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Monitoring equine parturition effectively is essential for preemptive intervention in periparturient issues and ensuring the overall well-being of both mares and foals. However, its implementation in breeding farms is challenging due to variable gestational lengths and nocturnal births. Predictive techniques have the potential to streamline the monitoring process, reduce labor intensity, and minimize costs. Research on foaling prediction in mares carrying mule or equine clone fetuses is scarce. Therefore, this study aimed to comparatively analyze foaling prediction parameters in mares pregnant with mule, equine, or equine clone fetus. The study included vulvar relaxation, sacroiliac ligament tension, pH, BRIX index, and concentrations of calcium, phosphorus, magnesium, sodium, and potassium in prepartum mammary secretions. Sixty pregnant mares were used for this study and grouped as follows: 25 mares with mule fetuses (MF), 20 with equine clone fetuses (CF), and 15 with equine control fetuses (EF). Results showed significant differences in vulvar relaxation and sacroiliac ligament tension only in MF group (p < 0.05) on the day of parturition compared to the other days evaluated, different from the other groups. Levels of pH notably decreased on parturition day (mean 5.7 ± 0.04, p < 0.0001), with lower values in MF (6.05 ± 0.02) and CF (6.08 ± 0.04) compared to EF (6.26 ± 0.04) (p < 0.03). The BRIX index showed variation across mares and was not a good parameter for foaling prediction. Electrolytes correlated positively with impending parturition, showing no significant differences among groups. The MF and CF groups exhibited a substantial increase (102.13 % and 110.66 %, respectively) in mean calcium concentrations on the day before foaling, unlike EF (38.29 %). In conclusion, the pH values were different in mammary secretions between mares carrying mule and clone fetuses, in contrast to equine control fetuses. Nevertheless, there was a trend of decreasing pH values closer to parturition in all groups. Conversely, the BRIX index serves as a valuable indicator of colostrum quality yet does not offer insights into the proximity of parturition. While electrolyte concentrations did not reveal significant differences among groups, it is worth noting that the evaluation of phosphorus emerges as a new parameter to explore in mares nearing parturition, since it obtained a pattern similar to calcium. • Mule had an increasing relaxation of physical parameter on the day of birth. • PH values were lower in mammary secretions of mares carrying mule and clone foals. • BRIX does not offer insights into the proximity of parturition. • Electrolyte concentrations did not reveal significant differences among pregnancies. • Phosphorus emerges as a new parameter to explore in mares nearing parturition. [ABSTRACT FROM AUTHOR]

There is an increasing burden of hepatitis C virus among persons of reproductive age, including pregnant and breastfeeding women, in many regions worldwide. Routine health services during pregnancy present a critical window of opportunity to diagnose and link women with hepatitis C virus infection for care and treatment to decrease hepatitis C virus-related morbidity and early mortality. Effective treatment of hepatitis C virus infection in women diagnosed during pregnancy also prevents hepatitis C virus-related adverse events in pregnancy and hepatitis C virus vertical transmission in future pregnancies. However, linkage to care and treatment for women diagnosed in pregnancy remains insufficient. Currently, there are no best practice recommendations from professional societies to ensure appropriate peripartum linkage to hepatitis C virus care and treatment. We convened a virtual Community of Practice to understand key challenges to the hepatitis C virus care cascade for women diagnosed with hepatitis C virus in pregnancy, highlight published models of integrated hepatitis C virus services for pregnant and postpartum women, and preview upcoming research and programmatic initiatives to improve linkage to hepatitis C virus care for this population. Four-hundred seventy-three participants from 43 countries participated in the Community of Practice, including a diverse range of practitioners from public health, primary care, and clinical specialties. The Community of Practice included panel sessions with representatives from major professional societies in obstetrics/gynecology, maternal fetal medicine, addiction medicine, hepatology, and infectious diseases. From this Community of Practice, we provide a series of best practices to improve linkage to hepatitis C virus treatment for pregnant and postpartum women, including specific interventions to enhance colocation of services, treatment by nonspecialist providers, active engagement and patient navigation, and decreasing time to hepatitis C virus treatment initiation. The Community of Practice aims to further support antenatal providers in improving linkage to care by producing and disseminating detailed operational guidance and recommendations and supporting operational research on models for linkage and treatment. Additionally, the Community of Practice may be leveraged to build training materials and toolkits for antenatal providers, convene experts to formalize operational recommendations, and conduct surveys to understand needs of antenatal providers. Such actions are required to ensure equitable access to hepatitis C virus treatment for women diagnosed with hepatitis C virus in pregnancy and urgently needed to achieve the ambitious targets for hepatitis C virus elimination by 2030. [Display omitted] [ABSTRACT FROM AUTHOR]

Mothers with a history of childhood maltreatment (CM) are particularly vulnerable to postpartum mental health changes. Variability in mental health trajectories is present over the first 18-months postpartum. Little is known about the potentially unique impacts of post-traumatic change or resilience on later postpartum mental health. Participants (N = 97) completed questionnaires over the first 18-months postpartum measuring demographic risk, mental health symptoms, traumatic experiences, and resilience. Mothers also completed an interview measure coded for post-traumatic changes at 6-months postpartum. Multinomial logistic regression models examined post-traumatic change and resilience factors as predictors of mothers' longitudinal latent mental health trajectory. Three classes of latent postpartum mental health emerged: low-symptom, vulnerable, and chronic high-risk. Mothers reporting stronger positive post-traumatic changes were more likely to be in the low-symptom class than the chronic high-risk class (B = −1.082, p =.01). Mothers reporting stronger negative post-traumatic changes were more likely to be in the vulnerable class (B = 0.778, p =.006) or chronic high-risk class (B = 0.906, p =.046) than the low-symptom class. Resilience was not predictive of mental health class. Findings are correlational, and causal effects between post-traumatic growth and mental health symptoms cannot be assumed. Mothers who consented to the interview may not be fully representative of all women who have experienced CM, limiting generalizability of findings. Positive post-traumatic change is associated with reduced psychopathology. These findings may assist in identification of mothers at greater risk of adverse postpartum outcomes and futher inform interventions focused on enhancing positive changes in post-traumatic cognitions. • Comorbid postpartum MDD and PTSD trajectories showed low-symptom, vulnerable, and chronic high-risk groups. • Both positive and negative post-traumatic change independently impacted postpartum depression and PTSD trajectories in mothers with childhood trauma history. • Resilience factors did not significantly impact differences in postpartum mental health trajectories. [ABSTRACT FROM AUTHOR]

The study was carried out on 18 advanced pregnant Gir cows, under two treatment (Group I, II) and control (Group III) groups, 6 cows in each. The cows under Group III were maintained as per routine farm feeding schedule, while cows under Group I and II were supplemented with mineral mixture containing rumen protected methionine and lysine @ 50 g/day/head. Additionally, animals in group I were supplemented with bypass fat @ at least 100 g/d/h during 30 days prepartum till 60 days postpartum. The postpartum reproductive events were monitored by USG (5-10 MHz linear array transducer). The mean cervical diameter and wall thickness in cows under control Group III were the highest on all days postpartum as compared to nutrient supplemented groups I & II. The values on day 7 were highest in all three groups and decreased gradually (p<0.01) on days 14 and 28/42 postpartum. The mean diameter and wall thickness of gravid uterine horn were not influenced by the nutrient supplementation in cows, and the values in all groups decreased gradually (p<0.01) from day 7 to 14 till day 28 postpartum, which thereafter did not vary much. The mean period of uterine involution and days for first estrus postpartum in treated Group I and II were significantly (p<0.05) lower than control Group III, with inverse finding on mean service period and conception rate (83.33, 33.33 and 16.66% in Gr I, II, III, resp) by day 120 postpartum. The bypass fat and mineral mixture supplementation had positive effects on uterine involution, early onset of postpartum estrus, better conception rate and reduced service period. [ABSTRACT FROM AUTHOR]

