Maternal Fetal Medicine
Maryam Saraei; Maryam Shefaat; Omid Aminian; Sahar Eftekhari; Elahe Hesari; Atefeh Behkar; Arezu Najafi
Articles in Press, Accepted Manuscript, Available Online from 26 April 2024
Abstract
Background and Objective: Pregnancy is an exceptionally delicate time in the lives of most women. Sleep disorders during pregnancy can substantially impact a healthy pregnancy. This study investigated the relationship between sleep quality during pregnancy and adverse maternal and fetal pregnancy outcomes.Methods: ...
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Background and Objective: Pregnancy is an exceptionally delicate time in the lives of most women. Sleep disorders during pregnancy can substantially impact a healthy pregnancy. This study investigated the relationship between sleep quality during pregnancy and adverse maternal and fetal pregnancy outcomes.Methods: This was a prospective cohort study on 500 pregnant women referred to the perinatology clinic. The Pittsburgh Sleep Quality Index questionnaire was used to evaluate sleep quality, and demographic data were collected from the case file of routine prenatal checkups. The study participants were followed until delivery. The association between sleep quality and postpartum complications, such as preterm birth, infant Apgar score, and NICU admission, was investigated. Results: This study included 500 pregnant women with a mean age of 31.12 ± 5.84. The number of pregnancies ranged from 1 to 7, with a mean of 2.55±1.30. Of the infants, 12% of infants were born prematurely and 27.8% required NICU admission. Poor sleep quality was found to be associated with preterm delivery (OR: 1.27, p = 0.039) and preeclampsia (OR: 0.543, p = 0.004). Women who experienced preeclampsia during pregnancy (p = 0.01), delivered via cesarean section (p = 0.009), and had infants weighing more than 2500 g (p = 0.07) exhibited significantly poorer sleep quality.Conclusion: We found that sleep quality was associated with preterm birth, cesarean section delivery, maternal preeclampsia risk, and the 5-minute Apgar score. Considering the impact of a mother’s sleep quality on pregnancy outcomes, assessing mothers' sleep health appears essential in prenatal care.
Obstetrics and Gynecology
Najmiatul Fitria; Nauratul Ikramah; Ade Sukma; Hansen Nasif
Articles in Press, Accepted Manuscript, Available Online from 05 August 2023
Abstract
Background and Objective: Pregnant women need more nutritional intake than before pregnancy. If this nutritional intake is insufficient for the mother, it will result in Chronic Energy Deficiency (CED). To determine if pregnant women are experiencing malnutrition or cannot be known by measuring the Mid-Upper ...
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Background and Objective: Pregnant women need more nutritional intake than before pregnancy. If this nutritional intake is insufficient for the mother, it will result in Chronic Energy Deficiency (CED). To determine if pregnant women are experiencing malnutrition or cannot be known by measuring the Mid-Upper Arm Circumference (MUAC). Based on service regulations for pregnant women in Indonesia, the minimum number of Iron-Folic Acid (IFA) tablets pregnant women get is 120. Regarding this condition, a study was conducted to analyze the relationship between the amount of IFA consumption on MUAC and several other therapeutic outcomesMethods: This study used a cross-sectional method by examining the patient's medical records. Patients who received IFA as many as 120 tablets or more will become the exposure group. Data will be analyzed descriptively using chi-squareResults: The MUAC size significantly differed at the end of pregnancy (p=0.01). However, overall there was no significant difference between the two groupsConclusion: The IFA administration generally gives good results, but the optimal number of IFA doses still needs further study.
Gynecology Oncology
Behnaz Nouri; Maliheh Arab; Sare Naz
Articles in Press, Accepted Manuscript, Available Online from 26 April 2024
Abstract
Background & Objective: The etiology of endometriosis is unknown and many hormonal, inflammatory, genetic and environmental factors are effective in the formation of endometriosis. The present study investigated the epidemiology of endometriosis in patients referred to Shohadaye Tajrish Hospital ...
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Background & Objective: The etiology of endometriosis is unknown and many hormonal, inflammatory, genetic and environmental factors are effective in the formation of endometriosis. The present study investigated the epidemiology of endometriosis in patients referred to Shohadaye Tajrish Hospital in six years.Materials & Methods: This descriptive study performed on endometriosis Iranian women who referred to Shohadaye Tajrish Hospital between 2016 and 2022. The sample size of this study was determined using the census method, and 711 patients. For analysis SPSS version 22 was used, and results were reported as Mean ± SD. Results: Finally, 711 patients enrolled in this study and the average age of patients was 34.69± 7.53 years and mean age of onset of disease was 29.97±4.61years. More than 55% of patients had healthy weight and normal body mass index. 17.72 percent of patients had history of infertility in her life’s. Conclusion: Endometriosis patients’ life in many aspects, including their job, lifestyle, education, marital status and health care is affected.
Obstetrics and Gynecology
Alfonsus Zeus Suryawan; Amillia Siddiq
Articles in Press, Accepted Manuscript, Available Online from 09 November 2023
Abstract
Background: Uncertainities exist about the diagnostic and prognostic role of hemocytometry values in patients with COVID-19 especially in pregnancy. This study aims to investigate hemostatic changes in pregnant woman with coronavirus disease (COVID-19) and their relationship to disease severity.Methods: ...
