This study examined the effects of heat stress on composition of colostrum from primiparous cows dur- ing late pregnancy and the early postpartum period. Two groups of 6 Holstein heifers were utilized. During the last 3 wk of pregnancy and during the first 36 h after calving, one group was exposed to thermal com- fort (temperature-humidity index = 65); the
A. Nardone; N. Lacetera; U. Bernabucci; B. Ronchi
This study examined the association between measures of objective sleep (OS) and subjective sleep (SS) to postpartum mood in healthy women from the third trimester of pregnancy to 10 to 12 weeks postpartum. Twenty-nine pregnant women completed self-report measures of mood and SS, and wore actigraphs for 7 continuous days during the third trimester (Time 1), within 15 days (Time 2), and 10 to 12 weeks postpartum (Time 3). The subjective perception of marked daytime dysfunction was associated with low mood during Time 1 and Time 3. Poor nighttime SS was related to low mood only at Time 2, whereas poor nighttime OS influenced stress during the same assessment time. These data indicate a stronger association between postpartum mood and the subjective perception of sleep than with OS quality and duration in healthy, non-depressed women, and highlight the awareness of poor daytime functioning as a significant contributor to new mothers' emotional wellbeing. PMID:24128191
Coo, Soledad; Milgrom, Jeannette; Trinder, John
Introduction\\/AimPostpartum depression interferes negatively with mother's well-being and infant's development. The aim of this study was to investigate whether Positive Affect in late pregnancy was a protective factor for later Postpartum depression.MethodsA total of 491 pregnant women filled in the Profile of Mood States (POMS), the Beck Depression Inventory, socio-demographic characteristics, psychosocial variables and answered a Psychiatric Interview. After delivery
S Carvalho Bos; A Macedo; M Marques; AT Pereira; B Maia; MJ Soares; J Valente; AA Gomes; MH Azevedo
During routine evaluation for lactation failure, hyperthyroidism was discovered in a postpartum woman. Although postpartum thyroiditis and Hashimoto's disease are relatively more common than Graves' disease during the postnatal period, this young woman was found to have new-onset Graves' disease. Distinguishing between normal postpartum symptoms and thyroid disorders can be challenging. Utilizing history, physical examination, and laboratory testing, the provider can identify the etiology of hyperthyroidism during the postpartum period. Treatment options differ depending on the cause of the thyroiditis and include antithyroid medications and beta-blockers for relief of symptoms. PMID:23590488
Goldstein, Ami L
Stress and fatigue are common complaints of pregnant and postpartum women as is depression. These symptoms may be related to immunomodulation. However, few studies have examined these relationships. The aim of this study was to examine the relationships among stress, fatigue, depression, and cytokines as markers of immune modulation in prenatal and postpartum women. Women completed questionnaires and gave blood samples during late pregnancy and again at 4-6 weeks postpartum. Blood was analyzed for cytokines as measures of immune modulation. Stress, fatigue, and depression were experienced at moderately high levels, with higher levels of fatigue and depression in the postpartum but higher stress in the prenatal period. Levels of several cytokines were increased in the postpartum over the prenatal period. Stress and depression were related in the prenatal period and stress, depression, and fatigue were related in the postpartum. While various cytokines were related to each other in both periods, only stress was related to MIP-1?, a cytokine that may be important for childbirth processes. More studies, especially longitudinal and interventional studies, are needed to increase our knowledge about etiology, patterns, symptoms, factors, and management of maternal distress. The search for reliable biomarkers for at-risk mothers remains a priority. PMID:24587741
Cheng, C Y; Pickler, R H
Post-partum eclampsia is an unfrequent entity (11 to 44 % of eclampsia), which can sometimes occur late, beyond the 48th hour. We report a case of late post-partum eclampsia which occurred 12 days after an uncomplicated pregnancy and delivery. Post-partum eclampsia differs from antepartum by a pauci symptomatic or unexpected context. The mortality rate is comparable with that of the ante-partum eclampsia. Brain MRI appears to be the investigation of choice in case of uncertain diagnosis. Magnesium sulfate treatment should be considered under the same conditions as during pregnancy. Identifying and informing high-risk women would allow early diagnosis, which may improve the prognosis of this atypical type of eclampsia. PMID:20022278
Bedel, B; Cartron, G; Vayssière, C; Parant, O
: Late-onset postpartum preeclampsia is atypical and potentially life-threatening. Diagnosis is frequently delayed because signs and symptoms of significant disease are subtle, thus, nurse practitioners should have a high index of suspicion. Immediate consultation, diagnosis, initial management, pathophysiology, and breastfeeding support are discussed as well as patient education and future health implications. PMID:24932793
Clark, Terri P
A twenty six years old woman presented with visual disturbance, headache and gait disturbance ten weeks postpartum. Imaging studies identified an acute infarction in the left thalamus. This case report discusses her presentation, investigations and management and the aetiology of stroke in pregnancy and the postpartum period. PMID:23905136
Sj, Allison; A, Basit; Hussein, Omer Mohd; Ra, Ahmed
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
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.
Wolfe, Diana S.; Williams, Shauna F.; Ross, Michael G.; Beall, Marie H.; Apuzzio, Joseph J.
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
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
The purpose of this study was to determine the prevalence of visual disturbances in patients with posterior reversible encephalopathy syndrome (PRES) associated with late postpartum eclampsia. We retrospectively reviewed the clinical records of late postpartum eclampsia patients with features of PRES for the presence of visual disturbances and location of radiological abnormalities. We found a higher prevalence of cortical visual loss in patients with PRES associated with late postpartum eclampsia. Bilateral symmetrical vasogenic edema of the parieto-occipital lobe was the most common magnetic resonance imaging (MRI) abnormality noted. No significant differences were observed in the extent of edema in patients with and without visual loss. PMID:24881617
Karuppannasamy, Divya; Vikrant, K; Raghuram, A; Kumaar, T M Sathish
The purpose of this study was to determine the prevalence of visual disturbances in patients with posterior reversible encephalopathy syndrome (PRES) associated with late postpartum eclampsia. We retrospectively reviewed the clinical records of late postpartum eclampsia patients with features of PRES for the presence of visual disturbances and location of radiological abnormalities. We found a higher prevalence of cortical visual loss in patients with PRES associated with late postpartum eclampsia. Bilateral symmetrical vasogenic edema of the parieto-occipital lobe was the most common magnetic resonance imaging (MRI) abnormality noted. No significant differences were observed in the extent of edema in patients with and without visual loss.
Karuppannasamy, Divya; Vikrant, K; Raghuram, A; Kumaar, T M Sathish
Women with active psychiatric disorders who become pregnant face treatment dilemmas. Although results from studies are inconsistent, small but significant, risks on birth outcomes occur with exposure to untreated disorders, as well as to psychotropic medications. Prenatal antidepressant medication exposure may increase the risk for spontaneous miscarriage, preterm birth, cardiac malformations, persistent pulmonary hypertension of the newborn and postnatal adaptation syndrome. The use of valproate is contraindicated during pregnancy due to teratogenicity and neurocognitive delay and deficits. This review of selected studies will highlight some of the current issues with the use of psychotropic medications during pregnancy and the postpartum period. PMID:24161312
To assess the wound healing capabilities of damaged lung tissue in the postpartum period, we investigated the parameters related to wound healing in a rat model of lung damage. Rats were divided into six groups: IA, IB, II, IIIA, IIIB and IV (n=7 in each group). Group IA included rats not in the postpartum period that were sacrificed on the third day after lung injury, group IB included rats not in the postpartum period that were sacrificed on the tenth day after lung injury, group II included rats not in the postpartum period that did not receive lung injury, group IIIA included rats in the postpartum period that were sacrificed on the third day after lung injury, group IIIB included rats in the postpartum period that were sacrificed on the tenth day after lung injury and group IV included rats in the postpartum period without lung injury. Wound healing was evaluated histopathologically and measurements of hydroxyproline levels, serum alanine and glutamine were taken. A significant difference in serum alanine levels was evident between groups IA and IIIA. Significant differences were also observed between serum alanine and glutamine levels in groups IB and IIIB. In conclusion, we demonstrated that serum alanine levels were reduced in the postpartum period following lung injury, which may be expected to negatively impact wound healing in this period. The administration of exogenous alanine for traumatic events occurring during the postpartum period may thus contribute positively to wound healing capabilities during this period. PMID:22969973
Karadayi, Sule; Sahin, Ekber; Nadir, Aydin; Tuncer, Ersin; Silig, Yavuz; Korkmaz, Ilhan; Tanzer, Fatos; Sezer, Hafize; Kaptanoglu, Melih
Postpartum psychic disorders can be mainly divided into 3 groups: The so-called postpartum blues, the postpartum depression and the postpartum psychosis. The postpartum blues occurs 3 - 5 days postpartum in 50 - 70 % of deliveries mostly disappearing after one week without specific therapy. However, 20 - 30 % of patients will develop a depression in their further postpartum course so that a thorough evaluation concerning depression is warranted, if blues symptoms persist more than 2 weeks. Postpartum depression can be found in 10 - 15 % of deliveries and mostly occurs several weeks or months after delivery with symptoms of depressive mood, sleeping disorders, anxiety, loss of interest and accord and feelings of guilt up to suicidal ideas. In order not to misinterpret them as postpartum blues specific questions concerning the mood of the young mother during the postpartum examination - if necessary using the Edinburgh scale - are recommended. In patients with known risk factors for a postpartum depression (i. e. postpartum depression or psychosis in previous pregnancies, depression disorder, anxiety disorder, bipolar illness), a thorough survey is mandatory and - if necessary - a prophylactic treatment in cooperation with the psychiatrist. Less severe forms of postpartum depression can mostly be treated with psychotherapy and sociotherapy on an outpatient basis. In more severe cases, antidepressant drugs (selective serotonin reuptake inhibitors, SSRIs or some tricyclic drugs) are indicated. Postpartum anxiety and compulsive disorders respond well to psychotherapy; besides in anxiety disorders benzodiazepines are recommended, in compulsive disorders SSRIs. Postpartum psychoses (about 0.1 - 0.2 %) most often occur in bipolar or schizoaffective disorders or after postpartum psychosis. They require a hopitalization mainly because of the danger of suicide and homicide toward the newborn; ideally this is performed in mother-child-units. PMID:14600849
Kemp, Birgit; Bongartz, Kerstin; Rath, Werner
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
Several diverse neurological conditions may be seen during pregnancy and the post partum period. These usually require neuroimaging for definitive diagnosis and range from a predisposition to neurovascular abnormalities, such as acute ischaemic stroke and cerebral venous sinus thrombosis, through to more specific pregnancy-related conditions, such as eclampsia/posterior reversible leukoencephalopathy and post-partum angiopathy. Additionally, the pregnant patient is predisposed to pituitary disease. It is necessary that the radiologist has an awareness of these conditions to allow swift specific diagnoses or suggest the most appropriate diagnosis when imaging findings are non-specific. We describe epidemiological and radiological features to allow the radiologist to guide the clinician in management, and review guidelines for safe cranial imaging of the pregnant patient. PMID:23063171
Mortimer, A M; Bradley, M D; Likeman, M; Stoodley, N G; Renowden, S A
Tested hypothesis that higher levels of positive affect and lower levels of negative affect would predict depression during pregnancy and in the postpartum period. Analysis of 100 women indicated that women at risk for depression during pregnancy and in the postpartum period may exhibit heightened negative moods and a dearth of positive affective…
Elliott, Timothy R.; And Others
Summary The development, reliability, and validity of a new instrument designed to assess aspects of social support specifically relevant\\u000a to the postpartum period, the Postpartum Social Support Questionnaire (PSSQ), is described. The PSSQ was administered to 126\\u000a women at 2, 4, 6, and 12 months postpartum. Results indicate that it has high test–retest reliability and internal consistency.\\u000a Factor analyses suggest that
J. Hopkins; S. B. Campbell
Women's sexual functioning in the postpartum period is understudied given its potential impact on women's mental health and\\u000a their relationships with their partners. The sexual functioning of women with postpartum depression (PPD) in particular is\\u000a not well characterized. The goals of this study were to examine factors associated with the sexual functioning of postpartum\\u000a women and to compare the long-term
Joy E. Moel; Melissa M. Buttner; Michael W. O’Hara; Scott Stuart; Laura Gorman
The way mothers reconstruct the childbirth experience during the early postpartum period may interfere in their mood and predisposition to get pregnant again. This study explored continuity and changes in the perception of childbirth experience throughout the first six postpartum months, taking into account different types of delivery. The sample consisted of 68 Portuguese pregnant women, who filled in the
Ana Albertina Conde; Bárbara Figueiredo; Raquel Costa; Alexandra Pacheco; Álvaro Pais
OBJECTIVEThis study investigated determinants of bone and blood lead concentrations in 430 lactating Mexican women during the early postpartum period and the contribution of bone lead to blood lead.METHODSMaternal venous lead was measured at delivery and postpartum, and bone lead concentrations, measured with in vivo K-xray fluorescence, were measured post partum. Data on environmental exposure, demographic characteristics, and maternal factors
Mary Jean Brown; Howard Hu; Teresa Gonzales-Cossio; Karen E Peterson; Luz-Helena Sanin; Maria de Luz Kageyama; Eduardo Palazuelos; Antonio Aro; Lourdes Schnaas; Mauricio Hernandez-Avila
Introduction. Despite the fact that maternal perinatal mental health problems have been extensively studied and addressed to be a significant health problem, the literature on paternal perinatal mental health problems is relatively scarce. The present study aims at determining the prevalence of paternal perinatal depression and identifying the risk factors and the relationship between antenatal and postpartum depression. Methodology. 622 expectant fathers were recruited from regional maternal clinics. The expectant fathers were assessed using standardized and validated psychological instruments on 3 time points including early pregnancy, late pregnancy, and six weeks postpartum. Results. Results showed that a significant proportion of expectant fathers manifested depressive symptoms during the perinatal period. Paternal antenatal depression could significantly predict higher level of paternal postpartum depression. Psychosocial risk factors were consistently associated with paternal depression in different time points. Conclusions. The present study points to the need for greater research and clinical attention to paternal depression given that it is a highly prevalent problem and could be detrimental to their spouse and children development. The present findings contribute to theoretical basis of the prevalence and risk factors of paternal perinatal depression and have implications of the design of effective identification, prevention, and interventions of these clinical problems.
Koh, Y. W.; Chui, C. Y.; Tang, C. S. K.; Lee, A. M.
Postpartum depression affects 15% of new mothers and previous depressive episodes increase the risk for postpartum depression. Chronic administration of corticosterone (CORT) to dams during the postpartum period causes depressive-like behaviour and has been used as a model of postpartum depression. To better understand the subsequent progress of this model, we examined whether there were persistent effects of CORT treatment during the dam's first postpartum period on maternal care and mood following a subsequent pregnancy. Sprague-Dawley female rats received either sesame oil (control) or CORT (40 mg/kg) injections for 22 days during their first postpartum period. Subsequently, all females were re-mated for a second time and neither group received treatment during the second postpartum period. Maternal care was observed from days 2-8 of each postpartum period and dams were tested in the forced-swim test on days 21 and 22 of the first and days 4 and 21 of the second postpartum period. As expected, the amount of time spent immobile in the forced-swim test was increased in CORT dams at the end of the first postpartum period; however, the amount of time spent immobile was decreased at the end of the second postpartum period relative to oil dams. Furthermore, dams treated with CORT in first postpartum period gave birth to a smaller litter with a larger male/female sex ratio after their second pregnancy. This implies that elevated stress hormone levels during the first postpartum period have a substantial influence on subsequent postpartum behaviour and litter characteristics. Further investigations are necessary to fully understand the effect of parity, experience during first motherhood, and hypothalamic-pituitary-adrenal axis regulation on postpartum depression. PMID:21623960
Wong, J H K; Brummelte, S; Galea, L A M
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)
ObjectivesThe goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance.
Goldy C. George; Tracey J. Milani; Henry Hanss-Nuss; Jeanne H. Freeland-Graves
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.
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.
Objectives Research has indicated that social support is a major buffer of postpartum depression. Yet little is known concerning women’s perceptions on social support during the postpartum period. The objective of this study was to explore postpartum women’s views and experiences with social support following childbirth. Methods Four focus groups were conducted with an ethnically diverse sample of women (n=33) in a large urban teaching hospital in New York City. Participants had completed participation in a postpartum depression randomized trial and were 6 to 12 months postpartum. Data transcripts were reviewed and analyzed for themes. Results The main themes identified in the focus group discussions were mother’s major needs and challenges postpartum, social support expectations and providers of support, how mothers mobilize support, and barriers to mobilizing support. Women across all groups identified receipt of instrumental support as essential to their physical and emotional recovery. Support from partners and families was expected and many women believed this support should be provided without asking. Racial/ethnic differences existed in the way women from different groups mobilized support from their support networks. Conclusions Instrumental support plays a significant role in meeting women’s basic needs during the postpartum period. In addition, women’s expectations surrounding support can have an impact on their ability to mobilize support among their social networks. The results of this study suggest that identifying support needs and expectations of new mothers is important for mothers’ recovery after childbirth. Future postpartum depression prevention efforts should integrate a strong focus on social support.
Negron, Rennie; Martin, Anika; Almog, Meital; Balbierz, Amy; Howell, Elizabeth A.
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
Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterised by seizure, headaches, visual symptoms, impaired consciousness and other focal neurological findings. It is caused by a wide variety of causes ultimately leading to a vasogenic cerebral oedema of occipital and parietal lobes of the brain. We present here a young woman with headache, generalised tonic-clonic seizures and cortical blindness in a late postpartum stage. Reversibility of the symptoms and characteristic imaging findings led us to a diagnosis of PRES in our patient. PMID:24577180
Rijal, Jharendra P; Giri, Smith; Dawadi, Suvash; Dahal, Khagendra V
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
Abdominal examination was performed in 75 healthy women after normal delivery. The liver was palpable in 23 patients, the spleen in nine. The author believes that these organs were palpable because of ptosis rather than enlargement. Knowledge of this fact should keep the physician from attributing undue importance to the presence of a palpable liver and spleen in the postpartum period.
Female genital mutilation (FGM) is a traditional practice with serious health consequences to women that is still practiced in 28 countries with approximately 2 million girls exposed to the practice annually. The complications of FGM cause suffering to the woman all her life. Pregnancy, childbirth and the postpartum period are particularly important as there is increased risk of mortality and
Eight healthy Baladi female goats were used in this study to investigate the changes which may occur in some hematological and biochemical parameters during different physiological stages in female Baladi goats. Blood samples were collected before pregnancy, prepartum (4, 3, 2, 1 weeks before parturition), day of parturition and postpartum periods (1, 2, 3 and 4 weeks after parturition). Hematological
Mohamed E Azab; Hussein A Abdel-Maksoud
Introduction The mechanism underlying the spontaneous improvement of rheumatoid arthritis (RA) during pregnancy and the subsequent postpartum flare is incompletely understood, and the disease course varies widely between pregnant RA patients. In pregnancy, total and free levels of cortisol increase gradually, followed by a postpartum decrease to prepregnancy values. The glucocorticoid receptor (GR) polymorphisms BclI and N363S are associated with relatively increased glucocorticoid (GC) sensitivity, whereas the 9? and ER22/23EK polymorphisms of the GR gene are associated with a relatively decreased GC sensitivity. We examined the relation between the presence of these GR polymorphisms and level of disease activity and disease course of RA during pregnancy and postpartum. Methods We studied 147 participants of the PARA study (Pregnancy-Induced Amelioration of Rheumatoid Arthritis study), a prospective study investigating the natural improvement during pregnancy and the postpartum flare in women with RA. Patients were visited, preferably before pregnancy, at each trimester and at three postpartum time points. On all occasions, disease activity was scored by using DAS28. All patients were genotyped for the GR polymorphisms BclI, N363S, 9?, and ER22/23EK and divided in groups harboring either polymorphisms conferring increased GC sensitivity (BclI and N363S; GC-S patients) or polymorphisms conferring decreased GC sensitivity (9? or 9? + ER22/23EK; GC-I patients). Data were analyzed by using a mixed linear model, comparing GC-S patients with GC-I patients with respect to improvement during pregnancy and the postpartum flare. The cumulative disease activity was calculated by using time-integrated values (area under the curve, AUC) of DAS28 in GC-I patients versus GC-S patients. Separate analyses were performed according to the state of GC use. Results GC-S patients treated with GC had a significantly lower AUC of DAS28 in the postpartum period than did GC-I patients. This difference was not observed in patients who were not treated with GCs. During pregnancy, GC-S and GC-I patients had comparable levels of disease activity and course of disease. Conclusions Differences in relative GC sensitivity, as determined by GR polymorphisms, are associated with the level of disease activity in the postpartum period in GC-treated patients, but they do not seem to influence the course of the disease per se.
Objective To investigate course and predictors of eating disorders in the postpartum period. Method A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for pre-pregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. Results Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. Discussion This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with pre-pregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.
Knoph, Cecilie; Holle, Ann Von; Zerwas, Stephanie; Torgersen, Leila; Tambs, Kristian; Stoltenberg, Camilla; Bulik, Cynthia M; Reichborn-Kjennerud, Ted
Although maternal screening and the administration of prophylactic intrapartum antibiotics have decreased the incidence of early onset group B streptococcal (GBS) disease in neonates, there is still significant morbidity and mortality as a result of neonatal GBS disease.Maternal GBS infections are not uncommon, but with appropriate therapy there is almost a uniformly good outcome. Little is written about the appropriate management of well infants born to mothers with postpartum GBS sepsis.The question of whether well infants born to mothers with GBS puerperal sepsis should be treated empirically with antibiotics and the lack of literature concerning this issue became apparent when an untreated term infant died of late onset GBS meningitis following maternal puerperal GBS sepsis. We describe this event in the following case presentation.With the current paucity of literature regarding the management of well infants born to mothers with postpartum GBS sepsis, it seems prudent to treat such infants empirically with antibiotics (following a full septic work-up) until this matter has been investigated further. PMID:20019951
Barnard, Chantelle; Goldbach, Mort; Whyte, Hilary; Ford-Jones, Lee; King, Susan
Coarctation of aorta and sinus of Valsalva aneurysm are frequently missed congenital cardiac defects that their diagnosis might be delayed. To our knowledge, coincidence of these cardiac defects is unusual and has not been reported in the literature before. Here, we present a patient with coarctation of aorta and ruptured noncoronary sinus of Valsalva aneurysm leading to aorto-right atrial fistula in the early postpartum period and our management of this unusual case.
Sener, Erol; Kucuker, Aslihan; Kurt, Kadir; Uguz, Emrah; Saglam, Muhammed Fethi
The aims were to study: prevalence of pelvic girdle pain (PGP) one year postpartum; clinical course of PGP, physical functioning (PF) and bodily pain (BP) (from SF-36, 0 (worst) to 100 (best)) from gestation week (GW) 30 to one year postpartum; and whether findings at GW30 were associated with development of PF and BP from GW30 to one year postpartum. 215 pregnant women were followed from GW30 to one year postpartum. Clinical examination and questionnaire were used at GW30, questionnaire only were used at 12 weeks and one year postpartum. The women were categorised by GW30 clinical variables: self-reported PGP, pain locations in the pelvis and response to two clinical tests. Linear mixed models for repeated measures were used to study PF and BP during follow-up, within the categories of clinical variables. PGP prevalence remained unchanged from 12 weeks to one year postpartum (31-30%). PF and BP scores improved markedly from GW30 to 12 weeks postpartum, and marginally thereafter. Median PF scores were 70, 95 and 100 at GW30, 12 weeks and one year postpartum, respectively. Corresponding median BP scores were 52, 84 and 84. We found significant interactions between each clinical variable and time (P ? 0.01) for PF and BP. The most afflicted women at GW30 experienced largest improvement. Despite high PGP prevalence one year postpartum, most women recovered in terms of PF and BP scores. Unfavourable clinical course postpartum did not appear to depend on self-reported PGP, pain locations in the pelvis, or response to clinical tests at GW30. PMID:24508067
Robinson, Hilde Stendal; Vøllestad, Nina K; Veierød, Marit B
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; Hu, Zheng; Otto, Jean; Rohrbeck, Patricia
OBJECTIVES To assess maternal quality of life (QoL) during the postpartum period and to compare the performance of two QoL questionnaires across a sample of 101 women in southern Brazil. To our knowledge, this is the first study that measures maternal quality of life during the postpartum period in Brazil. INTRODUCTION There is limited information about postpartum maternal quality of life in Brazil. The are no Portuguese versions of instruments specifically designed to measure quality of life during the postpartum period. METHODS Research participants completed the Portuguese version of the World Health Organization Quality of Life Assessment-Bref (WHOQOL-BREF) and Multicultural Quality of Life Index (MQLI) questionnaires. The correlations between the MQLI and the discrete areas of WHOQOL-BREF were examined using Pearson Product-Moment Correlation Coefficients. RESULTS We report a significant correlation between the global MQLI and the four domains of the WHOQOL-BREF scores (p < 0.01). An analysis of variance revealed a significant difference in mean scores in the Psychological and Environment domains according to different socio-economic strata: F (3, 97) = 3.81, p = 0.012 and F (3, 97) = 4.03, p = 0.01, respectively. DISCUSSION The WHOQOL-BREF questionnaire may be more sensitive than the MQLI in detecting the impact of socioeconomic status on the QoL of postpartum women. CONCLUSION The sample of postpartum women evaluated in this study presented favorable QoL scores according to both the MQLI and WHOQOL-BREF questionnaires. Our results also indicate that the WHOQOL-BREF and the MQLI questionnaires have a significant correlation in terms of their assessments of postpartum mothers.
Zubaran, Carlos; Foresti, Katia; Schumacher, Marina Verdi; Muller, Lucia Cristina; Amoretti, Aline Luz
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
Background Women who use antiretroviral therapy (ART) solely for the prevention of mother-to-child transmission of HIV discontinue postpartum. We hypothesized that women discontinuing ART by 6 weeks postpartum (“discontinuers”) would have elevated postpartum inflammatory biomarker levels relative to women remaining on ART postpartum (“continuers”). Methods Data from HIV-infected pregnant women enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 with CD4 counts >350 cells per cubic millimeter before initiating ART or first pregnancy CD4 counts >400 cells per cubic millimeter after starting ART and with available stored plasma samples at >20 weeks of gestation, delivery, and 6 weeks postpartum were analyzed. Plasma samples were tested for highly sensitive C-reactive protein, D-dimer, and interleukin-6. We used longitudinal linear spline regression to model biomarkers over time. Results Data from 128 women (65 continuers and 63 discontinuers) were analyzed. All biomarkers increased from late pregnancy to delivery, then decreased postpartum (slopes different from 0, P < 0.001). Continuers had a steeper decrease in log D-dimer between delivery and 6 weeks postpartum than discontinuers (P = 0.002). Conclusions In contrast to results from treatment interruption studies in adults, both ART continuers and ART discontinuers had significant decreases in the levels of D-dimer, highly sensitive C-reactive protein, or interleukin-6 postpartum. Continuation was associated with a more rapid decline in D-dimer levels compared with discontinuation.
Hoffman, Risa M.; Leister, Erin; Kacanek, Deborah; Shapiro, David E.; Read, Jennifer S.; Bryson, Yvonne; Currier, Judith S.
Introduction Pregnancy and the postpartum period present important intervention opportunities. Counseling can leverage the motivation women have during this time to change behaviors that may negatively affect their health and the heath of their infants. Methods Pregnant women attending an antenatal clinic in South Africa were randomly allocated to treatment (n?=?733) and control arms (n?=?747). Treatment arm participants received enhanced HIV pre- and post-test counseling, legal support and access to support groups at baseline, which occurred at the first antenatal visit, and then six and ten weeks postpartum. Control arm participants received standard HIV testing and counseling (HTC) and two postpartum attention control sessions. Outcomes were incidence of sexually transmitted infection (STI) by 14 weeks postpartum and past 30-day inconsistent condom use at 14 weeks and 9 months postpartum. Results There were no intervention effects on incident STIs for either HIV-negative (adjusted risk ratio (aRR) 1.01, 95% CI 0.71–1.44) or HIV-positive participants (aRR 0.86, 95% CI 0.61–1.23). The intervention was associated with a 28% decrease in risk of past 30-day inconsistent condom use at nine-months among HIV-negative women (aRR 0.72,95% CI 0.59–0.88), but did not affect inconsistent condom use among HIV-positive women (aRR1.08; 95% CI 0.67–1.75). Discussion An enhanced counseling intervention during pregnancy and the postpartum period can lead to reductions in inconsistent condom use among HIV-negative women. Results underscore the importance of the counseling that accompanies HIV HTC. More work is needed to understand how to promote and sustain risk reduction among HIV-positive women. Trial Registration ClinicalTrials.gov NCT01683461
Maman, Suzanne; Moodley, Dhayendre; McNaughton-Reyes, Heathe Luz; Groves, Allison K.; Kagee, Ashraf; Moodley, Prashini
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
Although Egypt was ruled by foreigners during most of the Late and Greco-Roman periods, native religious traditions remained strong and the period witnessed the production of a wide variety of religious texts written in the Egyptian language. This article presents many of the major religious texts of Egypt's Late and Greco-Roman periods and comments on the trends of continuity and
Jacqueline E. Jay
A new model for the care of women in the postpartum focuses on the development of life skills that promote complete well-being. The year following childbirth is a time of significant transition for women. In addition to the physiologic changes associated with the postpartum period, a woman undergoes marked psychosocial changes as she transitions into a motherhood role, reestablishes relationships, and works to meet the physical and emotional needs of her infant and other family members. It is a time when women are vulnerable to health problems directly related to childbirth and to compromised self-care, which can manifest in the development or reestablishment of unhealthy behaviors such as smoking and a sedentary lifestyle. In addition to long-term implications for women, compromised maternal health in the postpartum period is associated with suboptimal health and developmental outcomes for infants. Maternal health experts have called for a change in how care is provided for women in the postpartum period. This article presents the rationale for a health promotion approach to meeting the needs of women in the postpartum period and introduces the Perinatal Maternal Health Promotion Model. This conceptual framework is built around a definition of maternal well-being that asserts that health goes beyond merely the absence of medical complications. In the model, the core elements of a healthy postpartum are identified and include not only physical recovery but also the ability to meet individual needs and successfully transition into motherhood. These goals can best be achieved by helping women develop or strengthen 4 key individual health-promoting skills: the ability to mobilize social support, self-efficacy, positive coping strategies, and realistic expectations. While the model focuses on the woman, the health promotion approach takes into account that maternal health in this critical period affects and is affected by her family, social network, and community. Clinical implications of the model are addressed, including specific health promotion strategies that clinicians can readily incorporate into antepartum and postpartum care. PMID:24320095
Fahey, Jenifer O; Shenassa, Edmond
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 strategy used. Using covariate-adjusted linear and logistic regression models, we estimated associations before and after adjusting for maternal weight-related variables including prepregnancy BMI. At 6 months postpartum, 53% mothers were trying to lose weight. At age 3 years, mean (s.d.) child BMI z-score was 0.44 (1.01) and 8.9% of children were obese. Children whose mothers were trying to lose weight at 6 months postpartum had higher BMI z-scores (0.30 (95% confidence interval (CI) 0.18, 0.42)) and were more likely to be obese (3.0 (95% CI 1.6, 5.8)) at 3 years of age. Addition of maternal prepregnancy BMI to the models attenuated but did not eliminate the associations seen for BMI z-score (0.24 (95% CI 0.12, 0.36) and obesity (2.4 (95% CI 1.2, 4.7)). Attempting to lose weight by exercising alone was the only weight loss strategy that consistently predicted higher child BMI z-score (0.36 (95% CI 0.14, 0.58)) and odds of obesity (6.0 (95% CI 2.2, 16.5)) at age 3 years. In conclusion, we observed an association between maternal attempt to lose weight at 6 months postpartum, particularly through exercise alone, measured using a single item and child adiposity at age 3 years. This association should be thoroughly examined in future studies. PMID:21350436
Sonneville, Kendrin R; Rifas-Shiman, Sheryl L; Oken, Emily; Peterson, Karen E; Gortmaker, Steven L; Gillman, Matthew W; Taveras, Elsie 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 strategy used. Using covariate-adjusted linear and logistic regression models, we estimated associations before and after adjusting for maternal weight-related variables including prepregnancy BMI. At 6 months postpartum, 53% mothers were trying to lose weight. At age 3 years, mean (s.d.) child BMI z-score was 0.44 (1.01) and 8.9% of children were obese. Children whose mothers were trying to lose weight at 6 months postpartum had higher BMI z-scores (0.30 (95% confidence interval (CI) 0.18, 0.42)) and were more likely to be obese (3.0 (95% CI 1.6, 5.8)) at 3 years of age. Addition of maternal prepregnancy BMI to the models attenuated but did not eliminate the associations seen for BMI z-score (0.24 (95% CI 0.12, 0.36) and obesity (2.4 (95% CI 1.2, 4.7)). Attempting to lose weight by exercising alone was the only weight loss strategy that consistently predicted higher child BMI z-score (0.36 (95% CI 0.14, 0.58)) and odds of obesity (6.0 (95% CI 2.2, 16.5)) at age 3 years. In conclusion, we observed an association between maternal attempt to lose weight at 6 months postpartum, particularly through exercise alone, measured using a single item and child adiposity at age 3 years. This association should be thoroughly examined in future studies.
Sonneville, Kendrin R.; Rifas-Shiman, Sheryl L.; Oken, Emily; Peterson, Karen E.; Gortmaker, Steven L.; Gillman, Matthew W.; Taveras, Elsie M.
Twenty four periparturient cows were used to determine the effects of DCAD on acid-base balance, plasma and urine mineral concentrations, health status, and subsequent lactation performance. Each group of 12 cows received either a diet containing ?100 DCAD or +100 DCAD for 21 d prepartum. Both anionic and cationic groups were divided into two groups, one received a +200 DCAD and the other +400 DCAD diet for 60 d postpartum. Prepartum reduction of DCAD decreased DMI, urinary and blood pH, urinary concentrations of Na or K and increased plasma and urinary Ca, Mg, Cl and S. Also cows fed ?100 DCAD diet consumed the most dry matter in the first 60 d after calving. Postpartum +400 DCAD increased milk fat and total solid percentages, urinary and blood pH and urinary Na and K concentrations, but urinary Ca, P, Cl and S contents decreased. Greater DMI, FCM yields were observed in cows fed a diet of +400 DCAD than +200 DCAD. No case of milk fever occurred for any diets but feeding with a negative DCAD diet reduced placenta expulsion time. In conclusion, feeding negative DCAD in late gestation period and high DCAD in early lactation improves performance and productivity of dairy cows.
Razzaghi, A.; Aliarabi, H.; Tabatabaei, M. M.; Saki, A. A.; Valizadeh, R.; Zamani, P.
This article reviews the management and diagnosis of thyroid dysfunction during pregnancy and postpartum, which was published by any of the endocrine societies in 2012. The author presents human data based on these clinical practice guidelines, however, there are also many unresolved questions. Especially, there are inconsistencies about screening using plasma TSH measurement. In pregnancy the main causes of hyperthyroidism are Graves's disease and gestational transient thyrotoxicosis. Generally, gestational transient thyrotoxicosis does not require medication, whereas Graves's disease needs antithyroid drug therapy. Postpartum thyroiditis occurs more frequently in antithyroid peroxidase-positive women, who should be screened using serum thyrotropin measurements at 6 to 12 gestation weeks and at 3 and 6 months postpartum. Because overt maternal hypothyroidism, due to autoimmune pathophysioloical mechanisms, negatively affects the fetus, timely recognition and treatment are important. The subclinical form of maternal hypothyroidism should also be treated. A link between thyroid dysfunction and infertility has been warranted. PMID:24334133
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
In many species of small mammals, including meadow voles, Microtus pennsylvanicus, females come into postpartum estrus (PPE) within 12–24 h of giving birth, allowing them to mate and become pregnant while raising the current litter. PPE females show increases in attractivity, proceptivity, and receptivity, the three components of sexual behavior, relative to females not in PPE. Several studies have shown that food deprivation and restriction reduce attractivity, proceptivity, and receptivity of females not in PPE. We tested the hypothesis that food deprivation and restriction during late gestation causes deficits and decreases the attractivity, proceptivity, and receptivity of females when they enter PPE. Our data support the hypothesis. On day 1 of lactation, females that were food deprived and food restricted produced scent marks that were significantly less attractive as those produced by control PPE females. Food deprivation but not food restriction caused females to no longer display significant preferences for the scent marks of males over those of females (proceptivity). Food deprivation and food restriction were sufficient to induce females to become significantly less sexually receptive than control females. Eleven of 12 control PPE females mated, 4 of 12 food-restricted females mated, and 3 of 12 food-deprived females mated. Dams facing food deprivation or restriction during late gestation may have to balance the benefits of mating during PPE with the increased costs associated with getting pregnant while they are lactating.
Sabau, Ramona M.; Ferkin, Michael H.
Three decades of research point to both biological and psychological risk factors for postpartum depression, but very little research integrates the two. This study bridged this gap by testing whether prenatal social support predicted depressive symptoms at 8 weeks postpartum in a multiethnic sample of 210 women and whether the stress hormone placental corticotropin-releasing hormone (pCRH), measured at 19, 29, and 37 weeks’ gestation, mediated this relationship. We found that prenatal family support predicted significantly fewer depressive symptoms postpartum and more gradual increases in pCRH from 29 to 37 weeks’ gestation. Furthermore, steeper increases in pCRH during this same period predicted more depressive symptoms postpartum. Finally, these changes in pCRH in late pregnancy mediated the relationship between prenatal family support and postpartum depressive symptoms. These results suggest that social and biological risk factors for postpartum depressive symptoms are intertwined and move us closer to an integrated biopsychosocial understanding of postpartum depression.
Hahn-Holbrook, Jennifer; Schetter, Christine Dunkel; Arora, Chander; Hobel, Calvin J.
