Eleje George Uchenna, Ugwu Emmanuel Onyebuchi, Dinwoke Victor Okey, Enyinna Perpetua Kelechi, Enebe Joseph Tochukwu, Okafor Innocent Igwebueze, Onah Livinus Nnanyere, Umeononihu Osita Samuel, Obiora Chukwudi Celestine, Nweze Sylvester Onuegbunam, Emeka Ekene Agatha, Anyaoku Chinekwu Sochukwu, Ezugwu Frank O
Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Effective Care Research Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria.
PLoS One. 2020 Jul 10;15(7):e0235888. doi: 10.1371/journal.pone.0235888. eCollection 2020.
Puerperal period is an important and thought-provoking period for puerperal mothers. Surprisingly, reports have indicated that there is increasing number of women resuming menstruation within six weeks of childbirth (puerperal menstruation). To the best of knowledge, there is no prior study on predictors of puerperal menstruation.
To determine frequency and predictors of puerperal menstruation.
This was a single tertiary health institution cross-sectional study at ESUT Teaching Hospital, Parklane, Enugu, Nigeria that included data from May 2015 to December 2018. Women were interviewed at the end of the first six weeks of their childbirth. Women with HIV positive or had uterine rupture or peripartum hysterectomy were excluded. Bivariate analysis was performed by the chi-squared test and conditional logistic regression analysis was used to determine variables associated with puerperal menstruation. Statistical significance was accepted when P- value is <0.05.
A total of 371 women met the inclusion criteria. The return of menses within 6 weeks was present in 118(31.8%) women versus 253 (68.2%) women without puerperal menstruation, given a ratio of 1:3. Of the 371 women, 249 (67.1%) were on exclusive breastfeeding. The significant associated risk factors were age (p = 0.009), parity (p<0.001), early use of family planning (p = 0.001), socio-economic status (p<0.001) and manual removal of placenta (p = 0.007). At conditional logistic regression analysis, early use of family planning (p = 0.001), exclusive breastfeeding (p = 0.027) and manual removal of placenta (p = 0.012) were independently associated with puerperal menstruation. Induction/augmentation of labor, postpartum misoprostol use and mode of delivery were not statistically significant (p>0.05, for all).
One in 3 women resumes menstruation within 6 weeks of childbirth. The major predictor was early initiation of family planning, and exclusive breastfeeding with manual removal of placenta a major protective factor. These interesting issues require further investigation to better understand the mechanism of puerperal menstruation.
产褥期对产妇来说是一个重要且引人深思的时期。令人惊讶的是，报告显示产后六周内恢复月经（产褥期月经）的女性数量在增加。据了解，此前尚无关于产褥期月经预测因素的研究。
确定产褥期月经的频率及预测因素。
这是一项在尼日利亚埃努古帕克巷ESUT教学医院进行的单中心三级医疗机构横断面研究，纳入了2015年5月至2018年12月的数据。在产妇分娩后的前六周结束时对其进行访谈。排除HIV阳性、有子宫破裂或产后子宫切除术的女性。采用卡方检验进行双变量分析，并使用条件逻辑回归分析来确定与产褥期月经相关的变量。当P值<0.05时接受统计学显著性。
共有371名女性符合纳入标准。118名（31.8%）女性在6周内恢复月经，未出现产褥期月经的女性有253名（68.2%），比例为1:3。在这371名女性中，249名（67.1%）进行纯母乳喂养。显著的相关危险因素包括年龄（p = 0.009）、产次（p<0.001）、早期使用计划生育（p = 0.001）、社会经济地位（p<0.001）和人工剥离胎盘（p = 0.007）。在条件逻辑回归分析中，早期使用计划生育（p = 0.001）、纯母乳喂养（p = 0.027）和人工剥离胎盘（p = 0.012）与产褥期月经独立相关。引产/催产、产后使用米索前列醇和分娩方式无统计学显著性（所有p>0.05）。
三分之一的女性在产后6周内恢复月经。主要预测因素是早期开始使用计划生育，而纯母乳喂养和人工剥离胎盘是主要的保护因素。这些有趣的问题需要进一步研究以更好地理解产褥期月经的机制。
