Early Puerperium Research Articles

Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review

BackgroundPosterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as other conditions, especially, among pregnant women with severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome in the puerperium. We hereby contribute to the literature this rare complication and hightlight the appropriate management of PRES .Presentation caseA pregnant woman (gravida 3, parity 2) had a normal antenatal course. However, she was diagnosed with severe preeclampsia and HELLP syndrome at 29 weeks and 5 days of gestation. Therefore, she was indicated for a medical termination of pregnancy following a patient’s consent at our tertiary referral hospital. Severely, the patient developed rapidly with altered mental health in early puerperium. In result, PRES was diagnosed based on a brain magnetic resonance imaging (MRI) evidence with typical findings. After a strict multidisciplinary management, the clinical condition improved after 5 days of onset and recovered completely after a 4-month follow-up without any sequelae.ConclusionIn summary, despite its rarity, clinicians ought to be knowledgeable and raise an aware of PRES during pregnancy. Importantly, a brain imaging modalities should be taken into account among pregnant women with neurological symptoms subsequent to severe preeclampsia. In addition to early diagnosis, a timely appropriate treatment with multidisciplinary team is strongly indicated. Further studies with a large case series are required for this uncommon entity.

Percutaneous correction of structural congenital heart diseases during the early puerperium. Experience of a center

Congenital heart diseases (CHD) can be found in pregnant women. Although cardiac interventions in the catheterization laboratory are considered safe and effective, it is preferable to wait 3-6 months after delivery to correct simple, uncomplicated CHD; however, this may result in follow-up losses. The objective is to present our experience in correcting CHD during the early puerperium (EP). All cases of pregnant women with CHD, including atrial septal defect (ASD), patent ductus arteriosus (PDA), and aortic coarctation (CoA) between 2017-2023, who underwent percutaneous defect correction during the EP were collected. Fifteen pregnant women were included, diagnosed with ASD (5), PDA (6), and CoA (4). Five patients (33.3%) were classified as WHO risk class IV; the procedure was successful in 80% of the cases, and only 1 patient presented complications. In our experience, the closure of uncomplicated congenital defects during the EP did not present major complications and could be a treatment strategy to prevent follow-up losses after delivery in pregnant women with CHD.

Risk Factors and Outcome of Early Puerperium Following Caesarean Section

Introduction: The postpartum period, or puerperium, typically lasts six weeks following childbirth and is crucial for the reversal of pregnancy-induced anatomical and physiological changes. This period is often divided into three stages: immediate, early, and remote puerperium. Early puerperium, the first week after childbirth, is critical due to the heightened risk of complications, especially following cesarean sections (CS). Objective: This study aims to investigate the prevalence and types of early puerperal complications in women undergoing elective and emergency cesarean sections. Methods: A retrospective observational study was conducted in the Obstetrics and Gynecology department at Enam Medical College Hospital, Savar, Dhaka, Bangladesh. Hospital records from January 2015 to December 2015 were reviewed, including 100 women who had undergone cesarean sections. Data on demographic characteristics, antenatal care, risk factors, and types of early puerperal morbidities were collected and analyzed using SPSS version 20. Results: The study found that 55% of the participants were aged 21-30 years, 70% belonged to poor socioeconomic backgrounds, and 90% were housewives. A significant 70% of the women had not received any antenatal care. The most prevalent risk factors for early puerperal morbidities were obstructed labor (40%) and prolonged labor (30%). Common complications included wound infections (50%), endomyometritis (45%), and urinary tract infections (35%). Conclusion: Early puerperal complications are prevalent among women who undergo cesarean sections, particularly those from low socioeconomic backgrounds with inadequate antenatal care. Addressing these issues through improved prenatal and postnatal care and better access to skilled birth attendants can potentially reduce these complications and enhance maternal health outcomes.

