24h Postpartum Research Articles

29 The Role of Leptin and Its Regulation in the Hypothalamus of Neonatal Calves

Abstract The constant occurrence of increased feed intake in offspring exposed to intrauterine growth restriction has been noted across multiple species including ruminants. In ruminants, reduced circulating leptin concentrations from birth through the first week or two of life may influence the development of the appetite center of the hypothalamus. It should able be noted that increased circulating cortisol at birth has been associated with this decreased circulating leptin in the perinatal ruminants, yet information is limited as to any cause and effect relationship between the two hormones. The objectives of these studies were to test directly the effects of exogenous cortisol on leptin concentrations relative to development of the hypothalamus in perinatal calves and voluntary feed intake as yearling. In two experiments, Holstein bulls (n = 27) and calves (n = 32 males; n = 30 females) from commercial Angus cows were assigned to treatments at parturition (day 0). Calves were intravenously infused with either a low cortisol [LC; n = 9, 3.5 ug/kg of body weight (BW)], high cortisol (HC; n = 9, 7.0 ug/kg BW), or a control (CON; n = 9, saline). Calves were administered a half dose of their respective treatment 24h postpartum. Jugular vein blood samples were collected before infusion and daily until d 17 or necropsy. At 5 days of age Holstein bull calves were euthanized where cerebral-spinal fluid (CSF) and hypothalamic tissue were collected. Serum and CSF leptin concentrations were analyzed via RIA. Neuronal growth factors were analyzed in hypothalamus samples via qRT-PCR. In experiment 2, yearling calves entered a GROWSAFE System and daily feed intake (FI) measured. Animals were allowed a two-week adjustment period to a growing ration for heifers and a finishing ration for steers. Heifer body condition scores (BCS) were collected at the beginning and end of the trial. Heifers underwent the feeding trial for 70 days and steers until they obtained a back fat (BF) thickness of 1.15 cm. Blood samples were analyzed similar to experiment 1. All data were analyzed via repeated measures using appropriate models of SAS (SAS Institute Inc., Cary, NC). Perinatal dairy bull calves had decreased (P < 0.013) serum and CSF leptin concentrations of HC and LC calves compared with CON. Hypothalamic expression of BDNF, FGF1 and FGF2 were decreased (P < 0.006) in HC and LC compared with CON. During the feeding trial: BW gain, BCS change, and number of feed events were increased (P = 0.001) in LC compared with HC and CON heifers. However, LC observed greater daily FI (P = 0.047) and tended to have greater final BW (P = 0.080) compared with HC and CON steers. In summary, these data support that exogenous cortisol administered to perinatal calves affects leptin production and the appetite center of the hypothalamus when administered during the neonatal period.

Effect of vaginal delivery on adverse pregnancy outcomes after cesarean section in scar uterus

ABSTRACT The purpose of this study was to investigate the impact of vaginal delivery on adverse pregnancy outcomes after cesarean section for the cicatricial uterus. Eighty patients with scarred uterus after cesarean section admitted to our hospital from October 2019 to May 2021 were selected for the study. Among them, 44 cases were eligible for vaginal delivery. Thirty-eight cases of cesarean delivery were selected as the control group and 42 cases of vaginal delivery were selected as the observation group according to the mode of delivery. Baseline data, 24-h blood loss, length of hospital stay, hospital costs, 5-minute Apger score, and adverse pregnancy outcomes were compared between the two groups. When comparing the age, gestational age, number of pregnancies, and duration of cesarean delivery between the two groups (t = 1.333, 0.989, 0.597, 0.752, P > 0.05), the scar thickness in the observation group was higher than that in the control group. The 24-h postpartum bleeding and hospitalization cost was lower in the observation group than in the control group, the hospitalization time was shorter than in the control group, and the 5-minute Apger score was higher than in the control group (t = 21.744, 15.029, 11.524, 7.342, P < 0.05). The incidence of maternal and neonatal complications was compared between the two groups (23.68% vs 7.14%, 7.89% vs 0.00%, correction 2 = 1.083, 1.605, P > 0.05). The incidence of adverse pregnancy outcomes was 7.14% in the observation group, which was significantly lower than the 31.57% in the control group. The difference was statistically significant (correction 2 = 4.060, P < 0.05).

