Postpartum Recovery Research Articles

Improvement in post-partum uterine involution in rats treated with Apios americana.

Apios americana, a plant used as a staple ingredient of native American diets, has various properties, including anti-cancer, anti-hyperglycemic, hypotensive, and anti-inflammatory activity. In Japan, Apios is used as a post-natal medication. After parturition, women undergo a period of recovery as they return to pre-pregnancy conditions. However, few health products that aid post-partum recovery are on the market. We explored whether Apios can accelerate the post-partum recovery process, in particular the involution of the uterus. Female rats kept in individual cages were mated with two male rats, with the exception of the control group (female rats without mating, on basal diet; n=6). After delivery, rats were divided into five groups based on their diet: basal diet (model; n=6); basal diet+oral intake at 5.4 g/kg of Chanfukang granules (a Chinese patent medicine preparation for post-partum lochia) (positive; n=6); basal diet containing 10% Apios powder (low; n=6); basal diet containing 20% Apios powder (medium; n=6); basal diet containing 40% Apios powder (high; n=6). Five days later, uteri and spleens were weighed. Uterus and spleen indices for each rat were calculated by dividing visceral weight by the total weight. Hormone and cytokine concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Histological analysis of uteri was completed using hematoxylin and eosin (H&E) staining. Expression of matrix metalloproteinases and inhibitors in uteri was measured by western blotting. Our results showed that Apios treatment reduced the post-partum uterus index and regulated the hormone concentrations. Moreover, we found that the process of uterine involution was accelerated, based on morphological changes in the uterus. In addition, our results indicated that Apios alleviated the inflammatory response induced by the involution process. Transforming growth factor β was also found to be regulated by Apios. There were significant downregulation of matrix metalloproteinases and upregulation of their inhibitors by Apios, which suggested that Apios increased the rate of the collagen clearance process. These results, based on experimental observations at the molecular and protein levels, verified our hypothesis that Apios can improve uterine involution, and demonstrated the potential application of Apios in post-partum care.

A study protocol of mobile phone app-based cognitive behaviour training for the prevention of postpartum depression among high-risk mothers

BackgroundThe changes in China’s family planning policy in recent years have led to changes in the age structure of pregnant women, and the prevalence of postpartum depression (PPD) is also on the rise. Cognitive Behaviour Training (CBT) as an effective intervention is widely used for postpartum depression. However, the shortage and health disparities of mental health resources, the stigma of postpartum depression in postpartum women and the need for postpartum recovery and child care prevent postpartum women from seeking traditional face-to-face CBT. Therefore, the purpose of this proposed study is to examine the effect of mobile phone applications (App) based CBT on postpartum depression, anxiety, pressure and parenting sense of competence.MethodsA double blind, randomized controlled trial will be used in this study to examine the effectiveness of App-based CBT in reducing the prevalence of postpartum depression compared with usual postpartum care in China. A total of 120 participants will be recruited in this study. The intervention consists of a weekly theme module app for continuous six weeks, each module including learning content and assignments. The control group received usual postpartum care content through the App. Outcome measures include postpartum depression, anxiety, pressure and parenting sense of competence at 0-, 3- and 6-month after the intervention.DiscussionIf our intervention is effective, it will provide a time-friendly and unrestricted intervention for the psychological care of perinatal women, which can effectively solve the shortage and unevenness of mental health resources.Trial registrationChinese Clinical Trial Registry, ChiCTR1900020735. Registered 15 January 2019.

Efficacy of Postpartum Furosemide Therapy on Blood Pressure Recovery in Patients with Severe Preeclampsia: A Randomized Clinical Trial