Utilization of Herbal Medicine and Boiled Water (Areca Catechu, Piper Betle and Garcinia Xanthochymus) To Accelerate Recovery During Early Puerperium

Postnatal herbal medicine and boiled water are herbs are usually given to postpartum mothers to strengthen the body and speed up the recovery period of the uterus, speed up the cessation blood and healing perineal wounds. Method: Quasi Experimental research type Pretest-Posttest Nonequivalent Control Group Design. Held at PMB Nuripah Kubu Raya on 21-27 November 2023. Total sample was 34 respondents, the respondents were divided randomly into 2 groups, postpartum mothers in intervention group were given 1x1 multivitamin and postnatal healthy herbal medicine test ingredients at a dose of 1x1 suchet (25 grams) and Postpartum mothers in control group were given 1x1 multivitamin as a comparison, the research was carried out for 7 days. Results: The intervention group had an effect on changes in uterine involution based on anteroposterior diameter (p. 0.005), changes in uterine involution based on longitudinal length (p. 0.002), the amount of locheal discharge (p. 0.003), the smell of locheal discharge (p. 0.002), reducing the pain scale (p. 0.000) and perineal wound healing (0.003). Conclusion: Healthy postpartum herbal medicine and perineal wound fluid effective accelerating early puerperium period (uterine involution, lochea and perineal wounds) with the fastest start of action compared to the control group (multivitamin).

PO3_01. A randomized controlled trial on management of hypertension on early puerperium: methyldopa maintenance versus angiotensin converting enzyme inhibitor substitution

PO3_01. A randomized controlled trial on management of hypertension on early puerperium: methyldopa maintenance versus angiotensin converting enzyme inhibitor substitution

Influence of an eCG administration on puerperal involution and fertility in Simmentaler cows

In the literature, various methods aiming for a promotion of uterine involution and ovarian function in post-partum dairy cattle have been described. Recently, successful use of equine choriongonadotropin (eCG) in this context has been repeatedly reported, while other studies have failed to demonstrate positive effects of eCG administration on puerperal involution in cows. Due to the contradictory results described in the literature, the aim of this field study was to verify whether the administration of eCG on day 10 post-partum exerts a positive effect on uterine involution, ovarian activity and fertility indices in Simmental cows. In nine dairy farms, 205 Simmental cows were divided by lot into three groups: Group 1 animals received 500 I.U. eCG, group 2 received 50 µg gonadorelin, and group 3 animals received 250 mg butafosfan and 125 µg cyanocobalamin (control group). Treatment was administered on day 10 post-partum in each case. The animals were examined clinically and ultrasonographically on the 10th, 25th and 42nd day post-partum and the time to insemination and pregnancy were recorded. Group comparison with respect to the recorded parameters was initially performed without considering confounding factors by analysis of variance. In the second step, potential influencing variables (lactation, milk yield, change in backfat thickness, retentio secundarium and serverity of the obstetric intervention) were taken into account, as well as the combination of the random factors "farm" and "individual animal within the farm". The administration of eCG exhibited no significant effect on uterine involution, however, the cervical involution was influenced significantly. In the group of cows with eCG treatment, ovarian cysts were detected significantly more frequently on day 25 post-partum (p=0.04). This difference did not persist on the 42nd day post-partum. Neither voluntary waiting period nor the days open were significantly shortened by eCG administration. Lactation number showed a significant effect on uterine involution. Heifers exhibited more rapid involution by day 42 post-partum than cows. Administration of eCG in Simmentaler cows at day 10 post-partum showed no positive effect. The use of eCG in early puerperium to promote fertility in the cow should be avoided.

Specific changes and clinical significance of plasma D-dimer during pregnancy and puerperium: a prospective study

