Peripartum Period Research Articles

Microglial synaptic and perineuronal net remodeling in the rat medial prefrontal cortex across the peripartum period and in response to gestational stress

Microglial synaptic and perineuronal net remodeling in the rat medial prefrontal cortex across the peripartum period and in response to gestational stress

LBODP076 Hypophysitis Misdiagnosed As Pituitary Macroadenoma During Pregnancy

Abstract Introduction Surgical treatment of nonfunctioning symptomatic pituitary macroadenoma may be associated with significant morbidity and the need for long-term medications. In late pregnancy and the postpartum periods, lymphocytic hypophysitis can present as a pituitary macroadenoma. We present a rare case of a pregnant patient who underwent pituitary surgery for lymphocytic hypophysitis. Case presentation A 37-year-old woman was evaluated for headaches and double vision during the third trimester of her pregnancy. A visual field exam showed bitemporal hemianopsia. Brain magnetic resonance imaging (MRI) showed a 2 cm intrasellar tumor with suprasellar extension, interpreted as a pituitary macroadenoma. The patient underwent a cesarean section. Labs after delivery showed IGF-1: 153 ng/ml (79-259), LH: < 0.2 mIU/ml (1.9-12.8), FSH: 6.4 mIU/ ml (2.3-12.6), Prolactin: 4.3 ng/ml (2.2-30.3), and a low morning cortisol: 2.4 ug/dl (4.2- 22.4). Pituitary MRI with intravenous contrast found a stable pituitary macroadenoma with suprasellar extension compressing the optic chiasm and prechiasmatic optic nerves without evidence of apoplexy. She underwent image-guided endoscopic transsphenoidal resection of the pituitary mass. Postoperatively, she developed diabetes insipidus that was treated with desmopressin. She was treated with steroids for secondary adrenal insufficiency and levothyroxine for central hypothyroidism. The pathology report showed hypophysitis; a lymphoplasmacytic infiltrate identified within the specimen with increased IgG4 expression. Differential diagnoses included IgG4-related hypophysitis and lymphocytic hypophysitis with an IgG4-expressing plasma cell component. Serum IGG 4 was 62 mg/dl (normal: 2 - 96 mg/dl); however, patient was already on steroids. She has been requiring hydrocortisone, levothyroxine, and desmopressin. Discussion Lymphocytic hypophysitis often occurs in late pregnancy or the postpartum period. MRI usually shows a pituitary mass, mimicking an adenoma. However, differences between lymphocytic hypophysitis and pituitary adenoma, using different imaging techniques, have been described. Lymphocytic hypophysitis should be considered in the differential diagnosis of women presenting with pituitary enlargement in the peripartum period. These patients may benefit from conservative treatment with glucocorticoids based on clinical suspicion. Presentation: No date and time listed

Cohort profile: CareConekta: a pilot study of a smartphone application to improve engagement in postpartum HIV care in South Africa

PurposePregnant and postpartum women living with HIV in South Africa are at high risk of dropping out of care, particularly after delivery. Population mobility may contribute to disruptions in HIV...

Succenturiate Placental Lobe Abruption: a placental pathology complicating a dangerous delivery

The development of a placenta is a complex process that occurs without a clinically significant issue in most pregnancies. At times, however, the process develops in a way that isolates an island of placental tissue away from the main body, connected only by unprotected vasculature within the amniotic membranes. The vessels of this succenturiate lobe of the placenta are vulnerable both to compression or laceration, threatening the antepartum period with poor weight gain or the peripartum period with fetal distress, hemorrhage or retained products of conception. A majority of the time, this pathology is undiagnosed until recognized innocuously following delivery of the placenta. A placental abruption is a premature separation of the placenta from the uterus that can result in painful bleeding and fetal distress. This increased distress of mother or baby from continued blood loss usually necessitates delivery either vaginally, if stability is maintained, or by cesarean if it isn’t. The amount of distress correlates to where and how much of the placenta is affected. While succenturiate lobes of the placenta and placental abruptions are not routinely associated with each other, the abruption of only the succenturiate lobe of the placenta in this instance minimized the severity to the fetus, by allowing the main body of the placenta to remain intact. As the bleeding coagulated at the lobe, maternal well-being was maintained allowing enough time to complete a vaginal delivery.

