Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study

Background: The effects of etonogestrel (ETG)-releasing contraceptive implant during the immediate postpartum period on maternal safety are unknown. Study design: Forty healthy women exclusively breastfeeding were randomized to receive either ETG-releasing implant 24-48 h after delivery (n=20) or depot medroxyprogesterone acetate (DMPA group; n=20) at the sixth week postpartum. We measured blood pressure, maternal and neonatal weight, body mass index (BMI; kg/m(2)), waist circumference (WC), complete blood count, C-reactive protein, interleukin-6, tumor necrosis factor (TNF-alpha), lipid profile, fasting serum glucose and maintenance of exclusive lactation up to the 12th week postpartum. Results: Decreases in mean maternal weight, BMI (kg/m(2)) and WC were significantly greater in the ETG-releasing implant group than in the MPA group during the first 6 weeks postpartum (-4.64 +/- 2.71 kg vs. -2.6 +/- 2.45 kg mean +/- SD, p=.017; -1.77 +/- 1.06 kg/m(2) vs. -0.97 +/- 0.95 kg/m(2), p=.026; -15.3 +/- 6.72 cm vs. -9.05 +/- 5.84 cm, p=.003, respectively). In addition, total cholesterol and HDL, were lower in DMPA users, and TNF-alpha and leukocytes were higher in DMPA users compared to in the implant group, between 6 and 12 weeks after delivery. The newborns of implant users showed a trend towards gaining more weight, as compared with the infants of the DMPA mothers during the first 6 weeks of life (implant group: +1460.50 +/- 621.34 g vs. DMPA group: +1035.0 +/- 562.43 g, p=.05). The remaining variables, including the duration of exclusive breastfeeding, were similar between the groups. Conclusion: The insertion of ETG-releasing contraceptive implant during the immediate postpartum period was not associated with deleterious maternal clinical effects or with significant maternal metabolic alterations or decreased infant weight gain. (C) 2009 Elsevier Inc. All rights reserved.

Incidence and risk factors for intimate partner violence during the postpartum period

OBJECTIVE To estimate the incidence and identify risk factors for intimate partner violence during postpartum.METHODS This prospective cohort study was conducted with women, aged between 18-49 years, enrolled in the Brazilian Family Health Strategy in Recife, Northeastern Brazil, between 2005 and 2006. Of the 1.057 women interviewed during pregnancy and postpartum, 539 women, who did not report violence before or during pregnancy, were evaluated. A theoretical-conceptual framework was built with three levels of factors hierarchically ordered: women’s and partners’ sociodemografic and behavioral characteristics, and relationship dynamics. Incidence and risk factors of intimate partner violence were estimated by Poisson Regression.RESULTS The incidence of violence during postpartum was 9.3% (95%CI 7.0;12.0). Isolated psychological violence was the most common (4.3%; 95%CI 2.8;6.4). The overlapping of psychological with physical violence occurred at 3.3% (95%CI 2.0;5.3) and with physical and/or sexual in almost 2.0% (95%CI 0.8;3.0) of cases. The risk of partner violence during postpartum was increased for women with a low level of education (RR = 2.6; 95%CI 1.3;5.4), without own income (RR = 1.7; 95%CI 1.0;2.9) and those who perpetrated physical violence against their partner without being assaulted first (RR = 2.0; 95%CI 1.2;3.4), had a very controlling partner (RR = 2.5; 95%CI 1.1;5.8), and had frequent fights with their partner (RR = 1.7; 95%CI 1.0;2.9).CONCLUSIONS The high incidence of intimate partner violence during postpartum and its association with aspects of the relationship’s quality between the couple, demonstrated the need for public policies that promote conflict mediation and enable forms of empowerment for women to address the cycle of violence.

