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Composition of colostrum from dairy heifers exposed to high air temperatures during late pregnancy and the early postpartum period.

This study examined the effects of heat stress on composition of colostrum from primiparous cows during late pregnancy and the early postpartum period. Two groups of 6 Holstein heifers were utilized. During the last 3 wk of pregnancy and during the first 36 h after calving, one group was exposed to thermal comfort (temperature-humidity index = 65); the other group was exposed to high air temperatures (temperature-humidity index = 82 from 0900 to 2000 h and temperature-humidity index = 76 from 2100 to 0800 h). Heifers under heat stress had higher rectal temperatures and respiratory rates; lower plasma triiodothyronine and glucose; higher plasma nonesterified fatty acids and beta-hydroxybutyrate; lower intakes of dry matter, net energy for lactation, and crude protein; higher water intakes; and lower body condition scores. The decline of plasma immunoglobulins (Ig) over the final 2 wk of pregnancy was less pronounced for heifers under heat stress. For the first four milkings, colostrum of cows exposed to high air temperatures had lower mean concentrations of IgG and IgA; lower mean percentages of total protein, casein, lactalbumin, fat, and lactose; lower contents (grams per liter) of short- and medium-chain fatty acids; lower energy; lower titratable acidity; and higher pH. Thus, high air temperatures during late pregnancy and the early postpartum period markedly affected the composition of colostrum from primiparous dairy cows.

3-Hydroxybutyric Acid↗

Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature.

Spontaneous coronary dissection is a rare event occurring particularly in women during the peripartum and postpartum period. Two cases related to the early postpartum period with a successful outcome are described, together with a comprehensive review of all the previously published cases. Diagnostic and therapeutic considerations of this unique clinical entity are discussed and reviewed.

Adult↗

Progression of depression in the prenatal and postpartum periods.

Studies of birth related emotional disorders, which track a cohort of women prospectively throughout the prenatal and postpartum periods, have rarely been undertaken. We measured depression at six separate intervals in the prenatal and postpartum periods among an experimental cohort (n = 57) and at two separate intervals in a nonpregnant control cohort matched on age. Subjects with high levels of prenatal depression were three times more likely to report a past history of depression and two and one-half times more likely to have high depression levels at six weeks postpartum (indicating risk for a puerperal depression). However, they were only one-third more likely to experience transient postpartum depression. Prenatal depression may be another facet of a more encompassing maladjustment which includes past depressive episodes and increased risk for puerperal depression.

Depressive Disorder↗

Management of gallstone pancreatitis during pregnancy and the postpartum period.

In a 22 year study, 21 women had acute pancreatitis develop during pregnancy (11 women) or within six weeks post partum (ten women). Gallstones were the cause of the pancreatitis in all. Operation during the acute attack of pancreatitis was required in only two. Acute pancreatitis subsided in the remaining 19 patients; they were operated upon during the second trimester or the early postpartum period. During pregnancy, surgical treatment for gallstone pancreatitis should consist of cholecystectomy and exploration of the common bile duct without operative cholangiography. During the postpartum period, operative cholangiography is used to determine whether or not exploration of the common bile duct is necessary. Acute pancreatitis associated with pregnancy is "gallstone" pancreatitis; there is no evidence that pregnancy is a specific etiologic factor in pancreatitis. As opposed to nonoperative treatment of symptomatic gallstone pancreatitis in pregnancy, which is accompanied by maternal morbidity or fetal mortality, surgical treatment during the optimal time of the second trimester or early postpartum period was associated with no maternal morbidity or fetal mortality and no recurrent pancreatitis.

Acute Disease↗

Serum cholesterol decline and depression in the postpartum period.

We examined the relation between total serum cholesterol decline and depression in the postpartum period in a prospective study of 266 Dutch women, who were followed until 34 weeks after delivery. The decline in serum cholesterol between week 32 of pregnancy and week 10 postpartum was similar for women who became depressed (n = 63) in the subsequent period and women who did not (difference, 0.10 mmol/l; 95% confidence interval [CI] -0.16 to 0.37). Adjusting for age, multiparity, education level, smoking status, concurrent illness, and social support, the odds ratio of depression was 1.4 (95% CI, 0.64 to 2.9) for women in the highest tertile of serum cholesterol decline and 0.61 (95% CI, 0.28 to 1.3) for women in the intermediate tertile, as compared with women in the lowest tertile. Our results do not support the hypothesis that rapid serum cholesterol decline increases risk of depression in the postpartum period.

