RESUMO
BACKGROUND: Previous research suggests early postpartum fatigue (PPF) plays a significant role in the development of postpartum depression (PPD). Predicting risk for PPD via early identification of PPF may provide opportunity for intervention. OBJECTIVE: To replicate and extend previous studies concerning the impact of PPF on symptoms of PPD and to describe the relationships among PPF, PPD, and other variables using the theory of unpleasant symptoms. DESIGN: Correlational, longitudinal study. SETTING: Participants' homes. PARTICIPANTS: Convenience sample of 42 community-dwelling women recruited before 36 weeks of pregnancy. MAIN OUTCOME MEASURES: PPF, depressive symptoms, and stress measured during prenatal weeks 36 to 38, and on Days 7, 14, and 28 after childbirth. Salivary cortisol was measured as a physiological marker of stress. RESULTS: Significant correlations were obtained between PPF and symptoms of PPD on Days 7, 14, and 28, with Day 14 PPF levels predicting future development of PPD symptoms in 10 of 11 women. Perceived stress, but not cortisol, was also correlated with symptoms of PPD on Days 7, 14, and 28. Women with a history of depression had elevated depression scores compared to women without, but no variable was as effective at predicting PPD as PPF. CONCLUSIONS: Fatigue by Day 14 postpartum was the most predictive variable for symptoms of PPD on Day 28 in this population.
Assuntos
Depressão Pós-Parto/etiologia , Fadiga/complicações , Transtornos Puerperais/complicações , Adulto , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/psicologia , Fadiga/diagnóstico , Fadiga/metabolismo , Feminino , Humanos , Hidrocortisona/análise , Estudos Longitudinais , Modelos Psicológicos , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/metabolismo , Fatores de Risco , Saliva/química , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estresse Psicológico/complicações , Estresse Psicológico/diagnóstico , Estresse Psicológico/metabolismo , Fatores de TempoRESUMO
It is well known that chronic thyroiditis is frequently associated with other autoimmune disorders, but its association with inflammatory bowel diseases has rarely been described. We report a case of a 26-year-old woman, seven months after delivery, who developed a moderate attack of ulcerative colitis. Laboratory analysis, ultrasonography, anti-thyroid antibodies and cytological examination of fine needle aspiration biopsy led us to diagnose postpartum thyroiditis. The patient also presented erythema nodosum, anti-parietal cell and anti-intrinsic factor antibodies and a family history of autoimmune disorders. This case illustrates the need for clinical awareness of concomitant postpartum thyroiditis and ulcerative colitis and suggests that in patients with inflammatory bowel diseases thyroid function test should be carried
Assuntos
Autoanticorpos/sangue , Colite Ulcerativa/complicações , Transtornos Puerperais/complicações , Tireoidite Autoimune/complicações , Adulto , Colite Ulcerativa/imunologia , Feminino , Humanos , Transtornos Puerperais/imunologia , Tireoidite Autoimune/imunologiaRESUMO
Postpartum cardiomyopathy is rare form of cardiac failure, with the potential for cardiac function to recover to normal. When medical therapy fails to control symptoms or haemodynamic stability, circulatory support with a ventricular assist device may be considered as a bridge to cardiac transplantation. We describe 2 patients with severe postpartum cardiomyopathy, in whom cardiac function recovered sufficiently during mechanical circulatory assistance to enable device explantation. Bacteremia during device support was treated with chronic suppressive antibiotics, yet after cannula explantation and ventricular repair, residual infection led to destruction of the primary repair, with formation of a left ventricular pseudoaneurysm. This is a complication of device support not previously reported. Surgery was necessary to repair the infected ventricular cannula site. Both patients recovered; however one patient developed recurrent cardiomyopathy 4 months later.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Aneurisma Cardíaco/etiologia , Ventrículos do Coração/microbiologia , Coração Auxiliar/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Adulto , Falso Aneurisma/tratamento farmacológico , Falso Aneurisma/cirurgia , Aneurisma Infectado/tratamento farmacológico , Aneurisma Infectado/cirurgia , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/microbiologia , Remoção de Dispositivo , Feminino , Aneurisma Cardíaco/tratamento farmacológico , Aneurisma Cardíaco/cirurgia , Coração Auxiliar/microbiologia , Humanos , Insuficiência da Valva Mitral/etiologia , Gravidez , Infecções Relacionadas à Prótese/complicações , Transtornos Puerperais/complicações , Fatores de Risco , Fatores de TempoAssuntos
Hepatite Autoimune/complicações , Cirrose Hepática Biliar/complicações , Transtornos Puerperais/complicações , Adulto , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Colagogos e Coleréticos/uso terapêutico , Feminino , Hepatite Autoimune/tratamento farmacológico , Hepatite Autoimune/patologia , Hepatite Autoimune/fisiopatologia , Humanos , Síndrome , Resultado do Tratamento , Ácido Ursodesoxicólico/uso terapêutico , gama-Glutamiltransferase/sangueRESUMO
No disponible
Assuntos
Feminino , Adulto , Humanos , Obesidade Mórbida/complicações , Respiração com Pressão Positiva , Transtornos Puerperais/terapia , Edema Pulmonar/terapia , Transtornos Puerperais/complicações , Edema Pulmonar/complicaçõesRESUMO
A case of a 25-year-old primigravid woman at 31 weeks' gestation with the diagnosis of preeclampsia, malignant pelvic mass, fetal growth restriction and postpartum pulmonary thromboembolism is reported. Fertility preserving surgery for ovarian carcinoma following cesarean delivery was carried out. Final histopathology revealed Stage IC dysgerminoma. After eight months of initial surgery she became pregnant spontaneously. After two years of initial surgery she is still alive without any evidence of disease.
