فهرست مطالب sedigheh hantoushzadeh

The administration of antenatal corticosteroid is a standard treatment to reduce the rate of perinatal mortality and morbidity; however, there is limited evidence regarding the potential effects of betamethasone on the constriction of the ductus arteriosus (DA).

This study aimed to investigate the short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status.

This quasi-experimental observational (before-after) study was conducted on 32 singleton fetuses. The participants were healthy pregnant women with a diagnosis of placenta accreta spectrum who were eligible for 2 doses of betamethasone and referred to prenatal care clinic, Vali-E-Asr hospital, Tehran, Iran from January 2021-May 2022. The results of fetal echocardiography and Doppler sonography were compared before and after the administration of antenatal corticosteroid therapy.

Following betamethasone injection, significant increases were observed in peak systolic and diastolic velocity of the DA without constriction of the DA (p < 0.001, p = 0.002 respectively). However, no significant changes were observed in right ventricular function, tricuspid valve function, Doppler of ductus venous, and peak systolic velocity of the aortic isthmus (p > 0.05). Doppler examination of the uterine, umbilical, and middle cerebral arteries also showed no significant changes (p > 0.05).

Considering the benefits of antenatal corticosteroid therapy, its administration seems reasonable in preterm births. The transient changes in ductal blood flow are not prohibitive.

Despite the high efficacy of the Apgar score in finding respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one of the best indicators of fetal hypoxia. Therefore, it’s so beneficial to consider these criteria and their relationship with the Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively which reduces the unnecessary cesarean section (CS) rate.

162 full-term (≥259 days) neonates delivered by CS with the diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother’s age, gravidity, gestational age, birth weight, newborn sex, and causes of decreased FHR on Apgar scores and UApH were studied as well.

The most common cause of decreased FHR was fetal distress, boys had higher weight (P=0.033) and lower UApH (P=0.049) than girls. Other parameters were not different significantly between both sexes. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (P<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05 (CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%: 1-1.26).

Mild acidemia (UApH<7.2) at least in a male fetus would be a good predictor for postnatal complications and need for NICU admission. Future studies with more samples are suggested.

Pre-eclampsia (PE) is a multiorgan disorder that affects 2-5% of all pregnant women. Present recommendations for when to start aspirin in high-risk women are after 11 wk of gestation.

We present a protocol to investigate the effectiveness of aspirin use from early pregnancy, which is a randomized controlled trial to assess whether prescribed low-dose aspirin from early pregnancy reduces the prevalence of early and late-onset PE. Additionally, to compare the effectiveness of aspirin administration before and after 11 wk in reducing the occurrence of PE?

All pregnancies at risk of PE, according to demographic and midwifery history, who are referred to the Maternal-Fetal Clinic of Tehran University hospital, Tehran, Iran were invited to take part in the trial. The outcomes of pregnancy and newborns will be gathered and analyzed. The first registration for the pilot study was in January 2023, and the participants were recognized as high-risk for PE. In addition, enrollment in the main study will begin as of October 2023.

It was declared that COVID-19 might be more severe in symptomatic pregnant patients. This study was conducted to examine the pathological indices of the placenta in pregnant women who were diagnosed with COVID-19.

A total of 20 COVID-19–positive mothers were enrolled in this study. Detailed placental pathology findings were compared between subjects based on the history of abortion or occurrence of preterm delivery, hypertension, and diabetes.

Intervillositis was the most frequent abnormality of the placenta. There was also a significant association between abortion history and maternal vascular malperfusion (MVM; P=0.02). The placental abnormalities were found to be increased in women with COVID-19, regardless of maternal comorbidities. Further studies are needed to compare the placental pathology between COVID-19–positive women and healthy women.

To investigate the preferred method and education subjects among gynecologists and obstetricians to find the gaps between the current and expected states of continuing medical education (CME).

An online self-administered questionnaire was sent to Iranian gynecologists and obstetricians. Three main parts of the questionnaire were demographic information, general skills such as stress management, legal knowledge, and documentation, and specialized skills such as medical and surgical management. The level of clinical capability, the need for further training, and the preferred training method, virtual, theoretical, or bedside in private or academic centers, were asked and reported.

