فهرست مطالب mitra eftekhari yazdi

Heterotopic pregnancy means the coexistence of an intrauterine pregnancy and an ectopic pregnancy. Its incidence is 1 in 30,000 pregnancies. In this study, we report a heterotopic pregnancy with ectopic pregnancy and having heart rate in isthmus region of fallopian tube.

The patient was a 31-years-old woman who had referred to Mobini hospital of Sabzevar city in 2/4/2020 with menstruation delay for 2 weeks and abdominal pain in the hypogastric area with a constant and progressive nature that started about 3 days before the visit. Last menstruation period was 6 weeks and 3 days ago. She had no history of underlying disease or special drug use, and vital signs were stable. She had nausea before visiting and 2 episodes of vomiting in the emergency room of the hospital. In abdominal examination, there was optional guarding and suprapubic tenderness and rebound tenderness. Transvaginal ultrasound and beta titration was performed. In the ultrasound, an echo free focus was seen in the left adnexa with a diameter of 7 mm equivalent to 5 weeks and two days, separately from the ovary, along with a 25×35 mm hematoma around it; which contained the heartbeat of the fetus. A gestational sac with a diameter of 15 mm containing the yolk sac and heartbeat was seen in the endometrial cavity. The patient was transferred to the operating room with the diagnosis of heterotopic pregnancy. The left tube contained a mass of 2×4 cm in the isthmus area, which was completely damaged and was actively bleeding. A left salpingectomy was performed. The intrauterine pregnancy was preserved. The patient referred with labor pain on 6/31/2019 and underwent NVD.

Heterotopic pregnancy mostly occurs in the cases of using assisted reproductive methods. Spontaneous cases of heterotopic pregnancy are rare. Rapid and timely diagnosis plays an essential role in the treatment approach.

Limited use of episiotomy and performing selective episiotomy versus conventional episiotomy has been recommended in various studies. But according to the statistics from developing countries, episiotomy is still the most common obstetric incision. The most common cause of episiotomy in low-risk mothers is maternal concern about severe perineal injuries. This study was performed with aim to compare perineal injuries in normal delivery of primiparous mothers with and without episiotomy.

This descriptive-analytical study was performed by reviewing 3602 files of primiparous pregnant women who had a normal delivery in Sabzevar Obstetrics and Gynecology Hospital during 2017 and 2019. Data collection tool was a researcher-made checklist. The maternal demographic variables, active phase length, neonatal weight, neonatal head circumference, labor mobility, induction or non-induction with oxytocin, and exposure to analgesia, neonatal hospitalization in neonatal intensive care unit (NICU), neonatal death and the degree of perineal damage including grade 1, 2, 3 and 4 laceration. Data were analyzed by SPSS software (version 21) and Chi-square and regression tests. P<0.05 was considered statistically significant.

In the delivery group without episiotomy, 317 mothers (37.8%) had healthy perineum, 324 (38.5%) grade 1 laceration and 56 (6.6%) grade 2 laceration, but in the delivery group with episiotomy, 1302 (99.3%) had grade 2laceration. Chi-square test showed a significant difference between the two groups in terms of perineal injuries (P= 0.0001). The rate of severe perineal injuries was not significantly different in the delivery group with and without episiotomy (p> 0.05). The NICU admission was not significantly different between the two groups (p> 0.05).
 

Delivery without episiotomy in primiparous mothers who don't have risk factors for maternal diabetes, instrumental delivery and infant weight > 4000 g, does not increase severe perineal injuries.

With the onset of Covid 19 disease, the vertical transmission of the disease from mother to neonate was unknown. In this case, a mother affected by a severe Covid 19 a few days before delivery, was examined whether her baby get the disease without breastfeeding and close contact with his mother or not. Finally, the case study show corona virus did not transmitted through blood from mother to the baby and he was completely healthy.

The Apgar score of newborn babies is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol and thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score.

