Postpartum Group Research Articles

Effect of parity on metabolic and oxidative stress profiles in Holstein dairy cows.

Background and Aim:Pregnancy and lactation have an impact on health status of animals and constitute burden on body metabolites and the oxidant-antioxidant equilibrium. This study is aimed at evaluating metabolic and oxidative stress patterns and parity impacts in both primiparous and multiparous dairy cows.Materials and Methods:Twenty-seven primiparous and multiparous. Holstein cows were enrolled and categorized into four groups according to their physiologic status: Primiparous peripartum heifer (n=5), primiparous postpartum cow (n=9), multiparous peripartum cows (n=5), and multiparous postpartum cows (n=8). Blood sample was taken from each animal – peripartum groups at 3 weeks prepartum and postpartum groups at 3 weeks post-parturition – for complete blood picture, glucose, cholesterol, triglyceride, total protein, albumin, non-esterified fatty acids (NEFA), malondialdehyde (MDA), total antioxidant capacity, and haptoglobin estimation.Results:Postpartum primiparous cows showed significant decrease in glucose, total protein, and albumin while showing significant increase in MDA, NEFA, and globulin; on the other hand, multiparous postpartum cows showed significant decrease in glucose, total protein, and albumin, associated with significant increase in cholesterol and MDA when compared with prepartum PP and MP cows, respectively. Postpartum multiparous cows significantly showed reduction in NEFA when compared to primiparous postpartum cows. Hematologic profiles of postpartum primiparous and multiparous cows showed significant decrease in red blood cells and packed cell volume, significant increase in lymphocytes when compared with prepartum cows.Conclusion:Metabolic and oxidative abnormalities exist in both primiparous and multiparous cows during the transition phase, however postpartum primiparous cows show higher susceptibility to negative energy balance impacts. Oxidant/antioxidant imbalance occurred in both the primiparous and multiparous postpartum cows, highlighting the importance of oxidative stress profiles in the assessment of metabolic health status during transition.

Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births

IntroductionAlthough postpartum sexual concerns are common, limited data exist on postpartum sexual response. Furthermore, the physiological process of vaginal birth may negatively impact genital response compared with unlabored cesarean section (C-section), but this hypothesis has yet to be tested. AimTo (i) compare genital and subjective sexual response and sexual concordance by mode of delivery with inclusion of a control group, (ii) compare groups on self-reported sexual function over the past month, (iii) examine the relationship between laboratory measurement of sexual response and self-reported sexual function, and (iv) investigate association between obstetrical factors and breastfeeding and between sexual response and self-reported sexual function. Methods3 groups of cisgender women were recruited from the community: primiparous women who delivered via vaginal birth within the past 2 years (VB group; n = 16), primiparous women who delivered via unlabored C-section within the past 2 years (CS group, n = 15), and age-matched nulliparous women (NP group, n = 18). Laser Doppler imaging was used to assess genital response while participants watched a neutral and erotic film. Main Outcome MeasuresThe main outcome measures were change in flux units from neural to erotic video as a measure of genital response, subjective sexual arousal rated continuously throughout films, perceived genital response rated after films, and Female Sexual Function Index (FSFI). ResultsWomen in the VB group had significantly lower change in flux units than women in the CS (P = .005, d = 1.39) and NP (P < .001, d = 1.80) groups. Groups did not differ on their subjective indices of sexual response or in sexual concordance. Women in both postpartum groups reported lower FSFI scores than women in the NP group. No relationship was determined between FSFI scores and sexual response in the laboratory. Results suggested that genital trauma and breastfeeding may negatively impact FSFI scores, but they were not related to genital response or subjective sexual arousal as measured in the laboratory. Clinical ImplicationsResults underscore the importance of balancing objective and subjective indices of sexual response and function, especially considering the biopsychosocial nature of postpartum sexuality. Strengths & LimitationsThe present study is the first to apply modern sexual psychophysiological methodology to the study of postpartum sexuality. Cross-sectional methodology limits the ability to make causal inferences, and the strict inclusion criteria limits generalizability. ConclusionPhysiological changes as a result of labor and delivery may have a detrimental impact on genital response; however, these physiological differences may not impact women's subjective experience of postpartum sexuality.Cappell J, Bouchard KN, Chamberlain SM, et al. Is Mode of Delivery Associated With Sexual Response? A Pilot Study of Genital and Subjective Sexual Arousal in Primiparous Women With Vaginal or Cesarean Section Births. J Sex Med 2020; 17:257–272.

