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PubMed2006

[The impact of education in birthing schools on the course of pregnancy, labor, puerperium, and neonatal care].

INTRODUCTION: Pregnancy represents a special period in the life of a woman. It is the time of many joyous, sublime, and touching moments experienced by the family although not free from anxiety, uncertainty and doubt in the minds of the future parents. It is also the time of an intense quest for answers to annoying questions and a motivating factor to search for information on the physiology of pregnancy, as well as on labor, puerperium and child care. A birthing school is nowadays the most important institution which prepares for parenting in a most professional way. This form of education is gaining widespread acceptance. This study was designed to: 1. Study the effects of participation in birthing school classes on the course of pregnancy, labor, and puerperium. 2. Search for relationships between the birthing school program and motivation of mothers to breast feeding. 3. Determine the influence of education in a birthing school on the ability of mothers to cope with problems during puerperium. MATERIAL AND METHODS: The study was done in 294 women hospitalized at the Obstetrics Ward of the Chair and Department of Obstetrics and Perinatology, Pomeranian Medical University in Szczecin, between June 2001 and December 2002. Two groups were formed: group I--"study group"--comprised 129 gravida who participated in birthing school classes during at least one pregnancy but not earlier than two years before the present study; group II--"control group"--included 165 gravida who never participated in any organized form of birthing education. A questionnaire was developed consisting of 105 questions. Answers were recorded by the researcher and the results in both groups were compared statistically. CONCLUSIONS: Participation in birthing school classes helps develop healthy attitudes during pregnancy, reduced the feeling of pain and blood loss during labor, but does not alter the duration of labor in primipara nor has any effect on problems related to puerperium. Graduates of birthing schools are better motivated to start breast feeding, less often switch to artificial feeding during puerperium, and cope better with problems encountered during puerperium.

Adult↗
PubMed1989

[Serum monoamine oxidase (MAO) and diamine oxidase (DAO) activity and histamine level in the blood of women during the early puerperium].

In early puerperium various biochemical changes develop in the organism. Considering the role played by MAO, DAO and histamine, and absence of a comprehensive study of this problem in this life period a study was carried out on 36 women, who were selected randomly from women giving birth through the normal pathway. Blood samples were taken in morning hours on the 1, 2 and 3 days of puerperium. In each case the activity of serum monoamine oxidase, diamine oxidase and blood histamine level were measured. The results obtained on various days of puerperium were compared. Statistical analysis was carried out using the t test for paired measurements. Increased serum MAO activity was found on the second day and was decreased then on the third day of puerperium, but it was still above the level on the first day. A successive decrease of serum DAO activity was noted in these three days of puerperium. The blood histamine level increased successively on the successive days of puerperium. Normal values of the activity of these substances in the serum were established in women delivering the fetus through the vagina. The lower normal range of MAO activity, extension of the range of DAO activity, especially of its upper range, and decreased histamine level were found. The authors discuss the causes of these results.

Amine Oxidase (Copper-Containing)↗
PubMed1989

[Histology of the endometrium in cows in normal and pathologic puerperium].

There were repeated histological bioptic examinations of the endometrium during the period from the second to twentieth day post partum (p.p.) in cows with afterbirth retention (n = 5), with developing puerperal endometritis (n = 5), and with a physiological course of puerperium (n = 5). In cows with a physiological course of puerperium, a finished process of epithelization of endometrium with a morphological and functional consolidation of the epithelium could be observed on the 20th day p.p. In cows with disturbed puerperium, the surface epithelium still exhibited signs of disintegration and a low secretion activity. The endometria of both groups of cows with pathological puerperium had a high degree of infiltration with neutrophil granulocytes: in cows with retained afterbirth this picture was characteristic already the second day p.p. On the other hand, the endometrium of cows with physiological puerperium was characterized by a higher occurrence of folliculoid nodules as early as on the tenth day p.p., and a rapid increase in the number of fat cells and activated histiocytes--macrophages could be observed in the endometrium of these cows between the 15th and 20th day p.p. The dynamics of occurrence of mobile cells in the studied groups of cows confirmed their importance for a physiological course of the restitution of endometrium during the puerperium of cows.

