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PubMed1990

Changes in hemostasis activity during delivery and the immediate postpartum period.

Postpartum deep vein thrombosis is believed to be related to increased activation of the hemostasis system at the time of delivery. To date, studies designed to test this hypothesis have had relatively small sample sizes or used the measurement of specific coagulation factors and functional tests reflecting hemostasis activity in vitro. With the use of recent technologic advances we determined the effect of delivery on hemostasis in vivo by measuring 11 hemostatic indices simultaneously in 70 healthy pregnant women. Significant increases were found in fibrinopeptide A (p less than 0.001), beta-thromboglobulin (p less than 0.001), and platelet factor 4 (p less than 0.001), suggesting maximum platelet activation and fibrin formation at the time of delivery. In addition to continued clotting activity at 3 hours post partum, increased D-dimer, fibrin-fibrinogen degradation products, and decreased alpha 2-antiplasmin levels suggest maximum fibrinolysis. These changes reflect a peak in hemostatic activity at delivery and in the immediate postpartum period that may predispose the development of deep vein thrombosis.

Adult↗
PubMed2000

Maternal hypothalamic-pituitary-adrenal axis in pregnancy and the postpartum period. Postpartum-related disorders.

During pregnancy, placenta-derived CRH increases exponentially in the plasma. Circulating levels of CRH-binding protein decrease considerably in the last trimester of pregnancy, resulting in further elevation of bioavailable plasma CRH. The adrenal glands during pregnancy gradually become hypertrophic because of the increase in ACTH, which parallels that of CRH. Thus, pregnancy is a transient period of relative hypercortisolism. The activation of the hypothalamic-pituitary-adrenal axis during pregnancy has been proposed to function as a biological clock. In this model, the placenta is perceived as a stress-sensitive organ and placental CRH as a timing starter, determining a preterm, term, or postterm labor. During pregnancy, as well as during the immediate postpartum period, the hypothalamic maternal CRH secretion is suppressed, because of the circulating levels of cortisol. Hypothalamic CRH secretion normalizes within 12 weeks. This transient postpartum maternal hypothalamic CRH suppression, together with the steroid withdrawal that follows parturition, might be causally related to the mood disorders and the vulnerability to autoimmune diseases such as thyroiditis or rheumatoid arthritis often observed during the postpartum period.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Infections during the postpartum period.

Postpartum infections are costly in terms of delayed mother-infant interaction; lactation difficulties; prolonged hospital stay or readmittance to the hospital and increased expense; and possible permanent injury or death. The nurse is in a unique position to identify the woman at risk, recognize early warning signs, and provide teaching and counseling for prevention and care. Shortened hospital stays challenge the nurse to develop, research, and discover funding for new interventions to provide care and teaching to minimize the effects of this problem.

Diagnosis, Differential↗
PubMed1992

Control of growth hormone secretion during the postpartum period.

The postpartum period is characterized by high levels of circulating steroids which condition hypothalamo-pituitary activities. In pregnancy growth hormone (GH) levels are greatly increased and lack pulsatility. In order to investigate the behavior of GH during the postpartum period, the GH response to GH-releasing hormone stimulation (50 and 100 micrograms), to amphetamine, a dopamine receptor agonist, and to FK 33-824, an opiate receptor agonist, was investigated in women during the first 5 days after delivery. In all groups GH responses were significantly lower (p less than 0.01) than in normal women studied during the early follicular phase. FK-33-824-induced GH release was similar in postpartum and control women. These results demonstrate reduced pituitary GH response to GH-releasing hormone and to amphetamine in women during the postpartum period, confirming the peculiarity of the hypothalamopituitary component.

Adult↗
PubMed1983

Neuroendocrine control of the postpartum period.

This postpartum period is characterized by stimulation of lactation and suppression of ovulation. During pregnancy a number of hormonal changes prepare the breasts for lactation following delivery. The process of lactation is functionally related to the suppression of ovulation. These two physiologic changes observed in the puerperium are considered in detail in this review.

Amenorrhea↗
PubMed2004

Effects of abnormal ovarian cycles during pre-service period postpartum on subsequent reproductive performance of high-producing Holstein cows.

