum period. Young, unmarried women with recent stressful life events, complicated pregnancies, and poor overall health were at significantly increased risk of mental disorders during pregnancy. Low rates of maternal mental health care underscore the need to improve recognition and delivery of treatment for mental disorders occurring during pregnancy and the postpartum.
Vesga-Lopez, Oriana; Blanco, Carlos; Keyes, Katherine; Olfson, Mark; Grant, Bridget F.; Hasin, Deborah S.
Postpartum depression (PPD) is a common complication of childbirth with prevalence estimated at 10–20% reported in many countries,\\u000a including Israel. However, no data has been reported for Israeli Bedouin women, whose lifestyle is significantly different\\u000a from that of the general population. This study aimed to determine the prevalence of PPD among Bedouin women in the southern\\u000a Negev. The study included
Saralee Glasser; Ela Stoski; Victoria Kneler; Racheli Magnezi
Summary Postpartum depression (PPD) is a frequent complication of childbirth, but many women refuse pharmacological treatment. Little\\u000a data exists on bright light therapy for PPD. Fifteen outpatient women with PPD were randomly assigned to bright light (10,000\\u000a lux, n = 10) or dim red light (600 lux, n = 5) and completed a 6-week trial and weekly assessments using self-report depression
M. Corral; A. A. Wardrop; H. Zhang; A. K. Grewal; S. Patton
The phenomenon of reversible cerebral arterial segmental vasoconstriction has been associated with several conditions, including\\u000a pregnancy and puerperium (“postpartum angiopathy”), thunderclap headache, and use of vasoconstrictive medications. Patients\\u000a with cerebral vasoconstriction typically present with sudden, severe, and recurrent (“thunderclap”) headaches and can develop\\u000a strokes. Cerebral vasoconstriction syndromes are under-recognized, are poorly characterized, and are frequently misdiagnosed\\u000a as primary cerebral vasculitis.
Aneesh B. Singhal; Richard A. Bernstein
Whether to manage placenta previa percreta surgically or conservatively has been a controversial issue. A 30-year-old woman with placenta percreta with bladder involvement was treated conservatively. A planned cesarean section was performed at 33 weeks' gestation. A 1768-g female infant was delivered through a transverse fundal uterine incision with the placenta left inside the uterus. The following morning, a massive postpartum hemorrhage occurred, and was successfully treated with transarterial embolization. The placenta was never expelled and spontaneously disappeared 4 months after surgery. We demonstrate serial magnetic resonance imaging of the placenta percreta during pregnancy and the postpartum period. PMID:22672446
Ueda, Yusuke; Kondoh, Eiji; Kakui, Kazuyo; Hamanishi, Junzo; Ueda, Masashi; Nishikawa, Ai; Tatsumi, Keiji; Konishi, Ikuo
Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence.\\u000a Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms.\\u000a Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported\\u000a on demographic factors, physical and emotional symptoms, daily
Elizabeth A. Howell; Pablo A. Mora; Marco D. DiBonaventura; Howard Leventhal
To date, few studies have examined suicidality in women with postpartum depression. Reports of suicidal ideation in postpartum\\u000a women have varied (Lindahl et al. Arch Womens Ment Health 8:77–87, 2005), and no known studies have examined the relationship between suicidality and mother-infant interactions. This study utilizes\\u000a baseline data from a multi-method evaluation of a home-based psychotherapy for women with postpartum
Ruth Paris; Rendelle E. Bolton; M. Katherine Weinberg
This study examined the effects of exposure to ethanol through cultural practices by lactating mothers. Specifically, the pharmacokinetics of alcohol in Chinese lactating mothers was investigated after they consumed chicken soup flavored with sesame oil and rice wine (CSSR), a typically prescribed diet during the postpartum “doing-the-month” period. Experimental findings were employed to estimate the potential ethanol dose to neonates
Yeh-Chung Chien; Jen-Fang Liu; Ya-Jing Huang; Chun-Sen Hsu; Jane C.-J. Chao
Converging evidence suggests that the motivation to seek cocaine during the postpartum period is significantly impacted by the competing incentives of offspring, a stimulus unique to this life stage. In the present study, the functional role of the medial preoptic area (mPOA), a critical site involved in maternal responsiveness, on processing incentive value of pup-associated cues and influencing response allocation
M. Pereira; J. I. Morrell
Objective Adverse pregnancy outcomes, including preterm birth, are markedly higher among African-Americans versus Whites. Stress-induced immune dysregulation may contribute to these effects. Epstein-Barr virus (EBV) reactivation provides a robust model for examining cellular immune competence. This study examined associations of EBV virus capsid antigen immunoglobulin G (VCA IgG) with gestational stage, race, and racial discrimination in women during pregnancy and postpartum. Methods Fifty-six women (38 African-American, 18 White) were included. African-Americans and Whites did not differ in age, education, income, parity, or body mass index (ps ?.51). During the 1st, 2nd, and 3rd trimester and ~5 weeks postpartum, women completed measures of racial discrimination, perceived stress, anxiety, depressive symptoms and health behaviors. EBV VCA IgG antibody titers were measured via ELISA in serum collected at each visit. Results In the overall sample, EBV VCA IgG antibody titers were lower in the 3rd versus 1st trimester (p=.002). At every timepoint (1st, 2nd, 3rd trimester and postpartum), African-American women exhibited higher serum EBV VCA IgG antibody titers than Whites (ps<.001). This effect was most pronounced among African-Americans reporting greater racial discrimination [p=.03 (1st), .04 (2nd), .12 (3rd), .06 (postpartum)]. Associations of race and racial discrimination with EBV VCA IgG antibody titers were not accounted for by other measures of stress or health behaviors. Conclusions Compared to Whites, African-American women showed higher EBV VCA IgG antibody titers, indicative of impaired cellular immune competence, across pregnancy and postpartum. This effect was particularly pronounced among African-American women reporting greater racial discrimination, supporting a role for chronic stress in this association. In women overall, EBV antibody titers declined during late as compared to early pregnancy. This may be due to pregnancy-related changes in cell-mediated immune function, humoral immune function, and/or antibody transfer to the fetus in late gestation. As a possible marker of stress-induced immune dysregulation during pregnancy, the role of EBV reactivation in racial disparities in perinatal health warrants further attention.
