Elevation of oxytocin levels early post partum in women

BACKGROUND: The aim of this study was to determine plasma levels of oxytocin in women immediately after delivery. METHODS: Oxytocin was measured in 18 healthy women at 15 minute intervals after normal vaginal deliveries with healthy infants. The mothers had their infants put skin-to-skin on their chests immediately after birth. The infants stayed there up to two hours post partum. RESULTS: There were significant elevations of oxytocin 15, 30 and 45 minutes after delivery (p = 0.007, 0.02 and 0.02 respectively) when compared with average pre partum levels sampled approximately 7-15 minutes before partus. This elevation of oxytocin coincided with the expulsion of placenta. In most women this first elevation was followed by repeated elevations of oxytocin. Oxytocin levels returned to pre partum levels at 60 minutes post partum. CONCLUSIONS: Oxytocin is known to play a role in maternal bonding in animals. Earlier studies indicate that there is a sensitive period for bonding the first hour after giving birth even in women. Our study demonstrates a coincidence of this putative 'sensitive period' and high levels of oxytocin.     

The role of maternal thyroid hormones on the development of the brushtail possum, Trichosurus vulpecula

Thyroxine (T4) is a vital hormone for the development of mammals. To determine the role of maternal thyroid hormones on organ development, methimazole, an inhibitor of T4, was first administered via a minipump to 13 mothers with pouch young between days 10 and 80 post partum for 28 days. Three young survived and 10 of the young died at 104.0 +/- 10.8 days post partum (mean, SEM). Methimazole was then administered for 28 days to 6 lactating adult possums with pouch young at day 20 post partum. The effects of this treatment on the maternal plasma concentrations of T4 were monitored and the development of the lung, kidney and brain of the young were examined at day 90 post partum. There was no difference in the morphology of the lung, kidney and brain of pouch young at day 90 post partum whose mothers were treated with methimazole or saline. Thus methimazole administered to lactating possums for a short period early in lactation can cause the demise of the young about day 100 post partum although the cause of death is unknown. It is possible that the development of the central nervous system or some other vital organ has been inhibited, this altered state not being apparent morphologically. Nevertheless the marsupial appears to be similar to the eutherian in its requirement for thyroxine for normal development. However whereas this requirement is apparent during fetal development and around the time of birth in eutherians thyroxine is of importance during pouch development in marsupials.     

Parapartum mental illness: a long-term follow-Up study

All mothers (n = 79) in the county of Stockholm who gave birth to a child during 1976-77 and were also hospitalised for the first time in a psychiatric clinic were followed up after a mean interval of 15 years. The sample was classified according to the Research Diagnostic Criteria. Comparisons were made with matched obstetric controls. Five patients had died. The recurrence rate was 51% and 7. 3% relapsed after a subsequent childbirth. No difference was found between psychotic and non-psychotic mothers regarding mean sick-leave days per year. The majority of the women with a depressive disorder at index admission suffered from a minor depressive disorder. The women in the group with an unspecified functional psychosis showed a less severe course of illness than the women in the schizophrenia group.     

Psychiatry of minimal, early-childhood brain damage

Early psychoorganic syndrome in the child is the result of a diffuse cerebral lesion which usually occurs in pregnancy, during delivery or immediately post partum. In the majority of cases the symptoms are biological, normally of a neurologic character, and serve to underpin the diagnosis. They mainly comprise psychomotor disturbances, linguistic disorders and malregulation of central nervous functions. From the psychic viewpoint both intellectual and emotional disturbances are observable. Intellectually the disorders are chiefly of attention, perception and concentration, and in most cases lead to seriously impaired school performance. They are accompanied by an ideation which is frequently retarded and exhibits a tendency to perseveration. The psychoorganic child's affectivity is marked by pathologic lability, increased irritability and imperfect control of impulse and emotion. Secondary infantilism is nearly always observable. In very many cases reactive, and notably neurotic, disorders are superimposed on the psychoorganic substratum. There are thus a wide variety of clinical pictures. A broad spectrum of therapeutic resources is available, covering education, drugs and psychotherapy of superimposed reactive disorders.     