In this double-blind clinical trial, a total of 100 healthy women who volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical. Babies’ Apgar score 1 and 5 minutes after birth and recovery period and some of the critical maternal parameters after operation were recorded. The obtained data were analyzed by SPSS 19 software.

Apgar score I minute 1 (p=0.317) and Apgar score in minute 5 (p=1.00) for propofol group were not different meaningfully. The groups had significant differences in the indices such as first systolic (P=0.00) and diastolic (P=0.00) pressure in recovery, last diastolic pressure in recovery (P=0.001) and duration of postoperative recovery (P=0.001). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather than the thiopental group (p=0.000).

Propofol and thiopental did not differ significantly in Apgar score, but it seems that propofol can be a better option to induce anesthesia for an elective cesarean operation.

 Pregnancy anxiety that threatens maternal mental health has a negative impact on pregnancy outcomes and can develop even in a healthy pregnant woman with no depression or anxiety problems.

 The purpose of the present study was to investigate pregnancy anxiety and its related factors in pregnant women.

 This cross-sectional descriptive-analytical study was performed on 322 pregnant women who were registered at health centers from November 2018 to March 2018. A random sampling method was applied to select eight health centers in the city. Using the SIB system, 40 pregnant women were randomly selected in each center. Selected women who came to health centers to receive prenatal care filled out the revised version of the Farsi anxiety scale for pregnancy (F-ASP-R). Inclusion criteria were, having the ability to read and lack of psychological disorders requiring treatment. Data were analyzed by SPSS software version 18 and student t-test, analysis of variance, and multiple regression analyses.

 The mean score of the F-ASP-R was 32.63 ± 8.9 out of 56, and 49.7% of the study participants scored below the average. Cronbach’s alpha coefficient for the F-ASP-R was 0.867. Multiple regression analyses showed that unwanted pregnancy (P = 0.008), a history of hospitalization in pregnancy (P = 0.044), lack of knowledge about analgesia during labor (P = 0.019), a history of dysmenorrhea (P < 0.001), poor spousal emotional support (P = 0.001), and perceived poor health (P < 0.001) were independent risk factors of pregnancy anxiety.

 Intervention is necessary to reduce pregnancy anxiety in women with an unwanted pregnancy, a history of dysmenorrhea or hospitalization in pregnancy, poor spousal emotional support, and perceived poor health.

Acute fatty liver of pregnancy (AFLP) is a rare condition with an incidence rate of 1 to 20 000 that mostly occurs in the third trimester of pregnancy. There is no specific treatment for AFLP thus a conservative treatment is usually applied in this regard. This case report is related to a 28-year-old G3 P1 Ab1 L1 woman at 29 weeks of pregnancy who was referred to our emergency ward from a primary setting with an epigastric pain, a mild hypertension, and the suspicion of HELLP [Hemolysis, elevated liver enzymes, and low platelet count] syndrome. The lab exams ruled out viral infections including hepatitis B virus (HBV), hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). In addition, the urine protein was 40 mg/600 cc. AFLP was diagnosed and a cesarean was performed under spinal analgesia because of elevated liver enzymes, proteinuria in the normal range for pregnancy, the presence of viral infections that involved the liver, and lack of pruritus. A 29-week girl with a weight of 1115 g was born and the patient was discharged with a good condition. At 5 days postpartum, she referred with abdominal pain, fever, as well as incisional redness and discharge. The ultrasound scan showed a hematoma in the depth of the subdermis point of the cesarean incision. Thus, antibiotics and one unit of fresh frozen plasma were infused. On 14-day postpartum, the patient was discharged with a good condition. The purpose of this study was to focus the attention of physicians to the point that AFLP may improve after childbirth but it may predispose the patient to coagulation disorders and hematoma.