Two hundred and eighty-six general gynecologists and obstetricians participated in this survey. The majority (87.3%) of them were not academic staff. Nearly 70% of the participants could perform common procedures in obstetrics, general gynecology, infertility, oncology, and urogynecology, although more than two-thirds felt they needed more training. The lowest level of preparedness was in urogynecology skills, while the highest level of educational needs was reported in infertility. Surprisingly, the preferred method of education for the most specialized skills was bedside training in academic centers.

Despite time constraints and COVID-19 restrictions, most clinicians are keen to receive more education, and in most cases, their preferred method is bedside training in academic centers. Therefore, proper strategic planning based on different fields of obstetrics and gynecology to design practical and bedside CME courses seems necessary. 

 Monitoring fetal movement is a simple and effective approach to assessing fetal well-being. Among other issues, the maternal perception of altered (not just reduced) fetal movements remains a complex issue. This study aimed to report a case of fetal demise following the increased fetal movements in the third trimester of pregnancy.

 A 32-year-old woman in 34th week of her first pregnancy attended the emergency room while she had no chief complaint of fetal movement from the previous night; the fetus was examined, but no fetal heart rate was detected. She had reported an increased perception of fetal movements in the earlier week. Her maternal history, as well as her labs and obstetrics data, were normal. Despite the normal appearance of the fetus and placenta, the triple loops of tied nuchal cord was abnormal.

 Increased fetal movement (IFM) was a controversial finding, and earlier studies had questioned its safety. Therefore, any fetal movement alteration may have had clinical and fateful importance. Thus, it was recommended that further prospective studies should be conducted in order to clarify the association between IFM patterns and pregnancy adverse outcomes.

 COVID-19 infection may be associated with potential sequels on the hormonal system, which can substantially alter menstrual cycles in women.

 This study aimed to evaluate short-term menstrual distributions after COVID-19 infection and determine whether vaccination and type of vaccine could alter menstrual cycles.

 This study was carried out using an online survey to record any menstrual distributions such as any changes in duration, volume, and time of menstruation, intermenstrual bleeding (IMB) and dysmenorrhea as well as exacerbation of premenstrual syndrome (PMS) on 268 women aged 18 to 45 who were infected by COVID-19. The participants were followed at least for three months after their COVID-19 infection. The history of vaccine administration before infection was also recorded, and the results were compared regarding various vaccine types.

 Short-term menstrual distributions after infection were common. in this regard46.7% had IMB, 66.1% experienced exacerbation in PMS, 67.7% had increased volume of bleeding, 62.9% had dysmenorrhea or exacerbation in dysmenorrhea. Also, 27.4% and 35.4% experienced a shorter or longer duration of menstrual cycles, respectively. All distributions returned to normal after a maximum of two cycles. However, there was a substantial difference (P = 0.024) between women who received the AstraZeneca (recombinant) and Sinopharm (inactivated) vaccines, as the number of patients who experienced changes in menstrual cycles was relatively lower in the recombinant group.

 Menstrual distributions are common but temporary in the short term following COVID-19 infection. Although, the recombinant vaccine (AstraZeneca) was associated with lower menstrual disturbance rates compared to Sinopharm or Sputnik vaccines.

Ectopic pregnancy (EP) is the implantation of a fertilized egg outside the uterine cavity or in an unusual location. According to the clinical case reports, hormonal contraceptive failures may be related to emergency contraceptives and EP. EP may be treated medically, surgically, or expectantly. Currently, there is no consensus regarding whether a multiple- or double-dose regimen with methotrexate (MTX) or an additional dose could be more effective than a single-dose regimen.

This study aimed to assess risk factors and treatment outcomes for EP.

This case-control study was carried out in Tehran, Iran from March 2020-March 2021. The case group was comprised of all EP-diagnosed cases (n = 191). Based on the levels of β-human chorionic gonadotropin, MTX was administered to stable individuals with no surgical indications. Risk factors were assessed through 2 control groups: intrauterine pregnancy (n = 190) and nonpregnant groups (n = 180).

The medical treatment significantly improved with an extra dose of MTX, especially in individuals with higher β-human chorionic gonadotropin concentrations and gestational age > 7.5 wk (p = 0.002). Considering risk factors, it is assumed that hormonal contraceptive failures, including both oral and emergency contraceptives, may increase the EP likelihood (p < 0.001).

Based on our findings, we recommended an additional dose of MTX for subjects who are further along in their pregnancy. It is also concluded that failure of contraceptive pills increases the chances of EP.

