Postpartum Changes Research Articles

Postpartum changes in maternal physiology and milk composition: a comprehensive database for developing lactation physiologically-based pharmacokinetic models

IntroductionPharmacotherapy during lactation often lacks reliable drug safety data, resulting in delayed treatment or early cessation of breastfeeding. In silico tools, such as physiologically-based pharmacokinetic (PBPK) models, can help to bridge this knowledge gap. To increase the accuracy of these models, it is essential to account for the physiological changes that occur throughout the postpartum period.MethodsThis study aimed to collect and analyze data on the longitudinal changes in various physiological parameters that can affect drug distribution into breast milk during lactation. Following meta-analysis of the collated data, mathematical functions were fitted to the available data for each parameter. The best-performing functions were selected through numerical and visual diagnostics.Results and DiscussionThe literature search identified 230 studies, yielding a dataset of 36,689 data points from 20,801 postpartum women, covering data from immediately after childbirth to 12 months postpartum. Sufficient data were obtained to describe postpartum changes in maternal plasma volume, breast volume, cardiac output, glomerular filtration rate, haematocrit, human serum albumin, alpha-1-acid glycoprotein, milk pH, milk volume, milk fat, milk protein, milk water content, and daily infant milk intake. Although data beyond 7 months postpartum were limited for some parameters, mathematical functions were generated for all parameters. These functions can be integrated into lactation PBPK models to increase their predictive power and better inform medication efficacy and safety for breastfeeding women.

And Baby Makes Three: Postpartum Changes in Male-Female Affiliative Interactions in White-Faced Capuchins.

In group-living primates, male investment in infants is highly variable. Previous research on polygynandrous primates found that male care of infants, whether direct or indirect, may be a means to increase offspring survival, increase social status, invest in future mating opportunities, and/or invest in future social or coalition partners, any of which may increase fitness outcomes. Relationships between male white-faced capuchins (Cebus imitator) and infants are highly variable, ranging from neutral to highly affiliative during periods of group stability to lethal during times of instability. We used genetic paternity analysis and behavioral observations to investigate the impact of paternity status, female dominance rank, male dominance rank, and infant sex on changes in rates of affiliation (contact and proximity) between capuchin males and females following the birth of an infant (n = 92 dyads). We used generalized linear mixed models and an information theory approach to select models for averaging. We found that overall rates of male-female affiliation increased following the birth of an infant (contact change: +1.09 ± 2.55%; proximity change: +1.16 ± 3.08%). Infant sex was the only significant explanatory variable; dyads that included males and females who gave birth to male infants experienced a significant increase in their time in contact and proximity in comparison to dyads with females who gave birth to female infants (contact change: p < 0.05 in 2/3 models; proximity change: p < 0.001 in 3/3 models). These findings add to previous data indicating that male capuchins do not recognize their offspring or have the motivation to preferentially invest in their care. We suggest that the observed sex bias may be a form of sex-specific socialization connected to the importance of forming long-term cooperative male bonds that are maintained via male parallel dispersal in this species.

Review on Efficacy of Phytogenic Galacto Powder Supplement as Potential Galactogague

Milk production, in cattle as the name suggests is not just a monomer but a conglomeration of lactation issues faced by the industry like post-partum changes, endometritis, milk fever, acetonemia, oedema, galactic and may more. Synthetic substances named Galactogogues were used to combat this situation, but over a period of time and long applications lead to the reduction in the livability and disease tolerance of the animal, not to say a profound decrease in milk production. The herbal alternatives, the phytogenic Galacto herbs, involving the age old traditional Trigonella, Asparagus, Silybum etc when given as a synergestic blend acted as the Phytogenic Galactogoguesdue to their phytochemicals. The earlier studies on the individual Galacto herbs prove their efficacy, this review is about their blended work in various aspects of lactation and the expected results. This review finds a relevance to signify the importance of the synergestic blend of Galacto powder from the herbs presenting enhanced lactation, prevention and correction of lactational issues, an innovative area for more futuristic research too.

Amelioration of Insulin Resistance after Delivery Is Associated with Reduced Risk of Postpartum Diabetes in Women with Gestational Diabetes Mellitus.

