DOI: 10.4236/ojn.2018.83017 199 Open Journal of Nursing ( i.e. , pure lavender, ylang-ylang, citron, rosewood, and sweet orange) by mas- saging to the mother’s hands and forearms. The intervention treatment was pro- vided by 10 research assistants. During their year-long preparation, they at- tended various training sessions and seminars provided by the Certified Nurses of Japanese Society of Aromatherapy and they gained experience through vo- lunteer-related activities. In addition, the research assistants passed a technical qualifying examination for independent professional skills and completed a lec- ture on puerperium care. The aroma treatments used a blend of sweet almond oil as the carrier oil and the applied essential oil. The concentration of the essen- tial oil was diluted to within 2% in consideration of the women who were in their early postpartum period .
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A limitation of our study is that we used QUS, and not DXA, to assess bone quality in pregnant women and this measurement was available in only about half of the women. QUS has been demonstrated to predict fracture risk  and has been widely used in epidemiologic studies to measure bone density particularly where DXA is not available  or not advisable, such as during pregnancy [37-39] due to the potential for radiation ex- posure to the fetus. QUS has been found to be well- correlated with DXA at all sites measured over 7 years of follow-up  and provides our study with the advan- tage that we were able to include repeated measures of bone density, in addition to biochemical markers of bone turnover, over the entire course of pregnancy and the early postpartum period.
Compared with the NBM-200, the Pronto-7 has the advantage of portability. The size is smaller, and the weight is lighter, and it works on batteries. Importantly, at this point, the NBM-200 has not been approved for clinical use by the Ministry of Health, Labor and Welfare of Japan. More detailed studies are necessary for the assessment of the accuracy of the Pronto-7. We think that the accuracy of the SpHb measured by the Masimo Pronto-7 is almost high enough to merit its clinical use outside of pregnancy or in the first trimester of pregnancy. However, in the second and third trimesters of pregnancy and in early postpartum period, we think the SpHb measured with this device is not accurate enough.
Background : The purpose of the present study is to analyze the autonomic nervous activity in multiparas while resting, nursing, and rooming-in/room- ing-out during days 1 to 3 of early postpartum period. Methods : Subjects were asked to record the actions they performed while wearing a heart rate moni- tor. Changes in autonomic nervous activity from 9 am to 12 pm and relaxa- tion based on the relaxation (RE) scale were surveyed in multiparous women experiencing a normal postpartum period, on postpartum days 1 to 3. Results : Thirteen subjects were enrolled but heart rate data for all 3 days were available for only 5 of them. In these patients, the autonomic nervous activity (heat rate, high frequency [HF], or low frequency [LF]/HF) showed no significant differences between the days during any of the time periods. However, of the 3 days, day 2 demonstrated a lower HF and higher LF/HF. Subjective sense of relaxation was higher on postpartum day 3 compared to days 1 and 2, but there was no significant difference observed in the 3-day total score. Though no significant differences in HF and LF/HF at rest and during nursing were observed for any of the 3 days, there was a tendency for HF to be lower and LF/HF to be higher during nursing than at rest. Conclusions : Autonomic nervous activity demonstrated no significant major changes between the 3 days of postpartum (day 1 to 3). However, the lower HF and higher LF/HF during nursing and rooming-in suggest that even multiparas, who are suppo- sedly accustomed to nursing and child-rearing, can be tense. Results suggest that multiparas require monitoring, personal care, and attention so that they can be relaxed and less tense while nursing and caring for their children.