Animals↗
PubMed2005

Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium.

BACKGROUND: Haemorrhoids (piles) are swollen veins at or near the anus, normally asymptomatic. They do not constitute a disease, unless they become symptomatic. Pregnancy and the puerperium predispose to symptomatic haemorrhoids, being the most common ano-rectal disease at these stages. Symptoms are usually mild and transient and include intermittent bleeding from the anus and pain. Depending on the degree of pain, quality of life could be affected, varying from mild discomfort to real difficulty in dealing with the activities of everyday life. Treatment during pregnancy is mainly directed to the relief of symptoms, especially pain control. The so-called conservative management includes dietary modifications, stimulants or depressants of the bowel transit, local treatment, and phlebotonics (drugs that cause decreased capillary fragility, improving the microcirculation in venous insufficiency). For many women, symptoms will resolve spontaneously soon after birth, and so any corrective treatment is usually deferred to some time after birth. Thus, the objective of this review is to evaluate the efficacy of conservative management of piles during pregnancy and the puerperium. OBJECTIVES: To determine the possible benefits, risks and side-effects of the conservative management of symptomatic haemorrhoids during pregnancy and the puerperium. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 June 2004). SELECTION CRITERIA: Randomised-controlled trials comparing any of the conservative treatments for symptomatic haemorrhoids during pregnancy and the puerperium (such as dietary modifications, stimulant/depressant of the bowel transit, local treatments, drugs that improve the microcirculation in venous insufficiency) with a placebo or no treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently performed a methodological assessment for deciding which studies to include/exclude from the review and extracted data. MAIN RESULTS: From 10 potentially eligible studies, two were included in this review (150 women). Both compared oral rutosides against placebo. Rutosides seem to be effective in reducing the signs identified by the healthcare provider, and symptoms and signs reported by women, of haemorrhoidal disease. For the outcome no response to treatment: relative risk 0.07, 95% confidence interval 0.03 to 0.20. Regarding perinatal outcomes, one fetal death and one congenital malformation (possible not related to exposure) were reported in the control and treatment group respectively. AUTHORS' CONCLUSIONS: Although the treatment with oral hydroxyethylrutosides looks promising for symptom relief in first and second degree haemorrhoids, its use cannot be recommended until new evidence reassures women and their clinicians about their safety. The most commonly used approaches, such as dietary modifications and local treatments, were not properly evaluated during pregnancy and the puerperium.

Female↗
PubMed1999

How much risk does a woman with active epilepsy pose to her newborn child in the puerperium? A pilot study.

Much attention in the literature has recently been paid to women's issues in epilepsy but most of the literature stops in the delivery room or at the first moment of suckling. Although it is commonly supposed that a woman who continues to have active epilepsy during the puerperium will pose a risk to her child, little assessment of how great a risk this is has been carried out. We present an audit of the puerperal experiences of 187 women with epilepsy counselled before birth in our women's clinic and contrast this with a number of women with epilepsy seen for the first time in the puerperium (and therefore uncounselled). The audit suggests that in counselled women the risk is very low (women with Juvenile Myoclonic Epilepsy may be particularly at risk, as may women with tonic-clonic seizures that occur without warning, plus those with automatisms or who have prolonged post-ictal confusion). Some women with controlled epilepsy prior to conception may lose that control during the puerperium so even women with well controlled epilepsy should adopt precautions in the puerperium. The only baby to die (or be seriously injured) in the puerperium born to a woman with epilepsy was killed in the mother's first seizure.

Accidental Falls↗
PubMed1996

Erythrocyte ion and water balance and membrane potential in the puerperium of normal pregnancy.

