Search

Background: The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. In efforts to address this, new guidelines for postpartum care suggest that mobile health (mHealth) apps can help provide complementary clinical support for new mothers during the postpartum period. However, to date no study has evaluated the quality of existing mHealth tools targeted to this time period in terms of sufficiency of maternal health information, inclusivity of people of color, and app usability.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to review the peripartum apps from the Apple and Google Play stores in either the Health/Fitness, Medical, or Education categories. Apps were evaluated for extent and quality of maternal health information and inclusivity of people of color using an a priori coding scheme. App usability was evaluated using the Mobile Application Rating Scale (MARS) score.Results: Of the 301 apps from the Apple and Google Play stores, 25 met criteria for final evaluation. Of the 30 maternal health topics coded for, the median number addressed by apps was 19.5 (65%). Peripartum behaviors were more frequently addressed than peripartum outpatient care topics and peripartum acute health risks. The coverage of maternal health information and inclusivity of people of color in app imagery both correlated positively with the MARS usability score of the app. Only 8 apps (32%) portrayed greater than 24% images of people of color- the percent of non-white Americans according to 2019 census estimates. There was no correlation between MARS usability score and number of app users, as estimated by number of ratings for the app available on the app store. In addition, apps with evidence-based maternal health information had greater MARS engagement, information, and aesthetics scores. However, presence of evidence-based information did not correlate with greater numbers of app users.Conclusions: Current commercially available peripartum apps range widely in quality. Overall current app offerings generally do not provide adequate maternal health information and are not optimally accessible to the target users in terms of inclusivity of women of color or app usability. Apps delivering evidence-based information and more usable design are more likely to meet these standards but are not more likely to be downloaded by users. [ABSTRACT FROM AUTHOR]

Background: During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention. Methods: Data were derived from the M aternal A nxiety and it's R elation to I nfants' Development (MARI) study. N = 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in N = 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses. Results: Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment. Conclusions: Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy—both with the mother and the unborn child. [ABSTRACT FROM AUTHOR]

Background: Peripartum depression (PND) impairs mother-infant boding and perceived social support, yet limited research has examined if women at-risk for PND (AR-PND) also experience impairment. We examined if pregnant women AR-PND, women with PND, and healthy comparison women (HCW) differed in their mother-infant bonding and social support. As PND is highly comorbid with anxiety, we also examined if peripartum anxiety impacted postpartum diagnosis of PND. Methods: A total of 144 pregnant women AR-PND or euthymic were assessed twice antepartum and twice postpartum. We utilized regression models to examine the impact of PND risk group status and diagnostic status on mother-infant bonding and perceived social support postpartum. We conducted a sensitivity analysis using a generalized estimating equations model to determine if anxiety (Hamilton Anxiety Rating Scale, HAM-A) across all four time points was associated with the postpartum diagnosis of PND. Results: Women AR-PND experienced significantly worse mother-infant bonding compared to HCW (p = .03). Women diagnosed with PND experienced significantly worse mother-infant bonding and social support compared to HCW (p = .001, p = .002, respectively) and to those who were at-risk for but did not develop PND (p = .02, p = .008, respectively). HAM-A severity at each visit was associated with PND diagnosis status, where each increase in HAM-A was associated with 15% increased odds of being diagnosed with PND postpartum. Conclusions: Both women AR-PND and those with PND experience worse mother-infant bonding. Peripartum anxiety should also be assessed as it represents a marker for later PND. [ABSTRACT FROM AUTHOR]

Objective: Peripartum is a period of profound hormonal changes in the body and COVID‐19 seems to have an additional impact on these women's psychosocial functioning. This calls for a need to address the psychosocial and behavioural impact of COVID‐19 on peripartum women's lives. Methods: Three focus group discussions and ten in‐depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive sampling. In verbatim transcription was done, followed by thematic analysis to extract key conceptual themes. Results: Fourteen pregnant and eleven postpartum women were included. The mean age was 28.5 years. Two major domains were identified: 1) the psychological domain including the categories of thoughts, emotions, and behaviour, and 2) the social domain comprising categories of relationships with family members and friends, perceived loss of social support, doctor‐patient relationship, and social determinants of health. Conclusion: The pandemic has indeed affected the psychosocial functioning of peripartum women. The study results might prove to be helpful for clinicians and mental health specialists who can suggest and develop different coping strategies for peripartum women during this pandemic. Synopsis: This FGD shows how COVID‐19 has affected the psychosocial functioning of peripartum women in LMICs and highlights the need to develop strategies to mitigate them. [ABSTRACT FROM AUTHOR]

The peripartum period (pregnancy and postpartum) is a unique time filled with psychodynamic and biological changes that are critical in affecting the lives of mother and baby. Attachment, the biologically based emotional connection between a caregiver and infant, is critical to the development of the child. The early interactions in an infant's life shape their reward neuro-circuitry and the development of their internal working models and styles of attachment. Opioid use disorders in the mother affect the psychodynamics and neurobiology of attachment. There is significant overlap between the neurobiology of attachment and that of opioid use disorders. In this article, we hope to describe how opioid use disorders affect mother-infant attachment and how psychodynamic psychotherapy that is informed by attachment theory may be a potential treatment for mothers with opioid use disorders. Further, oxytocin plays a role in the attachment process and may function abnormally in mothers with opioid use disorders. As oxytocin affects attachment, administration of oxytocin during postpartum mother-infant interactions in the setting of psychotherapy may facilitate bonding and promote recovery from opioid use disorders in the peripartum population. [ABSTRACT FROM AUTHOR]

Emergency peripartum hysterectomy is a major operation performed when conservative measures fail to stop life-threatening postpartum hemorrhage. It is associated with a high rate of maternal morbidity among survivors. This work aims to evaluate the incidence, indication, and complications of peripartum hysterectomy at King Abdulla University Hospital over 15 years. A retrospective cohort study of emergency peripartum hysterectomy. The incidence was calculated. Risk factors for abnormally adherent placenta were explored. A comparison between total and subtotal hysterectomy in terms of morbidity outcomes was conducted. The chi-square test, Fisher's exact, and independent sample T test were used for analysis. Statistical significance was declared at α < 0.05. The incidence of peripartum hysterectomy was 1.38 per 1000 births. Fifty-nine were performed after cesarean section and three were performed after vaginal delivery (P<0.001). Abnormally adherent placenta (accreta, increta, and percreta) was the main indication (44.06%). The strongest risk factor for abnormally adherent placenta was placenta previa with previous cesarean section (P=0.001, OR 16.25, 95% CI 1.95-135.01). One maternal and three neonatal deaths were recorded. Urinary bladder injury was the most frequent complication (27.11%). No difference in morbidity was noted between total and subtotal hysterectomy. The incidence of emergency peripartum hysterectomy is increasing steadily over the last two decades in the north of Jordan. Abnormally adherent placenta is the most common indication for emergency peripartum hysterectomy. There is no significant difference between total and subtotal hysterectomy in terms of complications' development, admission to the intensive care unit, and estimated blood loss. The morbidity associated with emergency peripartum hysterectomy is significant. [ABSTRACT FROM AUTHOR]