BackgroundPregnant and puerperal women are high-risk populations for developing venous thromboembolism (VTE). Plasma D-dimer (D-D) is of good value in the diagnosis of exclusion of VTE in the nonpregnant population. Since there is no consensus reference range of plasma D-D applicable to pregnant and puerperal women, the application of plasma D-D is limited. To investigate the change characteristics and the reference range of plasma D-D levels during pregnancy and puerperium and to explore the pregnancy- and childbirth-related factors affecting plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section.MethodsA prospective cohort study was conducted with 514 pregnant and puerperal women (cohort 1), and 29 puerperal women developed VTE 24–48 h after caesarean section (cohort 2). In cohort 1, the effects of the pregnancy- and childbirth-related factors on the plasma D-D levels were analyzed by comparing the differences in plasma D-D levels between different groups and between different subgroups. The 95th percentiles were calculated to establish the unilateral upper limits of the plasma D-D levels. The plasma D-D levels at 24–48 h postpartum were compared between normal singleton pregnant and puerperal women in cohort 2 and women from the cesarean section subgroup in cohort 1, binary logistic analysis was used to analyze the relevance between plasma D-D level and the risk of VTE developing 24–48 h after caesarean section, and a receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of plasma D-D for excluding VTE during early puerperium after caesarean section.ResultsThe 95% reference ranges of plasma D-D levels in the normal singleton pregnancy group were ≤ 1.01 mg/L in the first trimester, ≤ 3.17 mg/L in the second trimester, ≤ 5.35 mg/L in the third trimester, ≤ 5.47 mg/L at 24–48 h postpartum, and ≤ 0.66 mg/L at 42 days postpartum. The plasma D-D levels of the normal twin pregnancy group were significantly higher than those of the normal singleton pregnancy group during pregnancy (P < 0.05), the plasma D-D levels of the GDM group in the third trimester were significantly higher than those of the normal singleton pregnancy group (P < 0.05). The plasma D-D levels of the advanced age subgroup at 24–48 h postpartum were significantly higher than those of the nonadvanced age subgroup (P < 0.05), and the plasma D-D levels of the caesarean section subgroup at 24–48 h postpartum were significantly higher than those of the vaginal delivery subgroup (P < 0.05). The plasma D-D level was significantly correlated with the risk of VTE developing at 24–48 h after caesarean section (OR = 2.252, 95% CI: 1.611–3.149). The optimal cut-off value of plasma D-D for the diagnosis of exclusion of VTE during early puerperium after caesarean section was 3.24 mg/L. The negative predictive value for the diagnosis of exclusion of VTE was 96.1%, and the area under the curve (AUC) was 0.816, P < 0.001.ConclusionsThe thresholds of plasma D-D levels in normal singleton pregnancy and parturient women were higher than those of nonpregnant women. Plasma D-D had good value in the diagnosis of exclusion of VTE occurring during early puerperium after caesarean section. Further studies are needed to validate these reference ranges and assess the effects of pregnancy- and childbirth-related factors on plasma D-D levels and the diagnostic efficacy of plasma D-D for excluding VTE during pregnancy and puerperium.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

BackgroundThe emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks.MethodsThe cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc.ResultsPPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2–5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50).ConclusionOur results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women’s mental and physical health in the early postpartum in China.

Leptin/SFRP5 ratio as a potential predictor of postpartum weight retention. A prospective pilot study.

Excessive gestational weight gain (EGWG) and failure to lose weight within 6 months from delivery are important and identifiable predictors of the long-term obesity. The aim of the study was to verify clinical usefulness of several substances that had been proved to play a significant role in metabolism and body mass regulation, i.e., leptin, ghrelin, fatty acid binding protein 4 (FABP4), secreted frizzled-related protein 5 (SFRP5), and vaspin, in relation to certain laboratory results, body composition and hydration status of females in the early postpartum period. The main goal was to determine a potential marker, which assessed as early as 48 hours after delivery, could predict serious difficulties in achieving pre pregnancy body mass of women with EGWG six months afterwards. The same inclusion criteria applied to the study group (women with EGWG) as well as the control group (women with appropriate body mass gain in pregnancy). These included normal pre-pregnancy BMI, absence of any diseases prior, during pregnancy and after delivery, 6-month long breastfeeding. Postpartum weight retention (PPWR) depended positively on gestational weight gain as well as the leptin/SFRP5 ratio assessed 48 hours after delivery. Both obstetricians and midwives should pay special attention to proper nutrition of pregnant women. The assessment of biophysical and biochemical parameters in the early postpartum period, when the mothers are usually hospitalized, seems to allow to predict the risk of greater body weight retention. Future research will help to determine to what extent the circulating concentrations of leptin and SFRP5 in the early puerperium are important for prediction of maternal PPWR and obesity.