OBJECTIVE: To examine the balance of erythrocyte ions and water during the rapid changes in plasma osmolality in the early puerperium, and during the subsequent period of sustained readjustment. DESIGN: A serial study from the third trimester of pregnancy to 20 weeks after delivery. PARTICIPANTS: Thirty-five primiparous women who had experienced no antenatal complications. MAIN OUTCOME MEASURES: Plasma osmolality, erythrocyte hydration, potassium, chloride and sodium were measured and nondiffusible ion content and erythrocyte membrane potential calculated. Plasma sodium, potassium and chloride were also measured. RESULTS: During the first week after delivery plasma osmolality increased (280 (SEM 0.52)-289 (SEM 0.64) mosmol/kg; P < 0.001) but erythrocyte hydration did not decrease (2.060 (SEM 0.018)-2.067 (SEM 0.021) 1/kg dry cells) because of an increase in total cell osmole content (577 (SEM 5.31)-597 (SEM 6.15) mosmol/kg dry cells; P = 0.001). This increase included nondiffusible anions, chloride and potassium. These changes in ionic balance did not affect membrane potential. After the first week of the puerperium and up to the 20th week, plasma osmolality was stable but erythrocyte osmole content and hydration both decreased. This was due to a decrease in nondiffusible anions and potassium with a smaller increase in chloride leading to a decrease in membrane potential (-14.31 (SEM 0.34)mV to -12.66 (SEM 0.28)mV; P < 0.001). CONCLUSIONS: A rapid increase in intracellular osmoles can occur in the mature erythrocyte and probably precedes the decrease in plasma osmolality in the puerperium. Changes in erythrocyte homeostasis in the first week of the puerperium can be accounted for by alterations in nondiffusible anions. After the first week of the puerperium it appears that the functional organisation of the membrane is changing.

Erythrocyte Membrane↗
PubMed2005

ABO blood groups and risk of venous thromboembolism during pregnancy and the puerperium. A population-based, nested case-control study.

OBJECTIVES: To examine possible associations of ABO blood types with the risk of venous thromboembolism (VTE) in pregnancy and the puerperium. PATIENTS AND METHODS: We conducted a nested case-control study within a cohort of 71,729 women who gave birth to 126,783 children in the North Jutland County, Denmark, from 1980 to 2001. We identified 129 cases with VTE in pregnancy (n = 61) or the puerperium (n = 68), and 258 controls with no VTE. We collected information on ABO blood groups and possible maternal confounding factors and estimated the relative risk [odds ratio (OR)]. RESULTS: Women with an A or AB blood group had elevated risk estimates of VTE in pregnancy or the puerperium compared with women with a O blood group [adjusted ORs 2.4, 95% confidence interval (CI) 1.3, 4.3, and 2.0, 95% CI 0.7, 5.8, respectively]. No increased risk estimate was found for group B (adjusted OR 1.2, 95% CI 0.5, 3.0). The increased risk estimates of VTE for blood groups A and AB appeared present in both pregnancy (adjusted ORs of 3.9, 95% CI 1.5, 9.7, and 2.2, 95% CI 0.4, 12.5) and in the puerperium (adjusted ORs of 2.4, 95% CI 1.0, 4.9 and 2.7, 95% CI 0.8, 9.3). Furthermore, blood groups A and AB appeared to be associated with increased risk estimates for both DVT and pulmonary embolism. CONCLUSION: Keeping the modest statistical precision of our study in mind, blood groups A and AB may be associated with increased risk estimates for VTE in pregnancy and the puerperium.

ABO Blood-Group System↗
PubMed2001

[The course of pregnancy, delivery and puerperium in women with varices and thrombophlebitis of lower extremities, after application of low molecular weight heparins].

