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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. 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. [ABSTRACT FROM AUTHOR]

Background: Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery. Methods: In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters. Discussion: By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes. [ABSTRACT FROM AUTHOR]

To determine the risk factors of osteoporosis and osteopenia of the spine in postmenopausal women. An analytical cross-sectional study was performed on postmenopausal women. The T-score of the lumbar spine (L2–L4) was measured by densitometry and compared between osteoporotic, osteopenia, and normal women. One thousand three hundred fify-nine postmenopausal women were evaluated. The prevalence of osteopenia and osteoporosis was 58.2% and 12.8% respectively. Age, BMI, parity, total breastfeeding years, dairy use, calcium-D supplements, and regular exercise were significantly different in women with osteoporosis, osteopenia, and normal women. Ethnicity, diabetes, and previous fracture history were only other among women with osteoporosis (not osteopenia) and normal women. For osteopenia of the spine, age [AOR 1.08 (1.05–1.11; p <.001)] was the risk factor, and BMI = >30 [AOR 0.36 (0.28–0.58; p <.001)] and BMI 25–<30 [AOR 0.55 (0.34–0.88; p =.012)] were protective factors. Hyperthyroidism (AOR 23.43, p =.010), Kurdish ethnicity (AOR 2.96, p =.009), not having regular exercise (AOR 2.22, p =.012), previous fracture history (AOR 2.15, p =.041)], and age (AOR 1.14, p <.001)], were risk factors for osteoporosis, while BMI ≥30 [AOR 0.09, p <.001], BMI 25–<30 [AOR 0.28, p =.001], and diabetes [AOR 0.41, p =.038] were protective factors for osteoporosis of the spine. Hyperthyroidism, low BMI <25, parity ≥ 6, Kurdish ethnicity, not having regular exercise, history of previous fracture, and age, were risk factors for osteoporosis of the spine respectively, while low BMI and age were risk factors for osteopenia. [ABSTRACT FROM AUTHOR]

A valid and reliable culture-based scale for the evaluation of risky sexual behaviours for married Iranian women is lacking. This study aimed to develop, and psychometrically test, a risky sexual behaviour scale for married Iranian women. A mixed-method sequential exploratory design was conducted from 2016 to 2020 in Tehran, Iran. First, a qualitative study was employed to define the concept of risky sexual behaviour using 16 semi-structured individual interviews and 10 focus group discussions (n = 100). Then, an item pool was generated, and the scale was developed. Finally, in the quantitative study, the psychometric properties of the scale were evaluated by validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 400 sexually active married women to assess the construct validity. The six components: (i) 'quality of sexual relations'; (ii) 'unusual pleasures in sexual relations'; (iii) 'sexual coercion'; (iv) 'verbal violence in sexual relations'; (v) 'self-care in sexual relations'; and (vi) 'concealment in sexual relations' could explain 57.49% of the total observed variance. The findings showed that the 27-item Risky Sexual Behaviour Scale (RSBS-MW) for married women in Iran has excellent internal consistency (α = 0.94) and stability (ICC = 0.98). Health care providers can use it to access risky sexual behaviours in married Iranian women. [ABSTRACT FROM AUTHOR]