Although antenatal anomaly screening tests (AAST) provide valuable information about fetal health, performed to prevent the birth of children with chromosomal abnormalities, uncontrolled stress while performing such tests may negatively affect the mother’s mental health. This study aimed to systematically review clinical trial studies in which reducing pregnant women’s anxiety and concern in the process of performing AAST was among their objectives.

In this systematic review, six electronic databases (Scopus, Cochrane Library, Science Direct, PubMed, Google Scholar, and CINAHL) were searched. Data extraction was performed through randomized controlled trials (RCTs) in English, which the core fell onto designing an intervention to reduce pregnant women’s anxiety and concern associated with performing AAST.

Out of the 1946 studies, six were included in this systematic review. In most studies, a positive impact on knowledge and satisfaction with the information received was observed. However, no effect was reported regarding decreasing or increasing the anxiety and concern of pregnant women in the process of performing AAST. Studies were heterogeneous in terms of intervention type and gestational age of participants.

Interventions aimed at providing pregnant women with specific information about prenatal screening for chromosomal abnormalities have no impact on reducing their anxiety and concern. Therefore, designing educational-psychological interventions to prevent and reduce anxiety and concern of pregnant women in this period is recommended.

CCTGA, also known as levo- or L-loop transposition (L-TGA), double discordance, or ventricular inversion, is a rare cardiovascular anomaly with inversion of the ventricles and great arteries. In this anomaly, the right atrium communicates with the morpho- logic left ventricle, which gives rise to the pulmonary artery, while the left atrium communicates with the morphologic right ventricle, which gives rise to the aorta. Thus, atrioventricular and ventriculoarterial discordance (double discordance) exist, and although the blood flows in the normal direction, it passes through the wrong ventricular chambers. It is a unique conotruncal anomaly, in which the four-chamber view is abnormal. It may be associated with other heart disorders. In most fetuses, TGA remains undiagnosed before birth. The diagnosis of TGA can be made by care- fully and appropriately evaluating the anatomic locations of cardiac chambers and the connections between the atria, ventricles, and great arteries with high-resolution ultrasound. Patients with isolated CTGA generally present later in life with signs and symptoms related to either arrhythmias or heart failure. TGA is rarely associated with chromosomal abnormality and amniocentesis is usually not undertaken. We report a case of CTGA detected at 18 week’s gestation on screening ultrasound.

 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.

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.

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.

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.

Several studies have described multisystem inflammatory syndrome (MIS) in children, but very few investigations presented this syndrome among neonates (MIS-N). The present study has reviewed the current knowledge about MIS-N, its etiology, symptoms, and outcomes to attract special attention with an eye on earlier diagnosis and treatment of newborns affected by perinatal SARS-CoV-2-infection. A narrative review study was conducted (Tehran, Iran, 2021). All types of full English articles (up to October 1 2021) were included. Detailed research on academic search engines was performed. The implemented Mesh-based keywords were "SARS-COVID-2" OR "COVID-19" OR "coronavirus" AND "Neonate" OR "Neonatal" OR "Newborn" AND "Multisystem Inflammatory Syndrome" OR "MIS-N" OR "inflammatory response syndrome" AND "Pregnancy" OR "Perinatal" OR "prenatal". Finally, 15 Full-text articles were included that met the eligibility criteria. Available data related to the disease, its etiology, presentations, and its outcome were collected and discussed. The cause of MIS-N is the transmission or production of SARS-CoV2 antibodies in response to SARS-CoV2 infection. By involving different organs, the clinical manifestations of MIS-N may mimic sepsis, toxic shock syndrome, RDS, Kawasaki disease, necrotizing enterocolitis, myocarditis, meningitis/encephalitis, aortic thrombosis, ETC. Besides the clinical presentations, detecting reactive anti-SARS-CoV-2 IgG antibodies could be a notable clue in MIS-N diagnosis. Supportive therapy, suppressing the autoimmune and inflammatory responses, anti-platelet agents, and anticoagulants were reported as effective therapeutic agents to improve the outcome. The present study highlighted the possibility of MIS-N as an infrequent but severe syndrome consequent to perinatal COVID-19 infection. Although the diagnosis is still controversial, clinical suspicion, laboratory findings, and early treatment initiation could improve the outcome of this immunological disease.

