Randomised Controlled Trial on Prophylaxis of Mastitis-Metritis-Agalactia Syndrome in Swine using Caulophyllum Logoplex and Lachesis Logoplex.

BACKGROUND: Mastitis-metritis-agalactia (MMA) syndrome occurs in the first days post-partum and causes piglet losses mainly due to malnutrition. One possibility for prophylaxis of MMA is via homeopathy. In this veterinary study, the effectiveness of a prophylactic administration of homeopathic remedies for the prevention of the occurrence of MMA in swine was evaluated. METHODS: In a randomised and blinded study, 60 sows were examined. Sows were randomly distributed in two groups: the experimental group (CL/LL) received a prophylactic administration of the complex homeopathic remedies Caulophyllum Logoplex and Lachesis Logoplex, and the placebo group was administered a sodium chloride (NaCl) solution in the same injection scheme as the experimental group. Clinical signs of MMA, behavioural changes, as well as production parameters, were recorded beginning with the day of farrowing until 5 days post-partum. RESULTS: The treatment group showed no significant effect on the occurrence of MMA in sows (CL/LL: 56.67% MMA positive sows; NaCl: 53.53% MMA positive sows). Treatment group had also no significant effect on health parameters (vaginal discharge, raised rectal temperature, shortage of milk) or behavioural parameters (impaired feeding behaviour and impaired general condition). For the production parameter average weight gain, statistically significant effects in the treatment group were detected. CONCLUSIONS: Prophylaxis with the homeopathic remedies Caulophyllum Logoplex and Lachesis Logoplex showed neither an improvement in MMA prevention nor an improvement in health parameters or behavioural traits in the present herd of sows.

Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation.

It is estimated that as many as 1 in 20 women worldwide are unable to successfully breastfeed or provide adequate nutrition for their infants through their breast milk alone. Compromised nutrition in the early stages of life places the infant at risk for insufficient growth as well as serious and potentially disabling or life-threatening complications. This review summarizes risk factors associated with impaired lactation that may result in either delayed lactogenesis or insufficient lactation. The risk factors for insufficient lactation are categorized into preglandular, glandular, and postglandular causes. Impaired lactation can occur despite maternal motivation, knowledge, support, and appropriate breastfeeding technique. Although there is no clear way to predict who will experience impaired lactation, knowledge about the risk factors can enable health care professionals to better identify at-risk mother-infant dyads. Early intervention may help prevent infant complications associated with inadequate nutritional intake.

Insufficient Lactation Leading to Postpartum Diagnosis of Placenta Accreta Spectrum Disorder in a Primigravid Patient.

BACKGROUND: Placenta accreta spectrum is most commonly diagnosed antenatally or at the time of delivery, but it may also present in the postpartum period. CASE: A 29-year-old primigravid patient without risk factors for placenta accreta spectrum had an uncomplicated vaginal birth with normal blood loss and delivery of an intact-appearing placenta. Five days postpartum, she was not lactating and uterine imaging to evaluate for retained products of conception was suspicious for placenta accreta spectrum. She began to develop bleeding in the following days and elected for definitive management. She underwent an uncomplicated hysterectomy on postpartum day 16 and began lactating on postoperative day 1. CONCLUSION: Retained placenta should be included in the differential diagnosis when lactation is insufficient.

An endocrine hypothesis to explain obesity-related lactation insufficiency in breastfeeding mothers.

In this Research Reflection I shall develop and validate the hypothesis that lactation insufficiency in obese breastfeeding mothers has an endocrine explanation. I shall not present data, but I shall review pertinent literature to show that obesity is associated with a partial or sometimes complete failure to initiate and maintain lactation, and critically examine the belief that this is due to psychosocial factors, a failure of prolactin secretion or both. Since progesterone is inhibitory to lactogenesis and oestrogens are inhibitory to milk secretion, I shall then explore the possibility that these steroids are linked to lactation failure, through sequestration of progesterone and aromatization of oestrogen in mammary adipose tissue. I shall conclude by describing experimental approaches in animal models that could be used to test this hypothesis.