Obstetric and perinatal complications associated with assisted reproductive treatment in Spain

Although most newborns conceived through assisted reproductive treatments are healthy, there are concerns about the safety of reproductive techniques and their effect on foetal/maternal well-being. This study aims to describe the incidence of obstetric and perinatal complications in women undergoing assisted reproductive treatments in the Spanish Health System. This is a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain. The data was collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated, through a multivariate analysis with binary logistic regression and multinomial logistic regression. Five thousand nine hundred forty-two women participated, 2.3% (139) through artificial insemination and 8.2% (486) through in vitro fertilisation (IVF) techniques. Women who underwent IVF had a higher likelihood of suffering problems during pregnancy (OR = 1.71; 95% confidence intervals (95% CI), 1.37-2.13), delivery (OR = 1.43; 95% CI, 1.01-2.02), and postpartum (OR = 1.94; 95% CI, 1.40-2.69) than women with spontaneous pregnancy. No increased likelihood of neonatal problems was observed in this group except for twin pregnancy (OR = 9.17; 95% CI, 6.02-13.96) and prematurity (OR = 1.43; 95% CI, 1.01-2.02). No differences were observed between spontaneous pregnancies and those achieved by artificial insemination. Pregnancies achieved through IVF present a higher risk of complications before, during and after delivery. However, there is no increased risk of neonatal problems except for a higher likelihood of twin pregnancy and prematurity.

Empowering Adolescent Mothers in the Choice of Contraception at Postpartum Period: Avoiding a Subsequent Pregnancy

Background: Almost 80% of adolescent pregnancies are unplanned and 28-63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescents mothers with increasing choice for LARC methods in postpartum consultation after a semi-structured group intervention involving adolescent mothers. Methods: Retrospective observational study conducted at University of Campinas, Brazil. The intervention involved antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraception. The data was compared to previous series followed in a period before the education group's implementation - an historical control group. Findings: We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Contraception methods before pregnancy were ever-used by 63%, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was IUC (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%). When comparing the rates before and after the education interventions - there was a 3-fold increase in IUC use. Interpretation: Antenatal and postpartum education increased the choice of IUCs by adolescents. Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors declare no conflict of interests Ethics Approval Statement: A retrospective observational study was performed at the Department of Obstetrics and Gynaecology, School of Medical Sciences University of Campinas (UNICAMP), Campinas, SP, Brazil. Ethical Committee of the University of Campinas approved this research (CAAE: 1909413.6.0000.5404). All items of the Strengthening the Reporting of Observational Studies in Epidemiology were followed.

Effectiveness of the combination of marmet technique and oxytocin massage against the breast milk production of mother postpartum

According to UNICEF improper Behaviourand less of knowledge contributed to the death of a child, one of them, namely the mothers do not realize the importance of breast feeding. According to Basic Medical Research percentage of breastfeeding pattern &lt;1 hourin 2010 i.e. 29,3% and increased to 34,5% in 2013. The breastfeeding patterns 1-6 the first hour of the in 2010 as many as 40,7% and decreased to 35,2% in 2013. A few methods to help improve the ASI production such as oxytocin massage methods, marmet technique, warm compresses, massase rolling (back), breast care, and methods of SEMOS (Stimulation of Endorphin Massage, Oxytocin and Suggestive). This research aimed to know the effectiveness combination of the mermet technique and oxytocin message against the breast milk production of mothers postpartum. This research used quasi alphabets experiment withpost testmenthods only with control group design. The results of using independent T-bivariat test obtained p value 0,007 &lt; ? (0,05) which means therewas a significant influence between breast milk production of mother postpartum group intervene the breastmilk production of mother postpartum with control group with an average of breast milk production of 30 respondents were divided into two groups that was 15 respondents of the intervention group obtained 1,113cc whereas 15 respondents of control group obtained 0,547cc. The combination of the marmet technique and oxytocin massage and was effective to stimulatehormone prolactin spending that would stimulate the cells of the alveoli and contain myoepithelial for breast milk Production of mothers postpartum process on the first days after birth..

