The Clinical and Experimental Research on Billings Ovulation Method During Breastfeeding

Objective The effectiveness and acceptability of Billings Ovulation Method (BOM) during breastfeeding were studied. At the same time, the monitoring indexes of fertility return were studied.Methods It was a clinical comparative study of BOM and IUD containing copper (200mm 2). The annual rate of pregnancy, discontinuation rate and continuation rate in the two groups was determined. The serum prolactin and estradiol in 90 breastfeeding mothers and urine estrogen and pregnanediol in different feeding mothers were measured.Results There were 219 subjects in the BOM group and 200 in the IUD group. The pregnancy rate in this two groups was 1. 43% and 1. 54% respectively. The rates of discontinuation and continuation in the IUD group were:8. 87% and 91. 35% as well as in the BOM group were 8. 53% and 90. 17% respectively. Neither result was statistically significant (P>0. 05). The experimtal research showed that menses return was well estimated by 0. 35 ratio of serum prolactin vs. estrodiol. Sensitivity and     

喂养与生育力的探讨

目的研究哺乳期妇女不同喂养方式的生育力恢复。方法104例对象分为母乳、混合、人工喂养三组,观察和记录宫颈粘液,其中33例连续测定了血生乳素和雌二醇,32例测定了尿雌激素和(或)孕二醇。结果产后第1次来经的平均日三组分别为198．16、175．35和91．44d,第2次与第1次月经间隔的平均日三组分别为67．50、28．57和23．28d,经统计分析,母乳、混合与人工喂养组之间都有显著差异(P<0．05)。宫颈粘液法估计月经恢复的正确性为86．53％,血生乳素和雌二醇的比例预测月经恢复的灵敏度达93．2496、特异性为89．28％,12例混合喂养者尿孕二醇水平均<7．10μmol／24h,表明无排卵发生。结论应用宫颈粘液观察法了解生育力简单、正确,妇女自己能掌握,可推广。遇到识别粘液有困难时,作内分泌测定,可了解生育力的恢复。     

分娩前后血清催乳素、雌二醇和孕酮水平的变化与产后抑郁症的相关性研究

目的探讨产后抑郁症与分娩前血清催乳素、雌二醇及孕酮的关系,并提出相关防治措施。方法选择我院2009年12月至2012年9月入院接受治疗的80例产妇作为研究对象,对所有产妇进行产前,产后调查,产前使用汉密尔顿抑郁症测量表排除抑郁症,产后42 d用爱丁堡产后抑郁量表(EPDS)评定,以EPDS总分≥13分为产后抑郁症,以35例产后抑郁症作为抑郁组,其余45例作为对照组,并于分娩前后采用放射免疫方法测定所有产妇的血清催乳素(PRL)、孕酮(P)和雌二醇(E2)水平。结果抑郁组产后5 d,42 d血清PRL显著高于对照组,组间差异具有统计学意义(P<0.05);产前E2抑郁组与对照组差异无统计学意义(P>0.05),产后5 d,42 d的E2、P值与产前比较,抑郁组低于对照组(P<0.05)。结论胎盘娩出后,产后抑郁症的发生同雌二醇,孕酮和催乳素的改变具有密切关系。     

The Impact of Breastfeeding Pattern on the Duration of Lactational Amenorrhoea in Chengdu,China

