Early Puerperium Research Articles

The effect of spousal support perceived by mothers on breastfeeding in the postpartum period.

To examine the effect of mothers' perceived spousal support on breastfeeding during lactation. This is a descriptive cross-sectional study. The sample of the study consist of 80 mothers who were registered with a Pediatric Adolescent Women and Reproductive Health Center. The socio-demographic and obstetric descriptive information form and Women's Perceived Spouse Support Scale in Early Puerperium Process were used for the collection of data. Data were analyzed with number and percentage, t-test, chi-square test, ANOVA, and Tukey test. The mean age of the mothers who participated in the study was 27.05±3.50, while the mean age of the spouses was 30.58±4.12. It was determined that 41.3% of the mothers and 48.8% of the spouses were high school or higher graduates and 68.8% of the mothers didn't work and all of the spouses worked. Most of the mothers (63.7%) were primiparous and 60% had a cesarean section, 56.3% did not receive lactation education and consultation, and most of the women had exclusive breastfeeding. The mean score of the Women's Perceived Spousal Support Scale in the Early Puerperium Period of the exclusively breastfeeding mothers was 72.93 while the partial breastfeeding mothers' was 54.93 (p=0.00). Also, it was found that males with younger age group and high school and lower education level had less support for their spouses (p=0.03, p=0.02), and the rate of exclusive breastfeeding was higher in the spouses of males in higher education level (p=0.01). Mothers who received more support from their spouses during the postpartum period had higher breastfeeding rates. It was determined that males with younger age and education level below high school gave less support to mothers in breastfeeding.

Communication Characteristics between Nurses and Women in Early Puerperium for Breastfeeding Guidance:

Communication Characteristics between Nurses and Women in Early Puerperium for Breastfeeding Guidance:

“Doing the month” and postpartum depression among Chinese women: A Shanghai prospective cohort study

BackgroundThe Chinese postpartum custom of “doing the month” characterized by generous social support available through the traditional cultural practices was considered to protect women from postpartum depression in early puerperium. MethodsThis study used data from the Shanghai Birth Cohort, a study of 2615 postpartum women from Shanghai, China, that was conducted between 2013 and 2016. Detailed information on the traditional “doing the month” practices and the on the Edinburgh Postnatal Depression Scale scores was collected from questionnaires administered on the 42nd day after childbirth. Logistic regression models were used to examine the association between the adopting traditional puerperium practices and postpartum depression. ResultsThe estimated prevalence of postpartum depression in women from the Shanghai area in China was 11.8% (n = 308) at six weeks postpartum. Women who went outside their homes during the first month postpartum showed higher risks of postpartum depression compared with those who never left the house (1–2 times: OR = 1.9, 95% CI = 1.4–2.4; 3–5 times: OR = 2.3, 95% CI = 1.5–3.5; ≥6 times: OR = 2.5, 95% CI = 1.2–5.1). Women with average sleep of 6 h or less per night were more likely to suffer from postpartum depression compared with those who slept 8 h (6 h: OR = 1.7, 95% CI = 1.2–2.4; less than 6 h : OR = 3.3, 95% CI = 2.2–5.0). Women who opened the house windows most of the time exhibited decreased risks of postpartum depression compared to those who never or rarely opened the windows (often: OR = 0.6, 95% CI = 0.4–0.9; always: OR = 0.4, 95% CI = 0.3–0.7). ConclusionsOur results suggested that not all the activities of “doing the month” provided protection against developing PPD. This study emphasized the need for flexibility to fit and adjust the ritual into the modern life to enhance the positive effects of traditional practices on maternal health.