OBJECTIVES: Estimation of the long term prophylactic or therapeutic application of low molecular weight heparin (LMWH) on the platelets count, and incidence bleedings during pregnancy, delivery and puerperium in the women with varices of lower extremities and past thrombophlebitis of lower extremities. MATERIAL AND METHODS: 5212 pregnant, women in labour and in puerperium divided into 4 groups.; 142 women with varices and thrombophlebitis of lower extremities (group I); 10 with past thrombophlebitis of lower extremities (group II); 15 with thrombophlebitis in current pregnancy; 5045 without vascular complications (group IV--control). In group I during pregnancy compression therapy was applied (stockings) and low molecular weight heparins (LMWH) in course of puerperium. In group II during the 1st trimester of pregnancy and in labour the same heparin doses were administered, while the doses were increased in the 2nd and 3rd trimester. In group III, when thrombophlebitis was stated non-steroid anti-inflammatory drugs and LMWH were administered. In all cases treated with heparin both number of platelets and incidents of bleedings from genitourinary tract were observed. Presence of embolic complications was also noted. RESULTS: No cases of decrease platelets number or bleedings from genitourinary tract were observed in group I-III during administering of LMWH. In women in group II where prophylactic with LMWH was applied no incidences of recurrent thrombophlebitis during pregnancy and puerperium were observed. In group I-III all newborns were born in good condition and no complications were observed. Average blood loss during both labour and cesarean section, among women in group I-III was not significantly different comparing with control group. No incidences of pulmonary artery embolism or decrease number of platelets were observed. CONCLUSIONS: 1. The long term prophylactic or therapeutical administration of LMWH in the women with varices of lower extremities or thrombophlebitis has no influence on the platelets count and incidence of bleedings from genitourinary tract during pregnancy or increase of blood loss during labour and puerperium. 2. In the women with past thrombophlebitis of the lower extremities after application of LMWH during pregnancy there were no recurrence observed.

Adult↗
PubMed2002

Inherited thrombophilia and first venous thromboembolism during pregnancy and puerperium.

Venous thromboembolism is a rare but threatening complication of pregnancy. Little conclusive information is available on the actual risk of venous thromboembolism during pregnancy or puerperium in women with inherited thrombophilia, particularly in carriers of factor V Leiden and of the G20210A prothrombin gene mutation. To determine the pregnancy-related and puerperium-related risk of venous thromboembolism in women with inherited thrombophilia, we performed a case-control study on 119 women who had a first episode of deep vein thrombosis and/or pulmonary embolism during pregnancy or puerperium and 232 healthy women who had at least one pregnancy without thrombosis. Inherited thrombophilia was diagnosed in 47 patients (39.5%) and 15 controls (6.5%). The relative risk of venous thromboembolism was 10.6 (95% CI, 5.6-20.4) for heterozygous carriers of factor V Leiden, 2.9 (95% CI, 1.0-8.6) for heterozygous carriers of the prothrombin mutation and 13.1 (95% CI, 5.0-34.2) for those with antithrombin, protein C or protein S deficiency taken together. Sixty-eight of the 119 women (57%) had thrombosis after delivery, confirming the puerperium as a particularly high-risk period. When women were divided into two groups of those with antenatal or postnatal thrombosis. the relative risks associated with each type of inherited thrombophilia were of similar magnitude. In conclusion, women with inherited thrombophilia have an increased risk of venous thromboembolism during pregnancy. Among thrombophilic abnormalities, the prothrombin mutation was the weakest risk factor. Thrombosis occurred more frequently in puerperium than in pregnancy, whether or not thrombophilia was diagnosed.

3' Untranslated Regions↗
PubMed1985

[Effect of dopaminergic agents on the endocrine profile in labor and early puerperium].

The purpose of this study was to investigate the prolactin (PRL) releasing mechanism of the hypothalamo-pituitary axis during labor and early puerperium. Ten full-term gravidas during labor and 42 women in early puerperium were examined in this study. The plasma PRL levels rose significantly (p less than 0.001 approximately 0.05) after an intravenous bolus of 10mg metoclopramide (MCP). The peak values for PRL increase were 609.3 +/- 194.1ng/ml during labor and 447.0 +/- 62.3ng/ml in early puerperium. However, there were no significant differences in PRL response to MCP between these two groups. The plasma PRL levels dropped significantly (p less than 0.001 approximately 0.01) after an oral administration of 2.5mg bromocriptine (BRC), and the PRL release from the pituitary by MCP was suppressed significantly (p less than 0.001) by pretreatment with BRC in the puerperium. In addition, no significant changes in plasma 17 beta-estradiol (E2), progesterone (P) and cortisol levels could be observed after MCP. We concluded that the control mechanism of PRL secretion remained unchanged during labor and early puerperium.

