Early Puerperal Period Research Articles

Late Postpartum Posterior Reversible Encephalopathy Syndrome: Case Series and Literature Review

Abstract Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by seizures, headache, visual symptoms and other focal neurological findings. It is caused by wide variety of causes ultimately leading to vasogenic cerebral edema of occipital and parietal lobes of the brain. Prompt and early diagnosis of PRES is key in reducing the risk of permanent neurological sequelae. Occurrence of PRES during pregnancy or early postpartum period is well known. However, occurrence of PRES between 48 hours and one month postpartum in women who had normal pregnancy and delivery and no signs of preeclampsia is rare. In this case series we present three cases of PRES that occurred in young women during late postpartum period. All these three patients were normotensive during antenatal and early puerperal period but developed hypertension and vision loss in late puerperium. The prompt diagnosis and management of symptoms resulted in complete reversal of the symptoms with no permanent neurological deficit. Posterior reversible encephalopathy syndrome (PRES) is a reversible neurological entity characterized by the presence of white matter edema affecting the occipital and parietal lobes. The predominantly affected area of the cerebral cortex determines presentation in the patient. The reversibility of these symptoms is one of the hallmarks of the disease. Diffusion-weighted MRI is the gold standard in diagnosis of PRES as it helps to distinguish between vasogenic edema from cytotoxic edema. Prompt diagnosis and initiation of early treatment may lead to complete recovery with no residual neurological deficit.

Investigation of the changes in physical and chemical parameters of Damascus goat milk in the early postpartum

The aim of this study was to reveal the milk components and the changes in their characteristics in Damascus goats during the early postpartum period. For this purpose, 50 Damascus goats (aged 2 to 8 years) were selected for this study. A total of 291 milk samples were collected under sterile conditions during the mornings of the 10th, 20th and 30th days postpartum. Results were statistically analysed using the Mann-Whitney U Test and repeated measures ANOVA. All collected samples were analysed for milk composition (lactose (L), protein (P), casein (C), fat (F), total solid (TS), solid not fat (SNF), freezing point (FP), acidity (A), density (D), free fatty acid (FFA), and citric acid (CA)). A significant decrease was detected in P, C, F, TS and SNF values between the 10th and 30th days postpartum (pp) (P <0.01). Similar results were also observed in FP, A, D and CA values between the same days (P <0.05; P <0.01). A significant positive correlation was detected between FP, A, P, C, F and TS (0.812 and 0.980; P<0.05 and P<0.01). Additionally, a correlation was detected between C and P (0.983; P <0.01). These results reveal that these parameters decreased significantly in the early puerperal period compared to the first 10 days, and these decreases were not associated with an increase during milk yield in the early period of lactation (up to the 30th-day pp).

ОКСИДАНТНЫЙ СТРЕСС В ОРГАНИЗМЕ КОРОВ И ПЕРВОТЕЛОК В ПАТОГЕНЕЗЕ МЕТРИТА В РАННИЙ ПОСЛЕРОДОВОЙ ПЕРИОД

The data established in the course of this work reveal the pathogenesis of metritis in fresh cows and first-calf heifers in the early puerperal period against the background of oxidative stress, in farms of various organizational and legal forms of ownership of the Volgograd, Saratov regions and the Chechen Republic of the Russian Federation. The use of indicators of the system "lipid peroxidation - antioxidant protection" (LPO-AOD) for the diagnosis of metritis in fresh cows and first-calf heifers has a high predictive reliability and, on this basis, the development of preventive measures for acute inflammation of the uterus. It was revealed that the increase in the amount of β-hydroxybutyric acids and their fractions (AcAc and BH) by 5.9 times, as well as mixing the content of buffer bases in the blood to 18.41 ± 1.53 mmol / L, glucose to 2.25 ± 0 , 16 mmol / l and the VL / AcAc index up to 1.53 ± 0.28 indicate abnormalities in metabolic metabolism characteristic of oxidative stress, with symptoms of postpartum acute metritis. It was confirmed that a 1.75-fold increase in the amount of manol dialdigide in this disease up to 1.125 ± 0.34 μmol / l, intermediate products of ketodienes, as well as conjugated trienes in the blood of fresh animals. Acute postpartum metritis in first-calf heifers and fresh-calf cows leads metabolic processes to a negative balance, increased release of estradiol and testosterone into the blood. Meanwhile, the content of cortisol (21.4 ± 3.47 ng / ml), as well as progesterone (11.2 ± 4.31 ng / ml) remains rather insignificant to ensure metabolic processes in the early pueperal period, which is associated with the completion of in the genitals of involutional processes. At the same time, the indicator of the ratio of progesterone to estradiol is significantly lower in heifers and cows with uterine disease in the primary postpartum period than in animals with its physiological course ranging from 1.8 to 2.2 times. The materials of the current work should be taken into account in the future, in the study of fresh cows and first-calf heifers suffering from acute postpartum metritis, as a concept for the development of the oxidative stress syndrome in such a pathology of metabolic processes.