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Background: Uncertainities exist about the diagnostic and prognostic role of hemocytometry values in patients with COVID-19 especially in pregnancy. This study aims to investigate hemostatic changes in pregnant woman with coronavirus disease (COVID-19) and their relationship to disease severity.Methods: This research is an analytic observational study with case control design. Subject was gathered from Hasan Sadikin General Hospital patients medical records from June 2021 – March 2022. Inclusion criteria on this study is all pregnant COVID-19 patient with Prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer examination. The exclusion of this study all pregnant COVID-19 patient without required examination. PT, aPTT, and D-dimer were measured by Stago kits on a Stago automated coagulation analyzer (STA Compact Max®). Data was then analyzed by Kruskal Wallis with IBM SPSS Statistic 26th with α=0.05.Results: Statistical analysis shows there’s corelation between different severity levels with D-Dimer. This study shows mean of D-Dimer of each severity levels; asymptomatic 4.85 mg/L, mild 2.86 mg/L, moderate 5.47 mg/L and severe 14.51 mg/L (p <0.000). Changes seen after mild group which increase to 5,47 mg/dL in moderate COVID-19 and furthermore increase in severe become 14,51 mg/L. No changes in PT and aPTT was found.Conclusion: In conclusion, our findings demonstrate that coagulopathy is associated with the severity of COVID-19 illness. D-dimer is important parameter for evaluating the COVID-19 severity in pregnancy. This further could serve as diagnostic category to differ the severity of COVID-19 in pregnancy.
Obstetrics and Gynecology
Ashwaq Kadhim Mohammed; Vian Hussam Almansi Alqani; Zainab Muayad Essa
Articles in Press, Accepted Manuscript, Available Online from 09 March 2024
Abstract
Background: An unusual manifestation of prenatal trophoblastic illness is a twin molar pregnancy with a live foetus and a hydatidiform mole. Due to increased ovulation stimulation, this unusual scenario is rising. Most hydatidiform moles are complete with a foetus, while 0.005 to 0.01% of gestations ...
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Background: An unusual manifestation of prenatal trophoblastic illness is a twin molar pregnancy with a live foetus and a hydatidiform mole. Due to increased ovulation stimulation, this unusual scenario is rising. Most hydatidiform moles are complete with a foetus, while 0.005 to 0.01% of gestations have a partial mole. This report examined the clinical appearance and outcome of live foetuses with molar pregnancies. Methods: This study was done at Adiwaniyah, where the Maternity and Pediatrics Teaching Hospital has one obstetrics centre. The researcher reviewed 20 years of obstetric reports and found 12 cases of hydatiform mole pregnancies with ultrasound reports and/or post-partum examination of the product of gestation indicating twin pregnancy with a single viable foetus. Results: The average age was 27.00 ±6.87 years, with a range of 18-37 years. The parity breakdown was 8 (66.7%) primiparous and 4 (33.3%) multiparous. The average gestational age upon diagnosis was 19.50 ±3.09 weeks, ranging from 15 to 25 weeks. The average gestational age at delivery commencement was 26.67 ±7.09 weeks, with a range of 17-35 weeks. Seven (58.3%) amniocentesis were normal. Maternal complications included bleeding, anemia, blood transfusion, threatening miscarriage, and pre-eclampsia. End-of-gestation outcomes comprised 5 (41.7%) living and healthy newborns and 3 (25.0%) dead babies. There were 5 (41.7%) men and 2 (16.7%) women. Also reported: miscarriage, premature labour, and caesarean sections. Conclusion: Twin pregnancy with a live viable foetus and a molar pregnancy is rare, hence early detection and care are crucial to prevent difficulties for the mother and foetus.
Obstetrics and Gynecology
Fariba Seyedoshohadaei; Masomeh Rezaie; Nasrin Sofizadeh; farnaz zandvakili; Khaled Rahmani; Hosna liravi
Articles in Press, Accepted Manuscript, Available Online from 29 November 2023
Abstract
Introduction: This study aims to determine the effectiveness of simultaneous use of aspirin with clomiphene citrate and letrozole on the success rate of ovulation induction in women with PCOS.
Materials and methods: This study was a double-blind randomized clinical trial. 120 patients with PCOS with ...
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Introduction: This study aims to determine the effectiveness of simultaneous use of aspirin with clomiphene citrate and letrozole on the success rate of ovulation induction in women with PCOS.
Materials and methods: This study was a double-blind randomized clinical trial. 120 patients with PCOS with complaints of infertility due to lack of ovulation were randomly divided into four groups using clomiphene citrate + placebo, letrozole + placebo, clomiphene citrate + Aspirin, and letrozole + aspirin divided by block randomizes. Follicometry was performed with the help of transvaginal ultrasound on the 14th day of the cycle. In the case of a positive pregnancy, the patients underwent transvaginal ultrasound in the 6th week of pregnancy to observe the gestational sac. Patients were followed up until the 12th week of pregnancy in terms of the abortion rate.
Results: This study showed that there was no significant difference in the number of follicles of 14 to 18 mm, follicles larger than 18 mm, and the thickness of the endometrium of the studied women in the four investigated groups (p>0.05). The pregnancy test results showed that the clomiphene citrate + aspirin group and the letrozole + aspirin group each had the highest pregnancy rate with 13 people (36.1%) having a positive test.
conclusion: Although the addition of aspirin to letrozole or clomiphene citrate does not affect the number of mature follicles and the thickness of the endometrium, it can increase the probability of pregnancy.