The peripartum period appears to be a potent trigger of obsessive-compulsive disorder in women; however, due to the lack of awareness and routine screening, women with obsessive-compulsive disorder may be at risk of under- or misdiagnosis. Unfortunately, the missed diagnosis or misdiagnosis can have serious consequences including symptom persistence, compromised ability to care for the newborn, poor quality of life and unnecessary reporting of the mother to child protective services. It is argued that future iterations of the DSM consider expanding the scope of the peripartum onset specifier to include obsessive-compulsive disorder to increase its detection, diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: Maternal hemorrhage protocols involve risk screening. These protocols prepare clinicians for potential hemorrhage and transfusion in individual patients. Patient‐specific estimation and stratification of risk may improve maternal outcomes. Study Design and Methods: Prediction models for hemorrhage and transfusion were trained and tested in a data set of 74 variables from 63 973 deliveries (97.6% of the source population of 65 560 deliveries included in a perinatal database from an academic urban delivery center) with sufficient data at pertinent time points: antepartum, peripartum, and postpartum. Hemorrhage and transfusion were present in 6% and 1.6% of deliveries, respectively. Model performance was evaluated with the receiver operating characteristic (ROC), precision‐recall curves, and the Hosmer‐Lemeshow calibration statistic. Results: For hemorrhage risk prediction, logistic regression model discrimination showed ROCs of 0.633, 0.643, and 0.661 for the antepartum, peripartum, and postpartum models, respectively. These improve upon the California Maternal Quality Care Collaborative (CMQCC) accuracy of 0.613 for hemorrhage. Predictions of transfusion resulted in ROCs of 0.806, 0.822, and 0.854 for the antepartum, peripartum, and postpartum models, respectively. Previously described and new risk factors were identified. Models were not well calibrated with Hosmer‐Lemeshow statistic P values between.001 and.6. Conclusions: Our models improve on existing risk assessment; however, further enhancement might require the inclusion of more granular, dynamic data. With the goal of increasing translatability, this work was distilled to an online open‐source repository, including a form allowing risk factor inputs and outputs of CMQCC risk, alongside our numerical risk estimation and stratification of hemorrhage and transfusion. [ABSTRACT FROM AUTHOR]

Background: During HIV retesting in antenatal and preexposure prophylaxis (PrEP) care, discrepant results occur, but guidelines are lacking.Methods: In a Kenyan trial implementing antenatal PrEP, if 1 test is reactive, a second is performed; if discrepant, both are repeated; if persistently discrepant, DNA polymerase chain reaction (PCR) is performed.Results: Among 4451 women, 23 265 HIV retesting sessions were performed; 14 (0.06%, 95% confidence interval, 0.03%-0.10%) had discrepant results among 10 individuals; in all 10 initial cases, PCR was negative.Conclusions: Discrepant rapid tests are an expected, rare, and important challenge for antenatal care HIV retesting, with and without PrEP.Clinical Trials Registration: NCT03070600. [ABSTRACT FROM AUTHOR]

Aims: Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results: From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in‐hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence‐based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in‐hospital death (1.6%), and after 1 year of follow‐up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions: A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM. [ABSTRACT FROM AUTHOR]

Aims Pregnancy is a known risk factor for arterial dissection, which can result in significant morbidity and mortality in the peripartum period. However, little is known about the risk factors, timing, distribution, and outcomes of arterial dissections associated with pregnancy. Methods and results We included all women ≥12 years of age with hospitalizations associated with pregnancy and/or delivery in the Nationwide Readmissions Database between 2010 and 2015. The primary outcome was any dissection during pregnancy, delivery, or the postpartum period (42-days post-delivery). Secondary outcomes included timing of dissection, location of dissection, and in-hospital mortality. Among 18 151  897 pregnant patients, 993 (0.005%) patients were diagnosed with a pregnancy-related dissection. Risk factors included older age (32.8 vs. 28.0 years), multiple gestation (3.6% vs. 1.9%), gestational diabetes (14.3% vs. 0.2%), gestational hypertension (6.0% vs. 0.6%), and pre-eclampsia/eclampsia (2.7% vs. 0.4%), in addition to traditional cardiovascular risk factors. Of the 993 patients with dissection, 150 (15.1%) dissections occurred in the antepartum period, 232 (23.4%) were diagnosed during the admission for delivery, and 611 (61.5%) were diagnosed in the postpartum period. The most common locations for dissections were coronary (38.2%), vertebral (22.9%), aortic (19.8%), and carotid (19.5%). In-hospital mortality was 3.7% among pregnant patients with a dissection vs. <0.001% in patients without a dissection. Deaths were isolated to patients with an aortic (8.6%), coronary (4.2%), or supra-aortic (<2.5%) dissection. Conclusion Arterial dissections occurred in 5.5/100 000 hospitalized pregnant or postpartum women, most frequently in the postpartum period, and were associated with high mortality risk. The coronary arteries were most commonly involved. Pregnancy-related dissections were associated with traditional risk factors, as well as pregnancy-specific conditions. Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]

We describe a case of undiagnosed heart block which was detected during the postpartum surgical repair of a vaginal tear, and the subsequent investigations that confirmed diagnosis of atrio-ventricular heart block. [ABSTRACT FROM AUTHOR]

Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment. [ABSTRACT FROM AUTHOR]

Thrombolysis in high-risk pulmonary embolism (PE) patients is recommended worldwide; however, the evidence for thrombolysis during pregnancy and the immediate puerperium remains unclear. We conducted a systematic review from 1950 to 2019 through PubMed, Ovid/Willey, and Cochrane Library to assess the safety and effectiveness of thrombolysis during pregnancy and the immediate puerperium. Additionally, we characterized the clinical presentation, risk stratification, and diagnostic approach. We have communicated our results according to the PRISMA statement. We collected 141 records and, after critical assessment, included 47 case reports of 54 patients, including 43 and 11 patients during pregnancy and puerperium, respectively. During pregnancy, alteplase was the most frequent systemic thrombolytic agent used (67%), but only nine patients received the approved FDA regimen. With catheter-directed thrombolysis, low-dose thrombolytics and fragmentation were the most common regimens. Major bleeding occurred in 18% of cases, but there was no intracranial bleeding. One maternal death occurred secondary to refractory cardiogenic shock. Fetal mortality was 20%. During the immediate puerperium, nine patients received "off-label" first-, second-, and third-generation thrombolytic regimens, and four cases underwent catheter-directed thrombolysis. We observed nine major bleeding events, seven of which were from the uterine location and none of which were intracranial. In conclusion, overall, these data do not suggest prohibitive risk associated with thrombolysis for PE in pregnancy. Management of massive and high-risk submassive PE in pregnancy should be individualized to each patient. In the data presented, no fatal bleeding or intracranial bleeding was observed. Finally, future efforts should systematically collect and report data on high-risk PE in pregnancy and peripartum patients to improve the evidence-base clinical practice. [ABSTRACT FROM AUTHOR]

