The effect of immediate postpartum levonorgestrel contraceptive implant use on breastfeeding and infant growth: a randomized controlled trial

Objective

This study assessed whether immediate postpartum insertion of levonorgestrel contraceptive implants is associated with a difference in infant growth from birth to 6 months, onset of lactogenesis, or breastfeeding continuation at 3 and 6 months postpartum compared to delayed insertion at 6 to 8 weeks postpartum.

卡前列甲酯栓阴道给药、舌下含服预防产后出血

目的观察卡前列甲酯栓（卡孕栓）对产后出血发生的影响及其副作用。方法将正常足月妊娠阴道分娩者８０例随机分成３组，其中２组为卡孕栓实验组，以不同给药途径分为阴道用药组（２５例）与舌下含服组（２５例），对照组（３０例）则常规静脉推注麦角新碱。结果３组产妇的第３产程平均时间分别是７．６４、５．５２和６．４４ｍｉｎ，无明显统计学差异（Ｐ＞０．０５）；产后２ｈ内的平均出血量，对照组（２６０．８３ｍｌ）与卡孕栓阴道给药组（１９０．２８ｍｌ）及舌下含服组（１９９．８０ｍｌ）相比均有显著差异（Ｐ＜０．００１）；两卡孕栓组间则未见差异。两实验组产妇均未发生明显副反应。结论卡孕栓预防产后出血的效果优于麦角新碱，其阴道用药及舌下含服都是有效给药途径。     

含服米索前列醇预防选择性剖宫产产后出血

目的：探讨舌下含服米索前列醇预防剖宫产产后出血的效果。方法：将妊娠晚期单胎选择性剖宫产者200例随机分为两组,研究组110例，在第二产程末胎头娩出后舌下含服米索400μg，对照组90例，在胎儿娩出后静脉注射催产素20IU，观察产后2h出血量和用米索前后血压及用药后出现的副作用，结果：产后2h内的出血量，研究组与对照组分别为174．43ml和219.73ml，二组比较有显著性差异（P＜0．01），用米索前后血压比较，二组无显著性差异（P＞0．05），结论：舌下含服前列醇促进子宫收缩作用强于催产素，能减少产后出血，也适用于某些与血管变化有关的高危孕产妇，预防产后出血。     

产后出血159例临床分析及护理

目的　探讨产后出血的原因与影响因素。方法　回顾分析收治的产后出血 15 9例 ,数据处理采用χ2 检验。结果　产后出血发生率 3.5 % ,产后 2小时内出血者 88.6 7% ,出血原因宫缩乏力为 6 6 .6 7% ,影响因素有手术产、流产史、分娩史、妊娠合并症及产程延长等 ,统计学处理P <0 .0 1。结论　重视产后出血的影响因素 ,正确评估出血量及产妇产后 2小时留置产房观察是产后出血早期诊断的关键 ,其预防重点在于早期发现并针对不同原因及时正确处理     

产后抑郁症相关因素调查研究

目的探讨产后抑郁症的相关因素.方法采用分层整群抽样方法,对长沙市4所医院300例产后6周复查的初产妇进行Edinburgh产后抑郁量表与自编问卷调查.结果产后抑郁症的发生率为17.3%;产妇年龄、婚姻状况、教育程度与产后抑郁症无关(均P＞0.05),分娩疼痛承受力、分娩方式、新生儿性别、母婴同室、母乳喂养为产后抑郁症的影响因素(P＜0.05、P＜0.01),且分娩方式是产后抑郁症的危险因素,分娩疼痛承受力与母婴同室是保护因素.结论产后抑郁症发生率较高,其影响因素应引起产科工作人员的重视.     

全程责任制助产的临床意义

目的:了解为产妇提供产时"全程责任制助产"的个性化服务,对产妇妊娠结局的影响,以及对提高产科护理质量的意义.方法:将114例住院分娩的初产妇随机分为"全程组"与常规待产组(对照组),"全程组"是指在导乐的基础上实行一名助产士专门为一名产妇提供全过程(宫口开大2cm至产后2h)的服务和指导.结果:"全程组"与对照组的产程时间、分娩方式、产后出血率,均有显著性差异(P＜0.05).结论:"全程"责任制助产有利于提高产科质量,护理满意度调查平均达98%,值得推广应用.     