Objective To determine the relation between infant feeding practices (and other fac-tors) and the duration of postpartum amenorrhoea in a sample of Chinese womendinally in 541 mothers and their infants in Pengxian County Sichuan Province. The,durations of breast feeding and of lactational amenorrhoea were estimated throughsurvival analysis. Cox's non-parametric hazards regression analysis was performed todetermine thevariables associated with the duration of lactational amenorrhoea.Results Mothers breast fed frequently per day, the mean frequency ranging from 6. 4per day at 3 weeks postpartum to 5. 4 per day at 6 months. They breast fed for over18. 3 monthson average. The median duration of lactational amenorrhoea was 9. 3months. Theperiod from birth until the first breast feed was a significant determinantof the duration of lactational amenorrhoea, P = 0. 038. Compared with women whoended full breastfeeding earlier, those who ceased full breast feeding at 120 to 24Cdays returned to menses significantly sooner (risk ratio ＝ 1. 34; 95% CI = 1. 06～1. 69). This finding is probably spurious since no relationship between full breast feed-ing duration and the return of menses was found among women who ended full breast-feeding after 240 days.Conclusion The most important determinant of the return of menses was the delay inthe first breast feed after birth, suggesting that the Ten Steps to Successful Breast feed-ing should be more precisely implemented.     

抗肌萎缩蛋白基因51号外显子的精确定位

抗肌萎缩蛋白基因是迄今发现的人类最大基因,长约2300 kb,含有75个外显子。对该巨大基因的研究是近年来医学分子生物学研究的一个热点。虽然抗肌萎缩蛋白基因HindⅢ片段排序后就知道第51号外显子位于3.lkb的第40号HlndⅢ片段中,由于抗肌萎缩蛋白基因组DNA至今未被克隆,233bP的第51号外显子在3.lkp HindⅢ片段中的部位并不知道,也不知道它两侧的DNA结构。51号外显子     

445例早产儿6个月内纯母乳喂养影响因素分析

  目的  调查早产儿6个月内的母乳喂养情况及其影响因素，以期能为早产儿母乳喂养干预提供一定的参考依据。  方法  使用方便抽样，于2018年4—12月选择在浙江省温州市4所三甲医院早产分娩的493例早产儿母亲作为研究对象，3个月回访时失访21例，6个月回访时失访27例，最终纳入445例。使用一般资料问卷和爱丁堡产后抑郁问卷进行问卷调查。使用χ2检验进行早产儿6个月内纯母乳喂养率影响因素的单因素分析，单因素分析差异有统计学意义的变量纳入多因素logistic回归分析。  结果  早产儿出院时的母乳喂养率为27.2%(134/493)，其中纯母乳喂养率为9.3%(46/493)。矫正月龄3个月时的母乳喂养率为39.2%(185/472)，其中纯母乳喂养率为18.4%(87/472)。矫正月龄6个月时的母乳喂养率为28.1%(125/445)，其中纯母乳喂养率为11.7%(52/445)。回归分析结果显示，母乳喂养史、产后抑郁、产后开始泌乳时间和家庭人均月收入可影响早产儿6个月内纯母乳喂养情况。  结论  医务工作者应提升早产儿母亲的母乳喂养知识与问题解决技能，尤其是对于无母乳喂养史和家庭收入较高的早产儿母亲，保证其正常泌乳开奶，并早期进行心理干预，疏导其不良情绪，以提高早产儿6个月内的纯母乳喂养率。      

The Application of Billings for Fertility Regulation Method during the Period of Breastfeeding

In order to adopt Billings Method for fertility regulation during the period of breast-feeding,cervical mucus was observed and monitored in 61 breast-feeding mothers.Urine estrogen and/or pregnanediol were/was measured in 15 breast feeding mothers.Observations on cervical mucus during 244 months were collected.The type of dry or no mucus was observed in 75.27% fully breast-feeding mothers.Constant unchanging mucus was ob-served in 69.39% partially breast-feeding mothers.Developmental changing mucus was observed in 79.25% of mothers bottle-feeding their infants.According to the record on cervical mucus within 6months postpartum,97.14% of the cervical mucus was consistent with normal menstrual cycles.Urine estrogen and /or pregnanediol were/was measured in 15 breast-feeding mothers.The level of estrogen in urine averaged 0.08 μmol/24 h in fully breast feeding mothers and 0.14 μmol/24 h in partially breast-feeding mothers.The peak level averaged 0.21 pmol/24 h in bottle-feeding mothers.The pregnanediol level was determined to confirm ovulation in bottle-feeding mothers.The average levels of cut off and the period of ovutation in 6bottle feeding mother were 7 μmol/24 h and 9 μmol/24 h respectively.Measurement of urine estrogen and pregnanediot level all matched with cervical mucus appearances.Conclusion: Billings Method is a simple,scientific method for contraception without side-effects during breast-feeding period.     

