Maternal Fetal Medicine
Zahra Panahi; Sedigheh Hantoushzadeh; Soudabeh Kazemi Aski,; Saeede Eslami Khotbesara; Mamak Shariat; Fahimeh Ghotbizadeh; Razieh Akbari
Articles in Press, Accepted Manuscript, Available Online from 17 May 2023
Abstract
Introduction: Despite the high efficacy of the Apgar score to find respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one the best indicator of fetal hypoxia. Therefore it’s so beneficial to consider these criteria and ...
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Introduction: Despite the high efficacy of the Apgar score to find respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one the best indicator of fetal hypoxia. Therefore it’s so beneficial to consider these criteria and its relationship with Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively and by which reduces the unnecessary cesarean section(CS) rate.
Methods: 162 full-term (≥259 days) neonates delivered by CS with a 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 gender, and causes of decreased FHR on Apgar scores and UApH were studied as well.
Results: 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 males and females. 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).
Conclusion: Mild acidemia (UApH<7.2) at least in male fetuses would be a good predictor for postnatal complications and the need for NICU admission. Future studies with more samples are suggested.
Maternal Fetal Medicine
tayebeh sedighi
Articles in Press, Accepted Manuscript, Available Online from 27 May 2023
Abstract
Introduction: Elevated blood flow resistance in the uterine artery is related to the development of pre-eclampsia and fetal growth restriction, which can be evaluated with uterine artery Doppler ultrasound (UtA). However, there is a lack of studies regarding its reproducibility. Therefore, we aimed to ...
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Introduction: Elevated blood flow resistance in the uterine artery is related to the development of pre-eclampsia and fetal growth restriction, which can be evaluated with uterine artery Doppler ultrasound (UtA). However, there is a lack of studies regarding its reproducibility. Therefore, we aimed to compare the reproducibility of UtA using transvaginal (TV) and transabdominal (TA) methods in both the first and second trimesters.Materials and Method: This prospective, cross-sectional study was performed in the Prenatal Clinic at Yas Hospital, Tehran University of Medical Sciences. Inclusion criteria were gestational age between 11 to 13 weeks and 18 to 22 weeks based on crown-rump length. Both TV and TA techniques were performed by an experienced specialist in maternal and fetal medicine. Intra- and inter-observer variability of the UtA pulsatility index (UtA-PI) was evaluated using intra-class correlation coefficients.Results: This study included 400 pregnant women in the first and second trimesters of pregnancy. There was no significant difference in the mean UtA-PI measured by the operators. Intra-observer and inter-observer reproducibility of TV and TA in both the first and second trimesters, based on ICC and CCC, was moderate and poor, respectively. Intra-observer ICC ranged from 0.97 to 0.85, while the inter-observer ICC ranged from 0.93 to 0.84.Conclusion: Our results showed that intra-observer and inter-observer reproducibility of TV and TA was excellent, whereas the intra-observer and inter-observer reproducibility of TV was better. Measured UtA-PI was not influenced by the operator.
Maternal Fetal Medicine
Seyedeh Noushin Ghalandarpoor-Attar; Fatemeh Rahimi-Sharbaf; Seyedeh Mojgan Ghalandarpoor-Attar
Volume 8, Issue 5 , September and October 2023, , Pages 536-540
Abstract
As widespread prophylaxis with anti-D Antibodies has dramatically diminished anti-D-associated hemolytic disease of the newborn (HDN), other antibodies-associated HDN has become relatively more significant. Two genes encode Rh proteins: the RhD gene coding for the D and the Rh CcEe gene coding for Cc ...
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As widespread prophylaxis with anti-D Antibodies has dramatically diminished anti-D-associated hemolytic disease of the newborn (HDN), other antibodies-associated HDN has become relatively more significant. Two genes encode Rh proteins: the RhD gene coding for the D and the Rh CcEe gene coding for Cc Ee Antigens. D is a rare Rh phenotype in which RBCs lack Cc/Ee antigens while D antigen is strongly expressed. Anti R17 antibodies are important monomorphic antibodies acting against all previously mentioned antigens. It can pass through the placenta as a G immunoglobulin, leading to fetal or neonatal hemolysis. Here, we reported an immunized pregnant female with D- - phenotype and a history of intrauterine fetal death who had high titer of anti-Rh17 antibodies in her subsequent pregnancy. We would discuss our management strategy which led to good perinatal outcomes. To the best of our knowledge, this is the second case of HDN reported in English written literature in Iran.
Maternal Fetal Medicine
Maryam Nurzadeh; Maryam Moshfeghi; Mamak Shariat; Ashraf Sadat Jamal; Vajiheh Marsoosi; Laleh Eslamian; Mahsa Naemi; Maria Nezam Nia; Fedyeh Haghollahi; Seyede Houra Mousavi Vahed
Volume 8, Issue 4 , July and August 2023, , Pages 334-340
Abstract
Background & Objective: A number of procedures have been developed for multifetal pregnancy reduction (MPR) to reduce the overall number of fetuses in the gestation and improve the maternal outcomes as well as the outcomes of the surviving fetus.Materials & Methods: An observational ...