Intoxicació per infusió de fonoll: causa d'irritabilitat en el lactant I el nounat / Intoxicación por infusión de hinojo: causa de irritabilidad en el lactante y el recién nacido / Intoxication by fennel infusion: cause of irritability in the infant and the newborn

INTRODUCCIÓ: La irritabilitat en el lactant és un motiu de consulta habitual que inclou les intoxicacions en el diagnòstic diferencial. L'ús de remeis casolans, com ara infusions, és freqüent en la població pediàtrica, en concret per tractar còlics, diarrees o vòmits. Aquest ús és més alt entre la població immigrant, amb la qual sovint existeix una barrera idiomàtica. Això pot dificultar la prevenció, la identificació I la resolució de possibles intoxicacions. En aquest treball es presenta el cas d'un nadó afectat per la ingesta d'infusió de fonoll, I s'insisteix en els efectes tòxics potencials. CAS CLÍNIC: Es presenta el cas d'un lactant de 16 dies de vida que consulta a infermeria per dificultats en l'alletament. S'observa una presa a la consulta, s'objectiva molta irritabilitat durant l'intent d'aferrament I es constata un escàs guany ponderal. Fent èmfasi en l'anamnesi, s'identifica l'administració durant dues setmanes de tres biberons al dia de 60 ml d'infusió de fonoll amb sucre com a remei per al còlic del lactant. COMENTARIS: Hi ha poca evidència de la tolerància al fonoll en lactants. Alguns dels seus compostos s'han aïllat en llet materna en cas que la mare n'hagi ingerit. La intoxicació depèn de la dosi I pot provocar cianosi sense resposta a oxigenoteràpia per metahemoglobinèmia. En quantitats més reduïdes, el component neurotòxic anetol provoca letargia, escàs guany ponderal, irritabilitat o vòmits; les proves complementàries no mostren alteracions, I la recuperació és completa al suprimirne la ingesta. És important detectar aquestes pràctiques potencialment perjudicials fent èmfasi en l'anamnesi

INTRODUCCIÓN: La irritabilidad en el lactante es un motivo de consulta habitual que incluye las intoxicaciones en su diagnóstico diferencial. El uso de remedios caseros a base de hierbas o infusiones es frecuente en la población pediátrica, en concreto para el tratamiento de cólicos, diarreas o vómitos. Dicho uso es mayor en la población inmigrante, con la cual suele existir también barrera idiomática. Esto puede dificultar la prevención, identificación y resolución de posibles intoxicaciones. Este trabajo presenta el caso de un recién nacido afectado por infusión de hinojo, haciendo hincapié en sus potenciales efectos tóxicos. CASO CLÍNICO: Se presenta el caso de un lactante de 16 días de vida que consulta a enfermería por dificultades en la lactancia. Se observa una toma en la consulta, se objetiva irritabilidad marcada y se constata una escasa ganancia ponderal. Poniendo énfasis en la anamnesis, se identifica la administración durante dos semanas de tres biberones al día de 60 ml de infusión de hinojo con azúcar como remedio para los cólicos del lactante. COMENTARIOS: Existe poca evidencia de la tolerancia al hinojo en lactantes. Algunos de sus compuestos han sido aislados en la leche materna en caso de ingesta por su parte. La intoxicación es dosis-dependiente y puede provocar cianosis sin respuesta a oxigenoterapia por metahemoglobinemia. En cantidades más reducidas, el compuesto neurotóxico anetol puede provocar letargia, fallo de medro, irritabilidad y vómitos. Las pruebas complementarias no muestran alteraciones y la recuperación es completa al suprimir la ingesta de la sustancia. Es importante detectar estas prácticas potencialmente perjudiciales para la población pediátrica haciendo hincapié en la anamnesis de forma activa

INTRODUCTION: Irritability in the newborn is a usual reason for consultation. It may include intoxications in its differential diagnosis. Herbal medicines and infusions are commonly used in paediatric patients, especially for infantile colic, diarrhoea and vomiting. These practices are common among the immigrant population, in which idiomatic barrier is frequent. Thus, prevention, identification and resolution of eventual intoxications can be difficult. In this paper a case report of a newborn being affected by fennel infusion is presented. The focus is put on fennel's potential toxic effects. CASE REPORT: A case of a 16-day-old infant who consults the nurse due to breastfeeding difficulties is presented. A breast milk intake with marked irritability is observed during the consultation and a low weight gain is detected. On further questioning, the administration of 3 bottles per day of 60 ml of infusion of fennel with sugar over the previous two weeks was documented, as a remedy for the infant's colics. COMMENTS: There is little evidence about fennel tolerance in new-borns. Some of its compounds have been found in breast milk in case of ingestion by the mother. Intoxication is dose-dependent and can cause cyanosis unresponsive to oxygen due to metahaemoglinaemia. In smaller quantities, the neurotoxic compound anethole can cause lethargy, failure to thrive, irritability and vomiting. Additional diagnostic tests show no alterations. Recovery after interruption of the substance's intake is ad integrum. It is important to focus on the anamnesis in order to identify dietary habits and home remedies, which could be potentially harmful in the paediatric population

