The effect of prolactin on the hypothalamo-pituitary-ovarian axis in puerperium

Serum prolactin (PRL) levels in puerperium were examined in order to determine the effect of prolactin on the recovery of the Hypothalamo-Pituitary-Ovarian Axis. It required thirteen weeks for the lactating group, four weeks for the non-lactating group and two days for the group receiving bromocriptine for serum PRL to be restored to pre-pregnancy levels. There was no significant difference between the lactating and non-lactating groups in FSH and LH levels. E2 tended to show higher levels in the non-lactating group until the fifteenth postpartum week. In the group receiving bromocriptine, the LH and FSH levels were significantly higher during the second postpartum week as compared with the lactating group. The LH-RH test was positive for the bromocriptine group. The mean periods between delivery and reappearance of the first ovulation were 143 days in the lactating group, 82 days in the non-lactating group and 55 days in the bromocriptine therapy group. Patients in whom PRL returned quickly to the normal level also showed early resumption of ovulation. From these results it can be postulated that elevated basal PRL levels in the puerperium inhibit the Hypothalamo-Pituitary Axis, producing a delay in the resumption of ovulation. Elevated basal PRL levels also had an inhibitory effect on ovarian response to gonadotropin.     

Effect of Lisuride on serum prolactin levels during puerperium

A new semisynthetic ergot derivative, Lisuride, has been administered to 40 women who wanted to have lactation inhibited. Purpose of the study was to evaluate the drug's effect on serum PRL levels. Treatment was carried out for 7 days with daily doses of 300 or 600 microgram. Lisuride lowered PRL levels, and the decrease was significantly more marked for the 600 microgram dose.     

Glucose tolerance tests in the early puerperium

Eight cases of a newly described type of vaginitis are reported. In many respects, this vaginitis resembles atrophic vaginitis, although it appears in women with normal estrogen levels. Its etiology is as yet undetermined. With or without treatment, the disease runs a protracted course. Thus far, intravaginal applications of preparations containing a corticosteroid have proved to be the most effective treatment.     

Feedback effect of estradiol on follicle-stimulating hormone and prolactin secretion during the puerperium

Injections of 3 mg of estradiol benzoate were given to seven lactating women during the second and third weeks postpartum to study its effects on secretion of follicle-stimulating hormone (FSH) and prolactin during the subsequent 4 days. Administration of estradiol during te second week postpartum had no effect on serum levels of FSH and prolactin, however, 1 week later estradiol injection elicited a double effect: FSH levels decreased and prolactin concentrations increased. Early lactation seems to abolish the estrogen induced positive feedback effect on pituitary gonadotropin secretion. The negative effect of estrogen on FSH secretion and the positive effect on prolactin release became evident by the third week postpartum.     

First spontaneous micturation in early puerperium

The time of the first spontaneous miction after delivery was analysed in 500 primiparae and 500 multiparae, all of them having had a normal pregnancy and a normal delivery. In none of them the first miction was recorded before the fourth hour following labour. In the first six hours, spontaneous miction was recorded in 16.6% of multiparae and 8.4% primiparae, up to 12 hours following labour in 99.6% multiparae and 51.4% primiparae. The latest appearance of miction in multiparae was recorded 22 hours after labour and in primiparae 32 hours after labour. The catheter was not employed in any single case. In the author's opinion, the primiparae is the protracted labour which reversibly or functionally impairs the urinary bladder.     

Stilbestrol administration in the puerperium and its effect on the prolactin excretion of non-lactacting patients.

The relationship between stilbestrol treatment and placebo treatment was studied in 2 groups of non-nursing patients. Plasma prolactin levels were evaluated in these 2 groups on day 1, 3 and 7 of the treatment, by a radioimmunoassay technique with the double antibody method using Serono hPRL kit. Our results show that prolactin values increased significantly in the stilbestrol-group and decreased in the placebo group. It seems that the main reason for "the drying up of milk" is the lack of stimulation of the nipples, which after a releatively constant time of 5--10 days will lead to decreased prolactin levels. Stilbestrol treatment is not effective in "drying up" the milk more rapidly in patients who do not want to nurse. When patients have symptoms a combination of analgesia and breast support usually brings relief within 24 to 48 hours.     