Relation of supplementary feeding to resumptions of menstruation and ovulation in lactating postpartum women

Background Resumption of menstrual cycles is one of the indicators for restoration of reproductive capability in postpartum women. However, menstruation does not necessarily mean that ovulation has taken place. The aim of this study was to investigate the relation of supplementary feeding to return of menstruation and ovulation after delivery. Methods A questionnaire was used to obtain data from 101 breastfeeding mothers. The following elements were analyzed: age, education level, breastfeeding practice, time of return of menstruation, contraceptive practice, and starting time of supplementary feeding during the lactation at intervals of 6 weeks to 18 months after delivery. The ovulation was continuously monitored by ultrasonography and basal body temperature (BBT) measurement.Results By ultrasonography, 53 of the 101 women (52.5%) had the first ovulation (follicle &gt;1.8 cm in diameter) within 154 days after delivery on average, among whom 11 (10.9%, 11/101) had restoration of ovulation within 4 months and 42 (41.6%, 42/101) had it after 4 months. In women with follicles &gt;1.8 cm in diameter (n=53), the menstruation resumed (138±84) days after delivery, and the supplementary feeding was started at (4.0±1.1) months, which were significantly earlier than those in the women with follicular diameter &lt;1.7 cm (n=48; (293±88) days, (5.1±1.3) months; t=9.003, P&lt;0.01 and t=4.566, P&lt;0.01). In the women with follicles &gt;1.8 cm in diameter, 30 had return of menstruation before the end of ultrasonographic monitoring, while only 8 in the women with follicular diameter &lt;1.7 cm had menstrual resumption at the same time (χ&sup2;=16.91, P&lt;0.01). The starting time of supplementary feeding was positively correlated with the time of the restoration of menstruation (n=100, r=0.4764, P&lt;0.01) and first ovulation after delivery (n=53, r=0.5554, P&lt;0.01). In this series, no woman had pregnancy within 18 months postpartum.Conclusion Supplementary feeding can affect the restoration of menstrual cycles and ovulation in lactating postpartum women.     

Sleep deprivation and fatigue in early postpartum and their association with postpartum depression in primiparas intending to establish breastfeeding

Objective: To examine the association of objective sleep and fatigue in the early postpartum period with postpartum depression in Japanese primiparas intending to establish breastfeeding.Materials and Methods: The participants were 34 primiparas who were in the postnatal ward after vaginal delivery and responsively breastfeeding their rooming-in baby. Actigraphy data for objective sleep were collected for three consecutive days starting from the first day postpartum. Fatigue and postpartum depression were assessed using the Postpartum Fatigue Scale and Edinburgh Postnatal Depression Scale, respectively, on numerous days between the first day postpartum and the one-month checkup. Breastfeeding and rooming-in data were also collected.Results: The mean total sleep time was 252.0 ± 73.1 min/day. Mean breastfeeding frequency was 12.4 ± 3.2 times/day and mean total breastfeeding time was 247.4 ± 101.8 min/day. Among the participants, 67.6% were exclusively breastfeeding on the discharge day. Fatigue scores were significantly higher during the hospital stay, compared with one month postpartum. Multiple regression analysis showed that sleep frequency on the third day postpartum and mean total breastfeeding time and fatigue on the fifth day postpartum were factors affecting the Edinburgh Postnatal Depression Scale score.Conclusion: The association between postpartum depression among breastfeeding primiparas in the early postpartum period and objective sleep, fatigue, and total breastfeeding time per day was suggested. An environment wherein breastfeeding mothers can rest and sleep without hesitation will be beneficial. Moreover, the importance of sleep during pregnancy and the early postpartum period must be highlighted. Midwifery and/or nursing care starting while the mother is in a postnatal hospital stay can play a key role in preventing postpartum depression.     

