Crescent Journal of Medical and Biological Sciences
Volume:6 Issue: 4, Oct 2019

Over the decades, the delivery of long-term care (LTC) in the Middle East has encountered substantial hurdles due to inadequate resource allocation. As a result, the low-income and uninsured populations have encountered growing challenges in accessing quality healthcare. The objective of this study was to investigate the impact of co-payments or out-of-pocket payments on LTC access in the United Arab Emirates (UAE) in contrast to other Middle East countries. A quantitative secondary research approach was used in the study to collect relevant data on the topic from government reports, academic studies, and international healthcare institutions. The fndings indicated that long-term healthcare fnancing that largely focuses on out-of-pocket payments has substantial negative economic impacts on low-income households. Growing evidence from low income earning countries like Yemen, Syria, the State of Palestine, and Iraq shows evidence of households pushed into deep destitution and impoverishment due to expensive long-term medical expenses. The condition is worsened in families without insurance cover, among the elderly, and loss of household income resulting from chronic health. As such, the existing LTC fnancing plan in the Middle East largely exposes poor households without insurance cover or government fnancing or subsidies to substantial fnancial burden and poverty. In conclusion, there is an urgent need for research into alternative LTC fnancing strategies for coping with indirect and direct costs of illness to inform better social care policies for poor households in the Middle East.

Using food to prevent diseases has become the focus of different researchers in recent years. Tea is a natural source of caffeine, flavonoids, ascorbate, theanine, and antioxidants. The purpose of this study was to provide a review of the benefits and harms of tea for different body systems.Methods and Materials: The present review study was conducted by searching through the websites and assessing the results in the literature using a library research method. The data were collected for publications during 2000-2018.

Various epidemiological studies concluded that tea and its polyphenolic contents have beneficial effects on different bodily systems including the cardiovascular system, diabetes control, and different types of cancer. However, some studies argue that tea may have harmful effects on the bodily systems.

Overall, tea is considered beneficial to human health. It can also be recommended as a healing beverage. Nevertheless, conflicting findings are reported about the risks of tea as well. Therefore, more studies are needed to further explore the benefits and possible harms of different types of tea

Histone acetylation is determined by a balance between the activities of the enzymes that are involved in the histone modifications, including histone deacetylases (HDACs) and histone acetyltransferases which affect gene expression and play a significant role in carcinogens. Valproic acid (VPA) belongs to the HDAC inhibitor family which inhibits HDAC activity and regulate biological events such as apoptosis in various cancers. The current review summarized various pathways by which VPA affects different types of cancers.

For this review, an online search of different sources such as ISI, PubMed, and Scopus resulted in finding the articles correlated with mechanisms and pathways of VPA in different cancers.

Based on these results, VPA may be a suitable agent and a good candidate for cancer treatment with multiple mechanisms of apoptosis induction.

Overall, VPA can protect against cancer by regulating histone modification and tumor suppressor gene reactivation.

Bone loss with skeletal trauma or metabolic diseases usually will require a bone graft. In addition, medical devices used for replacement in tissues such as bones and cartilages for more than 30 days must be checked and controlled for biological safety.

New Zealand white rabbits were divided into two groups. The first group had no defects and was selected as the control group. In the experimental group, tricalcium phosphate/collagen (TCP/collagen) nanocomposite was utilized as the replacement tissue in the femoral defect site. Then, the factors of kidney, liver, and TCP/collagen biocompatibility were evaluated drawing on hematological quality. Free radicals are generated by the damaged tissue when there is a fracture in a bone. Oxidative stress is involved in this mechanism which is defined as the excessive imbalance of reactive oxygen species (ROS) and inappropriate antioxidant anti-mechanical mechanisms.

In the treatment group, malondialdehyde (MDA) level increased postoperatively in the 15th and 30th days, but in due course, it reduced on days 45 and 60. Further, glutathione peroxidase (GPX) enzyme increased after the surgery on days 15 and 30 in the test group and superoxide dismutase (SOD) enzyme demonstrated a slight increase in 15th day. The hematologic investigations were all within a normal limit, including hepatic enzymes, alanine transaminase, aspartate aminotransferase, and alkaline phosphatase (ALP), which indicate the liver damage, as well as creatinine and urea levels displaying the renal function.