Mucosal Immunity and Liver Metabolism in the Complex Condition of Lactation Insufficiency.

Lactation insufficiency is variously defined and includes the inability to produce milk, not producing enough milk to exclusively meet infant growth requirements, and pathological interruption of lactation (e.g., mastitis). Of women with intent-to-breastfeed, lactation insufficiency has been estimated to affect 38%-44% of newly postpartum women, likely contributing to the nearly 60% of infants that are not breastfed according to the World Health Organization's guidelines. To date, research and clinical practice aimed at improving feeding outcomes have focused on hospital lactation support and education, with laudable results. However, researchers' reports of recent rodent studies concerning fundamental lactation biology have suggested that the underlying pathologies of lactation insufficiency may be more nuanced than is currently appreciated. In this article, we identify mucosal biology of the breast and lactation-specific liver biology as two under-researched aspects of lactation physiology. Specifically, we argue that further scientific inquiry into reproductive state-dependent regulation of immunity in the human breast will reveal insights into novel immune based requirements for healthy lactation. Additionally, our synthesis of the literature supports the hypothesis that the liver is an essential player in lactation-highlighting the potential that pathologies of the liver may also be associated with lactation insufficiency. More research into these biologic underpinnings of lactation is anticipated to provide new avenues to understand and treat lactation insufficiency.

Rusty Pipe Syndrome and Review of Literature.

Presence of blood in colostrum may change the color of breast milk and it is known as "rusty pipe syndrome." It may resolve within days, but it may be a barrier for exclusive breastfeeding. Knowledge of "rusty pipe syndrome" among health professionals is very helpful in the management of breastfeeding initiation.

Breast Pathology That Contributes to Dysfunction of Human Lactation: a Spotlight on Nipple Blebs.

Nipple blebs are blister-like fibrinous lesions that form on the surface of the nipple during lactation, and can result in orifice obstruction and mastitis. They likely result from superficial extension of underlying ductal plugging, and can present concurrently with hyperlactation and mammary dysbiosis. Despite their prevalence, few formal reports on nipple blebs exist. In this perspective, we review the experience of a breastfeeding medicine practice that receives referrals for patients with nipple blebs, and provide preliminary insight into etiology, management, and outcomes of these lesions.

Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks.

The nutritional and immunologic properties of human milk, along with clear evidence of dose-dependent optimal health outcomes for both mothers and infants, provide a compelling rationale to support exclusive breastfeeding. US women increasingly intend to breastfeed exclusively for 6 months. Because establishing lactation can be challenging, exclusivity is often compromised in hopes of preventing feeding-related neonatal complications, potentially affecting the continuation and duration of breastfeeding. Risk factors for impaired lactogenesis are identifiable and common. Clinicians must be able to recognize normative patterns of exclusive breastfeeding in the first week while proactively identifying potential challenges. In this review, we provide new evidence from the past 10 years on the following topics relevant to exclusive breastfeeding: milk production and transfer, neonatal weight and output assessment, management of glucose and bilirubin, immune development and the microbiome, supplementation, and health system factors. We focus on the early days of exclusive breastfeeding in healthy newborns ≥35 weeks' gestation managed in the routine postpartum unit. With this evidence-based clinical review, we provide detailed guidance in identifying medical indications for early supplementation and can inform best practices for both birthing facilities and providers.

Prevalence of ineffective breastfeeding technique and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia.