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Background & Objective: A number of procedures have been developed for multifetal pregnancy reduction (MPR) to reduce the overall number of fetuses in the gestation and improve the maternal outcomes as well as the outcomes of the surviving fetus.Materials & Methods: An observational historical cohort study was conducted on multiple pregnancies that underwent fetal reduction in Shariati Hospital and Omid Clinic between January 2018 and September 2021. The study population was divided into two groups according to gestational age at fetal reduction: 11–14 weeks' gestation (early reduction group) and 15–19 weeks’ gestation (late reduction group). The main outcome measures were the rates of pregnancy complications, pregnancy loss, preterm delivery, and adverse neonatal outcomes.Results: The study group included 107 patients with twin and multiple pregnancies that underwent abdominal MPR at 11-19 weeks’ gestation (79 in the early reduction group and 28 in the late group). The incidence of pregnancy complications (hypertension, diabetes, intrauterine growth disorder, preterm delivery, and pregnancy loss) was not significantly different between the two groups (P >0.05). The percentage of NICU admission was higher in the early reduction group compared to the late group (49% vs 18.5%, P=0.004). The weight of the first newborn was significantly heavier in the late versus early reduction group (2680.55±777.52 vs 2264.4±796.82, P=0.005).Conclusion: According to the present study, fetal reduction in twin or multiple pregnancies is a safe procedure with good obstetric outcomes if done by an expert specialist, especially when it is performed in the second trimester.
Maternal Fetal Medicine
Bushra Abbas Abdullah; Hala Saadi Abdulwahid
Volume 8, Issue 4 , July and August 2023, , Pages 408-414
Abstract
Background & Objective: Antenatal care service satisfaction is a measure of the degree to which a woman seeking care is happy with the antenatal care service provided to her. As well as, the pregnant women satisfaction is a first indicator about the quality of antenatal care. This study aimed ...
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Background & Objective: Antenatal care service satisfaction is a measure of the degree to which a woman seeking care is happy with the antenatal care service provided to her. As well as, the pregnant women satisfaction is a first indicator about the quality of antenatal care. This study aimed to identify if the reproductive factors can predict the level of satisfaction towards ANC.Materials & Methods: A descriptive cross-sectional study conducted in the city of Diwaniyah in primary health care centers for the period from October 1st, 2022 to March 1st, 2023. The study sample consisted of 150 pregnant women who were selected according to a non-probability sampling approach. The questionnaire was validated according to experts and its reliability was verified through a pilot study. The total number of items included in the questionnaire was 38 items. Data were collected using interviews and analyzed by applying descriptive and inferential statistical analysis.Results: The results of the study indicate that the average age of pregnant women is 27.8 years, (30%) of primary school graduates, and (62%) of housewives, (34.7%) of them expressed more than 900,000 Iraqi dinars as a monthly income, and (60.7%) of them live in the regions Urban area. The results showed that the level of satisfaction was relatively moderate (48%). The reproductive related factors of pregnant women such as number of abortions, number of visits to ANC and gestational age are predicted variables of satisfaction.Conclusion: The most of influencing related factors are number of abortions, number of visits of ANC and gestational age are considered predicted the level of satisfaction. Decision makers in the Health Directorate should be employed based on quality guidelines in order to improve antenatal care services compared to international standards and take into consideration reproductive characteristics in providing those services.
Maternal Fetal Medicine
Nematullah Shomoossi; Mostafa Rad
Volume 8, Issue 3 , May and June 2023, , Pages 306-307
Abstract
This letter comes to you in the hope of stressing the need to understand age differences and relevant requirements in delivering bad news to end-stage children. Among variables affecting the way healthcare providers communicate bad news, the age of the recipient is a critical factor requiring caregivers’ ...
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This letter comes to you in the hope of stressing the need to understand age differences and relevant requirements in delivering bad news to end-stage children. Among variables affecting the way healthcare providers communicate bad news, the age of the recipient is a critical factor requiring caregivers’ meticulous tactfulness. For practical purposes, various strategies are already suggested in communicating unexpectedly bad news to patients abruptly taken to face their end of life (1). However, patients of different ages may require different strategies. For some healthcare providers and physicians, breaking bad news to an elderly end-stage client may be taken for granted because public mindset is wired to assent to end-of-life deaths. While this tendency appears controversial by itself, communicating bad news to younger patients with life-threatening irremediable diseases appears more perplexing which should be given due attention in practice and special priority in training.Young frivolous patients hope for life rather than death because children conceive of disease as a temporary stage of abnormal functioning of body systems; never do they expect dying if they become ill. The concept gradually transforms; for instance, school-age children may tend to blame themselves by attributing illness to their own actions but as they grow up, illness becomes increasingly attributed to external causes. Therefore, such conceptualizations should guide healthcare providers’ behavior toward their patients.
Maternal Fetal Medicine
Tajossadat Allameh; Zahra Allameh; Zahra Javanmardi; Elham Moazam; Maryam Dehghan
Volume 8, Issue 2 , March and April 2023, , Pages 131-136
Abstract
Background & Objective: Due to the uncertainties of maternal and neonatal complications after delivery and the lack of similar studies in this regard, this study aimed to compare the maternal and fetal complications of vaginal birth after C-Section (VBAC), natural delivery and repeat Cesarean ...