Bromocriptine↗
PubMed1998

Maternal CA-125 levels in pregnancy and the puerperium.

OBJECTIVE: To determine the levels of CA-125 throughout pregnancy and the puerperium to establish a baseline, thereby indicating what values may be indicative of the pathologic conditions usually associated with elevated CA-125 levels. STUDY DESIGN: A prospective, longitudinal study was carried out on a consecutive series of pregnant women to determine their CA-125 levels throughout pregnancy and during the puerperium. Blood was drawn at four- to six-week intervals for clinically indicated tests. The residual sera were kept frozen, and subsequently CA-125 measurements were determined by radioimmunoassay. RESULTS: Of 34 women enrolled in the study, 20 completed the evaluations throughout pregnancy and in the puerperium. The remaining 14 had evaluations for varying portions of their pregnancies but not throughout pregnancy or during the puerperium. The results in these two groups were compared and found not to be statistically significantly different. For the group as a whole, the levels of CA-125 were high, with wide fluctuations in the first trimester; the levels in the early first trimester (five to eight weeks) were particularly high, with a mean of 55.8 and median of 36.2 (range, 6.9-251.2) U/mL. The levels then dropped and remained < 35 U/mL through the rest of pregnancy (including immediately prior to delivery). Another peak, with wide fluctuations, occurred soon after delivery, with a mean of 39.8 and median of 41.9 (range, 10.7-296.7) U/mL. In the late postpartum period (2-10 weeks after delivery) there was a return to baseline levels in all subjects. CONCLUSION: This study showed that there is a distinct pattern in CA-125 levels during pregnancy and the puerperium. Due to the wide fluctuations in CA-125 levels in very early pregnancy and the immediate postpartum period, CA-125 values during these periods are not useful for clinical correlation with the pathologic conditions known to be associated with elevated levels of CA-125. However, further study is needed to determine whether extreme values in the first trimester or elevated levels after the first trimester are diagnostic or predictive of any conditions related to pregnancy.

Adult↗
PubMedDate not supplied

[Effect of D-(-)-norgestrel on uterine contractility in the puerperium (author's transl)].

It is usual for women to ask for temporary control of fertility during the puerperium. When hormonal therapy is administered, the selection of the adequate pill is very important. The effect of D-(-)-norgestrel 300mg was studied on uterine contractility values during puerperium is seven patients breast feeding and was compared with a control group of 26. The 33 patients had the following characteristics: multiparous during puerperium without recent episiotomy, with healthy cervix, absence of genital septic focus, uterine tumours or malformations; all of them breast feeding. In the hypothesis, it was considered that the endogenous oxytocin increases and stimulates the mammary mioepithelium and uterine contractilities. For recording uterine contractility, the technique of Jaumandreu and Hendricks was used. The recordings were made during 24 hours postpartum, and at 5, 10, 20, 30, and 40 days with a duration 2 to 3 hours. All the studies were longitudinal. The changes of the human uterine contractility during normal puerperium were estimated. The range of the tonus was 22--41 mm Hg, the intensity 5--18 mm Hg, the frequency 17--23 contractions in 10 minutes, and the uterine activity 102--223 Montevideo Units. In the control group the following results were obtained: The range of the tonus was 24--34 mm Hg, the intensity 9--16 mm Hg, the frequency 17--37 contractions in 10 minutes, and the uterine contractility 137--524 Montevideo Units. In the comparative study Student's t test was used and p estimated.

Breast Feeding↗
PubMed1993

Uroflowmetry in the puerperium.

