After Childbirth Ebook
Getting Back Into Shape After The Pregnancy
Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.
Besides the SVZ and the dentate gyrus, active adult neurogenesis and or gliogenesis exist in other brain regions. The drug-affected area, striatum, is among those regions where cell proliferation and differentiation recently have been noticed (13). After BrdU injection, cell division is consistently observed in the dorsal and ventral striatum. Divided cells are scattered throughout the area. Newborn striatal cells survive beyond 60 d, with a graduate increase in their body size and processes (13,14). Although a small fraction of cells exhibit the morphological characteristics of radial glia 3 wk after birth, the vast majority of newborn cells show no obvious morphology of either projection neurons or glia. Parallel with the morphological observations, approx 10-20 of BrdU-labeled cells are immunoreactive to S100P and no BrdU cells are double labeled with NeuN even 6 wk after birth. Thus, it appears that gliogen-esis, but not neurogenesis, naturally occurs in the intact striatum at a...
Cannabis use in the USA typically begins in the mid to late teens, and is most prevalent in the early 20s (Bachman et al., 1997). Most cannabis use is intermittent and time-limited, with very few users engaging in daily cannabis use over a period of years (Bachman et al., 1997). In the USA and Australia, about 10 of those who ever use cannabis become daily users, and another 20 to 30 use weekly (Hall & Pacula, 2003). Cannabis use declines from the early and mid-20s to the early 30s, reflecting major role transitions in early adulthood (e.g. entering tertiary education, entering fulltime employment, marrying, and having children) (Anthony, 2006 Bachman et al., 1997). The largest decreases are seen in cannabis use among males and females after marriage, and especially after childbirth (Bachman et al., 1997 Chen & Kandel, 1995).
Et al. 1998 Williams and Kirkham 2002b). Since 2-AG is present in the milk of humans and animals, Fride and her collegues asked whether this endocannabinoid might promote appetite and suckling behaviour in newborn animals. Indeed, the administration of SR141716A to newborn mice, within the first 24 h after birth, had a devastating effect on milk ingestion and often led to the death of the treated animals. CB1 receptor-deficient mice also failed to drink in the first 24 h after birth, but started to display milk bands from day 2. It seems that this delayed onset of milk intake affects the survival rate of CB1 knockout pups, which was significantly lower than that of wild-type littermates in Fride's studies (Fride et al. 2001, 2003). Our (A.Z.) previous analysis of the distribution of genotypes among offspring of heterozygous matings indicated a small deviation from the expected Mendelian frequency at the time of weaning (CB1+ +, 29 CB1+ , 47,7 CB1- -, 23.3 n 1,439), thus also...
Streptomycin (a first-line drug in the non-pregnant patient) and kanamycin, amikacin, and capreomycin (second-line drugs) are contraindicated during pregnancy because of their ototoxic properties. Inadvertent use does not require termination of pregnancy or invasive diagnostic procedures, but hearing tests should be performed after birth.
Renal function in 14 children born to women with transplants treated throughout pregnancy with a ciclos-porin-based regimen has been extensively investigated at a mean of 2.6 years after delivery (205). No renal function abnormalities were found. In particular, glomerular filtration rate was within the reference range. Renal function was found to be normal in 22 children evaluated after a mean of 39 months after birth (206), and no adverse effects on the immune function were identified in the few infants examined in this respect (203).
Zidovudine, also known as azidothymidine (AZT), is a pyrimidine analog used in the treatment of HIV-1 and HIV-2 infections. AZT is a nucleoside reverse transcriptase inhibitor (NRTI). Pharmacokinetic studies indicate that AZT crosses the placenta fetal AZT levels arc found to be similar to or higher than maternal levels. The administration of zidovudine monotherapy to the mother (and to the infant after birth) rapidly became standard practice once it had been shown to reduce mother-to-child transmission by two-thirds (AIDS Clinical Trial Group, protocol 076, 1994). In combination with other antiretroviral drugs such as lamivudine and, recently, with HAART, the risk of perinatal transmission has decreased even more and is presently around 1-2 .
During and after pregnancy women are more susceptible to malaria infection and its consequences. Occult malaria infection, often without fever, may cause anaemia and placental dysfunction This effect is greatest in primi-gravidae and has been attributed to the adhesion of parasitized erythrocytes to chondroitin sulfate A and hyaluronic acid in the placenta (Fried and Duffy 1996 Beeson et al. 2000). Foetal growth is impaired and babies born to
Uses In China, the wood of Caesa pinia sappan L. is used to heal wounds, stop hemorrhage and haemoptysis, regulate menses after childbirth, and soothe bruises. In Malaysia, the wood is used to expel impurities and to clean infected skin. A decoction of wood is used to stop haemoptysis and hemorrhage. In Vietnam, a decoction of about 15 g of wood is ingested daily to stop dysentery intestinal and uterine hemorrhage, heal wounds and furuncles, regulate menses, soothe contusion, and treat impetigo and leucorrhea. Externally Caesa pinia sappan L. is used as a shampoo.
Ergot alkaloids are used only after birth for postpartum uterine hypotonia. They are contraindicated during pregnancy. Accidental use during the first trimester does not automatically require termination of the pregnancy. Detailed ultrasound scanning can exclude morphologic developmental disorders. For other ergotamine derivatives, see Chapters 2.1,2,8 and 2.15,
Uses In Laos, Cambodia and Vietnam, the leaves of Macrosolen cochichinensis (Lour.) Van Tieghem are used to make a tea-like drink, and the fruits are used to treat cough. In Malaysia, Macrosolen cochichinensis (Lour.) Van Tieghem is used to assuage headache, and to tighten the uterus after childbirth. To date, the pharmacological potential of Macrosolen cochichinensis (Lour.) Van Tieghem is undiscovered.