The primary objective of this study was to investigate the effects of abnormal ovarian cycles during the pre-service postpartum period on subsequent reproductive performance of high-producing Holstein cows. The study was conducted in a commercial dairy farm with approximately 150 lactating cows, in a subtropical region of Japan. Animals were kept in free-stall barn, and fed a total mixed ration. Cows that calved from June 2001 to July 2002 were included in the study. Milk samples were collected twice weekly from 2 to 11 weeks postpartum, and progesterone concentrations in skim milk were determined by ELISA. After a voluntary waiting period of 40 days, cows detected in estrus were bred by artificial insemination (AI). Pregnancy was confirmed by palpation per rectum 40-70 days after AI. Out of a total of 91 cases, 39 (42.9%) had normal ovarian cycles (ovulation within 45 days after calving, followed by normal ovarian cycles), 32 (35.2%) had prolonged luteal phase (i.e. luteal activity for >20 days), and 12 (13.2%) had anovulation or delayed first ovulation (i.e. first ovulation did not occur until >45 days after calving). The remaining (8.8%) had other types of abnormalities. When compared with cows with a normal ovarian cycle, prolonged luteal phase cows had a lower 100 days AI submission rate, conception rate and pregnancy rate (84.2% versus 56.3%; P<0.05, 50% versus 16.7%; P<0.05 and 42.1% versus 9.4%; P<0.01, respectively), and longer intervals to first AI and to conception ( 67+/-6 days versus 98+/-7 days and 95+/-9 days versus 136+/-11 days; P<0.01 for each). Similarly, when compared with cows with normal ovarian cycles, those with anovulation had lower 100 days conception rate and pregnancy rate (50% versus 0%; P<0.05 and 42.1% versus 0%; P<0.01, respectively), and longer intervals to first AI and to conception ( 67+/-6 days versus 93+/-12 days; P<0.05 and 95+/-9 days versus 155+/-14 days; P<0.01, respectively). Survival analysis of the data for calving to conception interval showed that cows with prolonged luteal phase or anovulation were getting pregnant at a slower rate, and took longer to get pregnant than the cows with normal resumption of ovarian cyclicity postpartum. In conclusion, abnormal ovarian cycles during the pre-service period postpartum adversely affected reproductive performance, including AI submission rate, pregnancy rate, interval to first AI, and calving to conception interval in high-producing Holstein cows.

Animals↗
PubMed2004

The acyclic period postpartum in automatic and conventional milking.

The acyclic postpartum period in cows is prolonged due to frequent suckling when compared with twice daily milking. In conventional milking systems twice daily milking is common, while in automatic milking systems (AMS) three or more milkings are performed in early lactation. In this study, the hypothesis was tested that an increased milking frequency in AMS causes a delay in resumption of ovarian cyclicity postpartum and increases days open in German Fleckvieh cows (n = 124). Calvings were equally distributed throughout the 1-year experimental period. All cows were housed in one barn. Sixty-three cows were milked in an AMS (AC) and 61 cows were twice daily milked in a conventional milking parlour (PC). Forty-two AC and 36 PC remained in the herd until conception. After parturition, milk samples were analysed for progesterone twice weekly to record the ovarian activity until pregnancy was diagnosed. The first and the second ovulation were determined by the progesterone profile of each individual cow. The mean milking frequency during the first 3 weeks after parturition was higher in AC (3.17 +/- 0.09 milkings/day) than in PC (milked twice daily). The individual mean milking frequency of AC for the first 3 weeks of lactation ranged from 2.0 to 5.9 daily milkings. The time span from parturition until the first and second ovulation did not differ between AC and PC. However, first ovulation was observed earlier in primiparous (23 +/- 1 days) than in multiparous cows (29 +/- 1 days, P < 0.05). Within AC no relationship between milking frequency and duration of the acyclic period was observed. Days open did not significantly differ between AC and PC and between primiparous and multiparous cows. In conclusion, the increased milking frequency in AMS did neither cause a delay in resumption of ovarian cyclicity postpartum nor did it increase days open.

Anestrus↗
PubMed1994

Reproductive function and contraception in the postpartum period.

