Assessment of a Novel Fixation Method of a Frameless Intrauterine Contraceptive Device Inserted during Cesarean Delivery as a Means of Preventing Displacements and Expulsions: A Prospective Observational Study

The primary objective of this study was to assess the novel fixation method of a frameless copper-releasing intrauterine device inserted following placental delivery during cesarean section and analyze its impact in reducing device displacement and expulsion during and after uterine involution. We hypothesized that the dual-anchoring technique could reduce the risk of intrauterine device displacement and expulsion during and after the uterine involution. The study was conducted at the Gazi University Medicine Faculty Hospital in Ankara, Turkey. Twenty-one pregnant women were enrolled. Insertion was performed following placental removal. To confirm the proper placement and good retention of the device, the distance between the fundal serosa (S) and device anchor knot (A) was measured (S–A) during follow-ups, by ultrasound. There were significant differences in the S–A, as observed by ultrasound at discharge and at 6 weeks post-delivery, which is consistent with the tissue contractions associated with uterine involution. Notwithstanding the uterine involution, no device displacements or expulsions occurred, which indicated a good retention of the frameless device. This innovative retention method of the frameless intrauterine device ensures a well-tolerated, long-term contraception, allowing for immediate contraception and proper pregnancy spacing for cesarean scar healing, and overcomes the issue of expulsion encountered with conventional intrauterine systems.

Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa

Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens life. As a countermeasure, two-stage surgery combined with selective uterine arterial embolization (UAE), named “stepwise treatment” was introduced in 2003. At a cesarean section (CS), only the baby is delivered and the placenta is left in situ. The transcatheter angiographic UAE is performed on the operation day, followed by the total hysterectomy on 5 to 7 days after CS. The difficulty in the operative procedures for hysterectomy and the amount of bleeding can be reduced by the added effect of the blood flow interruption by UAE and the uterine involution. Although there are not many indication cases, this is the prudent operation that should be considered for the most severe PAS case such as total placenta increta/percreta with placenta previa.In this article, the practical procedures and tips of stepwise treatment are described.

THE EFFECTIVENES OF MORINGA LEAVES AND YELLOW SWEET POTATO NOODLES FOR THE UTERINE INVOLUTION AND BREAST MILK PRODUCTION

Background: Breast swelling or engorgement breast is the blocking up of breast milk because of the narrowing of the lactiferous duct or glands that are not emptied completely and the percentage incidence of it to postpartum women is 72%-85%. Breast swelling that is not handled properly can cause complications such as obstructions that lead to breast infection that can hinder the realization of exclusive breastfeeding in the future and without adequate treatment, the engorgement with moderate severity can become the obstructions of ducts and breast infections/mastitis. The purpose of this study is to determine the effect of the moringa leaves and yellow sweet potato noodles for the uterine involution and breast milk production of postpartum women.Methods: This research was conducted in the Tembarak Public Health Center, Temanggung Regency using a quantitative approach with Quasi Experiment method. The design was post test only with control group. The population in this study was postpartum women who gave birth in September and October 2016. The sampling technique used was total sampling.Results: The results of this study showed that there were effects from the consumption of moringa leaves noodles for breast milk production of postpartum women, showed by the p value of 0.034 and there was no effect from the consumption of yellow sweet potato noodles for the uterine involution, showed by the p value of 0.767.Conclusion: The suggestions for professional organizations were to cooperate with the relevant authorities (Health Offices) in disseminating the results of this evidence-based research to help increasing breast milk production by using local food, and also to cooperate in cross-programs and cross-sectors in order to incorporate the use of local food based on the evidence as a procedure in providing health education for postpartum women

Postpartum Uterine Involution in Martina Franca Jennies

This study investigated the postpartum (PP) uterine involution in nine multiparous Martina Franca jennies with at term, normal, and singleton foaling. Transrectal ultrasonography performed at Days 1, 3, 7, 14, 21, and 28 showed that the uterine tip diameters did not differ between the post-pregnant (PPH) and non-post-pregnant uterine horns (NPPH), whereas the diameter of the middle PPH was larger than the NPPH until Day 7 (p < 0.05). The diameter of the corpora-cornual junction resulted larger in the PPH than NPPH at Day 7 (p < 0.05). At Day 3, the microcaruncolae were not detected. Endometrial glands (GL) number increased, with the highest value on Day 28. Endometrial GL area and perimeter decreased (p < 0.001) from Day 1 to Day 28. Epithelial thickness increased from Days 1–3 to Day 7 (p < 0.001), and concurrently with the foal heat to Day 14 (p < 0.001), with a decrease at Days 21–28. A marked neutrophils reduction on Day 7 and eosinophil increase from the first three days to Days 7–14 was observed. The results suggest that, in Martina Franca jennies with normal foaling, the PP uterine involution can be considered complete on Day 14.