INTRODUCTION: Improper positioning, attachment, and suckling are constructs for ineffective breastfeeding technique (IBT). IBT results in inadequate intake of breast milk, which leads to poor weight gain, stunting, and declines immunity. Besides, IBT increases the risk of postpartum breast problems. Despite its impact on maternal and child health, breastfeeding technique is not well studied in Ethiopia. Hence, the purpose of this study was to assess the prevalence of IBT and associated factors among lactating mothers attending public health facilities of South Ari district, Southern Ethiopia. MATERIALS AND METHODS: An institution-based cross-sectional study was conducted among 415 lactating mothers attending public health facilities of South Ari district from March 1-29, 2019. A structured observational checklist and interviewer-administered questionnaires were used. Bivariable and multivariable analyses were carried out using binary logistic regression to assess the association between explanatory variables and IBT. Statistical significance was declared at p-value < 0.05. RESULTS: Overall, the prevalence of IBT was 63.5% [95% confidence interval (CI); 59.0%, 68.0%]. Having no formal education [adjusted odds ratio (AOR): 5.0, 95% CI: 2.3, 10.5], delivering at home [AOR: 4.5; 95% CI; 1.6, 13.1], having breast problems [AOR: 2.5, 95% CI: 1.1, 5.7], being primiparous [AOR: 1.8, 95% CI: 1.0, 3.2], not receiving counseling during pregnancy and postnatal period [AOR: 2.3, 95% CI: 1.4, 3.9 and AOR: 2.5, 95% CI: 1.3, 5.1 respectively] were significantly associated with IBT. CONCLUSION: IBT was very high in the study area. Thus, empowering women, increasing institutional delivery, and providing continuous counseling about breastfeeding throughout the maternal continuum of care is invaluable to improve breastfeeding techniques.

Vivax malaria in pregnancy and lactation: a long way to health equity.

BACKGROUND: The Sustainable Development Goals (SDG) call for increased gender equity and reduction in malaria-related mortality and morbidity. Plasmodium vivax infections in pregnancy are associated with maternal anaemia and increased adverse perinatal outcomes. Providing radical cure for women with 8-aminoquinolines (e.g., primaquine) is hindered by gender-specific complexities. CASE PRESENTATION: A symptomatic episode of vivax malaria at 18 weeks of gestation in a primigravid woman was associated with maternal anaemia, a recurrent asymptomatic P. vivax episode, severe intra-uterine growth restriction with no other identifiable cause and induction to reduce the risk of stillbirth. At 5 months postpartum a qualitative glucose-6-phosphate dehydrogenase (G6PD) point-of-care test was normal and radical cure with primaquine was prescribed to the mother. A 33% fractional decrease in haematocrit on day 7 of primaquine led to further testing which showed intermediate phenotypic G6PD activity; the G6PD genotype could not be identified. Her infant daughter was well throughout maternal treatment and found to be heterozygous for Mahidol variant. CONCLUSION: Adverse effects of vivax malaria in pregnancy, ineligibility of radical cure for pregnant and postpartum women, and difficulties in diagnosing intermediate levels of G6PD activity multiplied morbidity in this woman. Steps towards meeting the SDG include prevention of malaria in pregnancy, reducing unnecessary exclusion of women from radical cure, and accessible quantitative G6PD screening in P. vivax-endemic settings.

Breastfeeding a small for gestational age infant, complicated by maternal gestational diabetes: a case report.

BACKGROUND: Small for gestational age (SGA) infants are those born small for their gestational age, with weight below the 10th percentile. Not only do SGA infants suffer growth issues after birth, they have elevated risk for the development of metabolic and cardiovascular diseases later in life. Current research has suggested that in cases of SGA infants, maternal milk and breastfeeding are not affected. The mother of an SGA infant was diagnosed with placental insufficiency and Gestational Diabetes Mellitus (GDM) during her pregnancy. The infant was born term, at 38 weeks 3 days, and SGA. The mother had a low milk supply and her milk composition differed from reference values such that the daily infant intake provided less than 50% of the required energy intake at 3 months. CONCLUSION: In cases of SGA and/or GDM, maternal milk quality and quantity may be compromised. This requires follow-up in order to reduce the disease risk for SGA infants and the corresponding public health implications.

Association between Delayed Lactogenesis â ¡ and Early Milk Volume among Mothers of Preterm Infants.