Christian, Lisa M.; Iams, Jay D.; Porter, Kyle; Glaser, Ronald
In this study, we investigated the body image of Turkish women in their first year postpartum. We recruited 440 postpartum women who had applied to the outpatient clinics of the Maternity and Children's Hospital in the city of Ordu, Turkey. The mean of the women's body image scores was over the "middle level." The women's body image scale (BIS) score showed a significant negative relation with age, number of births, weight before pregnancy, weight gain, during pregnancy, weight soon after childbirth, present weight, postpartum weight gain, and postpartum body mass index (BMI). PMID:22242653
Erbil, Nülüfer; Senkul, Asuman; Ba?ara, Gül Feyza; Sa?lam, Ye?im; Gezer, Mehtap
This study aimed to evaluate the feasibility of conducting a randomized controlled trial of postpartum intrauterine device insertion and to demonstrate that the postpartum intrauterine device is acceptable to women. Women attending prenatal care at a maternity hospital in Lilongwe, Malawi were recruited into a trial comparing immediate (10 minutes to 48 hours) to 6 week postpartum insertion. Feasibility of recruiting and consenting 140 women and randomizing 70% of them was evaluated. Satisfaction with the intrauterine device was also assessed. One hundred fifteen women consented and 49 (61%) were randomized. Twenty-six women were assigned to immediate insertion, and 23 to insertion at 6 weeks postpartum. Thirty (24%) women received the device as part of the study protocol, and 28 (93%) had the device in place at 12 weeks postpartum. The intrauterine device is acceptable to some postpartum women in Malawi, but conducting a randomized clinical trial may not be feasible. PMID:24069753
Bryant, Amy G; Kamanga, Gift; Stuart, Gretchen S; Haddad, Lisa B; Meguid, Tarek; Mhango, Chisale
Surface and histological changes of ovarian follicles and degree of atresia were characterized 3 and 6 d after a treatment with a GnRH agonist (buserelin) in postpartum beef cows. Sixteen cyclic cows on d 7 of their estrous cycle and eight acyclic cows were used. On d 0 of the experimental period, eight cyclic cows were injected with 2 mL of physiological saline and the remaining eight cyclic cows and the acyclic cows were injected i.m. with 8 micrograms of buserelin. Ovaries were collected 3 or 6 d later (n = 4 cows per group per day). All follicles (> 1.57 mm) were observed microscopically, measured using routine histological techniques, and classified as either nonatretic or atretic, with early or late atresia, and grouped into Class 1, 1.57 to 3.67 mm, Class 2, 3.68 to 8.56 mm, or Class 3, > 8.56 mm. Buserelin induced formation of new corpora lutea in all cows but one (acyclic cow). Class 1 follicles decreased on d 3 but increased on d 6 (day x treatment, P < .004), whereas those of Class 2 increased (P < .07) on both d 3 and 6 after buserelin treatment. However, within Class 2 follicles, we detected an increase on d 3 and 6 in the number (P < .01) and proportion (P < .07) of atretic follicles, an increase in the number of follicles in late atresia on d 6 (day x treatment, P < .03), and a decrease in the number (P < .06) and proportion (P < .03) of nonatretic follicles on d 6 (day x treatment).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8138489
Twagiramungu, H; Guilbault, L A; Proulx, J; Ramkumar, R; Dufour, J J
Background: The prevention and treatment of alcohol use disorders among women of reproductive age have been well described. However, there is limited information on women specifically during the postpartum period. This period in a woman's life is a time of transition and provides an ideal opportunity for primary care providers to intervene. Purpose: The goal of this report is to present the results of a brief alcohol intervention conducted in 34 obstetrical practices in women seeking routine postpartum care. Methods: A randomized clinical trial was conducted from 2002-2005 in a diverse sample of women located in 15 Wisconsin counties. This report presents 6 month follow-up data. Results: 8,706 women were screened for high-risk alcohol use during routine postpartum care with 997 (12%) of these women testing positive for at-risk drinking. 235 women met inclusion criteria and were randomized to either “usual care” or “brief intervention”. The four session intervention was delivered by outpatient obstetrical nurses and research staff. The mean age of the women in the sample was 28, 19.3% were from minority groups, 60.8% were married, 53.2% reported current tobacco use and 17.9% had used marijuana in the previous 30 days. At the 6 month follow-up appointment, there were significant reductions in mean number of total drinks in the previous 28 days (p<.013), number of drinking days (p<.024) and heavy drinking days (p<.019). In addition to a statistical difference between groups, there was a 19% difference in the mean number of drinks and number of drinking days, and a 36% difference in the number of heavy drinking days in favor of the intervention group. Conclusion: The findings of the Healthy Moms Trial support the implementation of brief alcohol intervention during the postpartum period.
Fleming, Michael F.; Lund, Michael R.; Wilton, Georgiana; Landry, Mary; Scheets, Dawn
The aim of this study was to evaluate the role of lysosomal enzymes in excessively heavy menstruation by comparing women with menorrhagia due to dysfunctional bleeding or intrauterine contraceptive device (IUCD) use with those with normal menstrual periods or with amenorrhoea associated with breastfeeding. This was a prospective cohort investigation of the activity of four endometrial lysosomal enzymes in three contrasting groups: (i) women with ovulatory dysfunctional uterine bleeding and users of intrauterine contraceptive devices; (ii) breastfeeding post-partum women in whom there are long periods of amenorrhoea, particularly in the early months post-partum; and (iii) normal cycling women. It was found that the total activity of lysosomal enzymes, particularly acid phosphatase and N-acetyl-beta-D-glucosaminidase, was markedly elevated (P < 0.001) in IUCD-exposed endometrium, and endometrium from women with dysfunctional uterine bleeding when compared with endometrium from women with a history of entirely normal menstrual periods or that in post-partum breastfeeding women. The activity of alpha-L-fucosidase was moderately elevated in IUCD users (P < 0.05) and ovulatory dysfunctional uterine bleeding (P < 0.05), whereas alphaD-mannosidase activity was elevated in ovulatory dysfunctional uterine bleeding (P < 0.05), but decreased in IUCD users (P < 0.01). No significant differences were observed in the lysosomal enzyme activities of breastfeeding post-partum women and normal cycling women. These results show that total endometrial tissue activity of four lysosomal enzymes was substantially increased throughout the cycle in most circumstances in women with two different causes for increased menstrual bleeding. This suggests a contributory role to the increased bleeding. PMID:10694274
Wang, I Y; Fraser, I S; Barsamian, S P; Manconi, F; Street, D J; Cornillie, F J; Russell, P
Forty-one pregnant cows at 240 days of gestation were selected from the cattle herd at the Indian Veterinary Research Institute, Izatnagar, Bareilly, India. The cows were critically observed daily during the periparturient period until 45 days postpartum. The prepartum sampling day was fixed on the basis of AI date supported by the external signs of the animals approaching parturition. Blood sampling was done for each experimental animal on 15 days prepartum (-15 d), calving day (0 d), 15 days (15 d), and 30 days (30 d) postpartum, and thorough gynecological examinations were performed on 0 d, 15 d, 30 d, and 45 d for diagnosis of postpartum reproductive diseases like retained placenta (ROP), clinical metritis (CM), clinical endometritis, cervicitis, and delayed involution of the uterus. The blood serum was used for estimation of the anti-inflammatory cytokine interleukin 10 (IL-10). Determintaion of IL-10 concentration in serum was done by using a commercially available bovine-specific ELISA kit. The IL-10 concentration (pg/mL) was significantly (P < 0.01) higher for ROP (1956.96 ± 325.30) and CM (2283.01 ± 326.82) than normal cows (827.19 ± 127.11) at 15 days before calving. The values for IL-10 was also significantly (P < 0.05) higher for cows with ROP and CM than for normal cows at 0 d and 15 d postpartum. However, the values for IL-10 were significantly (P < 0.05) higher for cows with clinical endometritis (1847.83 ± 539.38) than for normal cows (770.75 ± 29.22) at 30 d postpartum. The concentration of IL-10 was lower (P > 0.05) in cows with delayed involution of uterus than other groups of cows at all days of the periparturient period. The cytokine level in cows with delayed involution of the uterus was 328.906 ± 107.19, 263.08 ± 84.92, 415.26 ± 102.14, and 386.28 ± 111.11 on -15 d, 0 d, 15 d, and 30 d, respectively. According to the results of this study it can be concluded that increased serum concentration of IL-10 at 15 d prepartum was observed in cows that developed ROP and CM and remained significantly higher until 15 d postpartum. Therefore, this cytokine might be used as a prognostic marker to identify the cows that are going to develop ROP and CM. PMID:23434356
Islam, Rafiqul; Kumar, Harendra; Nandi, Sukdeb; Rai, R B
We describe the cases of 2 sisters with adult metachromatic leukodystrophy (MLD). Whereas one sister presented with disorganized schizophrenia–like symptoms as the initial manifestation of MLD, the other remained symptom free except for a 4-week period of postpartum depression. In both patients, there was some residual activity of leukocyte arylsulfatase A (1.7% and 5.5% of normal), and a marked increase in urinary sulfatides was present, as measured by tandem mass spectrometry. An arylsulfatase A pseudodeficiency was therefore excluded. The most common mutations of the adult phenotype, Ile-179-Ser and Pro-426-Leu, were not found. In the literature, only 1 case of adult MLD manifesting as disorganized schizophrenia–like symptoms has been described, whereas postpartum depression has been so far unknown as a presenting symptom of MLD.
