Neo-oogenesis in the postnatal ovary: fantasy or reality?

The central dogma of female reproductive biology has long held that oogenesis ceases around birth in almost all mammals. Consequently, the ovarian reserve is definitely fixed and will continuously deplete up to the menopause in humans. New papers by Johnson et al. (2004) and by Bukovsky et al. (2004, 2005) overturn this dogma since they claim that female mice and women, respectively, produce new oocytes during adult life. The following review is mainly devoted to an analysis of the study by Johnson et al. (2004) as well as unpublished data submitted for publication from the same authors. Two bodies of evidence were presented to support their hypothesis: morphologic and experimental. Whereas morphologic data can be easily refuted, experimental data remain disturbing. In conclusion, these recent observations need to be confirmed by others, and extended by additional supporting evidence before they could be considered to question the dogma of a fixed stock of oocytes at birth.     

Novel bioactive substances in human colostrum: could they play a role in postnatal adaptation?

Objective: To determine maternal colostrum/serum concentrations of the bioactive substances irisin, adropin and copeptin and investigate their association with several perinatal parameters and pathologic conditions during pregnancy.

Methods: In a cohort of 81 mothers with full-term deliveries, colostrum/serum concentrations of irisin, adropin and copeptin were prospectively evaluated by ELISA on Day 3–4 postpartum.

Results: Copeptin and adropin were detectable in human colostrum at higher, while irisin at lower concentrations than in maternal serum (p?r?=?0.421, p?r?=?0.304, p?=?0.006, respectively).

Conclusions: Irisin, adropin and copeptin are present in colostrum and we speculate that they may be implicated in postnatal adaptation with respect to thermoregulation, vascular adaptation, glucose metabolism, lung function and fluid homeostasis. These findings may possibly enhance the necessity for early breastfeeding, particularly of infants born by cesarean section, who are prone to hypothermia, breathing disorders and dehydration.     

Does cord blood bilirubin level help the physician in the decision of early postnatal discharge?

Objective: Early postnatal discharge of newborns leads to the risk of readmission to the hospital, mostly for neonatal hyperbilirubinemia. Increasing the length of hospital stay is not an acceptable solution for medical, social and economic constraints. Hence, predicting the high risk neonates for subsequent hyperbilirubinemia is required. This study was planned to investigate the predictive value of umbilical cord blood bilirubin (CBBil) level for significant neonatal hyperbilirubinemia. Methods: Cord blood bilirubin, serum total/direct bilirubin levels and newborn/mother’s blood groups were obtained from 350 term neonates. Total/direct serum bilirubin levels were reevaluated in 95 newborns at 72 hours of age when jaundice appeared according to Kramer’s dermal zones. Results: Phototherapy treatment was needed in 14.7% of 95 patients. For recognition the newborns at high risk for developing hyperbilirubinemia, using a CBBil cut-off level of 2.60?mg/dl, we found a positive predictive value of 41.18%, negative predictive value of 97.9% and sensitivity of 50%. Conclusion: Newborns with CBBil values below 2.6?mg/dl are at very low risk of developing hyperbilirubinemia and further need of phototherapy. Knowledge of low risk of hyperbilirubinemia in a newborn could encourage the physicians in the decision of early postnatal discharge.     

Anxiety in the perinatal period: antenatal and postnatal influences and women’s experience of care

Objective: To examine the characteristics of women with antenatal or postnatal anxiety and to investigate aspects of their care that may be associated with it. Background: Positive outcomes following childbirth are associated with good physical and mental health during pregnancy and following childbirth. Although a degree of anxiety is normal in pregnancy, for some women it can become a serious problem. Methods: This study used data on 5332 women from a 2010 national maternity survey which asked about antenatal and postnatal health and well-being three months after childbirth. Women self-identified as experiencing anxiety and other problems during pregnancy and the postnatal period. Results: Antenatal anxiety was reported by 14% of women and postnatal anxiety by 5% of women. Antenatal anxiety was associated with younger age, Black and Minority Ethnic status, single parenthood, living in a disadvantaged area, having an unwanted pregnancy and long-term health problems. Of these factors, only long-term mental health problems were associated with anxiety in the postnatal period. In the logistic regression models long-term mental health problems dominated the findings. Significant differences in the perceptions of the care experienced were evident in the responses from women with anxiety both antenatally and postnatally. Conclusions: This study shows that antenatal and postnatal anxiety are influenced by health and social factors. Asking women about their current physical and psychological health and past history during pregnancy and following up on their well-being in the postnatal period is an essential element in planning and providing care to meet their needs.     