Despite success in managing HIV during pregnancy, challenges remain around sustained adherence with antiretroviral therapy (ART), and the suboptimal viral load (VL) suppression during the postpartum period. The objective of this study was to compare VL levels at delivery and during the postpartum period and assess factors associated with lack of viral suppression during the postpartum period in Canada. We combined data from two Canadian prospective cohorts, which included 286 HIV-positive women (352 pregnancies) who delivered between 2012 and 2020. Delivery VL, postpartum VL, and potential factors associated with an undetectable VL (<50 copies/mL), 2–18 weeks after delivery were assessed. To account for the correlation between multiple pregnancies from the same woman, generalized estimating equations were used to assess bivariate associations. Ninety-nine per cent of pregnant women were on ART during pregnancy compared to 93% during the postpartum period. Of those with available VL results (n = 214 pregnancies), 94% of women achieved an undetectable VL at delivery compared to 87% during the postpartum period. The postpartum period is a challenging time for ART use and VL control. Qualitative studies are needed to better understand these challenges and guide us in designing adequate interventions. [ABSTRACT FROM AUTHOR]

Background Spontaneous coronary artery dissection (SCAD) is the most important cause of acute coronary syndromes during pregnancy and in the post-partum period and involves a spontaneous intimal tear or intramural haematoma of a coronary artery. Pregnancy-associated SCAD accounts for a minority of SCAD cases but is associated with a high rate of adverse events. Case summary We present a series of three cases with pregnancy-associated SCAD. All patients presented with acute coronary syndromes in the post-partum period, between 12 days and 5 months after delivery. They all had additional conditions that are associated with SCAD, such as fibromuscular dysplasia and migraine. The management of one patient was uncomplicated, however, the courses of the other two were characterized by adverse events. One presented after an out-of-hospital cardiac arrest, the other presented with multivessel SCAD and developed progression and recurrence of SCAD during follow-up. In conclusion, the patients could be successfully treated conservatively and were in good condition at their latest follow-ups. Discussion This case series highlights the wide range of clinical courses that could exist in pregnancy-associated SCAD, from a benign manifestation to a life-threatening condition. Importantly, those patients are at an increased risk for acute and late adverse events. [ABSTRACT FROM AUTHOR]

Purpose: Evaluate maternal and neonatal outcomes in peripartum coronavirus disease 2019 (COVID-19) positive women. Methods: A retrospective cohort study was conducted, comparing outcomes between women with and without peripartum COVID-19. All singleton deliveries from June 2020 to January 2022 were included. Univariate analysis was followed by multivariate analysis. Results: Of 26,827 singleton deliveries, 563 women had peripartum COVID-19, associated with preterm deliveries both near-term and remote from term [adjusted odds ratio (aOR) 1.6 and 2.0, respectively, p = 0.007 and 0.003]. Women with peripartum COVID-19 had a significantly higher rate of disseminated intravascular coagulation (DIC) (aOR 23.0, p < 0.001). Conversely, peripartum COVID-19 peripartum COVID-19 was negatively associated with premature rupture of membranes and prolonged maternal length of stay (aOR 0.7 and 0.5, respectively, p = 0.006 and <0.001). In cesarean delivery (CDs), patients with COVID-19 had higher rate of urgent CDs (75.5 vs. 56.1%, p < 0.001), higher rate of regional anesthesia (74.5 vs. 64.9%, p = 0.049), and longer anesthesia duration (86.1 vs. 53.4 min, p < 0.001). CD rate due to non-reassuring fetal heart rate (NRFHR) was significantly higher in women with COVID-19 (29.6 vs. 17.4%, p = 0.002). Conversely, CDs rate due to history of previous single CD was significantly higher in patients without COVID-19 diagnosis (13.6 vs. 4.1%, p = 0.006). Concerning neonatal outcomes, an association has been observed between COVID-19 and low one-minute APGAR score <5, as well as neonatal COVID-19 infection (aOR 61.8 and 1.7 respectively, p < 0.001 and p = 0.037). Conclusions: Peripartum COVID-19 is associated with preterm deliveries, urgent CDs and DIC, potentially aligning with the infection's pathophysiology and coagulation alterations. [ABSTRACT FROM AUTHOR]

The success of immediate adaptation to extrauterine life depends on appropriate lung function, however, elective cesarean section can increase the risk of respiratory distress as a result of reduced pulmonary fluid absorption. This study aimed to evaluate the influence of birth mode on pulmonary clearance and respiratory performance of canine neonates in the transition period. For this purpose, 37 neonates were selected according to the obstetric condition: Vaginal Eutocia (n = 17) and Elective C-section (n = 20). Neonates were evaluated for neonatal vitality score, as well as evaluation of heart and respiratory rates, body temperature and body weight, venous hemogasometric evaluation, blood lactate and glucose, pulse oximetry and radiographic evaluation during the first 24 h of life. Additionally, amniotic fluid electrolyte composition of each puppy was evaluated. There was no influence of the type of delivery on electrolyte composition of canine amniotic fluid and neonatal pulmonary liquid content, analyzed by thoracic X-Rays. On the other hand, elective cesarean section delayed pulmonary adaptation, resulting in hypoxemia and less efficient compensatory response to acid-base imbalance and thermoregulation. In conclusion, elective c-section does not delay pulmonary clearance, whilst alters pulmonary adaptation by less efficient gas exchange and lower oxygenation, hindering the compensatory response to acid-base imbalance during the fetal-neonatal transition in dogs. • Elective c-section does not modify radiographic pulmonary content in puppies. • Elective c-section delays clinical pulmonary stabilization after birth in puppies. • Elective c-section hinders the compensatory response to acid-base imbalance. • Elective c-section delays pulmonary efficient gas exchange in puppies. [ABSTRACT FROM AUTHOR]

Objective: Stroke represents a primary cause of morbidity and mortality in pregnant and postpartum people. While pregnancy-related stroke has drawn increased attention in certain domains of health research (e.g. obstetrics, neurology), neuropsychology has yet to contribute to this literature. Given neuropsychologists' crucial role in stroke evaluation and rehabilitation efforts, our field is poised to offer insights into this important topic. Method: This review presents facts about pregnancy-related stroke most relevant for neuropsychologists, including epidemiology, risk factors, and mechanisms, alongside clinical considerations and open areas of inquiry. Structured in the format of a traditional neuropsychological evaluation, we walk readers through factors to consider in record review, the clinical interview, and providing feedback and recommendations. Conclusions: Pregnancy-related stroke can be associated with marked functional disability and decreased quality of life, and it is notable that prevalence rates are increasing. Presenting at a time when people are experiencing adjustment to a new phase of life, and most commonly affecting women of color and other vulnerable populations, pregnancy-related stroke is a unique condition warranting special attention within the broader stroke discourse. This review aims to serve as a starting point for neuropsychologists to better understand the unique attributes of pregnancy-related stroke through a neuropsychology lens. Beyond that, it aims to promote broader meaningful discussion of neuropsychology's role in women's health. [ABSTRACT FROM AUTHOR]