The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes

Background: Uterine involution assessments are critical for the prevention of postpartum hemorrhage. Various methods have been used worldwide. Methods: The PUUS (Postpartum Uterine Ultrasonographic Scale) method evaluates, by transabdominal ultrasonography, the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). A total of 131 consecutive patients admitted for delivery in the Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, were prospectively evaluated using the PUUS method. The mean age was 27.72 years old, and they were examined during the first 24–48 h after vaginal delivery, or in the first 48–72 h after cesarean delivery. For patients with a PUUS grade greater than 1, re-examination was preformed daily in the following days, until the PUUS grade decreased to 1 or 0. Results: By standardizing uterine involution in a numerical fashion, we precisely demonstrate that uterine involution varied with the method of delivery (vaginal/cesarean) and with the number of vials of oxytocin received intrapartum, but not with the number of vials of ergometrine maleate received, and not with the origin of the parturient (rural/urban).

GAMBARAN KEJADIAN SUB INVOLUSI UTERI PADA IBU NIFAS DI POLINDES BUGIH II WILAYAH KERJA PUSKESMAS KOWEL

The postpartum period is the period that begins after the placenta comes out and ends when the uterine organs return to their original state (before pregnancy). One of the complications that can occur during the puerperium is uterine subinvolution, where the uterus fails to follow the normal pattern of involution as it should. So that the process of uterine shrinkage is hampered. Based on data obtained at Polindes BugihII in 2014 out of 10 postpartum mothers at 2-6 weeks, 7 (70%) postpartum mothers had uterine subinvolution and 3 (30%) did not. The purpose of this study was to describe the incidence of uterine subinvolution in postpartum mothers at Polindes Bugih II. This research design is descriptive. The total population in this study were 30 postpartum mothers, while the sampling used probability sampling with saturated sampling technique. The variable in this study was the incidence of uterine subinvolution in postpartum mothers. The research instrument used the MCH handbook, then analyzed using univariate analysis. The results of the study were almost entirely (76.67%) mothers did not experience uterine subinvolution, namely as many as 23 people. The solution that can be done to overcome this incident is to encourage the mother to move and breastfeed her baby as often as possible, because this will affect the hypothalamus and cause contractions. So that from these contractions will result in uterine involution and expenditure of Lochea running normally. It is also recommended for multiparous mothers to participate in family planning programs.

Resumption of postpartum ovarian cyclicity in winter-lambing Lohi sheep (Ovis aries)

The postpartum ovarian cyclicity which is associated with uterine involution has significant importance in fertility of sheep. The study was conducted to estimate the postpartum resumption of ovarian cyclicity in Lohi sheep during winter lambing season. Twelve pregnant ewes were selected. The commencement of ovarian cyclicity was investigated in postpartum ewes by estimating progesterone (P4) concentration in blood samples collected on weekly intervals starting from day of parturition till 12th week of postpartum. On the day of parturition, mean P4 concentration was 0.38 ± 0.08 ng / mL. After that, P4 level raised to 0.70 ± 0.13 and 0.83 ± 0.13 ng / mL during 1st and 2nd weeks respectively. During 3rd week, P4 concentration was 1.02 ± 0.18 ng / mL (ovulation). The peak P4 level during first estrous cycle was 3.02 ± 0.8 ng / mL and detected on 5th week. Second ovulation was observed during 6th week and again peak P4 concentration of 2nd cycle was found as 2.5 ± 0.64 ng / mL on 7th week. Based upon the hormonal profile, it was concluded that postpartum ovarian cyclicity resumed on 3rd week of postpartum in winter lambed Lohi sheep.