Maternal Fetal Medicine
Mahboobeh Shirazi; Fatemeh Rahimi Sharbaf; Fatemeh Golshahi; Behrokh Sahebdel; Elham Feizabad; Leila Asadi; Afsaneh Alimadad-Tafreshi; Arash Jafariyeh; Akram Valizadeh; tayebeh sedighi; Fatemeh Takaloo; Aazam Taghavi-Zahedkalaei
Articles in Press, Accepted Manuscript, Available Online from 09 December 2023
Abstract
Background & Objective: Clinical use of uterine artery (UtA) Doppler ultrasound imaging requires reference values but despite the common use of UtA Doppler examination during pregnancy, to the best of our knowledge, there is no such range for Iranian pregnant women. Hence, this study aimed to investigate ...
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Background & Objective: Clinical use of uterine artery (UtA) Doppler ultrasound imaging requires reference values but despite the common use of UtA Doppler examination during pregnancy, to the best of our knowledge, there is no such range for Iranian pregnant women. Hence, this study aimed to investigate uterine artery Doppler indices in Iranian normal pregnancies and compare these with the other country values.Materials & Methods: This observational longitudinal study was conducted on 486 low-risk pregnant women. The amount of plausibility index (PI) and resistance index (RI) as well as the presence of diastolic notch were assessed in weeks 11 to 14, 17 to 24, and 27 to 32 through Doppler ultrasound. Results: The bilateral notch for the gestational age of 11 to 14 weeks was detected at about 6%, for the gestational age of 17 to 24 weeks it was about 4.2% and for the gestational age of 27 to 32 weeks it was about 3.6%. Reference intervals for mean uterine artery PI according to gestational ages, show a significant (p<0.001) difference between different percentages. Also, there is a significant relation between the mean uterine arteries PI/RI and the presence or absence of pregnancy complications (IUGR, premature birth, IUFD) among the participants. Conclusion: The results of this research showed that there is a significant relation between PI and pregnancy complications, while this was not detected in RI and diastolic notch. These results are relatively consistent with the findings of researchers in other countries.
Obstetrics and Gynecology
Tiarma Uli Pardede; Heronimus Hansen Kaware; Leni Suhartini
Articles in Press, Accepted Manuscript, Available Online from 13 December 2023
Abstract
Background and Objective: Degenerated Uterine Leiomyomas (ULs) is one of the most common complications of UL in pregnancy and may cause severe maternal symptoms. In this study we present the rare case of UL permagna with cystic degeneration managed with Caesarean Section (CS) and Myomectomy with uterus ...
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Background and Objective: Degenerated Uterine Leiomyomas (ULs) is one of the most common complications of UL in pregnancy and may cause severe maternal symptoms. In this study we present the rare case of UL permagna with cystic degeneration managed with Caesarean Section (CS) and Myomectomy with uterus preservation.
Methods: A 37-year-old primigravid woman was referred to the clinic with the chief complaint of huge abdominal mass that coincides with the pregnancy. Physical examination showed that the abdomen was overdistended and upon palpation a mass at processus xiphoideus height was felt. Ultrasound examination showed that the foetus had IUGR (Estimated Fetal Weight below the 10th precentile of the fetal growth curve with oligohidramnion) and also a cystic mass with a clear border. The patient was diagnosed with cystic degeneration of UL premagna and IUGR. The first-line management given was CS and myomectomy as an effort to maintain the uterus because this is a case of pregnancy with 15 years primary infertility.
Result: The overall outcome was satisfactory. The neonate came out alive, Ballard score equivalent to 32 weeks, and weighing around 1480g. The degenerated UL was successfully extracted. The patient was discharged 4 days post-operatively. The baby was treated in the NICU for prematurity and went home after the baby's weight reached 1800 grams.
Conclusion : Degenerated UL permagna in pregnancy is a very rare and serious condition. It needs to be studied further as there are no global consensus on how to manage the case.
Gynecology Oncology
Zahraa Al-Tamimi; Mahmood A. Al Ani
Articles in Press, Accepted Manuscript, Available Online from 11 January 2024
Abstract
Background: Asymptomatic bacteruria is a form of lower urinary tract infections (UTIs) that is significant during pregnancy for its high prevalence, high tendendency for persistence and progression to the other symptomatic forms, besides posing adverse effects on pregnancy through effects on both maternal ...
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Background: Asymptomatic bacteruria is a form of lower urinary tract infections (UTIs) that is significant during pregnancy for its high prevalence, high tendendency for persistence and progression to the other symptomatic forms, besides posing adverse effects on pregnancy through effects on both maternal and fetal morbidity. In this respect, Cranberry has been suggested in the prevention and sometimes treatment with a big conflict in results and recommendations.
Materials & Methods: In our study we tried to search its role in treatment and prevention using capsules rather than juices (the most common form in previous studies) and comparing results of its use alone versus combined with antibiotics on the outcome.
Results: Results showed that it is less effective than antibiotics in the treatment ( 56% versus 88% cure rate) (X2: 6.3492; df=l; P value =0.01174), closely effective to them in prevention (26.7% recurrence on cranberry versus 12.5% on antibiotic) (X2:0.9954;P value=0.3184), but reducing the cure rate when used in combination with antibiotics in treatment versus antibiotics alone ( 28.6% versus 57.1% response) (X2=1.1667; P value = 0.2801). Regarding the most commonly reported side effects: headache was supervening consistent with reports in previous studies, whereas gastrointestinal upset commonly experienced in cranberry juice was reported in only (8%) of study cases.
Conclusion: In view of results we recommend using cranberry especially in what seems to be less harmful formulation (capsules) in the prevention of asymptomatic bacteruria in pregnant population and discourage using it in the treatment whether alone or in combination with antibiotics.