Effect of Lactobacillus casei on the depressive behavior and the expression of NR1 and NR2A receptors in hippocampus of rats with postpartum depression induced by maternal separation

Objective To investigate the effect of Lactobacillus casei on depressive behavior and the expression of NR1, NR2A receptor in postpartum depression rats induced by maternal separation. Methods Twenty-four Sprague-Dawley female rats were randomly divided into control group(CON group) (n=8), postpartum depression group(PPD group) (n=8), postpartum depression with lactobacillus casei group(PPD+ Lactobacillus casei group) (n=8). Rats of the control group were given no interventions.Rats in PPD group and PPD+ Lactobacillus casei group were given maternal separation to establish depression model.And then the rats in PPD+ Lactobacillus casei group were treated with Lactobacillus casei(8×108CFU/(kg·d)) for 4 weeks after 14 days of maternal separation.The forced swimming test (FST) was employed to detect the depressive behaviors.Lactobacillus, Bifidobacterium, Enterococcus faecalis and Escherichia coli in cecum of rats and the expression of NR1 and NR2A mRNA in hippocampus of rats were detected by real-time fluorescence quantitative PCR. Results Compared with CON group ((157.50±8.13) s), the immobility time of PPD group((200.00±10.35) s) was significantly longer (t=-3.23, P<0.05). Compared with PPD group, the immobility time of PPD+ Lactobacillus casei group ((153.25±7.41) s) was significantly shortened (t=3.67, P<0.05), and the depressive behavior was improved.Compared with CON group, the mRNA expression of Lactobacillus ((1.47±0.08), t=-5.87, P<0.01), Enterococcus faecalis ((1.23±0.08), t=-2.85, P<0.05) and Escherichia coli( (1.33±0.07), t=-4.96, P<0.01) in caecum were significantly increased in PPD group, while that of Bifidobacterium decreased significantly((0.65±0.07), t=5.18, P<0.01). Compared with PPD group, the mRNA expression of Lactobacillus( (1.05±0.05), t=3.67, P<0.01), Enterococcus faecalis ((0.97±0.05), t=2.74, P<0.05) and Escherichia coli ((1.06±0.05), t=3.31, P<0.01) were significantly decreased in PPD+ Lactobacillus casei group, while that of Bifidobacterium increased significantly ((0.98±0.04), t=-4.26, P<0.01). Compared with CON group, the mRNA expression of NR1 receptor ((0.57±0.04), t=9.65, P<0.01) and NR2A receptor ((0.60±0.05), t=8.64, P<0.05) in hippocampus of rats in PPD group were significantly decreased.Compared with PPD group, the expression of NR1 receptor ((1.01±0.05), t=-5.39, P<0.01) and NR2A receptor ((0.98±0.07), t=-3.91, P<0.05) in hippocampus were increased significantly in PPD+ Lactobacillus casei group. Conclusion Lactobacillus casei can improve the depressive behavior of postpartum depression in rats, and improve the intestinal flora, which affect the expression of NR1 and NR2A in hippocampus. Key words: Postpartum depression; Hippocampus; Intestinal flora; Lactobacillus casei; NR1 receptor; NR2A receptor; Rat

Empowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy

Almost 80% of adolescent pregnancies are unplanned, and between 28 and 63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescent mothers with increasing choice for long-acting reversible contraception (LARC) methods in postpartum consultation after a semistructured group intervention involving adolescent mothers. Retrospective observational study conducted at the Universidade Estadual de Campinas, Campinas, state of São Paulo, Brazil, involving new antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraceptive. The data was compared with previous series followed in a period before the implementation of the education group - a historical control group. We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Out of this total, 63% had ever used contraceptive methods before pregnancy, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was intrauterine contraception (IUC) (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%). When comparing the rates before and after the education interventions, there was a 3-fold increase in the use of IUCs. Antenatal and postpartum education have shown a significant increase in the choice for LARC methods among adolescent mothers, with very high acceptability after a period using the method. The educational groups performed during the antenatal care and beyond the gestational period are easy to be applied worldwide with low dependence on funding.

A preliminary study on the acceptability of a brief SMS program for perinatal women.

This study examined the acceptability of the BabyText program, a Spanish and English textmessaging program adapted from a prevention of postpartum depression group intervention. Ten ethnically and racially diverse pregnant and postpartum women (mean age = 31.3, standard deviation = 5.25) recruited from a metropolitan, urban area of the United States received the BabyText program over a 69-day period (between October 2015 and April 2016). Each tip was assessed for the helpfulness of the content, and all women were invited to provide qualitative feedback about the program. Eighteen of the tips received a positive endorsement of helpfulness from 75 to 100 percent of the women, 12 tips received a positive endorsement of helpfulness from 50 percent of the women, and one tip was rated negatively by those who responded. Qualitative feedback described the need to personalize the tips to reflect the characteristics of women such as planned/unplanned pregnancy status, available economic resources, and current psychological distress. Women in this study favored tips that described stress management skills and emphasized caring for the self (vs only the baby). Data from this study are preliminary but add to the growing sentiment that digital tools should continue to be developed and tested, and personalization of intervention content is important to users.

Experiences of Women with Postpartum Depression Participating in a Support Group Led by Mental Health Providers.

The purpose of this study was to explore experiences of women currently with or at high risk for developing postpartum depression (PPD) who were participating in a postpartum support group facilitated by mental health providers. Using a qualitative design, women ≥18 years of age, who had given birth within the past 2 years, and who were currently attending, or had attended the PPD support group within the past year were invited to participate. The women provided demographic data and participated in a semistructured face-to-face interview. Data were analyzed using qualitative content analysis. Seven women between 27 and 38 years of age participated. Most were married and college educated. At time of the interviews, participants were between 5 months and 2 years postpartum and all reported taking antidepressant medications for their symptoms. Qualitative content analysis revealed three overall themes: attendance, impact, and medication adherence, with associated subthemes. Women attending a PPD support group facilitated by mental health providers felt supported, were more likely to disclose their symptoms to other women in the same situation, and were able to share their feelings without fear of judgment. Having concerns about antidepressant medication addressed at each meeting promoted medication adherence. Nurses working with childbearing women should be aware of community support services available for women at risk for developing PPD.

“Being a mom = having all the feels”: social support in a postpartum depression online support group

ABSTRACTPostpartum depression represents one of the most common complications associated with childbirth, with current estimates placing its prevalence between 13% and 19% among recent mothers. Literature suggests severe implications for both mothers and children, and identifies stressful life events, poor marital relationships, lower socioeconomic status, and lack of social support as major predictors of a PPD diagnosis. This study sought to investigate types of social support sought and received by women with PPD. In contrast with previous research, informational support was found to be the most frequently used type of support, followed by emotional support and network/community support. Selective coding revealed two overarching themes in the PPD support group: social construction of motherhood, and social barriers to treatment. The study makes policy recommendations, including suggestions to facilitate women’s access to health care and support both in offline and online settings.

Postpartum Runners: Is There A Difference In Running Kinematics And Kinetics Compared To Controls?

