Evaluation of the effect of natural and emotional stress of labor on lactation and breast-feeding.

BACKGROUND: The amount of stress experienced by both the mother and fetus during labor and delivery varies considerably and is likely to be different in primiparous and multiparous women as well as in those who receive analgesia during labor and those who do not receive. OBJECTIVE: In this study, we explored relations between stress during birth experience and lactogenesis of 100 women, who experienced vaginal delivery in Department of Obstetrics and Gynecology of University Hospital of Alexandroupolis. METHOD: Stress hormones (cortisol and glucose) were measured in serum (cord and maternal blood) immediately after delivery. Moreover, breast-feeding frequency on day 4, the time when the subjects first felt fullness in the breasts, milk volume on day 4 postpartum and duration of labor were recorded. Also, we recorded maternal exhaustion score during labor and positive and negative affects, posttraumatic stress score and mother-infant bonding rate, with the use of questionnaires. RESULTS: There were significant intercorrelations among the outcome variables. Mothers who experienced pain, exhaustion and negative feelings in a stressful and long labor had delayed onset of lactation. CONCLUSIONS: These results indicate that primiparity, long labor, stress to the mother and fetus during labor and delivery, negative affects and high score of posttraumatic stress are risk factors for delayed lactogenesis.

Attenuation of the oestrogen positive feedback mechanism with the age in postmenopausal women.

OBJECTIVE: It has been reported that the positive feedback mechanism of oestrogens and progesterone is preserved, although attenuated, in late postmenopausal years. Whether this is also true for the positive feedback effect of oestrogens alone has not been investigated. DESIGN: Prospective intervention study. PATIENTS: Thirty healthy postmenopausal women. MEASUREMENTS: The women were divided into three groups according to the years since menopause (group I: 2-8 years, group II: 9-17 years, group III: 18-25 years). They were studied during a period of 41 days. Two acute experiments (EP) of exogenous oestradiol, given via skin patches, were performed from days 1 to 7 (EP1) and from days 35 to 41 (EP2) to induce an LH surge. Between the two experiments (days 7-34), oestradiol was given at the dose of 100 µg every 3 days, while oral progesterone was added from day 21 to day 34 in order to simulate a luteal phase. Blood samples were taken every 6 h during EP1 and EP2 as well as on days 8, 13, 20, 21, 27 and 34. FSH, LH, oestradiol and progesterone were measured in all blood samples. RESULTS: An LH surge occurred as a result of the oestradiol positive feedback mechanism in group I and in group II, in both EP1 and EP2. Peak LH values during the surge were significantly lower in group II than in group I in both experiments. None of the patients in group III displayed an LH surge. CONCLUSIONS: These results demonstrate for the first time a gradual attenuation of the pituitary response to oestrogenic provocation over a certain period following the menopause, with complete abolition after 20 years. It is suggested that the reserves of pituitary gonadotrophs diminish with age.

Attenuating activity of the ovary on LH response to GnRH during the follicular phase of the cycle.

OBJECTIVE: Oestradiol sensitizes the pituitary to GnRH, while gonadotrophin surge attenuating factor (GnSAF) may oppose this action. Using the LH response to GnRH during treatment with FSH as an in vivo bioassay for GnSAF, we tested the hypothesis that the augmented LH response to GnRH in the late follicular phase is related to reduced production of GnSAF from the ovulatory follicle. DESIGN: Prospective intervention study. PATIENTS: Ten healthy, normally cycling women. MEASUREMENTS: The LH response to 10 µg GnRH i.v. (ΔLH) was investigated on days 2 and 3 and on days v (follicle size 16-17 mm) and v + 1 of cycle 1 (control) and cycle 2. On days 2 and v, a single s.c. injection of either normal saline (cycle 1) or 450 IU recombinant FSH (cycle 2) was given after the end of the GnRH experiment. RESULTS: FSH injection increased both serum oestradiol and inhibin B. In cycle 1, ΔLH remained unchanged from days 2 to 3 but increased significantly from days v to v + 1. In contrast, in cycle 2, ΔLH decreased significantly from days 2 to 3 (P < 0·05) and showed a nonsignificant increase from day v to day v + 1. The percentage difference in ΔLH between cycle 1 and cycle 2 was similar on days 3 (-66·9 ± 17·5%) and v + 1 (-65·2 ± 3·6%). CONCLUSIONS: These results suggest that during the follicular phase of the menstrual cycle, GnSAF is produced by small antral follicles, while the contribution of the ovulatory follicle is minimal.

Preimplantation genetic diagnosis.

Preimplantion genetic diagnosis (PGD) is now used for identification of gene and chromosomal defects in embryos. In this article we describe its use primarily for identification of chromosomal defects in women with recurrent abortions, repeated in vitro fertilization (IVF) failure, and advanced maternal age. In all these situations there is increase in chromosomal defects. The identification of normal embryos and the elimination of abnormal embryos are argued to be helpful in increasing implantation and pregnancy rates in these women.