OBJECTIVES:We aimed to assess breastfeeding practices and the impact of breastfeeding on disease flare during the postpartum year in inflammatory bowel disease (IBD).METHODS:Women of childbearing age from 1985 to 2005 were identified from the University of Manitoba IBD Research Registry. Questionnaires were completed regarding pregnancy and the postpartum period. Data for initiation and duration of breastfeeding were compared with population-based
Dana C Moffatt; Alexandra Ilnyckyj; Charles N Bernstein
We report an exceptional case of secondary postpartum hemorrhage (PPH) twenty days after cesarean delivery, resulting from a ruptured uterine artery pseudoaneurysm (UAP). The diagnosis was initially confounded by a septic shock necessitating inotropic support in the intensive care unit. Intense vaginal bleeding occurred eleven days after uterine curettage. Doppler ultrasound showed an anechoic focus in the inferior part of the uterus with turbulent flow. Bilateral internal iliac artery angiograms revealed a left uterine artery pseudoaneurysm that was successfully embolized. UAP is a rare cause of unexplained PPH that requires a high index of suspicion for diagnosis. This first report in the anesthesia literature serves to focus our awareness on its possible occurrence, and gives track to its management. Pitfalls in UAP diagnostic are highlighted (delayed presentation, possibility of spontaneous hemostasis, and lack of typical findings on colour Doppler sonography in hypotensive patients). These pitfalls may further be confounded by a concomitant sepsis. Angiography and selective uterine artery embolization is the treatment of choice. PMID:24605417
Kulkarni, S S; Teoh, W H L; Sia, A T H; Nair, S
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
Summary. Seven Hereford cows with single calves were bled by jugular venepuncture, daily from parturition until 63\\\\p=n-\\\\79days post partum; 6 of the cows were also bled through jugular cannulae every 15 min for 8 h every 10 days. The average post-partum interval to first oestrus was 59\\\\m=.\\\\8\\\\m=+-\\\\3\\\\m=.\\\\7days for 5 of the cows. In cows returning to oestrus, plasma concentrations of
N. C. Rawlings; L. Weir; B. Todd; J. Manns; J. H. Hyland
Snowdonia has one of the most intensely studied pollen records in Britain. It has, therefore, been possible to provide a detailed description of all of the major vegetation types that developed since the last ice age. The account extends from the late glacial period (some 12,000 years BP), when pioneer plants were struggling to colonise the newly exposed, barren landscapes,
PETER RHIND; BARBARA JONES
Objective: To assess the frequency and severity of hypoestrogenic symptoms in lactating and nonlactating women during the postpartum period.Study design: Women were recruited in the immediate postpartum period and evaluated during the immediate postpartum period, at 3 weeks postpartum and at 6 weeks postpartum, using self-ranked symptoms questionnaires. Hypoestrogenic symptoms were assessed using a modified Kupperman index, a menopausal symptoms
Julie Kim; Carolyn Alexander; Lisa Korst; Sanjay Agarwal
Thyroid dysfunction is the second most common endocrine disorder, only after diabetes mellitus, affecting females in reproductive age group. Pregnancy is associated with profound repercussions on the thyroid status of a lady. Thyroid dysfunctions such as hypothyroidism, thyrotoxicosis and thyroid nodules may develop during pregnancy leading to abortion, placental abruptions, pre-eclampsia, preterm delivery and reduced intellectual function in the offspring. Thus, maintenance of euthyroid state is of utmost important for maternal and fetal well being during pregnancy as well as after. The Endocrine Society has issued latest guidelines regarding the diagnosis and management of thyroid dysfunction related to pregnancy. All the clinicians should be well aware of the latest recommendations regarding management of thyroid dysfunction in pregnancy and in postpartum phase and practice them accordingly. PMID:24510157
Vandana; Kumar, Amit; Khatuja, Ritu; Mehta, Sumita
With growing numbers of HIV-seropositive (HIV+) women of child-bearing age and increased access to effective clinical protocols for preventing mother-to-child transmission (MTCT) of HIV, mental health-related factors have become increasingly relevant due to their potential to affect the women's quality of life, obstetric outcomes and risk of MTCT. This review synthesizes evidence from 53 peer-reviewed publications examining mental health-related variables in pregnant and postpartum HIV+ women. The presentation of results is organized by the level of socioeconomic resources in the countries where studies were conducted (i.e., high-, middle-, and low-income countries). It is concluded that psychiatric symptoms, particularly depression, and mental health vulnerabilities (e.g., inadequate coping skills) are widespread among pregnant HIV+ women globally and have a potential to affect psychological well-being, quality of life and salient clinical outcomes. The current body of evidence provides rationale for developing and evaluating clinical and structural interventions aimed at improving mental health outcomes and their clinical correlates in pregnant HIV+ women. PMID:24584458
Kapetanovic, Suad; Dass-Brailsford, Priscilla; Nora, Diana; Talisman, Nicholas
Postpartum depression (PPD) is a debilitating illness, yet little is known about its causes. The purpose of this study was to examine a major symptom of depression during the postpartum period, anhedonia, by comparing sucrose preference in female rats that had undergone actual pregnancy or hormone-simulated pregnancy (HSP) to their respective controls. Whereas HSP rats showed significantly less preference than vehicle-control rats for 1% sucrose solution during the first three weeks of the “postpartum” period, previously pregnant females showed only slightly depressed sucrose preference for the first 1–2 days postpartum, compared to non-pregnant controls. Habituation to 1% sucrose during the pregnancy period, which increased preference upon later testing in previously pregnant rats tested on postpartum day 2, did not significantly increase preference in HSP rats, suggesting that depressed preference in the latter group was not due to neophobia. Pre-treatment with desipramine did not prevent suppressed sucrose preference in HSP rats, and preference was even further suppressed following chronic sertraline treatment. These results suggest that estradiol withdrawal following HSP may cause anhedonia during the early “postpartum” period. In contrast, females that have undergone actual pregnancy are less likely to show this effect, suggesting that postpartum hormonal changes other than the dramatic decline in estradiol may buffer its negative mood effects.
Navarre, Brittany M.; Laggart, Jillian D.; Craft, Rebecca M.
Two experiments were carried out to investigate the effect of dry period supplementation with protein on milk production and composition in the subsequent early lactation period. In Experiment one, 87 Holstein\\/Friesian cows (including 18 first calvers) were blocked into groups of three on the basis of lactation number (first and second+) and expected calving date. Within each group, animals were
J. J. Murphy
Therehasbeensubstantialrecentinterestinshorten- ing dry periods; however, the effects of this manage- ment change on reproduction have not been adequately evaluated. Holstein cows (n = 58) were assigned in a randomized block design to 1 of 3 treatments: 1) tradi- tional (T) dry period (?56 d) in which cows were fed a low energy diet from 56 to 29 d prepartum followed
A. Gümen; R. R. Rastani; R. R. Grummer; M. C. Wiltbank
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
... register. I'm interested in: Pregnancy Baby growth & care Research Volunteer opportunities Advocacy in government For health ... acid During your pregnancy Your pregnant body Prenatal care Eating and nutrition Physical activity Emotional and life ...
... register. I'm interested in: Pregnancy Baby growth & care Research Volunteer opportunities Advocacy in government For health ... acid During your pregnancy Your pregnant body Prenatal care Eating and nutrition Physical activity Emotional and life ...
... register. I'm interested in: Pregnancy Baby growth & care Research Volunteer opportunities Advocacy in government For health ... acid During your pregnancy Your pregnant body Prenatal care Eating and nutrition Physical activity Emotional and life ...
Abstract Objectives. Adherence to medical treatment among women with Crohn's disease (CD) in the postpartum period has never been examined. The impact of breast-feeding on disease activity remains controversial. We aimed to assess rates of non-adherence to medical treatment among women with CD in the postpartum period. Further, to assess breast-feeding rates and the impact of breast-feeding on the risk of relapse. Methods. Within a population of 1.6 million, we identified 154 women with CD who had given birth within a 6-year period. We combined questionnaire data, data from medical records and public register data. We used logistic regression to estimate prevalence odds ratios (POR) for non-adherence, relapse and breast-feeding according to different predictors. Results. Among 105 (80%) respondents, 59 (56%) reported taking medication. Of these, 66.1% reported to be adherent to medical treatment. Fear of medication transmission to the breast milk was stated as the reason for non-adherence in 60%. Those who received counselling regarding medical treatment were less likely to be non-adherent (POR 0.55, 95% confidence interval [CI] 0.1-2.5). In total, 87.6% were breast-feeding. Breast-feeding rates did not vary by medical treatment. Predictors for relapse in CD were smoking (POR 1.85, 95% CI 0.62-5.54) and non-adherence among medical treated (POR 1.25, 95% CI 0.26-6.00). Breast-feeding seemed protective against relapse (POR 0.33, 95% CI 0.10-1.26). Conclusions. Adherence to medical treatment in the postpartum period was high, and counselling seemed to increase adherence. Relapse may be explained by non-adherence or smoking while breast-feeding seemed protective. PMID:24897523
Julsgaard, Mette; Nørgaard, Mette; Hvas, Christian Lodberg; Grosen, Anne; Hasseriis, Sara; Christensen, Lisbet Ambrosius
Effects of feeding dry glycerol to primiparous Holstein dairy cows on follicular development, reproductive performance and metabolic parameters related to fertility during the early post-partum period.
This study examined the effects of dry glycerol supplementation on follicular growth, post-partum interval to first ovulation, concentration of serum metabolites and hormones related to fertility, body condition score (BCS) and body weight (BW) in primiparous Holstein dairy cows. Sixty primiparous Holstein dairy cows were randomly assigned to two groups (control: n = 30 and glycerol supplemented: n = 30). Dry glycerol (250 g/day/cow) was fed as a top dressing to the common lactating total mixed ration (TMR) from parturition to 21 days post-partum. Ovaries were examined four times using ultrasonography on days 13, 19, 25 and 36 post-partum to determine ovarian follicular growth. Concentration of serum metabolites and hormones was determined weekly. Body condition score was evaluated weekly from weeks 1 to 5 after parturition, and BWs were recorded three times on days 1, 11 and 21 during the experimental period. The cows fed dry glycerol had more large follicles (p < 0.0001) and corpora lutea (CL) (p = 0.02) compared with the control cows. Days to the first ovulation (p = 0.06), days to first oestrus (p = 0.05), services per conception (p = 0.06) and days open (p = 0.004) were positively affected by dry glycerol supplementation. Serum concentration of glucose and insulin was higher in dry glycerol-supplemented cows (p = 0.1; p = 0.06, respectively). Feeding glycerol had no effect on mean serum concentrations of ?-hydroxybutyrate, non-esterified fatty acids and IGF-1 during the experimental period. However, significant differences were observed at concentration of BHBA and IGF-1 (p = 0.02 and p = 0.04, respectively) between two groups on day 21 after calving. The cows in the glycerol-fed group had higher serum progesterone concentrations on days 33 (p = 0.007) and 36 (p = 0.004) after calving. Supplemented cows had lower body condition loss during weeks 1-5 after calving compared with the control cows (0.34 vs 0.41 BCS). In week 13 post-partum, the proportion of cycling cows was 83.3 and 69.9% for those which received supplemented or non-supplemented diet, respectively. These results demonstrated that feeding dry glycerol as a glucogenic supply may be useful to improve negative energy balance and reproductive efficiency in young cows which calve with high requirement of energy. PMID:23772805
Karami-Shabankareh, H; Kafilzadeh, F; Piri, V; Mohammadi, H
The mean magnetic field dynamo theory is utilized to obtain the qualitative dependence of the period of activity on the angular velocity of rotation for stars with sufficiently extensive convective shells. The dependence of the cycle period on the spectral class is also discussed.
Kliorin, N. I.; Ruzmaykin, A. A.; Sokolov, D. D.
Background The HELLP syndrome (haemolysis, elevated liver enzymes, and low-platelet count) occurs in about 0.5 to 0.9% of all pregnancies. With occurrence of thrombocytopaenia, it signals for several potentially lethal conditions such as complete or partial HELLP syndrome, thrombotic thrombocytopaenic purpura and acute fatty liver of pregnancy. Case presentation A previously healthy 27-year-old, Sinhala ethnic primigravida with pregnancy-induced hypertension was admitted at 38 weeks of gestation with lower abdominal pain and a blood pressure of 140/90 mmHg. She underwent emergency Caesarian section due to faetal distress giving birth to a healthy baby girl. Since postpartum day one, she was having intermittent fever spikes. All the routine investigations were normal in the first three weeks. Platelet count started dropping from post-partum day-20 onwards. On day-23, she had developed a seizure and computed tomography scan brain showed a subdural haemorrhage. She had a platelet count of 22,000?×?109/liter and was managed conservatively. She also had elevated liver enzymes, lactate dehydrogenase and bilirubin levels. Blood picture on day-24 showed haemolytic anemia. On day- 36, patient again developed seizures and she was having intermittent fever with generalized headache and signs of meningism. Computed tomography scan revealed an acute on chronic subdural haemorrhage. Conclusions Hypertensive disorders in pregnancy should be managed as high-risk throughout the postpartum period. Development of thrombocytopaenia can be considered as an early warning sign for HELLP, thrombotic thrombocytopaenic purpura or acute fatty liver of pregnancy which are lethal conditions. Prompt recognition of intracranial haemorrhages and early neurosurgical intervention is lifesaving.
Postpartum thyroid dysfunction is found in 5-10% of women within one year after delivery. Dysfunction is developed from subclinical autoimmune thyroiditis through immune rebound mechanism and divided into 5 types. Most frequent one is destructive thyrotoxicosis, named as postpartum thyroiditis, which occur in early postpartum period and usually followed by transient hypothyroidism. Some of them progress into permanent hypothyroidism. Graves' disease is also developed mainly after 4 months postpartum and found in one out of 200 postpartum women in general population. Treatment of this dysfunction is principally the same as ordinal thyroid disease except for transient hypothyroidism. PMID:23214072
Amino, Nobuyuki; Ide, Akane; Tamai, Hidekazu
Women's experiences during late pregnancy and the early postpartum period were examined relative to time of discharge from the hospital Women who were discharged in 3 days or sooner were compared to women who were discharged after 3 days, with respect to fatigue. A rest and activity questionnaire was completed by the women in the third trimester of pregnancy, in
Elaine M. Carty; Christine Bradley; Wendy Winslow
The aim of this study was to evaluate the use of forage diets (grazing vs. hay) around the time of ewe parturition, on the fatty acids profile of suckling lamb meat (10-12kg body weight). Forty-eight multiparous single-bearing ewes were used. The experimental treatments were conducted during the last 5weeks of pregnancy and the 5weeks of lactation in a 2×2 factorial design. Ewes were fed ad libitum on pastures or hay in the autumn. Results showed that milk from grazing ewes during the pre-partum period had a higher content of PUFA and CLA (P<0.05) and VA, CLA in their suckling lambs' meat (P<0.05). The effect in post-partum feeding was greater, revealing higher CLA, PUFA/SFA, PUFA n-3 and PUFA n-6/n-3 in milk and meat (P<0.05). The CLA, VA and PUFA n-6/n-3 ratios are those that are most affected by grazing. Pre-partum grazing, regardless of post-partum feeding, improves FA composition, increasing CLA content in both milk and meat. PMID:22127148
Joy, M; Ripoll, G; Molino, F; Dervishi, E; Alvarez-Rodriguez, J
The petrology record on the Moon suggests that a cataclysmic spike in the cratering rate occurred ~700 million years after the planets formed; this event is known as the Late Heavy Bombardment (LHB). Planetary formation theories cannot naturally account for an intense period of planetesimal bombardment so late in Solar System history. Several models have been proposed to explain a
R. Gomes; H. F. Levison; K. Tsiganis; A. Morbidelli
Objective To examine socioeconomic status (SES) as a risk factor for depressive symptoms in late pregnancy and the early postpartum period. A secondary objective was to determine whether SES was a specific risk factor for elevated postpartum depressive symptoms beyond its contribution to prenatal depressive symptoms. Design Quantitative, secondary analysis, repeated measures, descriptive design. Setting Participants were recruited from paid childbirth classes serving upper middle class women and Medicaid-funded hospitals serving low-income clients in Northern California. Participants A sample of 198 first time mothers was assessed for depressive symptoms in their third trimester of pregnancy and at one, two, and three months postpartum. Main Outcome Measure Depressive symptoms were measured with the Center for Epidemiological Studies-Depression (CES-D) Scale. Results Low SES was associated with increased depressive symptoms in late pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk factors (low monthly income, less than a college education, unmarried, unemployed) were 11 times more likely than women with no SES risk factors to have clinically elevated depression scores at 3 months postpartum, even after controlling for the level of prenatal depressive symptoms. Conclusion Although new mothers from all SES strata are at risk for postpartum depression, SES factors including low education, low income, being unmarried, and being unemployed increased the risk of developing postpartum depressive symptoms in this sample.
Goyal, Deepika; Gay, Caryl; Lee, Kathryn A.
The study was conducted to correlate the periparturient immune status in terms of neutrophil functions and cytokine expression in peripheral blood mononuclear cell culture with impending postpartum reproductive disorders in buffaloes. Forty pregnant buffaloes were observed for occurrence of postpartum reproductive disorders (PRD), i.e., metritis, endometritis and delayed uterine involution etc., during one week prepartum to four weeks postpartum period. A representative number (n = 6) of buffaloes that did not develop any PRD were included in group I (healthy, control), while the animals which experienced PRD were assigned into group II (PRD, n = 8). The blood samples were collected at weekly interval from one week prepartum to four weeks postpartum period considering the day of calving as ‘d 0’. Differential leucocytes counts, superoxide and hydrogen peroxide production activity in isolated neutrophils and the mRNA expression profile of cytokines i.e., IL-2, IL-4 and IFN-? in PBMC culture were studied in all the samples. A higher total leucocytes, neutrophil and band cells count along with impaired neutrophil functions i.e., lowered level of production of superoxide and hydrogen peroxide before parturition and during early postpartum period were observed in buffaloes developing PRD. Further, a lower expression of IL-2, IFN-? and IL-4 mRNA in PBMC culture was observed at calving in buffaloes that subsequently developed PRD at later postpartum. Thus, suppression in neutrophil function and cytokine expression at prepartum to early postpartum period predisposes the buffaloes to develop postpartum reproductive disorders. Hence, monitoring of neutrophils function and cytokine expression profile would be effective to predict certain reproductive disorders at late pregnancy or immediately after parturition in buffaloes. In future, this may be a novel approach for determining suitable management and therapeutic decisions for prevention of commonly occurring reproductive disorders in farm animals.
Patra, Manas Kumar; Kumar, Harendra; Nandi, Sukdeb
A previously observed rise in the plasma viral load postpartum in both treated and untreated HIV-positive women remains unexplained. Virological and immunological markers were evaluated in HIV-negative controls and HIV-positive pregnant women with and without antiretroviral treatment. Plasma HIV RNA, CD4/CD8 T cells, and serum activation markers were sequentially measured during the third trimester, at delivery, and 2 to 8 weeks postpartum in a cohort of HIV-positive pregnant women (n = 96) enrolled in a maternal-fetal HIV transmission study and a control group of HIV-negative pregnant women (n = 28). Mean plasma HIV RNA (P = 0.003) increased from delivery to postpartum, and mean CD4 T cells (P = 0.002) and serum ?2-microglobulin (P < 0.0001) increased from the third trimester through postpartum among the HIV-positive women. Mean CD8 T cells increased from the third trimester through postpartum in women receiving zidovudine (ZDV) and in those not treated (P < 0.05) but remained stable in those on highly active antiretroviral therapy (HAART) and the HIV-negative controls. Increases in serum ?2-microglobulin were correlated with increases in HIV RNA (P = 0.01). HIV-positive pregnant women showed postpartum increases in plasma HIV RNA, CD4 T cells, and serum ?2-microglobulin regardless of the treatment regimen. The rise in CD4 T cells and ?2-microglobulin was also observed in HIV-negative pregnant women, suggesting hormonal changes and/or labor-induced cytokines may contribute to immune activation. Immune activation correlated with increased plasma HIV RNA in postpartum women despite treatment, although HAART appeared to blunt the effect. The observed rise in plasma HIV RNA postpartum, which correlated with markers of immune activation, may have implications for enhanced transmission to infants through early breast-feeding and to sexual partners.
Truong, Hong-Ha M.; Sim, Myung S.; Dillon, Maryanne; Uittenbogaart, Christel H.; Dickover, Ruth; Plaeger, Susan F.; Bryson, Yvonne J.
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
Pregnancy and lactation are times of physiologic stress during which bone turnover is accelerated. Previous studies have demonstrated that there is increased mobilization of lead from the maternal skeleton at this time and that calcium supplementation may have a protective effect. Ten immigrants to Australia were provided with either calcium carbonate or a complex calcium supplement (~ 1 g/day) during pregnancy and for 6 months postpartum. Two immigrant subjects who did not conceive acted as controls. Sampling involved monthly venous blood samples throughout pregnancy and every 2 months postpartum, and quarterly environmental samples and 6-day duplicate diets. The geometric mean blood lead at the time of first sampling was 2.4 ?g/dL (range, 1.4–6.5). Increases in blood lead during the third trimester, corrected for hematocrit, compared with the minimum value observed, varied from 10 to 50%, with a geometric mean of 25%. The increases generally occurred at 6–8 months gestation, in contrast with that found for a previous cohort, characterized by very low calcium intakes, where the increases occurred at 3–6 months. Large increases in blood lead concentration were found during the postpartum period compared with those during pregnancy; blood lead concentrations increased by between 30 and 95% (geometric mean 65%; n = 8) from the minimum value observed during late pregnancy. From late pregnancy through postpartum, there were significant increases in the lead isotopic ratios from the minimum value observed during late pregnancy for 3 of 8 subjects (p < 0.01). The observed changes are considered to reflect increases in mobilization of lead from the skeleton despite calcium supplementation. The identical isotopic ratios in maternal and cord blood provide further confirmation of placental transfer of lead. The extra flux released from bone during late pregnancy and postpartum varies from 50 to 380 ?g lead (geometric mean, 145 ?g lead) compared with 330 ?g lead in the previous cohort. For subjects replete in calcium, the delay in increase in blood lead and halving of the extra flux released from bone during late pregnancy and postpartum may provide less lead exposure to the developing fetus and newly born infant. Nevertheless, as shown in several other studies on calcium relationships with bone turnover, calcium supplementation appears to provide limited benefit for lead toxicity during lactation.
Gulson, Brian L.; Mizon, Karen J.; Palmer, Jacqueline M.; Korsch, Michael J.; Taylor, Alan J.; Mahaffey, Kathryn R.
Effect of PGF2? and GnRH on the reproductive performance of postpartum dairy cows subjected to synchronization of ovulation and timed artificial insemination during the warm or cold periods of the year.
This study was designed to evaluate the reproductive performance of lactating dairy cows (Holstein Friesian) after the injection of PGF2? analogue on Day 15 postpartum, and GnRH analogue on Day 23 after artificial insemination (AI) with Presynch (two injections of PGF2?, administered 14 days apart starting at 30-35 days postpartum) + Ovsynch-based (GnRH-7 days-PGF2?-2 days-GnRH-16-20 hours-timed artificial insemination) treatments, during the warm and cold periods of the year. All the cows (n = 313) were assigned to one of the four groups including: M1 (n = 72) in which the cows were treated with PGF2? on Day 15 postpartum + Presynch-Ovsynch + GnRH on Day 23 post-AI; M2 (n = 41) in which the cows received PGF2? on Day 15 postpartum + Presynch-Ovsynch; M3 (n = 100) including the cows that got Presynch-Ovsynch; and control group (n = 100) including the cows that were not treated and were inseminated at natural estrus. Pregnancy diagnosis was performed 28 to 35 days post-insemination by means of ultrasound. The results showed that treatment with PGF2? on Day 15 postpartum significantly decreased the days to conception and the number of services per conception (P < 0.01) and it also improved the first service conception rate (P < 0.1) only in cows that were treated with M2 protocol. Whereas, the days to first service was not influenced by the treatment of PGF2? on Day 15 postpartum (P > 0.05). In contrast, administration of GnRH on Day 23 post-AI increased the days to conception and the number of service per conception (P < 0.01) and tended to decrease the first service conception rate (P < 0.1) in cows that were treated with M1 compared with M2 protocol. Therefore, it was concluded that Presynch-Ovsynch protocol could be more reproductive and beneficial when a single treatment with PGF2? was administered at 15 days postpartum (15 days after the PGF2?, Presynch-Ovsynch protocol was initiated). Interestingly, the administration of a GnRH agonist on Day 23 post-AI not only did not improve the reproductive performance of the cows receiving first postpartum timed artificial insemination after Presynch-Ovsynch protocol but also reduced that. PMID:24934375
Akbarabadi, M Afsari; Shabankareh, H Karami; Abdolmohammadi, A; Shahsavari, M H
The Late Maunder Minimum (LMM; 1675-1715) delineates a period with marked climate variability within the Little Ice Age in Europe. Gridded monthly mean surface pressure fields were reconstructed for this period for the eastern North Atlantic-European region (25°W-30°E and 35-70°N). These were based on continuous information drawn from proxy and instrumental data taken from several European data sites. The data
J. Luterbacher; R. Rickli; C. Tinguely; E. Xoplaki; E. Schüpbach; D. Dietrich; J. Hüsler; M. Ambühl; C. Pfister; P. Beeli; U. Dietrich; A. Dannecker; T. D. Davies; P. D. Jones; V. Slonosky; A. E. J. Ogilvie; P. Maheras; F. Kolyva-Machera; J. Martin-Vide; M. Barriendos; M. J. Alcoforado; M. F. Nunes; T. Jónsson; R. Glaser; J. Jacobeit; C. Beck; A. Philipp; U. Beyer; E. Kaas; T. Schmith; L. Bärring; P. Jönsson; L. Rácz; H. Wanner
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
3 Abstract: This experiment was carried out to investigate the effect dietary calcium level and vitamin-D on 3 calcium and phosphorus concentrations in plasma and eggshell of laying hens in late production period. Two hundred forty 70 weeks white lohman LSL laying hens were randomly assigned to ten groups equally (n=24) each treatment was replicates six times. Experimental diets were
S. Canan Bölükbasi; Saban Çelebi; Necati Utlu
The North Atlantic and Western Europe regions comprise a key area to study climate variations in the form of cold relapses which may be a possible manifestation of reduced ocean circulation. By using multi-proxy data of the late Maunder Minimum period, temperature and precipitation distribution during winter was studied in connection with atmospheric circulation, with the goal of obtaining an
H. Wanner; C. Pfister; R. Brázdil; P. Frich; K. Frydendahl; T. Jónsson; J. Kington; H. H. Lamb; S. Rosenørn; E. Wishman
Forty-four dairy ewes were placed at lambing under long (n = 22) or short (n = 22) artificial photoperiods. In each photoperiodic treatment 2 diets (high or low) were offered to 11 group-fed ewes. The duration of the anovulatory period (DAP, in d) was estimated by bi-weekly blood progesterone measurements. Within 2 months, ewes exposed to the long photoperiod had no resumption of ovulation, while most of the ewes (18/22) exposed to the short photoperiod ovulated. In vivo measurements of body composition (D2O) showed that the shortest DAP (ie 36 d) was observed for ewes which gained 1 kg body lipids during the first month postpartum. Above and below this threshold, DAP increased. Other relationships between DAP and ewe body composition variations (dynamic) and/or total chemical body mass (static) were determined. In dairy ewes, it seems that the dynamic aspects are more closely related to DAP than the static aspects. Results were compared to the available literature on anestrus in dairy cows. PMID:8240683
Bocquier, F; Kann, G; Thimonier, J
Background Research has shown that exposure to interpersonal violence is associated with poorer mental health outcomes. Understanding the impact of interpersonal violence on mental health in the early postpartum period has important implications for parenting, child development, and delivery of health services. The objective of the present study was to determine the impact of interpersonal violence on depression, anxiety, stress, and parenting morale in the early postpartum. Methods Women participating in a community-based prospective cohort study (n?=?1319) completed questionnaires prior to 25 weeks gestation, between 34–36 weeks gestation, and at 4 months postpartum. Women were asked about current and past abuse at the late pregnancy data collection time point. Postpartum depression, anxiety, stress, and parenting morale were assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale, the Spielberger State Anxiety Index, the Cohen Perceived Stress Scale, and the Parenting Morale Index, respectively. The relationship between interpersonal violence and postpartum psychosocial health status was examined using Chi-square analysis (p?0.05) and multivariable logistic regression. Results Approximately 30% of women reported one or more experience of interpersonal violence. Sixteen percent of women reported exposure to child maltreatment, 12% reported intimate partner violence, and 12% reported other abuse. Multivariable logistic regression analysis found that a history of child maltreatment had an independent effect on depression in the postpartum, while both child maltreatment and intimate partner violence were associated with low parenting morale. Interpersonal violence did not have an independent effect on anxiety or stress in the postpartum. Conclusion The most robust relationships were seen for the influence of child maltreatment on postpartum depression and low parenting morale. By identifying women at risk for depression and low parenting morale, screening and treatment in the prenatal period could have far-reaching effects on postpartum mental health thus benefiting new mothers and their families in the long term.
Postpartum depression (PPD) affects up to 15% of mothers. Recent research has identified several psychosocial and biologic risk factors for PPD. The negative short-term and long-term effects on child development are well-established. PPD is under recognized and under treated. The obstetrician and pediatrician can serve important roles in screening for and treating PPD. Treatment options include psychotherapy and antidepressant medication. Obstacles to compliance with treatment recommendations include access to psychotherapists and concerns of breastfeeding mothers about exposure of the infant to antidepressant medication. Further research is needed to examine systematically the short-term and long-term effect of medication exposure through breastmilk on infant and child development.
Pearlstein, Teri; Howard, Margaret; Salisbury, Amy; Zlotnick, Caron
Background Depression is a common disorder affecting 10–15% women in the postpartum period. Postpartum depression can disrupt early mother-infant interaction, and constitutes a risk factor for early child development. Recently, attention has been drawn to the hypothesis that a low intake of seafood in pregnancy can be a risk factor for postpartum depression. Seafood is a unique dietary source of the marine omega-3 fatty acids and is a natural part of a healthy balanced diet that is especially important during pregnancy. Methods In a community based prospective cohort in a municipality in Western Norway, we investigated both nutritional and psychological risk factors for postpartum depression. The source population was all women who were pregnant within the period November 2009 - June 2011. The fatty acid status in red blood cells was assessed in the 28th gestation week and participants were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) three months after delivery. The aim of the present study was to investigate if a low omega-3 index in pregnancy is a possible risk factor for postpartum depression. Results In a simple regression model, the omega-3 index was associated with the EPDS score in a nonlinear inverse manner with an R square of 19. Thus, the low omega-3 index explained 19% of the variance in the EPDS score. The DPA content, DHA content, omega-3 index, omega-3/omega-6 ratio, total HUFA score, and the omega-3 HUFA score were all inversely correlated with the EPDS score. The EPDS scores of participants in the lowest omega-3 index quartile were significantly different to the three other omega-3 index quartiles. Conclusion In this study population, a low omega-3 index in late pregnancy was associated with higher depression score three months postpartum.
Markhus, Maria Wik; Skotheim, Siv; Graff, Ingvild Eide; Fr?yland, Livar; Braarud, Hanne Cecilie; Stormark, Kjell Morten; Malde, Marian Kjellevold
This study was conducted to determine effects of dietary NaHCO supplementation on egg 3 production and egg quality during the late laying period. Hisex Brown layers, 54 wks of age, were blocked according to the cage location and then assigned randomly to receive one of four diets containing 0, 0.1, 0.2, or 0.4% NaHCO for 75 d. Each diet was
Aiming at seeded precipitation of aluminate solution with high caustic ratio(?k>2.4), corresponding to the late period of seeded precipitation, the influence of different types of seed on precipitation ratio was explained with respect to solution structure in the interface of seed and the evolution of Al(OH)3 growth units in this layer. The effects of solid content and seed size on
Xiao-bin LI; Gang-tao FENG; Qiu-sheng ZHOU; Zhi-hong PENG; Gui-hua LIU
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
This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB) study (N = 4,075) were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women's health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women's health care.
DiBari, Jessica N.; Yu, Stella M.; Chao, Shin M.; Lu, Michael C.
This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB) study (N = 4,075) were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women's health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women's health care. PMID:24693433
DiBari, Jessica N; Yu, Stella M; Chao, Shin M; Lu, Michael C
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.
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The petrology record on the Moon suggests that a cataclysmic spike in the cratering rate occurred approximately 700 million years after the planets formed; this event is known as the Late Heavy Bombardment (LHB). Planetary formation theories cannot naturally account for an intense period of planetesimal bombardment so late in Solar System history. Several models have been proposed to explain a late impact spike, but none of them has been set within a self-consistent framework of Solar System evolution. Here we propose that the LHB was triggered by the rapid migration of the giant planets, which occurred after a long quiescent period. During this burst of migration, the planetesimal disk outside the orbits of the planets was destabilized, causing a sudden massive delivery of planetesimals to the inner Solar System. The asteroid belt was also strongly perturbed, with these objects supplying a significant fraction of the LHB impactors in accordance with recent geochemical evidence. Our model not only naturally explains the LHB, but also reproduces the observational constraints of the outer Solar System. PMID:15917802
Gomes, R; Levison, H F; Tsiganis, K; Morbidelli, A
Occurring in about 12 percent of postpartum women, postpartum depression has been focus of considerable research. Variables that have been correlated with postpartum depression range from biological causes, to lack of social support, to relationship with husband, to attributional styles, to psychodynamic explanations. There is need for more…
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. PMID:22279118
Tavlasoglu, Murat; Kurkluoglu, Mustafa; Arslan, Zekeriya; Durukan, Ahmet Baris
Objective To identify challenges that women face 2–9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment\\u000a Monitoring System (PRAMS). Methods PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and\\u000a experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states\\u000a who
Sarojini Kanotra; Denise D’Angelo; Tanya M. Phares; Brian Morrow; Wanda D. Barfield; Amy Lansky
We determined the effect of calcium supplementation on bone mineral density (BMD) and bone mineral content (BMC) and identified predictors of bone mass changes in adolescent mothers 6 months postpartum. A prospective, analytical, clinical study was performed in adolescent mothers (< or = 19 years old; n = 37) from La Plata, Argentina. At 15 days postpartum, mothers were randomly assigned into one of two groups and started with calcium supplementation; one group received dairy products (932 mg Ca; n = 19) and the other calcium citrate tablets (1000 mg calcium/day; n = 18). Weight, height and dietary intake were measured and BMD was determined by DEXA at 15 days (baseline) and 6 months postpartum. BMC, total body BMD and BMD were assessed in lumbar spine, femoral neck, trochanter and total hip. Regression models were used to identify the relationship of total body BMD and BMC with independent variables (calcium supplementation, months of lactation, weight at 6 months, percent weight change, lean mass at 6 months, percent lean mass change, total calcium intake). Results showed that changes in BMD and BMC at the different sites were similar in both groups, and changes in percent body weight and total calcium intake were the main predictive factors. In conclusion, the effect of calcium was similar with either form of supplementation, i.e., dairy products or tablets, and changes in percent body weight and total calcium intake were predictors of total body BMD and BMC changes. PMID:23477205
Malpeli, Agustina; Apezteguia, María; Mansur, José L; Armanini, Alicia; Macías Couret, Melisa; Villalobos, Rosa; Kuzminczuk, Marta; Gonzalez, Horacio F
A case of remarkable silent anuria caused by bilateral nephrolithiasis in the post-partum period is reported. The anuria was not associated with any kind of pain and the diagnosis was not revealed until three days postpartum when an intravenous pyelography was carried out. Differential diagnosis and management of nephrolithiasis are discussed. Ultrasound scanning is recommended as a routine procedure for all patients with signs and symptoms of renal dysfunction during pregnancy. PMID:3425236
Jakobson, J; Norman, M; Ulmsten, U; Westgren, M
The variation in the period distribution function of late-type binaries is studied. It is shown that the Taurus-Auriga pre-main-sequence population and the main-sequence G dwarf sample do not stem from the same parent period distribution with better than 95 per cent confidence probability. The Lupus, Upper Scorpius A, and Taurus-Auriga populations are shown to be compatible with being drawn from the same initial period function (IPF), which is inconsistent with the main-sequence data. Two possible IPF forms are used to find parent distributions to various permutations of the available data, which include Upper Scorpius B (UScB), Chameleon, and Orion Nebula Cluster pre-main-sequence samples. All the pre-main-sequence samples studied here are consistent with the hypothesis that there exists a universal IPF that is modified by binary-star disruption if it forms in an embedded star cluster leading to a general decline of the observed period function with increasing period. The pre-main-sequence data admit a log-normal IPF similar to that arrived at by Duquennoy & Mayor (1991, A&A, 248, 485) for main-sequence stars, provided the binary fraction among pre-main-sequence stars is significantly higher. However, for consistency with proto-stellar data, the possibly universal IPF ought to be flat along the log-P or log-semi-major axis and must be similar to the K1 IPF form derived by means of inverse dynamical population synthesis, which has been shown to lead to the main-sequence period function if most stars form in typical embedded clusters.
Kroupa, P.; Petr-Gotzens, M. G.
