Maternal Fetal Medicine
Mohaddeseh Ghazi; Ashraf Jamal; Vajiheh Marsosi; Laleh Eslamian; Maryam noorzadeh; Mahsa Naemi; Mamak Shariat; Paria Boustani
Articles in Press, Accepted Manuscript, Available Online from 26 April 2024
Abstract
Background: Prenatal invasive procedures are used for diagnostic and therapeutic purposes. The present study aimed to assess the indications and early complications of invasive diagnostic tests.Materials and Methods: This retrospective descriptive study was conducted on 708 pregnant women who were referred ...
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Background: Prenatal invasive procedures are used for diagnostic and therapeutic purposes. The present study aimed to assess the indications and early complications of invasive diagnostic tests.Materials and Methods: This retrospective descriptive study was conducted on 708 pregnant women who were referred for prenatal invasive tests in Tehran, Iran from May 2018-to April 2022. All medical records of the participants were reviewed and entered into the study. According to the implemented procedures, medical records were categorized into two chorionic villus sampling (CVS) and amniocentesis groups. The primary outcome was determining the frequent indications of invasive diagnostic tests and post-procedure complications. Results: Six hundred and sixty-eight medical records were included. Amniocentesis procedure was performed for 624 (93.7%) and 44 cases (6.3%) underwent CVS. The most frequent indication for invasive prenatal procedures was a history of abnormal findings related to the first trimester biomarkers followed by the abnormal findings of the second trimester biochemical markers, a history of high nuchal translucency>99th percentile, and abnormal biomarkers of sequential test. Comparing post-procedure complications, the results showed no significant difference between the CVS and amniocentesis groups (P=0.845). In the amniocentesis group, 2 cases had shown spontaneous abortion and 3 leakage of amniotic fluid, as well as two cases in the CVS group, had reported vaginal bleeding. Conclusion: Our results delineated that positive fetal aneuploidy screening tests together with increased nuchal translucency were the main indications of the invasive prenatal tests. Amniotic fluid leakage, vaginal bleeding, and spontaneous abortion should be considered as procedure-related complications.
Maternal Fetal Medicine
Maryam Saraei; Maryam Shefaat; Omid Aminian; Sahar Eftekhari; Elahe Hesari; Atefeh Behkar; Arezu Najafi
Articles in Press, Accepted Manuscript, Available Online from 26 April 2024
Abstract
Background and Objective: Pregnancy is an exceptionally delicate time in the lives of most women. Sleep disorders during pregnancy can substantially impact a healthy pregnancy. This study investigated the relationship between sleep quality during pregnancy and adverse maternal and fetal pregnancy outcomes.Methods: ...
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Background and Objective: Pregnancy is an exceptionally delicate time in the lives of most women. Sleep disorders during pregnancy can substantially impact a healthy pregnancy. This study investigated the relationship between sleep quality during pregnancy and adverse maternal and fetal pregnancy outcomes.Methods: This was a prospective cohort study on 500 pregnant women referred to the perinatology clinic. The Pittsburgh Sleep Quality Index questionnaire was used to evaluate sleep quality, and demographic data were collected from the case file of routine prenatal checkups. The study participants were followed until delivery. The association between sleep quality and postpartum complications, such as preterm birth, infant Apgar score, and NICU admission, was investigated. Results: This study included 500 pregnant women with a mean age of 31.12 ± 5.84. The number of pregnancies ranged from 1 to 7, with a mean of 2.55±1.30. Of the infants, 12% of infants were born prematurely and 27.8% required NICU admission. Poor sleep quality was found to be associated with preterm delivery (OR: 1.27, p = 0.039) and preeclampsia (OR: 0.543, p = 0.004). Women who experienced preeclampsia during pregnancy (p = 0.01), delivered via cesarean section (p = 0.009), and had infants weighing more than 2500 g (p = 0.07) exhibited significantly poorer sleep quality.Conclusion: We found that sleep quality was associated with preterm birth, cesarean section delivery, maternal preeclampsia risk, and the 5-minute Apgar score. Considering the impact of a mother’s sleep quality on pregnancy outcomes, assessing mothers' sleep health appears essential in prenatal care.