Nannochloropsis species should be given priority when it comes to microalgae that should be added to feed since they are suitable for intense culture and have a high concentration of PUFAs (especially EPA), antioxidants, and certain vitamins. This study investigated the possible immune and antioxidant impacts of Nannochloropsis supplementation on Barki ewes during transition period and their newly born lambs. Three weeks prior to the expected time of lambing, the researched ewes were divided into two equal groups of thirty ewes each. The second group, on the other hand, was fed the same base diet as the first group plus 10 g of commercially available Nannochloropsis powder per kg of concentrate, given daily to each ewe's concentrate. Findings revealed that supplementation of ewes with Nannochloropsis significantly up-regulated the expression pattern of immune (NFKB, RANTES, HMGB1, TNF-α, IRF4, TLR7, CLA-DRB3.2, IL1B, IL6, CXCL8, S-LZ, and Cathelicidin), and antioxidant (SOD1, CAT, GPX1, GST, ATOX1, Nrf2 and AhpC/TSA) markers in ewes post-lambing and their newly born lambs. Additionally, mRNA levels of lipogenic (ACACA, FASN SCD, LPL, and BTN1A) markers were significantly up-regulated in lambs from supplemented ewes than control ones. There was a significant increase in the WBCs, Hb, RBc count, serum level of glucose, total protein, triacylglycerol and total cholesterol, GPx, catalase, IL1α and IL6 with significantly decreased serum level of TNF-α and MDA in supplemented ewes after lambing as compared with control ones. There was also a significant increase in WBCs, Hb, RBc count, birth weight and body temperature with significantly decreased in the serum levels of TNF-α and stillbirth of newly born lambs from supplemented ewes as compared to other lambs from control ones. [ABSTRACT FROM AUTHOR]

It has been suggested that a 30–50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes. A retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post. Sixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028). It is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium. Lithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects. • Lithium completely equilibrates across the placenta, both in mono and polytherapy • A brief peripartum discontinuation is associated with slight lithemia fluctuations. • Neonatal lithemia at delivery is associated with transient neonatal complications. [ABSTRACT FROM AUTHOR]

ABSTRACT: The objectives of this retrospective observational study were to investigate the association between BCS at 21 d before calving with prepartum and postpartum DMI, energy balance (EB), and milk yield. Data from 427 multigravid cows from 11 different experiments conducted at the University of Florida (Gainesville, FL) were used. Cows were classified according to their BCS at 21 d before calving as fat (BCS ≥ 4.00; n = 83), moderate (BCS = 3.25–3.75; n = 287), and thin (BCS ≤ 3.00; n = 57). Daily DMI from −21 to −1 and from +1 to +28 DIM was individually recorded. Energy balance was calculated as the difference between net energy for lactation consumed and required. Dry matter intake in fat cows was lower than that in moderate and thin cows both prepartum (fat = 9.97 ± 0.21, moderate = 11.15 ± 0.14, and thin = 11.92 ± 0.22 kg/d) and postpartum (fat = 14.35 ± 0.49, moderate = 15.47 ± 0.38, and thin = 16.09 ± 0.47 kg/d). Dry matter intake was also lower for moderate cows compared with thin cows prepartum, but not postpartum. Energy balance in fat cows was lower than in moderate and thin cows both prepartum (fat = −4.16 ± 0.61, moderate = −1.20 ± 0.56, and thin = 0.88 ± 0.62 Mcal/d) and postpartum (fat = −12.77 ± 0.50, moderate = −10.13 ± 0.29, and thin = −6.14 ± 0.51 Mcal/d). Energy balance was also lower for moderate cows compared with thin cows both prepartum and postpartum. There was a quadratic association between BCS at 21 d before calving and milk yield. Increasing BCS from 2.5 to 3.5 was associated with an increase in daily milk yield of 6.0 kg and 28 d cumulative milk of 147 kg. Increasing BCS from 3.5 to 4.5 was associated with a decrease in daily milk yield of 4.4 kg and 28 d cumulative milk of 116 kg. In summary, a moderate BCS at 21 d before calving was associated with intermediate DMI and EB pre- and postpartum but greater milk yield compared with thinner and fatter cows. Our findings indicate that a moderate BCS is ideal for ensuring a successful lactation.

Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2–3 days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2 days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care. [ABSTRACT FROM AUTHOR]

The objectives of this retrospective observational study were to investigate the association between BCS at 21 d before calving with prepartum and postpartum DMI, energy balance (EB), and milk yield. Data from 427 multigravid cows from 11 different experiments conducted at the University of Florida (Gainesville, FL) were used. Cows were classified according to their BCS at 21 d before calving as fat (BCS ≥ 4.00; n = 83), moderate (BCS = 3.25–3.75; n = 287), and thin (BCS ≤ 3.00; n = 57). Daily DMI from −21 to −1 and from +1 to +28 DIM was individually recorded. Energy balance was calculated as the difference between net energy for lactation consumed and required. Dry matter intake in fat cows was lower than that in moderate and thin cows both prepartum (fat = 9.97 ± 0.21, moderate = 11.15 ± 0.14, and thin = 11.92 ± 0.22 kg/d) and postpartum (fat = 14.35 ± 0.49, moderate = 15.47 ± 0.38, and thin = 16.09 ± 0.47 kg/d). Dry matter intake was also lower for moderate cows compared with thin cows prepartum, but not postpartum. Energy balance in fat cows was lower than in moderate and thin cows both prepartum (fat = −4.16 ± 0.61, moderate = −1.20 ± 0.56, and thin = 0.88 ± 0.62 Mcal/d) and postpartum (fat = −12.77 ± 0.50, moderate = −10.13 ± 0.29, and thin = −6.14 ± 0.51 Mcal/d). Energy balance was also lower for moderate cows compared with thin cows both prepartum and postpartum. There was a quadratic association between BCS at 21 d before calving and milk yield. Increasing BCS from 2.5 to 3.5 was associated with an increase in daily milk yield of 6.0 kg and 28 d cumulative milk of 147 kg. Increasing BCS from 3.5 to 4.5 was associated with a decrease in daily milk yield of 4.4 kg and 28 d cumulative milk of 116 kg. In summary, a moderate BCS at 21 d before calving was associated with intermediate DMI and EB pre- and postpartum but greater milk yield compared with thinner and fatter cows. Our findings indicate that a moderate BCS is ideal for ensuring a successful lactation. [ABSTRACT FROM AUTHOR]