Adult↗

Blood pressure changes in normotensive women readmitted in the postpartum period with severe preeclampsia/eclampsia.

The purpose of this study was to determine whether women who had no clinical evidence of preeclampsia at delivery, but who were later readmitted with postpartum severe preeclampsia or eclampsia, differed in mean arterial pressure (MAP) and clinical presentation from women who either remained normotensive or had severe preeclampsia or eclampsia at the time of delivery. Control subjects did not require readmission and were matched (2:1) with study subjects in consecutive order for date of delivery and maternal age, race, and parity. Women in the study group had a significantly greater increase in MAP after delivery than control subjects, and analysis of variance for linear trends demonstrated highly significant differences between the study and control groups in the average intrapartum and postpartum MAPs. Compared to women in either control group, mothers who were readmitted were significantly more likely to demonstrate a > 10-mm Hg increase in MAP between the intrapartum and postpartum periods (delta MAP). Normotensive women with a delta MAP > 10 mm Hg had more than a threefold risk of readmission in the postpartum period with severe preeclampsia or eclampsia. Women who were readmitted reported a significantly greater frequency of headaches and nausea and vomiting than women with intrapartum preeclampsia. In summary, our findings indicate that MAP increase following delivery in normotensive women who were later readmitted with severe preeclampsia or eclampsia.

Analysis of Variance↗

[Does drug therapy in the postpartum period interfere with breastfeeding recommendations?]

OBJECTIVE: To study the frequency of medication use in the immediate postpartum period and to evaluate possible effects on breastfeeding. METHODS: A cross-sectional study was carried out with 2,173 women that gave birth in four hospitals in Belo Horizonte, a city in the southeast of Brazil, between July 1998 and July 1999. The sample was calculated by means of the data obtained from the Citýs Health Department according to the number of labors made in these four hospitals in 1995, which amounts to approximately 5% of the total number that usually occurs within a year. Women were randomized according to the calendar of epidemiological weeks. The interviews consisted of a questionnaire through which information about breastfeeding and sociodemographic data were obtained. In addition, the data were collected from motherś and newbornś medical records. The drugs were classified according to their compatibility and incompatibility with breastfeeding, and were monitored as to the possible adverse effects on newborn infants. RESULTS: 2,090 (96.2%) of 2,173 women received drug therapy in the immediate postpartum period. Among the drugs used, 2,054 (98.3%) were not contraindicated for breastfeeding; 338 (16.2%) did not contain safe information, and 3 (0.14%) were contraindicated. CONCLUSIONS: Although drug therapy was widespread among the mothers followed up at these four hospitals, there seems to be no influence on breastfeeding. Fortunately, most prescribed drugs did not interfere with motherś and infantś health.

Journal Article↗

Bovine CD8+ suppressor lymphocytes alter immune responsiveness during the postpartum period.

This study examined the immunoregulatory role of CD8+ lymphocytes during the postpartum period. Peripheral blood cells were isolated from postpartum and mid to late lactating animals. Flow cytometric analysis was performed to determine the frequencies of relevant cell populations. Depletion of CD8+ lymphocytes from whole cultures significantly decreased proliferation and cytotoxic ability of cells isolated from mid to late lactating animals. Enrichment of whole cultures with CD8+ lymphocytes further decreased their proliferative ability but pure CD8+ lymphocyte had increased cytotoxic activity. In contrast, neither depletion nor enrichment of whole cultures with CD8+ lymphocytes altered the already diminished proliferative responses of cells isolated from postpartum cows. No cytotoxic activity was observed by cells isolated from postpartum animals. Cultures from mid to late lactating cows mainly expressed IFN-gamma mRNA where as IL-4 mRNA was mainly expressed by cultures isolated from postpartum animals. Flow cytometric analysis revealed that CD8+ lymphocytes have a high level of activation and expression of the beta-chain during the postpartum compared with the mid to late lactating period. These data indicate that CD8+ lymphocytes are of the suppressor compared to the cytotoxic nature immediately following parturition.

Animals↗

Frequency and determinants of vaginal infection in postpartum period: a cross-sectional survey from low socioeconomic settlements, Karachi, Pakistan.