The postpartum period is crucial in dairy cows and is marked by major physiological and metabolic changes that affect milk production, immune response and fertility. Nutrition remains the most important lever for limiting the negative energy balance and its consequences on general health status in highly selected dairy cows. In order to analyze the effect of a commercial micronutrient on intrinsic parameters, performances and the epigenome of dairy cows, 2 groups of 12 Holstein cows were used: 1 fed a standard diet (mainly composed of corn silage, soybean meal and non-mineral supplement) and the other 1 fed the same diet supplemented with the commercial micronutrient (µ-nutrient supplementation) for 4 weeks before calving and 8 weeks thereafter. Milk production and composition, BW, body condition score (BCS), DM intake (DMI) and health (calving score, metritis and mastitis) were recorded over the study period. Milk samples were collected on D15 and D60 post-calving for analyses of casein, Na+ and K+ contents and metalloprotease activity. Milk leukocytes and milk mammary epithelial cells (mMECs) were purified and counted. The viability of mMECs was assessed, together with their activity, through an analysis of gene expression. At the same time points, peripheral blood mononuclear cells (PBMCs) were purified and counted. Using genomic DNA extracted from PBMCs, mMECs and milk leukocytes, we assessed global DNA methylation (Me-CCGG) to evaluate the epigenetic imprinting associated with the µ-nutrient-supplemented diet. The µ-nutrient supplementation increased BCS and BW without modifying DMI or milk yield and composition. It also improved calving condition, reducing the time interval between calving and first service. Each easily collectable cell type displayed a specific pattern of Me-CCGG with only subtle changes associated with lactation stages in PBMCs. In conclusion, the response to the µ-nutrient supplementation improved the body condition without alteration of global epigenetic status in dairy cows. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Reddito is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Cushing's disease (CD) is one of the most severe endocrine disorders and primarily affects women of reproductive age. The peripartum period has been observed to be a common time to develop CD. This study aims to retrospectively analyze the clinical characteristics of CD potentially associated with pregnancy and to evaluate relevant pregnancy outcomes.Methods: Patients who underwent surgery from January 2010 to May 2019 at Peking Union Medical College Hospital (PUMCH) with biochemically and pathologically confirmed CD were retrospectively analyzed. Pregnancy-associated CD was defined as CD onset during gestation or within 12 months after delivery or abortion. Data including demographics, biochemical tests, magnetic resonance imaging (MRI) findings, and disease outcomes were obtained from all patients by reviewing their medical records. Information regarding pregnancy was collected through a supplementary online questionnaire.Results: In a series of female patients (n = 70) of reproductive age with childbearing desire, 27.1% (n = 19) met the criteria for pregnancy-associated CD. The timing of diagnosis of pregnancy-associated CD was 2.7 ± 3.4 years after symptom onset, and the overall remission rate for these women was 89.5%. Three patients with pregnancy-associated CD developed hypertension during pregnancy, two of whom had new-onset hypertension at 16 weeks of gestation and one of whom had a complication of severe diabetes. The rates of spontaneous abortion and preterm birth among the women with pregnancy-associated CD were 26.3 and 28.6%, respectively. The proportions of all low-birth-weight (LBW) newborns (p = 0.002) and term LBW newborns (p = 0.033) were significantly higher in the pregnancy-associated CD group than in the non-pregnancy-associated CD group.Conclusions: In this study, a total of 27.1% of women of reproductive age with CD had pregnancy-associated CD, which might be induced by the hormonal milieu of pregnancy. An increased risk of having a LBW newborn was observed among mothers with pregnancy-associated CD. A high degree of clinical suspicion for CD may be warranted in the peripartum period. Patients with symptoms suspicious for CD throughout pregnancy and after childbirth, such as early-onset hypertension, severe hyperglycemia, and persistent weight gain, should be carefully diagnosed and closely monitored by clinicians.

Peripartum Cardiomyopathy (PPCM) merupakan salah satu jenis kardiomiopati dilatasi tanpa diketahui penyebabnya yang terjadi pada wanita hamil usia reproduktif yang jarang terjadi. Patofisiologi PPCM masih kontroversial, penyebab PPCM tidak bisa dijelaskan dengan etiologi tunggal, karena memiliki penyebab multifaktor. Pasien wanita, 43 tahun, ASA III dengan preeklamsi berat pada multigravida hamil preterm belum dalam persalinan dengan PPCM NYHA II riwayat seksio sesarea 10 tahun rencana dilakukan re-seksio sesarea elektif. Pada pasien ini didapatkan pada pemeriksaan kardiovaskuler dengan murmur pansistolik. Ekokardiografi ventrikel kiri dilatasi, kontraktilitas ventrikel kiri menurun ejection fraction 31%, fungsi diastolik restriktif, mitral regurgitasi ringan. Rencana dilakukan anestesi dengan teknik epidural namun dalam pelaksanaannya gagal epidural kemudian dikonversi menjadi anestesi umum intubasi oral. Secara umum, target hemodinamik pada berbagai teknik anestesi adalah sama, yaitu mengurangi kardiak preload dan afterload serta mencegah penurunan kontraktilitas kardiak yang sudah buruk sebelumnya. Teknik anestesi yang menghasilkan penurunan mendadak pada tahanan pembuluh darah sistemik sebaiknya dihindari. Manajemen anestesi pada pasien dengan PPCM, teknik regional anestesi maupun anestesi umum dapat diterapkan. Namun tetap mempertimbangkan beberapa faktor seperti kondisi pasien dan kemampuan dari dokter anestesi itu sendiri. Anesthetic Management for Caesarean Section in Multygravida with Peripartum Cardiomyopathy Abstract Peripartum Cardiomyopathy (PPCM) is one type of dilated cardiomyopathy without known cause in pregnant women in reproductive age are rare. Pathophysiology of PPCM is still controversial, the cause of PPCM can not be explained by a single etiology because it has multifactor. Female patient, 43 years, ASA III with severe preeclamsia pregnancy, preterm, multigravida and not yet in labor with PPCM NYHA II and history of caesarian section 10 years ago planned for elective re-caesarian section. In this patient was obatained pansistolic murmur on cardiovascular examination. Echocardiography was obtained dilated left ventricle, left ventricular contractility decrease with ejection fraction 31%, restrictive diastolic function, mild mitral regurgitation. Planned for anesthesia with epidural technique but in implementation the epidural was fail then converted into general anesthesia oral intubation. In general, hemodynamic targets in anesthesia techniques are the same, ie reducing cardiac preload and afterload and preventing a decline in bad cardiac contractility. Anesthesia techniques that produce a sudden decrease in systemic vascular resistance should be avoided. Anesthesia management in patient with PPCM both regional and general anesthesia technique can be applied. But still considering several factors such as patient’s condition and the ability of the anesthesiologist itself.