Successful pregnancy of a patient with primary sclerosing cholangitis awaiting liver transplantation

In women, primary sclerotising cholangitis (PSC) associated with ulcerative colitis and intrahepatic cholestasis is a rare disease. To date, there are no data from Hungary on the fertility and pregnancy outcome of women with this chronic liver disease. Our aim is to present the favorable pregnancy outcome of a woman with PSC associated with ulcerative colitis, intrahepatic cholestasis and postpartum colectomy, and review of the literature. A young nulligravida was first diagnosed with ulcerative colitis. Five years later, PSC developed with progressive fibrosis and cholestasis necessitating liver transplantation. While on waiting list, spontaneous conception occurred. Except for pregnancy-induced hypertension, pregnancy uneventfully progressed until the third trimester when 8 g oral cholestyramine/day was administered to lower high maternal (over 100 μmol/L) total bile acid (TBA) level. In the 36th week of gestation acute exacerbation of ulcerative colitis resulted in maternal fever and chorioamnionitis leading to fetal distress. Elective delivery of the eutrophic neonate followed by emergency cesarean section. In the early puerperium, colitis progressed to septic pancolitis resistant to medical treatment. 12 days after laparoscopic subtotal colectomy, the patient was discharged in good health condition. 3 months later, ileostomy was closed and she got back on the transplantation waiting list. Our data correspond with previous reports and suggest that women with PSC with underlying ulcerative colitis and cholestasis have a good chance for favorable pregnancy outcome. However, both PSC and underlying colitis might progress during pregnancy and puerperium. Oral cholestyramin is an effective and safe treatment for high maternal TBA levels. Orv Hetil. 2023; 164(6): 234-240.

Prepregnancy Obesity and Breastfeeding in the First Month of Life: A Birth Cohort

Objective: This study aimed to investigate the association between prepregnancy obesity and disruption of exclusive breastfeeding (EBF) within the first month of life. Materials and Methods: This was a prospective cohort study conducted among Brazilian mothers and their babies born between February and December 2017. Research was conducted in all maternity hospitals in Vitória da Conquista, Brazil. Data collection started in the maternity hospitals of the city and, subsequently, an interview was conducted during a home visit on the 30th day of the child's life. Survival analysis was performed using Kaplan-Meier curves and a log rank test was applied to compare the curves. The association between independent variables and the response variable was assessed using Cox regression, following the conceptual model created for the study. Results: The study analyzed 329 pairs of mothers and babies. The prevalence of prepregnancy obesity was 12%. The prevalence of EBF disruption in the first month of life was 41.1% in nonobese mothers (confidence interval [95% CI]: 35.3-46.9) and 52.6% in obese mothers (95% CI: 36.3-68.4), with a shorter survival time among mothers with prepregnancy obesity (log rank p < 0.05). The risk of EBF disruption in the first month of life was 83% higher among mothers with prepregnancy obesity, after adjusting for confounding variables-demographic, socioeconomic, prenatal maternal data, and childbirth variables (hazard ratio = 1.84; 95% CI: 1.08-3.11). Conclusions: We observed an association between pregestational obesity and disruption of EBF in the first month of life. This finding reinforces the need for a thorough professional approach to the practice of breastfeeding in this population in the prenatal period as well as early puerperium.

The Impact of the COVID-19 Pandemic on the Level of Physical Activity, Emotional State, and Health Habits of Women in Late Pregnancy and Early Puerperium.

The study population was women 1-8 days postpartum. Participants were divided into three groups depending on when they were recruited: (1) prepandemic (Ppan: n = 252, December 2019-March 2020), (2) COVID1 group (Cov1: n = 262, May 2020-September 2020), and (3) COVID2 group (Cov2: n = 226, June 2021-September 2021). The Ppan group included women from before the pandemic. The Cov1 group included patients after some restrictions were lifted. The Cov2 group included women after vaccinations became available. Research tools included a demographical questionnaire (age, education, childbirth details), the Pregnancy Physical Activity Questionnaire (PPAQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Health Behavior Inventory (IZZ). Regression analysis showed that regardless of other variables, women who gave birth during the pandemic spent less energy on total physical activity compared to the prepandemic group (Cov1: β = -18.930, 95%CI: -36.499 to -1.361; Cov2: β = -26.527, 95%CI: -44.322 to -8.733). We also found that as the risk of depression increased, engagement in general health habits decreased during the pandemic. The Covid-19 pandemic decreased the level of some subdomains of physical activity in pregnant women, with a general negative correlation between emotional state and healthy habits.

