Misoprostol in preventing postpartum hemorrhage: a meta-analysis.

OBJECTIVE: To assess misoprostol's ability to prevent postpartum hemorrhage (PPH) where no alternatives exist. Comparison to oxytocics demonstrates how similarly misoprostol achieves a level of effectiveness-obtainable only in hospitals-in remote locations around the world. METHOD: Using the Mantel-Haenszel fixed-effects model and the DerSirmonian and Laird random-effects model, summary statistics indicated that misoprostol's excess risk of PPH was only 4% when compared to oxytocics. RESULT: This risk difference was well within the range of expected results for all uterotonic agents and does not warrant branding misoprostol as an inferior drug. CONCLUSION: Conventional uterotonic drugs should not be used to set the lowest-accepted level of effectiveness in settings where they are entirely unsuitable. Continuing to weigh the benefits of one effective drug against another only delays the distribution of misoprostol in countries where it is the only feasible choice and must be measured against no treatment at all.     

产后出血48例临床分析

目的：探讨产后出血发生的病因及防治措施。方法：对2004—2005年48例产后出血的临床资料进行分析。结果：发病原因依次为：子宫收缩乏力、子宫颈撕裂伤、子宫切口的撕裂、胎盘因素。结论：针对出血主要原因，应采取快速、有效的止血方法，加强产程的观察及产前的预测，减少产后出血的发生率。     

Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006.

Postpartum hemorrhage (PPH) is the main cause of maternal mortality. Yet, even though solutions have been identified, governments and donor countries have been slow to implement programs to contain the problem. While poverty and low educational level remain the underlying cause of PPH, the current literature suggests that active management of the third stage of labor can prevent it. The International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO) are attempting to address the chronic PPH crisis by educating their members on best practices and on troubleshooting where resources are inadequate. Some studies found oxytocin to be preferable to misoprostol in settings where active management is the norm. However, secondary clinical effects may prove more troublesome with oxytocin than with misoprostol, and misoprostol may prove to be more practical and equally effective in low-resource settings. Two new interventions are also proposed, the anti-shock garment and the balloon tamponade.     

动脉栓塞治疗产后出血的临床应用研究

目的评价经导管动脉栓塞术(TAE)治疗产后出血的血管造影表现及疗效。方法65例产后出血患者采用右股动脉Seldinger's穿刺技术,选择性插管至双侧髂内动脉或子宫动脉,行数字减影血管造影(DSA)明确出血原因、部位后用庆大霉素浸泡过的明胶海绵颗粒或条栓塞。结果插管成功率100%,手术时间30～60min,平均45.2±4.8min,术后止血总有效率98.46%。术后随访3～60个月,均无严重并发症发生,子宫体按期复旧,转经后月经正常。结论TAE创伤小,疗效快速肯定,对危及生命的产后出血是一种有效的治疗措施。     

Postpartum copulation and induction of pregnancy in roof rats (Rattus rattus)

Two groups of 10 female roof rats were mated either in cycling or postpartum estrus to provide a quantitative comparison of copulatory behavior and to compare the stimulus requirements for the initiation of pregnancy. Animals in both estrous conditions were mated to one ejaculation, three ejaculations and to sexual satiety in repeated tests. The results indicate there were no differences between estrous conditions in the qualitative patterns of copulation but that males achieved more intromissions in the first series of postpartum tests than in cycling estrous tests. The stimulus requirements for pregnancy initiation were not found to vary as a function of estrous condition, however it was found that postpartum matings resulted in more pups per litter than did cycling estrous matings. The results were discussed with regard to the functional significance of species differences in copulatory behavior and in stimulus requirements for pregnancy.     

A history of personal violence and postpartum depression: is there a link?

Summary Background: A link between violence and depression has been shown, but not a link between violence and postpartum depression. This study sought to determine if there is an association between a history of abuse (physical, sexual, emotional as a child or adult) and postpartum depression (PPD). Method: 200 postpartum women were recruited from 6 hospitals. At 8–10 weeks postpartum, a telephone interviewer asked women about physical, emotional or sexual abuse as an adult or child and sociodemographic, obstetrical and personal medical history. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS, score of ≥12). Abuse was determined by the Conflict Tactics Scale or the Abuse Assessment Screen. Chi-square and logistic regression were used to determine the relationship between violence and PPD. Results: 11% of women had EPDS scores of ≥12. Rates of childhood (6.5%), or adult (6.5%) physical abuse; and childhood (13%) or adult (14%) sexual abuse were reported by respondents. Emotional abuse in the current relationship (29.6%) exceeded that of childhood abuse (3.5%). Overall 43.2% of respondents had at least one form of abuse. Having a history of depression (OR = 3.3 (95% CI, 1.3–8.7)), panic attack during pregnancy (OR = 5.4 (1.6–19.0)), maternal complications (OR = 5.0 (1.7–15.1)), low social support (OR = 3.3 (1.3–8.7)) and emotional abuse (OR = 2.8 (1.1–7.4) were associated with PPD. Conclusion: Emotional abuse but not physical or sexual abuse was found to be associated with PPD. A possible explanation for this relationship may be that being in an abusive situation puts one at risk for depression and in turn, postpartum depression.     