PURPOSE: This study aimed to evaluate the effect of delayed lactogenesis Ⅱ on early milk volume in mothers expressing milk for their preterm infants. METHODS: 142 mothers with preterm infants participated in a longitudinal cohort study, the milk volumes over 14 days postpartum between mothers with delayed lactogenesis Ⅱ (≥ 72 hours) and mothers with non-delayed lactogenesis Ⅱ(< 72 hours) were compared using Wilcoxon's rank sum tests. RESULTS: The prevalence of delayed lactogenesisⅡ among mothers of preterm infants was 36.0% (36/100). There existed negative correlations between the onset of lactogenesis Ⅱ and the daily milk volumes( rs = -0.525∼-0.354, p = .002 ∼ p < .001). The milk volumes in every 24-hour of the 14 days postpartum in delayed group were significantly less than that in non-delayed group (p = .002 ∼ p < .001). After controlling for the covariates, pregnancy-induced hypertension syndrome, delayed expression initiation, shorter daily sleeping time were found to be the risk factors for delayed lactogenesis Ⅱ. CONCLUSION: Delayed lactogenesis Ⅱ was associated with lower milk volume in early postpartum period. Women who were at risk for delayed lactogenesis Ⅱ need targeted interventions and additional support during pregnancy and postpartum.

Associations between liveweight, body condition score and previous reproductive outcomes, and the risk of ewes bred at 18-months of age being dry at docking.

AIMS Firstly, to investigate associations between liveweight and body condition score (BCS) of two-tooth ewes (18-months-old at breeding) at breeding, pregnancy diagnosis (PD) and pre-lambing and the risk of being dry at docking, on commercial New Zealand sheep farms. Secondly, to investigate the association between previous reproductive outcomes as ewe lambs, and risk of being dry at docking as two-tooth ewes. METHODS Two-tooth ewes (n=9,006) were enrolled in four cohorts from three commercial sheep farms between 2010-14. Ewes were weighed and BCS assessed immediately pre-breeding, at PD (mid-pregnancy) and pre-lambing. At PD, ewes were identified as either non-pregnant, or having single or multiple fetuses. Palpation and examination of udders at docking was used to classify each ewe as either lactating or dry at docking. RESULTS Overall, 437/8,025 (5.4%) of ewes that were diagnosed pregnant at PD were dry at docking. The risk of being dry at docking decreased with increasing pre-lambing conceptus adjusted liveweight (CALW) on all farms (p≤0.002); for 2010-born ewes from Farm A the OR=0.87 (95% CI=0.81-0.92); for Farm B the OR=0.88 (95% CI=0.83-0.92) and for Farm C the OR=0.86 (95% CI=0.79-0.95). The risk of being dry at docking also decreased with increasing CALW gain from PD to pre-lambing for all farms (p≤0.003); for 2010-born ewes from Farm A the OR=0.89 (95% CI=0.84-0.94); for Farm B the OR=0.85 (95% CI=0.81-0.89) and for Farm C the OR=0.88 (95% CI=0.80-0.96). There was no association between BCS at breeding, PD or pre-lambing and the risk of being dry at docking for 2010-born ewes from Farm A, Farm B or Farm C (p>0.05). For 2010-born ewes on Farm A, the risk of being dry at docking was greater for two-tooth ewes that were previously dry at docking as ewe lambs than those that were lactating at docking as ewe lambs (OR=1.7 (95% CI=1.1-2.8); p=0.018), but this difference was not observed for ewes on Farm B or Farm C (p>0.5). CONCLUSIONS There were negative associations between ewe CALW pre-lambing, and CALW gain between PD and pre-lambing, and risk of being dry at docking. For all cohorts, heavier ewes and those that gained CALW were less likely to be dry at docking than lighter ewes or those that lost CALW, however these relationships varied between cohorts.

Delayed Lactogenesis II and potential utility of antenatal milk expression in women developing late-onset preeclampsia: a case series.