The pharmacokinetics of three doses of nelfinavir, 15, 30, and 45 mg kg bd, have been studied in 22 neonates, who were also given stavudine and didanosine for 4 weeks after birth (11). Median values of Cmin (mg ml) at 1, 7, 14, and 28 days of age were respectively 0.19, 1.21, 0.51, and 0.33 (15 mg kg) 1.02, 3.18, 0.73, and 0.55 (30 mg kg) and 0.67, 3.21, 0.70, and 0.73 (45 mg kg). The median values of steady-state AUC (hours.mg ml) at 14 and 28 days were respectively 14 and 8.7 (15 mg kg) 19 and 16 (30 mg kg) and 23 and 19 (45 mg kg). There were no serious adverse events. Thus, systemic exposure to nelfi-navir fell after 7 days of age, perhaps because of hepatic enzyme maturation, autoinduction of nelfinavir metabolism, and or changes in nelfinavir absorption. Because of the highly variable kinetics the authors suggested that plasma concentration monitoring was warranted to ensure adequate nelfinavir dosing in neonates.
In humans no increase in birth defects has been observed in offspring of women who used morphine during pregnancy. A morphine dose quickly passes from the woman into the fetus, however, and reaches a blood level similar to the woman's. A dose lasts longer in the fetus than elsewhere in a woman's body. The drug reduces fetal motions. A baby born to a chronic morphine user can have dependence on the drug and exhibit withdrawal symptoms after birth. One study found that infants receiving morphine for medical purposes soon after birth show no ill effects five years later in conduct, muscular coordination, or intelligence.
Endocannabinoid signaling via CB1 receptors has a critical role in nursing (Fride et al., 2001). Injection of the CB1 antagonist SR141716 into newly born mouse pups produces devastating effects on suckling and milk ingestion, followed by death within 4 to 8 d. CB1 receptor blockade must occur within 24 h after birth to produce these effects (Fride, Foox, et al., 2003). Coadministration of (-)A9-THC protects pups from the adverse effects of SR141716 on suckling and survival, suggesting involvement of CB1 receptors. This conclusion is supported by similar but more moderate deficiencies observed in (untreated) CB1- - knockout pups (Fride, Foox, et al., 2003). Significantly, smaller litters and high rates of cannibalism (infanticide) were observed in knockout compared to wild-type mice, which indicate important roles for CB1 receptors in fertility and normal maternal behavior. CB1 knockout pups did not ingest milk on the first day of life, began to ingest on the second day, and were less...
Clozapine has a half-life of up to 25 hours. With a daily dosage of 50 mg clozapine, a concentration of 63.5 ig l was reported in the colostrum on the day after birth the maternal serum level was 14.7 ng l. One week later, with a dosage of lOOmg daily, the concentration of the drug in the milk had risen to 115.6 ig l the maternal serum level was 41.4 ig l (Barnas 1994). This represents an M P ratio of 2.8. Based on this, an infant would take in 17.3 ig kg daily, or about 1 of the maternal weight-related dosage. In two of the case studies collected by the manufacturer, sleepiness in the intake. Levels rapidly fell to almost prc-dose levels by 2 hours. A relative dose of on average 0. l o, and at maximum 0.4 o, was calculated. The child was fully breastfed from 8 weeks after birth, and was normally developed at 4.5 months (Lee 2004B).
Tacrolimus is used for immunosuppression after liver transplant, and is reported on in 25 full-term pregnancies. The first milk samples after birth were measured at 0.6 ig l, which suggests that the infant would receive less than 0.1 ig kg daily. This represents a relative dosage of about 0.1 . Because the babies were not breastfed, there are no observations of any possible effects available (fain 1997). A single case is reported where the mother received 0.1 mg kg per day throughout pregnancy. Milk levels were measured sequentially. The maximum was measured at 1 hour post-dose, at 0.57 ig l. This was estimated to be 0.06 of the maternal dose, or 0.02 absorbed by the infant based on the poor oral bioavailability (14-32 ) (French 2003). A 29-year-old woman was exclusively breastfeeding her healthy 3-month-old infant while on tacrolimus 4mg daily plus other drugs relevant to her transplant. The milk-to-blood ratio was 0.23, and average tacrolimus concentrations in milk were 1.8 g l. The...
Thyroid receptor antibodies (TRAb) can result in transient neonatal thyroid disease by transfer through milk from mothers treated for thyrotoxicosis, Serum TRAb concentration in neonates decrease continuously with time after birth. The calculated half-life for offspring-serum and breast-milk TRAb was calculated as approximately 3 weeks and 2 months, respectively. Transient neonatal thyroid disease may be worse and more prolonged during breastfeeding as a consequence of TRAb in breast milk (Tbrnhage 2006).
All infants should receive the first dose of hepatitis B vaccine soon after birth and before hospital discharge the first dose may also be given by age 2 months if the infant's mother is HBsAg-negative. Only monovalent hepatitis B vaccine can be used for the birth dose. Monovalent or combination vaccine containing Hep B may be used to complete the series four doses of vaccine may be administered if combination vaccine is used. The second dose should be given at least 4 weeks after the first dose, except for Hib-containing vaccine which cannot be administered before age 6 weeks. The third dose should be given at least 16 weeks after the first dose and at least 8 weeks after the second dose. The last dose in the vaccination series (third or fourth dose) should not be administered before age 6 months.