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Background & Objective: Due to the uncertainties of maternal and neonatal complications after delivery and the lack of similar studies in this regard, this study aimed to compare the maternal and fetal complications of vaginal birth after C-Section (VBAC), natural delivery and repeat Cesarean section in Isfahan province.Materials & Methods: In this one-year descriptive cross-sectional study, 49889 pregnant women who had the natural childbirth (29631 deliveries), elective repeat Cesarean section (20148 deliveries) and VBAC delivery (110 deliveries) were enrolled, then maternal and neonatal complications were compared in three groups.Results: There was a significant difference between the three groups based on the maternal and neonatal outcome, Apgar scores in the first and fifth minutes after delivery and the need for resuscitation at birth (P <0.05). Neonatal outcome was better in natural delivery and then VBAC compared to repeat C-section, respectively. Maternal outcome was better in VBAC and then repeat C-section than the natural childbirth. Apgar scores in the first and fifth minute were better in VBAC, and later natural delivery than repeat C-section. Resuscitation at birth demonstrated better results for natural delivery and then VBAC than repeat C-section.Conclusion: Utilizing VBAC and natural delivery have better maternal and fetal outcomes compared to C-section, along with being more satisfactory and safer.
Maternal Fetal Medicine
Sedigheh Hantoushzadeh; Taraneh Geran Orimi; Mohammad Reza Zarkesh; Tahmineh Geran Orimi
Volume 7, Issue 6 , September and October 2022, , Pages 471-478
Abstract
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 ...
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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.
Maternal Fetal Medicine
Zahra Panahi; Seyedeh Noushin Ghalandarpoor-Attar; Azade Shabani; Mamak Shariat; Fahimeh Ghotbizadeh; Sedigheh Hantoushzadeh; Elham Feizabad; Seyedeh Mojgan Ghalandarpoor-Attar
Volume 7, Issue 6 , September and October 2022, , Pages 536-542
Abstract
Background & Objective: 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 ...
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Background & Objective: 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.Materials & Methods: 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.Results: 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. Conclusion: 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.
Maternal Fetal Medicine
Seyed Mohammad Ayyoubzadeh; Mahnaz Ahmadi; Fariba Khounraz; Marjan Ahmadi; Rashed Pourhamidi; Sakineh Abbasi
Volume 7, Issue 6 , September and October 2022, , Pages 554-562
Abstract
Background & Objective: There are a lot of apps for pregnancy care using mHealth technologies. However, it has not been studied which criteria in these apps are essential for increasing the quality of these mHealth programs in pregnant women. Thus this study aimed to review the desirable features ...
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Background & Objective: There are a lot of apps for pregnancy care using mHealth technologies. However, it has not been studied which criteria in these apps are essential for increasing the quality of these mHealth programs in pregnant women. Thus this study aimed to review the desirable features of mobile-based pregnancy care applications and provide a model to evaluate existing applications.Materials & Methods: Features of a mobile-based pregnancy app were designed using a qualitative approach. In this research, an open questionnaire was developed. Obstetricians and gynecologists filled out this questionnaire. After thematic analysis of the questionnaires, the obtained items are embedded into a general framework for evaluation mHealth.Results: Fifteen gynecology and obstetrics experts participated in this study. Eight themes were obtained from 34 items mentioned by the experts. Finally, a specialized framework for evaluating mHealth apps for pregnancy care is proposed. Conclusion: To design mobile-based pregnancy care app and evaluate the existing apps in the field of pregnancy, the provided indicators can be used. This framework and other similar specialized frameworks could be developed to improve the quality of the mHealth apps.
Maternal Fetal Medicine
Maryam Moshfeghi
Volume 7, Issue 5 , July and August 2022, , Pages 382-390
Abstract
Background & Objective: The aim of this study was to evaluate the effectiveness of adjunctive pessary therapy after cerclage in increasing the gestational age (GA) to 37 weeks in women with cervical insufficiency (CI).Materials & Methods: This randomized controlled trial (RCT) was conducted at ...
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Background & Objective: The aim of this study was to evaluate the effectiveness of adjunctive pessary therapy after cerclage in increasing the gestational age (GA) to 37 weeks in women with cervical insufficiency (CI).Materials & Methods: This randomized controlled trial (RCT) was conducted at the infertility department of Royan Institute, Tehran, Iran. A total of 170 singleton pregnant women aged 18-42 years old, diagnosed with CI by GA 14-24weeks, who had intact membrane with no signs of intrauterine infection, vaginal bleeding, or uterine contraction, were enrolled. Patients were randomized 1:1 to receive either cervical cerclage or pessary after cerclage. The primary outcome was spontaneous preterm birth (SPB) (<37weeks). The secondary outcomes were GA at the time of delivery, SPB (less than 34, 32 & 28 weeks), delivery method, neonatal outcomes, maternal adverse events, and maternal satisfaction with the intervention.Results: The incidence of SPB (<37, 34, 32 & 28weeks), method of delivery, GA at time of delivery, and neonatal outcomes were not significantly different between the two groups. The incidence of vaginal bleeding (P < /i>=0.007) and pelvic pain (P < /i>=0.03) significantly was less in the intervention group. The mean score of satisfaction in the intervention group was significantly higher than the control group < /span> (P < /i>=0.01). Conclusion: The placement of an adjunctive pessary for pregnant women with singleton pregnancy and CI, did not result in a lower rate of SPB (<37weeks) compared to cerclage alone. However, pregnancy complications after the intervention until delivery were less in these women, while the level of satisfaction was higher.