A recent study found that 70% of elite female runners ran during their pregnancy. Most resumed running within 2 months after childbirth. Despite the increased prevalence of running in women before and after childbirth, there is very little research on the physical changes and impairments experienced by these runners. Pregnancy and childbirth lead to well-established unique anatomical and physiological changes that more than likely influence running kinematics (joint excursion) and kinetics (landing forces). No studies have investigated running gait in this population; however, a few studies have reported the presence of pain in this population. PURPOSE: To identify differences in running kinematics and kinetics between postpartum (PP) women and controls. METHODS: Four PP and 4 age-matched women without children (CON) ran on a treadmill at their self-selected speed. All participants were pain-free. Five 5s trials were collected after warm-up. A 3D motion capture system was used to determine hip and knee joint angles. Participants also performed 6 overground running trials. Impact peak and vertical loading rates were calculated from the ground reaction forces during overground running. An independent samples t-test was used to compare the 2 groups. RESULTS: Hip range of motion (CON: 48.63±7.68°; PP: 52.67±4.65°), Knee range of motion (CON: 70.26±10.57°; PP: 78.74±16.70°), peak knee flexion during stance (CON: 43.48±6.40°; PP: 38.47±8.91°), peak impact force normalized to bodyweight (CON: 1.90±0.47; PP: 2.04±0.50), average vertical loading rate (CON: 55.85±15.69 s-1; PP: 55.47±25.60 s-1) were not significantly different between the groups. CONCLUSION: Though there were no significant differences, postpartum runners had greater hip and knee range of motion but lesser peak knee flexion during stance compared to age-matched controls. Further, the PP group had similar vertical loading rates but greater variability in their rate of loading when compared to their age-matched controls. These preliminary findings could indicate that runners two months into postpartum show similar running biomechanics compared to age-matched women who did not have a child. These results could have implications on guidelines for postpartum women returning to running. A larger sample size is required to confirm these findings.

Emergency Department Usage Prior to Pregnancy is Associated With Use Postpartum [30F

INTRODUCTION: Improvement of care during the 90 days postpartum (“4th trimester”) is needed. Fifty percent of women return for their postpartum office visit; 10% use the emergency department (ED). We evaluated what factors might be associated with postpartum ED usage METHODS: This retrospective cohort study from an urban hospital-based clinic compared women who visited the ED within 90 days postpartum (Group 1) to women who did not visit the ED (Group 2). Variables assessed: age, marital status, race, delivery gestational age, parity, ED visits during the year prior to conception. We performed regression analysis to determine independent variables associated with ED usage 90 days postpartum. A P&lt;.05 was significant. IRB approval was obtained for this study. RESULTS: Of 1297 women, there were 190 (14.8%) in Group 1. This group visited the ED 252 times (48.0% for non-emergent diagnoses). Three variables were significant. Group 1 women with cesareans (OR 1.77, 95% CI 1.29-2.42), women who visited the ED in the year prior to conception (OR 2.00, 95% CI 1.45-2.75) and frequent (≥3 visits/year) ED users (OR 2.94, 95% CI 1.84-4.62) were more likely to visit the ED in the 4th trimester versus Group 2. CONCLUSION: We found that women who visit the ED and were frequent users prior to pregnancy are more likely to continue that usage during the postpartum. Understanding risk factors for maternal ED usage is important as initiatives and care plans are developed during pregnancy for preemptive education and postpartum care.

Effectiveness of shortened time interval to postpartum visit in improving postpartum attendance: Design and rationale for a randomized controlled trial

