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Background Aims Materials and methods Results Conclusions Pregnant and post‐partum (collectively peri‐partum) women may be at increased risk of severe COVID‐19 disease.To describe the characteristics, interventions, and outcomes of peri‐partum patients admitted to intensive care units (ICUs) in Australia with COVID‐19.We conducted a prospective, multicentre observational study using the SPRINT‐SARI Australia database across 63 ICUs in Australia. All women <45 years of age, admitted to a participating Australian ICU, with laboratory‐confirmed COVID‐19 between 1 March 2020 and 1 June 2023 were included. Participants were categorised as either peri‐partum, defined as pregnant or up to six weeks post‐partum, or non‐pregnant. The primary outcome was in‐hospital mortality.A total of 737 eligible female patients were admitted to ICUs over the study period: 168/737 (23%) were peri‐partum, while 569/737 (77%) were non‐pregnant. The median age of peri‐partum women was 31 (interquartile range (IQR) 27–36) years old, and median gestation was 28.0 (IQR 4–40) weeks. When compared to non‐pregnant women, peri‐partum women had lower rates of comorbidities (1.8% vs 14.4% P < 0.001), lower vaccination rates (27.4% vs 45.2%, P < 0.001), similar rates of mechanical ventilation, and greater use of tocilizumab (29.2% vs 4.0%, P < 0.001). Complications were low in both groups. In‐hospital mortality was lower in peri‐partum patients: 1/168 (0.6%) vs 24/569 (4.2%); P = 0.04.Peri‐partum patients made up ~25% of all women aged <45 years old admitted to Australian ICUs with COVID‐19, and nearly 30% required mechanical ventilation. Despite lower vaccination rates in peri‐partum patients, in‐hospital mortality was lower than in non‐pregnant patients. [ABSTRACT FROM AUTHOR]

Purpose: To explore the recalled experience of pregnancy and motherhood in women diagnosed with Autism Spectrum Disorders (ASD) without intellectual disabilities, focusing on sensory perceptions and mood. Methods: We retrospectively evaluated, through an ad-hoc structured interview, the sensory sensitivity during the pre-partum, the peri-partum, and the post-partum of thirty-three mothers with ASD and thirty-two neurotypical mothers. Participants also underwent a psychometric assessment about autistic traits, general sensory sensitivity, and post-partum depressive symptomatology. Results: Mothers with ASD recalled a higher sensitivity than the comparison group across the three time-points; however, during the peri-partum their recalled hypersensitivity decreases, and in the post-partum it returned as high as before childbirth. The difference in the length of recall between groups did not statistically influence our results. Higher levels of autistic traits correlated with higher depressive post-partum symptomatology. Conclusions: Mothers with ASD seem to recall their experience of pregnancy, childbirth, and post-partum period differently from neurotypical mothers, particularly in terms of hypersensitivity. The correlation with depressive symptoms and the potential role of oxytocin and of long-term memory (encoding and recollection) are discussed. Further exploring these aspects might give fundamental hints to provide tailored support to mothers with ASD during pregnancy and motherhood. [ABSTRACT FROM AUTHOR]

This study was conducted at the ruminant station of the Technical Institute of Breeding Baba-Ali on the peri-partum period in ewes of the Rembi breed. It focused on the variations of some hematological and biochemical parameters of 7 ewes during 2 months (1 month before lambing and one month after). The blood samples were taken every 15 days, which were analyzed by blood count within the hour following the blood sampling, concerning the hematological parameters. Besides, for the biochemical parameters, the blood was centrifuged and the sera were frozen until the day of analysis. The results of the analysis using logicial R revealed nonsignificant variations (P >0.05) for the following parameters: White blood cells, Lymphocytes, Red blood cells, Hemoglobin, Hematocrit, and Blood platelets. These results are contradictory to the results obtained in previous studies except for a study conducted on ewes of the Lacaune breed. Regarding the biochemical parameters, the variation was significant (P<0.05) for cholesterol, urea, and creatinine, but not significant for calcium, glucose and triglycerides (P >0.05). The results obtained are debatable from the results quoted by several authors, except for creatinine which was found to be much higher. [ABSTRACT FROM AUTHOR]