Post-partum eclampsia is an unfrequent entity (11 to 44 % of eclampsia), which can sometimes occur late, beyond the 48th hour. We report a case of late post-partum eclampsia which occurred 12 days after an uncomplicated pregnancy and delivery. Post-partum eclampsia differs from antepartum by a pauci symptomatic or unexpected context. The mortality rate is comparable with that of the ante-partum eclampsia. Brain
B. Bedel; G. Cartron; C. Vayssière; O. Parant
Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the first described postpartum endocrine syndrome and consists on a hypophyse necrosis in relation with a hypovolemic shock during delivery. The immunologic consequences of the pregnancy are the most frequent, sometimes discrete and transitory. The physiological evolution of the endocrine glands during pregnancy and the most frequent post-partum endocrine syndromes are discussed: postpartum lymphocytic hypophysitis, thyroiditis and Sheehan' syndrome. PMID:18314279
Ducarme, G; Châtel, P; Luton, D
Climate was the main factor that influenced environment in Late Glacial. The general warming trend was interrupted by cooling periods. This fluctuations had a great impact on the lakes environment not only directly by the changing temperature and precipitation but also indirectly influencing, among others, vegetation cover changes and intensity of erosion which consecutively effected lake productivity. In this study we analyzed the sediments of Lake ?ukie located in East part of Poland in ??czna-W?odawa Lake District, beyond the reach of the last glaciation. In present time lake ?ukie is shallow, eutrophic lake and its area do not extend 140ha. The aim of this study was to find out how lake ecosystem changed in Late Glacial under the influence of the climate. In order to reconstruct those changes we did several analysis: subfossil Cladocera, macrofossil, pollen, chemical composition of the sediment (TOC, OC, IC, SiO2biog, SiO2ter). The chronology was based on palinology and correlated with the lake Perespilno chronology which was based on the laminated sediments and several 14C data (lake Perespilno is located 30 km east of ?ukie lake). Our results show that during Late Glacial lake ?ukie ecosystem changed dynamically. Its history started in Older Dryas, whan the lake was shallow with low biodiversity. The erosion played very important role in the sediment formation as the vegetation cover was sparse, dominated by shrubs and grasses. The Allerod warming caused the deepening of the lake and the increase of biodiversity and productivity. The pine - birch forests developed. At the end of this period fishes appeared in the lake. The Younger Dryas cooling marked very visibly in all the results but though the productivity decreased the biodiversity maintained high. The vegetation cover become more open, with high share of grasses, which caused the increase in the erosion of the catchment. At the end on YD sudden change in lake ecosystem happened, probably caused by the water level drop. This dramatic event was probably caused by the changes in the ground water circulation connected with the permafrost disappearance.
Zawiska, Izabela; S?owi?ski, Micha?; Obremska, Milena; Woszczyk, Micha?; Milecka, Krystyna
Background Few studies measure physical activity objectively or at multiple time points during postpartum. We describe physical activity at 3- and 12-months postpartum among a cohort of women using both self-reported and objective measures. Methods In total, 181 women completed the 3-month postpartum measures, and 204 women completed the 12-month postpartum measures. Participants wore an Actigraph accelerometer for one week and completed in-home interviews that included questions on physical activity. A cohort of 80 women participated at both time points. Poisson regression models were used to determine whether physical activity differed over time for the cohort. Results For the cohort, average counts/minute were 364 at 3-months postpartum and 394 at 12-months postpartum. At both time periods for the cohort, vigorous activity averaged 1 to 3 minutes/day, and moderate activity (NHANES cutpoints) averaged 16 minutes/day. Sedentary time averaged 9.3 hours at 3-months postpartum and 8.8 hours at 12-months postpartum, out of a 19-hour day. Average counts/minute increased and sedentary behavior declined from 3- to 12-months postpartum. Conclusion Interventions are needed to help women integrate more moderate to vigorous physical activity and to capitalize on the improvements in sedentary behavior that occur during postpartum.
Evenson, Kelly R.; Herring, Amy H.; Wen, Fang
Background: A better understanding of risk factors associated with postpartum psychosis may contribute to the better management. Aims: This study was to identify the risk factors contributing to postpartum psychosis. Materials and Methods: In this cross-sectional, case control study 100 patients of postpartum psychosis (PP) were compared with the healthy controls. Risk factors explored were sociodemographic factors (age, education, occupation, income, and family type); positive family history; pregnancy and perinatal factors (number of antenatal check-up, parity, and complications during pregnancy, perinatal phase or in newborn); and presence of husband during peripartum period. Data were analyzed by graph pad instat software using chi square test and Fisher's exact test. Results: Total of 64% patients and 42% controls were less than 25 years of age (P = 0.001). Among the patients, 62% were primiparae compared with 46% in the controls (P = 0.02). Per capita family income was less than 5000 INR in 72% patients and 56% controls (P = 0.01). Maternal complications during perinatal period were observed in 38% patients and 22% controls (P = 0.01), while the complications in newborns were seen in 21% patients and 8% controls (P = 0.009). Husband was present in 58% patients and 76% controls. (P = 0.006). Conclusions: The risk factors related to PP were younger age, lower per capita income, perinatal and neonatal complications, and absence of husband in peripartum phase.
Upadhyaya, Suneet Kumar; Sharma, Archana; Raval, Chintan M
Postpartum psychosis is a rare, however severe mood disorder in the perinatal period. It is most commonly associated with postpartum bipolar disorder. The author reports a case where a male patient with psychosis was admitted to the psychiatric unit 5 days after his wife gave birth to their male child. The patient was very concerned about the well being of his child and was afraid that something bad would happen to his child. The patient was diagnosed with an acute manic episode with psychotic symptoms and treated with olanzapine and lithium. The patient has been continued on therapeutic dose of lithium without any relapse of the symptoms, 3 months after the initial episode. The role of psychological stress in precipitating such a severe mood or psychotic disorder needs to be highlighted.
The Late Maunder Minimum (LMM; 1675-1715) delineates a period with marked climate variability within the Little Ice Age in Europe. Gridded monthly mean surface pressure fields were reconstructed for this period for the eastern North Atlantic-European region (25°W-30°E and 35-70°N). These were based on continuous information drawn from proxy and instrumental data taken from several European data sites. The data include indexed temperature and rainfall values, sea ice conditions from northern Iceland and the Western Baltic. In addition, limited instrumental data, such as air temperature from central England (CET) and Paris, reduced mean sea level pressure (SLP) at Paris, and monthly mean wind direction in the Øresund (Denmark) are used. The reconstructions are based on a canonical correlation analysis (CCA), with the standardized station data as predictors and the SLP pressure fields as predictand. The CCA-based model was performed using data from the twentieth century. The period 1901-1960 was used to calibrate the statistical model, and the remaining 30 years (1961-1990) for the validation of the reconstructed monthly pressure fields. Assuming stationarity of the statistical relationships, the calibrated CCA model was then used to predict the monthly LMM SLP fields. The verification results illustrated that the regression equations developed for the majority of grid points contain good predictive skill. Nevertheless, there are seasonal and geographical limitations for which valid spatial SLP patterns can be reconstructed. Backward elimination techniques indicated that Paris station air pressure and temperature, CET, and the wind direction in the Øresund are the most important predictors, together sharing more than 65% of the total variance. The reconstructions are compared with additional data and subjectively reconstructed monthly pressure charts for the years 1675-1704. It is shown that there are differences between the two approaches. However, for extreme years the reconstructions are in good agreement.
Luterbacher, J.; Rickli, R.; Tinguely, C.; Xoplaki, E.; Schüpbach, E.; Dietrich, D.; Hüsler, J.; Ambühl, M.; Pfister, C.; Beeli, P.; Dietrich, U.; Dannecker, A.; Davies, T. D.; Jones, P. D.; Slonosky, V.; Ogilvie, A. E. J.; Maheras, P.; Kolyva-Machera, F.; Martin-Vide, J.; Barriendos, M.; Alcoforado, M. J.; Nunes, M. F.; Jónsson, T.; Glaser, R.; Jacobeit, J.; Beck, C.; Philipp, A.; Beyer, U.; Kaas, E.; Schmith, T.; Bärring, L.; Jönsson, P.; Rácz, L.; Wanner, H.
Background: Postpartum women are a population at risk for sedentary living. Physical activity (PA) prior to pregnancy may be effective in predicting similar behaviour in the postpartum period. Objective: To test a composite version of the extended transtheoretical model (TTM) by adding "past behaviour" in order to predict PA behaviour…
Roozbahani, Nasrin; Ghofranipour, Fazlollah; Eftekhar Ardabili, Hassan; Hajizadeh, Ebrahim
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
This study reports on developmental patterning in the intralimb indices of Late/Final Jomon period (4000-2300 BP) people. Jomon foragers represent the descendants of migrants from Northeast Asia, who arrived in the Japanese Islands around 20,000 BP. Among adults, Jomon brachial indices are elevated and similar to warm adapted, low latitude people, while crural indices are intermediate and similar to people from moderate latitudes. Two hypotheses regarding the development of intralimb indices among Jomon period foragers are tested: (1) intralimb indices of Jomon people maintain predicted ecogeographic relationships over ontogeny; (2) greater evolvability will be observed in the brachial index, while greater developmental constraint will be observed in the crural index. Changes in intralimb proportions in a Jomon skeletal growth series are compared to those in two contrasting samples: Inuit from Point Hope (cold adapted) and Nubians from Kulubnarti (warm adapted). A quadratic equation best describes the ontogeny of brachial and crural indices, with high indices in infancy followed by a decline in childhood and an increase in adolescence. Despite these shifts, ecogeographically predicted differences and similarities in the indices are maintained between samples throughout ontogeny. In addition, radial relative to humeral length is significantly less correlated than tibial relative to femoral length. These results suggest genetic conservation of intralimb indices over the course of development. However, radial and humeral lengths are less correlated than tibial and femoral lengths among Jomon subadults and adults, potentially suggesting greater evolvability of the brachial index and more developmental constraint on the crural index. PMID:21541923
Temple, Daniel H; Okazaki, Kenji; Cowgill, Libby W
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
Objectives. To determine, among immigrants, what ethnocultural variables predict postpartum infant?care behaviours over and above other maternal and infant characteristics.Methods. We recruited a cohort of immigrant women on hospital postpartum units. Data on predictor variables were collected during face?to?face interviews in the early postpartum period. Follow?up telephone interviews occurred at 3 months postpartum to assess infant?care behaviours. We identified 411
Nancy C. Edwards
The main objectives of this study was to reconstruct climate impact on the functioning of Lake ?ukie and its catchment (??czna W?odawa Lake District, East European Plain) during Late Glacial period. In order to reconstruct climatic fluctuations and corresponding ecosystem responses, we analysed lake sediments for pollen, subfossil Cladocera, plant macrofossils and chemical composition of the sediment. Of these, plant macrofossils and Cladocera were used to infer minimum and mean July temperatures and ordination analysis was used to examine biotic community shifts. Multiproxy analyses of late-glacial sediments of Lake ?ukie clearly show that the main driver of aquatic and terrestrial ecosystems as well as geomorphological processes in the catchment was climate variation. The history of the lake initiated during the Older Dryas. In that period, ??czna W?odawa Lake District was covered by open habitats dominated by grasses (Poaceae), humid sites were occupied by tundra plant communities with less clubmoss (Selaginella selaginoides), dry sites by dominated by steppe-like vegetation with light-demanding species such as Helianthemum, Artemisia, Chenopodiaceae, and juniper bushes (Juniperus). Cold climate limited the growth and development of organisms in the lake, Cladocera community species composition was poor, with only few species present there all the time. During this time period, permafrost was still present in the ground limiting infiltration of rainwater and causing high erosion in the catchment area. Surface runoff is confirmed by the presence of sclerotia of Cenococcum geophilum and high terrigenous silica content. The warming of the early Allerød caused a remarkable change in the natural environment of this area. This is in accordance with the temperature rise reconstructed with the use of plant macrofossils though the Cladocera reconstruction did not recorded the rise than. This temperature increase resulted in turnover of vegetation in the catchment of Lake ?ukie, pioneer birch-pine forests dominated, later replaced by pine-birch forests. Consequently this limited the erosion. The results of all proxy suggest the water-lever rise in lake ?ukie. The Younger Dryas cooling in the region began about 12 630 14C years BP and recorded in significant drop in temperature reconstructed with plant macrofossils and Cladocera. The cooling resulted in a decline of forest communities and development of open habitats with grasses (Poaceae), Artemisia, and Chenopodiaceae), as well as juniper thickets (Juniperus) At the end of the Younger Dryas, plant communities changed, the non-arborescent pollen declined, while pollen of trees (especially Pinus) became more abundant. This change was more abruptly reflected in Cladocera and aquatic pollen results and is probably related to gradual climate warming. This study is a contribution to the Virtual Institute ICLEA (Integrated Climate and Landscape Evolution Analysis) funded by the Helmholtz Association, projects UMO-2011/01/B/ST10/07367 and N N306 036436 founded by National Science Center, Poland.
Zawiska, Izabela; S?owi?ski, Micha?; Correa-Metrio, Alex; Obremska, Milena; Luoto, Tomi; Nevalainen, Liisa; Woszczyk, Micha?; Milecka, Krystyna
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.
The lymphocyte subsets and the percentages of activated T cells or regulatory T cells were observed during the course of postpartum thyroiditis (PPT). Heparin anticoagulant vein bloods were collected at 3, 6, 9 and 12 months postpartum consequently from 27 PPT patients and 23 normal postpartum subjects. Lymphocyte surface antigen CD3, CD4, CD8, HLA-DR and CD25 were stained in appropriate combination and detected with fluorescence-activated cell sorter analysis. The percentage of CD4 was significantly lower in both PPT groups with biphasic diseases and isolated hypothyroidism at 3 months postpartum as compared to control postpartum women separately (both P < 0.05). Then, decreased CD4/CD8 ratios were also appeared in these groups. Patients with both positive TPOAb and TgAb had higher percentage of activated T (HLA-DR(+)CD3(+)) cells compared to control postpartum women at 3 months postpartum (P < 0.05). The percentage of activated T cells correlated with a raised percentage of CD8(+) T cell subset (P < 0.001) and a decreased percentage of regulatory T (CD25(+)CD4(+)) cells (P < 0.01). The percentages of regulatory T cells were significantly higher in control postpartum women at 3, 6 and 9 months postpartum compared with non-postpartum women (P < 0.05). However, it was lower in PPT patients at 3 months compared to itself at 6 and 9 months postpartum (P < 0.05). In the early postpartum period of PPT patients, a reduced helper/inducer T cell subset, an increased percentage of activated T cells and a reduced percentage of regulatory T cells were reported, indicating that T cells may play a key role in the pathogenesis of PPT. PMID:19418019
Shi, Xiaoguang; Li, Chenyang; Li, Yushu; Guan, Haixia; Fan, Chenling; Teng, Ying; Ouyang, Yuhong; Shan, Zhongyan; Teng, Weiping
The Polallie eruptive period of Mt. Hood, Oregon, is the last major episode of eruption and dome growth, before the late Holocene activity which was centered at Crater Rock. A volume of 4–8 km3 of Polallie deposits forms an apron of ca. 60 km2 on the east, northeast and southeast flanks. The Polallie deposits can be divided, stratigraphically, into four
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…
Bedny, Marina; Pascual-Leone, Alvaro; Dravida, Swethasri; Saxe, Rebecca
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
Background Maternal depression during pregnancy has been studied less than depression in postpartum period. The aims of this study were to find out the prevalence of prepartum and postpartum depression and the risk factors associated in a cohort of Afro-Jamaican pregnant women in Jamaica. Methods The Zung self-rating depression scale instrument was administered to 73 healthy pregnant women at 28 weeks gestation and at 6 weeks postpartum for quantitative measurement of depression. Blood samples were collected at 8, 28, 35 weeks gestation and at day 1 and 6 weeks postpartum to study the thyroid status. Results Study demonstrated depression prevalence rates of 56% and 34% during prepartum and postpartum period, respectively. 94% women suffering depression in both periods were single. There were significant variations in both FT3 and TT4 concentrations which increased from week 8 to week 28 prepartum (p < 0.05) and then declined at the 35th week (p < 0.05 compared with week 28) and 1 day post delivery study (p < 0.05 compared with week 35). The mean values for TSH increased significantly from week 8 through week 35. The mean values at 1 day postpartum and 6 week postpartum were not significantly different from the 35 week values. For FT3, TT4 and TSH there were no significant between group differences in concentrations. The major determinants of postpartum depression were moderate and severe prepartum depression and change in TT4 hormone concentrations. Conclusion High prevalence of depression was found during pre- and postpartum periods. Single mothers, prepartum depression and changes in TT4 were factors found to be significantly associated with postpartum depression.
Wissart, Janice; Parshad, Omkar; Kulkarni, Santosh
The purpose of this study was to identify a serological marker of successful treatment as distinct from treatment failure\\u000a in late Lyme borreliosis. Consecutive serum samples from 68 treated patients with late Lyme borreliosis were analyzed during\\u000a a 1–2 year follow-up period after the start of treatment. End-point enzyme immunoassay titres of IgG1, IgG2, IgG3, and combined\\u000a IgG1+3 subclasses against
J. Panelius; I. Seppälä; H. Granlund; D. Nyman; P. Wahlberg
Subacute, silent, and postpartum thyroiditis are temporary forms of thyroid dysfunction caused by thyroid gland inflammation. They classically present with a triphasic course: a brief period of thyrotoxicosis due to release of preformed thyroid hormone that lasts for 1 to 3 months, followed by a more prolonged hypothyroid phase lasting up to 6 months, and eventual return to a euthyroid state. However, the types and degree of thyroid dysfunction are variable in these disorders, and individual patients may present with mild or more severe cases of thyrotoxicosis alone, hypothyroidism alone, or both types of thyroid dysfunction. PMID:22443972
Samuels, Mary H
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.
OBJECTIVE To determine the rate of adherence to postpartum glycemic testing in women with gestational diabetes mellitus (GDM) and the performance of fasting plasma glucose (FPG) versus the 75-g oral glucose tolerance test (OGTT) in detecting postpartum glucose intolerance. RESEARCH DESIGN AND METHODS The study was a retrospective cohort of 1,006 women with GDM attending a pregnancy diabetes clinic. RESULTS Postpartum screening was completed in 438 (48%) women. Women nonadherent to testing had higher parity (1.10 vs. 0.87) and were less likely to require insulin for management of their GDM. Among women who were tested, 89 (21%) had an abnormal result, only 25 (28%) of whom were identified by FPG. Factors associated with abnormal postpartum diabetes screening include non-Caucasian ethnicity, previous GDM, higher A1C, and OGTT values during pregnancy and treatment with insulin. CONCLUSIONS The rate of postpartum diabetes screening is low, and FPG lacks sensitivity as a screening test in comparison with OGTT.
Kwong, Sarah; Mitchell, Rebecca S.; Senior, Peter A.; Chik, Constance L.
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
Iron deficiency in the postpartum period is common and associated with impaired quality of life. Interpretation of ordinary laboratory parameters is considered to be simple in postpartum women, as normalization of pregnancy induced physiological changes is assumed to take place in the early postpartum period. We have studied changes in erythrocyte and iron parameters during the first 11 postpartum months. Erythrocyte parameters and iron markers, serum ferritin, and soluble transferrin receptor (sTfR), and an inflammation marker, neopterin, were investigated in healthy mothers 6 weeks (n = 104), 4 months (n = 100), and 11 months (n = 43) after giving birth to a term infant. Healthy nonpregnant and nonlactating women (n = 61) were included as controls. The hemoglobin level increased throughout the first 11 postpartum months and was significantly higher from 4 months on, compared to control women. At all time points, the mothers had significantly lower mean corpuscular volume (MCV) and higher erythrocyte count and percentage of hypochromic erythrocytes. sTfR levels were significantly higher over the whole serum ferritin distribution during the first 4 postpartum months compared to the controls, indicative of an increased cell production. At 6 weeks, postpartum mothers had higher neopterin levels and this was associated with markers of a low iron status, not including sTfR. Substantial changes in erythrocyte and iron parameters were observed in the postpartum period, consistent with an increased, but iron restricted erythropoiesis. The increased erythropoietic activity was reflected in higher sTfR concentrations. Given the vital role for iron in both mothers and infants, further studies are warranted for establishing proper cut off levels for sTfR as an iron marker in postpartum women. PMID:22526367
Bjørke-Monsen, Anne-Lise; Torsvik, Ingrid Kristin; Ueland, Per Magne; Sætran, Hege Aase; Sandberg, Sverre
Objective To compare maternal competence and responsiveness in mothers of late preterm infants (LPIs) with mothers of full-term infants. Design A nonexperimental repeated-measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers and the relationship of the theoretical antecedents to these outcomes. Setting Urban academic medical center. Participants Mothers of late preterm infants (34–36, 6/7-weeks gestation) and mothers of term infants (?37-weeks gestation), including primiparas and multiparas. Data were collected after delivery during the postpartum hospital stay and again at 6-weeks postpartum. Methods Descriptive and inferential analysis. Results A total of 70 mothers completed both data collection periods: 49 term mothers and 21 LPI mothers. There were no differences between the two groups related to their perception of competence or responsiveness at delivery or 6-weeks postpartum. At 6-weeks postpartum, none of the assessed factors in the model was significantly related to competence or responsiveness. Conclusions The results, which may have been limited by small sample size, demonstrated no difference in the perceptions of LPI and term mothers related to competence or responsiveness. Maternal stress and support were significantly related to other factors in the model of maternal competence and responsiveness.
Baker, Brenda; McGrath, Jacqueline M.; Pickler, Rita; Jallo, Nancy; Cohen, Stephen
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.
The analysis of a wide sample of stars including both main-sequence and evolved stars shows that while flux-flux correlations are the same for the whole sample, the flux-period relations show a lower dependence of period for evolved stars. A gravity depen...
B. Montesinos C. Jordan
Climatic records from Greenland ice and Baltic Sea provide as well information about global climate changes as about local basin peculiarities. Late Quaternary sediments have been accumulated in the Baltic Basin with high accumulation rates, qualifying them for the study of late Pleistocene to Holocene climate and environmental history in Northern Europe and the North Atlantic realm. Physical and geochemical properties have been successfully used as proxies for paleo-temperature, primary production, hydrographic circulation pattern. The variability of these sediment parameters mirror changing depositional conditions determined by climatically-driven sea level change and glacio-isostatic adjustment which controls the coupling of the Baltic Sea’s hydrographical regime with the world ocean. During the late Holocene when the Baltic basin was permanently connected with the Atlantic Ocean the dynamics of the atmospheric circulation of the North Atlantic, but also its modification due to the variation of Eurasian anticyclones is reflected in the facies of sediments in the Baltic Sea varying on the centennial scale. On the other hand, there are components within the sedimentary facies that express environmental parameters that are periodically changing at annual to decadal scales. Changes in the salinity of the depositional basin reconstructed by diatom analysis play an important role, here. Data records provided by the Greenland Ice Sheet Project Two serve as proxy measure of climate conditions during Holocene on the global scale. We have compared different sediment proxies from the Baltic Basin with climate relevant ice core data from Greenland. Refined with Singular Spectrum Analysis, all the records have been analyzed on periodicity via Fourier analysis. Time series analysis covering a time span of the last 11.000 years reveals different periods of climate proxy-parameters. Decomposed and noise-free signals demonstrate the obvious presence of ‘global’ components with concordant periods of about 900, 500 and 400 years in both records. Particularly prominent is a 900 year period found in Baltic, North Atlantic, and Greenland proxy data seems to be of global relevance. This period, also present in late Quaternary sun activity reconstructions, explains not only the Late Glacial to Middle Holocene record, but also to the more recent climate variations from the Dark Ages to the Medieval Climate Optimum, the Little Ice Age, and the Modern Warm Period. According to our data analysis the current phase of anthropogenic global warming coincides with a phase of naturally increasing temperature of the atmosphere. Periodicity analysis allows the development of future projections (scenarios) of the development of climate parameters based on mathematical models of proxy-data variability from sediments and ice cores. According to results of these projections, our planet is now towards the end of an ascending temperature cycle within a global process with a 900 years period.
Harff, J.; Endler, R.; Kotov, S.; Leipe, T.; Witkowski, A.
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
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 pregnancy. Women (N = 183) with biochemically confirmed cigarette abstinence at the end of pregnancy were recruited between February 2003 and November 2006. Women self-reported demographic information and weight before pregnancy. Smoking status and weight were documented at the end of pregnancy and at 6, 12, and 24 weeks postpartum. Breastfeeding was reported at 6 weeks postpartum. Differences in weight retention by relapse status at each assessment were evaluated. To examine weight retention in the presence of conceptually relevant covariates, mixed models with log-transformed weight data were used. At 24 weeks postpartum, 34.6% of women remained abstinent. Women who remained abstinent throughout the 24-week period retained 4.7 ± 2.1 kg more than did women who had relapsed by 6 weeks postpartum, P = 0.03. This difference in postpartum weight retention was significant after controlling for relevant covariates (age, race, breastfeeding, and pregravid BMI). Resumption of smoking within the first 6 weeks following childbirth is associated with decreased postpartum weight retention, even after controlling for breastfeeding and pregravid weight. Interventions to sustain smoking abstinence postpartum might be enhanced by components designed to minimize weight retention.
Levine, Michele D.; Cheng, Yu; Marcus, Marsha D.; Kalarchian, Melissa A.
Purpose: To investigate changes in mothers' body dissatisfaction from delivery to 9 months postpartum, and the relationship of postpartum body dissatisfaction to weight, other health, and social characteristics. Methods: In this prospective longitudinal study, 506 mothers completed surveys at 0–1 and 9 months postpartum. Postpartum changes in body dissatisfaction and weight were evaluated by paired t-tests, and predictors of postpartum
Dwenda Gjerdingen; Patricia Fontaine; Scott Crow; Patricia McGovern; Michael Miner
The sympathetic nervous system and children's sleep serve critical arousal regulation functions. Shortened pre-ejection period, a reliable indirect index of greater sympathetic nervous system activity, has been associated with reduced sleep duration and quality in adults, but limited evidence exists in children regarding associations between pre-ejection period and sleep. We examined relations between pre-ejection period reactivity in response to a laboratory-based stressor and multiple parameters of actigraphy-based sleep duration and quality in children. The sample included 123 boys and 112 girls [mean age = 11.31 years, standard deviation (SD) = 0.63 years]. Controlling for body mass index, sex and pre-ejection period baseline, increased sympathetic nervous system reactivity, indexed by a lower level of pre-ejection period during the challenge than the baseline, was associated with worse sleep quality indicated by lower sleep efficiency, greater sleep activity and greater long wake episodes. The findings add to a small literature on relations between sympathetic nervous system functioning and children's sleep, suggesting that poor sleep quality is related to dysregulation of this stress response system. PMID:24372764
Bagley, Erika J; El-Sheikh, Mona
Acute exacerbations may complicate the course of pregnancy and the postpartum period in patients with relapsing-remitting multiple sclerosis (RRMS). To evaluate relapse rate and the effect of immunomodulatory treatment with intravenous immunoglobulin (IVIg) during pregnancy and the postpartum period we retrospectively analysed the data of 108 pregnant RRMS patients. Group I patients were not treated, Group II patients were treated
Anat Achiron; Irena Kishner; Mark Dolev; Yael Stern; Mordechai Dulitzky; Eyal Schiff; Reuven Achiron
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.
The expression patterns of transforming growth factor beta 1 (TGF??), urokinase-type plasminogen activator (uPA) and uPA receptor (uPAR) were analysed after artery ligation-induced myocardial infarction (MI) in the rat myocardium. uPA and uPAR expressions were significantly increased both at transcriptional and protein level during early phase post MI period (uPA at 1 hour and uPAR at 24 hours post infarction). TGF?1 mRNA expression profile revealed a significant increase of TGF?1 expression from day 4 up to 8 weeks post infarction. These data suggest that the need for an increasing TGF?? bioavailability during the post-infarction period in rat myocardium is achieved in the early post MI period by an increased expression of uPA/uPAR proteolytic system (indirect activation of latent TGF??) and in the late post MI period by direct regulation of TGF?? expression. It is therefore concluded that differential regulation of the TGF?? bioavailability may be a crucial step of the repair mechanisms during the post MI infarction period in the rat myocardium. PMID:20952728
Stavropoulou, Anastasia; Philippou, Anastassios; Halapas, Antonios; Sourla, Antigone; Pissimissis, Nikolaos; Koutsilieris, Michael
This review summarises the psychiatry of the puerperium, in the light of publications during the past 5 years. A wide variety of disorders are seen. Recognition of disorders of the mother-infant relationship is important, because these have pernicious long-term effects but generally respond to treatment. Psychoses complicate about one in 1000 deliveries. The most common is related to manic depression, in which neuroleptic drugs should be used with caution. Post-traumatic stress disorder, obsessions of child harm, and a range of anxiety disorders all require specific psychological treatments. Postpartum depression necessitates thorough exploration. Cessation of breastfeeding is not necessary, because most antidepressant drugs seem not to affect the infant. Controlled trials have shown the benefit of involving the child's father in therapy and of interventions promoting interaction between mother and infant. Owing to its complexity, multidisciplinary specialist teams have an important place in postpartum psychiatry. PMID:14751705
This study clarifies the causes of the repetitive occurrences of such phenomena as rinderpest, epidemic, famine, and tiger disasters recorded in the Joseon Dynasty Chronicle and the Seungjeongwon Journals in the period of great catastrophe, the late 17th century in which the great Gyeongsin famine (1670~1671) and the great Eulbyeong famine (1695~1696) occurred, from the perspective that they were biological exchanges caused by the new arrival of rinderpest in the early 17th century. It is an objection to the achievements by existing studies which suggest that the great catastrophes occurring in the late 17th century are evidence of phenomena in a little ice age. First of all, rinderpest has had influence on East Asia as it had been spread from certain areas in Machuria in May 1636 through Joseon, where it raged throughout the nation, and then to the west part of Japan. The new arrival of rinderpest was indigenized in Joseon, where it was localized and spread periodically while it was adjusted to changes in the population of cattle with immunity in accordance with their life spans and reproduction rates. As the new rinderpest, which showed high pathogenicity in the early 17th century, was indigenized with its high mortality and continued until the late 17th century, it broke out periodically in general. Contrastively, epidemics like smallpox and measles that were indigenized as routine ones had occurred constantly from far past times. As a result, the rinderpest, which tried a new indigenization, and the human epidemics, which had been already indigenized long ago, were unexpectedly overlapped in their breakout, and hence great changes were noticed in the aspects of the human casualty due to epidemics. The outbreak of rinderpest resulted in famine due to lack of farming cattle, and the famine caused epidemics among people. The casualty of the human population due to the epidemics in turn led to negligence of farming cattle, which constituted factors that triggered rage and epidemics of rinderpest. The more the number of sources of infection and hosts with low immunity increased, the more lost human resources and farming cattle were lost, which led to a great famine. The periodic outbreak of the rinderpester along with the routine prevalence of various epidemics in the 17thcentury also had influenced on domestic and wild animals. Due to these phenomenon, full-fledged famines occurred that were incomparable with earlier ones. The number of domestic animals that were neglected by people who, faced with famines, were not able to take care of them was increased, and this might have brought about the rage of epidemics like rinderpest in domestic animals like cattle. The great Gyeongsin and Eulbyeong famines due to reoccurrence of the rinderpest in the late 17th century linked rinderpester, epidemics and great famines so that they interacted with each other. Furthermore, the recurring cycle of epidemics-famines-rinderpest-great famines constituted a great cycle with synergy, which resulted in eco-economic-historical great catastrophes accompanied by large scale casualties. Therefore, the Gyeongsin and Eulbyeong famines occurring in the late 17th century can be treated as events caused by the repetition of various periodic disastrous factors generated in 1670~1671 and in 1695~1696 respectively, and particularly as phenomena caused by biological exchanges based on rinderpester., rather than as little ice age phenomena due to relatively long term temperature lowering. PMID:24804681
Kim, Dong Jin; Yoo, Han Sang; Lee, Hang
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 participants in Project Viva who enrolled during early pregnancy from 1999 to 2002. Logistic regression models estimated odds ratios of SPPWR for sleep categories, controlling for sociodemographic, prenatal, and behavioral attributes. Of the 940 women, 124 (13%) developed SPPWR. Sleep distributions were as follows: 114 (12%) women slept ?5 hours/day, 280 (30%) slept 6 hours/day, 321 (34%) slept 7 hours/day, and 225 (24%) slept?8 hours/day. Adjusted odds ratios of SPPWR were 3.13 (95% confidence interval (CI): 1.42, 6.94) for ?5 hours/day, 0.99 (95% CI: 0.50, 1.97) for 6 hours/day, and 0.94 (95% CI: 0.50, 1.78) for ?8 hours/day versus 7 hours/day (p = 0.012). The adjusted odds ratio for SPPWR of 2.05 (95% CI: 1.11, 3.78) was twofold greater (p = 0.02) for a decrease in versus no change in sleep at 1 year postpartum. Sleeping ?5 hours/day at 6 months postpartum was strongly associated with retaining ?5 kg at 1 year postpartum. Interventions to prevent postpartum obesity should consider strategies to attain optimal maternal sleep duration.
Gunderson, Erica P.; Rifas-Shiman, Sheryl L.; Oken, Emily; Rich-Edwards, Janet W.; Kleinman, Ken P.; Taveras, Elsie M.; Gillman, Matthew W.
BACKGROUND: Hypogastric artery ligation is a therapeutic option for severe post-partum haemorrhage. Little is known about the outcomes of subsequent fertility and pregnancy. We studied these parameters in women who required hypogastric artery ligation for severe post-partum haemorrhage in our institution over a 13-year period. METHODS: All patients who required hypogastric artery ligation for severe intractable post-partum haemorrhage from January,
J. Nizard; L. Barrinque; R. Frydman; H. Fernandez
Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression. PMID:19238520
Howell, Elizabeth A; Mora, Pablo A; DiBonaventura, Marco D; Leventhal, Howard
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.
Cows in negative energy balance after calving often have reduced reproductive performance, which is mediated by metabolic signals. The objective of these studies was to determine the association of serum metabolites, days to first postpartum ovulation, milk production, cow BW change, BCS, and calf performance with conception date in spring-calving 2- and 3-yr-old beef cows grazing native range. In Exp. 1, cows were classified by conception date in a 60-d breeding season as early (EARLY; conceived in first 15 d of breeding) or late conception (LATE; conceived during the last 45 d of breeding). Beginning on d 35 postpartum, blood samples were collected twice per week for serum metabolite analysis and progesterone analysis to estimate days to resumption of estrous cycles. As a chute-side measure of nutrient status and glucose sufficiency, whole-blood ?-hydroxybutyrate (BHB) concentrations were measured 14 ± 2 d before breeding. In Exp. 2, cows were classified by subsequent calving date resulting from a 55 ± 2 d breeding season as conceiving either early (EARLY; conceived in first 15 d of breeding) or late (LATE; conceived during the remaining breeding season). Blood samples were collected in 2 periods, 30 ± 4 d before calving and 14 ± 3 d before the initiation of breeding, to determine circulating concentrations of IGF-I and BHB. In Exp. 1, BHB and serum glucose concentrations were less (P ? 0.04) in EARLY cows than LATE cows. Serum insulin concentrations were greater (P = 0.03) in EARLY cows relative to LATE cows. Milk production and composition did not differ (P ? 0.24) by conception date groups. In Exp. 2, cow age × sample period × conception date interaction (P < 0.01) occurred for serum BHB concentrations. Serum BHB concentrations were similar (P > 0.10) for 2-yr-old cows (in greater nutritional plane compared with Exp. 1) regardless of their conception date classification and sampling period. However, precalving serum BHB concentrations were greater (P < 0.01) for LATE than EARLY in 3-yr-old cows with no difference (P = 0.86) at prebreeding. Serum IGF-1 concentrations were greater (P < 0.01) for EARLY cows relative to LATE cows at precalving and prebreeding. This study indicates that blood BHB concentrations during times of metabolic dysfunctions may provide a more sensitive indicator of energy status than body condition, predicting rebreeding competence in young beef cows as measured by interval from calving to conception. PMID:23478827
Mulliniks, J T; Kemp, M E; Endecott, R L; Cox, S H; Roberts, A J; Waterman, R C; Geary, T W; Scholljegerdes, E J; Petersen, M K
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
Smallpox was one of the most dreadful epidemic diseases in Korea until the early twentieth century. In the Chos?n period, smallpox came to prevail more frequently and vigorously, and many people died of the disease. To cope with smallpox, the society of Chos?n had various modes of measures, though they were not always effective, which included the government's rituals, medical men's prescriptions, and folk's recipes. Among various responses to smallpox, the recipes of folklore seem to be very interesting. While attitude toward other contagious diseases (e.g., typhoid fever, or malaria) mainly consisted of exorcism, smallpox was believed to be the passage of the smallpox deity. Sonnim (which means guest), through the body of patient for certain time span, and gods of smallpox were treated hospitably. This attitude toward smallpox was deeply rooted in Korean shamanism, and partly in the natural history of the disease. From 1876 smallpox vaccination was reintroduced and practiced. There were, however, a lot of difficulties in practice of vaccination due to distrust and prejudice. and traditional dealings with smallpox, in spite of vaccination, didn't disappear even after the Japanese compulsory occupation. PMID:11618926
Kim, O J
One couple's experience of a postpartum mental illness that led to the tragedy of infanticide is described. A case background is presented to highlight significant objective data relevant to a previous pregnancy. Individual recommendations are made to the health care profession on how to better intervene with families experiencing a postpartum psychiatric illness. Nursing implications are discussed. PMID:2206762
Comitz, S; Comitz, G; Semprevivo, D M
This study was conducted to evaluate the effects of indigenous herbal supplements on growth, blood metabolites and carcass characteristics in the late fattening period of Hanwoo steers. In a 6 month feeding trial, thirty Hanwoo steers (647±32 kg) were allotted to one of 5 treatment groups, control (basal diet contained lasalocid), licorice, clove, turmeric and silymarin, with six steers per pen. All groups received ad libitum concentrate and 1 kg rice straw/animal/d throughout the feeding trial. Blood samples were collected at the beginning, middle, and the end of the experiment and the steers were slaughtered at the end. Blood glucose, triglyceride, total protein, and albumin concentrations were higher in the turmeric treatment compared with other treatments. Blood urea nitrogen and creatinine concentrations were highest (p<0.003 and p = 0.071, respectively) in steers treated with silymarin. Alanine aminotransferase activity was lower (p<0.06) for licorice and silymarin compared with the control group. There were no alterations in serum aspartate aminotransferase and gamma glutamyltransferase activities as a consequence of herb treatments (p = 0.203 and 0.135, respectively). Final body weight, body weight gain, average dairy gain and dry matter intake were not significantly different among treatments. Yield grade, marbling score and quality grade were higher for silymarin group than those of the control group (p<0.05). Therefore, the results suggest that silymarin can be used an effective dietary supplement as an alternative to antibiotic feed additive and a productivity enhancer, providing safe and more consumer acceptable alternative to synthetic compounds during the late fattening period of steers.