OLIVE OIL ON NIPPLE TRAUMA AMONG LACTATING MOTHERS

Nipple trauma is among the challenges that a lactating mother may face during early postpartum period. This study aimed to evaluate the effect of olive oil on nipple trauma among lactating mothers. A quasi-experimental study design was carried out at three private obstetric centers in Menyat El-Nasr City in Dakahlia governorate from January, 2017 to July, 2017. A purposive sample technique of 116 lactating mothers suffering from nipple trauma at their early puerperal period were chosen according to the inclusion criteria and assigned randomly into two equal groups of 58 lactating mothers; group one was the study group who rubbed olive oil on nipple after each feeding; group two was the control group who received routine pharmacological management for nipple trauma according to physician prescription. Two tools were used to collect the data; Structured Interview Schedule, and Nipple Trauma Score. Results of the present study showed that, majority of lactating mothers who used olive oil had faster recovery of nipple trauma post intervention more than control group with statistical significant differences. Conclusion: Olive oil is a safe natural method that can be used to treat nipple trauma among lactating mothers.

OLIVE OIL ON NIPPLE TRAUMA AMONG LACTATING MOTHERS

Nipple trauma is among the challenges that a lactating mother may face during early postpartum period. This study aimed to evaluate the effect of olive oil on nipple trauma among lactating mothers. A quasi-experimental study design was carried out at three private obstetric centers in Menyat El-Nasr City in Dakahlia governorate from January, 2017 to July, 2017. A purposive sample technique of 116 lactating mothers suffering from nipple trauma at their early puerperal period were chosen according to the inclusion criteria and assigned randomly into two equal groups of 58 lactating mothers; group one was the study group who rubbed olive oil on nipple after each feeding; group two was the control group who received routine pharmacological management for nipple trauma according to physician prescription. Two tools were used to collect the data; Structured Interview Schedule, and Nipple Trauma Score. Results of the present study showed that, majority of lactating mothers who used olive oil had faster recovery of nipple trauma post intervention more than control group with statistical significant differences. Conclusion: Olive oil is a safe natural method that can be used to treat nipple trauma among lactating mothers.

Effect of suppression of postpartum ovulation on endometrial inflammation in dairy cows

The objective of this study was to investigate the effect of time of first postpartum ovulation on endometrial inflammation in dairy cows with and without uterine disease during the early puerperal period. Transvaginal follicular puncture (FP) was carried out to suppress postpartum ovulation and formation of a CL until Day 42. Fifty-three lactating Holstein Friesian cows were divided into four groups on the basis of presence (UD+) or absence (UD−) of uterine disease, which was defined as retained fetal membranes and/or metritis, and whether FP had (FP+) or had not been (FP−) carried out. This resulted in the following groups: UD−FP− (n = 15), UD−FP+ (n = 13), UD+FP− (n = 13), and UD+FP+ (n = 12). Cloprostenol was given on Days 55 to 60 postpartum, and GnRH was administered 2 days later for synchronization of ovulation. In the FP− groups, endometrial swab and biopsy samples were collected during the second estrus (approximately Day 40) and during the estrus after synchronization. In the FP+ groups, the same samples were collected during the first estrus (approximately Day 49) and during the estrus after synchronization. The prevalence of positive bacteriologic cultures of the endometrium was not affected by FP (P > 0.05). Histologic signs of endometritis were more severe in UD+FP− cows at second sampling than in UD+FP+ cows (P ≤ 0.05). Endometrial expression of IL1α (in UD− after first sampling and in UD+ after second sampling) and IL1β (in UD− and UD+ after first sampling) was higher (P ≤ 0.05) in FP− cows than in FP+ cows. Regardless of group, cows with histopathologic evidence of endometritis had higher expression (P ≤ 0.05) of IL1α, IL1β, IL6, and TNFα than cows without endometritis. In conclusion, suppression of early ovulation by transvaginal FP enhances clearance of uterine inflammation in postpartum cows.

Sigmoid colon migration of an intrauterine device.

Background. Intrauterine devices (IUD) are commonly used birth control methods. Colonic perforation is an infrequent but serious complication of IUD. Case. A 34-year-old woman with 2-years history of IUD, inserted at early puerperal period, presented to gynecologist with chronic pelvic pain and dyspareunia. Radiological assessment revealed that there were two copper-T devices: one in uterine cavity and another in the colonic lumen. Attempts of retrieval with colonoscopy and laparoscopy were unsuccessful. Intrauterine device embedded in sigmoid colon wall was removed with resection of the involved segment and primary anastomosis was performed. Conclusion. Although there are cases in literature that are successfully managed with colonoscopy, in chronic cases, formation of granulation tissue complicates retrieval of an IUD by this intervention.