Introduction: Mental health and substance use disorders in pregnant and postpartum people (PPP) are common, and most will not receive adequate treatment. In addition, Black PPP experience higher rates of mental health conditions and are less likely to receive treatment compared with White PPP. Yet, our understanding of the experience of Black PPP with respect to these conditions is limited. The goal of this study was to better understand these experiences with respect to mental health, substance use, and barriers to treatment. Methods: Semi-structured interviews were completed with 68 Black PPP who were pregnant or had been pregnant in the last 24 months to gain an understanding of mental health and substance use screening and treatment during the peripartum and postpartum period. Interview data were analyzed with qualitative software, using a qualitative content analysis method, informed by grounded theory. Results: Four main themes were identified: (1) personal beliefs and views about mental health and substance use, (2) family and community beliefs about mental health and substance use, (3) personal experience with mental health and substance use, and (4) comfort in talking to others about mental health and substance use. Subthemes evolved within each of the four themes. Black PPP indicated that maternal mental health and substance use disorders are common in the Black community, but negative stigma related to these conditions often prevents PPP from talking about these conditions or seeking support or treatment despite believing that support and treatment can be beneficial. Conclusions: Clinical practice initiatives within this population can focus on advanced training for providers to more clearly understand personal experiences and related stigma related to mental health and substance use disorders, with the goal of supporting Black PPP mental health needs. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effects of intravenous nicardipine as initial therapy and oral labetalol combined with nifedipine controlled-release tablet as subsequent treatment of severe peripartum hypertension. Material and methods: Intravenous nicardipine was delivered as the initial treatment, after the target blood pressure (BP) had been achieved, oral labetalol was used to maintain the target BP. If oral labetalol failed to maintain the target BP, oral labetalol combined with nifedipine controlled-release tablet was used. Results: A total number of 131 patients were enrolled. The target BP (BP < 140/90 mmHg) was achieved in all patients within 60 minutes by intravenous nicardipine. After receiving labetalol orally, the target BP was maintained in nine patients. However, in 104 patients, we had to combine oral labetalol and nifedipine controlled-release tablet due to re-elevation of their systolic BP to 140-159 mmHg. In 18 patients, we restarted intravenous nicardipine because their systolic BP re-elevated above 160 mm Hg. Among the 104 patients who received oral labetalol and nifedipine controlled-release tablet, the target BP was achieved and maintained in 96 patients, and eight patients had to restart nicardipine. Of the total number of 26 patients in whom intravenous nicardipine was resumed, the target BP was successfully maintained in 22 patients with oral labetalol combined with nifedipine controlled-release tablet. Conclusions: Intravenous nicardipine rapidly and safely lowered severe peripartum hypertension. As subsequent therapy, oral labetalol combined with nifedipine controlled-release tablet protocol may be applied to effectively maintain a target BP. [ABSTRACT FROM AUTHOR]

Introduction: Although women often experience mental health comorbidities in the perinatal period, the evidence-base for psychological therapy across diagnostic boundaries in the perinatal period remains limited. As there is a need to understand experiences of therapy, irrespective of diagnosis, to inform intervention provision, the aims of this study were to explore women's experiences of psychological therapy for perinatal mental health difficulties and to identify the mechanisms that women attributed to the most significant therapeutic change for themselves and/or the mother-infant relationship. Method: Semi-structured interviews were conducted with 16 women who received therapy within specialist perinatal community mental health settings in the Northwest of England, the UK. Interview data were analysed using reflexive thematic analysis. Results: One overarching theme entitled participant life stories were at the heart of therapy was identified alongside three other main themes: 1.) We're in this together - therapeutic bond and establishing a coherent sense of self, 2.) Surfing the urge to 'fix' feelings - Sitting with emotions improved regulation and 3.) Seeing myself in a new light - Shifting self-blame to self-compassion enhanced self-efficacy. Theme 1 consisted of three subthemes. Participants described the quality of the therapeutic relationship as the fundamental foundation to (re) connecting with their needs, values and boundaries, which improved their sense of agency, self-esteem, therapeutic engagement and self-understanding. Shifting emotional avoidance to emotional engagement improved their selfregulation. Considering alternative factors that could have contributed to their experiences helped them to defuse self-blame and enhance self-compassion. Finally, changes in their mental health led to positive relational changes in their relationship with their infant and improved communication with partners. Discussion: Sensitivity, engagement and responsivity experienced in the therapist-woman relationship was reported to be mirrored in the motherinfant relationship. Developing a coherent sense of self and self-regulation skills both appeared to heighten women's self-compassion and empathy for their infants, which also seemed to improve their ability to tolerate uncertainty and mixed emotions within themselves and their infants. The mechanisms of change in the perinatal period are important to consider at a stakeholder, therapist and service management level to parsimoniously and best meet the needs of women and the mother-infant relationship. [ABSTRACT FROM AUTHOR]

The association of weaning with depression has long been recognized. However, interest in the study of post-weaning depression has waned over the last few decades partly due to changes in the nosology of perinatal psychiatric disorders. In this paper, we review the relevant literature and conclude that post-weaning depression is a rare but severe complication of breastfeeding cessation. Given that post-weaning depression is an understudied and often undiagnosed clinical condition, research is needed to address this important unmet need. [ABSTRACT FROM AUTHOR]

Objective Pregnancy-related infective endocarditis (IE) caries a high risk of morbidity and mortality. With increasing intravenous drug abuse (IVDA) amid the opioid epidemic, the risk factor profile may be shifting. In this case series, we aimed to describe risk factors and outcomes for peripartum IE in a contemporary cohort. Study Design We identified patients with IE diagnosed during pregnancy or up to 6 weeks' postpartum from 2015 through 2018 at a single tertiary care center. We abstracted detailed medical history and clinical outcome measures from the electronic medical record. The diagnosis of IE was supported by the modified Duke Criteria. Results Nine patients had peripartum IE: eight (89%) with a history of IVDA, one with an indwelling central venous catheter (11%), and one with prior IE (11%). None had preexisting congenital or valvular heart disease. Six (67%) had comorbid hepatitis C. Eight cases (89%) had gram-positive cocci with vegetations involving the tricuspid valve (56%) and both mitral and tricuspid valves (22%). Major complications included shock (33%), mechanical ventilation (44%), septic emboli (67%), and noncardiac abscesses (33%). Two patients underwent valve surgery, and there were two cases of postpartum maternal mortality (22%), one from septic shock and one from intracerebral hemorrhage. While four patients (44%) delivered preterm (average gestational age 35 weeks), most delivered vaginally (89%) with only one requiring an emergent caesarean section. There was no fetal mortality, although three newborns (43%) required admission to the neonatal intensive care unit. Two patients were initiated on medication-assisted treatment for opioid use disorder. Consultants included infectious disease, cardiology, cardiac surgery, maternal-fetal medicine, and psychiatry. Conclusion These findings confirm that IVDA is a growing risk factor for pregnancy-related IE. Peripartum IE carries a high risk of complications, including maternal mortality, and warrants management with a multidisciplinary care team at a tertiary center. Key Points Intravenous drug use was the most common risk factor for IE in pregnancy. IE in pregnancy carries a high morbidity and mortality with complications including septic emboli, septic shock, and need for mechanical ventilation. A multidisciplinary team approach can assure the best possible maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Summary: Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep‐related impairment, and mood. Data were from a two‐arm randomised controlled trial testing parent‐focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self‐reported bedtime, rise‐time, chronotype, insomnia symptoms, sleep‐related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed‐effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise‐times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep‐related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non‐significant (all p > 0.65). Sleep–wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep‐protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy (PPCM) is a rare but significant cause of new-onset heart failure (HF) during the peri- and post-partum periods. Advances in GDMT for HF with reduced ventricular function have led to substantial improvements in survival and quality of life, yet few studies examine the longitudinal care received by patients with PPCM. The aim of this research is to address this gap by retrospectively characterizing patients with PPCM across a multihospital health system and investigating the frequency of cardiology and HF specialty referrals. Understanding whether surveillance and medical management differ among patients referred to HF will help to underscore the importance of referring patients with PPCM to HF specialists for optimal care. [ABSTRACT FROM AUTHOR]