Kim, D. H.; Kim, K. H.; Nam, I. S.; Lee, S. S.; Choi, C. W.; Kim, W. Y.; Kwon, E. G.; Lee, K. Y.; Lee, M. J.; Oh, Y. K.
The Polallie eruptive period of Mt. Hood, Oregon, is the last major episode of eruption and dome growth, before the late Holocene activity which was centered at Crater Rock. A volume of 4-8 km 3 of Polallie deposits forms an apron of ca. 60 km 2 on the east, northeast and southeast flanks. The Polallie deposits can be divided, stratigraphically, into four groups: Group I rockslide avalanche and pyroclastic-flow deposits; Group II debris-flow and pyroclastic-flow deposits that suggest some explosive activity and remobilization of pyroclastic debris in a glacial environment; Group III block-and-ash flow deposits that attest to summit dome growth; Group IV alternating debris-flow deposits, glacial sediments, and reworked pyroclastic-flow deposits that indicate a decrease in dome activity and an increase in erosion and transport. Group III clearly indicates frequent episodes of dome growth and collapse, whereas Groups II and IV imply increasing erosion and, conversely, decreasing volcanic activity. The Polallie period occurred in the late Pleistocene during and just after the last Alpine glaciation, which is named Evans Creek in the Cascade Range. According to four K-Ar age dates on lava flows interbedded with Polallie deposits and to published minimum 14C ages on tephra and soils overlying these deposits, the Polallie period had lasted 15,000-22,000 years between 28-34 ka and 12-13 ka. From stratigraphic subdivisions, sedimentary lithofacies and features and from the grain-size and geochemical data, we infer that the Polallie depositional record is a result of the interplay of several processes acting during a long-lasting period of dome growth and destruction. The growth of several domes near the present summit was intermittent, because each group of sediments encompasses primary (pyroclastic) and secondary (volcaniclastic and epiclastic) deposition. Direct deposition of primary material has occurred within intervals of erosion that have probably included meltwater processes from snow and ice fields. Interactions of hot pyroclastic debris with glacier ice that capped the mountain at that time contributed to release meltwater, enhancing the remobilization of primary deposits.
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. PMID:21725836
Mott, Sarah L; Schiller, Crystal Edler; Richards, Jenny Gringer; O'Hara, Michael W; Stuart, Scott
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
Postpartum hemorrhage is the outstanding cause of maternal mortality, and a redoubtable contributor to puerperal death from other causes, notably infection and renal failure. The clinical situations in which hemorrhage is liable to occur must be better known, so that anticipatory and preventive measures can be taken. Recent knowledge about defibrinated blood in women with degenerative changes at the placental site must be incorporated in the thinking and practice of physicians dealing with obstetrical cases. The indications, limitations, and hazards of the various anesthetic methods available for parturient women should be carefully considered in the circumstances of each case. ImagesFigure 1.Figure 2.Figure 3.
Melody, George F.
BackgroundHyper ammonia is well described cause of postpartum coma. It can be a consequence of inherited enzyme defects in the urea cycle. Severe forms present in the neonatal period with symptoms ranging from lethargy, seizures or even coma. With milder enzyme deficiencies, onset can be later in life and ammonia accumulation occurs during periods of stress such as sepsis, surgery
S Muzerengi; A Salek-Haddadi
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
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
Research on Middle-Late Woodland and Mississippian subsistence-settlement change has modified substantially the traditional models of late fall, coastal to interior transhumance patterns along the southeastern Atlantic Coast. The archeological, ethnohisto...
M. J. Brooks V. Canouts
Postpartum women have highly disturbed sleep, also known as sleep fragmentation. Fragmentation extends their total sleep period, also disrupting sleep timing. A stable and earlier sleep period among non-postpartum populations is related to better performance, physical health, and mental health. However, sleep timing has not been examined among postpartum women who are also vulnerable to daytime impairment. The study objective was to examine how the timing and regularity of sleep during the early postpartum period are related to daytime functioning across postpartum weeks 2-13. In this field-based study, 71 primiparous women wore an actigraph, a small wrist-worn device that monitors sleep and sleep timing, for the 12-week study period. Mothers self-administered a 5-min psychomotor vigilance test (PVT) each morning to evaluate the number of >500ms response lapses. They also completed a Morningness-Eveningness scale at the beginning of the study to identify chronotype. After controlling for maternal age, earlier sleep timing was associated with significantly fewer PVT lapses at postpartum weeks 9,12; a more stable sleep midpoint was associated with significantly fewer PVT lapses at postpartum weeks 2,5-13. Earlier sleep midpoints were related to more stable sleep midpoints at postpartum week 2 and a morning-type chronotype. An earlier sleep midpoint was also associated with a reduced slope of worsening PVT lapses across weeks. Across the first 12 postpartum weeks, women with earlier or more stable sleep periods had less daytime impairment than women with later or more variable sleep midpoints. Postpartum women with earlier sleep midpoints also showed less severe decrements in performance across time, which has been attributed to cumulative impacts of sleep disturbance. These data suggest that the sleep period, in addition to sleep duration and fragmentation, should be more closely examined, particularly among vulnerable women, as it may affect the neurobehavioral performance of new mothers. PMID:24041725
McBean, Amanda L; Montgomery-Downs, Hawley E
Recent studies using oxygen isotopes from conodont apatite and carbonate clumped isotopes suggest that the transition from the Early Ordovician warm period (greenhouse) to the Latest Ordovician glacial period (icehouse) occurred in two stages- cooling during the Early and Middle Ordovician and another, more abrupt cooling in the Latest Ordovician (Hirnantian). These results come from samples collected at time intervals of >0.5 My; therefore, the data does not resolve orbital-scale climatic changes. This study utilizes oxygen isotopes from conodont apatite collected across multiple, orbital-scale carbonate cycles (or parasequences) in the early Late Ordovician to evaluate high-frequency paleoclimate changes. More specifically, we are addressing whether the observed carbonate cycles formed in response to orbital-scale, glacio-eustasy and to shed light on the dynamics of the Ordovician warm-to-cool climatic transition. The Upper Ordovician (early Katian) Lexington Limestone of Kentucky is characterized by cyclic carbonates and shales deposited in southern subtropical waters of the Laurentian craton. Orbital-scale (~15-130 ky) subtidal cycles (1-3 m) are composed of offshore limestone and shale, overlain by lower shoreface, then upper shoreface skeletal carbonates and show no evidence of subaerial exposure at cycle tops. ?18Oapatite values from multiple cycles range from ~18-19.5%. The majority of cycles record low isotopic values in the deepest water facies (during sea-level rise and highstand) and higher isotopic values in the shallowest water facies (during sea-level fall and lowstand). The magnitude of isotopic shift across individual cycles is up to ~1%. Estimated subtropical SSTs range from ~28°-34°C. If the intracycle isotopic shifts were due only to SST changes, then the temperatures fluctuated up to 4°C during individual cycle formation; estimated thermo-eustatic changes given these SST changes are not sufficient in magnitude to generate the observed offshore to upper shoreface facies changes. We suggest that similar to the Pleistocene, the measured isotopic shifts were due to a combination of SST and ice-volume effects. If we assume Pleistocene relationships for partitioning of SST versus ice-volume effects, this suggests orbital-scale glacio-eustatic sea-level changes of many tens of meters along with SST changes of <2°C. Such magnitudes of glacio-eustasy imply that high-latitude continental ice sheets were waxing and waning at orbital time scales at least 6 My before the peak Hirnantian glacial period and that orbital-scale, glacial-interglacial cycles were superimposed upon the long-term Ordovician cooling trend- a pattern similar to that observed during the more recent Cenozoic cooling trend.
Elrick, M.; Reardon, D.; Labor, W. A.
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 larger study of northern and rural Ontario women's stories of help-seeking for PPD. The interpretive description approach was used to illustrate the complexity of women's spousal connections in PPD. Data from a purposive community sample of 27 women who self-identified as having been diagnosed with PPD was used. From the verbatim transcribed interviews a number of data excerpts were identified and labeled as "my husband" stories. Narrative analysis was employed to examine these stories. Results During this time of vulnerability, the husbands' physical, emotional and cognitive availability positively contributed to the women's functioning and self-appraisals as wife and mother. Their representations of their husbands' 'doing for' and/or 'being with' promoted their well-being and ultimately protected the family. Conclusion Given that husbands are perceived to be central in mitigating women's suffering with PPD, the consistent implementation of a triad orientation, that includes woman, child and partner rather than a more traditional and convenient dyadic orientation, is warranted in comprehensive postpartum care. Finally, this study contributes a theoretical understanding of responsive as well as reactive connections between women and family members during the postpartum period.
Montgomery, Phyllis; Bailey, Pat; Purdon, Sheri Johnson; Snelling, Susan J; Kauppi, Carol
Postpartum urinary retention is an uncommon event that occurs in 0.7 to 0.9% of vaginal deliveries. An ignorance of this situation can lead to delayed diagnosis worsening the prognosis and to inadequate treatments. This complication is defined as the absence of spontaneous micturition within 6hours of vaginal delivery with a bladder volume above 400mL. The etiology depends on multiple factors. Because of physiological changes during pregnancy, the bladder is hypotonic with an increased post-void residual volume. The occurrence of a perineal neuropathy during delivery may cause a urinary retention. Risk factors are primiparity, prolonged labour, instrumental delivery and perineal lacerations. Treatment consists on clean intermittent catheterization and recovery occurs generally in 72hours. Persistent urinary retention is the principal short-term complication and should be treated by clean intermittent self-catheterization. Long-term consequences are poorly reported in the literature. PMID:21193140
Bouhours, A C; Bigot, P; Orsat, M; Hoarau, N; Descamps, P; Fournié, A; Azzouzi, A-R
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 postpartum dose of Rh immune globulin varies according to an individual laboratory estimation of fetal red blood cells in each mother's peripheral blood. In the United States, a four-step procedure determines the postpartum dose (number of vials of 300 micrograms; 1,500 international units) of Rh immune globulin (anti-D) for each RhD-negative mother who has delivered an RhD-positive newborn and has not already formed anti-D. The first step is a rosette fetal red blood cell screen to determine whether an excessive (greater than 30 mL fetal whole blood) fetomaternal hemorrhage occurred. If the rosette screen is negative, the mother receives one vial of Rh immune globulin for Rh immunoprophylaxis. If the rosette screen is positive, the blood sample is retested by a quantitative method, typically an acid-elution (Kleihauer-Betke) assay. The result of the acid-elution assay is converted to an estimation of the volume of the fetomaternal hemorrhage, which is the basis for calculating the dose of Rh immune globulin. The acid-elution assay is subjective, imprecise, and poorly reproducible. As a result, the formula for calculating the dose includes a precautionary adjustment, adding an extra vial in borderline situations to prevent underdosing. Flow cytometry is a more precise method for quantifying a fetomaternal hemorrhage. However, few hospitals use flow cytometry, because it is not cost-effective to maintain an expensive, high-technology laboratory service for the relatively few occasions when a precise quantitative determination of fetomaternal hemorrhage is required. PMID:23168770
Sandler, S Gerald; Gottschall, Jerome L
Several ancient Mayan vessels from the Kislak Collection of the US Library of Congress were examined for the presence of alkaloids. One of them, a codex-style flask, bears a text that appears to read yo-'OTOT-ti 'u-MAY, spelling y-otoot 'u-may 'the home of its/his/her tobacco'. Samples extracted from this Late Classic period (600 to 900?AD) container were analyzed by gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS) methods. Nicotine was identified as the major component of the extracts. LC/MS analyses also yielded signals due to nicotine mono-oxides. The identities of the compounds were determined by comparison of the chromatographic and/or mass spectral characteristics with those from standards and literature data. High-resolution high mass accuracy tandem mass spectrometry (MS/MS) spectra of protonated nicotine and nicotine mono-oxides were measured to verify and to correct previous product ion assignments. These analyses provided positive evidence for nicotine from a Mayan vessel, indicating it as a likely holder of tobacco leafs. The result of this investigation is the first physical evidence of tobacco from a Mayan container, and only the second example where the vessel content recorded in a Mayan hieroglyphic text has been confirmed directly by chromatography/mass spectrometry trace analysis. PMID:22279016
Zagorevski, Dmitri V; Loughmiller-Newman, Jennifer A
We are conducting a multiproxy, regional reconstruction of climate variability during the last two millennia including the Medieval Warm Period (MWP) and Little Ice Age (LIA) in eastern North America. Pollen, benthic foraminifers, ostracodes, and other proxies were analyzed from high-resolution sampling of continuous sedimentary records from lakes, wetlands, and estuaries in Florida, North Carolina, Chesapeake Bay, and Lake Champlain. These records document multi-decadal changes in vegetation, temperature, precipitation, and estuarine salinity across a latitudinal transect. During both the MWP and LIA, decreased precipitation altered plant community composition and distribution in the southeastern United States, and the LIA triggered threshold changes in vegetation that persisted until anthropogenic land-cover change overwhelmed the climate signature. In the mid-Atlantic region, progressively cooler and wetter late Holocene springs culminated in a cool, wet LIA; this trend correlates with observed oceanic changes. Trend analysis of the data suggest that inter-regional correlation of multi-decadal and centennial-scale Holocene climate events will be forthcoming.
Willard, D. A.; Cronin, T. M.; Hayo, K. M.
This study was conducted to evaluate the effects of dietary supplementation of catechins and wheat bran on growth performance, carcass characteristics and meat color using forty-eight Hanwoo steers. Each steer was randomly assigned to one of four treatments. Treatments were as follows: control, catechins, wheat bran, and catechins+wheat bran (CW). At the end of the feeding trial, blood samples were collected for analysis of hemoglobin and iron concentration, and then steers were slaughtered at a commercial abattoir. Catechins, wheat bran, and CW had no effect on growth performance and carcass characteristics. Percentage of myoglobin in M. longissimus dorsi was not affected by treatments. Percentage of oxymyoglobin was increased (p<0.05) by CW and maintained at the highest level (p<0.05) for CW during meat display time up to 24 h. Percentage of metmyoglobin was the lowest (p<0.05) for CW between 5 and 24 h during display time. Although blood iron concentration was not affected by treatments, total concentration of muscle iron was the lowest (p<0.05) for CW compared with that of other treatments. Therefore, the results of the present study suggest that CW may provide good protection against oxidation of myoglobin, and might be an effective dietary supplement for improving meat color in the late fattening period of Hanwoo steers.
Kim, Do Hyung; Oh, Young Kyoon; Jang, Sun Sik; Kwon, Eung Gi; Seol, Yong Joo; Ok, Ji Un; Park, Keun Kyu; Lee, Sung Sill; Kim, Kyoung Hoon
An agency program designed to reduce the incidence of teenage pregnancy and meet the needs of school age mothers found that assertive postpartum services were essential to preserve prenatal gains. (Author/SE)
Cartoff, Virginia G.
OBJECTIVE: The objective is to provide an overview of the clinical features, prognosis, differential diagnosis, evaluation, and treatment of postpartum psychosis.\\u000aMETHODS: 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.\\u000aRESULTS:
Dorothy Sit; Anthony J. Rothschild; Katherine L. Wisner
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. PMID:22663185
Kreitchmann, Regis; Harris, D Robert; Kakehasi, Fabiana; Haberer, Jessica E; Cahn, Pedro; Losso, Marcelo; Teles, Elizabete; Pilotto, Jose H; Hofer, Cristina B; Read, Jennifer S
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.
Rationale\\/Objectives Prior studies using a dual-choice conditioned place preference (CPP) procedure revealed that postpartum female rats (dams)\\u000a strongly prefer chambers associated with pups over those associated with subcutaneously administered cocaine almost exclusively\\u000a during early but not late postpartum (Mattson et al. 2001). The present study examines whether early postpartum dams retain strong pup-associated chamber preference when contrasted\\u000a with a cocaine stimulus
Katharine M. Seip; Joan I. Morrell
Climatic records from Greenland ice and Baltic Sea provide as well information about global climate changes as about local basin peculiarities. Late Quaternary sediments have been accumulated in the Baltic Basin with high accumulation rates, qualifying them for the study of late Pleistocene to Holocene climate and environmental history in Northern Europe and the North Atlantic realm. Physical and geochemical
J. Harff; R. Endler; S. Kotov; T. Leipe; A. Witkowski
Around 1000 years ago, the eastern North American Arctic was occupied by people known to archaeologists as Late Dorset, who exhibited a high degree of sedentism, reliance on storage and in some regions a relatively high population density. At the same time, the Late Dorset archaeological record has yielded evidence for a well-developed artistic tradition, construction of elaborate communal structures
T. Max Friesen
Past studies suggest that African American women who quit smoking during pregnancy are more likely to relapse during the postpartum period than white women, although it is not intuitively clear why this should be the case. To shed further light on this issue, two studies were carried out to determine factors that influence smoking cessation during pregnancy and postpartum relapse to smoking in a predominantly low-income African American population. In Study 1, the women were asked to fill out a written survey, and in Study 2, women participated in a structured interview. The same variables that influence smoking cessation and postpartum relapse in the general population, such as nicotine addiction levels, smoking by other members of the household, lack of social support, stress, weight gain, behavioral intentions to quit temporarily, and quitting for others, as opposed to one's self, influenced the behavior of low-income inner city residents. These findings suggest that the difference in rates of postpartum relapse to smoking in African American women and the general population is a matter of degree, rather than kind. The implications of these findings for understanding postpartum relapse in general and assisting low-income women in particular were discussed.
Hymowitz, Norman; Schwab, Maria; McNerney, Christopher; Schwab, Joseph; Eckholdt, Haftan; Haddock, Keith
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
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 W.; Smith, Jeremy
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.
Background Diabetes and obesity have reached epidemic proportions in the U.S. with rates consistently higher among Hispanics as compared to non-Hispanic whites. Among Hispanic women diagnosed with gestational diabetes mellitus (GDM), 50% will go on to develop type 2 diabetes within 5?years of the index pregnancy. Although randomised controlled trials among adults with impaired glucose tolerance have shown that diet and physical activity reduce the risk of type 2 diabetes, such programs have not been tested in high-risk postpartum women. The overall goal of this randomised controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce risk factors for type 2 diabetes and cardiovascular disease among postpartum Hispanic women with a history of abnormal glucose tolerance during pregnancy. Methods/Design Hispanic pregnant women who screen positive for GDM will be recruited and randomly assigned to a Lifestyle Intervention (n?=?150) or a Health & Wellness (control) Intervention (n?=?150). Multimodal contacts (i.e., in-person, telephone, and mailed materials) will be used to deliver the intervention from late pregnancy (29?weeks gestation) to 12?months postpartum. Targets of the intervention are to achieve Institute of Medicine Guidelines for postpartum weight loss; American Congress of Obstetrician and Gynecologist guidelines for physical activity; and American Diabetes Association guidelines for diet. The intervention draws from Social Cognitive Theory and the Transtheoretical Model and addresses the specific cultural and environmental challenges faced by low-income Hispanic women. Assessments will be conducted at enrollment, and at 6-weeks, 6-months, and 12-months postpartum by trained bicultural and bilingual personnel blinded to the intervention arm. Efficacy will be assessed via postpartum weight loss and biomarkers of insulin resistance and cardiovascular risk. Changes in physical activity and diet will be measured via 7-day actigraph data and three unannounced 24-hour dietary recalls at each assessment time period. Discussion Hispanic women are the fastest growing minority group in the U.S. and have the highest rates of sedentary behavior and postpartum diabetes after a diagnosis of GDM. This randomised trial uses a high-reach, low-cost strategy that can readily be translated into clinical practice in underserved and minority populations. Trial registration NCT01679210
Postpartum depression (PPD) is a serious mood disorder that may carry life-long consequences for a woman and her family. Multiple risk factors for PPD have been identified, including psychosocial, situational, and biological stimuli, several of which are experienced by most, if not all, postpartum women. Given the commonality of these risk factors, it is unclear why fewer than 20% of postpartum women actually develop PPD. In this review, we suggest that different susceptibility to PPD among postpartum women may be explained by the presence or absence of genetic variants that confer increased risk. We review three categories of genes known to code for proteins associated with depression in the general population or proteins known to be affected by childbirth for their possible association with PPD, including genes related to central nervous system monoamine availability, proinflammatory cytokines, and brain neuropeptides. Only two studies are available in the literature to date specifically looking at polymorphisms in postpartum women as related to PPD; both are concerned with monoamine availability. These are discussed in further depth. Conclusions regarding the contribution of genetic polymorphisms to the development of PPD are mixed. Ultimately, the complexity of the disorder and the interrelationships among different genes thought to contribute to depression suggest that much more research is required to understand the heritability of PPD. The complexity of the disorder also suggests that epigenetic influences must be considered as well when discussing susceptibility.
Corwin, Elizabeth J.; Kohen, Ruth; Jarrett, Monica; Stafford, Brian
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
Little is known about the motivational background of smoking after a period of nicotine abstinence during pregnancy. The study examines the intention to resume smoking (IRS) in the post-partum period and its predictive value for smoking within 12 months post-partum. In a sample of 301 women recruited from obstetric wards who reported having stopped smoking during pregnancy, data on IRS, sociodemographic variables, recent smoking behaviour and smoking in the social network were collected. Smoking status was assessed 6 and 12 months after pregnancy. Among all formerly smoking women, 39 (13%) intended to resume smoking and 262 (87%) intended to maintain abstinence. Women with IRS returned to smoking more often than women without IRS [77 versus 45%, odds ratio (OR) = 4.1, 95% confidence interval (CI): 1.89-9.05]. In a logistic regression model, IRS (OR = 3.7, 95% CI: 1.51-9.01) and number of months currently abstinent (OR = 0.9, 95% CI: 0.76-0.96) attained statistical significance. IRS proved to be the main predictor for relapse; yet, women with no IRS are at risk to restart smoking again, too. IRS offers a cue for tailoring interventions. PMID:16293673
Röske, Kathrin; Hannöver, W; Grempler, J; Thyrian, J R; Rumpf, H-J; John, U; Hapke, U
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
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
The results of numerous hormonal profile studies in the dairy cow are reviewed with respect to specific hormone changes in the early postpartum period, and factors contributing to the onset of cyclic reproductive activity. Variations from the normal pattern of postpartum hormonal activity or uterine involution are reviewed also. The normal involutionary changes of the bovine uterus are discussed.
Leslie, K. E.
Objective. Postpartum hemorrhage (PPH) is an important cause of maternal mortality (MM) around the world. Seventy percent of the PPH corresponds to uterine atony. The objective of our study was to evaluate multicenter PPH cases during a 10-month period, and evaluate severe postpartum hemorrhage management. Study Design. The study population is a cohort of vaginal delivery and cesarean section patients with severe postpartum hemorrhage secondary to uterine atony. The study was designed as a descriptive, prospective, longitudinal, and multicenter study, during 10 months in 13 teaching hospitals. Results. Total live births during the study period were 124,019 with 218 patients (0.17%) with severe postpartum hemorrhage (SPHH). Total maternal deaths were 8, for mortality rate of 3.6% and a MM rate of 6.45/100,000 live births (LB). Maternal deaths were associated with inadequate transfusion therapy. Conclusions. In all patients with severe hemorrhage and subsequent hypovolemic shock, the most important therapy is intravascular volume resuscitation, to reduce the possibility of target organ damage and death. Similarly, the current proposals of transfusion therapy in severe or massive hemorrhage point to early transfusion of blood products and use of fresh frozen plasma, in addition to packed red blood cells, to prevent maternal deaths.
Montufar-Rueda, Carlos; Rodriguez, Laritza; Jarquin, Jose Douglas; Barboza, Alejandra; Bustillo, Maura Carolina; Marin, Flor; Ortiz, Guillermo; Estrada, Francisco
Inherited bleeding disorders are caused by various genetic defects in the proteins involved in haemostasis. Female patients or carriers are faced with the risk of haemorrhage throughout life. During pregnancy and postpartum, this complication affects the health of either the mother or the baby, or both. This retrospective cohort study was designed to assess the occurrence of obstetric bleeding in the three trimesters of pregnancy, along with primary and secondary postpartum haemorrhage among 100 women with inherited bleeding disorders. A questionnaire was designed in order to collect historical data. The patients were evaluated in three groups: haemophilia carriers, von Willebrand disease (VWD) and rare bleeding disorders. In comparison with normal women, significantly severe bleeding was observed among patients in all of the five stages. VWD patients showed a higher frequency of bleeding in first trimester but the rate of miscarriage was lower. Haemophilia carriers were threatened with bleeding complications during the prenatal period, but they also had the highest frequency of postpartum haemorrhage. Based on our results, vaginal bleeding is a serious threat in all three patient groups, especially during the first trimester of pregnancy and in the postpartum period. PMID:22821002
Shahbazi, Shirin; Moghaddam-Banaem, Lida; Ekhtesari, Fatemeh; Ala, Fereydoun A
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 objective of this study was to determine the susceptible days for the adverse effects of di-n-butyl phthalate (DBP) on development of reproductive system in male offspring following maternal administration on successive 3-day period during late pregnancy. Pregnant rats were given DBP by gastric intubation at 1000 or 1500 mg\\/kg on days 12–14 or 18–20 of pregnancy or at 500,
Makoto Ema; Emiko Miyawaki; Kunio Kawashima
In water balance estimations within palaeoenvironmental studies river runoff is estimated as the difference between precipitation and evapotranspiration. The other technique is numerical modeling using general circulation models. Both approaches fail to recognize epochs of extremely high surface runoff characteristic for the Pleistocene cold epochs and recorded in geomorphic outcomes of this runoff. We have studied two kinds of such archives that have wide spatial coverage over the East European Plain (EEP). 1. Post-LGM large palaeochannels (macromeanders) in river valleys with channel width and meander wavelength 5-15 times as great as that of modern rivers. Massive measurements of their parameters and application of specially constructed transfer function provided estimations of palaeo-runoff from large river basins: in the Black Sea and Caspian Sea catchments it carried from 2.2 (Kama River) to 3.1 (Don, Dnieper Rivers) times as great as modern runoff. High runoff lasted long enough to provide formation of 2-3 generations of macromeanders characteristic for many valleys. Macromeanders were radiocarbon dated at 6 sites over EEP in the range 13-19 cal ka BP, but it is not clear whether high runoff was characteristic for the entire period or it performed during short isolated epochs within this interval. Therefore, it is not clear to what exact time palaeohydrological estimations should be attributed. 2. Dendritic and parallel systems of gentle hollows clearly designated in vegetation-free areas south from 55-57ºN. Distinctive spatial patterns and full integration into water transportation through modern fluvial landscapes provides interpretation of these hollow systems as partially or totally buried networks of small dry valleys (balkas). It is supported by revelation of buried incisions up to 10 m deep by coring and trenching across hollows. Ancient erosion network demonstrates erosion density much higher and Horton's "belt of no erosion" much narrower and therefore exhibits much abundant surface runoff than those at present. Dating of buried balkas has until recent times been based either on pollen spectra from peat deposits (in central EEP), or on stratigraphy of paleosoils found in the bottom of paleoforms (in southern EEP). Both markers point at Eemian (MIS 5e) age of their stabilization and therefore pre-Eemian (late MIS 6?) age of incision. However first attempt of OSL dating gave the contradictory result of filling of a 6-m deep balka by slopewash sediments during 80-70 ka BP. Questionable is the >30-ka delay between the soil formation in the balka bottom and start of its filling. It may mean either post-Eemian age of the soil, which would be unfortunate for the regional soil stratigraphy, or insufficient sensitivity of local quartz at ages close to Eemian. The conclusion is that geomorphic evidences make unique palaeohydrological archives that document changes not recorded in other types of palaeoenvironmental data, but they suffer from uncertainties and low resolution of dating. This presentation contributes to RFBR Projects 14-05-00119 and 14-05-00146.
Panin, Andrei; Belyaev, Yury; Eremenko, Ekaterina; Sidorchuk, Alexei
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
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
Background: Postpartum thyroid dysfunction occurs in approximately 5-10% of women in the general population within one year of delivery. Differentiation of postpartum Graves' thyrotoxicosis (PPGr) from postpartum destructive thyrotoxicosis (PPDT) is essential because of the difference in treatment measures between the two. However, it is sometimes difficult because radioactive iodine uptake is contraindicated when patients are lactating. We examined the usefulness of determining the time of onset postpartum and measurement of antithyrotropin (anti-TSH) receptor antibodies and thyroid blood flow. Methods: Forty-two patients with newly developed thyrotoxicosis after delivery were examined: 18 had Graves' disease and 24 had destructive thyrotoxicosis. Serum free thyroxine (fT4), free triiodothyronine (fT3), and TSH were measured by chemiluminescent immunoassays. Anti-TSH receptor antibodies (TRAb), antithyroglobulin antibodies (TgAb), and antithyroid peroxidase antibodies (TPOAb) were measured by the Elecsys electrochemiluminescence immunoassay. Thyroid volume and blood flow (TBF) were measured quantitatively by color flow Doppler ultrasonography. Results: Onset of thyrotoxicosis was distributed from 2 to 12 months postpartum. Twelve (85.7%) of 14 patients who developed thyrotoxicosis at three months or earlier after delivery had PPDT. On the other hand, all 11 patients who developed thyrotoxicosis at 6.5 months or later had PPGr. All patients with PPGr had positive TRAb (14.9±14.9?IU/L, mean±standard deviation (SD)) and all patients with PPDT had negative TRAb (0.1±0.3?IU/L, p<0.0001). Fifteen (83.3%) of 18 PPGr patients had high TBF of more than 4.0% (8.9±4.4), and all PPDT patients had low TBF of <4.0% (1.6±1.0, p<0.0001). The fT3/fT4 ratio was higher in PPGr (64.0±23.9) than in PPDT (38.9±13.1, p<0.0002), but absolute values overlapped between the two. Conclusion: Early onset of thyrotoxicosis postpartum was associated mainly with PPDT, and a late onset was suggestive of PPGr. Positive TRAb and high TBF >4.0% are indicators of postpartum onset of Graves' disease. PMID:24400892
Ide, Akane; Amino, Nobuyuki; Kang, Shino; Yoshioka, Waka; Kudo, Takumi; Nishihara, Eijun; Ito, Mitsuru; Nakamura, Hirotoshi; Miyauchi, Akira
Background Pyomyoma is a life-threatening complication of uterine leiomyoma. It may occur in post- menopausal women, during pregnancy and in the postpartum period. Fever may be the only manifestation during the early stages of the disease. We detail the first reported case of postpartum pyomyoma-related sepsis due to Sphingomonas paucimobilis, a Gram-negative bacillus that is gaining recognition as an important human pathogen. Case presentation A woman presented with an asymptomatic uterine fibroid and a two-week history of fever during the postpartum period. Suppurative uterine leiomyoma was diagnosed, and blood cultures grew Sphingomonas paucimobilis. The myoma was surgically removed from the uterus without hysterectomy. Intravenous antimicrobial therapy was given for fifteen days, and the patient was discharged from hospital in good condition. Conclusion Pyomyoma should be considered in broad differential diagnosis of postpartum fever. This case highlights a unique disease manifestation of S. paucimobilis, an emerging opportunistic pathogen with increasing significance in the nosocomial setting.
The palaeoclimatic significance of Eurasian Giant Salamanders (Cryptobranchidae: Zaissanurus, Andrias) - indications for elevated humidity in Central Asia during global warm periods (Eocene, late Oligocene warming, Miocene Climate Optimum)
Cryptobranchids represent a group of large sized (up to 1.8 m) tailed amphibians known since the Middle Jurassic (Gao & Shubin 2003). Two species are living today in eastern Eurasia: Andrias davidianus (China) and A. japonicus (Japan). Cenozoic Eurasian fossil giant salamanders are known with two genera and two or three species from over 30 localities, ranging from the Late Eocene to the Early Pliocene (Böhme & Ilg 2003). The Late Eocene species Zaissanurus beliajevae is restricted to the Central Asian Zaissan Basin (SE-Kazakhstan, 50°N, 85°E), whereas the Late Oligocene to Early Pliocene species Andrias scheuchzeri is distributed from Central Europe to the Zaissan Basin. In the latter basin the species occur during two periods; the latest Oligocene and the late Early to early Middle Miocene (Chkhikvadse 1982). Andrias scheuchzeri is osteological indistinguishable from both recent species, indicating a similar ecology (Westfahl 1958). To investigate the palaeoclimatic significance of giant salamanders we analyzed the climate within the present-day distribution area and at selected fossil localities with independent palaeoclimate record. Our results indicate that fossil and recent Andrias species occur in humid areas where the mean annual precipitation reach over 900 mm (900 - 1.300 mm). As a working hypothesis (assuming a similar ecology of Andrias and Zaissanurus) we interpret occurrences of both fossil Eurasian giant salamanders as indicative for humid palaeoclimatic conditions. Based on this assumption the Late Eocene, the latest Oligocene (late Oligocene warming) and the late Early to early Middle Miocene (Miocene Climatic Optimum) of Central Asia (Zaissan Basin) are periods of elevated humidity, suggesting a direct (positive) relationship between global climate and Central Asian humidity evolution. Böhme M., Ilg A. 2003: fosFARbase, www.wahre-staerke.com/ Chkhikvadze V.M. 1982. On the finding of fossil Cryptobranchidae in the USSR and Mongolia. Vertebrata Hungarica, 21: 63-67. Gao K.-Q., Shubin N.H. 2003. Earliest known crown-group Salamanders. Nature, 422: 424-428. Westphal F. 1958. Die Tertiären und rezenten Eurasiatischen Riesensalamander. Palaeontolographica Abt. A, 110: 20-92.
Vasilyan, Davit; Böhme, Madelaine; Winklhofer, Michael
One negative outcome of the post-partum period is the occurrence of post-partum depression. While the incidence levels are high in the U.S. for the 'Blues' and the 'moderate level depression disorder', the nature of this phenomenon--as a disease and as an illness--remains unclear. It is suggested that an anthropological perspective incorporating symbolic behavior and biological processes may more effectively address
Gwen Stern; Laurence Kruckman
Background: Post-partum depression, although heterogeneous, is often considered a medical disease when viewed from the biomedical perspective. However, recent reports from the Indian subcontinent have documented psychosocial causal factors.Method: This study employed qualitative methodology in a representative sample of women in rural South India. Women in the post-partum period were assessed using the Tamil versions of the Short Explanatory Model
R. J. S. Savarimuthu; P. Ezhilarasu; H. Charles; B. Antonisamy; S. Kurian; K. S. Jacob
Depression is the most common psychiatric disease among women, exhibiting a prevalence which is 2–3× higher than in men. The postpartum period is considered the time of greatest risk for women to develop major depression and postpartum depression affects approximately 15% of women. A dysregulation of the hypothalamus–pituitary–adrenal (HPA) axis is the most prominent endocrine change seen in depression and
S. Brummelte; Liisa A. M. Galea
Introduction Postpartum depression (PPD) is one of the major psychological disorders worldwide that affects both mother and child. The aim of this study was to correlate the risk of PPD with obstetric and demographic variables in Saudi females. Materials and methods Data were collected by interviewing females 8–12 weeks postpartum. PPD symptoms were defined as present when subjects had an Edinburgh Postnatal Depression Scale score of 10 or higher. Variables included in this study were age, education, occupation, parity, baby’s sex, pregnancy period, delivery type, hemoglobin level, anemia, and iron pills taken during pregnancy. Results Of the 352 postpartum females, the prevalence of PPD symptom risk was 117 (33.2%). Among the PPD symptomatic females, 66 (39.8%) had low hemoglobin levels, and 45 (40.5%) females were anemic during pregnancy (P?0.05). These results suggest that early postpartum anemia, indicated by low hemoglobin level, is a significant risk factor for PPD (adjusted odds ratio 1.70, 95% confidence interval 1.05–2.74; P=0.03). Other variables, including age, parity, education, occupation, and delivery type, were not significantly correlated (P=0.15–0.95), but marginally indicative of the risk of depressive symptoms. Conclusion Low hemoglobin level and anemia during pregnancy were risk factors for PPD in Saudi females. Many other factors may be considered risk factors, such as age, occupation, and parity. Anemic women need more attention and to be checked regarding their PPD, and treated if necessary.
Alharbi, Abeer A; Abdulghani, Hamza Mohammad
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
Background The aim of the present study was to explore the prospective relationship between anxiety symptoms and coping strategies during late pregnancy and early postpartum. Methods Participants completed the Hospital Anxiety Depression-Anxiety subscale and Carver’s Brief COPE at two time points, namely during the last trimester of pregnancy (N?=?400) and at two months postpartum (N?=?158). Results Antenatally, 18.8% of pregnant women presented severe anxiety symptoms while 20.2% of women presented severe anxiety symptoms after birth. Carver's proposed coping styles allowed to significantly distinguish between anxious and non anxious women during these two periods. Anxious women used significantly more inappropriate coping and less adaptive coping responses, such as self-blame and denial of reality, which remained associated with anxiety in the perinatal period. Our results also indicated a decrease in adaptive coping in women without anxiety after birth (e.g. acceptance, positive reframing). Conclusion Our findings confirm that antenatal and postnatal anxiety symptoms occur frequently and that inappropriate and/or non functional coping may account for persisting anxiety after childbirth. Limitations: Data were based on self-reports and participating women were predominantly primiparous. A high drop-out rate at two months postpartum must also be acknowledged.
Objective The purpose of this paper was to describe the rationale, data collection, and proposed analyses for examination of mediators of change in physical activity from pregnancy to postpartum among a cohort of pregnant women. Method The Pregnancy Infection and Nutrition 3 (PIN3) Study enrolled 2006 pregnant women into the cohort from 2001 to 2005. All women lived in central North Carolina upon enrollment. Physical activity was assessed using a self-reported one week recall, measured twice during pregnancy and once each at 3- and 12-months postpartum. On a subset of women, one-week accelerometer measures were also collected during the two postpartum time periods. Potential mediators (intrapersonal, interpersonal, community) were collected during pregnancy and postpartum through interviews and take home questionnaires. Results To assess mediation of physical activity among our cohort, we will first describe change in physical activity and the mediators, as well as their associations, through pregnancy into the postpartum period. Following this, the product of coefficients approach will be applied to examine whether each measure had indirect effects on change in physical activity. Each individual level mediator will be examined one at a time and across the time points in which it was available. The Sobel standard error approximation formula will be used to test for significance of the mediation effect. Conclusions This study will provide evidence to develop appropriate interventions targeted at physical activity and will help focus efforts on the appropriate time periods between pregnancy and postpartum.