Background: Hypertensive disorders are an important cause of maternal mortality and morbidity, and severe preeclampsia is the most common cause [Baha M. Sibia, AJOG (2012)]. The blood pressure rises progressively during the first 5 days after delivery, and it is due to mobilization of 6-8 liters of liquid, and 950 meq of accumulated sodium,from interstitial and extravascular space to intravascular space[Davison JM and Dunlop W, Seminars in Nephrology,4:198–207 (1984)].Severe rising of blood pressure may lead to complications, such as renal failure, pulmonary edema, eclampsia, intracranial hemorrhage, stroke, coma and death [Baha M. Sibia, AJOG (2012)].Therefore, postpartum anti-hypertensive therapy can prevent these complications and diminishes maternal mortality and morbidity rate.
 Objective: This investigation was done to evaluate whether a short course of postpartum furosemide therapy in patients with severe preeclampsia accelerates blood pressure recovery, reduces antihypertensive drugs usage, prevents complications such as eclampsia and finally diminishes hospitalization.
 Study design: In a randomized clinical trial, 90 patients with severe preeclampsia participated. After spontaneous onset of diuresis and discontinuation of sulfate magnesium, patients were randomly allocated to receive either no therapy or 20 mg oral furosemide daily for five days with oral potassium supplementation. Postpartum blood pressure, the need for antihypertensive therapy, rate of complications and duration of hospitalization between treatment and control groups were compared.
 Results: Mean systolic blood pressure on the third day after delivery was not different significantly between treatment and control groups(127.9±10.2 compared with 130 ± 11.5 mm-Hg, P=0.36). Mean diastolic blood pressure on the third day after delivery was not different between two groups. Patients in treatment group required less antihypertensive therapy during hospitalization (26.7% compared with 33.3%, P=0.64) but the difference was not significant. Eclampsia occurred in two patients in control group and not occurred in treatment group. Duration of hospitalization was not affected by the intervention.
 Conclusion: Brief postpartum furosemide therapy in patients with severe preeclampsia may not be effective in postpartum blood pressure recovery and reducing the need for antihypertensive therapy. It may be useful to prevent complications such as eclampsia. Duration of hospitalization was not affected by the intervention.
 Bangladesh Journal of Medical Science Vol.18(3) 2019 p.636-640

Breastfeeding and pelvic floor disorders one to two decades after vaginal delivery

Postpartum recovery from pelvic floor trauma associated with vaginal delivery may be impaired by the transient hypoestrogenic state associated with breastfeeding. The aim of our study was to examine the association between exclusive breastfeeding and pelvic floor disorders 1-2 decades after the first vaginal delivery. We hypothesize that compared with women who did not breastfeed following vaginal delivery, women who breastfeed would have a higher proportion of pelvic floor disorders s, and those women who practiced sustained exclusive/unsupplemented breastfeeding would have the highest proportion. This is a secondary analysis of the Mothers' Outcomes After Delivery study, a prospective cohort study of pelvic floor disorders after childbirth. Participants were recruited 5-10 years after their first delivery and followed up annually for up to 9 years. This analysis focused on participants who experienced at least 1 vaginal delivery. Each participant completed a self-administered questionnaire regarding breastfeeding. Based on questionnaire responses, breastfeeding status was classified into 3 ordinal categories: unexposed (did not breastfeed or breastfed <1 week); limited exclusive breastfeeding (breastfed without supplementation for ≥1 week but <12 weeks); and sustained exclusive breastfeeding (unsupplemented breastfeeding ≥12 weeks). Our primary outcomes of interest were the proportions of stress urinary incontinence, anal incontinence, and pelvic organ prolapse. The outcomes of interest were defined using the Epidemiology of Prolapse and Incontinence Questionnaire and the Pelvic Organ Prolapse Quantification Examination at enrollment and annually for up to 9 years thereafter. Additionally, a subanalysis examined the relationship between breastfeeding and anal incontinence in an obstetric anal sphincter injury-specific population. Generalized estimating equations were utilized to determine the relationship between breastfeeding and the outcomes of interest. Among 705 women, 189 (27%) were classified as unexposed, 145 (20%) were categorized as limited exclusive breastfeeding, and the remaining 371 women (53%) met our definition of sustained exclusive breastfeeding. Median follow-up was 5 years, contributing to a total of 3079 person years. The proportion of each pelvic floor disorder, based on 3079 person-years of follow-up was: stress urinary incontinence (27%), pelvic organ prolapse (20%), or anal incontinence (25%). Using generalized estimating equations adjusting for race, education, parity, and body mass index, sustained exclusive breastfeeding was not significantly associated with stress urinary incontinence (adjusted odds ratio, 0.82, 95% confidence interval, 0.55-1.23), pelvic organ prolapse (adjusted odds ratio, 0.78, 95% confidence interval, 0.49-1.26), and anal incontinence (adjusted odds ratio, 0.67, 95% confidence interval, 0.44-1.00). Regarding our obstetric anal sphincter injury subanalysis, 123 women within our cohort experienced obstetric anal sphincter injuries at delivery. Anal incontinence was reported in 32% of these women. However, there was no observed relationship between breastfeeding and the development of anal incontinence during study follow-up in this population. Breastfeeding after vaginal childbirth was not associated with the development of stress urinary incontinence, pelvic organ prolapse, or anal incontinence 1-2 decades after the first vaginal delivery.

Osteopathic Manipulative Medicine Consultations for Hospitalized Patients.