BACKGROUND: Preeclampsia is a multi-system, hypertensive disorder of pregnancy that increases a woman's risk of later-life cardiovascular disease. Breastfeeding may counteract the negative cardiovascular sequela associated with preeclampsia; however, women who develop preeclampsia may be at-risk for suboptimal breastfeeding rates. In this case series, we present three cases of late-onset preeclampsia and one case of severe gestational hypertension that illustrate a potential association between hypertensive disorders of pregnancy and suboptimal breastfeeding outcomes, including delayed onset of lactogenesis II and in-hospital formula supplementation. CASE PRESENTATION: All cases were drawn from an ongoing pilot randomized controlled trial investigating the impact of antenatal milk expression versus an education control on breastfeeding outcomes. All study participants were healthy nulliparous women recruited at 34-366/7 gestational weeks from a hospital-based midwife practice. The variability in clinical presentation among the four cases suggests that any effect of hypertensive disorders on breastfeeding outcomes is likely multifactorial in nature, and may include both primary (e.g., preeclampsia disease course itself) and secondary (e.g., magnesium sulfate therapy, delayed at-breast feeding due to maternal-infant separation) etiologies. We further describe the use of antenatal milk expression (AME), or milk expression and storage beginning around 37 weeks of gestation, as a potential intervention to mitigate suboptimal breastfeeding outcomes in women at risk for preeclampsia and other hypertensive disorders of pregnancy. CONCLUSIONS: Additional research is needed to address incidence, etiology, and interventions, including AME, for breastfeeding issues among a larger sample of women who develop hypertensive disorders of pregnancy.

Delivery mode and breastfeeding outcomes among new mothers in Nicaragua.

Breastfeeding has been shown to benefit infants and mothers. Women who have caesarean deliveries (C-sections) are expected to be less likely to initiate and continue breastfeeding than those who have vaginal deliveries. Given the high rate of C-sections in Nicaragua, the importance of breastfeeding, and the centrality of culture in choices about breastfeeding, this study sought to examine if mode of delivery relates with breastfeeding initiation and exclusivity in Nicaragua. Two hundred fifty mothers were surveyed about birth experiences and breastfeeding behaviour in 3 public clinics in León, Nicaragua, between June and August 2015. Logistic regression analyses were performed to examine the association of mode of delivery with initiation of breastfeeding within 1 hr of birth (early initiation) and exclusive breastfeeding for 6 months post-partum. The rate of early initiation was 68.8% and that of exclusively breastfeeding for 6 months was 12.7%. Mode of delivery was not significantly associated with early initiation (p = .383) or exclusive breastfeeding (p = .518). Early initiation was negatively associated with prelacteal feeding, AOR = 0.30, 95% CI [0.16, 0.58]; p = .001. Mothers who had perceived their infants as large at birth were significantly less likely to exclusively breastfeed for 6 months, AOR (95%CI) = 0.25 (0.06-0.97); p = 0.046. Mode of delivery was not significantly associated with optimal breastfeeding initiation and exclusivity among mothers in Nicaragua. The 2 risk factors identified for delayed initiation of breastfeeding and lack of exclusive breastfeeding were prelacteal feeding and maternal perception of a large infant at birth, respectively.

An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation.

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Obesity as a Predictor of Delayed Lactogenesis II.

BACKGROUND: Lactogenesis II is the onset of copious milk production. A delay in this has been associated with an increased risk of formula supplementation and early cessation of breastfeeding. Prepregnancy obesity has also been associated with decreased breastfeeding rates and early cessation. Research aim: This study aimed to evaluate the effect of prepregnancy obesity on self-reported delayed lactogenesis II. METHODS: We conducted a prospective observational cohort study of 216 women with a singleton pregnancy and who planned to breastfeed. We compared the onset of lactogenesis II between women with a body mass index (BMI) < 30 kg/m2 and women with a BMI ≥ 30 kg/m2. Using multivariate logistic regression analyses, we assessed the relationship between maternal BMI and delay of lactogenesis II. RESULTS: The prevalence of delayed lactogenesis II among women with prepregnancy BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 was 46.4% and 57.9%, respectively. Delayed lactogenesis II occurred more frequently among women who were obese at the time of delivery ( p < .05). After controlling for the covariates, age, prepregnancy BMI, and gestational weight gain were positively associated with delayed lactogenesis II. CONCLUSION: Prepregnancy obesity and excessive gestational weight gain are associated with an increased risk of delayed lactogenesis II. Women who are at risk for delay in lactogenesis II and early breastfeeding cessation will need targeted interventions and support for them to achieve their personal breastfeeding goals.

Hypopituitarism presenting as congestive heart failure.

Sheehan's syndrome (SS) develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and is characterized by various degrees of hypopituitarism. Although the occurrence of SS is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency any time following the event. Appropriate hormone replacement therapy results in marked clinical improvement. We present an unusual case of SS in a young lady who continued to have normal menstruation after the index event, had two spontaneous pregnancies, and was diagnosed only 11 years later when she presented to us with acute heart failure.