Acute coronary syndrome during pregnancy and postpartum in France: the nationwide CONCEPTION study

Cardiovascular diseases, including acute coronary syndromes, are the leading cause of maternal death in many developed countries. We assessed acute coronary syndrome incidences during pregnancy, peripartum, and postpartum periods. We also compared overall pregnancy (ie, covering all 3 periods) incidence with that found in nonpregnant women of childbearing age. All women aged between 15 and 49 years without ischemic heart disease who delivered between 2010 and 2018 in France were included in the CONCEPTION cohort. Data were extracted from the French National Health Insurance Information System database. Acute coronary syndromes were defined according to the International Classification of Diseases, Tenth Revision codes recorded in the principal hospital diagnosis. We used Poisson regression to estimate crude acute coronary syndrome incidences, and tested age-adjusted Poisson models to compare the incidence risk ratio of acute coronary syndrome between pregnant and nonpregnant women, with 95% confidence intervals. Among 6,298,967 deliveries in France, we observed 225 first-time acute coronary syndrome diagnoses during overall pregnancy (overall pregnancy-related acute coronary syndrome incidence, 4.34/100,000 person-years; 1 case/23,000 pregnancies). In multivariate analysis, independent factors associated with acute coronary syndrome were age, social deprivation, obesity, tobacco use, chronic hypertension, and hypertensive disorders of pregnancy (all P<.05). Among the nonpregnant women aged 15 to 49 years in the general French population, 18,247 cases of acute coronary syndrome (incidence, 16.5/100,000 person-years) occurred throughout the whole study period (>100 million person-years). Compared with the acute coronary syndrome incidence in nonpregnant women, age-adjusted overall pregnancy-related acute coronary syndrome incidence was lower (incidence rate ratio, 0.76; 95% confidence interval, 0.57-0.98; P<.05). Although compared with nonpregnant women, age-adjusted incidence rates were lower during pregnancy, risk was increased during peripartum and postpartum periods. With an incidence of 4.34 per 100,000 person-years, acute coronary syndrome still accounts for a significant proportion of maternal mortality. The peripartum and postpartum periods remain high-risk periods, and greater efforts should be made in terms of acute coronary syndrome prevention, especially because several cardiovascular risk factors are treatable, such as tobacco use and hypertensive disorders of pregnancy.

Long-term hepatic and cardiac health in patients diagnosed with Sheehan's syndrome.

Sheehan's syndrome (SS) is characterised by chronic pituitary insufficiency following a vascular insult to the pituitary in the peripartum period. There is a lack of substantial evidence on the long-term hepatic and cardiac consequences in these patients, following hormone replacement. Patients with a diagnosis of SS were recruited for the study. Detailed clinico-biochemical and radiological evaluation were performed in all patients (n = 60). Hepatic and cardiac complications were assessed using fibroscan and echocardiography (2D speckle-tracking) respectively, in a subset of patients (n = 29) as well as age-and BMI-matched controls (n = 26). Controlled attenuation parameter (for steatosis) and liver stiffness measurement (for fibrosis) were used to define non-alcoholic fatty liver disease (NAFLD). Diastolic cardiac function was evaluated using standard criteria and systolic function by ejection fraction and global longitudinal strain (GLS). The mean age of the cohort was 42.7 ± 11.6 years. Multiple (≥ 2) hormone deficiencies were present in 68.8% of patients, with hypothyroidism (91.4%), hypocortisolism (88.3%), and growth hormone (GH) deficiency (85.7%) being the most common. At a mean follow-up of 9.8 ± 6.8 years, NAFLD was present in 63% of patients, with 51% having severe steatosis, which was predicted by the presence of GH deficiency and higher body mass index. Though the ejection fraction was similar, increased left ventricular GLS (18.8 vs. 7.7%) was present in a significantly higher number of patients versus controls. NAFLD, especially severe hepatic steatosis, is highly prevalent in SS. Subclinical cardiac systolic dysfunction (impaired GLS) is also more common, but of mild intensity.