Overall, the results of the current study revealed that the oxidative stress factor in the treatment group was not higher compared to the control group, thus showing good biocompatibility of TCP/collagen nanocomposite.

A registry is a vital tool for understanding genetic fields and therapeutic strategies for the treatment of rheumatoid arthritis (RA). In addition, it is valuable in research related to the long-term effect of drugs on patients. Therefore, this study aimed to explain the challenges of RA registry in Iran.

Using a purposive sampling method, ten rheumatologists were selected as the samples of the current qualitative research. Further, semi-structured interviews were conducted to the saturation level for collecting the data. Finally, the content analysis was performed to collect and name data, as well as to obtain analytic categories and subcategories.

The challenges were classified into physical (software and hardware), financial (financing), human (skilled personnel for RA data entry and the tendency of more specialists for medical treatment), and managerial (the lack of referral system and support of Ministry of Health) variables, along with time parameter (the lake of time for health and education). The lack of proper infrastructure, financial limitations, and management challenges were among the most important barriers.

The findings showed that RA registry faces many challenges in Iran. In the case of eliminating the existing obstacles, it would be possible to take advantage of effective and useful outcomes in the basic care of patients with RA

Biological alterations throughout the lives of women make them highly vulnerable compared to men. Thus, being empowered to make better reproductive decisions is an important and valuable aspect of women’s lives. One of the Millennium Development Goals was women’s empowerment. The present study aimed to investigate the relationship between marital satisfaction and women’s empowerment in progenitive decision-making.

This explanatory correlational study was conducted on 400 women who had referred to medical centers associated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. Data were collected using a questionnaire encompassing the participants’ demographic information, the indices of marital satisfaction and women’s empowerment in reproductive decisions. The gathered data were evaluated via the SPSS software version 21.0.

The results indicated that there was a significant relationship between female marital satisfaction and relevant reproductive empowerment (r = 0.34; P < 0.05). Based on the results, the participants also showed an average level of progenitive empowerment.

In general, women’s empowerment and relevant progenitive decision-makings are defined in relation to their marital satisfaction; hence both fields require undivided attention

Maintaining and promoting women’s reproductive health is one of the main goals of healthcare system. Meanwhile, men play a substantial role in the success or failure of reproductive health programs though their role is unfortunately unknown in many countries including Iran, thereby facing many problems. The purpose of this study was to investigate the barriers to the role and understanding of men’s involvement in sexual and reproductive health (SRH) of their wives.

The present study mixed-method study (review and qualitative design) was conducted in 2 steps. First, relevant data were retrieved using several online databases such as Scopus, Medline, Science Direct, Google Scholar, SID, Noormags, and Magiran. Then, additional information and supplementary codes were gathered utilizing an in-depth semi-structured individual interview with 13 married men and 2 focus groups among 14 married women after obtaining the informed consent.

The study findings showed that men had a good perception of participating in reproductive health at the levels of family supervision and management, creating a suitable condition for their wives’ pregnancy and overall health, and finally, taking actions regarding medical care and preventions and providing informative and helpful educations for their wives. However, a wide range of economic-occupational, psychological-mental, socio-cultural, educational-informational, and policy barriers to the healthcare system of the community have prevented their participation in SRH care and programs.

Overall, policymakers and stakeholders are expected to consider these barriers to men’s involvement in SRH in their policy and management plans, leading to the development of men’s participation in SRH care of their women

Sexual dysfunction is one of the most serious problems that may occur in the postpartum period and can lead to physical, psychological, and social adverse effects in women. The type of delivery is one of the factors that may affect the prevalence of sexual disorders in this period. The present study evaluated the relationship between the mode of delivery and women’s sexual function in 6 months and one year after the delivery.

The participants of this cohort study included all nulliparous mothers aged 18 to 35 years, who referred to healthcare centers in Sanandaj, the capital city of Kurdistan province, Iran. The sample size for the vaginal delivery with episiotomy and cesarean section (C-section) was 68 women. Sexual function was evaluated using the Female Sexual Function Index (FSFI) 6 and 12 months after the delivery.

There was no significant difference between the two groups before pregnancy regarding women’s sexual function (P = 0.9) while both types of deliveries resulted in a significant reduction in sexual function 6 months after the childbirth. In addition, vaginal delivery reduced sexual function more than C-section. The mean scores of sexual function were 24.4 for the vaginal delivery group and 26.8 for cesarean delivery (P = 0.01). Finally, women in the C-section group had significantly higher levels of sexual desire one year after the delivery (P = 0.03).