Evenson, Kelly R.
The suprachiasmatic nucleus generates circadian rhythms which are synchronized to the environmental light–dark cycle via the retinohypothalamic tract. Pituitary adenylate cyclase-activating polypeptide and glutamate, two neurotransmitters co-stored in the retinohypothalamic tract of the rat, are able to phase shift the endogenous rhythm similar to light. The “clock genes” period1 (per1) and per2, which show circadian oscillation within the suprachiasmatic nucleus,
H. S Nielsen; J Hannibal; S. M Knudsen; J Fahrenkrug
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
Postpartum depression (PPD) is common, occurring in 10%–15% of women. Due to concerns about teratogenicity of medications in the suckling infant, the treatment of PPD has often been restricted to psychotherapy. We review here the biological underpinnings to PPD, suggesting a powerful role for the tryptophan catabolites, indoleamine 2,3-dixoygenase, serotonin, and autoimmunity in mediating the consequences of immuno-inflammation and oxidative and nitrosative stress. It is suggested that the increased inflammatory potential, the decreases in endogenous anti-inflammatory compounds together with decreased omega-3 poly-unsaturated fatty acids, in the postnatal period cause an inflammatory environment. The latter may result in the utilization of peripheral inflammatory products, especially kynurenine, in driving the central processes producing postnatal depression. The pharmacological treatment of PPD is placed in this context, and recommendations for more refined and safer treatments are made, including the better utilization of the antidepressant, and the anti-inflammatory and antioxidant effects of melatonin.
Anderson, George; Maes, Michael
BACKGROUND Fifty percent of aortic dissections in women younger than 40 years occur in association with pregnancy. Of these, half of type B dissections occur in the postpartum period. CASE A 30-year-old woman was status post spontaneous vaginal delivery at 30 weeks of gestation for fetal death, complicated by an eclamptic seizure. On post-partum day 4, she suffered an acute, complicated type B aortic dissection treated with endovascular stent graft placement. CONCLUSION Endovascular repair may be an attractive option for the treatment of complicated type B aortic dissections in pregnancy and the peripartum period, with reduced maternal and fetal mortality. This may allow the fetus to remain in situ and avoid the risks of surgery and possible cardiopulmonary bypass, with little radiation risk to the fetus.
Rosenberger, Laura H.; Adams, Joshua D.; Kern, John A.; Tracci, Margaret C.; Angle, J. Fritz; Cherry, Kenneth J.
Purpose To investigate changes in mothers’ body dissatisfaction from delivery to 9 months postpartum, and the relationship of postpartum body dissatisfaction to weight, other health, and social characteristics. Methods In this prospective longitudinal study, 506 mothers completed surveys at 0-1 and 9 months postpartum. Postpartum changes in body dissatisfaction and weight were evaluated by paired t-tests, and predictors of postpartum body dissatisfaction were identified by stepwise multiple regression analysis. Results Mothers’ body dissatisfaction increased significantly from 0-1 to 9 months postpartum (mean scores of 15.2 and 18.2, respectively, p < .001). Although women lost an average of 10.1 pounds (sd = 16.3) or 4.6 kg. (sd = 7.4) between 0-1 and 9 months postpartum (p < .001), their weight at 9 months postpartum remained an average of 5.4 pounds (sd = 15.6) or 2.5 kg (sd = 7.1) above their pre-pregnancy weights (p < .001). Body dissatisfaction at 9 months postpartum was associated with overeating or poor appetite, higher current weight, worse mental health (SF-36 Mental Health scale), race other than black, bottle-feeding (vs. breastfeeding), being single (vs. married), and having fewer children,. Conclusions Mothers’ body satisfaction worsened from 1 to 9 months postpartum, and 9-month body dissatisfaction was associated with eating/appetite abnormalities, greater weight, worse mental health, non-black race, non-breastfeeding status, and fewer immediate family relationships. Given these relationships, it is important to educate women about expected postpartum weight and body changes, and to find ways to enhance mothers’ postpartum self-esteem and body satisfaction.
Gjerdingen, Dwenda; Fontaine, Patricia; Crow, Scott; McGovern, Patricia; Center, Bruce; Miner, Michael
Objective To clarify the risk of violence for women during pregnancy and the first year postpartum, we examined the timing of hospital visits for assault among a population cohort of women in Massachusetts. Methods Using linked natality and hospital data from 2001 through 2007 for Massachusetts, we examined the timing of hospital (i.e., emergency, inpatient, and observation) visits for maternal assault during seven time periods: the three prenatal trimesters and four three-month postpartum periods. To describe the risk of assault for each of the time periods, we calculated the rate as the number of such visits per 100,000 person-weeks. We used the denominator of 100,000 person-weeks to adjust for variable lengths of gestation and for postpartum periods shortened by subsequent pregnancies. Results Rates of hospital visits for maternal assault were highest in the first trimester and lowest in the third trimester, with rates of 16.0 and 5.8 per 100,000 person-weeks, respectively. The four postpartum period rates were higher than the third trimester rate but never reached the levels observed in the first and second trimesters. Conclusions These findings suggest a changing rate for assault visits during each prenatal trimester and postpartum period. In addition, the importance of violence prevention strategies as part of women's health care across the life span and the need for preconception care initiatives are reaffirmed.
Nannini, Angela; Lazar, Jane; Berg, Cynthia; Barger, Mary; Tomashek, Kay; Cabral, Howard; Barfield, Wanda; Kotelchuck, Milton
Postpartum psychosis is a rare but serious psychiatric illness that follows delivery. Although controversy continues to surround its diagnostic status, it is generally considered an episode of bipolar disorder with accompanying psychotic features. The consequences of untreated postpartum psychosis can be serious due to the associated risk of suicide and infanticide; however, its close temporal association with childbirth should provide an opportunity to undertake prophylactic measures in women at risk for developing postpartum psychosis. This article reviews the literature concerning acute and prophylactic pharmacological treatment and suggests a comprehensive approach for management of postpartum psychosis. PMID:18690984
The labour records of 1000 consecutive deliveries were studied to compare the incidence of postpartum haemorrhage after induced labour with that after spontaneous labour. The discovery of an increased incidence of postpartum haemorrhage in the induced group prompted further analysis of the incidence of haemorrhage among 3674 normal deliveries. This analysis confirmed that the incidence of postpartum haemorrhage was increased after induction of labour; among primiparous patients the increased incidence after induced labours was nearly twice that after spontaneous labours, even when only normal deliveries were considered. These findings indicate that postpartum haemorrhage is another complication of induction that needs to be taken into account when induction is being considered.
Brinsden, P R; Clark, A D
A 27-year-old woman experienced anterior myocardial infarction three weeks after the delivery of her second child. Coronary arteriography subsequently showed primary dissection of the left coronary artery. This patient is believed to be the second reported survivor of angiographically proven peripartal left coronary artery dissection and the only such patient to achieve and maintain asymptomatic status for a prolonged period without operative intervention. Images
Shaver, P J; Carrig, T F; Baker, W P
Pregnancy and the postpartum period are associated with changes of the immune system. These changes might eventually result in autoimmune diseases, such as Graves' disease and type?1 diabetes mellitus, in the postpartum period. We describe a case of a patient with gestational diabetes who developed both Graves' disease and type?1 diabetes mellitus in the postpartum period. The pathology of gestational diabetes (GDM) is close to that of type?2 diabetes mellitus. However, the present case emphasizes the importance of screening and monitoring high-risk GDM patients for all available autoimmune antibodies throughout pregnancy and the postpartum period, as GDM has a risk of developing into type?1 diabetes and multiple autoimmune diseases. In addition, only Graves' disease was transient, whereas type?1 diabetes mellitus remained permanent in the present case. Thus, the present case shows etiological differences between these two autoimmune diseases. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00089.x,2011). PMID:24843507
Negishi, Mayumi; Shimomura, Kenju; Proks, Peter; Nakahara, Rieko; Murakami, Masami; Shimomura, Yohnosuke; Kobayashi, Isao
Objectives To determine the optimal time for a second HIV-1 nucleic acid amplification assay to detect late postnatal transmission of HIV-1 (first negative test at 4–8 weeks of age) in resource limited settings. Design A longitudinal analysis of data from HPTN 024 Methods Children born to HIV-1 infected mothers enrolled in the HIV Prevention Trial Network trial 024 (HPTN 024) were tested for HIV-1 infection at six intervals within the first year of life. Mothers and infants received nevirapine prophylaxis. We estimated the probability of being alive and having a positive test in each interval after 4–8 weeks and at 30 days post-weaning, conditional on having acquired HIV during the late postnatal period. The interval with the highest probability was taken to be the optimal visit interval. Results A total of 1609 infants from HPTN 024 had at least one HIV-1 diagnostic test and were included in the analysis. We found that testing at one month after weaning or 12 months of age (whichever comes first), identified 81% of those infected during the late postnatal period (after 4–8 weeks) through breastfeeding. In total, 93% (95% CI: 89,98) of all infected infants would be detected if tests were performed at these two time points. Conclusions In resource-limited settings, HIV-1 PCR testing at 4–8 weeks followed by a second test at one month after weaning or at one year of age (whichever comes first), led to the identification of the vast majority of HIV-1 infected infants.
Brown, Elizabeth; Chi, Benjamin H.; Read, Jennifer S.; Taha, Taha E.; Sharma, Usha; Hoffman, Irving F.; Pikora, Cheryl; Goldenberg, Robert; Fiscus, Susan A.
Introduction Several factors have been found to be independently associated with decline in sexual activity after delivery. However, the association between depression in pregnancy/postpartum and sexual problems is less clear. Aim To prospectively evaluate the relationship between depressive/anxiety symptoms (DAS) during the perinatal period and sexual life in the postpartum period. Methods A prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. Four groups with DAS during antenatal and postpartum periods were identified using the Self Report Questionnaire (SRQ-20): absence of both antenatal and postpartum DAS; presence of antenatal DAS only; presence of postpartum DAS only; and presence of both antenatal and postpartum DAS. The primary outcome was perception of sexual life decline (SLD) before and after pregnancy/delivery. Crude and adjusted risk ratios (RR), with 95% confidence intervals (95% CI), were calculated using Poisson regression to examine the associations between DAS and SLD. Main Outcome Measure The main outcome measure of this study is the perception of SLD before and after pregnancy/delivery. Results SLD occurred in 21.1% of the cohort. In the multivariable analysis, the following variables were independently associated with SLD: DAS during both pregnancy and postpartum (RR: 3.17 [95% CI: 2.18–4.59]); DAS during only the postpartum period (RR: 3.45 [95% CI: 2.39–4.98]); a previous miscarriage (RR: 1.54 [95% CI: 1.06–2.23]); and maternal age (RR: 2.11 [95% CI: 1.22–3.65]). Conclusions Postpartum women with DAS have an increased likelihood for SLD up to 18 months after delivery. Efforts to improve the rates of recognition and treatment of perinatal depression/anxiety in primary care settings have the potential to preserve sexual functioning for low-income mothers.
Faisal-Cury, Alexandre; Huang, Hsiang; Chan, Ya-Fen; Menezes, Paulo Rossi
More and more evidence indicates that the onset of the East Asian (EA) monsoon can be traced back to the Oligocene-Miocene boundary (at about 23 Ma). However, the process of its evolution is still less well known until now. Here we investigate its late Neogene evolution by analyzing a terrestrial mollusk sequence, from the Chinese Loess Plateau (CLP), covering the period between 7.1 and 3.5 Ma. Considering the modern ecological requirements of these organisms, we were able to define two groups of cold-aridiphilous (CA) and thermo-humidiphilous (TH) species, representing the EA winter and summer monsoon variations, respectively, as previously defined in the Quaternary glacial-interglacial cycles. Variations in these two groups indicate two different monsoon dominated periods during 7.1-3.5 Ma. First, between 7.1 and 5.5 Ma, the EA winter monsoon, with a 100 kyr periodicity, was dominant. Second, between 5.1 and 4 Ma, the EA summer monsoon dominated, with a 41 kyr periodicity. Furthermore, our mollusk record yields valuable evidence for a late Miocene-Pliocene transition of about 400 kyr from winter monsoon dominated towards summer monsoon dominated, associated with a periodicity transition from weak 100 kyr to 41 kyr. The strengthened winter monsoon interval, with a 100 kyr periodicity, is coeval with orbital-scale global ice volume changes, in conjunction with the uplift of the Tibetan Plateau which probably reinforced the winter monsoon sub-regime. Conversely, closures of the Panama and Indonesian seaways, associated with changes in obliquity between 5.1 and 4 Ma, are probably major forcing factors for the observed dominant summer monsoon with 41 kyr frequency, favoring heat and moisture transports between low and high latitudes to allow TH mollusks to grow and develop in the CLP. The transition from a 100 kyr dominated interval towards a 41 kyr dominated one is contrary to the mid-Pleistocene transition (MPT), which corresponds to ice volume expansion at high latitude and show a shift in the periodicity from 41 kyr to 100 kyr.
Li, F.; Rousseau, D.-D.; Wu, N.; Hao, Q.; Pei, Y.
Postpartum depression is a national health priority. It affects nearly half ofall adolescent mothers. Postpartum depression can lead to developmental and psychological disabilities in both mother and child. This article reviews three previously completed studies to gather information about various risk factors for the development ofpostpartum depression. The article also proposes solutions to prevent depression that can be put into
Bridget A. Baginsky
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
Objective To describe the physical and social environment of sleep self-management in postpartum socioeconomically disadvantaged women. Design Descriptive, exploratory design. Setting Participants were recruited in the hospital after giving birth. Data were collected in participant homes after discharge. Participants Postpartum women on Medicaid with normal healthy infants. Methods Participants completed a survey about features within their physical and social sleep environment at 2 weeks postpartum. Participants then completed three days and nights of sleep diaries at both 4 and 8 weeks postpartum to document perceived awakenings, select sleep hygiene practices, bed sharing, and reasons for sleep disruption. Results The sleep environments of participants were dynamic from night to night. Bed sharing was common with nearly half of participants sharing with a partner, approximately 25 percent with the infant, and 20 percent with older children. Fifty-two percent of participants slept with the television on part (31%) or all (69%) of the night. Eight-five percent of participants drank caffeine and 24 percent smoked. Conclusions These results inform theory-driven postpartum sleep interventions. Modifications to the physical and social sleep environment that attend specifically to how sleep hygiene and environmental factors are manifested in the postpartum period have the potential to improve sleep for socioeconomically disadvantaged women. Future research is needed to articulate which changes can be effectively self-managed by mothers through nursing interventions.
Milk and milk solids production per cow is increasing annually in dairy systems. Peak milk production is in early lactation when the uterus and ovary are recovering from the previous pregnancy. The competing processes of milk production and restoration of reproductive function can be at odds, particularly if unique homeorhetic mechanisms that typify early lactation become imbalanced and cows experience metabolic disease. Homeorhesis leads to an increase in the synthesis of glucose that is irreversibly lost to milk lactose. Irreversible loss of glucose during lactation can invoke an endocrine and metabolic state that impinges upon postpartum uterine health, oestrous cyclicity and subsequent establishment of pregnancy. The first 30 days postpartum may be most critical in terms of the impact that metabolites and metabolic hormones have on reproduction. Depressed immune function caused in part by the postpartum metabolic profile leads to a failure in uterine involution and uterine disease. Oestrous cyclicity (interval to first ovulation and subsequent periodicity) is affected by the same hormones and metabolites that control postpartum immune function. Slower growth of the embryo or foetus perhaps explained by the unique metabolic profile during lactation may predispose cows to pregnancy loss. Understanding homeorhetic mechanisms that involve glucose and collectively affect postpartum uterine health, oestrous cyclicity and the establishment of pregnancy should lead to methods to improve postpartum fertility in dairy cows. PMID:24679333
Lucy, M C; Butler, S T; Garverick, H A
Aim: Postpartum haemorrhage rates have been increasing in NSW and internationally, and blood transfusion is required in severe cases. Using routinely collected administrative data provides a convenient method with which to monitor trends in both postpartum haemorrhage and associated transfusion use. In order for this to be feasible however, the reliability of reporting of the conditions needs to be assessed. Methods: This study used linked data to compare the reporting of postpartum haemorrhage with transfusion as reported in the NSW Admitted Patient Data Collection (hospital data), with the same information obtained from the Perinatal Data Collection (birth data), for births in NSW from 2007 to 2010. Results: The rate of postpartum haemorrhage requiring blood transfusion was 1.0% based on the hospital data and 1.1% based on the birth data, with a rate of 1.7% if identifying cases from either source. Agreement between the two sources improved from fair to moderate over the time period. Conclusion: Postpartum haemorrhage requiring transfusion recorded in the birth data shows only moderate agreement with hospital data, so caution is recommended when using this variable for analysis. Linkage of both datasets is recommended to identify birth information from birth data and postpartum haemorrhage with transfusion from hospital data until further validation work has been undertaken. PMID:24939224
Patterson, Jillian A; Roberts, Christine L; Taylor, Lee K; Ford, Jane B
Postpartum depression (PPD) is a psychiatric disorder that occurs in 10-15% of childbearing women. It is hypothesized that omega-3 fatty acids, which are components of fish oil, may attenuate depression symptoms. In order to examine this hypothesis, the animal model of postpartum depression was established in the present study. Ovariectomized female rats underwent hormone-simulated pregnancy (HSP) regimen and received progesterone and estradiol benzoate or vehicle for 23 days, mimicking the actual rat's pregnancy. The days after hormone termination were considered as the postpartum period. Forced feeding of menhaden fish oil, as a source of omega-3, with three doses of 1, 3, and 9g/kg/d, fluoxetine 15mg/kg/d, and distilled water 2ml/d per rat started in five postpartum-induced and one vehicle group on postpartum day 1 and continued for 15 consecutive days. On postpartum day 15, all groups were tested in the forced swimming test (FST) and open field test (OFT), followed by a biochemical assay. Results showed that the postpartum-induced rats not treated with menhaden fish oil, exhibited an increase in immobility time seen in FST, hippocampal concentration of corticosterone and plasmatic level of corticosterone, and pro-inflammatory cytokines. These depression-related effects were attenuated by supplementation of menhaden fish oil with doses of 3 and 9g/kg. Moreover, results of rats supplemented with menhaden fish oil were comparable to rats treated with the clinically effective antidepressant, fluoxetine. Taken together, these results suggest that menhaden fish oil, rich in omega-3, exerts beneficial effect on postpartum depression and decreases the biomarkers related to depression such as corticosterone and pro-inflammatory cytokines. PMID:24867329
Arbabi, Leila; Baharuldin, Mohamad Taufik Hidayat; Moklas, Mohamad Aris Mohamad; Fakurazi, Sharida; Muhammad, Sani Ismaila
Two calcified objects recovered from a 3rd to 4th-century grave of an adolescent in Amiens (Northern France) were identified as probable hydatid cysts. By using thin-section petrographic techniques, probable Calodium hepaticum (syn. Capillaria hepatica) eggs were identified in the wall of the cysts. Human hepatic capillariosis has not been reported from archaeological material so far, but could be expected given the poor level of environmental hygiene prevalent in this period. Identification of tissue-dwelling parasites such as C. hepaticum in archaeological remains is particularly dependent on preservation conditions and taphonomic changes and should be interpreted with caution due to morphological similarities with Trichuris sp. eggs. PMID:24572211
Mowlavi, Gholamreza; Kacki, Sacha; Dupouy-Camet, Jean; Mobedi, Iraj; Makki, Mahsasadat; Harandi, Majid Fasihi; Naddaf, Saied Reza
Background Although research has established the profound effects that intimate partner abuse can have on postpartum mental health, little is known regarding how this association may change as a function of the timing and type of abuse. This study examined associations of psychological, physical and sexual abuse experienced as adults before and during pregnancy with symptoms of postpartum mental health problems in a non-clinical sample of women. Methods English-speaking mothers aged 18 years and older in the metropolitan area of a large, Western Canadian city were recruited to participate in a study of women’s health after pregnancy. The study was advertised in hospitals, local newspapers, community venues, and relevant websites. One-hundred women completed standardized, self-report questionnaires during semi-structured interviews conducted by female research assistants at approximately 2 months postpartum. In addition to questions about their general health and well-being, participants answered questions about their experiences of intimate partner abuse and about their mental health during the postpartum period. Results Almost two-thirds (61.0%) of women reported postpartum mental health symptoms above normal levels, with 47.0% reporting symptoms at moderate or higher levels. The majority reported some form of intimate partner abuse before pregnancy (84.0%) and more than two-thirds (70.0%), during pregnancy; however, the abuse was typically minor in nature. Multivariate models revealed that women who experienced intimate partner abuse—whether before or during pregnancy—reported higher levels of postpartum mental health problems; however, associations differed as a function of the timing and type of abuse, as well as specific mental health symptoms. Multivariate models also showed that as the number of types of intimate partner abuse experienced increased, so did the negative effects on postpartum mental health. Conclusions Results of this study provide further evidence that intimate partner abuse is a risk factor for postpartum mental health problems. They also underscore the complex risks and needs associated with intimate partner abuse among postpartum women and support the use of integrated approaches to treating postpartum mental health problems. Future efforts should focus on the extent to which strategies designed to reduce intimate partner abuse also improve postpartum mental health and vice versus.
Summary. Plasma samples were taken every 10 min for periods of 8 h on 3 occasions during the post-partum period from 8 cows milked twice daily (Groups M1 and M2) and from 4 cows each suckling 4 calves (Group S). All samples were assayed for LH, and ovarian activity was monitored by measurement of milk progesterone. Three of the Group
A. R. Peters; G. E. Lamming; M. W. Fisher
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.
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.
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
In the U.S., the last ~300 years have been a period of progressive and widespread resource exploitation, ecosystem degradation, and habitat destruction. In southern New England, the European Colonists thrived on the spread of slave-based plantation farming, which peaked ~1750 in RI. They produced commodities such as livestock, apples, onions, flax, and dairy. Trees felled to produce the necessary pasture- and farm-land were quickly used as lumber for boards, planks, timber, and barrels. In 1793, Slater Mill, located on the Blackstone River at the head of Narragansett Bay, was the first mill in the U.S to spin yarn using water power, making it the birthplace of the U.S Industrial Revolution. The ensuing urbanization drove the human population of the watershed up from ~50,000 in 1790 to more than 2 million by the year 2000. More recently, the Bay has experienced episodic hypoxic events . These events correlate well with spatial and temporal patterns of nutrients and productivity  suggesting that human-induced increases in nutrient nitrogen and phosphorus are responsible for eutrophication-induced oxygen depletion . However, these post-Colonial land use changes have yet to be characterized within the longer context of Native American land use practices, mainly due to the lack of historical records for the period. Additionally, the impact of this ecosystem disturbance on the Bay has not been fully described. Here we present results based on sedimentary profiles of biomarkers diagnostic for soil delivery to marine systems, branched glycerol dialykl glycerol tetraethers, and pollen for disturbance taxa, that suggest land use change began in the Bay's watershed 300 years before European contact. This contradicts long standing ideas regarding the land use practices of local tribes but agrees with new archaeological findings suggesting large semi-permanent settlements and widespread horticulture of maize may have been the norm at this time. We also show results of pollen, nitrogen isotopes, and foraminiferal abundance (proxies for land disturbance, nutrient sources, and ecosystem productivity, respectively) implying the large domestic animal population housed on the plantations were a new source of nitrogen to the Bay. This nutrient input may have led to an increase in the Bay's primary productivity, which may have decreased or stabilized as plantations became less important. Lastly, these same proxies show that the industrialization and urbanization of the Bay's watershed added additional nutrients, further stimulating the Bay's productivity. 1. Codiga, D.L., et al., Narragansett Bay Hypoxic Event Characteristics Based on Fixed-Site Monitoring Network Time Series: Intermittency, Geographic Distribution, Spatial Synchronicity, and Interannual Variablity. Estuaries and Coasts, 2009. 32: p. 621-641. 2. Oviatt, C.A., Impacts of Nutrients on Narragansett Bay Productivity: A Gradient Approach, in Science for Ecosystem-based Management, Narragansett Bay in the 21st Century, A. Desbonnet, Editor 2008, Springer: New York. p. 523-543. 3. Nixon, S.W., et al., Nitrogen and Phosphorus Inputs to Narragansett Bay: Past, Present, and Future, in Science for Ecosystem-based Management: Narragansett Bay in the 21st Century, A. Desbonnet and B.A. Costa-Pierce, Editors. 2008, Springer: New York, NY. p. 101-175.
Salacup, J. M.; Altabet, M. A.; Herbert, T.; Prell, W. L.
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
Postpartum thyroiditis is a form of autoimmune thyroiditis developing during the first 12 months postpartum as a consequence of the immunologic flare following the immune suppression of pregnancy. This disease, found in 5-10% of women in a general population and even more frequently in patients suffering from other autoimmune disorders, may re-occur in about 70% of women after a subsequent pregnancy. Postpartum thyroiditis is strongly associated with antithyroid peroxidase antibodies. Patients may present with symptoms of either thyrotoxicosis or hypothyroidism which may be transient or, in some (20-30%) cases of hypothyroidism, permanent in nature. A thyrotoxic phase of postpartum thyroiditis is usually brief and often unnoticed before a more long-lasting hypothyroid phase occurs. The diagnosis of postpartum thyroiditis is based on the observation of abnormal thyroid function tests in a postpartum antithyroid peroxidase- positive woman. In this paper, we discuss the etiopathogenesis, clinical picture, diagnosis, prognosis and treatment of postpartum thyroiditis and provide the reader with some practical guidance concerning dealing with a patient suffering from this disorder. PMID:18465693
Krysiak, Robert; Marek, Bogdan; Okopie?, Bogus?aw
Background The postpartum period is a time of increased morbidity for mothers and infants under 12 months, yet is an under-researched area of primary care. Despite a relatively clear framework for involving general practitioners (GPs) in antenatal care, the structure of maternity service provision in some Australian jurisdictions has resulted in highly variable roles of general practice in routine postpartum care. This study aimed to investigate the views and experiences of mothers and GPs about postpartum care in general practice. Methods This was a qualitative study of mothers and GPs in rural, regional and metropolitan areas of Queensland, Australia. Semi-structured interviews were conducted with 88 mothers and six general practitioners between September 2010 and February 2012. Interviews were recorded and transcribed verbatim. Data were analysed thematically and compared across groups. Results Three main themes emerged: The relationship between the mother and GP; practice management; and GP visits. This paper focuses on the theme GP visits and its subthemes: recommendations for GP visits; scope of practice; and content of a routine visit. Recommendations about GP visits given to mothers varied by birthing sector, obstetric provider and model of maternity care resulting in confusion amongst mothers about the timing and role of GPs in routine postpartum care. Similarly, GPs voiced concerns about a lack of consistent guidelines for their involvement in routine postpartum care. Although ideally placed to provide primary care to mothers and their infants in the postpartum period, the lack of consistent guidelines for the role of GPs is of concern to both the GPs and early parenting women. Conclusion General practice is an important source of postpartum care for mothers and provides a basis for ongoing support for the family. More consistent guidelines and better coordination with other care providers would benefit both mothers and GPs.
The aim of this study was to evaluate the effect of postpartum pelvic floor muscle exercise in the prevention and treatment of urinary incontinence. A prospective comparison design of 99 matched pairs (n= 198) of mothers, a training group and a control group, was used. Eight weeks postpartum the training group attended an 8-week intensive pelvic floor muscle exercise course, training in groups led by a physical therapist for 45 minutes once a week. In addition they were asked to exercise at home at least three times per week. The control group followed the ordinary written postpartum instructions from the hospital. Pelvic floor muscle strength was measured pretreatment at the eighth, and post-treatment at the 16th week after delivery, using a vaginal balloon catheter connected to a pressure transducer. Vaginal palpation and observation of inward movement of the balloon catheter during contraction were used to test the ability to perform correct the pelvic floor muscle contraction. Urinary leakage was registered by interview, specially designed instruments to measure how women perceive SUI, and a standardized pad test. At baseline (8 weeks postpartum) there was no significant difference in the number of women with urinary incontinence in the training group compared to the control group. At 16 weeks postpartum, after the 8-week treatment period, there was a significant (P<0.01) difference in favor of the training group. In addition, a significantly greater improvement in pelvic floor muscle strength between test 1 and test 2 was found in the training group compared to the control group. The results show that a specially designed postpartum pelvic floor muscle exercise course is effective in increasing pelvic floor muscle strength and reducing urinary incontinence in the immediate postpartum period. PMID:9449300
Mørkved, S; Bø, K
Postpartum depression (PPD) is a modified form of major depressive disorders (MDD) that can exert profound negative effects on both mothers and infants than MDD. Within the postpartum period, both mothers and infants are susceptible; but because PPD typically occurs for short durations and has moderate symptoms, there exists challenges in exploring and addressing the underlying cause of the depression. This fact highlights the need for relevant animal models. In the present study, postpartum adult female cynomolgus monkeys (Macaca fascicularis) living in breeding groups were observed for typical depressive behavior. The huddle posture behavior was utilized as an indicator of behavioral depression postpartum (BDP) as it has been established as the core depressive-like behavior in primates. Monkeys were divided into two groups: A BDP group (n=6), which were found to spend more time huddling over the first two weeks postpartum than other individuals that formed a non-depression control group (n=4). The two groups were then further analyzed for locomotive activity, stressful events, hair cortisol levels and for maternal interactive behaviors. No differences were found between the BDP and control groups in locomotive activity, in the frequencies of stressful events experienced and in hair cortisol levels. These findings suggested that the postpartum depression witnessed in the monkeys was not related to external factors other than puerperium period. Interestingly, the BDP monkeys displayed an abnormal maternal relationship consisting of increased infant grooming. Taken together, these findings suggest that the adult female cynomolgus monkeys provide a natural model of behavioral postpartum depression that holds a number of advantages over commonly used rodent systems in PPD modeling. The cynomolgus monkeys have a highly-organized social hierarchy and reproductive characteristics without seasonal restriction-similar to humans-as well as much greater homology to humans than rodents. As such, this model may provide a greater translational efficiency and research platform for systematically investigating the etiology, treatment, prevention of PPD. PMID:24866487
Chu, Xun-Xun; Dominic Rizak, Joshua; Yang, Shang-Chuan; Wang, Jian-Hong; Ma, Yuan-Ye; Hu, Xin-Tian
OBJECTIVE: To determine the strength of the association between antenatal psychosocial risk factors and adverse postpartum outcomes in the family, such as assault of women by their partner, child abuse, postpartum depression, marital dysfunction and physical illness. DATA SOURCES: MEDLINE, Cinahl, Famli, Psych Abstracts and the Oxford Database of Perinatal Trials were searched from relevant articles published from Jan. 1, 1980, to Dec. 31, 1993, with the use of MeSH terms "depression, involutional," "child abuse," "child neglect," "domestic violence," "family," "marital adjustment," "family health," "newborn health," "child health," "physical illness," "social support," "psychosocial risk," "prediction," "risk factors," "obstetrics" and "prenatal care." Further articles were identified from bibliographies. STUDY SELECTION: Of the 370 articles identified through the search, 118 were included for review. Studies were included if they examined the association between psychosocial risk factors and the outcomes of interest. Articles were excluded if they were reviews of poor quality or they had one or more of the following features: insufficient description of the sample, a high attrition rate, a lack of standardized outcome measures, outcomes other than the ones of interest or results that had already been reported in a previous study. DATA EXTRACTION: The strength of evidence of each study was evaluated. On the basis of the evidence, each risk factor was assigned a rating of the strength of its association with each of the postpartum outcomes. The ratings were class A (good evidence of association), class B (fair evidence) and class C (no clear evidence). Of the 129 antenatal psychosocial risk factors studied, 15 were found to have a class A association with at least one of the postpartum outcomes. DATA SYNTHESIS: Child abuse and abuse of the mother by her partner were most strongly correlated (class A evidence) with a history of lack of social support, recent life stressors, psychiatric disturbance in the mother and an unwanted pregnancy. Child abuse was also strongly associated with a history of childhood violence in the mother or her partner, previous child abuse by the mother's partner, a poor relationship between the mother and her parents, low self-esteem in the mother and lack of attendance at prenatal classes. Postpartum abuse of the mother was also associated with a history of abuse of the mother, prenatal care not started until the third trimester and alcohol or drug abuse by the mother or her partner (class A evidence). Child abuse had a fair (class B) association with poor marital adjustment or satisfaction, current or past abuse of the mother and alcohol or drug abuse by the mother or her partner. There was class B evidence supporting an association between abuse of the mother and poor marital adjustment, traditional sex-role expectations, a history of childhood violence in the mother or her partner and low self-esteem in the mother. Postpartum depression was most strongly associated with poor marital adjustment, recent life stressors, antepartum depression (class A evidence), but was also associated with lack of social support, abuse of the mother and a history of psychiatric disorder in the mother (class B evidence). Marital dysfunction was associated with poor marital adjustment before the birth and traditional sex-role expectations (class A evidence), and physical illness was correlated with recent life stressors (class B evidence). CONCLUSIONS: Psychosocial risk factors during the antenatal period may herald postpartum morbidity. Research is required to determine whether detection of these risk factors may lead to interventions that improve postpartum family outcomes.
Wilson, L M; Reid, A J; Midmer, D K; Biringer, A; Carroll, J C; Stewart, D E
An experiment was conducted to investigate the effects of dietary supplementation of Rhodobacter capsulatus KCTC-2583 on egg-yolk and serum cholesterol, egg production and quality parameters during the late laying periods in hens. A total of 160 Hy-Line Brown layers (54 wk-old) were randomly allotted to 4 treatment groups on the basis of laying performance. Each treatment had 4 replicates with 10 birds each (40 birds per treatment). Two hens were confined individually with cage size 35×35×40 cm and each 10 birds (5 cages) shared a common feed trough between them forming one experimental unit. Dietary treatments were; basal diet supplemented with 0 (control), 0.05, 0.10 and 0.15% R. capsulatus KCTC-2583. Experimental diets were fed in meal form for 56 d. Dietary supplementation of increasing levels of R. capsulatus KCTC-2583 reduced (linear, p<0.05) egg-yolk cholesterol and triglycerides (d 28, 42 and 56) concentrations. Also, serum cholesterol and triglycerides (d 21, 42 and 56) concentrations were linearly reduced (p<0.05) with increasing dietary R. capsulatus KCTC-2583. Laying hens fed a diet supplemented with increasing levels of R. capsulatus KCTC-2583 had increased (linear; p<0.05) overall egg production, egg weight, egg mass and feed efficiency. However, dietary treatments had no effect (linear or quadratic; p>0.05) on feed intake of laying hens. At d 28 and 56, breaking strength and yolk colour of eggs were linearly improved (p<0.05) in laying hens fed dietary increasing levels of R. capsulatus KCTC-2583. Dietary treatment had no effects (linear or quadratic; p>0.05) on albumin height, shell thickness and shell weight at any period of experiment. These results indicate that dietary supplementation of R. capsulatus KCTC-2583 has the potential to improve the laying hen performance and lead to the development of low cholesterol eggs during late laying period in Hy-Line Brown hens.
Lokhande, Anushka; Ingale, S. L.; Lee, S. H.; Kim, J. S.; Lohakare, J. D.; Chae, B. J.; Kwon, I. K.
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
...However, pregnant women may be certified to participate for the duration of their pregnancy and for up to six weeks post-partum. (2) Elderly persons. For elderly persons, the State agency must establish certification periods...
Background Activities and diet during the postpartum period are culturally dictated in many Southeast Asian cultures, and a period of confinement is observed. Plants play an important role in recovery during the postpartum period in diet and traditional medicine. Little is known of the Kry, a small ethnic group whose language was recently described, concerning its traditions and use of plants during pregnancy, parturition, postpartum recovery and infant healthcare. This research aims to study those traditions and identify medicinal plant use. Methods Data were collected in the 3 different Kry villages in Khammouane province, Lao PDR, through group and individual interviews with women by female interviewers. Results A total of 49 different plant species are used in women's healthcare. Plant use is culturally different from the neighboring Brou and Saek ethnic groups. Menstruation, delivery and postpartum recovery take place in separate, purpose-built, huts and a complex system of spatial restrictions is observed. Conclusions Traditions surrounding childbirth are diverse and have been strictly observed, but are undergoing a shift towards those from neighboring ethnic groups, the Brou and Saek. Medicinal plant use to facilitate childbirth, alleviate menstruation problems, assist recovery after miscarriage, mitigate postpartum haemorrhage, aid postpartum recovery, and for use in infant care, is more common than previously reported (49 species instead of 14). The wealth of novel insights into plant use and preparation will help to understand culturally important practices such as traditional delivery, spatial taboos, confinement and dietary restrictions, and their potential in modern healthcare.