An Unruptured True Aneurysm of the Uterine Artery during Pregnancy.

The antenatal diagnosis of an unruptured true aneurysm of the uterine artery is extremely rare and has never been reported, whereas pseudoaneurysms associated with previous trauma or cesarean section have been reported several times. True aneurysms occur when the artery or vessel weakens and bulges, sometimes forming a blood-filled sac. Nearly all cases of pelvic true aneurysms involved ovarian arteries which ruptured during the peripartum period. The case presented here is unique in terms of being an unruptured true aneurysm of the uterine artery with a first diagnosis during pregnancy at 32 weeks of gestation and the spontaneous development of thrombosis in the aneurysm in late pregnancy, documented at 37 weeks of gestation. The diagnosis of a true aneurysm of the uterine artery was based on, (1) a demonstration of the cystic mass located in proximity to the lower segment of the uterus with ultrasound characteristics of arterial flow in the mass, and (2) the occurrence in a woman who had no history of trauma or surgery in the pelvis. The finding during cesarean section confirmed the prenatal sonographic finding. The pregnancy ended with successful outcomes.

Relationship between cardiovascular symptoms, health status assessment and cardiomyopathy in the obstetric population

Abstract Background Pregnancy related cardiomyopathy is a significant cause of maternal morbidity and mortality globally. A presumed overlap between normal pregnancy-associated symptoms and clinical symptoms of cardiomyopathy contributes to delays in diagnosis and increased risk of maternal mortality. Purpose We sought to evaluate the association between patient-reported cardiovascular symptoms and the presence of cardiomyopathy among pregnant and postpartum patients. We hypothesize that individual cardiovascular symptoms are unrelated to the presence of cardiomyopathy. We also evaluated the use of a novel adaptation of a validated health status questionnaire in relation to cardiomyopathy. Methods We enrolled 48 pregnant (&amp;gt;13 weeks) and postpartum (up to 12 months) participants in a prospective study between October 2021 and February 2022. All study participants completed a baseline questionnaire, which included current cardiovascular symptoms, an assessment of health status using an adapted version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), followed by a resting transthoracic echocardiogram on the same day. We defined cardiomyopathy as a left ventricular ejection fraction (LVEF) &amp;lt;50% based on 2-D echocardiography. Fisher's exact and Wilcoxon rank-sum tests were employed to evaluate the association between reported cardiovascular symptoms, the adapted KCCQ-12 (KCC-A) score, and cardiomyopathy. Results At the time of enrollment, 67% were pregnant and 33% postpartum. Forty-eight percent identified as White, 31% as Black, 10% as Asian, and 10% as other race. The median age was 31 years (Q1: 28, Q3: 35) and 6% had an LVEF &amp;lt;50%. We found no statistically significant association between four reported cardiovascular symptoms (shortness of breath, orthopnea, fast breathing, and episodes of “asthma” that did not improve with inhalers or other treatment) and cardiomyopathy or medial E/e' ratio. KCC-A scores were low in the study population overall (median 52; Q1:40, Q3: 61). We demonstrated a significantly lower KCC-A score among women with LVEF &amp;lt;50% (median 24; Q1: 15, Q3: 44) compared to women with LVEF ≥50% (median 54; Q1: 44, Q3: 61) p=0.02. Conclusions We showed no significant association between individual cardiovascular symptoms and cardiomyopathy in an obstetric population. However, we demonstrate for the first time that an adapted KCCQ-12 questionnaire for health status assessment could potentially identify women with a high-likelihood of cardiomyopathy during the peripartum period who may benefit from additional evaluation including echocardiography. Larger studies are needed to validate this finding. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This study was funded by a research grant from the Miami Heart Research Institute, Florida Heart Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