Overall, sexual function in the C-section group was better than the vaginal delivery group 6 months after the delivery. However, this difference was only significant in the domain of sexual desire one year after the childbirth

Caesarean section is one of the most common gynecological surgeries of women. In the traditional method, the patients are prohibited by the surgeon from eating and drinking until the presence of bowel sounds or the passage of flatus after caesarean section surgery. The aim of this study was to determine the effect of early oral feeding on post-caesarean pain in patients undergoing caesarean section.

This clinical trial was conducted on126 women with repeat caesarean deliveries referring to hospital in Divandareh in the northwest of Iran from 2016 to 2017. The samples were randomly divided in to groups of intervention (early feeding) and control (routine feeding). The severity of pain was recorded before and 6, 12, 18, and 24 hours after the intervention. Data analysis was conducted using SPSS version 21.0. Descriptive statistics and analytical statistics, including t test, paired t-test and repeated measures ANOVA were used. The P < 0.05 was considered statistically significant.

The mean pain severity in the intervention group was significantly lower compared to the control group at 6, 12, 18, and 24 hours after the intervention (P < 0.001).

Early feeding turned out to reduce the severity of post-caesarean pain.

According to health surveys, population growth and total fertility rate (TFR) are decreasing in Iran. The economic and social factors in addition to the changing values and attitudes in the Iranian society have had a major impact on fertility decisions and the actions of families, especially women towards childbearing. This is an important issue for policymakers and many researchers in demography and public health thus the investigation of factors that affect low TFR is considered as a necessity.

The classification and regression trees (CART) algorithm, as one of the most applicable classification trees, along with logistic regression was applied to model the tendency of 4898 women for childbearing in provinces with a TFR lower than the replacement level in Iran. The secondary data were then analysed by SPSS version 24.0.

Based on these two approaches, it was concluded that despite the CART algorithm, logistic regression suffers from some shortcomings including the difficult interpretation of three levels of interactions while not containing a specific method for handling the outliers. In addition, CART results demonstrated that women’s children ever born (CEB), age, and opinion had significant impacts on their desire to have a child. The groups encompassing “10-39-year-old women with CEB≤2” and “40-49-year-old women with positive attitudes towards childbearing” desired to have more children while “women with CEB ≥3” showed no tendency for childbearing.

In general, the results revealed that adopting policies for changing women’s views on childbearing and creating the necessary resources for preventing the delays in marriage are regarded as important actions toward altering fertility rates. Another important conclusion is applying the CART algorithm as a convenient method for classifying demographical data.

Biophysical profile (BPP) is a method to check fetal health. The purpose of this study was to evaluate the effects of caffeine and acoustic stimulation on fetal BPP duration and score, and compare their results with control group with no intervention.

This randomized clinical trial was conducted on 150 women who had referred to Tabriz Al-Zahra hospital. The participants were divided randomly into three groups of 50; group I (control) without intervention; group II (caffeine-recipient) who had caffeine before the procedure; and group III (acoustic stimulation) who received acoustic stimulation during the procedure using a reflex hammer.

Our results showed that both fetal BPP duration and fetal profile score were significantly different across the 3 groups. The fetal BPP duration was significantly shorter in the caffeine-receiving group (P=0.00), and fetal profile score in the same group was significantly higher (P=0.00).

Generally, using caffeine-containing drink before BPP tests may result in shorter test duration and higher test score.

Urinary tract infections (UTIs) are related to female anatomy, sexual activity, and menopause. The present study aimed to survey the antibiotic resistance pattern and some risk factors that are associated with UTIs with Pseudomonas aeruginosa.

In this case-control study,26 and 21 women patients with and without P. aeruginosa UTIs in case and control groups were considered, respectively, in North West of Iran from December 2015 to August 2017. P. aeruginosa was detected in urine samples using phonotypic test and polymerase chain reaction (PCR). Then, several risk factors were highlighted, including diabetes, kidney failure, pregnancy, residence, hospitalized, ICU stay, ventilator support, nosocomial infection, antibiotic use in the past 14 days, and age. Finally, the disk diffusion method was used to investigate the antimicrobial resistance pattern, followed by analyzing the data by Fisher’s exact test and SPSS 16 (95% CI, P ≤ 0.05).

