Uterine infections (metritis and endometritis) are a leading cause of culling and reproductive failure in transition dairy cows, and antibiotic-resistant Gram-negative pathogens limit conventional therapy. This randomized, controlled, multi-farm field trial evaluated whether four intravaginal infusions of a host-adapted lactic acid bacteria (LAB) cocktail (Lactobacillus sakei FUA3089, Pediococcus acidilactici FUA3138, P. acidilactici FUA3140; 108-109 cfu/dose) at -3, -2, +3, and +4 weeks relative to calving reduce periparturient disease and improve milk production. A total of 526 pregnant cows (426 Holstein, 100 Jersey) from four commercial Alberta farms (automatic-milking, parlor, and certified-organic systems) were block-randomized within farm and parity to TRT1 (saline; n = 175), TRT2 (saline + skim milk; n = 176), or TRT3 (LAB cocktail in saline + skim milk; n = 175). Uterine infection incidence was assessed by Metricheck™ mucus scoring and transrectal ultrasonography at +3 and +4 weeks postpartum. Across the principal peripartum infectious outcomes, TRT3 showed a consistent protective effect: uterine infection incidence was lowest in TRT3 (18.8% vs. 25.1% in pooled controls; OR = 0.69; 95% CI, 0.44-1.09; an approximately 25% relative reduction; exact p = 0.12), and this metritis signal was additionally supported by a repeated-measures mixed model accounting for farm, parity, and week (p = 0.0175), although the Bonferroni-adjusted pairwise contrasts were tendencies (adjusted p ≈ 0.12), and the effect did not differ by parity (treatment × lactation interaction, p = 0.97). Subclinical mastitis was numerically lower in TRT3 than in pooled controls (5.3% vs. 8.9%; OR = 0.57; 95% CI, 0.27-1.24; exact p = 0.16), whereas retained placenta, milk fever, displaced abomasum, and lameness showed no clear cow-level treatment effect in the cow-level exact analyses. Milk yield increased significantly in multiparous cows, which produced 4.6 L/day more milk than TRT1 and 3.22 L/day more than TRT2 over the first 50 days in milk (p < 0.01 for both contrasts; treatment × parity interaction, p = 0.01). No effect was seen on milk composition, uterine involution, or reproductive performance. The trial supports intravaginal LAB as a candidate antibiotic-free prophylactic whose response depends on farm- and cow-level contexts and whose mechanisms require confirmation through microbiological and metabolic measurements.

Background and Clinical Significance: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Among its various etiologies, uterine atony accounts for approximately 70% of cases, while other causes include genital tract trauma, pathologic placentation, and intrapelvic arterial injury. Uterine artery embolization (UAE) has emerged as a preferred management option for severe PPH due to its high success rates of 89-98% and fertility preservation benefit. Despite its efficacy, UAE can lead to complications, such as pain, re-bleeding, infection, persistent vaginal discharge, ovarian insufficiency, and uterine necrosis-a rare but serious complication occurring in 1.4-2.7% of cases. Case Presentation: We present three cases of uterine necrosis following UAE from a single center (CHA Bundang Medical Center) between 2003 and 2024. All patients developed persistent high-grade fever approximately two weeks after the procedure, despite an initial response to antibiotic therapy. Imaging studies, including contrast-enhanced CT and MRI, revealed uterine ischemia and necrosis, and all patients ultimately required total hysterectomy. Conclusions: Uterine necrosis is a rare but potentially life-threatening complication of UAE that should be suspected in patients with persistent high-grade fever beyond the typical post-procedural course. Early imaging evaluation, particularly with contrast-enhanced modalities, is essential for prompt diagnosis. Timely surgical intervention, including hysterectomy, may be required to prevent severe morbidity.

