postpartum period

O objetivo deste estudo foi analisar aspectos clínicos, epidemiológicos e evolutivos da paralisia facial periférica idiopática em 180 pacientes. Houve ligeiro predomínio do sexo feminino (66,7%). Quanto à faixa etária mais acometida, foram observados dois picos de incidência um nas terceira e quarta décadas, e o outro na sexta década de vida. Nos 180 pacientes houve 198 episódios de paralisia facial periférica, sendo 17 recorrências e em um paciente a paralisia foi de instalação inicial bilateral. Em 15 pacientes (8,3%) houve recidiva da paralisia facial, em dois casos a paralisia se repetindo por mais duas vezes. Em 12 casos (70,6%) a recidiva ocorreu no mesmo lado da paralisia anterior. O lado esquerdo da face estava envolvido em 55,6% dos casos. Em oito pacientes a paralisia aconteceu na gestação (n=5) ou no pós-parto (n=3). Quatro das pacientes grávidas apresentaram paralisia de Bell no terceiro trimestre. Uma paciente com 18 anos de idade desenvolveu paralisia facial do lado di...

To describe national and regional prevalence rates for significant depressive symptoms in women after 12 weeks during the postpartum period, and to identify predictors of postpartum depressive symptoms during this later time period. Data from the Maternity Experiences Survey of the Canadian Perinatal Surveillance System were analyzed. Participants completed a computer-assisted telephone interview between 5 and 14 months during the postpartum period (n = 6421). Depressive symptomatology was measured using the Edinburgh Postnatal Depression Scale (EPDS ≥ 13). Proportions and odds ratios with 95% confidence intervals were calculated using bootstrap methods to account for sample design and weighting adjustments. About 8% of Canadian women exhibited depressive symptoms past 12 weeks during the postpartum period. Prevalence rates varied between regions. In multivariable analysis, previous history of depression (OR 1.87; 95% CI 1.43 to 2.45, P < 0.001), low household income (OR 1.64; 95...

We propose a cycles-breaking conceptual framework to guide perinatal research, interventions, and clinical innovations that can prevent or disrupt intergenerational cycles of childhood maltreatment and psychiatric vulnerability. The framework is grounded in literature, clinical observations, team science collaboration, and empirical research from numerous disciplines and is specific to the childbearing year. Adoption of the framework has the potential to speed the progress of research on the social problems of intergenerational childhood maltreatment and psychiatric vulnerability.

Metformin can be regarded as a first-line treatment in Gestational Diabetes Mellitus (GDM) due to its safety and effectiveness. However, a proportion of women do not achieve adequate glycemic control with metformin alone. We aim to identify predictors of this poor response to metformin. Retrospective multicentre cohort study of women with GDM who started metformin as first-line treatment. The assessed cohort was divided into a metformin group and metformin plus insulin group. Biometric and demographic characteristics, glycemic control data, obstetric, neonatal and postpartum outcomes were compared between groups and analysed in order to identify predictors of poor response to metformin. Data were analysed using STATA version 13.1. Of the 388 women enrolled in the study, 135 (34.8%) required additional insulin therapy to achieve the glycemic targets. Higher age [aOR 1.08 (1.03-1.13), p = 0.003], higher pre-pregnancy body mass index (BMI) [1.06 (1.02-1.10), p = 0.003] and earlier intr...

A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH) programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs), a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC), the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example. We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal co...

Objective. To compare two fixed-time artificial insemination protocols (FTAI) according to the pregnancy percentage in Brahman cattle. Materials and methods. 60 cows between days 90 and 360 postpartum were selected and randomly divided into two groups. For Treatment 1 (T1; n=30), an intravaginal device (IVD) containing 0.5 g of progesterone and 2.0 mg of estradiol benzoate were inserted on Day 0. At the time of IVD withdrawal (Day 8), 150 mg of PGF2α, im and 300 UI of eCG, im and 0.5 mg of estradiol cypionate, im were administered. FTAI was performed on Day 10, 48 – 50 h after IVD withdrawal. For Treatment 2 (T2; n= 30) an IVD was inserted on Day 0 and 0.01 mg GnRH, im were administered. At the time of the IVD withdrawal (Day 5), two doses of 0.150 mg of PGF2α were administered at midnight and noon. FTAI was performed on Day 8, 72h after IVD withdrawal, and 0.01 mg of GnRH, im was administered. FTAI was performed using semen of proven fertility. Results. Pregnancy diagnosis by rectal palpation occurred 45 days after the FTAI. T2 and T1 presented pregnancy percentages of 46.7% (14/30) and 33.3% (10/30), respectively. Conclusions. Treatment 2 is preferred in terms of results and public health.

Background and Aim: Several Ecuadorian farms use human test strips (cheaper than veterinary strips) to diagnose bovine ketosis; however, their reliability is unknown. This study aimed to determine the confidence level of human strips for the detection of ketosis in bovines by comparing two diagnostic methods for ketosis: one used in bovines (gold standard) to analyze blood samples and the other used in humans to analyze urine samples.