Feasibility of pulse oximetry for assessment of infants born in community based midwifery care

Objectiveto evaluate the feasibility of using pulse oximetry (PO) for evaluating infants born in community-based midwifery care. Designa prospective, observational study of infants born after midwifery supervised (home) births. Setting27 midwives from seven practices providing primary care in (home) births used PO at birth or the early puerperal period over a ten-month period. Data were obtained on the effect of PO on outcome, interventions and decision-making. Midwives were surveyed about applicability and usefulness of PO. Participants153 infants born in primary midwifery care. Findingsall births were uncomplicated except for one infant receiving supplemental oxygen and another was mask ventilated. In 138/153 (90%) infants PO was successfully used and 88% of midwives found PO easy to use. In 148/153 (97%) infants PO did not influence midwives’ clinical judgment and referral policy. In 5/153 (3%) infants, midwives were uncertain of the infant's condition, but PO measurements were reassuring. In case of suboptimal neonatal condition or resuscitation, 100% of midwives declared they would use PO again. Key conclusionsit is feasible to use PO in community based midwifery care, but not considered an important contribution to routine evaluation of infants. Midwives would like to have PO available during suboptimal neonatal condition or when resuscitation is required. Implications for practicePO can be applied in community based midwifery care; it does not lead to insecurity or extra referral. Further research on a larger group of infants must show the effect of PO on neonatal outcomes.

Effect of Preventive Intrauterine Ozone Application on Reproductive Efficiency in Holstein Cows

The aim of the research was to determine the influence of preventive application of two different ozone preparations on reproductive efficiency in dairy cows with physiological puerperium. The research was conducted on 404 Holstein cows aged 2-8 years, divided into three groups. The first group consisted of cows treated using 6 intrauterine ozone pearls (RIPROMED OVULI O(3) (®) , Novagen, Italy) at once. The second group consisted of cows treated with ozone foam spray (RIGER SPRAY(®) , Novagen, Italy) application in the body of uterus for 5 s, and the third group was the control group. Cows from the first two groups were observed and treated during early puerperium, 24-48 h after parturition. To assess the reproductive performance of Holstein cows, interval from calving to first insemination (days open to first service, DOFS), interval from calving to pregnancy (days open to pregnancy, DOP), relative pregnancy rate (%), first service conception rate (FSCR, %) and all service conception rate (ASCR, %) were measured. The estimate of hazard ratio (HR) for group B relative to group C for DOFS was 0.62 (p = 0.0002), implying that the relative rate of first service decreased in the control group by 38%. The estimate of HR for group B relative to group C for DOP was 0.65 (p = 0.0006), implying that the relative rate of pregnancy decreased in group C by 35%. Cows treated with Riger spray (group B) became pregnant earlier and had better FSCR and ASCR. It is supposed that the form of ozone preparations and the amount of active substance were decisive. A conclusion may be made that preventive ozone intrauterine application during early puerperal period, especially the foaming form of ozone preparations (spray), improved the reproductive efficacy in dairy cows.

Pregnancy-Associated Thrombotic Thrombocytopenic Purpura with Anti-Centromere Antibody-Positive Raynaud's Syndrome

Thrombotic thrombocytopenic purpura (TTP), scleroderma renal crisis (SRC), and hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP) syndrome display common symptoms that include microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Therefore, it is important to distinguish between them because their treatments vary: however, the differential diagnosis is sometimes difficult. We report a 32-year-old woman who was referred to our department for further examination of microangiopathic hemolytic anemia, thrombocytopenia, and a slightly elevated serum creatinine level with anti-centromere antibody-positive Raynaud's syndrome in the early puerperal period. TTP, SRC, and HELLP syndrome were considered in the differential diagnosis, but the measurement of a disintegrin-like metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS 13) activity and its inhibitor level led to the diagnosis of TTP. She was successfully treated by plasma exchange and high-dose prednisolone and angiotensin-converting enzyme inhibitor. If microangiopathic hemolytic anemia and thrombocytopenia are observed in perinatal women or patients with signs of systemic sclerosis, the measurement of ADAMTS13 activity and its inhibitor level are essential for diagnosis and therapeutic choice.