The behaviors associated with domestic cattle such as maternal care are quite similar to those behaviors observed in wild ungulates. These behaviors allow the cow to bond with her calf, protect and provide it with nourishment and ultimately reduce the bond at weaning. Although maternal behavior is an important factor influencing the survival and early development of the newborn calf, Zebu type cows around calving have not been studied extensively. Herein, we consider the four main aspects of maternal behavior in cattle and particularly Bos indicus cows and calves. Firstly, we provide a brief description of the behavior of cows around parturition and the behavior of the first stages of the calves’ lives. In the second part, the protective behavior of the mother is analyzed. Subsequently, examples of animal welfare implications followed by an analysis of some factors that affect calf survival, including mother experience and weather conditions, are discussed, and in the last part, reproduction along with some peculiarities of reproductive behavior, and the wellbeing of mother and calves are examined. We concluded that knowledge of maternal behavior of Zebu type cows around calving and interactions with calves might contribute to an enhanced reproductive efficiency of the mother and the welfare of the calf.

(1) Background: Sepsis is the leading cause of maternal death in 11–15% of women worldwide. This emphasises the importance of administrating timely and appropriate antibiotic therapy to women with sepsis. We aimed to evaluate the appropriateness of antimicrobial prescribing in women diagnosed with peripartum sepsis. (2) Method: A prospective observational cohort study in a single Scottish health region with 12,233 annual live births. Data were collected on women diagnosed with sepsis in the peripartum period using physical and electronic medical records, drug Kardex® (medication administration) and ward handover records. (3) Results: A sepsis diagnosis was concluded in 89 of the 2690 pregnancy cases reviewed, with a median hospital stay of four days. Good overall adherence to the local guidelines for the empiric antimicrobial treatment of sepsis was observed. Group B Streptococcus was associated with 20.8% of maternal sepsis cases, whilst in 60% of clinical specimens tested no causative pathogen was isolated. (4) Conclusion: The lack of specific and sensitive clinical markers for sepsis, coupled with their inconsistent clinical application to inform diagnosis, hindered effective antimicrobial stewardship. This was further exacerbated by the lack of positive culture isolates from clinical specimens, which meant that patients were often continued on broader-spectrum empiric treatment. [ABSTRACT FROM AUTHOR]

Objectives: To examine the outcomes of planned induction of labour versus spontaneous onset of labour among women using prophylactic-dose low-molecular weight heparin (LMWH) therapy.Design: Retrospective cohort study.Setting: University hospital.Population: Women receiving antepartum prophylactic LMWH therapy undergoing a trial of vaginal delivery.Methods: Charts from 2018-2019 were reviewed.Main Outcome Measures: Duration of anticoagulation interruption and eligibility to receive neuraxial anaesthesia.Results: Data from 199 women were analysed; 78 (39.2%) were admitted following spontaneous onset of labour and 121 (60.8%) underwent planned induction of labour. Compared to women who underwent planned induction of labour, women who presented with spontaneous onset of labour had a shorter median admission-to-delivery interval (4.7 versus 29.3 hours, P < 0.001). Similarly, intervals from the last LMWH injection to delivery (25.8 versus 48.2 hours, P < 0.001) and to the first postpartum LMWH injection (41.2 versus 63.7 hours, P < 0.001) were shorter. Among those with spontaneous onset of labour, 69 (88.5%) were eligible to receive neuraxial anaesthesia. Rates of postpartum haemorrhage and blood transfusion were similar between the groups. No thrombotic events were encountered in those with spontaneous onset of labour, but four (3.3%) women who delivered following induction of labour developed a postpartum thrombotic event.Conclusion: Planned induction of labour was associated with a higher risk of postpartum thrombotic events than was spontaneous onset of labour (4 of 121 [3.3%] versus 0 of 78 [0%]), presumably due to prolonged duration of anticoagulation interruption, although the difference was not statistically significant. Allowing spontaneous onset of labour was associated with comparable rates of bleeding complications, and only a low proportion (9 of 78, 11.5%) were not eligible to receive neuraxial anaesthesia.Tweetable Abstract: Planned induction among women using prophylactic LMWH therapy might increase the risk of thromboembolic complications. [ABSTRACT FROM AUTHOR]

The aims of this study were to characterize the biochemical profile, the reproductive performance and to identify potential predictive biomarkers of disease state of dairy cows with hyperketonemia, lipomobilization and hypocalcemia raised in tropical conditions in southeastern Brazil. Dairy cows (n = 50) were divided into a group of healthy cows (n = 14), cows with lipomobilization (n = 14), cows with hypocalcemia (n = 11), and a group of cows with hyperketonemia (n = 11). Evaluation of body condition score (BCS), body weight (BW) and blood samples was performed on 21, 14, 7, 4 and 2 days before calving, parturition, 1, 7, 14, 21, 30, 45 and 60 days post‐partum and milk production was recorded on days 7, 14, 21, 30, 45 and 60 after parturition. Blood samples were assayed for aspartate aminotransferase (AST), gamma‐glutammyltransferase (GGT), albumin, total protein, globulin, fibrinogen, total cholesterol, triglyceride, urea and creatinine concentrations. The biochemical profile, BCS, BW, milk production and reproductive performance differed (p <.05) among the groups. Our findings indicate changes in the biochemical profile of dairy cows with metabolic diseases and impaired production and fertility of dairy cows in this group. Variable importance in projection plots demonstrated that cholesterol, urea, total protein, albumin and fibrinogen in the serum were the strongest discriminators between cows with hypocalcemia and healthy cows; and AST, cholesterol, urea and triglycerides for cows with hyperketonemia and healthy cows; and cholesterol, urea, triglycerides, total protein and fibrinogen for lipomobilization and healthy cows, which might be useful as predictive biomarkers of the disease state. [ABSTRACT FROM AUTHOR]

Background: The use of Chinese herbal medicine (CHM) has been widely promoted as a natural and safe way to treat illness during pregnancy. However, prescription patterns and factors influencing its use are largely unknown. Therefore, we conducted a population-based study to address these questions. Methods: Pregnant women aged 18–50 years were selected from Taiwan's National Health Insurance Research Database between 2001 to 2011. CHM prescriptions and diagnostic records were collected. Demographic data and pre-existing diseases were compared between CHM users and non-users. A multivariate logistic regression analysis was performed to identify possible factors influencing the use of CHM during pregnancy. Results: A total of 81,873 eligible prescription records were identified, and 16,553 pregnant women were prescribed CHM during pregnancy, yielding a CHM prescription rate of 20.2%. The three most frequently used herbs were Scutellariae Radix (Huang Qin) (4.4%), Eucommiae cortex (Du Zhong) (2.5%), and Atractylodes Rhizome (Bai Zhu) (2.4%). The most frequently used herbal formulae were Dang-Guei-Shao-Yao-San (4.1%), Jia-Wei-Xiao-Yao-San (3.5%), and Xiang-Sha-Liu-Jun-Zi-Tang (2.6%). Multivariate logistic regression revealed that subjects with an older age, a university education, a pre-pregnancy history of CHM use, asthma, chronic renal disease, and cardiac valvular disease and living in a residential area other than northern Taiwan had an increase in adjusted odds ratio for CHM use during pregnancy. Conclusions: In this population-based study, we found that demographic factors and pre-existing diseases were associated with the use of CHM among pregnant women. It is worth noting that Leonuri Herba (Yi Mu Cao) and Shao-Fu-Zhu-Yu-Tang should be used with caution in the first trimester. Further research is needed to explore the safety and effectiveness of the use of CHM in pregnant women. [ABSTRACT FROM AUTHOR]