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
Mahboobeh Shirazi; Fatemeh Rahimi Sharbaf; Fatemeh Golshahi; Behrokh Sahebdel; Elham Feizabad; Leila Asadi; Afsaneh Alimadad-Tafreshi; Arash Jafariyeh; Akram Valizadeh; tayebeh sedighi; Fatemeh Takaloo; Aazam Taghavi-Zahedkalaei
Articles in Press, Accepted Manuscript, Available Online from 09 December 2023
Abstract
Background & Objective: Clinical use of uterine artery (UtA) Doppler ultrasound imaging requires reference values but despite the common use of UtA Doppler examination during pregnancy, to the best of our knowledge, there is no such range for Iranian pregnant women. Hence, this study aimed to investigate ...
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Background & Objective: Clinical use of uterine artery (UtA) Doppler ultrasound imaging requires reference values but despite the common use of UtA Doppler examination during pregnancy, to the best of our knowledge, there is no such range for Iranian pregnant women. Hence, this study aimed to investigate uterine artery Doppler indices in Iranian normal pregnancies and compare these with the other country values.Materials & Methods: This observational longitudinal study was conducted on 486 low-risk pregnant women. The amount of plausibility index (PI) and resistance index (RI) as well as the presence of diastolic notch were assessed in weeks 11 to 14, 17 to 24, and 27 to 32 through Doppler ultrasound. Results: The bilateral notch for the gestational age of 11 to 14 weeks was detected at about 6%, for the gestational age of 17 to 24 weeks it was about 4.2% and for the gestational age of 27 to 32 weeks it was about 3.6%. Reference intervals for mean uterine artery PI according to gestational ages, show a significant (p<0.001) difference between different percentages. Also, there is a significant relation between the mean uterine arteries PI/RI and the presence or absence of pregnancy complications (IUGR, premature birth, IUFD) among the participants. Conclusion: The results of this research showed that there is a significant relation between PI and pregnancy complications, while this was not detected in RI and diastolic notch. These results are relatively consistent with the findings of researchers in other countries.
Maternal Fetal Medicine
Shalan HB Al-Mayoofee; Nabiha Missaoui; Sihem Hmissa; Ali Esmail Al-Snafi
Articles in Press, Accepted Manuscript, Available Online from 08 January 2024
Abstract
Background & Objective: Polycystic ovary syndrome (PCOS) is a common disease in women of childbearing age. The inflammation has participated in the metabolic disorders and irregular menstruation associated with this disease. This study was carried out to correlate between the disturbance of pro-inflammatory ...
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Background & Objective: Polycystic ovary syndrome (PCOS) is a common disease in women of childbearing age. The inflammation has participated in the metabolic disorders and irregular menstruation associated with this disease. This study was carried out to correlate between the disturbance of pro-inflammatory markers resistin, adiponectin and metabolic parameters in women with PCOS.Materials & Methods: Fasting blood samples were collected from 100 PCO married infertile women (23.30±4.659 years) attending Bint AL-Hoda and Al-Shatra hospitals in Thi- Qar province - Iraq, in addition to 50 healthy age matched (23.84±4.804 years) control, through the period from June 2022 to December 2022.Results: The BMI of PCO patients (27.22±7.20) was significantly (<0.001) more that BMI of the healthy control (22.84±4.63). PCO patients showed significantly elevation of serum levels of resistin (470.00±114.00 vs 350.00±90.60 ng/l, P<0.01 (and significant decline of adiponectin (5.13±1.22 vs 11.00±1.40 mg/l, P<0.001) in comparison with healthy control. PCO patients also showed significant elevation of the serum glucose (P<0.01), total cholesterol (P<0.05), triglycerides (P<0.001) and LDL (P<0.001). However, serum HDL level was insignificant declined and VLDL was insignificantly elevated in PCO group compared with healthy control group.Conclusion: Adiponectin and resistin represented part of the pathophysiology of PCO, and may serve as beneficial indicator in the diagnosis and treatment.