Although osteopathic manipulative treatment (OMT) is predominantly known for its benefits in improving musculoskeletal pain, many studies have examined the effects of OMT on hospitalized patients with a variety of conditions, showing improved outcomes in conditions such as pneumonia, postoperative and postpartum recovery, preterm newborn recovery, and newborn feeding dysfunction. To determine the reasons osteopathic manipulative medicine (OMM) consultations are being ordered at a tertiary care teaching hospital. This descriptive study was conducted at an academic medical center with a well-established electronic health record system. A retrospective review examined data on all OMM consultations between January 1, 2015, and June 30, 2015. Reasons for consultations in a free text field were grouped into categories of "primary reason for consult" by a single reviewer. Demographics and patient location were also assessed. Of 1310 total consultations included in the study, 620 (47.0%) listed a musculoskeletal complaint as the primary or only reason for a consultation, 231 (18.0%) of which were for back pain, followed by neck pain (69 [5.0%]) and headache (46 [4.0%]). The next most common reason for consultation was for newborn feeding difficulty (352 [27.0%]) or other newborn consultation (66 [5.0%]). A total of 272 consultations (21.0%) were not limited to musculoskeletal complaints and included general nonspecific discomfort (96 [7.0%]) or respiratory complaint (53 [4.0%]). A total of 209 (16.0%) consultations noted patients to be postoperative; 124 (9.5%) to be postpartum; 57 (4.4%) to have cystic fibrosis; and 21 (1.6%) to have constipation. The majority of inpatient OMM consultations were placed for musculoskeletal complaints, followed by newborn feeding problems. Although it is clear that some physicians think that OMT will help their patients for the aforementioned conditions, the number was still quite low, suggesting that many physicians may be unaware that OMT can help patients with conditions such as respiratory disorder, postoperative recovery, and constipation. There are many opportunities for treatment teams to be ordering OMM consultations as a way to reduce morbidity in their patients.

SAT-485 Transient Vision Loss Due to Physiologic Pituitary Enlargement during Normal Pregnancy

Background: It is well know that the pituitary gland can naturally enlarge during a normal pregnancy due to hyperplasia of lactotroph cells. However, vision loss during pregnancy due to enlargement of the pituitary gland is extremly rare. Case Report: A 23 year old, gravida 10, para 1-0-8-1, female with a history of , Ehlers-Danlos, PCOS, , status post C-section at 38 and 0/7 weeks presented to the hospital with transient loss of left sided vision for 30 minutes, which then fully resolved. She denies any previous complaints of vision loss prior to pregnancy. . The patient denied any headache, problems swallowing, history of ophthalmoplegia difficulties with speech, vertigo, lightheadedness, or any focal weakness, numbness, or tingling in her arms or legs. She reported a similar event happening the month prior while pregnant and MRI of the brain without contrast at that time showed an enlargement of the pituitary gland. Series of subsequent imaging showed no evidence of dural venous sinus thrombosis, an unremarkable intracranial and neck MRA, but was positive for diffuse pituitary gland enlargement measuring approximately 1.1 x 1.0 cm. The pituitary gland was seen extending cephalad above the sella turcica contacting the left side of the optic chiasm similar appearance compared to the MRI one month prior. The patient returned to baseline and was advised to follow up with outpatient ophthalmology for visual field testing. Interpretaion : During pregnancy, the normal pituitary gland enlarges considerably, due to the estrogen-stimulated lactotroph hyperplasia; on magnetic resonance imaging (MRI) scans the peak size of up to 12 mm occurs in the first few days Postpartum.Differential diagnosis of pituitary enlargement during pregnancy can be difficult since MRI is not specific to each condition. Pituitary adenoma can be ruled out due to the quick recovery postpartum and the patient’s lack of other symptoms. Prolactinoma can be determined by finding elevated prolactin levels during pregnancy, which is common. Granulomatous hypophysitis due to sarcoidosis and lymphocytic hypophysitis can be ruled out due to the patient’s negative history for autoimmune diseases. Definitive diagnosis of this patient would be to undergo neurosurgical procedure, which would not be reasonable in this case since visual loss was mild and the patient returned to baseline. Management of conscious patient with mild visual disturbances is still debatable. Some investigators argue early surgical intervention to prevent permanent visual loss and/or preserve pituitary function.patient follow up MRI post Pregnancy showed decrease in size of the enlarged pituitary gland Conclusion: Physiologic enlargement of Pituitary sholud be included in differential diagnosis of Transient Visual loss during late pregnancy . 1. Loss of vision due to a physiologic pituitary enlargement during normal pregnancy. Clin Exp Opthalmol 245: 1049-1051

Effect of progressive muscle relaxation training on the psychological status, compliance and delivery outcomes of primiparas