Curative effect of cervical lifting suture combined with the improved Hayman suture in pernicious placenta previa under noninterventional conditions: A retrospective cohort study.

To propose a novel operative strategy involving cervical lifting suture (CLS) in conjunction with the improved Hayman suture (CLS-Hayman) to apply in the cesarean section of pernicious placenta previa (PPP) under noninterventional conditions and evaluate the curative effect of the CLS-Hayman operation by comparing with conventional CLS. A retrospective cohort study was conducted on 119 pregnant women diagnosed with PPP, including 50 cases in the CLS-Hayman group and 69 cases in the CLS group. The authors used different statistical methods to compare intraoperative bleeding, 24-h postpartum bleeding, postoperative complication rates, and uterine involution between the two groups under noninterventional conditions. The median intraoperative blood loss was 800 mL in the CLS-Hayman group versus 1000 mL in the CLS group. The amount of 24-h postpartum bleeding in the CLS-Hayman group was lower than that in the CLS group. The complication rates in the two groups were 12% and 27.5%, respectively (P=0.04). B-ultrasound or magnetic resonance imaging data showed that the uterine involution was better in the CLS-Hayman group. The CLS-Hayman suture achieves the desired intraoperative hemostasis and also stands out for its better prevention of postpartum hemorrhage, better prognosis at follow-up, and lower complication rates.

Endocrine-metabolic adaptations in Dorper ewes: comparison between single and twin pregnancies during gestation, parturition, and postpartum.

The experiment was conducted at Araí & Zumbi farm on sixty healthy Dorper ewes to compare blood glucose, hormonal profile, and insulin resistance evaluation in sheep from conception until 48h postpartum in single and twin pregnancies. All experimental ewes raised under semi-intensive management system. Sixty animals were selected from 150 estrous synchronized and pregnant ewes. The animals were divided into two groups based on single (G1, n = 30) and twin pregnancies (G2, n = 30). Blood samples were collected at nine time points: immediately after fixed-time artificial insemination (D0); at 30days (D30), 90days (D90), 120days (D120), 130days (D130), and 140days (D140) of pregnancy; on the delivery day (DD); and at 24h (PD1) and 48h (PD2) postpartum. The results of blood glucose, insulin, glucagon, cortisol, and thyroid hormones (T3 and T4) levels showed significant differences over the analyzed sample times; however, only cortisol showed differences within groups, with the G1 having higher values than the G2 group. The interaction of the groups × nine sample times showed a significant result (P = 0.001) only for glucagon. The number of fetuses directly interfered with the glucagon profile throughout gestation. The glucose, cortisol, glucagon, and the homeostatic model assessment for insulin resistance (HOMA IR) concentrations increased at DD and decreased at PD1 and PD2. T3 and T4 showed different behaviors among the sample times. T3 values presented a decrease from D0 to D90, followed by an increase from D90 to DD. Otherwise, for T4 values, a decrease from D90 to D130 was observed, followed by an increase from D130 to D140. Despite the changes found in the endocrine system and metabolism in Dorper ewes throughout pregnancy, the nutritional management ensured a healthy status during pregnancy, delivery, and postpartum in single and twin gestation, whose HOMA IR profiles remained identical.

Comparison of hematological parameters between single and twin pregnancies in Dorper ewes during gestation, lambing, and postpartum

ABSTRACT: The hematopoietic system changes during the pregnancy to carry fetal development and maternal needs. This study compared the hematological parameters between ewes with single and twin pregnancies during gestation, delivery, and postpartum. The experiment was conducted on 60 healthy pregnant Dorper ewes that were divided into two experimental groups: Group 1 (G1), with single pregnancies (n=30), and Group 2 (G2), with twin pregnancies (n=30). Blood samples were collected from all ewes at different times: immediately before fixed-time artificial insemination (AI); on day 30, 90, 120, 130, and 140 of pregnancy; immediately after delivery; and at 24h and 48h postpartum. Statistical analysis compared the two groups at different times (P&lt;0.05). Mild, normocytic, and hypochromic anemia was detected in all ewes from AI time and throughout pregnancy from both groups, but did not prove to be of clinical relevance. In the peripartum stage (from the 140th day of pregnancy to 48h postpartum), the ewes with twin pregnancies (G2) exhibited higher erythrogram values and neutrophil:lymphocyte ratio than did ewes with single pregnancies (G1). This indicated a greater hematopoietic adaptation in the body during the development of two fetuses. Except for the eosinophil numbers, all leukogram parameters were influenced by pregnancy in a similar way in both groups, and was characterized mainly by leukocytosis with neutrophilia during peripartum due to the high presence of endogenous cortisol at delivery. Thus, these findings showed that pregnancy was a stressful physiological event that increased the leukocyte count with a slight alteration in the erythrogram of Dorper ewes.