Background Spontaneous coronary artery dissection (SCAD) is a common and under-recognized cause of myocardial infarction during the post-partum period. Case summary We report a case of a young women presenting with chest pain in the post-partum period. Her clinical appearance was that of a myocardial infarction, and angiography was indicative of a Type 2 SCAD. The patients had persistent chest pain, reduced left ventricular function, and critical left anterior descending artery stenosis. Percutaneous coronary intervention was done with caution. Shared decision-making with the patient helped guide the medical treatment plan and follow-up. Discussion We discuss the clinical considerations surrounding the management of this patient. [ABSTRACT FROM AUTHOR]

Abstract Background Stress urinary incontinence (SUI) is highly prevalent during pregnancy and after delivery. It is often associated with a failing pelvic floor, sphincteric and/or supportive system. Pelvic-floor-muscle training (PFMT) peri-partum has been proven effective for up to 1 year post-partum; however, its long-term effects are unknown. Group PFMT, given by a physiotherapist, has been proven to be as equally effective as individual therapy. Motherfit is a group-PFMT therapy with an emphasis on pelvic floor exercises, adherence and general fitness. Care-as-usual (CAU), if guideline driven, should, as first treatment option, consist of PFMT. Cost-effective strategies are of relevance, given the rise of health care costs. Motherfit group therapy has the potential to be cost-effective in women with urinary incontinence. Therefore, the objectives of the two current studies are: (1) to investigate whether intensive, supervised, pre-partum (MOTHERFIT1) or post-partum (MOTHERFIT2) pelvic-floor-muscle group therapy reduces 18-month post-partum severity of SUI compared to CAU and (2) whether MOTHERFIT1 OR MOTHERFIT 2 is more (cost-)effective compared to CAU. Methods Two multi-centred, randomised controlled trials (MOTHERFIT1, n = 150, MOTHERFIT2, n = 90) will be performed. Participants will be recruited by their midwife or gynaecologist during their routine check. Participants with SUI will receive either motherfit group therapy or CAU. Motherfit group therapy consists of eight group sessions of 60 min each, instructed and supervised by a registered pelvic physiotherapist. Motherfit group therapy includes instructions on pelvic floor anatomy and how to contract, relax and train the pelvic-floor muscles correctly and is combined with general physical exercises. Adherence during and after motherfit will be stimulated by reinforcement techniques and a mobile app. The primary outcome measure is the absence of self-reported SUI based on the severity sum score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) at 18 months post-partum. Secondary outcomes evaluate quality of life, subjective improvement and health care costs. Discussion The motherfit studies are, to our knowledge, the first studies that evaluate both long-term results and health care costs compared to CAU in pregnant and post-partum women with SUI. If motherfit is shown to be (cost-)effective, implementation in peri-partum care should be considered. Trial registration Netherlands Trial Register, ID: NL5816. Registered on 18 July 2016.

Background: Patient satisfaction is one of the key outcome measures of healthcare services. Aim and Setting: To explore factors that influence women’s satisfaction with peri-partum care at Bertha Gxowa district hospital, South African primary care. Methods: A cross-sectional study involving 260 women was conducted. A structured questionnaire collected information from participants on pain relief, health education provided by healthcare providers, privacy, cleanliness of the ward and their participation in decision-making about care received in the peri-partum period. Results: Most respondents were co-habiting with their partners (100, 38%) and had completed only secondary school education (119, 46%). The average participant age was 27 years, with an average parity of two children. Most participants were satisfied with the privacy (218, 84%) and the general cleanliness of the wards (233, 90%). However, large proportions of women were dissatisfied with the information given to them by doctors (104, 55%) and nurses (89, 37%), and the rest were unsure. About 189 (73%) participants were dissatisfied with the extent of their participation in decision-making about their own care. The study had a caesarean rate of 53 (20%). Compared to normal vaginal delivery, participants who had caesarean section were significantly more likely to report being satisfied with pain relief during labour (p 0.001). Conclusion: The study findings showed varying levels of satisfaction with different aspects of peri-partum care and suggested the need for better pain relief during vaginal delivery, information sharing by doctors and patient emancipation for decision-making about their own care.