Objective To explore the effect of progressive muscle relaxation training on the psychological status, compliance and delivery outcomes of primipara. Methods From January 2016 to December 2017, 224 primiparas who delivered at Taizhou Municipal Hospital were divided into control group and observation group according to the random number table method, with 112 cases in each group. The control group was given routine treatment, and the observation group was given gradual muscle relaxation training based on the control group. The depression and anxiety scores before and after treatment in the two groups were evaluated. The compliance of mothers to the doctors' choice of delivery methods was investigated, and the delivery outcomes and postpartum recovery status were analyzed. Results The scores of depression and anxiety in the observation group were significantly lower than those in the control group(all P<0.05). The compliance with the doctors' choice of delivery mode in the observation group was 95.53%(107/112), which was significantly higher than that in the control group[87.50%(98/112)](χ2=4.658, P=0.030). The normal delivery rate of the observation group was 91.07%(102/112), which was significantly higher than that of the control group[80.35%(90/112)](χ2=5.250, P=0.021). The total labor of spontaneous delivery in the observation group was significantly shorter than that in the control group, the bleeding volume at 2 hours after delivery in the observation group was obviously less than that in the control group, the postpartum hospital stay in the observation group was significantly shorter than that in the control group, the differences were statistically significant(all P<0.05). The scores of postpartum maternal pain, libido, vaginal resistance, and vaginal lubrication in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion Application of progressive muscle relaxation training in primiparas can reduce the negative emotions, better coordinate with medical personnel, enhance rational choice, better improve pregnancy outcome, promote postpartum recovery, and improve postpartum sexual life quality. Key words: Maternal health services; Progressive muscle relaxation training; Depression; Anxiety; Pregnancy outcome; Compliance; Quality of life

Fatiguing Trunk Flexor Exercise Decreases Pain Sensitivity in Postpartum Women.

BackgroundLow back pain (LBP) is common in the general population and among postpartum women. Abdominal muscle exercise is often used to treat LBP, but it is unknown if fatiguing abdominal muscle exercise can produce exercise-induced hypoalgesia (EIH).ObjectivesTo assess pressure pain thresholds (PPTs) at rest and following fatiguing trunk flexor exercise (EIH) in (1) nulligravid and postpartum women to evaluate the impact of pregnancy and childbirth and (2) nulligravid women and men to examine sex differences.MethodsSeventy healthy adults (31 postpartum women, 23 nulligravid women, 16 men) participated. Postpartum and nulligravid women were tested twice (16–18 weeks apart) to identify changes in EIH with postpartum recovery. PPTs were measured at the nailbed and superior rectus abdominis before and after exercise to investigate systemic and local EIH, respectively. Rectus abdominis muscle thickness was assessed with ultrasound.ResultsPostpartum women reported lower PPTs than nulligravid women at the abdomen (p < 0.05) whereas postpartum women had lower PPTs at the nailbed during the first session only. Men reported higher nailbed PPTs (p = 0.047) and similar PPTs at the abdomen than women (p = 0.294). All groups demonstrated EIH at the abdomen (p < 0.05). Systemic EIH was absent in postpartum and nulligravid women (p > 0.05), while men demonstrated hyperalgesia. Local EIH was positively associated with muscle thickness for men and women, which was not significant at the second timepoint.LimitationsAcute exercise response may not reflect changes that occur with exercise training.ConclusionFatiguing trunk flexor exercise produced local EIH for all groups including postpartum and nulligravid women. Clinically, trunk exercises may be useful for acute pain relief for clinical populations that are characterized by pain and/or weakness in the abdominal region muscles in populations with abdominal pain syndromes.

Drugs in lactation.

Although most medications can be taken safely during breastfeeding, potential risks of infant toxicity do exist because all medications will be excreted into the breast milk to some extent. The amount of medication excreted in the milk depends mainly on (i) within-drug variation, such as dosing; (ii) between-drug variation including chemical characteristics of the medication; and (iii) host factors, such as maternal pharmacokinetics (PK), including variations of pregnancy-associated changes and their post-partum recovery. Neonatal drug exposure is usually assessed by calculating an expected total infant daily dose through breast milk and comparing it to the normal therapeutic dose. However, clinical PK studies in this population are challenging to conduct. Recently, research methods using population PK analyses and physiologically-based PK modeling and simulation techniques have been recognized as a complementary approach to the conventional PK studies in this field. These efforts are important for rational risk assessment balancing the toxicity risk against the benefits of human milk. Health benefits of lactation for both mother and child are significant and a decision to withhold from this should not be taken lightly. In case limited information is present, additional expertise from pharmacists or clinical pharmacologist with expertise in this area should be sought.