OBJECTIVE: Examine frequency, timing, and reasons for maternal postpartum rehospitalizations and acute care visits 1 year postpartum after a high-risk pregnancy.STUDY DESIGN: Secondary analysis of data collected during a randomized clinical trial of advanced practice nurses gives transitional care for women with high-risk pregnancies. The 171 women were primarily African American, never married, Medicaid eligible, diagnosed with pregestational diabetes (20),
Margaret S Hamilton; Dorothy Brooten; JoAnne M Youngblut
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
In order to determine the prevalence of post-partum thyroid dysfunction in our region, 1,376 randomly selected mothers were enrolled immediately post-partum and followed prospectively over a 2 year period in a large single-center survey. Beginning at delivery, sequential clinical and laboratory assessments were conducted at 6-8 week intervals up to 1 year post-partum and a questionnaire was administered at 3 months post-partum. Among the 1,376 mothers who qualified for entry into this study, 495 (36%) completed at least 3 months follow-up and 300 (22%) completed at least 1 year of follow-up. Abnormalities in post-partum thyroid function (PTD) were detected in 82 of the 1,376 enrolled mothers for an overall minimum prevalence rate of 6.0%. Hyperthyroidism confirmed to be associated with a low 24h radioactive iodine thyroid uptake (RAIU), compatible with the post-partum painless thyroiditis syndrome (PPT) was documented in 44 (3.2% minimum prevalence of typical PPT) of which 39 (89%) had a typical biphasic (hyperthyroid to hypothyroid) PTD while 5 (11%) had only a hyperthyroid phase with a suppressed RAIU without a subsequent hypothyroid phase. Another 17 (1.2%) had transient hyperthyroidism likely due to PPT but were not confirmed by an RAIU test and did not evolve to a detectable hypothyroid phase; and, 17 mothers (1.2%) had hypothyroidism between 5-7 months post-partum without preceding hyperthyroidism, resulting in an overall minimum prevalence of 5.7% for all variants of PPT. Graves' hyperthyroidism occurred in 3 (0.2%) and toxic nodular goiter was present in 1 (0.07%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1512416
Walfish, P G; Meyerson, J; Provias, J P; Vargas, M T; Papsin, F R
Current literature on cognitive functioning in pregnancy and postpartum is mixed, with most research showing deficits in memory and attention during pregnancy or no difference between pregnant participants and controls with little emphasis on the postpartum period. In the current study, we used a longitudinal controlled design and 42 primarily not depressed participants to compare pregnant women in the third trimester and approximately three months postpartum with matched controls over the same time period on neuropsychological domains including memory, attention, learning, visuospatial, and executive functioning. We also evaluated the role of mood and quality of life as potential moderators of cognitive functioning in pregnancy/postpartum. Results indicated no differences between controls and pregnant/postpartum women on neuropsychological measures at any time points. Self-reported memory difficulties, however, were higher in the pregnant/postpartum women. Pregnant and postpartum women had worse self-reported mood and quality of life than controls. Mood and quality of life slightly moderated specific measures of attention and verbal fluency; however, neither mood nor quality of life moderated overall neuropsychological functioning in either group. Number of previous pregnancies had no effect on the study findings. Results suggest differences in subjective memory complaints, but no differences in objective neuropsychological test results between controls and pregnant/postpartum women who are primarily not diagnosed with depression. PMID:24820853
Logan, Dustin M; Hill, Kyle R; Jones, Rochelle; Holt-Lunstad, Julianne; Larson, Michael J
Yellow nail syndrome (YNS) is an uncommon clinical syndrome characterized by yellow-green discoloration of nails and recurrent respiratory tract lesions, pleural effusions and lymphedema. A 38-year-old woman was referred to the emergency complaining of chronic cough and increasing dyspnea within last 2 weeks. She had given birth 1 month ago. On examination, the patient exhibited dystrophic yellowish nails and mild peripheral lymphedema. A chest roentgenogram revealed a large right pleural effusion and a small left pleural effusion. YNS is a rare clinical entity but should be taken into consideration in patients with massive pleural effusions and persistent lymphedemas on the postpartum period. PMID:24279775
Günbatar, Hülya; Sertogullarindan, Bunyamin; Ekin, Selami; Arisoy, Ahmet; Ozkol, Hatice Uce
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.
Postpartum thrombosis of varicose veins of the round ligament may present in a clinical picture similar to an irreducible inguinal hernia. Two such unusual cases are reported. One patient underwent surgery while the other, with a presumptive diagnosis of the same condition, was observed, with no complications occurring in both patients. This condition has not to my knowledge been previously reported. The increased incidence of both varicose veins and thrombosis in the postpartum period should alert the physician to the diagnosis of such conditions. Images Figure 1
al-Qudah, M. S.
The post-partum period is a time of extreme vulnerability for a whole spectrum of psychiatric disorders. Delivery may be considered an important risk factor in genetically susceptible women. Five hundred and eight SNPs in 44 genes at candidate pathways putatively related to mood changes after delivery were genotyped in a multicenter cohort of 1804 women from Spain. Participants completed two
Javier Costas; Mònica Gratacòs; Geòrgia Escaramís; Rocío Martín-Santos; Yolanda de Diego; Enrique Baca-García; Francesca Canellas; Xavier Estivill; Roser Guillamat; Miriam Guitart; Alfonso Gutiérrez-Zotes; Luisa García-Esteve; Fermín Mayoral; María Dolores Moltó; Christopher Phillips; Miquel Roca; Ángel Carracedo; Elisabet Vilella; Julio Sanjuán
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
Despite the confirmed health benefits of exercise during the postpartum period, many new mothers are not sufficiently active. The present research compared the effectiveness of two types of messages (health versus appearance) and the moderating role of self?monitoring (SM) on attitudes, subjective norms, perceived behavioral control and intention to exercise after giving birth in two groups of pregnant women (low
Anca Gaston; Kimberley L. Gammage
We characterized depressive symptoms in the prenatal and/or postpartum periods and examined associated risk factors among 594 women who received care at community health care centers. Women were screened with comprehensive risk assessments, which included the Patient Health Questionnaire-9 depression screen, during pregnancy and at least 4 weeks after delivery. Fifteen percent had depressive symptoms in the prenatal period only; 6 % in the postpartum period only, and 8 % had depressive symptoms in both periods. Risk markers varied for women who reported depressive symptoms at one period only compared with those who reported persistent depressive symptoms. Age (25 years versus younger), having experienced abuse, not living with the infant's father, and cigarette smoking were associated with depressive symptoms at both periods; being US-born, lacking social support, and experiencing food insecurity were associated with reporting symptoms only in the prenatal period, and lack of phone access was associated with risk only in the postpartum period. Our findings confirm the importance of repeated screenings for depressive symptoms during the perinatal period. The variability in risk markers associated with periods of reported depressive symptoms may reflect their varying associations with persistence, new onset, or recovery from depressive symptoms. PMID:24037098
Sidebottom, Abbey C; Hellerstedt, Wendy L; Harrison, Patricia A; Hennrikus, Deborah
Pregnancy and the postpartum period are generally considered as contraindications for thrombolysis. We evaluate in this report the safety and effectiveness of using ultrasound-accelerated catheter-directed thrombolysis (UACDT) in treating three symptomatic postpartum deep vein thrombosis (DVT). UACDT was performed using a recombinant human tissue plasminogen activator (alteplase) which was delivered using the EKOS EkoSonic® system. Postprocedure venography was repeated after treatment which include stenting if stenosis was present. The treatment was successful in all three cases of iliofemoral DVT and symptom relief was achieved in all cases. Minor bleeding at the catheter insertion site in one patient was observed but none of the patients suffered from major bleeding or symptomatic pulmonary embolism. UACDT is a safe and effective treatment for restoration of the venous flow in patients with postpartum iliofemoral DVT. Residual venous obstruction should be treated by angioplasty and stent insertion to avoid early re-thrombosis. PMID:23434721
Dumantepe, Mert; Arif, Tarhan Ibrahim; Ilhan, Yurdakul; Ozdemir, Arzu; Azmi, Ozler
In this paper studies are reviewed from the last decade on postpartum depression effects on early interactions, parenting, safety practices and on early interventions. The interaction disturbances of depressed mothers and their infants appear to be universal, across different cultures and socioeconomic status groups and, include less sensitivity of the mothers and responsivity of the infants. Several caregiving activities also appear to be compromised by postpartum depression including feeding practices, most especially breastfeeding, sleep routines and well-child visits, vaccinations and safety practices. These data highlight the need for universal screening of maternal and paternal depression during the postpartum period. Early interventions reviewed here include psychotherapy and interaction coaching for the mothers, and infant massage for their infants. PMID:19962196
The effect of space flight in a National Aeronautics and Space Administration (NASA) shuttle was studied in pregnant rats. Rats were launched on day 9 of gestation and recovered on day 20 of gestation. On day 20 of gestation, rats were unilaterally hysterectomized and subsequently allowed to go to term and deliver vaginally. There was no effect of space flight on pituitary and ovary mass postpartum. In addition, space flight did not alter healthy and atretic ovarian antral follicle populations, fetal wastage in utero, plasma concentrations of progesterone and luteinizing hormone (LH) or pituitary content of follicle stimulating hormone (FSH). Space flight significantly increased plasma concentrations of FSH and decreased pituitary content of LH at the postpartum sampling time. Collectively, these data show that space flight, initiated during the postimplantation period of pregnancy, and concluded before parturition, is compatible with maintenance of pregnancy and has minimal effects on postpartum hypophyseal parameters; however, none of the ovarian parameters examined was altered by space flight.
Burden, H. W.; Zary, J.; Lawrence, I. E.; Jonnalagadda, P.; Davis, M.; Hodson, C. A.
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.
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 aromatic plants are laid). This research focuses on the use of plants during pregnancy, parturition, postpartum recovery and infant healthcare among three ethnic groups, the Brou, Saek and Kry. It aims to identify culturally important traditions that may facilitate implementation of culturally appropriate healthcare. Methods Data were collected in 10 different villages in Khammouane province, Lao PDR, through group and individual interviews with women by female interviewers. Results A total of 55 different plant species are used in women's healthcare, of which over 90% are used in postpartum recovery. Consensus Analysis rejects the hypothesis that the three ethnic groups belong to a single culture for postpartum plant use, and multidimensional scaling reveals non-overlapping clusters per ethnic group. Conclusion Medicinal plant use is common among the Brou, Saek and Kry to facilitate childbirth, alleviate menstruation problems, assist recovery after miscarriage, mitigate postpartum haemorrhage, aid postpartum recovery, and for use in infant care. The wealth of novel insights into plant use and preparation will help to understand culturally important practices such as confinement, dietary restrictions, mother roasting and herbal steam baths and their incorporation into modern healthcare.
de Boer, Hugo; Lamxay, Vichith
This study followed a sample of 217 new mothers in a North Carolina county as they returned to work full-time, measuring their mental and physical health-related quality of life through 16 months postpartum. In general, working mothers of infants had mental health scores that were comparable to the general population of U.S. women, and physical health that was slightly better than women in general. Using ANCOVA and controlling for important demographic characteristics, health-related quality of life was compared between mothers experiencing low and high levels of economic hardship. Across the study period, women with high economic hardship, who constituted 30.7% of the sample, had levels of mental and physical health below those of women with low economic hardship. Mothers with high economic hardship also had less stable health trajectories than mothers with low economic hardship. The findings highlight the importance of reconsidering the traditionally accepted postpartum recovery period of six weeks and extending benefits, such as paid maternity and sick leave, as well as stable yet flexible work schedules. PMID:21104566
Tucker, Jenna N; Grzywacz, Joseph G; Leng, Iris; Clinch, C Randall; Arcury, Thomas A
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
Background A postpartum hemorrhage prevention program to increase uterotonic coverage for home and facility births was introduced in two districts of Liberia. Advance distribution of misoprostol was offered during antenatal care (ANC) and home visits. Feasibility, acceptability, effectiveness of distribution mechanisms and uterotonic coverage were evaluated. Methods Eight facilities were strengthened to provide PPH prevention with oxytocin, PPH management and advance distribution of misoprostol during ANC. Trained traditional midwives (TTMs) as volunteer community health workers (CHWs) provided education to pregnant women, and district reproductive health supervisors (DRHSs) distributed misoprostol during home visits. Data were collected through facility and DRHS registers. Postpartum interviews were conducted with a sample of 550 women who received advance distribution of misoprostol on place of delivery, knowledge, misoprostol use, and satisfaction. Results There were 1826 estimated deliveries during the seven-month implementation period. A total of 980 women (53.7%) were enrolled and provided misoprostol, primarily through ANC (78.2%). Uterotonic coverage rate of all deliveries was 53.5%, based on 97.7% oxytocin use at recorded facility vaginal births and 24.9% misoprostol use at home births. Among 550 women interviewed postpartum, 87.7% of those who received misoprostol and had a home birth took the drug. Sixty-three percent (63.0%) took it at the correct time, and 54.0% experienced at least one minor side effect. No serious adverse events reported among enrolled women. Facility-based deliveries appeared to increase during the program. Conclusions The program was moderately effective at achieving high uterotonic coverage of all births. Coverage of home births was low despite the use of two channels of advance distribution of misoprostol. Although ANC reached a greater proportion of women in late pregnancy than home visits, 46.3% of expected deliveries did not receive education or advance distribution of misoprostol. A revised community-based strategy is needed to increase advance distribution rates and misoprostol coverage rates for home births. Misoprostol for PPH prevention appears acceptable to women in Liberia. Correct timing of misoprostol self-administration needs improved emphasis during counseling and education.
Background Postpartum intrauterine contraceptive devices (PPIUCD) are increasingly included in many national postpartum family planning (PPFP) programs, but satisfaction of women who have adopted PPIUCD and complication rates need further characterization. Our specific aims were to describe women who accepted PPIUCD, their experience and satisfaction with their choice, and complication of expulsion or infection. Methods We studied 2,733 married women, aged 15–49 years, who received PPIUCD in sixteen health facilities, located in eight states and the national capital territory of India, at the time of IUCD insertion and six weeks later. The satisfaction of women who received IUCD during the postpartum period and problems and complications following insertion were assessed using standardized questionnaires. Results Mean (SD) age of women accepting PPIUCD was 24 (4) years. Over half of women had parity of one, and nearly one-quarter had no formal schooling. Nearly all women (99.6%) reported that they were satisfied with IUCD at the time of insertion and 92% reported satisfaction at the six-week follow-up visit. The rate of expulsion of IUCD was 3.6% by six weeks of follow-up. There were large variations in rates of problems and complications that were largely attributable to the individual hospitals implementing the study. Conclusions Women who receive PPIUCD show a high level of satisfaction with this choice of contraception, and the rates of expulsion were low enough such that the benefits of contraceptive protection outweigh the potential inconvenience of needing to return for care for that subset of women.
Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were ? 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management. PMID:23892523
Neville, C E; McKinley, M C; Holmes, V A; Spence, D; Woodside, J V
Spontaneous coronary artery dissection (SCAD) is a deadly cause of myocardial infarction (MI) that mainly affects otherwise healthy, young females. Forty percent of patients die suddenly or within a few hours of symptom onset. We examine the case of a young female who presented with chest pain. She developed ST elevations in anterolateral leads mimicking ST elevation MI. Cardiac catheterization was done and showed a middle left anterior descending (LAD) dissection. The patient underwent primary percutaneous transluminal coronary angioplasty with coronary stent placed in the LAD.
Asker, Muntecep; Asker, Selvi; Gursu, Ozgur
The number of patients who develop cardiac problems during pregnancy are increasing and represent to date the major cause of maternal death in western countries. Pregnancy induces several changes which together increase the hemodynamic burden on the cardiovascular system and can also cause a prothrombotic state. Hence, latent or apparent cardiac disease can acutely decompensate during pregnancy. From a cardiovascular perspective, pregnancies are most often complicated by acute coronary syndromes, peripartum cardiomyopathy, arrhythmias, or pulmonary embolism. Due to potential fetal harm conventional diagnostic and therapeutic approaches are limited by the restricted use of radiogenic cardiac imaging and applicable medications. Therefore, knowledge about available therapeutic options is of greatest importance, since guideline recommendations have clearly been demonstrated to reduce morbidity and mortality in acute cardiac emergencies during pregnancy. PMID:22349533
Rosenberg, M; Frey, N
Infants exposed to secondhand smoke, especially preterm infants with a very low birth weight (VLBW), have an increased risk for developing health problems. Smoking has been associated with numerous health problems in mothers and may reduce immune functioning as well. The purposes of this study were to examine smoking in postpartum mothers of term and preterm infants and to examine the relationship between smoking and immune status. Peripheral blood was drawn on 142 women at four data-collection points and tested for cotinine, immune cell phenotypes, and immune functioning. Overall, 39% of the participants smoked in the postpartum period, but 49% of mothers who delivered preterm infants smoked compared to only 28% of mothers who delivered term infants. There was no difference in cotinine levels between the smokers in both groups of postpartum mothers, nor was smoking related to immune phenotypes or immune function. Given the documented health risks to the mother and infant and the significant number of women who continue to smoke in the postpartum period, it is imperative that health care providers continue to assess smoking status and provide smoking-cessation counseling at every encounter. PMID:11260581
Gennaro, S; Dunphy, P; Dowd, M; Fehder, W; Douglas, S D
Contraceptive use during the postpartum period is critical for maternal and child health. However, little is known about the use of family planning and the determinants in Nepal during this period. This study explored pregnancy spacing, unmet need, family planning use, and fertility behaviour among postpartum women in Nepal using child level data from the Nepal Demographic and Health Surveys 2011. More than one-quarter of women who gave birth in the last five years became pregnant within 24 months of giving birth and 52% had an unmet need for family planning within 24 months postpartum. Significantly higher rates of unmet need were found among rural and hill residents, the poorest quintile, and Muslims. Despite wanting to space or limit pregnancies, nonuse of modern family planning methods by women and returned fertility increased the risk of unintended pregnancy. High unmet need for family planning in Nepal, especially in high risk groups, indicates the need for more equitable and higher quality postpartum family planning services, including availability of range of methods and counselling which will help to further reduce maternal, perinatal, and neonatal morbidity and mortality in Nepal.
Thyroiditis encompasses a group of disorders characterized by thyroid inflammation. Though clinically indistinguishable from silent thyroiditis, postpartum thyroiditis occurs in women within 12 months after delivery. Recurrent postpartum thyroiditis in subsequent pregnancies is common, but recurrent silent thyroiditis is rare. We reported a case of patient with recurrent episodes of thyroiditis, unrelated to pregnancy, after an episode of postpartum thyroiditis. It is of interest that postpartum thyroiditis and silent thyroiditis could occur closely to each other; however, the link between these disorders is not well established. This report is to remind physicians of the possibility of recurrent silent thyroiditis in women with a history of postpartum thyroiditis.
Thyroiditis encompasses a group of disorders characterized by thyroid inflammation. Though clinically indistinguishable from silent thyroiditis, postpartum thyroiditis occurs in women within 12 months after delivery. Recurrent postpartum thyroiditis in subsequent pregnancies is common, but recurrent silent thyroiditis is rare. We reported a case of patient with recurrent episodes of thyroiditis, unrelated to pregnancy, after an episode of postpartum thyroiditis. It is of interest that postpartum thyroiditis and silent thyroiditis could occur closely to each other; however, the link between these disorders is not well established. This report is to remind physicians of the possibility of recurrent silent thyroiditis in women with a history of postpartum thyroiditis. PMID:24987536
Hanseree, Preaw; Salvador, Vincent Bryan; Sachmechi, Issac; Kim, Paul
Background Postpartum depression (PPD) is a global phenomenon. Depression in the first month following delivery is experienced by 20% of mothers in Japan. Therefore, a screening instrument that identifies the risk for depression during pregnancy and in the early postpartum period is required for primary prevention. The aims of this study were to develop the Japanese version of the Postpartum Depression Predictors Inventory-Revised (PDPI-R-J) and determine its predictive validity during pregnancy and one month after delivery. Methods In order to develop the inventory, two bilingual translators translated the PDPI-R into Japanese. Then, back translation was done and a thorough discussion with the original developer was conducted in order to establish semantic equivalence. After the PDPI-R-J was developed, the study used a prospective cohort design. A total of 84 women in their eighth month of pregnancy participated in the study. Seventy-six mothers completed the PDPI-R-J at the first month after childbirth. Women were diagnosed using Mini-International Neuropsychiatric Interview (M.I.N.I.) to determine the presence of minor or major depression at the first month after childbirth and the receiver operating characteristic curve was plotted to evaluate the predictive capacity of PDPI-R-J. Results Of the 76 mothers who completed the PDPI-R-J during the first-month assessment, 16 mothers (21%) met the PPD criteria. The prenatal version of the PDPI-R-J administered during pregnancy accurately predicted 62.8% of PPD (95% CI 0.48–0.77) and the postpartum version administered at the first month after delivery predicted 82.0% of PPD (95% CI 0.71–0.93). The cutoffs identified were 5.5 for the prenatal version and 7.5 for the postpartum version. The PDPI-R-J postpartum version, which includes items relating to the infant, increased the predictive validity of PPD (0.67 to 0.82). Comments from the participants included that the use of the PDPI-R-J enhanced the chance to openly communicate about their history and risks for depression with the researchers, if any existed. Conclusions The PDPI-R-J was found to be a useful and valid screening tool for predicting PPD. Both the prenatal and postpartum versions should be continuously administered to mothers because delivery and infant-related factors affect the potential for PPD.
Since postpartum blues was described by Savage in 1875, the controversy regarding its nature and cause has been sustained. In a first part, the author reviews the conventional clinical assessment of the blues as described in international medical literature. Its constitutive symptoms are mundane, of an affective, emotional, cognitive or psychosomatic nature. On the other hand, their originality resides in
Polyaerylamide gel disc electrophoresis was used to study changes in the relative concentration of the fi-lactoglobulin, a- laetalbumin, blood serum albumin, and im- mune globulin in milk serum during the first 21 days post-partum. All four protein fractions were found to be concentrated in cotostrum serum at parturition, with im- mune globulin being a major fraction. A graphic analysis of
R. M. Porter; H. R. Conrad
This study examines the health, nutritional status, and health care seeking behaviour of a community based sample of 122 postpartum women from an urban slum in Dhaka, Bangladesh. It describes a physically impoverished environment in which malnutrition is serious, and non-trivial morbid episodes as a consequence of childbirth are very common. Malnutrition was found to be widespread: about one-quarter of
Amatul Uzma; Peter Underwood; David Atkinson; Rose Thackrah
A postpartum four-vessel cervical artery dissection with no stroke is reported. This transient vasculopathy took place in the autoimmune context of the HELLP syndrome combined with the reversible posterior leucoencephalopathy syndrome. Correlations between the clinical, radiological and biological entities are discussed.
Barroso, Bruno; Demasles, Stephanie
Postpartum depression (henceforth PPD) is an emotional disturbance which occurs in as much as 20% of the childbearing population. This study attempted to ascertain whether dreams, offering unconscious expression of internal emotional processes, could help to identify early signs of PPD. It was hypothesized that differences would be found in the “emotional dream work” of pregnant women who either later
Tamar Kron; Adi Brosh
Imwon-Gyeongjeji which was created by Seo Yu-gu in the first half of the 19th century is a encyclopedia of practical use in rural life. It consists of 113 volumes, 16 fields, and 2.52 million total characters. Of these, the field of medicine comes 11th of the contents covering 28 volumes and 1.1 million characters. Its name is Inje-ji. This paper examines the academic background of Seo Yu-gu and his life work briefly, and investigates the characteristics of medical knowledge of late Joseon period contained in the Imwon-Gyeongjeji, Inje-ji Here, we made key comparisons especially with Dongui-Bogam, Joseon's leading medical book. Of the pioneers of medical history studies of Joseon, a Japanese researcher Miki Sakae has made a negative evaluation to Inje-ji. But after concrete investigation we have come to conclude as follows. First, familial ancestors of Seo Yu-gu were engaged in the introduction of foreign-language books, so Seo Yu-gu as an officer of proof-reading and editing of the various books, also had a lot of knowledge on the medical books ever in history. On this background and experience, for over 36 years from 1,806 retirement from official position to his death, he had compiled and edited Imwon-Gyeongjeji. Second, unlike Dongui-Bogam which included improving health skill, Inje-ji focused on curing medicine readily accessible from the major population of that time. Its main features are as follows: i) prescriptions directly linked to the diseases and symptoms, ii) greatly increased medicinal knowledge especially on infectious diseases and trauma, iii) detailed index easy to look up for prescription and iv) his 'own opinions'[an-seol] which can indicate relevant contents within the book and organically combines the whole knowledge in it. Third, "Inje-ji" utilizing medical books in China and Korea even those of Japan, collected more massively almost all the medical knowledge, new illness, herbs of local area, private prescription. Meanwhile Inje-ji modified the errors of the older medical books like Dongui-Bogam or Bencao-Gangmu, expressed its own subjective views about controversial topics. In summary "Inje-ji" can be the last general medical book which collected and edited almost all the medical knowledge of the period in the East Asia with its own editing format. In addition it is recognized that it pursued an evidence-based medicine and the practical medicine relieving the people, rather than medico-philosophical theories in oriental traditional medicine which was criticized by many critical intellectuals afterwards. Given the scrutiny, it seems that evaluation of the "Inje-ji" by Miki Sakae should be revised by thorough investigations. We are just on the starting line of the Inje-ji research in earnest meaning, and expect this research would give more fruitful and deep perspective in the area of Korea history of medicine. PMID:23388488
Jeon, Jongwook; Jo, Changrock
Childhood abuse is a powerful risk factor for developing postpartum depression in adulthood, and recently it has been associated to thyroid dysfunction in postpartum depressive women. The purpose of this study was to investigated the effects of childhood abuse on thyroid status and depressive symptomatology in two hundred and thirty-six (n=236) postpartum women 24-48h after delivery. The Early-Trauma-Inventory Self-Report was used to assess the presence of childhood abuse and the Edinburgh Postpartum Depression Scale (EPDS) to evaluate depressive symptomatology (EPDS?11). Free thyroxin (fT4) and thyroid-stimulating hormone (TSH) were measured. Thyroid dysfunction (TD) was defined as altered TSH or TSH and fT4. Socio-demographic, reproductive, and psychopathological variables were also collected. Multivariate analysis shows that childhood physical abuse increases by four times the risk for TD (OR: 3.95, 95% CI: 1.23-12.71) and five times the risk for depressive symptomatology (OR: 5.45, 95% CI: 2.17-13.66) in the earlier postpartum. Our findings suggest that women with history of childhood physical abuse are particularly at-risk for thyroid dysfunction and depressive symptomatology 24-48h after delivery. The assessment of childhood abuse in the perinatal period is important to identify women at-risk for physical and mental health problems in this period. PMID:22878032
Plaza, Anna; Garcia-Esteve, Lluïsa; Torres, Anna; Ascaso, Carlos; Gelabert, Estel; Luisa Imaz, María; Navarro, Purificación; Valdés, Manuel; Martín-Santos, Rocío
In this cohort study, our objective was to identify potentially modifiable risk factors and causes for febrile morbidity in teenage mothers. We identified all cases of febrile morbidity using the United States Joint Commission on Maternal Welfare definition in a cohort of teenage deliveries over a 4-year period at one institution. Of the 730 included teenage deliveries, 49 (7%) women suffered postpartum febrile morbidity. Higher maternal pre-pregnancy body mass index (BMI: 34.0 ± 8.6 vs 30.3 ± 6.0 kg/m(2), p = 0.0001), caesarean delivery (RR 21.3, 95% CU 8.9-54.9) and postpartum haemorrhage (RR 3.0, 95% CI 1.1-6.7) were associated with postpartum febrile morbidity. Risk factors for febrile morbidity in the teenage parturient include obesity, caesarean delivery and postpartum haemorrhage. Considering the increasing rates of teenage obesity and overall caesarean delivery rates, attention must be focused on these modifiable risk factors to avoid this complication during a tenuous time for the teenage parent. PMID:23445136
Haeri, S; Baker, A M
Offshore and onshore stratigraphic studies, together with high-resolution shallow seismic reflection profiling and multibeam bathymetric mapping, were carried out in the western and central part of the ?zmit Gulf. These studies indicate that the ?zmit Gulf was a lacustrine environment as part of the Marmara ‘Lake’ during the late glaciation and early deglaciation until ?12 kyr BP, when the Marmara
M. N. Ça?atay; N. Görür; A. Polonia; E. Demirbag; M.-H. Cormier; L. Capotondi; C. McHugh; Ö. Emre; K. Eris
Despite the mid-Cretaceous super-greenhouse with generally rising and high sea-level stands, the Cenomanian-Turonian interval (C-T, early Late Cretaceous, ~100-90 ma) was repeatedly punctuated by large and rapid sea-level drops, the reasons of which are still poorly understood. In order to test the isochrony of those early Late Cretaceous sea-level changes, an interplate sequence stratigraphic study of selected Cenomanian-Turonian basins on different tectonic plates (Europe, northern Africa, Middle East) has been conducted. Well exposed shelf sections have stratigraphically been calibrated and correlated by means of integrated approaches, especially high-resolution ammonoid biostratigraphy, carbon stable isotopes and cyclostratigraphy. In combination with analyses of (bio-)facies and stratal architectures (such as on-/offlap geometries or incision at sequence boundaries), a precise correlation of unconformities and an assessment of the magnitudes of sea-level changes involved in their formation has been possible. High-resolution orbital time-scales provide the possibilities to elucidate the rates of sea-level change. The study shows that C-T sea-level changes have in fact been strictly time-equivalent and iso-directional on different tectonic plates. Major sea-level falls, resulting in the development of depositional sequence (i.e., 3rd-order) bounding unconformities occurred in the latest Albian, the mid- and latest Early Cenomanian, the late Middle and mid-Late Cenomanian, the Lower-Middle Turonian boundary interval, the Middle Turonian as well as the early, mid-and late Late Turonian. Especially the sea-level falls were of high-magnitude and short duration (tens of metres in less than 100 kyr). The resulting rates of sea-level change are in the order of 150-1000 m/myr and can only be explained by glacio-eustasy (or a yet unknown process). The study also showed a regular temporal recurrence of unconformities and suggests that early Late Cretaceous 3rd-order sequences developed by low-frequency modulations of the Milankovitch oscillations, i.e. the nodes of obliquity cycle (ca. 1.2 myr), regularly amplified by the ca. 2.4 myr minima of Earth' eccentricity. High-frequency sequences, controlled by the ca. 400-kyr-long eccentricity cycle, are components of the depositional sequences. The study thus perfectly integrates the hitherto conflicting approaches of high-frequency and depositional sequence stratigraphy.
Wilmsen, Markus; Richardt, Nadine
Postpartum anxiety is a condition of concern due to associated difficulties for the mother, her relationships, and her infant's development. We revised one measure of postpartum anxiety symptoms, the Postpartum Worry Scale (PWS) to include items that tap concerns related to infant health and development, important potential domains of postpartum worry. This study presents the initial phase of validation for the PWS-R. An online sample of 1,231 mothers of infants ages birth to 24 months completed the PWS-R as well as a battery of measures. We conducted a split-sample confirmatory factor analysis (CFA) to assess the latent factor structure, and a series of models were tested to refine the measure. The newly constructed factors were correlated with theoretically similar measures to test the construct validity. Initial model testing revealed a four-factor structure (i.e., Relationships, Household, Time Allocations, and Health and Development) that included 13 items. Two-group CFA confirmed the latent factor structure. Theoretically similar measures correlated moderately with the newly created PWS-R factors. The psychometric findings for the PWS-R provide preliminary support for its use as a measure of postpartum worry. Next steps in the iterative validation process are considered. Recommendations for the PWS-R's use in clinical and research contexts are discussed. PMID:24026389
Moran, Tracy E; Polanin, Joshua R; Wenzel, Amy
Few studies have investigated maternal aggression toward infants among women with a severe mental illness that emerges in the postpartum period. In this prospective study of 50 Indian women admitted to a psychiatric hospital for severe mental illness occurring in the postpartum period, we examined the prevalence, pattern, and predictors of maternal aggression, infanticidal ideas, and infanticidal behavior. Nearly half (43%) of the mothers reported infanticidal ideas, 36% reported infanticidal behavior, and 34% reported both infanticidal ideas and behavior. Infanticidal ideas and behavior co-occurred frequently (r =.80). Infanticidal ideas were associated with depression in the mother, adverse maternal reaction to separation from the infant, and psychotic ideas toward the infant. Infanticidal behavior was associated with having a female infant, psychotic ideas toward the infant, and adverse maternal reaction to separation from the infant. Logistic regression analyses indicated that presence of depression and of psychotic ideas predicted infanticidal ideas, whereas presence of psychotic ideas toward the infant predicted infanticidal behavior. PMID:12142847
Chandra, Prabha S; Venkatasubramanian, Ganesan; Thomas, Tinku
The modifying effects of late neonatal administration of p-nonylphenol (NP), a suspected xenoestrogen, on 3,2?-dimethyl-4-aminobiphenyl (DMAB)-induced prostatic carcinogenesis were investigated in male F344 rats. Three-week-old rats received 25, 250 or 2000 ppm of NP in the diet for 3 weeks prior to DMAB treatment and were sacrificed at 67 weeks of age for histopathological assessment of lesions and Ki-67 immunohistochemical
Shingo Inaguma; Satoru Takahashi; Katsumi Imaida; Shugo Suzuki; Tomoyuki Shirai
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
Background: Postpartum depression is endangering the health of mothers and has negative impacts on the evolution of social communication and newborns evolution. This study was conducted to determine the effects of Fordyce Happiness program on the postpartum depression. Materials and Methods: This quasi-experimental intervention carried out on postpartum mothers that referred to 4 health centers in Isfahan. A total of 133 mothers were selected by convenient sampling and then randomly allocated in two groups (63 and 70 mothers for intervention and control respectively). Maternal depression 3 times before, immediate and 1 months after intervention in both groups was evaluated with Beck Depression Inventory-II-Persian standardized questionnaires. Educational sessions based on the Fordyce happiness program were conducted for intervention group. Data was analyzed in SPSS17 (SPSS Inc, Chicago, Illinois) descriptive and analytic statistical tests at significance level of 0.05. Results: No significant differences in demographic variables between the two groups (P ? 0.05). No significant differences in depression scores in the two groups before training. However after 2 months a significant difference in depression score was observed between two groups (control group: 19.38 ± 3.94; intervention group: 16.24 ± 4.8; P < 0.001). Furthermore in intervention group showed significant differences in depression scores before and after intervention (19.15 ± 3.41 and 16.24 ± 4.83; P < 0.001). However in the control group had not any significant change. Conclusion: Fordyce happiness program was effective in reducing postpartum depression in our study. With attention to the effectiveness and low cost of this program, it is recommended that this program might be considered for all mothers after childbirth in health centers or other community-based settings.
Rabiei, Leili; Mazaheri, Maryam Amidi; Masoudi, Reza; Hasheminia, Sayed Ali Mohammad
Postpartum thyroiditis (PPT) is the occurrence of de novo autoimmune thyroid disease, excluding Graves' disease, in the first year postpartum. The incidence of PPT is 5.4% in the general population, and it is increased in individuals with other autoimmune diseases such as type 1 diabetes mellitus. The classic presentation of PPT of hyperthyroidism followed by hypothyroidism is seen in 22% of cases. The majority of women with PPT experience an isolated hypothyroid phase (48%), with the remainder experiencing isolated thyrotoxicosis (30%). Up to 50% of women who are thyroid antibody positive (thyroid peroxidase antibody and/or thyroglobulin antibody) in the first trimester will develop PPT. Symptoms are more common in the hypothyroid phase of PPT and include fatigue, dry skin, and impaired memory. Despite multiple studies exploring the relationship between PPT and postpartum depression, or postpartum depression in thyroid antibody-positive euthyroid women, the data are conflicting, and no firm conclusions can be reached. Long-term follow-up of women who had an episode of PPT reveals a 20-40% incidence of permanent primary hypothyroidism. In a single study, selenium administration significantly decreased the incidence of PPT, but replication of the findings is needed before the recommendation can be made that all pregnant thyroid peroxidase antibody-positive women receive selenium. The indication for treating the hyperthyroid phase of PPT is control of symptoms, whereas treatment of the hypothyroid phase of PPT is indicated for symptomatic relief as well as in women who are either breastfeeding or attempting to conceive. PMID:22312089
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 amygdalae (AMYG), hippocampi (HIPP) and dorsolateral prefrontal cortices (DLPFC). 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.
Deligiannidis, Kristina M.; Sikoglu, Elif M.; Shaffer, Scott A.; Frederick, Blaise; Svenson, Abby; Kopoyan, Andre; Kosma, Chelsea; Rothschild, Anthony J.; Moore, Constance M.
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
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
Rupture of the thoracic aorta is a rare but recognized complication following pregnancy. The common causes of thoracic aortic rupture in the peripartum period are trauma, dissecting aneurysms and saccular aneurysms secondary to systemic connective tissue disease. We report a case of non-traumatic spontaneous aortic rupture in a patient without trauma or systemic connective tissue disease 1 day postpartum, which was successfully managed by surgical repair of the thoracic aorta. PMID:23242990
Menon, Ashvini; Bonser, Robert S
Summary A case report of a 34-year-old female with the Cronkhite-Canada syndrome is presented. The patient developed the characteristic clinical features of intestinal polyposis, skin pigmentation, alopecia, and onychodystrophy which later resolved. An unusual feature was that symptoms developed during the postpartum period. This is the youngest female patient described with the syndrome. The etiology, pathophysiology, clinical manifestations, and management
Aubrey G. Peart; Michael V. Sivak; George B. Rankin; L. Stephen Kish; Willard D. Steck
The effect of early and\\/or extended mother-infant contact in the postpartum period on 54 German middle-class mothers (mean age 25 yrs) was examined with respect to their tactual contact of their newborns. The control group had neither early nor extended contact, a 2nd group had early contact starting with the 1st hr after birth, a 3rd group had extended contact
Karin Grossmann; Kerstin Thane; Klaus E. Grossmann
This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g = 0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes.
Sockol, Laura E.; Epperson, C. Neill; Barber, Jacques P.
