-
Ugeskrift For Laeger Nov 2023Rusty pipe syndrome (RPS) is a benign, self-limiting condition characterized by bloody milk secretion, and is primarily seen among primiparous women. This case report...
Rusty pipe syndrome (RPS) is a benign, self-limiting condition characterized by bloody milk secretion, and is primarily seen among primiparous women. This case report highlights the clinical presentation of a 31-year-old primiparous woman with bloody milk secretion from gestational week 31. This persisted throughout pregnancy until seven days after birth. RPS should be considered in pregnant women with painless bilateral bloody milk secretion during pregnancy and/or the early days post-partum. The milk can safely be provided to the infant, and RPS is not an indication for formula feeding.
Topics: Infant; Female; Pregnancy; Humans; Adult; Animals; Breast Feeding; Lactation; Milk; Postpartum Period; Syndrome; Parity
PubMed: 38018741
DOI: No ID Found -
Hypertension Research : Official... Dec 2023
Topics: Female; Humans; Postpartum Period
PubMed: 37648848
DOI: 10.1038/s41440-023-01429-1 -
Journal of Obstetric, Gynecologic, and... Nov 2023In August 2023, the U.S. Food and Drug Administration approved Zurzuvae (zuranolone) as the first oral medication to treat postpartum depression. Despite recommendations... (Review)
Review
In August 2023, the U.S. Food and Drug Administration approved Zurzuvae (zuranolone) as the first oral medication to treat postpartum depression. Despite recommendations to screen and treat depression during pregnancy and after birth, perinatal depression is still considered under-detected and under-treated. In this column, I review screening recommendations and the new pharmacological treatment for postpartum depression, research findings on gaps in the cascade of mental health care, integrative care models, and recommendations from professional organizations on screening and treating postpartum depression within broader systems of mental health care.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Depression; Depression, Postpartum; Mass Screening; Perinatal Care; Postpartum Period
PubMed: 37806320
DOI: 10.1016/j.jogn.2023.09.007 -
American Family Physician Nov 2023
Topics: Female; Humans; Postpartum Period; Breast Feeding; Breast
PubMed: 37983705
DOI: No ID Found -
MCN. the American Journal of Maternal...
Topics: Female; Humans; Urinary Retention; Postpartum Period; Puerperal Disorders; Risk Factors
PubMed: 37365705
DOI: 10.1097/NMC.0000000000000922 -
International Journal of Gynaecology... Jan 2024The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding... (Review)
Review
The postpartum period is the perfect time to access family planning services. WHO guidelines contraindicate combined hormonal contraceptives postpartum in breastfeeding patients between 6 weeks and 6 months after delivery (Medical Eligibility Criteria category 3). On the contrary, the Faculty of Sexual and Reproductive Healthcare and the Centers for Disease Control and Prevention guidelines do not contraindicate their use in women who breastfeed from 6 weeks to 6 months postpartum. New combined hormonal contraceptives with natural estrogens have never been studied in this setting. Guidelines agree on the prescription of the progestin-only pill postpartum in non-breastfeeding women (category 1). Differences are found in women who breastfeed. In non-breastfeeding women, an implant is considered safe (category 1) by all guidelines, without any distinction in time. Regarding postpartum breastfeeding women, the guidelines for implants give quite different indications but are still permissive. Intrauterine devices are viable options for postpartum contraception but guidelines give different indications about the timing of insertion. Postplacental intrauterine device placement can reduce the subsequent unintended pregnancy rate, particularly in settings at greatest risk of not having recommended postpartum controls. However, it has yet to be understood whether this approach can really have an advantage in high-income countries. Postpartum contraception is not a 'matter of guidelines': it is the best customization for each woman, as early as possible but at the ideal timing.
Topics: Pregnancy; Humans; Female; Contraception; Postpartum Period; Reproduction; Family Planning Services; Intrauterine Devices; Contraceptive Agents
PubMed: 37334892
DOI: 10.1002/ijgo.14928 -
American Journal of Perinatology Jul 2023Nearly half of women describe childbirth as traumatic in some way, making them more vulnerable to perinatal psychiatric illness. Patients with high risk pregnancies,...