Kumperscak, Hojka Gregoric; Paschke, Eduard; Gradisnik, Peter; Vidmar, Jernej; Bradac, Stanislava Umek
The available evidence indicates that from the founding of the Ottoman state in the later part of the 13th century to the middle of the 15th century, the Ottoman scholars who were trained in such medieval subjects as sheriah (Islamic law), rhetoric and logic were not very interested in the study of the natural sciences. With the accession of Mehmet
Osman Recep Bahadir; H. Günhan Dani?man
The case of a patient who experienced a late, spontaneous breast hematoma 9 years after augmentation mammaplasty in the absence of trauma or anticoagulation is reported. Although hematoma is not an uncommon complication in the immediate postoperative period, it is very rare as a late complication of breast implantation. A review of the literature suggested that a chronic inflammatory reaction to
Michael Brickman; Natalie N. Parsa; Fereydoun Don Parsa
BACKGROUND: To ascertain the impact of postpartum onset (PPO) on the subsequent time course of mood disorders. METHODS: This retrospective study compared per year rates of excited (manic or mixed) and depressive episodes between fifty-five women with bipolar (N = 22) or major depressive (N = 33) disorders with first episode occurring postpartum (within four weeks after childbirth according to
Alessandro Serretti; Paolo Olgiati; Cristina Colombo
A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia
I. A. Clemetson; A. Popp; K. Lippuner; F. Ballmer; S. E. Anderson
In this study, we investigated the body image of Turkish women in their first year postpartum. We recruited 440 postpartum women who had applied to the outpatient clinics of the Maternity and Children's Hospital in the city of Ordu, Turkey. The mean of the women's body image scores was over the “middle level.” The women's body image scale (BIS) score
Nülüfer Erbil; Asuman ?enkul; Gül Feyza Ba?ara; Ye?im Sa?lam; Mehtap Gezer
In this study, we investigated the body image of Turkish women in their first year postpartum. We recruited 440 postpartum women who had applied to the outpatient clinics of the Maternity and Children's Hospital in the city of Ordu, Turkey. The mean of the women's body image scores was over the “middle level”. The women's body image scale score showed
Nülüfer Erbil; Asuman ?enku; Gül Feyza Ba?ara; Ye?im Sa?lam; Mehtap Gezer
Public policy erects two barriers to adequate prevention and treatment of postpartum depression (PPD) in the United States: 1) the lack of parity between insurance coverage for mental and physical illness decreases access to care and 2) the current model of postpartum care fails to incorporate screening and follow-up. Treatment for PPD falls into the insurance category of mental health.
Wendy Sand Sobey
Obesity and being overweight affect almost half of all women of childbearing age, with postpartum weight retention (PWR) being a key contributing factor. Retention of postpartum weight has a number of negative health implications for mothers and offspring, including longer-term higher body mass index (BMI). There is increasing evidence that psychological factors are associated with PWR, including depressive symptoms, anxiety,
Joanne Phillips; Ross King; Helen Skouteris
|With recent media attention and a growing awareness in popular culture, the appropriate treatment for postpartum depression has taken center stage as a prevalent women's health issue. There is little agreement on the definition, existence and treatment of postpartum depression. Contributing to this factor is the lack of research that exists to…
Lewis, Carol A.; Byers, Alison Daly; Malard, Sarah Deann; Dawson, Gregory A.
The main objective of this study was to examine the associated factors of the early postpartum depression, in a Turkish sample of 151 postnatal women. Besides positive and negative affect and marital adjustment measures, demographic and labor related variables, which may affect the postpartum depression, were also included into the study. To reveal the critical factors associated with the early
Özden Yalç?nkaya Alkar; Tülin Gençöz
Objective: A ‘ginger vinegar soup’ and other special dietary practices have been traditionally recommended for postpartum Chinese women. This paper describes these practices in the first 6 weeks postpartum, and details of the calcium and iron content of the ‘ginger vinegar soup’.Design and subjects: Results of this paper were generated from a longitudinal study on the nutritional status of Hong
SM Chan; EAS Nelson; SSF Leung; PCK Cheung; CY Li
Maternal complications are common during and following childbirth. However, little information is available on the psychological, social and economic consequences of maternal complications on women's lives, especially in a rural setting. A prospective cohort study was conducted in southern Rajasthan, India, among rural women who had a severe or less-severe, or no complication at the time of delivery or in the immediate postpartum period. In total, 1,542 women, representing 93% of all women who delivered in the field area over a 15-month period and were examined in the first week postpartum by nurse-midwives, were followed up to 12 months to record maternal and child survival. Of them, a subset of 430 women was followed up at 6-8 weeks and 12 months to capture data on the physical, psychological, social, or economic consequences. Women with severe maternal complications around the time of delivery and in the immediate postpartum period experienced an increased risk of mortality and morbidity in the first postpartum year: 2.8% of the women with severe complications died within one year compared to none with uncomplicated delivery. Women with severe complications also had higher rates of perinatal mortality [adjusted odds ratio (AOR)=3.98, confidence interval (CI) 1.96-8.1, p=0.000] and mortality of babies aged eight days to 12 months (AOR=3.14, CI 1.4-7.06, p=0.004). Compared to women in the uncomplicated group, women with severe complications were at a higher risk of depression at eight weeks and 12 months with perceived physical symptoms, had a greater difficulty in completing daily household work, and had important financial repercussions. The results suggest that women with severe complications at the time of delivery need to be provided regular follow-up services for their physical and psychological problems till about 12 months after childbirth. They also might benefit from financial support during several months in the postpartum period to prevent severe economic consequences. Further research is needed to identify an effective package of services for women in the first year after delivery.
Yadav, Ranjana; Sen, Swapnaleen
Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women. Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n = 6126) were classified as living in rural (< 1000 inhabitants or population density < 400/km2), semirural (nonrural but < 30 000 inhabitants), semiurban (30 000–499 999 inhabitants) or urban (? 500 000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ? 13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression. Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42–0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection. Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression.
Vigod, Simone N.; Tarasoff, Lesley A.; Bryja, Barbara; Dennis, Cindy-Lee; Yudin, Mark H.; Ross, Lori E.
OBJECTIVES: (1) To describe the relative importance of gestational weight gain, postpartum exercise, food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum; and (2) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing.DESIGN: A prospective cohort study of women who registered for obstetrical care in a hospital and primary care
C M Olson; M S Strawderman; P S Hinton; T A Pearson
The onset of sexual cycle postpartum was described in the collared peccary (Tayassu tajacu). Serum progesterone and 17beta-estradiol profiles, vaginal smears and external genitalia were analyzed in 20 animals housed with their piglets during the first postpartum month. The appearance of external genitalia showed no variation in any of the females: a shallow, reddish vulva, and vaginal mucus were constant features throughout the study. Based on hormonal profiles and vaginal smear cell patterns, 16 (80%) of the 20 peccaries showed signs of estrus and were considered cycling. The remaining four females (20%) did no show signs of estrus confirmed by low levels of progesterone (0.9+/-0.4 ng/mL) during the first postpartum month. In the cycling peccaries, a serum 17beta-estradiol peak (53.4+/-8.1 pg/mL) was observed on Day 7+/-1 postpartum, along with a linear increase in progesterone concentration from 3 (4.3+/-2.6 ng/mL) to 11 (30.8+/-4.9 ng/mL) days after this estradiol peak. Proportions of the different cells of the vaginal epithelium also changed in these females: superficial plus intermediate cells amounted to 76% of the cell total between Days 6 and 9 postpartum, corresponding to the estradiol peak. Nine (56%) of the 16 cycling females mated, indicated by the presence of sperm cells in their vaginal smears, and 6 (67%) became pregnant, reaching term. Non-pregnant cycling females (n=10) showed a steady decrease in serum progesterone concentration from 11 to 23 days after the estradiol peak, when basal levels were attained and a new estradiol peak registered, indicating the resumption of cyclicity in these females. The time interval between the two estradiol peaks was 23.5+/-2.1 days in these females. In pregnant females, progesterone concentrations continued to rise to levels of 60 ng/mL (n=6) 23 days after mating. These findings indicate that the lactating collared peccary female can become cycling and fertile during the early postpartum period, and that a predominance of superficial plus intermediate vaginal cells can be taken as the first sign of estrus. PMID:16837033
Mayor, Pedro; Guimaraes, Diva Anelie; Lopez-Gatius, Fernando; Lopez-Bejar, Manel
Background The Edinburgh postnatal depression scale (EPDS) has been validated and used successfully in detecting postnatal depression in several language versions in a number of countries. However, there is not any Mexican version of the EPDS that had been validated. Therefore, we sought to validate a Spanish translated Mexican version of the EPDS in a population of puerperal Mexican women. Methods One hundred puerperal women within their three month postpartum period attending routine postnatal consultations in a public hospital in Durango City, Mexico participated in the study. The participants were divided into two groups: one group included 49 women with less than 4 weeks of postpartum, and the other group included 51 women within 4 to 13 weeks of postpartum. All participants submitted a Spanish translated Mexican version of the EPDS and were interviewed by a psychiatrist to assess major and minor depression by using DSM-IV criteria. Results Out of the 49 women with less than 4 weeks of postpartum, 4 were found as suffering from major depression and none from minor depression by using the DSM-IV criteria. In this group of women we found that the best EPDS score for screening depression was 11/12. This threshold showed a sensitivity of 75% (95% CI: 63.8–86.2), a specificity of 93% (95% CI: 84.6–100), a positive predictive value of 50%, a negative predictive value of 97.6%, and an area under the curve of 0.84. While in the 51 women within 4 to 13 weeks of postpartum, 7 were found as suffering from major depression and 1 from minor depression by using the DSM-IV criteria. In this group we found that the best EPDS score for screening depression was 7/8. This threshold showed a sensitivity of 75% (95% CI: 66.1–83.9), a specificity of 84% (95% CI: 76.1–91.9), a positive predictive value of 46.2%, a negative predictive value of 94.7% and an area under the curve of 0.80. Conclusion The Mexican version of the EPDS can be considered for screening depression in puerperal Mexican women whenever cut-off scores of 11/12 and 7/8 in women with less than 4 weeks and within 4 to 13 weeks of postpartum are used, respectively.