Background: Patient satisfaction is one of the key outcome measures of healthcare services. Aim and Setting: To explore factors that influence women's satisfaction with peri-partum care at Bertha Gxowa district hospital, South African primary care. Methods: A cross-sectional study involving 260 women was conducted. A structured questionnaire collected information from participants on pain relief, health education provided by healthcare providers, privacy, cleanliness of the ward and their participation in decision-making about care received in the peri-partum period. Results: Most respondents were co-habiting with their partners (100, 38%) and had completed only secondary school education (119, 46%). The average participant age was 27 years, with an average parity of two children. Most participants were satisfied with the privacy (218, 84%) and the general cleanliness of the wards (233, 90%). However, large proportions of women were dissatisfied with the information given to them by doctors (104, 55%) and nurses (89, 37%), and the rest were unsure. About 189 (73%) participants were dissatisfied with the extent of their participation in decision-making about their own care. The study had a caesarean rate of 53 (20%). Compared to normal vaginal delivery, participants who had caesarean section were significantly more likely to report being satisfied with pain relief during labour (p < 0.001). Conclusion: The study findings showed varying levels of satisfaction with different aspects of peri-partum care and suggested the need for better pain relief during vaginal delivery, information sharing by doctors and patient emancipation for decision-making about their own care. [ABSTRACT FROM AUTHOR]

Background Atypical haemolytic uraemic syndrome (aHUS) is a rare condition with the triad of microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury. Other conditions that present in a similar manner peri-partum include thrombotic thrombocytopaenic purpura, and pregnancy associated conditions including HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), severe pre-eclampsia and less commonly acute fatty liver of pregnancy. Case Reports We describe two cases of suspected aHUS, who presented post-partum with foetal death-in-utero at 33 and 37 weeks respectively. Both presented with the triad features of aHUS but had considerably different clinical courses. The first case required a prolonged ICU admission, needed intubation for neurological deterioration and dialysis for acute kidney injury, and developed complications including acute liver failure, septic shock, pancreatitis, and ischaemic colitis. Initial ADAMSTS13 activity was borderline-low (10.3%) and normal on repeat testing (42.6%), and there was no peri-partum pre-eclampsia. The other case remained clinically stable throughout her admission with creatinine peaking at 495, not requiring dialysis, minor liver transaminases derangement and was discharged after a week. Her ADAMSTS13 activity was normal (62%), and her pregnancy was complicated by peri-partum pre-eclampsia. Both eventually had a reduction in haemolysis with rapid and sustained reduction in LDH and normalised platelet counts, and complete recovery of renal function whilst receiving eculizumab therapy. Conclusions It can be difficult to distinguish aHUS from other causes in peri-partum patients presenting with features of microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury, and often, aHUS can be precipitated by pregnancy. In the setting of the clinical urgency to treat aHUS early with eculizumab, this presents a diagnostic challenge, as confirmatory tests for aHUS are not immediately available. [ABSTRACT FROM AUTHOR]

Obesity in women is prevalent and growing at an alarming pace worldwide, resulting in significant healthcare and socioeconomic consequences. Obesity is a multisystemic disease that is associated with numerous comorbidities, particularly sleep-disordered breathing, hypertension, coronary artery disease, pulmonary hypertension, thromboembolism, and diabetes mellitus. Additionally, obesity poses several peri-operative challenges including difficulty with airway management and mechanical ventilation, challenges with intravenous access or regional blocks, the need for modified anaesthetic drug dosing, the requirement for correctly sized and rated equipment, and appropriate post-operative monitoring. Therefore, early multidisciplinary planning is crucial to identify and address important peri-operative and clinical issues. Parturients with obesity are especially at high risk due to the additional physiological changes and obstetric comorbidities associated with obesity. Antenatal anaesthetic consultation along with close communication and collaboration within the multidisciplinary team are important to improve maternal and neonatal safety., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