Evaluation of the hypothalamus-pituitary axis response to exogenous GnRH, estradiol benzoate, And LH during the postpartum period in Nellore cows

The objective was to evaluate when the LH reserve was re-established in postpartum Nellore (Bos indicus) cows by evaluating the response of the hypothalamic-pituitary axis responsiveness to exogenous GnRH or estradiol benzoate (EB). Additionally, we tested the influence of dietary supplementation (SUPL) and calf removal (CR) on the duration of postpartum anestrus. Ninety multiparous lactating Nellore cows were randomly assigned to eight groups. The EB and GnRH groups received 1.0 mg EB (N = 7), and 50 μg lecireline (N = 16), respectively. Additional cows were given the same hormones, and subjected to either nutritional supplementation (EB-SUPL, N = 9; GnRH-SUPL, N = 16), or calf removal at 72 hours after calving (EB-CR, N = 4; GnRH-CR, N = 13). The remaining two groups were the LH (12.5 mg, N = 14) and control groups (saline, N = 11). Hormones were administered weekly from 7 (±5) days postpartum to first ovulation (detection of a CL during a weekly ultrasonographic examination). Blood samples were collected just before and 2 hours (GnRH, LH, and control groups) or 18 hours (EB groups) after hormone or saline (control) administration. Ovulation occurred as early as 15 days postpartum in the GnRH group. The mean ± SEM intervals (days) from calving to first ovulation were EB, 87.7 ± 4.2; EB-CR, 20.3 ± 1.2; EB-SUPL, 60.3 ± 3.2; GnRH, 40.4 ± 2.1; GnRH-CR, 21.0 ± 1.1; GnRH-SUPL, 26.4 ± 1.1; LH, 35.6 ± 1.1; and control, 60.9 ± 2.1. We concluded that there was sufficient LH in the pituitary gland (of Nellore cows) from the second week postpartum to induce ovulation in response to exogenous GnRH. Additionally, calf removal and nutritional supplementation reduced, by 2 to 4 weeks, the interval from calving to an LH increase and ovulation induced by GnRH or EB. © 2013.

Maternal flow-mediated dilation and nitrite concentration during third trimester of pregnancy and postpartum period

Objectives. To compare maternal flow-mediated dilation (FMD) of the brachial artery and nitrite concentration between third trimester of pregnancy (3rdT) and postpartum (PP) period. Additionally, we will evaluate whether FMD correlates with nitrite concentration in both periods. Methods. Eligibility criteria was healthy women with singleton pregnancy, gestational age >28 weeks, nonsmokers, and no personal or family history of vascular disease. Each women was examined during 3rdT and between 8 and 12 weeks PP to evaluate FMD and nitrite concentration in whole blood. Women not examined in both periods were excluded. Values between both periods were compared using paired t tests. Correlation between FMD and nitrite was examined by Pearson correlation coefficient. Significance level set as p<0.05. Results. We invited 42 pregnant women. Among them, 35 were eligible and 7 of them were excluded for not attending the PP evaluation resulting in 28 participants analyzed. We found no significant change in FMD (10.39±5.57% vs. 8.42±4.21%; p=0.11; 3rdT vs. PP, respectively) and no significant change in nitrite concentration (257.41±122.95nmol/L vs. 237.16±90.01nmol/L; p=0.28). Baseline brachial artery diameter had a significant reduction (3.11±0.30 to 2.75±0.34mm; p<0.01). No significant correlation between FMD and nitrite during 3rdT (r=-0.13; p=0.50) or PP (r=0.14; p=0.48) was found. Conclusions. We did not observe significant changes in both FMD and nitrite concentration between third trimester and the PP period. FMD did not correlate with nitrite in both periods. More studies are needed to confirm our findings. © Informa Healthcare USA, Inc.

SELF-REPORTED URINARY INCONTINENCE IN THE POSTPARTUM PERIOD: CLINICAL CHARACTERISTICS

The objective of this cross-sectional study was to characterize the manifestations of self-reported urinary incontinence in the postpartum period. We interviewed 288 women who were clients of a teaching health center in Sao Paulo, between the months of January and August of 2009. The data showed that among the 71 incontinent women (24.6%), 44 (62%) reported stress urinary incontinence, 65 (91.5%) were aware of urine leakage, 33 women (46.5%) experienced urine loss more than once a week, and 24 (33.8%) reported persistent urinary incontinence at the time of interview. The severity classified as moderate urinary incontinence was identified in 53 women (74.7%). The findings highlight the importance of studies on urinary incontinence in the postpartum period, as well as approaching this issue in education and health care interventions with women in the reproductive stage.