Acupuncture at traditional Chinese medicine (TCM) sites used to treat low milk supply has been claimed to cause release of prolactin and oxytocin, although published studies have found mixed results on serum prolactin. In one study, acupuncture did not affect prolactin hyperresponsiveness after stimulation with metoclopramide in women with amenorrhea-galactorrhea syndrome. Galactorrhea has been reported following acupuncture for pain treatment. No adverse effects on milk production were seen among lactating women who received acupuncture for postpartum sciatica.[1] Acupuncture has been well described in TCM for treating insufficient milk supply,[2,3] and is also recommended in some Western countries.[4] Numerous studies found acupuncture at CV 17 (also referred to as Ren 17, Danzhong or Shanzong; located at the center of the sternum), SI 1 (Shaoze; on the little finger), ST 18 (Rugen; lower breast margins), Zusanli (ST 36), and Taichong (LR 3) to benefit women with a low postpartum milk supply.[5] These studies generally do not meet current evidence-based guidelines, partly because of the extreme difficulty in double-blinding and placebo-controlling acupuncture studies. However, 2 studies did find a better response to electroacupuncture applied at a traditional site for lactation stimulation (SI 1) than electroacupuncture applied at a site unrelated to milk production (LI 1). Electroacupuncture increased serum prolactin, infant weight and maternal perception of milk production more than domperidone alone.[6] None of the studies reported to date have made an attempt to optimize maternal nursing technique before acupuncture. Although less studied, acupressure at milk acupuncture sites has had similar effects. A systematic review concluded that acupuncture and acupressure are effective in increasing breastmilk volume.[7] Acupuncture therapy has been used to treat breastfeeding for milk stasis (engorgement). Randomized, nonblinded studies in an outpatient Swedish lactation clinic compared routine care (including oxytocin spray) to routine care plus acupuncture at 2 or 3 points for treating milk stasis.[8,9] A meta-analysis concluded that women who received acupuncture were less likely to develop an abscess, had less severe symptoms on day five, and had a lower rate of fever than women in the usual care group However, there is insufficient evidence from published trials to justify widespread implementation.[10] A survey of 50 Swedish maternity units in 2007 found that 60% of hospitals used acupuncture to treat milk stasis, 18% used acupuncture to treat mastitis, and 2.2% each used it for painful breastfeeding or to improve milk supply. The authors felt that this extensive use was not justified based on the limited evidence for most of these uses.[11] Acupuncture and acupressure have also been used successfully as a treatment for breast engorgement.[7,12] Auricular therapy uses stimulation of acupoints on the ear corresponding to various anatomical sites and functions of the body for the diagnosis, treatment, and prevention of disease. All studies applied Vaccaria seeds to press on ear acupoints. Two systematic reviews on auricular therapy to increase milk supply have come to differing conclusions. One review found a positive effect on milk production, onset of lactation, serum prolactin, breast fullness, neonate states, and frequency of newborn urination and defecation.[13] A more recent review found varying efficacy between studies and poor methodology that did not allow for a definitive conclusion on efficacy as a galactogogue.[14] No adverse effects were reported in any studies.

The current study aimed to establish biochemical threshold values for serum non-esterified fatty acids (NEFA), β-hydroxybutyric acid (BHBA), glucose, and calcium during prepartum period to predict the likelihood of postpartum production diseases (ketosis, milk fever, mastitis, and metritis) in Karan Fries (KF) cows under tropical climates of northern India. 31 KF cows were monitored from -6 weeks prepartum to +7 weeks postpartum, with blood sampling at -6, -3, -2, -1 weeks, on the day of calving, and +1, +2, +3, +5, +7 weeks. Based on postpartum production disease incidence, cows were classified as no production disease (NPD; n = 10), single production disease (SPD; n = 12), and multiple production diseases (MPD; n = 9). The MPD group exhibited significantly higher (P < 0.05) serum NEFA and BHBA levels from -3 and -1 weeks prepartum, respectively and lower (P < 0.05) glucose and calcium levels from -2 weeks and -1 week prepartum onward compared to SPD and NPD groups. Receiver Operating Characteristic (ROC) analysis identified NEFA ≥ 0.29 mmol/L (-1 week) as predictive of SPD, and ≥ 0.36 mmol/L (-1 week) as predictive of MPD. Similarly, BHBA ≥ 1.23 mmol/L (calving) indicated SPD and whereas > 1.40 mmol/L (-1 week) indicated MPD. Glucose ≤ 37.55 mg/dL at -2 and -1 weeks predicted SPD and MPD respectively, while calcium ≤ 6.60 mg/dL (calving) and ≤ 6.35 mg/dL (-1 week) were indicative of SPD and MPD. These evidence based thresholds provide reliable early biomarkers of postpartum production diseases, supporting routine biochemical monitoring and timely interventions to improve herd health and productivity under tropical dairy farming conditions.

A 28-year-old postpartum woman presented with severe headache, fever, and decreased level of consciousness. Cerebrospinal fluid PCR detected 185,000 copies of Epstein-Barr virus DNA.

The postpartum period is associated with a wide spectrum of potential complications that may lead to significant maternal morbidity and mortality if not promptly diagnosed and treated. Clinical presentation is frequently nonspecific - including symptoms such as pelvic pain, fever, and vaginal bleeding - rendering imaging indispensable for differentiating normal postpartum changes from pathologic conditions. Radiologists should be familiar with the expected postpartum imaging appearance of the uterus as well as the imaging findings of common and uncommon complications. This review provides an imaging-centered overview of postpartum complications after vaginal and cesarean delivery, including endometritis, retained products of conception, postpartum hemorrhage, uterine rupture, uterine dehiscence, along with key extrauterine complications. We discuss the strengths and limitations of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) in the evaluation of these conditions. Key imaging features and diagnostic pitfalls across modalities are highlighted to aid radiologists in accurate interpretation. This review aims to improve diagnostic confidence and ultimately enhance patient outcomes in the postpartum population.