Responses to electrical stimulation, noradrenaline, serotonin, and vasopressin in the isolated ear artery of the developing lamb and ewe

Responses of isolated helical strips of ovine ear artery to electrical stimulation of postganglionic adrenergic neurons and exogenous agonists were studied at various stages of development from 110 days of gestation through to adulthood. Only rudimentary responses were observed at 110-115 days of gestation. A parallel development of responses to noradrenaline (NA), serotonin, and lysine vasopressin began sometime after 110-115 days of gestation and continued until 133-137 days of gestation but there was little development of the latter responses until more than 3-5 days post partum. Development of responses to exogenous agonists was incomplete 2-3 weeks post partum. The development of postganglionic adrenergic responses lagged behind those to exogenous NA. Two to three weeks post partum the NA maximal response was one-third that of adult tissue whereas the response to 16 Hz (highest frequency used) was one-sixth that of adult tissue. The NA threshold concentration was lower in arterial strips of adult animals than it was in those of younger animals. The data suggest that development of functional post-ganglionic adrenergic innervation of vascular smooth muscle begins late in gestation and continues well after birth; this development is preceded by development of vascular mechanisms involved in the response to several agonists.     

The onset of the ovarian cycle following calving

The onset of ovarian activity post partum was investigated by measuring progesterone concentrations in milk samples, in two dairy herds consisting of 118 cows with an average milk yield of 8340 kg FCM. Samples were taken three times a week till 50 days post partum. In 17 cows (14.4%) anoestrus occurred. The daily milk yield in this group was 2.65 kg FCM higher than the average yield in the group returning to oestrus before day 50 post partum. In cows returning to oestrus within 50 days post partum the first rise in progesterone was detected on average 27.6 days after calving. In first calvers (31.4 +/- 10.2) and in multiparous cows in the winter period (26.9 +/- 9.4) the onset of ovarian activity was delayed compared to start of ovarian activity in the summer period. In the first cycle only 28% of the cows had a normal luteal phase (12-17 days), 36% of the cows had a shortened luteal phase (less than 6 days), and 24% of the cows had a short luteal phase (6-11 days). In 12% of the cows the luteal phase was longer than 17 days. In the second cycle 56% of the cows had a normal luteal phase while 17% had a shortened luteal phase, and 17% had a short luteal phase. Pregnancy rates after first insemination in cows with a short dioestrus (10-25 days) were higher than in cows with a prolonged dioestrus (26-50 days). On the basis of these result it might be expected that postponing the first insemination until the second or even the third cycle in high-yielding cows will have only a marginal effect on the number of open days and a large effect on the number of inseminations per pregnancy.     

XO monosomy is associated with reduced birthweight and lowered weight gain in the mouse

The growth of XO mice and their XX sisters was followed from the day of birth up to 15 weeks post partum. XO mice were underweight at birth, and grew more slowly than XX mice in the preweaning period. Some, but not all, of this decrease in growth rate was attributable to an effect of the reduced birth weight.     

Emergencies in obstetrics]