Background: The incidence of Clostridioides difficile infection (CDI) is increasing in the general population. Data on the epidemiology of CDI in peripartum women – a highly vulnerable patient population – is scarce. The objective of this study was to report the incidence of CDI in peripartum women. Methods: A single-center retrospective cohort study was conducted in peripartum women from 1997 to 2017. Peripartum CDI was defined as definite CDI (watery diarrhea for >24 h with positive stool assay) during pregnancy, or within 6 weeks postpartum. Incidence was reported per 100,000 pregnancies and time trends in incidence were analyzed using Poisson regression. Analyses were done separately for time trends before and after 2007, when CDI testing strategy changed to polymerase chain reaction. Results: From 1997 to 2017, 80 patients with peripartum CDI (47 during pregnancy, 33 postpartum) out of 125,683 pregnancies (0.064%) were identified. Incidence of CDI increased 3.4 fold (95% confidence interval 1.5–7.4, p = 0.005) over the 21 year period. Time trends were evident after (p = 0.054), but not before 2007 (p = 0.97). Conclusion: Incidence of CDI in peripartum women increased over the 21 year study period. The rise in incidence is concerning, and calls for heightened surveillance for CDI in this highly vulnerable population. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy (PPCM) is an idiopathic reduction in left ventricular function, presenting at the peripartum period. The diagnosis is based on echocardiographic features and excluding other causes of heart failure. Similar to any other cause of heart failure, the management of PPCM consists of diuretics, prevention of ventricular remodeling, preventing short and long-term complications. Ventricular clots, transient cerebral ischemic attacks, lower extremity thrombosis, kidney and liver infarcts and pulmonary thromboembolism have been previously reported in PPCM cases. Among them, pulmonary thromboembolism is one of the most important complications, as it is also a challenging differential diagnosis of PPCM. We discuss a case of PPCM followed by a diagnosis of pulmonary thromboembolism and briefly review the relevant PPCM literature. [ABSTRACT FROM AUTHOR]

Purpose: There is little information on the use of extracorporeal membrane oxygenation (ECMO) in pregnant women. Our objectives are to estimate the use of ECMO in pregnant patients, identify clinical conditions associated with ECMO use, and assess survival rates by the associated condition.Methods: Using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we carried out a retrospective cohort study of all delivery admissions in the United States from January 1, 1999, to October 1, 2015. Within the cohort, women who received ECMO therapy were identified using ICD-9 codes and then survival rates among these women were calculated.Results: There were 83 women who underwent ECMO therapy in our cohort of 15,335,205 births, for an overall ECMO use rate of 0.54/100,000 pregnancies. The incidence of ECMO use increased from 0.23/100,000 in 1999 to 2.57/100,000 in 2015. Patients on ECMO were more likely to be older, have a lower income, and have pre-existing medical conditions when compared with the patients not on ECMO. The overall survival rate for the ECMO group was 62.7%. The most common reason for ECMO use was acute respiratory failure. Etiologies associated with the highest survival in those on ECMO were pneumonia and venous thromboembolism, which were found to have survival rates of 75.0% and 81.0%, respectively.Conclusion: The incidence of ECMO use in the obstetric population increased over the last decade and a half. Although it carries a limited survival rate within this population, it has proven life-saving for many suffering from complications of pregnancy and delivery. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate temporal variations in circulating levels of selected hormones and metabolites in commercial dairy goats during the transition period. Blood samples from 940 goats were collected weekly, from −3 to 3 wk relative to delivery, to measure the effects of level of milk production, parity number, and litter size on concentrations of glucose, β-hydroxybutyrate (BHB), fatty acids, and plasma urea nitrogen (PUN). A subset of 80 goats [40 low-yielding (LY, < 1.8 L/d) and 40 high-yielding goats (HY, > 3.7 L/d)] were selected from the study population to measure the effects of level of milk production on plasma concentration of insulin, prolactin, and growth hormone. Average (±SD) milk yield (from 3 to 30 d in milk), body weight, and body condition score for the study population were 2.4 ± 0.78 L/d, 70 ± 16.0 kg, and 2.5 ± 0.28 units, respectively. Milk yield was moderately correlated with parity number (r = 0.49) but had weak correlation with litter size (r = 0.14). In multiparous but not in primiparous goats, antepartum concentrations of fatty acids and BHB increased with increasing litter size. Concentrations of fatty acids, BHB, and PUN were consistently lower in primiparous goats compared with those in second or greater parity. Postpartum, HY goats had higher ratios of glucose, fatty acids, and BHB to insulin than did LY goats, which might explain the greater mobilization of body tissues and enhanced milk production observed in this group. Collectively, our results indicate that increased milk yield has the most significant influence on the magnitude of body tissue mobilization. Our results also show that goats of higher parity display higher levels of lipid mobilization, and that both pregnancy and lactation are less able to elicit lipomobilization in primiparous compared with multiparous goats. [ABSTRACT FROM AUTHOR]

Background: Therapeutic anticoagulation may be required during pregnancy to treat venous thromboembolism (VTE), for patients considered at high risk of thrombosis and for the management of mechanical heart valves (MHVs). Prescribing of therapeutic anticoagulation during the postnatal peripartum period is complicated by managing the risk of postpartum haemorrhage. Currently, there are no standardised protocols for the use of therapeutic heparin in this setting and no randomised control trials have been undertaken to evaluate best practice. Aim: Using survey techniques, this study aimed to establish current practice in Australia and New Zealand regarding the use of therapeutic anticoagulation during the postnatal peripartum period. Methods: The survey consisted of 36 questions and was made available using the electronic Internet platform Survey Monkey. Results: For patients at low risk of rethrombosis, 91% and 78% of respondents would use low molecular weight heparin (LMWH) after standard vaginal delivery (SVD) and after caesarean section (CS), respectively, with the remaining respondents choosing to use unfractionated heparin (UFH). For patients at high risk of rethrombosis, 56% and 51% of respondents would use LMWH after SVD and CS, respectively, with the remaining respondents choosing to use UFH. For patients with MHVs, 29% and 26% of respondents would use LMWH after SVD and CS, respectively, with the remaining respondents choosing to use UFH. Conclusion: Although this study included a relatively small cohort of respondents, the results do indicate trends among therapeutic anticoagulation in the postnatal peripartum period. Research regarding the most efficacious anticoagulation management would help clinicians develop evidence‐based protocols to guide best practice. [ABSTRACT FROM AUTHOR]

