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Background: Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran. Methods: This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019–2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05. Results: Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery. Conclusion: The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth. [ABSTRACT FROM AUTHOR]

Background: Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. Methods: This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. Results: Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. Conclusions: This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap. [ABSTRACT FROM AUTHOR]

Transition from antepartum to postpartum care is important, but often fragmented, and attendance at postpartum visits can be poor. Access to care is especially important for individuals diagnosed antepartum with conditions associated with longer-term implications, including gestational diabetes (GDM) and hypertensive disorders in pregnancy (HDP). Strategies to link and strengthen this transition are essential to support people to attend recommended appointments and testing. This narrative review evaluates what is known about postpartum transition of care after higher-risk antepartum conditions, discusses barriers and facilitators to uptake of recommended testing, and outlines strategies trialled to increase both postpartum attendance and testing. Barriers to attendance frequently overlap with general barriers to accessing healthcare. Specific postpartum challenges include difficulties with transport, coordinating breastfeeding and childcare access. Systemic challenges include inadequate communication to women around implications of health conditions diagnosed in pregnancy, and the importance of postpartum follow up. Uptake of recommended testing after a diagnosis of GDM and HDP is variable but generally suboptimal. Strategies which demonstrate promise include the use of patient navigators, focused education and specialised clinics. Reminder systems have had variable impact. Telehealth and technology are under-utilised in this field but offer promising options particularly with the expansion of virtual healthcare into routine maternity care. Strategies to improve both attendance rates and uptake of testing must be designed to address disparities in healthcare access and tailored to the needs of the community. This review provides a starting point to develop such strategies from the community level to the population level. [ABSTRACT FROM AUTHOR]

Background: Genitopelvic pain following childbirth is common and likely to challenge the psychological, relational, and sexual well-being of new mothers. While genitopelvic pain generally decreases during the postpartum period, personal and interpersonal characteristics may explain why genitopelvic pain persists beyond the period of physical recovery in some mothers. Body image concerns, increased stress, and relationship challenges would be particularly salient during pregnancy and the postpartum period, which could put new mothers at greater risk of sexual difficulties. Also, mothers may display a negative appraisal regarding genitopelvic pain and doubt their ability to cope with it, which may contribute to the pain. Aim: The current study aimed to examine the role of perfectionism, body image concerns, and perceived intimacy in the occurrence and change in genitopelvic pain in new mothers in postpartum. Methods: A total of 211 new mothers and their partners were recruited for a larger prospective dyadic study on the transition to parenthood. Outcomes: Mothers completed a single item assessing genitopelvic pain, in addition to brief validated questionnaires measuring perfectionism, body image concerns, and perceived couple intimacy during pregnancy and at 4, 8, and 12 months postpartum. Results: Five multilevel modeling analyses revealed that adaptive perfectionism, maladaptive perfectionism, and body image concerns were associated with a higher occurrence of genitopelvic pain from 4 to 12 months postpartum. Mothers' and partners' perceived intimacy was not significantly related to new mothers' genitopelvic pain. None of the predictors modified the trajectory of genitopelvic pain over time. Clinical Implications: Raising awareness among health care professionals regarding the role of perfectionism and body image concerns in genitopelvic pain may help them identify new mothers at risk of chronic genitopelvic pain, while offering a new avenue of intervention. Strengths and Limitations: There has been little research examining the role of perfectionism, body image concerns, and intimacy in postpartum genitopelvic pain. Based on a longitudinal prospective approach, this study identified perfectionism and body image concerns as significant predictors of postpartum genitopelvic pain. However, prepregnancy genitopelvic pain, genitopelvic pain intensity, and sexual distress were not measured. Conclusion: Adaptive and maladaptive perfectionism and body image concerns are associated with new mothers' genitopelvic pain up to 12 months postpartum. [ABSTRACT FROM AUTHOR]

This article discusses the complications that can arise from a previous caesarean section, specifically focusing on the caesarean scar defect. It emphasizes the importance of recognizing and managing these complications, as they can occur even after a successful vaginal birth after caesarean section. The article describes the anatomical changes of the caesarean scar defect and its relationship with placenta accrete spectrum disorder. It also addresses the management of these complications during pregnancy, including a technique for myometrial uterine repair. The article provides case studies to demonstrate how knowledge of scar anatomy can be used to manage complications related to the caesarean scar defect. The authors suggest the potential benefit of dedicated teams in Obstetrics and Gynecology departments to manage scar complications and improve outcomes. [Extracted from the article]

Background: This study aimed to determine whether birthing people who experience severe maternal morbidity (SMM) are more likely to be diagnosed with a postpartum mental illness. Materials and Methods: Using the Massachusetts All Payer Claims Database, this study used modified Poisson regression analysis to assess the association of SMM with mental illness diagnosis during the postpartum year, accounting for prenatal mental illness diagnoses and other patient characteristics. Results: There were 128,161 deliveries identified, with 55.0% covered by Medicaid. Of these, 3.1% experienced SMM during pregnancy and/or delivery hospitalization, and 20.1% had a mental illness diagnosis within 1 year postpartum. In adjusted regression analyses, individuals with SMM had a 10.6% increased risk of having any mental illness diagnosis compared to individuals without SMM, primarily due to an increased risk of a depression or post-traumatic stress disorder diagnosis among people with SMM than those without SMM. Conclusions: Individuals who experienced SMM had a higher risk of a mental illness diagnosis in the postpartum year. Given increases in SMM in the United States in recent decades, policies to mitigate mental health sequelae of SMM are urgently needed. [ABSTRACT FROM AUTHOR]

Background: There has been limited research on the lasting impact of giving birth on both mothers and infants. This study aimed to investigate women's memories of their childbirth experience 4 months and 4 years after giving birth. Additionally, it aimed to examine how the childbirth experience is linked to women's mental health, sexual satisfaction, exclusive breastfeeding, and the type of subsequent birth. Methods: In this prospective cohort study, a total of 580 women giving birth in Tabriz hospitals in 2018 were followed up for 4 years. The data were collected using a childbirth experience questionnaire, a mental health inventory, and a sexual satisfaction scale for women, and were analyzed by a Pearson correlation test, an independent samples t-test, and a general linear model. Results: The total scores of the childbirth experience in two short-term (4 months) and long-term (4 years) time points following the birth had a significant and strong correlation with each other (r =.51; p <.001). After adjusting for the effects of socio-demographic and obstetric characteristics, sexual satisfaction had significant relationships with childbirth experience (p <.001) and postpartum complications (p <.001). In addition, mental health had significant relationships with childbirth experience (p <.001), postpartum complications (p <.001), and low income (p =.004). Conclusions: Even 4 years after giving birth, women have a clear recall of their childbirth experience. This experience has a significant association with long-term outcomes such as sexual satisfaction, mental health, exclusive breastfeeding, and subsequent birth type. Plain Language Summary: Childbearing is a significant event in a mother's life. Women often remember the births of their babies distinctly, even after many years. However, some mothers do not perceive this life event as a positive one. Factors affecting this perception are multidimensional and may include demographic variables and obstetric events (e.g., immediate postpartum complications like hemorrhage), which contribute to negative childbirth experiences. It's important to note that women who feel unsupported or lack control during labour and childbirth are more likely to have negative birth experiences. Although a birth experience is influenced by various factors, this can have serious consequences, such as mental health problems, disrupted mother-infant bonding, and reluctance to have subsequent pregnancies or initiate or continue breastfeeding. Therefore, this study mainly aimed to investigate women's recollection of their childbirth experience at 4 months and 4 years after giving birth, as well as examine the correlation of childbirth experience with women's mental health, sexual satisfaction, exclusive breastfeeding, inclination to have children, and the type of next birth 4 years after the childbirth. [ABSTRACT FROM AUTHOR]