Maternal Fetal Medicine
Maryam Kashanian; Nooshin Eshraghi; Majid Kalani; Arash Bordbar; Nasim Eshraghi; Mahnaz Kalati; Sara Norouzi; Amir Hossein Kashanian
Volume 9, Issue 2 , March and April 2024, , Pages 125-130
Abstract
Background & Objective: Preterm birth is the most important cause of neonatal mortality and morbidity. Finding the best treatment regimen, of antenatal corticosteroids, has been under serious concern. To compare the efficacy of intravascular versus intramuscular betamethasone phosphate ...
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Background & Objective: Preterm birth is the most important cause of neonatal mortality and morbidity. Finding the best treatment regimen, of antenatal corticosteroids, has been under serious concern. To compare the efficacy of intravascular versus intramuscular betamethasone phosphate on neonatal outcomes in the cases of imminent preterm birth.
Materials & Methods: A double-blind randomized clinical trial was performed on 136 eligible pregnant women with gestational age of 26- 34 weeks and imminent preterm birth (delivery within 24 hours). They were randomly assigned into two groups. Group A received intramuscular betamethasone phosphate, and group B received a similar dose of betamethasone phosphate intravenously. Women were followed up to delivery, and their neonatal outcomes were compared.
Results: Women of the two groups (68 women in each group), did not show a significant difference in maternal age, BMI, gravidity and parity, gestational age at the time of admission and delivery, history of miscarriage and assisted reproductive techniques, delivery route, sex and weight of newborns, and Apgar score in minutes 1 and 5. The need for NICU admission, duration of hospitalization, neonatal respiratory distress syndrome, surfactant requirement, and intubation were lower in the IV betamethasone group. There were no significant differences between the two groups according to necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death.
Conclusion: Using IV betamethasone, in cases where there is no enough time to complete the 24-hour betamethasone course due to the possibility of impending delivery, may reduce neonatal complications due to quicker onset of action.
Maternal Fetal Medicine
Zahra Panahi; Fahimeh Ghotbizadeh Vahdani; Saeede Eslami Khotbesara; Razieh Akbari; Sedigheh Hantoushzadeh; Soudabeh Kazemi Aski; Mamak Shariat
Volume 9, Issue 2 , March and April 2024, , Pages 137-143
Abstract
Background & Objective: 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 ...
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Background & Objective: 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.
Materials & Methods: 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.
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 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).
Conclusion: 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.
Maternal Fetal Medicine
Leili Rezaie Kahkha; Farzaneh Zamani; Khadije Rezaie Keikhaie; Masoumeh Mirteimouri
Volume 9, Issue 2 , March and April 2024, , Pages 225-230
Abstract
Background & Objective: Determining the clinical manifestations of COVID-19 in pregnant and recently pregnant women is important to identify risk factors in order to evaluate complications and maternal and perinatal outcomes. The aim of the present study was to investigate the symptoms of COVID-19 ...
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Background & Objective: Determining the clinical manifestations of COVID-19 in pregnant and recently pregnant women is important to identify risk factors in order to evaluate complications and maternal and perinatal outcomes. The aim of the present study was to investigate the symptoms of COVID-19 in pregnant women and its effects on the newborn.
Materials & Methods: The Now study was a prospective descriptive study. This research was conducted in 2020 on 101 pregnant women with COVID-19 infection admitted to the intensive care unit in Zabol city, Iran. All studied patients were examined in terms of clinical symptoms, maternal and neonatal complications, and laboratory findings such as WBC and ESR in all patients were checked. Finally, all information was entered into each patient's form and by using SPSS V22 software analyzed.
Results: Number of 101 pregnant women participated in the study, with an average age of 31.09 years. In this study, 93 individuals had PCR positive (92.1%), 84 individuals with COVID+ in CT scan (83.2%), 25 individuals with an underlying disease (24.8%), and 54 individuals with addiction (53.5%). 20 feet (19.8%) were reported. 20 deaths (19.8%) were reported. The average BMI of the participants was 25.46. Among maternal complications, pulmonary involvement (71.28%) the most frequently was reported. Among the hospitalized patients (95 individuals), 25 individuals had underlying diseases. In this population, maternal complications were significantly more reported (P value=0.012). Among neonatal complications, the most common cases of death were IUFD and abortion. 62.1% of the participants had a natural delivery and 63.4% had a term delivery.