Based on the results,26 P. aeruginosa strains were detected in both phenotypic test and PCR. In addition, a significant relationship was observed between diabetes, hospitalization, pregnancy, kidney failure, residence, and nosocomial infections with UTIs (P≤0.005). The highest and lowest rate of antibiotic resistance belonged to cefpodoxime and trimethoprim/sulfamethoxazole (each one with 92.30%) and imipenem (19.23%).

Overall, UTIs and antibiotic resistance related to P. aeruginosa was observed among womenand diabetes and hospitalization were detected as the potential risk factors. Considering the geographic location of Kurdistan province, evaluating the risk factors and periodic reports on antibiotic resistance for UTIs can be more effective in its control and treatment in this area

Pregnancy is considered as one of the most enjoyable events although it is one of the most stressful periods of women’s lives. The pregnant women’s stress is harmful to maternal and fetal health and thus can lead to various complications including preterm labor. In this regard, social support is the most important and known force to deal with such stressful situations. Accordingly, this research aimed to assess the relationship between perceived stress and perceived social support in pregnant women.

The present descriptive-analytical cross-sectional study was performed on 200 pregnant women who visited the health centers of Ardebil during February-August 2018. Cluster sampling method was used for sampling and perceived Stress Scale and perceived social support questionnaire were utilized for data collection. Finally, Pearson correlation, independent t test, one-way ANOVA test, and general linear model (GLM) were applied to analyze the data.

The mean (SD) total scores of the perceived stress and the social support were obtained 24.22 (7.33)/56 and 134.67 (18.47)/175, respectively. Based on the GLM (after adjusting the socio-demographic variables), a significant inverse association was observed between perceived social support and perceived stress (P < 0.001).

Regarding the relationship between perceived social support and perceived stress, it seems necessary for pregnant women to receive support from their husbands, family members, and society

Polycystic ovary syndrome (PCOS) is known as one of the most usual hormone disorder in women of childbearing age. Accordingly, the aim of this research was to investigate the effect of hydroalchoholic extract of Cinnamon zeylanicum (CZ) on oxidative damages and biochemical change in adult rats with PCOS.

In our experimental research, 32 Wistar female rats were used (n=8 per group) including control group (G1), PCOS group without any therapy (G2), rats with PCOS that received a daily intake of hydroalcoholic extract (the 200 mg/kg/orally) of CZ for 2 weeks (G3), and the group with no PCOS while with a daily intake of the extract of CZ (200 mg/kg) for 2 weeks (G4). PCOS was induced by estradiol valerate with a single injection dose (16 mg/kg) intramuscularly. After 14 days, all animals were anesthetized with ketamine and xylazine, followed by obtaining the blood sample and using their plasma for checking the blood glucose, insulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and testosterone. Finally, the ovaries of all animals were removed and fixed for assessing the histological damage.

As regards the plasma levels of blood glucose, insulin, LH, FSH, and testosterone, a significant change was observed between G2 and G1 groups while G3 and G4 groups demonstrated a significant decline in terms of such parameters as compared to G2 group. In addition, the level of estrogen in the plasma decreased significantly in G2 as compared to G1 while in G2 and G1, it was significantly higher when compared to the PCOS group. Eventually, the number of follicles reduced in PCOS group while it indicated an increase in the groups which were treated with CZ extract.

The results of the present research showed that the hydroalcoholic extract of CZ has a beneficial effect on regulating the plasma levels of testosterone, estradiol, LH, FSH, FBS, and insulin in the palliation of PCOS complications

There are contradictory results regarding the effects of foot reflexology on postoperative pain and hemodynamic status in patients undergoing coronary artery bypass graft (CABG). Therefore, the present study aimed to investigate the effects of foot reflexology on post-sternotomy pain and physiological parameters in patients undergoing CABG.

This randomized clinical trial was conducted on 40 women in Shahid Madani hospital of Tabriz in 2019. The sample size was determined based on previous studies using a formula and the participants were randomly assigned to treatment (n=20) and control (n=20) groups. In addition, all participants completed a three-part questionnaire (i.e., demographics, the visual analog scale, and hemodynamic symptoms forms) before and 40 minutes after the intervention. Then, the women in the test group received 20 minutes of left foot reflexology based on the existing method while those in the control group received no intervention. The data were statistically analyzed using the Kolmogorov–Smirnov and chi-square tests, as well as the paired sample and independent t tests at the significance level less than 0.05.