Background: Negative childbirth experiences can be related to the onset of perinatal post-traumatic stress symptomatology (P-PTSS), which significantly impacts the mother and the infant. As a response in the face of the discomfort caused by P-PTSS, maladaptive emotion regulation strategies such as brooding can emerge, contributing to the consolidation of post-partum depressive symptoms. Ultimately, both types of symptomatology, P-PTSS and post-partum depression, can act as risk factors for developing mother-child bonding difficulties. Still, this full set of temporal paths has to date remained untested. The present longitudinal study aimed to analyze the risk factors associated with the appearance of P-PTSS after post-partum and to test a path model considering the role of P-PTSS as an indirect predictor of bonding difficulties at eight months of postpartum. Methods: An initial sample of pregnant women in the third trimester of gestation (N = 594) participated in a longitudinal study comprising two follow-ups at two and eight months of postpartum. The mothers completed online evaluations that included socio-demographic data and measures of psychological variables. A two-step linear regression model was performed to assess the predictive role of the variables proposed as risk factors for P-PTSS, and a path model was formulated to test the pathways of influence of P-PTSS on bonding difficulties. Results: A history of psychopathology of the mother, the presence of depression during pregnancy, the presence of medical complications in the mother, and the occurrence of traumatic birth experiences all acted as significant predictors of P-PTSS, explaining 29.5% of its variance. Furthermore, the path model tested further confirmed an indirect effect of P-PTSS, triggered by a negative childbirth experience, on subsequent bonding difficulties eight months after labor through its association with higher levels of brooding and, ultimately, postpartum depression levels. A further path showed that bonding difficulties at two months postpartum can persist at eight months postpartum due to the onset of brooding and postpartum depression symptoms. Conclusion: We identified a set of robust predictors of P-PTSS: the mother's previous history of depression, perinatal depression during pregnancy, the presence of medical complications in the mother and the occurrence of traumatic birth experiences, which has important implications for prevention. This is particularly relevant, as P-PTSS, when triggered by a negative childbirth experience, further indirectly predicted the development of mother-child bonding difficulties through the mediation of higher use of brooding and symptoms of postpartum depression. These findings can serve as a basis for developing new longitudinal studies to further advance the understanding of perinatal mechanisms of mental health. [ABSTRACT FROM AUTHOR]

Background: The influence of gestational diabetes mellitus (GDM) on postpartum cardiometabolic indicators is primarily restricted to glucose and lipid metabolism, however the indicators for liver and kidney function have been rarely explored, and the role of the third-trimester inflammatory factors in these associations has never been investigated. Methods: Based on the Ma'anshan birth cohort (MABC), women with or without GDM history were selected and invited to participate in a 6-year postpartum follow-up. The fasting blood samples were collected to measure 16 comprehensive metabolic indicators during a 6-year postpartum follow-up: fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), triglycerides (TG), total cholesterol (TC), uric acid (UA), blood urea nitrogen (BUN), serum creatinine (SCR), etc. Seven inflammatory factors, including TNF-α, IFN-γ, IL-1β, IL-6, IL-10, IL-12p70, and IL-17 A, were measured with serum samples collected during the third trimester of pregnancy. Linear regression models were used to analyze the associations between GDM and 6-year postpartum metabolic indicators, GDM and third-trimester inflammatory factors, and the third-trimester inflammatory factors and 6-year postpartum metabolic indicators. Mediating and moderating effect analyses were further performed to explore if the third-trimester inflammatory factors mediate or modify the association between GDM and postpartum cardiometabolic indicators. Results: From July 2021 to August 2022, 307 participants have been followed up, with 99 women with a prior GDM history. Compared with those without GDM, individuals with a prior history of GDM had significantly elevated levels of FPG (β = 0.40, 95% CI: 0.18 to 0.62, PFDR < 0.001), HbA1c (β = 0.22, 95% CI: 0.09 to 0.34, PFDR = 0.009), TyG (β = 0.22, 95% CI: 0.07 to 0.37, PFDR = 0.024) at 6 years postpartum, and the association between GDM and SCR (β = 2.43, 95% CI: 0.02 to 4.85, PFDR = 0.144) reached nominal significance level. GDM history was associated with a decreased level of third-trimester IL-17 A (β = -0.58, 95% CI: -0.99 to -0.18, PFDR = 0.035). No significant association between third-trimester inflammatory factors and 6-year postpartum metabolic indicators was observed. And no mediating or moderating effect of third-trimester inflammatory factors was observed in those associations. Conclusion: A prior history of GDM was significantly associated with elevated FPG, HbA1c, and TyG in women at 6 years postpartum, whereas third-trimester inflammatory factors had no role in mediating or moderating these associations. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the prevalence of postpartum diabetes among women with a history of overt diabetes in pregnancy (ODiP) and compare with women having a history of gestational diabetes mellitus (GDM) and normoglycemia in pregnancy. Methods: We have an established longitudinal cohort of postpartum women with a history of hyperglycemia (preexisting diabetes [PED] [n = 101], ODiP [n = 92], GDM [n = 643]), and normoglycemia (n = 183) in pregnancy. For this study, we excluded women with PED and invited other eligible women in a fasting state for clinical and biochemical evaluation. Results: We evaluated 918 women with a mean (SD) age of 33.6 (5.0) years and at a median (interquartile range) postpartum interval of 31 (20–45) months. Diabetes was diagnosed in 65 (70.7%) women in ODiP compared to 99 (15.4%) in GDM (p <.001) and 4 (2.2%) in normoglycemia group (p <.001). In the ODiP group, the prevalence of diabetes was 47.4% among women tested in the first year postpartum, increasing to 86.8% among women tested at >3 years postpartum. Diabetes was more common when ODiP was diagnosed in the first (27/29, 93.1%) compared to the second trimester of pregnancy (35/57, 61.4%). The adjusted odds ratio for diabetes in ODiP was 14.82 (95% confidence interval, 8.49–25.87; p <.001; reference category: GDM). Conclusions: The prevalence of postpartum diabetes was significantly higher in women with ODiP compared to GDM. Nearly 50% of women with ODiP did not develop diabetes in the first year of follow‐up, especially when ODiP was diagnosed after the first trimester of pregnancy and on the basis of a 2‐h oral glucose tolerance test value. Such women are amenable to prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: Although several biologic, psychosocial, and behavioral factors have been linked to postpartum depressive symptoms, studies examining the association between non‐cigarette tobacco products and symptoms of postpartum depression are currently lacking. This study examined the association between hookah use and postpartum depressive symptoms. Methods: A cross‐sectional study was conducted using data from the US Centers for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System 2016–2020. Self‐reported data on hookah use in the last 2 years and maternal mental health were captured using a structured questionnaire. Descriptive and inferential statistics were performed. Results: The final study sample consisted of 106 894 participants. Approximately 8.2% of the participants reported postpartum depressive symptoms and 4.1% reported hookah use in the past 2 years. Compared with those without postpartum depressive symptoms, participants with postpartum depressive symptoms were more likely to be hookah users (5.5% vs 4.0%, P < 0.001). After adjustment for confounders, the odds of having postpartum depressive symptoms were significantly higher among participants who used a hookah in the past 2 years compared with non‐users; adjusted odds ratio (95% confidence interval) 1.20 (1.03–1.40); P = 0.022. Conclusion: In a large, population‐based sample of US women, hookah use in the past 2 years significantly increased the odds of having postpartum depressive symptoms, independent of potential confounders. This finding underscores the need for healthcare providers to communicate effectively about the health risks of hookah use. Synopsis: Hookah use increases the odds of postpartum depressive symptoms, emphasizing the need for awareness and communication about the risks during prenatal visits. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effect of Andrographis paniculata (A. paniculata) supplementation in sow diets before and after farrowing on the sow and piglets' performances during early postpartum period and on sows' backfat and longissimus muscle losses during lactation. Methods: Seventy Landrace×Yorkshire sows and their offspring (1,186 piglets) were distributed into three groups: control (n = 31), treatment-250 (n = 18), and treatment-1000 (n = 21). From 110.2±0.7 days of gestation until farrowing (5.8 days) and throughout the lactation period (25.2 days), sows in the control group were given the conventional lactation diet, while sows in the treatment-250 and treatment-1000 groups received supplements of 250 ppm and 1,000 ppm of A. paniculata, respectively. Results: In sows with parity 3-5, piglets from the treatment-1000 group had higher colostrum intake than the control and treatment-250 groups (p<0.05), but not in sows with parity 6-9. Colostrum immunoglobulin G (IgG) increased in treated sows versus controls for parity 6-9 (p<0.05), but was consistent for parity 3-5. Piglet performance until day 3 postnatal was similar across groups (p>0.05). Treatment-250 sows had higher feed intake post-farrowing than treatment-1000 sows (p<0.05). Longissimus loss was less in both treatment groups than control (p<0.05), but backfat loss was similar across groups (p>0.05). Post-partum complications were consistent across groups (p>0.05). Farrowing duration and piglet birth intervals in sows with parity 6-9 were prolonged in the treatment-1000 group. Conclusion: Supplementing with 1,000 ppm A. paniculata for 5.8 days pre-farrowing and 25.2 days post-farrowing enhanced sow colostrum IgG and piglet colostrum intake, while also reducing longissimus loss in sows. However, for sows of parity 6-9, this supplementation led to prolonged farrowing, increased intervals between piglet births, increased stillbirth, and reduced piglet birth weight. These effects should be considered when using A. paniculata supplementation. [ABSTRACT FROM AUTHOR]