Predictors of ICU admission in patients with peripartum cardiomyopathy

Abstract Background Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy that affects women in the peripartum period. The incidence of PPCM in the United States is 1,100 women per year. We studied the admission of women diagnosed with PPCM to the intensive care unit (ICU) with the goal of identifying factors that increase risk for adverse outcomes. Methods This was a retrospective study of 2,286 patients with a diagnosis of PPCM admitted to a private hospital system across the United States between the years 2017 and 2021. Logistical regression analysis was utilized to identify specific patient characteristics and risk factors that were associated with admission to the ICU. Results The average age of patients was 32.13 years. The patient cohort was 39.76% black, 39.15% white, and 13.12% Hispanic. The average length of stay was 3.35 days. Preeclampsia was present in 342 (14.96%) patients, cerebral infarction in 31 (1.36%) patients, eclampsia in 48 (2.10%) patients, myocardial infarction (MI) in 52 (2.27%) patients, and HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in 24 (1.05%) patients. There was a total of 504 (22.05%) patients admitted to the ICU. Preeclampsia (adjusted odds ratio [adj. OR] 1.588, 95% confidence interval [CI] 1.215–2.074, p&amp;lt;0.001), eclampsia (adj. OR 3.131, 95% CI 1.718–5.708, p&amp;lt;0.001), cerebral infarction (adj. OR 4.381, 95% CI 2.028–9.463, p&amp;lt;0.001), age (adj. OR 0.967, 95% CI 0.953–0.982, p&amp;lt;0.001), MI (adj. OR 2.961, 95% CI 1.608–5.455, p&amp;lt;0.001), and HELLP syndrome (adj. OR 4.655, 95% CI 1.926–11.256, p&amp;lt;0.001) were all associated with increased odds of requiring ICU level of care. However, hypertension, d-dimer level, troponin level, active tobacco smoking, alcohol use, and diabetes mellitus were not associated with increased likelihood of admission to the ICU. Conclusion In our study of 2,286 women with PPCM, we found statistically significant predictors of ICU admission included age, HELLP syndrome, eclampsia, preeclampsia, MI, and cerebral infarction. This data may be useful for the early identification and triaging of patients with PPCM that require higher level of care. These results can be utilized in developing a risk score to assist in this goal. Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): HCA-Riverside Community Hospital

Management of Antithrombin Deficiency in Pregnancy.

Antithrombin (AT) deficiency is a high-risk thrombophilia and a rare condition. The risk of venous thromboembolism (VTE) is increased in AT-deficient women during pregnancy and the postpartum period and is especially high in women with a prior history of VTE. A thorough assessment of VTE risk is recommended in pregnant AT-deficient women, comprising the degree and type of AT deficiency, genetic mutations, personal and family history, and additional preexisting or pregnancy-specific risk factors. Due to a lack of adequate study data, there is limited guidance on the management of AT deficiency in pregnancy, including the need for prophylactic anticoagulation, the appropriate dose of low-molecular-weight heparin (LMWH), and the role of AT substitution. LMWH is the medication of choice for the pharmacological prophylaxis and treatment of VTE in pregnancy. Patients with a history of VTE should receive full-dose LMWH during pregnancy and the postpartum period. AT concentrates are a treatment option when anticoagulation is withheld in potentially high-risk events such as childbirth, bleeding, or surgery and in cases of acute VTE despite the use of therapeutic dose anticoagulation. Women with AT deficiency should be counseled at specialized centers for coagulation disorders or vascular medicine, and close cooperation between obstetricians and anesthesiologists is warranted before delivery and during the peripartum period.

