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.

Still's disease (SD) in pregnancy is a rare autoinflammatory disorder presenting considerable diagnostic and therapeutic challenges. Balancing maternal disease control with foetal safety is essential, and evidence supporting biologic therapies - particularly interleukin-1 (IL-1) blockade - during gestation remains scarce. A 34-year-old primigravida developed de novo SD at 27 weeks' gestation with high-grade fever, evanescent maculopapular rash, polyarthralgia, neutrophilic leucocytosis, and hyperferritinaemia (peak 27,967 ng/mL; CRP 342 mg/L; WCC 18.1 × 10⁹/L; ALT 69 IU/L). Intravenous methylprednisolone, oral prednisolone, and subcutaneous anakinra (100 mg daily) achieved disease control, but anakinra was complicated by suspected drug-induced liver injury (ALT 1138 IU/L) with biochemical improvement after withdrawal. Intravenous immunoglobulin (IVIg; 0.4 g/kg/day for 5 days) was administered as rescue therapy. Caesarean delivery at 34 weeks resulted in a healthy neonate. Postpartum control was achieved with tocilizumab, which the patient self-discontinued after two years, remaining in drug-free remission. A CABARET-compliant search of PubMed/MEDLINE, EMBASE and DOAJ (to May 2026) identified 23 publications describing 29 pregnancies; only five referenced anakinra with two cases of new antenatal exposure with no complications, underscoring the paucity of evidence for IL-1 blockade in pregnancy. SD in pregnancy demands prompt multidisciplinary assessment, exclusion of mimics (Haemophagocytic Lymphohistiocytosis (HLH)/Macrophage Activation Syndrome (MAS), Haemolysis, Elevated Liver Enzymes, Low Platelets Syndrome (HELLP), sepsis, intrahepatic cholestasis of pregnancy), and vigilant monitoring for treatment-related toxicity. This case documents suspected anakinra-related hepatotoxicity and supports IVIg as a potential rescue option, with tocilizumab as a viable postpartum strategy.

Cesarean myomectomy has traditionally been avoided because of hemorrhage risk, but removal at cesarean delivery (CD) may be required when a fibroid distorts the lower uterine segment or prevents secure hysterotomy closure. A 35-year-old primigravida with fetal growth restriction at 38 + 2 weeks' gestation had a large anterior intramural fibroid in the lower uterine segment. Intraoperatively, the fibroid caused distortion and traction along the hysterotomy line, and prevented approximation of the myometrial edges, precluding secure closure without excision. A trans-endometrial myomectomy was performed. The lesion was enucleated using combined blunt and sharp dissection, and the myoma bed was repaired with targeted hemostatic suturing. Hemostasis was supported with continuous intravenous oxytocin infusion, followed by multilayer uterine closure. Estimated blood loss was 1,300 mL and one unit of packed red blood cells was transfused. Histopathology confirmed leiomyoma. At 6 weeks postpartum, the patient reported no secondary postpartum hemorrhage, fever, or pelvic pain, and transvaginal ultrasonography was normal. This case highlights that a trans-endometrial approach can be considered in selected situations, particularly when a large lower-segment intramural fibroid prevents secure uterine closure during CD.

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 transition period in dairy cows is characterized by temporary decline in immune efficiency, increasing susceptibility to metabolic and infectious diseases. Pro-inflammatory cytokines (PIC) play central role in coordinating immune responses and initiating the acute phase reaction (APP). This study aimed to determine whether calving itself influences PIC release and to explore the association between cytokine dynamics, metabolic changes, and development of clinical disorders. Blood samples were collected from 12 Holstein Friesian cows from -7 to 7 days relative to calving and analysed for plasma concentrations of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Dry matter intake and health status were recorded daily, and cows were categorized as healthy (n = 7) or diseased (n = 5; showing ketosis, milk fever, mastitis, and diarrhoea within the first week postpartum). A comprehensive metabolic profile was also assessed. When considering all cows, calving had no significant impact on PIC release. However, diseased cows displayed elevated TNF-α concentrations (P < 0.05) from -7 to 0.5 days prepartum, a trend for higher IL-6 concentrations from -1 day, reaching significance (P < 0.05) at +1 day, and increased IL-1β concentrations from -2 to +3 days. Compared with healthy, Diseased cows also showed reduced DMI and a stronger APP, reflected by significantly (P < 0.05) increased haptoglobin and ceruloplasmin, reduced albumin, and elevated zinc concentrations. In this exploratory cohort, cows that developed postpartum disorders showed higher prepartum cytokine concentrations. These findings support the hypothesis that increased prepartum inflammatory tone is associated with poorer transition adaptation, but larger prospective studies are required before predictive claims.