The Effect of Socialising Piglets During Lactation on Performance, Suckling Behaviour and Weaning Aggression: a Preliminary Field Study

The post-weaning aggression among piglets is a serious problem in modern pig production which compromises animal welfare and health, as well as could cause considerable economic losses. To prevent post-weaning aggression between piglets an approach of early socialisation of piglets during lactation was tested in the present study. In the group farrowing pen (GFP) three individual farrowing pens were interconnected whereby piglets had free access to move across pens and/or cross-suckled alien sows that were still individually crated – passage between pens was released within 24h postpartum. Piglets/litters in the control group went through the conventional breeding practice (i.e. individual farrowing pen/crate). Altogether, the experiment involved 235 piglets. The preliminary results revealed that the suckling order stability differed between studied breeding technologies (group and individual). About one third of all piglets (31.3%) were found being involved (at least once) in the cross-suckling, i.e. suckling by the alien mother. Consequently, suckling stability was found generally lower in the GFP, with a significant drop after two weeks of lactation. Regarding the growth performance, piglets from GFP grew relatively, i.e. considering initial body weight, faster both during lactation and after weaning, although their daily weight gain was not significantly higher. The present preliminary study revealed early socialisation of piglets as an effective method to mitigate post-weaning aggression, as well as to improve their growth performance. However, considering mortality in lactation and disturbances in suckling stability, additional studies are needed to optimize the process of early socialisation, particularly in terms of piglets’ age when grouping of non-littermates is implemented during lactation.

Comparison of electrolyte and acid-base balances of Dorper breed ewes between single and twin pregnancies

ABSTRACT: During pregnancy there are modifications in the metabolic profile of sheep that may predispose to the occurrence of metabolic disorders, of which pregnancy toxaemia (PT) is highlighted. Blood gas analysis is detects changes in acid-base and electrolyte balance effectively. The objectives of this study were to study the acid-base and electrolyte balance of sheep during gestation and in the immediate peripartum (up to 48 hours postpartum), comparing single gestation with twins. Sixty healthy sheep of Dorper breed, two to five years old were raised in a semi-intensive system and were divided in two experimental groups: Group 1: 30 ewes, with ultrasonographic diagnosis of single fetus gestation; Group 2: 30 ewes, with ultrasonographic diagnosis of twin pregnancy. The experimental moments were defined as: MI-immediately after artificial insemination (control); MG30 - 30 days of gestation; MG90 - 90 days of gestation; MG120 - 120 days of gestation; MG130 - 130 days of gestation; MG140 - 140 days of gestation; MP - lambing; MPP1 - 24h postpartum; MPP2 - 48h postpartum. At all times 1mL of blood was collected per jugular vein puncture for blood gas evaluation in a portable equipament (I-Stat®). The pH, carbon dioxide pressure (PCO2), bicarbonate (HCO3-), base excess (BE), sodium (Na+), potassium (K+), chloride (Cl-), ionized calcium (Ca+2), lactate, anion gap (AG) were mensured and strong ion difference (SID) were calculed. This work showed that there were changes in acid-base and electrolyte balance in pregnant ewes, due to the decrease in BE, HCO3-, TCO2 and increase of lactate and AG during gestation, but the pH remained normal and did not present any difference among moments in both groups. Comparing the groups, single-gestation ewes presented higher alkaline expenditure at delivery than twin-gestation, evidenced by lower levels of BE and HCO3-. Lower Na+ levels were observed in prepartum; drop in K+ values with advancing gestation; hyperchloremia and hypocalcemia during gestation according to the reference standards for species; decreased iCa+2 levels in the final third of gestation in both groups. It was concluded that the ewes of this study were healthy until the last moment analyzed (48h postpartum), although have shown greater consumption of the alkaline reserve in the peripartum, being more explicit in the single gestation animals. In addition, this situation can be physiological and result in increased energy demand during gestation, more exacerbated by peripartum.