The survey on emergencies in Obstetrics is addressed here to practitioners and advanced medical students. The specialized gynecologist will, however, find some case reports interspersed illustrating what he/she has already experienced sometimes. The paper should be a refreshment for them. Acute abdominal pain in pregnancy challenges the diagnostic skills of the physician first contacted. Is it, what causes the pain, appendicitis as is frequently in nonpregnant young women, or gall-bladder disease as in the elderly obese, or even dangerous intestinal obstruction, or is the pain deriving from a twisted pedicle of an occult ovarian cyst or is it simple gastrointestinal discomfort? Putting into account the differing frequency of incidences of disease does not always help. Emergency may arise from the rarest event. With increasing traffic on our streets blunt trauma occurs and it might hurt pregnant women as well as their fetus. Even seat-belts can cause damages, if pelvic belts are used instead of shoulder belts. Traumata from accidents are often associated to immediate shock. Shock in pregnancy poses different questions according to the physiology of the progressing pregnancy. There is a variety of shock etiologies. Bleeding from the vagina is the most common complaint. Those can be harmless or they can be the first and leading sign of imminent danger to the fetus and the mother. Diagnosis does not allow any delay. One of the most striking complications in late pregnancy is described by the acronym "HELLP"-syndrome [hemolysis, elevated liver enzymes, low platelets]. This syndrome is a critical complication of preeclampsia. One third of the cases occur after delivery. It has not yet been clearly decided whether active management including immediate delivery by cesarean section in disregard of the maturity of the child, or the conservative approach with intensive care, drastic antihypertensive medication and additional serial plasmapheresis might prove to be more efficient in terms of live-saving for mother and child. The mortality of mothers suffering from HELLP remains to be high, the perinatal mortality is even higher. Post partum hemorrhage is due to the lack of contractibility of the uterus after overdistension, protracted labour, malpositions, mere inertia etc., from lacerations, or from placental retention. It is always an emergency with hemorrhagic shock impending. The risk situation around even normal birth is well known. Emergencies will appear every time unannounced. There are post partum risks as well; they should not be underestimated when home-delivery is desired.     

Development of perirenal adipose tissue in the neonatal lamb: effects of dietary safflower oil

Perirenal adipose tissue development was investigated in lambs from birth until 17 days of age. Changes in the morphology, the lipid, protein, RNA and DNA content, the adipocyte number and size, and the rate of protein, RNA and DNA synthesis of the perirenal fat-pads are reported. During the first 9 days after birth the tissue lost the morphological characteristics of brown adipose tissue and acquired those of white adipose tissue. As there was no change in either the number of adipocytes or the DNA content of the fat-pads between birth and 9 days of age it is concluded that there was a differentiation of brown into white adipocytes. Over 80% of the increase in tissue weight between birth and 17 days of age was due to lipid deposition. Administration of safflower oil to the lambs had no apparent effect on the change from brown to white fat, but it markedly reduced the rate of lipid deposition between days 9 and 17 post partum.     

The influence of progesterone on the antidiuretic and oxytocic activities of the posterior pituitary lobe of female rats

The course of delivery and labor, the post partum period and the postpartal condition of the newborn were reviewed in 315 obese patients with a bodyweight of 90 kg or more at delivery. The results were compared with those of a group of 315 patients with a body-weight of less than 90 kg, choosed by random and evaluated by statistic (t-test, x2-test). In the group of obese gravidae we found a significant higher rate of cases with induction of labor, protracted deliveries, breech presentation and operative deliveries. Also the rate of manual removal of the placenta, post partum uterine infections and disorders in the milk secretion was significant higher in this group. Post partum abnormal glucose tolerance tests ocurred abnormal more frequently in the obese patients. The weight of the infants of obese mothers was higher as in the control group. Significant higher were the perinatal mortality and the cases of fetal death in utero in the obese group compared to the non obese group.     

Obese patients in obstetrics

The results of two studies about the course of pregnancy and delivery in adipose women in our hospital are combined and discussed. We found a higher rate of EPH-gestosis in overweight patients. The frequency of Cesarean section was increased. Belated uterine involution post partum is more frequent in adipose women, also the occurrence of urinary tract infections. There is a significant increase in perinatal mortality, mainly due to an increase in still-born. Pneumonia due to aspiration and birth traumata occur more frequently as well and endanger the children.     

Tolerance to rat parathyroid allograft induced by depletion of Ia+ donor cells plus short course cyclosporine]

Five hundred and thirty families with at least 1 child who had been referred to a dermatologist with atopic dermatitis were interviewed in an effort to determine whether factors such as the age of the mother when a child is born and/or birth rank can contribute to the development of atopic dermatitis. The families interviewed had a total of 1,084 children, or an average of 2 children per family. Sixty per cent of the children with atopic dermatitis were under 5 years of age. Ninety-one per cent of them had developed the disease before the age of 3; those most severely affected had developed the disease during the first year of life. In families with 2 children, but only 1 child with atopic dermatitis, the odds ratio for the second child to develop atopic dermatitis was 1.379 (0.025 < p < 0.05). The average maternal age was 24.8 to 25.2 years when giving birth to the first child and 28 years when giving birth to the second child, irrespective of the status of the child. Thus, atopic dermatitis can be related to birth rank or to the age of the mother.     