Identifying risk factors for postpartum type 2 diabetes in women with gestational diabetes mellitus (GDM) is crucial for effective interventions. We examined whether changes in insulin sensitivity after delivery affects the risk of type 2 diabetes in women with GDM. This prospective cohort study included 347 women with GDM or gestational impaired glucose tolerance, who attended the follow-up visits at 2 months postpartum and annually thereafter. Changes in insulin sensitivity were calculated using the Matsuda index at GDM diagnosis and at 2 months postpartum (ΔMatsuda index). After excluding women with pregestational diabetes or those followed up only once, we analyzed the risk of postpartum type 2 diabetes based on the ΔMatsuda index tertiles. The incidence of type 2 diabetes at the two-month postpartum visit decreased with increasing ΔMatsuda index tertiles (16.4%, 9.5%, and 1.8%, P=0.001). During a 4.1-year follow-up, 26 out of 230 women who attended more than two follow-up visits (11.3%) developed type 2 diabetes. Compared to the lowest tertile, subjects in the highest ΔMatsuda index tertile showed a significantly reduced risk of type 2 diabetes (hazard ratio, 0.33; 95% confidence interval, 0.12 to 0.93; P=0.036) after adjusting for confounders. Improvement in insulin sensitivity after delivery is associated with a reduced risk of postpartum type 2 diabetes in women with GDM. Postpartum changes in insulin sensitivity could be a useful prediction for future type 2 diabetes development in women with GDM.

Postpartum obstetric complications: a guide for radiologists.

The puerperium refers to the 6-8weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key.

THE RELATIONSHIP OF HUSBAND'S SUPPORT AND BOUNDING ATTACHMENT WITH THE RISK OF POSTPARTUM BLUES IN POSTPARTUM S ECTIO CAESAREA MOTHERS IN THE SAKURA ROOM OF DR. SOEDOMO TRENGGALEK

After giving birth, women will go through postpartum psychological changes which are divided into 3, namely taking in, taking hold, and letting go. If postpartum psychological changes cannot be overcome properly, it can cause postpartum blues. The changes that occur require the husband's support and the success of bonding attachment in preventing failure to get through the postpartum period, thereby preventing the emergence of postpartum blues. The aim of this study was to determine the relationship between husband's support and bounding attachment with the risk of postpartum blues in postpartum caesarean section mothers. This research design uses cross sectional. The sampling technique used was non-probability sampling, purposive sampling type with a total of 59. Data processing uses the SPSS application with the Spearman-Rank test and Multiple Correlation. The research results showed a relationship between husband's support and the risk of postpartum blues with a p-value = 0.000. There is a relationship between bounding attachment and the risk of postpartum blues with a p-value = 0.000, and there is a relationship between husband's support and bounding attachment with the risk of postpartum blues simultaneously with a p-value = 0.000. It is recommended that postpartum mothers, especially caesarean sections, can adapt during the postpartum period and changes in new roles by increasing bounding attachment, and it is also recommended that husbands increase their support to wife so that they can prevent the risk of postpartum blues.

Self-efficacy with Pelvic floor muscle training mediates the effect of an App-based intervention on improving postpartum urinary incontinence severity among pregnant women: A causal mediation analysis from a randomised controlled trial

BackgroundA pragmatic randomised controlled trial has confirmed the effectiveness of Urinary Incontinence for Women (UIW) app-based intervention in improving postpartum urinary incontinence (UI) severity among pregnant women. However, the causal mechanisms underlying this intervention effect remain unclear. ObjectiveTo examine the mediating role of self-efficacy with pelvic floor muscle training (PFMT) on the effect of the UIW app-based intervention in improving postpartum UI severity. MethodsThis was a secondary causal mediation analysis of a single-center, 2-arm, unblinded pragmatic randomised controlled trial. Singleton pregnant women without UI before pregnancy aged ≥18 years and between 24 and 28 weeks of gestation were recruited from a tertiary public hospital in China and randomised to receive the UIW app intervention plus oral PFMT instructions (n = 63) or oral PFMT instructions alone (n = 63). The primary outcome was postpartum changes in UI severity at 6 weeks. Changes in self-efficacy with PFMT 2 months after randomisation were a hypothesised mediator. Causal mediation analysis was used to estimate the average causal mediation effect (ACME), average direct effect (ADE), average total effect (ATE), and proportion mediated. A sensitivity analysis was conducted to examine the robustness of the ACME in relation to potential unmeasured confounding. ResultsData from 103 participants were analyzed. The ATE of UIW app-based intervention on postpartum UI severity was 2.91 points (95 % confidence intervals [CI] 1.69 to 4.12), with ADE of 1.97 points (95 % CI 0.63 to 3.41) and the ACME 0.94 points (95 % CI 0.27 to 1.72). The proportion of ATE mediated by self-efficacy with PFMT was 0.32 (95 % CI 0.08 to 0.67). Sensitivity analysis revealed the robust ACME with respect to the potential effects of unmeasured confounding. ConclusionAn increase in self-efficacy with PFMT partially mediated the effect of the UIW app intervention on improvements in postpartum UI severity. Trial registrationThe original trial was prospectively registered in the Chinese Clinical Trial Registry under the reference number ChiCTR1800016171 on 16/05/2018. Further details can be accessed at: http://www.chictr.org.cn/showproj.aspx?proj=27455.