Ruptured renal artery aneurysm in pregnancy and puerperium: literature review of 53 cases.

To summarize and define the most appropriate diagnostic methods and therapeutic options for ruptured renal artery aneurysms in pregnancy based on rarely published data. Literature searches of English-, German-, Spanish-, and Italian-language articles were performed in PubMed (1946-2018), PubMed Central (1900-2018) and Google Scholar. The search terms included renal artery aneurysm, renal artery rupture, pregnancy, puerperium, nierenarterienaneurysma, schwangerschaft, wochenbett, aneurisma de la arteria renal, el embarazo, puerperio, aneurisma dell'arteria renale and gravidanza. Additional studies were identified by reviewing reference lists of retrieved studies. Fifty-three cases were collected. The average maternal age was 31 ± 6years; 71.4% were multiparous and significantly older than primiparas. The majority presented in the third trimester (62.3%), followed by second (20.7%) and the first (5.7%), while 11.3% presented postpartum. All postpartum patients presented during the first week postpartum and 50% during the first 24h postpartum. Parity was not associated with the trimester of presentation. The left renal artery was affected slightly more frequently (58.5% vs. 41.5%). There were no differences in the affected side according to trimester of presentation, including postpartum. 25 out of 53 cases underwent ipsilateral nephrectomy (47.1%) and 18 underwent aneurysm repair or coil embolization (34.0%). There was no difference in maternal (25.8%) vs. 4 (18.1%) and fetal mortality according to the side of rupture. There were no differences in the distribution of maternal or fetal mortality frequency according to the trimester of presentation. The clinical presentation is easily confused with more common conditions and time to diagnosis is often delayed. Diagnostic delay is associated with high maternal and fetal mortality. Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with acute and severe flank pain, especially if followed by a drop in blood pressure. Early diagnosis and immediate intervention are important for achieving better maternal and fetal outcomes. There are several methods of managing asymptomatic or ruptured renal artery aneurysm during pregnancy although no established guidelines exist.

Effects of attapulgite dietary supplementation on sow performance in two commercial farms in Greece

The present study investigated the effects of attapulgite supplementation in sow diets during gestation and lactation on sow performance. The study comprised two reproductive phases (cycles) in two commercial farrow to finish farms: Farm A (capacity: 550 sows) and Farm B (capacity: 220 sows). The treatment groups were: a) control group (CN): the sows were fed a common gestation or lactation diet; b) attapulgite group (AT): the sows were fed the CN diet supplemented with attapulgite at 0,7% level; c) attapulgite plus group (AT+): the sows were fed the CN diet supplemented with attapulgite (0.7%) and a mix of enzymes, live yeast and amino acids (0.1%), at a total of 0.8% level. Within each cycle the sows included per treatment were: 24 for Farm A; 12 for Farm B. Initially data were analyzed per cycle and per each farm. Data from sows that completed both cycles within each farm, were analyzed by repeated measures analysis. Regarding sow parameters, sow body weight loss during lactation tended to be greater in AT sows compared to CN sows during cycle 1 in Farm B and was greater in AT and AT+ than CN sows in Farm A that completed both cycles (P=0.063 and P=0.023, respectively). A greater litter size 24h postpartum was observed in favour of AT compared to CN group during cycle 1 in Farm A and in sows that completed both cycles in Farm A (P=0.001 and P= 0.011, respectively). Litter size at weaning was greater in sows from the AT group than CN during cycle 1 and 2 in Farm A, in cycle 1 in Farm B and in sows that completed both cycles in Farm A (P=0.004, P=0.037, P=0.037, and P=0.022, respectively). Piglet weight at weaning and average daily gain during lactation were greater in AT group than CN and AT+ in sows that completed both cycles in Farm A (P=0.049 and P=0.040 respectively). Notable similar effects, although not statistically significant, were also observed in Farm B. This field study suggests that attapulgite supplementation in sow diets can improve performance indexes. Further research should investigate the underlying mechanisms involved.

Relationship between duration of second stage of labour and postpartum anaemia.