Longitudinal studies have shown that in utero exposure to methadone is not associated with abnormal development. Methadone maintenance should therefore be continued by women who become pregnant, though the dose may need to be reduced during the third trimester. The neonate may develop abstinence symptoms and this should be expected and treated after birth.
Uses In Indonesia, the juice extracted from the leaves is drunk believing to threaten abortion. A decoction is used to heal hemorrhoids, promote menses, expel impurities after childbirth, and to soothe inflamed eyes. In Malaysia, a decoction of the leaves or the juice extracted from the leaves is drunk to stop flatulence, to treat congestion of the liver, to assuage heart and liver pain, to treat smallpox, to soothe swollen parts and to induce vomiting. In the Philippines, a paste of leaves is used to assuage headache and to soothe bruises. In Vietnam, the plant is pectoral.
In the former case, symptoms appear within a few hours after stopping the drug and may be more severe. In the latter case, symptoms usually take a few days to appear. If a woman uses tranquillizers regularly, the drug can affect the baby for up to 10 days after birth. Babies may exhibit the withdrawal symptoms common to such other depressant drugs as alcohol and barbiturates. These symptoms include feeding difficulties, disturbed sleep, sweating, irritability, and fever. Symptoms will be more severe if the doses the mother took are higher. Administration of diazepam during labor has been linked to decreased responsiveness and respiratory problems in some newborns. Tranquillity Colloquial term for STP. Tranquillizer Tranquilizer. Tranquilone Meprobamate. Tranquinal Meprobamate. Tranquinox Meprobamate. Tranquipam Lorazepam. Tranquirit Diazepam. Tranquisan Meprobamate. Tranquo-Alupent Drug containing more than one substance whereof one under international control Oxazepam....
9.5 of in utero PTU-exposcd children developed hypothyroidism and 5.4 also developed goiter. Not all hypothyroid neonates demonstrated goiter directly after birth some were noted only at the screening control 2 weeks later. co-therapy increases the mother's thyrostatic needs. Fetal hypothyroidisms as a consequence of maternal antithyroid therapy as well as hyperthyroidism as a consequence of placental transfer of auto-antibodies in case of Graves' disease have been described. Therefore, the thyroid gland of the fetus should be monitored by ultrasound scan. The screening of thyroid parameters of the newborn is absolutely necessary, and this is compulsory in many countries. A second evaluation of the thyroid status should be performed 2 weeks after birth in the case of intrauterine exposure. Mild symptoms of hyperthyroidism with borderline laboratory parameters can be treated symptomatically without thyrostatics, for example with i-receptor blockers such as propranolol or metoprolol. If...
Seizures starting 4 hours after birth, whose mother had received 150 mg hydroxyzine per day for anxiolysis. The newborn's plasma levels paralleled those of its mother 6 hours after birth. The authors interpreted the seizures as withdrawal symptoms. The neurological development was uneventful at the age of 6 months (Serreau 2005).
The endocannabinoids appear to play a major role in fertility and reproductive functions, which is described elsewhere in this book (S. K. Dey, Cannabinoids and reproduction ). Recent work on the medicinal aspects of marijuana have indicated that the plant may be used beneficially to combat weight loss in AIDS and cancer patients by enhancing appetite (Mechoulam et al., 1998b). More recently we have uncovered evidence that the above mentioned observations may just be the tip of the iceberg of the critical involvement of the cannabinoid system in growth and in the feeding response of the neonate. Thus, when endocannabinoid function is blocked in newborn mouse pups by the administration of the CBX antagonist SR141716A, the pups fail to ingest maternal milk and die within the first week of life. This is not a general toxic effect of SR141716A because co-administration of A9-THC almost completely prevented pup mortality (Fride et al., 1999), indicating that the growth-arresting effect of...
Uses In China, the rhizome of Belamcanda chinensis (L.) DC. is used to combat fever, promote urination and menses, expel impurities, relieve the bowels of costiveness, treat tonsillitis, laryngitis, asthma, gonorrhea, alleviate cough, and to assuage stomachache, spleen and liver discomfort. In Malaysia, a decoction of 10 g of the rhizome is used to promote menses, to treat mumps and to soothe sore throat. A decoction of the roots and leaves is used in baths after childbirth. In Vietnam, a decoction of 10g-20g of the rhizomes is to alleviate cough, soothe sore throat, treat tonsillitis, laryngitis, pertusis, mastitis, combat fever, regulate menses and urination, and to counteract snake poisoning.
Meconium, the first fecal matter passed by a neonate, has recently been given much attention because it is a useful specimen in which to determine fetal drug exposure. Issues relating to the screening and confirmation of most drugs of abuse in meconium have been reviewed.94 While meconium analysis has principally been performed to assess in utero drug exposure in newborns so that treatment may begin as early after birth as possible, it may also be useful in determining drug exposure in stillborn infants. One study demonstrated the presence of cocaine in the meconium of a 17-week-old fetus, suggesting that fetal drug exposure can be determined early in gestation.95
Pure gestagen preparations (mini-pills) are the oral contraceptive of choice during breastfeeding. If the mother does not tolerate them, then the low-dosage combination pills (ethinylestradiol plus gestagen), or gestagen depot preparations, are acceptable. If necessary, they can be started about 6-8 weeks after birth. There is no preparation among the well-established hormonal contraceptives which requires an interruption of breastfeeding.
