Η επίδραση της μεθυλοεργονοβίνης στην γαλουχία

Abstract

The benefits of lactation are well known worldwide, and we have observed the last 50 years a noticeable reduction, in the number of lactating women. Many scientists have investigated this phenomenon and have found the explanations interesting. In Greece this reduction was defined in the last 30 years and this experience led us to look at common practices which affected lactation; practices in labor and puerperium, which could be compared with findings from other countries of the world. We focused on methylergonovine and its use in delivery. But the effect of this drug on lactation was not enough to explain such a reduction. So the behavior of the new mothers in relation to breast feeding, led us to look for other factors to explain this reduction. Smoking, drugs, initiation of lactation, intervals between feeds, infant’s crying etc. was investigated and from this we will try to draw a rational conclusion. Material and Methods. We randomized 218 pregnant women from the outpatient clinic of our Hospital, and looked after them during pregnancy with 5 samples of blood for 5 different periods of pregnancy to determine the prolactin levels during pregnancy. After that we isolated 34 women at low risk for haemorrage, after the third stage of labor, and we did not give them methyloergonovine. Then we determined the prolactin levels on the third day of puerperium. We compared these results with homologous results from 34 women who received methyloergonovine. In addition we sent a questionnaire letter in 1514 women who had given birth and we collected the answers. These were not at all complete, but we collected the more complete and divided them in 2 groups of 430 (lactating and not lactating). We analyzed the results in the TEI Serron computer department with SPSS statistical package. This has led to some useful results, which will be discussed below. Results. In outpatient clinic in DUHI and GPNS, 218 women randomized when came to us to take after their pregnancy. We took blood samples for PRL from pregnancy devided into 5 periods (8-12 w, 13- 18 w, 19-24 w, 25-36 w, 37-40 w) and studied the levels of PRL (table 1). These values were ranged from 41.0782ng/ml to 238,0183 ng/ml the same like around the world. Thirty four women consisted the coutril group (didn’t received methylergonovine). In this group determined PRL levels the same time on the third day after delivery. It was 200.8618ng/ml a 15% lower from mean level at 40th w of gestation (table II). The mean level of PRL in the group who received methylergonovine the mean level of PRL was 190.6029 ng/ml; about 19% lower than the corresponded mean level in the fourteenth week of gestation, a statistically significant. The difference in Ht between the two groups wasn’t statistically significant (table II). In table III we analyzed smoking, sore nipples, breast discomfort and sedation (1st week of puerperium). We found no statistical significance in the difference between smoking, sore nipples, breast discomfort and breast feeding in the 6th week after delivery (p>0.05, n=430) but sedation seems to be significantly effective (p<0.01). In table IV we studied previous experiences, decision for breast feeding and frequency of feeding at 1st week of puerperium. There was a difference between two groups (p<0.01), except for the category of standard feeds every 4 h (p>0.01). In table V we investigated the time of initiation of breast feeding, night feeds and bottle feeds (1st week after delivery). There were differences between groups (p<0.01) in all categories. In table VI we were looking at frequency of feeds at home, problems at home and pleasure in breast feeding. We found statistical importance in all categories except the problem of sore nipples at home (p>0.01). Notice that 69% of women were breast feeding by the 6th week of lactation. But between "active" and "physiological" groups there were no difference in breast feeding at 6th week of lactation (table VII). Discussion. Someone could say that not giving methylergonovine at the 3rd stage or after 3rd stage of labor in selected cases, or giving oxytocin in medium risk cases, promotes prolactin levels and probably breast feeding. There is a statistical important decline in PRL levels at 3rd day after delivery with use of methylergonovine in contrast with no use, but by the 6th week of lactation we didn’t notice such a difference in breast feeding. It may be said that if "active" group of mothers could be encouraged during the 1st week of lactation to continue breast feeding then they will encouraged to continue breast feeding after the 6th week of lactation. We didn’t find the effects on breast feeding from smoking, sore nipples or breast discomfort in the 1st week of lactation, throughout the duration of breast feeding instead of sedation. The time of decision for breast feeding, and frequency of feeds, plays a role in the duration of breast feeding. The time of initiation of breast feeding, and night feeds has a great impact on the duration of breast feeding. Bottle feed is related to early discontinuation of breast feeding. Frequency of feeds at home, problems at home, and mother’s pleasure are factors which affect the duration of breast feeding. We must say that all findings in this study are from result and not reasonable causation. Many other reasons may play a role on the duration of breast feeding. The references agree with our findings except for slight differences in the findings of some authors. This attempt leads to a body of advice to health professionals in relation to manipulation of delivery and the new mother, focusing their acts and behavior on breast feeding keeping this as the main target with knowledge of many advantages of breast feeding for newborns and their mothers.

