ثریا صالح گرگری

Ambiguous genitalia is an uncommon situation that happensbetween 1 and 2 per every 1000 live births and falls under the umbrella diagnosisof disorders of sexual development.

Case:

 In this article, we report a case of male pseudohermaphroditism withambiguous genitalia. The proband was a 12 yr old girl without any uterus orovarian tissues. Karyotype of the case is 46, XY. Genes involved in sexualdifferentiation such as AR, SRD5A2, LH, LHR, FSH, 17 B HSD and SRY geneswere sequenced in both directions. No mutations were found in these geneseither.

It seems advisable to be cautious in similar cases, and reviseprotocol for tracing the genes involved in the patients

Morbidity and mortality of preterm babies are important issues in perinatal medicine. In developed countries, preterm delivery is the cause of about 70% of mortality and 75% of morbidity in the neonatal period, respectively.

The aim of this study was to determine the risk factors for preterm labor and the outcomes, in terms of perinatal mortality and morbidity at the time of discharge home, among preterm infants at less than 34 weeks gestation.

A retrospective study was conducted and all infants with a gestational age of 24 to 33 weeks and 6 days who were born from November 1st, 2011 to March 31, 2012 were enrolled in this study.

From 1185 preterm infants were born during this period, 475 (40.08%) infants with less than 34 weeks gestational age were included in the study. Our study showed the major obstetrical risk factors for preterm labor were as follows: preeclampsia (21%), premature rupture of membranes (20.3%), abruption of placenta (10%), and idiopathic cases (48.7%). The neonatal mortality rate in less than 34 weeks was 9.05%. Significant perinatal morbidity causesd in less than 34 weeks were as follows: sepsis (46.94%), respiratory distress syndrome (41.47%), patent ductus arteriosus (21.47%), retinopathy of prematurity (3.57%), necrotizing entrocolitis (1.68%), intra-ventricular hemorrhage (9%), and broncho-pulmonary dysplasia (0.84%).

Preterm birth is associated with adverse perinatal outcome. This situation needs to be improved by directing appropriately increased resources for improving prenatal health services and providing advanced neonatal care.

The major aneuploidies that are diagnosed prenatally involve the autosomal chromosomes 13, 18, and 21, as well as sex chromosomes, X and Y. Because multiplex ligation-dependent probe amplification (MLPA) is rapid and non-invasive, it has replaced traditional culture methods for the screening and diagnosis of common aneuploidies in some countries.

To evaluate the sensitivity and specificity of MLPA in a cross-sectional descriptive study for the detection of chromosomal aneuploidies in comparison to other methods.

Genomic DNA was extracted from the peripheral blood samples of 10 normal controls and the amniotic fluid of 55 patients. Aneuploidies screening of chromosomes 13, 18, 21, X and Y were carried out using specific MLPA probe mixes (P095-A2). For comparison purposes, samples were also tested by Quantitative Fluorescent-PCR (QF-PCR) and routine chromosomal culture method.

Using this specific MLPA technique and data-analyzing software (Genemarker v1.85), one case was diagnosed with 45, X (e.g. Monosomy X or Turner’s Syndrome), and the remaining 54 cases revealed normal karyotypes. These results were concordant with routine chromosomal culture and QF-PCR findings.

The experiment demonstrates that MLPA can provide a rapid and accurate clinical method for prenatal identification of common chromosomal aneuploidies with 100% sensitivity and 100% specificity.

Evaluation of the potential impact of vaginal progesterone on both mother and fetus is necessary before expanding the indication of this drug especially throughout pregnancy. To evaluate the potential impact of vaginal progesterone on both mother and fetus. This case-control study was designed to collect data on the potential gestational diabetes mellitus complication associated with progesterone use comparing maternal and neonatal outcomes between 245pregnant women receiving vaginal suppository of Cyclogest (200mg) and 808controls without progesterone. The incidence of gestational diabetes was 9. 8% and 5. 2% in case and control groups، respectively (p=0. 039). According to linear regression analysis، there was a direct association between duration of progesterone usage and impairment of glucose tolerance test in group of cases (r=0. 43; p=0. 002). The use of progesterone for the prevention of recurrent preterm delivery could associate with an increased risk of developing gestational diabetes.

Unwanted pregnancy termination is a big issue for dog owners.

In this study we attempted to reduce the number of fetuses in pregnant bitches through ultrasound-guided induced fetal death.

The study was performed on 6 privately owned crossbred pregnant bitches, in the second and third trimester of pregnancy, with variable number of fetuses (n=2 to 8). Fetal death was induced by transabdominal injection of potassium chloride (KCl) into the fetal cardiac chamber under ultrasonographic guidance.

