Search Results (2,679)

This study compared the regulatory effects of dietary supplementation with natural clinoptilolite (CLN) versus a dietary cation-anion difference (DCAD) regimen on calcium homeostasis in dairy cows during the last 21 days prepartum. Results showed that cows in the DCAD group exhibited significantly higher blood ionized calcium (iCa) and parathyroid hormone (PTH) concentrations than those in the CLN group (p < 0.05). Serum PTH concentrations displayed a declining trend in both groups prepartum, which deviates from the classical theory of compensatory PTH secretion, suggesting that alternative compensatory pathways may be involved in the regulation of calcium homeostasis during the periparturient period in dairy cows. Monitoring of calcium homeostasis and related metabolic parameters following postpartum oral calcium bolus administration revealed that the incidence of subclinical hypocalcemia in the DCAD group was 26%, lower than the 62% observed in the CLN group. However, blood iCa concentrations returned to normal levels more rapidly in the CLN group. Additionally, CLN supplementation was associated with more stable blood pH and lower prepartum serum potassium concentrations (p < 0.05) that remained within the physiological range, which may contribute to improved tissue sensitivity to PTH. Full article

Perinatal mood disorders (PMDs) affect approximately 15% of birthing persons during the pregnancy or postpartum (up to one year after birth) time period. People who recently gave birth and are of diverse backgrounds and identities, especially those who are oppressed, are disproportionately affected by PMDs and may experience these conditions differently. One such group is low-income birthing persons living in urban areas. This article will summarize PMDs, including their prevalence rates and how they are disproportionately experienced among low-income birthing persons living in urban areas. The factors to be reviewed include racism, cultural stigma, community stressors, issues with access to services, lack of resources, socioeconomic concerns, and healthcare system problems. Additionally, how PMDs among low-income birthing persons living in urban areas can be prevented, identified, and treated will be discussed. Strategies include practicing cultural humility and promoting anti-oppressive practice, building positive relationships with birthing persons, utilizing formal and informal social supports, promoting community engagement, sharing resources and tangible supports, following universal screening recommendations, addressing barriers to care, and advocating for effective policies. Full article

Background: Postpartum oral glucose tolerance test (OGTT) screening after gestational diabetes mellitus (GDM) enables early detection and prevention of type 2 diabetes, yet adherence is suboptimal, particularly in regional and rural areas. This study examined lifestyle behaviour and health-related quality-of-life factors associated with OGTT non-adherence over time. Methods: A longitudinal cohort study of women with prior GDM in regional and rural New South Wales, Australia, was conducted. Binary logistic regression models examined associations between lifestyle behaviours, health-related quality of life, and OGTT non-adherence at 3, 18, and 36 months postpartum. Results: OGTT non-adherence increased over time. Multivariable models were not statistically significant at any timepoint. At 3 months postpartum, several lifestyle and health-related quality-of-life variables were associated with non-adherence; however, these associations were not sustained at later timepoints. No consistent predictors of non-adherence were identified across follow-up. Conclusions: All women with prior GDM remain at risk of missed postpartum screening, with engagement declining over time. Findings should be interpreted as exploratory, reflecting time-specific patterns rather than stable predictors. Early postpartum represents a critical window for intervention, while longer-term strategies require flexible, integrated, and accessible models of care to support sustained diabetes prevention, particularly in regional and rural populations. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDPs) affect approximately one in seven hospital deliveries in the United States and increase the risk of pregnancy-associated mortality. Home blood pressure monitoring (HBPM) for patients with HDPs has emerged as a model of care poised to improve ascertainment of blood pressure and triage of care during pregnancy and postpartum periods. However, the strength of evidence supporting HBPM approaches has been variable. This rapid review aimed to understand how HBPM approaches for pregnant and postpartum populations with HDPs have been evaluated in order to strengthen future research. Methods: Search criteria included peer-reviewed literature in English and French published during 2018–2024 that assessed HBPM approaches for pregnant and postpartum populations in high-income countries. A total of 370 records were screened and reviewed to identify 52 eligible articles. Key study characteristics, methodologies, and outcome measures were extracted. Identified outcome measures were mapped by outcome type (implementation, health service, and client) to assess gaps in evaluation of HBPM approaches. Results: A range of study designs were employed to evaluate HBPM approaches: experimental (17%), observational (52%), qualitative (10%), mixed method (10%), and economic (11%) designs. Over a third employed a comparison group, most of which compared HBPM approaches to usual antepartum or postpartum care. Only 11 studies reported on impact outcomes (long-term blood pressure control, adverse maternal and perinatal outcomes). Significant gaps were identified among the implementation outcomes examined. While patient engagement measures were common, assessment of provider adherence and engagement was limited. Hospital admissions and emergency department visits were often employed as proxies to measure HBPM effectiveness, efficiency, and safety. However, no studies adequately reported effectiveness measures for remote patient triage. Conclusions: Our results call for improved HBPM metrics to ensure patients are receiving high-quality care responsive to their clinical condition. Future studies on HBPM approaches should prioritize more transparent reporting on health actor engagement. A composite measure including both patient and provider adherence to monitoring and triage processes will provide stronger evidence on the effectiveness of HBPM for pregnant and postpartum patients and share impactful learning for health systems interested in adopting HBPM approaches. Full article