ERYTHROGRAM PROFILE DURING POSTPARTUM PERIOD IN HOLSTEIN COWS

With the intention to evaluate the erythrogram profile during postpartum period in Holstein cows, 142 blood samples were collected from cows during the first 90 days after parturition. Blood samples were collected from clinically healthy cows that were non-reactive to the antigen of bovine leukosis virus (GP 51). These animals were divided into nine experimental groups based on the time of the postpartum sample collection. The blood samples were collected with EDTA and submitted to the following tests: erythrocyte counts, packed cell volume, hemoglobin concentration and calculated blood indices (MCV, MCH, MCHC). There was influence of the postpartum period on the erythrogram. These alterations were observed during the first 24 h after parturition. The hemoconcentration observed during the parturition disappeared during the first 24h of postpartum. Variation of the values were observed: red blood, 5.08 +/- 0.60 and 6.11 +/- 0.72 cells /mu L; hemoglobin concentration, 9.85 +/- 1.6 and 11.46 +/- 1,40 g/dL; packed cell volume, 27.9 +/- 3.3 and 31.9 +/- 3.6 %; MVC, 50.10 +/- 5.90 and 55.27 +/- 6.88 fL; MHC, 18.19 +/- 1.63 and 19.50 +/- 2.76 pg; MCHC, 34.83 +/- 2.07 and 36.88 +/- 1.67 %. The values of the hematological components obtained in this study did not exceed the limits of the reference values, obtained from cows raised within the state of Sao Paulo.

HPV clearance in postpartum period of HIV-positive and negative women: a prospective follow-up study

Abstract Background HPV persistence is a key determinant of cervical carcinogenesis. The influence of postpartum on HPV clearance has been debated. This study aimed to assess HPV clearance in later pregnancy and postpartum among HIV-positive and negative women. Methods We conducted a follow-up study with 151 HPV-positive women coinfected with HIV, in 2007–2010. After baseline assessment, all women were retested for HPV infection using PCR in later pregnancy and after delivery. Multivariable logistic regressions assessed the putative association of covariates with HPV status in between each one of the successive visits. Results Seventy-one women (47%) have eliminated HPV between the baseline visit and their second or third visits. HIV-positive women took a significantly longer time (7.0 ± 3.8 months) to clear HPV, compared to those not infected by HIV (5.9 ± 3.0 months). HPV clearance was significantly more likely to take place after delivery than during pregnancy (84.5% x 15.5%). Conclusions Both HIV-positive and negative women presented a significant reduction in HPV infection during the postpartum period. HIV-positive status was found to be associated with a longer period of time to clear HPV infection in pregnant women.

Treatment of Retained Fetal Membranes: Comparison of the Postpartum Period after Routine Treatment or Routine Treatment Including an Additional Phytotherapeutic Substance in Dairy Cattle in Switzerland

Background: The therapy of retained fetal membranes (RFM) is a controversial subject. In Switzerland, intrauterine antibiotics are routinely administered although their effect on fertility parameters is questionable. The objective of this study was to compare the post-partal period after a routine treatment of RFM in 2 groups: one group received a placebo additionally (A), whereas the other group received a phytotherapeutic substance (lime bark) (B) additionally. The routine treatment of RFM included an attempt to manually remove the fetal membranes (for a maximum of 5 min), intramuscular administration of oxytetracycline and intrauterine treatment with tetracycline. In case of an elevated rectal temperature (>39.0°C), an additional non-steroidal inflam-matory drug was allowed. Methods: Cows undergoing caesarean section, suffering from prolapse of the uterus, deep cervical or vaginal injuries, hypocalcaemia, and illnesses during the last 14 days before calving were excluded. Cows had to be more than 265 days pregnant. Only cows that were artificially inseminated after RFM were included. Group stratification was done according to the last number on the ear tag (even/uneven) with (n = 50) cows in group A and (n = 55) cows in group B. Results: The number of treatments after the initial treatment of RFM was not significantly different between groups. The median interval from calving to the first insemination was 77 days in group A compared to 82 days in group B (p = 0.72). The number of AI’s until conception was not significantly different between groups. The median number of days open was 89 days in group A compared to 96 days in group B (p = 0.57). The culling rate was not significantly different between groups. Conclusion: There was neither a difference between the groups concerning therapies within the first 50 days after RFM nor concerning the subsequent fertility variables.