A atuação do residente em Odontologia Hospitalar neonatal na abordagem multidisciplinar do SUS: relato de experiência

A reorganização dos serviços de saúde vinculada ao programa Humaniza SUS possibilita o cuidado multiprofissional do indivíduo. Neste sentido, a inclusão do cirurgião-dentista nas equipes visa somar esforços para o alcance da integralidade da atenção, a qual abrange as diversas alterações que podem acometer o sistema estomatognático de sujeitos em cuidados hospitalares. A residência em odontologia hospitalar neonatal, como parte integradora da abordagem multiprofissional, é extremamente importante para garantir a abordagem adequada de gestantes, puérperas e recém-nascidos (RN) em sua plenitude. As frentes de atuação do residente em odontologia neonatal envolvem, principalmente, o pré-natal odontológico, o puerpério imediato e mediato, a abordagem ambulatorial e as unidades de terapia intensiva neonatal e pediátrica. Este artigo objetiva relatar a experiência de atuação de residentes em odontologia hospitalar neonatal em um hospital escola pertencente ao Sistema Único de Saúde (SUS) do Paraná.

Fatty Acid-Binding Protein 4-An "Inauspicious" Adipokine-In Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain and Gestational Diabetes Mellitus.

The exact roles of adipokines in the pathogenesis of type 2 diabetes and obesity are still unclear. The aim of the study was to evaluate fatty acid binding protein 4 (FABP4) concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) and gestational diabetes mellitus (GDM) in the early post-partum period, with reference to their laboratory test results, body composition, and hydration status. The study subjects were divided into three groups: 24 healthy controls, 24 mothers with EGWG, and 22 GDM patients. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of FABP4, leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Healthy women were characterized by the lowest serum leptin concentrations and by a negative correlation between the serum and urine FABP4 levels. Serum FABP4 levels were the highest in the GDM group. Serum FABP4 and leptin concentrations correlated positively in the GDM group. The EGWG group had the highest degree of BIA disturbances in the early puerperium and positive correlations between the urine FABP4 and serum leptin and ghrelin concentrations. The physiological and pathological significance of these findings requires further elucidation.

Early Puerperal Complications - A Prospective Clinical Study on Caesarean Deliveries

Introduction : when a healthy pregnant woman with no obstetric or medical risk factors goes into spontaneous labour, she should anticipate a normal delivery. But still 580, 000 women in the world die from pregnancy and childbirth each year.1 Lack of attention to postpartum care in developing countries is neglected tragedy and requires immediate attention. This study evaluates the incidence of complications of early puerperium and also focuses the specific types of complications and to detect the risk factors associated with these complications.
 Aims and objectives : Main aim of the study is to evaluate the common complications in early puerperium with special attention to identify the risk factors.
 Materials and method : This study was carried out in Dhaka Medical College Hospital and Sir Sallimullah Medical College Hospital within the period of March ’2004 to August’ 2004. Two hundred patients were selected for this study who were delivered by caesarean section in these two institutions and complications occurring within 7 days excluding first 24 hours. Patients delivered outside the hospital and with known medical diseases were excluded from this study. Detailed history taking and appropriate clinical examination and specific investigations were done for diagnosis of complications. All relevant informations was noted in prescribed data sheet and results were tabulated and statistical analysis was done.
 Results : Among 200 cases only 44(22%) cases had early puerperal morbidity.Most of the patients who suffered complications underwent caesarean section for obstructed labour and fetal distress who had trial at home. Many of the patients suffered from wound infection and endometritis (40.9%). Among patients, age group -<20 years suffered from wound infection(53.8%) and endometritis(45.8%) were common in age group 21-30 years. VVF was common in patients in age <20 years.Endometritis (42.2%) was maximum in women with parity 1-3 and wound infection (50%) in women with parity 4-6. Some of the patients had more than one early puerperal morbidity. Maximum number of poor class suffered from wound infection (42.4%).Early puerperal morbidity was more prevalent in women with duration of labour <18 hours and Premature rupture of membrane had relationship with endometritis (15.9%), wound infection (13.6%) and UTI (11.4%).
 Conclusion : Incidence of early puerperal morbidities is still quite high (22%) and many patients experiences more than one problem at a time.Long term sequelae of early puerperal infectious morbidity should not be neglected as this may interfere quality of life of a woman.
 J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 68-71