Background/Objectives: Skin-to-skin contact (SSC) between mother and infant is known to promote breastfeeding initiation and early bonding. However, evidence regarding the sustained effects of daily SSC during the postpartum period on breastfeeding outcomes and maternal mental health remains limited. This study aimed to evaluate the effects of structured daily SSC on breastfeeding outcomes, lactation status, and maternal postnatal mental health in a real-world clinical setting. Methods: A quasi-experimental design was used to compare mothers who performed daily SSC (SSC group) with those receiving care as usual (control group). Data were collected on postpartum Day 1, Day 3, Week 2, and Week 4. Primary outcomes included exclusive breastfeeding duration, continued breastfeeding duration, and lactation status. Multiple linear regression analyses adjusted for baseline breastfeeding intention and maternal age. Results: A total of 50 mother–infant dyads were included (SSC: n = 40; control: n = 10). The SSC group was associated with longer exclusive and continued breastfeeding durations and better lactation status (p < 0.05). Depressive symptoms did not differ significantly between groups, although both groups showed decreasing trends over time. After adjustment, daily SSC remained significantly associated with longer exclusive breastfeeding duration (adjusted β = 9.18 days, p = 0.034) and continued breastfeeding duration (adjusted β = 10.57 days, p = 0.001). Conclusions: Daily SSC is a simple and feasible intervention that may be associated with improved breastfeeding outcomes and lactation performance. Incorporating structured SSC into routine postpartum care may support breastfeeding sustainability and maternal recovery. Full article

Milk-derived exosomes (MDEs) are bioactive nanocarriers rich in microRNAs (miRNAs) that play critical roles in post-transcriptional regulation during neonatal development and immune adaptation. However, the dynamic changes in miRNA expression across lactation stages and their biological functions remain insufficiently explored. We hypothesized that the miRNA cargo of buffalo MDEs exhibits temporal specificity, thereby dynamically matching the immune requirements of the neonatal calves. Therefore, the present study aimed to systematically characterize the miRNA expression profiles of MDEs derived from colostrum, transitional milk, and mature milk. MDEs were isolated, purified using differential ultracentrifugation, and characterized via transmission electron microscopy, Western blotting, and nanoparticle-tracking analysis. A total of 370 miRNAs were identified in the MDEs, with 220 (59.5%) co-expressed across colostrum, transitional milk, and mature milk. Comparative analysis revealed that colostrum MDEs exhibited the greatest miRNA diversity. Expression patterns of miRNAs showed distinct stage-specific clustering as lactation progressed. Compared to mature milk, 100 differentially expressed miRNAs (DE-miRNAs) were identified in colostrum MDEs, including 39 upregulated and 61 downregulated miRNAs. Bioinformatics analyses indicated that predicted target genes were associated with transmembrane transport, immune response, cell development, and apoptosis. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis identified pathways involved in immune regulation, inflammation, and apoptosis. Moreover, macrophages incubated with buffalo colostrum MDEs showed upregulation of proliferation-related genes and downregulation of pro-inflammatory factors, suggesting an anti-inflammatory effect through activation of the phosphoinositide 3-kinase-protein kinase B (PI3K-Akt) signaling pathway. These findings offer new insights into miRNA profiles of buffalo MDEs across the early postpartum transition and provide a preliminary basis for exploring immunomodulatory potential of buffalo MDEs. Full article