Maternal Fetal Medicine
Mahboobeh Shirazi; Mohammadreza Zarkesh; Maliheh Fakehi; Marjan Ghaemi
Volume 7, Issue 4 , March and April 2022, , Pages 329-334
Abstract
Background & Objective: This study aimed to compare the neonatal outcomes and infant development one year after birth at different gestational ages of elective cesarean section (CS) beyond 38 weeks.Materials & Methods: This retrospective cohort study was recruited in an academic hospital affiliated ...
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Background & Objective: This study aimed to compare the neonatal outcomes and infant development one year after birth at different gestational ages of elective cesarean section (CS) beyond 38 weeks.Materials & Methods: This retrospective cohort study was recruited in an academic hospital affiliated with Tehran University of Medical Sciences between June 2018 and June 2020. The subjects of the study were the women who were scheduled for elective CS and divided into 3 groups according to the gestational age (38 0/7 to 38 6/7 as group A, 39 0/7 to 39 6/7 as group B, and 40 0/7 to 40 6/7 as group C). The neonatal outcomes and the growth and development status were evaluated by ages and stages questionnaires® (ASQ) after 12 months and compared between groups.Results: Totally, 952 neonates were eligible for this study. In groups A, B, and C, CS was performed in 314, 409, and 229 neonates, respectively. The first minute Apgar was significantly lower in the neonates with lesser gestational age at delivery (P < /em>=0.026). Indeed, neonatal hospitalization, hypoglycemia, and jaundice in group A were significantly higher than in other groups (P < /em><0.001). Regarding psychomotor development, the scores related to gross motor and problem-solving abilities in group A were significantly lower than those in other groups (P < /em><0.05).Conclusion: It is suggested to plan elective CS beyond 39 weeks of gestation to decrease prenatal morbidities and improve psychomotor development one year after birth.
Maternal Fetal Medicine
Sedigheh Borna; Vida Radi; Maasoumeh Saleh; Mina Ataee; Hanieh Feizmahdavi; Zohreh Salari; Mamak Shariat
Volume 7, Issue 3 , January and February 2022, , Pages 144-150
Abstract
Background & Objective: This study assessed the relationship between the ratio of fetal lung volume to head circumference and amniotic fluid index (AFI) in the third trimester of pregnancy.Materials & Methods: This prospective study was performed on low-risk pregnant women in their third trimester ...
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Background & Objective: This study assessed the relationship between the ratio of fetal lung volume to head circumference and amniotic fluid index (AFI) in the third trimester of pregnancy.Materials & Methods: This prospective study was performed on low-risk pregnant women in their third trimester of pregnancy. Fetal lung volume was determined separately using the lung-to-head ratio (LHR) for the right and left lungs. Moreover, the AFI was evaluated, and the Pearson correlation coefficient between LHR for both lungs and AFI was investigated.Results: Overall, 112 pregnant women were included in the study. The mean ± standard deviation (SD) of fetal Observed/Expected Right LHR (O/E RLHR) and O/E Left LHR (O/E LLHR) were 113.9±0.36 and 97.13±27.87, respectively. The mean ± SD of AFI was 12.5±4.96 cm. Pearson correlation coefficient did not show a significant relationship between AFI and the left and right LHR (P < /em>>0.05). However, O/E RLHR was significantly correlated with abdominal circumference (P < /em>=0.02, r=0.2), gestational age (P < /em>=0.21, r=0.27), and fetal weight (P < /em><0.001, r=0.27). There was a positive correlation between the number of days the infant was admitted to the neonatal intensive care unit and the volume of the right lung of the fetus (P < /em>=0.03, r=-0.2). No correlation was observed between fetal parameters and the volume of the left lung of the fetus.Conclusion: The results of this study showed that AFI in the third trimester of pregnancy was not significantly correlated with LHR.
Maternal Fetal Medicine
Laleh Eslamian; Ashraf Jamal; Vajiheh Marsosi; Marjan Ahmadi; Alireza Golbabaei; Paria Boustani
Volume 7, Issue 3 , January and February 2022, , Pages 165-170
Abstract
Background & Objective: IUGR (intrauterine growth restriction) fetuses have been known as a significant concern in clinical practice. It is associated with fetal mortality and morbidity and prenatal adverse cardiac remodeling. The aim of this study is the evaluation of the relation between MPI (myocardial ...