A verminose é um dos principais problemas sanitários da criação de pequenos ruminantes no Brasil e no mundo. Entretanto, pouco se conhece sobre a variação sazonal da contaminação parasitária e os efeitos da associação de um controle estratégico com um tático sobre ovinos criados em condições do Semiárido no norte de Minas. Este trabalho foi realizado com o objetivo de avaliar a variação sazonal da contaminação por helmintos gastrintestinais em borregos e matrizes ovinas em um sistema de controle integrado no norte de Minas Gerais, Brasil. Durante um ano, mensalmente, foram coletadas amostras de 30 borregos e 30 matrizes de uma propriedade. Durante o mês de abril de 2007, foram também avaliados 68 ovinos em uma segunda propriedade, período esse que correspondeu à época de parição nas duas fazendas. Amostras de fezes foram obtidas diretamente da ampola retal para determinação do número de ovos por gramas de fezes (OPG) e os dados submetidos à análise de variância. Os valores médios do OPG das matrizes apresentaram aumento significativo nos meses de maio e outubro de 2007, meses de parição na propriedade. Já para os borregos, ocorreu aumento significativo no OPG médio em março de 2007, coincidindo com o final da estação chuvosa. O controle integrado adotado foi eficiente na redução da contaminação após esses períodos relatados. Após o cultivo das larvas, os gêneros mais observados foram Trichostrongylus, Haemonchus e Strongyloides, tanto para o período seco, quanto para o chuvoso. A comparação das contaminações das matrizes das duas propriedades no mês de abril de 2007 indicou uma média de OPG significativamente maior na segunda propriedade, que não tratou esses animais antes do parto.The verminosis is one of the principal sanitary problems in ovine herds in Brazil and around the world. However, little is known about the seasonal variation of the helminth contamination and the effects of the combination of a strategy control and a tactical control in sheep raised under in the Northern Minas semiarid conditions. In this study, the objective was to evaluate the seasonal helminth contaminations in lambs and ewes under an integrated control in the North of Minas Gerais, Brazil. The research was carried through during December 2006 to November 2007. Monthly faecal samples from 30 lambs and 30 ewes of one farm were collected. During April 2007, 68 sheep of a second farm were also evaluated, corresponding to the peri-partum time to both farms. The samples were collected directly from the recto and the faecal egg count (FEC) was determined and evaluated by variance analysis. The ewe FEC increased significantly in May and October ,which were peri-partum periods. Lamb FEC increased significantly in March , which coincided with the rainy season end. The integrated control was efficient to reduce the contaminations after these related periods. After the larvae culture, the genus Trichostrongylus, Haemonchus and Strongyloides were the most observed to both dry and rainy periods. During April 2007 the ewe contamination was significantly higher in the second farm that did not treat these animals in the pre-partum.

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The aim of this work was to assess maternal and neonatal changes in plasma proteins, glucose and cortisol and to quantify the colostral immunoglobulin G (IgG) transfer in the peri-partum period in D'man sheep, a prolific breed, taking into account the parity of the ewe. The concentrations of proteins and glucose were high in the ewes on day 7 and at lambing before decreasing. Likewise, cortisol plasma concentration was maximal during the 6 h following lambing and dropped at 12 h. Protein and glucose concentrations were low in lambs at 1 h of birth after which they increased. By contrast, cortisol level was the highest during the first 12 h of birth and then decreased. The colostral IgG level was high at lambing and dropped by over 87 % from 1 to 48 h post-partum. In the newborn, the plasma IgG concentration was lowest at birth and increased rapidly during the first 24 h of birth. Parity influenced maternal physiology with multiparous ewes having the lowest concentrations of proteins, glucose, IgG and cortisol, but the highest colostrum IgG level. Accordingly, lambs born from primiparous ewes had lower protein, glucose and plasma IgG concentrations than lambs born from multiparous ewes. The main outcome of this study was that lambs born from primiparous ewes are characterized by the lowest physiological indices and this may influence their survival chance. [ABSTRACT FROM AUTHOR]

peripartum Cardiomyopathy is insufficient congestive heart occurring in the last month of pregnancy and 5 months after delivery, in the absence of preexisting heart disease and identified etiology. This heart disease is associated with echocardiography systolic dysfunction and left ventricular dilatation. Its incidence ranges from 1/3000 to 1/15000, depending on the region, including much higher in some African countries, it particularly concern women over 30 years, multiparous and multiple pregnancies. The pathogenesis remains unclear, the prognosis is closely related to the complete recovery of cardiac function. We report through the clinical case of a woman aged 33 years admitted to the ICU for acute pulmonary edema of sudden onset of a term pregnancy and what to do before this critical situation