The results indicated that the intervention significantly reduced systolic (P = 0.001) and diastolic (P = 0.005) blood pressures, along with heart (P = 0.003) and respiratory (P = 0.041) rates. Further, foot reflexology significantly decreased the severity of postoperative pain in the treatment group (P = 0.003).

Overall, the study findings revealed that foot reflexology had positive effects on the stability of hemodynamic status and thus relieved postoperative pain in patients undergoing CABG.

Electromagnetic field (EMF) causes damages to the kidney through the increase of oxidative stress, and the use of antioxidants can reduce the effects caused by EMF. The present study investigated the effects of vitamin E and sodium selenite on the expression levels of Bax and Bcl2 genes and renal histopathology in the EMF-exposed mice.

In this study, 48 mice with the approximate weight of 24-28 g were used. The mice were randomly assigned to six groups (n=8): 1) control; 2) EMF; 3) EMF + vitamin E; 4) EMF + sodium selenite; 5) EMF + vitamin E + sodium selenite; and 6) vitamin E + sodium selenite. Mice were exposed to the EMF for 4 hours a day for 2 months. After this duration, the mice were sacrificed by cervical dislocation and the right kidney was taken out for the evaluation of the histopathological changes and the left kidney was used to determine the expression of Bax and Bcl2 genes by real-time polymerase chain reaction (PCR).

Statistical analyses showed that EMF significantly decreased the kidney corpuscle diameter and bcl2 gene expression. Moreover, increased urinary space, basal membrane thickness, and increased expression of Bax gene were observed compared to the control group (P < 0.05). However, the treatment of mice exposed to EMF with vitamin E and sodium selenite significantly decreased the effects of EMF on these parameters (P < 0.05).

The results of this study showed that vitamin E and sodium selenite could significantly inhibit the destructive effects of EMF on the expression of Bax and bcl2 genes and prevent the histopathological changes in the kidneys of mice.

Redo mitral valve replacement (MVR) is an important therapeutic approach in patients with the malfunction of the prosthetic mitral valve, especially in patients with severe dyspnea or a large thrombus burden. Redo replacement (MVR) and thrombectomy are different surgical approaches in these patients. This study evaluated the outcome of the second mitral valve surgery including mechanical MVR (M-MVR), biologic MVR (B-MVR), and surgical thrombectomy.

To this end, 71 patients were included in this study, who underwent second mitral valve surgery following the malfunction of the prosthetic mitral valve in the last 10 years. These patients were divided into M-MVR, B-MVR, and surgical thrombectomy groups and their demographic, clinical, echocardiographic, and laboratory findings were gathered as well. Then, the patients were evaluated for their third MV surgery if it was performed, followed by evaluating the pump time and cross-clamp time

Fifty-seven, 8, and 6 patients underwent M-MVR, B-MVR, and thrombectomy, respectively. Based on the results, the mortality rate was not significantly different between the 3 groups (P = 0.059). In addition, 12 patients underwent the third surgery with the highest (100%) and lowest (0%) rates at thrombectomy and B-MVR groups, respectively. Higher pump time and cross-clamp time were significantly associated with an increased mortality rate (P = 0.014 and P = 0.026, respectively).

In the malfunction of the prosthetic mitral valve, mortality rate failed to significantly differ between the patients undergoing M-MVR, B-MVR, and thrombectomy but third surgery is often needed after thrombectomy. It seems that the replacement of previous prosthetic valve with a new mechanical or biological valve yields better results in the case of prosthetic valve malfunction

Asthma and intermittent asthma attacks impose a heavy mental and financial burden on families and serum level of resistin influences the incidence of childhood asthma and response to drug therapies. The purpose of this paper was to assess the serum level of resistin in asthmatic children in the division of pulmonary and respiratory diseases at Tabriz Children’s hospital.

This study was conducted on 50 subjects in the control group and 50 subjects in the case group (asthmatic and healthy prepubertal children under 12 years old with a normal (BMI) (5-84th percentile); asthmatic and healthy overweight prepubertal children under 12 years old (85-94th percentile); and obese prepubertal children under 12 years old (BMI ≥95) without any other illnesses. The control group was matched to the case group in terms of age and sex and did not have inflammatory, acute and chronic infectious diseases or a history of medication consumption. Venous blood samples were collected from the subjects after 8 hours of fasting. Serum levels of resistin were measured using Elisa.