Obesity in women of reproductive age is a major issue. It is associated with reduced fertility and an increased risk of obstetric and perinatal complications. Bariatric surgery is the most effective treatment for severe obesity, leading to substantial weight reduction, improvement of metabolic disorders, and enhanced fertility. Consequently, an increasing number of women are becoming pregnant after undergoing bariatric surgery. The aim of this paper is to review current recommendations and research data regarding the care of women after bariatric surgery in the periconceptional and perinatal periods, as well as throughout pregnancy, delivery, and the postpartum period. Research suggests that pregnancy after bariatric surgery is associated with a lower risk of gestational diabetes, hypertension, preeclampsia, and fetal macrosomia compared with pregnancies in women with similar baseline BMI (body mass index) who have not undergone surgical treatment. At the same time, an increased risk is observed for low birth weight, maternal micro- and macronutrient deficiencies, and complications characteristic of bariatric procedures, such as dumping syndrome or intra-abdominal hernias. Most scientific societies recommend postponing pregnancy planning for 12–18 months after surgery and using effective contraception, preferably methods that do not require gastrointestinal absorption. Regular monitoring of laboratory parameters, individually tailored supplementation, and interdisciplinary care are essential for the safe management of pregnancy after bariatric surgery. In particular, care should include achieving a stable body weight before conception, monitoring of nutritional status, verifying proper weight gain during pregnancy, and considering alternative methods for gestational diabetes screening (e.g., glycaemic monitoring instead of oral glucose tolerance testing) due to the risk of dumping syndrome. Appropriate preparation for pregnancy and proper management throughout its course allow for reducing the risk of perinatal complications. Bariatric surgery itself is not a contraindication to vaginal delivery. Full article

Background: Placenta accreta spectrum (PAS) refers to the abnormal placental implantation into the uterine wall, and its incidence is rising in parallel with increasing cesarean deliveries and myomectomies. PAS carries high maternal risks, including hemorrhage, shock, and death. Management involves either a hysterectomy or conservative approaches to preserve fertility that come with higher risks of maternal morbidity and mortality. Radiofrequency ablation (RFA) is a well-established modality for treating soft tissue tumors, but its use for PAS is not well studied. Case: We report a case of successful postpartum treatment of placenta accreta with transcervical radiofrequency ablation, which preserved uterine integrity and resolved significant bleeding without postoperative complications. Conclusions: Transcervical RFA may offer a safe and minimally invasive treatment for placenta accreta that conserves the uterus and may maintain reproductive capacity. Full article

Hormonal contraception is used by hundreds of millions of women worldwide and remains one of the most effective reversible methods of pregnancy prevention. Cardiovascular (CV) safety concerns, particularly venous thromboembolism (VTE), ischemic stroke, myocardial infarction, and blood pressure elevation, are important considerations when choosing forms of contraception. Estrogen-containing combined hormonal contraceptives (CHCs) increase the relative risk of VTE; however, among healthy young nonsmokers, absolute event rates remain low. Risk is strongly modified by estrogen dose, progestin type, route of administration, and individual factors such as age, smoking, migraine with aura, hypertension, obesity, inherited thrombophilia, the postpartum period, and concomitant prothrombotic medications. Progestin-only contraceptives and levonorgestrel-releasing intrauterine systems (LNG-IUSs) generally show a more favorable thrombotic profile and are preferred options for women with contraindications for estrogen. This review summarizes current evidence on the method-specific CV risks of hormonal contraception, highlights the mechanisms underlying these effects, and provides practical guidance for clinical decision-making. Full article

Background and Objectives: Thrombocytopenia complicates 6.6–11.6% of pregnancies. While gestational thrombocytopenia (GT) is usually benign, etiologies such as immune thrombocytopenia (ITP), preeclampsia, and HELLP syndrome require individualized management. This study aimed to characterize the etiological spectrum, maternal peripartum hematologic outcomes, blood product utilization, and mode of delivery in a tertiary-center cohort of thrombocytopenic pregnancies and to assess whether platelet count should influence delivery mode decisions. Materials and Methods: This retrospective cohort study included 137 thrombocytopenic pregnant women at a tertiary center (2010–2019), categorized by etiology and severity. Peripartum hemoglobin, hematocrit, and platelet counts were compared between delivery groups. Blood product utilization was recorded and analyzed using t-test, ANOVA, chi-square, Fisher’s exact, and Fisher–Freeman–Halton tests; binary logistic regression was used for multivariable analysis. Results: GT (43.1%) and ITP (32.1%) were the most prevalent diagnoses; cesarean delivery rate was 52.6%. Postpartum Hb was higher in the vaginal delivery group (10.24 ± 1.28 vs. 9.80 ± 1.26 g/dL; p = 0.003), while platelet counts were paradoxically lower (p = 0.039). Platelet transfusion rates did not differ significantly between delivery modes (23.1% vs. 27.8%; p = 0.621). Severe thrombocytopenia required platelet transfusion in 92.6% of cases versus 11.6% (moderate) and 0% (mild) (p < 0.001). RBC transfusion was highest in gestational hypertensive disease (41.2%) versus GT (5.1%) and ITP (2.3%) (p < 0.001). General anesthesia was used in 75% of cesarean cases. Conclusions: Delivery mode in thrombocytopenic pregnancies should be guided by obstetric indications, not platelet count alone. Although postpartum platelet counts declined more steeply after vaginal delivery, this did not increase transfusion requirements. Gestational hypertensive disorders carried the greatest hemorrhagic burden, highlighting the need for etiology-specific multidisciplinary planning. The high general anesthesia rate warrants prospective institutional audit of anesthetic decision-making protocols to determine adherence to current neuraxial anesthesia thresholds. This study is limited to maternal peripartum hematologic outcomes; neonatal outcomes were not captured and should be addressed in future prospective research. Full article