To assess the relationship between the duration of the second stage of labour and postpartum anaemia during vaginal birth. An observational, analytical retrospective cohort study was performed at the "Mancha-Centro Hospital" (Spain) during the 2013-2016 period. Data were collected from 3437 women who had a vaginal birth. Postpartum anaemia was defined as a haemoglobin level below 11g/dL at 24h postpartum. A univariate analysis was used for potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors. The incidence of postpartum anaemia was 42.0%. The risk of postpartum anaemia did not increase in nulliparous women whose duration of the second stage of labour exceeded 4h. Compared with multiparous women who delivered between 0 and 3h, multiparous women with a duration of the second stage of labour beyond 3h were at higher risk of postpartum anaemia (OR=2.43 [1.30-4.52]). The duration of the second stage of labour beyond 4h is safe for postpartum anaemia in nulliparous women. However in multiparous women, monitoring should increase if the second stage of labour exceeds 3h given the increased risk of postpartum anaemia.

Incidence of postpartum anaemia and risk factors associated with vaginal birth.

Postpartum anaemia is a frequent and potentially preventable complication that has serious repercussions on health and maternal well-being. Determine the incidence and perinatal risk factors associated with postpartum anaemia in women who gave birth vaginally. An observational and analytical retrospective cohort study conducted at the Mancha-Centro Hospital during the 2010-2014 period. Data were collected from 2990 women who gave birth vaginally. The main outcome variable was postpartum anaemia for two cut-off points (haemoglobin (Hb) <11g/dL and <9g/dL at 24-h postpartum). Women with prepartum anaemia (<11g/dL) were excluded. It included a multivariate analysis by multiple linear regression. 45% (1341) of women had postpartum levels of Hb <11g/dL, and 7.1% (212) of women had Hb <9g/dL. The most strongly associated risk factors with more severe anaemia (Hb <9g/dL) were episiotomy (OR 3.19. 95%CI: 2.10-4.84), first stage of labour >9h (OR 2.50. 95%CI: 1.58-3.94), primiparity (OR 2.50. 95%CI: 1.61-3.87) and previous caesarean section (OR 2.43. 95%CI: 1.51-3.90). The other independent risk factors for both Hb cut-off points were prolonged second stage of labour, instrumental birth, tearing>first degree, non-practice of active management and heavier birth weight of newborns. Postpartum anaemia has a high incidence. The active management of third stage of labour, selective practice of episiotomies, and performing instrumental births only when strictly necessary are efficient measures to lower the incidence of postpartum anaemia.

Lethal Gastric Mucosal Necrosis due to Administration of Oral Ferrous Bisglycinate Chelate to Suckling Piglets

The oral application of a newly developed ferrous bisglycinate paste for suckling piglets at a dose of 180mg/kg body weight led to increased death rates in 10% (n=10) of Swiss test pig breeding farms (n=100). Necropsy examination of suckling piglets (n=12), selected randomly from the test farms with increased death rates, demonstrated severe gastric mucosal ulceration and necrosis. Due to the presence of crystalline iron surface coating within the gastric lesions, the iron was considered as the toxic principle and cause of death. To demonstrate the direct toxicity of ferrous bisglycinate, the paste was administered experimentally to a litter of suckling piglets (n=11). Different time points (24, 48 and 72h post partum) and doses (180mg/kg and 360mg/kg) were investigated. The manufacturer's recommended dose of 180mg/kg corresponded to approximately 36mg Fe/kg and to 6.4 % of the acute lethal dose50 of oral iron in rats. In all piglets the lesions were reproduced and most severe at the earliest time point (24h post partum) and with the highest applied dose (360mg/kg). The lesions were in accordance with those described from oral iron intoxication in man, suggesting pigs as an ideal animal model for oral iron toxicity studies.

Clinical and laboratory markers in the recovery from severe preeclampsia.

To examine the recovery from severe Preeclampsia toxemia (PET) in women treated with magnesium sulfate (MgSO4) during the first 24h postpartum as reflected by the changes in various clinical and laboratory markers. The study population included all women diagnosed with severe PET that gave birth at the Soroka University Medical center between 2013 and 2014, and were treated with MgSO4 in the first 24h postpartum. Data were collected from the institutional computerized records. The different parameters were examined in 6h intervals and were compared using appropriate statistical tests. Change in various postpartum laboratory and clinical parameters. During the study period there were 132 singleton deliveries with severe PET treated with a 24-hours postpartum MgSO4 regimen. Most of the women were primigravida and delivered vaginally. Both mean systolic and mean diastolic blood pressure values have shown recovery to normal values after the first 6h of treatment (P<0.001). Urine output and proteinuria have demonstrated later recovery (after 12h). When assessing the natural recovery of severe PET features, the earliest parameter to recover during the first 24h postpartum is hypertension followed by urine output and the proteinuria. Further larger studies are needed in order to confirm these results. Moreover, the use of these parameters may allow using shorter MgSO4 treatment regimens for appropriate women showing earlier recovery and facilitating quicker mother-baby bonding and emotional recovery.