Obstetrics and Gynecology
Salma Samy Abdellateef; Safaa Kamal Marei; Nagwa Mahmoud Elghorab; Hesham Gaber Al-Anany
Articles in Press, Accepted Manuscript, Available Online from 21 February 2024
Abstract
Background and Objective: Intrauterine infusion of autologous platelet-rich plasma (PRP) is a novel modality that has a role in the treatment of thin endometrial layer. This study aimed to assess the efficacy of intrauterine infusion of autologous PRP on success rate of intracytoplasmic sperm injection ...
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Background and Objective: Intrauterine infusion of autologous platelet-rich plasma (PRP) is a novel modality that has a role in the treatment of thin endometrial layer. This study aimed to assess the efficacy of intrauterine infusion of autologous PRP on success rate of intracytoplasmic sperm injection (ICSI) and clinical pregnancy rates in females with history of implantation failure.
Methods: This prospective study was carried out on 109 females aged ˂ 40 y, with FSH level < 10mIU /ML, AMH > 1ng/mL, presented with either primary or secondary infertility and advised for IVF or ICSI after IVF/ICSI failure. Cases was divided in to two groups with history of implantation or previously unsuccessful IVF cycles: 1st group (n=50) did ICSI without PRP injection and 2nd group (n=50) did ICSI with PRP injection.
Results: Endometrial thickness at OR day was insignificantly different between both groups, but at ET day it was significantly elevated in PRP group in comparison with non-PRP group (P<0.001). The two groups were comparable regarding numbers of retrieved oocytes, mature oocytes, and numbers of fertilized ova but without significant differences. The numbers of good quality embryos showed no significant differences in PRP group in comparison with non-PRP group. There was no significant difference regarding numbers of embryos transferred at day of ET in both groups.
Conclusions: PRP is a new procedure of treatment in the field of reproductive medicine with high safety. Although it significantly increased endometrial thickness at day of ET day and consequently it increased the chemical pregnancy rate
Gynecology Oncology
elham sharafkhani
Articles in Press, Accepted Manuscript, Available Online from 13 March 2024
Abstract
Ovarian Low-grade serous carcinoma (LGSC), a type of epithelial ovarian tumor, is often diagnosed in the advanced stage, arising from fallopian tube cells or borderline tumors that cause symptoms like abdominal or pelvic pain, bloating, and unexplained weight loss. Treatment involves surgery and chemotherapy. ...
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Ovarian Low-grade serous carcinoma (LGSC), a type of epithelial ovarian tumor, is often diagnosed in the advanced stage, arising from fallopian tube cells or borderline tumors that cause symptoms like abdominal or pelvic pain, bloating, and unexplained weight loss. Treatment involves surgery and chemotherapy. Fertility may be affected depending on the cancer stage. In advanced stages (3 and 4), removing all tumoral implants with both the uterus and ovaries (debulking surgery) may be the first surgical goal, and it can be anticipated that the possibility of pregnancy will be diminished. We presented a case of a 38-year-old woman who became pregnant three years after being diagnosed with LGSOC at stage 3c. Although the standard surgery at a higher stage is debulking surgery and we resected all tumoral implants, the decision was made to preserve the uterus for her since there were no signs of tumor metastasis to the uterus, and the patient wanted to be pregnant. The patient underwent surgery then followed by a standard chemotherapy regimen with carboplatin (AUC 6) and paclitaxel (175 mg/m2) every three weeks for four cycles. During the three years of follow-up, there were no signs of tumor return; she decided to get pregnant by egg donation through an in vitro fertilization (IVF) procedure. She received routine supplements during her pregnancy with the incidence of gestational diabetes and HTN. A cesarean section was done in the week 35th, and the twin infants were born in good condition and with good APGAR scores.
Gynecology Oncology
Kavitha Nagandla; Khine Khine Lwin; Phyu Synn Oo; Thin Thin Win; Afshan Sumera
Articles in Press, Accepted Manuscript, Available Online from 13 March 2024
Abstract
Background and Objective: The management of cervical cancer during pregnancy is significantly challenging. This systematic review summarises the current data on chemotherapy agents (platinum and taxanes) in the management of cervical cancer during pregnancy.
Methods: Two independent investigators searched ...
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Background and Objective: The management of cervical cancer during pregnancy is significantly challenging. This systematic review summarises the current data on chemotherapy agents (platinum and taxanes) in the management of cervical cancer during pregnancy.
Methods: Two independent investigators searched the literature and extracted data from all studies that examined the efficacy and safety of platinum and taxanes in managing cervical cancer during pregnancy. A quantitative synthesis of the published articles was performed and Kaplan–Meier survival curves were estimated to determine the overall and progression-free survival.
Results: Overall, 43 studies with 114 patients were included in this systematic review. All patients received neoadjuvant chemotherapy during pregnancy; the majority received platinum-based chemotherapy. Cisplatin was the main platinum-based chemotherapy agent in 49% (n = 56) of patients, followed by combined platinum and paclitaxel therapy in 36% (n = 41) of patients. A few and two patients were treated with single-agent vincristine and platinum with external beam radiation therapy, respectively. Bleomycin and 5-fluorouracil were administered to two patients. The most frequent complications were grade 2 thrombocytopenia and grade 3 hepatotoxicity in 32 (28%) and 18(20.5%) cases, respectively. The common fetal complications were low birth weight and growth restriction. Chemotherapy was well tolerated by most women in the case group. The progression-free survival was 35% (n = 22).
Conclusion: Platinum and taxane neoadjuvant chemotherapy has proven to be safe and effective in preventing cervical cancer disease progression until definitive surgical treatment.
