Postpartum

Ergonovine (100, R = NHCH(CH3)CH2 0H) was found to yield lysergic acid (100, R = OH) and (+)-2-aminopropanol on alkaline hydrolysis during the early analysis of its stmcture (66) and these two components can be recombined to regenerate the alkaloid. Salts of ergonovine with, for example, malic acid are apparently the dmgs of choice in the control and treatment of postpartum hemorrhage. 

Because of the increa sing worldwide interest and demand for simple, effective, and inexpensive female sterilisation, a variety of procedures and methods have been developed. These approaches differ whether they are performed postpartum, postabortum, or in interval situations. The choice of methods also largely depends upon the physician s prior training, knowledge, and experience. Excellent reviews have been written on sterilisation (98). 

This section of the chapter discusses FSH, LH, GH, and ACTH. FSH and LH are called gonadotropins because they influence the gonads (the organs of reproduction). GH, also called somatotropin, contributes to the growth of the body during childhood, especially the growth of muscles and bones. ACTH is produced by the anterior pituitary and stimulates the adrenal cortex to secrete the corticosteroids. The anterior pituitary hormone, TSH, is discussed in Chapter 51. Prolactin, which is also secreted by the anterior pituitary, stimulates the production of breast milk in the postpartum patient Additional functions of prolactin are not well understood. Prolactin is the only anterior pituitary hormone that is not used medically. 

Long-term injectable contraceptive administered IM every 3 months. The injection is given only during the first 5 days after the onset of a normal menstrual period, within 5 days postpartum if not breastfeeding, or at 6 weeks postpartum. 

Ergonovine and methylergonovine both increase the strength, duration, and frequency of uterine contractions and decrease the incidence of uterine bleeding. They are given after the delivery of the placenta and are used to prevent postpartum and postabortal hemorrhage caused by uterine atony (marked relaxation of the uterine muscle). 

Ergonovine and metiiylergonovine may be given orally during die postpartum period to reduce die possibility of postpartum hemorrhage and to prevent relaxation of die uterus. When die patient is to receive eitiier of tiiese drains after delivery, it is important to take die blood pressure, pulse, and respiratory rate before administration. 

Rat DBTC Day 2 of pregnancy to 34 days postpartum at 0, 50, or 150 mg/kg diet = 0, Decreased number of antibody-producing ceiis in spieen Lowest dose at which effect was reported = 2.5 Seinen et ai. (1977b)... 

The quantity P50, a measure of O2 concentration, is the partial pressure of Oj that half-saturates a given hemoglobin. Depending on the organism, P50 can vary widely, but in all instances it will exceed the PO2 of the peripheral tissues. For example, values of P50 for HbA and fetal HbF are 26 and 20 mm Hg, respectively. In the placenta, this difference enables HbF to extract oxygen from the HbA in the mother s blood. However, HbF is suboptimal postpartum since its high affinity for O2 dictates that it can deliver less Oj to the tissues. 

Laxatives may provide appropriate relief when constipation occurs during the postpartum period, when not breastfeeding and in immobile patients. Patients who are not constipated but who need to avoid straining (e.g., patients with hemorrhoids, hernia, or myocardial infarction) may benefit from stool softeners or mild laxatives. 

Monitor postpartum antiepileptic drug serum concentrations to guide adjustments of drug doses... 

Cough-, exertion-, or Valsalva-triggered headache Pregnancy or postpartum... 

Yonkers KA, Wisner KL, Stowe Z, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry 2004 161 608-620. 

Any woman diagnosed with GDM should be retested at 6 weeks postpartum. If the fasting plasma glucose (FPG) level is normal, then reassessment for DM should occur every 3 years. Family planning for subsequent pregnancies should be discussed, and monitoring for the development of symptoms of DM should be undertaken. 

Drugs (amiodarone, radiocontrast media, lithium, a-interferon) Silent thyroiditis (including postpartum)... 

Remission of Graves disease occurs in 40% to 60% of patients after 1 to 2 years of therapy. Levels of TSHR-SAb after a course of treatment may have predictive value in that antibodypositive patients almost always will relapse. However, antibodynegative patients also may relapse after therapy is stopped. Antithyroid therapy may be stopped or tapered after 12 to 24 months. Relapse usually occurs in the first 3 to 6 months after stopping antithyroid therapy. About 75% of women in remission who become pregnant will have a postpartum relapse. When therapy is discontinued, a therapeutic strategy should be in place in the event of relapse. Many patients will opt for radioactive iodine as a long-term solution. 

Chronic hypertension (blood pressure greater than or equal to 140/90 mm Hg prior to pregnancy or prior to 20 weeks gestation that lasts more than 12 weeks postpartum)... 

Postpartum women Women should receive a single booster of Tdap in the immediate postpartum period if Tdap has not been previously received. 

HCH also penetrates the placenta barrier [A96, A101]. Complications during pregnancy occurred 1.5 times more frequently in the 213 women whose blood contained HCH than in the 89 women with no signs of this insecticide (78.3% and 58.4% respectively). It is especially significant that twice as many women with HCH in their blood spontaneously miscarried during the first trimester as those without HCH (7.5% and 3.4% respectively). Causal factors included disruptions in prenatal fetal development, and disruptions in women s hormonal systems under the effect of HCH [A96]. Postpartum complications in women who had HCH in their blood were 2.5... 

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