Amniotic fluid as a potent activator of blood coagulation and platelet aggregation: Study with rotational thromboelastometry

IntroductionPulmonary thromboembolism (PTE) is a leading cause of maternal death and frequently occurs during early puerperium. Amniotic fluid components are frequently observed in the maternal circulation in parturition; however, it currently remains unclear whether amniotic fluid contamination in maternal blood is related to the high incidence of PTE in early postpartum. ObjectivesTo examine the influence of amniotic fluid on blood coagulation and fibrinolysis systems with thromboelastometry. Materials and methodsTwenty-one pregnant women were recruited. We used whole citrated blood in ROTEM® (Tem Innovations GmbH, Munich, Germany), including the non-activated assay (NATEM), assessments for extrinsic (EXTEM) and intrinsic pathways (INTEM), fibrin polymerization (FIBTEM), and hyperfibrinolysis (APTEM), with amniotic fluid contamination, and measured the clotting time (CT), clot formation time (CFT), alpha, amplitude at 10 min (A10), maximum clot firmness (MCF), and lysis indices at 30 min (LI30) and 60 min (LI60). ResultsShort CT in all assays as well as short CFT, high alpha, and increased A10 and MCF in NATEM were observed with amniotic fluid contamination. A10 and MCF as well as LI30 and LI60 decreased in EXTEM. Decreased LI60 with the mixture of amniotic fluid was not improved by tranexamic acid in APTEM. ConclusionsAmniotic fluid accelerated thrombin production and activated platelet aggregation without inducing hyperfibrinolysis in whole blood. The activated tissue factor pathway with amniotic fluid produced soft and fragile clots due to its influence on platelets, which may be associated with, at least partly, the high incidence of PTE in early puerperium, particularly after cesarean section.

Efficacy of methylergometrine during the early puerperium: a randomized double-blind placebo-controlled clinical trial

Objective: To determine if oral methylergometrine administration during the first 10 d following spontaneous vaginal delivery has any beneficial effect on the increase of hemoglobin levels. Methods: This was a parallel group double-blind placebo-controlled clinical trial conducted at single center university hospital in Italy. Participants were puerperal women, who delivered singleton gestation with spontaneous vaginal delivery at term. Participants were randomized into a 1:1 ratio to receive either 0.125 mg methylergometrine per os twice a day or placebo for 10 d. Hemoglobin levels were recorded on the day of delivery and after 10 d. The primary outcome was the variation in hemoglobin levels between the first and the 10th day of treatment. Results: From December 2012 to October 2015, 220 agreed to take part in the study, underwent randomization, and were enrolled and followed-up. Of the randomized women, 110 (50%) were randomized to the methylergometrine group and 110 (50%) to the placebo group. No women were excluded after randomization or lost to follow-up (100%). We found no significant difference in the median variation of hemoglobin levels between the intervention and the placebo group Conclusions: The use of 10 d oral methylergometrine in puerperal women was not associated with any benefit in the variation of hemoglobin levels from delivery to 10 d after delivery. Key Message Methylergometrine in puerperal women was not associated with any benefit.

Evaluation of C-reactive protein (CRP) plasma concentration among women during labour and in early puerperium

Evaluation of C-reactive protein (CRP) plasma concentration among women during labour and in early puerperium

Blood rheology during normal pregnancy.

