زهره سالاری

Anaphylaxis is an acute multi-organ dysfunction syndrome produced by the immunogenic release of inflammatory mediators from mast cells and basophils. This complication is typically a result of medications or substances used during surgery and can have fatal consequences.

A 41-year-old woman underwent spinal anesthesia for cesarean section. After the delivery of the fetus and clamping of the umbilical cord, 5 units of oxytocin were injected intravenously and 25 units were infused. All infusions were stopped when the patient complained of swollen lips, periorbital edema, and skin rashes. Subsequently, the patient experienced agitation, decreased SPO2, respiratory distress, and loss of peripheral pulses and was subjected to tracheal intubation. Subsequently, the patient developed ventricular tachycardia, and immediate cardiopulmonary resuscitation was initiated. The patient was cared for until the improvement of respiratory and hemodynamic status. After  extubation, the patient was transferred to the intensive care unit and discharged after 24 days of treatment with improved condition.

Anaphylaxis is a life-threatening reaction in a pregnant mother, but its complications in the mother and neonate can be prevented through interdisciplinary cooperation, rapid diagnosis, and treatment.

Preeclampsia is one of the complications of pregnancy and a major cause of maternal mortality. Since, hypercoagulation is one of the risk factors, defined polymorphisms of V and II coagulation factors (G1691A and G20210A) may increase the risk of the disease.
This investigation was performed on blood samples of 64 preeclamptic women and control group. DNA of white blood cells were extracted using salt satutation method. Then, G1691A and G20210A polymorphisms were investigated using ARMS-PCR technique.
Significant difference was found between the mean age of case (28.734 yrs) and control (24.921 yrs) groups (P=0.000196). But, mean of gestational age did not show significant difference between the case and control groups (34.719 wks & 34.421 wks respectively).
Among the preeclamptic patients, we found two heterozygotes (3.1%) for each factor II and factor V. No homozygote mutation (0%) was found in this study, while we found one heterozygote subject (1.6%) for factor V in the control group.
in comparison of preeclamptic and control group for single nucleotid polymorphisms (G1691A and G20210A), no significant difference was found. Therefore, these polymorphisms cannot be considered as prediagnostic risk factors for preeclampsy. We suggest more wide genetic and invironmental investigations for finding preeclampsia risk factors.

Preterm labor affects 8 – 10% of pregnancies. Many drugs have been used to manage preterm labor. This study was done to compare the effect of ‘Progesterone vaginal suppository’ with ‘Isoxuperine oral tablet’ used to prolong latent period after controlling preterm labor. In this clinical trial study، 100 pregnant women with preterm labor pain admited to Afzalipoor Hospital-kerman were assessed. After their contractions was controlled، patients were divided in two groups، randomly. First group was prescribed progesterone supp. 400 mg daily and the other isoxuperine tab 10 mg TDS. They were followed to compare the effectiveness and side effects of the drug. Statistical analyses were done by independent t-test and chi-square. The two groups were equal in average time between latent phase and labor، gestational age at the time of labor، preterm labor recurrence، birth weight، admission in NICU and neonatal jaundice. In the group which used progesterone، no side effects were observed، in isoxuperine group 11. 6% suffered side effects. But a significant difference was not found in the side effects (p= 0. 058). Based on our results and because of lower maternal side effects of vaginal progesterone، it seems that vaginal progesterone could be a better choice for maintenance therapy after preterm labor arrest.

Therapeutic abortion in the second trimester pregnancy is the choice treatment in cases with severe anomalies or intrauterine fetal death. It can be done by a number of medical (e.g. misoprostol) or mechanical methods (e.g. laminaria). The aim of this study was to compare the efficacy of misoprostol alone and misoprostol in combination with laminaria in the induction of second trimester abortion. In this interventional study, 80 pregnant women with the gestational age of 13-25 weeks who were candidates of therapeutic abortion were selected and randomly divided into two groups (n=40). One group received misoprostol alone and the other received misoprostol in combination with laminaria. Combination of misoprostol and laminaria caused not only a significant shorter time interval from the initiation of intervention to abortion (P=0.034), but also lower dose of administered misoprostol (P=0.001), less need for curettage (P=0.001), and shorter hospitalization period (P = 0.042). Based on the obtained results, misoprostol in combination with laminaria is recommended for the induction of second trimester therapeutic abortion.

Toxoplasma gondii, a member of the Apicomplexa,is an obligatory intracellular parasite. Toxoplasma gondii infection during pregnancy can result in abortion, stillbirth and fetal malformation. Due to the geographic variation in the prevalence of the infection and in order to assess the role of Toxoplasma gondii in abortion in Kerman the present study was carried out. In a case-control design, 57 women whose pregnancy was spontaneously terminated prior to 20th week of gestation and 112 women with their pregnancy beyond 20 weeks, matched for age and were studied in Afzalipour Maternity Center. Blood samples were taken after obtaining informed consent and then sera were tested for anti-Toxoplasma IgG and IgM using ELISA technique. Data analysis performed by t-test and Chi square using SPSS 17. The seroprevalence of anti-toxoplasma IgG and IgM antibodies were 30.8% and 3.6%, respectivelyin the whole population studied. The seroprevalence of anti-toxoplasma IgM was not significantly different between the two groups (p=0.40). However, the seroprevalence of anti-toxoplasma IgG was significantly different between abortion and normal pregnancy groups (43.9% and 24.1%, respectively). No significant relationship was observed between anti-Toxoplasma IgG antibodies and education level, consumption of undercooked meat, unwashed vegetables, and contact with cats. Based on the above results we can conclude that chronic infection of toxoplasmosis implicates in abortion, while acute infection has no role in this regard. However, more investigation is needed.