Selective transsphenoidal adenomectomy in women with galactorrhea-amenorrhea.

Thirty women with prolactin (PRL)-secreting adenomas underwent selective adenomectomy via a transsphenoidal route. All had abnormal sella polytomes or visual fields, amenorrhea with low basal serum gonadotropin levels despite decreased serum estradiol concentrations, and elevated basal serum PRL levels with blunted PRL response to neuroendocrine stimulation tests )thyrotropin-releasing hormone, levodopa, chlorpromazine, and hypoglycemia). Of 17 patients with microadenomas, 14 (82.4%) were cured and three (17.6%) improved. None were unchanged or worse. Three (60%) of five patients with larger, but still intrasellar tumors, had normalization of PRL levels, return of menses, and resolution of galactorrhea. The patients with tumors extending out of the sella did not fare as well. Overall, 21 (70%) were cured, six (20%) improved, two (6.7%) were unchanged, and the condition of one (3.3%) became worse. All preoperative neurologic deficits resolved. Postoperative complications were minimal with no neurologic morbidity. When tumors are small, surgical results are excellent with minimal risk.     

The employment-related breastfeeding decisions of physician mothers

One hundred and forty-six physician mothers responded to a survey of their personal decisions regarding employment and breastfeeding. The mean duration of breastfeeding was 18.8 weeks with a range of 1 week to 128 weeks. The three major factors contributed to the physician mother' decisions to completely wean their children were return to work (45%), diminishing milk supply (31%), and lack of time to pump (18%). Return to part-time work was positively associated with greater duration of maternity leave and breastfeeding. The relationship between breastfeeding and weeks of maternity leave was positive for first- and second-born children. It was not significant for subsequent children. Upon returning to work, space and time for milk expression were obstacles for the majority of the physician mothers. Without time, space, and workplace support, mothers who attempt to combine full time employment and breastfeeding are likely to delay or skip milk expression. This may cause them to experience breastfeeding problems, resulting in premature weaning. Flexible employment arrangements may increase duration among physician mothers and provide an atmosphere of greater acceptance. Protected time and a space for milk expression could contribute to greater frequency of pumping and fewer problems associated with incomplete emptying of the breast.     

硬膜外麻醉分娩镇痛对初产妇产后母乳喂养及盆底功能的影响

目的 研究硬膜外麻醉分娩镇痛对初产妇产后母乳喂养及盆底功能的影响。方法 选择我院2017年1月至2019年12月入院的初产妇120例作为研究对象,根据给予患者麻醉镇痛方法不同将其分成芬太尼组、舒芬太尼组及无分娩镇痛组,每组各40例。对比三组产妇的母乳喂养情况、泌乳初始时间及新生儿72 h内的添奶次数以及盆底功能。结果 舒芬太尼组初产妇的母乳喂养率为62.5%(25/40),芬太尼组产妇的母乳喂养率为45%(18/40),无分娩镇痛组母乳喂养率为30.0%(12/40),舒芬太尼组高于芬太尼组及无分娩镇痛组,差异有统计学意义(P=0.001、0.004);舒芬太尼组泌乳初始时间及新生儿72 h内添奶次数高于芬太尼组及无分娩镇痛组;舒芬太尼组初产妇的盆底功能各项指标高于芬太尼组及无分娩镇痛组,差异均有统计学意义(P0.05)。结论 初产妇分娩之后给予其硬膜外麻醉分娩镇痛的措施,可提升产妇的母乳喂养率,促使产妇逐渐分泌母乳,且不会对产妇的盆底功能造成严重影响,值得临床推广。     