Objective: The impact of first stage labour duration on maternal outcomes is sparsely investigated. We aimed to study the association between a longer active first stage and maternal complications in the early postpartum period. Design: A population‐based cohort study. Setting: Regions of Stockholm and Gotland, Sweden, 2008–2020. Population: A cohort of 159 459 term, singleton, vertex pregnancies, stratified by parity groups. Methods: The exposure was active first stage duration, categorised in percentiles. Poisson regression analysis was performed to estimate the adjusted relative risk (aRR) and the 95% confidence interval (95% CI). To investigate the effect of second stage duration on the outcome, mediation analysis was performed. Main outcome measures: Severe perineal lacerations (third or fourth degree), postpartum infection, urinary retention and haematoma in the birth canal or ruptured sutures. Results: The risks of severe perineal laceration, postpartum infection and urinary retention increased with a longer active first stage, both overall and stratified by parity group. The aRR increased with a longer active first stage, using duration of <50th percentile as the reference. In the ≥90th percentile category, the aRR for postpartum infection was 1.64 (95% CI 1.46–1.84) in primiparous women, 2.43 (95% CI 1.98–2.98) in parous women with no previous caesarean delivery (CD) and 2.33 (95% CI 1.65–3.28) in parous women with a previous CD. The proportion mediated by second stage duration was 33.4% to 36.9% for the different outcomes in primiparous women. The risk of haematoma or ruptured sutures did not increased with a longer active first stage. Conclusions: Increasing active first stage duration is associated with maternal complications in the early postpartum period. [ABSTRACT FROM AUTHOR]

Objective: The study examines the outcomes of pregnancies conceived at advanced maternal age (AMA) and maternal complications after childbirth among Meitei women of Northeast India. Method: A total of 760 women participants were included in this study and compared among women aged ≥35 years, with a reference group of women aged 20–34 years. Data on obstetric characteristics were collected after obtaining consent. The data were compared using chi‐square analysis, and the results were adjusted using a logistic regression model. Decision trees were developed to predict the potential variables associated with preterm delivery and postpartum complication. Results: In the study, 18.95% of AMA women experienced one or more adverse pregnancy outcomes (APOs). Women with AMA are at significantly increased risk of placenta previa (adjusted odds ratio [AOR] = 4.89, 95% confidence interval [CI]: 2.78–8.57), induction of labor (AOR = 3.69, 95%CI: 2.48–5.50), and caesarean section (AOR = 3.42, 95%CI: 2.28–5.12). Moreover, AMA women have a 1.86–2.76 AOR for developing gestational diabetes, pregnancy‐induced hypertension, urinary tract infections, preterm delivery, and postpartum complications. Decision tree analysis revealed that AMA and urban residence independently predict preterm delivery and postpartum complications. Conclusion: The study's findings confirm the adverse impact of AMA on pregnancy outcomes and postpartum complications. Such issues should be addressed, and counseling on the risk of AMA should be provided, particularly for those in the high‐risk group. Further prospective studies are needed to understand other potential risk factors of APOs and the impact of AMA complications to prevent the associated burden. [ABSTRACT FROM AUTHOR]

Background: The early postnatal period is defined as the first 48 h to 7 days after delivery. The early postnatal visit is especially the most critical time for the survival of mothers and newborns, particularly through early detection and management of postpartum complications. Despite the benefits, most mothers and newborns do not receive early postnatal care services from healthcare providers during the critical first few days after delivery. Objectives: This study is aimed at assessing the prevalence of early postnatal care utilization and associated factors among mothers who gave birth within the last 6 weeks in Hosanna town, Southern Ethiopia, from April 20 to May 30, 2022. Method: A community-based cross-sectional study was conducted in Hadiya Zone, Hosanna town, Southern Ethiopia. A simple random sample technique was used to recruit 403 mothers who had given birth in the previous 6 weeks from a family folder. Data was collected through face-to-face interviews using a standardized questionnaire. Binary logistic regression was used to assess the association between outcomes and explanatory variables, and the strength of the association was interpreted using an odds ratio with a 95% confidence interval. In our study, p values of 0.05 were considered statistically significant. Results: The prevalence of early postnatal care utilization among mothers who gave birth within 1 week of the study area was 25.8% (95% CI: 21.7–30.0). No formal and primary educational level of husband (AOR = 0.05 , 95% CI: [0.02, 0.16]), antenatal care follow-up (AOR = 2.13 , 95% CI: [1.11, 4.1]), length of hospital stay before discharge (≥24 h) (A O R = 0.3 , 95% CI: [0.16, 0.55]), and information about early postnatal care utilization (AOR = 3.08 , 95% CI: [1.72, 5.52]) were factors significantly associated with early postnatal care utilization. Conclusion: In comparison to World Health Organization standards, the study's overall prevalence of early postnatal care utilization was low. Early postnatal care use was significantly associated with antenatal care follow-up, the husband's educational level, knowledge of early postnatal care use, and length of stay at the health institution following birth. As a result, the strength of health facilities is to improve service provision, information education, and communication. [ABSTRACT FROM AUTHOR]

Background: Short-term poor uterine involution manifests as uterine contraction weakness. This is one of the important causes of postpartum hemorrhage, posing a serious threat to the mother's life and safety. The study aims to investigate whether low-intensity focused ultrasound (LIFUS) can effectively shorten lochia duration, alleviate postpartum complications, and accelerate uterine involution compared with the sham treatment. Methods: A multicenter, concealed, randomized, blinded, and sham-controlled clinical trial was conducted across three medical centers involving 176 subjects, utilizing a parallel group design. Enrollment occurred between October 2019 and September 2020, with a 42-day follow-up period. Participants meeting the inclusion and exclusion criteria based on normal prenatal examinations were randomly divided into the LIFUS group or the sham operation group via computer-generated randomization. Patients in the LIFUS group received usual care with the LIFUS protocol, wherein a LIFUS signal was transmitted to the uterine site through coupling gel, or sham treatment, where no low-intensity ultrasound signal output was emitted. The primary outcome, lochia duration, was assessed via weekly telephonic follow-ups post-discharge. The involution of the uterus, measured by uterine fundus height, served as the secondary outcome. Results: Among the 256 subjects screened for eligibility, 176 subjects were enrolled and randomly assigned to either the LIFUS group (n = 88) or the Sham group (n = 88). Data on the height of the uterine fundus were obtained from all the patients, with 696 out of 704 measurements (99%) successfully recorded. Overall, a statistically significant difference was noted in time to lochia termination (hazard ratio: 2.65; 95% confidence interval [CI]: 1.82–3.85; P < 0.001). The decline in fundal height exhibited notable discrepancies between the two groups following the second treatment session (mean difference: −1.74; 95% CI: −1.23 to −2.25; P < 0.001) and the third treatment session (mean difference: −3.26; 95% CI: −2.74 to −3.78; P < 0.001) after delivery. None of the subjects had any adverse reactions, such as skin damage or allergies during the treatment. Conclusions: This study found that LIFUS treatment can promote uterine involution and abbreviate the duration of postpartum lochia. Ultrasound emerges as a safe and effective intervention, poised to address further clinical inquiries in the domain of postpartum rehabilitation. [ABSTRACT FROM AUTHOR]

Both mothers and fathers are at risk for experiencing postpartum depressive symptoms shortly after the birth of a child. Previous studies suggest mothers' and fathers' depressive symptoms to be interrelated. This study examined bidirectional relations between mothers' and fathers' depressive symptoms across four years postpartum. Longitudinal data for this study were collected across five waves from 485 mothers and 359 fathers of infants when infants were on average 6 months-old until children were 54 months-old (1-year lags). Mothers and fathers reported on their depressive symptoms using the Center for the Epidemiological Studies Short Depression Scale (CES-D 10). A random intercept cross-lagged panel model (RICLPM) was specified to examine the bidirectional relations between mothers' and fathers' depressive symptoms over time. At the between-person level, mothers' and fathers' depressive symptoms were positively associated. At the within-person level, unique carry-over effects were found for mothers and fathers in that when reporting higher depressive symptoms than their trait levels, they were more likely to report higher depressive symptoms one year later. Moreover, intermittent cross-lagged effects were observed from mothers' depressive symptoms to fathers' depressive symptoms during toddlerhood. The sample was not racially or structurally diverse thereby limiting the generalizations of the findings. After the birth of a child, mothers and fathers are at risk for experiencing chronic depressive symptoms which can have implications for individual, couple and child health. Mothers' depressive symptoms are related to fathers' depressive symptoms over time. • Mothers' and fathers' depressive symptoms are related across the first four years postpartum. • Carry-over effects were observed for both mothers and fathers. • Intermittent spillover effects were observed from mothers' depressive symptoms to fathers' depressive symptoms one-year later. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of carbetocin and oxytocin in the prophylaxis of postpartum hemorrhage (PPH). Methods: Data from 136 cases who gave birth at Selçuk University Faculty of Medicine Hospital between January 1, 2023, and September 30, 2023, were retrospectively analyzed. Cases with risk factors for PPH were not included in the study. Data on mothers who received carbetocin and oxytocin during the active management of birth were obtained from the hospital electronic system and patient files. The amount of PPH was compared between the two groups. Results: Carbetocin was administered to 67 cases in the study group and oxytocin to the remaining 69 cases. No statistically significant difference was found between the two groups in terms of changes in hemoglobin (Hgb) (0.6±0.9-0.7±0.8), hematocrit (Htc) (2.0±3.0- 2.1±2.3), and platelet (Plt) (10.6±56.8-14.2±32.8) (p: 0.790, p: 0.733, p: 0.645). The estimated blood loss was 306±113 milliliters (mL) in the carbetocin group, while it was 333.05±165 mL in the oxytocin group (p=0.715). The estimated blood loss in vaginal births was 319.1±157 mL in the oxytocin group and 294±109 mL in the carbetocin group (p=0.576). In the Cesarean section (CS) group, the estimated blood loss was 354.0±172 mL in the oxytocin group and 323±128mL in the carbetocin group (p=0.691). Conclusion: Oxytocin and carbetocin demonstrate similar efficacy in the prophylaxis of PPH. Carbetocin can be safely used as an alternative to oxytocin in cases with low risk. [ABSTRACT FROM AUTHOR]