One hundred women underwent uroflowmetry once per day for the first 3 days after delivery, and the results compared to those of 53 nonpregnant controls in an effort to determine 1) whether urinary flow in the puerperium is different to that found without pregnancy, 2) whether uroflow parameters change as the puerperium progresses, and 3) which characteristics of a patient or her labour bear most influence upon the results of uroflowmetry. Urinary flow in the puerperium was seen to be different from that of the nonpregnant female in that mean flow rates were lower. In addition to this, voided volume, total flow time, and time to peak flow were all significantly increased on day 1, but were comparable on days 2 and 3. Other than for falling voided volumes, uroflow parameters did not alter significantly as the puerperium progressed. Correlation of the variables age, parity, baby weight, length of first and second stage, use of epidural and perineal suturing with the parameters of urinary flow failed to show any significant relationship.

Adult↗
PubMed1988

Plasma levels and diurnal variation of beta-endorphin, beta-lipotropin and corticotropin during pregnancy and early puerperium.

Using a specific radioimmunoassay the concentrations of beta-endorphin, beta-lipotropin and corticotropin in maternal plasma were studied during pregnancy and in the early puerperium. Compared with the values in nonpregnant women, levels of beta-endorphin and beta-lipotropin were slightly lower in the first and second trimesters; corticotropin showed no difference in the first trimester. The concentrations of all these peptides increased towards term, most markedly in the case of corticotropin. The diurnal variation was studied near term and again in the early puerperium. beta-Endorphin and corticotropin showed a parallel diurnal variation. The values in the morning and during the day were slightly higher during pregnancy than in the puerperium, whereas the values at midnight were similar. After vaginal delivery, a rapid and parallel decrease in the plasma levels of beta-endorphin, beta-lipotropin and corticotropin was found. In elective cesarean section, the values were highest 30 min after delivery, reflecting surgical stress, and then the decrease was similar to that after vaginal delivery. Thus parallel changes in the plasma levels of beta-endorphin, beta-lipotropin and corticotropin during pregnancy and in the early puerperium were found, which can be explained by their origin from a common precursor peptide, pro-opiomelanocortin. The rise in the plasma levels of corticotropin and endorphins near term and the exaggerated diurnal variation is probably a reflection of a maternal adaptation to stress.

Adrenocorticotropic Hormone↗
PubMed1975

The effects of stilboestrol and quinestrol upon coagulation and fibrinolysis during the puerperium.

Two oestrogens, stilboestrol and quinestrol, were used to inhibit lactation and their effects upon coagulation and fibrinolysis were compared with control patients before delivery, during the puerperium and six weeks after delivery. During the first week of the puerperium, stilboestrol therapy was associated with rises of factors IX and X and quinestrol therapy with rises of factors IX and II. Six weeks after delivery, the clotting factors were similar to the control values in those who had received stilboestrol but factor II was still raised in the quinestrol treated patients. Additionally, a significant rise of factor X in the quinestrol group was noted at this time. Plasma antithrombin levels rose during the first week of the puerperium in all three groups but, six weeks after delivery, they were lower in those who had received oestrogens. Stilboestrol and quinestrol were also associated with a rise of plasminogen and antiplasmin concentration during the first week of the puerperium. Six weeks after delivery, quinestrol treated patients still had raised levels of plasminogen and antiplasmin while the stilboestrol treated patients only had raised levels of antiplasmin. These changes in coagulation and fibrinolysis are similar to those reported during oral contraceptive therapy. The persisting changes six weeks after delivery in women who had taken quinestrol might indicate an increased thrombogenic risk when long acting oestrogen preparations are used to inhibit lactation.

Antithrombins↗
PubMed1996

Changes in maternal heart dimensions and plasma atrial natriuretic peptide levels in the early puerperium of normal and pre-eclamptic pregnancies.