Unimpaired postnatal respiratory adaptation in a preterm human infant with a homozygous ENaC-α unit loss-of-function mutation

The amiloride-sensitive epithelial sodium channel, ENaC, is thought to have a major role in clearing fluid from the alveoli immediately after birth. ENaC-α knockout mice die soon after birth from failure to clear their lungs of liquid. We report on a male infant born after 33 weeks of gestation with uneventful postnatal adaptation (Apgar 9/9/9 at 1, 5 and 10 min after birth) who did not require any respiratory support during his first days of life. At nine days of life, he became lethargic and hyperthermic, displaying low Na(+) (126 mmol?l(-1)), high K(+) (8.9 mmol?l(-1)), high aldosterone (3000 ng?l(-1))and high renin (1000 ng?l(-1)) plasma concentrations, commensurate with pseudohypoaldosteronism type I. He was found to be homozygous for the c.1678G>A mutation in the SCNN1A gene that codes for the ENaC-α unit. We conclude that clearance of alveolar fluid after birth in humans does not critically depend on ENaC.     

Do postnatal glucocorticoids and retinopathy of prematurity relate?

To study a possible relation between the use of postnatal glucocorticoids and the incidence and severity of retinopathy of prematurity (ROP), we conducted a retrospective study over a 4-year period that compared data of 161 preterm infants treated with hydrocortisone for bronchopulmonary dysplasia (BPD) with the data of 253 controls. The incidence of overall ROP was 62.7% in the hydrocortisone group and 21.3% in the control group. The incidence of severe ROP (stages 3-5) was 5% in the treatment group and 0.4% in the control group. Using logistic regression, postnatal hydrocortisone therapy was not associated with an increased risk for ROP or severe ROP (OR 1.387, 95% confidence interval 0.773-2.489, p = 0.272 and OR 4.112, 95% C.I. 0.44-38.37, p = 0.16, respectively). Also, in a subgroup of extremely low-birth-weight infants (<1000 g), postnatal hydrocortisone had no influence on the incidence of (severe) ROP. In the infants with ROP (n = 155), only prolonged use of postnatal hydrocortisone was associated with an increased risk for severe ROP (OR 1.02, 95% C.I. 1.00-1.03, p = 0.03). In this study postnatal use of hydrocortisone was not associated with an increased risk for (severe) ROP. However, in infants already suffering from ROP, prolonged treatment with hydrocortisone concurred with an increased risk for severe ROP.     

Mild postnatal anemia: is it a problem?

Mild postnatal anemia is common. However, determination of postnatal hemoglobin level or iron supplementation are not routine in many obstetric units. This study was designed to evaluate the impact of mild postnatal anemia and iron supplementation on women. One hundred fifty women who had postnatal hemoglobin levels between 80 and 99 g/L were randomly assigned into two groups with iron tablets or placebo provided from the time of diagnosis until reassessment at 6 weeks. The patients' general well-being, hemoglobin levels, iron status, side effects, and compliance were assessed. One hundred twenty-two women returned for reassessment. Twelve (9.8%) of the 122 women recruited and four (3.2%) of 122 nonanemic matched controls complained of dizziness 2 days after delivery; the difference was statistically significant (chi2 test, p<0.05). At 6 weeks postpartum, significantly more women were anemic (chi2 test, p<0.05) and iron deficient (chi2 test, p<0.01) in the placebo group. The score of general well-being as assessed by a 4-point scale was significantly higher in the iron supplementation group (Mann-Whitney test, p<0.05). The amounts of drugs consumed in both groups were comparable and the incidences of side effects were similar.     