Background: This study aimed to contribute to the growing empirical interest in the role of positive body image in the context of breastfeeding. Research Aim: We examined the association between positive attitudes toward breastfeeding and breastfeeding intentions among postpartum women and investigated the mediation of functionality appreciation. Method: A total of 305 women who had given birth within the past 1 to 3 months (M = 34.11 years) participated in the study. Women completed a questionnaire assessing breastfeeding attitudes, appreciation of breastfeeding functionality, breastfeeding intentions, previous breastfeeding experience, as well as Body Mass Index and sociodemographic and obstetric characteristics. A mediation model was used to examine direct and indirect associations between attitudes toward breastfeeding, breastfeeding intentions, and functionality appreciation. Results: Results showed significant associations between positive attitudes towards breastfeeding, breastfeeding intentions, and functionality appreciation. Positive attitudes toward breastfeeding were positively associated with breastfeeding intentions (β = 0.63, p < 0.001) and with functionality appreciation (β = 0.51, p < 0.001), with functionality appreciation accounting for a significant indirect association (β = 0.21, 95% CI [0.14, 0.29]). Finally, previous breastfeeding experience was positively associated with breastfeeding intentions (β = 0.15, p < 0.001). Conclusions: This study marks the initial attempt to examine the significance of functionality appreciation in postpartum women, highlighting potential associations between breastfeeding attitudes and breastfeeding intentions. These findings may offer preliminary insights for future research and for informing the development of targeted interventions, although further evidence from more diverse populations is needed. Full article

Objective: The study aimed to assess the accuracy of two distinct methods for estimating blood loss (EBL) and to identify potential factors contributing to early-onset postpartum hemorrhage (PPH) following a vaginal delivery (VD). Methods: Women in singleton pregnancies undergoing spontaneous/induced VD were recruited for this prospective observational cohort study. Methods of EBL included: (1) visual assessment by an attending obstetrician (sEBL) and (2) implementation of a mathematical formula (fEBL). Early PPH was defined as a cumulative blood loss exceeding 500 mL within the first 24 h after delivery as reflected by clinical assessment. Results: During the study period, 485 women delivered vaginally, and early PPH was diagnosed in 29 cases (5.97%). Among patients with PPH, a significant increase in the duration of the 2nd (61 min. vs. 33.5 min., p < 0.05) and 3rd (13 min. vs. 7 min., p < 0.001) stages of labor, as well as in the application of a dinoprostone insert (31% vs. 10.5%, p < 0.01) was noted. Additionally, in the same cohort, uterine atony (41.4% vs. 1.5%, p < 0.001), 3rd/4th degree perineal rupture (6.9% vs. 0%, p < 0.01), fetal macrosomia (17.2% vs. 4.8%, p < 0.05) and stillbirth (6.9% vs. 0.2%, p < 0.05) occurred significantly more frequently. In both groups visual estimation of blood loss was significantly lower compared to fEBL: (PPH sEBL: 800 mL vs. fEBL 1439.6 mL, p < 0.001; control sEBL: 250 mL vs. fEBL 621.8 mL, p < 0.001). In the multivariate analysis, factors such as third stage of delivery time ≥ 30 min. (OR 11.6; 95% CI: 4.18–32.33), FBW ≥ 4000 g (OR 6.37; 95% CI: 1.54–26.3), and dinoprostone insert application (OR 4.33; 95%CI: 1.63–11.48) were selected as independent predictors of the PPH. Conclusions: Compared to mathematical formula, visual estimation of blood loss by an attending obstetrician is significantly decreased. Prolonged third stage of delivery, fetal macrosomia, and application of a dinoprostone insert are the strongest contributors to early PPH following a VD. Full article