OBJECTIVE: To measure plasma atrial natriuretic peptide (ANP) in relation to maternal haemodynamics and body fluid balance in the early puerperium following uncomplicated pregnancy and pre-eclampsia. DESIGN: A longitudinal study from late pregnancy and into the early postpartum period (days 1 to 3 and days 4 to 6) compared with nonpregnant controls. SUBJECTS: Eleven women with uncomplicated pregnancies, 12 women with pre-eclampsia and 12 healthy, nonpregnant women. MAIN OUTCOME MEASURES: Maternal heart dimensions determined by M-mode echocardiography, concentrations of ANP, and daily urine output and sodium excretion. RESULTS: After delivery increases in left atrial dimensions, represented as mean (SEM), from 33.2 (1.6) to 37.7 (1.7) mm and ANP levels from 7.9 (1.1) to 19.0 (2.7) pmol/L were observed at 1-3 days postpartum in normal pregnant women, but we were not able to demonstrate a significant increase in diuresis and natriuresis. In the third trimester left atrial dimensions (38.4 (1.2) mm) and ANP levels (15.4 (2.2) pmol/L) were greater in pre-eclampsia. ANP levels rose further in pre-eclamptic women in the early puerperium (27.4 (7.4) pmol/L) with an increase in diuresis and natriuresis, while left atrial dimensions did not change significantly (39.4 (1.7) mm). A pericardial effusion was found in 11 pre-eclamptic but in only three healthy pregnant women. CONCLUSIONS: A concommitant increase in left atrial dimensions and ANP in the early puerperium following uncomplicated pregnancies is consistent with the mechanism of atrial stretch as a stimulus for ANP release, although the biological significance of this finding remained unclear. A significantly higher release of ANP in the early puerperium after pregnancies complicated by pre-eclampsia may be a mechanism which promotes the renal elimination of excessive body fluids and sodium.

Adult↗
PubMed2007

Catastrophic antiphospholipid syndrome during pregnancy and puerperium: maternal and fetal characteristics of 15 cases.

BACKGROUND: The catastrophic variant of the antiphospholipid syndrome (APS) is a life-threatening form of presentation of this syndrome that can be triggered by several factors. AIM: To describe the characteristics of patients who developed catastrophic APS triggered during pregnancy and puerperium. METHODS: A review of the first 255 cases collected in the website-based "CAPS Registry" was undertaken. Three new and unpublished cases of catastrophic APS developed during pregnancy and puerperium were added. RESULTS: Fifteen cases were identified. The mean (range) age was 27 (17-38) years. Most patients had a previous unsuccessful obstetric history. In 7 of 14 (50%) cases with available medical history, the catastrophic APS appeared during pregnancy, in 6 (43%) during the puerperium and in 1 (7%) after curettage for a fetal death. The main clinical and serological characteristics were similar to those patients with catastrophic APS triggered by other factors, except for a history of a higher prevalence of previous abortions (p<0.01). Several specific features were found, including the HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome in 8 (53%) patients, placental infarctions in 4 (27%) patients, and pelvic vein thrombosis and myometrium thrombotic microangiopathy in 1 (7%) patient each. Mortality rate was high for the mothers (46%), and for the babies (54%). CONCLUSIONS: It is important to consider the possibility of the development of catastrophic APS in those patients with signs of HELLP syndrome and multiorgan failure during pregnancy or puerperium, especially in those patients with previous history of abortions and/or thrombosis.

Adolescent↗
PubMed1996

Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal study.

In a longitudinal study, we analyzed the speed of sound (SOS) and broadband ultrasound attenuation (BUA) of the os calcis as an index of bone mineral density (BMD) to define the effects of pregnancy and lactation on bone metabolism. We used an ultrasound bone densitometer and measured 6 biochemical markers of bone turnover in 18 healthy women throughout pregnancy and puerperium. The measurement of SOS and BUA by such an ultrasound device was clinically advantageous; not only is it radiation-free technology, but it also correlates highly with BMD measured by conventional X-ray bone densitometry. While a significant decrease in SOS was found in the 3rd trimester of pregnancy as compared with the early stage of pregnancy, there was no difference in both SOS and BUA between the breast-feeding women and the principally formula-feeding women during a 6-month period of puerperium. The analysis of biochemical markers revealed that both bone formation and bone resorption were elevated in the 3rd trimester of pregnancy as well as during puerperium, and that the breast-feeding women had significantly higher bone metabolism than the principally formula-feeding women. These results indicate that bone mass decreases as bone turnover itself is enhanced during pregnancy, while lactation does not substantially affect bone mass during at least 6 months of puerperium, although bone turnover is active.

Adult↗