Asphyxia of the newborn in east, central and southern Africa

Very scanty information is available in East, Central and Southern Africa on the incidence and risk factors associated with asphyxia of the newborn. A multicentre prospective study involving 4267 deliveries in eight countries was undertaken over a three month period, in maternity units of the central hospitals to determine the incidence; maternal, service and logistic risk factors for asphyxia of the newborn as determined by an abnormally low apgar score. 30% of births were by primigravida mothers, of whom 67% were teenagers. A birth by a teenager had a higher risk for low birth weight. Overall incidence of low birth weight was 13.9%. The overall incidence of asphyxia of the newborn was 22.9% while that associated with low birth weight (i.e. babies weighing less than 2500 grams) was 29.3% compared with 21.5% among the normal birth weight babies. Low birth weight contributed a large proportion of the high neonatal mortality of 15.9% compared to 1.8% for normal birth weight babies by 24 hours after birth. The mean mortality by 24 hours post delivery was 3.8%. Obstetrical complications are important risk factors for asphyxia of the newborn. Among the important risk factors are those associated with prolonged labour and intra partum accidents. The incidence of risk for asphyxia broadly was 21.3%, which is very close to the actual incidence of asphyxia of 22%. Lack of referral contributed to increased risk of asphyxia. In a significant proportion of infants, resuscitation measures taken were inappropriate. The stillbirth rate was 3.0% while the incidence of externally evident congenital malformations was 1.2%. There is urgent need to institute appropriate measures to prevent and manage asphyxia of the newborn in the region. These should include identification of the at risk mother, proper referral and management while adhering to correct established procedures. There is also need to develop appropriate and relevant technologies for perinatal and neonatal care through research undertaken in the region. It is also concluded that the co-operation and joint effort between the obstetricians, paediatricians and the nursing staff who all contributed to the collection of this data is a cost effective approach to research in perinatal health and consequently in instituting interventions.     

Premorbid anomalies and risk of schizophrenia and depressive disorders in a birth cohort exposed to prenatal rubella.

In a birth cohort prenatally exposed to rubella, we assessed whether prospectively documented premorbid neuromotor dysfunction, mannerisms, deviant behaviors, and temperament during childhood and adolescence were impaired in cases who developed depressive disorder (DD) relative to rubella-exposed controls and cases who developed schizophrenia spectrum psychosis (SSP). Premorbid neuromotor dysfunction and mannerisms were not increased among DD cases compared to controls or SSP cases. With regard to temperament, approachability was greater in DD cases than in controls and SSP cases. There were numerical increases in the proportions of DD cases with premorbid deviant behaviors compared to controls, but the findings fell short of statistical significance; the proportion of subjects with deviant behaviors in DD cases was similar to that found for SSP. These results indicate that premorbid neuromotor dysfunction and mannerisms may be specific to SSP among major psychiatric disorders in this cohort, and suggest that premorbid deviant behaviors are increased in both DD and SSP. Greater premorbid approachability may be associated with an increased risk of adult DD. Implications of these findings for school psychology are furnished. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of drug combination of antitumor activity and myelotoxicity

Concentrations of cortisol, corticosterone and cortisone in the plasma and adrenal glands, liver glycogen and plasma glucose of foetal, newborn and mother guinea-pigs were estimated during the last 6 days of pregnancy and throughout the first 24 h post partum. At the same time progesterone was measured in the plasma of the mother. During the prepartum rise in foetal plasma cortisol levels and liver glycogen, no significant change in the foetal adrenal cortisol content was observed. The plasma and adrenal cortisol concentrations of the mother were much higher than those observed in the foetus and increased significantly before parturition. In the mother as in the foetus, cortisone and corticosterone represent only a small percentage of corticosteroids compared with cortisol. These results indicate that the autonomous capacity of foetal adrenals, inhibited by maternal secretions before term, appears suddenly at birth.     