The postpartum period is a time of major cellular and hormonal change enabling the return of pelvic organs and the hypothalamic-pituitary-ovarian axis to the nonpregnant state. Breast-feeding modifies this change and maintains the endocrine profile and uterine endometrium in a "static" state. In nonlactating women, menstruation returns on average by day 55 to 60 postpartum and ovulation returns on average by day 40 to 50 postpartum. Breast-feeding prolongs the return of menstruation to some 8 to 15 months postpartum and the first ovulation on average was between 30 to 40 weeks postpartum. However, in breast-feeding women, the return of menstruation and ovulation can be quite variable and is influenced by the pattern of breast-feeding, in particular, the intensity and pattern of suckling. There is concern that breast-feeding, although an effective contraceptive on a wide population scale, is unpredictable for the individual. An overall pregnancy rate of 2 to 10 per cent during lactational amenorrhea has been reported. Barrier methods, intrauterine contraceptive devices, and progestogen-only contraceptives are some of the highly effective and most commonly used additional methods of contraception by lactating women. Other methods of contraception during this period include the use of periodic abstinence and combined oral contraceptives. This paper provides an overview of postpartum reproductive function in relation to breast-feeding and the use of contraception in this unique period.

Breast Feeding↗
PubMed2003

Interleukin-1beta elevation during the postpartum period.

During the postpartum period, women frequently report increased fatigue, which, if severe, may interfere with maternal-child bonding, delay a new mother's return to her activities of daily living, and contribute to depression. Several studies have sought to determine psychosocial contributions to fatigue during the postpartum period, but few evaluate any physiological changes that may contribute to fatigue during this time. The following study was designed to test whether the potent, pro-inflammatory cytokine interleukin-1beta (IL-1beta), known to be a physiological mediator of fatigue in several clinical and experimental conditions, is elevated in women during the postpartum period and whether it might be related to symptoms of fatigue. Levels of fatigue and the urinary excretion of IL-1beta were measured in 26 women over 4 weeks postpartum. Correlations between fatigue and activation of the inflammatory response were investigated. Results demonstrated a significant elevation in IL-1beta during the postpartum period compared to control participants (p < .05) and a significant, although delayed, correlation between IL-1beta elevation and fatigue (p < .05). These results suggest that activation of the inflammatory response, as reflected by elevation in urinary IL-1beta, occurs in association with postpartum fatigue. Studies to explore further this association and to identify specific mechanisms of action are needed.

Adult↗
PubMed1997

Does differential neuroendocrine control of cytokine production govern the expression of autoimmune diseases in pregnancy and the postpartum period?

Pregnancy and the postpartum period are associated with significant changes in levels of several hormones, such as estrogen, progesterone, cortisol and possibly catecholamines. Moreover, several autoimmune diseases such as rheumatoid arthritis tend to remit, develop or exacerbate during pregnancy or the postpartum period. Thus, the question arises: are the changes in the hormones and the expression of autoimmune diseases during these periods causally linked, or are these associations an epiphenomenon? Here we suggest that a causal link might be provided through differential neuroendocrine regulation of Th1-type and Th2-type cytokine production.

Autoimmune Diseases↗
PubMed1992

Atrial natriuretic factor concentrations during pregnancy and in the postpartum period.

Atrial natriuretic factor (ANF) is a hormone that regulates fluid and electrolyte homeostasis. Increased intra-atrial pressure or atrial distention, which might occur secondary to intravascular volume expansion, stimulate the secretion of ANF by human atrial myocytes. During normal human pregnancy, there is a progressive increase in total intravascular fluid volume. Thus, we asked the following question: Does this physiologic adaptation to pregnancy result in an increase in ANF concentrations? Concentrations of alpha-human ANF (alpha-hANF) were measured by a specific radioimmunoassay in venous blood samples obtained longitudinally in the first, second, and third trimesters of pregnancy, during the intrapartum period, in the early postpartum period, and 6 to 8 weeks postpartum from 11 normal women who had no antepartum, intrapartum, or postpartum complications. Maternal circulating alpha-hANF levels were not different from those seen in the nonpregnant state. However, higher alpha-hANF concentrations were noted in the early postpartum period. Although the hypervolemia of normal pregnancy is not associated with higher alpha-hANF concentrations, other possibilities (such as increased ANF clearance, dilutional effects) need to be investigated. Finally, the etiology for the transient increase in alpha-hANF levels in the early postpartum period remains to be elucidated.

