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Background & aim: Trial of labor after cesarean (TOLAC) to achieve vaginal delivery is considered acceptable in women with one previous cesarean. This study was performed to compare the success rate and maternal and neonatal outcomes of TOLAC after one and two previous cesarean sections.Methods: This cross-sectional study was conducted in September 2018 and March2020 by convenience sampling on 339 pregnant women with a history of one or two previous cesarean sections in Mashhad. TOLAC was performed for all eligible participants, if cesarean section performed due to any reason, it was considered a failed TOLAC. Maternal and neonatal outcomes by a check list were recorded during TOLAC and one week later. Data were analyzed by SPSS (version 24). Results: TOLAC was successful in 301 cases (94.1%), but 19 (5.9%) underwent cesarean section. Maternal age, parity, and frequency of comorbidities were significantly higher in those with two previous cesarean sections compared to those with one previous cesarean section (P0.05). Conclusion: Considering standard precautions in patient selection, TOLAC has a high enough success rate to justify recommending it to the selected women with one or two previous cesarean section.

Background & aim: One of the risk factors of premature rupture of membranes is striae gravidarum, which occurs in 50-90% of pregnancies due to poor skin elasticity. It was found that Equisetum arvense is a medicinal plant containing silicic acid, which can increase tissue elasticity, strength and resistance by stimulating collagen synthesis. Therefore, this study examined the effect of Equisetum arvense vaginal cream on premature rupture of membranes in primiparous women with striae gravidarum.Methods: This triple-blind randomized controlled trial was performed on 90 pregnant women with gestational age of 37-38 weeks who had moderate and severe striae gravidarum, referred to the prenatal governmental and private clinics in Mashhad, Iran, between 2020 and 2021. Intervention and placebo groups, who were randomly assigned using quadruple blocks, soaked every night the beginning of the vagina with a fingertip of 3% Equisetum arvense vaginal cream or placebo from the beginning of 37-38 weeks until delivery. The occurrence of premature rupture of membranes was confirmed in case amniotic fluid leaks two hours before the onset of uterine contractions. Data were analyzed using independent t-test and Mann-Whitney.Results: The subjects in the two groups were homogeneous in terms of demographic and obstetric variables. Premature rupture of membranes in the intervention group (13.0%) was significantly lower than the placebo group (38.6%) (p = 0.005).Conclusion: Equisetum arvense vaginal cream is effective in preventing premature rupture of membranes. Therefore, its use is recommended to prevent premature rupture of membranes in women with moderate and severe striae gravidarum.

Introduction: Eclampsia is defined as generalized tonic-clonic seizure in a pregnant woman with preeclampsia. Eclampsia is one of the leading causes of maternal and fetal mortality worldwide. This study was performed with aim to evaluate maternal and fetal complications in pregnancies with eclampsia in Ghaem Hospital of Mashhad. Methods: In this cross-sectional study, all patients with a diagnosis of eclampsia who were admitted to Ghaem Hospital between June 2018 and June 2020 were included in the study. Maternal and fetal complications were assessed. For all patients, a checklist was completed by the researcher including information and history of underlying diseases, surgery, obstetrics, and maternal and neonatal complications. Data were analyzed by SPSS statistical software (version 16). Results: In this study, 51 patients with eclampsia were evaluated. The frequency percentage of eclampsia in Ghaem Hospital was 0.45%. Eclampsia before delivery was 66.7% and was higher than during and after delivery. Maternal complications included: increased rate of cesarean section (70%), postpartum bleeding (1.96%), liver disorders (1.96%), PRES syndrome (13.7%), HELLP syndrome (9.8%), DIC (1.96%), placental abruption (3.9%) and pulmonary edema (1.96%). Fetal complications were low Apgar (43.1%), low birth weight (41.1%), NICU admission (33.3%), preterm delivery (25.4%), IUGR (19.6%) and neonatal and fetal deaths (27.5%) that 4 cases were stillbirth and 10 cases died up to 7 days after birth. There was no maternal death. Conclusion: Maternal complications were: preterm pregnancy, cesarean section due to placental abruption or IUGR, HELLP syndrome, ICU hospitalization and maternal death, respectively. Fetal complications were: preterm delivery, IUGR and NICU hospitalization and intrauterine fetal death, respectively.