Effects of bovine somatotrophin (bST) on ovarian function in post-partum beef cows

The effects of bovine somatotrophin (bST) on ovarian follicle development and function and associated gonadotrophin profiles during the first nine weeks post partum were investigated in beef cows. Thirty-two cows (Shorthorn x Galloway) in moderately low body condition (BC) at calving were fed to maintain BC thereafter. At Weeks 2, 4, 6 and 8 post partum, animals were injected with 320 mg bovine somatotrophin (bST) (T, treated; n = 17) or with the carrier oil only (C, control; n = 15). Ovulation occurred in 4 of 17 T cows and 0 of 15 C cows (P = 0.10) by nine week post partum. Treatment with bST did not affect the numbers of small (3-8 mm in diameter) or large (> 8 mm in diameter) follicles or the granulosa cell populations but enhanced the oestradiol (P < 0.05) and insulin-like growth factor-I (IGF-I) content (P < 0.01) of large follicles by nine weeks post partum. It did not significantly affect the testosterone concentrations of large follicles. Circulating concentrations of growth hormone (GH) and IGF-I were higher in T cows than in C cows (P < 0.001) but were unrelated to gonadotrophin profiles or gonadotrophin receptor concentrations in the follicles. At Week 8, plasma insulin concentrations were higher in T cows than in C cows both before (P < 0.05) and after (P < 0.05) glucose injection. It is concluded that GH may play an important role in mediating the effects of nutritional state on ovarian function during the post-partum period, possibly through alteration of intrafollicular IGF-I concentrations.     

Relation between prolactin and gonadotrophin secretion in post-partum lactating rats

In post-partum lactating rats, sucking by the young was associated with high prolactin release and maintenance of lactation but severe inhibition of LH and FSH release and suspension of oestrous cycles. Shortly after the pups were removed on day 22 post partum LH and FSH release returned to normal and oestrous cycles resumed. Twice-daily injections of ergocornine methanesulphonate (ERG) into mothers beginning at 5 or 7 days post partum, resulted in sustained inhibition of prolactin release and diminished mild secretion. By frequent exchange of pups between control and ERG-treated mothers, it was possible to maintain vigorous sucking and almost normal pup growth despite low serum prolactin levels and diminished lactation. In these rats, serum levels of LH remained low during 11 or more days of treatment with ERG, but serum FSH was consistently higher than in untreated control mothers. After 11 or more days of ERG treatment, most rats showed a return to normal LH and FSH release and resumption of oestrous cycles. These results suggest (a) that the sucking stimulus rather than high prolactin levels in the circulation is mainly responsible for inhibition of LH and FSH release during the first 11 days post partum, (b) that the sucking stimulus acts to increase prolactin and inhibit LH release by separate hypothalamic mechanisms, and (c) that administration of ERG results in diminished prolactin release and lactation, and in increased release of FSH and subsequently of LH with earlier resumption of oestrous cycles.     

Fasting serum triglycerides, free fatty acids, and malondialdehyde are increased in preeclampsia, are positively correlated, and decrease within 48 hours post partum