A systematic review of changes in women’s physical activity before and during pregnancy and the postnatal period

Objectives: To determine the magnitude and type of naturally occuring physical activity changes in women around the time of pregnancy. Background: This systematic review synthesises the results of studies examining naturally occurring physical activity in women before they become pregnant and the magnitude and type of changes during pregnancy and the postnatal period. Methods: Electronic databases were searched for relevant articles and PRISMA guidelines for selection of articles were used. Only studies examining naturally occurring, non-intervention changes in regular activity levels were included. The quality assessment was based on protocols of the Cochrane Database of Systematic Reviews. Of the initial 720 titles, 24 studies met the inclusion criteria and were included in the final review. Results: Compared to pre-pregnancy, the magnitude of physical activity decreased over the course of pregnancy and postnatally and the types of activities tended to be of lesser intensity than pre-pregnancy. The quality of the research was varied; methodological limitations included using subjective methods of assessment of physical activity (9/24), failing to report reliabilities or validity of measures used (8/24), no information on parity (13/24) or level of fitness prior to pregnancy (11/24). Conclusion: The evidence suggests a marked decrease in the amount and type of moderate to strenuous physical activity during the transition to motherhood, which does not always increase again postpartum. Patient education targeting specific physical activities at regular intervals during and after pregnancy to improve long-term maternal health is necessary.     

Are Slovenian midwives and nurses ready to take on a greater role in caring for women with postnatal depression?

OBJECTIVE: to answer the question of whether Slovenian midwives and nurses feel prepared to take over the responsibility for the care of women with postnatal depression. DESIGN: questionnaire survey using a tool designed with data from previously conducted focus groups and a literature review. SETTING: the central maternity hospital and six community centres in the Slovenian capital city of Ljubljana. PARTICIPANTS: 134 participants completed the questionnaire, out of 175 distributed. The sample consisted of 86 participants from the maternity hospital, who were almost evenly divided into midwives and nurses, and 48 participants from the community services, where nurses prevailed over midwives. FINDINGS: participants lacked knowledge of postnatal mental health, and 99% of them expressed the need for more information. They considered the woman's partner to be the most appropriate person to detect postnatal depression, and doctors to be the key people involved in the treatment. In order to take over the role of prevention, detection and management of postnatal depression, midwives and nurses felt that they would need more knowledge and more continuous contact with women. KEY CONCLUSIONS: most participants did not know the main characteristics of postnatal depression, and were not confident in their knowledge. They felt that they lacked continuity in the care they could provide, and this affected their ability to establish a trusting relationship with women. IMPLICATIONS FOR PRACTICE: information on postnatal mental health should be provided during undergraduate study of midwifery and nursing, and with continuous education through seminars and workshops in Slovenia. In order to enable continuity of carer, the role of the midwife should be expanded in pregnancy, and more visits in the puerperium should be planned.     

Fetal and early postnatal magnetic resonance imaging--is there a difference?

AIM: To evaluate whether fetal magnetic resonance imaging (MRI) could replace early postnatal MRI in fetuses with central nervous system (CNS) anomalies. METHODS: Thirteen pregnancies presenting with fetal CNS anomalies were investigated using MRI. Indications included ventriculomegaly combined with additional CNS anomaly (n=5), isolated ventriculomegaly (n=2), arachnoid cyst (n=2), holoprosencephaly (n=1), complex malformation syndrome (n=1), Dandy walker malformation (n=1) and midline cyst (n=1). Early postnatal MRI followed within the first six weeks of life. RESULTS: Investigation with early postnatal MRI confirmed the fetal MRI diagnosis in all cases. Investigation with postnatal MRI presented additional information in two cases. However, there was no change in patient care. CONCLUSIONS: Fetal MRI should replace early postnatal MRI in infants with CNS anomalies.     