Recent studies have shown increased RBC aggregation and no difference in plasma viscosity in the presence of markedly lower hematocrit in women at term compared to non-pregnant women. Little is known about the outcome of blood rheological parameters and red blood cell (RBC) deformability particularly in the course of normal pregnancy. During a 36 months interval 1.913 blood samples were randomly collected from a total of 945 pregnant women in the course of their pregnancy (n = 1.259) and during puerperium (upto 1 week; n = 654). Next to the blood count, hemorheological parameters including red blood cell (RBC) -aggregation (stasis E0; low shear E1), -deformability (low, moderate and high shear conditions) and plasma viscosity (pv) were assessed. Plasma viscosity (pv) was examined using KSPV 1 Fresenius, RBC aggregation (stasis: E0 and low shear: E1) using MA1-Aggregometer; Myrenne and RBC deformability (def) was determined by Rheodyn SSD Diffractometer, Myrenne, Roetgen, Germany were tested. In some of these women laboratory results prior to pregnancy (n = 145) were available which were compared with those during pregnancy. Mean maternal pv remained unchanged within each trimester and compared to the values before pregnancy and during early puerperium (Range of means: 1.18-1.20 mPa S). In contrast, RBC agg (E0 and E1) was markedly higher in the 2nd (21.8 ± 7.0 and 28.9 ± 9.4; p < 0.001) and 3rd trimester (18.74 ± 8.4 and 28.2 ± 9.4; p < 0.01) compared to the values before pregnancy (16.4 ± 6.4 and 20 ± 7.5) and during 1st trimester (17.49 ± 6.5 and 22.4 ± 7.4). There was a stat. significant temporary reduction in RBC def. under all shear rate conditions during 2nd trimester compared to the values before pregnancy which remained significantly lower during 3rd trimester only under high shear rates.An increase RBC agg was stat. significantly inversely correlated with reduced RBC def being most pronounced under low shear rate conditions. While RBC rigidity was stat. significantly correlated with higher hematocrit values there was only a weak correlation between RBC agg and haematocrit (E0: r = -0.084; p = 0.03; E1: r = -0.06; p = 0.1). Pv was not correlated with haematocrit or RBC def but stat. significantly correlated with RBC agg. Blood rheological changes manifest during 1st trimester, and fairly remain unchanged during 2nd trimester until term. Physiologic hemodilution and increasing hypercoagulability is accompanied by high RBC -aggregation and - rigidity during 2nd trimester while plasma viscosity remains nearly unaffected throughout normal pregnancy.

Blood biochemical parameters of bone metabolism in cows and calves kept in a beef suckler system during the early postpartum period

The early lactation and early neonatal period are characterised by intense changes in bone metabolism. The aim of this study was to evaluate blood biochemical parameters of bone metabolism during early lactation in cows and neonatal calves. The study was carried out on 13 Simmental cows and 13 beef suckler calves in cow-calf operations. Blood samples were obtained at 6 time points: 6, 12 and 48 h and 7, 14 and 30 d postpartum (pp). An increase in the concentration of total calcium (tCa) of cows 14 d pp (P = 0.04), an increase in the concentration of inorganic phosphorus (iP) 12 and 48 h pp (P = 0.001, P = 0.002, respectively), an increase in bone specific alkaline phosphatase (BALP) and parathyroid hormone (PTH) concentration 7 d pp (P = 0.02, P = 0.02, respectively) and a decrease of total alkaline phosphatase (TALP) activity during the first 14 d pp (P < 0.05) indicated that the early puerperium in cows is an intense period of change in bone and mineral metabolism. An increase of iP and magnesium (Mg) concentrations in calves at 48 h pp (P < 0.01, P < 0.01, respectively), a decrease in BALP concentration at 48 h pp (P = 0.01), higher TALP activity at 30 d pp (P = 0.02) and decreased PTH at 7 d pp (P = 0.04), indicated bone formation and growth in calves. Our results in cows indicated increased bone resorption and Ca loss through milk production. In neonatal calves we demonstrated high bone turnover during the period of intensive growth and development. The results contribute to a better understanding of bone metabolism in the early postpartum period of cows and neonatal period of calves, and also towards the elucidation of disorders of bone metabolism after calving.