INTRODUCTION: La cardiomyopathie du péripartum (CMPP) est une défaillance cardiaque dont l'étiologie demeure encore méconnue. METHODES: Il s'agit d'une étude prospective descriptive réalisée dans le service de cardiologie du CHU Sylvanus olympio de Lomé du 1er janvier 2010 au 30 avril 2012. Elle a concerné 41 patientes ayant présenté une insuffisance cardiaque entre le 8eme mois de la grossesse et les 5 premiers mois du post-partum. RESULTATS: L'âge moyen des patientes était de 31,47 ans (extrêmes 21 et 44ans). L'incidence de la CMPP était de 1/362 grossesses. La parité moyenne était de 3,07 (extrêmes 1 et 6). Les symptômes étaient apparus dans le post-partum dans 90,24% des cas. Un retard important de diagnostic était observé. L'insuffisance cardiaque globale était le mode de décompensation dans 65,85%. Les signes électrocardiographiques étaient essentiellement la tachycardie sinusale (97,56%) et l'hypertrophie ventriculaire gauche (97,56%). L'échographie cardiaque a montré dans tous les cas une cardiomyopathie dilatée. Quatre cas de thrombus intraventriculaire gauche étaient notés. La FEVG était sévèrement altérée. L'HTAP était importante dans 56,09%. CONCLUSION: La cardiomyopathie du péripartum est une complication cardiaque grave de la grossesse de cause inconnue, fréquente dans la population africaine.

Retention of fetal membranes (RFM) adversely affects the production and reproduction potential of the affected cows leading to huge economic loss. Physiological separation of fetal membranes is reported to be an inflammatory process. The present study compared the concentrations of certain pro inflammatory cytokines [Interleukin 1β (IL-1), Interleukin 6 (IL-6), Interleukin 8 (IL-8) and Tumor necrosis factor α (TNF-α) between the cows that developed RFM ( n = 10) and the cows that expelled fetal membranes normally ( n = 10) to find out if they could serve as a predictive tool for RFM. Blood samples were collected from the cows from 30 days before expected parturition through day −21, day −14, day −7, day −5, day −3, day −1, on the day of parturition (day 0), day 1 postpartum and the pro-inflammatory cytokines were estimated in blood plasma by ELISA method. The IL-1β concentration was significantly lower ( P < 0.05) in cows that developed RFM compared to those that expelled fetal membranes normally from 3 days before calving till the day of calving. The plasma concentrations of IL-6 and IL-8 were also lower ( P < 0.05) in cows that developed RFM than those calved normally. On the day of calving, significantly ( P < 0.05) lower concentrations of TNF-α was observed in cows that developed RFM compared to those expelled fetal membranes normally. It may be inferred that the concentrations of IL-1, IL-6, IL-8 and TNF-α around parturition were altered in cows developing RFM compared to those expelled fetal membranes normally. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Comparer le devenir péri-partum des patientes sous anticoagulants en termes d’accès à l’analgésie périmédullaire, d’hémorragie du post-partum et de complications thromboemboliques selon qu’une fenêtre thérapeutique planifiée a pu ou non être respectée. Patientes et méthodes Nous avons mené une étude rétrospective de janvier 2005 à septembre 2011 sur tous les cas d’accouchement sous anticoagulants dans une maternité de niveau 3. Résultats Nous avons recensé 120 cas avec traitement anticoagulant prophylactique (71 %) ou curatif (29 %). Deux complications thromboemboliques sont survenues. En cas de traitement curatif, le taux d’accès à l’analgésie périmédullaire était plus faible qu’en cas de traitement prophylactique ( p < 0,0001), et le taux d’hémorragie du post-partum plus élevé ( p = 0,07). Selon le respect ou non de la planification initiale, il existait une différence significative de la durée de la fenêtre thérapeutique avant l’accouchement (55,6 h ± 63,3 vs 26,4 h ± 11,6, p < 0,0001), du taux d’accès à l’APM (83 % vs 71 %, p = 0,02) mais pas du taux de césarienne (35 % vs 39 %, p = 0,8) ni de la survenue d’une HPP (13 % vs 14 %, p = 0,9). Conclusion En cas de posologie curative, la nécessité d’obtenir une fenêtre de 24 heures pour avoir accès à l’analgésie périmédullaire justifie une planification systématique de l’accouchement. En cas de posologie prophylactique, la facilité d’obtention d’une fenêtre de seulement 12 heures incite à ne pas imposer cette planification. Objective To compare peripartum management of anticoagulated patients concerning locoregional analgesia, post-partum hemorrhage and thrombotic events according to planified interruption or not of antithrombotic therapy. Patients and methods We conducted a single tertiary care center retrospective study of all deliveries associated with antithrombotic therapy from January 2005 to September 2011. Results We identified 120 cases with prophylactic (71%) or curative (29%) anticoagulation. Two thrombotic events occurred. In case of curative therapy, the use of locoregional analgesia was lower ( P < 0.0001) and post-partum hemorrhage occurred more frequently ( P = 0.07) compared to prophylactic therapy. According to planified interruption or not of antithrombotic therapy, we observed a more prolonged duration of therapeutic interruption before delivery (55.6 h ± 63.3 vs 26.4 h ± 11.6, P < 0.0001), higher use of locoregional analgesia (83% vs 71%, P = 0.02) but no difference concerning cesarean rate (35% vs 39%, P = 0.8) or post-partum hemorrhage (13% vs 14%, P = 0.9). Conclusion In case of curative anticoagulation, plannified interruption favours the use of perimedullar analgesia after 24 hour delay. In case of preventive anticoagulation, plannified interruption appears unnecessary as the 12 hour delay is easier to reach. [ABSTRACT FROM AUTHOR]