OBJECTIVE: We tested the hypothesis that serum free (nonesterified) fatty acid and triglyceride concentrations are increased in nulliparous women with preeclampsia relative to women with uncomplicated pregnancies and that these lipids decrease post partum, consistent with the known resolution of clinical symptoms. The relationships between serum concentrations of these lipids and the lipid peroxidation metabolite malondialdehyde were also examined. STUDY DESIGN: Predelivery and 24 to 48 hour postpartum venous blood samples were collected from eight women with preeclampsia and nine women with uncomplicated pregnancies after an 8- to 10-hour fast. Sera were analyzed for concentrations of triglycerides, free fatty acids, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and malondialdehyde. RESULTS: Antepartum serum triglyceride and free fatty acid concentrations were increased approximately twofold in women with preeclampsia relative to uncomplicated pregnancies (p <0.02 and 0.004, respectively). Total, high-density lipoprotein, and low-density lipoprotein cholesterol concentrations did not differ between groups. Concentrations of all lipids decreased significantly in both groups within 48 hours post partum. However, triglyceride and free fatty acid concentrations remained higher in women with preeclampsia (p<0.006, both variables). Triglyceride and free fatty acid concentrations correlated positively, both ante partum (R2 0.42, p<0.01) and post partum (R2 0.39, p<0.02). Antepartum concentrations of malondialdehyde were 50% higher in women with preeclampsia (p<0.01) and decreased post partum (p <0.02) but did not decrease in controls (p = 0.07). Antepartum serum triglycerides and free fatty acids correlated positively with malondialdehyde concentrations (R2 0.38, p <0.02, both cases). CONCLUSION: Triglycerides and free fatty acids, but not cholesterol, are increased in preeclampsia and correlate with the lipid peroxidation metabolite malondialdehyde. We speculate that these interactions may contribute to endothelial cell dysfunction in preeclampsia.     

The forms of vitamin B12 on the transcobalamins

Prolactin (PRL) secretion in the periparturitional period in patients undergoing labor and vaginal delivery follows a remarkable multiphasic pattern not found in patients who underwent elective cesarean section without labor. There is a highly significant decline in PRL levels during active labor which reaches a nadir about two hours prior to delivery. Immediately after delivery, a surge of PRL is noted, reaching peak levels within two hours post partum. Thereafter, PRL levels fall, reaching a second nadir about nine hours post partum, and this low level is maintained for nine to 24 hours after delivery. This multiphasic pattern of PRL secretion is not correlated with changes in serum concentrations of cortisol, progesterone, estradiol, or estrone. PRL levels in all pregnant patients at term were unaffected by the administration of synthetic narcotic analgesic agents, anesthesia, or the stress of operation. It is concluded that PRL secretion in the pregnant patient at term is unresponsive to usual stimuli and that the multiphasic pattern of PRL secretion uniquely found with labor and vaginal delivery may be associated with dopaminergic neuroendocrine processes during human parturition.     

Lactose handling by women with lactose malabsorption is improved during pregnancy

OBJECTIVE: To evaluate lactose handling among women in late pregnancy and post partum to determine whether lactose handling is altered in pregnancy. DESIGN: Prospective study of lactose intolerance among pregnant women with and without lactose malabsorption. SETTING: Gastroenterology service of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal. PATIENTS: Thirty-three pregnant women, of whom 18 had lactose malabsorption, 12 did not and 3 were excluded. OUTCOME MEASURES: Lactose breath hydrogen (BH2) concentration after ingestion of lactose or lactulose; comparison before and after delivery of area under the curve (AUC) for lactose, oral-cecal transit time (OCTT) for lactulose, lactose-BH2-derived transit time and estimated dietary lactose consumption. RESULTS: After weaning (at a median time of 9 months after delivery), 28 of the women returned for follow-up. Of the 12 who could absorb lactose before delivery, 4 could no longer absorb lactose. Of the other 16 women, lactose intolerance worsened in 12, remained the same in 2 and improved in 2. The AUC was greater (p < 0.005), the maximal BH2 concentration was higher (p = 0.004) and the number of women whose BH2 concentration peaked was fewer (p < 0.025) post partum than before delivery. The women's symptoms during and after lactose BH2 tests were also greater post partum. The OCTT (based on the lactulose BH2 test) was shorter post partum (p = 0.001). Transit time derived from lactose BH2 tests was also shorter, but not significantly so. The OCTT was not inversely correlated with the change in AUC before and after delivery, but the lactose-BH2-derived transit time was inversely correlated. Pregnant women consumed more lactose before delivery than afterward (p < 0.004). CONCLUSIONS: Women with lactose malabsorption handle lactose better than usual in late pregnancy. Slow intestinal transit and bacterial adaptation to increased lactose intake may be primarily responsible.