General Gynecology and Pelvic Floor
Leila Pourali; maryam salehi; reyhaneh rahmani; elmira fardi; sedigheh ayati; hasan Mehrad-Majd; mehrdad gazanchian; elham rahmanipour; mohammad ghorbani; Ali mehri
Articles in Press, Accepted Manuscript, Available Online from 16 July 2023
Abstract
Background: Vaginal birth after Caesarean (VBAC) is often offered as an option after a single caesarean section (CS).
Objectives: to evaluate the success rate of vaginal birth after two caesarean sections (VBAC-2).
Search strategy: Systematic review and meta-analysis
Selection criteria and Data collection: ...
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Background: Vaginal birth after Caesarean (VBAC) is often offered as an option after a single caesarean section (CS).
Objectives: to evaluate the success rate of vaginal birth after two caesarean sections (VBAC-2).
Search strategy: Systematic review and meta-analysis
Selection criteria and Data collection: We searched MEDLINE, EMBASE, PubMed, Scopus, using search terms (cesarean OR cesarean OR caesarean OR caesarian) AND (“Vaginal birth after” OR VBAC) AND (two OR Twice OR second OR multiple Two independent reviewers performed the study selection, and abstracted and tabulated data and pooled estimates were obtained. Meta-analyses were performed using Open-meta and Comprehensive Meta-Analysis.
Main results: Mean success rate of VBAC-2 was 72% (2174 out of 3020 cases) with a range of 24-90%. Mean hysterectomy rate was 0.43% ranging from 0% to 1.7%. Our meta-analysis showed no significant difference between VBAC-2 and CS-3 in the case of hysterectomy, with a pooled odds ratio (OR) of 0.699, but with a wide confidence interval (95% CI was 0.347-1.407). VBAC-2 being associated with 2 fold increased risk of perinatal mortality compared to CS-3.
Conclusion: Vaginal delivery is a suitable option for women with two previous cesarean sections, the outcomes are significantly more favorable for women with history of vaginal birth.
Obstetrics and Gynecology
Soheila Dabiran; Shahla Khosravi; Leila Pourali; Sedigheh Ayati; Zahra Mohaddes Ardebili; Shamim Delavari
Volume 8, Issue 1 , January and February 2023, , Pages 35-40
Abstract
Background & Objective: Delayed childbearing has become a worldwide phenomenon, yet the association between advanced maternal age (AMA ≥35 years) and pregnancy outcomes remains unclear. This issue has also been inadequately explored in Iran. To assess the relationship between pregnancy complications ...
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Background & Objective: Delayed childbearing has become a worldwide phenomenon, yet the association between advanced maternal age (AMA ≥35 years) and pregnancy outcomes remains unclear. This issue has also been inadequately explored in Iran. To assess the relationship between pregnancy complications and AMA in the Iranian context.Materials & Methods: This cross-sectional study involved 891 women who had consecutive pregnancies and were referred for delivery to an academic hospital at Mashhad university of medical sciences, Mashhad , Iran, from March 2015 to March 2019 for The women were considered into the two age groups, namely, a 20 to 34year group and an AMA group, who were then assessed in terms of complications of late childbearing, such as preeclampsia, gestational hypertension, and gestational diabetes mellitus (GDM); mode of delivery; and five-minute Apgar score. The data were analyzed using the chi-square test and the Mann–Whitney U test in SPSS version 9. The P<0.05 was considered statistically significant.Results: The AMA group exhibited lower five-minute Apgar scores and a significantly higher prevalence of preeclampsia, gestational hypertension, and GDM (p < 0.05). The two groups also substantially differed concerningquality of prenatal care (p < 0.001). Regarding the mode of delivery, cesarean section was more prevalent in the AMA group, whereas vaginal delivery was more common in the younger group (p < 0.001).Conclusion: With regard to trend to pregnancy in higher maternal age and higher pregnancy complication in this population, precise preconception counseling is crucial to educating couples for early childbearing at younger age.
Leila Pourali; Sedigheh Ayati; Atiyeh Vatanchi; Anis Darvish
Volume 4, Issue 1 , March and April 2019, , Pages 42-44
Abstract
Introduction: Postpartum hemorrhage has different etiologies. One of the rare causes is inner myometrial laceration that makes the diagnosis more difficult. This report aimed to introduce a case of massive postpartum hemorrhage following an inner myometrial laceration.
Case Report: A 24-year-old primigravid ...
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Introduction: Postpartum hemorrhage has different etiologies. One of the rare causes is inner myometrial laceration that makes the diagnosis more difficult. This report aimed to introduce a case of massive postpartum hemorrhage following an inner myometrial laceration.
Case Report: A 24-year-old primigravid woman referred to an academic Hospital due to hypertension of 140/90 and diagnosis of preeclampsia. Her pregnancy was terminated at 39th gestational week. She received two doses of 25 μg misoprostol sublingually. Subsequently, an induction was performed and normal vaginal delivery occurred. A 2800 gr infant was born. After the delivery, the patient suffered from massive postpartum hemorrhage which continued in spite of all medical treatments. With regard of unstable vital signs, laparotomy was done. By transverse uterine incision, a longitudinal inner myometrial laceration was found in the lower uterine segment, which was repaired, thus, hemorrhage was controlled.
Conclusion: An inner myometrial laceration is one of the differential diagnoses of postpartum hemorrhage which should be taken into consideration. Laparotomy and hysterotomy for repairing the inner myometrial laceration would control postpartum hemorrhage and could avoid hysterectomy.
Sedigheh Ayati; Leila Pourali; Atiyeh Vatanchi; Lida Jedi; Zahra Mohades Ardebili
Volume 3, Issue 4 , November and December 2018, , Pages 173-176
Abstract
Background & Objective: HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and low platelet count; it probably shows a severe form of preeclampsia. This syndrome usually occurs in third trimester of pregnancy and may be associated with severe complications, including subcapsular ...
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Background & Objective: HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and low platelet count; it probably shows a severe form of preeclampsia. This syndrome usually occurs in third trimester of pregnancy and may be associated with severe complications, including subcapsular liver hematoma, eclampsia, pulmonary edema, liver or renal dysfunction, and even maternal death. This study aimed to report a case of maternal death misdiagnosis of HELLP syndrome.
Case Report: A 28-year-old pregnant woman with gestational age of 28 weeks referred to an emergency ward because of epigastric pain, nausea, and vomiting. She was discharged after receiving outpatient treatment. The next day, she was referred to the hospital because of seizure, decreased level of consciousness, and hypertension. A cesarean section was performed immediately. Unfortunately, some hours after the surgery, cardiac arrest occurred and she died in intensive care unit (ICU).
Conclusion: Nausea, vomiting, and epigastric pain in the late second or third trimester of pregnancy are among the significant symptoms which should be seriously taken into consideration. Therefore, it is recommended that a patient be hospitalized and precise evaluation be performed to rule out the life-threatening differential diagnoses, like HELLP syndrome, and to prevent dangerous complications which can lead to maternal death.