Uses In Cambodia, Laos and Vietnam Parameria laevigata (Juss.) Moldenke is used to treat fever, rheumatism, renal diseases, to promote digestion, and to stop dysentery. In Malaysia and Indonesia, a decoction of the bark is used to tighten the uterus after childbirth and to counteract putrefaction of the skin. In the Philippines, Parameria laevigata (Juss.) Moldenke is used to counteract putrefaction of the skin, to resolve inflammation, to soothe itchiness, promote menses and to treat skin diseases.
Anticholinergic drugs, 22.507 Anticonvulsants, see Antiepileptic drugs Antidepressants, during and after pregnancy, 21.17 Antidysrhythmic drugs in atrial fibrillation, 24.197 prodysrhythmic effects, 17.218, 23.196 Antiepileptic drugs comparison, 25.78 death, 23 83 overdosage, 22.84 psychiatric effects, 22.82 Antifungal drugs
There are more than 20 case reports regarding apparently normal children following vincristine therapy during the first trimester (for an overview, see Schardein 2000 and www.motherisk.org), However, there are also reports of an aborted fetus with renal aplasia after combination therapy (Mennuti 1975) the newborn cited above (Thomas 1976) who had a defect an atrial septal defect and died of respiratory distress syndrome a child with cleft palate after vincristine treatment until week 6 followed by vinblastine and other cytostatic drugs (Mulvihill 1987) and a woman receiving combination therapy for Hodgkin's disease during the first trimester whose hydrocephalic child died four hours after birth (Zemlicki 1992). Furthermore, there are reports about apparently normal pregnancies after exposure during the second and or third trimesters, but also
On the average, a female gives birth to about 25 to 40 (5D4+20) young. They remain on her back until they molt for the first time, which is usually within a week or two after birth. Once they climb down, they assume an independent existence, and periodically molt to reach adulthood. Typically 5 or 6 molts over 2 to 6 years are required for the scorpion to reach maturity. Adult scorpions range in size from .5 to 9 in length.
Uses In Malaysia, Cyrtandra cupulata Ridl. is used to promote recovery from childbirth and to combat fever. The Orang Asli people drink a decoction of the roots to prevent further pregnancies. This remedy is only effective after childbirth. The decoction is drunk for several days following birth, and it is said to permanently prevent further pregnancies.
Pharmaceutical interest A common example of Loranthaceae is Viscum album L. (mistletoe) which is used as a decoration during Christmas and has long been used by Celtic shamans. The berries of this plant contain a series of toxic amines and proteins which cause gastroenteritis if eaten in large quantities. Note that a number of the plants classified within the family Loranthaceae are used to strengthen the uterus after childbirth and that Phoradendron serot-inum (American mistletoe) were long used by North American Indians as oxy-totic agents, namely in arresting postpartum hemorrhages. About 20 species of the plants classified within the family Loranthaceae are used for medicinal purposes in the Asia-Pacific. One may have noticed that many of these medicinal plants are used to check post-partum hemorrhages, promote the secretion of milk, soothe the pregnant uterus and to make tea-like drinks. It will be interesting to learn whether a more intensive study on the family Loranthaceae...
Alcohol is firmly established as a teratogen (an agent that produces defects in the developing fetus) and is considered the most common known cause of mental retardation. Fetal alcohol syndrome (FAS) defects range from specific structural bodily changes to growth retardation and subtle cognitive-behavioral abnormalities. The diagnostic criteria for fetal alcohol syndrome include prenatal (before birth) and postnatal (after birth) growth retardation characteristic craniofacial defects central nervous system (CNS) dysfunction and organ system malformations. When only some of these criteria are met, the diagnosis is termed fetal alcohol effects (U.S. Department of Health and Human Services, 2000). The abnormalities in physical appearance seem to decrease with age, whereas the cognitive deficiencies tend to persist. There is no clear dose-response relationship between alcohol use and abnormalities. The safe amount of drinking during pregnancy (if it exists at all) is...
The carbonic anhydrase inhibitors brinzolamide, dorzolamide, and for systemic application, acetazolamide, which are used for glaucoma therapy, have not been systematically studied. A new bom of 34 weeks' gestation was tachypnoic, and a combined respiratory-metabolic acidosis, hypoglycemia, and hypokalemia was diagnosed. Its mother had been treated with 750 mg azetazolamide daily during the 3 days prior to delivery. There was 2.9pg ml in the blood of the newborn when this was measured 5 hours after birth - almost a therapeutic concentration (3-10(ig ml). There was no substance detectable on day 11. Further development of the child was uneventful (Ozawa 2001). There were no birth defects or postnatal disorders observed in the newborn of 12 women using, on average, 500 mg azetazolamide daily for idiopathic increased intracranial pressure. Nine of them were exposed during the first trimester (Lee 2005).