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Background & Objective: IUGR (intrauterine growth restriction) fetuses have been known as a significant concern in clinical practice. It is associated with fetal mortality and morbidity and prenatal adverse cardiac remodeling. The aim of this study is the evaluation of the relation between MPI (myocardial performance index) abnormalities and doppler findings in both normal and IUGR fetuses.Materials & Methods: In this cross-sectional study, 400 consecutive pregnant women in Shariati Hospital, Tehran, Iran, in 2019 and 2020 underwent ultrasound assessment at 28-40 weeks, in which among the 400 performed ultrasounds, 47 fetuses with IUGR were selected as a case group, and 47 fetuses with normal weight were selected based on AGA (appropriate gestational age). Cardiac function was evaluated by measuring MPI in diastolic and systolic function in two groups. The results were compared to the IUGR (case group) and control group by SPSS software version 20.Results: In receiver operating characteristic (ROC) analysis, the AUC (area under the curve) for left ventricular MPI (LV MPI) was 0.929 (CI95%: 0.868-0.991; P < /em>=0.001), and the sensitivity and specificity values were 87% and 69.4% with a cut-off point of 0.2850. In ROC analysis, the area under the curve for RV MPI was 0.842 (CI95%: 0.741-0.942; P < /em>=0.001), and the sensitivity and specificity values were 78.3% and 63.9%, with a cut-off point 0.2850. Left and right ventricular MPI showed a significant difference statistically between the case and the control groups.Conclusion: The study showed a significant rise of MPI in IUGR fetuses. MPI can be considered as a useful parameter for evaluating the severity of growth restriction in IUGR fetuses.
Maternal Fetal Medicine
Marjan Ahmadi; Seyed Mohammad Ayyoubzadeh; Sakineh Abbasi
Volume 7, Issue 3 , January and February 2022, , Pages 254-255
Abstract
Pregnant women are at higher risk of severe COVID-19 than the general population. Furthermore, COVID-19 increases the preterm and cesarean rates due to maternal and fetal complications. Owing to the adverse effects of the COVID-19 on pregnant women, in-person prenatal visits face challenges. Thus, alternative ...
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Pregnant women are at higher risk of severe COVID-19 than the general population. Furthermore, COVID-19 increases the preterm and cesarean rates due to maternal and fetal complications. Owing to the adverse effects of the COVID-19 on pregnant women, in-person prenatal visits face challenges. Thus, alternative solutions that reduce the number of visits while preserving maternal and fetal care quality should be considered. Digital health is one of the potential solutions. Obstetricians and gynecologists, and other clinical experts should cooperate to define digital tools’ requirements and standards for prenatal care. Moreover, governments and healthcare insurances should facilitate the coverage of provided services’ costs by digital health tools, especially in developing countries.
Maternal Fetal Medicine
Fatemeh Mirzaie; Khadije Rezaie Keikhaie; Mahin Badakhsh; Bahareh Khajehpour; Samira Ghofrani
Volume 7, Issue 2 , September and October 2021, , Pages 89-98
Abstract
Background & Objective: Pregnancy is a stressful event in and of itself, which may have an impact on the present prevalence of COVID-19 illness. It is crucial to think about what factors can help pregnant women cope with the anxiety brought on by the COVID-19 outbreak. The purpose of this study was ...
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Background & Objective: Pregnancy is a stressful event in and of itself, which may have an impact on the present prevalence of COVID-19 illness. It is crucial to think about what factors can help pregnant women cope with the anxiety brought on by the COVID-19 outbreak. The purpose of this study was to determine the prevalence of COVID-19 in pregnant women, as well as the impact of COVID-19 anxiety on pregnant women's Apgar scores and birth weights of newborns.Materials & Methods: From early January to late March 2021, 102 pregnant women were included in this descriptive cross-sectional study using any accessible sampling method. Questionnaires such as the "Demographic" and "Corona Anxiety Scale" were used to collect data. SPSS software version 22 was used to analyze the data.Results: The mean score of total anxiety caused by COVID-19 in pregnant women was 20.88 ± 21.08, which was moderate. Among the components of anxiety, the mean score of psychological symptoms (13.05 ± 5.31) of pregnant women was higher than physical symptoms (5.64 ± 5.72). There was no statistically significant link between demographic characteristics and COVID-19-induced anxiety (P < /em>>0.05). The findings also revealed no statistically significant connection between COVID-19-induced anxiety and newborn weight or Apgar score 1 and 5 minutes after birth (P < /em>>0.05).Conclusion: The definitive incidence of COVID-19 in pregnant women was low. They experienced a moderate level of anxiety caused by COVID-19, which requires the necessary measurements to be taken by the relevant authorities, family and others to reduce this anxiety during the coronavirus pandemic.
Maternal Fetal Medicine
mandana Mansour Ghanaie; Roxana Mansour Ghanaie; Seyed Mohammad Asgari Galebin; Seyedeh Hajar Sharami; Mojgan Mohebalizade
Volume 7, Issue 1 , September and October 2021, , Pages 25-31
Abstract
Background & Objective: Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the ...
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Background & Objective: Nucleated red blood cells (NRBCs) enter the circulation in response to hypoxia, but it remains unknown how physiological delivery without fetal distress can change the NRBC level. Accordingly, in the present study, we compared the mean NRBCs per white blood cell (WBC) in the umbilical cord of normal vaginal delivery (NVD) with cesarean section (C/S). To compare the mean NRBCs per WBC within umbilical cord in normal term newborns who were born by NVD with those delivered by C/S. Methods: This case-control study was conducted for 305 neonates in two different groups, i.e., NVD (case) and C/S (control) groups. The blood samples were taken from umbilical veins to evaluate fetal NRBCs and WBC count after recording their demographic characteristics. Finally, all data were assessed using SPSS 16.Results: The average age of mothers was 25.79±5.35 years. The average Apgar score of neonates was 8.23±0.6. The average NRBC count was 4.63±5.2. There was no significant difference in maternal age, parity, neonatal weight, and NRBC count per 100 WBCs between the two groups. Conclusion: In the present study, the mean NRBC count within the umbilical cord of neonates born by elective C/S was less than those delivered by NVD, although this difference was not significant.