Introduction: One of the important issues in obstetrics is labor induction in the inappropriate conditions of the cervix. Misoprostol improves the condition of the cervix and shortens the duration of the labor and help in delivery sucess. Some studies have been published on the effect of propranolol on labor process in favor of shortening the labor. Therefore, this study was performed with aim to compare the effect of propranolol plus misoprostol with misoprostol alone on labor induction. Methods: This double-blind clinical trial study was performed from November 2017 to September 2019 on 70 pregnant women referred to the maternities of Mashhad University Hospitals. The subjects were randomly divided into two groups. One group received 25 micrograms of sublingual misoprostol every 4-6 hours up to 6 doses plus a placebo capsule, and the other group received misoprostol with the same dose and method of the first group plus two doses of oral 20mg Propranolol tablet with interval of 4 hours. The interval between drug administration with onset of effective contractions, and onset of active phase and delivery were evaluated and compared in the two groups. Data were analyzed by SPSS statistical software (version 16). T-test and chi-square test were used to compare the groups, and equivalent non-parametric methods were used if necessary. Results: Mean interval of induction onset to effective contractions did not show any significant difference between the two groups (P=0.394). There was no significant difference between the two groups in the mean interval of induction onset to 4cm dilatation (P=0.82) and the mean interval of induction onset to delivery (P=0.108). Delivery complications showed no significant difference between the two groups (P=0.397). There was no significant difference between the two groups in the mean first and fifth minute Apgar score (P=0.715 and P=0.819, respectively). Conclusion: Propranolol use had no effect on decreasing the induction to delivery interval and reducing cesarean rate. Also, it didn’t cause changes in neonatal outcomes and maternal complications. There were no side effects of propranolol tablets, including bradycardia, hypotension, and drowsiness.

Introduction: Acute fatty liver of pregnancy (AFLP) has been noticed due to high mortality rate for mother and fetus. However, the cause and pathogenesis of AFLP are unclear, and the absence of specific symptoms precludes early diagnosis and effective treatment. Therefore, this study was performed with aim to investigate the pregnancy outcomes in patients with acute fatty liver of pregnancy. Methods: This cross-sectional descriptive study was performed in 2013-2018. A total of 1475 records of women suspected to acute fatty liver of pregnancy, HELLP syndrome, severe pre-eclampsia and Thrombotic Thrombocytopenic Purpura (TTP) who were hospitalized in the university hospitals of Mashhad were selected and evaluated. Chief complaints at admission, laboratory data and pregnancy outcomes were evaluated. Data were analyzed by SPSS software (version 23). Results: A total of 34 records with diagnosis of AFLP were included in this study. Nausea and vomiting (94.11%), abdominal pain (94.11%) and hypertension (52.94%) were three main complaints in these patients, respectively. Laboratory test showed an increase in bilirubin, liver enzymes, coagulation tests, creatinine and a decrease in albumin and platelet count. Mean gestational age at the time of pregnancy termination was 34.2±2.04 weeks. We found 5 cases of maternal and 4 cases of neonatal mortality. Mean recovery time was 6.03±2.53 days. Conclusion: AFLP is associated with maternal mortality and the complications like multi organ failure, Diseminated intravascular coagulation, preterm labor, postpartum hemorrhage, and neonatal mortality. Since in this study, the most common complications of patients with AFPL were nausea, vomiting and abdominal pain, it is recommended to evaluate all pregnant women in third trimester who refer with these symptoms for diagnosis of AFLP.

Introduction: Acute pancreatitis during pregnancy is a rare event that its frequency has been estimated as ranging from of 1/1000 to 1/10000 births. The aim of this study was to report a case of acute pancreatitis during pregnancy and its maternal and neonatal outcomes following conservative management. Case presentation: A 25 years old woman G2ab1(second pregnancy, one abortion) with gestational age of 30 weeks and sudden epigastria pain from the last night who had referred to the Ghaem hospital of Mashhad due to severe stomach pain along with nausea and vomiting.. MRI reported increase in gall bladder thickness and pancreatic inflammation and left plural effusion. In laboratory tests, amylase and lipase were three time higher than normal. With diagnosis of pancreatitis, the patient underwent conservative treatment. At 6th day of hospitalization, 38°C fever and uterine contractions were started. A preterm neonate was born. The mother and neonate discharged from the hospital with good conditions. Conclusion: Acute pancreatitis during pregnancy can lead to preterm delivery. Early diagnosis and conservative treatment can be associated with desirable maternal and neonatal outcomes.

Introduction: Postpartum hemorrhage is associated with highest rate of mortality and has many known etiologies. Inner myometrial laceration is one of the rare etiologies that lack of diagnosis can lead to maternal mortality. This report introduced a rare case of postpartum hemorrhage due to inner myometrial laceration. Case presentation: The patients were a 35-year-old woman (gravida 3 and live 2) referred to the hospital due to term pregnancy and premature rupture of membrane for pregnancy termination. Normal vaginal delivery was done following labor induction. After delivery of a 3700 gr neonate, severe postpartum hemorrhage occurred which was unresponsive to medical treatment and uterotonic drugs; she was transferred to operating room and hysterectomy was performed. Then, she was transferred to ICU. On the first day of Intensive Care Unit admission, the patient was complicated by ventricular tachycardia and bradycardia, and finally cardiopulmonary arrest. CPR was done, but it was unsuccessful, and the patient was expired. Pathological assessment revealed inner myometrial laceration at the posterior uterine wall. Conclusion: Considering inner myometrial laceration as one of the important and controllable causes of postpartum hemorrhage can lead to the diagnosis of this complication