Relationship between proteinuria and changes in antepartum and postpartum choroidal thickness in patients with pre-eclampsia

Pre-eclampsia (PE) is a hypertensive disorder characterised by systemic vascular resistance and endothelial dysfunction. It is known to influence choroidal thickness (CT). No previous studies have explored the antepartum and postpartum changes in CT with respect to the protein-creatinine ratio (PCR), a measure of proteinuria that is a clinical hallmark of PE. This study evaluated the correlations between antepartum and postpartum CT and the PCR in patients with PE. In this retrospective study, sixty-six eyes (66 patients) were analysed. The patients were divided into two groups according to the median PCR value (2.36 mg/mg): low PCR group (< 2.36 mg/mg) and high PCR group (≥ 2.36 mg/mg). Ophthalmologic clinical data were collected and assessed. We observed higher antepartum CT and higher mean arterial pressure in high PCR group than in low PCR group. Moreover, postpartum CT decreased significantly in high PCR group. In the multivariate analysis, CT changes were correlated with antepartum CT and antepartum PCR after logarithm transformation. In conclusion, a greater decrease in CT was observed in high PCR group than in low PCR group. Further, the antepartum PCR showed a correlation with the extent of CT reduction.

From the womb to the world: a study of pregnancy narratives by celebrity moms in India

This article examines how celebrity moms in India are self-constructing their public persona through their pregnancy narratives. As a form of personal narrative, pregnancy narratives provide important insights into the...

Postpartum Changes in Levator Plate Shape and Genital Hiatus Size After Vaginal Delivery.

Vaginal delivery is a risk factor for pelvic organ prolapse. We sought to quantify changes in level III pelvic support measurements at 7weeks and 8months following vaginal delivery. This secondary analysis included primiparous women who underwent pelvic MRI and clinical examinations at 7weeks and 8months after vaginal delivery. Demographics and obstetrical data were abstracted. Mid-sagittal resting MRIs were used to perform level III measurements including urogenital hiatus (UGH), levator hiatus (LH), and mid-sagittal levator area (LA), and to trace the levator plate (LP). Using principal component analysis, 7-week and 8-month principal component scores (PC1s) and MRI measurements were compared using paired t test. If the PC1 score change from 7weeks to 8months was > 0, women were considered to have a more dorsally oriented LP shape. Of 76 participants, POP-Q values did not significantly differ between 7weeks and 8months, but MRI measurements improved (UGH: 3.9 ± 0.8 vs 3.5 ± 0.8, p < 0.001; LH: 5.4 ± 0.8 vs 5.2 ± 0.8, p = 0.01; LA: 18.0 ± 6.0 vs 15.2 ± 6.5, p < 0.001). Approximately 30% (22 out of 76) had a more dorsally oriented LP shape and larger level III measurements at 8months than women with a more ventrally oriented LP shape (LA: 86.4% vs 1.9%, p < 0.001; LH: 16% vs 12%, p < 0.001; UGH: 59.1% vs 3.7%, p < 0.001). After vaginal delivery, most women had "recovery" of level III support-defined by smaller UGH, LH, and LA measurements-and a more ventrally oriented LP shape. However, nearly 30% had larger level III measurements and a more dorsally oriented LP shape, indicating "impaired recovery" of support.