Assuntos
Disgerminoma/diagnóstico , Neoplasias Ovarianas/diagnóstico , Pré-Eclâmpsia/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Adulto , Cesárea , Diagnóstico Diferencial , Disgerminoma/complicações , Disgerminoma/patologia , Disgerminoma/cirurgia , Feminino , Humanos , Recém-Nascido , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Pré-Eclâmpsia/complicações , Pré-Eclâmpsia/patologia , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Complicações Neoplásicas na Gravidez/cirurgia , Terceiro Trimestre da Gravidez , Transtornos Puerperais/complicações , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/patologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/patologiaRESUMO
Postpartum cerebral angiopathy (PCA) is an uncommon cause of ischemic and hemorrhagic stroke in young women. It is usually clinically benign and not relapsing. We describe a patient with nonhemorrhagic PCA who had an atypical progressive neurological deficit from bilateral hemisphere watershed ischemia despite treatment with aggressive medical therapy and intracranial balloon angioplasty.
Assuntos
Angioplastia com Balão , Infarto da Artéria Cerebral Anterior/complicações , Infarto da Artéria Cerebral Anterior/terapia , Transtornos Puerperais/complicações , Transtornos Puerperais/terapia , Adulto , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico , Transtornos Puerperais/diagnósticoRESUMO
Although the incidence of stroke is extremely low, the complications are serious. Maternal mortality has been reported to be as high as 26%. It is important for doctors to be aware of the causes, diagnostic techniques, and management strategies for stroke in order to achieve the best outcome for the mother and fetus. Recurrence risk appears extremely low, so women should feel confident in future positive pregnancy outcomes.
Assuntos
Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/terapia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Adulto , Transtornos Cerebrovasculares/complicações , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Transtornos Puerperais/complicações , Fatores de RiscoAssuntos
Dor no Peito/etiologia , Insuficiência Cardíaca/complicações , Transtornos Puerperais/complicações , Adulto , Diagnóstico Diferencial , Emergências , Tratamento de Emergência/métodos , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Cuidado Pós-Natal/métodos , Transtornos Puerperais/diagnóstico , Embolia Pulmonar/diagnóstico , Resultado do TratamentoRESUMO
A case controlled study about HIV seroprevalence among women with post-partum endometritis-myometritis (PPEM) matched with two controls. Each was performed in a non-governmental organization hospital in Kampala, Uganda. All participants were offered HIV pre- and post-test counselling. Personal and clinical information was obtained and HIV-1 ELISA tests performed on blood samples and discordant results resolved by Western blot test. HIV-1 seroprevalence was significantly higher among women with PPEM than controls, 26 (42.3%) and 26 (21.3%) respectively (P = 0.002). Women with PPEM were two-and-a-half times more likely to be HIV-positive than controls, odds ratio 2.74 (95% CI 1.34-5.65). Single or cohabiting women and low salaried women were also significantly more among PPEM cases than controls. In conclusion, PPEM cases had significantly higher seroprevalence of HIV-1 infection than controls and this needs further elucidation for purposes of management strategies.