Postpartum weight retention contributes to obesity risk in women. Given that most women who quit smoking as a result of pregnancy will resume smoking within 6 months postpartum and that there is a robust association between smoking and weight, we sought to evaluate postpartum weight retention as a function of postpartum smoking status among women who had quit smoking during
Michele D. Levine; Yu Cheng; Marsha D. Marcus; Melissa A. Kalarchian
There have only been thirty cases of total post-partum hypopituitarism published in the literature and these have nearly all been secondary to Sheehan's syndrome. The authors report a case of partial anterior hypopituitarism associated with diabetes insipidus which arose after an uneventful Caesarean operation and the origin of which seems to lie in auto-immune hypophysitis. The authors first describe the morphological and endocrine changes that the hypophysis undergoes during pregnancy and then point out that auto-immune hypophysitis seems to have been only recently recognised. This can be used to explain some cases of post-partum hypophyseal insufficiency occurring almost silently without any history of third haemorrhage. Research has been made systematically for anti-hypophyseal antibodies and for specific antibodies of the organ, but has not always been positive. So the diagnosis of auto-immune hypophysitis is often made only after eliminating other reasons for it. A brief review of the physiopathological mechanisms of diabetes insipidus makes it possible to suggest that vasopressinase coming from the placenta together with prostaglandins could play a role. PMID:8228021
Tordjeman, N; Monnier, J C; Vantyghem-Haudiquet, M C; Bouthors-Ducloy, A S; Vinatier, D
Postpartum depression (PPD) is a common complication of childbirth with prevalence estimated at 10-20% reported in many countries, including Israel. However, no data has been reported for Israeli Bedouin women, whose lifestyle is significantly different from that of the general population. This study aimed to determine the prevalence of PPD among Bedouin women in the southern Negev. The study included 104 women attending public health clinics for pregnancy and postpartum care. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). The rate of PPD symptoms was 43% at the EPDS cut-off score of 10, and 26% at the more stringent cut-off score of 13. This rate is considerably higher than reported rates among Israeli Jewish women. No significant difference was found between a score of ?10 and maternal age, number of children, or level of education; however, at the EPDS score of ?13, there was an inverse relationship between educational level and PPD symptoms. Lower rates were found among women whose pregnancies were planned and those who worked out of the home. The high rate of PPD among these Israeli Bedouin women challenges health authorities to find ways minimize the negative consequences for themselves, their children, and families. PMID:21479760
Glasser, Saralee; Stoski, Ela; Kneler, Victoria; Magnezi, Racheli
The medial prefrontal cortex (MPFC) is a key brain area in depressive symptomatology; specifically, glutamate (Glu) has been reported to play a significant role in major depression (MD) in this area. MPFC Glu levels are sensitive to ovarian hormone fluctuations and pregnancy and the postpartum period are associated with the most substantial physiological alterations of female hormones. It is therefore logical to measure MPFC Glu levels in women with postpartum depression (PPD). Using in vivo magnetic resonance spectroscopy (MRS) at a field strength of 3?T, we acquired single-voxel spectra from the MPFC of 12 women with PPD and 12 healthy controls (HCs) matched for postpartum scan timing. Water-referenced MPFC Glu levels were measured using a MRS technique that allowed us to be specific for Glu with very little glutamine contamination. The concentrations of other water-quantified brain metabolites such as glycerophosphorylcholine plus phosphorylcholine, N-acetylaspartate (NAA), and creatine plus phosphocreatine were measured in the same MR spectra. MPFC Glu levels were higher in women with PPD (7.21±1.20) compared to matched HCs (6.04±1.21). There were no differences between groups for other brain metabolites measured. These findings suggest an association between Glu dysregulation in the MPFC and PPD. Whether the pathophysiology of PPD differs from the pathophysiology of MD remains to be determined. Further investigations are needed to determine the chronological associations between the occurrence of symptoms of PPD and the onset of changes in MPFC Glu levels. PMID:22805604
McEwen, Alyssa M; Burgess, Denee T A; Hanstock, Christopher C; Seres, Peter; Khalili, Panteha; Newman, Stephen C; Baker, Glen B; Mitchell, Nicholas D; Khudabux-Der, Janisse; Allen, Peter S; LeMelledo, Jean-Michel
Objective At our institution, traditional postpartum rounds were time consuming and inefficient with a low percentage (approximately 12%) of patients meeting the goal of being discharged by 11:00 am. A patient-centered collaborative care (PCCC) initiative was implemented to improve discharge efficiency, staff communication, and patient satisfaction. We investigated whether this paradigm shift to PCCC could improve clinical inefficiencies and timely discharge. Methods The PCCC rounding system was created by a representative group of physicians, residents, nurses, case managers, and social workers. An intervention study was conducted to examine the impact of PCCC during which physicians, residents, medical students, nurses, case managers, and social workers made rounds together. Efficiency data were collected for patients whose infants were delivered by the obstetric service for a 1-month period before and 6 months after implementing PCCC. Comparisons were made on the time of discharge and whether Foley catheter removal affected discharge time. ?2 test, Wilcoxon 2-sample test, and Pearson correlation coefficient were used where appropriate. Results Three hundred five patients were included in this analysis, of which 156 participated in traditional postpartum rounds and 149 in PCCC rounds. Discharge efficiency significantly improved with PCCC rounds, with 20.8% of patients being discharged by 11:00 am as compared to 11.5% for traditional postpartum rounds (P??=??.03). Early Foley catheter removal was significantly associated with time to discharge order (Pearson correlation coefficient, 0.22; P??=??.01) and discharge time (Pearson correlation coefficient, 0.28; P??=??.002). Conclusions Patient-centered collaborative care rounds improve the efficiency of postpartum care and discharge time.
Segel, Sally; Hashima, Jason; Gregory, William Thomas; Edelman, Alison; Li, Hong; Guise, Jeanne-Marie
Abstract Background Body image (BI) and body satisfaction may be important in understanding weight loss behaviors, particularly during the postpartum period. We assessed these constructs among African American and white overweight postpartum women. Methods The sample included 162 women (73 African American and 89 white) in the intervention arm 6 months into the Active Mothers Postpartum (AMP) Study, a nutritional and physical activity weight loss intervention. BIs, self-reported using the Stunkard figure rating scale, were compared assessing mean values by race. Body satisfaction was measured using body discrepancy (BD), calculated as perceived current image minus ideal image (BD<0: desire to be heavier; BD>0: desire to be lighter). BD was assessed by race for: BDIdeal (current image minus the ideal image) and BDIdeal Mother (current image minus ideal mother image). Results Compared with white women, African American women were younger and were less likely to report being married, having any college education, or residing in households with annual incomes >$30,000 (all p?0.01). They also had a higher mean body mass index (BMI) (p?=?0.04), although perceived current BI did not differ by race (p?=?0.21). African Americans had higher mean ideal (p?=?0.07) and ideal mother (p?=?0.001) BIs compared with whites. African Americans' mean BDs (adjusting for age, BMI, education, income, marital status, and interaction terms) were significantly lower than those of whites, indicating greater body satisfaction among African Americans (BDIdeal: 1.7 vs. 2.3, p?=?0.005; BDIdeal Mother: 1.1 vs. 1.8, p?=?0.0002). Conclusions Racial differences exist in postpartum weight, ideal images, and body satisfaction. Healthcare providers should consider tailored messaging that accounts for these racially different perceptions and factors when designing weight loss programs for overweight mothers.