A unicornuate uterus with a rudimentary horn is a rare uterine anomaly occurring in 1 out of 100,000 to 140,000 pregnancies. The diagnosis of this complication is conventionally difficult and missed, which may cause uterine rupture leading to hemoperitoneum. The standard treatment is the surgical excision of the horn through laparotomy. The aim of this report was to introduce a case of pregnancy in a rudimentary horn of the uterus. Case report: We present a 31-year old nulliparous woman at 19 weeks of gestation with a live fetus in a rudimentary horn. The first ultrasound showed a bicornuate uterus at 13 weeks. The patient was referred to Mobini Hospital with abdominal and epigastric pain, nausea, and vomiting. Repeated blood tests, ultrasonography, and clinical signs raised the suspicion of a ruptured ectopic pregnancy. The diagnosis of a rudimentary horn pregnancy was made in the operative room. The rudimentary horn with the left tube was excised and the patient was discharged in good condition two days later.

This case highlights the importance of following up of patients whose early ultrasound indicates a uterine anomaly. In addition, obstetricians and midwives must have a high level of clinical suspicion and pay careful attention to such complicated cases.

Routine episiotomy is a common procedure to shorten the second stage of labor. The attitude of individuals is an important factor in episiotomy, which is often carried out without an indication. Therefore, this study aimed to determine the effect of education and support of labor practitioners on their attitude and performance in conducting routine episiotomy.

This was a quasi‑experimental study. A sample of 66 midwives, physicians, and midwifery faculty members were selected through the convenience sampling method. The data collection instrument was the questionnaire of personnel’s attitude toward episiotomy. This questionnaire was completed by the participants before and 3 months after the intervention. A 16‑h workshop about the education of natural childbirth for 2 days was performed on the experimental group. Data analysis was performed using paired t‑test and Pearson’s correlation test.

The findings showed that mean attitude of the participants toward episiotomy was 50.5 ± 1.58 before the intervention, which changed to 61.18 ± 2.5 after the intervention, demonstrating a significant difference between the attitude of the participants before and after the intervention using paired t‑test (P < 0.001). In terms of the performance of the midwives, participating in the research, there was a significant decrease in the number of deliveries without episiotomy.

According to the results of the study, education and support of midwifery personnel can change the attitude and performance of these individuals in conducting a routine episiotomy, thereby reducing the number of child deliveries without episiotomy.

Heterotopic pregnancy is the existence of both intrauterine pregnancy and ectopic pregnancy simultaneously. Heterotopic pregnancy (HP) has been a rare type of multifetal pregnancy. Heterotopic abdominal pregnancy (HAP) is a very rare diagnosis with very few reported cases. We reported a rare case of HAP in a 32-year-old woman (G2L1) with a history of 13 weak amenorrhea and mild pelvic pain presenting with two live fetuses in the 13th week. The patient also did not mention any risk factor of ectopic pregnancy such as pelvic inflammatory disease, assisted reproductive techniques, endometriosis, and multiparity. Diagnosis of HAP was performed with the use of sonography and magnetic resonance imaging. We managed the patient with emergency laparotomy due to acute abdominal pain a few hours after admission. Laparotomy revealed the rupture of the left fimbria with 500 cc hemoperitoneum. The excision of the ectopic gestational sac in the cul-de-sac and left salpingectomy with preserving the intrauterine fetus was performed. The patient finally gave birth to one live term birth. Physicians should consider the possibility of HP in women with spontaneous pregnancy and abdominal pain. Both sonography and MRI should be performed to help timely diagnosis.

Acute fatty liver of pregnancy (AFLP) is a rare but lethal disease with liver involvement that appears in the third trimester of pregnancy. There is no specific treatment for AFLP. Because liver dysfunction is the most pathogenesis in AFLP the following hypothesis will be raised that plasma exchange can be useful. A 26-year-old mother was referred to our emergency ward with AFLP. The ultrasonography reported a single alive anhydramnios fetus at 34 weeks and fatty liver G1-2. Emergent cesarean was performed and the patient was then admitted to the intensive care unit. The day after surgery, our patient developed periumbilical tenderness and displayed abnormal coagulative factors. Ultrasonography reported 500cc liquid in the abdominal space. Relaparotomy was performed and during the next several days, her general condition worsened and supportive treatment was not effective and the patient experienced a seizure. We started plasmapheresis and after 10 days platelet levels started to rise, lactate dehydrogenase began to reduce, the edema reduced significantly, and her orientation became better. We continued plasmapheresis for about 20 sessions. After one month, the patient was discharged from the hospital in good general condition. Plasmapheresis may be effective in the treatment of fatty liver of pregnancy.