COVID-19 has several different presentations including cutaneous manifestations. In this report, we introduce a case of generalized herpes zoster in a COVID-19 patient. No sign of upper or lower respiratory tract involvement was detected, but due to unexpected dissemination of the lesions, COVID-19 Polymerase Chain Reaction (PCR) was tested and revealed positive. Although the incidence of herpes zoster during COVID-19 infection has been reported previously, none of them was disseminated. Therefore, we recommend that during the pandemic of COVID-19, any unexpected disseminated herpes zoster be considered as a possible case of this disease and be quarantined until the PCR is negative.

Pregnant women with coronavirus disease 2019 (COVID-19) have a higher risk of morbidity and mortality compared with the general population. Possible pathways are: I) in patients with COVID-19, cytokine storm defined as the excess release of pro-inflammatory cytokines such as interleukin 1β (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α) has been associated with morbidities and an even higher rate of mortality. II) Labor, despite being a term/preterm, has an inflammatory nature, although, inflammation is more prominent in preterm delivery. During labor, different pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α are involved which as mentioned, all are crucial role players in the cytokine storm. III) Tissue injury, and during labor, (especially cesarean section) is shown to cause inflammation via pro-inflammatory cytokines release including those involved in the cytokine storm through the activation of nuclear factor κB (NFκB). IV) post-partum hemorrhage with a notable amount of blood loss which can cause significant hypoxemia. In this condition, hypoxia-inducible factor 1α which has a cross-talk with NFκB, leads to the expression of IL-1β, IL-6, and TNF-α as both angiogenic and pro-inflammatory factors. Considering all the mentioned issues and pathways, we suggest that clinicians be careful about the escalation of the inflammatory status in their pregnant COVID-19 patients during/following labor.

Threatened miscarriage is a common disorder in early pregnancy and is seen in 20% of pregnant women. Currently, there is no effective therapeutic solution for this condition. This study aimed to determine the effects of a special food (fried egg with grape molasses) on threatened miscarriage in combination with conventional therapies.

This randomized controlled clinical trial was conducted on 93 pregnant women with mild or moderate vaginal bleeding up to 16 weeks of gestation in two groups. The control group (n = 47) used progesterone 400 mg suppository daily with abstinence from sexual intercourse and physical activity. The intervention group (n = 46) consumed fried eggs with grape molasses and the routine treatment like the control group. The treatment was considered successful if the pregnancy continued up to 20 weeks. Finally, the risk of abortion (miscarriage rate) and the duration of vaginal bleeding were compared between two groups.

The risk of abortion in the control group was about 26% (12 of 45 pregnancies), while in the intervention group, it was 15% (7 of 45 pregnancies). This result was not statistically significant between the two groups (Risk ratio: 0.69, 95% CI: 0.37-1.30, P= 0.197). Additionally, no significant difference was detected regarding the duration of vaginal bleeding between the intervention and control groups (P= 0.699).

There is no significant statistical relationship between the consumption of “fried eggs with grape molasses” and reduction of abortion risk.

A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo.

This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends.

Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period.

In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media.

Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics.

Fetal demise can complicate aneuploidy screening in a multi fetal pregnancy. The cell-free DNA (CF-DNA) from a non-viable conception may be discordant with the viable fetuses. The Aim of study was to review the waiting period, follow-on single fetal demise in a twin gestation before performing NIPT (Non-Invasive Prenatal Testing). In this review article we searched through online databases of CINAHL, Cochrane, Database of Abstracts of Reviews of Effects (DARE), PubMed, Medical Library, and Google Scholar for English literature between 2011 to 2020, with the following keywords: “NIPT”, “non-invasive prenatal screening testing”, “cell-free DNA”, “vanishing twin” and “co-twin demise”. We included the studies regarding the duration between the twin vanishing or reduction and NIPT false results. 201 studies across the eight scientific websites were detected; 178 of which were excluded for duplication or being irrelevant. And 29 studies were fully read. 4 case series, finally, met the criteria for systematic review. The findings suggested that the NIPT screening test can be falsely-positive several weeks after vanishing twins although the live fetus is normal. Therefore, the time duration in which the placenta can release CF-DNA of the vanished twin is unknown. In addition, several weeks after reduction, the fetal CF-DNA increases and then decreases, thus CF-DNA analyzing in multifetal pregnancies with reduction can be challenging as well. In pregnancies with vanishing twin or reduction, evaluating NIPT results is more complex than single fetal pregnancy. According to the reviewed studies, after a fetal demise, the cytotrophoblast continues to release to the CF-DNA in the maternal circulation for a variable time, which may cause a false-positive result if the demised twin is aneuploidy.