Depression among Women during Menopause and Its Effect

Major depressive disorder (MDD) is a serious medical condition that affects how people feel, how they think and how they behave. In developed countries, menopause usually begins between the ages 40 and 58. The average age in the United States is 52 years. For some women, menopause (perimenopause), or the "change of life", is a rollercoaster of physical and emotional highs and lows. The so-called "change of life" is accompanied by a variety of symptoms, such as hot flashes and insomnia, mood swings and depression. When women experience sudden hormonal changes, such as menopausal changes, puberty and postpartum changes, and even changes in their monthly cycles, they are at an increased risk for developing depression. In fact, women are three times more likely to develop depression than men. The main focus of this study was on “depression among women during menopause and its effect”. The study included women aged 45-55 years. For the study, a sample of sixty women from Madakasira village in the Sathya Sai district comprised the sample. Under the direction of subject matter specialists, the researcher created a questionnaire, which was pre-tested on a different sample before being given to the real sample. According to the study, women experienced anxiety and despair throughout menopause.

Tenofovir alafenamide or tenofovir disoproxil fumarate in pregnancy to prevent HBV transmission: Maternal ALT trajectory and infant outcomes.

The use of antiviral agents, specifically tenofovir disoproxil fumarate (TDF), in pregnant women to prevent mother-to-child HBV transmission is a key step towards hepatitis elimination. However, data on using tenofovir alafenamide (TAF) is insufficient. The frequent occurrence of postpartum ALT flares may impact the clinical implementation. The maternal and infant outcomes were compared in multi-centre trials of high viral load HBsAg/HBeAg+ pregnant women receiving TAF or TDF from the third trimester until 2 weeks postpartum with intensive follow-ups. To explore the dynamic pre- and postpartum changes in ALT levels, we used a group-based trajectory model for analysing data of 332 women from three prospective studies. After treatment, the maternal HBV DNA levels significantly decreased from baseline to delivery: 7.87 ± 0.59 to 3.99 ± 1.07 Log10 IU/mL TAF (n = 78) and 8.30 ± 0.36 to 4.47 ± 0.86 Log10 IU/mL (TDF, n = 53), with viral load reductions of 3.87 versus 3.83 Log10 IU/mL. The HBsAg-positive rates among 12-month-old infants were 1.28% (1/78) versus 1.82% (1/55) respectively (p = 1.00). Of the TAF or TDF-treated mothers, 25.64% versus 16.98% experienced ALT > 2X ULN, and 11.54% versus 1.89% received extended antiviral treatment. Our model revealed four distinct ALT patterns: stable ALT (87.2%), moderate (8.0%) or marked (2.4%) postpartum flares, or prepartum elevations (2.4%). TAF effectively reduces mother-to-child HBV transmission, but prophylaxis failure still occurred in few cases. Postpartum ALT flares are common in women receiving TAF or TDF during pregnancy. Approximately 12.8% of mothers may require extended postpartum antiviral treatment. NCT03695029 (ClinicalTrials.gov).

The clinical importance and correlations of post-partum changes in the clinical findings, reproductive cyclicity, serum-milk oxidant/antioxidant parameters as a stress indicator in female dromedary camel (Camelus dromedarius) and their effect on milk palatability

Dramatic metabolic changes during pregnancy and post-partum period resulted in alteration of the biochemical parameters in dromedary she-camels. The current study focused on assessment of stress indicators in post-partum dromedary she-camels on days 14, 28 and 42 post-calving through monitoring the clinical findings, serum steroid hormones, serum or milk oxidant/antioxidant indicators, and milk somatic cell count (SCC) status with reference to serum lipid profile changes. The study also stated several correlations between reproductive cyclicity parameters, stress biomarkers and serum-milk oxidant/antioxidant indicators. The study was conducted on clinically healthy recently calved she-camels (n = 25). They were subjected to clinical and laboratory assays including lipid profiles, serum steroid hormones [Progesterone (P4) and estradiol (E2)], serum or milk oxidant/antioxidant biomarkers [Malondialdehyde (MDA), reduced glutathione (GSH) and cortisol], and milk SCC on days 14, 21 and 28 post-calving. The study concluded the influence of stress as a result of lactation in post-partum period in recently calved she-camels and its relationship with reproductive cyclicity as well as changes in serum steroids, lipid profiles, serum-milk oxidant/antioxidants parameters, and milk SCC that was reflected through significant elevations in serum levels of P4, E2, cortisol, MDA and glucose, and milk values of MDA, cortisol and SCC as well as significant drop in serum levels of GSH, TPs, albumins and globulins on day 14 post-calving comparing with their values particularly on day 42. The study stated variable correlation relationships between reproductive cyclicity parameters, lipid profiles, serum-milk oxidant/antioxidants parameters and milk SCC.