Adult↗
PubMed2006

Anxiety disorders during pregnancy and the postpartum period: A systematic review.

OBJECTIVE: The postpartum period is recognized as a time of vulnerability to affective disorders, particularly postpartum depression. In contrast, the prevalence and clinical presentation of anxiety disorders during pregnancy and the postpartum period have received little research attention. In this article, we review the medical literature as it relates to the prevalence and clinical presentation of panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder during pregnancy and the postpartum period. DATA SOURCES: MEDLINE (1966 to July 2005 week 1) and PsycInfo (1840 to July 2005 week 1) were searched using combinations of the following search terms: pregnancy, childbirth, postpartum, panic disorder, phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. STUDY SELECTION: All relevant papers published in English and reporting original data related to perinatal anxiety disorders were included. DATA EXTRACTION: Studies were examined for data related to the prevalence, presentation, predictors/risk factors, new onset, course, and treatment of anxiety disorders during pregnancy and the postpartum period. DATA SYNTHESIS: Anxiety disorders are common during the perinatal period, with reported rates of obsessive-compulsive disorder and generalized anxiety disorder being higher in postpartum women than in the general population. The perinatal context of anxiety disorders presents unique issues for detection and management. CONCLUSIONS: Future research is needed to estimate the prevalence of perinatal anxiety disorders more precisely, to identify potential implications of maternal anxiety disorders for maternal quality of life and child development, and to determine safe and effective treatment methods.

Adolescent↗
PubMed2002

Exercise in the postpartum period: practical applications.

Pregnancy, birth, and the postpartum period are important events in the reproductive lives of women. Exercise guidelines exist for pregnancy, but recommendations for exercise during the postpartum period are virtually nonexistent. It is important to examine the theoretic concerns and potential benefits of exercise during this period, especially with respect to weight retention following pregnancy, lactation performance, and infant growth. It is recommended to increase the definition of the postpartum period to 1 year, because many physiologic changes due to pregnancy remain up to 1 year after delivery. Evidence-based guidelines are presented for postpartum exercise and lactation. Future research should address the impact of exercise and lactation on bone mineral density, nutrition status and weight loss, cardiovascular health, and how to optimize health promotion during the postpartum period.

Adaptation, Physiological↗
PubMed2002

Mucin-like carcinoma-associated antigen in paired serum and breast milk samples of lactating mothers and sera of their neonates in the early postpartum period.

OBJECTIVE: To evaluate postpartum MCH changes in the early postpartum period, and to examine whether neonatal MCA is related to that in maternal serum (MS) or milk. STUDY DESIGN: MCA was measured by EIA on the second and fifth postpartum day in serum and BM from 30 lactating women and their single term neonates. Sera from 20 healthy women (controls), were also analyzed. RESULTS: All neonatal antigen concentrations were below the cut-off level for MCA (11 ng/ml). MS MCA was significantly increased compared with that in controls (P<0.00001), while antigen values in BM were highly elevated (P<0.00001), with a significant increase (P<0.0003) from the second to the fifth postpartum day. A strong correlation was found between the second and fifth day postpartum samples in MS, neonatal serum and BM MCA concentrations (r(s)=0.94, P<0.00001; r(s)=0.75, P<0.00001 and r(s)=0.69, P<0.0001, respectively). A significant correlation was also found in MCA values on the fifth postpartum day between neonatal serum and BM (r(s)=0.54, P<0.02). CONCLUSIONS: From these findings one may speculate on some ripening process in milk production and a possible transition of MCA from the neonatal gastro-intestinal tract into circulation.

Adult↗
PubMed1995

The minimum alveolar concentration of isoflurane in patients undergoing bilateral tubal ligation in the postpartum period.