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Breast milk expression (breast pumping) is widely prac- ticed by mothers as an important dimension of breast- feeding behavior. Many experts and lactation consultants believe that breast milk expression is a helpful alternative for mothers to feed their babies breast milk when direct breastfeeding is not convenient or feasible, thereby allow mothers to continue breastfeeding and achieve their breastfeeding goals. Feeding a premature or unhealthy in- fant had been the main reason for using a pump to ex- press breast milk in the past . Breast pumps play an important role in promoting breastfeeding among work- ing mothers . A breast pump loan program involving 12,283 low-income women demonstrated an increase in the breastfeeding initiation from 1992 to 1996 in America . Therefore, education of both breastfeeding and breast pump usage has been routinely provided by lactation con- sultants to new mothers for promoting breastfeeding . Nowadays, expressing breast milk has become increas- ingly prevalent. A large proportion of mothers rely on breast pumps to feed their infants for health-related rea- son, early returning to work, and more importantly, con- venience sake. Some mothers prefer exclusive milk expressing to direct feeding at breast, as a way of breast milk feeding immediately after giving birth [5–7]. As a re- sult, the methods and patterns of breastfeeding are much more complicated than before. Breastfeeding behaviors re- flect the thoughts and actions of a mother about breast- feeding, such as breastfeeding intention, confidence, persistence, and emotional reactions, which may in turn affect the decision to continue breastfeeding after return- ing to work and the overall breastfeeding duration. It is, however, not clear whether increasing breast pump usage really contributes to extend the duration of breastfeeding, or just complicates the life of the lactating women, as questioned by some health professionals [8–10]. The out- comes related to breast milk expression are not well understood so far, for the studies evaluating the impact of breast milk expression (breast pumping) on breastfeeding have generated inconsistent results. Win et al. reported that women who expressed breast milk were more likely to continue breastfeeding at 6 months than those who did not express . Geraghty’s (2005) research, however, indi- cated that women who fed infants solely at the breast at early postpartum time points, were more likely to breast- feed for longer than women who combined direct breast- feeding with expressing or pumped only . Interestingly, Geraghty’s another study (2012) suggested that breast milk expression by 4 weeks did not signifi- cantly influence duration of breast milk feeding .
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Treatment of IPPH involves volume replacement with crystalloid solutions and transfusion. That will permit to reduce risk of the occurrence of dissemi- nated intravascular coagulopathy. Early postpartum hemorrhage has been at the origin of severe anemia in most of our patients, motivating thus blood transfu- sion. However, only 26.9% of need of transfusion has been satisfied. More than quarter of our patients has not received the number of packages of blood prod- ucts that was necessary to care patients. The issue of blood transfusion is a chal- lenge in Mali that any program has been able to take up. This accounts for cur- rent persistent difficulties concerning the constant availability of unstable blood products. There is only one blood bank which has the difficulty to cover the transfusion need of the district of Bamako. The policy of this blood bank is based on the donation of blood made by volunteer donors and on the substitution of the stock of blood whatever is the context (emergency or not) by individuals re- lated to the family of the patient to transfuse the blood. In these conditions, the blood is often not available for patients received in emergency  causing the death somehow avoidable.
Objective: This study aims to ascertain the prevalence of fatigue and depres- sion from early postpartum to 1 month after delivery among postpartum women with mental disorders. Methods: The participants of this study were postpartum women who had delivered a child after a full-term pregnancy and were suffering from a mental disorder. We administered the Postpartum Fa- tigue Scale (PFS) on days 1, 3, and 4 (to multiparas), and 1, 3, and 5 (to pri- miparas), and 1 month after delivery to all participants. The Edinburgh Post- natal Depression Scale (EPDS), Japanese version, was also administered at the same time intervals as PFS except on day 3 after delivery. Results: A total of 7 primiparas and 9 multiparas participated in this study. The average age was 29.0 ± 7.0 years in primiparas and 32.0 ± 4.0 years in multiparas. The PFS scores were higher among the primiparas and peaked at day 1, and more than half the primiparas scored more than 9 points in EPDS. In addition, the EPDS score at 1 month had a strong correlation with the PFS subscale “mental stress situation” (r = 0.818/ p = 0.047). In multiparas, the percentage of women who scored more than 9 points decreased. However, their EPDS scores at 1 month were related to the total scores of the PFS, “physical stress situation”, “mental stress situation”, and “sleep deprivation situation”. Especially, the score of “sleep deprivation situation” was higher than those during hospitalization. Conclusion: There was more fatigue 1 month after the discharge among postpartum women with mental disorders. The percentage of women whose EPDS scores were more than 9 points was high in both primiparas and multi- paras. This study suggests assisting primiparas and multiparas by controlling the former’s disorder during childcare, and using family support for the latter, so that they get time to rest.