Time-sensitive changes in the maternal brain and their influence on mother-child attachment

Pregnancy and the postpartum period are characterized by an increased neuroplasticity in the maternal brain. To explore the dynamics of postpartum changes in gray matter volume (GMV), magnetic resonance imaging was performed on 20 healthy postpartum women immediately after childbirth and at 3-week intervals for 12 postpartum weeks. The control group comprised 20 age-matched nulliparous women. The first 6 postpartum weeks (constituting the subacute postpartum period) are associated with decreasing progesterone levels and a massive restructuring in GMV, affecting the amygdala/hippocampus, the prefrontal/subgenual cortex, and the insula, which approach their sizes in nulliparous women only around weeks 3–6 postpartum. Based on the amygdala volume shortly after delivery, the maternal brain can be reliably distinguished from the nulliparous brain. Even 12 weeks after childbirth, the GMV in the dorsomedial prefrontal cortex, and the cortical thickness of the subgenual and lateral prefrontal cortices do not reach the pre-pregnancy levels. During this period, a volume decrease is seen in the cerebellum, the thalamus, and the dorsal striatum. A less hostile behavior toward the child at 6–12 weeks postpartum is predicted by the GMV change in the amygdala, the temporal pole, the olfactory gyrus, the anterior cingulate, the thalamus and the cerebellum in the same period. In summary, the restructuring of the maternal brain follows time-dependent trajectories. The fact that the volume changes persist at 12 weeks postpartum indicates that the maternal brain does not fully revert to pre-pregnancy physiology. Postpartum neuroplasticity suggests that these changes may be particularly significant in the regions important for parenting.

Immunological quality of colostrum and specific antibodies against enteropathogens in the colostrum and transition milk of crossbred Gir×Holstein cows.

Colostrum management is crucial for enhancing the immune response against enteropathogens and the survival of dairy calves during the first few weeks of life. However, few physiological studies have investigated the dynamics of general and specific immunoglobulin G (IgG) content in cow milk during early lactation stages, particularly in that of crossbred Gir × Holstein dairy cows, the most predominant dairy cattle population in tropical countries, such as Brazil. Therefore, this study evaluated the effects of parity and milking order on the volume and quality of colostrum, transition milk, and mature milk in crossbred Gir × Holstein cows using 3 traditional on-farm tests. The dynamics of IgG in the mammary secretions and the specific antibody levels against enteropathogens were also determined using sandwich enzyme-linked immunosorbent assay (ELISA) during the early stages of lactation. Fifty healthy Gir × Holstein cows were divided into 2 groups based on parity number, i.e., primiparous (n = 18) and multiparous (n = 33). They were monitored from the first to the 43rd milking. The colostrum volume and quality were evaluated using a colostrometer, Brix refractometer, and Colostro Balls after the first milking, in addition to the colostral IgG levels measured using sandwich ELISA as a reference standard. On-farm tests showed that the colostrum samples obtained from Gir × Holstein cows exhibited an optimal colostrum quality based on the literature criteria, regardless of parity number; however, the IgG mass was higher in the colostrum of multiparous (201 ± 67.03g) cows than in that of primiparous (144 ± 32.40g) cows. The volume and composition of transition and whole milk were also assessed at the 2nd to 9th, 11th, 13th, 15th, 29th, and 43rd milkings. Multiparous cows produced higher volumes of transition milk than primiparous cows. In addition, multiparous cows exhibited a higher total solids percentage in their postpartum mammary secretions than primiparous cows. A higher percentage of inhibition of specific antibodies against Escherichia coli K99 was observed in the blood serum of multiparous cows than in that of primiparous cows. The volume and composition of mammary secretions changed over time; milk production increased, whereas total solids, total IgG, and specific antibody levels against most enteropathogens decreased, regardless of parity. Additionally, an association between parity and time was observed with respect to milk yield, the Brix score (%), and specific antibody levels against the Clostridium perfringens alpha toxin in mammary sections and against coronavirus and rotavirus in blood samples. This association indicated higher values in multiparous cattle than in primiparous cattle at specific time points. In conclusion, this study reveals postpartum time-dependent changes in the physiological and immunological components in the mammary secretions and blood of crossbred Gir × Holstein cows from the first to the 43rd milking. These results will contribute to the development of future research in Gir × Holstein-specific neonatology, which is genetically adapted to tropical and subtropical countries.