Peripartum Cardiomyopathy is insufficient congestive heart occurring in the last month of pregnancy and 5 months after delivery, in the absence of preexisting heart disease and identified etiology. This heart disease is associated with echocardiography systolic dysfunction and left ventricular dilatation. Its incidence ranges from 1/3000 to 1/15000, depending on the region, including much higher in some African countries, it particularly concern women over 30 years, multiparous and multiple pregnancies. The pathogenesis remains unclear, the prognosis is closely related to the complete recovery of cardiac function. We report through the clinical case of a woman aged 33 years admitted to the ICU for acute pulmonary edema of sudden onset of a term pregnancy and what to do before this critical situation. [ABSTRACT FROM AUTHOR]

Introduction: La cardiomyopathie du péripartum (CMPP) est une défaillance cardiaque dont l'étiologie demeure encore méconnue. Méthodes: Il s'agit d'une étude prospective descriptive réalisée dans le service de cardiologie du CHU Sylvanus olympio de Lomé du 1er janvier 2010 au 30 avril 2012. Elle a concerné 41 patientes ayant présenté une insuffisance cardiaque entre le 8eme mois de la grossesse et les 5 premiers mois du post- partum. Résultats: L'âge moyen des patientes était de 31,47 ans (extrêmes 21 et 44ans). L'incidence de la CMPP était de 1/362 grossesses. La parité moyenne était de 3,07 (extrêmes 1 et 6). Les symptômes étaient apparus dans le post-partum dans 90,24% des cas. Un retard important de diagnostic était observé. L'insuffisance cardiaque globale était le mode de décompensation dans 65,85%. Les signes électrocardiographiques étaient essentiellement la tachycardie sinusale (97,56%) et l'hypertrophie ventriculaire gauche (97,56%). L'échographie cardiaque a montré dans tous les cas une cardiomyopathie dilatée. Quatre cas de thrombus intraventriculaire gauche étaient notés. La FEVG était sévèrement altérée. L'HTAP était importante dans 56,09%. Conclusion: La cardiomyopathie du péripartum est une complication cardiaque grave de la grossesse de cause inconnue, fréquente dans la population africaine. [ABSTRACT FROM AUTHOR]

The verminosis is one of the principal sanitary problems in ovine herds in Brazil and around the world. However, little is known about the seasonal variation of the helminth contamination and the effects of the combination of a strategy control and a tactical control in sheep raised under in the Northern Minas semiarid conditions. In this study, the objective was to evaluate the seasonal helminth contaminations in lambs and ewes under an integrated control in the North of Minas Gerais, Brazil. The research was carried through during December 2006 to November 2007. Monthly faecal samples from 30 lambs and 30 ewes of one farm were collected. During April 2007, 68 sheep of a second farm were also evaluated, corresponding to the peri-partum time to both farms. The samples were collected directly from the recto and the faecal egg count (FEC) was determined and evaluated by variance analysis. The ewe FEC increased significantly in May and October ,which were peri-partum periods. Lamb FEC increased significantly in March , which coincided with the rainy season end. The integrated control was efficient to reduce the contaminations after these related periods. After the larvae culture, the genus Trichostrongylus, Haemonchus and Strongyloides were the most observed to both dry and rainy periods. During April 2007 the ewe contamination was significantly higher in the second farm that did not treat these animals in the pre-partum. [ABSTRACT FROM AUTHOR]