Background/AimsRecent evidence suggests that there are numerous benefits to scheduling postpartum visits as early as 3 weeks post-delivery. However, findings are not conclusive due to methodological limitations. This report discusses the unique aspects of a randomized controlled trial's (RCT) design, intervention, and strategies to maintain participant retention. MethodsThis study was a four-year, prospective, open-label RCT conducted at the Virginia Commonwealth University Medical Center. Women who recently delivered a healthy, full-term baby vaginally, were randomized to receive a 3–4 or 6–8 weeks postpartum appointment and were followed for 18 months. ResultsA total of 364 women participated in this study. A large proportion of women were retained in the study as demonstrated by the high completion rates at the 18-month follow-up interview (Total sample: 87.6%; 3–4 weeks group: 88.0%; 6–8 weeks group: 87.3%). Similarly, high adherence to the protocol-directed postpartum visit schedule was reported in the overall study sample (79.7%), as well as in the 3–4 (70.5%) and 6–8 (90.0%) week postpartum groups. ConclusionThe study design offered unique features which ensured excellent participant completion and adherence rates, despite the presence of hard-to-track women who typically do not return for their postpartum visits.

Postpartum Changes in Microglia Density and Activation in a Rat Model of Superimposed Preeclampsia

Microglia are the primary immune cells of the central nervous system, surveying the microenvironment and responding to cell injury or tissue damage. The Dahl Salt Sensitive (Dahl‐S) rat model of superimposed preeclampsia (PE) has preexisting hypertension and chronic kidney disease and exhibits characteristic symptoms of PE during pregnancy. Preexisting cardiovascular and renal disease increase the risk of superimposed PE, which further increases risk of maternal complications. Recently, we showed that the rat model of placental ischemia (induced preeclampsia) has increased posterior cortical microglia activation 2 months postpartum. However, whether superimposed PE exacerbates postpartum microglia activation is not known. Because the Dahl‐S rat has increased peripheral inflammation (increased circulating TNFα) during pregnancy and exacerbated hypertension and proteinuria with subsequent pregnancies, we hypothesized that the Dahl‐S model has increased microglia activation after two pregnancies. Dahl‐S rats were randomly assigned to virgin (DSV) or postpartum (DSP) groups (n=3 per group). Postpartum rats were mated twice (3 and 5 months of age) and brains were collected at 8 months of age. Posterior cerebrum was cryo‐sectioned and immuno‐stained using ionized calcium binding adapter molecule (Iba1). Microglia density and morphology were analyzed using ImageJ in 3 images per region and averaged per rat. There was no difference in microglia density (number of Iba1+ microglia per image) in the hippocampus (10±2 in DSV vs. 9±1 in DSP) or cortex (7±1 in DSV vs. 7±2 in DSP). DSP rats had higher proportion of hippocampal Type 3 (78% vs. 62% in DSV) and fewer Type 4 (5% vs. 22% in DSV) microglia (p&lt;0.05). DSP had fewer hippocampal amoeboid (activated) microglia and higher cortical ramified (surveying) microglia compared to DSV (Figure). Taken together, history of superimposed preeclampsia symptoms in DSP rats does not induce exacerbated microglia activation suggesting that pregnancy is either protective to the brain or that following damage, microglia fail to activate, contributing to incomplete repair processes. These hypotheses will be tested in future studies. Future studies will also determine cortical and hippocampal cytokine levels and astrocyte activation in the postpartum Dahl‐S rats.Support or Funding InformationNIH R00HL129192, R25HL121042, 5T32HL105324‐09, R01HL134711This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery

ObjectiveTo compare intra- and postoperative surgical complications of opportunistic bilateral total salpingectomy during postpartum permanent contraception procedures in elective and unscheduled cesarean delivery. Study designWe conducted a retrospective cohort study (2010–2017) of women who had postpartum permanent contraception procedures during cesarean delivery, and we collected baseline characteristics, scheduling of delivery (elective versus unscheduled), operative time, estimated blood loss (EBL) and surgical complications (bleeding, iatrogenic injury, infection, anemia and relaparotomy). We classified patients according to contraceptive technique: bilateral total salpingectomy, bilateral partial salpingectomy with or without fimbriae, and other methods. ResultsFive hundred twenty-eight women underwent postpartum permanent contraception procedures, 245 (46.4%) had bilateral total salpingectomy, 239 (45.3%) had bilateral partial salpingectomy, and 48 (8.3%) underwent other methods. We did not find differences in baseline characteristics, operative time and EBL among postpartum permanent contraception groups. Unscheduled cesarean delivery did not influence the choice of postpartum permanent contraception technique (p=.22). Postpartum permanent contraception-related intraoperative bleeding occurred in 1 (0.4%) and 2 (0.9%) patients, respectively, in bilateral total and partial salpingectomy group (p=.23). Postoperative complications were 13 (5.3%) and 6 (2.5%), respectively, in bilateral total and partial salpingectomy groups (p=.11). Subgroup analysis confirmed no differences for intra- and postoperative complications during unscheduled cesarean delivery. We noted a 4.3-min increase in operative time for total salpingectomy after multivariate analysis (p<.01). ConclusionAt maternal request for postpartum permanent contraception during cesarean delivery, bilateral total salpingectomy can be a safe and feasible method even in case of unscheduled cesarean delivery. Implications statementOur results suggest that bilateral total salpingectomy during any cesarean delivery may be an acceptable choice for its higher contraceptive efficacy and risk-reduction effect for ovarian cancer, at the price of a small increase in operative time.

PERIPARTUM CARDIOMYOPATHY IN POSTPARTUM PERIOD IS ASSOCIATED WITH WORST OUTCOMES COMPARED TO ANTEPARTUM PERIOD: A PROPENSITY MATCHED ANALYSIS

Peripartum cardiomyopathy (PPCM) accounts for 11% of maternal deaths in the United States. Data regarding clinical outcomes among antepartum (A-PPCM) and postpartum (P-PPCM) groups remain poorly understood. We queried Nationwide Readmission Database (NRD) from January 2010 to November 2014 using

Rehospitalization of Postpartum Depression and Psychosis After Electroconvulsive Therapy: A Population-Based Study With a Matched Control Group.

ObjectivesElectroconvulsive therapy (ECT) is used in some cases of postpartum depression (PPD) and postpartum psychosis (PPP). The risk of relapse for PPD and PPP after ECT is unknown. This study compared the relapse rate after ECT between women who had been treated for PPD and/or PPP and women who had been treated for depression and/or psychosis outside the postpartum period.MethodsThe Swedish National Quality Register for ECT and the Swedish National Patient Register were used to identify women with PPD and/or PPP who had been treated with ECT within 6 months after delivery. For each case, a control (treated with ECT but not postpartum) patient was also selected. A Kaplan-Meier estimator was used to calculate the relapse rate (defined as rehospitalization or suicide) after ECT. Cox regression was used to identify variables associated with relapse.ResultsA total of 180 patients were included in each group. The proportions of patients who suffered relapse after 6 months, 1 year, and 2 years were 28%, 31%, and 40% for the postpartum group and 39%, 50%, and 55% for the nonpostpartum group. Treatment with benzodiazepines, several previous psychiatric admissions, and the absence of improvement after ECT were associated with relapse.ConclusionsThe risk of relapse after ECT is lower for patients with PPD and/or PPP than for patients outside the postpartum period, but the risk is nonetheless substantial in both groups.

Obstetric Outcomes in Young Women with Breast Cancer: Prior, Postpartum, and Subsequent Pregnancies.

This study aimed to describe obstetric outcomes in a large cohort of young women with breast cancer, considering the chronological relationship of pregnancies with breast cancer diagnosis. From a population-based cohort study of young women with breast cancer from 2004 to 2010, we conducted secondary interviews to obtain detailed obstetric histories. Pregnancies were categorized based on timing of breast cancer diagnosis: prior, postpartum, and subsequent pregnancies after breast cancer diagnosis. A generalized estimated equation model was used to account for correlated data. In this cohort (n = 366), median age at breast cancer diagnosis was 40.1 years, and 84.7% were Caucasian. Tumor type was notable for 25.1% triple negative, and 56.1% had Stage I disease. There were 922 prior pregnancies, 21 with postpartum diagnosis of breast cancer, and 24 pregnancies subsequent to breast cancer diagnosis. Non-live birth outcomes occurred significantly more often in the postpartum group (p-value: 0.001) compared with the other groups, which had higher live birth rates, after adjustment for maternal age, parity, body mass index, and race. Overall, pregnancy outcomes before and after breast cancer diagnosis are reassuring.