While selective fetal reduction was successfully achieved in 4 bitches (66.6%) 2 bitches showed complete pregnancy termination.

Data presented in this research provide evidence for possible use of this technique in order to selectively reduce the number of fetuses without whole pregnancy termination in the bitch. Ultrasound-guided induced fetal death seems to be a safe procedure and a viable method for reducing the number of fetuses with no side effect in the bitch.

Substance abuse is a major public health issue in all over the world. The types and ingredients of drugs used in our country are different from other countries. The study was conducted to determine relationship between substance abuse during pregnancy, and perinatal complications in Iran.

A retrospective cohort study was carried out over a 6 years period on all the substance user pregnant women (519 cases) and 519 non users attending 4 major educational university hospitals labor ward. All the substance user pregnant mothers abusing heroin, opium, crack, cannabis, crystal, methadone, and polydrug were included and compared to non-exposed ones.

Our study demonstrated a 0.5% prevalence of substance abuse in pregnant women. Opium (62.6%) was the most prevalent substance followed by crack (20.3%). Pre-term birth was higher in all substance user groups, the most in crack group (45.8%) with relative risk of 2.55. Neonatal abstinence syndrome developed in 38.7% of infants born of addicted mothers (40.4% crack, 38.6% opiates, 35.3% crystal and 45.5% poly drug use). Neonatal birth weight of infants of mothers using crack, opium and polydrug were significantly lower to non -users (P<0.05). Neonatal Intensive Care Unit (NICU) admission in substance using mothers was significantly higher than non-users (P < 0.001). Neonatal death was 10.1% in crack group (RR=3.48) and 5.8% in opium user group (RR=2.79) with significant difference with non-users (P<0.05).

The frequent types of substances used during pregnancy in our country are different from others (opium was the most prevalent substance). Subsequently the frequencies of the complications during pregnancy are different. Substance abuse during pregnancy has increased risk of pre-term birth, Small for Gestational Age, NICU admission and neonatal death.

Cesarean section is one of the most commonly performed surgical procedures in hospitals. The rates of surgical site infection after cesarean section reported in the literature range from 3% to 15 %. The aim of this study was to identify incidence and risk factors of wound disruption following cesarean delivery. A retrospective multistage study in two phases (the first stage a historical cohort and the second stage a case control) was carried out over a 6 year period from 21st March 2002 to 20th Feb 2008 in Mahdieh Tertiary Care Hospital. In the first stage, we identified wound disruption cases with using wound complication code in all cesarean sections were performed during this period. In the second phase of the study, risk factors associated with the wound disruption after cesarean section were evaluated and for each case two controls were selected. These controls were non complicated cesarean section patients just before and after each disrupted cesarean wound. A total 10525 women who underwent cesarean section during this period, 48 (0.4%) were complicated by wound disruption. Using a multivariable logistic regression model, the following risk factors were identified: diabetes (P=0.02, OR: 5.46; 95%CI: 1.02-49.2), hypertension disorders(P=0.001; OR: 5 95%CI: 1.7-14.3), emergency cesarean delivery (P=0.01; OR: 3.3; 95%CI: 1.2-9.4), post cesarean fever (P=0.0001; OR: 16.2; 95% CI: 4.4-59), and post cesarean laparatomy (P=0.013, OR: 6.3; 95%CI: 6.3-62). Identification of the predictable risk factors for wound disruption and control of these factors may lead to decrease of wound disruption after cesarean section.

Acute liver failure may be caused by fulminant viral hepatitis, drug-induced hepatic toxicity, or acute fatty liver of pregnancy. Acute fatty liver of pregnancy is a rare condition that is estimated to affect 1 in 7000 to 16000 pregnancies in the third trimester of pregnancy. The maternal mortality rate has been estimated to be 18%, and neonatal mortality rates have ranged from 7% to 58%. Early diagnosis and treatment, will improve the consequences of the disease in fetuses and mother.Case Report: A 24-year old women, gravid 1, was admitted in our hospital with term pregnancy because of labour pain, nausea, vomiting and jaundice. Diagnosis of acute fatty liver of pregnancy was made in this case on the basis of the clinical and para clinical findings. After correction of the coagulation defect with 3 units of FFP, caesarean section was performed because of lack of progression of labour and presence of meconium stain in amniotic fluid. 3 days after the operation, the patient developed ascites and bilateral pleural effusion. Intensive care and supportive measures after caesarean section led to improved hepatic function. We recommend evaluation of liver and kidney function tests and a complete blood count in all patients with nausea, persistent vomiting, or epigastric pain in the third trimester of pregnancy to rule out the diagnosis of acute fatty liver of pregnancy.