Background: Emergency obstetric situations require rapid clinical decision-making, technical competence, and emotional preparedness to ensure safe and compassionate care for both mother and newborn. However, nursing students often have limited opportunities to experience such high-risk, low-frequency events during clinical placements. Simulation-based education has emerged as an effective strategy to prepare future nurses for caring in emergency contexts, allowing them to develop both technical and non-technical skills in a safe learning environment. This study aimed to evaluate the effects of a high-fidelity obstetric emergency simulation program on nursing students’ knowledge, perceived safety, and learning experience. Methods: A mixed-methods design was employed, combining a quasi-experimental pretest–posttest assessment without a control group and qualitative analysis of open-ended reflections. Eighty-two third-year nursing students participated in two simulation sessions addressing obstetric emergencies such as breech birth, shoulder dystocia, out-of-hospital delivery, eclampsia, postpartum hemorrhage, and maternal cardiac arrest. Data were collected using validated instruments measuring knowledge, perceived safety, and satisfaction and self-confidence in learning, and were analyzed using Wilcoxon signed-rank tests and thematic analysis. Results: Significant improvements were observed in specific knowledge areas related to complex obstetric maneuvers and in their perceived safety when managing emergency situations (p < 0.001, r > 0.40). Participants reported high levels of satisfaction and confidence in learning. Qualitative findings highlighted increased emotional preparedness, improved clinical reasoning, and recognition of the importance of teamwork and reflective debriefing in emergency care contexts. Conclusions: High-fidelity simulation appears to be an effective educational strategy for preparing nursing students to provide safe and confident care in obstetric emergencies. Integrating simulation into nursing curricula can strengthen both technical competence and the emotional readiness required for caring in urgent and high-pressure clinical situations. Full article

Peripartum cardiomyopathy (PPCM) is a distinct condition that presents as heart failure (HF) in a woman who was previously healthy and has no prior cardiovascular issues. It results from idiopathic left ventricular (LV) dysfunction, characterized by a reduced LV ejection fraction below 45%. PPCM is a life-threatening condition with a high mortality rate (MR) that demands urgent treatment. Methods: This narrative review aims to define PPCM and its pathophysiology and conduct a scoping review of the latest data on the management of patients with peripartum cardiomyopathy during pregnancy and the postpartum period. Results: Currently, treatment follows standard HF protocols for reduced ejection fraction, with the possible addition of bromocriptine, and during pregnancy, medications that do not harm the fetus. Conclusions: Early, aggressive therapy is essential for a better prognosis, but managing PPCM can be challenging. Treatment of PPCM patients should be led by a team of highly qualified specialists, known as the Obstetric and Cardiac Care Team, comprising an obstetrician-perinatologist, an anesthesiologist, a cardiologist, and a cardiac intensive care specialist. Baseline left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) are the main prognostic factors. LVEF less than 30%, significant LV dilatation, LVEDD ≥ 6.0 cm, and right ventricular involvement are factors indicative of a poor prognosis. While pregnancy after PPCM is possible, it should be discouraged due to the significant risk of complications and even death. The most common causes of death in patients with PPCM are thromboembolic complications, severe HF, serious ventricular arrhythmias, cardiogenic shock, and sudden cardiac arrest. Full article

Background/Objectives: Acute pancreatitis in pregnancy and the early postpartum period (APIP) is an uncommon but potentially life-threatening condition associated with significant maternal morbidity. Physiological adaptations of pregnancy, recent obstetric surgery, and overlapping postoperative symptoms frequently obscure early diagnosis and complicate perioperative and critical care management. This review provides a clinically oriented, anaesthesiology-focused overview of APIP, integrating current evidence with perioperative decision-making, pain management strategies, and intensive care considerations relevant to obstetric practice. Methods: A narrative, clinically structured review of the literature was performed focusing on epidemiology, aetiology, diagnosis, severity stratification, and management of APIP. Anaesthesiology- and ICU-specific aspects are synthesised into a pragmatic management framework. Results: Gallstone disease and hypertriglyceridaemia remain the predominant causes of APIP, with most cases occurring in the third trimester or early postpartum period. Diagnosis relies on pancreatic enzyme elevation and pregnancy-adapted imaging strategies. Early goal-directed fluid resuscitation, effective multimodal analgesia, and timely initiation of enteral nutrition are key determinants of outcome. Therapeutic ERCP and laparoscopic cholecystectomy can be safely performed during pregnancy when clinically indicated and may reduce recurrence in biliary pancreatitis. Neuraxial analgesia provides effective, opioid-sparing pain control and may improve respiratory mechanics and haemodynamic stability. Persistent organ failure remains the strongest predictor of adverse outcome and should prompt early intensive care admission. Conclusions: APIP requires early recognition and severity-adapted, multidisciplinary management. Anaesthesiology-led strategies play a central role in optimising analgesia, haemodynamic stability, and timely escalation of care. Framing APIP within a perioperative and critical care context may improve maternal outcomes in this vulnerable patient population. Full article