Objectives: Suicide is the leading cause of maternal death in New Zealand particularly amongst Māori and Pacific. We explored current maternal mental health (MMH) screening practices and supports. Methods: Qualitative research included interviews and focus groups with maternity carers and mothers of Māori and Pacific descent. Thematic analysis used a general inductive approach. Results: Both mothers and carers reported that MMH screening is ad hoc and discussed multilevel barriers that hamper screening and access to supports. Conclusion: There are gaps in MMH services, and service improvements need to be targeted at patient, provider, and systems levels. [ABSTRACT FROM AUTHOR]

Purpose: Cushing's disease (CD) is one of the most severe endocrine disorders and primarily affects women of reproductive age. The peripartum period has been observed to be a common time to develop CD. This study aims to retrospectively analyze the clinical characteristics of CD potentially associated with pregnancy and to evaluate relevant pregnancy outcomes. Methods: Patients who underwent surgery from January 2010 to May 2019 at Peking Union Medical College Hospital (PUMCH) with biochemically and pathologically confirmed CD were retrospectively analyzed. Pregnancy-associated CD was defined as CD onset during gestation or within 12 months after delivery or abortion. Data including demographics, biochemical tests, magnetic resonance imaging (MRI) findings, and disease outcomes were obtained from all patients by reviewing their medical records. Information regarding pregnancy was collected through a supplementary online questionnaire. Results: In a series of female patients (n = 70) of reproductive age with childbearing desire, 27.1% (n = 19) met the criteria for pregnancy-associated CD. The timing of diagnosis of pregnancy-associated CD was 2.7 ± 3.4 years after symptom onset, and the overall remission rate for these women was 89.5%. Three patients with pregnancy-associated CD developed hypertension during pregnancy, two of whom had new-onset hypertension at 16 weeks of gestation and one of whom had a complication of severe diabetes. The rates of spontaneous abortion and preterm birth among the women with pregnancy-associated CD were 26.3 and 28.6%, respectively. The proportions of all low-birth-weight (LBW) newborns (p = 0.002) and term LBW newborns (p = 0.033) were significantly higher in the pregnancy-associated CD group than in the non-pregnancy-associated CD group. Conclusions: In this study, a total of 27.1% of women of reproductive age with CD had pregnancy-associated CD, which might be induced by the hormonal milieu of pregnancy. An increased risk of having a LBW newborn was observed among mothers with pregnancy-associated CD. A high degree of clinical suspicion for CD may be warranted in the peripartum period. Patients with symptoms suspicious for CD throughout pregnancy and after childbirth, such as early-onset hypertension, severe hyperglycemia, and persistent weight gain, should be carefully diagnosed and closely monitored by clinicians. [ABSTRACT FROM AUTHOR]

Background: Pregnancy in all animal species requires special care and attention. During this period there is great variation in hematological and biochemical parameters. Many times these parameters are misinterpreted as being obtained from nonpregnant animals with unknown parasite status. Objective: To characterize the hematological, biochemical, and parasitological values within the peripartum period of Santa Ines sheep naturally infected. Methods: For this purpose, 45 ewes were used, with an average body weight of 50 kg. Data were collected during pregnancy, birth and, lactation. Measurements included body weight, body condition score (BCS), evaluation of conjunctive staining, and collection of blood and feces. Results: All variables changed throughout physiological stages. Weight and BCS were different between periods (p<0.05). Fecal egg counts (FEC) were higher in the peripartum period, with a predominance of Haemonchus ssp, 92.85%. Mean hematological and biochemical values varied throughout the study, (p>0.05). Conclusion: The influence of peripartum on the parameters studied should be considered and its use as a reference value. Regarding the physiological variations observed during peripartum, proper animal management could help minimizing the negative effects of parasitic infections on productivity. [ABSTRACT FROM AUTHOR]

Background: Haemorrhage in pregnancy may be life‐threatening to woman and infant. The impact of severe obstetric haemorrhage can be reduced by detecting high‐risk women, implementing guidelines and treatment plans, early detection of hypovolaemia and timely appropriate treatment. Aims: To describe cases of severe maternal morbidity caused by obstetric haemorrhage in New Zealand and investigate the potential preventability of these cases. Materials and Methods: A multidisciplinary expert review panel was established to review cases of obstetric haemorrhage admitted to intensive care or high‐dependency units over an 18‐month span in New Zealand. Cases were critically analysed by a multidisciplinary team of clinicians to determine the potential preventability. Results: One hundred and twenty cases were identified, most commonly due to postpartum haemorrhage with 36% (n = 43) deemed potentially preventable, mainly due to delay or failure of diagnosis (65%, 28/43) and/or failure or delay in treatment (91%, 39/43). Twenty‐three per cent of cases (28/120) resulted in peripartum hysterectomy of which one‐third were deemed potentially preventable. Conclusions: Prompt recognition and treatment in accordance with evidence‐based guidelines is imperative to decrease the burden of morbidity from obstetric haemorrhage. An emphasis on training clinicians to identify haemorrhage in a timely way may avoid unnecessary obstetric emergencies and can improve maternity and neonatal outcomes. [ABSTRACT FROM AUTHOR]

The maternal and fetal mortality rate in unstable pulmonary embolisms accompanied by obstructive cardiac shock is approximately 30%. An intervention aimed at the pulmonary clot is essential under these conditions. There are various ways of removing this clot from the pulmonary arteries, including thrombolytic administration, percutaneous catheter-based thrombectomy, and direct surgical clot removal. These procedures all have advantages and disadvantages. Increasing use is being made of extracorporeal membrane oxygenation (ECMO) as a means of reducing these risks to a minimum. There are studies recommending ECMO together with thrombolysis or surgical thrombectomy. However, which study is superior to another is unclear. The purpose of the present study was, therefore, to assess the benefits and risks of ECMO use in pregnant patients with pulmonary embolism and to endeavor to produce a new algorithm. [ABSTRACT FROM AUTHOR]

The cumulative effect of seasonal heat stress and peripartum stress in inducing the seasonal alterations in the plasma cortisol levels was studied in Murrah buffaloes (n = 6) on days ±30, ±15, ±5, ±3, ±1 and 0 prepartum and postpartum with respect to the day of parturition (day 0) in each of the two different seasons (hot-humid and spring). The microclimatic Temperature Humidity Index (THI, mean ± SE) during spring season exhibited thermoneutral conditions (60.10 ± 2.56–72.67 ± 0.65) while that in the hot-humid season showed heat stress. Total cortisol in the plasma as assayed by a modified enzymeimmunoassay developed for buffaloes reflected an increase in cortisol level around parturition (days −1, 0 and +1) in both the seasons. Between the two seasons, the cortisol levels were significantly lower in the hot-humid season on days −5 (p < 0.01), +1 (p < 0.055) and +3 (p < 0.051), which indicated adaptation of buffaloes to thermal environment. Substantial exposure to high THI thus plays a significant role in determining the overall stress as reflected by plasma cortisol in circulation during the peripartum periods in Murrah buffaloes in the tropics. [ABSTRACT FROM AUTHOR]

