Glucose Tolerance in Women 24 h Postpartum Is Related to Blood Pressure,Anthropometric Data,and Adipokine Serum Levels

Objectives. To characterize glucose tolerance and adipokine serum levels in a cohort of women shortly after delivery. Study Design. A study population of healthy pregnant women (n = 65) was invited to undergo a standardized oral glucose tolerance test within 24 h after delivery at the University Hospital of Leipzig. As controls, 30 nonpregnant healthy, lean women were studied. Glucose, insulin, proinsulin, c-peptide, leptin, adiponectin, and soluble leptin receptor levels were compared in cases and controls by using the Mann–Whitney U two-sample statistics and correlation according to Spearman. Results. As compared to normal glucose tolerant (NGT) women postpartum, fasting c-peptide levels were significantly higher (NGT mothers = 0.23 nmol/L, controls: 0.49 nmol/L, p < 0.001), whereas proinsulin serum levels were significantly lower in nonpregnant controls (NGT mothers = 1.37 pmol/L, controls = 1.00 pmol/L, p = 0.05). Considering fasting adiponectin values, postpartum adiponectin was significantly decreased compared with controls (NGT mothers = 6.9 μg/L, controls = 8.9 μg/L, p = 0.05). Fasting serum levels of leptin (NGT mothers = 17 ng/mL, controls = 10.6 ng/mL, p < 0.009) and soluble leptin receptor (NGT mothers = 34.4 ng/mL, controls = 17.7 ng/mL, p < 0.001) were increased postpartum. Conclusion. We found significantly lower adiponectin and higher leptin sera levels in women postpartum as compared to nonpregnant women. In addition, adipokine serum levels shortly after delivery were related to parameters of adiposity and glucose tolerance. We hypothesize that women in the post-delivery period exhibit biochemical features resembling metabolic syndrome, impaired glucose tolerance, and derangement of the adipokine system.     

Chronic pelvic pain of obscure origin: A clinical study

A Pelvic Pain Clinic was established to provide diagnostic and therapeutic services to women with severe, chronic pelvic pain of obscure origin. Sixty such women were studied. Their histories revealed a complex pattern of complaints. Conventional clinical investigations usually failed to reveal organic pathology responsible for the symptoms. Twenty-eight patients consented to undergo surgery. Two patients were found to have gynaecological pathology causing prolonged pain. Seventeen patients had normal internal genitalia. Nine patients had minor gynaecological pathology, frequently observed in asymptomatic patients. Twenty-two patients underwent psychological evaluation. The interviews produced evidence of psychiatric syndromes in twenty-one. Patients improved with surgery if organic disease was found. The response to reassurance based on negative laparoscopic findings was also good. The majority of patients were distrustful of explanations involving psychosomatic concepts and were not amenable to group psychotherapy.     

围生期情绪相关知识教育策略对产后心理弹性及产后抑郁的影响

目的分析围生期情绪相关知识教育策略对产后心理弹性及产后抑郁的影响,为产后康复综合干预方案制定提供参考。方法随机选取该院2019年2月-2020年1月分娩的产妇60例作为研究对象,采用数字随机表法分为对照组和观察组,每组30例。对照组围生期予以常规健康宣教,观察组在对照组常规健康宣教的基础上再予以围生期情绪相关知识专项教育,两组产妇均随访观察至产后第一次健康体检(产后42 d)。对两组产妇产前1周、产后42 d均行心理弹性(CD-RISC10)及产后爱丁堡产后抑郁表(EPDS)测评并行组间比较。对两组产妇产前1周、产后42 d进行围生期情绪相关知识认知水平进行问卷调查,判断认知合格情况并行组间比较。收集整理两组产妇产后并发症并行组间比较。结果两组产妇产前1周对围生期情绪相关知识认知合格率比较差异无统计学意义(P>0.05),产后42 d,两组产妇对围生期情绪相关知识认知合格率均明显上升,且观察组产妇认知合格率明显高于对照组产妇(P<0.05);两组产妇产前一周EPDS评分比较差异无统计学意义,产后42 d两组产妇EPDS较产前有上升,但观察组产妇EPDS评分较对照组产妇低(P<0.05);两组产妇产前一周CD-RISC10各维度及总评分比较组间差异无统计学意义(P>0.05);产后42 d对照组心理弹性各维度及总评分与产前差异无统计学意义(P>0.05);观察组产妇CD-RISC10各维度及总评分较产前1周及对照组高(P<0.05);观察组产妇出院后至42 d并发症率明显低于对照组产妇(P>0.05)。结论围生期情绪相关知识教育可有效提升产妇对围生期情绪管控相关知识的认知水平,提升产后心理弹性水平,降低其产后抑郁及并发症发生率,具有较高的临床价值。     

两种产后访视方式对母婴健康状况的影响

目的研究产后访视服务的方式、促进母婴健康,提高母婴生存质量。方法将2008年7月～2009年12月在本院产科分娩出院的接受传统访视的400例产妇作为常规组,将2010年l月～2011年6月在本院产科分娩出院的接受访视的410例产妇作为观察组,观察组在常规访视的基础上提高了产后访视人员的综合素质并增加新的访视内容,观察两组母婴健康状况。结果常规组中产妇有异常情况132例,发生率33%;新生儿有异常情况127例,发生率为31.75%。观察组中产妇有异常情况65例,发生率15.85%;新生儿有异常情况63例,发生率为15.36%。结论通过提高访视人员的综合素质和拓展访视内容等方法提高产后访视质量,能更好地促进母婴健康,提高母婴生存质量。     

卡前列素氨丁三醇防治产后出血的临床疗效观察

目的探讨卡前列素氨丁三醇防治产后出血的临床疗效情况。方法分析我院2012年2月至2014年5月收治的产妇1200例临床资料,依据治疗方式不同进行分组,对照组600例和观察组600例。结果观察组产妇剖宫产术中出血量、术后2 h出血量及总出血量、产后24 h Hb下降值和RBC下降值均优于对照组,观察组产妇临床治疗总有效率明显高于对照组,P<0.05,差异均有统计学意义。结论卡前列素氨丁三醇防治产后出血的临床疗效明显,值得临床推广应用。     

Clinician views and knowledge regarding healthcare provision in the postpartum period for women with recent gestational diabetes: A systematic review of qualitative/survey studies

AimTo examine clinician views and knowledge regarding postpartum healthcare provision for women who have experienced gestational diabetes (GDM).MethodsSystematic review that searched PubMed, Web of Science, EMBASE and CINAHL. Qualitative studies and surveys, with clinicians as participants, which reported pre-specified outcomes, including barriers and facilitators to postpartum care for GDM, were included. Two authors independently assessed quality and undertook thematic synthesis.ResultsEleven surveys and two interview studies were included (4435 clinicians). Key themes included adequacy of knowledge of risk of type 2 diabetes mellitus (T2DM), gaps between knowledge and practice relating to postpartum screening, and differing perceptions of the value of postpartum screening. Clinicians perceived that women faced obstacles to accessing healthcare, and a need for improved GDM education. Studies reported shortfalls in systems to ensure postpartum screening occurs, and a need to improve communication and collaboration relating to care of women who have experienced GDM. The surveys were often limited in their depth and ability to identify remedial strategies.ConclusionsBarriers to provision of care for women who have had GDM, such as lack of communication of the diagnosis, need to be addressed, and further interview studies exploring clinician views on screening for T2DM are required.