Clinical response after chitosan microparticle administration and preliminary assessment of efficacy in preventing metritis in lactating dairy cows.

The objectives were to evaluate the clinical response to intrauterine administration of chitosan microparticles (CM) and to assess efficacy for preventing metritis in dairy cows. Holstein cows (n=104; 40 primiparous and 64 multiparous) at increased risk for metritis (cows that had abortion, dystocia, twins, stillbirth, or retained placenta) were randomly assigned to 1 of 2 treatments at 1d in milk (DIM; 24h postpartum): CM group (n=52), daily intrauterine infusion of 8g of CM dissolved in 40mL of sterile water for 5d; control (CON) group (n=52), daily intrauterine infusion of 40mL of sterile water for 5d. Clinical response was assessed by evaluation of parameters associated with inflammation (rectal temperature and plasma haptoglobin concentration) and metabolism [plasma nonesterified fatty acid (NEFA) and β-hydroxybutyrate (BHB) concentrations] up to 14 DIM, and daily milk yield up to 30 DIM. Uterine discharge pH was evaluated at 4, 7, 10, and 14 DIM as an indicator of bacterial load and acid byproduct production. The cumulative incidence of metritis was evaluated up to 4, 7, 10, and 14 DIM. Continuous and dichotomous outcomes were evaluated with mixed linear and logistic regression analysis, respectively. Treatment with CM did not affect rectal temperature (39.17±0.04 vs. 39.14±0.04°C), haptoglobin (1.10±0.05 vs. 1.07±0.05mg/mL), NEFA (0.64±0.04 vs. 0.63±0.04mmol/L), BHB (0.61±0.03 vs. 0.57±0.03mmol/L), or milk yield (30.3±0.92 vs. 30.1±0.97kg/d) compared with CON. An interaction between treatment and time showed that NEFA concentrations were lower for CM than CON at 10 DIM (0.46±0.06 vs. 0.64±0.06mmol/L). Treatment with CM resulted in greater uterine discharge pH than CON (6.91±0.03 vs. 6.83±0.02). Cows that developed metritis had increased concentrations of haptoglobin and BHB, and decreased uterine discharge pH and milk yield. Treatment with CM resulted in decreased incidence of metritis up to 7 DIM compared with CON (46.2 vs. 65.4%); however, no differences were found at 4 (11.5 vs. 17.3%), 10 (61.5 vs. 73.1%), and 14 DIM (63.5 vs. 73.1%) for CM versus CON, respectively. In conclusion, CM did not alter clinical parameters of cows at risk for metritis, and may merit further investigation for prevention of metritis. However, the duration of treatment may have to be extended to effectively reduce the incidence of metritis during the high-risk period.

Short communication: Changes in the composition of yak colostrum during the first week of lactation

Although the great interest has been paid to colostrum utilization for calves, no systematic studies evaluating the compositional changes of yak colostrum during the first week after parturition have been reported. The aim of this study was to elucidate such postpartum nutritional changes. Colostrum samples from 12 multiparous (2–7 lactations) yaks, grazed on alpine pasture, were collected at exactly 1, 24, 48, 72, 96, 120, 144, and 168h postpartum. Gross composition (fat, total solids, protein, and ash) were measured, as well as fat and water-soluble vitamins, fatty acid and mineral composition, and IgG. The colostrum, collected 1h postpartum, had the highest concentrations of crude protein, total solids, ash, vitamin A and E, β-carotene, and most minerals (Na, Mg, Zn, Cu, and Fe). These components decreased rapidly within 24h. Similarly, at 24h postpartum, IgG content decreased to 7.5% of the value (87.78mg/mL) at 1h postpartum. In contrast, the concentration of vitamin C increased from 1 to 24h and then decreased consistently thereafter to the lowest value at 168h. Phosphorus and Ca contents showed an increasing trend from 24 to 168h after calving. Lactose content increased from 2.88% at 1h to 4.96% at 48h postpartum and was steady to 168h. Total n-3 fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and n-3-to-n-6 fatty acid ratio were proportionally similar as a percentage of total fatty acid methyl esters during the first 168h of milk production. However, the proportion of total n-6 fatty acid content to total fatty acid methyl esters decreased from 3.07% at 1h to 2.60% at 24h. In summary, experimental results indicate colostrum should be provided to yak calves as soon as possible after birth to provide nutrients and enhance passive immunity.