Introduction: Oligomenorrhea is one of the most common menstrual disorders defined as the prolongation of menstrual intervals. This growing disorder reduce the quality of life for women of reproductive age due to complications, such as abnormal uterine bleeding, infertility, hirsutism and psycho-social consequences. Due to the complications of hormonal medications which are the common treatment of this disorder, the necessity of using complementary therapies is suggested; therefore, the present review study was conducted to investigate the therapeutic strategies of Persian medicine. Methods: In this review study, the main sources of Persian Medicine were investigated using the synonyms of oligomenorrhea such as “Ehtebās-e-tams”, “Habs-e- heiz”, reduction and discontinuation of menstruation. Then, to find new studies, the databases such as Google scholar, PubMed and ISI were searched with the keywords of Oligomenorrhea, Amenorrhea, PCOS, Persian Medicine and Traditional Medicine and the results were compared. Results: In texts of Persian Medicine, oligomenorrhea is referred as the "Ehtebas Tams". Therapeutic approaches to "Ehtebas Tams", like other treatments in Persian Medicine, in the first step include lifestyle modification, dietary modification, sleep and wake adjustment, exercise and bathing. The second step includes the use of emmenagogue herbal medicine which are mostly considered as phytoestrogen. These herbs are prescribed in various forms (Pill, Decoction, Herbal Tea, Vaginal Suppository, Vaginal Douche, ointment and sitz-bath). In the third step, manipulations such as wet cupping and phlebotomy are recommended as a therapeutic approach. Conclusion: Considering the effectiveness of some of these treatments in new studies such as Vitex agnus-castus, Mentha longifolia and Foeniculum vulgare, it is recommended to conduct more clinical studies based on Persian medicine therapies in addition to conventional medicine for treatment of oligomenorrhea.

Introduction: Pregnancy at a young age is considered high-risk, and the prevalence of teenage pregnancy has been reported to be on the rise. The present study aimed to evaluate the pregnancy outcomes in primigravid adolescents. Methods: This cross-sectional study was conducted at Ghaem Hospital in Mashhad, Iran during July 2012-2013. Sample population consisted of primigravid women aged 12-19 and 20-35 years at delivery. In total, 100 primigravid adolescents and 200 primigravid adults aged 20-35 years were enrolled in the study. A researcher-made questionnaire including the demographic characteristics, gestational age, and other variables (medical history, medical condition of the subjects at the current pregnancy, and neonatal status) was completed by the researcher for the subjects. Data analysis was performed in SPSS version 14 using Chi-square, Fisher’s exact test, and Mann-Whitney U test, and P-value of less than 0.05 was considered statistically significant. Results: Mean gestational age in the adolescents and adults was 38.35±3.15 and 37.2±3.08 weeks, respectively (P0.05), and only preeclampsia was significantly more prevalent in the adults compared to the adolescents (P0.05). In addition, no significant differences were observed between the groups regarding intended/unwanted pregnancies and smoking habits (P>0.05). Conclusion: Considering the favorable perinatal outcomes of teenage pregnancies, recommendations for early pregnancy may be rational, even in adolescent mothers.

Introduction: Neonatal mortality is a global health issue. Preterm delivery is considered as a leading cause of neonatal mortality and morbidity. Preterm neonates may develop complications such as Respiratory Distress Symptom (RDS), Intraventricular Hemorrhage (IVH) and neonatal sepsis. This study aimed to evaluate the effective factors in the prognosis of preterm infants. Materials and Methods: This cross-sectional study was conducted on 283 premature neonates born in Ghaem Hospital in Mashhad, Iran during September 2013-March 2014. Demographic data and perinatal mortality and morbidity rates were recorded for all the neonates. Data analysis was performed in SPSS Version19. Results:In this study, rates of morbidity and mortality were 33.2% and 18.7%, respectively. In total, 50.9% of the neonates were admitted to the neonatal intensive care unit. Among the study samples, 26.5% had RDS, 18.4% had neonatal sepsis, and 2.8% had IVH. Moreover, 18.4% of the neonates required mechanical ventilation. Increased gestational age and birth weight significantly reduced the rates of morbidity and mortality. Although mode of delivery and premature rupture of membranes affected the mortality rate, they had no significant associations with the morbidity rate of the neonates. Also, maternal factors such as age, gravidity, history of diseases or pregnancy complications, and drug use during pregnancy had no significant effects on the rates of neonatal morbidity and mortality. Conclusion: According to the results of this study, gestational age and birth weight were the most significant predictive factors for neonatal morbidity and mortality in preterm infants.