Parenteral Versus Oral Iron for Treatment of Iron Deficiency Anaemia During Pregnancy and post-partum: A Systematic Review

The burden of iron deficiency anaemia during pregnancy and post-partum continues to remain high especially in India. Challenges to treatment include gastrointestinal side effects and non compliance to oral iron therapy. Newer parenteral formulations need to be explored as alternatives. Meta-analysis of randomized controlled trials published between years 2011 and 2018 comparing anaemic pregnant and post-partum women treated with intravenous iron sucrose versus oral iron was performed. The primary outcomes were mean maternal haemoglobin, serum ferritin and haematocrit at the end of 1st, 2nd, 4th and 6th weeks and comparison of adverse effects. Eighteen studies including 1633 antenatal women were randomly assigned to intravenous iron sucrose (n = 821) or oral iron [ferrous sulphate, ferrous ascorbate or fumarate] group (n = 812) in ten trials . Another eight studies compared iron sucrose infusion with oral iron in 713 post-partum women who were randomly assigned to intravenous iron sucrose group (n = 351) or oral iron group (n = 362). Cumulative analysis of all the time points indicates that the estimated mean values of Hb in the intravenous iron sucrose and oral iron groups were 10.11g/dl and 9.33g/dl, respectively, in antenatal group, while it was 10.57g/dl and 9.74g/dl in post-partum. The estimated mean ferritin level from first week to six weeks was 63.1μg/l and 28.6μg/l, respectively, in intravenous and oral iron groups. Cumulative estimate of haematocrit in the intravenous sucrose and oral iron over 6weeks showed that the mean values in the respective groups were 30.5% and 29.5% in antenatal and 33.8% and 31.6%, respectively, in post-partum groups. Sensitivity analysis confirmed the reliability and consistency of the results. Oral iron was associated with significant gastrointestinal side effects. There was no significant difference in birthweight between the groups. This meta-analysis demonstrates that intravenous iron sucrose is more effective than oral iron therapy for pregnant and post-partum women with iron deficiency anaemia. It is an effective and safe alternative to address the problem of iron deficiency especially in those who require rapid replacement of iron stores though medical personnel for intravenous administration of drug is required.Trial registration CRD42015024343.

Seeking social support and postpartum depression: A pilot retrospective study of perceived changes

Postpartum depression prevalence rates reach as high as 25% (Gavin, 2006). Negative effects on mothers and children are well established. Although low social support is an important predictor of perinatal depression (Leahy-Warren, McCarthy, and Corcoran, 2012), the value of peer group support remains equivocal and is examined in this pilot study. ObjectiveEvaluations of interventions that focus on social support in real world settings for women experiencing PPD are lacking. In this pilot study we asked how perceived changes over time in three types of social support (significant other, family, and friends) in participants who sought help and attended postpartum peer support groups related to perceived changes in depression over the same time period. DesignRetrospective design and Internet survey. SettingOn-line survey referring to in-person participation in peer support groups for postpartum women. ParticipantsFifty-seven women who attended postpartum peer support groups. MethodsWe investigated how self-reported changes over time in three types of social support (significant other, family, and friends) relate to perceived changes in depression over the same period. Parametric statistical analyses using SPSS 20.0 included Cronbach's alpha tests, paired sample t-tests and Pearson correlational analyses. FindingsSignificant improvement was reported. Pre-post change scores of perceived social support from friends and significant other were significantly correlated to pre-post depression change scores suggesting that social support contributed to a reduction in depression in this sample of postpartum women. Implications for practiceSeeking social support may contribute to a reduction in depression, particularly as it relates to perceived support from friends and significant other. Other variables not measured are discussed.