Materials and Methods: The study was conducted on an Ecuadorian farm using 50 animals, ten from each of five categories: heifers, 4 months pregnant (4MP), 15 days prepartum (15DPRE), 15 days postpartum (15DPOST), and 42 days postpartum (42DPOST). Blood samples were collected through coccygeal venipuncture and urine samples were collected during spontaneous urination. BHBCheck™ assay was used to measure β-hydroxybutyrate (BHB) in the blood, whereas Combur10Test® was used to measure acetoacetate (AcAc) in urine for the determination of ketosis.

Results: BHB was detected in all animals. Based on a ketosis cutoff point of 0.8-1.2 mmol/L, 13 animals from the 15DPOST and 42DPOST categories had ketosis; AcAc was detected in the urine from nine animals originated from the two same categories. Metabolites, either BHB or AcAc, were not detected in heifers, 4MP, or 15DPRE individuals. Finally, the BHBCheck™ assay had better efficiency in detecting ketosis in animals (p<0.05) than the Combur10Test®.

Conclusion: Combur10Test® urine strips reached 92% reliability for the detection of ketosis in dairy cattle, compared to BHBCheck™ assays.

This study compared postpartum women from the inner city (n = 94) and postpartum women from the urban middle class (n = 80) on values and goals for themselves and their newborn children. Terminal values of inner-city women for themselves related more to social and religious goals in contrast to the more intrapersonal and personal goals of middle-class women. Instrumental values of inner-city women for their newborn children demonstrated concern with conformity and control, whereas for the middle class there was more concern with competence. Goals for the near future of the inner-city mothers were based on a desire for jobs and education.

Young Southern African women have the highest HIV incidence globally. Pregnancy doubles the risk of HIV acquisition further, and maternal HIV acquisition contributes significantly to the paediatric HIV burden. Little data on combination HIV prevention interventions during pregnancy and lactation are available. We measured HIV incidence amongst pregnant and postpartum women receiving a community-based combination HIV prevention intervention in a high HIV incidence setting in South Africa. A cohort study that included HIV-uninfected pregnant women was performed. Lay community-based workers provided individualized HIV prevention counselling and performed three-monthly home and clinic-based individual and couples HIV testing. Male partners were referred for circumcision, sexually transmitted infections or HIV treatment as appropriate. Kaplan-Meier analyses and Cox&#39;s regression were used to estimate HIV incidence and factors associated with HIV acquisition. The 1356 women included (m...

Dairy cows experience dramatic changes in host physiology from gestation to lactation period and dietary switch from high-forage prepartum diet to high-concentrate postpartum diet over the transition period (parturition +/- three weeks). Understanding the community structure and activity of the rumen microbiota and its associative patterns over the transition period may provide insight for e.g. improving animal health and production. In the present study, rumen samples from ten primiparous Holstein dairy cows were collected over seven weeks spanning the transition period. Total RNA was extracted from the rumen samples and cDNA thereof was subsequently used for characterizing the metabolically active bacterial (16S rRNA transcript amplicon sequencing) and archaeal (qPCR, T-RFLP and mcrA and 16S rRNA transcript amplicon sequencing) communities. The metabolically active bacterial community was dominated by three phyla, showing significant changes in relative abundance range over the tr...

Primiparous Angus x Simmental heifers (n = 43) in a single-calf heifer (SCH) system (i.e., heifers are bred, calved, and placed in drylot pens with their calves at side and fed to slaughter weights) were studied to evaluate the effects of prenatal androgenization on parturition and on periparturient reproductive and metabolic hormone concentrations. Seven prenatally androgenized (PA) and seven control (C) heifers were used for blood collection to characterize parturient and lactation endocrine profiles; all heifers were used for blood collection to characterize postpartum ovarian cyclicity. Serum concentrations of progesterone, estradiol, testosterone, 13,14-dihydro-15-keto-PGF2 alpha (PGFM), and prolactin from 10 d before to 3 d after parturition were similar for PA and C heifers. Calf birth weights (34.7 +/- .9 kg) and calving ease scores (1.34 +/- .14) were similar between treatments. Postpartum ovarian cyclicity was similar; only 6 of 22 PA (27.3%) and 3 of 21 C (14.3%) heifers ...

Modeling studies of the insulin-glucose relationship have mainly utilized parametric models, most notably the minimal model (MM) of glucose disappearance. This article presents results from the comparative analysis of the parametric MM and a nonparametric Laguerre based Volterra Model (LVM) applied to the analysis of insulin modified (IM) intravenous glucose tolerance test (IVGTT) data from a clinical study of gestational diabetes mellitus (GDM). An IM IVGTT study was performed 8 to 10 weeks postpartum in 125 women who were diagnosed with GDM during their pregnancy [population at risk of developing diabetes (PRD)] and in 39 control women with normal pregnancies (control subjects). The measured plasma glucose and insulin from the IM IVGTT in each group were analyzed via a population analysis approach to estimate the insulin sensitivity parameter of the parametric MM. In the nonparametric LVM analysis, the glucose and insulin data were used to calculate the first-order kernel, from wh...