Clinicoetiological Profile of Cerebral Venous Sinus Thrombosis Patients at a Tertiary Care Center

Background: Cerebral venous sinus thrombosis (CVST) accounts for 10%–20% of strokes in young persons. In India, CVST accounts for around 30% of all strokes. The majority of CVSTs are caused by procoagulant circumstances, with pregnancy and early puerperium being well-established risk factors. The study aimed to look into the clinical profile, radiological characteristics, etiological variables, and outcome of CVST in venous stroke patients admitted to a tertiary care facility. Methods: We included individuals between the ages of 18 and 75 years who had a cerebral venous thrombosis (CVT) diagnosis confirmed by magnetic resonance imaging (MRI) + magnetic resonance venography computed tomography (CT) plus CT venography. The research included all individuals suspected of having CVST with or without particular neurological deficits and a confirmed imaging diagnosis. Patients were removed in situations of ambiguous neuroimaging, arterial strokes, space-occupying lesions, metabolic encephalopathy, and patient reluctance to participate. Results: This study included 82 patients, 21 (25.6%) males and 61 (74.4%) of whom were females. The most common presenting symptom was headache (79.2%), followed by vomiting (54.8%) and abnormal sensorium (35.3%). In this study, 34/82 (41.4%) patients had evident clinical triggers and were classified as induced CVT. Para infectious disease was recognized as a risk factor for CVT in 13/34 (38.2%) patients. A prothrombotic conditions could be established in 48 (58.5%) of these patients. Conclusion: CVST is a treatable and reversible cause of stroke in adolescents. The clinical presentation varies greatly, and symptoms may appear gradually over weeks or months. Although it is still an uncommon cause of headache and stroke, MRI has allowed for early detection.

Effect of Abdominal Binder on Constipation in the Early Puerperium Period

Context: Constipation being one of the most common and exasperating postpartum problems in Female population, i.e., defined as a large bowel problem leading to pain while defecating, hard and lumpy stools resulting in strain, and a sense of incomplete evacuating. It impacts the quality of life of every individual. Aim: To investigate the effect of abdominal binder on constipation in early puerperium period. Setting and design: The department of OBG physiotherapy at KLE Hospital in Belagavi. Karnataka India did a pilot study. Methods and Materials: 17 women between 19 and 35 years of age within the early puerperium period having constipation. The women reporting any chronic history of constipation and laxatives induced after the delivery were not included in the study. They were administered with the Modified Constipation Assessment Scale (MCAS), which rated them into mild, moderate, and severe constipation, and the Visual Analog Scale (VAS), to rate the abdominal discomfort due to constipation. The binder was prescribed for 2 days. Both pre-.and post-intervention data were collected and were statistically analyzed to know the effect. Statistical analysis used: Parametric Paired sample t-test was used to compare the results. Results: According to Paired sample t-test, the difference between the values of pre- and post-treatment with a P &lt;5% significance level (i.e. 0.002 &lt; 0.05) on MCAS can be observed. Similarly, on VAS, the significant and reliable statistical differences on the pre-.and post-treatment values with P &lt;5% significance level (i.e., 0.001 &lt; 0.05) can be observed. Therefore, this study justifies the improvements in health outcome post-intervention. Conclusion: The study concluded that the abdominal binder has an effect on constipation within the early puerperium period. The binder also helps to relieve the abdominal discomfort as a result of constipation.

A Study to Assess the Knowledge Regarding “Prevention of Puerperal Sepsis” in Early Puerperium among Postnatal Mothers Admitted in the Maternity Unit of NMCH, Jamuhar, Rohtas

Introduction: According to survey conducted by World Health Organization (WHO) in 1998 only a small proportion of women in developing countries i.e. less than 30% receive adequate postpartum care and in very poor countries and regions only 5% of women receive such care where as in developed countries 90% of mothers receive postpartum care. World health organization reported about 358000 maternal deaths occurring during labour and childbirth and 15% were related with puerperal sepsis in 2019. Background: Postpartum period or puerperium is the period following childbirth and of great importance for both mother and baby as it is an aspect of maternity care which receives less attention compared to pregnancy and delivery. Also, the others are less aware of their health while taking care of newborn baby and also many alarming complications can arise due to lack of knowledge in preventive measures. So it is necessary to assess the knowledge of postnatal mothers regarding the prevention of puerperal sepsis, in a selected hospital. It was conducted at selected hospital in NMCH jamuhar, Rohtas among 60 postnatal mothers selected by using convenient sampling technique and who met the inclusion criteria. Objectives: To assess the level of knowledge of postnatal mothers regarding prevention of puerperal sepsis in early puerperium. To find out the association between the knowledge of postnatal mothers regarding prevention of puerperal sepsis in early puerperium with selected demographic variables. The population of sample consists of postnatal mothers in NMCH, jamuhar, Rohtas. Methodology: A non-experimental descriptive approach is using for this study as it is considered as suitable one to assess the knowledge regarding prevention of puerperal sepsis among postnatal mothers. The research design for present study is descriptive Design. Results: In order to collect the scientific data we used self structured questionnaire index. According to the Majority of sample (8.33%) postnatal mothers were having poor knowledge change, (88.33%) postnatal mothers were having average knowledge change and (3.33%) postnatal mothers were having good knowledge change. With the help of self structure questionnaire knowledge has been assess that majority of the participant average knowledge about puerperal sepsis. Conclusion: the study concluded that assess the level of knowledge of postnatal mothers regarding prevention of puerperal sepsis in early puerprium. The level of knowledge significantly different between postnatal mothers.