Bastian, Lori A.; Revels, Jessica; Durham, Holiday; Lokhnygina, Yuliya; Amamoo, M. Ahinee; Ostbye, Truls
OBJECTIVE: it is known that very few women who continue to smoke at the time of delivery stop smoking during the postpartum period. Discovering strategies that can be incorporated during pregnancy to help improve women's participation in postpartum interventions could increase the number of women non-smokers. The aim of this study is to identify the predictors of participation by pregnant women smokers in a postpartum smoking cessation intervention. DESIGN: a cross-sectional study was carried out amongst women smokers who had attended to give birth. SETTING: women attended the University Clinical Hospital 'Lozano Blesa' of Zaragoza (Spain) who were smokers before pregnancy and reported at delivery to have continued smoking during pregnancy were eligible and were invited to participate in the study. FINDINGS: 2044 women completed the questionnaire 24 hours after giving birth. The smoking prevalence during pregnancy was 18.2% (n=372) and 62.9% of them (n=234) participated. The logistic regression model provided five significant predictors for women who participated: intention to breast feed, having less of an urge to smoke the first cigarette of the day before pregnancy, having reduced consumption during pregnancy by 50% or more, having received advice and being willing to get help. CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: the factors associated with participation show aspects that can be modified by maternal and child health professionals. Advice to stop smoking, received during pregnancy, encourages participation in a postpartum intervention. From the point of view of public health, the huge increase in the prevalence of smoking women poses the need to take advantage of the pregnancy as an opportunity for giving up smoking definitely. It would be necessary to identify what programmes of smoking cessation have better results in pregnant women and to know how to motivate health professionals to implement them. PMID:23707052
Nerín, Isabel; Jiménez-Muro, Adriana; Samper, Pilar; Marqueta, Adriana; Gargallo, Pilar; Beamonte, Asunción; Rodríguez, Gerardo
Objectives To determine the health and economic burdens of post-partum Staphylococcus aureus breast abscess. Study design We conducted a matched cohort study (N?=?216) in a population of pregnant women (N?=?32,770) who delivered at our center during the study period from 10/1/03–9/30/10. Data were extracted from hospital databases, or via chart review if unavailable electronically. We compared cases of S. aureus breast abscess to controls matched by delivery date to compare health services utilization and mean attributable medical costs in 2012 United States dollars using Medicare and hospital-based estimates. We also evaluated whether resource utilization and health care costs differed between cases with methicillin-resistant and -susceptible S. aureus isolates. Results Fifty-four cases of culture-confirmed post-partum S. aureus breast abscess were identified. Breastfeeding cessation (41%), milk fistula (11.1%) and hospital readmission (50%) occurred frequently among case patients. Breast abscess case patients had high rates of health services utilization compared to controls, including high rates of imaging and drainage procedures. The mean attributable cost of post-partum S. aureus breast abscess ranged from $2,340–$4,012, depending on the methods and data sources used. Mean attributable costs were not significantly higher among methicillin-resistant vs. –susceptible S. aureus cases. Conclusions Post-partum S. aureus breast abscess is associated with worse health and economic outcomes for women and their infants, including high rates of breastfeeding cessation. Future study is needed to determine the optimal treatment and prevention of these infections.
Branch-Elliman, Westyn; Lee, Grace M.; Golen, Toni H.; Gold, Howard S.; Baldini, Linda M.; Wright, Sharon B.
Late life is a distinct phase of life that occurs after the aging period and is now known to be general among aging organisms. While aging is characterized by a deterioration in survivorship and fertility, late life is characterized by the cessation of such age-related deterioration. Thus, late life presents a new and interesting area of research not only for
Michael R. Rose; Casandra L. Rauser; Laurence D. Mueller
Twenty-six Balady goats categorized according to parity into primiparous and pluriparous goats were used to investigate bacterial flora of the genital tract and hormonal profiles during the postpartum (PP) period. Escherichia coli and Staphylococcus aureus were isolated in pure or mixed culture from the uterus. Arcanobacterium pyogenes was isolated from swabs obtained from the vagina and cervix of one primiparous goat. Uteri and cervices but not vaginas were free of bacterial contamination by day 10 PP except for one pluriparous goat with scanty E. coli contamination on day 25 PP. Fluctuating oestradiol 17beta (E2) levels demonstrated resumption of follicular activity as early as day 13 PP in both parity groups. Progesterone (P4) levels remained low at basal levels throughout the study period. Higher concentrations of 15-keto-13,14-dihydroprostaglandin F2alpha (PGFM) were observed during the first week PP compared with the rest of the PP period. PGFM concentrations dropped to low basal level by day 10 PP and remained constantly low throughout the study period. P4, E2 and PGFM profiles were not different between the different parity groups. In conclusion, intrauterine infection is not common in goats with normal kidding. E. coli was the most common intrauterine bacterial isolate. E2 and P4 profiles were consistent with resumption of follicular growth but not ovulation. High PGFM concentrations coincided with the fast regression phase of uterine involution. Hormonal profile and bacterial contamination and clearance were similar to those reported in other related species and not related to parity. PMID:16420321
Ababneh, M M; Degefa, T
Objective Postpartum hemorrhage (PPH) is the leading cause of maternal death and disability worldwide. Recognition depends on subjective visual quantification. This study sought to assess and compare the thresholds for excessive postpartum blood loss reported by skilled birth attendants (SBA), traditional birth attendants (TBA), and laywomen in Matlab, Bangladesh. Method Data from six questions asking about excessive blood loss in the postpartum period were analyzed using analysis of variance (ANOVA), Hochberg test, Kruskal-Wallis and standard descriptive statistics. Results Thresholds for excessive blood loss estimated by laywomen and TBAs exceed biomedical standards for PPH. Skilled birth attendant reports are consistent with the definition of severe acute PPH. Conclusion Further research on locally validated blood collection devices, in birth kits, for diagnostic aid or referral indication is needed. Areas where coverage and uptake of skilled birth attendance are low should be targeted due to the number of home births attended by TBAs and laywomen in such settings. Precis A comparison of excessive postpartum blood loss estimates among skilled birth attendants, traditional birth attendants and laywomen in Matlab, Bangladesh.
Edmonds, Joyce K.; Hruschka, Daniel; Sibley, Lynn M.
Background We explored how family psychoeducation could be made culturally sensitive for postpartum mothers with psychotic illness in a Ugandan setting. Methods A qualitative multi-method approach using an already existing family psychoeducation Tool Kit was adapted to incorporate lay perceptions related to psychotic illness in the postpartum period in this Ugandan setting. The participants consisted of postpartum women with psychotic illness, caregivers/family members, psychiatric nurses and psychologists. A modified version of a family psychoeducation programme for postpartum women with psychosis was formulated and pilot-tested. Results Modifications in the standard family psychoeducation programme were both in the process and content of family psychoeducation. Under process, effective communication, cultural background, appropriate dress, involving only one family member, low literacy, and flexibility in timekeeping were raised. The theme of content yielded the incorporation of lay perceptions of mental illness, family planning, income generating, and an emphasis of premorbid and morbid personalities of the patients. Conclusion The basic principles and assumptions underlying psychoeducation remained the same. Changes made in the process and content of family psychoeducation reflected the social, cultural and gender reality of the population.
The risk of infection from puerperal tubal ligation is studied 1, 2, 3, and 5 days postpartum. Aliquots of 52 oviduct homogenates and 26 endometrial saline aspirates were cultured in serum. PPLO, tryptic soy, and thioglycolate broth, and blood, PPLO, and chocolate agar. A Brown and Brenn Gram stain was run on oviduct sections. Results indicated that, except for contamination with airborne Staphylococcus epidermidis, 1 oviduct harbored S. epidermidis, and 1 endometrium yielded Streptococcus epidermidis and Staphylococcus epidermidis. Fever occurred only in 2 other patients whose cultures were sterile; one had bronchial pneumonia and the other had positive transcervical lochial culture. No histologies were positive, and no fastidious organisms, L-forms, or fungi were cultured. The widely held view that tubal sterilization is unwise 48 hours after delivery because of infection is therefore opposed. PMID:5463700
Spore, W W; Moskal, P A; Nakamura, R M; Mishell, D R
The Rapunzel syndrome describes a disorder in which a significant amount of hair is swallowed, forming a trichobezoar that extends past the stomach into the small intestines. Given the indigestible nature of hair, it subsequently leads to obstruction within the gastrointestinal system. Clinically, patients may present with symptoms of gastrointestinal obstruction, including abdominal complaints such as pain, nausea, vomiting, and diarrhea. However, due to its broad and nonspecific presenting symptoms, the diagnosis of Rapunzel syndrome warrants consideration once other common etiologies have been excluded. Surgical intervention is often required to remove the abdominal mass. This unusual syndrome is often associated with psychiatric disorders, affecting young women most commonly. In this report, we will discuss a unique case of Rapunzel syndrome in a one-month postpartum woman.
