Treatment of COVID-19 disease in pregnancy and breastfeeding

The physiological and anatomical clinical characteristics of pregnant women make them susceptible to complications caused by coronavirus disease (COVID-19). Increased coagulation and risk of thromboembolic phenomena are common during pregnancy; they are further enhanced when associated with a thrombogenic pathology such as in COVID-19. The treatment of COVID-19 is controversial and limited, even for non-pregnant patients. During pregnancy, the options are even more restricted due to the teratogenicity of some drugs and anatomical and physiological difficulties, especially in advanced pregnancy in patients with respiratory failure. Therefore, the focus of treatment for pregnant patients should be centered on isolation, monitoring fetal and maternal vital signs, uterine activity, and general maternal-fetal well-being. The prescription of drugs and management orientation should be based on gestational age and maternal clinical conditions. The optimal type of delivery is guided by obstetric indications and COVID-19 disease severity. Breastfeeding should be encouraged with the use of masks and hand hygiene. The treatment of pregnant women with COVID-19 brings important peculiarities that should be considered in order to make better decisions for preserving the health of the mother and fetus.

Determinants of Postpartum Blues for Postpartum Mothers Survey Study at the Madiun City General Hospital

BACKGROUND: Postpartum blues in mothers fail in adapting to changes in life patterns due to pregnancy and the process of pregnancy, childbirth, and postpartum. Many factors influence the incidence of postpartum blues. AIM: The purpose of this study was to determine the determinants that affect the symptoms of postpartum blues in patients treated at the Madiun City General Hospital. METHODS: A cross-sectional study design, the population is all postpartum mothers at the Madiun City Hospital in March–April 2020, the population is 52 respondents. The sample size is 47 people, sampling using simple random sampling technique. The independent variables were age, type of delivery, parity, education, and family support. The dependent variable is postpartum blues symptoms. The research instrument used a questionnaire and a checklist. Data analysis used Chi-square and Fisher’s exact test with significance level = 0.05. RESULTS: The results showed that age for postpartum blues symptoms had p = 0.006, and the type of delivery had p = 0.032. Meanwhile, data analysis using Chi-square test of childbirth experience (parity) on postpartum blues symptoms showed p = 0.033, education showed p = 0.006, and family support showed p = 0.000. CONCLUSION: The conclusion of the research is the determinants of age at risk, type of delivery, parity, education, and family support which have a significant impact on the occurrence of postpartum blues symptoms. This research recommends the need for early detection efforts and increased counseling for postpartum mothers to prevent postpartum blues symptoms.

Biphasic Drug Release from Rolled-Up Gelatin Capsules with a Cylindrical Cavity

Biphasic drug delivery systems are used for quick release of a specific amount of drug for immediate amelioration of a patient’s state, followed by sustained release, to avoid repeated administration. This type of delivery is often necessary for pain management and the treatment of many pathologies, such as migraines, hypertension, and insomnia. In this work, we propose a novel architecture of a biphasic release media that does not need the rapidly disintegrating layer and that allows for easily setting the sustained release rate. A drug-containing capsule is made by rolling up a thermally crosslinked gelatin strip on which drug reservoirs are formed by casting. The quick-release reservoir (QRR) is placed at the strip’s extremity, from which the rolling starts, while the sustained-release reservoir (SRR) is formed in the middle part of the strip. The strip is rolled around a cylinder that is a few millimeters wide, which is removed after rolling. The roll is stabilized by transglutaminase-catalyzed crosslinking of the consecutive shells. A biphasic release is successfully demonstrated with the use of model fluorescent drugs for single-dye and double-dye systems in phosphate-buffered saline (PBS) solution with pH = 7.4. In vitro, the drug from the QRR, placed at the walls of the cavity of the roll, is released immediately upon the capsule’s contact with the PBS solution. The drug from the SRR, embedded between the roll’s layers, diffuses steadily, with the lag time defined by the radial position of the reservoir.

Research Progress on Cell Membrane-Coated Biomimetic Delivery Systems

Cell membrane-coated biomimetic nanoplatforms have many inherent properties, such as bio-interfacing abilities, self-identification, and signal transduction, which enable the biomimetic delivery system to escape immune clearance and opsonization. This can also maximize the drug delivery efficiency of synthetic nanoparticles (NPs) and functional cell membranes. As a new type of delivery system, cell membrane-coated biomimetic delivery systems have broadened the prospects for biomedical applications. In this review, we summarize research progress on cell membrane biomimetic technology from three aspects, including sources of membrane, modifications, and applications, then analyze their limitations and propose future research directions.