Assuntos
Endometrite/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Soropositividade para HIV , HIV-1/imunologia , Transtornos Puerperais/complicações , Adulto , Biomarcadores , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Anticorpos Anti-HIV/análise , Infecções por HIV/complicações , Soroprevalência de HIV , HIV-1/isolamento & purificação , Humanos , Gravidez , Uganda/epidemiologiaRESUMO
Short-term postpartum sexual problems are highly prevalent, ranging from 22% to 86%; however, there are few studies that address how mode of delivery affects sexual functioning after childbirth. The objective of this study was to perform a systematic review of the literature on selected postpartum sexual function outcomes as affected by cesarean, assisted vaginal, and spontaneous vaginal delivery. We searched PubMed, CINAHL, and Cochrane databases from January 1990 to September 2003 and focused on mode of delivery and the most commonly reported sexual health outcomes, which included perineal pain, dyspareunia, resumption of intercourse, and self-reported perception of sexual health/sexual problems. The studies all showed increased risks of delay in resumption of intercourse, dyspareunia, sexual problems, or perineal pain associated with assisted vaginal delivery. Some studies showed no differences in sexual functioning between women with cesarean delivery and those with spontaneous vaginal delivery, whereas others reported less dyspareunia for women with cesarean delivery. A systematic review of the literature suggests an association between assisted vaginal delivery and some degree of sexual dysfunction. Reported associations between cesarean delivery and sexual dysfunction were inconsistent. Continued research is necessary to identify modifiable risk factors for sexual problems related to method of delivery.
Assuntos
Coito/psicologia , Parto Obstétrico/efeitos adversos , Dispareunia , Período Pós-Parto , Transtornos Puerperais/complicações , Saúde da Mulher , Atitude Frente a Saúde , Parto Obstétrico/psicologia , Dispareunia/etiologia , Dispareunia/psicologia , Feminino , Humanos , Período Pós-Parto/psicologia , Transtornos Puerperais/psicologia , Fatores de Risco , Parceiros Sexuais/psicologia , Estados UnidosRESUMO
A case of late recurrence of uterine inversion is presented. Symptoms included constipation and urinary retention without uterine bleeding. Symptoms resolved 3 months after the replacement of the uterus. It is hypothesized that the symptoms were related to stretch injury to the pelvic parasympathetic nerves. Timely intervention may prevent long-term sequelae.
Assuntos
Transtornos Puerperais/diagnóstico , Inversão Uterina/diagnóstico , Adulto , Feminino , Humanos , Hemorragia Pós-Parto/etiologia , Transtornos Puerperais/complicações , Transtornos Puerperais/cirurgia , Recidiva , Fatores de Tempo , Retenção Urinária/etiologia , Inversão Uterina/complicações , Inversão Uterina/cirurgiaRESUMO
Although rare, sacral stress fractures may occur in pregnant women, and osteoporosis of pregnancy is a poorly understood entity. We present the case of a young, postpartum, recreational runner who developed low back pain (LBP) and radicular symptoms suggestive of L5 radiculopathy found to be secondary to sacral stress fracture. The patient had a good clinical outcome after several months and was able to resume her normal activities. This case illustrates that clinicians should have a high index of suspicion for sacral stress fracture in athletic pregnant or postpartum women presenting with LBP and/or lumbar radiculopathy. Also included are a brief review of osteoporosis in pregnancy and guidelines on the diagnosis and management of sacral stress fractures.
Assuntos
Traumatismos em Atletas , Fraturas de Estresse , Transtornos Puerperais , Radiculopatia/etiologia , Sacro/lesões , Fraturas da Coluna Vertebral , Adulto , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Diagnóstico Diferencial , Terapia por Exercício , Feminino , Consolidação da Fratura , Fraturas de Estresse/complicações , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Humanos , Dor Lombar/etiologia , Imageamento por Ressonância Magnética , Exame Físico , Guias de Prática Clínica como Assunto , Transtornos Puerperais/complicações , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Amplitude de Movimento Articular , Doenças Raras/complicações , Doenças Raras/diagnóstico , Doenças Raras/terapia , Corrida/lesões , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/terapia , Caminhada/lesões , Suporte de CargaAssuntos
Glomerulosclerose Segmentar e Focal/complicações , Pré-Eclâmpsia/complicações , Proteinúria/etiologia , Transtornos Puerperais/complicações , Adulto , Biópsia por Agulha , Ciclosporina/uso terapêutico , Feminino , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/patologia , Humanos , Imunossupressores/uso terapêutico , Rim/patologia , Período Pós-Parto , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/patologia , Gravidez , Proteinúria/diagnóstico , Proteinúria/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Transtornos Puerperais/patologia , Resultado do TratamentoRESUMO
A case of acquired uterine arteriovenous fistula in a 28 Year old patient is reported that probably is secondary to a "difficult" delivery. Sono-graphic, MRI and angiographic findings are reported, before and after endovascular management.