Tegene, Teshome; Foda, Yahia; Hussain, Omar; Manikonda, Geeta
Summary This study assesses the prevalence and determinants of postpartum depression (PPD). 396 women delivering in Beirut and a rural area (Beka’a Valley) were interviewed 24 hours and 3–5 months after delivery. During the latter visit, they were screened using the Edinburgh postnatal depression scale. The overall prevalence of PPD was 21% but was significantly lower in Beirut than the Beka’a Valley (16% vs. 26%). Lack of social support and prenatal depression were significantly associated with PPD in both areas, whereas stressful life events, lifetime depression, vaginal delivery, little education, unemployment, and chronic health problems were significantly related to PPD in one of the areas. Prenatal depression and more than one chronic health problem increased significantly the risk of PPD. Caesarean section decreased the risk of PPD, particularly in Beirut but also in the Beka’a Valley. Caregivers should use pre- and postnatal assessments to identify and address women at risk of PPD.
Chaaya, M.; Campbell, O. M. R.; Kak, F. El; Shaar, D.; Harb, H.; Kaddour, A.
Fluctuating neurosteroid levels during the ovarian cycle modulate neuronal excitability through effects on GABAA receptors (GABAARs). The large increase in progesterone-derived neurosteroids during pregnancy and their precipitous decrease at parturition may have considerable effects on GABAARs during pregnancy and postpartum. Here we show a significant decrease in tonic and phasic inhibitions in pregnant mice, mediated by a downregulation of GABAAR ? and ?2 subunits, respectively. This decrease rebounds immediately postpartum. Mice with GABAAR ? subunit deficiencies (Gabrd+/? and Gabrd?/?), in which the rapid postpartum restoration of tonic inhibition is likely to be impaired, exhibit signs of depression-like and abnormal maternal behaviors resulting in reduced pup survival, that were ameliorated in Gabrd+/? mice by a selective agonist (THIP) of GABAARs containing ? subunits. Such mice constitute a novel mouse model of postpartum depression and have great potential for evaluating potential therapeutic interventions.
Maguire, Jamie; Mody, Istvan
Background: The purpose of this study was to evaluate prenatal to postnatal changes in first-time par- ents' physical and mental health, and to describe social and health predictors of parents' postpartum health. Methods: This prospective study surveyed 261 expectant fathers and mothers during pregnancy and again at 6 months' postpartum regarding their health, partner, and work characteristics. Postpartum changes in
Dwenda K. Gjerdingen
First steps of vulagarization of science in the late ninetheen century: The Yearbook of the Observatorio Astronomico Nacional de Chapultepec, Mexico during the period of Mr. Angel Anguiano (1878-1889)
Since the founding of the Observatorio Astronomico Nacional de Chapultepec in 1878 during the presidential term of General Porfirio Diaz, begins the publication of the Yearbook of the Observatorio Astronomico Nacional de Chapultepec (from now on OAN) in a period when the positivist paradigm based on will boost science as a means of national progress. Here we describe the actions taken by the observatory's director and editor of the publication, the engineer Angel Anguiano, to initiate and successfully carry out the exchange of scientific publications and / or dissemination through the exchange of the Yearbook of the OAN, both nationally and internationally. The importance of conferences to which he attended started the sharing printed information relating to subjects such as astronomy, meteorology, cartography and geography. The Yearbook was intended to publish two or three months before the beginning of each year and according to the editor would serve to popularize science, making its contents available to anyone with basic knowledge of geometry or for amateur astronomers. I find that the yearbook was the publication that was released to the observatory in the country and abroad, but was sent to distant places where no one speaks or reads Spanish. I think that the content of articles published in, did not respond and objective and informative to the public as mentioned by, because at the late 1800s, 90% of the inhabitants of the Mexican Republic were illiterate and lived in rural areas. The access to the Bulletin was the Mexican intellectual elite grouped into societies, astronomical or meteorological observatories and another wealthy person individually. The same happened abroad. The collection of data from reports to the Secretaria de Fomento, that was the government agency that funds money destined to different scientific institutions founded during this period were published in the Yearbook, the oficios that sent the OAN over a hundred sites in the world responding to the exchange of scientific publications of the mentioned areas through the Library. These documents are available on the Fund of National Astronomical Observatory Historical Archive of the UNAM. The importance of this publication is reflected in the fact that it has continued publishing without interruption since 1881 and gave rise to the Bulletin of the OAN which later became the Boletin del Observatorio Astronomico Nacional de Tacubaya in and finally to the Boletin del Observatorio Astronomico Nacional de Tonantzintla y Tacubaya.
Zueck, S. L.
This review provides a status on the definition, prevalence, causes, and consequences of anemia in women who have given childbirth,\\u000a i.e., postpartum anemia. The diagnosis of iron deficiency anemia relies on a full blood count including hemoglobin, serum\\u000a ferritin, and serum soluble transferrin receptor, which appear to be reliable indicators of anemia and iron status 1 week\\u000a postpartum while serum transferrin
Identification of women at risk for postpartum depression requires reliable and valid assessment indices. The purpose of this article is to describe the psychometric properties of the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Psychometric assess- ment of the PDPI-R was conducted in conjunction with the Centers for Epidemiologic Studies Depressed Mood Scale, and the Edinburgh Postnatal Depression Scale, using data from
Kathie Records; Michael Rice; Cheryl Tatano Beck
Rhabdomyolysis and peripheral neuropathy are two distinct disease entities which are rarely encountered in combination. We\\u000a present a woman with rhabdomyolysis and peripheral neuropathy 3 weeks postpartum. Her symptoms were caused by bilateral femoral\\u000a artery thrombosis due to postpartum cardiomyopathy (PPCM). This demonstrates that PPCM may present with predominantly non-cardial\\u000a symptoms and underscores the importance of rapidly recognizing this disorder.