Short-course postpartum (6-h) magnesium sulfate therapy in severe preeclampsia.

To assess the efficacy of short-course postpartum (6-h) magnesium sulfate therapy versus 24-h conventional magnesium sulfate therapy in severe preeclampsia. Cases of severe preeclampsia were randomly allocated to group A (n = 76) and group B (n = 43). Group A and group B received magnesium sulfate loading dose (4 g) followed by infusion for 6 and 24 h postpartum (1 gm/h), respectively. Cases in both the groups were monitored closely after the initiation of therapy. t test and Chi-square test were used for data analysis. No occurrence of convulsions was noted in both group A and group B. The mean amount of magnesium sulfate used in the study group was 15.1 ± 5.4 g as against 42.3 ± 7.3 g in controls. The duration of Foley catheterization and monitoring was significantly less in group A (mean 11.3 ± 5.1 and 11.1 ± 4.9 h, respectively) as compared to group B (mean 38.3 ± 7.3 and 38.4 ± 7.2 h, respectively). The mean duration of hospital stay was 2.7 ± 0.7 days in cases delivered vaginally and 7.5 ± 1.6 days in those who underwent cesarean section in group A, while it was 4.04 ± 1.47 and 11.11 ± 3.14 days, respectively, in group B. Short-course, i.e., 6-h, postpartum magnesium sulfate therapy is as effective as conventional 24-h postpartum magnesium sulfate therapy in preventing convulsions in severe preeclampsia.

Responses in colostrum production and immunoglobulin concentrations to conjugated linoleic acid fed to multiparous sows during late gestation

This study was conducted to determine whether supplemental conjugated linoleic acid (CLA) fed during late gestation affects reproductive performance, colostrum production and colostral immunoglobulin (Ig) levels of multiparous sows. Forty-eight, pregnant, Landrace×Large White, multiparous sows were allotted to four dietary treatments (n=12), control (CTR, no CLA addition) and 7.5, 15.0, or 22.5g/kg CLA supplementation from d 85 of gestation until farrowing. The CLA was added at the expense of soybean oil. All sows were fed the same commercial lactation diet postpartum. Blood samples were collected from sows on d 85, 100 and 112 of gestation while blood samples were obtained from neonatal piglets 24h postpartum. Colostrum was collected immediately after farrowing and its production was estimated for 24h starting with the birth of the first piglet. Neither the body weight nor backfat thickness of sows were altered by dietary CLA. Reproductive performance, piglet growth and calculated colostrum production were also unaffected. Compared with the CTR diet, dietary CLA supplementation during late gestation decreased (P<0.01) the colostral fat, and increased (P<0.01) the concentrations of IgG, IgA, and IgM in colostrum (P<0.01). The concentrations of serum Ig and interleukin-2 on d 112 of gestation were increased (P<0.01) in sows receiving CLA, although those factors did not differ among different levels of CLA supplementation. Serum IgG, IgA, and IgM concentrations in piglets from sows fed diets containing CLA were increased (P<0.05) 24h postpartum. This study indicates that dietary CLA has potential immunomodulatory effects in gestating sows and neonatal piglets, whereas there were no differences within the CLA treatments.