Apart from clinical evaluation and timely inter- vention, routine health promotion services and building strong relationships with service systems that can provide social as well as health-focused services are likely to be a crucial component of care designed to lead to optimal health and well-being of newborns, mothers, and families. The currently available evidence on how different approaches to routine postpartum care affect outcomes is limited, in large part because this area has been relatively neglected as a focus for rigorous research. Until stud- ies of adequate design are directed to questions about routine postpartum care, no single model of in-hospital and postdischarge services can be defined as a “best practice.” Although routine lengths of stay following uncomplicated childbirth have been ⬍ 3 or 4 days for many years, available evidence suggests that most mothers and infants with short stays do not receive early follow-up. 10 –12 These findings suggest
paired t-test (if the weight change is normally distrib- uted) or a Wilcoxon non-parametric test (if weight change is not normally distributed) to determine if there is a significant change in weight from pre-pregnancy to last prenatal visit preceding delivery weight and from this to six months postpartum. To determine the effect of the various predictors on these outcomes, we will use two approaches to model construction. First, we will use general linear models to model change in weight during gestation or change in weight post-partum, using the definitions for these outcomes from above. Second, we will use a mixed effects model to examine the individual trajectories of change over time, using all of the mea- sures of weight throughout the gestation and post- partum periods. The predictors will be similar for the two analytic approaches, based on the conceptual model in Figure 1. In general we will first investigate the effect of related groups of predictors (such as the behavioral predictors from Table 1) and then combine the resulting significant factors into the final model. With a relatively limited sample size, this will be a feasible approach – and potentially more revealing – than a more omnibus variable selection process.
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The postpartum period is a challenging period because the mother experiences physiological changes; there is a transition to parenthood; new roles and responsibilities are experienced. Anxiety and depression experienced in this period are important as they affect not only the mother but also the baby and the entire family. The frequency of experiencing postpartum depression varies from one society or culture to another. International studies on the frequency of postpartum depression [12- 16] reveal a postpartum depression frequency of 9 to 39.8% and it ranges from 12.5 to 40.9% in the studies conducted in Turkey [2, 17-21]. Postpartum depression frequency was found as 33.3% in our study, which is consistent with the results of the aforementioned studies. However, as the depression scores obtained in the present study are based on the self-assessment of individuals, determining only the frequency of such data would not suffice to determine the depression frequency, yet it would not be wrong to say that the depression rate is high. Differences in the postpartum depression frequencies reported in various studies result from the factors such as design and evaluation of different postpartum periods, differences in the characteristics of the target group, differences in the socio-economic development level and different reference points taken in the same scale.
The prenatal care of women with GDM includes routine pregnancy care, as well as diagnosis and management of conditions which are common in these patients. Moreover, other common complications include macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. The risks related to GDM increase after the pregnancy and this is a marker for maternal development of type 2 diabetes. Therefore, glycemic control is the key intervention to control diabetic pregnancy. Glucose monitoring, nutritional therapy, and the use of insulin or other antiglycemic agents are the main methods for managing these patients. The early postpartum period is an important time to identify the risk of diabetes mellitus in women with GDM. The OGTT can help guide the lifestyle management and reduce the future risk of type 2 diabetes mellitus.
Also, EPDS scores during early and mid-pregnancy were correlated with VAS score at mid-pregnancy, and VAS score at mid-pregnancy was correlated with EPDS scores at late pregnancy and in the postpartum period. Mental health con- ditions at early and mid-pregnancy are associated with LBPP at mid-pregnancy, and LBPP at mid-pregnancy is associated with mental health conditions thereaf- ter. Thus, there is a close mutual relationship between mental symptoms and LBPP as a physical symptom during pregnancy and in the early postpartum pe- riod. Women with depression are likely to have chronic pain. It has been re- ported that preoperative depression before Cesarean section was associated with chronic post-surgical pain at 3 months postpartum . Also, Borges et al. re- ported that preoperative anxiety increases the risk of moderate-severe postoper- ative pain in women who received Cesarean section . Based on these results, an unstable mental condition is considered to be a factor enhancing subsequent pain. An unstable mental state at early pregnancy may be a factor enhancing LBPP at a later stage of pregnancy. Stability of mental health at early pregnancy may prevent exacerbation of LBPP at mid and late pregnancy. On the other hand, it has been reported that perineal pain at 3 - 5 days postpartum predicted depressive symptoms at 3 months postpartum , suggesting that physical pain influences the mental health condition thereafter. Exacerbation of pain may be involved in psychological instability. It is important to evaluate mental health by the EPDS score as well as the VAS score for LBPP in early pregnancy and to prevent LBPP in pregnancy and in the postpartum period.