Abstract: Heifers managed under pastoral conditions are at risk from Streptococcus uberis mastitis infections at calving. A total of 397 heifers from six farms around New Zealand were enrolled in a study to identify and enumerate S. uberis on teat-ends of heifers in the peri-partum period, and to understand the effect of teat-spraying in the pre-calving period on the prevalence and incidence of S. uberis mastitis post-calving. Heifers were randomly assigned to Control or Sprayed groups. Sprayed heifers were teat-sprayed once, three times a week (Monday, Wednesday and Friday) with a commercial iodine-based teat sanitizer, starting at 3 weeks prior to calving and ending at day of calving. Across three farms, all glands of cows in both groups were sampled at calving to determine S. uberis intra-mammary infection (IMI) prevalence. For all farms, clinical mastitis (CM) cases detected during the week after calving were sampled and submitted for bacteriological analysis. Swabbing of teat-ends of 54 heifers from one farm showed that heifers had a pre-existing S. uberis contamination averaging 610 colony-forming units per swab (cfu/swab), at 3 weeks prior to calving. At calving, teat-end contamination was 560cfu/swab for Sprayed heifers and 1775cfu/swab for Control heifers. Two weeks after calving, teat-end contamination was similar between both groups, at 30cfu/swab. The prevalence of S. uberis IMI was significantly lower in the Sprayed (3.5% glands) vs. the Control (7.4%) heifers in the first week after calving. There was a trend for Sprayed heifers (3.6% heifers) to have a lower incidence of S. uberis CM compared with Control heifers (7.4% heifers). It is concluded that teat-spraying in the dry period is a management option that could contribute to controlling heifer S. uberis mastitis in the transition period. [Copyright &y& Elsevier]

Reference values have been established for serum biochemical parameters in sows from high producing pig herds. In total, 132 clinically healthy sows from eight breeding herds were serially sampled three weeks and one week before farrowing, and at one week and three weeks after farrowing. Fourteen serum biochemical parameters, focusing mainly on energy and protein metabolism, hepatobiliary and kidney function and inflammation, were investigated. The reproductive state significantly influenced the investigated parameters, other than for urea and non-esterified fatty acids. First parity sows showed higher concentrations of γ-glutamyltransferase, phosphorus and haptoglobin, and higher albumin/globulin and haptoglobin/albumin ratios compared to sows with ≥ 2 parities. The concentrations of creatinine, globulin and total protein however were lower in first parity sows. Between-herd variations were especially high (<50%) for γ-glutamyltransferase, alkaline phosphatase and non-esterified fatty acids. Serum biochemical parameters constitute an important diagnostic tool to assess the health status of sows, but to interpret the outcome properly, it is important to consider reproductive state and parity. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac disease remains the largest single cause of maternal death. Whilst uncommon, left ventricular failure during pregnancy and delivery can be devastating to both mother and child. Echocardiography can play a significant role in rapidly establishing a diagnosis, guiding initial therapy and then monitoring response., Clinical Vignettes: The history, presentation and management of three cases of peri-partum left ventricular failure is examined: stress cardiomyopathy in a 34 year old with twins, left ventricular dysfunction secondary to pre-eclampsia in a 22 year old with a singleton pregnancy and a true peri-partum cardiomyopathy in a 42 year old with IVF twins. The defining risk factors, presenting characteristics and echocardiographical findings for each pathology are highlighted., Conclusion: Echocardiography is playing an increasingly important role in the immediate assessment and management of left ventricular failure. This is especially true in the peri-partum woman, where establishing the correct therapy is both challenging and crucial due to the significant cardiovascular changes that occur around the time of delivery. To this end we believe that echocardiography should be rapidly available to guide the management of these patients by a multidisciplinary team made up of obstetricians, cardiologists, anaesthetists and intensive care physicians., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Intensive Care Society 2021.)