Gynecology Oncology
Forozan Milani; Seyedeh Hajar Sharami; Negar Gholamalipour; Ehsan Kazemnezhad Leyli; Seyedeh Fatemeh Dalil Heirati; Yalda Donyaei-Mobarrez
Volume 9, Issue 1 , January and February 2024, , Pages 53-62
Abstract
Background & Objective: Evaluation of the alpha-fetoprotein is one of the screening tests during pregnancy. The purpose of this study was to determine the relationship between the level of alpha-fetoprotein in amniotic fluid (AF-AFP) and adverse pregnancy outcomes.Materials & Methods: This ...
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Background & Objective: Evaluation of the alpha-fetoprotein is one of the screening tests during pregnancy. The purpose of this study was to determine the relationship between the level of alpha-fetoprotein in amniotic fluid (AF-AFP) and adverse pregnancy outcomes.Materials & Methods: This comparative analytical study was performed on 244 pregnant women who referred to a private prenatal clinic in Rasht (Iran). Amniocentesis was performed on pregnant women with maternal serum alpha-fetoprotein (MS-AFP) was higher than 2.5MoM in the second trimester and based on this finding, participants were divided into four groups of 61 patients. The first group (control group) included pregnant women with normal MS-AFP, the second group included pregnant women with high MS-AFP and normal AF-AFP, the third group included pregnant women with high MS-AFP and low AF-AFP and the fourth group included pregnant women with high MS-AFP and high AF-AFP.Results: Adverse outcomes include abortion (6.6%), stillbirth (6.6%), IUGR (18%), LBW (29.5%), PTL (21.3%), fetal abnormalities (4.9%), preeclampsia (14.8%), gestational diabetes (8.2%), in the fourth group (high AF-AFP) was higher than other groups. The incidence of adverse pregnancy outcomes in the fourth group was 1.2 times higher than the control group, and this relationship was borderline statistically significant (P=0.056).Conclusion: Considering that adverse pregnancy outcomes are important causes of mortality and morbidity, early diagnosis of high-risk pregnancies and efforts for preventive interventions can be associated with reducing mortality and morbidity. Therefore, evaluation of the level AF-AFP can be helpful in determining adverse pregnancy outcomes.
Obstetrics and Gynecology
Ahmed Elkhyat; Amal Elsokary; Shereef Elshwaikh
Volume 9, Issue 1 , January and February 2024, , Pages 70-75
Abstract
Background & Objective: To evaluate the effect of weight gain in lean patients with polycystic ovary syndrome (PCOS) on ovulation and pregnancy rates.Materials & Methods: Lean patients with PCOS seeking fertility were invited to participate in the study. Weight gain was commenced by ...
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Background & Objective: To evaluate the effect of weight gain in lean patients with polycystic ovary syndrome (PCOS) on ovulation and pregnancy rates.Materials & Methods: Lean patients with PCOS seeking fertility were invited to participate in the study. Weight gain was commenced by dietary modifications. Patients were classified later into respondent and non-respondent. All patients were stimulated with Letrozole 2.5 mg twice daily for five days for six cycles. Ovulation and pregnancy rates were assessed.Results: From 84 patients who were enrolled in our study, 33 patients were allocated into non responder group and 28 patients were allocated to the responder group, and it was found that despite there was statistical difference between both groups as regard weight gain, weight after six months and BMI after six months, there was no significant difference between both groups as regard the ovulation rate, pregnancy rate and complications to ovulation induction ovarian hyperstimulation syndrome (OHSS).Conclusion: weight gain in lean PCOS patients - although non-significant- but it may improve the reproductive outcomes (ovulation rate and pregnancy rate) and the need of further study with larger number and longer duration of follow up for confirmation of these results.
Obstetrics and Gynecology
Sowmya Shree Thimmappa; KB Suma
Volume 8, Issue 6 , November and December 2023, , Pages 641-644
Abstract
Guillain-Barré syndrome is a rare neurological complication that presents in pregnancy and postpartum. We present a case of a 23-year-old Gravida 2 Para 1 Living 1 with 39 weeks of gestation and previous lower (uterine) segment cesarean section (LSCS) who presented with nonspecific symptoms ...
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Guillain-Barré syndrome is a rare neurological complication that presents in pregnancy and postpartum. We present a case of a 23-year-old Gravida 2 Para 1 Living 1 with 39 weeks of gestation and previous lower (uterine) segment cesarean section (LSCS) who presented with nonspecific symptoms in the antenatal period and progressed to develop symmetrical progressive ascending paralysis in the postpartum period with no antecedent history of infection. The patient was managed by a multidisciplinary team and treated with plasma exchange, with complete recovery at follow-up. We are reporting this case because of the rarity of Guillain-Barre syndrome in pregnancy and postpartum and the nonspecific initial presentation with an unexpected diagnosis in the immediate postpartum.
Obstetrics and Gynecology
Mahin Najafian; Mahtab Shariati; Roshan Nikbakht; Sara Masihi
Volume 8, Issue 5 , September and October 2023, , Pages 438-445
Abstract
Background & Objective: Hypertension during pregnancy is associated with significant negative outcomes. In this study, we evaluated the effectiveness of dietary approaches to stop hypertension (DASH) on pregnancy outcomes of pregnant women with gestational and chronic hypertension.Materials ...