Short-term postnatal quality of life in women with previous Misgav Ladach caesarean section compared to Pfannenstiel–Dorffler caesarean section method

Objective.?To examine whether short-term postnatal health-related quality of life differed among women after different methods of cesarean sections.

Methods.?One hundred forty-five women were evaluated with previous CS (85 by Misgav Ladach and 60 by Pfannenstiel–Dörffler). Short-time quality of life was measured using the Croatian version of Short Form Health Survey (SF – 36). Short-term postoperative recovery was assessed using two criteria: febrile morbidity and degree of pain. Incidence of peritoneal adhesions was assigned using Bristow scoring system.

Results.?Four weeks after delivery women with previous Misgav Ladach cesarean section significantly scored higher on the bodily pain (72.4 vs. 56.7, p?<?0.05), social functioning (71.5 vs. 60.4, p?<?0.05), and the vitality (61.7 vs. 50.3, p?<?0.05) subscales. These differences disappeared in the second assessment (12-weeks postpartum) except in the bodily pain (74.7 vs. 61.2, p?<?0.05) subscale. There was a significant trend toward a higher requirement for postoperative analgesics in the Pfannenstiel–Dörfler group (doses: 5.4 vs. 8.7, p?<?0.05; hours: 17.9 vs. 23.3, p?<?0.05), and they had a significantly higher rate of febrile morbidity than the Misgav Ladach group (5.7 vs. 9.4%, p?<?0.05). Hospitalization time was reduced in the Misgav Ladach group (4.2 vs. 7.3, p?<?0.05). The incidence of adhesions was significantly lower in patients who had undergone a previous operation using the original Misgav Ladach method (0.47 vs. 0.77, p?<?0.05).

Conclusion.?Misgav Ladach cesarean section method might lead to better short-time quality of life resulting in reducing postoperative complications compared to Pfannenstiel–Dörfler cesarean section method.     

Protein kinase C isoforms α, δ and ε are differentially expressed in mouse ovaries at different stages of postnatal development

Background

The protein kinase C (PKC) is a family of serine/threonine kinases that consists of 12 different isoforms. Since PKC isoform expressions are known to be specific for different cell types and postnatal developmental stages, we aimed to determine immunolocalizations and protein expression levels of different PKC isoforms in pre-pubertal, pubertal and adult mouse ovaries.

Methods

Ovaries were obtained from postnatal day 1 (PND1) and PND7 of pre-pubertal, PND21 of pubertal and PND60 of adult mice. Immunolocalizations of PKCα, PKCδ and PKCε isoforms were determined and immunostainings in different cellular components of all follicular stages were evaluated by H-Score. PKCα, PKCδ and PKCε protein expression levels were determined by Western blot. The bands were quantified via ImageJ software. The data obtained from H-Score and ImageJ evaluations were analyzed by ANOVA statistical test.

Results

PKCα immunostainings were more intense in oocytes when compared to granulosa and theca cells at different follicular stages of all groups. The Western blot analysis revealed that PKCα expression was significantly higher in PND60 adult ovaries. Conversely, PKCδ immunostainings were more intense in granulosa cells. According to the Western blot analysis, PKCδ protein expression was also higher in PND60 and significantly lower in PND1 ovaries. PKCε immunostaining was more apparent in oocytes. PKCε protein expression was significantly higher in adult PND60 and pubertal PND21 ovaries when compared to pre-pubertal PND7 and PND1 ovaries. Interestingly, PKCε immunostaining was significantly higher in primordial follicles, though PKCα and PKCδ immunostainings were more apparent in larger follicles. PKCα immunostainings of corpora lutea (CL) were significantly higher when compared to follicles in PND60 ovaries.

Conclusions

This study demonstrates that PKCα, PKCδ and PKCε isoforms are differentially expressed in particular cellular components of pre-pubertal, pubertal and adult mouse ovarian follicles. Therefore, we suggest that each PKC isoform has unique functions that are controlled by gonadotropin dependent mechanisms during follicular growth, oocyte maturation, ovulation and luteinization.

     

Does pain relief during delivery decrease the risk of postnatal depression?