Interaction Between Diet and Dominant Fecal Microbiota Along the First Year of Life

Extensive work has established the importance of the gut microbiota during the first years of life. However, there are few longitudinal studies describing the role of infants´ diet on the evolution of the fecal microbiota and their metabolic activity during this stage. The aim of this work was to explore the impact of diet on the composition of the major intestinal microorganisms and their main microbial metabolites from birth to 12 months. This is a longitudinal prospective study analyzing fecal microbiota, bacterial groups levels were determined by qPCR and short-chain fatty acids (SCFAs) levels by gas chromatography, as well as information from self-administered questionnaires about general characteristics and food frequency from a cohort of 83, Spanish and full-term, infants at 15, 90, 180 and 365 days of age. Results revealed that Enterobacteriaceae and Bifidobacterium decrease in weaning period contrary to Bacteroides group and Clostridium cluster IV. Furthermore, a clustering based on fecal bacterial groups, SCFAs and type of delivery and feeding, gender and living area suggested that the excretion of SCFAs is strongly related to the type of lactation. Conclusion: our study supports weaning period as a key step for gut microbiota transition and suggests the importance of the consumption of dietary fiber with the increase of certain bacterial groups as Clostridium cluster IV, which could be beneficial for the host. Finally, studies specially designed to analyze the production and the excretion of SCFAs in children are needed to understand how diet could influence in this process.

Comparing the effect of in-person and virtual childbirth preparation trainings on the fear of childbirth (FOC) and pregnancy experience of pregnant women: protocol for a quasi-experimental feasibility study

Background Childbirth preparation trainings are an important component of prenatal education, and pregnant women are increasingly interested in seeking information from online sources. The aim of this study is to compare the feasibility and the effects of in-person and virtual childbirth preparation training courses on the pregnancy experience, fear of childbirth (FOC), birth preference, and type of delivery among pregnant women. Methods In total, 165 primiparous women referring to a prenatal clinic at Milad Hospital in Tehran, will be included in this study. The subjects will be selected using the convenience sampling method and will be divided into three groups of study A, study B, and control. The study groups A and B will receive virtual and in-person childbirth training with similar content, respectively. The control group will receive only routine prenatal care. In the 18th and 20th weeks of pregnancy, the demographic information, pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed, and in the 36th and 38th weeks of pregnancy, the PES and WDEQ-A questionnaires, as well as birth preference form will be completed. The type of delivery will be recorded in the first few days of postpartum. Conclusion This quasi-experimental clinical trial will investigate the effect of virtual childbirth preparation training on primiparous women. The expected outcomes will include the difference in pregnancy experience measured by the brief version of PES, the difference in FOC measured by WDEQ-A, the birth preference, and the type of delivery. Trial registration IRCT.ir: IRCT20180427039436N2;

The Sexual Function of Primiparous Women after Normal Delivery and Cesarean Section According to the Female Sexual Function Index

BACKGROUND: Various anatomical and physiological changes occur to provide a suitable environment for fetal development during pregnancy. Changes in body shape and other physical changes also undergo changes and are associated with postpartum sexual dysfunction. AIM: This study aims to measure and determine the difference in female sexual function index scores for primiparous women post normal delivery and post-cesarean section. METHODS: An observational analytic study with a cross-sectional study design conducted in a hospital. This study involved 60 women with inclusion criteria aged 20–35 years, primiparous women with post-term pregnancy, primiparous women after normal delivery and cesarean section at 3–4 months, women who were married and living with their husbands and were willing to participate in this study. Data were analyzed descriptively and statistically. RESULTS: The results showed that the cause of perineal damage was mostly due to the mediolateral episiotomy, the degree of perineal damage with Grade II status, and there was variation in the indication of an elective cesarean section. The statistical test results show that there was no difference in the type of delivery, both normal delivery and cesarean delivery on desire, arousal, satisfaction, lubrication, orgasm, and dyspareunia and the total female sexual index in primiparous (P > 0.05). CONCLUSION: This study recommends that in primiparous women care, it is not advisable to choose one type of delivery as a form of prevention of postpartum sexual dysfunction. In addition, in the management of complaints of sexual dysfunction in primiparous it is not required to consider the type of delivery as the main cause.

Effect of the Iranian Health Sector Evolution Plan Implementation Focused on the Type of Delivery on Maternal and Neonatal Health Indicators in Selected Hospitals of East Azerbaijan Province

Background: Health systems are making reforms to ensure and promote public health. Measuring the effects of reform is one way to determine its effectiveness and consequences. Objectives: This study was aimed at investigating the effect of the Iranian Health Sector Evolution Plan (HSEP) implementation with a focus on the type of delivery on maternal and neonatal health indicators in East-Azerbaijan Province. Methods: This descriptive-analytical study was conducted in 2017. The data of 800 patients were randomly selected through the dataset of eight hospitals equally in the two time periods of before and after the HSEP implementation. A researcher-made checklist was used for data extraction. Data were analyzed by SPSS version 22 using descriptive statistics, t-test, and chi-square. Results: The mean age of the mothers in both periods was 27 years. Most of the participants did not have a previous delivery and had a diploma or a lower level of education. The rate of natural childbirth increased from 34.5% (before the HSEP) to 44.2% (after the HSEP) (P < 0.05). Maternal and neonatal mortality rates decreased from 0.3 and 0.8% to 0.0 and 0.5%, respectively. Maternal and neonatal mortality and stillbirth rates were not significantly different based on the study period and type of delivery (P > 0.05). Conclusions: The findings indicated a significant increase in the rate of natural childbirth after the HSEP implementation. Maternal and neonatal mortality rates had also decreased. These results can guide policymakers in deciding whether to continue or review the reform.