This pilot study observed motivations of peripartum cannabis use and correlates of postpartum cannabis use. Objectives: Peripartum cannabis use can be harmful to pregnant individual's and children's health, yet it is the most used illicit substance during the peripartum period. Despite the ability of some people to reduce and abstain from cannabis use during pregnancy, the first year postpartum is a high-risk time for returning to cannabis. However, characterization of cannabis use patterns in the peripartum period and risk factors for return to use postpartum are not well established. The aims of this exploratory study were to describe patterns of peripartum cannabis use and identify factors associated with increased frequency of postpartum cannabis use among individuals who reported reduced use during pregnancy. Methods: An online survey identified 47 individuals who used cannabis during the peripartum period. Descriptive statistics characterized the sample and among those who reduced use during pregnancy, χ2 determined the frequency of postpartum cannabis use per preconception reasons for use. Results: During preconception, 95.7% of individuals used cannabis, and of those who were presently postpartum, 65% resumed use after delivery. Anxiety and stress were the most common motivations for cannabis use throughout the peripartum period, but social motivations (ie, fun, relaxation) were the only preconception factors that increased frequency of return to cannabis use postpartum. Conclusions: Our exploratory study describes the characteristics of individuals using cannabis in the peripartum period and provides insight into correlates of resumption of cannabis use postpartum. These findings may inform future work to further determine temporal associations, confounding risk factors, and intervention techniques to prevent the return to cannabis use postpartum. [ABSTRACT FROM AUTHOR]

During the postpartum period, fathers may be at risk of increased stress and loneliness, which may be offset or buffered by the provision of social support. This study aimed to explore fathers' postpartum experiences of loneliness, perceived stress, and social support. A constructivist grounded theory approach was used to inform study design and analysis. Semistructured interviews were conducted to collect data from 12 fathers, living in the Republic of Ireland, who had an infant aged 6 months or younger. A grounded theory entitled "support for the supporter," describing fathers' experiences with social support, and loneliness during the postpartum period, was derived. Participants described experiencing increased financial pressure and having difficulty balancing the role of "breadwinner" with fatherhood. Participants described feeling excluded from maternity care and lacked avenues for information within the Irish health care system. Participants linked their experiences of loneliness to the lack of social support in the postpartum period. This study offers a novel insight into Irish fathers' experiences with maternity care during the COVID-19 pandemic. This study is the first to qualitatively explore paternal postpartum loneliness and provides a good foundation for future research and intervention in this area. Findings suggest that it would be wise to promote social support from other experienced fathers, friends, family, and from partners to reduce paternal postpartum loneliness. [ABSTRACT FROM AUTHOR]

Heart failure is the most common cardiovascular complication during pregnancy and the postpartum period. It is associated with increased risk of maternal morbidity and mortality as well as potentially life‐threatening foetal pathology. Management of heart failure in pregnancy requires expert knowledge of cardiovascular disease as well as obstetrics which underscores the importance of multidisciplinary cardio‐obstetrics teams in order to optimize diagnosis, treatment and outcome. This includes counselling of women at risk before and during the course of pregnancy in order to strengthen the relationship between medical specialists and patients, as well as to allow patient‐centred delivery of care and improve quality of life. [ABSTRACT FROM AUTHOR]

Complications throughout the peripartum period may be caused by preexisting conditions or pregnancy-induced conditions and may alter pharmacotherapy management. Pharmacotherapy management during late pregnancy and delivery requires careful consideration due to changing hormones, hemodynamic status, and pharmacokinetics, and concerns for potential maternal and/or fetal morbidity. Increased maternal and fetal monitoring are often required and may lead to therapy changes. Pharmacists, as key members of the interprofessional team, can contribute essential perspective to the management of postpartum pharmacotherapy through assessment and recommendation of appropriate and judicious use of medications. [ABSTRACT FROM AUTHOR]

Summary: Suicidal risk in mothers is a public health priority. Risk factors include biological, psychological and psychosocial factors. Among the biological factors, the role of sleep disturbances as potential contributors to increased suicidal risk during the peripartum period is becoming apparent. To explore this further, we conducted a systematic review following the PRISMA criteria. Currently, 10 studies have examined the role of insomnia and poor sleep quality in suicidal risk during the peripartum period and have involved 807,760 women. The data showed that disturbed sleep and poor sleep quality increase the risk of suicidal ideation in both pregnant women with and without perinatal depression. The results of the meta‐analysis indicated that insomnia and poor sleep quality increase the odds of suicidal risk in pregnant women by more than threefold (OR = 3.47; 95% CI: 2.63–4.57). Specifically, the odds ratio (OR) for poor sleep quality was 3.72 (95% CI: 2.58–5.34; p < 0.001), and for insomnia symptoms, after taking into account perinatal depression, was 4.76 (95% CI: 1.83–12.34; p < 0.001). These findings emphasise the importance of assessing and addressing sleep disturbances during the peripartum period to mitigate their adverse effects on peripartum psychopathology and suicidal risk. [ABSTRACT FROM AUTHOR]

Nowadays, obstetrical anesthesia-related mortality is a very rare complication in industrialized countries. The recommended choice of intrathecal opioid for spinal anesthesia in the context of a multimodal peripartum pain management concept is discussed in this narrative review. Nowadays, there is a consensus that a perioperative multimodal pain concept should be used for caesarean delivery. This pain concept should include neuraxial opioids for spinal anesthesia, acetaminophen, NSAIDs, intravenous dexamethasone, and postoperative local or regional anesthetic procedures. Long-acting lipophobic opioids (diamorphine and morphine) have a significant analgesic advantage over short-acting lipophilic opioids (sufentanil and fentanyl). The risk of clinically relevant respiratory depression after neuraxial long-acting opioids is nowadays considered negligible, even if the data situation is weak in this regard. The question remains as to whether a pain concept that is ideally adapted to a neuraxial short-acting opioid shows benefit to a pain concept that is optimally adapted to neuraxial morphine. If long-acting opioids are used, the timing of each additional component of the multimodal analgesia strategy could ideally be adjusted to this longer duration of action. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. Methods: Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018. Results: The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first‐ and third‐generation cephalosporins, respectively. Clinical sources of infection included intra‐amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%). Conclusion: Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first‐line antibiotics. Synopsis: Peripartum bacteremia was most associated with Escherichia coli, and while resistance to first‐line empiric antimicrobials is a concern, current antibiotic protocols remain appropriate. [ABSTRACT FROM AUTHOR]

Objective: Transition to parenthood is a life-changing yet stressful event for both men and women. The present study aims to: (1) establish the incidence of prenatal paternal depression and anxiety in a sample of expectant fathers and (2) assess the relationship between sexist beliefs and mental health outcomes. Methods: We recruited expectant fathers (n = 100) who attended the Gynecology and Obstetrics Outpatient Clinic of Eskişehir Osmangazi University Hospital with their pregnant partners. Fathers completed the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and the Ambivalent Sexism Scale. Results: 36% of expectant fathers reported depression, and 12% reported anxiety. Hostile sexism was correlated with depression (r = 0.303, p < 0.01), and anxiety (r = 0.228, p < 0.05). Benevolent sexism was not related to anxiety or depression (each, p > 0.05). Family social support (p = 0.004) and perceived financial satisfaction (p = 0.027) predicted anxiety, while family social support (p < 0.001) and perceived financial satisfaction (p = 0.036) predicted depression. Hostile sexism predicted both anxiety (B = 0.28, p = 0.004) and depression (B = 0.32, p < 0.001). Limitations: Results may not show a causal relationship due to the study's cross-sectional design. We recruited participants in only one center. Our measures of anxiety and depression were purely psychometric. Conclusions: Sexist beliefs may serve as environmental stressors among men in the perinatal period by increasing the masculine role stress. Future interventions to treat prenatal paternal depression may target sexism. [ABSTRACT FROM AUTHOR]