Peripartum Cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM. While there are numerous potential mechanisms for Peripartum (post-partum) cardiomyopathy, its exact cause remains unknown1, but the etiopathogenesis is likely to be multifactorial. PPCM is uncommon before 36weeks of pregnancy, and afflicted women generally present during the first month after delivery. PPCM should be differentiated from pre-existing cardiomyopathy, undiagnosed congenital heart disease, pre-existing valvular heart disease, myocardial infarction, pulmonary embolism and diastolic heart failure due to hypertensive heart disease. The principles for treating acute HF caused by PPCM are the same as those for acute HF caused by any other cause with some limitations during pregnancy. Prompt treatment is critical. There is no necessity for an early delivery unless the maternal or foetal health has deteriorated. In women who present with advanced HF with haemodynamic instability, urgent delivery, regardless of gestation, may be considered. Because women with PPCM have a significant chance of relapse in subsequent pregnancies, they need comprehensive contraceptive counselling. In general, the prognosis is good, with more than half of the patients regaining LV function spontaneously within six months of giving birth. Our aim is to put forth an in-depth review of the Peripartum Cardiomyopathy in contemporary practice.

The Effect of SPEOS Method and Acupuncture Point Gb 21 To Increase Breast Milk Production

The success of breastfeeding in the early puerperium can affect the success of exclusive breastfeeding. This is because the production of breast milk for infants is sufficient for growth. One method to increase breast milk production is the SPEOS method (Endorphin, Oxytocin, and Suggestive Stimulation) and the Acupuncture method at GB 21 point. This study aims to determine the effect of the SPEOS method and GB 21 acupuncture method on increasing breast milk production at the Az – Maternity Clinic. Zahwa South Sumatra in 2020. Where breast milk production is assessed from the amount of milk that comes out and can be accepted by the baby, measured by using the baby's weight indicator. Measurements were made on day 5 and day 10. This study uses a quasi-experimental design with a non-equivalent approach Pretest-Posttest with Control Group. The subjects in this study were normal postpartum mothers who gave birth at the Az – Zahwa clinic. The total sample size was 90 people with 30 samples being divided into the SPEOS method group, 30 samples in the GB 21 acupuncture method and 30 in the control group. This research was conducted in October-November 2020. The data were analyzed using the T dependent test and the one way ANOVA test. The results of the study obtained the average difference in body weight before and after the study. In the control group, the average difference was -5.0 (86.4) grams, in the SPEOS group the average difference in body weight was 22.1 (57.3) grams, in the GB 21 Acupuncture group the average difference in body weight is -41.3 (298.7) grams. The results of statistical tests showed that there was no significant difference in body weight after the study in the three groups (p value 0.405). This shows that there is no difference in the three methods of milk production.