Background: Stress urinary incontinence (SUI) is highly prevalent during pregnancy and after delivery. It is often associated with a failing pelvic floor, sphincteric and/or supportive system. Pelvic-floor-muscle training (PFMT) peri-partum has been proven effective for up to 1 year post-partum; however, its long-term effects are unknown. Group PFMT, given by a physiotherapist, has been proven to be as equally effective as individual therapy. Motherfit is a group-PFMT therapy with an emphasis on pelvic floor exercises, adherence and general fitness. Care-as-usual (CAU), if guideline driven, should, as first treatment option, consist of PFMT. Cost-effective strategies are of relevance, given the rise of health care costs. Motherfit group therapy has the potential to be cost-effective in women with urinary incontinence. Therefore, the objectives of the two current studies are: (1) to investigate whether intensive, supervised, pre-partum (MOTHERFIT1) or post-partum (MOTHERFIT2) pelvic-floor-muscle group therapy reduces 18-month post-partum severity of SUI compared to CAU and (2) whether MOTHERFIT1 OR MOTHERFIT 2 is more (cost-)effective compared to CAU.Methods: Two multi-centred, randomised controlled trials (MOTHERFIT1, n = 150, MOTHERFIT2, n = 90) will be performed. Participants will be recruited by their midwife or gynaecologist during their routine check. Participants with SUI will receive either motherfit group therapy or CAU. Motherfit group therapy consists of eight group sessions of 60 min each, instructed and supervised by a registered pelvic physiotherapist. Motherfit group therapy includes instructions on pelvic floor anatomy and how to contract, relax and train the pelvic-floor muscles correctly and is combined with general physical exercises. Adherence during and after motherfit will be stimulated by reinforcement techniques and a mobile app. The primary outcome measure is the absence of self-reported SUI based on the severity sum score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) at 18 months post-partum. Secondary outcomes evaluate quality of life, subjective improvement and health care costs.Discussion: The motherfit studies are, to our knowledge, the first studies that evaluate both long-term results and health care costs compared to CAU in pregnant and post-partum women with SUI. If motherfit is shown to be (cost-)effective, implementation in peri-partum care should be considered.Trial Registration: Netherlands Trial Register, ID: NL5816 . Registered on 18 July 2016. [ABSTRACT FROM AUTHOR]

Objective: To compare peripartum management of anticoagulated patients concerning locoregional analgesia, post-partum hemorrhage and thrombotic events according to planified interruption or not of antithrombotic therapy., Patients and Methods: We conducted a single tertiary care center retrospective study of all deliveries associated with antithrombotic therapy from January 2005 to September 2011., Results: We identified 120 cases with prophylactic (71%) or curative (29%) anticoagulation. Two thrombotic events occurred. In case of curative therapy, the use of locoregional analgesia was lower (P<0.0001) and post-partum hemorrhage occurred more frequently (P=0.07) compared to prophylactic therapy. According to planified interruption or not of antithrombotic therapy, we observed a more prolonged duration of therapeutic interruption before delivery (55.6h±63.3 vs 26.4 h±11.6, P<0.0001), higher use of locoregional analgesia (83% vs 71%, P=0.02) but no difference concerning cesarean rate (35% vs 39%, P=0.8) or post-partum hemorrhage (13% vs 14%, P=0.9)., Conclusion: In case of curative anticoagulation, plannified interruption favours the use of perimedullar analgesia after 24hour delay. In case of preventive anticoagulation, plannified interruption appears unnecessary as the 12hour delay is easier to reach., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Although deaths caused by infection during pregnancy and the postpartum period are rare in France, mortality rates have increased in several countries of the European community. In France, the rate of maternal mortality by infectious cause has decreased over the last 12 years. Infectious causes are currently in fifth place of maternal deaths. Over the period 2007-2009, 18 deaths occurred, eight by direct infectious causes and 10 by indirect infectious causes. Among the 18 deaths, 17 were examined by the National Expert Committee on Maternal Mortality (CNEMM) with the objectives to determine the direct or indirect link with pregnancy, the adequacy of care and the preventability of death. Among 8 deaths from direct infectious causes, four deaths were deemed "preventable" or "possibly preventable" because of inadequate care. Among nine deaths from indirect infectious causes, preventability could not be established in two deaths, five were non-preventable and two were preventable due to non-optimal care. These cases of puerperal septicemia show that when sepsis is clinically manifest, infection is already well established and widespread deterioration is therefore often irreversible. Maternal mortality is preventable in most cases if several points are observed: early diagnosis, probabilistic antibiotics targeting most frequently involved bacteria including Escherichia coli and Streptococcus A, early transfer to ICU, control septic portal entry, simple preventive measures, influenza vaccination. A "microbiological clinical diagnosis" approach must be initiated at the first clinical signs., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)