BACKGROUND: The minimum alveolar concentration (MAC) of volatile anesthetics is decreased during pregnancy, but MAC in the early postpartum period has not been reported. The aim of this study was to determine the MAC of isoflurane and to evaluate the relation between MAC and serum progesterone and beta-endorphin in patients after delivery. METHODS: Eight patients undergoing elective bilateral tubal ligation during general anesthesia in the early postpartum period (< 12 h postpartum) and eight patients undergoing this procedure in the late postpartum period (12-25 h postpartum) were studied. Eight patients undergoing bilateral tubal ligation more than 6 weeks after delivery served as control subjects. Anesthesia was induced with propofol and maintained with isoflurane in oxygen to a steady end-tidal concentration of 0.8-1.0 vol% for 10 min. Reaction to a standardized electric stimulation applied to the forearm was graded as positive (gross or delayed movement) or negative. By using the bracketing technique, the concentration of isoflurane was increased or decreased by 0.1 vol%, depending on the positive or negative responses. RESULTS: The MAC (mean +/- SD) in patients in the early postpartum period was significantly less (0.75 +/- 0.17 vol%) than that in control subjects (1.04 +/- 0.12 vol%; P < 0.01) and that in patients in the late postpartum period (0.95 +/- 0.2 vol%; P < 0.05). The difference in MAC values between late postpartum and control was not significant (P > 0.05). There was an inverse correlation between progesterone concentration postpartum and time after delivery (r = -0.527; P = 0.036), but P = 0.744). There was no correlation between plasma progesterone or beta-endorphin and MAC by multiple regression (r = 0.166; P = 0.950). CONCLUSIONS: Isoflurane MAC remains 28% less than normal within the 1st 12 h postpartum and then returns to normal 12-25 h after delivery.

Adult↗
PubMed1988

Monoamine neurotransmitters and metabolites during the estrous cycle, pregnancy, and the postpartum period.

A wide variety of behavioral changes in the female rat have been associated with the estrous cycle, pregnancy, and the postpartum period and their accompanying hormonal fluctuations. Since monoamine systems have been implicated in the control of these behaviors, the present study examined the tissue concentrations of norepinephrine (NE), dopamine (DA), and serotonin (5HT) and their primary metabolites dihydroxyphenylglycol (DHPG), 3-methoxy-4-hydroxyphenylglycol (MHPG), 3,4-dihydroxyphenylacetic acid (DOPAC), and 5-hydroxyindoleacetic acid (5HIAA) in the anterior cerebral cortex, hippocampus, and cerebellum during the estrous cycle, late pregnancy, and the early postpartum period. Results show no significant differences in neurotransmitter or metabolite levels during the estrous cycle in any of the three brain regions examined. However, profound differences were observed between samples from late pregnancy, early postpartum, and the estrous cycle. In general, NE and 5HT levels in all three brain regions fell from normal values during late pregnancy and rose in the early postpartum period; levels of their metabolites rose in postpartum samples. Conversely, DA levels were elevated in late pregnancy and depressed in the early postpartum period in anterior cortex, while DOPAC levels were depressed in both late pregnancy and the early postpartum period. The finding of changes in monoamine metabolism associated with pregnancy and its termination could be important in understanding the increased susceptibility to affective illness in women during the postpartum period.

Animals↗
PubMed2002

[Causes of non-use of contraceptives in the immediate postpartum period].

OBJECTIVE: To determine the causes of not use of contraceptive during immediate postpartum period. METHODOLOGY: Cross-section observational descriptive study. We include women that went for attention of obstetric event, we identified those were in immediate postpartum period, and we selected the women which not started contraceptive use. Data were collected directly with an interview; the causes of not use of contraceptive were classified in three groups. Group I: causes be derived by patient: personal, religious, moral, families, culture, etc. reasons, when they received information, and advice or when they did not attend to educational actions. Group II: causes be derived by the hospital: technique administrative factors, insufficient educational communication activities by service provider. Group III: Medic Indication: presence of risk factors for health women. We found 2,593 women, we identified 1,493 (57.5%) in immediate postpartum period, 478 (32%) not started contraceptive use. In 349 (73%) women the causes were group I, in 91 (19%) group II, and 38 (8%) group III. CONCLUSION: Is necessary more research to know users concerns, ideas and perspectives in relation with methods of contraception, contraceptive counseling, informants, advisers, and with health service institution, to improve educational communication strategies; and to unify medical criterions for not use contraceptive during immediate postpartum period.

Adolescent↗