The level of resistin increased with asthma severity. Increased weight and BMI also led to a significant increase in the severity of asthma. The serum levels of resistin were significantly higher in the subjects of the control group who did not receive drug therapy. Response to drug therapy was significantly poorer in tall, heavier and high-BMI subjects than in other groups. The number of cases with severe persistent asthma was greater in formula-fed and breastmilk/formula-fed babies. History of allergy or asthma in first-degree relatives was significantly higher in the case group than in the control group (P = 0.001). Indoor smoking had a significant effect on the type of asthma (P = 0.001). The history of non-asthmatic allergy had a significant effect on the type of asthma (P = 0.001).

Obesity and overweight are among the influential factors in the severity of asthma. The amount of resistin is significantly higher in children with severe persistent asthma and uncontrolled asthma than in healthy children. However, the results showed that smoking may also increase serum resistin in at-risk individuals

Parents with children suffering from congenital heart disease (CHD) faced with a severe emotional crisis. This study was conducted based on the idea that the more knowledgeable the parents are about such diseases, the more they can cooperate with the physician in the child’s treatment process.

Given the aim of the study, parents’ information of 104 children who were referred to the outpatient clinic was collected by a questionnaire. The instrument contained five questions regarding the awareness of the name of the child’s heart disease, the ability to indicate the location of the disease on a schematic image of the heart, the knowledge of the symptoms of the heart disease, the awareness of the causes of CHD, and the importance of children’s oral hygiene.

Children’s mean age was 4.8 ± 4.3 years. Based on the results, there was a significant association between parents’ education and the above-mentioned parameters except for the importance of children’s oral hygiene (P<0.05).

In this study, parents’ information about their children’s heart disease was largely incomplete which was generally attributed to the parents’ level of education. Currently, it seems that the probable explanations provided by physicians about children’s illnesses play no effective role in creating the awareness of parents, especially those with lower levels of education.

Visual inspection is a known procedure for cervical cancer screening in low income societies. The present study aimed to assess the sensitivity, specificity, and positive and negative predictive values of digital cervicography in the diagnosis of cervical precancerous lesions.

Patients who had referred to Colposcopy Clinic of Al-Zahra Hospital (Tabriz-Iran) between September 23, 2017 and September 23, 2018 and underwent digital cervicography were included in the study. Before the procedure, written informed consent was obtained from all the cases. Digital photographs were captured before and after the application of 4% acetic acid in addition to the routine colposcopy. Modified Reid index was used for the interpretation of the images as positive, negative, and suspicious, and the results were compared to cervical biopsy findings as a gold standard.

From 95 patients, 31 positive and 64 negative cases were reported in the colposcopy procedure. The sensitivity, specificity, positive and negative predictive values of digital cervicography were calculated as 89.47%, 81.57%, 54.83%, and 96.87%, respectively.

To sum up, digital cervicography can be used as an effective screening tool for cervical cancer prevention in low and middle income countries.

Vitamin D receptors exist in the reproductive system of women. Vitamin D is a fat-soluble vitamin that plays a double role as vitamin and hormone. Vitamin D deficiency is a major health problem around the world. The prevalence of vitamin D deficiency is high worldwide. The morbidly adherent placenta is now a significant obstetric challenge. Therefore, we decided to conduct a study on the effects of vitamin D deficiency on placenta accreta to help identify high-risk women.

This analytical cross-sectional study was conducted from August 2016 to February 2017 at Alzahra hospital affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. In our study, we had 2 groups of women who referred to the high risk pregnancy clinic in Alzahra hospital.

According to the results obtained from independent samples t test, serum level of vitamin D was lower than 30 ng/mL in 97% of the participants.

Based on the results of the present study, since the diagnosis of placenta accreta was made earlier in the pregnancy, it can be determined simultaneously with an anomaly scan during pregnancy to prevent the possible complications of placenta accreta. We hope that with this study we can help prevent and reduce the occurrence of placenta accreta in order to prevent the psychiatric and surgical complications of hysterectomy caused by placenta accreta