Unaltered Long-Term Maternal Endothelin System in a Gestational Hypertensive Rat Model

INTRODUCTION: Cardiovascular diseases (CVDs) are two to four times more likely to affect women with a history of hypertensive disorders of pregnancy (HDPs). One of the etiologies of CVDs is endothelial dysfunction, which results from an imbalance in the production of endothelin-1 (ET-1) and nitric oxide (NO). Although blood pressure (BP) is normalized postpartum, we hypothesize that a transient increase in BP during HDPs may cause ongoing endothelial dysfunction. We aimed to discover the impact of HDPs in the development of cardiovascular diseases after long-term postpartum changes in endothelin-A receptor (ETAR) and endothelin-B receptor (ETBR) expression and the concentration of ET-1 and NO. MATERIALS AND METHOD: Twenty-four female Sprague-Dawley (SD) rats were assigned into four groups (n = 6), including two treatment and two control groups. All rats were sacrificed on Day 30 postpartum. The NO and ET-1 concentrations were determined by ELISA and the ETAR and ETBR expression of the mesenteric arteries were measured by immunohistochemistry studies. RESULTS: The mean concentrations of ET-1 and NO were not significantly different in all groups. There was no significant difference in the mean immunoreactivity of ETAR and ETBR percentages area in the tunica intima and media in all groups. CONCLUSION: No evidence demonstrates significant changes in the endothelin system of the resistance arteries at the proteomic level in the long-term duration following HDP. Further investigation of its potential chronic effect warrants a deeper analysis at the molecular and ultrastructural levels.

Development of an educational guide for postpartum sexual health promotion: The Delphi method.

The Promotion of sexual health has been emphasized in Sustainable Development Goals (SDGs). As a primary prevention strategy, the promotion of sexual knowledge can reduce the incidence of postnatal sexual disorders. This study aimed to develop an educational guide for postpartum sexual health promotion. This qualitative study was conducted in 2021 in Tehran. The steps of developing the educational guide were based on the model of the National Institute for Health and Clinical Excellence (NICE). First, the related guidelines, books, booklets, and original articles were comprehensively reviewed. Based on the scientific evidence, the educational content was compiled. Then, the quality of this content was evaluated using the Delphi method; It was performed using expert opinions with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool. The educational content was developed in three chapters as follows: basic sexual education, postpartum changes and prevalent sexual problems of this period, and strategies for solving or adapting to postpartum sexual problems. This guide was developed in two separate sections for healthcare providers and mothers. The content was of excellent quality in all 6 domains of the AGREE tool (>90%); and evaluated to be optimal in terms of scientificity, significance, and feasibility with the consensus of experts (>95%). In this research, the steps of developing a comprehensive evidence-based educational guide for sexual health services in postpartum care were described, and its content was presented. The validity of the compiled content was also confirmed.

Clinical and Radiological Evaluation of Onlay Mesh Abdominoplasty in Obese Multiparous Patients with Moderate-to-Severe Rectus Diastasis.