To assess parenting stress and major difficulties experienced in early motherhood among immigrant and Taiwanese women in Pingtung, southern Taiwan. A comparative, descriptive, cohort study of parenting stress and maternal psychological health, using the Child Care Stress Checklist and Edinburgh Postpartum Depression Scale. A purposive sample of 26 foreign-born Vietnamese and 162 Taiwanese mothers were surveyed at 6 weeks&#39; postpartum. Both groups of mothers experienced similar parenting difficulties including the establishment of a regular sleeping schedule for the infant, consoling a crying infant, awareness of infant&#39;s needs, conflict with family members, and difficulties managing household chores. Curtailment of social activities was reported more often by Taiwanese mothers, whereas inaccessibility to other experienced mothers and poor maternal-infant bonding were experienced more by immigrant mothers. There were significant differences between groups, with high levels of ...

Introduction and hypothesis The aim of this study was to determine the effectiveness of pelvic floor muscle exercises on urinary incontinence during pregnancy and the postpar-tum period. Methods The study was carried out on 80 pregnant women (study group, 40 subjects; control group, 40 subjects).The study group was trained by the researcher on how to do the pelvic floor muscle exercises. Both groups were evaluated for pelvic floor muscle strength and urinary complaints in their 36th to 38th week of pregnancy and postpartum sixth to eighth week. Results The study group had a significant decrease in urinary incontinence episodes during pregnancy and in the postpartum period, and their pelvic floor muscle strength increased to a larger extent. Control group had an increase in the postpartum muscle strength and decrease in the incontinence episodes in the postpartum period. Conclusions Pelvic floor muscle exercises are quite effective in the augmentation of the pelvic floor muscle strength and consequently in the treatment of urinary incontinence.

To describe the rates of breastfeeding initiation and breastfeeding for at least six months and identify risk factors for failing to breastfeed for six months among a community sample of mothers in Calgary, Alberta. A cohort of women (n=1737) who participated in a longitudinal study of prenatal support and who could be contacted when their child was three-years-old (n=1147) were invited to participate in a follow-up telephone questionnaire. Of these 1147 women, 780 (69% participating rate) participated and provided breastfeeding data. Risk factors for early cessation of breastfeeding prior to six months were identified using bivariate and multivariable strategies. Of the 780 women, 95.6% initiated breastfeeding and 71.6% continued to breastfeed for at least six months. Risk factors identified for early cessation included younger maternal age, obesity prior to pregnancy, lower maternal education, working full-time or intending to within the first year, history of depression, depression or anxiety during pregnancy, poor social support, and smoking during pregnancy (all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Multivariable analysis revealed that working full-time or intending to within the first year, lower maternal education, obesity prior to pregnancy and anxiety during pregnancy most increased a woman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s risk of early cessation (all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). Nearly all mothers initiated breastfeeding and 70% continued to breastfeed for six months, although subgroups of women remained at an elevated risk of early cessation. Research to better understand breastfeeding decisions among women with the risk factors identified is needed to facilitate the development of more effective breastfeeding promotion strategies.

Demographic methods provide an invaluable foundation for population program planning by giving quantitative expression to present and future characteristics of a population. It must be recognized that, while the formulas may be precise, the validity of the outputs are constrained by the quality of input data available and the assumptions required. Fertility projections present special problems because of the multiplicity of factors that can independently influence reproductive performance. The estimation of births averted by family planning programs is particularly tenuous. Population planners must be cognizant of all the dimensions of population change if effective programs are to be developed.

To explore primary care provider (PCP) and patient perspectives on postpartum screening for type 2 diabetes (T2DM), including reasons for not completing oral glucose tolerance tests (OGTTs) specifically, preferred provider for organizing screening, and value of reminder letters for facilitating screening. A follow-up survey, administered by fax or telephone, to PCPs and patients who participated in a randomized controlled trial assessing effectiveness of postpartum postal reminders to enhance screening for T2DM in women with gestational diabetes mellitus (GDM). The Ottawa Hospital, a university-affiliated tertiary centre in Ottawa, Ont. A total of 223 female patients with previously identified GDM and their respective PCPs were surveyed; 173 PCPs and 140 patients participated. Whether or not the patient was screened for T2DM post partum, the test used for screening, the factors contributing to the patient not being screened, perspectives on the importance of screening post partum, a...

Thyroid disease in pregnancy is a common clinical problem. Since the American Thyroid Association&#39;s (ATA&#39;s) guidelines for the management of these disorders were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English-language articles were eligible for inclusion. The American College of Physicians Guideline Gradin...

Anxiety and related disorders (AD) disproportionately affect women, and are the most prevalent of all mental health conditions. The current research represents the first study of maternal postpartum AD prevalence in which all of the AD are assessed, and one of few studies of this type in which maternal prenatal AD incidence is assessed. A Canadian sample of pregnant women (N=310) was recruited from a defined geographical area between November 2007 and November 2010. Participants were first administered postnatal mood and anxiety screening measures. Those who scored at or above cutoff on one or more of these measures were administered a diagnostic interview for depression and anxiety at approximately three months postpartum (n=115). Findings from the diagnostic interview were used to estimate the prevalence and incidence of mood and AD in pregnancy, as well as at and during the first three months postpartum. Period prevalence and incidence estimates were obtained retrospectively from...