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Based on binary logistic regression analyses, socio- demographic variables such as maternal age, religion, occupa- tion, education, education of spouses and pressure from hus- bands, as well as obstetrics and sexual history, including parity, sex of the baby, desire to have another child, using family planning, and return of menses, were associated with resuming sexual intercourse. Most of these variables remained statisti- cally signi ﬁ cant at a p-value of <0.05 after adjusted analysis. That is, the odds of early resumption of sexual intercourse were 78% (AOR=0.22, 95% CI: 0.07 – 0.71) lower for women who had secondary education than for those with no formal educa- tion. Similarly, mothers whose husbands had attended elemen- tary school were 77% less likely (AOR=0.23, 95% CI: 0.06 – 0.87) to resume sexual intercourse than those who had not received any formal education. And mothers whose husbands had attended secondary school were 75% less likely (AOR=0.25, 95% CI: 0.07 – 0.88) to resume early postpartum sexual intercourse than those who had had no formal educa- tion. Study participants who had a parity of one were about four times (AOR=3.5, 95% CI: 1.24, 10.01) more likely to resume early sexual intercourse than those who had had ﬁ ve or more deliveries. Moreover, mothers who had given birth to a male child were nearly two times (AOR=1.94, 95% CI: 1.05 – 3.60) more likely to resume sexual intercourse within the ﬁ rst 6 weeks postpartum period than those who had given birth to a female child.
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Background & Aims: Breastfeeding improves glucose tolerance in the early postpartum period of women with prior gestational diabetes GDM, but it is unclear whether future risk of metabolic al- terations, like type 2 diabetes, is reduced. The aim of this study was to investigate the effect of lac- tation, three years after pregnancy, on glucose and lipid metabolism in women with prior gesta- tional diabetes. Materials & Methods: A population of women with prior gestational diabetes (Carpenter and Coustan Criteria) was evaluated with comparison of results for “lactating” [BF] versus “nonlactating women” [non BF]. Breast feeding was defined [BF] if lasting? 4 weeks. In each woman a 75-g oral glucose tolerance test (OGTT) was performed to analyze the glucose tolerance, insulin sensitivity/resistance and b-cell function. Fasting serum was used to study their lipid pro- file (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglycerides), apolipoprotein B, apolipoprotein A1, homocysteine, fibrinogen, hs- CRP, uric acid, microalbuminuria. Statistics: Paired and Un-paired t-test, Mann-Whitney and χ 2
Abstract: The syndrome of pregnancy- and lactation-associated osteoporosis is a rare disorder whose precise etiology and treatment are largely unknown. We herein report two such cases occurring in the early postpartum period that led to multiple fragility compression fractures. Combination therapy of vitamin D and vitamin K enabled a marked gradual increase in bone mineral density.
The development of a preference for the mother is entirely dependent on suckling in sheep (Nowak et al., 1997). The association of vocal activity by the mother and her lamb with nursing, which was marked at 2 weeks of lactation, develops very soon after parturition. Evidence for nursing-dependent structuring of vocal behaviour in ewes and lambs was present at 3–6 h after parturition, indicating that acoustic communication has already started to develop at that time. This is likely to be the result of a number of converging factors. Both ewes and lambs display intense vocal activity that peaks during the first 3 h following parturition (Poindron et al., 1980; Shillito- Walser et al., 1984; Dwyer et al., 1998; Sèbe et al., 2007) thus providing a propitious context for the establishment of vocal communication and hearing recognition. Since the lamb starts to suck within the first hour after birth, it is likely that nursing begins to play a reinforcing role in vocal activity very early on, thus providing a basis for the two members of the dyad to learn each other’s vocal identity. In the lamb, this is likely to depend on the well-established reinforcing influence of colostrum intake on the development of a preference for the mother (Nowak et al., 1997; Val-Laillet et al., 2004; Nowak and Poindron, 2006). The reinforcement of vocal activity by nursing is also consistent with the shaping of neonatal behaviour by stimuli associated with sucking, which can have a calming effect and facilitate learning, as reported in a wide range of species, including rats, rabbits, dogs, sheep and humans (Nowak, 2006). Also, it must be kept in mind that the bleating activity of the mother in the early postpartum period has a very high frequency of occurrence, more than 10 times higher than that of the lamb (Sèbe et al., 2007). Consequently it is likely 0
PPD is a serious condition that affects many women from diverse cultures. The review findings suggest that in addition to the well-documented maternal and infant health consequence of PPD, women in the perinatal period who experience depressive symptomatology may be at increased risk for poorer infant-feeding outcomes including decreased breastfeeding initiation, duration, and exclusivity. These findings support the need for early identification and treatment of pregnant women and breastfeeding mothers with depressive symptom- atology to improve infant-feeding outcomes. Research to determine effective interventions to support depressed breastfeeding mothers is warranted.