Ο θηλασμός των νεογνών ήταν ο μοναδικός τρόπος διατροφής τους μέχρι τη βιομηχανική εποχή. Οι αλλαγές που παρατηρήθηκαν στις βιομηχανικές χώρες με συνέπεια την μείωση των θηλαζουσών μητέρων στο 28% από το 100%, έφθασαν στην Ελλάδα με καθυστέρηση και ενσωματώθηκαν στρεβλά με συνέπεια να μην υπάρχει σαφής κωδικοποίηση της συμπεριφοράς των μητέρων καθώς και των επαγγελματιών της υγείας (Μαιευτήρων, Μαιών και Νοσηλευτριών) ως προς τον θηλασμό. Η παρούσα μελέτη ανέλαβε να ερευνήσει την επίδραση της μεθυλοεργονοβίνης στη γαλουχία καθώς και άλλων παραγόντων που προέκυψαν επιπρόσθετα κατά την εξέλιξη της έρευνας και να κωδικοποιήσει τα αποτελέσματα για την σωστότερη καθοδήγηση των μητέρων. Επελέγησαν 218 έγκυες από τα εξωτερικά ιατρεία και από την αρχή της κύησης και μετρήθηκε η πορεία της προλακτίνης στην κύηση. Από αυτές κατά τον τοκετό δεν χορηγήθηκε μεθυλοεργονοβίνη σε 34 που χαρακτηρίστηκαν χαμηλού κινδύνου. Μετρήθηκε η μεθυλοεργονοβίνη την τρίτη ημέρα της λοχείας σε δύο ομάδες λεχωίδων (34 χωρίς μεθυλοεργονοβίνη και 34 με μεθυλοεργονοβίνη). Στη συνέχεια επιδόθηκε ή απεστάλη ταχυδρομικά ερωτηματολόγιο με τις συνήθειες των μητέρων σε 1514 γυναίκες που είχαν γεννήσει. Οι απαντήσεις μετά από επεξεργασία κατατάχθηκαν σε δύο ομάδες των 430 (θηλάζουσες και μη θηλάζουσες) και μελετήθηκαν στατιστικά. Οι θαυμάσιες προσπάθειες των ερευνητών που έδειξαν την φύση της προλακτίνης και τον πολύπλοκο μηχανισμό ελέγχου της έκκρισής της μελετήθηκαν από τη βιβλιογραφία και κατεγράφησαν, στην παρούσα για να γίνουν κατανοητά τα συμπεράσματα στα οποία καταλήγει. Είναι αρκετά ενδιαφέρον το εύρημα ότι στις γυναίκες που έγινε χρήση μεθυλοεργονοβίνης στον τοκετό, η τιμή της προλακτίνης την τρίτη ημέρα της λοχείας είναι ελαττωμένη περισσότερο από τις γυναίκες που δεν τους χορηγήθηκε μεθυλοεργονοβίνη. Αλλά την 6η εβδομάδα δεν υπάρχει στατιστικά σημαντική διαφορά ως προς τον θηλασμό των βρεφών. Η σύγκριση των αποτελεσμάτων με τα στοιχεία της διεθνούς βιβλιογραφίας, οδηγεί στο ότι δεν διαφέρουν αφ’ ενός σημαντικά και αφ’ ετέρου οι προσπάθειες πρέπει να επικεντρωθούν στην υποστήριξη των μητέρων, ως προς τον θηλασμό, την 1η εβδομάδα της λοχείας και στη λελογισμένη και σταθμισμένη χρήση των μητροσυσπαστικών από τους Μαιευτήρες και τις Μαίες.