Rick C. G. Helmich; Hanneke W. M. van Laarhoven; Hennie C. Schoonderwaldt; Mirian C. H. Janssen
Objectives: Data were collected on postpartum depression from 151 women, ages 16–40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic make-up of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or
Lisa Baker; Sandra Cross; Linda Greaver; Gou Wei; Regina Lewis
Postpartum depression is the number one complication of childbirth , and healthcare providers need to have a keen understanding\\u000a of the disorder in order to provide support and advice. In the first portion of this chapter, the prevalence and onset of\\u000a postpartum depression is discussed, with a consideration for risk factors that have been associated with the disorder. Within\\u000a this
Michelle Price Judge; Cheryl Tatano Beck
Background: Weight gained during pregnancy and not lost post- partum may contribute to obesity in women of childbearing age. Objective: We aimed to determine whether breastfeeding reduces postpartum weight retention (PPWR) in a population among which full breastfeeding is common and breastfeeding duration is long. Design:WeselectedwomenfromtheDanishNationalBirthCohort whoeverbreastfed(98%),andweconductedtheinterviewsat6(n 36 030) and 18 (n 26 846) mo postpartum. We used regression analyses
Jennifer L Baker; Michael Gamborg; Berit L Heitmann; Lauren Lissner; Thorkild IA Sørensen; Kathleen M Rasmussen
Objective To examine attitudes and knowledge about vaccinations in postpartum mothers. Methods This cross-sectional study collected data via written survey to postpartum mothers in a large teaching hospital in Connecticut.\\u000a We used multivariable analysis to identify mothers who were less trusting with regard to vaccines. Results Of 228 mothers who participated in the study, 29% of mothers worried about vaccinating
Ann Chen Wu; Daryl J. Wisler-Sher; Katherine Griswold; Eve Colson; Eugene D. Shapiro; Eric S. Holmboe
A better understanding of the process of adaptation to motherhood should enhance nurses' ability to prepare women for the transition to motherhood and to provide care following childbirth. Knowledge about women's adaptation to motherhood was developed primarily from the 1960s to the 1990s. Cesarean birthing was a special focus of research throughout the late 1970s and the 1980s, followed by functional status, and more recently, depression and stress associated with birth and postpartum. Adaptation to motherhood in the context of the early 21st century has received limited attention in nursing research, creating an assumption that the process of adaptation is universal and context-free rather than evolving within the life and societal context of women across generations. Although becoming and being a mother has been described as a normative transition rather than a stressor by some, knowledge development about adaptation to motherhood also has been constrained by the limited use of a unified perspective of transition as a process of adaptation. Therefore, the purposes of this exploratory study were to describe contemporary women's physical, emotional, functional, and social adaptation to motherhood and to examine the relations of selected demographic and perinatal variables to adaptation to motherhood in the first 3 to 6 weeks of the postpartum. PMID:24085672
Aber, Cynthia; Weiss, Marianne; Fawcett, Jacqueline
This study investigated the relationships of thyroid hormones, serum energy metabolites, reproductive parameters, milk yield and body condition score with the different patterns of postpartum luteal activity in the postpartum period. A total of 75 multiparous healthy (free of detectable reproductive disorders) Holstein dairy cows (mean peak milk yield = 56.5 ± 7.0 kg/day) were used in this study. Transrectal ultrasound scanning and blood sample collection were performed twice weekly. Serum concentrations of progesterone (P4) were measured twice weekly and beta-hydroxybutyrate (BHBA), non-esterified fatty acids, thyroxine (T4), 3,30,5-tri-iodothyronine (T3), free thyroxine (fT4) and free 3,30,5-tri-iodothyronine (fT3) were measured every 2 weeks from the 1st to the 8th week postpartum. On the basis of the serum P4 profile of the cows, 25 (33.4%) had normal luteal activity (NLA), whereas 30 (40%), 10 (13.3%), 6 (8%) and 4 (5.3%) had prolonged luteal phase (PLP), delayed first ovulation (DOV), anovulation (AOV) and short luteal phase, respectively. Serum T4 concentrations in PLP cows were higher than that in NLA cows at the 3rd week postpartum and did not change during the period of study, whereas in the NLA cows the concentrations increased (P < 0.05). Further, the least square (LS) mean of serum fT4 concentrations in the DOV and AOV cows were significantly lower than in the NLA cows during the study period (P < 0.05). In addition, the AOV cows had higher LS mean serum BHBA and T4 concentrations than the NLA cows in early weeks postpartum (P < 0.05). In conclusion, the serum thyroid hormones' profile differs in high-producing dairy cows showing PLP, AOV and DOV in comparison with the postpartum NLA cows. PMID:23217229
Kafi, M; Tamadon, A; Saeb, M; Mirzaei, A; Ansari-Lari, M
Objectives: The goals of this longitudinal study were to evaluate 1) the prevalence and stability of high depressive symptom levels during the first 18 months postpartum in a sample of otherwise healthy Black mothers varying in socio-economic status and 2) the relation of socio-demographic variables and level of socio-demographic risk to maternal depressive symptom levels during this time period. Methods:
Marjorie Beeghly; Karen L. Olson; M. Katherine Weinberg; Snaltze Charlot Pierre; Nikora Downey; Edward Z. Tronick
In the dual purpose milk\\/beef production system practised in Mexico, the cows are milked once a day in the presence of the calf and then the calf suckles for the next 1–8h. It was hypothesised that the imposition of milking and suckling in close succession contributes to the long postpartum anoestrous periods experienced by cows in this system. Therefore, separating
P Pérez-Hernández; M Garc??a-Winder; J Gallegos-Sánchez
The negative consequences of untreated depression on the health and well-being of women and their children are well-documented,\\u000a underscoring the need to develop effective interventions to prevent the onset of major depression during the perinatal period.\\u000a This article describes recruitment data from two randomized controlled trials of preventive interventions for postpartum depression:\\u000a one conducted with immigrant Latinas in Washington, DC,
Huynh-Nhu Le; Ma. Asunción Lara; Deborah F. Perry
OBJECTIVE: Our purpose was to investigate the postpartum use of plasma exchange in patients considered to have atypical preeclampsia-eclampsia manifested as persistent HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome with or without evidence of other organ injury.STUDY DESIGN: During a 10-year period, 18 patients with HELLP syndrome were treated post partum with single or multiple plasma exchange with
James N. Martin; Joe C. Files; Pamela G. Blake; Kenneth G. Perry; John C. Morrison; Patricia H. Norman
During pregnancy, fetal cells cross into the maternal organs where they reside postpartum. Evidence from multiple laboratories suggests that these microchimeric fetal cells contribute to maternal tissue repair after injury. In mouse models, most injury experiments are performed during pregnancy; however, in a clinical setting most injuries or diseases occur postpartum. Therefore, experiments using animal models should be designed to address questions in the time period following delivery. In order to provide a baseline for such experiments, we analyzed the natural history of fetal cells in the postpartum maternal organs. Female C57BL/6J mice were mated to males homozygous for the enhanced green fluorescent protein gene. Fetal cells in the maternal lungs and bone marrow were identified by their green fluorescence using in a high-speed flow cytometer and their counts were compared between the lung and bone marrow. Spearman correlation analysis was used to identify relationships between the duration of time postpartum and the cell counts and ratio of live and dead cells. Our results show that fetal cells persist in these organs until at least three months postpartum in healthy female mice. We show a two-stage decline, with an initial two and a half-week rapid clearance followed by a trend of gradual decrease. Additionally, an increase in the ratio of live to dead cells within the lung over time suggests that these cells may replicate in vivo. The results presented here will inform the design of future experiments and may have implications for women's health. PMID:23128065
Pritchard, Stephanie; Peter, Inga; Johnson, Kirby L; Bianchi, Diana W
The potential role of thyroid microsomal (Mic) antibodies in the development of postpartum hypothyroidism was investigated in 34 euthyroid women, whose sera were found to contain Mic antibodies in pregnancy. Additional serum samples were obtained 2. 5 and 10-12 months after delivery and analysed for IgG class and IgG subclass levels of Mic antibodies by ELISA techniques. Characteristically, Mic antibodies decreased from early pregnancy to 2 months postpartum, increased two-fold 5 months postpartum and had returned 10-12 months postpartum to the early pregnancy level. Mic antibodies were predominantly subclass IgG-1 or IgG-4 with only minor contributions from IgG-2 and IgG-3. In each individual the percentage contribution made by each IgG subclass to Mic antibody was essentially similar in early pregnancy and the postpartum period despite changes in total IgG class Mic antibody. During the year following delivery, thyrotoxicosis alone (Graves' disease) developed in 5 women. In the remaining 29 patients the absolute levels of Mic antibodies of IgG-4 subclass were similar 5 months postpartum in women with maximal serum thyrotropin (TSH) greater than 20 mU/1 (mean optical density in ELISA +/- s.d.; 0.84 +/- 0.538; n = 13) and in women with maximal TSH less than 10 mU/l (0.69 +/- 0.457; n = 16). In contrast, significantly higher values were observed for Mic antibody of IgG-1 subclass in patients with TSH greater than 20 mU/l (1.14 +/- 0.440) compared with women with maximal TSH less than 10 mU/l (0.65 +/- 0.289) (P less than 0.001 by t-test for groups). These results imply that the magnitude of Mic antibody levels of subclass IgG-1 but not IgG-4 is associated with the development of postpartum hypothyroidism and possibly with tissue destruction in autoimmune thyroid disease in general.
Jansson, R; Thompson, P M; Clark, F; McLachlan, S M
Gonadotrophin releasing hormones have become widely used hormonal compounds in veterinary medicine, particularly with respect to bovine reproduction. The character and physiological actions of gonadotrophin releasing hormone are briefly reviewed and its clinical applications are summarized. The endocrinological research concerned with the use of gonadotrophin releasing hormone in the early postpartum period is discussed. Field trials which have been conducted to assess the effects of postpartum gonadotrophin releasing hormone administration on reproductive performance have varied widely in both design and interpretation of results. These experiments are reviewed, including the clinical trials using normal cows as well as those on cows with retained placenta.