OBJECTIVE: To determine the frequency and factors associated with perceived vaginal infections among married women in their postpartum period. METHODS: A cross-sectional study was conducted from July 2000 to October 2000 in five squatter settlements of Karachi, Pakistan. These squatter settlements were selected on the basis of an existing surveillance system run by female community health workers for maternal and child healthcare which identified women who had delivered 42-56 days prior to the date of interview. Vaginal infection was considered present when a mother perceived foul smelling vaginal discharge during the postpartum period. Mothers were interviewed to gain insight into socioeconomic and demographic variables, materials used to staunch lochia, duration of labour, personal and perineal hygiene and past obstetric history. RESULTS: A total of 525 women were interviewed. The estimated prevalence of perceived vaginal infection was 5.1%. Factors associated with perceived vaginal infections included, delivery conducted by a non-medical personnel (AOR 3.5, CI 1.3-9.5) and use of unhygienic cloth or cotton for staunch of lochia (AOR 2.7, CI 1.1-6.2). CONCLUSION: Among women who reported perceived vaginal infection, a higher proportion were delivered by non-medical personnel, and used unhygienic material (cloth or cotton) for staunch of lochia as compared to women who did not perceive vaginal infection. We recommend deliveries to be conducted by trained personnel and provision of health education for persons who conduct delivery and women to use hygienic material for staunch of lochia during post partum period.

Adolescent↗

6-Keto prostaglandin F1 alpha, thromboxane B2, and 13,14-dihydro-15-keto prostaglandin F concentrations of normotensive and preeclamptic patients during pregnancy, delivery, and the postpartum period.

Plasma 6-keto prostaglandin F1 alpha, 13,14-dihydro-15-keto prostaglandin F, and thromboxane B2 levels were measured in normotensive and preeclamptic patients during pregnancy and the postpartum period. From 30 to 40 weeks of gestation, 6-keto prostaglandin F1 alpha levels of preeclamptic patients were significantly lower than those of normotensive women; 13,14-dihydro-15-keto prostaglandin F and thromboxane B2 concentrations in preeclamptic patients did not significantly differ from those of the normotensive group. At delivery, 6-keto prostaglandin F1 alpha levels of maternal and umbilical venous plasma of preeclamptic women were also significantly lower than those of normotensive women. In the postpartum period these three prostanoids were not significantly different in normotensive women compared to preeclamptic women, with clinical preeclamptic symptoms soon disappearing in most of our patients. From the results, it seems that prostacyclin plays an important role in preeclampsia.

6-Ketoprostaglandin F1 alpha↗

Measurement of messenger RNA for luteinizing hormone beta-subunit and alpha-subunit during gestation and the postpartum period in ewes.

Pituitary content of luteinizing hormone (LH) and mRNAs for LH beta-subunit (LH beta), alpha-subunit, prolactin, and growth hormone were measured in ewes on Days 50 and 140 of gestation and on Days 2, 13, 22, and 35 postpartum. Content of LH in dissociated anterior pituitary cells declined (P less than 0.05) between Days 50 and 140 of gestation and remained low at 2 days postpartum. By 22 days postpartum, pituitary concentrations of LH were comparable to concentrations in normally cycling ewes. During gestation concentrations of mRNA for LH beta and alpha-subunit paralleled changes in cellular content of LH, reaching minimal levels on Day 140. By Day 2 postpartum, pituitary concentrations of mRNAs for LH beta and alpha-subunit began to increase; they reached maximum levels by Day 13 postpartum. There appeared to be a gradual linear increase in mRNA for prolactin through gestation and the postpartum period. No changes in mRNA for growth hormone were noted during the prepartum or postpartum periods. These data suggest that the decline in pituitary concentrations of LH during gestation is due to a decrease in cellular mRNA for LH beta and alpha-subunit. The increase in mRNA for LH beta and alpha-subunit appears to precede an increase in cellular content of LH in the postpartum ewe by several days.

Animals↗

Levels of stable metabolites of prostacyclin and thromboxane A2 and their ratio in normotensive and preeclamptic pregnant women during the antepartum and postpartum periods.