Promoting and supporting breastfeeding for optimal nutrition during infancy

As general physician one can significantly influence a mother's or family's decision to optimally feed their baby and good feeding practices during first year greatly reduce the risk of a child being sick and being malnourished. It is recommended that health personnel should focus on exclusive breastfeeding for first six months and continued breastfeeding for up to two years along with appropriate and timely complementary foods that are started at the age of six months. Mothers need breastfeeding information and support during antenatal time; during hospital stay or at health care facility, and during postpartum visits. Encouragement especially during antenatal period increases breastfeeding rates. Subsequent paediatric and matemal visits are also important for promotion of breastfeeding. In this paper we would provide you new and updated information on recommended feeding practices, how you can support and help mothers, and what kind of skilled help is needed to initiate breastfeeding early, maintain exclusive breastfeeding and avoid artificial feeding. We will also discuss some strategies to support mothers.     

Breastfeeding patterns among six-week-old term infants at the University Hospital of the West Indies

Eighty-nine mothers attending post-natal clinics at the University Hospital of the West Indies were interviewed at six weeks postpartum regarding their breast-feeding patterns and problems. Breastfeeding was practised by 97.8% of the mothers, with 29.9% practising exclusive breastfeeding and 70.1% partial breastfeeding. Only two women were solely bottle feeding. The pattern of breastfeeding was not significantly affected by maternal parity, age, education, employment or socioeconomic status. An intention to wean later (at six months) or when the mother felt the baby was 'ready,' was associated with increasing parity, age and further education. Babies who were exclusively breastfed achieved greater weight gain compared with those who partially breastfed but this difference did not achieve statistical significance. Breastfeeding trends appear to have remained stable over the last several years.     

父亲参与式护理对产妇母乳喂养自我效能感和行为的影响研究

目的 探讨基于自我效能理论的父亲参与式护理干预对产妇母乳喂养自我效能及行为的影响。 方法 收集2018年1月—2019年1月绍兴市中心医院产妇250例,按照随机数字表法将其分为对照组与观察组,每组各125例。对照组给予常规护理,观察组给予基于自我效能理论的父亲参与式护理。采用各级量表比较2组产妇母乳喂养自我效能得分、幸福感评分及护理满意度,并计算2组纯母乳喂养率。 结果 产后3 d、1个月、3个月,2组母乳喂养自我效能得分均明显高于护理前(均P<0.05);产后1个月、3个月,2组母乳喂养自我效能得分均明显高于产后3 d(均P<0.05);产后3个月,2组母乳喂养自我效能得分均明显高于产后1个月(均P<0.05);产后3 d、1个月、3个月,观察组母乳喂养自我效能得分均明显高于对照组(均P<0.05)。产后3个月,2组产妇纯母乳喂养率明显低于产后3 d(P<0.05);产后3天,产后3个月,观察组产妇纯母乳喂养率均明显高于对照组(P<0.05)。产后3个月,2组幸福感评分明显高于护理前(均P<0.05);观察组独立自主、个人成长、自我接纳、生活目标、良好关系及环境控制评分均明显高于对照组(均P<0.05)。观察组满意度为96.8%,对照组满意度为81.6%,2组差异有统计学意义(P<0.05)。 结论 基于自我效能理论的父亲参与式护理可显著提高产妇母乳喂养自我效能及纯母乳喂养率,增强产妇幸福感及护理满意度。      

Feeding practices of infants delivered in a district hospital during the implementation of Baby Friendly Hospital Initiative

A study on infant feeding practices was conducted during the implementation of the Baby Friendly Hospital Initiative (BFHI) in a district hospital. The aim was to identify which population subgroups had lower breastfeeding rates at 4 months and the effect of attendance of antenatal breastfeeding education on breastfeeding practices. All infants delivered in May 1996 were followed-up. 204 respondents were analyzed. This study demonstrated a higher exclusive and any breastfeeding rates at 4 months than some other studies. (48% and 76% respectively). It was found that the Malays were more likely to be breastfeeding exclusively at 4 months (72%) than the Indians (32%) and the Chinese (4%). (P < 0.01). There were more non-working mothers breastfeeding exclusively at 4 months than working mothers. (60% versus 26%) P < 0.01. Antenatal breastfeeding education in the form that was given appeared to improve breastfeeding rates at 4 months. Future efforts to promote breastfeeding should target the Chinese mothers and the working mothers.     