Objective  This study aimed to determine whether switching from low-molecular-weight heparin (LMWH) to unfractionated heparin (UFH) or its continuation in the peripartum affected anesthesia choice or bleeding complications. Study Design  A retrospective cohort study of 189 anticoagulated pregnant women who delivered at the University of Illinois at Chicago Hospital and Health Science System from 2005 to 2016. Demography, anesthesia choice, and bleeding complications were compared between the two groups. Results  There were 138 (73%) women on LMWH versus 51 (27%) who switched from LMWH to UFH during the peripartum. The demographics were similar, 123 women were on prophylactic: 81 (66%) were on LMWH and 42 (34%) switched to UFH. Of the 66 women on therapeutic anticoagulation, 57 (86%) continued on LMWH, while 9 (14%) switched to UFH. No difference in neuraxial anesthesia type received: 42 (82.4%) versus 108 (79.7%) women (odds ratio: 1.20, 95% confidence interval [CI]: 0.52–2.73, p  = 0.837). Bleeding complications more than 1,000 mL, 6 versus 10% (relative risk [RR]: 0.58, 95% CI: 0.17–1.94, p  = 0.380) and relaparotomy due to hemoperitoneum, 2% in either group (RR: 0.9, 95% CI: 0.10–8.48, p  = 0.930) were similar in the two groups regardless of time of last injection. Conclusion  Anesthesia type and rate of bleeding complications were similar between women on LMWH and UFH during the peripartum. [ABSTRACT FROM AUTHOR]

Introduction: Peripartum Cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that presents like heart failure, due to left ventricular systolic dysfunction, at the last month of pregnancy and up to 5 months postpartum, that any reason of heart failure absent. PPCM appears to women without any history of cardiac disease. It is a rare condition, although the prevalence its continuously increasing and more women affected by this disease, causing poor maternal and neonatal outcomes. Aim: The investigation of the risk factors for peripartum cardiomyopathy. Material and Method: It was a systematic review of English literature at the database MEDLINE and CINAHL, using keywords with all possible combinations. The research was done at the period December 2019 and January 2020. For the evaluation of methodological quality of the included articles in this review, the EPHPP tool was used. Entry and exclusion criteria were set, for the selection of articles. Results: 24 articles were reviewed, from the period 2010-2020 who met the default criteria. At the end of the systematic literature of review, the main risk factors were advanced maternal age ≥35, low socioeconomical status, African-American race, hypertensive disease, hypertensive disease of pregnancy, preeclampsia/eclampsia in a previous or in current pregnancy, multiparity, multifetal pregnancy, 1st pregnancy, substance or alcohol abuse, diabetes mellitus and gestational diabetes mellitus. Conclusions: Further research needed to investigate this disease, in order to identify all the risk factors, achieving early recognition and confronting. [ABSTRACT FROM AUTHOR]

Objective: Uncertainty surrounds the risks of lithium use during pregnancy in women with bipolar disorder. The authors sought to provide a critical appraisal of the evidence related to the efficacy and safety of lithium treatment during the peripartum period, focusing on women with bipolar disorder and their offspring.Methods: The authors conducted a systematic review and random-effects meta-analysis assessing case-control, cohort, and interventional studies reporting on the safety (primary outcome, any congenital anomaly) or efficacy (primary outcome, mood relapse prevention) of lithium treatment during pregnancy and the postpartum period. The Newcastle-Ottawa Scale and the Cochrane risk of bias tools were used to assess the quality of available PubMed and Scopus records through October 2018.Results: Twenty-nine studies were included in the analyses (20 studies were of good quality, and six were of poor quality; one study had an unclear risk of bias, and two had a high risk of bias). Thirteen of the 29 studies could be included in the quantitative analysis. Lithium prescribed during pregnancy was associated with higher odds of any congenital anomaly (N=23,300, k=11; prevalence=4.1%, k=11; odds ratio=1.81, 95% CI=1.35-2.41; number needed to harm (NNH)=33, 95% CI=22-77) and of cardiac anomalies (N=1,348,475, k=12; prevalence=1.2%, k=9; odds ratio=1.86, 95% CI=1.16-2.96; NNH=71, 95% CI=48-167). Lithium exposure during the first trimester was associated with higher odds of spontaneous abortion (N=1,289, k=3, prevalence=8.1%; odds ratio=3.77, 95% CI=1.15-12.39; NNH=15, 95% CI=8-111). Comparing lithium-exposed with unexposed pregnancies, significance remained for any malformation (exposure during any pregnancy period or the first trimester) and cardiac malformations (exposure during the first trimester), but not for spontaneous abortion (exposure during the first trimester) and cardiac malformations (exposure during any pregnancy period). Lithium was more effective than no lithium in preventing postpartum relapse (N=48, k=2; odds ratio=0.16, 95% CI=0.03-0.89; number needed to treat=3, 95% CI=1-12). The qualitative synthesis showed that mothers with serum lithium levels <0.64 mEq/L and dosages <600 mg/day had more reactive newborns without an increased risk of cardiac malformations.Conclusions: The risk associated with lithium exposure at any time during pregnancy is low, and the risk is higher for first-trimester or higher-dosage exposure. Ideally, pregnancy should be planned during remission from bipolar disorder and lithium prescribed within the lowest therapeutic range throughout pregnancy, particularly during the first trimester and the days immediately preceding delivery, balancing the safety and efficacy profile for the individual patient. [ABSTRACT FROM AUTHOR]

Rates of opioid prescribing are at historically high levels, and, as opioid exposure increases, the number of women of childbearing age with opioid use disorder is rising. Despite this growing population, the optimal management of pain for parturients maintained on medical-assisted therapy (MAT, i.e., methadone or buprenorphine) is unknown. This systematic review is intended to evaluate patient outcomes associated with pain management strategies for parturients on MAT. Literature databases EMBASE, MEDLINE, and the Cochrane Library were searched up to September 2017. Articles were included if they discussed peripartum analgesic options for pregnant women with opioid dependence. The search identified 1,814 articles, of which, nine matched all inclusion criteria and were selected for data extraction and analysis. Articles were a mix of case series, retrospective case reviews, retrospective cohorts, and randomized controlled trials. They showed various responses ranging from no difference in analgesic requirements between MAT and non-MAT patients to MAT patients requiring higher amounts of opioids after a cesarean section. Parturients on MAT present a number of challenges for obstetric anesthesiologists, but various approaches can be used to achieve satisfactory analgesia. It is important to practice an individualized yet multidisciplinary approach to ensure the delivery of optimal patient care. [ABSTRACT FROM AUTHOR]

A total of 30 dairy cows were attended in veterinary practice investigations have been done under Egyptian conditions, in Seds farm belong to animal production research institute , from the reproductive perspective . the study divided the animals according to parities to - one parity , two parity , three parity and more than three parity .The study followed values of some biochemical parameters glucose, calcium, phosphorus, potassium, sodium ,cholesterol, triglyceride, albumin ,total protein and urea. showed that cows affected by hypocalcaemia. The most important notifeibal results in postpartum 1-7 days the calcium level of cows with parity one calcium level were 7.06 gm /dl while in cows with parity two were 6.64 gm/dl, in cows with three parity 6.6 gm /dl and cows more than three parity calcium level were 6.91 gm/dl. 14-21 days post partum .4 cows with parity one calcium level were 7.46 gm /dl, first parity cows has along interval from calving to estrus ,days open and number of services. cows with parity two has along period to come in first estrus at 86 ±5.6 s days and long days open which were 106±4.7 days. But NO. of services were high in cows with more than three parity 1.9±0.16