Changes in T,B, and NK Lymphocyte Subsets During and After Normal Pregnancy

PROBLEM: Pregnancy affects the maternal immune system and the clinical course of maternal diseases. Here we report the changes in the detailed lymphocyte subsets of helper T cells, suppressor T cells, CD5⁺ B cells, T cell receptor (TCR) αβ-positive T cells (Tαβ cells), TCRαβ-negative T cell (Tγδ cells), and others during and after pregnancy through to one year postpartum, and discuss the significance of the changes. METHOD: The absolute numbers of helper T cells, suppressor T cells, cytotoxic T cells, TCRαβ-negative T cells (Tγδ cells), CD5^— B cells, CD5⁺ B cells, and NK cell subsets were examined by two-color flow cytometry in peripheral blood from 51 healthy non-pregnant women, 106 healthy pregnant women, and 148 healthy postpartum women. RESULTS: In early pregnancy, the numbers of suppressor T cells and NK cells with strong cytotoxicity (NK⁺⁺⁺ cells) increased, and the number of cytotoxic T cells decreased. In late pregnancy, the helper T cell and NK⁺⁺⁺ cell numbers decreased. Tαβ, CD5^— B and CD5⁺ B cells decreased during pregnancy. After delivery, helper T cells and cytotoxic T cells increased from 1 to 4 months postpartum, and suppressor T cells increased at 7 months postpartum. TCRαβ-negative T cells increased at 4 to 10 months postpartum. Both CD5^— and CD5⁺ B cells decreased further at 1 month postpartum, but CD5⁺ B cells increased markedly at 7 to 10 months postpartum. CONCLUSIONS: These data indicate that 1) early increases of suppressor T cells and NK⁺⁺⁺ cells during pregnancy may be related to the mechanism to accept or reject the fetus in early pregnancy, respectively; 2) late decreases of helper T cells and NK⁺⁺⁺ cells may be related to the maintenance of pregnancy: 3) postpartum increases of helper T cells, cytotoxic T cells, TCRαβ-negative T cells (Tγδ cells), and CD5⁺ B cells may be related to the postpartum aggravation of autoimmune diseases; and 4) the immunological effects of pregnancy remains until about 1 year after delivery.     

Changes of Lymphocyte Subsets in Normal Pregnant and Postpartum Women: Postpartum Increase of NK/K (Leu 7) Cells

ABSTRACT: Changes in lymphocyte subsets in whole blood of normal pregnant and postpartum women were examined by flow cytometry with an automated leukocyte differential system. From the first trimester and throughout pregnancy, the absolute counts of T(CD3) and B(CD20) and T-cell subsets (CD4, CD8) decreased with a decrease in the absolute lymphocyte count, although the proportions of these cells remained unchanged except for a decrease in the percentage of T helper-inducer (CD4) cells in the first trimester. On the contrary, the percentage of NK/K (Leu 7) cells, but not of NK/K (CD16) cells, increased in the first trimester and then both gradually decreased in the second and third trimesters. In the postpartum period, the percentages and absolute counts of T(CD3) and NK/K (Leu 7) cells, but not of other cells, increased transiently. These changes of lymphocyte subsets may indicate suppression of immunological activity during pregnancy and its “increase” in the postpartum period.     

Influence of breast-feeding on the production of cytokines

PROBLEM: Recently, we reported increases in the production of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), and IL-4 during the postpartum period. The present study was undertaken to investigate whether these increases might be explained by increased prolactin while breast-feeding. METHOD: Whole blood from 41 women who were breast-feeding, 13 women not breast-feeding, and 31 healthy non-pregnant women was stimulated with phorbol 12-myristate 13-acetate and ionomycin, and the levels of cytokines in the supernatant were measured by enzyme-linked immunosorbent assay. Their serum levels of prolactin were measured by enzyme immunoassay. RESULTS: Increases in IFN-gamma, IL-2, IL-4, and IL-10 production were observed in women who were breast-feeding but not in women who were not breast-feeding. Serum levels of prolactin correlated with the levels of IFN-gamma in culture supernatant. CONCLUSIONS: These results suggest that breast-feeding induces production of cytokines and that IFN-gamma production is enhanced by physiological concentrations of prolactin.