Comparative anti-osteoporotic properties of the leaves and roots of Marantodes pumilum var. alata in postmenopausal rat model

BackgroundMarantodes pumilum var. alata (MPva), popularly known as Kacip Fatimah, is widely used to maintain female reproductive health, facilitate post-partum recovery and manage symptoms of menopause and osteoporosis in South-East Asia. This study aims to further evaluate the osteoprotective potential of MPva in view of reports of its bone-protective properties in postmenopausal condition. MethodsThirty female Sprague-Dawley rats were sorted into 5 groups (n = 6) namely: MPv (leaf treatment); MPr (root treatment); ERT (estrogen treatment); OVXC (untreated ovariectomized control) and Sham (untreated sham-operated control). All rats (except the Sham) were ovariectomized to induce a state of estrogen deficiency that simulates menopause. Two weeks after ovariectomy, the rats were treated for 8 weeks with oral gavages of estrogen and plant extracts. The ERT group received 64.5 μg/kg/day dose of estrogen while MPv and MPr groups received 20 mg/kg/day dose of leaf and root extracts, respectively. At the end of treatment, left femora were excised from euthanized rats and investigated for changes in bone micro-architecture, mineral density, and biomechanical properties. ResultsBone volume fraction, degree of anisotropy and structure-model-index of bone were significantly improved (p < 0.05) in the MPv group compared to OVXC. Breaking force and maximum stress of bone were also significantly higher (p < 0.05) in the MPv group compared to the OVXC. ConclusionTreatment with MPva leaf protected bone microarchitecture and density against osteoporosis-related changes in postmenopausal rats. Similar to estrogen, the protective effects of MPva leaf translated into better-enhanced bone mechanical properties compared to the root treatment.

Telerehabilitation for Treating Pelvic Floor Dysfunction: A Case Series of 3 Patients' Experiences

Background: Pelvic floor dysfunctions (PFD) affect women, men, and children globally. While physical therapy (PT) has been shown to improve PFDs, overall access to PT is limited because of provider shortage and expertise. We hypothesize telerehabilitation (TR) is a novel approach to address access and expertise care for PFD. Study Design: Case series. Case Descriptions: Three pelvic health patients (1 male and 2 females) volunteered to receive initial and follow-up care via TR. The male patient was treated for premature ejaculation, and the female patients were seen for postpartum recovery, stress urinary incontinence, and diastasis recti. A total of 9 visits were completed. Outcomes: Using a HIPAA-compliant, cloud-based, synchronous mobile app, a 14-question survey, and the Premature Ejaculation Diagnostic Tool (for the male health participant), participants rated their experience with TR. The 3 participants rated the TR system as high quality (2/3) and very high quality (1/3). Using a mobile phone was the preferred digital device (2/3) compared with laptop use. All 3 participants felt their needs were met and that they received good care during the session. Summary: Telerehabilitation has the potential to deliver quality care with improved access for patients with PFD for both initial and follow-up visits. This case series presents 3 patients' perceptions of using TR for pelvic health PT care.

Effect of prenatal calcium supplementation on bone during pregnancy and 1 y postpartum

Low calcium intake during pregnancy may cause maternal skeletal calcium mobilization to meet fetal needs. The Recommended Dietary Allowance (RDA) for calcium in nonpregnant, pregnant, or lactating women aged 19-50 y is 1000 mg/d; most women in the United States report consuming 60-80% of the calcium RDA. An insufficient calcium intake could increase maternal bone loss during pregnancy and reduce bone recovery postpartum. The aim of this study was to determine the effect of maternal calcium supplementation on peripheral cortical and trabecular bone loss during pregnancy and bone gain postpartum. A total of 64 women were enrolled in the study at 16 wk of gestation and randomly assigned to receive 1000 mg Ca/d or placebo for the remainder of the pregnancy. Measurements were performed at 16, 26, and 36 wk of pregnancy and at 4 and 12 mo postpartum for serum 25-hydroxyvitamin D and markers of bone turnover. Trabecular and cortical bone mineral density (BMD) and content were assessed at the tibia and radius by peripheral quantitative computed tomography. Mean±SD daily calcium intake at baseline was 733±350 mg; only 25% of the women met the RDA. Thirty women (47% of those enrolled) remained in the study at 12 mo postpartum. After controlling for baseline bone value, serum 25-hydroxyvitamin D concentrations, length of breastfeeding, and body mass index, the calcium group had significantly greater increases in radial total BMD (P=0.02) and tibial cortical BMD (P=0.03) at 12 mo postpartum than the placebo group. Trabecular and total BMD at the tibia trended toward higher values (P<0.06) in the calcium group than in the placebo group in the same models. These data show that supplemental calcium provided during pregnancy may improve bone recovery postpartum in women consuming a typical US diet. A larger study is warranted to solidify the conclusions. This trial was registered at clinicaltrials.gov as NCT01145573.