Congenital hypothyroidism (C.H) is one of the most common infants’ endocrine diseases and the cause of mental retardation in newborns. This study was performed to determine the prevalence of C.H and it’s relation with neonatal’s sex, birth weight and height and mothers’ age, gestational age, parents’ educational level, past medical history of thyroid disease in mother and family and consumption of Iodine salt by mother. A Total of 3000 neonates aged 2-5 days were screened from November 2005 to July 2006. Specimen collection and transportation to lab were performed according to NCCLS and Wisconsin newborn screening program guidelines. Thyroid stimulating Hormone (TSH) concentration in dried blood spot was determined quantitatively using ELISA technique. From 3000 neonates, 23 cases (0.8%) had TSH≥20 mIU/L that were recalled for verification of C.H. Of them, 13 cases (56%) were male and 10 cases (44%) were female. All of 23 infants were detected during 1-2 months after birth and 3 of them had serum TSH≥10 mIU/L. According to the protocol of kit they were considered as hypothyroidism cases and were referred for treatment. Considering the importance of congenital hypothyroidism in mental retardation, neonatal screening programs are of high importance. In this study, the prevalence of the disease was 1 in 1000 that is more than that in developed countries.Therefore, it should be considered as one of the hygienic priorities in our country.

Metritis is one of the causes of maternal morbidity and there are many risk factors for it. Because of the importance of possible association of meconium-stained amniotic fluid and maternal metritis the present study was done to determine whether meconium stained amniotic fluid (MSAF) is associated with puerperal infection. In this case-control study 150 women with MSAF and 150 women with clear amniotic fluid (gestational age > 37 weeks) were compared for puerperal metritis. Subjects’ educational level, gestational age, gravida, mean vaginal exams, route of delivery and mean neonatal weight were not significantly different between the two groups. But mean maternal age and neonatal Apgar were significantly different in the two groups. That is, post partum metritis in women with clear amniotic fluid occured less than women with MSAF (2.7% vs 10%, P<0.014). Since meconium stained amniotic fluid is associated with metritis, special care in this regard is recommended.

Preeclampsia has remained one of the important obstetrical problems for which different factors have been suggested. Decrease of serum levels of albumin, total protein and phosphorous have been suggested in the pathophysiology of preeclampsia. The aim of this study was to determine serum levels of Albumin, total protein and phosphorous in normal pregnancy and preeclamptic women. In this case-control study, 100 pregnant women aged 20 to 30 years with the gestational age of 28 to 40 weeks were studied. Patients were divided into two groups: 50 women as case group (preeclamsia) and 50 women as control group (normal pregnancy). The serum levels of Albumin, total protein and phosphorous were measured in both groups. There were no significant difference between two groups in demographic factors and mean maternal age but duration of pregnancy was significantly different in the two groups (36.29±3.2 weeks in case group and 38.19±2.5 in control group) (P<0.0001). The mean systolic and diastolic blood pressurse and body mass index were significantly different in both groups (P<0.0001). The mean systolic blood pressure in preeclamptic women was 149.8±13.39 and in normal group was 108.7±9.73 and the mean diastolic blood pressure in preeclamptic women was 95±8.57 and in normal group was 67.4±10.72. Body mass index was 22.84±2.07 in preeclamptic women and in normal pregnants was 21.21±2.09. There was no significant difference between the two groups in mean serum levels of albumin, total protein and phosphorous. Serum Albumin in preeclamptic women was 4.12±0.45 and in women with normal pregnancy was 4.26±0.57. Serum level of total protein was 5.95±1 and 6.03±0.92 and serum phosphorous was 3.53±0.68 and 3.35±0.82 in preeclamptics and normals respectively.. There was no significant relationship serum between levels of Albumin, total protein and phosphorous and preeclampsia.

Preeclampsia remains one of the important obstetrical problems and changes calcium metabolism and low dietary calcium intake has been suggested in the pathophisiology of preeclampsia. The aim of this project was to determine the total and ionized calcium level in normal pregnancy and preeclamptic women. This case control study included 100 pregnant women, 20 to 30 years who were 28 to 40 weeks pregnant. Patients were divided into two groups, 50 women as case group (preeclampsia) and 50 women as control group (normal pregnancy). The serum total and ionized calcium were measured in both groups. There were no significant differences between two groups in demographic factors. Duration of pregnancy was significantly different in two groups (36.29±3.2 weeks in case group and 38.19±2.5 in control group) (p<0001). The mean systolic and diastolic blood pressure and body mass index were significantly different in both group (p<0001). The mean systolic blood pressure in preeclamptic women was 149.8±13.39 and in normal group was 108.7±9.73 and the mean diastolic blood pressure in preeclamptic women was 95±8.57 and in normal group was 67.4±10.72, body mass index was 22.84±2.07 in preeclamptic women and in normal pregnancy was 21.21±2.09. There was no significant differences between the two groups in mean serum level of total and ionized calcium (total calcium in preeclamptic women was 9.95 ± 1.28 and in normotensive women was 10.13 ± 1.11) Ionized calcium was 4.7 ± 0.29 vs. 4.55 ± 0.54. Conclusions There was no significant differences in serum total and ionized calcium between preeclamptic and normotensive pregnant women.