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Background & Objective: Hypertension during pregnancy is associated with significant negative outcomes. In this study, we evaluated the effectiveness of dietary approaches to stop hypertension (DASH) on pregnancy outcomes of pregnant women with gestational and chronic hypertension.Materials & Methods: This randomized controlled clinical trial study was conducted on 60 pregnant women with a diagnosis of gestational hypertension and chronic hypertension. Women were randomly divided into the control (n=30) and the DASH diet (n=30) groups for 2 months and were followed until delivery. The outcomes of maternal pregnancy including the incidence of preeclampsia, placental abruption and preterm delivery (<37 weeks) were assessed during follow-up examinations. Birth weight and minute 1 and minute 5 Apgar score of the infant were also assessed.Results: After 1 and 2 months of intervention, systolic and diastolic blood pressure in the DASH diet group was significantly lower than the control group (P<0.05). The incidence of preeclampsia (P=0.035), preterm delivery (P=0.020) and placental abruption (P=0.007) in the DASH diet group was significantly lower than the control group. The mean gestational age at the time of termination of pregnancy was not significantly different between the two groups (P = 0.467). There was no significant difference between minute 1 and minute 5 Apgar scores of the infants and the mean birth weight of the infants was not significantly different between the DASH and control groups (P = 0.756, P = 0.115 and P = 0.101, respectively).Conclusion: The DASH diet could be used as an effective strategy to improve the clinical outcomes of pregnant women with gestational and chronic hypertension.
Obstetrics and Gynecology
Eighty Mardiyan Kurniawati; Gatut Hardianto; Hari Paraton; Tri Hastono Setyo Hadi; Anis Widyasari; Anisah Nur Rahmawati
Volume 8, Issue 5 , September and October 2023, , Pages 538-541
Abstract
Vaginismus is a medical condition characterized by involuntary tightening of the muscles around the vagina. This situation disrupts sexual relations and impacts the chances of pregnancy. This study explores the occurrence of pregnancy in women with vaginismus after treatment in 2022 in East Java Indonesia. ...
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Vaginismus is a medical condition characterized by involuntary tightening of the muscles around the vagina. This situation disrupts sexual relations and impacts the chances of pregnancy. This study explores the occurrence of pregnancy in women with vaginismus after treatment in 2022 in East Java Indonesia. There were 60 patients with a diagnosis of vaginismus in 2022. Married less than 1 year as many as 6 people (10%), 1-5 years as many as 49 people (82%), and more than 5 years as many as 5 people (8%). Management is carried out independently and collaboratively. The management is independent dilatation with the help of dilators, Botox injection, hymenectomy, and collaboration with psychiatrists and andrologists. Of the 60 patients who underwent anamnesis and physical examination, five patients successfully obtained pregnancy treated with Botox injections, independent dilatation or independent dilatation, and andrology consultation. Proper management of vaginismus can increase the chances of pregnancy.
Obstetrics and Gynecology
Leila Asadi; Zahra Behboodi-Moghadam; Mahboobeh Shirazi; Fateme Moshirenia; Behjat Khorsandi
Volume 8, Issue 3 , May and June 2023, , Pages 223-232
Abstract
Background & Objective: Understanding the reproductive and sexual needs of pregnant women seems to be crucial in increasing the effectiveness of services and addressing their needs and expectations. Therefore, the aim of this study was to explain the needs and concerns of reproductive and sexual ...
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Background & Objective: Understanding the reproductive and sexual needs of pregnant women seems to be crucial in increasing the effectiveness of services and addressing their needs and expectations. Therefore, the aim of this study was to explain the needs and concerns of reproductive and sexual health of pregnant women during the COVID-19 pandemic.Materials & Methods: This is a qualitative study with a content analysis approach. In this probe, 16 interviews were accomplished with 15 pregnant women who had been referred to pregnancy care centers. Data analysis was performed predicated on the content analysis approach using MAXQDA software version 12.Results: Based on 17 interviews conducted with pregnant women during the COVID-19 pandemic, pregnant women were found to be suffering from mental disorders, fears, disrupting prenatal care, and sexual problems.Conclusion: Reproductive and sexual health of pregnant women in the Covid-19 epidemic should not be neglected and considered in health planning.
Obstetrics and Gynecology
Hamza Radhi; Shaymaa Abdulhameed Khudair; Miaad Adnan; Muntaha Kadhem Mejbel; Ahmed S. Abed; Nizar Awish Jassem
Volume 8, Issue 3 , May and June 2023, , Pages 249-254
Abstract
Background & Objective: The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; ...
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Background & Objective: The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% of them rotate to the occiput anterior. This research aims to analyze the rate of delivery in the OP position (also called sunny-side-up) concerning the outcome of manual rotation carried out contingent upon the OP position remains persistent. Perinatal outcomes were the secondary goals.Materials & Methods: This prospective cohort study was carried out in Obstetrics & Gynecology Clinic (OGC) at Faruk Medical City, Iraq. The study included all women who experienced a singleton pregnancy after 36 weeks, had an effort to rotate the fetus manually and had the fetus remain in the persistent OP position. The primary result was the delivery's occiput position. Perineal injuries, labor length, and the method of delivery have been the secondary outcomes. According to the outcome of manual rotation, two groups were contrasted.Results: The overall number of women participating was 250, and the manual rotation success rate was 59.1%. The success was strongly correlated with a reduction in the OP position during vaginal, cesarean, operative vaginal delivery, episiotomy, and obstetric anal sphincter injury.Conclusion: Reduced incidence of OP position at anal sphincter injury during operative vaginal delivery is linked to attempts at manual rotation in the case of persistent OP position.