Is Postpartum Uterine Involution Impacted by Instrumental or Operative Procedures? Ultrasound Study

Objectives: Practitioners are continuously concerned with the differences between the normal puerperium and the uterine involution after operated deliveries. This prospective observational study pays attention to the uterine involution period after the instrumental or operative delivery and compares the results with those observed in uncomplicated labour. Methods: Over two postpartum months 66 women after normal (48) and complicated (18) labour were examined for repeated uterine parameters. The analysis was performed using SPSS version 21. Results: There was no statistically significant difference between the median uterine size parameters or the uterine artery indices after the normal delivery and instrumental/operative uterine manipulations during the involution period, except for a faster declining trend observed in anteroposterior diameter within the first month after normal labour. The diastolic notch was more frequent in early puerperium after complicated labor, but less frequent later. The diastolic notch did not appear in all the postpartum women even two months after labour. There was evidence of more frequent gas detected in the pathological rather than in the physiological group. Conclusion: Postpartum uterine involution is not impacted by instrumental or operative procedures. After complicated labour gas appearance is more common, but it does not necessarily indicate the presence of endometritis or retained placental tissues.

Maternal hemodynamics in late gestation and immediate postpartum in singletons vs. twin pregnancies.

Differences in hemodynamic changes during a cesarean section (CS) between twin and singleton pregnancies are poorly defined. The Non-Invasive Cardiac System (NICaS) is an impedance device that measures cardiac output (CO) and its derivatives. We compared maternal cardiac parameters using NICaS™ in singleton and twins before and during delivery, as well at the early puerperium in healthy women undergoing CS at term. This prospective longitudinal study included women with twin (n=27) or singleton pregnancies (n=62) whose hemodynamic parameters were assessed by NICaS before an elective CS, after spinal anesthesia, immediately after delivery, after fascia closure, and within 24-36 and 48-72h postpartum. By 24-36h postpartum, the mean arterial pressure and the total peripheral resistance equaled preoperative values in both groups. The CO increased throughout the CS and peaked immediately after delivery in the singleton group (P<0.0001), after which it abruptly began to decline until reaching a nadir 24-36h after delivery (P<0.0001), while it remained steady throughout the CS and then dropped until 24-36h after delivery in the twin group (P<0.05). None of the studied parameters differed significantly between the groups for the 24-36 and 48-72h postpartum measurements. Hemodynamic parameters immediately before, during and shortly after CS in singleton and twin pregnancies are equivalent. Further evaluations of the value of NICaS™ in assessing cardiovascular-related pregnancy complications are warranted.

Effectiveness of Aloe Vera Gel Vs Lavender Oil on Episiotomy Wound among Postnatal Mothers in a Selected Hospital, Mangalore

Introduction: The mother undergoing episiotomy has a greater blood loss in conjunction with delivery and there is a risk of improper wound healing and increased pain during early puerperium. The objective of the study was to determine and compare the effect of aloe vera gel and lavender oil on healing of episiotomy wound and pain among postnatal mothers. Methods: An evaluative approach with pre- test post- test design (quasi experimental) was used for this study. Forty mothers who had an episiotomy wound were selected by non-probability purposive sampling technique (twenty mothers in the aloe vera gel group and twenty mothers in lavender oil group).Each group received treatment for two days . REEDA scale, anduniversal pain assessment tool were used. Results: The computed‘t’ value of wound healing (0.623) was lesser than table value (1.96) (t38=1.96, p<0.05) and‘t’ value of pain (2.307) was greater than the table value (1.96) (t38=1.96, p<0.05). Hence it shows aloe vera gel and lavender oil were equally effective in wound healing, whereas aloe vera gel was found to be most effective in reducing pain as the mean post test pain score in aloe vera gel (3.8±1.02) was lower than mean post test pain score in lavender oil group (4.55±0.97). Conclusion: The findings of the study indicated that aloe vera gel is effective in reducing episiotomy wound pain than lavender oil among postnatal mothers.