Energetic limits on reproduction: Maternal food intake

We examined the factors influencing maternal food intake and pup growth in Norway rats. Mother rats allowed pups in naturally large litters to grow at a slower rate than pups in naturally small litters. Pups reared by dams in a warm ambience (26°C) gained weight more slowly than dams at 22°C, and maternal food intake but not weight gain was depressed in the high ambient temperature. Pup growth at 18°C was unimpaired, with those dams eating no more and gaining no less weight than dams at 22°C. Nest material, however, was found to be essential for the successful rearing of young at cooler ambient temperatures. While restriction of food during gestation resulted in a marginally lower weight gain for the pups during the first 2 weeks postpartum, the dams appeared not to mobilize corporal stores or increase their food intake during lactation. Heavy body weight mothers did not eat any more, nor did they gain any less weight nor rear larger pups than light body weight dams. Rat mothers increased their consumption of a diet diluted with non-nutritive fiber to equal the nutritive intake of their controls, with their pups not differing in their growth rate. Pups reared by dams eating a high quality diet grew faster than pups with dams on the control diet. Food intake by mother rats is required during lactation relative to the amount of milk that is delivered to the pups, rather than to an absolute amount of food. Lactating females with a concurrent pregnancy neither increase their food intake nor appear to mobilize their corporal stores to deal with the added energetic drain of pregnancy. Indeed, their young grew somewhat more quickly than pups nursed by dams that were simply lactating. Taken as a whole, these results suggest that Norway rat dams apparently do not monitor and defend a maximal pup growth rate. Rather, rat dams seem to continue to defend their own homeostasis, and by doing so, allow the young to grow and survive under a wide variety of circumstances.     

Do changes in mood and concerns about weight relate to smoking relapse in the postpartum period?

Summary The majority of women who quit smoking during pregnancy will resume smoking during the postpartum period. Little is known, however, about the predictors of postpartum relapses to smoking. Changes in mood and increases in concerns about weight are common during the postpartum period, and these factors may affect womens postpartum smoking behavior. In this paper, we present a model of the relationship among mood, weight concerns and postpartum smoking. Data from previous postpartum relapse prevention trials are reviewed and evidence of a connection between changes in mood and weight concerns to postpartum relapse is presented. Directions for future research on the prevention of smoking relapses during the postpartum period, and the roles of mood and weight concerns in smoking relapse are presented.     

Postpartum depression and mother-infant relationship at 3 months old

Background: This paper is part of a prospective, epidemiologic study concerning postpartum depression (PPD). The women were first examined during pregnancy; after delivery they were seen with their infants at 3 and 18 months. The present study focuses on the 3-months-postpartum results. Methods: A sample of 570 women and their infants were examined 3 months after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox et al., 1987. Br. J. Psychiatry 150:782–786), 10.2% of these new mothers presented PPD. The focus of the study concerned the effects of this neurotic disorder on the mother, the infant and on the mother–infant relationship. Results: The deleterious effects concerning the infant were functional disorders such as eating or sleeping difficulties. The ‘depressed’ dyads presented less vocal and visual communications, less corporal interactions and less smiling. Conditions surrounding delivery and tiredness at 3 months are linked to difficulties in mother–infant relationship for the non-depressed mothers. Logistic models showed that primiparous PPD mothers have difficulties bathing their infants, whereas multiparous PPD mothers are more tired. Limitation: This study did not take into account either protective factors or the effects of the infant himself. Clinical relevance: Knowledge of the mothers’ and infants’ difficulties may help caregivers to detect these at-risk dyads and initiate therapeutic measures.     

Prevalence of generalized anxiety at eight weeks postpartum

Summary Objective: This study investigated the prevalence and nature of generalized anxiety symptoms in women who were eight weeks postpartum. Method: A community-based sample of 68 postpartum women completed an interview assessing generalized anxiety disorder and depression and a self-report measure of worry associated with concerns relevant to postpartum women. Results: Three women (4.4%) met DSM-IV criteria for generalized anxiety disorder, and an additional 19 women (27.9%) endorsed subsyndromal difficulties with generalized anxiety. Approximately one third of these women endorsed symptoms of depression. In contrast, only two woman met criteria for major depressive disorder. Conclusion: Postpartum generalized anxiety has a higher prevalence than postpartum depression. Received February 26, 2002; accepted November 11, 2002 Published online January 31, 2003 Acknowledgement This work was supported by a New Faculty Scholar Award and a Graduate Research Fellowship from the University of North Dakota. The authors would like to express their appreciation to Jennifer Brendle, Peter Schmutzer, Talia Tweten, and Chad Lystad for their assistance with this research. Correspondence: Amy Wenzel, Ph.D., Department of Psychology, University of North Dakota, Grand Forks, ND 58202-8380, U.S.A.; e-mail: amy_wenzel@und.nodak.edu