Obstetrics and Gynecology
Zena M. Al Hindawi
Volume 8, Issue 2 , March and April 2023, , Pages 137-142
Abstract
Background & Objective: Infertility in women can be attributed to a wide variety of factors, including inherited and acquired abnormalities of the uterus. Ultrasonography is used for determining the thickness of the endometrium during various phases of the menstrual cycle. The purpose of this ...
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Background & Objective: Infertility in women can be attributed to a wide variety of factors, including inherited and acquired abnormalities of the uterus. Ultrasonography is used for determining the thickness of the endometrium during various phases of the menstrual cycle. The purpose of this study is to determine the thickness of the endometrium in women who are unable to conceive using ultrasound imaging during the secretory phase.Materials & Methods: A total of 134 adult females between the ages of 22 and 45 were examined by means of an endo-vaginal and transabdominal approach with EVN 4-9 MHZ and CA1-7AD probes, respectively, during the course of this research project, which took place in Imam Al-Hujjah Charitable Hospital, Karbala, Iraq, between February 2021 and April 2022.Results: The findings showed that primary infertility accounted for 69.4% of cases, which was significantly higher than women with secondary infertility, which accounted for 30.6% of cases. There were 68.8% of women who presented with primary infertility who had endometrial thickness between 9-12 mm, and there were 31.1% of women who presented with secondary infertility who had this thickness. 65.8% of women who are experiencing primary infertility and 34.1% of women who are experiencing secondary infertility have an endometrial thickness of 14-18 mm. Our study showed that 40% of women who suffer from primary infertility and 60% of those who have secondary infertility have an endometrial thickness of 19-23 mm.Conclusion: When it comes to diagnosing and treating infertility, ultrasound is a crucial tool for measuring the thickness of the endometrium in women.
Obstetrics and Gynecology
Zinah Hammad; Ban J. Edan
Volume 8, Issue 2 , March and April 2023, , Pages 167-172
Abstract
Background & Objective: One of the worldwide healthcare problems is Diabetes mellitus (DM), and the prevalence of this disease increases steadily, particularly in pregnancy. The several metabolic disorders in the pregnancy were revealed by the placenta. The pathogenesis of diabetes mellitus ...
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Background & Objective: One of the worldwide healthcare problems is Diabetes mellitus (DM), and the prevalence of this disease increases steadily, particularly in pregnancy. The several metabolic disorders in the pregnancy were revealed by the placenta. The pathogenesis of diabetes mellitus is associated with hyperglycemia, insulin resistance, and oxidative stress, and it negatively impacts the mother-placenta-fetus system. This research aims to compare the amount of leptin expression, as well as its score and intensity, in the placentas of women with diabetes with those of healthy controls.Materials & Methods: In this work, we used a case-control methodology. Thirty women were diagnosed with diabetes and were placed in one group, while the other 40 served as a comparison. Primary monoclonal antibodies were used for the immunohistochemical analysis of leptin (Abcam, UK).Results: The patients group showed the greatest percentage (23%) of placental expression of leptin. The expression of leptin was high in around 53% of the patient population. The intensity of leptin expression was significantly higher in DM patient than control groups (P>0.05). About 77% of patients group had moderate intensity of leptin expression, while 37.5% of control group had no leptin expression.Conclusion: Diabetes mellitus was related with alterations in expressions of leptin as metabolic placental factor. Leptin may affect the pregnancy diverse disorders and pregnancy outcome.
Obstetrics and Gynecology
Farzaneh Abedini; Mahdis Mohammadian Amiri; Mahsa Danaei; Nooshin Eshraghi
Volume 7, Issue 6 , September and October 2022, , Pages 489-496
Abstract
Background & Objective: Premature rupture of membranes (PROM) and preterm delivery are the most important problems observed in pregnancies that can cause many consequences. The present study investigated the relationship between amniotic fluid index (AFI) and uterocervical angle in patients with ...
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Background & Objective: Premature rupture of membranes (PROM) and preterm delivery are the most important problems observed in pregnancies that can cause many consequences. The present study investigated the relationship between amniotic fluid index (AFI) and uterocervical angle in patients with PROM between 24 and 34 weeks of gestation.Materials & Methods: This study was a cohort study carried out on 50 pregnant women with PROM. Inclusion criteria were 24 to 34 weeks of gestation and singleton deliveries. Demographic characteristics and pregnancy history of the subjects were determined through interviews and examinations. Moreover, AFI and uterocervical angle were determined based on ultrasound results. Subjects were followed up until delivery.Results: Mean age of the patients was 25.14±5.32 years; 23 patients (46%) had delivery latency less than 7 days. The mean uterocervical angle in the delivery latency group ≤7 was significantly higher than that in the group more than 7 days (P < /i> <0.001). Moreover, the mean AFI in the delivery latency group ≤7 was significantly higher (P < /i> <0.001). The uterocervical angle above 107.7 with a sensitivity of 87% and a specificity of 88.9% had a predictive power and its area under curve (AUC) was 0.912 (P < /i> <0.001). The mean AFI below 5.4 with a sensitivity of 81.5% and a specificity of 65.5% had a predictive power (AUC: 0.866, P < /i> <0.001). Conclusion: Uteroservical angle and AFI can be good predictors for assessing delivery latency in women with PROM. Furthermore, the mean uterocervical angle in the delivery latency group ≤7 days is significantly higher than that in the group more than 7 days, but conversely AFI is less.
Reproductive Medicine
Marzieh Mehrafza; Azadeh Raoufi; Elmira Hosseinzadeh; Gholam Reza Pourseify; Tahereh Zare Yousefi; Termeh Shakery; Amirhossein Tamimi
Volume 7, Issue 6 , September and October 2022, , Pages 518-523
Abstract
Background & Objective: Autologous platelet-rich plasma consists of concentrated autologous plasma and several cytokines and growth factors released by activated platelets in injury and inflammation. There is an increasing trend towards the effectiveness of intrauterine PRP infusion in repeated implantation ...