血清性激素测定对女性不孕症的诊断意义

目的 :对 93例不孕症患者进行血清LH、FSH、E2 、T、PRL的测定 ,探讨女性不孕症患者性激素水平的变化 ,对诊断、治疗的意义。方法 :将 93例不孕症患者分为月经正常组 (31例 )、月经紊乱组 (6 2例 )。应用放射免疫分析法测定 5项性激素 ,选取同一年龄组健康育龄女性 (6 8例 )作为正常对照组。结果 :月经正常组 5项性激素与正常对照组比较 ,差异无显著性 (P >0 .0 5 ) ;月经紊乱组与对照组比较 ,LH、FSH、PRL差异有显著性 (P <0 .0 5 ) ,E2 和T与对照组比较差异无显著性 (P >0 .0 5 )。结论 :测定 5项性激素 ,可较准确、较全面地反映体内内分泌情况 ,对判断女性不孕症的原因、诊断和治疗提供可靠的指标     

母乳喂养对妊娠期糖尿病患者产后的影响

目的通过对妊娠期糖尿病女性产后哺乳情况探讨母乳喂养是否可以减轻糖耐量异常、胰岛素抵抗及改善心理状态。方法选择2016年1月～2017年1月在我院产检的妊娠期糖尿病的单胎妊娠女性,于产后6～12周,12个月分别行75 g可糖耐量检查。根据是否母乳喂养分为纯母乳喂养组、人工喂养组和混合喂养组,分析母乳喂养对妊娠期糖尿病患者产后的糖代谢及心理变化的影响。结果 290例曾患妊娠期糖尿病的女性,产后6～12周及12个月时分别有75例、31例为糖耐量异常。母乳喂养组发生糖耐量异常及心理问题的几率明显下降,且在产后1年时胰岛素抵抗明显下降。结论对于既往患妊娠期糖尿病的女性,母乳喂养对其产后1年间糖耐量及心理状态均起到保护作用。     

产后抑郁症患者雌、孕激素及催乳素变化的研究

目的:研究产后3d与42d雌二醇(E2)、孕酮(P)、催乳素(PRL)水平变化与产后抑郁症的关系。方法:采用Ed in-burgh(EPDS)抑郁量表评定152例产妇产后抑郁情况,比较产后3d及42d的抑郁症发病率,并对比其产后3d与42d的E2、P、PRL水平的差异。结果:抑郁症产后42d发病率明显低于产后3d(P<0.01);抑郁组产后3d、42d血清E2均低于正常组(P<0.05或P<0.01),产后42d血清P水平高于正常组(P<0.05);抑郁组产后3d、42d血清E2水平与EPDS量表分呈负相关性,产后42d血清P水平与EPDS量表分呈正相关性;PRL变化不恒定(P>0.05)。结论:产后体内雌孕激素变化可能是产后抑郁症的诱因之一。     

妊娠期雌二醇和催乳素与瘦素的关系

目的研究妊娠期间性激素与瘦素水平之间的关系。方法在180例不同孕周的妇女中,按孕周分为＜20周组,20～23周组,24～27周组,≥28周组,采用酶联免疫吸附法测定其外周血血清雌二醇(E2)和催乳素(PRL),放射免疫法测定血清瘦素水平,分析这些激素之间的相互关系。结果E2和PRL均随妊娠进展而逐步升高(P＜0.0001),组间均有显著差异(P＜0.05)。各组瘦素水平均高于非妊娠组,但组间差异无显著性。瘦素水平与孕妇的体重及体重指数显著相关(P＜0.01),与PRL也呈正相关(P＜0.05),而与B无明显相关。结论PRL水平与妊娠期瘦素水平升高有一定关系。