The Ontario Prospective Prenatal Study has studied developmental and behavioural abnormalities in children born to women who reported using cannabis during pregnancy (Fried & Smith, 2001 Fried & Watkinson, 2000 Hutchings & Fried, 1999). In this study, mothers were asked about their drug use during pregnancy and their children were measured on the Brazelton scales after birth, neurologically assessed at one month, and again at six and twelve months. There was some developmental delay shortly after birth in the visual system, and increased tremor and startle among the children of cannabis users (Fried & Smith, 2001), but these behavioural effects faded by one month, and no differences were detected on ability tests at six and twelve months. Subtle behavioural effects of cannabis were subsequently reported at 36 and 48 months, but not at 60 and 72 months (Fried & Smith, 2001). These results are suggestive of a subtle developmental impairment occurring among children who had experienced a...
Uses In Burma, the seeds of Entada phaseoloides (L.) Merr. are used to treat fever. In China, the seeds are used to heal hemorrhoids. In Indonesia, the roasted seeds are used to expel impurities after childbirth, assuage stomachache, and induce vomiting. The juice expressed from the stems is used to stop dysentery. In India, the seeds are used to aid recovery from childbirth, soothe inflammation, assuage pain in the loins and induce vomiting. In Malaysia, the pods are burned and the ash obtained is applied to the abdomen to treat internal discomfort. Pieces of sun-dried bark are macerated in water and the liquid obtained is used to wash the hair, heal wounds, and treat ptyriasis and irritated skin. In the Philippines, a decoction of the roots is used to reduce abdomen rigidity. The seeds are pulped and applied to the abdomen to assuage colic. An infusion of the bark is used to treat infected skin. In Vietnam, the seeds are used to counteract poison, and to induce stupor and vomiting.
In the fetus, CYP3A7 is the major hepatic cytochrome responsible for steroid metabolism. Variably expressed in the fetus, CYP3A5 is also present in significant level in half of the children. However, in adults, CYP3A4 is the major functional hepatic enzyme responsible for metabolism of many drugs. CYP1A1 is also present during organogenesis whereas CYP2E1 may be present in some second trimester fetuses. After birth, hepatic CYP2D6, CYP2C8 9, and CYP2C18 19 are activated. CYP1A2 becomes active during the fourth to fifth months after birth (100).
The amount of milk produced daily is between 500 and 900 ml. This amount is achieved about 4 days after birth, in order to better compare the different medications, the average daily amount per kg bodyweight that the infant takes in, rather than the individual total amount of milk consumed, is used as a basis for calculation. It is presumed that an infant receives about 150 ml kg per day ( 0.151 kg per day).
Uses In Cambodia, Laos and Vietnam, the seeds are eaten to induce vomiting, stop hiccups, and relieve the bowels of costiveness. A paste made from the leaves is used to treat zona. In India, the berries are used to treat fever, expel worms from intestines, and cure biliousness, asthma, and bronchitis. In Indonesia, the leaves are used to treat fever. In Malaysia, the juice is used after childbirth.
Uses In Cambodia, a decoction of the bark is drunk to invigorate health after childbirth. It will be interesting to learn whether a more intensive study on this plant will disclose any cytotoxic clerodane diterpenes such as casearvestrins reported Casearia sylvestris (Oberties NH etal., 2002).
Likewise, Fried and colleagues, investigating the consequences of prenatal exposure to marijuana in the same well defined human population in Canada, have pointed at subtle but definite cognitive deficiencies in these offspring, becoming apparent only from the age of four years. (Fried, 1996 Fried et al., 1998 Fried and Watkinson, 2000). Thus it seems that prenatal exposure to cannabinoids does result in adverse consequences for the offspring. However, these defects are subtle and are not apparent immediately after birth.
Uses The ripe berries of Flacourtia rukam Zoll. & Mor. are acid and astringent, but rubbing them between the hands bruises the flesh and renders it sweet and palatable. In Indonesia, the sap expressed from young shoots is used to wash the eyes. In Malaysia, the juice expressed from the berries is ingested to stop diarrhea and dysentery. The sap expressed from the leaves is applied to inflamed eyelids. The powdered dried leaves are used to heal wounds. In the Philippines, a decoction of the roots is drunk to invigorate health after childbirth. The pharmacological properties of Flacourtia rukam Zoll. & Mor. are unknown til to date.
There are at least 20 case reports on epirubicin in combination therapy, including two exposures during the first trimester which ended in spontaneous miscarriage. Regarding the other pregnancies, there was 1 abortion, 1 stillbirth and 1 child who died shortly after birth. Furthermore, there were cases of intrauterine growth restriction, premature births, and a transient leukopenia (Ring 2005, Gadducci 2003, Giacalone 1999, M ller 1996, Goldwasser 1995).
Uses In Malaysia, the juice expressed from Eleusine indica (L.) Gaertn. f is used to promote menses after childbirth, to treat encephalitis, heat stroke, malaria, uterus and rectum prolapse, leucorrhea and dysentery. In the Philippines, a decoction of the fresh plant is drunk to promote urination and to treat dysentery. In Vietnam, a decoction of 60g-100g of this herb is drunk to assuage liver discomfort, stomachache, promote urination, treat influenza and to lower blood pressure. In Cambodia, the whole plant is used to combat fever. The therapeutic potential of Eleusine indica (L.) Gaertn. remains unexplored. Note that Eleusine species are known to produce flavonoids such as vitexin and tricin (Hilu KW etal., 1978).