Normal pregnancy leads to a state of chronically increased intra-abdominal pressure. Obstetric and non-obstetric conditions may increase intra-abdominal pressure further, causing intra-abdominal hypertension and abdominal compartment syndrome, which leads to maternal organ dysfunction and a compromised fetal state. Limited medical literature exists to guide treatment of pregnant women with these conditions. In this state-of-the-art review, we propose a diagnostic and treatment algorithm for the management of peripartum intra-abdominal hypertension and abdominal compartment syndrome, informed by newly available studies. [ABSTRACT FROM AUTHOR]

Obstetric intensive care unit (ICU) admissions comprise only a small part of severe maternal morbidity. The incidence rate of both remains relatively unclear due to inconsistent definitions across publications, although this has begun to be addressed. There is a relative paucity of information regarding disease-specific survival following obstetric ICU admission, but outcomes are clearly related to the cause of admission and the quality of care. The ratio between maternal near-miss cases (many of whom are admitted to ICUs) and maternal death may provide insight into the preventability of death. Hemorrhage and pre-eclampsia constitute the leading causes of ICU admission and have relatively low mortality rates, perhaps demonstrating the impact of informed care in managing obstetric critical illness. Obstetric sepsis, heart disease and anesthesia complications should be the focus of future research. The incidence of obstetric sepsis has been increasing in the last decade, with mortality rates remaining relatively high. The incidence of obstetric heart disease is increasing and maternal complications have been attributed to fractionated care of mothers within this category. Anesthesia complications remain a predominant cause of maternal death and likely intensive care admission. Data are lacking regarding the relative proportion of cases per disease that remain treated outside the ICU; and the outcomes of various management strategies. The only study of the health status of survivors of obstetric ICU admission revealed that six months after hospital discharge, one in five women still had a poorer health-related quality of life than those of a reference age- and sex-matched cohort. [ABSTRACT FROM AUTHOR]

Background  The appearance of anthelmintic resistance has made it difficult to control verminosis in sheep, leading to increased research to find alternative nematode control. The use of homeopathy in veterinary medicine has been studied as an alternative for the treatment and control of some diseases. In this study, ewes received an anti-parasitic homeopathic complex medicine during the critical peripartum period of increased susceptibility to nematodes. Methods  Three randomized groups containing 16 animals each were assigned as follows: 'H10' received 10 g homeopathic complex added to concentrated food per day; 'H20' received 20 g homeopathic complex added to concentrated food per day; 'C' (control group) did not receive a homeopathic complex. Animals were tested to evaluate the effect of homeopathy on several health parameters during a period of 110 days. Results  The parasite that prevailed in the copro-cultures of both treatments throughout the experiment was Haemonchus contortus (78.26%). Packed cell volume averages did not present statistically significant differences between the treatments (24.5, 24.4 and 23.9% to C, H10 and H20, respectively; p  < 0.05). For total white cell count, lower mean values ( ±  standard error of mean) were observed for the H20 treatment (5,490.9 ± 0.02/µL; p  < 0.05), whereas the H10 (5,919.4 ± 0.02/µL) and control (6,098.5 ± 0.02/µL) presented higher and similar averages (p  > 0.05). The values for erythrocytes, monocytes, and lymphocytes did not show differences between treatments (p  > 0.05). Body weight was greater in the H10-treated animals compared with control. For the fecal egg count (FEC) of Trichostrongylidae and Strongyloides spp., respectively, the averages of the H20 treatment (1,523.0 and 30.6) were not different from control (1,616.0 and 31.6) and H10 (1,038.0 and 27.6); for Trichostrongylidae , however, H10 presented a lower FEC than the control (p  = 0.02). For Cooperia, H10- and H20-treated animals showed FEC reductions of 97% and 98%, respectively. Conclusions  H20 treatment in peripartum sheep resulted in greater body weight and lower leukocyte count. H10 was associated with lower FEC for Trichostrongylidae. Both H10 and H20 justify a label of 'effective anthelmintic' for Cooperia. [ABSTRACT FROM AUTHOR]

Reductions in insulin sensitivity in periparturient dairy cows develop as a means to support lactation; however, excessive mobilization of fatty acids (FA) increases the risk for peripartal metabolic disorders. Our objectives were to investigate the effect of prepartum body condition score (BCS) on systemic glucose and insulin tolerance, and to compare direct and indirect measurements of insulin sensitivity in peripartal lean and overweight dairy cows. Fourteen multiparous Holstein cows were allocated into two groups according to their BCS at day −28 prepartum: lean (n = 7; BCS ≤ 3.0) or overweight; (n = 7; BCS ≥ 4.0). Liver biopsies were performed on day −27, −14 and 4, relative to expected parturition. Intravenous insulin or glucose tolerances tests were performed following each liver biopsy. Relative to lean cows, overweight cows exhibited lower dry matter intake, lost more BCS and displayed increased plasma FA and β-hydroxybutyrate concentrations and elevated liver lipid content during peripartum. Glucose clearance rate was lower for all cows postpartum. Prepartum BCS had minimal effects on insulin and glucose tolerance; however, the ability of the cow to restore blood glucose levels following an insulin challenge was suppressed by increased BCS. Glucose-dependent parameters of insulin and glucose tolerance were not correlated with surrogate indices of insulin sensitivity. We conclude that prepartum BCS had minimal effect on systemic insulin sensitivity following parturition. The observed inconsistency between surrogate indices of insulin sensitivity and direct measurements of insulin and glucose tolerance adds support to growing concerns regarding their usefulness as tools to estimate systemic insulin action in periparturient cows. [ABSTRACT FROM AUTHOR]

The objective of the present study was to evaluate the effects of an antioxidant and anti-inflammatory compound found in rosemary plants (Salvia rosmarinus) named carnosic acid during the transition period of dairy cows. From day 1 to 3 after calving, 16 multiparous Holstein cows received a daily intravenous infusion of either 500 mL of saline (NaCl 0.9%; Saline; n = 8) or carnosic acid at a rate of 0.3 mg/kg of BW supplied in 500 mL of saline (CA; n = 8). Blood samples were taken at –7, 2, 5, 7, 14, and 21 d relative to parturition, then analyzed for metabolites related to energy metabolism, muscle mass catabolism, liver function, inflammation, and oxidative stress. CA infusion tended to improve milk performance; however, DMI was unaffected by treatment. At 2 d relative to parturition, CA cows had lower blood concentrations of haptoglobin, paraoxonase, FRAP, and NO2– than saline cows. After treatment infusions, haptoglobin remained lower in CA cows than saline at 5 d relative to parturition. Our results demonstrate that carnosic acid promoted positive responses on inflammation and oxidative stress biomarkers and may promote beneficial effects on lactation performance in peripartal dairy cows.