475: Postpartum cervical insufficiency - a novel cause or consequence of preterm birth?

A short cervix is a risk factor for preterm delivery (PTD). Cervical recuperation postpartum however, is still an enigma. We aimed to establish the normal cervical recovery postpartum and investigate differences in cervical recuperation regarding term vs PTD, the influence of parity, mode of delivery and cervical manipulations. The study was conducted between June 2016 to June 2018. Following informed consent, trans-vaginal cervical length (CL) measurements were performed by a single observer (R.L) at 8, 24 and 48 hours postpartum. CL at the second trimester, prophylactic progesterone, demographic characteristics, obstetric history, parity, delivery outcomes, previous cervical manipulations and induction mode, were obtained from the patient's’ medical records. Our cohort included 714 women. The average CL, 48 hours postpartum, following term deliveries was 35.2± 3.5 mm. Parity: The most rapid cervical recovery was demonstrated following the 2nd delivery (39.7±2.5 mm). A significant delay in cervical recovery was observed from the 4th delivery and above (27.8±2.7 mm; p=0.013) (Fig 1A). Preterm delivery: Women delivered before 34 weeks of gestational (n=119) demonstrated an abnormal cervical recovery when compared to deliveries between 34-37 (n=97) weeks and term deliveries (n=498) (17.2±1.9 mm vs 32.4±3.6 mm vs 35.2±3.5 mm respectively P<0.0001) (Fig 1B). No differences were demonstrated between the groups regarding demographic characteristics and CL at midtrimester. Mode of induction: 156 patients underwent medical induction (Dinoprostone or Pitocin) and 88 underwent mechanical induction by cervical ripening balloon (CRB). Abnormal cervical recovery was demonstrated in the CRB group (26.3±1.9 mm vs. 35.2±2.7 mm respectively P=0.012) (Fig 1C). This study gives a novel insight regarding cervical recuperation postpartum. Nomograms of postpartum cervical recovery have been firstly established. Early spontaneous PTD is associated with pathological cervical recovery which might imply “true” cervical insufficiency. Increased parity and mechanical inductions may cause damage to the cervix Although the clinical implications of delayed postpartum cervical recuperation has not been elucidated, it might imply future cervical insufficiency and possible increased risk of preterm birth.

982: Arrest of descent- “The descent in cervical recovery postpartum after emergent C-Section”

Cervical recuperation postpartum remains a mystery. Cervical length (CL) returns to normal during the puerperium. Recent studies have demonstrated that emergent C-Section (CS) with full dilatation increases the risk for preterm birth in the following pregnancy. We aimed to investigate differences in cervical recuperation between spontaneous term vaginal deliveries and emergent CS at full dilatation. The study was conducted between 2016-2018. Following informed consent, CL measurements were performed for primipara women following emergent CS and spontaneous term deliveries. Women undergoing elective CS or emergent CS without full dilatation were excluded. All measurements were conducted trans-vaginally by a single observer (R.L) at 8, 24 and 48 hours postpartum. All relevant demographic and medical characteristics, were obtained from the patients’ medical records. Our cohort included 292 patients of whom, 38 patients underwent emergent CS at full dilatation. The indications for CS included arrest of descent (25 patients) and non-reassuring fetal heart rate (13 patients). The mean length of the 2nd stage of labor was 3.8±0.4 hrs and 1.3±0.5 hrs in the arrest of descent group and the non- reassuring fetal heart rate group, respectively. Significant pathological cervical recuperation was demonstrated following emergent CS due to arrest of descent compared to emergent CS due to non-reassuring fetal heart rate and spontaneous vaginal deliveries (27.4±2.5 mm vs. 30.4±1.6 mm vs. 35.2±3.5 mm P=0.018 respectively). (Fig 1). Emergent CS, especially due to prolonged 2nd stage, has a clear effect on cervical recuperation postpartum. Though the clinical significance of abnormal cervical recovery is yet unknown, it might imply for long term damage to the cervix. Our findings reinforce the results of recent studies which demonstrated a significant correlation between emergent CS and future preterm delivery.

Nutritional evaluation and productivity of supplemented sheep grazing in semiarid rangeland of northeastern Brazil.