These genetic techniques, however, were also burdened by an inherent caveat. The absence of a gene product during development could theoretically produce nonspecific effects. In fact, some genes proved so important developmentally that their ablation prevented the survival of mutant mice. Standard knockout of the R1 subunit of the NMDA receptor resulted in lethality soon after birth,24 thus seriously limiting its utility. Other genetic manipulations produce anatomical defects that can also complicate interpretation of these knockout studies. For example, the deletion of the tyrosine kinase fyn in a study by Grant et al43 resulted in impairments in LTP and learning. However, it was later shown that this genetic manipulation interferes with normal myelination and resulted in gross anatomic abnormalities in the hippocampus.108 Additionally, mutant mice often have altered behavior independent of learning. As with nonspecific drug effects, aberrant behavior produced by the absence of a...
Since conventional disruption of GR signaling is lethal shortly after birth due to lung failure (Cole et al. 1995), a conditional G -knockout where GR function is selectively disrupted in the nervous system has been generated (Tronche et al. 1999). Using the Cre loxP system to achieve tissue-specific gene inac-tivation, expression of Cre under the control of the rat nestin promoter and enhancer results in a selective disruption of GR in neuronal and glial cell precursors (Tronche et al. 1999). Mutant mice (GRNesCre) display several symptoms characteristic of patients suffering from Cushing's syndrome, a disease characterized by elevated levels of glucocorticoids. In GRNesCre mice, basal morning plasma corticosterone levels were significantly increased, whereas plasma ACTH concentrations were moderately reduced. Stress-induced plasma ACTH and corticosterone levels were unaltered in conditional GR mutants. CRH expression in the paraventricular nucleus was found to be increased, most...
Or after childbirth as of the 21st day, if the woman does not breastfeed - Breast-feeding it is recommended to wait 6 weeks after childbirth before starting desogestrel in breastfeeding women. However, if it is the only contraceptive method available or acceptable, it can be started 3 weeks after childbirth.
Prenatal exposure to enzyme-inducing anticonvulsants entails a risk of serious neonatal hemorrhage in the first few days after birth. To reduce the risk, some authorities recommend that pregnant women taking enzyme-inducing drugs be given vitamin K (20 mg day) during the last month of pregnancy. Intramuscular vitamin K (1 mg) should be given to the neonate immediately after birth. The value of additional vitamin K orally for the first 3 months of life is controversial (168).
NR2 subunit expression is highly regulated during development and subunit segregation is observed between brain regions. In general, NR2B and NR2D are expressed early in development and NR2A and NR2C expression occurs in rats in the weeks after birth and continues into the adult in selected areas. In the adult cortex, hippocampus and thalamus NR2A and NR2B predominate while in the cerebellum and spinal cord, NR2C and NR2D are also expressed in the adult and their expression is specific to particular cell types. Transgenic mice technology is increasingly used to investigate the functional significance of different receptor subunits to the development and behaviour of the whole animal. Mice lacking the el (rat NR2A) subunit show apparently normal growth and mating behaviour, but an enhanced startle response and reduced hippocampal long-term potentiation (LTP) and spatial learning. Mice lacking the e2 (rat NR2B) subunit die soon after birth showing impairment of suckling response,...
A systematic review of randomized controlled trials has been performed to determine whether dexamethasone therapy in the first 15 days of life prevents chronic lung disease in premature infants (9). Studies were identified by a literature search using Medline (1970-97) supplemented by a search of the Cochrane Library (1998, Issue 4). Inclusion criteria were (a) prospective randomized design with initiation of dexamethasone therapy within the first 15 days of life (b) report of the outcome of interest and (c) less than 20 crossover between the treatment and control groups during the study period. The primary outcomes were mortality at hospital discharge and the development of chronic lung disease at 28 days of life and 36 weeks postconceptional age. The secondary outcomes were the presence of a patent ductus arteriosus and treatment adverse effects. Dexamethasone reduced the incidence of chronic lung disease by 26 at 28 days (RR 0.74 CI 0.57, 0.96) and 48 at 36 weeks postconceptional...
For prophylaxis with vitamin K, oral administration of 1-2 mg directly after birth is recommended. Parenteral administration is advised in neonates at high risk. Recommendation. Newborns should routinely receive 1-2 mg of vitamin K directly after birth. In those cases where the mother was treated with vitamin K-antagonizing drugs (such as the antiepileptics carba-mazepine, ph nobarbital, phenytoin or primidone, or with rifampicin or coumarin derivatives), parenteral administration directly after birth is advised, and the neonate should be given 1-2 mg vitamin K orally two to three times a week during the first 2 weeks after birth.
Urinary tract Renal tubular acidosis occurred in a preterm boy shortly after birth (4A). His mother had taken oral acetazolamide during pregnancy for glaucoma. When renal tubular acidosis developed, acetazolamide was detected in his serum, demonstrating transplacental passage of acetazolamide. Acetazolamide therapy is ill-advised in pregnancy.
In contrast to alcohol and cocaine, heroin and other opiates do not appear to have any teratogenic potential. In contrast to those children who are damaged by alcohol, problems with neurological development (including cognitive abilities) in the children whose mothers who have abused drugs seems to be more a consequence of the deprived social environment in the first years of life. In such instances, intact family relationships as a result of prompt adoption after birth appear to permit broadly normal development (Ornoy 2001, Coles 1993). Only attention deficits and hyperactivity (ADHD) were noted more often in adopted children than in the unexposed control group. However, there were significant differences between adopted children (37 ) and those children who remained in a drug-taking environment (67 ). This was the result of a follow-up study of 6- to 11-year-old children exposed prenatally (Ornoy 2001). Severe withdrawal symptoms beginning, for the most part, within 24-72 hours...