Palmitic acid hinders extracellular traps of neutrophil from postpartum dairy cow in vitro.

Peripartum dairy cows experience negative energy balance, characterized by high concentrations of blood free fatty acids (FFA) and immune dysfunction. Palmitic acid (PA), the most abundant saturated fatty acid in cow blood, is not only an energy precursor, but causes cellular dysfunction when in excess. Neutrophil extracellular traps (NET) are one of the arsenals of weapons neutrophils use to fight invading pathogens. However, given the marked increase in circulating PA during the peripartum period, it remains to be determined what effect (if any) PA has on NET release. Thus, the objective of this study was to evaluate the effect of PA on NET release and the underlying mechanism in vitro. Phorbol-12-myristate-13-acetate (PMA; 100 ng/mL, 3 h) was used to induce the release of NET in vitro. We isolated neutrophils from the peripheral blood of 5 healthy postpartum dairy cows with similar parity (median = 3, range = 2-4), milk yield (median = 27.84 kg/d per cow, range = 25.79-31.43 kg/d per cow), days in milk (median = 7 d, range = 4-10 d), and serum FFA <0.25 mM, β-hydroxybutyric acid <0.6 mM, and glucose >3.5 mM. Inhibition of double-stranded DNA (dsDNA) level, a marker of NET release, in response to PA was used to determine an optimal incubation time and concentration for in vitro experiments. Cells were maintained in RPMI-1640 basic medium without phenol red, treated with 600 μM PA for different times (4, 5, 6, and 7 h) in the presence or absence of PMA. There was a decrease for dsDNA level in the supernatant due to increased duration of PA treatment, with a peak response at 6 h. Thus, 6 h was selected as the challenge time. Then, cells were treated with different concentrations of PA (100, 200, 400, and 600 μM) for 6 h in the presence or absence of PMA. There was a decrease for dsDNA level in the supernatant due to increased dose of PA, with a peak response at 400 μM. Finally, 400 μM PA for 6 h was selected as the treatment for subsequent experiments. Protein abundance of citrullinated histone in the presence or absence of PMA was markedly lower in response to incubation with PA. Morphological observations by laser confocal microscopy and scanning electron microscopy showed that the ratio of NET-releasing cells decreased in response to incubation with PA. Autophagy is a potential key intermediate process in the regulation of NET by PA. To investigate the effect of PA on autophagy, we used chloroquine to block lysosomal degradation. Exogenous PA led to accumulation of sequestosome-1 and microtubule-associated protein 1 light chain 3-II, and no further accumulation in the presence of chloroquine, all of which suggested an impairment of autophagic flux. To verify the role of autophagy in NET, we used rapamycin to promote autophagic flux; 100 nM rapamycin attenuated the suppressive effect of PA on NET release indicated by greater dsDNA levels, accumulation of citrullinated histone, and ratio of NET-releasing neutrophils. Overall, these data demonstrate PA inhibits NET release by suppressing autophagic flux, which provides information for understanding the immune dysfunction in postpartum cows.

Breastfeeding Duration Is Inversely Associated with Postpartum Allostatic Load: A Possible Mechanism for Improved Maternal Health.