Sheep production systems in Brazilian caatinga rangelands require supplementation adapted to changes in floristic and chemical composition as dry seasons progress. Meeting sheep nutritional needs in extensive semiarid systems is challenging because of sheep dietary preferences and habits. The objective of this trial was to evaluate the substitutive effect of concentrate supplementation on grazing sheep in the Brazilian caatinga rangeland and its consequences on performance in different seasons. The trial was conducted from March to August 2013 at Embrapa Goat and Sheep in Sobral, Ceará State, Brazil. Thirty-two Brazilian Somali multiparous ewes were submitted to estrus synchronization and controlled breeding. At the start of the trial, ewes averaged 30.45 + 2.60kg body weight (BW). Ewes were divided into four groups and individually offered 0, 200, 350, or 500g supplement head-1 day-1. Intake prediction and digestibility trials were evaluated at three periods: rainy season (April), transition rainy-dry (June), and dry season (August). Sheep weights were taken every 14days to measure their performance from late gestation until weaning. Ewe BW and body condition score changes were determined too. Lamb BW changes were also measured every 14days from birth through weaning. A completely randomized design with split plot arrangement using eight replications was used for intake and digestibility measurements. The differences between supplement offered (0, 200, 350, and 500g sheep-1) and season (rainy, transition rainy-dry, and dry) were submitted to analyses of variance and multiple means were separated, where differences were detected, using the Tukey's test. During lactation up through weaning, ewes supplemented at 500gday-1 had greater BW than ewes without supplement. Ewes supplemented with 200g concentrate head-1 day-1 had 9.1% greater (P ≤ 0.05) BW at weaning and their lambs had 19.7% greater birth and 16.6% heavier wean BW despite lower dry matter intake compared to unsupplemented animals. Supplementation with 200g concentrate increased carrying capacity by 28.8% during the dry season and by 20.5% during the rainy season. This study confirmed that in the dry season, when quality of rangeland forages decreases, supplementation contributes to greater DMI, improves postpartum and lactation BW recovery of ewes, and contributes to greater lamb birth and wean weights. Moreover, supplementation leads to feed substitution effects that may increase rangeland resilience by mitigating overgrazing. Supplementation with 200g concentrate can also prevent negative energy balance for grazing animals, improving longer postnatal recovery, longer intervals between parturitions, fewer double and is necessary to ensure a better BW at birth to lambs.

Effects of continuous epidural analgesia during labor on the early postpartum recovery of pelvic floor function

Objective To explore the effect of continuous epidural analgesia on the early postpartum recovery of pelvic floor function. Methods This retrospective analysis involves two hundred cases of maternal deliveries in our hospital, including 57 cases received continuous epidural analgesia and 143 cases did not. The pelvic floor muscle strength, fatigue and myoelectric value, pelvic and abdomen dynamics, POP-Q stage assessment of pelvic organ prolapse, and pelvic floor dysfunction were compared between the two groups 6 post partum. Results Postpartum pelvic floor muscle strength was significantly higher in cases received epidural analgesia than in those did not received analgesia. Muscle fatigue of maternal Ⅰ and Ⅱ fibers in the analgesia group was significantly worse than that in the non-analgesic group (P<0.05). The pelvic floor muscle electrical values of maternal Ⅰ fibers in the analgesia group were higher than those of the non-analgesia group (P<0.05). Compared with non-analgesia group, analgesia group showed significantly lower incidence of abnormality in vaginal dynamic pressure, pelvic floor muscle static tension, pelvic floor contraction, maternal pelvic organ prolapse, and pelvic floor function (P<0.05). Conclusions Continuous epidural anesthesia during labor has a positive impact on the early postpartum recovery of pelvic floor function. Key words: Epidural analgesia; Primipara; Pelvic floor function

Early life environment influences the trajectory of post-partum weight loss in adult female rats.

Research questionThe physiological processes of pregnancy and lactation require profound changes in maternal metabolism and energy balance. The timescale of metabolic reversion after pregnancy, in particular post-partum weight loss, is highly variable between individuals. Currently, mechanisms influencing post-partum metabolic recovery are not well understood. The hypothesis tested here is that, in common with other metabolic and obesity-related outcomes, capacity for post-partum weight loss is influenced by developmental programming.DesignAdult female Wistar rats exposed to a maternal low-protein diet in utero then weaned onto a control diet post-natally (recuperated group) were compared with controls. Adult females from both groups underwent pregnancy at 3 months of age. Weight changes and metabolic parameters during pregnancy and lactation were compared between control and recuperated groups, and also with non-pregnant littermates.ResultsPregnancy weight gain was not different between the control and recuperated groups, but post-partum recuperated animals remained significantly heavier than both post-partum control animals (P<0.05) and their non-pregnant recuperated littermates (P<0.05) at the end of lactation. Post-partum recuperated animals had more intra-abdominal fat mass (P<0.05) and higher serum triglyceride concentrations (P<0.01) than controls. Post-partum recuperated animals also had increased expression of IL6, NRF2 and ALOX12 (key regulators of inflammation and lipoxygenase activity) in the intra-abdominal adipose tissue compared with control groups.ConclusionsMothers who themselves have been exposed to adverse early life environments are likely to have slower metabolic recovery from pregnancy than controls. Failure to return to pre-pregnancy weight after delivery predisposes to persisting sequential inter-pregnancy weight gain, which can represent a significant metabolic burden across a life course involving several pregnancies.