Leslie, K. E.
This study was designed to evaluate the effect of nutritional supplementation offered during the pre- and postpartum periods on serum cholesterol, triglycerides and total lipids of Canchim beef cows and their relationship with folliculogenesis. Thirty cows with predicted calving date between September and October, kept in pastures of Brachiaria brizantha cv. Marandú together with their calves, were randomly distributed into three experimental groups: the first received only a mineral mixture (Control Group, CG); the second group received a concentrate with 16%crude protein/kg dry matter (DM) and 3000 kcal digestible energy/kg DM offered for 45 days prepartum and 120 days postpartum (PREG); the third group received the concentrate from parturition until the 120th day postpartum (POSG). Consumption was estimated at 1% of body weight, and each cow received approximately 4.0 kg/day (fresh weight) of supplement. Blood samples were taken and an ultrasound examination of the ovaries was performed twice a week until the 60th day postpartum. The body condition score (BCS) and the weight of the cows were recorded at 15-day intervals from calving until the 60th day postpartum. Data are presented as mean+/-SEM. Mean weight and BCS at calving were, respectively, 448+/-54.9 kg and 6.2+/-0.25 (PREG); 432+/-71.1 kg and 5.5+/-0.69 (POSG); and 434+/-66.4 kg and 5.5+/-0.69 (CG). Total cholesterol (TC), triglycerides (TRIG) and total lipids (TLIP) were measured using colorimetry until the 60th day postpartum. TC averages were PREG 186+/-62.6 mg/dL, POSG 159+/-43.1mg/dL and CG 133+/-35.1mg/dL (P<0.05). For TRIG, the means were PREG 29+/-11.3mg/dL (P<0.05), POSG 24+/-8.1mg/dL and CG 26+/-12.1mg/dL (P>0.05). Serum concentrations of TLIP were PREG 588+/-145.6 mg/dL, POSG 512+/-137.6 mg/dL and CG 452+/-122.4 mg/dL (P<0.05). The first dominant follicle (DF) was identified on Day 21+/-10.3 (PREG), 36+/-28.5 (POSG) and 51+/-32.8 (CG) after calving. The difference between PREG and CG was significant (P<0.05). TC was positively correlated with the calving to first estrus interval (P<0.05). Results showed that nutritional supplementation before parturition assured good body condition at calving and suggested that it was effective at increasing cholesterol availability to maintain ovarian follicle function and to favor earlier resumption of ovarian activity. PMID:20494529
Oliveira Filho, B D; Toniollo, G H; Oliveira, A F D; Viu, M A O; Ferraz, H T; Lopes, D T; Gambarini, M L
Changes in emotional behavior occur across the reproductive cycle in female rodents, with reduced anxiety found during the postpartum period, but relatively little is known about factors contributing to this decreased anxiety. Using increased duration of time spent in the open arms of an elevated plus-maze as an indicator of reduced anxiety, it was found in a series of experiments
Joseph S. Lonstein
Venous thromboembolism is an important cause for maternal morbidity and mortality in postpartum period. Though catheter-directed thrombolysis (CDT) is now considered as a safe and effective therapy for the management of deep venous thrombosis (DVT) but still it is not indicated in postpartum DVT. We are presenting a case of 22-year-old female patient who presented with post-partum lower limb DVT and managed successfully with CDT by using injection streptokinase and temporary inferior vena caval filter was inserted as prophylactic for pulmonary embolism as she had extensive DVT extending into inferior vena cava (IVC). During follow-up, she developed large skin necrosis in left lower limb which was managed by adding injection low-molecular-weight heparin. IVC filter also could not be retrieved even after trying all manoeuvres during follow-up after 2 weeks. PMID:23887994
Srinivas, B C; Patra, Soumya; Agrawal, Navin; Manjunath, C N
PURPOSE Most new mothers return to work soon after childbirth. A need exists to reexamine the definition of postpartum health and evaluate employed women’s recovery from childbirth in association with such factors as delivery type and breastfeeding. METHODS Using a prospective cohort design, we recruited Minnesota women into the study while they were hospitalized for childbirth in 2001. Telephone interviews were conducted 5 weeks postpartum. Eligible women were 18 years or older, employed, and spoke English. Multivariate models using 2-stage least squares were used to estimate factors associated with physical and mental health and postpartum symptoms. RESULTS A total of 817 women were enrolled (71% response) in the study; 716 women completed interviews at 5 weeks postpartum. On average, women reported 6 postpartum symptoms, most frequently fatigue (64%), breast discomfort (60%), and decreased desire for sex (52%). Findings showed that cesarean (vs vaginal) deliveries were associated with significantly worse physical function, role limitations, and vitality. Multivariate findings showed that the effect of delivery type on physical health was moderately large (? = ?5.96; P = <.01), and breastfeeding was associated with an increased frequency of postpartum symptoms (? = 4.63; P = .01). CONCLUSIONS These mothers experienced several childbirth-related symptoms at 5 weeks postpartum, indicating a need for ongoing rest and recovery. Health concerns were greater for women who were breastfeeding and for those whose babies were delivered by cesarean section, suggesting a need for greater support for these women and a reassessment by the medical community of the progressively growing practice of cesarean deliveries.
McGovern, Pat; Dowd, Bryan; Gjerdingen, Dwenda; Gross, Cynthia R.; Kenney, Sally; Ukestad, Laurie; McCaffrey, David; Lundberg, Ulf
AIMS AND OBJECTIVES: To investigate the significant features in health-related quality of life and to examine the changes over time during the perinatal period. BACKGROUND: Health-related quality of life during the perinatal period is significant for women. Screening or surveillance during the perinatal period is inconsistent and often not part of continued assessment. DESIGN: Prospective. METHODS: Setting involved antenatal clinics at three public hospitals in metropolitan Brisbane, Australia. A total of 363 participants out of a cohort of 605 women completed all items of the Short Form-12 Health Survey in late pregnancy and again at 6 and 12 weeks postpartum. RESULTS: There was a significant difference across the three perinatal time periods in all the health-related quality-of-life subscales. Significant improvements were noted from late pregnancy to 6 weeks following childbirth and again at 12 weeks particularly in physical health, role physical, bodily pain, vitality, role emotional and mental health. Even when confounding variables such as maternal ages, partner status, parity, delivery type and ethnicity were introduced, significant improvements were noted. Maternal distress significantly related to almost all quality-of-life factors over time even when all possible confounding factors were controlled. CONCLUSION: Significant changes occur in health-related quality of life across the perinatal period. All dimensions of health-related quality of life except for social functioning and maternal distress showed marked improvement following childbirth. During this period, maternal distress was negatively related to health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be mindful of the broader view of health as encompassed in health-related quality-of-life measures and the potential these have for alerting health professionals when providing care. More rigorous health assessment for mothers at risk is useful so that appropriate support and follow-up can be given. PMID:23750859
Emmanuel, Elizabeth N; Sun, Jing
Postpartum depression (PPD) is a relatively common and often severe mood disorder that develops in women after childbirth. The aetiology of PPD is unclear, although there is emerging evidence to suggest a psychoneuroimmune connection. Additionally, deficiencies in n-3 PUFA, B vitamins, vitamin D and trace minerals have been implicated. This paper reviews evidence for a link between micronutrient status and PPD, analysing the potential contribution of each micronutrient to psychoneuroimmunological mechanisms of PPD. Articles related to PPD and women's levels of n-3 PUFA, B vitamins, vitamin D and the trace minerals Zn and Se were reviewed. Findings suggest that while n-3 PUFA levels have been shown to vary inversely with PPD and link with psychoneuroimmunology, there is mixed evidence regarding the ability of n-3 PUFA to prevent or treat PPD. B vitamin status is not clearly linked to PPD, even though it seems to vary inversely with depression in non-perinatal populations and may have an impact on immunity. Vitamin D and the trace minerals Zn and Se are linked to PPD and psychoneuroimmunology by intriguing, but small, studies. Overall, evidence suggests that certain micronutrient deficiencies contribute to the development of PPD, possibly through psychoneuroimmunological mechanisms. Developing a better understanding of these mechanisms is important for guiding future research, clinical practice and health education regarding PPD. PMID:22853878
Ellsworth-Bowers, E R; Corwin, E J