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Background & Objective: Autologous platelet-rich plasma consists of concentrated autologous plasma and several cytokines and growth factors released by activated platelets in injury and inflammation. There is an increasing trend towards the effectiveness of intrauterine PRP infusion in repeated implantation failure patients. The aim of the present study was to describe the impact of intrauterine platelet-rich plasma infusion on the live birth rate in patients with repeated implantation failure.Materials & Methods: The present retrospective uncontrolled study was performed on 96 patients with more than two failed intracytoplasmic sperm injection cycles at Mehr medical institute between 2019 and 2021. Forty-eight hours before embryo transfer, patients received 1 mL lympho-platelet-rich plasma through an intrauterine insemination catheter. Patients were evaluated for pregnancy rate. Endometrial preparation for frozen-thawed embryo transfer was performed.Results: Participants' basal and stimulation characteristics, including gonadotropin dosage, the total number of oocytes, metaphase II oocytes and embryos, endometrial thickness, embryo transfer, quality of transferred embryos, and blastocyst transfer rate were evaluated. A total of 33 and 27 chemical (34.3%) and clinical pregnancies (28.1%) were achieved. Twenty (20.8%) and nineteen (20%) cycles resulted in ongoing pregnancies or live births, respectively. Conclusion: The current study suggests that platelet-rich plasma infusion 48 hours before frozen-thawed embryo transfer may be a good option for repeated implantation failure patients and results in 20% live birth.
Maternal Fetal Medicine
Zahra Panahi; Seyedeh Noushin Ghalandarpoor-Attar; Azade Shabani; Mamak Shariat; Fahimeh Ghotbizadeh; Sedigheh Hantoushzadeh; Elham Feizabad; Seyedeh Mojgan Ghalandarpoor-Attar
Volume 7, Issue 6 , September and October 2022, , Pages 536-542
Abstract
Background & Objective: The thymus gland significantly affects fetal immune system maturation. Additionally, there is a linear association between thymus gland size and its performance. Given the high prevalence of vitamin D deficiency in Iran and scarce studies with conflicting results, subjecting ...
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Background & Objective: The thymus gland significantly affects fetal immune system maturation. Additionally, there is a linear association between thymus gland size and its performance. Given the high prevalence of vitamin D deficiency in Iran and scarce studies with conflicting results, subjecting maternal vitamin D concentration effect on fetal thymus, we decided to investigate maternal vitamin D concentration and its relation to fetal thymus size in mid-gestation. This study also aimed to generate a race-specific reference range.Materials & Methods: We performed a cross-sectional study of ultrasound measurements of the fetal thymus at 18-22 weeks of gestational age in 94 pregnant women and its correlation with maternal serum vitamin D levels from May to July 2021 at the tertiary center of Imam Khomeini Hospital in Tehran, Iran.Results: The mean values of thymus perimeter, thymus-thoracic ratio, thymus transverse diameter, and thymus area in all participants were 4.18±0.56 cm, 0.37±0.04, 1.56±0.21 cm, and 1.11±0.76 cm2, respectively. There was a trend toward decreased thymus perimeter and transverse thymus diameter with decreasing level of maternal vitamin D. There was also a significant correlation between thymus perimeter and transverse thymus diameter with fetal biometric indices and gestational age. Furthermore, a significant correlation was observed between the thymus perimeter and transverse thymus diameter. Conclusion: We generated a race-specific nomogram for fetal thymus size in Iranian pregnant women. Moreover, the observed trend toward decreased fetal thymus size with decreasing maternal vitamin D levels requires further prospective investigations. A high prevalence of vitamin D deficiency and low compliance with daily vitamin D intake during pregnancy was also shown, which requires a solution.
Obstetrics and Gynecology
Shahnaz Ahmadi; Elnaz Salarifar; Kambiz Ahmadi; Maryam Rahimi; Mahshid Bahraini
Volume 7, Issue 5 , July and August 2022, , Pages 399-404
Abstract
Background & Objective: Preeclampsia is associated with the release of soluble endoglin (sENG) into the maternal circulation. It inhibits sENG secretion, inhibiting the complex I of the mitochondrial electron transport chain. Therefore, using metformin may be helpful in the prevention of preeclampsia. ...
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Background & Objective: Preeclampsia is associated with the release of soluble endoglin (sENG) into the maternal circulation. It inhibits sENG secretion, inhibiting the complex I of the mitochondrial electron transport chain. Therefore, using metformin may be helpful in the prevention of preeclampsia. The aim of this study was to evaluate the effect of metformin in preventing superimposed preeclampsia.Materials & Methods: This single-blind randomized clinical trial was conducted on 60 pregnant women 25-40 years old with chronic hypertension before the 20th week of pregnancy. The patients were randomized and divided into two groups (n=30). The first group received 1000 mg metformin (tablet metformin 500 mg bid), and the second group received a placebo (2 tablets daily). Then the incidence of preeclampsia and intrauterine retardation growth of the fetus were compared in the two groups.Results: The metformin consumption significantly reduced the incidence of preeclampsia (P < /i>=0.04) and intrauterine growth restriction (P < /i>=0.035) compared to the control group. Conclusion: Metformin effectively reduced the incidence of superimposed preeclampsia and related factors in a pregnant patient with chronic hypertension.