Early Postpartum Complications and Maternal Mortality: An Experience of Mymensingh Medical College Hospital, Bangladesh

A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH), Bangladesh, between April and September of 2010, to observe and evaluate common complications in early puerperium. A total of 384 patients were selected for the study, who were admitted with immediate postpartum complications, or who experienced complications after delivery at MMCH. Most of the patients 202(52.6%) belongs to 21-30 years age group followed by 118(30.73%) in &gt;30 years and 64(16.67%) in ≤20 years group. Low parity accounts for most patients, 217(56.5%), while grand multiparity was documented in 42(10.9%) patients. 211(54.95%) patients had no history of antenatal checkup. 179(46.62%) patients had home delivery, while the rest had institutional delivery. 239(62.24%) patients had normal vaginal delivery, while 129(33.6%) had Caesarean operation, 7(1.82%) needed vacuum extraction and 2.34% had forceps’ delivery. 146(38.02%) had their delivery without attending doctor, nurse/midwife or skilled birth attendant. Most of the patients, 281(73.18%), had their symptoms and signs within 24 hours of delivery, while 41(10.67%) and 62(16.15%) had within 48 hours and within 7 days respectively. Primary postpartum haemorrhage (PPH) was the leading complication found in 114(29.68%) patients, while the other major complications were puerperal sepsis 53(13.8%), urinary tract infection 40(10.42%), postpartum eclampsia 38(9.9%). 329(85.68%) patients were discharged without any morbidity; however, maternal mortality was observed in 18(4.68%) cases. Puerperal sepsis 5(28%), postpartum eclampsia 4(22%) and pulmonary embolism 3(17%) were the leading causes of mortality. Skilled obstetric care, active management of third stage of labour, prevention and treatment of anaemia, and maintenance of strict asepsis during delivery can prevent a considerable incidence of those complications.&#x0D; CBMJ 2021 January: vol. 10 no. 02 P: 85-90

The COVID-19 Pandemic and Levels of Physical Activity in the Last Trimester, Life Satisfaction and Perceived Stress in Late Pregnancy and in the Early Puerperium.

Background: The aim of this study was to determine the impact of the COVID-19 pandemic on the levels of physical activity during the third trimester of pregnancy, life satisfaction and stress in women in late pregnancy and early postpartum. Methods: The study was conducted among 740 patients of maternity wards in Cracow hospitals on days 1–8 postpartum. Patients who were surveyed before the pandemic (December 2019–March 2020) were included in the prepandemic group (PPan: n = 252). The second group of women (COVID 1 group, Cov1: n = 262) was examined in the early stages of the pandemic (May–September 2020). In turn, participants who were surveyed during the population vaccination campaign (June–September 2021) were qualified to the COVID 2 group (Cov2: n = 226). The research tools used were the original questionnaire in addition to standardized questionnaires assessing physical activity in the last trimester of pregnancy (the Pregnancy Physical Activity Questionnaire); previous life satisfaction (the Satisfaction with Life Scale); and stress levels during the last month (the Perceived Stress Scale). Results: During the pandemic, women reduced the level of energy spent on total physical activity; nevertheless, statistically significant differences were found only between the PPan and Cov2 groups (p = 0.001). At the early stages of the pandemic, patients significantly reduced mobility activities (Cov1 vs. PPan: p < 0.001; Cov1 vs. Cov2: p = 0.007), while late in the pandemic they spent less energy on household activities (Cov2 vs. PPan: p = 0.002, Cov2 vs. Cov1: p = 0.002). There were no differences in the levels of stress and life satisfaction. Conclusions: The COVID-19 pandemic impacted the level of physical activity; however, it did not change levels of perceived stress and life satisfaction in women in late-stage pregnancy and in the early puerperium.

Are Cesarean Section and Appendectomy in Pregnancy and Puerperium Interrelated? A Cohort Study.

IntroductionIt is not known whether appendectomy for acute appendicitis (AA) increases the Cesarean section (CS) rate and whether CS increases the likelihood of AA and appendectomy in the early puerperium. In this study, delivery type and delivery outcomes and appendectomy during pregnancy and puerperium were analyzed.MethodsThis cross-sectional retrospective study was performed on 11,513 women, delivered during 2015–2020. Inclusion criteria were patients undergoing appendectomy for AA during pregnancy and the first 6 weeks after delivery. Evaluating parameters were age, parity, gestational week at birth, delivery type, and babies' birth weight.ResultsThirty-two patients underwent appendectomy: 12 during pregnancy (2 in the first trimester, 6 in the second trimester, 4 in the third trimester) and 20 women during puerperium. 58.2% of pregnant women and 65% of puerperal women were submitted to CS.DiscussionHalf of the women who underwent appendectomy for AA during pregnancy may require urgent CS. The cause of acute abdomen in the postpartum period, especially in the first week, could be AA, especially in women delivered by CS.