Nearly half of women describe childbirth as traumatic in some way, making them more vulnerable to perinatal psychiatric illness. Patients with high risk pregnancies, such as abnormal placentation, are even more susceptible to childbirth related mental health sequelae. There are no formal recommendations for mental health intervention in women with placenta accreta spectrum (PAS). In many institutions, the Edinburgh Postpartum Depression Scale is used to assess for depressive and anxiety symptoms during pregnancy and postpartum. Women with PAS should be screened at time of diagnosis, monthly until delivery, and at multiple time points through the first year postpartum. It is also recommended to screen women for PTSD prior to and after delivery. Interventions shown helpful in the PAS population include establishing a multidisciplinary team, patient access to a support person or care coordinator, development of a postpartum care team and plan, and extending mental health follow up through the first year postpartum. Women with PAS are at increased risk for negative mental health outcomes. To support the mental health of women with PAS and their families, we recommend a multi-disciplinary treatment team, screening for mental health sequelae early and often, referring women with positive screens to mental health professionals, involving the partner/family in care, and considering referral to a PAS support group for peer support.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Mental Health; Postpartum Period; Parturition; Mental Disorders; Placenta
PubMed: 37336219
DOI: 10.1055/s-0043-1761913 -
Brain Research Oct 2023During pregnancy and the postpartum period, changes in brain volume and in motivational, sensory, cognitive, and emotional processes have been described. However, to...
During pregnancy and the postpartum period, changes in brain volume and in motivational, sensory, cognitive, and emotional processes have been described. However, to date, longitudinal modifications of brain function have been understudied. To explore regional cortical coupling, in pregnancy and at 3 months postpartum, we analyzed resting-state electroencephalographic (EEG) coherence in the delta, theta, alpha, alpha, beta, and beta frequency bands across frontal and parietal regions of the maternal brain (Fp1, Fp2, F3, F4, P3, and P4). We found that from pregnancy to the postpartum period, mothers showed less intrahemispheric EEG coherence between the frontal and parietal regions in the alpha and alpha bands, as well as greater interhemispheric EEG coherence between frontopolar regions in the beta band. These changes suggest decreased inhibition of neural circuits. These neurophysiological changes may represent an adaptive process characteristic of motherhood.
Topics: Pregnancy; Female; Humans; Electroencephalography; Brain; Parietal Lobe; Postpartum Period; Emotions
PubMed: 37336317
DOI: 10.1016/j.brainres.2023.148468 -
Journal of Neuroendocrinology Jul 2023Pregnancy is associated with prominent structural changes in brain areas involved in Theory of Mind (ToM), pointing to the possibility of modifications in ToM-related... (Review)
Review
Pregnancy is associated with prominent structural changes in brain areas involved in Theory of Mind (ToM), pointing to the possibility of modifications in ToM-related behavior and brain responses in parents. We performed a systematic review screening for studies that examined ToM in pregnant and/or early postpartum parents. The evaluation of the included 12 studies allowed us to construct an overview of ToM changes during pregnancy and postpartum as well as other associated factors, such as oxytocin, mental health, and parental behavior. Four studies examined ToM changes by comparing pregnant/early postpartum parents with nulliparous parents or prepregnancy measures. They reported no differences between groups measured with a self-report questionnaire but found group differences using an experimental approach. The results from the summarized studies further suggest a mediatory role of oxytocin between ToM and certain parental behavior. In addition, while no link between postpartum depression and ToM was observed, findings do point to an association between depressive and remote maternal behavior and anxious attachment style and ToM abilities in pregnant participants. Research findings regarding the interaction of ToM with both parity and maternal attachment to the fetus are ambivalent. Overall, research on this topic is scarce, limiting our ability to draw firm conclusions and stressing the need for further research on this topic. This review presents an overview of research findings on ToM and associated factors in pregnancy and the postpartum period and discusses directions for future research.
Topics: Pregnancy; Female; Humans; Oxytocin; Theory of Mind; Postpartum Period; Maternal Behavior; Depression, Postpartum
PubMed: 37094082
DOI: 10.1111/jne.13266 -
Obstetrical & Gynecological Survey Feb 2024Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of... (Review)
Review
IMPORTANCE
Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being.
OBJECTIVE
The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices.
EVIDENCE ACQUISITION
A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted.
RESULTS
There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period.
CONCLUSIONS
Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Postnatal Care; Maternal Health Services; Postpartum Period; Contraception; Obstetrics
PubMed: 38377454
DOI: 10.1097/OGX.0000000000001224