Assessment of significant psychological distress at the end of pregnancy and associated factors

The aim of this study is to study the prevalence of mental distress at the end of pregnancy and after birth and the impact of selected socio-demographic and obstetric factors. This is a cross-sectional study. The sample is consisted of 351 puerperal women at the age of 18 and over. Sociodemographic, obstetric variables were collected to detect significant psychological distress; the instrument used was General Health Questionnaire (GHQ-28). Logistic multivariable regressions were used to investigate associations. The prevalence of significant mental distress amounted to 81.2%, mostly related to social relationship and anxiety. The women who affirmed having more stress during pregnancy had too significantly increased emotional distress before the birth as well as during early puerperium, increasing somatic symptoms (p<0.001; OR 2.685; CI 95% 1.583-4.553), anxiety (p<0.001; OR 4.676; CI 95% 2.846-7.684), and depressive symptoms (p<0.01). Somatic symptoms (p<0.05; OR 2.466; CI 95% 1.100-5.528) and social dysfunction (p<0.001; OR 1.672; CI 95% 0.711-3.932) occur most frequently in women who already had children. Regarding socio-demographic data, being an immigrant is the only protective factor reducing the social dysfunction in the last weeks of pregnancy (p<0.01; OR 0.478; CI 95% 0.274-0.832). Psychological distress at the end of a full-term pregnancy and in the postpartum period occurs frequently and was associated mainly with stress experienced during pregnancy and parity. It is advisable to perform proper assessment of stress and significant psychological distress at the early stage of pregnancy and repeatedly later on until delivery. Information and support from professionals can help to decrease and prevent their negative impact on maternal and fetal health, as observed in the current evidence.

EP19.04: Sonographic appearance of the uterus in the early puerperium in vaginal vs Caesarean deliveries: a prospective study

Ultrasound may assist in the diagnosis of post-partum pathologies. However, data are scarce regarding the sonographic appearance of the uterus in the puerperal period, according to mode of delivery, and following third stage of labour abnormalities. We described uterine sonographic characteristics in early puerperium, following vaginal vs. Caesarean deliveries; and in women with abnormal third stage of labour, compared to uncomplicated vaginal delivery. This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates. Sonographic uterine dimensions (height, length and width), intracavitary thickness and its echogenicity (at level of fundus, mid-cavity and cervix) were recorded at less than and after 24 hours from delivery, and compared between women delivered vaginally and by Caesarean delivery. Among women delivered vaginally, data were analysed according to whether women underwent manual revision of the uterine cavity. Of the 99 women included in the study, 33 (33%) delivered by Caesarean section. Sonographic evaluations were taken at 15.4 (4.3-24.0) and 39.5 (28.8-108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24 hours from delivery. Postpartum sonographic evaluation of the uterus appears similar after vaginal and Caesarean deliveries.

Sonographic appearance of the uterus in the early puerperium in vaginal versus cesarean deliveries: a prospective study

Purpose: The purpose of this study is to compare uterine sonographic characteristics in early puerperium, following vaginal versus cesarean deliveries; and in women with abnormal third stage of labor, compared to uncomplicated vaginal delivery.Materials and methods: This is a prospective study of women after delivery of singleton, appropriate-for-gestational-age weight, term neonates; 66 women delivered vaginally and 33 delivered by cesarean section. Sonographic uterine dimensions (height, length, and width), intracavitary thickness and its echogenicity (at level of fundus, midcavity and cervix) were recorded at less than and after 24 h from delivery, and compared between women delivered vaginally and by cesarean section. Among women delivered vaginally, data were further analyzed according to whether women underwent manual revision of the uterine cavity.Results: Sonographic evaluations were taken at 15.4 (4.3–24.0) and 39.5 (28.8–108.8) hours after delivery (median, range). We found no clinically significant differences in uterine characteristics according to mode of delivery or according to manual revision of the uterine cavity. The sonographic appearance of the uterus was similar when performed at less than or after 24 h from delivery.Conclusions: Postpartum sonographic evaluation of the uterus appears similar after vaginal and cesarean deliveries.