The risk of venous thromboembolism (VTE) is increased postpartum and contributes to important morbidity and mortality. While there have been advances in evaluating diagnostic algorithms for suspected VTE during pregnancy, there is limited data for postpartum individuals. We conducted a scoping review to describe and evaluate diagnostic strategies used to investigate suspected VTE in postpartum individuals. A comprehensive search strategy was conducted in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (January 1, 2000-September 30, 2022) to identify original articles that reported on diagnostic strategies in postpartum individuals with suspected VTE. We extracted demographics, clinical decision rules used, D-dimer and imaging completed, including test performance and VTE outcomes. A total of 13 studies conducted across 11 countries with separate postpartum data were included for 759 individuals with suspected PE (n = 634) or DVT (n = 125), including unpublished data (n = 251). Among those with suspected PE, computed tomography pulmonary angiography was conducted more commonly (n = 522) than ventilation-perfusion scans (n = 69), with PE positivity rates that ranged from 4 %–27.6 % and 0–50 % across studies, respectively. Among 131 postpartum individuals with suspected PE who had a D-dimer measured, only 4.6 % (6/131) had a negative D-dimer test. For postpartum individuals with suspected DVT, the most common diagnostic test was compression ultrasonography (positivity rate 12.2 %–18.6 %). There were limited retrospective data evaluating the clinical decision rules. There are heterogeneous approaches globally in the diagnosis of suspected postpartum VTE. Limited high-quality data available underscores the need for more robust evidence to inform clinical practice. • How best to evaluate suspected VTE in postpartum individuals is unknown. • This scoping review evaluates diagnosis of suspected VTE in postpartum individuals. • Postpartum, CT pulmonary angiography was the most common test for suspected PE. • There is heterogeneity globally in the diagnosis of suspected postpartum VTE. [ABSTRACT FROM AUTHOR]

Introduction: For women presenting with breast cancer during pregnancy, treatment guidelines were historically restricted to only surgical treatment. Over the past decades, chemotherapy administered during pregnancy has been gradually introduced. Although breast cancer treatments during ongoing pregnancy have been deemed safe, detailed information on potential obstetric risks is lacking. We aimed to assess the risk of adverse obstetric and perinatal outcomes of breast cancer in pregnancy and within 1 year postpartum and in relation to trimester at breast cancer diagnosis, tumor stage, and cancer treatment during pregnancy. Material and methods: Population‐based matched study. Women diagnosed with breast cancer during pregnancy in 1973–2017 were identified in the Swedish Cancer Register and the Medical Birth Register, with additional information from the National Quality Register for Breast Cancer. Each birth with maternal breast cancer (n = 208 pregnant, n = 672 postpartum) was matched by age, calendar year, and birth order to 10 unexposed births from cancer‐free women in the population (n = 2080 and n = 6720). Adjusted conditional logistic and multinomial regression models were used to estimate odds ratios and relative risk ratios, commonly denoted relative risks (RR) with 95% confidence intervals (CI), of adverse obstetric and perinatal outcomes. Results: Breast cancer during pregnancy was associated with higher risks of preterm birth, both planned (RR 67.1, 95% CI 33.2–135.6) and spontaneous preterm birth (RR 3.8, 95% CI 2.0–7.5), and low birthweight (<2500 g: RR 7.5, 95% CI 4.9–11.3). The associated risks were higher if the breast cancer was diagnosed in the second trimester, and of similar magnitude irrespective of stage and treatment groups. There was a higher risk of low birthweight for gestational age (<25th centile) if breast cancer was diagnosed in the first trimester (RR 2.8, 95% CI 1.1–7.3). Risks of other pregnancy complications were similar to those of unexposed women, as were risks of neonatal mortality and malformations. Postpartum breast cancer was only associated with bleeding during pregnancy (RR 1.6, 95% CI 1.0–2.8). Conclusions: Preterm birth and related adverse outcomes were more common in women diagnosed with breast cancer during pregnancy. Reassuringly, breast cancer was not associated with other maternal pregnancy complications or adverse outcomes in children. [ABSTRACT FROM AUTHOR]

Background: At the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, studies showed that the risk of severe disease was higher in pregnant women. Objective: This study investigates the characteristics of severe and critical types of COVID-19 coronavirus infection in pregnant women. Materials and Methods: This prospective cross-sectional study compared the medical records of 120 pregnant women with severe and very severe COVID-19 treated at the Infectious Disease Center, Shymkent, Kazakhstan from December 2021 to May 2022. Factors such as time of hospital admission, hospitalization period, maternal comorbidities, age, pregnancy and postpartum complications, pregnancy outcomes, and treatment type were analyzed. Results: 87 (72.5%) pregnant women with severe and 33 (27.5%) with critical type of COVID-19 were included. The following data were obtained when comparing the pregnancy parity of the subjects, depending on the gestational age: in 1-12 wk, the indicator was 3.75 ± 0.95; in 13-27 wk 3.00 (Q1-Q3: 2.00-4.00), in 28-40 wk 3.00 (Q1-Q3: 2.00-4.00). Severe COVID-19 coronavirus infection occurs in women with more than a third pregnancy (Me 3.00 [Q1-Q3: 2.00-4.00]). Conclusion: There is a risk of disease progression to severe and critical COVID-19 in pregnant women older than 33 yr of age and at 28-40 wk gestation. Early referral to a doctor in hospital, timely hospitalization, and initiated treatment reduces the risk of aggravation of the patient's condition and development of formidable complications. [ABSTRACT FROM AUTHOR]

Simple Summary: A high percentage of mares (92–94%) exhibit foal heat in the first 21 days postpartum, and insemination during this estrus is critical to ensure a higher fertility rate per breeding season. A retrospective descriptive study evaluated follicular dynamics peripartum and at foal heat, uterine edema, and endometrial cytology between mares that did or did not become pregnant when inseminated. Mares became pregnant if inseminated when the foal heat started from the second postpartum week, had a lower growth rate of the larger diameter follicle and had an adequate degree of edema compared to non-pregnant mares. No studies have evaluated the peripartum follicular dynamics resulting in foal heat under tropical environments. We aimed to assess retrospectively the peripartum follicular dynamics in Colombian Paso Fino mares that were inseminated at the foal heat, becoming pregnant or not. Records including follicular dynamics of pregnant mares prepartum and from foaling until foal heat ovulation were assessed in Colombian Paso Fino mares (CPF, n = 24) bred under permanent grazing in a tropical herd in Colombia. The number of ovarian follicles >10 mm before foaling and the largest follicle (F1) growth rate (mm/day) from foaling until the F1 reached the largest diameter (pre-ovulatory size) at the foal heat were assessed. Mares were inseminated at foal heat with 20 mL of semen (at least 500 million live spermatozoa) with >75% motility and 80% viability from a stallion of proven fertility. Ovulation was confirmed the day after follicles had reached the largest diameter. Quantitative data from follicular growth, the day at ovulation, from mares that became pregnant (PM) or not (NPM) at 16 days post-insemination were compared by one-way ANOVA, repeated measures ANOVA (follicle growth rate data) or Chi-square test (edema and cytology scores data). Epidemiological data, gestation length, and the number of follicles on third prepartum days did not significantly differ between PM and NPM (p > 0.05). Seventy-one percent of mares (17/24) got pregnant. Ovulatory follicles grew faster in the NPM group (n = 7), which ovulated between the seventh and ninth postpartum days, compared to PM (n = 17), which ovulated between the 11th and 13th postpartum days. Pre-ovulatory follicle diameter in PM (48.57 ± 0.8 mm) was significantly larger than in NPM (42.99 ± 1.0 mm) (p < 0.05). In addition, the PM edema score (2.93 ± 0.32 mm) on ovulation day was significantly lower (p < 0.05) than NPM (4.47 ± 0.05 mm). First postpartum ovulation occurred at 12.6 ± 0.3 and 8.5 ± 0.4 days (p < 0.05) in PM and NPM, respectively. Colombian Paso Fino mares bred under permanent grazing under tropical rainforest conditions with no foaling or postpartum complications showed a 71% gestation rate when inseminated at foal heat when ovulation occurs between the second and third postpartum week. [ABSTRACT FROM AUTHOR]