Background: Allostatic load, a multisystem composite measure of chronic stress reflecting the cumulative wear and tear on the body, has utility in explaining maternal and child health disparities and predicting future health when measured during the peripartum period. Research using cross-sectional data has demonstrated an inverse association between concurrent breastfeeding status and maternal postpartum allostatic load. However, the relationship between breastfeeding duration and postpartum allostatic load has not been determined. Objective: This study aimed to examine the association between breastfeeding duration and postpartum allostatic load using prospective data, and to compare the association by race/ethnicity to better understand etiologies of health inequities. Materials and Methods: A secondary analysis of a data sample of 1,791 postpartum women from the Community Child Health Research Network was conducted. Multiple linear regression tested the association between and breastfeeding duration and allostatic load (range 0-10, calculated from 10 biomarkers) at 6 and 12 months postpartum, adjusting for race/ethnicity, maternal age, education, poverty level, study center, smoking, marital status, and prepregnancy body mass index. Stratified analyses examined differences in associations by race/ethnicity. Results: Breastfeeding duration was inversely associated with maternal allostatic load. In adjusted models, mothers who breastfed ≥6 months had 0.41 points lower allostatic load at 6 months (95% CI: -0.71 to -0.11) and 0.36 points lower allostatic load at 12 months postpartum (95% CI: -0.69 to -0.036) compared with mothers who never breastfed. Effect sizes varied in strength and significance across race/ethnic groups. Conclusions: Study findings suggest that extended breastfeeding for at least 6 months is linked with reduced chronic stress load in mothers during the first year postpartum. The inconsistency of findings across race/ethnic groups signals the importance of adjusting for prepregnancy allostatic load in future studies.

OBSTETRIC OUTCOMES OF FERTILITY PATIENTS WITH PELVIC PAIN DISORDERS

Previous research has shown vaginismus to be an independent risk factor for cesarean delivery (CD).1 CD is associated with increased maternal and neonatal morbidity compared with vaginal deliveries; despite this, the rate of CD continues to rise. The American College of Obstetricians and Gynecologists has proposed strategies to help reduce the rate of CD. Most of which focus on the peripartum and intrapartum periods. Therefore, an opportunity exists for reproductive endocrinology and infertility (REI) providers to identify patients at risk for CD based on a history of pelvic pain disorders (PPDs).

Does inpatient access to lactation specialists during the peripartum period improve exclusive breastfeeding rates in the first year of life?

Nellis Air Force Base Family Medicine Residency Program, Nellis AFB, NV The corresponding author is James Honeycutt; [email protected]. The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force Medical Department, the Air Force at large, or the Department of Defense.

PSVI-9 Effect of Supplementing Confined Goats with Cucumis Melo During the Peripartum Period

Abstract The aim was to evaluate the effect of Cucumis melo supplementation on the quality and production of colostrum, milk, as well as live weight dynamics in both mothers and kids during the peripartum period. Pregnant multiparous adult goats (n=15) were divided into two experimental groups: 1) GS; n=8; supplemented with 300 g of dehydrated C. melo plus 100 g of concentrate); 2) GC; n=7; supplemented with 100 g of concentrate but without C melo). Data were analyzed by an ANOVA in a completely randomized design with the SAS statistical package (Evenston, ILL, USA, 2000) and differences were considered as significant at p≤ 0.05. Live weight did not differ between groups P=0.5, while colostrum fat content was greater in the GS compared with the GC (9.6 ± 1.1 vs 6.2 ± 0.8; P˂0.02). In milk production, no difference was observed between groups (2.2 ± 0.1 kg/day; P=0.8), however, on day 21 postpartum, an increase of 100 g/day was recorded for GS, compared with GC. Nutritional supplementation based on C. melo in goats during peripartum improves colostrum quality and increases milk production, under the conditions in which the experimental work was developed and could be adopted by goat breeders as an alternative so that their goats have a higher performance.

48 Supplementation of Condensed Tannins to Beef Heifers During Peripartum Period Affects Coccidia Parasite Load in Dam and Offspring