Influence of body composition on gait Kknetics throughout pregnancy and postpartum period

Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. The purpose was to quantify the morphology and body composition of women throughout pregnancy and in the postpartum period and identify the contribution of these parameters on the lower limb joints kinetic during gait. Eleven women were assessed longitudinally, regarding anthropometric, body composition, and kinetic parameters of gait. Body composition and body dimensions showed a significant increase during pregnancy and a decrease in the postpartum period. In the postpartum period, body composition was similar to the 1st trimester, except for triceps skinfold, total calf area, and body mass index, with higher results than at the beginning of pregnancy. Regression models were developed to predict women’s internal loading through anthropometric variables. Four models include variables associated with the amount of fat; four models include variables related to overall body weight; three models include fat-free mass; one model includes the shape of the trunk as a predictor variable. Changes in maternal body composition and morphology largely determine kinetic dynamics of the joints in pregnant women.

Influence of body composition on gait Kknetics throughout pregnancy and postpartum period

Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. The purpose was to quantify the morphology and body composition of women throughout pregnancy and in the postpartum period and identify the contribution of these parameters on the lower limb joints kinetic during gait. Eleven women were assessed longitudinally, regarding anthropometric, body composition, and kinetic parameters of gait. Body composition and body dimensions showed a significant increase during pregnancy and a decrease in the postpartum period. In the postpartum period, body composition was similar to the 1st trimester, except for triceps skinfold, total calf area, and body mass index, with higher results than at the beginning of pregnancy. Regression models were developed to predict women’s internal loading through anthropometric variables. Four models include variables associated with the amount of fat; four models include variables related to overall body weight; three models include fat-free mass; one model includes the shape of the trunk as a predictor variable. Changes in maternal body composition and morphology largely determine kinetic dynamics of the joints in pregnant women.

Biomechanical and morphological adaptations in women during pregnancy and the postpartum period in walking

A gravidez é uma fase especial da vida, com diversas alterações nos sistemas hormonais, anatómicos, e na composição corporal da mulher. No entanto, não é claro que alterações biomecânicas tridimensionais ocorrerem. Através do acompanhamento da mulher na gravidez e pós-parto, os objetivos da presente tese foram: 1) determinar os parâmetros temporais e espaciais do ciclo da marcha; 2) descrever a cinemática angular do membro inferior; 3) calcular os momentos e potências articulares do tornozelo, joelho e coxofemoral, utilizando o cálculo por dinâmica inversa; 4) descrever as magnitudes dos picos dos momentos e potências articulares dos membros inferiores; 5) identificar possíveis diferenças entre as fases de recolha relativamente aos parâmetros biomecânicos; 6) descrever longitudinalmente a composição corporal as alterações morfológicas; 7) analisar a influência das alterações antropométricas na cinética articular. Os resultados mostram que as mulheres mantêm os parâmetros temporais e espaciais da marcha. A cinemática angular do membro inferior tem o mesmo padrão, no entanto, a magnitude de alguns picos, especialmente na bacia e coxofemoral durante a fase terminal do apoio, pré-balanço e de balanço, apresentam alterações significativas. A coxofemoral é a articulação com mais alterações na cinética articular, com um aumento da carga interna associada aos momentos articulares da coxofemoral no plano transversal. No entanto, diversos momentos e potências articulares revelam uma diminuição significativa para o final da gravidez e/ou um aumento entre alguns trimestres da gravidez e o pós-parto. Como esperado, a maioria das variáveis associadas à composição corporal e às dimensões corporais tem um aumento significativo durante a gravidez e uma diminuição no pós-parto. Os modelos desenvolvidos para prever a carga interna aplicada ao membro inferior da grávida através de variáveis antropométricas, incluem quatro modelos com variáveis associadas à quantidade de gordura, quatro modelos com variáveis associadas à massa corporal global, três modelos que incluem a massa livre de gordura, e um modelo que inclui a forma do tronco. Os altos valores do R2 ajustado, mostram que as alterações na composição corporal e morfologia, determinam em grande parte a cinética articular da mulher nesta fase particular da vida.

Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study

Aim. To compare the measurements of women`s pelvic floor musculature strength (PFMS) during pregnancy and postpartum period. Background. Pregnancy and childbirth can have an influence on the muscles and pelvic floor and can cause morbidities of women`s genito-urinary tract. Design. A prospective cohort study. Methods. There were included 226 primigravidae women, attended by community health services in the city of Itapecerica da Serra, Sao Paulo, Brazil. The participants were followed in four stages: (1) within 12 weeks of pregnancy; (2) between 36-40 weeks of pregnancy; (3) within 48 hours after childbirth; (4) 42-60 days after childbirth. Data were collected from February 2007-August 2008. The pelvic floor musculature strength was evaluated by perineometry and digital vaginal palpation in stages 1, 2 and 4. The final sample included 110 women who completed all four stages of the study. Results. The pelvic floor musculature strength of the women did not change significantly during pregnancy or after delivery (anova: p = 0 center dot 78). In all three examined stages, a low-intensity pelvic floor musculature strength was prevalent (in mmHg: stage 1 = 15 center dot 9; stage 2 = 15 center dot 2, stage 4 = 14 center dot 7), with scores from 0-3 on the Oxford scale. The pelvic floor musculature strength did not differ in relation to maternal age, skin colour, conjugal status, dyspareunia, stool characteristics, type of delivery, or conditions of the perineum. An interaction between maternal nutritional state and newborn`s weight may affect the pelvic floor musculature strength (manova: p = 0 center dot 04). Conclusion. Pregnancy and childbirth did not reduce significantly pelvic floor musculature strength. The perineometry and digital vaginal palpation used to assess the pelvic floor musculature strength were well accepted by the women. Relevance to clinical practice. In clinical practice, digital vaginal palpation is effective for supporting the diagnosis of urinary, intestinal and sexual dysfunctions. Perineometry use is particularly important together with the performance of perineal exercises with biofeedback in the treatment these disorders.

Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: parity differences and effects

This study aimed to investigate both anxiety and depression symptoms from early pregnancy to 3-months postpartum, comparing women and men and first and second-time parents. Methods: A sample of 260 Portuguese couples (N=520), first or second-time parents, recruited in an Obstetrics Out-patients Unit, filled in the State-Anxiety Inventory (STAI-S) and the Edinburgh Post-Natal Depression Scale (EPDS) at the 1st, 2nd and 3rd pregnancy trimesters, childbirth, and 3-months postpartum. Results: A decrease in anxiety and depression symptoms from early pregnancy to 3-months postpartum was found in both women and men, as well as in first and second-time parents. Men presented less anxiety and depression symptoms than women, but the same pattern of symptoms over time. Second-time parents showed more anxiety and depression symptoms than first-time parents and a different pattern of symptoms over time: an increase in anxiety and depression symptoms from the 3rd trimester to childbirth was observed in first-time parents versus a decrease in second-time parents. Limitations: The voluntary nature of the participation may have lead to a selection bias; women and men who agreed to participate could be those who presented fewer anxiety and depression symptoms. Moreover, the use of self-report symptom measures does not give us the level of possible disorder in participants. Conclusions: Anxiety and depression symptoms diminish from pregnancy to the postpartum period in all parents. Patterns of anxiety and depression symptoms from early pregnancy to 3-months postpartum are similar in women and men, but somewhat different in first and second time parents. Second-time parents should also be considered while studying and intervening during pregnancy and the postpartum.