This report is about a pregnancy with a triploid fetus and underscores the potential of first trimester combined screening to detect this devastating chromosomal aberration earlier in pregnancy. This report is about a pregnancy with a triploid fetus identified from the first trimester combined screening and confirmed by amniocentesis. A 28 year old, G5P2AB2 woman was referred to our clinic at 15 weeks of gestation due to a remarkable decrease of her first trimester double biochemical markers and therefore in the high-risk range for trisomy 13 and 18. The woman underwent amniocentesis which revealed a karyotype of 69,XXX. The parents opted for termination and in post mortem physical examination, a hydrocephalus fetus with marked Intra-Uterine Growth Retardation (IUGR) in addition to syndactyly of third and fourth digits, low set malformed ears, micrognathia and club foot, was seen. Our results and previous reports highlight the need to consider a somewhat consistent pattern of the first trimester combined screening in a pregnancy with triploidy and underscore the potential of this screening strategy to detect this chromosomal aberration earlier in pregnancy. Early prenatal diagnosis of this syndrome would provide women an opportunity to terminate an affected pregnancy earlier. This is also important in preventing the risks of associated later induced abortion or obstetric complications.

Low levels of maternal haemoglobin and haematocrit in the first, second, and third trimesters are considered as possible risk factors regarding low birth weight (LBW) and preterm labour (PTL). The present study aimed to evaluate the relationship between maternal haemoglobin (Hb) and haematocrit (HCT) levels with LBW and PTL. This cross-sectional study was conducted on 383 pregnant women who were admitted in postnatal ward and gave birth to live neonates. Maternal Hb and HCT levels in the first, second, and third trimesters were obtained from medical records. The data were analysed using chi-square test by SPSS software (version 19). A total of 383 pregnant women with the mean age of 25.5 years were participated in this study. There was a significant relationship between maternal HCT in the first, second, and third trimesters with LBW (P<0.01). Also a significant relationship was observed between maternal Hb in the first, second, and third trimesters with the LBW (P<0.01). In addition, a significant relationship was reported between maternal HCT with the PTL (P<0.01). There was a significant correlation between maternal Hb in the first, second, and third trimesters with the PTL (P=0.01). Based on the findings of this study, it was suggested that maternal anaemia should be diagnosed and treated at any stage of pregnancy in order to reduce the risk of the LBW and PTL.

Asymptomatic bacteriuria is a common problem during pregnancy. Delayed diagnosis and treatment may end up in harmful events for both mother and fetus. Physiological changes of urinary system during pregnancy facilitate the growth of microorganisms and cause this infection. This study was performed with aim to evaluate the prevalence of asymptomatic bacteriuria and determine the antibiotic susceptibility and its risk factors in pregnant women.
This cross-sectional study was performed on 220 pregnant women referred to Shahidan Mobini Hospital in Sabzevar in 2014-2015. Sterile urine sample of pregnant women was analyzed in terms of Full urine test and culture. Antibiogram of isolated bacteria was done with colony count greater than 100000 by Bauer-Kirby Disk Diffusion. Individual characteristics of the subjects were recorded in the checklist. Data were analyzed by SPSS software (version 19) and Chi-square test. P In this study which was performed on 220 pregnant women, 7% of pregnant women had asymptomatic bacteriuria. Significant relationship was found between asymptomatic bacteriuria and education level (p0.05). Most common isolated organisms were Escherichia coli and staphylococcus ureus. Antibiogram results showed that cotrimoxasol, nitroforantoin, ciproflouxasin and nalidixic acide are appropriate antibiotics for treatment of patients.
Asymptomatic bacteriuria has favorable prevalence in Sabzevar city. In the screening of this situation, considering individual and social characteristics seems to be necessary.