Following intoxication with carbamazepine in week 33. with suicidal intent, the mother was comatose and was treated with activated carbon and plasmapheresis. The baby did not show any damage after birth the Apgar score and umbilical artery pH were normal (Saygan-Karamursel 2005).
Methods used to find out prenatal exposure include interview, questionnaire and urine testing of mother and infant. Due to the consequences of admitting illicit drug abuse, maternal self-reporting drug use is not reliable, and underreporting of drug abuse by pregnant women has been reported in several studies (93,94). To avoid underestimation of in utero exposure, the use of a combination of maternal history, newborn clinical symptoms and laboratory toxicological testing is the best approach (92). In addition, a physician caring for a newborn may be required to investigate and report fetal drug exposure to child protective services. Due to legal implications, a positive maternal history of drug use may not be sufficient, and a definitive documentation of the presence of drug in the baby may be required. Urine underestimates drug exposure, as drugs are present in urine only for few days. Meconium has been shown to be a reliable source for detection of fetal drug exposure with higher...
Two case reports (Rambeck 1997, Tomson 1997) and a study of lamotrigirie among nine mothers (Ohman 2000) showed an M P ratio of about 0.6. According to the two case reports, lamotrigine appears to pass into the milk in significant quantities. Up to 6.5 mg l was found in the milk of a woman who took 300 mg daily as monotherapy. This represents a maximum relative dosage of 20 . Concentrations of up to 2.8 mg l were measured in the serum of the unremarkable baby. This is not far from the lower range of the maternal serum concentrations (3.6-9.6 mg l). In the serum of four children whose mothers took between 200 and 800 mg daily, levels of
Substantial amounts of levetiracetam were measured in the milk of a single mother (99fig ml) the M P ratio was 3 (Kramer 2002). Based on seven mothers taking between 1500 and 3500 mg daily, Johannessen (2005) calculated an M P ratio of 1, which remained stable until 10 months after birth. The relative dosage for the infants was 7.8 at maximum. No side effects were observed in the infants. The drug was detected in only one of the exposed children. For recommendations, see section 4.8.15.
With long-term therapy with oxcarbazepine (1200 mg d) plus topira-mate (150 mg d), neither oxcarbazepine nor its metabolite were found in the blood of an unremarkable fully breastfed 2-month-old child (detection limits 0.1 and l.Opg ml, respectively) (personal observation). In a 5-day-old fully breastfed newborn, oxcarbazepine and its metabolite 10-hydroxy-carbazcpin were measured. Compared to the values measured directly after birth, which represented cord blood transfer, only 12 of the drug and 7 of the metabolite were detected on day 5 (cited in Pennell 2003).
Prostaglandins are, for the most part, used in obstetrics for priming and inducing labor. After birth, other pharmaceuticals are used for uterine involution so that therapy during breastfeeding for obstetrical indications is not common. Latanoprost is administered as eye drops for glaucoma.
There are very few situations where a mother who is breastfeeding and develops an infection puts her infant at risk because the infection might be transmitted through the milk. Vertical transmission after birth mainly occurs via close contact between mother and child. Pathogens discussed in context with breast milk transmission are HIV, human cytomegaly virus (HCMV), and - limited to tropical regions - Human T cell lymphotropic virus (HTLV), with the potential for leukemia, myelopathies, and neurological diseases (Biggar 2006, Lawrence 2004). The following sections discuss the most important infections. The issue of anti-infectious drug therapies has been covered in Chapter 4.4.
Hepatitis B is only rarely transmitted via the placenta, In contrast, there is a great risk of infection during the birth. For this reason, newborns whose mothers carry hepatitis antigens (HBs-Ag and HBc-Ag), which indicate the possibility of infection, are simultaneously vaccinated immediately after birth. HBs-Ag has also been detected in mothers' milk (Boxall 1974). However, various studies have shown that there Is no increased risk of illness for infants when their mothers are only HBs-Ag carriers (Gonzalez 1995, Tseng 1988, Beasley 1975). No infection via breast milk was observed in the infants of 100 mothers with chronic hepatitis B. The infants had received simultaneous vaccination, and 11 mothers were HBc-Ag positive (Hill 2002). Nevertheless, the authors interpret their data with caution because of the small cohort of I lBe-Ag-positive mothers with potentially higher infection risk.
Heroin as a street drug is a contraindication to breastfeeding because the ingredients, dosage, and possible contamination of illegally produced products cannot be properly calculated. When methadone substitution is continued, a fully breastfed child who has already been exposed in utero to opiates or methadone is likely to develop fewer withdrawal symptoms after birth than one who is not breastfed. For this reason, the baby can or should be breastfed if there is maternal methadone substitution when it is certain that there are no other drugs involved, and no maternal infection, such as HIV, that would argue against it. The daily methadone dosage that can be tolerated by the breastfed baby should be decided individually, considering the therapy up to the birth and any symptoms in the infant. Each individual case must be reviewed individually, including social services in the discussions, to be sure the mother has been stable with her therapy. Abrupt weaning after...
With treatment using 400 mg propylthiouracil, a maximum of 0.7 mg l was found in the mother's milk. For the infant this is at most 0.1 mg kg, i.e. 1.5 of the maternal weight-related dosage in 24 hours. The M P ratio is 0.1 (Kampmann 1980), In older studies in which the methodology was insufficient, M P values of 12 were calculated. In a newer study of 11 children whose mothers took 300-750 mg daily, elevated TSH values were seen in 2 children 7 days after birth. However, these normalized over the course of time, although the maternal dosage remained stable or was even increased. No correlation was found between the maternal dosage or the maternal thyroid hormone FT4 on the one hand, and the infant's TSH on the other. Even with the highest daily dosage, there appears to be no risk for the breastfed baby (Momotani 2000).