Cardiac hemodynamics before, during and after elective cesarean section under spinal anesthesia in low-risk women

The aim of this study was to describe maternal central hemodynamic parameters before and during delivery as well at the early puerperium in healthy women undergoing elective cesarean section (CS) at term. The noninvasive Cardiac System (NICaS, NI Medical, Petah-Tikva, Israel) is a regional impedance device that measures cardiac output (CO) and its derivatives with a good correlation with the gold standard Swan-Ganz catheter. We performed a prospective longitudinal study of healthy women with a singleton pregnancy at term. Maternal hemodynamic parameters were assessed by the NICaS at six time points: a few minutes before undergoing an elective CS, immediately after receiving spinal anesthesia, immediately after delivery of the fetus and placenta, after abdominal fascia closure, and within 24 to 36 and 48 to 72 h postpartum. Sixty-one consenting women were recruited during the study period (January 2015 to June 2015). Baseline (pre-CS) mean arterial pressure (MAP) was 87.7±7.9 mm Hg, baseline CO was 7.5±1.7 l per min and baseline total peripheral resistance (TPR) was 994±301 dyne × s per cm5. After spinal anesthesia CO significantly increased by 13%, no significant changes were observed in MAP or TPR. Immediately after delivery, a nadir for all parameters was reached: MAP and TPR were significantly reduced by 8% and 26%, respectively (comparing to pre-CS), and CO further increased by 9% (24% comparing to pre-CS). After fascia closure, partial recoveries of all parameters were observed. Twenty-four to thirty-six hours postpartum MAP returned to pre-CS values, while CO and TPR reached -9% and +11% comparing to baseline, respectively. None of the parameters differed significantly between 24 to 36 and 48 to 72 h postpartum. Significant hemodynamic changes (reduction of TPR and increase of CO) take place at the time of delivery of fetus and placenta. Knowledge of normal hemodynamic values using a reliable noninvasive technique during various stages of pregnancy and the postpartum period is feasible, and might assist clinicians in assessing the level of patient deviation from expected cardiac performance, especially in high-risk women.

Ultrasonographic Evaluation of Uterine Involution in the Early Puerperium.

Purpose Our aim was to describe the changes observed by ultrasonography in uterine dimensions during the early puerperium among women who experienced an uncomplicated puerperium. Additionally, the influence of parity, mode of delivery, breastfeeding and birth weight on uterine involution was evaluated. Methods Ninety-one patients underwent an ultrasound examination on days 1 (D1), 2 (D2) and 7 (D7) of the postpartum period. The longitudinal, anteroposterior and transverse uterine diameters were measured, and the uterine volume was calculated by the formula: longitudinal diameter (LD) X anteroposterior diameter (APD) X transverse diameter (TD) X 0.45. The thickness and length of the uterine cavity were also measured. Results The uterine volume and the LD, APD and TD decreased by 44.8%, 20.9%, 11.8% and 20.0% respectively. The uterine cavity thickness was reduced by 23%, and the length of the cavity was reduced by 27.2% on D7. Uterine involution was correlated inversely with parity when the day of the postpartum period was not taken into account (p = 0.01). However, when the uterine involution was correlated to parity separately, with D1, D2 or D3, no correlations were found. A significant difference occurred at D2, when it was found that the uterus had a smaller volume following cesarean section compared with vaginal delivery (p = 0.04). The high birth weight and breastfeeding were significantly related to uterine involution (p ≤ 0.01 and p = 0.04). Conclusion The sonographic evaluation of the uterus in the early puerperium should consider birth weight, breastfeeding and parity, as well as the delivery route on D2, to identify abnormalities related to uterine involution.

Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes.

The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort. Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system. Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not. In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy. 4. Laryngoscope, 127:2854-2859, 2017.