OBJECTIVE: To measure the levels of the circulating metabolites of prostacyclin and thromboxane A2 during the antepartum and postpartum periods in severe preeclamptic and eclamptic patients as well as in normotensive pregnant women. METHODS: 6-Keto-prostaglandin F1alpha (6-keto-PGF1alpha) and thromboxane B2 (TxB2) were measured in the plasma of 15 severe preeclamptic, 15 eclamptic, and 15 normotensive pregnant women during the antepartum and postpartum (5th day) periods. At the same time blood pressure measurements were obtained. Kruskal-Wallis, Wilcoxon rank-sum, and Wilcoxon's signed-rank tests were used for statistical analysis. RESULTS: 1) There was no significant difference in the levels of 6-keto-PGF1alpha and TxB2 of the normotensive pregnant women between the antepartum and the postpartum (5th day) periods. 2) In the severe preeclamptic and eclamptic groups, 6-keto-PGF1alpha levels showed significant increase after the delivery (P < 0.01, and P < 0.001, respectively). 3) In the severe preeclamptic and eclamptic groups TxB2 levels showed significant decrease after delivery (P < 0.01, and P < 0.001, respectively). 4) The 6-keto-PGF1alpha/TxB2 ratio both during the antepartum and the postpartum (5th day) periods showed significant differences between the severe preeclamptic and normotensive, and between the eclamptic and normotensive groups (P < 0.001, and P < 0.001 respectively). 5) No correlation was observed between the mean arterial pressure and the antepartum levels of 6-keto-PGF1alpha TxB2 or their ratios. CONCLUSIONS: Our study was able to demonstrate a significant difference in circulating metabolites of prostacyclin and TxA2 between normotensive pregnant women and those with severe preeclampsia and eclampsia. But no correlation was observed between the blood pressure and the antepartum 6-keto-PGF1alpha, TxB2 levels or their ratios. 6-keto-PGF1alpha levels increased and TxB2 levels decreased in the postpartum period (5th day). However, the 6-keto-PGF1alpha/TxB2 ratio was still low in the severe preeclamptic and eclamptic patients when compared with the control group. This situation shows that the pathophysiologic mechanism does not improve completely within a few days after delivery.

6-Ketoprostaglandin F1 alpha↗

Shifts in bovine CD4+ subpopulations increase T-helper-2 compared with T-helper-1 effector cells during the postpartum period.

This study determined the cytokine profile of CD4+ T-helper cells to elucidate the specific CD4+ T-helper phenotype during the postpartum period. Peripheral blood mononuclear cells were isolated from cows during periods of increased susceptibility (3 d postpartum, n = 7) and decreased susceptibility (mid- to late lactation, n = 6) to mastitis. Isolated mononuclear cells were magnetically separated into CD4(+)-enriched or CD4(+)-depleted populations using specific bovine monoclonal antibodies and were confirmed to be enriched or depleted by flow cytometric analysis. T-helper-1 and T-helper-2 subpopulations were distinguished by cytokine profiles, at both the molecular and protein level, by competitive quantitative reverse transcriptase-polymerase chain reaction and specific bioassays, respectively. The CD4(+)-enriched cultures isolated postpartum had enhanced interleukin-4 and interleukin-10 mRNA transcript expression; cultures isolated during the mid- to late lactating period had enhanced interleukin-2 mRNA transcripts. Depletion of CD4+ lymphocytes decreased, and enrichment of CD4+ lymphocytes increased interferon-gamma transcripts in cultures isolated from mid- to late lactation cows. Interferon-gamma and interleukin-2 bioassays revealed that cytokine secretion paralleled mRNA transcript levels. These data suggest that CD4+ lymphocytes act predominantly as T-helper-2 compared with T-helper-1 within 3 d after calving. Alterations in the T-helper-1 and T-helper-2 responses, and therefore the repertoire of cytokines produced, may be an underlying reason for diminished host immune response during the postpartum period.

Animals↗

Endocrinology of the postpartum period in the Pelibuey ewe.