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
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
Postpartum onset of eclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome is a rare but life-threatening complication for both mother and fetus. A case of a 38-year-old parturient (gravida 2, para 1) who was asymptomatic prior to delivery is reported. Emergency caesarean section had to be performed due to sudden onset of fetal bradycardia as a result of partial placental separation. The perioperative course was characterized by new onset hypertension, nausea and restlessness; within 2 h the patient suffered a generalized seizure which was treated with magnesium sulfate and hydralazine. Despite management in accordance with current guidelines, the condition deteriorated with hypotension, anemia and renal failure. On further examination hematomas in the abdominal cavity and walls were identified and laboratory tests confirmed HELLP syndrome with severe coagulopathy. Explorative laparotomy revealed diffuse bleeding without a significant isolated source or postpartum uterine hemorrhage. Retrospectively, the anemia could be ascribed to severe hemolysis and diffuse bleeding from coagulopathy. The patient required packed red cells, platelets, fresh frozen plasma and prothrombin complex. After admission to the intensive care unit persistent diffuse bleeding mainly caused by hyperfibrinolysis and renal failure occurred, which required blood transfusion, antifibrinolytic (tranexamic acid) and renal replacement therapy (continuous veno-venous hemodiafiltration with citrate) for 6 days. The patient recovered without any sequelae and was discharged 26 days later. Placental separation with new onset peripartum hypertension is to be interpreted as a precursor of severe gestosis and associated complications, especially disseminated intravascular coagulation (DIC), acute renal failure and pleural effusion. A differentiation between a rapid drop in hemoglobin concentration secondary to hemolysis in postpartum HELLP syndrome rather than postpartum hemorrhage can be challenging. In addition, HELLP syndrome can lead to rapidly developing, fulminant hyperfibrinolysis in the context of DIC. Keys to successful management of postpartum gestosis and associated complications are early detection and perception of clinical and laboratory warning signs, a multidisciplinary approach with rapid and consistent targeted symptomatic therapy to save the mother and fetus. PMID:21184033
Schott, M; Henkelmann, A; Meinköhn, Y; Jantzen, J-P
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))
This work was a first attempt to discover whether the suppression of adenopituitary gonadotropin secretion might be responsible for a decrease of systemic T4 and T3 levels in the post-partum period in ewes, and also whether the depression of T4 and T3 levels might be retroactively responsible for a depression of sexual activity in the post-partum period and in spring.
E. Bekeova; M. Krajnicakova; V. Hendrichovsky; I. Maracek
The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03-4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery. PMID:22838157
Ferdous, J; Ahmed, A; Dasgupta, S K; Jahan, M; Huda, F A; Ronsmans, C; Koblinsky, M; Chowdhury, M E
The 6 to 8-week period centered on parturition, known as the transition or periparturient period, is critical to welfare and profitability of individual cows. Fertility of high-producing cows is compromised by difficult transitions. Deficiencies in either nutritional or non-nutritional management increase risk for periparturient metabolic disorders and infectious diseases, which decrease subsequent fertility. A primary factor impeding fertility is the extent of negative energy balance (NEB) early postpartum, which may inhibit timing of first ovulation, return to cyclicity, and oocyte quality. In particular, pronounced NEB during the first 10 days to 2 weeks (the time of greatest occurrence of health problems) is critical for later reproductive efficiency. Avoiding over-conditioning and preventing cows from over-consuming energy relative to their requirements in late gestation result in higher dry matter intake (DMI) and less NEB after calving. A pooled statistical analysis of previous studies in our group showed that days to pregnancy are decreased (by 10 days) by controlling energy intake to near requirements of cows before calving compared with allowing cows to over-consume energy. To control energy intake, total mixed rations (TMR) must be well balanced for metabolizable protein, minerals and vitamins yet limit total DM consumed, and cows must uniformly consume the TMR without sorting. Dietary management to maintain blood calcium and rumen health around and after calving also are important. Opportunities may exist to further improve energy status in fresh cows. Recent research to manipulate the glucogenic to lipogenic balance and the essential fatty acid content of tissues are intriguing. High-producing cows that adapt successfully to lactation can have high reproductive efficiency, and nutritional management of the transition period both pre- and post-calving must facilitate that adaptation. PMID:24844126
Drackley, J K; Cardoso, F C
This article reviews the historical development of the concept of late paraphrenia. Studies that attempt to define symptoms, demographics, and risk factors for late-onset paranoid disorders are reviewed. Differences between late-onset schizophrenia and early-onset schizophrenia are highlighted. Current research on potential brain abnormalities in these disorders is examined critically. PMID:7659602
Addonizio, G C
The aim of the authors in this study was to assess the prevalence of postpartum depression and evaluate the association of affective temperaments with emotional disorders in a sample of 92 pregnant women consecutively admitted for delivery between March and December 2009. In the first few days postpartum, women completed the Suicidal History Self-rating Screening Scale, the Beck Hopelessness Scale, the Edinburgh Postnatal Depression Scale, the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire, and the Gotland Male Depression Scale. Fifty percent of the women reported an Edinburgh Postnatal Depression Scale score of 9 or higher, and 23% a score of 13 or higher. Women with a dysphoric-dysregulated temperament had higher mean scores on the Beck Hopelessness Scale (p < 0.05), the Gotland Male Depression Scale (p < 0.001), the Edinburgh Postnatal Depression Scale (p < 0.001), and the Suicidal History Self-Rating Screening Scale (p < 0.01) than other women after adjusting for covariates. Multiple logistic regression analysis with the temperament groups as the dependent variable indicated that only the Gotland Male Depression Scale was significantly associated with temperament when controlling for the presence of other variables. Women with a dysphoric-dysregulated temperament were 1.23 times as likely to have higher depressive symptom scores. Future studies should evaluate the effectiveness of psychiatric screening programs in the postpartum period as well as factors associated with depression and suicidality during the same period. PMID:21797682
Girardi, Paolo; Pompili, Maurizio; Innamorati, Marco; Serafini, Gianluca; Berrettoni, Claudia; Angeletti, Gloria; Koukopoulos, Alexia; Tatarelli, Roberto; Lester, David; Roselli, Domenico; Primiero, Francesco M
Changes in mental health symptoms throughout pregnancy and postpartum may impact a woman's experience and adjustment during an important time. However, few studies have investigated these changes throughout the perinatal period, particularly changes in posttraumatic stress disorder (PTSD) symptoms. The purpose of this study was to examine longitudinal changes in PTSD, depression, and anxiety symptomatology during pregnancy and postpartum. Pregnant women of ethnically diverse backgrounds receiving services for prenatal care at an outpatient obstetric-gynecology clinic or private physicians' office were assessed by interview on symptoms of PTSD, depression, anxiety, and general stress up to four times, including their first, second, and third trimester, and postpartum visits. Overall, during pregnancy there was a declining trend of PTSD symptoms. For anxiety, there was no overall significant change over time; however, anxiety symptoms were individually variable in the rate of change. For both depression and general stress symptoms, there was a declining trend, which was also variable in the individual rate of change among women during their pregnancy. Visual and post hoc analyses also suggest a possible peak in PTSD symptoms in the weeks prior to delivery. While most mental health symptoms may generally decrease during pregnancy, given the individual variability among women in the rate of change in symptoms, screening and monitoring of symptom fluctuations throughout the course of pregnancy may be needed. Further studies are needed to examine potential spiking of symptoms in the perinatal period. PMID:23797809
Onoye, Jane M; Shafer, Leigh Anne; Goebert, Deborah A; Morland, Leslie A; Matsu, Courtenay R; Hamagami, Fumiaki
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.
Objective: To determine if the routine initiation of dexamethasone in patients with post-partum HELLP syndrome produces therapeutic benefits. Method: The puerperal courses of 17 mothers who initially received dexamethasone after delivery were compared to 17 other mothers with HELLP syndrome who received no corticosteroids during the puerperium course. Treated patients immediately received 10 mg of dexamethasone post-partum (intravenously) followed 12
P Vigil-De Gracia; E Garc??a-Cáceres
Prolonged postpartum acyclicity in suckled beef cows is a source of economic loss to beef cattle producers. Duration of postpartum acyclicity is influenced by suckling status, nutritional status, calving season, age, and several other factors. Although uterine involution begins and ovarian follicular waves resume soon after parturition, dominant follicles of these waves fail to ovulate, due to a failure to
Y. Yavas; J. S. Walton
Background: Cardiac arrest following a massive pulmonary embolism in pregnancy or the puerperium is a rare and catastrophic event. Case: We describe a case of massive pulmonary embolism with cardiac arrest in a 36-year-old patient, presenting 48 hours postpartum. She was treated with thrombolytic therapy and suffered a massive hemorrhage thereafter, which was compounded by disseminated intravascular coagulation. Following an emergency hysterectomy and massive blood-product transfusion, she survived with no neurological sequelae. The medical team present had participated in two simulation sessions with similar scenarios in the weeks before the event. Conclusion: To our knowledge, this is only the fifth case reported in the literature on thrombolytic therapy in the postpartum period, and of these has the most severe hemorrhagic complication. An effective multidisciplinary approach to such a complex situation can be acquired through simulation-based training. PMID:24927187
Shaulov, Talya; David, Michèle; Pellerin, Marieve; Morin, Francine
The purpose of this case report is to present a return to running program for a postpartum client who had delivered via cesarean section. The client, a 29-year-old female health care professional who was 8 months postcesarean section, was referred to physical therapy for a return to running exercise program. The client had three live births during a 30-month time period (February 2004 to August 2006). During her last labor she underwent an emergency cesarean section because of a low fetal heart rate. Since her surgery the client had not participated in an exercise routine. Following an 8-week training program the client was able to demonstrate both quantitative and qualitative functional improvements, including running a 12-minute mile. This case describes a successful return to running program for a postpartum client who delivered her child via cesarean section. Future research is warranted to determine the optimal evaluation strategy and exercise training programs for this population. PMID:19418367
Pregnancy increases the risk of being overweight at a later time period, particularly when there is excessive gestational weight gain. There remains a paucity of data into the effect of low glycaemic index (GI) pregnancy interventions postpartum. Aim: To examine the impact of a low glycaemic index diet during pregnancy on maternal diet 3 months postpartum. Methodology: This analysis examined the diet, weight and lifestyle of 460 participants of the ROLO study 3 months postpartum. Questionnaires on weight, physical activity, breastfeeding, supplement use, food label reading and dietary habits were completed. Results: The intervention group had significantly greater weight loss from pre-pregnancy to 3 months postpartum than the control group (1.3 vs. 0.1 kg, p = 0.022). The intervention group reported greater numbers following a low glycaemic index diet (p < 0.001) and reading food labels (p = 0.032) and had a lower glycaemic load (GL) (128 vs. 145, p = 0.014) but not GI (55 vs. 55, p = 0.809) than controls. Conclusions: Low GI dietary interventions in pregnancy result in improved health-behaviours and continued reported compliance at 3 months postpartum possibly through lower dietary GL as a result of portion control. Greater levels of weight loss from pre-pregnancy to 3 months postpartum in the intervention group may have important positive implications for overweight and obesity.
Horan, Mary K.; McGowan, Ciara A.; Gibney, Eileen R.; Donnelly, Jean M.; McAuliffe, Fionnuala M.
The principal modulators of the hypothalamic-pituitary-adrenal (HPA) axis are corticotropin-releasing hormone (CRH) and arginine-vasopressin (AVP). Corticotropin-releasing hormone is not exclusively produced in the hypothalamus. Its presence has been demonstrated at peripheral inflammatory sites. Ovulation and luteolysis bear characteristics of an aseptic inflammation. CRH was found in the theca and stromal cells as well as in cells of the corpora lutea of human and rat ovaries. The cytoplasm of the glandular epithelial cells of the endometrium has been shown to contain CRH and the myometrium contains specific CRH receptors. It has been suggested that CRH of fetal and maternal origin regulates FasL production, thus affecting the invasion (implantation) process through a local auto-paracrine regulatory loop involving the cytotrophoblast cells. Thus, the latter may regulate their own apoptosis. During pregnancy, the plasma level of circulating maternal immunoreactive CRH increases exponentially from the first trimester of gestation due to the CRH production in the placenta, decidua, and fetal membranes. The presence in plasma and amniotic fluid of a CRH-binding protein (CRHbp) that reduces the bioactivity of circulating CRH by binding is unique to humans. Maternal pituitary ACTH secretion and plasma ACTH levels rise during pregnancy-though remaining within normal limits-paralleling the rise of plasma cortisol levels. The maternal adrenal glands during pregnancy gradually become hypertrophic. Pregnancy is a transient, but physiologic, period of hypercortisolism. The diurnal variation of plasma cortisol levels is maintained in pregnancy, probably due to the secretion of AVP from the parvicellular paraventricular nuclei. CRH is detected in the fetal hypothalamus as early as the 12th week of gestation. CRH levels in fetal plasma are 50% less than in maternal plasma. The circulating fetal CRH is almost exclusively of placental origin. The placenta secretes CRH at a slower rate in the fetal compartment. AVP is detected in some neurons of the fetal hypothalamus together with CRH. AVP is usually detectable in the human fetal neurohypophysis at 11 to 12 weeks gestation and increases over 1000-fold over the next 12 to 16 weeks. The role of fetal AVP is unclear. Labor appears to be a stimulus for AVP release by the fetus. The processing of POMC differs in the anterior and intermediate lobes of the fetal pituitary gland. Corticotropin (ACTH) is detectable by radioimmunoassay in fetal plasma at 12 weeks gestation. Concentrations are higher before 34 weeks gestation, with a significant fall in late gestation. The human fetal adrenal is enormous relative to that of the adult organ. Adrenal steroid synthesis is increased in the fetus. The major steroid produced by the fetal adrenal zone is sulfoconjugated dehydroepiandrosterone (DHEAS). The majority of cortisol present in the fetal circulation appears to be of maternal origin, at least in the nonhuman primate. The fetal adrenal uses the large amounts of progesterone supplied by the placenta to make cortisol. Another source of cortisol for the fetus is the amniotic fluid where cortisol converted from cortisone by the choriodecidua, is found. In humans, maternal plasma CRH, ACTH, and cortisol levels increase during normal labor and drop at about four days postpartum; however, maternal ACTH and cortisol levels at this stage are not correlated. In sheep, placental CRH stimulates the fetal production of ACTH, which in turn leads to a surge of fetal cortisol secretion that precipitates parturition. The 10-day-long intravenous administration of antalarmin, a CRH receptor antagonist, significantly prolonged gestation compared to the control group of animals. Thus, CRH receptor antagonism in the fetus can also delay parturition. The HPA axis during the postpartum period gradually recovers from its activated state during pregnancy. The adrenals are mildly suppressed in a way analogous to postcure Cushing's syndrome. Provocation testing has shown that hypothalamic CRH secretion is transiently suppri
Mastorakos, George; Ilias, Ioannis
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
We have reported previously that exposure to the cyanobacterial neurotoxin ?-N-methylamino-l-alanine (BMAA) during the neonatal period causes cognitive impairments in adult rats. The aim of this study was to investigate the long-term effects of neonatal BMAA exposure on learning and memory mechanisms and to identify early morphological changes in the neonatal brain. BMAA was injected subcutaneously in rat pups on
Oskar Karlsson; Erika Roman; Anna-Lena Berg; Eva B. Brittebo
Post-partum depression (PPD) belongs to the depressive spectrum consecutive to a pregnancy. It is important to detect it as soon as possible to avoid non-negligible consequences for the mother, the new born and close relatives. It some cases, PPD may give way to post-partum psychosis, a psychiatric emergency. The present study splits 88 women in two groups, within days of delivery, as a function of their score at the Edinburgh postnatal Depression Scale (EPDS), an internationally validated scale which predicts future episodes of PPD. The two groups are then compared to a series of open items, obtained by personal interview, with the objective to better differentiate psychological and historical data giving way to this condition. Among the women, 27.3% had a score on the EPDS > or = 12 which is higher than what is generally encountered in the literature. The main results of this study are: 1) the higher percentage in the at risk group of women living with a significant other; 2) the presence of psychic or somatic issues during the pregnancy; 3) the feelings of negligence by the immediate environment; 4) auto-depreciative tendency, the ill-fulfilling of maternal function. These items are easily detectable if a little more attention was dedicated to young mothers soon after delivery. PMID:24683836
Amaru, D; Le Bon, O
Severe postpartum hemorrhage (PPH) can be defined as a blood loss of more than 1500 mL to 2500 mL. While rare, severe PPH is a significant contributor to maternal mortality and morbidity in the United States and throughout the world. Due to the maternal hematologic adaptation to pregnancy, the hypovolemia resulting from hemorrhage can be asymptomatic until a large amount of blood is lost. Rapid replacement of lost fluids can mitigate effects of severe hemorrhage. Current evidence on postpartum volume replacement suggests that crystalloid fluids should be used only until the amount of blood loss becomes severe. Once a woman displays signs of hypovolemia, blood products including packed red blood cells, fresh frozen plasma, platelets, and recombinant factor VIIa should be used for volume replacement. Overuse of crystalloid fluids increases the risk for acute coagulopathy and third spacing of fluids. A massive transfusion protocol is one mechanism to provide a rapid, consistent, and evidence-based team response to this life-threatening condition. PMID:24751109
Schorn, Mavis N; Phillippi, Julia C
Background The physical exercise consists of trainable physical abilities such as strength and endurance. It can be inferred that the individual cardiac patient is dependent on it as an associated therapy to the drug treatment for a rapid and lasting improvement of their overall clinical status Case presentation The patient – with Spontaneous Coronary Artery Dissection Postpartum period – was subjected to 21 sessions of cardiac rehabilitation. A physical evaluation was performed, before and after the treatment period, for data collection: anthropometric values, flexibility, aerobic capacity and strength of grip. Conclusion The patient had a positive response in aerobic capacity, flexibility and grip strength and the anthropometric values were kept in short term rehabilitation.
Background Postpartum weight retention is a significant risk factor for long-term weight gain. Encouraging new mothers to consume a healthy diet may result in weight loss. Objective To assess predictors of diet quality during the early postpartum period; to determine if diet quality, energy intake, and lactation status predicted weight change from five to 15 months postpartum; and to determine whether an intervention improved diet quality, reduced energy intake, and achieved greater weight loss compared to usual care. Design Randomized clinical trial (KAN-DO: Kids and Adults Now - Defeat Obesity), a family and home-based, ten-month, behavioral intervention to prevent childhood obesity, with secondary aims to improve diet and physical activity habits of mothers, in order to promote postpartum weight loss. Participants Overweight/obese, postpartum women (n=400), recruited from 14 counties in the Piedmont region of North Carolina. Intervention Eight education kits, each mailed monthly; motivational counseling; and one group class. Methods Anthropometric measurements and 24-hour dietary recalls collected at baseline (approximately five months postpartum) and follow-up (approximately ten months later). Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). 3 Statistical analyses Descriptive statistics, chi-square, analysis of variance, bi-and multivariate analyses were performed. Results At baseline, mothers consumed a low quality diet (HEI-2005 score = 64.4 ± 11.4). Breastfeeding and income were positive, significant predictors of diet quality; while BMI was a negative predictor. Diet quality did not predict weight change. However, total energy intake, not working outside of the home, and breastfeeding duration/intensity were negative predictors of weight loss. There were no significant differences in changes in diet quality, decreases in energy intake or weight loss between the intervention (2.3 ± 5.4 kg) and control (1.5 ± 4.7 kg) arms. Conclusions The family-based intervention did not promote postpartum weight loss. Reducing energy intake, rather than improving diet quality, should be the focus of weight loss interventions for overweight/obese postpartum women.
Wiltheiss, Gina A.; West, Deborah G.; Brouwer, Rebecca J. N.; Krause, Katrina M.; ?stbye, Truls
Ether or chloroform, was in use for ambulatory surgery after 1861 in Japan. An inhalational anesthetic, especially chloroform, was administered for cesarean section in early Meiji Period (from 1868) up to 1897. According to an article in 1903, chloroform was recommended as a strategy for internal cephalic version. However, it is uncertain whether inhalational anesthetic had been utilized for vaginal deliveries before 1903. There is evidence that hypnosis had attracted attention as a method of labor analgesia around that time. PMID:24364284
There is significant geomorphologic evidence for the past presence of longitudinally widespread, latitudinally zoned deposits composed of ice-rich material at the northern and southern mid latitudes on Mars (lobate debris aprons, lineated valley fill, concentric crater fill, pedestal craters, etc.). Among these features, pedestal craters (Pd) are impact craters interpreted to have produced a protective layer on top of decameters-thick ice deposits now missing in intercrater regions. The time during which these various deposits were present is still highly debated. To address this question we have analyzed the distribution and characteristics of pedestal craters; here, we use a population of 2287 pedestal craters (Pd) to derive a crater retention age for the entire population, obtaining a minimum timescale of formation of ~90 Myr. Given that the ice-rich deposit has not been continuously present for this duration, the timescale of formation is necessarily longer than ~100 Myr. We then compiled impact crater size-frequency distribution dates for 50 individual pedestal craters in both hemispheres to further assess the frequency distribution of individual ages. We calculated pedestal crater ages that ranged from ~1 Myr to ~3.6 Gyr, with a median of ~140 Myr. In addition, 70% of the pedestal ages are less than 250 Myr. During the 150 Myr period between 25 Ma and 175 Ma, we found at least one pedestal age every 15 Myr. This suggests that the ice-rich paleodeposit accumulated frequently during that time period. We then applied these results to the relationship between obliquity and latitudinal ice stability to suggest some constraints on the obliquity history of Mars over the past 200 Myr. Atmospheric general circulation models indicate that ice stability over long periods in the mid latitudes is favored by moderate mean obliquities in the ~35° range. Models of spin-axis/orbital parameter evolution predict that the average obliquity of Mars is ~38°. Our data represent specific observational evidence that ice-rich deposits accumulated frequently during the past 200 Myr, supporting the prediction that Mars was characterized by this obliquity range during an extensive part of that time period. Using these results as a foundation, the dating of other non-polar ice deposits will permit the specific obliquity history to be derived and lead to an assessment of volatile transport paths in the climate history of Mars.
Kadish, Seth J.; Head, James W.
Plasma lipoprotein distribution during late pregnancy is unusual since high-density lipoprotein (HDL) levels are increased in the presence of hypertriglyceridemia; the latter is usually associated with decreases in HDL levels. To determine whether there is a relationship between late-pregnancy lipid levels and specific HDL subclasses, HDL size distribution was determined by nondenaturing gradient gel electrophoresis (GGE) in a group of 36 women at 35 to 36 weeks of gestation and again at 6 weeks' postpartum, and in a group of 10 nonpregnant women. At 35 to 36 weeks of gestation, plasma triglyceride (TG) and cholesterol concentrations were significantly increased over postpartum levels (218 +/- 62 v 112 +/- 69 mg/dL and 234 +/- 48 v 197 +/- 36 mg/dL, respectively). During late pregnancy, apolipoprotein A-I (apo A-I) and HDL cholesterol concentrations were also increased relative to postpartum levels (211 +/- 42 v 168 +/- 20 mg/dL and 63 +/- 13 v 53 +/- 11 mg/dL, respectively). GGE analysis indicated that at 35 to 36 weeks of gestation, 86% of the subjects had a substantial increase of the most buoyant and largest of the HDL species, HDL2b; postpartum and nonpregnant HDL subclass distribution was characterized by the predominance of HDL3a, which are smaller, more dense HDL. The shift in the HDL subclass distribution during late pregnancy was associated with significant positive correlations between HDL2b and apo A-I (r = .50, P < .05) and HDL cholesterol (r = .60, P < .001). There were significant elevations in the concentrations of cholesteryl ester transfer protein (CETP) and estrogen during late pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8246775
Silliman, K; Tall, A R; Kretchmer, N; Forte, T M
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
Postpartum depression (PPD) continues to significantly impact women and their families during the perinatal period. Consequences of untreated PPD in the mother may lead to impaired mother-infant bonding, recurring psychiatric illness, and fewer positive parenting behaviors. North Carolina participates in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey and has the second highest self-reported rate of postpartum depressive symptoms at 19.0%. The full study used both quantitative and qualitative methods. The qualitative approach, an interpretive Heideggerian perspective, elicited the postpartum clients' perceptions of risk factors, how those perceptions affected the pregnancy experience, and how self-efficacy played a role in their perceived ability to make healthy choices. The sample was comprised of 60 pregnant women between the ages of 18 and 40. Four themes were found: (1) Feeling joy and apprehension at once, (2) Depression is something you think about (3) Rearranging your thinking, and (4) Garnering support. The women in this study believed that support was an indispensable tool in dealing with feelings of sadness and depression. Critical aspects of becoming involved in their pregnancy included changing their expectations and knowing how to detect and seek help when depressive symptoms occurred. PMID:24597584
Jarosinski, Judith M; Pollard, Deborah Lynn
Active duty personnel in the U.S. Air Force (USAF) are required to pass periodic fitness assessments in order to facilitate and evaluate physical readiness. Pregnant women are exempt from testing but must take the fitness test 6 months after childbirth. However, evidence from prior research indicates that in the first 6 months postpartum, women may not achieve prepregnancy fitness levels and may be more vulnerable to mental and physical health problems. It is important for health care clinicians to understand how training for the USAF fitness test after childbirth may impact health and well-being. The purpose of this study was to develop a deep understanding of the experiences of postpartum USAF women as they train for their fitness assessment. Understanding was sought through a phenomenological study by interpreting the meaning of the lived experiences of 17 active duty women at two USAF bases. Two overarching patterns emerged from this analysis: "Striving to Perform under Pressure through Profound Life Transitions of Childbirth" and "Seeking Understanding from Others." These results provide insight into the challenges postpartum women encounter while training for their fitness assessments, and they can inform practices that facilitate efforts of women in returning to optimal fitness and well-being. PMID:25003862
Armitage, Nicole H; Severtsen, Billie M; Vandermause, Roxanne; Smart, Denise A
Objectives To conduct a community-based, postpartum depression (PPD) screening initiative, and recommend PPD screening practices. Design Descriptive correlational. Settings Two academic medical centers, a university research office, and participants’ homes. Participants Five thousand one hundred sixty nine (5,169) postpartum women aged 14–49 years. Methods The Agency for Healthcare Research and Quality (AHRQ) framework was implemented by identifying a cohort of mothers and conducting PPD screening followed by diagnostic evaluation of those with positive screens. Mothers in the postpartum period were recruited from two academic medical centers and screened for PPD at 4–6 weeks postpartum by telephone or mail using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with EPDS scores ? 10 were invited to participate in the Structured Clinical Interview for DSM IV (SCID) to confirm PPD. Results Six hundred seventy four (674) (13%) women had EPDS scores ?10; 185 women with elevated EPDS scores agreed to have a SCID diagnostic interview, and 144 were diagnosed with minor or major depression. A significantly higher percentage of women who self-administered and mailed in the EPDS than women who were screened via telephone had scores ? 10. Elevated PPD scores were not associated with age or parity. Race/ethnicity identification other than White, and having less than high school education were associated with higher PPD scores Conclusions The AHRQ framework was effective in guiding a large-scale PPD screening initiative by identifying mothers at risk for PPD. Results support previous findings regarding prevalence, selected risk factors, and continued use of the EPDS with SCID confirmation.
Horowitz, June Andrews; Murphy, Christine A.; Gregory, Katherine E.; Wojcik, Joanne
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.
Background After delivery, many women experience symptoms of postpartum depression (PPD), and early identification of women at risk is therefore important. The opioid peptide ?-endorphin has been implicated in non-puerperal depression but its role in the development of PPD is unknown. Methods Three hundred and seven women with a singleton, full-term (>37.0 weeks’ GA) pregnancy were recruited early in pregnancy and followed up into the postpartum period. Blood samples were obtained at 15, 19, 25, 31 and 37 weeks’ gestational age (GA) and at 9 weeks postpartum for assessment of ?-endorphin. Depressive symptoms were assessed with the Center for Epidemiological Studies – Depression scale at the last four pregnancy visits and with the Edinburgh Postnatal Depression Scale postpartum. Results Among women who were euthymic at 25 weeks’ GA, those who proceeded to develop PPD symptoms had higher levels of ?-endorphin throughout pregnancy compared to women without PPD symptoms (all t > 2.11, p < .05). At each assessment, women above the cut-off score for ?-endorphin were at more than three-fold risk for PPD symptoms (odds ratios 3.19 – 4.68) compared to women below the cut-off score. Limitations Self-report of depressive symptoms, no mental health history. Conclusions ?-Endorphin may be a useful early predictor of PPD symptoms in women who do not report depressive symptoms in midpregnancy. If replicated, these findings have clinical implications for the identification and treatment of this at risk group and further suggest that some of the pathways leading to this complex disorder may be specific to subgroups of women.
Yim, Ilona S.; Glynn, Laura M.; Schetter, Christine Dunkel; Hobel, Calvin J.; Chicz-DeMet, Aleksandra; Sandman, Curt A.
Study objectives: Evaluate the prevalence and phenomenology of dream-associated behaviors affecting pregnant and postpartum mothers. Episodes consist of anxious dreams and nightmares about the new infant that are accompanied by complex behaviors (motor activity, speaking, expressing emotion). Design: Three-group design (postpartum, pregnant, null gravida), self-report, and repeated measures. Setting: Pregnancy and postpartum groups: completion of questionnaires in hospital room within 48 hours of giving birth and home telephone interviews; null gravida group: completion of questionnaires and interview in person or by telephone. Participants: Two hundred seventy-three women in 3 groups: postpartum: n = 202 (mean age = 29.7 ± 4.94 years; 95 primiparas, 107 multiparas); pregnant: n = 50 (mean age = 31.1 ± 5.44 years); null gravida: n = 21 (mean age = 28.5 ± 6.34 years). Interventions: Subjects completed questionnaires about pregnancy and birth factors, personality, and sleep and participated in interviews concerning the prevalence of recent infant dreams and nightmares, associated behaviors, anxiety, depression, and other psychopathologic factors. Measurements and Results: Most women in all groups recalled dreams (88%-91%). Postpartum and pregnant women recalled infant dreams and nightmares with equal prevalence, but more postpartum women reported they contained anxiety (75%) and the infant in peril (73%) than did pregnant women (59%, P < 0.05 and 42%, P < 0.0001). More postpartum (63%) than pregnant (40%) women reported dream-associated behaviors (P < 0.01), but neither group differed from null gravida women (56%). This was due to different distributions over groups of the behavior subtypes. Motor activity was present in twice as many postpartum (57%) as pregnant (24%) or null gravida (25%) women (all P < 0.0001). Expressing emotion was more prevalent among null gravida (56%) than postpartum women (27%) (P < 0.05) but was not different from pregnant women (37%). Speaking was equally prevalent among the 3 groups (12%-19%). Behaviors were associated with nightmares, dream anxiety and, among postpartum women, post-awakening anxiety (41%), confusion (51%), and a need to check on the infant (60%). Primiparas and multiparas differed in dream and nightmare recall but not in prevalence of dream-associated behaviors. Conclusion: The prevalent occurrence of pregnancy and postpartum infant dreams and associated behaviors may reflect the pervasive emotional influence of maternal concerns or changes instigated by severe sleep disruption, rapid eye movement sleep deprivation, and altered hormone levels. Citation: Nielsen T; Paquette T. Dream-associated behaviors affecting pregnant and postpartum women. SLEEP 2007;30(9):1162-1169.
Nielsen, Tore; Paquette, Tyna
Mature Angus-cross beef cows (n = 144) were used to determine effects of late gestation dietary energy source on pre- and postpartum cow performance in a complete randomized block design experiment. Cows were adapted to diets starting at 167 +/- 9 d of gestation and fed until 1 wk before expected calving date. Cows were fed 1 of 3 dietary energy sources: grass hay (HY), corn (CN), or dried distillers grains (DDGS). Cows allotted to HY were allowed ad libitum access to round-bale grass hay, and average hay disappearance was 12.4 kg/d. Limit-fed corn and DDGS diets contained 5.3 kg of whole-shelled corn or 4.1 kg of DDGS, respectively, plus 2.1 kg of hay, and 1.0 kg of supplement to meet cow nutritional needs during late gestation and to allow for an energy intake similar to HY. Every 21 d, BW, BCS, and ultrasound measurement of backfat between the 12th and 13th ribs were collected. At 210 d in gestation, jugular blood samples were collected from cows at 0, 3, 6, and 9 h postfeeding and were analyzed for glucose, insulin, NEFA, and blood urea N (BUN) concentrations. After parturition, cows were fed a common diet and managed similarly. Milk production was determined by weigh-suckle-weigh procedure on d 31, 100, and 176 postpartum. Cows fed DDGS during late gestation gained more (P = 0.04) BW than cows fed HY or CN; however, no difference in BCS change was detected (P = 0.28) among treatments. Plasma glucose concentrations were similar among treatments (P = 0.64), whereas insulin concentrations at 3 h postfeeding were greater (P = 0.002) for cows fed DDGS than those fed HY or CN. Plasma BUN concentrations were greater (P < or = 0.02) for cows fed DDGS vs. CN or HY up to 6 h postfeeding. Birth weight was greater (P < 0.001) for calves from cows fed CN and DDGS than for those fed HY, but this did not result in any differences in frequency of dystocia (P = 0.21). Prepartum energy source did not affect conception rates (P = 0.79), milk production (P > or = 0.51), or milk composition (P > or = 0.39). Maternal dietary energy source in late gestation did not affect pre- or postpartum cow performance, but did change plasma hormones and metabolites during gestation. Heavier birth weights in calves from cows fed CN or DDGS indicate the changes in maternal metabolism affected energy partitioning of nutrients to the fetus and subsequent fetal growth. PMID:20453084
Radunz, A E; Fluharty, F L; Day, M L; Zerby, H N; Loerch, S C
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
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.
Few studies have assessed physical activity at multiple time points in the postpartum period or used both self-reported and objective measures of assessment. The purpose of this study was to describe physical activity and sedentary behavior at two time points in a cohort of overweight or obese postpartum women using both self-reported and objective measures. In total, 132 women completed physical activity assessments at a median of 24 weeks postpartum and again approximately 10 months later. At both time points, women wore an Actical accelerometer for one week and completed the Kaiser Physical Activity Survey at both time points. Adjusted Poisson regression models were used to determine whether physical activity changed over time for the cohort. Overall counts per minute and moderate to vigorous physical activity increased from baseline to 10-months later, although the absolute levels were modest (median 6.9 to 8.8 minutes/day). A median of 64–71% at baseline and 63–67% at follow-up of their monitored time was sedentary. More intensive interventions are needed to help postpartum women integrate physical activity and reduce sedentary behavior.
Evenson, Kelly R.; Brouwer, Rebecca J. N.; ?stbye, Truls
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 purpose of this qualitative study was to describe the nature of postpartum depression (PPD) among African-American women. Twelve women, who had experienced PPD within the last three years, were interviewed for approximately one hour at two intervals. Nudist-4 software and the constant comparative method were used to analyze the data. Five themes "Stressing Out," "Feeling Down," "Losing It," "Seeking Help," and "Feeling Better" represented aspects of PPD as experienced by the participants. The last theme, "Dealing with It," represented the cultural ways in which African-American mothers managed their depression. These included Keeping the Faith, Trying to Be a Strong Black Woman, Living with Myths, and Keeping Secrets. Suggestions for future directions in nursing research are included. PMID:12623687
Amankwaa, Linda Clark
Postpartum affective disorders continue to be a major health issue for women. There is a general belief that electroconvulsive therapy (ECT) is effective in treating severe or treatment-refractory postpartum affective illnesses, but evidence to support this assertion is lacking. In this case series, we present 5 cases of women with postpartum depression and psychosis, all of whom had failed prior pharmacological therapy. All 5 women had a significant response within 3 to 6 treatments with ECT. Our findings suggest that ECT is overall an effective treatment of postpartum illnesses. In addition to being an excellent choice for women who have failed prior medication trials, ECT may also be considered for women whose severity of illness necessitates rapid symptom resolution. PMID:17804998
Forray, Ariadna; Ostroff, Robert B
To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample\\u000a of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure,\\u000a was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for\\u000a DSM-IV Disorders (SCID), the 12-item General
Carlos Zubaran; Katia Foresti; Marina Verdi Schumacher; Aline Luz Amoretti; Mariana Rossi Thorell; Lúcia Cristina Müller
Studies reporting incidence rates for the “postpartum blues” (defined as atransient depressive episode occurring in the first 10-14 days after childbirth) are surveyed, and the methodological issues involved\\u000a in collecting these data are considered. When women provide self-report ratings of depression on each day in the first postpartum\\u000a week, the incidence of the blues is about 66%. Psychological factors found
Jacqueline A. Thirkettle; Robert G. Knight
Objective To examine the feasibility of using the Internet to screen for postpartum depressive symptoms. Methods A total of 142 participants completed the Postpartum Depression Screening Scale (PDSS) and the Edinburgh Postnatal Depression\\u000a Scale on the Internet, and these findings were compared with those administered in-person by the authors of the PDSS (Beck\\u000a and Gable) in recruitment sources, demographic characteristics,
Huynh-Nhu Le; Deborah F. Perry; Xi Sheng
Background Knowledge on how well we can predict primary postpartum hemorrhage (PPH) can help policy makers and health providers design current delivery protocols and PPH case management. The purpose of this paper is to identify risk factors and determine predictive probabilities of those risk factors for primary PPH among women expecting singleton vaginal deliveries in Egypt. Methods From a prospective cohort study, 2510 pregnant women were recruited over a six-month period in Egypt in 2004. PPH was defined as blood loss ? 500 ml. Measures of blood loss were made every 20 minutes for the first 4 hours after delivery using a calibrated under the buttocks drape. Using all variables available in the patients' charts, we divided them in ante-partum and intra-partum factors. We employed logistic regression to analyze socio-demographic, medical and past obstetric history, and labor and delivery outcomes as potential PPH risk factors. Post-model predicted probabilities were estimated using the identified risk factors. Results We found a total of 93 cases of primary PPH. In multivariate models, ante-partum hemoglobin, history of previous PPH, labor augmentation and prolonged labor were significantly associated with PPH. Post model probability estimates showed that even among women with three or more risk factors, PPH could only be predicted in 10% of the cases. Conclusions The predictive probability of ante-partum and intra-partum risk factors for PPH is very low. Prevention of PPH to all women is highly recommended.
Objective to examine the associations between total and domain-specific moderate-to-vigorous physical activity (MVPA) during pregnancy and postpartum depressive symptoms. Design a prospective cohort study. Participants data were obtained from 652 women recruited from prenatal clinics at University of North Carolina during 2001–2005 for the Pregnancy, Infection, and Nutrition (PIN) Postpartum Study. Measurements MVPA measured at 17–22 and 27–30 weeks’ gestation was investigated as a predictor of depressive symptoms assessed with the Edinburgh Postnatal Depression Scale at 3 months postpartum. Findings total MVPA was not associated with depressive symptoms when using either 17–22 weeks’ gestation or 27–30 weeks’ gestation MVPA measures. In general, there were minimal associations for domain-specific MVPA. The direction of associations between depressive symptoms and work, adult and child care, and outdoor household MVPAs differed by time of measurement. Key Conclusions the association between physical activity and postpartum depressive symptoms may differ with the timing of assessment. Additional studies (i.e. with a larger sample of women or a sample of at-risk women) following women throughout pregnancy and postpartum are needed to explore differences in the influence of physical activity on depressive symptoms. Implications for Practice assessment of potential risk factors for elevated depressive symptoms, such as participation levels in different types of physical activity, throughout pregnancy may assist in determining who may be susceptible to postpartum depression.