Assuntos
Fístula Arteriovenosa/diagnóstico , Transtornos Puerperais/diagnóstico , Útero/irrigação sanguínea , Adulto , Amenorreia/etiologia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Feminino , Humanos , Histerossalpingografia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Prognóstico , Transtornos Puerperais/complicações , Transtornos Puerperais/terapia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
Second to diabetes mellitus, thyroid diseases are the most common endocrinopathies seen in pregnancy. The incidence of post-partum thyroid dysfunction (PPTD) in women with type 1 diabetes mellitus is three-fold increased. We determined the incidence of thyroid abnormalities in a well-defined group of young subjects with type 1 diabetes and in an age-matched healthy controls during and six months after pregnancy in an area of mild iodine deficiency. Twenty-five out of twenty-eight pregnant women completed the study. Fifteen were affected by type 1 diabetes and ten were controls. Our protocol of study consisted of four evaluations of each subject: in the first, in the second trimester, at delivery and six months after. At each control the patients were submitted to physical examination, thyroid ultrasonography, and determination of fT3, fT4, TSH, Antithyroglobulin antibodies (TgAbs), Antithyroperoxidase antibodies (TPOAbs). The variation of thyroid volume is statistically significant in both the diabetics and in the controls during the different times of observations. Four out of the fifteen diabetic pregnant patients (27%) developed a thyroid disease: two cases of post-partum thyroiditis (PPT) and two cases of euthyroid benign nodular goiter, as confirmed by cytological examination. Two out ten controls (20%) developed positive antibodies (TPO Abs and TgAbs) since the first observation and showed an autoimmune thyroiditis six months after delivery. Both of them showed a familial history of thyroid disease. Our study suggests that in an area of mild iodine deficiency the incidence of thyroid autoimmunity in pregnant women is similar, whether diabetic or not; moreover, thyroid volume is increasing in the diabetics as much as in the non diabetics during pregnancy.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/imunologia , Gravidez em Diabéticas/imunologia , Transtornos Puerperais/complicações , Transtornos Puerperais/imunologia , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/imunologia , Adulto , Autoanticorpos/sangue , Autoantígenos/imunologia , Estudos de Casos e Controles , Feminino , Bócio Nodular/complicações , Bócio Nodular/imunologia , Humanos , Iodeto Peroxidase/imunologia , Iodo/deficiência , Proteínas de Ligação ao Ferro/imunologia , Gravidez , Estudos Prospectivos , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/fisiopatologia , Tireoglobulina/imunologia , Doenças da Glândula Tireoide/diagnóstico por imagem , Doenças da Glândula Tireoide/fisiopatologia , Tireoidite/complicações , Tireoidite/imunologia , Tireoidite Autoimune/complicações , Tireoidite Autoimune/imunologia , Tireotropina/sangue , UltrassonografiaRESUMO
A 28-year-old woman with thyroid hemiagenesis, who had been diagnosed as having Graves' disease, became pregnant during the course of methimazole treatment. The treatment was terminated in the second trimester. She delivered a normal infant at full term. She became thyrotoxic 3 months after the delivery, hypothyroid 6 months after the delivery, and finally euthyroid 11 months after the delivery without undergoing any treatment. This clinical course indicates that she developed silent thyroiditis after the delivery. A diagnosis of thyroid hemiagenesis was made on the basis of ultrasonography of the thyroid and 99mTc-pertechnetate thyroid scintiscan.
Assuntos
Complicações na Gravidez , Transtornos Puerperais/complicações , Glândula Tireoide/anormalidades , Tireoidite/complicações , Adulto , Antitireóideos/uso terapêutico , Feminino , Doença de Graves/complicações , Doença de Graves/tratamento farmacológico , Humanos , Hipotireoidismo/etiologia , Metimazol/uso terapêutico , GravidezRESUMO
Postpartum ovarian vein thrombosis is a rare condition, with an incidence rate being 1/600 deliveries. It most often arises in the right ovarian vein. A 33-year-old patient who had had normal vaginal delivery presented with fever, pain in the right iliac fossa, and leukocytosis on the sixth day after delivery. An antibiotic course was instituted but 3 days later symptoms reappeared. Diagnosis of acute appendicitis was made. At surgery through a McBurney incision, a woody tumoration consistent with ovarian vein thrombosis was found. Anticoagulation therapy with heparin and antibiotics were instituted. Phlebography and color Doppler sonography confirmed the presence of thrombosis of both the common femoral iliac and inferior vena cava. Fribrolysis with urokinase was performed. The patient has remained stable and symptom-free over a 4-year follow-up. Ovarian vein thrombosis typically presents with symptoms suggestive of acute appendicitis, as was the case in our patient. Color Doppler sonography is the favored diagnostic procedure, with CT being a supplementary tool. Surgery is not necessary and treatment consists of anticoagulants and antibiotics. Even though postpartum ovarian vein thrombosis is rare, early recognition of the condition is of paramount importance to institute the adequate treatment and avoid potential serious sequelae.