الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
The current study is one of very few studies that investigated in great details the ovarian activity during the postpartum period with an attempt to show the various factors that may play a role in the suppression or initiation of ovarian activity. The factors which have been investigated in this study were the patterns of lactation and maternal nutritional status. The results indicated that ”” the suckling behaviour is an important factor affecting resumption of menstruation and ovulation postpartum than maternal nutritional status. Postpartum lactating mothers were followed longitudin ally from delivery throughout lactation until resumption of normal fertility. The main objectives of the study were to identify the pattern of resumption of ovarian activity in the postpartum period and to establish the relationship , betwee n the nutritional status of the mothers and the nursing behaviour with their pattern of ovulation. The ovarian activity was monitored through measurements of ud nary estrone 3- glucuronide and pregnanediol 3- glucuronide, Collection of urine was a non-invasive method for such a prolonged longitudinal study. Estrone 3 glucuronide and pregnanediol 3 glucuronide analysis provided information on both follicular and luteal activity. In addition, luteinizing midcycle LH peak. hormone assay was used to detect The study involved 37 fully lactating mothers and eight 11 partial lactating mothers who were followed up for a total of 1632 weeks with a mean of 36.3 weeks per woman. A total of 3100 regular home visits to collect urine samples and data from lactating mothers were carried out. Fifteen cases ., out. of the 37 fully lactating mothers were excluded out after they were followed-up for a period of 300 weeks because of using confraceptive pills (4 cases), moving away (3 cases) or incooperative and refusing to continue (8 cases). Four cases were excluded out in the control group because of using contraceptive pi lIs. Sufficient data was obtained from 20 fully lactating mothers and four partial lactating mothers to identify their ovarian activity patterns during the postpartum period. Two ca s e s were still amenorrhoeic at 59 and 83 weeks respectively when the study discontinued. The results demonstrated that the resumption of ovarian activity in the postpartum period is a very variable event. The mean age of the women involved in the study was 26.7 years, whi le thei r mean age at marriage was 20 years. The average number of 11 v1ng ch1ldern was 2.8. About 461 of the women involved in the study were illiterate while the rest did achieve different levels of education. Only 231 of the studied were working and only 541 of them had a previous history of lactat iona 1 amenorrhoea. ~ The study demonstrated that full breastfeeding delays the resumption of menstruation and ovulation postpartum. The mean duration of amenorrhoea in fully breastfeeding mothers was 39.2 weeks + 27.7 versus 14 + 4 . 7 weeks in partial ”I breastfeeding. Whi le the first ovulation and normal fertility started at 38 + 26 and 36 + 21 weeks respectively in fully breast feeding women versus 13 + 3.4 and 14 + 2.2 weeks respectively in partial breastfeeding women. The pattern of resumption of ovarian activity postpartum was divided into the following phases based on Phase I:A period in which excretion of E13G and Pd3G are I I I I I I I I I I I I E13G and Pd3G leve Is: low. There is a complete suppression of ovarian activity. Phase 11:A period characterised by fluctuations in E13G Pd3G levels above the mean baseline but without any rise in above the baseline. This is usually followed by menstruation. Phase Ill: Is the period of subnormal cyclical activity; it consists of anovulatory cycles in which there is follicular activity ~ut no rise in Pd3G levels above the baseline. Or ovulatory cycles with inadequate luteal phase, which may be either short luteal phase (less than 10 days) or the Pd3G excretion was deficient (less than 9 ug/ml). Phase IV:In which there is resumption of normal fertility as indicated by adequacy of luteal phase. During phase I when . there is a complete ovarian suppression, the urinany levels of E13G and Pd3Gwere low (18.4 ug/ml and 0.9 ug/ml). This period of gonadal suppression varied widely from one woman to another; it was as short as 5 weeks or as long as 60.4 weeks. During phase II,there was an initiation of follicular growth as indicated by the rise in E13G levels. However the rise in El3G was fluctuating and not sustained. The Pd3G levels were within the baseline level. Three different patterns of incomplete follicular growth were identified. In one the rise in E13G was for a short period ranged between 1 to 1.3 weeks and was enough to cause a withdrawal bleeding.