İneklerde Eken Puerperal Dönemde Theranekron® Uygulamalarının Uterus İnvolusyonu ve Vaginal Akıntı Üzerine Etkisi

İneklerde Eken Puerperal Dönemde Theranekron® Uygulamalarının Uterus İnvolusyonu ve Vaginal Akıntı Üzerine Etkisi

Maternal Thyroid Function during Pregnancy and Puerperal Period

It has been noted that hypothyroidism in pregnant women can adversely affect the children's subsequent psychoneurotic development. Also, transient elevation of serum free thyroxine is occasionally seen in the first trimester of normal pregnancy. However, normal thyroid function during pregnancy and the puerperal period has not been clearly defined in Japan. The aim of this study was to assess maternal thyroid function during pregnancy and puerperal period in Japan. The concentrations of thyroid stimulating hormone (TSH), free triiodo-thyronine (free T(3)), free thyroxine (free T(4)) and thyroid binding capacity (TBC) of 522 normal pregnant and puerperal women (119 in the first trimester; 132 in the second trimester; 135 in the third trimester and 136 in the early puerperium) were measured by electrochemiluminescence immunoassay. We compared the measured data with those of healthy nonpregnant control. Twenty-six (21.8%) of 119 women in the first trimester had lower TSH levels and 23 (16.9%) of 136 women in the early puerperium had higher TSH levels than the normal range of healthy nonpregnant controls. Free T(3) gradually decreased during pregnancy, although it remained within the normal control range. Eight (6.7%) of 119 women in the first trimester had high free T(4) levels, which gradually decreased during pregnancy. Sixty (44.4%) of 135 women in the third trimester had low free T(4) levels. The values of TBC in the second trimester increased compared with the first trimester and did not change in the third trimester and decreased after delivery. There were no correlations between maternal TSH and levels of thyroid hormones (free T(3) or free T(4)), except for TSH and free T(4) in the first trimester. In conclusion, we showed that maternal thyroid function, especially TSH and free T(4), changed during the course of pregnancy. In assessing the thyroid function associated with pregnancy, one needs to keep in mind the tendency toward low free T(4) levels in the third trimester and high TSH levels in the early puerperal period.

Plasma Biopterin Levels and Depressive State in Pregnancy and the Early Puerperal Period

Plasma total biopterin and tetrahydrobiopterin levels of 14 normal pregnant and 15 normal puerperal women (within 1 week after delivery) were measured. In the first group, total biopterin levels were already increased (average: 18.2 pmol/ml) in the second trimester and remained high until the early puerperal period. In the second trimester, the ratio of tetrahydrobiopterin to total biopterin levels decreased to 72.3% and even further to 66.1% in the third trimester. This tendency continued until the puerperal period. Compared with the control group (12 healthy nonpregnant women), total biopterin levels increased during pregnancy and the puerperal period (p < 0.001), and the ratio in the third trimester and the early puerperal period decreased (p < 0.001). The depressive state according to Zung’s score appeared most markedly in the third trimester with a mean score of 48, and tended to recover to a mean score of 36.2 in the early puerperal period. In this period, a correlation was found between Zung’s score and the total biopterin levels (r = 0.80), and the ratio of tetrahydrobiopterin levels to the total biopterin levels (r = –0.92). In the early puerperal period, total biopterin levels were higher in subjects with Zung’s scores ≧36 (p < 0.001); the ratios of this group were lower than those of subjects with Zung’s scores <36 (p < 0.001). Plasma biopterin levels in pregnancy and the early puerperal period closely resembled those of patients with mood disorders who show depressive symptoms from a psychoneurological perspective. Therefore, it seems possible that a depressive state in pregnancy and the early puerperal period has the same pathology as depression.

Correlation Between Physical Pain and Psycho-physical Condition in Postpartum Women during Early Puerperal Period

Correlation Between Physical Pain and Psycho-physical Condition in Postpartum Women during Early Puerperal Period

Endorphin activity in cerebrospinal fluid prior to elective cesarean section and in early puerperium.

Opioid activity in cerebrospinal fluid (CSF) was estimated by radioreceptor-assay (RRA) in samples obtained from ten women at term pregnancy and in the early puerperal period. The samples were fractioned on Sephadex G-10 columns and two opioid receptor active fractions, FI and FII, were recovered. Two pools of FII materials from pregnant and puerperal women, respectively, were further analyzed by electrophoresis and the concentrations of opioid activity were measured by radioreceptor assay. There was a significant rise in receptor-assayed FII opioid activity in late pregnancy as well as in the early puerperal period compared to that of healthy, nonpregnant, nonpuerperal females. Pooled FII material obtained before delivery could be separated into two major components tentatively assigned the hexapeptide [Met]enkephalin-Lys6 and the heptapeptide [Met]enkephalin-Arg6-Phe7. These two opioid peptides both have their origin in the [Met]enkephalin precursor, proenkephalin A. In the puerperal period there was predominance of only one of these components.

Rate of plasma protein normalization after parturition and withdrawal of oral contraceptives.

The increased levels of α1-antitrypsin, TBG, cerculoplasmin, plasminogen, transferrin, hemopexin, β1C-globulin and β-lipoprotein found on use of contra ceptive estrogens or in pregnancy are normalized within 6 weeks of delivery and 4 weeks of withdrawal of the oral contraceptives. The changes of the ceruloplasmin and α1-antitrypsin do not run parallel to those other acute phase reactants in the early puerperal period.