Conclusion: Fever, throat redness and swelling, respiratory distress and cough are the most common clinical symptoms and lung involvement is the most common complication of COVID infection in pregnant mothers. In infants, IUFD and abortion were also very common. PCR and CT scan are two high-sensitivity tests for detecting COVID.
Maternal Fetal Medicine
Adibeh Mauwloudi; Laleh Eslamian; Vajiheh Marsousi; Ashraf Jamal; Maryam Noorzadeh; Mahsa Naemi; Ali Reza Norouzi; Nazila Mesbah
Volume 9, Issue 1 , January and February 2024, , Pages 1-6
Abstract
Background & Objective: The aim of this study was to determine which of the two drugs of ibuprofen, as a common non-steroidal anti-inflammatory drugs (NSAID), and acetaminophen would have the least effect on postpartum hypertension in patients with preeclampsia.Materials & Methods: Clinicodemographic ...
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Background & Objective: The aim of this study was to determine which of the two drugs of ibuprofen, as a common non-steroidal anti-inflammatory drugs (NSAID), and acetaminophen would have the least effect on postpartum hypertension in patients with preeclampsia.Materials & Methods: Clinicodemographic data including age, gestational age at delivery, body mass index, parity, and route of delivery, were collected through interviews with patients and reviewing patient records. In this double-blind clinical trial, among 84 patients included in the study, 42 patients were randomly assigned to the acetaminophen (650 mg every 6 to 24 hours) and 42 patients into the ibuprofen (600 mg every 6 to 24 hours) group.Results: The two groups were not significantly different in terms of mean age (P = 0.322), body mass index (P = 0.950), route of delivery (P = 0.657), parity (P = 0.818), and mean systolic (p = 0.530) and diastolic blood pressure (P = 0.691). Following the intervention, the duration of blood pressure control (P = 0.182), mean systolic blood pressure (P = 0.371), and mean diastolic blood pressure (P = 0.13) were not significantly different in the acetaminophen and ibuprofen groups. There was no significant difference between the two groups in terms of the number of patients and the dosage of opioids used.Conclusion: The results revealed that in patients with preeclampsia, acetaminophen and ibuprofen to control postpartum pain have a similar impact on blood pressure.
Maternal Fetal Medicine
Azam Jafari Fard; Sonia Sadeghpour; Fatemeh Bahadori; Javad Rasouli
Volume 9, Issue 1 , January and February 2024, , Pages 36-44
Abstract
Background & Objective: Preeclampsia is a perinatal and maternal morbidity and mortality-related pregnancy disease. A diagnostic challenge is frequently presented by the finding of a small femur length, especially below the fifth percentile. When the ultrasound was performed, it can be related ...
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Background & Objective: Preeclampsia is a perinatal and maternal morbidity and mortality-related pregnancy disease. A diagnostic challenge is frequently presented by the finding of a small femur length, especially below the fifth percentile. When the ultrasound was performed, it can be related to fetal growth restriction. This study sought to determine how short femur diaphysis length (FDL) during 32–37 weeks of gestation affected preeclampsia.Materials & Methods: Between February 2021 and February 2022, pregnant women who received a regular abnormality scan at the Shahid Motahari University Hospital in Urmia, Iran, between 32 and 37 weeks of gestation were included in the study. As part of the abnormality scan, fetal biometry and uterine artery Doppler ultrasound were evaluated, and the mean pulsatility index of the two uterine arteries was noted. From our database system, we gathered information on maternal obstetric features such as ethnicity, age, weight, parity, smoking, and medical history including hypertension and diabetes mellitus.Results: The present study's findings showed that preeclampsia, maternal age, and the number of prior pregnancies were all connected with multivariate analysis of the fetal femoral length percentile. Additionally, the 50th percentile femoral's sensitivity and specificity for the diagnosis of preeclampsia were 96.88 and 81.88, respectively.Conclusion: According to our findings, there is a substantial association between PE and short FLduring 32–37 weeks of gestation.
Maternal Fetal Medicine
Seyedeh Noushin Ghalandarpoor-Attar; Fatemeh Rahimi-Sharbaf; Seyedeh Mojgan Ghalandarpoor-Attar
Volume 8, Issue 5 , September and October 2023, , Pages 533-537
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 335-341
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 404-410
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.