Reliability of student midwives’ visual estimate of blood loss in the immediate postpartum period: A cross-sectional study

BackgroundIn France, postpartum hemorrhage (blood loss≥500mL in the first 24h postpartum) is the leading direct obstetric cause of maternal mortality. In French practice, PPH is mainly diagnosed by a quantitative assessment of blood loss, performed by subjective methods such as visual estimates. Various studies have concluded that visual estimates are imprecise, tend to underestimate blood loss, and thus to delay diagnosis of PPH. ObjectivesThe principal objective of this study was to assess the accuracy of visual estimates of blood loss by student midwives. The secondary objectives were to study intraobserver agreement of these assessments, to assess the accuracy of visual estimates for threshold values, and to look for a region effect. DesignA cross-sectional multicentre study. SettingAll French midwifery schools (n=35). ParticipantsVolunteer French student midwives at their fifth (final) year (n=463). MethodsThe online questionnaire contained 16 photographs (8 different, each presented twice) of simulated volumes of blood loss (100, 150, 200, 300, 500, 850, 1000, and 1500mL). A 50-mL reference standard for calibration accompanied each photograph. Only one answer could be selected among the 7 choices offered for each photograph. Comparisons used χ2 and Kappa tests. ResultsThe participation rate was 48.43% (463/956), and 7.408 visual estimates were collected. Estimates were accurate for 35.34% of the responses. The reproducibility rate for the visual estimates (0.17≤к≤0.48) and for the accurate visual estimates (0.11≤к≤0.55) were moderate for 4 of the 8 volumes (100, 300, 1000, and 1500mL). The percentage of accurate responses was significantly higher for volumes≤300mL than for those ≥500mL (52.94% vs. 17.17%, p<0.0001) and those ≥1000mL (52.94% vs. 18.30%, p<0.0001). The percentage of accurate responses varied between the regions (p=0.042). ConclusionDespite the help of a visual aid, both the accuracy and reproducibility of the visual estimates were low.

Carbetocin versus oxytocin for prevention of postpartum hemorrhage in obese nulliparous women undergoing emergency cesarean delivery

Objective: To assess and compare the effectiveness and safety of single IV polus dose of carbetocin, versus IV oxytocin infusion in the prevention of PPH in obese nulliparous women undergoing emergency Cesarean Delivery.Methods: A double-blinded randomized-controlled trial was conducted on 180 pregnant women with BMI >30. Women were randomized to receive either oxytocin or carbetocin during C.S. The primary outcome measure was major primary PPH >1000 ml within 24 h of delivery as per the definition of PPH by the World Health Organization Secondary outcome measures were hemoglobin and hematocrit changes pre- and post-delivery, use of further ecobolics, uterine tone 2 and 12-h postpartum and adverse effects.Results: A significant difference in the amount of estimated blood loss or the incidence of primary postpartum haemorrhage (>1000 ml) in both groups. Haemoglobin levels before and 24-h postpartum was similar. None from the carbetocin group versus 71.5% in oxytocin group needed additional utrotonics (p < 0.01). The uterine contractility was better in the carbetocin group at 2, and 12-h postpartum (p < 0.05).Conclusions: A single 100-µg IV carbetocin is more effective than IV oxytocin infusion for maintaining adequate uterine tone and preventing postpartum bleeding in obese nulliparous women undergoing emergency cesarean delivery, both has similar safety profile and minor hemodynamic effect.

Primary postpartum haemorrhage in women with von Willebrand disease or carriership of haemophilia despite specialised care: a retrospective survey.

Pregnant women with bleeding disorders require specialised peripartum care to prevent postpartum haemorrhage (PPH). If third trimester coagulation factor levels are <0.50 IUmL(-1) , prophylactic treatment is indicated and administered according to international guidelines. However, optimal dose and duration are unknown and bleeding may still occur. The aim of this study was to investigate the outcome in women with von Willebrand disease (VWD) or haemophilia carriership treated according to current practice guidelines. From the period 2002-2011, 185 deliveries in 154 VWD women or haemophilia carriers were retrospectively included. Data on blood loss, bleeding disorder characteristics and obstetric risk factors were obtained. The outcome was primary PPH, defined as blood loss ≥500mL within 24h postpartum and severe PPH as blood loss ≥1000mL. Primary PPH was observed in 62 deliveries (34%), 14 (8%) of which resulted in severe PPH. In 26 deliveries prophylactic treatment was administered due to factor levels below the 0.50IUmL(-1) cut-off in the third trimester, 14 of which (54%) were complicated by PPH. We found an increased PPH risk in deliveries given prophylactic treatment compared with deliveries without (OR 2.7, 95% CI 1.2-6.3). In conclusion, PPH incidence was highest in deliveries with the lowest factor levels in the third trimester. Currently, delivery outcome in women with bleeding disorders is unsatisfactory, given the high PPH incidence despite specialised care. Future studies are required to optimise management of deliveries in this patient population.