Abstract Background Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes. Methods Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration’s Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software. Results Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention’s safety was recorded only in four trials. Conclusion More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care. Trial registration PROSPERO Registration No: CRD42023399626

The objective of this study was to identify changes and associations in body condition score (BCS), serum glucose and β-hydroxybutyrate (BHB) concentrations, and white blood cell populations in dual-purpose cows during the transition period in the Veracruz tropic. BCS was evaluated and blood samples were taken weekly to determine white blood cell populations, serum glucose and BHB concentrations of 30 multiparous dual-cows (Bos taurus × Bos indicus) from 3 weeks before the expected date of calving to 3 weeks postpartum. During the prepartum period, BCS (3.56 vs 3.11 points), leukocytes (8.964 vs 7.032 × 103 cells µL-1), neutrophils (3.353 vs 2.201 × 103 cells µL-1), lymphocytes (4.750 vs 4.051 × 103 cells µL-1), and monocytes populations (222 vs 126 × 103 cells µL -1) were higher compared to the postpartum period. Contrarily, BHB concentration was higher in the postpartum period (1.34 vs 0.84 mmol L-1) than in the prepartum period. No differences in basophils and eosinophils populations and glucose concentration were identified. Associations between BCS, BHB, glucose, and populations of neutrophils, monocytes, and basophils were detected. The higher BCS, the higher the monocyte population (r = 0.22). The lower the glucose concentration, the higher the BHB concentration (r = −0.51). The higher the concentration of BHB, the lower the number of neutrophils (r = −0.22), monocytes (r = −0.32) and basophils (r = −0.23). In conclusion, low-producing dual-purpose cows experienced fluctuations in BCS, BHB, and immune cell populations during the transition period, suggesting similar metabolic and immune changes as in high-producing dairy cows.

Abstract Background The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless, there are cases where surgical intervention is necessary. We analyzed five surgical cases treated in our department and performed a literature review. Case presentations Five women, ranging in age from 25 to 38, who experienced peripartum symphysis rupture were primarily treated with a conservative approach. Patients who did not show improvement and met certain criteria, such as experiencing pain starting from childbirth, having a separation in the pubic bone of more than 10 mm, and/or having a vertical instability greater than 5 mm, were recommended to undergo surgery. The average length of time between childbirth and surgery was 5.6 months, ranging from 1 to 14 months. One patient was treated with an external fixator, another patient received a combination of an external fixator and an anterior plate, and three patients were treated with anterior plates. In four cases, we observed a failure in fixation and a partial or complete loss of reduction. The plate and screws were removed in one case, and in three cases, revision surgery was performed. One case involved using a larger plate, while the other used 90-90 plating, known as “box plate fixation.” The mean follow-up was 7.4 years. Two cases had good results, and two had excellent results on the Lindahl scale. Conclusion For patients with peripartum pubic symphyseal dislocation, our case series and literature review demonstrated that early reduction and fixation correlate with improved clinical outcomes and lower implant failure. For patients with subacute/chronic injuries, there was a higher incidence of implant failure. Orthogonal plate fixation and/or pubic symphysiodesis was associated with improved clinical outcomes.

Psychiatric illness may develop or relapse during pregnancy, and understanding best practices is paramount. In 2017, the British Association for Psychopharmacology (BAP) consensus guidance on the use of psychotropic medication preconception, in pregnancy, and postpartum was released. The BAP guidelines provide concise evidence and additional insight and flexibility for use of psychiatric medication. Key takeaways of these guidelines are highlighted serving as a concise reference for practitioners. Additionally, practice points, such as recommendations for rapid tranquilization and the role of long-acting injectable antipsychotic medications as well as additional insights to the growing body of literature associated with psychiatric medications in pregnancy since 2017 are summarized. Providers are strongly encouraged to stay up to date to provide optimal care for pregnant patients and their babies.

Twelve Holstein (HOL), 9 Brown Swiss (BRO), and 9 Simmental (SIM) dairy cows raised in the same barn and managed identically were enrolled to characterise the responses to the transition period. From −21 to 28 d from calving (DFC), body condition score (BCS) and milk yield were measured, and blood samples were collected to assess plasma biomarkers of metabolism, minerals, liver function, inflammation, and oxidative status. Compared with SIM, HOL and BRO had higher milk yield during the first week of lactation. HOL had the highest milk yield from the second to the fourth week and the lowest BCS at 28 DFC. SIM had the highest BCS and the highest plasma creatinine and P, reflecting a greater attitude to gain muscle mass. Compared with SIM, BRO and HOL had lower plasma fructosamine, indicating reduced glucose availability driven by lactose synthesis. SIM had the mildest acute phase response at the onset of lactation, as suggested by the lowest ceruloplasmin concentration. HOL had the highest cholesterol and paraoxonase concentrations, and the greatest interleukin-1β production by leukocytes following ex-vivo stimulation, suggesting that they had the quickest resolution of the acute phase response due to the fastest immune cell activation. BRO had the highest concentration of reactive oxygen metabolites, ceruloplasmin, bilirubin, glutamate-oxaloacetate transaminase, γ-glutamyl transferase, and β-hydroxybutyrate, and the lowest concentration of paraoxonase, reflecting the strongest activation of leukocytes and the most severe acute phase response. Together, these results highlight different metabolic and inflammatory conditions around calving in the three explored breeds.HIGHLIGHTS Holstein, Brown Swiss, and Simmental are dairy breeds selected for different purposes. These three breeds have different productivity, and metabolic and inflammatory responses during the transition period. Understanding the differences among breeds might improve their management, nutrition, and productivity in commercial dairy farms.

Abstract Background Perinatal women are highly vulnerable to developing mental health issues and particularly susceptible to a recurrence of psychiatric illness. Poor mental health during the perinatal period can have long-term impacts on the physical and psychiatric health of both mother and child. A potentially useful strategy to improve women’s mental health is through a mobile application teaching mindfulness, an evidence-based technique helping individuals focus on the present moment. Methods A mixed method, prospective randomised controlled trial. The study group comprise women aged 18 years and over, who are attending the public and private maternity clinics at Mater Mothers’ Hospital. A sample of 360 prenatal women will be randomised into the intervention group (with the use of the mindfulness app) or usual care. Participants will remain in the study for 11 months and will be assessed at four timepoints for changes in postnatal depression, mother-infant bonding, and quality of life. A cost-effectiveness evaluation will also be conducted using quality-adjusted life year (QALY) calculations. A random selection of intervention participants will be invited to attend focus groups to give feedback on the mindfulness app. Discussion Previous studies have found mindfulness interventions can reduce stress, anxiety, depression, and sleep disturbances in a prenatal population. The risks of the intervention are low, but could be of significant benefit for women who are unable to attend face-to-face appointments due to geographical, financial, or time barriers; during endemic or pandemic scenarios; or due to health or mobility issues. Trial registration This study was approved by the Mater Misericordiae Human Research Ethics Committee (83,589). Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001581752 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385107&isReview=true ). Registered on 22 Dec. 2022.