BACKGROUND: To test the hypothesis that sufficient pain relief during delivery decreases the risk of postnatal depression. METHODS: As part of a prospective follow-up study of the risk factors for postnatal depression and its impact on the mother-infant interaction and child development, 185 parturients filled in the Edinburgh Postnatal Depression Scale (EPDS), first during the first postpartum week and again (n = 162) 4 months later. The incidence and the risk of high EPDS scores was calculated according to the mode of delivery and the mode of pain relief during vaginal delivery, also after adjusting for the length of labor. RESULTS: Mothers who received epidural/paracervical blockade during their delivery spent less time in the delivery room than mothers in the nitrous oxide/acupuncture group (p = 0.033) or mothers with no pain relief (p = 0.026) and had shorter length of labor than mothers without pain relief (p = 0.04). The adjusted risk of depressive scores at the first postnatal week was decreased in the epidural/paracervical group when compared with no analgesia group (OR: 0.25, 95% CI: 0.09-0.72). This difference was not shown at 4 months postpartum. Elective or emergency cesarean section did not increase the risk of high EPDS scores at the first week or at 4 months postpartum. CONCLUSION: The mode of pain relief during vaginal delivery seems to be associated with the incidence of postpartum depression, especially immediately after delivery.     

Is the organisation and structure of hospital postnatal care a barrier to quality care? Findings from a state-wide review in Victoria, Australia

OBJECTIVE: to describe the structure and organisation of hospital postnatal care in Victoria, Australia. DESIGN: postal survey sent to all public hospitals in Victoria (n=71) and key-informant interviews with midwives and medical practitioners (n=38). SETTING: Victoria, Australia. PARTICIPANTS: providers of postnatal care in Victorian public hospitals. FINDINGS: there is significant diversity across Victoria in the way postnatal units are structured and organised and in the way care is provided. There are differences in numerous practices, including maternal and neonatal observations and the length of time women spend in hospital after giving birth. Although the benefits of continuity of care are recognised by health care providers, continuity is difficult to provide in the postnatal period. Postnatal care is provided in busy, sometimes chaotic environments, with many barriers to providing effective care and few opportunities for women to rest and recover after childbirth. The findings in this study can, in part, be explained by the lack of evidence that has been available to guide early postnatal care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: current structures such as standard postnatal documentation (clinical pathways) and fixed length of stay, may inhibit rather than support individualised care for women after childbirth. There is a need to move towards greater flexibility in providing of early postnatal care, including alternative models of service delivery; choice and flexibility in the length of stay after birth; a focus on the individual with far less emphasis on care being structured around organisational requirements; and building an evidence base to guide care.     

A longitudinal study on the maternal–fetal relationship and postnatal maternal sensitivity

Objective: The present study examined whether early signs of maternal sensitivity can be detected during pregnancy by focusing on the maternal–fetal relationship and postnatal maternal sensitivity. Background: Earlier research has identified maternal sensitive behaviour as an important factor for the quality of the mother–infant relationship and the child’s emotional and cognitive development later in life. Research on this topic has predominantly focused on the postnatal period and little is known about early predictors (i.e. during pregnancy) of maternal sensitivity. Methods: Participants were 273 women and their (unborn) infants. Mothers’ attitudes, thoughts and feelings towards the fetus were assessed by the Maternal Antenatal Attachment Scale at 26 weeks of gestation. At the infant’s age of 6 months, maternal sensitivity was assessed in three different situations (i.e. face-to-face play, caregiving and free play) using the NICHD global rating scales. Results: Mothers with a higher quality of the maternal–fetal relationship displayed more maternal sensitivity towards their 6-month-old infant in caregiving and free play situations, even when controlling for covariates such as parity, ethnicity, maternal education, maternal age and the postnatal mother–infant relationship. No associations were found in the face-to-face situation. Conclusion: This study shows that mothers who reported a higher quality of the maternal–fetal relationship were more sensitive while interacting with their infants during caregiving and free play, but not during face-to-face play.