Effects of low-caloric diet in puerperium on prolactin, TSH estradiol and milk secretion

Ten puerperal women were put on a 1,200 kcal diet per day for 3 days followed by an ordinary 1,800 kcal diet per day for 3 days [Low-Caloric (LC) group]. Fifteen puerperal women were put on an ordinary 1,800 kcal diet per day for 6 days[Ordinary-Caloric (OC) group]. All of the women took breakfast at 7:30 am, blood was drawn at 9:30 am and then the breasts were milked for 2 minutes with an electric breast pump starting on the day of delivery (Day 0) and continuing to Day 5. Four women in the LC and OC groups underwent a thyrotropin-releasing hormone (TRH) stimulation test on Days 1 and 3. Serum prolactin (PRL) and TSH levels in the LC group tended to be much lower than those of the OC group during the test period. Serum PRL and TSH release response to TRH in the OC group were much higher than in the LC group on Days 1 and 3. No significant difference was noted between the OC and LC groups in serum estradiol (E2) and cortisol levels from Day 0 to Day 5. The milk volume in the LC group was significantly less than in the OC group on Day 1. Analysis of milk specimen components revealed little difference between the OC and LC groups. These results suggested that a low-caloric diet may suppress PRL, TSH and milk secretion and may not be useful for breast-feeding.     

Prevalence of depressive disorders in early puerperium]

OBJECTIVE: The aims of this investigation were to detect the prevalence and influencing factors of early postpartal depressive disorders in a large hospital sample. METHODS: By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, obstetric and psychological variables. The German version of the Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive disorder of our patients. The interview was carried out on 1,250 women at the maternity ward 5 days after delivery. RESULTS: According to the results of the German validation of the EPDS, 254 (20.3%) women at the maternity ward had an at least mild depressive disorder. A comparison between nondepressed women (n = 996, 79.7%) and depressed women (n = 254, 20.3%) revealed the following risk factors for the development of an early postpartal depressive disorder: higher subjective burden of childbirth, higher trait anxiety, poorer couple compatibility, lower job satisfaction and lower social status. Of all the obstetric variables previous abortions, elevated pregnancy risks, low weight of the newborn at delivery and cesarean section were of significant influence. CONCLUSIONS: Early postpartal depressive disorder appears in 20% of all women 5 days after delivery. According to previous studies this group seems to be at highest risk for developing a later postpartum depression. Considering the psychosocial and obstetric risk factors, preventive psychotherapeutic interventions at the maternity ward are indicated.     

The role of neuropeptide Y (NPY) in control of gonadotropin and prolactin release in the rat

Neuropeptide Y is a peptide found in a variety of hypothalamic loci which is frequently colocalized with catecholamines. It is also secreted into hypophyseal portal vessels. We have previously evaluated the effects of this peptide on FSH, LH and prolactin release. In ovariectomized females neuropeptide Y inhibits LH release. It has similarly been reported to inhibit LH release in intact males; however, estrogen priming of ovariectomized animals converts this inhibitory action into a stimulatory effect. In ovariectomized animals the peptide has a direct stimulatory effect on perifused pituitary cells, enhancing the release of both FSH and LH, an effect which is contrary to that obtained with LH release after intraventricular injection of the peptide. In the present experiments the physiological significance of these effects has been evaluated by the intraventricular injection (3V) of highly specific antiserum directed against the peptide. In ovariectomized and in ovariectomized, estrogen-primed rats, the third ventricular injection of antiserum had no effect on gonadotropin release. In male rats intraventricular injection of the antiserum elevated LH, which indicates that the inhibitory action of the peptide seen in intact males is of physiological significance. However, it has been reported by others that the proestrous type discharge of LH-RH is blocked by intraventricular injection of neuropeptide Y antiserum. Neuropeptide Y might therefore play an essential role in the preovulatory release of LH. On the other hand, others have shown that intraventricular injection of neuropeptide Y in male rats can either stimulate, at low doses, or inhibit, at high doses, the release of prolactin. We have confirmed the inhibitory action, which appears to be of physiological significance since antisera directed against the peptide injected intraventricularly resulted in an elevation of prolactin release. The results of these studies indicate that neuropeptide Y plays a very important and often physiologically significant role in the control of LH and prolactin release by hypothalamic action.