Background: Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes. Methods: Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software. Results: Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials. Conclusion: More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care. Trial registration: PROSPERO Registration No: CRD42023399626 [ABSTRACT FROM AUTHOR]

The peripartum period, characterized by dynamic hormonal shifts and physiological adaptations, has been recognized as a potentially vulnerable period for the development of mood disorders such as postpartum depression (PPD). Stress is a well-established risk factor for developing PPD and is known to modulate mitochondrial function. While primarily known for their role in energy production, mitochondria also influence processes such as stress regulation, steroid hormone synthesis, glucocorticoid response, GABA metabolism, and immune modulation – all of which are crucial for healthy pregnancy and relevant to PPD pathology. While mitochondrial function has been implicated in other psychiatric illnesses, its role in peripartum stress and mental health remains largely unexplored, especially in relation to the brain. In this review, we first provide an overview of mitochondrial involvement in processes implicated in peripartum mood disorders, underscoring their potential role in mediating pathology. We then discuss clinical and preclinical studies of mitochondria in the context of peripartum stress and mental health, emphasizing the need for better understanding of this relationship. Finally, we propose mitochondria as biological mediators of resilience to peripartum mood disorders. [ABSTRACT FROM AUTHOR]

Due to limited existing literature available on the presentation and treatment of catatonia in the peripartum, this retrospective descriptive cohort study aimed to examine demographic data, catatonic features, diagnoses pre- and post-catatonic episodes, treatment and the presence of obstetric complications. Individuals with catatonia were identified in a previous study using anonymised electronic healthcare records from a large mental health trust in South-East London. The presence of features from the Bush-Francis Catatonia Screening Instrument was coded by the investigators and longitudinal data were extracted from structured fields and free text. 21 individuals were identified from the larger cohort, each of whom experienced one episode of catatonia in the postpartum period, and all had had an inpatient psychiatric admission. 13 patients (62 %) presented after their first pregnancy and 12 (57 %) experienced obstetric complications. 11 (53 %) attempted breastfeeding and 10 (48 %) received a diagnosis of a depressive disorder following the episode of catatonia. The majority presented with immobility or stupor, mutism, staring and withdrawal. All were treated with antipsychotics and 19 (90 %) received benzodiazepines. This study suggests that signs and symptoms of catatonia during the peripartum are similar to other catatonic presentations. However, the postpartum may be a period of high risk for catatonia and obstetric factors, such as birth complications, may be relevant. [ABSTRACT FROM AUTHOR]

The aim of this narrative review is to consolidate knowledge on the role of the hypothalamic-pituitary-adrenal (HPA) axis in depression pathophysiology at different reproductive stages across the female lifespan. Despite growing evidence about the impact of gonadal hormones on mood disorders, no previous review has examined the interaction between such hormonal changes and the HPA axis within the context of depressive disorders in women. We will focus on HPA axis function in depressive disorders at different reproductive stages including the menstrual cycle (e.g., premenstrual dysphoric disorder [PMDD]), perinatally (e.g., postpartum depression), and in perimenopausal depression. Each of these reproductive stages is characterized by vast physiological changes and presents major neuroendocrine reorganization. The HPA axis is one of the main targets of such functional alterations, and with its key role in stress response, it is an etiological factor in vulnerable windows for depression across the female lifespan. We begin with an overview of the HPA axis and a brief summary of techniques for measuring HPA axis parameters. We then describe the hormonal milieu of each of these key reproductive stages, and integrate information about HPA axis function in depression across these reproductive stages, describing similarities and differences. The role of a history of stress and trauma exposure as a contributor to female depression in the context of HPA axis involvement across the reproductive stages is also presented. This review advances the pursuit of understanding common biological mechanisms across depressive disorders among women. Our overarching goal is to identify unmet needs in characterizing stress-related markers of depression in women in the context of hormonal changes across the lifespan, and to support future research in women's mental health as it pertains to pathophysiology, early diagnosis, and treatment targets. [ABSTRACT FROM AUTHOR]

Background: The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless, there are cases where surgical intervention is necessary. We analyzed five surgical cases treated in our department and performed a literature review. Case presentations: Five women, ranging in age from 25 to 38, who experienced peripartum symphysis rupture were primarily treated with a conservative approach. Patients who did not show improvement and met certain criteria, such as experiencing pain starting from childbirth, having a separation in the pubic bone of more than 10 mm, and/or having a vertical instability greater than 5 mm, were recommended to undergo surgery. The average length of time between childbirth and surgery was 5.6 months, ranging from 1 to 14 months. One patient was treated with an external fixator, another patient received a combination of an external fixator and an anterior plate, and three patients were treated with anterior plates. In four cases, we observed a failure in fixation and a partial or complete loss of reduction. The plate and screws were removed in one case, and in three cases, revision surgery was performed. One case involved using a larger plate, while the other used 90-90 plating, known as "box plate fixation." The mean follow-up was 7.4 years. Two cases had good results, and two had excellent results on the Lindahl scale. Conclusion: For patients with peripartum pubic symphyseal dislocation, our case series and literature review demonstrated that early reduction and fixation correlate with improved clinical outcomes and lower implant failure. For patients with subacute/chronic injuries, there was a higher incidence of implant failure. Orthogonal plate fixation and/or pubic symphysiodesis was associated with improved clinical outcomes. [ABSTRACT FROM AUTHOR]

Twelve Holstein (HOL), 9 Brown Swiss (BRO), and 9 Simmental (SIM) dairy cows raised in the same barn and managed identically were enrolled to characterise the responses to the transition period. From −21 to 28 d from calving (DFC), body condition score (BCS) and milk yield were measured, and blood samples were collected to assess plasma biomarkers of metabolism, minerals, liver function, inflammation, and oxidative status. Compared with SIM, HOL and BRO had higher milk yield during the first week of lactation. HOL had the highest milk yield from the second to the fourth week and the lowest BCS at 28 DFC. SIM had the highest BCS and the highest plasma creatinine and P, reflecting a greater attitude to gain muscle mass. Compared with SIM, BRO and HOL had lower plasma fructosamine, indicating reduced glucose availability driven by lactose synthesis. SIM had the mildest acute phase response at the onset of lactation, as suggested by the lowest ceruloplasmin concentration. HOL had the highest cholesterol and paraoxonase concentrations, and the greatest interleukin-1β production by leukocytes following ex-vivo stimulation, suggesting that they had the quickest resolution of the acute phase response due to the fastest immune cell activation. BRO had the highest concentration of reactive oxygen metabolites, ceruloplasmin, bilirubin, glutamate-oxaloacetate transaminase, γ-glutamyl transferase, and β-hydroxybutyrate, and the lowest concentration of paraoxonase, reflecting the strongest activation of leukocytes and the most severe acute phase response. Together, these results highlight different metabolic and inflammatory conditions around calving in the three explored breeds. Holstein, Brown Swiss, and Simmental are dairy breeds selected for different purposes. These three breeds have different productivity, and metabolic and inflammatory responses during the transition period. Understanding the differences among breeds might improve their management, nutrition, and productivity in commercial dairy farms. [ABSTRACT FROM AUTHOR]