Uses In Burma, the flowers of Mesua ferrea L. are used to make an astringent tea and the leaves are used externally to counteract snake-poison. In Malaysia, a bath with these flowers is taken to invigorate health after childbirth. In Indonesia, the pounded seeds or the oil expressed from the seeds are used externally to heal wounds and to treat skin infection.
Primordial germ cells arc present in the embiyo at about 1 month after the first day of the last menstruation. They originate from the yolksac-entoderm outside the embtyo. and migrate into the undifferentiated primordia of gonads located at the medio-ventral surface of the urogenital ridges. They subsequently differentiate into oogonia and oocytes, or into spermatogonia. The oocytes in postnatal life are at an arrested stage of the meiotic division. This division is restarted much later after birth, shortly before ovulation, and is finalized after fertilization with the expulsion of the polar bodies. Thus, all-female germ cells develop prcnatally and no germ cells are formed afterbirth. Moreover, during a female lifespan approximately 400 oocytes undergo ovulation. All these facts make it possible to state that an 8-weeks' pregnant mother of an unborn female is already prepared to be a grandmother Final morphological and functional development occurs at different times during...
Mesoridazine can elevate prolactin, a hormone released by the pituitary that may cause breast cancer to grow faster epilepsy, as mesoridazine may increase the frequency of seizures glaucoma, low blood pressure, prostatic hypertrophy or urinary retention, as the symptoms may worsen. Tests before starting None. Alcohol Should be avoided, as the simultaneous use of mesoridazine and alcohol can lower blood pressure significantly and cause confusion. Also, alcohol worsens anxiety and depression and impairs insight and judgment. Use in pregnancy Some antipsychotics have been linked with the floppy infant syndrome, in which the baby has poor muscle tone. The fetus may also experience pseudoparkinsonism and dystonia, muscular side effects that may cause fetal distress before, during, and shortly after birth. Sunlight Severe sunburns can occur on mesoridazine. Avoid sunbathing entirely and avoid casual exposure to the sun for more than thirty minutes. Use a sunblock of a sun protection factor...
Both before and after birth a baby experiences its mother her physiological rhythms, mental patterns, sound and flow of consciousness. Games of manipulation, image fixation, and attachment all create blocks in mental physical energy patterns, which are experienced by the baby. It is in relationship to this experience that the baby's own mental physical energy patterns develop. When a baby has the opportunity to consistently experience eight or ten people and to nurse from three or more women, whether or not they are lactating, the baby's mental physical development will pattern after a DNA-based affinity for the most balanced physiological rhythms of the various people. The baby's mental physical development will be structured as it experiences the comfortable or pleasurable mental physical patterns of the people and rejects the patterns that are blocked and uncomfortable or painful.
In 1938 the Swiss chemist Albert Hofmann was working with ergot, a rye fungus, in the natural products division of Sandoz Laboratories, even then a maj or pharmaceutical company. He hoped to find a drug that might help stop uterine bleeding after childbirth. One of these ergot-based compounds was LSD-25, or lysergic acid diethylamide. It had little effect on the uterus of laboratory animals, and Hofmann shelved it. Five years later, a curious presentiment called Hofmann back to examine LSD, and he accidentally discovered its powerful psychedelic properties.
Fluorescein (fluorescein sodium) has yellow coloring, and is used as a diagnostic agent as topical, ophthalmic and intravenous solutions, ft is excreted into breast milk. Fluorescein is photosensitive and there is a risk of phototoxicity, especially in neonates who may require phototherapy (i.e. extensive light exposure). There is a case reported of a premature infant who received the compound directly, and had a skin reaction (Kearns 1985). A woman was given 5 ml intravenous dose of a 10 solution for diagnostic angiography shortly after birth,
PRECAUTIONS Warnings All antipsychotics can cause neuroleptic malignant syndrome, a rare but severe and potentially fatal reaction consisting of fever, muscle rigidity, mental status changes, and alterations in pulse and blood pressure. They can also cause tardive dyskinesia, a potentially irreversible disorder of rhythmical, involuntary muscle movements (see chapter 19 for details of both conditions). Use extra caution if you have Breast cancer as molindone can elevate prolactin, a hormone released by the pituitary that may cause breast cancer to grow faster epilepsy, as molindone may increase the frequency of seizures glaucoma, low blood pressure, prostatic hypertrophy or urinary retention, as the symptoms may worsen. Tests before starting None. Alcohol Should be avoided, as the simultaneous use of molindone and alcohol can lower blood pressure significantly and cause confusion. Also, alcohol worsens anxiety and depression and impairs insight and judgment. Use in pregnancy Some...
CXCR4 knockout mice generated by several groups have shown multiple functions associated with this receptor. SDF-la and knockout mice present very similar phenotypes. Both showed defective lympho-poieis and myelopoiesis in the bone marrow (312,313), as well as severe heart defects, defective formation of large blood vessels, and derailed cerebellar neuron migration (312-315). Moreover, most CXCR4 _ mice died in utero at 18.5 days of embryonic development and the remainder died within 1 h after birth. This is the only chemokine receptor null mutation described to date that results in embryonic lethality.