Postpartum psychosis (PP) is a severe psychiatric illness that occurs in about 1 to 2 per 1000 people in the perinatal period. To date, qualitative research investigating PP has focused on specific topics, such as treatment experiences or the impact of the illness on patients' lives and families. These studies have included small samples of women with histories of PP, often limited to certain geographical areas or treatment centers. Given the heterogeneity in presentations of PP and access to care, larger and geographically diverse samples are needed to broadly understand this complex illness. Initiated in 2018, the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) consists of a large, international sample of those who have experienced PP. In addition to the specific aims of MGHP3, which include to better understand the phenomenology and potential genetic underpinnings of PP, this investigation invites participants to qualitatively describe their narratives of postpartum psychosis. This analysis included 130 participants who reported on 133 episodes of PP. Participants' responses to the PP narrative prompt fell under several overarching categories: 1) broad psychosocial experiences surrounding postpartum psychosis, 2) impact on the mother-baby dyad, 3) treatment experiences, and 4) recovery experiences. Our findings shed light on a range of ways in which individuals' lives are impacted by this illness, and point to areas for future research and clinical directions to improve the support and care for individuals with PP and their families. • This study highlights qualitative findings from the Massachusetts General Hospital Postpartum Psychosis Project (MGHP3). • MGHP3 consists of a large international sample of women who have experienced and described their narratives of PP. • Their responses fell under themes: broad psychosocial experience, mother-baby dyad, and treatment and recovery experiences. • These qualitative findings point to future work to improve support and care for individuals with PP and their families. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is an illness that is difficult for the affected women themselves to recognize. Moreover, many mothers believe that mothers should not complain about the mental difficulties of taking care of their children. Therefore, in addition to self-evaluation for PPD, evaluation from others is also necessary. We aimed to develop a novel measure to screen for PPD based on a parent-rating scale that is administered to the parents of postpartum mothers. The 15-item maternity-monitoring scale by parents (MMSP) was designed and applied to the feasibility cohort (n = 61) and the emergency cohort (n = 55). The Edinburgh Postnatal Depression Scale (EPDS) (threshold score of 8/9) was used to evaluate a high risk of PPD. An egogram-based index, the over-adaptation index for depression (OAID), was performed along with the EPDS and MMSP. In the feasibility cohort, MMSP was moderately correlated with EPDS. In the emergency cohort, under the circumstance of the state of emergency declaration over the coronavirus disease 2019 in Japan, application of the MMSP was delayed, resulting in the proportion of parents who overlooked PPD symptoms in their daughters increasing from 33 % to 50 %. Our findings suggest that a novel approach of parent-rated PDD screening of postpartum women is potentially possible, and the MMSP is a potential candidate for screening. Moreover, the OAID is also helpful in identifying women with hidden PPD, along with the EPDS. The performance of the MMSP should be confirmed in the parents of patients with PPD diagnosed by psychiatrists. • The Edinburgh Postnatal Depression Scale (EPDS) has been the most used measurement of PPD, but required greater precision. The novel approach, parent-rating depression screening MMSP and over-adaptation index for depression OAID, are helpful to distinguish PPD. The MMSP, followed by a composite measure constructed using the EPDS and OAID, will broadly contribute to the screening of PPD. [ABSTRACT FROM AUTHOR]

Evidence maps illustrate connections between racism and social and structural determinants of health exposures, and nine outcome domains of maternal health and morbidity. OBJECTIVE: To identify the social–structural determinants of health risk factors associated with maternal morbidity and mortality in the United States during the prenatal and postpartum periods. DATA SOURCES: We searched MEDLINE, CINAHL, and Social Sciences Citation Index through November 2022 for eligible studies that examined exposures related to social and structural determinants of health and at least one health or health care–related outcome for pregnant and birthing people. METHODS OF STUDY SELECTION: After screening 8,378 unique references, 118 studies met inclusion criteria. TABULATION, INTEGRATION, AND RESULTS: We grouped studies by social and structural determinants of health domains and maternal outcomes. We used alluvial graphs to summarize results and provide additional descriptions of direction of association between potential risk exposures and outcomes. Studies broadly covered risk factors including identity and discrimination, socioeconomic, violence, trauma, psychological stress, structural or institutional, rural or urban, environment, comorbidities, hospital, and health care use. However, these risk factors represent only a subset of potential social and structural determinants of interest. We found an unexpectedly large volume of research on violence and trauma relative to other potential exposures of interest. Outcome domains included maternal mortality, severe maternal morbidity, hypertensive disorders, gestational diabetes, cardiac and metabolic disorders, weathering depression, other mental health or substance use disorders, and cost per health care use outcomes. Patterns between risk factors and outcomes were highly mixed. Depression and other mental health outcomes represented a large proportion of medical outcomes. Risk of bias was high, and rarely did studies report the excess risk attributable to a specific exposure. CONCLUSION: Limited depth and quality of available research within each risk factor hindered our ability to understand underlying pathways, including risk factor interdependence. Although recently published literature showed a definite trend toward improved rigor, future research should emphasize techniques that improve the ability to estimate causal effects. In the longer term, the field could advance through data sets designed to fully ascertain data required to robustly examine racism and other social and structural determinants of health, their intersections, and feedback loops with other biological and medical risk factors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022300617. [ABSTRACT FROM AUTHOR]

Purpose: Postpartum psychosis (PPP) is a serious mental health illness affecting women post-parturition. Around 1 in 1000 women are affected by postpartum psychosis, and the symptoms usually appear within 2 weeks after birth. Postpartum mental disorders are classified into 3 main categories starting from the least to most severe types, including baby blues, postpartum depression, and postpartum psychosis. Materials and Methods: In this systematic review, genetic and epigenetic factors associated with postpartum psychosis are discussed. A PRISMA flow diagram was followed, and the following databases were used as main sources: PubMed, ScienceDirect, and Scopus. Additional information was retrieved from external sources and organizations. The time period for the articles extracted was 5 years. Results: Initially, a total of 2379 articled were found. After the stated criteria were applied, 58 articles were identified along with 20 articles from additional sources, which were then narrowed down to a final total of 29 articles. Conclusions: It can be concluded that there is an association between PPP and genetic and epigenetic risk factors. However, based on the data retrieved and examined, the association was found to be greater for genetic factors. Additionally, the presence of bipolar disorder and disruption of the circadian cycle played a crucial role in the development of PPP. [ABSTRACT FROM AUTHOR]

Objective As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m 2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. Study Design The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m 2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40–49.9, 50–59.9, 60–69.9, and >70 kg/m 2). Results Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50–59.9 kg/m 2 ; 13.7% BMI: 60–69.9 kg/m 2 ; and 21.9% BMI >70+ kg/m 2 ; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50–59.9 kg/m 2 ; 6.2% for BMI: 60–69.9 kg/m 2 ; and 9.4% for BMI >70+ kg/m 2 ; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m 2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m 2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37–29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35–4.02 for BMI 50–59.9 kg/m 2 ; aOR = 4.91, 95% CI: 2.07–11.7 for BMI of 60–69.9 kg/m 2 ; and aOR = 36.2, 95% CI: 7.45–176 for BMI >70 kg/m 2). Conclusion Women with BMI 50 to 70+ kg/m 2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m 2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. Key Points Women with super obesity have higher rates of wound complications. Women at extremes of obesity experience worse postpartum infectious morbidity. More research is needed on effective strategies to minimize morbidity in this population. [ABSTRACT FROM AUTHOR]

Purpose: Pre-conceptual comorbidities, an inherent risk of graft loss, rejection during pregnancy, and the postpartum period in women with thoracic lung transplant may predispose them to increased risk of adverse feto-maternal outcomes. The study aimed to systematically analyze and assess the risk of adverse pregnancy outcomes in women with thoracic organ transplant. Methods: MEDLINE, EMBASE, and Cochrane library were searched for publication between January 1990 and June 2020. Risk of bias was assessed using Joanna Briggs critical appraisal tool for case series. The primary outcomes included maternal mortality and pregnancy loss. The secondary outcomes were maternal complications, neonatal complications, and adverse birth outcomes. The analysis was performed using the DerSimonian–Laird random effects model. Results: Eleven studies captured data from 275 parturient with thoracic organ transplant describing 400 pregnancies. The primary outcomes included maternal mortality {pooled incidence (95% confidence interval) 4.2 (2.5–7.1) at 1 year and 19.5 (15.3–24.5) during follow-up}. Pooled estimates yielded 10.1% (5.6–17.5) and 21.8% (10.9–38.8) risk of rejection and graft dysfunction during and after pregnancy, respectively. Although 67% (60.2–73.2) of pregnancies resulted in live birth, total pregnancy loss and neonatal death occurred in 33.5% (26.7–40.9) and 2.8% (1.4–5.6), respectively. Prematurity and low birth weight were reported in 45.1% (38.5–51.9) and 42.7% (32.8–53.2), respectively. Conclusions: Despite pregnancies resulting in nearly 2/3rd of live births, high incidence of pregnancy loss, prematurity and low birth weight remain a cause of concern. Focused pre-conceptual counseling to avoid unplanned pregnancy, especially in women with transplant-related organ dysfunctions and complications, is vital to improve pregnancy outcomes. PROSPERO number: CRD42020164020. [ABSTRACT FROM AUTHOR]