Background: Glanzmann thrombasthenia (GT) is a rare, autosomal recessive disorder of platelet glycoprotein IIb‐IIIa receptors. Pregnant patients with GT are at increased risk of maternal and fetal bleeding. There is a paucity of literature on the peripartum management of patients. Case Description: We present the antepartum through the postpartum course of a patient with GT who was managed by a multidisciplinary approach that included communication across maternal‐fetal medicine, hematology, transfusion medicine, and anesthesiology services. In addition to routine prepartum obstetric imaging and hematologic laboratory studies, we proactively monitored the patient for anti‐platelet antibodies every 4–6 weeks to gauge the risk for neonatal alloimmune thrombocytopenia. Furthermore, we prioritized uterotonics, tranexamic acid, and transfusion of HLA‐matched platelets to manage bleeding for mother and fetus intrapartum through the postpartum periods. Conclusion: To date, there are limited guidelines for managing bleeding or preventing alloimmunization during pregnancy in patients with GT. Here, we present a complex case with aggressive management of bleeding prophylactically for the mother while serially monitoring both mother and fetus for peripartum bleeding risks and events. Moreover, future studies warrant continued evaluation of these approaches to mitigate increased bleeding risks in subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Obesity during pregnancy represents a significant health issue and can lead to increased complications during pregnancy and impairments with breastfeeding, along with long‐term negative health consequences for both mother and offspring. In rodent models, diet‐induced obesity (DIO) during pregnancy leads to poor outcomes for offspring. Using a DIO mouse model, consisting of feeding mice a high fat diet for 8 weeks before mating, we recapitulate the effect of high pup mortality within the first 3 days postpartum. To examine the activity of the dam around the time of birth, late pregnant control and DIO dams were recorded in their home cages and the behaviour of the dam immediately before and after birth was analysed. Prior to giving birth, DIO dams spent less time engaging in nesting behaviour, while after birth, DIO dams spent less time in the nest with their pups compared to control dams, indicating reduced pup‐engagement in the early postpartum period. We have previously reported that lactogenic hormone action, mediated by the prolactin receptor, in the medial preoptic area of the hypothalamus (MPOA) is critical for the onset of normal postpartum maternal behaviour. We hypothesized that DIO dams may have lower lactogenic hormone activity during late pregnancy, which would contribute to impaired onset of normal postpartum maternal behaviour. Day 16 lactogenic activity, transport of prolactin into the brain, and plasma prolactin concentrations around birth were all similar in control and DIO dams. Moreover, endogenous pSTAT5, a marker of prolactin receptor activity, in the MPOA was unaffected by DIO. Overall, these data indicate that lactogenic activity in late pregnancy of DIO dams is not different to controls and is unlikely to play a major role in impaired onset of normal postpartum maternal behaviour. [ABSTRACT FROM AUTHOR]

Background: Perinatal women are highly vulnerable to developing mental health issues and particularly susceptible to a recurrence of psychiatric illness. Poor mental health during the perinatal period can have long-term impacts on the physical and psychiatric health of both mother and child. A potentially useful strategy to improve women's mental health is through a mobile application teaching mindfulness, an evidence-based technique helping individuals focus on the present moment. Methods: A mixed method, prospective randomised controlled trial. The study group comprise women aged 18 years and over, who are attending the public and private maternity clinics at Mater Mothers' Hospital. A sample of 360 prenatal women will be randomised into the intervention group (with the use of the mindfulness app) or usual care. Participants will remain in the study for 11 months and will be assessed at four timepoints for changes in postnatal depression, mother-infant bonding, and quality of life. A cost-effectiveness evaluation will also be conducted using quality-adjusted life year (QALY) calculations. A random selection of intervention participants will be invited to attend focus groups to give feedback on the mindfulness app. Discussion: Previous studies have found mindfulness interventions can reduce stress, anxiety, depression, and sleep disturbances in a prenatal population. The risks of the intervention are low, but could be of significant benefit for women who are unable to attend face-to-face appointments due to geographical, financial, or time barriers; during endemic or pandemic scenarios; or due to health or mobility issues. Trial registration: This study was approved by the Mater Misericordiae Human Research Ethics Committee (83,589). Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001581752 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385107&isReview=true). Registered on 22 Dec. 2022. [ABSTRACT FROM AUTHOR]

Introduction: The onset of hypertension and proteinuria beyond 20 weeks of pregnancy are hallmarks of preeclampsia, a multiorgan disease syndrome of unknown cause. Several theories have been presented to explain its emergences, such as immunologic intolerance and vascular endothelial damage. Primiparaty, numerous pregnancies, persistent hypertension, and maternal age over 40 are all risk factors for preeclampsia. Aims and objectives: This research aimed to understand better the demographics and medical background of hypertensive pregnant women. Methods: This prospective cohort study examined gestational hypertension, preeclampsia, and eclampsia as potential risk factors for Peripartum cardiomyopathy (PPCM) in pregnant women with elevated blood pressure. Patients with PPCM were examined during their hospital stays and again at 1-, 3-, and 6-months during follow-up visits to an outpatient clinic, all with the participants' informed agreement. The primary objective of this study was to evaluate the clinical characteristics and cardiac health of hypertensive pregnant women over the long term. Results: There was no statistically significant difference in the mean number of leucocytes between this study's oldest and youngest individuals (p=0.799). There was also no statistically significant variation in the distribution of participants' jobs (p=0.99). There were, however, statistically significant variations in the incidence of abortions (p=0.31), the prevalence of paternal hypertension (p=0.76), the incidence of previous PPCM (p=0.001), and the severity of preeclampsia (p=0.03). Conclusion: The study has concluded no statistically significant differences between PPCM and non-PPCM women regarding leucocyte counts or employment status. [ABSTRACT FROM AUTHOR]

Aim: Guided by Mcleroy's socio‐ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post‐partum women living with HIV. Method: Quantitative, research methodology. Design: We conducted a retrospective, secondary data analysis of 143 Black post‐partum women living with HIV who received peripartum care in South‐Florida, United States, from 2009 to 2017. We examined odds of immediate post‐partum engagement at 3 months post‐partum, and ongoing primary care engagement at 12 months post‐partum. Results: The independent group analyses showed low levels of immediate post‐partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post‐partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post‐partum engagement. Also, immediate post‐partum disengagement was a significant predictor for ongoing primary care disengagement. Conclusion: This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities. Impact: The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at‐risk women and intervene accordingly to ensure that their care is not marginalized. Patient/Public Contribution: This study includes direct patient data from Black post‐partum women living with HIV who were seen at prenatal and post‐partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service‐users, who further corroborated our findings, and provided insights and future recommendations. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and the peripartum period is a hypercoagulable state increasing the risk of venous thromboembolism (VTE). There may be a role in utilising D‐dimer in the peripartum setting. Aims: The purpose of this review was to summarise the latest evidence regarding the diagnostic accuracy of D‐dimer in the peripartum setting with or without the addition of clinical decision rules. Methods: We searched PubMed and CENTRAL databases to identify articles that included studies of women who had suspected VTE, underwent a D‐dimer index test to rule out VTE and where radiological imaging or clinical follow‐up, to a minimum of 30 days, was used as the reference standard. Results: We included 11 studies in the systematic review and meta‐analysis. The log diagnostic odds ratio (DOR) for identifying VTE using D‐dimer was 1.56 (95% confidence interval (CI) 0.59–2.52). The pooled sensitivity was 87% (95% CI 76.8–93%), specificity was 63.2% (95% CI 47.1–76.7%), and the area under receiver operator characteristic (ROC) curves was 0.76. We included four studies evaluating D‐dimer combined with YEARS to detect VTE. The log DOR for identifying VTE using D‐dimer combined with YEARS was 1.13 (95% CI 0.005–2.25). The pooled sensitivity was 89.8% (95% CI 60.2–98.1%), specificity was 65.7% (95% CI 54.7–75.2%) and the area under ROC for studies included with the YEARS clinical decision rule was 0.49. Conclusion: This review highlighted that D‐dimer use in the peripartum period for detection of VTE had a high sensitivity and high DOR but a poor area under ROC, which may limit its use in clinical practice. [ABSTRACT FROM AUTHOR]