Cesarean rate increased in recent decades worldwide. One of the consequences of the increased cesarean rate and repeat cesarean is the significant increase in cesarean scar pregnancies (CSPs). Diagnosis of a CSP is more difficult when there is a heterotopic pregnancy in a non-assisted pregnancy.
The patient was a 34-year-old G5P2L2Ab2 referred for spotting in Shahidan Mobini hospital, Sabzevar, Iran in 2016. She had a history of 2 cesareans and 2 abortions. Three ultrasounds were performed showing a gestational sac in the lower segment of the uterus with different diagnoses: 1) with hemorrhage over it, 2) with the 2nd gestational sac over it, which was diagnosed as missed abortion, and 3) with an echo-free and irregularly region supporting the 2nd sac or a clot in the lower part of the uterus. The increased local vascularity suggested a level of placenta accreta, partial mole, or trophoblastic reaction. Since the first diagnosis was missed abortion, curettage was performed. Due to the continuation of severe bleeding, abdominal hysterectomy was performed. The patient was discharged in good condition after 3 days.
Heterotopic CSP does not have any specific symptoms, which caused it to be easily misdiagnosed. Physicians should use precise diagnostic tests in case of controversial test results.

Diabetes mellitus may accompany and complicate a pregnancy, resulting in poor neonatal outcomes.
The aim of this study was to compare middle cerebral arterial (MCA) and umbilical arterial (UA) Doppler assessments for the evaluation of fetal well-being in mothers with pre-gestational or gestational diabetes mellitus.
This cohort study was performed on 103 pregnant diabetic women, admitted for prenatal care to the department of gynecology and obstetrics of Jame Zanan hospital (Tehran, Iran) in 2015. Sampling was performed, using the convenience method. All women underwent one or more Doppler ultrasound examinations in the third trimester of pregnancy, which included blood flow measurement through umbilical and middle cerebral arteries. Women with abnormal UA or MCA Doppler test results were subjected to labor induction or cesarean section, according to different parameters. The outcomes included neonatal acidosis, one- and five-min Apgar scores, hypoglycemia, hypocalcaemia, neonatal intensive care unit (NICU) admission, gestational age at delivery, and neonatal death. Chi-square test, t-test or Fisher’s exact test, and logistic regression analysis were performed to analyze the data.
Based on the findings, poor outcomes were detected in 48 women. Nearly 17.5% and 9.7% of women had abnormal UA and MCA Doppler test results, respectively. In total, 62% of women gave birth via cesarean section. The UA Doppler test results were significantly related with hypoglycemia, respiratory distress syndrome (RDS), one-min Apgar score Both UA and MCA Doppler tests were associated with some neonatal outcomes. However, sensitivity of both UA and MCA assessments was low in the prediction of adverse neonatal outcomes. By the comparison of these two methods, we found that UA Doppler assessment is a better predictor of neonatal outcomes.

The incidence of very echogenic amniotic fluid on ultrasonographic examination at term pregnancy is very low and its causes and significance in outcome of pregnancy are not well- understood. In previous studies, meconium was considered to be an important cause of very echogenic amniotic fluid and follow-up with amniocentesis and fetal well-being tests were recommended; however, in recent studies vernix caseosa has been identified to be an important cause. As a result, termination of pregnancy should not be performed due to discovery of ultrasonographic echogenic amniotic fluid because it is not associated with adverse pregnancy outcomes.

We report a single term pregnancy with very echogenic amniotic fluid diagnosed by ultrasonography that was terminated by cesarean section.

There were no adverse outcomes for the mother or neonate and the amniotic fluid was clear at the time of delivery.