Women with multiple pregnancies often experience abdominal protrusion and/or a lax abdominal wall. Various open surgical techniques have been developed to address rectus diastasis in abdominoplasty, ranging from suture plication to mesh reinforcement. This study aims to compare the clinical and radiological changes between traditional abdominal plication and the addition of non-absorbable mesh for rectus muscle (RM) diastasis repair in terms of function, postoperative outcome, and recurrence. This prospective retrospective study involved 63 women who underwent cosmetic tummy tuck surgery and met certain eligibility criteria. Patients with only mild diastasis recti, midline hernia, contraindications for major surgery, recent smoking history, or refusal of mesh augmentation were excluded. Clinical examination for abdominal protrusion or bulging and CT imaging was performed to check for recurrence of diastasis recti. The study included 33 patients who underwent mesh repair and 30 who underwent traditional abdominal plication. Follow-up was conducted after 1year using CT and a questionnaire to assess various factors compared to preoperative measurements, with overall satisfaction rated on a 10-point Likert scale. There was no significant difference in demographic data between the two groups. Patients who underwent mesh repair had a slightly longer hospital stay and drain duration. The average waist circumference decreased in both groups without any statistically significant difference. Objective CT showed significant reductions in both groups in inter-rectus distance, RM width and circumference, and intra-abdominal circumference compared to preoperative values. All patients expressed satisfaction with scar quality and umbilicus aesthetics, and no recurrence was detected either clinically or radiologically during the follow-up period. Comprehensive preoperative assessment and imaging techniques like ultrasound and CT scans allow surgeons to detect postpartum changes in the abdominal wall. Mesh reinforcement may be indicated for diastasis above 4 cm in obese multiparous females. Thorough preoperative evaluation permits customized surgical plans to optimally restore abdominal wall anatomy and function. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .

Expanded Study on Patterns of Myometrial Lesions in Hysterectomy Specimens: A Retrospective Study of 520 Specimens

Introduction: Hysterectomy is the second most frequently performed major surgical procedure on women worldwide, peri and post-menopausal. In India, it accounts for only 6% of the major surgeries. Aims and objectives: To study the profile of different myometrial lesions in the 520 hysterectomy specimens received in the Department of Pathology, GMC Jammu, for histopathological studies. Material and methods: The study was retrospective in nature. The study material comprised 520 hysterectomy specimens for a period of one year. They were labelled correctly, numbered with complete clinical details and then subjected to gross and detailed histopathological examination. Results: In the present study, the mean age of the cases was 46.9 years. 49.62% undergoing hysterectomy was in the age group of 41-50 years. The most common clinical indication for hysterectomy was menorrhagia in 42.75% of cases, followed by uterovaginal prolapse in 26.6%, fibroid uterus in 20.24% of cases and other less common indications. Myometrium was grossly unremarkable in most subjects, i.e. 55.77 %. The most common lesion in the myometrium was a fibroid, i.e., 41.73% of cases. On microscopic examination, in most cases, i.e., 263 (49.77%), myometrium was within normal limits histologically. Leiomyomata were found to be commonest, i.e., 180(34.2%) followed by adenomyosis 36 (6.92%) and leiomyoma with adenomyosis 32 (6.08%) cases. Post-partum changes were seen in the myometrium in 6 (1.14%) cases. Conclusion: Histopathological examination is the gold standard for giving the final diagnosis, planning further management and ensuring the best post-operative management of the patient. Keywords: Fibroid, Hysterectomy, Myometrium

Психологические особенности телесного опыта родильниц со здоровыми и с больными детьми: культурно-исторический подход в психосоматике

&lt;p&gt;From the standpoint of the cultural-historical approach in psychosomatics, physicality also changes in adulthood: in the situation of illness, aging, the birth of a child, etc., and factors that enrich bodily experience are highlighted. In the postpartum period, this factor may be the child's illness. The paper studies the bodily experience of maternity patients. It has been hypothesized that the bodily experience in the postpartum period changes compared to the usual one, and the bodily experience of maternity hospitals with sick children differs from that of maternity hospitals with healthy children. 136 women aged 19-30 took part in the work: women who do not have children, maternity hospitals with healthy children and maternity hospitals with sick children. The methods "Classification of sensations", "10 sensations", "Scale of sensations in the postpartum period", "Scale of vegetative perception", "Questionnaire for maternity hospitals", "Body attention questionnaire" were used. The features of the bodily experience of maternity hospitals with healthy children were revealed: the predominance of the number of physical descriptors over mental ones, etc., and with patients: increased concentration on the sensations from the child etc. The results reinforce the importance of the joint stay of the mother and the baby when placing him in the hospital.&lt;/p&gt;