The role of anticoagulant medications in preventing placental mediated pregnancy complications in patients with and without thrombophilia has not been investigated well. One underlying cause is associated with adverse effects of anticoagulants in pregnancy including teratogenicity, complexities in dosing and management of anticoagulants during pregnancy and labor. We aimed to assess effects of prophylactic anticoagulant medications in pregnant women with history of the PMPCs who were tested for hereditary thrombophilia.

This retrospective cohort study was done in obstetric clinics of Tehran University of Medical Sciences on medical records of 148 pregnant women with history of poor obstetric outcome due to placental complications. Pregnant women with both positive and negative thrombophilia test results were included in the study. They were divided into two group according to receiving anticoagulants. 

148 patients were analyzed over 1.5 years. Among them, 85 women received anticoagulant medications and 63 did not receive these treatments for the next pregnancy. Moreover, 58 out of 148 pregnant women were thrombophilic according to positive tests. Successful pregnancy outcomes were significantly higher in treated groups. The risk of abortion and unsuccessful pregnancy was significantly reduced in the treated groups. The occurrence of intrauterine fetal death (IUFD), intrauterine growth retardation (IUGR), and preeclampsia were not reduced. The use of anticoagulant during pregnancy did not have any adverse effects. The results in thrombophilia group and non-thrombophilia group demonstrated the benefit of anticoagulant therapy in improvement of pregnancy outcomes.

Testing for inherited thrombophilia in women who have experienced placental mediated pregnancy complications is not recommended. Anticoagulant therapy can be useful in women without thrombophilia and with poor obstetric history because of placental mediated pregnancy complications.

 The American Diabetes Association defines gestational diabetes as no glucose tolerance in the second or third quarter of pregnancy. Gestational diabetes imposes a huge economic burden on the health system. Diagnosis of gestational diabetes is important because it not only predicts prenatal disorders but also affects the long-term outcomes of the mother and child. Since screening tests are costly, it is necessary to find a cheaper method with an acceptable feature.

 The present study aimed to examine the costs of gestational diabetes screening in pregnant women referring to gynecology hospitals affiliated with medical sciences universities in Tehran.

 This was a descriptive-analytical study conducted in the selected hospitals affiliated with medical sciences universities in Tehran in 2016. The study population included all the pregnant women with no risk factors, referring to the selected centers. A multi-stage random sampling model was utilized, and the sample size was 392. The data were gathered through the forms designed for recording costs, as well as interviews, and were analyzed using SPSS18 software, t-test, and one-way ANOVA.

 The mean direct medical costs, direct non-medical costs, and indirect costs of the one-step method were $516,960, $71,593, and $142,162, respectively. Also, the mean direct medical costs, direct non-medical costs, and indirect costs of the two-step method were $262,890, $46,536, and $28,621, respectively.

 The screening of pregnant women using the two-step method is cheaper to diagnose diabetes. The results of this study recommend gynecologists to use the two-step method to diagnose gestational diabetes with lower costs.

Intrauterine growth restriction (IUGR) is one of the pregnancy problems that can be caused by improper vascular changes. Due to the role of NK cells in IUGR and the difficulties of studying them in tissues, it is necessary to study them in peripheral blood. The aim of this study was to evaluate the percentage and number of peripheral blood CD3-CD56+CD16+NK cells in pregnant women with IUGR fetus.. 18 pregnant women with IUGR fetus and 15 pregnant women with healthy fetus were invited. The number and percentage of peripheral blood CD3-CD56+CD16+NK cells in both groups were assessed by flow cytometry. The percentage of CD3-CD56+CD16+NK cells in the patient and healthy groups was 24.11 and 26.17, respectively. The number of these cells was 97.27 in the patient and 129.7 in the healthy group. No significant difference was observed between the two groups by Mann-Whitney analysis. Spearman analysis showed a significant relationship between age and NK cells in the patient group. The comparison of percentage and number of CD3-CD56+CD16+NK cells in the patient group with the control group was not significantly different which could be due to the lack of analysis of NK cell subgroups. In future studies, analysis of NK subtypes should be investigated. Considering the significant relationship between age and the number and percentage of NK cells in the patient group, it seems that increasing age as a negative factor is associated with a decrease in these cells.