Women with bipolar disorder (BD) are at high risk of postpartum psychosis (PP). The factors that increase risk of PP among women with BD are not fully understood. Here, we examine whether sleep disruption in the perinatal period (poor sleep quality in late pregnancy and sleep deprivation related to childbirth) is associated with PP in a longitudinal study of pregnant women with BD. Participants were 76 pregnant women with lifetime DSM-5 bipolar I disorder or schizoaffective-BD, followed from week 12 of pregnancy to 12 weeks postpartum. Demographics and lifetime psychopathology were assessed at baseline via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry). Psychopathology and sleep disruption within the current perinatal period were assessed in the third trimester and at 12 weeks postpartum. Data were supplemented by clinician questionnaires and case-note review. After controlling for prophylactic use of mood stabilising medication, the loss of at least one complete night of sleep across labour/delivery was associated with five times the odds of experiencing PP compared to no or less than one night of sleep loss across labour/delivery (OR 5.19, 95 % CI 1.45–18.54; p = 0.011). Sleep quality in late pregnancy was not associated with PP, and perinatal sleep disruption was not associated with postpartum depression. Lack of objective measures of sleep factors. In the context of other aetiological factors, severe sleep loss associated with childbirth/the immediate postpartum may act as a final trigger of PP. These findings could have important clinical implications for risk prediction and prevention of PP. • Perinatal sleep factors and postpartum psychiatric outcomes assessed longitudinally • Acute, childbirth related sleep loss associated with postpartum psychosis • No relationship between perinatal sleep factors and postpartum depression. • Implications for risk prediction of postpartum psychosis in bipolar disorder [ABSTRACT FROM AUTHOR]

Introduction: Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown. Material and methods: This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25‐hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25‐hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders. Results: Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage. Conclusions: In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Background: Postpartum dysfunctions and complications can occur in women. However, functional assessment should be conducted to make treatment plans before any intervention is implemented. In this context, the International Classification of Functioning, Disability and Health (ICF) may be a useful tool for women postpartum to document functional data and set rehabilitation goals. The purpose of this study was to determine the corresponding domains that should be considered in the evaluation of women's postpartum functioning based on the International Classification of Functioning, Disability and Health (ICF) model using the Delphi method. Methods: Fifteen domestic experts were invited to conduct two rounds of expert consensus survey on the ICF-based postpartum functional assessment category pool obtained through literature retrieval, clinical investigation, and reference to relevant literature. The sample was medical staff with professional knowledge of women's health. The opinions of experts were summarized, and the positive coefficient, authority coefficient and coordination degree of experts were calculated. Results: A total of 15 domestic experts participated in this expert consensus. Through two rounds of a questionnaire survey, 69 items were finally selected to form the ICF-based postpartum functional assessment tool for women. The items included 32 items of body function, 12 items of body structure, 17 items of activity and participation, and 8 items of environmental factors. In addition, we identified 8 items of personal factors. The expert positive coefficients of the two rounds of expert consensus were both 100%, the authority coefficient was 0.789, and the coefficient of variation was between 0.09 to 0.31. Conclusion: A postpartum functional assessment tool for women based on the ICF model was constructed based on the Delphi method, which can provide more comprehensive health management and life intervention for postpartum women. Trial registration: The Registration number of the Chinese Clinical Trial Registry is ChiCTR2200066163, 25/11/2022. [ABSTRACT FROM AUTHOR]

Introduction. The postpartum period is considered a period of increased risk of developing bipolar affective disorder (BDII) type II. According to the available data, postpartum BDII is a highly neglected area of observation, with negative consequences for mothers, offspring, and the family as a whole. Case report. The paper describes the case of a patient with symptoms of a depressive episode of atypical features following childbirth. The patient had one mild postpartum depression episode and multiple previously detected hypomania-like episodes. Postpartum depression and bipolar affective disorder were detected in the family history. Escitalopram 20 mg in combination with Lamotrigine 200 mg was prescribed. There were no detected side effects to the prescribed therapeutic dose, and there have been no relapses so far. Conclusion. During pregnancy and postpartum, women should be screened for BDII. Based on the experience from the presented case, the combination of escitalopram and lamotrigine has shown promising results and complies with all recommended BDII treatment guidelines. [ABSTRACT FROM AUTHOR]

Background: Intravenous iron (IV-iron) is used as an alternative to, or alongside, red blood cell transfusion (RBC-T) to treat more severe postpartum anemia (PPA), although optimal treatment options remain unclear. No previous systematic reviews have examined IV-iron and RBC-T, including patient-reported outcomes and hematological responses. Methods: A systematic review and meta-analysis of randomized trials comparing IV-iron and RBC-T with each other, oral iron, no treatment, and placebo for the treatment of PPA. Key inclusion criteria were PPA (hemoglobin < 12 g/dL) and IV-iron or RBC-T as interventions. Key exclusion criteria were antenatal IV-iron or RBC-T. Fatigue was the primary outcome. Secondary outcomes included hemoglobin and ferritin concentrations, and adverse events. From 27th August 2020 to 26th September 2022, databases, registries, and hand searches identified studies. A fixed-effect meta-analysis was undertaken using RevMan (5.4) software. The quality of the studies and the evidence was assessed using the Cochrane Risk of Bias table, and Grading of Recommendations, Assessment, Development, and Evaluation. This review is registered with the Prospective Register of Systematic Reviews (CRD42020201115). Results: Twenty studies and 4196 participants were included: 1834 assigned IV-iron, 1771 assigned oral iron, 330 assigned RBC-T, and 261 assigned non-intervention. Six studies reported the primary outcome of fatigue (1251 participants). Only studies of IV-iron vs. oral iron (15 studies) were available for meta-analysis. Of these, three reported on fatigue using different scales; two were available for meta-analysis. There was a significant reduction in fatigue with IV-iron compared to oral iron (standardized mean difference − 0.40, 95% confidence interval (CI) − 0.62, − 0.18, I2 = 0%). The direction of effect also favored IV-iron for hemoglobin (mean difference (MD) 0.54 g/dL, 95% confidence interval (CI) 0.47, 0.61, I2 = 91%), ferritin, (MD 58.07 mcg/L, 95% CI 55.74, 60.41, I2 = 99%), and total adverse events (risk-ratio 0.63, 95% CI 0.52, 0.77, I2 = 84%). The overall quality of the evidence was low-moderate. Discussion: For all outcomes, the evidence for RBC-T, compared to IV-iron, non-intervention, or dose effects of RBC-T is very limited. Further research is needed to determine whether RBC-T or IV-iron for the treatment of PPA is superior for fatigue and hematological outcomes. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery, particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs.Methods: This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs, with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications, blood loss, and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth, neonatal ICU (NICU) admission, respiratory distress syndrome (RDS), and perinatal death.Results: Of the 6,316 women in the study, 2,608 (41.3%) had a primary CD. 30.3%, 17.5%, and 7.3% of the cohort had their second, third, and fourth CDs, respectively. Women undergoing the 5th CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1%, p = 0.015) and postpartum hemorrhage (7.5%, p = 0.010). 24% of babies in Group 5 were born preterm (p < 0.001). They also had a 3.5 times higher risk of having a surgical complication (RR = 3.5, 95% CI 1.6-7.6, p = 0.002), a 1.8 times higher risk of developing postpartum hemorrhage (RR = 1.8, 95% CI 1.1-2.9, p = 0.014), a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR = 1.7, 95% CI 1.3-2.2, p < 0.001), a higher risk of the baby getting admitted to NICU (RR = 1.3, 95% CI 1.0-1.6, p = 0.038), and developing RDS (RR = 1.5, 95% CI 1.2-2.0, p = 0.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9, 95% CI 2.1-4.0) and RDS (RR 3.5, 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p < 0.001 for both).Conclusion: Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups—consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion. [ABSTRACT FROM AUTHOR]