Maternal Fetal Medicine
rana razavi; samira jahangard
Volume 7, Issue 1 , September and October 2021, , Pages 52-58
Abstract
Pregnant women appear to be more severely affected by COVID-19. Coagulopathy is known as one of the most challenging effects of COVID-19, and the effects of acute airway diseases resulting from the coronavirus on pregnant mothers and their fetuses can be dangerous. Two women who where pregnant suffering ...
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Pregnant women appear to be more severely affected by COVID-19. Coagulopathy is known as one of the most challenging effects of COVID-19, and the effects of acute airway diseases resulting from the coronavirus on pregnant mothers and their fetuses can be dangerous. Two women who where pregnant suffering from coagulopathy (one of them with disseminated intravascular coagulation (DIC) and the other one with hypercoagulation) and COVID-19 infection are reported in this study. During hospitalization due to severe vaginal bleeding and placental detachment, cesarean section was performed on the first caseand because of acute severe DIC, she received a massive transfusion. The second patient epigastric pain and tachycardia. COVID-19 might have a variety of effects on pregnancy outcome, from vascular and placental involvement to respiratory involvement; there is an association between the coronavirus and hyper-coagulopathy state and coagulopathy like DIC.
Maternal Fetal Medicine
Ali Reza Norouzi; Mahsa Siavashi; Fatemeh Norouzi; Maryam Talayeh; Somayyeh Noei Teymoordash
Volume 6, Issue 4 , August 2021, , Pages 217-223
Abstract
Background & Objective: Gestational diabetes mellitus (GDM) is the most prevalent disorder during pregnancy, which is the result of insulin resistance and hyperinsulinemia due to the secretion of placental diabetogenic hormones. This study aimed to investigate the utility of glycated hemoglobin ...
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Background & Objective: Gestational diabetes mellitus (GDM) is the most prevalent disorder during pregnancy, which is the result of insulin resistance and hyperinsulinemia due to the secretion of placental diabetogenic hormones. This study aimed to investigate the utility of glycated hemoglobin A1c (HbA1c) alone and in combination with hematocrit for early detection of gestational diabetes mellitus.Materials & Methods: In this prospective cohort research, 373 pregnant women who referred to prenatal clinics were included. Hematocrit and HbA1c were determined at gestational age of 12 to 16 weeks and compared with the oral glucose tolerance test (OGTT) results at gestational age of 24-28 weeks.Results: The best cut-off hematocrit for determining pregnancy diabetes mellitus was 37.3. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 70.15%, 64.12%, 32.71 %, and 89.51% respectively.In terms of HbA1c, the best cut-off value to determine GDM in pregnant women was 5, with a sensitivity of 98.51%, specificity rate of 99.02%, PPV of 95.07%, and NPV of 99.49%. In terms of diagnosing GDM, the area under the ROC curve (AUC) for HbA1c was equal to 0.985 which was higher than the AUC for the combination of HbA1c with HCT.Conclusion: Measuring HbA1c can be useful as a screening test for GDM, which is an inexpensive and available test. The combined evaluation of HbA1c and hematocrit did not improve the diagnostic value of HbA1c in GDM screening compared to exclusive evaluation of HbA1c.
Maternal Fetal Medicine
Maryam Dehghan; Neda Ebrahimian; Leila Mousavi Seresht
Volume 6, Issue 4 , August 2021, , Pages 228-232
Abstract
Background & Objective: Since the first reported respiratory distress syndrome due to the new version of the coronaviruses family, COVID-19, there is a concern about the possible maternal and perinatal outcome of new infection in a short and even long time, our information about the prognosis ...
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Background & Objective: Since the first reported respiratory distress syndrome due to the new version of the coronaviruses family, COVID-19, there is a concern about the possible maternal and perinatal outcome of new infection in a short and even long time, our information about the prognosis of pregnancy in sync with COVID-19 is limited. What is our task as scientists in eliminating the unknown facts?Materials & Methods: Here we try to present a couple of pregnant cases in their third trimesters of pregnancy that complicated with two contrary complication of COVID-19 infection, intending to illuminate the best management strategy in COVID-19 infected pregnant.Results: The first case had experienced thromboembolism, and also bleeding accident, who fortunately survived unlike the other case, who expired due to multi-organ failure and impossibility of anticoagulant agent administration for the suspected pulmonary thromboembolic accident.Conclusion: The prior report revealed the thrombo-inflammatory and hypoxic effect of COVID-19 that could lead to microvascular thrombosis and progression, which enforce health care providers, introducing the anticoagulant agents to decline COVID-19 mortality, especially in a critically ill patient. Pregnancy is associated with coagulation abnormality which could intensify the COVID-19-induced coagulopathy. But, one should balance the harm and benefit of such a hazard approach, is there any concern about vascular damage of COVID-19 and subsequent bleeding, that could be exacerbated with high dose anticoagulant agent administration? The other question that we want to discuss in the present report is about comparing the cost and benefit of anticoagulant therapy?