Abstract Our objective was to explore the effects of condensed tannins peripartum supplementation of beef heifers on their offspring incidence of coccidiosis, diarrhea, and growth performance. A total of 30 beef heifers, diagnosed as pregnant were enrolled in the study. At approximately 60 d pre-partum, determined by breeding and expected calving dates, heifers were stratified by body weight (BW), coccidial oocyst counts per gram of feces (OPG) and randomly assigned one of two treatments: supplementation of 450g-1hd-1d corn gluten feed (Control; n=14); or supplementation of 450g-1hd-1d corn gluten feed and 20g-1hd-1d of condensed tannins (n=16; CT). Heifers received treatment using an automated feeding system (SmartFeed PRO, C-Lock Inc., Rapid City, SD) until 30d postpartum for a total of approximately 90d. Dam BW was determined every 30d, and offspring BW was determined at birth and 30d after. Fecal samples for OPG were collected every 30d from dams, and weekly from calves after birth. All animals were managed as a single group during the duration of the experiment. Initial BW (day -60 relative to calving; 446±7.5 kg), day -30 (480±8.1 kg) and day 30 (453±7.1) was similar (P&amp;gt;0.10) between treatments. Supplement individual daily intake was similar between treatments (395±15.8 and 448±18.2 g/d for CT and Control, respectively; P&amp;gt;0.10). Calf birth weight and at 30d were similar (P&amp;gt;0.10) between treatments (30.4±2.2 kg and 60.7±4.1 kg, respectively). Dam fecal OPG for Eimeria spp. was similar (P&amp;gt;0.10) at day -60 (161.5±8.5 OPG), and day 30 (107.5±9.4 OPG), but were greater (P&amp;lt; 0.05) on day -30 for Control than CT (140.9±8.5 and 54.2±16.2 OPG, respectively). Calf OPG was similar on week 2 (0.0±0.0 OPG), and week3 (283.1±25 OPG); however, it was greater (P&amp;lt; 0.05) for Control than CT calves on week4 (2,744.4±168.4 and 1,150.0±64.7 OPG, respectively). Supplementation of condensed tannins reduced coccidia load pre-calving for dams and their offspring postnatal.

Is maternal defensiveness of Gyr cows (Bos taurus indicus) related to parity and cows' behaviors during the peripartum period?

The maternal care of cows can influence both the milk production and the performance of their calves, making this a topic of important relevance for the production industry that uses zebu cattle. The aims of this study were to 1) investigate the effects of parity on the behaviors of Gyr cows during the peripartum period; 2) characterize the maternal defensiveness of primiparous and multiparous cows towards handlers during the first handling of their calves; and 3) evaluate the relationships between cows’ behaviors at the peripartum period and maternal defensiveness. Thirty-one Gyr cows (primiparous and multiparous), from Empresa de Pesquisa Agropecuária de Minas Gerais (Brazil), were used. The animals were placed in a maternity paddock monitored by video cameras. The behaviors of the animals were collected in four periods: Pre-calving, Post-calving, First handling of calf and Post-handling. Primiparous cows presented more pain signs, reflected in arched spine (P = 0.05), and tended to move more (P = 0.07) than the multiparous in the Pre-calving period. Trends were observed for both Maternal Composite Score (P = 0.06) and Maternal Protective Behavior score (P = 0.06), indicating that both primiparous and multiparous were protective, but only multiparous cows were aggressive toward the caretakers on the first handling of their calves. The most protective cows spent more time eating during the prepartum period (P = 0.03), while the least attentive cows spent more time lying down (P = 0.02) in the prepartum period. The cows who nursed and stimulated their calves more were also calmer (P = 0.02) and more attentive (P = 0.01). In conclusion, the peripartum behaviors of Gyr cows were related to maternal care and maternal defensiveness. Multiparous cows tended to be more aggressive than primiparous cows at the time of the first handling of their calves.

Clinical significance of unexplained persistent sinus tachycardia in women with structurally normal heart during the peripartum period