Objective: To identify whether infection, cervical laceration and perineal laceration are associated with postpartum hemorrhage in the setting of vaginal delivery induced by Cook balloon catheter. Materials and methods: The retrospective study included 362 women who gave birth vaginally at or beyond 37 weeks of gestation with a diagnosis of postpartum hemorrhage between February 2021 to May 2022, of which including 216 women with induction of labor (Cook balloon catheter followed by oxytocin or oxytocin) and 146 women with spontaneous delivery. Risk factors for postpartum hemorrhage were collected and compared. Results: 362 women were divided into three groups, group 1 with spontaneous delivery, group 2 with oxytocin, group 3 with Cook balloon catheter followed by oxytocin. There was no significant difference in incidence of infection within three groups (P > 0.05). The rate of cervical laceration and perineal laceration was significantly higher in group 3 compared with groups 2 and 1 (P < 0.05); Multivariate logistic regression analysis found that compared with group 1, either group 3 or group 2 was associated with increased risks of cervical laceration and perineal laceration (P < 0.05), and compared with group 2, group 3 was not associated with increased risks of cervical laceration and perineal laceration (P > 0.05). Conclusion: Infection, cervical laceration and perineal laceration are identified not to be independent risk factors for postpartum hemorrhage for women undergoing labor with Cook balloon catheter; Cervical laceration and perineal laceration increase the risk of postpartum hemorrhage in women with labor induction. [ABSTRACT FROM AUTHOR]

Preterm labor, one of the common pathological phenomena during pregnancy, necessitates prompt and accurate detection to safeguard the health of both pregnant women and newborns. This study focused on placental alkaline phosphatase, a pregnancy-specific enzyme, and its potential role in identifying preterm labor. This study aimed to investigate the relationship between placental alkaline phosphatase, placental maturity, the nutritional status of newborns, and its utility in evaluating preterm labor. A total of 85 pregnant women with singleton pregnancy of more than 15 weeks of gestation admitted to our hospital from March 2022 to May 2023 were selected as study subjects. Our study revealed a positive correlation between PLAP levels and both gestational age and placental maturity (P < 0.05). Our findings indicated that with an increase in gestational age and placental maturity, there was a corresponding increase in placental alkaline phosphatase levels. However, there were no differences in placental alkaline phosphatase between pregnant women of Grade III and Grade II in terms of placental maturity (P > 0.05). There was a significant increase in placental alkaline phosphatase levels among pregnant women who gave birth prematurely (P < 0.05). The receiver operating characteristic curve showed that placental alkaline phosphatase had an excellent effect on the evaluation of preterm labor (P < 0.05). However, there were no significant differences in placental alkaline phosphatase between the pregnant women with and without postpartum complications (P > 0.05). Lastly, placental alkaline phosphatase was found to have an inverse relationship with levels of neonatal albumin and transferrin levels (P < 0.05). [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is one of the most common complications of the postpartum period. This prevalent woman's mental health problem is a serious threat to the psychological and physical well-being of both mothers and infants, and its consequences may persist in the long term. Because of the unique changes at the biological, psychological, and social levels that result from childbirth and early adaptation to motherhood, treatment of postpartum depression requires a specific approach. Although many systematic reviews describing therapeutic interventions for the treatment of PPD have appeared in the literature in recent years, the most effective therapeutic options have still not been identified. This paper reviews current treatment recommendations for postpartum depression, with consideration of their effectiveness and safety. The authors also formulate practical guidelines in the therapeutic management of postpartum depression, paying attention to the course and character of accompanying symptoms. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare maternity leave satisfaction between physicians and nonphysicians. Currently, paid maternal leave is not guaranteed in the United States, resulting in palpable dissatisfaction among parents. Previous studies have shown associations between length of paid leave and career satisfaction and maternal happiness. Materials and Methods: A Qualtrics® electronic survey was distributed to female professionals through email and social media from April 2019 to March 2020. Inclusion criterion was ≥1 child by birth or adoption, or active pregnancy. Continuous and categorical data were analyzed using two-sample t-test and chi-square, respectively. Results: Of 808 respondents, 77% were physicians. Mean age at birth/adoption of first child was higher in physicians versus nonphysicians (32.1 years vs. 29.7 years; p < 0.001). Physicians took shorter maternity leave than nonphysicians (10.9 weeks vs. 12.0 weeks, p = 0.017) with half of that time paid by employers (5.4 weeks vs. 5.9 weeks, p = 0.2). Dissatisfaction was high among physicians (85.1%) and nonphysicians (92.4%) that correlates with maternity leave compensation dissatisfaction (49% vs. 71.3%, p < 0.001). Thirty-four percent of physicians versus 41% of nonphysicians stated that their health was negatively impacted by maternity leave length. Physicians and nonphysicians reported similar incidences of depression, and breastfeeding, delivery, and other postpartum complications. When queried, 38.8% of physicians and 57% of nonphysicians said they would desire >16 weeks of paid maternity leave (p < 0.001). Conclusions: In conclusion, dissatisfaction among professional women on maternity leave duration and compensation is high in the United States. Given health implications for both mother and child, this should invite further discussion and changes. [ABSTRACT FROM AUTHOR]

Our research aimed to identify the risk factors that may contribute to postpartum depression (PPD) in the immediate postpartum period. The study was conducted at the University Emergency County Hospital Constanta, Romania, between 2019 and 2021. We included 904 women on the 2nd day of the postpartum period, divided into 2 groups: women with PPD (n=236) and control (women without PPD, n=668). Demographic characteristics and clinical information (i.e., women's age, urban or rural areas, level of education, Rh blood group, chronic diseases, mode of delivery, women's parity, and the number of abortions) were assessed. The prevalence of PPD found was 26.1%. Our findings suggest that only the women's age and level of education were significantly associated with PPD (p=0.05 and p=0.002), being appraised as risk factors in PPD. Our study shows that early detection of PPD represents an important task for its prevention and women should be counseled in order to reduce negative child follow-up. [ABSTRACT FROM AUTHOR]

This case report highlights the diagnostic challenges in distinguishing between postpartum headaches caused by preeclampsia and those caused by a suspected dural puncture in a patient with both conditions. The patient had a history of preeclampsia, was well-controlled with labetalol, and received epidural anesthesia using the Tuohy needle during labor. Six hours after delivery, she reported postural headaches, neck tension, and tinnitus, typical symptoms of dural puncture headaches. However, the patient eventually experienced a generalized tonic-clonic seizure and was diagnosed with posterior reversible encephalopathy syndrome and intracranial hypotension. This case highlights the importance of considering multiple underlying factors when analyzing postpartum headaches and the need for prompt and appropriate management to prevent potentially life-threatening complications. [ABSTRACT FROM AUTHOR]

Sleep problems are extremely common during the postpartum period. The role of sleep in the development of postpartum psychosis (PP) is, however, still under-researched. This narrative review aims to (1) provide a summary of the existing evidence for the associations between sleep problems and PP, (2) discuss the relevant risk factors associated with sleep problems and PP, and (3) suggest future lines of research in this area. Some of the existing literature suggests an association between sleep problems, specifically insomnia, sleep loss and sleep disruption during pregnancy and postpartum, and PP, with the most relevant risk factors including history of bipolar disorder and time of delivery. However, it is still unclear whether the previously mentioned sleep problems are a symptom of, or a trigger for PP. Thus, further research is needed to identify the specific role of sleep problems in PP, using longitudinal designs and more objective measures of sleep. This will allow appropriate detection, intervention and support for women experiencing and/or at risk for PP. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus is associated with perinatal mental disorders. Effective management may reduce this risk, but there is little evidence on effects of different glycaemic treatment targets. We assessed whether tight glycaemic treatment targets compared with less-tight targets reduce the risk of poor mental health outcomes in women with gestational diabetes. Methods: This was a secondary analysis of data from women who consented to complete perinatal mental health questionnaires as participants in the TARGET Trial, a stepped-wedge cluster randomized trial in 10 hospitals in New Zealand. All hospitals initially used less tight glycaemic targets for management of gestational diabetes and were sequentially randomized, in clusters of two at 4-monthly intervals, to using tighter glycaemic targets. Data were collected from 414 participants on anxiety (6-item Spielberger State Anxiety scale), depression (Edinburgh Postnatal Depression Scale), and health-related quality of life (36-Item Short-Form General Health Survey) at the time of diagnosis (baseline), 36 weeks of gestation, and 6 months postpartum. The primary outcome was composite poor mental health (any of anxiety, vulnerability to depression, or poor mental health-related quality of life). Generalized linear mixed models were used to determine the main treatment effect with 95% confidence intervals using an intention-to-treat approach. Results: We found no differences between randomised glycaemic target groups in the primary outcome at 36 weeks' (relative risk (RR): 1.07; 95% confidence interval 0.58, 1.95) and 6 months postpartum (RR: 1.03; 0.58, 1.81). There were similarly no differences in the components of the primary outcome at 36 weeks' [anxiety (RR: 0.85; 0.44, 1.62), vulnerability to depression (RR: 1.10; 0.43, 2.83), or poor mental health-related quality of life (RR: 1.05; 0.50, 2.20)] or at 6 months postpartum [anxiety (RR:1.21; 0.59, 2.48), vulnerability to depression (RR:1.41; 0.53, 3.79), poor mental health-related quality of life (RR: 1.11; 0.59, 2.08)]. Conclusion: We found no evidence that adoption of tighter glycaemic treatment targets in women with gestational diabetes alters their mental health status at 36 weeks' gestation and at 6 months postpartum. Trial registration: The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583 (ANZCTR—Registration). Date of registration: 25 March 2015. [ABSTRACT FROM AUTHOR]