Prediction of Outliers in Pain, Analgesia Requirement, and Recovery of Function After Childbirth: A Prospective Observational Cohort Study

(Br J Anaesth. 2018;121:417–426) Most women report opioid-free functional recovery ∼3 to 4 weeks after childbirth. However, a minority of women report severe pain and remain on opioids for a prolonged period after childbirth, which has potential for long-term harm. There is limited information available to predict which women will have poor recovery or require opioids for a protracted period. Consequently, the authors of the present study identified demographic, obstetrical, and psychological factors associated with parturients who are likely to have a difficult postpartum recovery with respect to pain, opioid use, and recovery of function.

Percepção de dor no parto normal em gestantes

A gestação é um período em que o corpo feminino sofre variadas alterações, sendo elas físicas e psíquicas. O parto é um evento que desperta nos gestantes sentimentos de angústia, medo, ansiedade e dor. O presente artigo foi realizado através de um levantamento bibliográfico realizado por meio de uma revisão de literatura de caráter qualitativo, considerando a relevância do tema. Notou-se uma grande rejeição por parte das mulheres em optarem pelo parto normal, devido às dores sentidas no trabalho de parto e no parto. Porém, perceberam-se também pontos relevantes na optação pelo parto normal; ele traz benefícios para a mãe e para o bebê, pois minimiza os riscos para a saúde de ambos os envolvidos em gestações de baixo risco, além de o parto natural ser recomendado pela Organização Mundial de Saúde (OMS). Notou-se, com esta pesquisa, que a fisioterapia pode auxiliar para a qualidade do trabalho de parto, facilitando em todas as suas fases, com técnicas que podem ajudar aliviando a dor, permitindo que a parturiente tenha melhor consciência corporal, prevenindo lesões no assoalho pélvico, e auxiliando na recuperação no pós-parto. É papel do fisioterapeuta esclarecer às gestantes quanto aos tipos de parto e todas as possibilidades existentes. Percebeu-se também que o fisioterapeuta pode ser especializado em saúde da mulher, trabalhando com gestantes, auxiliando e orientando para que a mesma estimule a potencialidade do seu corpo no trabalho de parto e parto prevenindo complicações. A abordagem fisioterapêutica terá resultados benéficos sobre o bem-estar da gestante, ajudando e prevenindo maiores lesões na musculatura do assoalho pélvico nos partos normais.

Intermittent aortic balloon occlusion combined with cesarean section for the treatment of patients with placenta previa complicated by placenta accreta: A retrospective study.

To compare the efficacy of cesarean section (CS) combined with intermittent aortic balloon occlusion with that of CS alone for treating patients with placenta previa complicated by placenta accreta. Forty-five patients with placenta previa complicated by placenta accreta who underwent CS were retrospectively studied. Twenty-two patients had undergone CS combined with intermittent aortic balloon occlusion (combination group) and 23 patients received conventional hemostatic support only (control group). The postpartum hemorrhage, transfusion requirements, operation time and recovery time, and the ability to preserve the uterus and fertility were analyzed. Intermittent aortic balloon occlusion significantly decreased the volume of blood loss in the combination group relative to the control group (597 ± 359 mL vs 2687 ± 575 mL; P < 0.001), and transfusion requirements were also reduced (498 ±195 mL vs 2390 ±789 mL; P <0.001). We observed shorter operation time in the combination group relative to the control group (63.8 ± 12.3 min vs 118.8 ± 22.4 min; P < 0.001), and fewer patients required uterine cavity stuffing followed by uterine artery embolization (n = 2 vs n = 10; P <0.05), uterine artery ligation (n = 1 vs n = 9; P < 0.05), and hysterectomy (n = 0 vs n =7; P < 0.05). Intermittent aortic balloon occlusion may control postpartum hemorrhage in pregnancies complicated by placenta accreta, and improve the postoperative conditions.