Maternal Fetal Medicine
Maryam Kashanian; Arezoo HoseiniMoghaddam; Seyyed Ali Javad Moosavi; Narges Sheikhansari; Hoda Abdollahi
Volume 6, Issue 2 , March 2021, , Pages 65-71
Abstract
Background and Objective: Asthma is the most common chronic respiratory disorder during pregnancy and it may affect pregnancy outcomes. This study aims to compare the pregnancy, delivery and neonatal outcomes between asthmatic and non-asthmatic pregnant women.Methods: The study was designed as a historical ...
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Background and Objective: Asthma is the most common chronic respiratory disorder during pregnancy and it may affect pregnancy outcomes. This study aims to compare the pregnancy, delivery and neonatal outcomes between asthmatic and non-asthmatic pregnant women.Methods: The study was designed as a historical cohort among pregnant women with and without asthma. A total number of 583 asthmatic patients were allocated to the case group and 753 women without asthmatic history were placed in the control group. Pregnancy, labor and neonatal outcomes were compared between the two groups.Results: The baseline characteristics of the women in both groups did not show significant differences. Gestational hypertension was more in the asthmatic group [43 (7.37%) VS 26 (3.45%), P < /em>=0.001]. Also the rate of preterm delivery was higher in asthmatic women [72 (12.34%) VS 77 (10.22%) in the control group, P < /em>=0.04]. However, the rate of preeclampsia was less in the asthmatic group [29 (4.97%) VS 71 (9.42%), P < /em>=0.008]. Apgar score at minutes 1 and 5 was less in asthmatic group. Intra Uterine Fetal Demise (IUFD) [24 (4.1%) VS 13(1.7%), P value=0.009], and neonatal death [31 (5.31%) VS 10 (1.32%), P < /em>=0.001] were more in the asthmatic group. The maternal and neonatal complications did not show significant differences in various severities of asthma. Multivariate regression model showed more risks for neonatal death [adjusted odds ratio (AOR)=4.18; CI95% 2.03-8.60], IUFD (AOR=2.43; CI95% 1.22-4.82), gestational hypertension (AOR= 1.43; CI 95% 1.40-1.45), and lower risk for preeclampsia (AOR 0.37; CI95%0.17-0.79) in asthmatic women.Conclusion: Regardless of the fact that asthmatic mothers had higher frequencies of gestational hypertension, IUFD and neonatal death, the effect of asthma on perinatal outcome is minimal, probably because of efficient medical control.
Maternal Fetal Medicine
Fatemeh Bahadori; Zahra Fakour; Roghayeh Redaei; Hamid Reza Khalkhali; Zahra Sahebazzamani
Volume 6, Issue 1 , January 2021, , Pages 10-15
Abstract
Background & Objective: This study aimed to assess the effect of betamethasone on neonatal and maternal complications of late preterm labor. Materials and Methods: The women at the gestational age of 34 weeks to 36 weeks and 6 days who referred to Shahid Motahari Hospital, Urmia, Iran for premature ...
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Background & Objective: This study aimed to assess the effect of betamethasone on neonatal and maternal complications of late preterm labor. Materials and Methods: The women at the gestational age of 34 weeks to 36 weeks and 6 days who referred to Shahid Motahari Hospital, Urmia, Iran for premature labor or had a maternal indication of pregnancy termination were selected for this study. The participants were classified into the case group receiving two doses of 12 mg intramuscular betamethasone every 24 h or the control group who did not receive betamethasone. The incidence of respiratory distress syndrome (RDS), need for mechanical or noninvasive ventilation, days of stay in Neonatal Intensive Care Unit (NICU) or Neonatal Ward, umbilical arterial blood gases, maternal hyperglycemia, and wound infection were evaluated.Results: A total of 200 pregnant women were enrolled with a mean age of 27.06±6.55 years. Out of 200 neonates, 52 cases had RDS of which 21 received betamethasone. The first-minute Apgar score was 6.96±0.75 in the control and 7.57±0.67 in the case groups (P < /em><0.001). The incidence of RDS, need for surfactant administration, noninvasive ventilation, and days of stay at NICU or Neonatal Ward were significantly different between the study groups. However, because of the low number of cases (2 cases), we did not find a significant difference in the need for mechanical ventilation between the two groups (P < /em>=0.041). There was maternal hyperglycemia in 65% of women in the test group. Conclusion: Administration of betamethasone in late premature pregnancies can be effective in the reduction of neonatal complications without any increase in maternal complications.
Maternal Fetal Medicine
Mona Taghavipour; Tahereh Galini-Moghaddam; Seyed Jaber Mousavi
Volume 6, Issue 1 , January 2021, , Pages 22-28
Abstract
Background and Objectives: Maternal serum levels of the first- and second-trimester markers for aneuploidy have been revealed to be associated with adverse pregnancy outcomes in the absence of neural tube defects or aneuploidy. This finding can guide clinicans for early diagnosis and management of such ...