Reducing maternal mortality is one of the targets for achieving global health Sustainable Development Goals (SDGs). The cause of maternal death is still a major problem that continues to receive attention to be addressed. The breadth of the territory and the variety of demographic, economic, social, and cultural conditions of the Indonesian people are important to investigate regarding the causes of maternal death in the community. The purpose of this study was to find out the causes of maternal death in one of the districts in the province which is in the eastern part of Indonesia. Materials and methods: a retrospective observational study was conducted on 23 cases of maternal death in the local area. Data collection has been carried out using the three-delay model approach. Results: the majority of maternal deaths were caused by two delays, namely 1) being late in deciding to seek care at a health facility due to lack of awareness of complications (78.%), lowincome families (74%), and the culture of visiting traditional healers to help with deliveries (57%), and 2 ) were late reaching health facilities due to cost and availability of transportation (52%), poor road conditions (43%), and travel time > 1 hour (39%). Dominant factors that cause maternal death are due to postpartum hemorrhagic complications (52%). Conclusion: awareness of mothers and families about the dangers of perinatal complications is an important point that must be addressed early so as not to affect delays in making decisions to seek care at health facilities, which ultimately results in delays in reaching health facilities, and delays in receiving treatment from health workers. Maternal health promotion activities, development of good road infrastructure, availability of transportation, availability of the number of health workers, and availability of infrastructure in health facilities are important concerns to be continuously improved. [ABSTRACT FROM AUTHOR]

Background: High milk production and excellent fertility is a dream of livestock owners. The major reproductive disorders which lead to decrease the productivity and reproductive ability of farm animals is postpartum anestrous. Recently, kisspeptin was reported as game changer in the animal reproduction. Kisspeptin increases the number of follicles at wave emergence, oestrus response rate and duration of oestrus. Thus, indicating its potentiality for induction of oestrus in anestrous animals. Methods: The present study was conducted to compare the efficacy of Ovsynch and kisspeptin protocol and need of fortification for treatment of postpartum anestrous. Fifty postpartum anestrous cows were selected. The animals were divided into four treatment groups (10 cows in each) and treated with Ovsynch (Group I), Ovsynch fortified with mineral mixture (MM) and bypass fat (BPF) (Group II), kisspeptin (Group III) and kisspeptin fortified with MM +BPF (Group IV). The remaining 10 cows served as control (Group V). The oestrus response was recorded on the basis of behavioral signs, physical signs and clinico-gynaecological changes. The blood was collected following treatment for hormonal estimation. The pregnancy was confirmed on day 45 post AI using ultrasound. Result: The oestrus response was pronounced in Ovsynch as compared to kisspeptin groups. Further, fortification has enhanced the response. The serum oestrogen concentration increased following treatment and was significantly high on day of onset of oestrus with highest concentration in group II. The results indicate Ovsynch distinguishly succeeded in addressing postpartum anestrus with fortification enhances fertility response. However, kisspeptin also emerged as a potent candidate for the resumption of cyclicity. [ABSTRACT FROM AUTHOR]

Purpose: There are different studies worldwide, which have shown a higher risk of mental disorders due to the COVID-19 pandemic. One aim of this study was to identify influencing factors of the psychological burden related to the COVID-19 pandemic and the impact on the development of postpartum depression. Further, the role of individual stress and coping strategies was analyzed in this context. Materials and methods: Between March and October 2020, 131 women in obstetric care at the LMU Clinic Munich completed a questionnaire at consecutive stages during their perinatal period. The times set for the questionnaire were before birth, 1 month, 2 months, and 6 months after birth. The questionnaire was designed to evaluate the psychological burden related to the COVID-19 pandemic. For this a modified version of the Stress and coping inventory (SCI) and the Edinburgh Postnatal Depression Scale (EPDS) was used. Results: We could show that the psychological burden related to the COVID-19 pandemic influenced the EPDS score 1, 2 and 6 months after birth. In addition, the prenatal stress and individual coping strategies affected the EPDS and the burden related to the COVID-19 pandemic before and after birth significantly. Conclusion: An association of the psychological burden related to the COVID-19 pandemic with the risk of developing postpartum depressive symptoms could be shown in this study. In this context, the separation of the partner and the family was recognized as an important factor. Furthermore, the SCI was identified as an effective screening instrument for identifying mothers with an increased risk of postpartum depression. Hereby allowing primary prevention by early intervention or secondary prevention by early diagnosis. [ABSTRACT FROM AUTHOR]

Researchers have found considerable evidence in the past 20 years that perinatal opioid exposure leads to an increased risk of developmental disorders in offspring that persist into adulthood. The use of opioids to treat pain concerning pregnancy, delivery, and postpartum complications has been rising. As a result, communities have reported a 300–400 % increase in Neonatal Opioid Withdrawal Syndrome (NOWS). NOWS represents the initial stage of several behavioral, phenotypic, and synaptic deficits. This review article summarizes the Developmental Outcomes of Perinatal Exposure (DOPE) to prescription opioids. Moreover, we also seek to connect these findings to clinical research that describes DOPE at multiple stages of life. Since specific mechanisms that underlie DOPE remain unclear, this article aims to provide a framework for conceptualizing across all ages and highlight the implications they may have for longevity. [ABSTRACT FROM AUTHOR]

A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman's correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother's MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children. [ABSTRACT FROM AUTHOR]

Aim: This study aims to thoroughly explore to comprehensively examine the diverse types and subjective experiences of pain in postpartum women throughout perinatal period, aiming to deepen understanding and support the development of precise pain management strategies in nursing care.Design: A descriptive qualitative study.Methods: Between August and November 2022, postpartum women attending outpatient clinics at a tertiary level A hospital were selected as participants. The study followed the framework of the THRIVE model and utilized a phenomenological method for qualitative research. In-depth semi-structured interviews were conducted with 21 postpartum women, and the data were analyzed using the Colaizzi 7-step analysis method.Results: Thematic analysis revealed that different postpartum women exhibited diverse perceptions of their own pain experiences. Three themes were identified to describe the pain encountered by postpartum women: (1) Experiencing pain is complex (including experiencing multiple kinds of pain, individual differences in pain, and pain is variable), (2) Double perceptions of pain (negative effects of pain and positive energy for perceiving pain), and (3) Fighting pain requires active support (active outside support and construct a positive self-coping style).Conclusion: This study provides a comprehensive overview of perinatal pain management in postpartum women, offering recommendations for accurate pain understanding and management. Healthcare professionals should be vigilant about maternal pain changes and individual experiences, implement targeted measures and support, aid in alleviating psychological burdens, boost maternal confidence in childbirth, and enhance postpartum quality of life.Patient or Public Contribution: In this study, interviews were conducted in the hospital outpatient department, and the participants included in this study participated in the interviews to provide support for the implementation of this subject. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The pathogenesis of vaginal wind remains unclear. This study was aimed at assessing the association between functional constipation and vaginal wind in women at 6 weeks postpartum. Methods: This is a multicenter cross-sectional study. We collected data, such as baseline demographic, clinical characteristics, pelvic organ prolapse quantification score. and surface electromyography parameters of pelvic floor muscles, of women at 6 weeks postpartum who visited the postpartum rehabilitation clinic between May 2022 and September 2022. The cohort data were from women who visited the postpartum rehabilitation clinic of the First Affiliated Hospital of Gannan Medical University and the Women and Children's Health Care Hospital of Yudu County. Follow-up for the control and study cohorts was conducted until 6 weeks postpartum. Results: Among the 377 women, 101 (26.79%) reported vaginal wind. Multivariate regression analysis showed that postpartum women with functional constipation were at a higher risk for vaginal wind than women without functional constipation (odds ratio [OR], 2.41). The results remained stable across the propensity score analyses (OR, 1.86–2.30). In addition, we found age, body mass index, mode of delivery, changes in the anatomical location of Bp points, urinary incontinence, pelvic floor muscle strength, and birth weight of the neonate were not associated with increased odds of vaginal wind in women at 6 weeks postpartum. Conclusions: Vaginal wind is common among women at 6 weeks postpartum and is associated with functional constipation. Functional constipation may serve as a reference for the pathogenesis, prevention, and treatment of vaginal wind. [ABSTRACT FROM AUTHOR]