Siega-Riz, Anna Maria; Evenson, Kelly R.; Herring, Amy H.; Dole, Nancy; Gaynes, Bradley N.
The effect of hormone withdrawal following hormone-simulated "pregnancy" on "depressive-like behavior" in the Forced Swim Test (FST) was investigated in female Long-Evans rats. Females were randomly assigned to "pregnant", "pregnant"+estradiol benzoate (EB), and control groups. Both the "pregnant" and "pregnant"+EB groups received daily injections of the hormones estradiol and progesterone to simulate the 23-day gestational period in the rat. However, the "pregnant"+EB group continued to receive daily estradiol injections after "pregnancy". All groups were tested 48 h after the last injection of the pregnancy period in the FST and subsequently in the Open Field Test (OFT). Results revealed that the "pregnant" rats exhibited significantly increased immobility and decreased struggling and swimming behaviors as compared to the "pregnant"+EB and control groups. These findings could not be explained by an overall depression in general locomotor activity among "pregnant" rats, as the "pregnant" rats made more area crossings in the OFT. Thus "pregnant" rats exhibited behaviors consistent with "depressive-like" symptoms "post-partum" (after their hormone regime was discontinued). Continual treatment with high levels of estradiol in the "pregnant"+EB group, however, reversed the exhibition of these behaviors. These results imply that withdrawal from chronic high levels of pregnancy-associated hormones (estradiol and progesterone) can produce depressed symptomology in rodents, which can be prevented by prolonging exposure to high levels of estradiol through the post-partum period. These findings are the first demonstration of "depressive-like" symptoms in a rodent model of post-partum pregnancy and the ability of high levels of estradiol to attenuate these "depressive-like" symptoms. PMID:11287071
Galea, L A; Wide, J K; Barr, A M
We review clinical care issues that are related to illicit and therapeutic opioid use among pregnant women and women in the postpartum period and outline the major responsibilities of obstetrics providers who care for these patients during the antepartum, intrapartum, and postpartum periods. Selected patient treatment issues are highlighted, and case examples are provided. Securing a strong rapport and trust with these patients is crucial for success in delivering high-quality obstetric care and in coordinating services with other specialists as needed. Obstetrics providers have an ethical obligation to screen, assess, and provide brief interventions and referral to specialized treatment for patients with drug use disorders. Opioid-dependent pregnant women often can be treated effectively with methadone or buprenorphine. These medications are classified as pregnancy category C medications by the Food and Drug Administration, and their use in the treatment of opioid-dependent pregnant patients should not be considered "off-label." Except in rare special circumstances, medication-assisted withdrawal during pregnancy should be discouraged because of a high relapse rate. Acute pain management in this population deserves special consideration because patients who use opioids can be hypersensitive to pain and because the use of mixed opioid-agonist/antagonists can precipitate opioid withdrawal. In the absence of other indications, pregnant women who use opioids do not require more intense medical care than other pregnant patients to ensure adequate treatment and the best possible outcomes. Together with specialists in pain and addiction medicine, obstetricians can coordinate comprehensive care for pregnant women who use opioids and women who use opioids in the postpartum period. PMID:24120973
Jones, Hendrée E; Deppen, Krisanna; Hudak, Mark L; Leffert, Lisa; McClelland, Carol; Sahin, Leyla; Starer, Jacquelyn; Terplan, Mishka; Thorp, John M; Walsh, James; Creanga, Andreea A
Objective To compare the emotional responses of mothers of late-preterm infants "(34 0/7 to 36 6/7 weeks gestation) with those of mothers of full-term infants. Design A mixed method comparative study. Setting A southeastern tertiary academic medical center postpartum unit. Participants Sixty mothers: 29 mothers of late-preterm infants and 31 mothers of full-term infants. Methods Measures of maternal emotional distress "(four standardized measures of anxiety, postpartum depression, posttraumatic stress symptoms, and worry about infant health) and open-ended semistructured maternal interviews were conducted in the hospital following birth and by phone at one month postpartum. Results Mothers of late-preterm infants experienced significantly greater emotional distress immediately following delivery, and their distress levels continued to be higher at one month postpartum on each of the standardized measures. Mothers of late-preterm infants also discussed the altered trajectories in their birth and postpartum experiences and feeling unprepared for these unexpected events as a source of ongoing emotional distress. Conclusion Mothers of late-preterm infants have greater emotional distress than mothers of term infants for at least one month after delivery. Our findings suggest that it may not be a single event that leads to different distress levels in mothers of late-preterm and full-term infants but rather the interaction of multiple alterations in the labor and delivery process and the poorer-than-expected infant health outcomes. In the future, researchers need to examine how and when mothers’ emotional responses change over time and how their responses relate to parenting and infant health and development.
Brandon, Debra H.; Tully, Kristin P.; Silva, Susan G.; Malcolm, William F.; Murtha, Amy P.; Turner, Barbara S.; Holditch-Davis, Diane
The objective of this study was to determine the effect of supplemental chromium as chromium-L-methionine (Cr-Met) on productive and reproductive performances and some metabolic parameters in late gestation and early lactation of dairy cows. Sixty multiparous Holstein dairy cows according to prior lactation, parity, body mass (682±33 kg), and expected calving date were divided equally (30 cows/treatment) and were randomly allocated to one of the two groups. One group received basal diet without Cr (control group) and another group received Cr-Met supplement added at manufacturer's recommended level (8 mg of "Cr"/head per day) from 21 days before expected calving date until 21 days of lactation. Supplemental Cr tended to increase milk yield (P=0.08) while percentage of lactose and lactose yield increased (P<0.01). Chromium supplementation decreased serum nonesterified fatty acids concentration at 7 days prepartum and 21 days postpartum. Serum insulin concentration for cows receiving Cr was higher than the control group (P=0.05). Serum cortisol concentration decreased (P<0.05) in prepartum period in supplemented group. Chromium did not affect concentrations of metabolic parameters at calving. However, serum glucose concentration increased at 21 days postpartum in the supplemented group (P<0.05). Chromium supplementation increased neutrophil and neutrophil to lymphocyte ratio in prepartum period (P<0.05). Based on serum concentrations of progesterone, days to first ovulation tended (P=0.07) to occur earlier in the supplemented group. Furthermore, days to first service and days to first estrus of the supplemented group occurred earlier than the control group (P<0.05) but days open, services per conception and conception rates at first insemination did not differ between two groups (P>0.05). Percentage of cyclic cows at 36 days postpartum and estrous behavior before AI was higher in the supplemented group. PMID:22552822
Kafilzadeh, F; shabankareh, H Karami; Targhibi, M R
Background Negative energy balance (NEB) is an altered metabolic state in high yielding cows that occurs during the first few weeks postpartum when energy demands for lactation and maintenance exceed the energy supply from dietary intake. NEB can, in turn, lead to metabolic disorders and to reduced fertility. Alterations in the expression of more than 700 hepatic genes have previously been reported in a study of NEB in postpartum dairy cows. miRNAs (microRNA) are known to mediate many alterations in gene expression post transcriptionally. To study the hepatic miRNA content of postpartum dairy cows, including their overall abundance and differential expression, in mild NEB (MNEB) and severe NEB (SNEB), short read RNA sequencing was carried out. To identify putative targets of differentially expressed miRNAs among differentially expressed hepatic genes reported previously in dairy cows in SNEB computational target identification was employed. Results Our results indicate that the dairy cow liver expresses 53 miRNAs at a lower threshold of 10 reads per million. Of these, 10 miRNAs accounted for greater than 95% of the miRNAome (miRNA content). Of the highly expressed miRNAs, miR-122 constitutes 75% followed by miR-192 and miR-3596. Five out of thirteen let-7 miRNA family members are also among the highly expressed miRNAs. miR-143, down-regulated in SNEB, was found to have 4 putative up-regulated gene targets associated with SNEB including LRP2 (low density lipoprotein receptor-related protein 2), involved in lipid metabolism and up-regulated in SNEB. Conclusions This is the first liver miRNA-seq profiling study of moderate yielding dairy cows in the early postpartum period. Tissue specific miR-122 and liver enriched miR-192 are two of the most abundant miRNAs in the postpartum dairy cow liver. miR-143 is significantly down-regulated in SNEB and putative targets of miRNA-143 which are up-regulated in SNEB, include a gene involved in lipid metabolism.
Ebstein's anomaly is a rare congenital cardiac malformation that is characterized by abnormalities of the tricuspid valve and right ventricle. Pregnancy is usually well tolerated unless cyanosis or arrhythmia develops. We report a case with Ebstein's anomaly, whose condition was asymptomatic before pregnancy but remarkably deteriorated down during the postpartum period, even though a successful pregnancy and cardiac surgery were achieved. Women with Ebstein's anomaly should be carefully assessed and may need to be advised to have corrective surgery prior to pregnancy even if they were asymptomatic.
Kimura, Masato; Kakizaki, Shuhei; Tazawa, Seiichi; Adachi, Osamu; Saiki, Yoshikatsu; Kure, Shigeo
Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity presenting with headache, confusion, visual disturbances or blindness, and seizures. Parieto-occipital white matter changes due to vasogenic oedema can be observed on imaging modalities. It rarely occurs without seizures and after delivery. We report a 33-year-old multigravida with a history of preeclampsia in term pregnancy complicated by PRES without seizures at the postpartum period. Clinical improvement with complete resolution without any complications was observed on the 6th day after delivery. Posterior reversible encephalopathy syndrome is reversible when early diagnosis is established and appropriate treatment is started without delay. PMID:24592342
Ural, Ulkü Mete; Balik, Gülsah; Sentürk, Senol; Ustüner, I??k; Cobano?lu, U?ur; Sahin, Figen K?r
A patient with viral hepatitis in the third trimester of pregnancy is described. She developed acute hepatic failure in the postpartum period which was associated with evidence of intravascular coagulation. Following therapy with heparin and fresh-frozen plasma, the patient made a dramatic recovery. Hepatitis developed during the puerperium may predispose to pathological intravascular coagulation and hepatocellular necrosis may thereby be perpetuated.
Jones, C. T. A.; Birch, C. R.; Poller, L.; Dymock, I. W.
Postpartum maternal health care is a neglected aspect of women's health care. This neglect is evident in the limited national health objectives and data related to maternal health. Missed opportunities for enhancing the health care of postpartum women occur in the scope of routine postpartum care. Differing perceptions of maternal needs between nurses and new mothers also contribute to inadequate health care. Therefore, collecting national data on postpartum maternal morbidity, reforming postpartum care policies, providing holistic and flexible maternal health care, encouraging family support and involvement in support groups, and initiating educational programs are recommended. Further research is needed on issues related to postpartum maternal health.
Cheng, Ching-Yu; Fowles, Eileen R.; Walker, Lorraine O.
Guidelines for HIV primary care include visits every 3 months (up to 6 months in those with stable HIV). During pregnancy, women with HIV commonly attend once weekly to once monthly visits; however, after delivery, many are lost to follow-up. Our goal was to assess the frequency of loss to primary care follow-up postpartum and to identify predictors of loss to care. A retrospective chart review of HIV-infected women in a Houston prenatal program was done. Optimal care was defined as one visit to HIV primary care providers (PCPs) every 6 months within the first year after delivery, and loss to follow-up as no visits within the first postpartum year. Multivariate logistic regression analysis was used to identify factors associated with loss to follow-up. Charts (n=213) were analyzed for follow-up with PCPs. The loss to follow-up rate was 39% in the first postpartum year. Associated factors were younger age, black race, late entry to prenatal care, and no plans for contraception. Predictors of loss to primary care after pregnancy can be used to identify specific subpopulations of pregnant women at highest risk for falling out of care. PMID:24720630
Siddiqui, Robaab; Bell, Tanvir; Sangi-Haghpeykar, Haleh; Minard, Charles; Levison, Judy
We present a 27-year-old woman with hypoparathyroidism following total thyroidectomy for papillary carcinoma, who presented postpartum during lactation with several vertebral osteoporotic fractures, increase in bone turnover markers, and measurable parathyroid hormone-related protein (PTHrP) levels. Cessations of lactation led to gradual decrease in bone turnover markers and PTHrP and improvement in bone mineral density. Pregnancy- and postpartum-associated osteoporosis is an uncommon condition characterized by the occurrence of fractures during late pregnancy or the puerperium. The patient presented postpartum with severe back pain and multiple vertebral fractures. Metabolic evaluation performed at presentation revealed hypercalcemia, hypercalciuria, increased alkaline phosphatase, vitamin D insufficiency, normal serum protein immunoelectrophoresis, and a detectable level of PTHrP. Serum levels of bone turnover markers were markedly increased. Bone mineral density at the lumbar spine was severely reduced. After cessation of lactation, the PTHrP level became undetectable. Bone turnover markers gradually decreased to normal and bone mineral density improved. Several factors contributed to the reduced bone mass in this patient, including amenorrhea treated with oral contraceptives, suppressive levothyroxine treatment, and lactation of twins with increased PTHrP. Patients with severely reduced bone mass need surveillance during pregnancy and lactation and should possibly consider avoiding breastfeeding. Patients with hypoparathyroidism should temporarily reduce their alphacalcidiol dose while lactating. PMID:21243337
Segal, E; Hochberg, I; Weisman, Y; Ish-Shalom, S
Background: Postpartum sexual abstinence until when the child is weaned from breast milk is deeply rooted in most cultures in Nigeria. Aim: The study aimed at describing the current sexual practices of postpartum women, sexual morbidity, contraceptive prevalence and predictive factors for early postpartum sexual intercourse and associated sexual problems in our setting. Subjects and Methods: This cross-sectional study was conducted among consecutive 340 women at a child welfare clinic 14 weeks after childbirth. Questionnaires were administered between January 2012 and June 2012 to ascertain their socio-demographic and obstetric features, sexual activity, time to coital resumption, reasons for resumption and non-resumption of intercourse, sexual problems encountered and contraceptive usage. Statistical analysis was performed using the SPSS version 16 for windows (SPSS Inc., Chicago, IL, USA). Results: Sexual intercourse was resumed by 67.6% (230/340) of women with a mean time to resuming intercourse of 8.2 (2.9) weeks postpartum and a median time of 8.0 weeks. About 3.5% (8/230) did so within the puerperium. Sexual intercourse was initiated mainly (77.4% [178/230]) by their husbands and only 19.1% (44/230) of them were using modern contraceptives. About 62.6% (144/230) of women experienced sexual morbidities including vaginal dryness/insufficient lubrication, dyspareunia and vaginal discharge. Socio-demographic and obstetric features, menstrual and breastfeeding status were not predictive of early resumption of coitus. Vaginal delivery (OR: 3.6, 95% CI: 1.3-10.0, P = 0.01,) and previous episiotomy (OR: 2.4, 95% CI: 2.0-6.1, P = 0.04,) were predictive of sexual morbidity. Conclusion: Women in our setting resume sexual intercourse early after childbirth without the use of contraception and often with associated sexual morbidity. Emphasis on sexual and contraceptive education during the immediate postpartum period is therefore imperative.
Anzaku, AS; Mikah, S
Aims To evaluate the effect on quitting smoking at 18 months postpartum of smoking cessation interventions based on the Transtheoretical Model (TTM) delivered in pregnancy compared to current standard care. It has been claimed that TTM-based interventions will continue to create quitters after the end of the intervention period. Design Cluster randomized trial. Setting Antenatal clinics in general practices in
Terry Lawrence; Paul Aveyard; K. K. Cheng; Carl Griffin; Carol Johnson; Emma Croghan
A strategy widely adopted in the modern dairy industry is the introduction of postpartum health monitoring programs by trained farm personnel. Within these fresh cow protocols, various parameters (e.g., rectal temperature, attitude, milk production, uterine discharge, ketones) are evaluated during the first 5 to 14 days in milk (DIMs) to diagnose relevant diseases. It is well documented that 14% to 66% of healthy cows exhibit at least one temperature of 39.5 °C or greater within the first 10 DIM. Although widely adopted, data on diagnostic performance of body temperature (BT) measurement to diagnose infectious diseases (e.g., metritis, mastitis) are lacking. Therefore, the objective of this study was to identify possible factors associated with BT in postpartum dairy cows. A study was conducted on a commercial dairy farm including 251 cows. In a total of 217 cows, a vaginal temperature logger was inserted from DIM 2 to 10, whereas 34 cows did not receive a temperature logger as control. Temperature loggers measured vaginal temperature every 10 minutes. Rectal temperature was measured twice daily in all cows. On DIM 2, 5, and 10, cows underwent a clinical examination. Body temperature was influenced by various parameters. Primiparous cows had 0.2 °C higher BT than multiparous cows. Multiparous cows that calved during June and July had higher BT than those that calved in May. In primiparous cows, this effect was only evident from DIM 7 to 10. Furthermore, abnormal calving conditions (i.e., assisted calving, dead calf, retained placenta, twins) affected BT in cows. This effect was more pronounced in multiparous cows. Abnormal vaginal discharge did increase BT in primiparous and multiparous cows. Primiparous cows suffering from hyperketonemia (beta-hydroxybutyrat ? 1.4 mmol/L) had higher BT than those not affected. In multiparous cows, there was no association between hyperketonemia and BT. The results of this study clearly demonstrate that BT is influenced by various parameters in dairy cows. Therefore, these parameters have to be considered when interpreting measurements of BT in dairy cows. This information helps to explain the high incidence of type I and II errors when measuring BT and clearly illustrates that measures of BT should not be used as a single criterion to decide whether or not to provide antibiotic treatment to dairy cows. However, research-based test characteristics of other parameters (e.g., vaginal discharge) alone or in combination with BT are still lacking. PMID:24742963
Burfeind, O; Suthar, V S; Voigtsberger, R; Bonk, S; Heuwieser, W
Summary \\u000a Background: To date there has been no study investigating mother–infant bonding impairment and its link to pospartum depressive symptoms\\u000a in a representative German population sample. The present study therefore aimed to carry out initial analyses of the psychometric\\u000a properties of the German version of the Postpartum Bonding Questionnaire (PBQ).\\u000a \\u000a \\u000a Methods: Eight hundred and sixty two mothers provided the data
C. Reck; C. M. Klier; K. Pabst; E. Stehle; U. Steffenelli; K. Struben; M. Backenstrass
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
Introduction: Postpartum depression (PPD) is a common and serious illness that affects up to 14% of women in the first month after childbirth. We present an update on the pharmacologic treatment of PPD, although there continues to be a lack of large, randomized controlled trials (RCTs). Areas covered: A review of the literature on the use of antidepressants, hormonal supplements and omega-3 fatty acids for the prevention and the treatment of PPD published since the original review in 2009 and the authors' opinion on the current status of the pharmacological treatment of PPD are covered. An electronic search was performed by using PubMed, Medline and PsychINFO. Inclusion criteria were: i) empirical articles in peer-reviewed English-language journals; ii) well-validated measures of depression; and iii) a uniform scoring system for depression among the sample. Expert opinion: Since the last Expert Opinion review, four antidepressant treatment studies and one prevention study of PPD have been published. Six RCTs evaluating the use of omega-3 fatty acids (four for prevention and two for treatment) have been published. There continues to be lack of data regarding the pharmacotherapy of PPD. However, serotonin reuptake inhibitors should be considered first-line for women with PPD after it has been determined that the proper diagnosis is not bipolar disorder. It is important to individualize treatment for women with PPD and consider the risks and benefits of treatment while breastfeeding. PMID:24773410
Kim, Deborah R; Epperson, C Neill; Weiss, Amy R; Wisner, Katherine L
Introduction Postpartum depression (PPD) is a common and serious illness that affects up to 14% of women in the first month after childbirth. We present an update on the pharmacologic treatment of PPD, although there continues to be a lack of large, randomized controlled trials (RCTs). Areas covered A review of the literature on the use of antidepressants, hormonal supplements and omega-3 fatty acids for the prevention and the treatment of PPD published since the original review in 2009 and the authors’ opinion on the current status of the pharmacological treatment of PPD are covered. An electronic search was performed by using PubMed, Medline and PsychINFO. Inclusion criteria were: i) empirical articles in peer-reviewed English-language journals; ii) well-validated measures of depression; and iii) a uniform scoring system for depression among the sample. Expert opinion Since the last Expert Opinion review, four antidepressant treatment studies and one prevention study of PPD have been published. Six RCTs evaluating the use of omega-3 fatty acids (four for prevention and two for treatment) have been published. There continues to be lack of data regarding the pharmacotherapy of PPD. However, serotonin reuptake inhibitors should be considered first-line for women with PPD after it has been determined that the proper diagnosis is not bipolar disorder. It is important to individualize treatment for women with PPD and consider the risks and benefits of treatment while breastfeeding.
Kim, Deborah R; Epperson, C Neill; Weiss, Amy R; Wisner, Katherine L
Post-partum endometritis are frequent and account for the fifth cause of maternal death. This disease is preventable and effective treatments are available. Streptococcus agalactiae is the primary pathogen implicated. The clinical diagnosis is usually easy and involves pelvic pain, fever and abnormal lochia. Whenever antibiotic treatment provides no clinical improvement, or in case of doubt on the vacuity of the uterus, an ultrasound exam must be performed. Likewise, a CT scan or a MRI will be performed in case of persistent fever in search of a pelvic abscess requiring a drainage, or of a pelvic thrombophlebitis. Thromboplebitis requires heparin for the duration of antibiotic therapy, or oral anticoagulants for at least 3 months in case of pulmonary embolism or extension to the vena cava. The recommended antibiotic regimen combines clindamycin with gentamicin (once daily) intravenously. In case of contraindication or breastfeeding, other regimens may be prescribed. Adequate duration of treatment has not been evaluated and a switch to oral antibiotics after clinical improvement brings no benefit. Antibioprophylaxy (mostly cephalosporins) is recommended in cases of cesarean section (at skin incision), while it is debated in case of assisted delivery or of 3rd and 4th degree perineal tears. PMID:23141132
Lamy, C; Zuily, S; Perdriolle, E; Gauchotte, E; Villeroy-de-Galhau, S; Delaporte, M-O; Wahl, D; Morel, O; Judlin, P
A case of postpartum taeniasis will be discussed along with the pathophysiology, proper treatment, potential risks, and prevention of taeniasis infections to the pregnant mother, her infant, and her family members. Taenia spp. infections are relatively rare in developed societies. Increasing immigration to developed countries and an expanding role of medical aid in developing countries will lead to an increase in the number of taeniasis cases seen by medical providers. Taenia solium and T. saginata are the most common species and can be differentiated by proglottids (a segment of a tapeworm containing both male and female reproductive organs) or scolex (the head of a tapeworm which attaches to the intestine of the definitive host). Both carry different risks when considering autoinfection and transmission. Cystercercosis caused by T. solium is a risk for neonates and is cause for immediate treatment of the mother. A 23-year-old new mother, originally from Ethiopia, passed T. strobili shortly after giving birth. Her pregnancy was complicated by limited prenatal care. She did not experience any symptoms related to tapeworm infection. The patient received treatment with praziquantel. With a possible future increase in the number of cases seen by health care providers, understanding the risks of Taenia sp. infection is important as proper treatment and education are needed to halt the life cycle of the tapeworm before more serious infection ensues. PMID:23707843
Noss, Matthew R; Gilmore, Katherine; Wittich, Arthur C
This study explores the historical development of postpartum medical surveillance and women's contemporary experiences of postpartum care during the first month after vaginal childbirth in Canada and in the United States. An analysis of clinical publicati...
C. M. Kelleher
This study tested the hypothesis that individual counselling in the third trimester would increase postpartum contraceptive use to a greater extent than only providing an educational leaflet. A total of 180 third trimester pregnant women of mean age 28.3 years who were attending Marmara University Hospital for prenatal care were enrolled. One-third were randomly allocated to receive prenatal contraceptive counselling and the remaining two-thirds (control group) received an educational leaflet. Participants were followed-up at 6 - 9 months postpartum. The majority of subjects (91.5%) wanted to use contraception after delivery but 26.7% did not know which method to use. At follow-up, 79.6% of all women had begun a postpartum contraceptive regime and 68.7% were using a modern contraceptive method. Overall, there was no statistically significant difference in postpartum contraception use between the control and intervention groups in this study population. It is, therefore, concluded that prenatal counselling was not superior to educational leaflets for increasing the use of effective and modern postpartum contraception. PMID:20925996
Akman, M; Tüzün, S; Uzuner, A; Ba?gul, A; Kavak, Z
Abstract Objective Lactation has been associated with reduced risk of type 2 diabetes and the metabolic syndrome in mothers. We examined the relation between breastfeeding duration and metabolic markers at 3 years postpartum. Methods We used linear regression to relate duration of lactation to maternal glucose and lipid metabolism, inflammatory markers, and anthropometry at 3 years postpartum among 570 participants with 3-year blood samples (175 fasting) in Project Viva, a cohort study of mothers and children. Results Among the participants, 88% had initiated breastfeeding, and 26% had breastfed ?12 months. In multivariate analyses, we observed no consistent trends relating duration of lactation to maternal metabolism at 3 years postpartum. Women who exclusively breastfed for >6 months had lower postpartum weight retention at 3 years than women with shorter durations of exclusive breastfeeding (multivariate adjusted predicted mean ?0.5, ?3.6–2.6?kg vs. 4.8, 2.0–7.6?kg for those who never exclusively breastfed, partial F p?=?0.03). Conclusions In this prospective cohort study, we did not observe a dose-response relationship between duration of lactation and metabolic risk at 3 years postpartum.
Kleinman, Ken; Gillman, Matthew W.; Rifas-Shiman, Sheryl L.; Gunderson, Erica P.; Rich-Edwards, Janet
Postpartum depression is a prevalent mental disorder; however, scarce research has examined its association with prenatal health behaviors. This study investigated the associations of cigarette smoking, caffeine intake, and vitamin intake during pregnancy with postpartum depressive symptoms at 8 weeks after childbirth. Using a prospective cohort study design, participants were recruited from the postpartum floor at a hospital for women and newborns located in a northeastern city, from 2005 through 2008. Eligible women who were at least 18 years old and spoke English were interviewed in person while hospitalized for childbirth (N?=?662). A follow-up home interview was conducted at 8 weeks postpartum with a 79% response rate (N?=?526). Hierarchical regression analyses showed that smoking cigarettes anytime during pregnancy and not taking prenatal vitamins in the first trimester were significantly associated with worse depressive symptoms (Edinburgh Postnatal Depression Scale). Moreover, having a colicky infant, an infant that refuses feedings, being stressed out by parental responsibility, and having difficulty balancing responsibilities were stressors associated with worse depressive symptoms. Primary health care providers should consider evaluating women for risk of postpartum depression during their first prenatal visit, identifying prenatal health behaviors such as smoking and taking prenatal vitamins. PMID:22215286
Dagher, Rada K; Shenassa, Edmond D
Objective: To examine changes in activity prepregnancy to postpartum; examine postpartum activity and sociodemographic predictors of maternal well-being; and, examine maternal well-being in subjects on the basis of sport\\/exercise activity prepregnancy to postpartum. Methods: Ninety-one postpartum women completed a Kaiser Physical Activity Survey (KPAS) Ainsworth BE, Sternfeld B, Richardson MT, Jackson K. Evaluation of the Kaiser Physical Activity Survey in
Janet Whatley Blum; Christina M. Beaudoin; Laurie Caton-Lemos
Poor breastfeeding outcomes among late preterm infants (LPIs) have been attributed to inadequate breast milk transfer stemming from physiological immaturities. However, breastfeeding is more than a biological phenomenon, and it is unclear how mothers of LPIs manage other factors that may also impact the breastfeeding course. Using grounded theory methods and incorporating serial postpartum interviews with several novel data collection techniques, we examined breastfeeding establishment over a 6–8 week period among 10 late preterm mother-infant dyads recruited from a maternity hospital in Pittsburgh, Pennsylvania, USA. We found that breastfeeding in the LPI population was a fluctuating, cascade-like progression of trial and error, influenced by a host of contextual factors and events and culminating with breastfeeding continuation (with or without future caveats for duration or exclusivity of breastfeeding) or cessation. The trajectory was explained by the basic psychosocial process Weighing Worth against Uncertain Work, which encompassed the tension between breastfeeding motivation, the intensity of breastfeeding work, and ambiguity surrounding infant behavior and feeding cues. Several sub-processes were also identified: Playing the Game; Letting Him be the Judge vs. Accommodating Both of Us; and Questioning Worth vs. Holding out Hope. If valid, our theoretical model indicates a need for earlier, more extensive, and more qualified breastfeeding support for mothers of late preterm infants that emphasizes the connection between prematurity and observed feeding behaviors.
Demirci, Jill Radtke; Happ, Mary Beth; Bogen, Debra L.; Albrecht, Susan A.; Cohen, Susan M.
Late Pliocene foraminiferal Mg/Ca and ?18O records from Ocean Drilling Program Hole 806B in the western equatorial Pacific (WEP) reveal warm pool climate evolution during the onset of Northern Hemisphere glaciation, 3.1-2.3 Myr B.P. Mg/Ca data indicate an average late Pliocene sea surface temperature (SST) of 27.8°C, a small long-term cooling of 0.3°C between 3.1 and 2.3 Ma, and a glacial-interglacial (G-I) SST range of 2°C throughout this time interval. For comparison, Pleistocene SSTs at this site over the last 0.9 Myr average 27.7°C with a G-I range of 3°C. Orbital-scale variability in Hole 806B SSTs during the late Pliocene occurs predominantly at ˜100 ka, in contrast to foraminiferal ?18O records, which show a dominant 41 kyr period. Variability at a 41 kyr period, out of phase with local annual insolation changes driven by obliquity, is also observed in the new WEP SST record. The WEP SST record suggests that an ˜3°C equatorial Pacific SST zonal gradient prevailed during the late Pliocene, compatible with a weaker Walker circulation. Adjustment of Hole 806B SSTs for past changes in seawater Mg/Ca suggests that SSTs higher than 30°C prevailed at 3 Myr B.P., followed by a progressive cooling of the warm pool through the late Pliocene. The characteristics of late Pliocene tropical climate evolution suggest that atmospheric greenhouse gas forcing played a major role in driving the observed G-I SST changes.
Medina-Elizalde, Martín; Lea, David W.
Bipolar disorder is a chronic condition characterized by periods of mania, depression, or mixed states (co-occurring mania and depression). The postpartum period is associated with a high risk for symptom relapse or intensification, which can be reduced with the use of medications. Abrupt discontinuation of these medications increases the probability of relapse, which is associated with high-risk behaviors, significant family dysfunction, and suicide. Drugs used to treat patients with bipolar disorder vary in teratogenic potential. Although first trimester lithium use is associated with Ebstein's anomaly, the risk was overestimated in the past. Valproate and its derivatives and carbamazepine are human teratogens. Lamotrigine does not negatively impact major reproductive outcomes, but the data are limited. Typical antipsychotic medications are relatively well studied and the data do not identify major morphologic teratogenicity. There are fewer studies of newer atypical antipsychotic medications, and registries have been developed to collect prospective data. Clinical management of bipolar disorder during pregnancy, postpartum, and lactation requires a careful balancing of maternal and fetal risks and benefits. Communication and careful comanagement between the obstetric and psychiatric team is essential when treating women with bipolar disorder during the reproductive years. PMID:17207745
Ward, Sheila; Wisner, Katherine L
We reviewed all cases of massive primary postpartum haemorrhage greater than 1000 mL over a six month period in 1999 to establish the incidence, identify aetiological factors and implement change. Fifty-four cases (1.7%) were identified. We classified four as 'near-miss' maternal mortality. Over 60% were delivered by caesarean section. Seventy-six percent were due to uterine atony, 9% due to genital tract trauma and 15% were associated with significant antepartum haemorrhage from placenta praevia or abruption. No obvious labour or delivery risk factors were identified but deviation from hospital guidelines was common. Following revision of the guidelines, dissemination to staff and use of practice drills, we repeated the study on a prospective basis over the same time period in 2002. There was a significant reduction in the incidence of massive postpartum haemorrhage to 0.45%, and 100% adherence to the guidelines which resulted in a significant reduction in maternal morbidity. We believe that this approach can be replicated in other units. PMID:15104617
Rizvi, Fauzia; Mackey, Rachel; Barrett, Tom; McKenna, Peter; Geary, Michael
Sodium bicarbonate was added to complete mixed rations to evaluate the effect of buffer addition on adaptation to high-energy rations by dairy cows in early lactation. Forty-five Holstein cows were assigned to one of three treatment groups: control pre- and postpartum; control prepartum, buffer postpartum; and buffer pre- and postpartum. Rations consisted of 85% chopped grass hay: 15% concentrate prepartum
L. H. Kilmer; L. D. Muller; P. J. Wangsness
The objective of this research was to investigate adolescent mothers' perceptions of the quality of their postpartum nursing care. The first of two studies was a matched cohort survey designed to compare unmarried adolescent and married adult mothers' satisfaction with their postpartum nursing care. Eighty adolescent\\/adult postpartum mother pairs were matched according to their parity, mode of delivery, infant health
Wendy E. Peterson
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 assessment 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 139 pregnant women who were followed for 8 months after birth. The prenatal PDPI-R demonstrated concept, concurrent, and predictive validity. The postpartum PDPI-R demonstrated concurrent validity. Factor analysis revealed four underlying factors that did not match the original conceptualization of the instrument. Reliability of the total score resulting from the factor analysis was .83. Initial support for the reliability and validity of the PDPI-R was indicated. PMID:18232618
Records, Kathie; Rice, Michael; Beck, Cheryl Tatano
While extensive research has been conducted on postpartum depression (PPD), the majority has been focused on psychological risk factors and treatments. There is limited research on the explicit relationship between the degree to which individuals are informed about relevant prenatal and postnatal health topics and whether this level of knowledge influences psychological outcome. This study assesses health information levels of new mothers and their influence on PPD as measured by Edinburgh Postnatal Depression Scale (EPDS) scores. Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N?=?6,421) were used. The study population included mothers ?15 years of age at the time of the birth, who had a singleton live birth in Canada during a 3-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Pre- and postnatal health information components were measured using latent variables constructed by structural equation modeling. EPDS score was added to the model, adjusting for known covariates to assess the effects of information levels on EPDS score. Pre- and postnatal health information levels are associated with decreased EPDS scores. More specifically, information on topics such as postnatal concerns and negative feelings was associated with the largest decrease in score for primiparous and multiparous women, respectively (p?0.0001 for both). The pre-established predictors of PPD were confirmed for both samples, with life stress associated with the largest change in EPDS score for both samples (p?0.0001 for both). This study demonstrates a distinct role for pre- and postnatal health information in influencing EPDS scores, supplementing previous literature. Primiparous and multiparous women benefited from different information content, with information on postnatal concerns had the largest effect on the primiparous group while information on negative feelings had the largest effect on the multiparous group. Therefore, information provision should be tailored to these two groups. PMID:23820644
Youash, Sabrina; Campbell, M Karen; Campbell, Karen; Avison, William; Penava, Debbie; Peneva, Debbie; Sharma, Verinder; Xie, Bin
Background Weight gain in the postpartum period is a risk factor for long-term obesity. Investigations of dietary intake among lactating and non-lactating, overweight women may identify nutritional concerns specific to this population. Objective To compare nutrient, meal and snack intakes, food group servings and prevalence of dieting among fully breastfeeding (BF) mixed breast and formula feeding (MF), and formula feeding (FF), overweight and obese women. The second aim was to compare nutrient intakes and food group servings to the Dietary Reference Intake (DRI) and MyPyramid recommendations, respectively. Design Data were collected from September 2004 through April 2006 in Durham, NC. Infant feeding practices and dietary information were collected on 450 women between six and nine weeks postpartum. Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research. Analysis of covariance was used to compare infant feeding groups in dietary quality (nutrient intake per 1000 kcal) and food group servings, controlling for pre-pregnancy body mass index, race, age, education, income, and marital status. Chi-squared (X 2) analysis was performed to determine differences in meal and snack intake and dieting among infant feeding groups. Results BF women consumed more energy (2107 ± 50 kcal) than MF (1866 ± 56 kcal) or FF (1657 ± 50 kcal), p<0.001. Adjusted nutrient intake did not differ between groups. All groups were at risk for inadequate intakes of vitamins A, E, C, and folate and did not meet recommended servings of all food groups. BF women consumed lunch and snacks more frequently, were less likely to diet and reported higher intakes of grains and desserts than MF and FF women. Conclusions To help increase intakes of nutrients lacking in the diet and prevent postpartum weight gain, overweight women should be encouraged to increase fruits, vegetables, low-fat dairy, whole grains, legumes, and healthy types of fat, while decreasing refined grains, regular soda, sweetened beverages, and desserts.
Durham, Holiday A.; Brouwer, Rebecca J. N.; Krause, Katrina M.; ?stbye, Truls
Postpartum depression (PPD) is a major depressive disorder that most often emerges within 6 to 12 weeks of delivery, but can happen any time up to 1 year after birth. In developed countries, the incidence of postnatal depression is about 10–15% in adult women depending upon the diagnostic criteria, timing of screening and screening instruments used. Mothers with depressive symptoms have been found to have more complex behavioral contacts with their children; this situation can damage family relationships, and even leads to infanticide. Various pathophysiologies are proposed for postpartum depression: Nutritional deficiencies, iron deficiency anemia, rapid decrease in the levels of reproductive hormones following delivery, alterations in hypothalamic–pituitary–adernocortical mechanism and alterations in neurotransmitter levels. Among pathophysiologies of postpartum depression, the role of trace elements is highlighted. The purpose of this review is to assess the role of trace elements including zinc, magnesium, iron and copper in PPD. Zinc as a trace element has the second highest concentration of all transition metals in the brain, and its deficiency is associated with behavioral disturbances. Lower zinc blood concentration was found in women with postpartum depression. Another trace element, magnesium, also influences the nervous system via its