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Background and Objectives: Maternal serum levels of the first- and second-trimester markers for aneuploidy have been revealed to be associated with adverse pregnancy outcomes in the absence of neural tube defects or aneuploidy. This finding can guide clinicans for early diagnosis and management of such outcomes. However, previous finding are conflicting in this regard. Therefore, this study evaluated the detection of adverse pregnancy outcomes by first- and second-trimester serum screening analytes.Methods & Materials: We prospectively recruited 972 females who underwent first and second-trimester aneuploidy screening. We gathered information on maternal demographic characteristics and serum biomarkers (free B-hCG and PAPP-A for the first-trimester; AFP, Β-hCG, Inhibin-A, and unconjugated estradiol for second-trimester). At the end of the study, adverse pregnancy outcome was recorded.Results: Abnormal screening results were reported in 34 (3.5%) patients. Two groups were significantly different in maternal age, BMI, and gestational period (P < /em>=0.017, 0.003 and 0.021, respectively). Among the measured adverse outcomes, preeclampsia was significantly more prevalent in the case group (P < /em><0.0001). Abnormal levels of Inhibin-A is associated with the incidence of preeclampsia (RR: 29.87, CI: 13.22-67.49, P < /em><0.0001). Additionally, patients with an abnormal level of Inhibin-A had a shorter gestational period (255.5 ± 24.53 vs. 264.79 ± 8.99, P < /em>=0.006). Likewise, patients with an abnormal level of maternal serum alpha-fetoprotein (MSAFP) had a shorter gestational period (252.0 ± 29.3 vs. 264.8 ± 8.93, P < /em>=0.001).Conclusion: First- and second-trimester maternal serum biomarkers could provide a possible screening tool for early detection of preeclampsia.
Maternal Fetal Medicine
Maryam Saraei; Pegah Estakhrian Haghighi; Hamed Amirifard; Arezu Najafi
Volume 6, Issue 1 , January 2021, , Pages 29-34
Abstract
Background & Objective: Gestational hypertension (GH) is considered as one of the important health-related issues of pregnant women. One of the raised problems in the pathogenesis of GH is obstructive sleep apnea (OSA). This study aimed to evaluate associated factors of OSA among an employed pregnant ...
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Background & Objective: Gestational hypertension (GH) is considered as one of the important health-related issues of pregnant women. One of the raised problems in the pathogenesis of GH is obstructive sleep apnea (OSA). This study aimed to evaluate associated factors of OSA among an employed pregnant population.Materials and Methods: In this study, 200 employed pregnant women with GH as the case group and 200 healthy pregnant ones as the control group were enrolled. Blood pressure >140/90 after 20 weeks of gestational age without proteinuria was defined as GH. Chi-square and Mann-Whitney tests were applied for statistical analysis.Results: Mean ± SD of age and body mass index (BMI) were 32.85 ± 5.45 (years) and 31.85±5.97 (kg/m2) among the case group, respectively. Participants with GH had higher mean BMI, neck circumference, and more frequency of snoring than the control group, which was statistically significant (P < /em><0.012, P < /em><0.025, and P < /em><0.007, respectively). Sales and service occupations consisted the group with the highest frequency of GH.Conclusion: Participants with GH had higher BMI, snoring, observed apnea, and neck circumference. This observation warrants comprehensive assessment of OSA and related risk factors among patients with GH.
Maternal Fetal Medicine
Seddighe Borna; Marjan Ghaemi; Fatemeh Golshahi; Mamak Shariat; Mahboobeh Shirazi; Behrokh Sahebdel
Volume 5, Issue 4 , December 2020, , Pages 159-166
Abstract
Background & objective: Premature preterm rupture of membrane (PPROM) is a cause of preterm birth. This study investigated the effectiveness of Doppler ultrasound in predicting fetal complications and neonatal outcomes of pregnant women with PPROM.Materials & Methods: In this cross-sectional ...
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Background & objective: Premature preterm rupture of membrane (PPROM) is a cause of preterm birth. This study investigated the effectiveness of Doppler ultrasound in predicting fetal complications and neonatal outcomes of pregnant women with PPROM.Materials & Methods: In this cross-sectional study, a total of 23 pregnant women with PPROM were chosen in their 24 to 34 weeks of gestational age. The fetuses’ blood flow indices were evaluated by Doppler ultrasound pulsatility index (PI) in the middle cerebral, main pulmonary, right kidney, and fetal umbilical arteries and descending aorta at admission (because of PPROM) and 24 hours before delivery. Neonatal outcomes were assessed within the first week of birth.Results: The kidney artery PI increased (P < /em>=0.047) and pulmonary artery PI decreased (P < /em>=0.024) at pregnancy termination time. There was a negative correlation between the 5-minute Apgar score and fetal umbilical artery PI at admission (P < /em>=0.003) and pregnancy termination times (P < /em>=0.031). The fetal umbilical artery PI of neonates with abnormal brain ultrasound imaging results significantly decreased at admission (P < /em>=0.002) and pregnancy termination times (P < /em>=0.004).Conclusion: Fetal artery Doppler ultrasound PI may be a valid tool for predicting neonatal outcomes of women with PPROM.