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Among the main strengths of this study are the large sample size and the number of studied variables on an individual level, which gave the possibility of controlling for multiple confounders in the analyses. On the nega- tive side, it could be argued that women answered ques- tions on breastfeeding initiation via self-report at six weeks postpartum, which poses an eventual problem of recall bias. Nevertheless, it has been shown that women a long time after giving birth, are capable of successfully recalling what happened during the birth process and the early hours postpartum . Additionally, intention to breastfeed was not assessed in the questionnaires, as we assume that nearly all mothers in this Swedish set- ting had planned to breastfeed; indeed, all women in- cluded in the study actually initiated breastfeeding. Nevertheless, one could speculate that some women who delayed the breastfeeding initiation might have a lower commitment to breastfeeding, which could be reflected in not exclusively breastfeeding at six weeks postpartum. To be considered is also the fact that, women participating in the present study have a higher exclusive breastfeeding rate compared to the Swedish national and county-level average. Overall, the BASIC study has a participation rate of 22% pregnant women, probably due to extensive questionnaires and collection of biological material. The participating women have a slightly higher educational level than the background Table 1 Distribution of study variables by breastfeeding or not within two hours after delivery (Continued)
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An integrative literature review was considered the most appropriate method for this review as the method allows for inclusion of studies using a range of methodological approaches [57, 58]. The synthesis of such a diverse range of studies has the potential to de- velop new knowledge and perspectives on topics that re- late to clinical practice, and can help identify areas for future research . The integrative review process was conducted according to a clear methodology  and guided by a pre-defined protocol. A systematic approach was taken by a team of reviewers to search, select, critique and interpret the range of studies exploring blood loss evaluation. However, there are a number of limitations which should be considered. Combining diverse method- ologies can be a complex process which may contribute to bias and inaccuracies in the conclusions that are drawn from such reviews . This issue may be exacerbated by the variable quality of the studies included. Many studies used small sample sizes or samples that were described as ‘convenience’ , ‘opportunistic’ and ‘volun- tary’. In addition, many of the study designs reduced the reliability and generalisability of the results. Des- pite this, many authors made claims and recommen- dations that went beyond their findings and the scope of their studies. All these factors required careful con- sideration when interpreting the studies in the review. However, such limitations were considered carefully and balanced against the advantages of including the range of studies that have contributed to the con- struction of knowledge in this area and informed the direction of research over the last 50 years. A com- prehensive search of online databases of systematic reviews revealed that no other reviews were in pro- gress or had been previously completed on this topic. One previously published literature review  had concluded that a combination of direct measurement and gravimetric measures were the most practical and reliable to use to provide an accurate measurement of blood loss. However, questions remained unanswered about whether such methods were useful in the early detection of PPH.
The prevalence of the various Group B capsular serotypes varies over time and may differ from place to place. Prior to the 1990s, most Group B Streptococcal disease was caused by serotypes Ia, Ib, II, III, and V; serotypes IV and VI through VIII were relatively uncommon. During the early to mid- 1990s, serotype V stains began to emerge, with the percentage of isolates in this group increasing from 2.6% in 1992 to 20% in 1994 90,91 . Studies conducted in the U.S. and abroad indicate that serotypes Ia, Ib, II, III and V now predominate among vaginal isolates and clinical isolates from patients 92,94,94 . Recently, serotypes VI and VII have appeared as the predominant serotypes in Japan 95 .
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