BackgroundPersistent sinus tachycardia (ST) is frequently encountered during pregnancy and peripartum period and its etiology often remains elusive. We sought to examine the possible association between unexplained persistent ST and obstetric outcomes.MethodsA case control study was conducted using chart review of women admitted in labor to one of 7 hospitals of Northwell Health between January 2015 to June 2021. After excluding women with structurally abnormal hearts, we identified patients with persistent ST during the peripartum period, defined as a heart rate of more than 100 bpm for more than 48 h. A control group was created by randomly subsampling those who did not meet the inclusion criteria for sinus tachycardia. Obstetric outcomes were measured as mother’s length of stay (LOS), pre-term labor (PTL), admission to the neonatal ICU (NICU), and whether she received cesarean-section (CS).ResultsSeventy-eight patients with persistent ST were identified, out of 141,769 women admitted for labor throughout the Northwell Health system. 23 patients with ST attributable to infection or hypovolemia from anemia requiring transfusion and 55 with unclear etiology were identified. After adjusting for age and parity, pregnant mothers with ST were 2.35 times more likely to have a CS than those without (95% CI: 1.46–3.81, p = 0.0005) and had 1.38 times the LOS (1.21- 1.56, p < 0.0001). Among mothers with ST, those with unexplained ST were 2.14 times more likely to have a CS (1.22–3.75, p = 0.008).ConclusionAmong pregnant patients, patients with ST have higher rates of CS.This association is unclear, however potential mechanisms include catecholamine surge, indolent infection, hormonal fluctuations, and medications. More studies are needed to explore the mechanism of ST in pregnant woman to determine the clinical significance and appropriate management.

Effect of feeding rumen-protected lysine through the transition period on postpartum uterine health of dairy cows.

Feeding rumen-protected methionine as an indispensable amino acid source has been shown to improve reproductive performance in dairy cows, but the effect of feeding rumen-protected lysine (RPL) during the peripartum period on reproductive performance is not well explored. Therefore, we aimed to determine the effects of feeding RPL (AjiPro-L Generation 3, Ajinomoto Heartland Inc.) prepartum, postpartum, or both on follicular dynamics, uterine health, and mRNA gene expression of the endometrium. Seventy-five multiparous Holstein cows were assigned to 1 of 2 dietary treatments with or without RPL in a randomized, complete block design. A 2 × 2 factorial arrangement of treatments was used. Prepartum (-28 d to calving), animals were fed a diet (68% of dietary DM from forage) with RPL [PRE-L; 0.54% RPL of dietary dry matter intake] or without RPL (PRE-C). After calving, half of the cows from each prepartum treatment group were assigned to a diet (56% forage) with RPL (PRE-L POST-L; PRE-C POST-L; 0.40% RPL of dietary dry matter intake) or without RPL (PRE-C POST-C; PRE-L POST-C) until 28 d in milk (DIM). Vaginal discharge was detected with a Metricheck device (Simcro) to detect metritis, and at 28 DIM polymorphonuclear leukocytes were evaluated as a percentage of the epithelial cells using a cytology brush (Andwin Scientific) and an endometrial tissue biopsy was collected for mRNA expression and histology. The first postpartum follicular growth cycle was monitored at 7, 10, 11, 13, 15, 17, 19, 21, 23, 25, 27, and 28 DIM via transrectal ultrasonography. Time to first ovulation did not differ between treatments and averaged 18 ± 1.6 DIM. Follicular diameter at first ovulation was not affected by the treatments, but the growth rate of dominant follicle before first ovulation tended to be lower for cows in POST-L in comparison with cows in POST-C. Prevalence of fetid vaginal discharge and metritis did not differ between treatments. Cows in PRE-L POST-L had lower polymorphonuclear leukocytes percentage at 15 and 28 DIM than cows in PRE-L POST-C, PRE-C POST-L, and PRE-C POST-C. Feeding RPL prepartum downregulates the expression of TLR4, SLC7A6, EHMT2, and tends to downregulate the expression of PTGES3 in uterine tissues at 28 DIM. Additionally, it upregulates the expression of APOL3 and NFKB1, and tends to upregulate the expression of AHCY and MAT2A. In conclusion, feeding RPL pre- and postpartum improved indicators of uterine immune status, but did not change days to first ovulation postpartum.

International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training

Introduction and hypothesisThis manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP.MethodsAn international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0–10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0–10).ResultsAfter exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT.ConclusionsThere are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.