The postpartum (PP) period in the Pelibuey ewe was studied. Laparotomies were performed on 14 ewes in the first year at d 10, 20 and 30 PP, and at d 10 and 20 PP in the second year on 17 ewes. Progesterone concentrations were determined in serum taken daily, from 4 to 7 d after parturition until estrus. Temporal fluctuation of luteinizing hormone (LH) was determined in samples taken at 30-min intervals for 4 h weekly. The mean interval from lambing to first ovulation was longer (P less than .001) in 1980 (59 +/- 4.9 d) than 1979 (26 +/- 3.1 d), the mean interval from lambing to first estrus was also longer (P less than .001) in 1980 (91 +/- 5.6 d) than 1979 (51 +/- 5.5 d). Follicles were present on the ovaries of the majority of the ewes at d 10. The mean diameter of the largest follicles on each ovary was reduced (P less than .025) in ewes in 1980 (6 mm) compared with 1979 (7.7 mm). Corpora lutea (CL) occurred in 67 and 75% of the ewes by d 20 and 30, respectively in 1979; no CL were found by d 20 in 1980. Progesterone profiles suggested that the PP period was composed of a period of anestrus, and a period of cyclic ovarian activity with one, two or three ovulations without behavioral estrus. In some ewes, the first cycle was of shorter duration, and its CL secreted less progesterone (P less than .05) relative to CL of silent and regular estrous cycles. Luteinizing hormone peaks were recorded as early as 6 d PP. When progesterone concentrations were elevated to luteal phase levels, the frequency, but not magnitude, of LH peaks per 4-h bleeding period was reduced (P less than .05) relative to anestrus. It is concluded that there are periods of anestrus and of silent cycles, which precede the first postpartum estrus in Pelibuey ewes.

Animals↗

Successful intra-arterial thrombolysis for acute ischemic stroke in the immediate postpartum period: case report.

Stroke in pregnancy and the puerperium is a rare but potentially devastating event. We present the case of a previously healthy woman who underwent a cesarean delivery and experienced a middle cerebral artery thrombosis in the immediate postpartum period that was subsequently lysed with intra-arterial urokinase. The patient made a complete neurologic recovery. To the best of our knowledge, this is the first reported case of successful intra-arterial thrombolysis for ischemic stroke in the postpartum period.

Acute Disease↗

Influence of pregnancy and the postpartum period on estrogen uptake of the rat fallopian tubes and uterus.

After incubation with 6,7-3H-estradiol, the uptake of radioactivity was measured in rat fallopian tubes and uterus during diestrus, estrus, early and late stages of gestation, and the postpartum period (PP). Uptake patterns during early and late pregnancy reflect the critical endogenous estogenic influence on in vitro hormonal (estrogenic) sensitivity of fallopian tubes and uterus. Very low levels of uptake are observed during the middle and late stages of pregnancy, i.e., day 12 to day 20 postcoitum, followed by a sharp increase during the puerperium (days 1 to 6 PP). However, a close similarity exists between tubal and uterine estrogen uptake patterns during the estrous cycle and critical stages of implantation, followed by pregnancy and the postpartum period.

Animals↗

Macrophages and other endocytic cells in the mouse uterus during the second half of pregnancy and into the postpartum period.

The spatiotemporal distribution of macrophages in the uterine wall of mice in the second half of pregnancy and the early postpartum period has been studied. Macrophages were identified using a combination of morphological criteria, the capacity to endocytose horseradish peroxidase and the expression of the Mac-1 antigen. Macrophages were a consistent feature of the myometrium. Numerous endocytic cells were found in the decidua basalis and metrial gland of pregnant mice and in the 'scar' regions of postpartum mice. However, few of the endocytic cells expressed the Mac-1 antigen. It is concluded that stromal/decidual cells, and not monocyte-derived macrophages, are primarily responsible for the removal of cellular debris in the decidua basalis and metrial gland during the last week of pregnancy and in repair of the uterine wall in the postpartum period.

Animals↗

Maternal responsiveness of primiparous mothers during the postpartum period: age differences.

Variables influencing maternal responsiveness of primiparous mothers in the postpartum period were explored. Forty mothers, aged 17 to 24, were randomly assigned to either a control group, or to a group with one of two experimental conditions: additional information given mothers about the sensory capacity of neonates, or additional postpartum contact with their infants. Age differences in maternal responsiveness were also examined. Fourteen dependent measures of maternal behavior were obtained from video-taped sessions of mothers watching their infants. In addition, lateral preference of mothers for their infant following midline presentation was also noted. At the time of hospital discharge (a mean time of 3.5 days following birth) no differences were found on the dependent measures for either experimental condition. The age of the mother was isolated as a variable influencing maternal readiness. Mothers were divided into three age groups: low (17 and 18 years, N = 17), middle (19 and 20 years, N = 10), and high (21 to 23 years, N = 13). Age effects upon the 15 measures were assessed. The results suggest that there is a "critical" age when a mother may develop maternal readiness. Mothers 19 years of age and older demonstrated significantly more maternal responsiveness toward their infants than did mothers 18 years and younger.

Age Factors↗