Objectives: Patient experience is the focus of individual care and services to meet patient needs, but this depends on how health care providers deliver their services. The aim of this study was to explore the perceptions of human papilloma virus (HPV)-positive married women from the care they received from health professionals at a colposcopy clinic in Tehran, Iran. Materials and Methods: Three focus group discussions were conducted between September and December 2016 with 30 women who had recently been referred to the clinic for cervical screening or colposcopy. Samples were collected by a purposeful sampling method in Tehran, the capital of Iran. The focus group discussions were carefully recorded at the same time as data collection. After ensuring the data saturation, interviews were terminated and data were categorized. Data was analyzed by direct conventional content analysis using MAXQDA-10. Results: Two themes and three sub-themes resulted from the data analysis, including emotional responses (anxiety and fear of women), and appropriate/inappropriate behavior of the healthcare providers. Conclusion: Healthcare providers, by identifying factors that affect patient's stress, could help reduce the negative outcomes such as patients' emotional responses to HPV positive results. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean delivery is the most common surgery in obstetrics, and pain relief after cesarean section is an important concern for obstetricians and their patients. Objective: The aim of this study was to evaluate the relationship between serum progesterone level and pain perception after cesarean delivery. Method: The study was performed as a prospective cohort study on 166 pregnant women who were candidates for elective cesarean delivery due to previous cesarean section. Before surgery, serum progesterone level was measured. Pain score of women was evaluated 4, 8, 12, and 24 h after surgery using visual analog scale (VAS) score, and correlation between progesterone level and pain was evaluated. Results: The median value of serum progesterone was 119.45 ng/ml. Mean pain score in hours 4, 8, 12, and 24 were 6.80 ± 2.11, 5.31 ± 1.48, 3.89 ± 1.68, and 2.30 ± 1.26, respectively. The women were divided according to mean progesterone level of 119.45 ng/ml into two groups of high progesterone level (≥119.45) and low progesterone level (<119.45), and the pain score was evaluated in different times (hour 4, 8, 12, and 24) for both levels of progesterone. The mean pain score in the 4, 8, 12, and 24 h were significantly lower in high progesterone group (progesterone level ≥119.45). The number of women with low pain score (less than five) in hours 12 and 24 was significantly higher in high progesterone level group. With increasing BMI, progesterone level was lower and women with higher BMI, had a higher pain score in hours 4, 8, 12, and 24, while women with lower BMI had a lower pain score during the same hours. (p = .004, r = 0.223; p = .004, r = 0.223; p = .039, r = 0.160; and p = .007, r = 0.207). Progesterone level and BMI (p = .025, r = - 0.174), and progesterone level and pain score in hours 4, 8, 12, and 24 (p = .000, r = - 0.324; p = .000, r = - 0.474; p = .000, r = - 0.329; and p = .000, r = - 0.417, respectively) showed a negative significant correlation. Putting three variables of age, gestational age, and BMI in a multiple regression model, progesterone level showed significant negative correlation with the pain score in hour 4 (p = .000, r = - 0.305), hour 8 (p = .000, r = - 0.461), hour 12 (p = .000, r = - 0.328), and hour 24 (p = .000, r = - 0.409). Conclusions: Serum progesterone level showed a negative correlation with the pain score after cesarean section. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the present study was a survey of venous thromboembolism (VTE) prophylaxis in obstetrics patients in Iran. Materials and methods: A national, multicenter, non-interventional, prospective study was performed on 1000 women at 11 different parts of Iran. Primary outcome was to assess the situation of VTE prophylaxis in pregnant and postpartum women and the secondary outcome was risk stratification in obstetrics patients and to evaluate the guideline adherence in physician's practice of VTE prophylaxis. Results: 1,036 women entered the final analysis. The three main VTE risk factors before hospitalization were BMI > 30 kg/m2, history of oral contraceptive (OCP) use, and the age over 35.VTE risk factors upon enrollment were detected in 780 (75.28%) patients. 219 women (28.07%) were deemed eligible for drug prophylaxis, however, only 37 women (17%) received it. A total of 113 (10.9%) patients received VTE prophylaxis, of which 76 (67.25%) women had no clear indications. Concordance between theory and practice was detected with a Cohen's Kappa coefficient to be 0.74 (p < 0.001), which fell within "good agreement". Multivariate analysis for association between VTE prophylaxis and VTE risk factors showed that history of VTE [OR = 9.06 (CI 95% 1.16 – 70.8) p = 0.036] was the most frequent risk factor for receiving VTE prophylaxis followed by obesity (BMI > 30 Kg/m2); [OR = 3.74 (CI 95% 1.79 – 5.69), p = <0.001], multiple pregnancy [OR= 2.81 (CI 95% 1.70 – 4.64), p = < 0.001] and age > 35 years; [OR =1.09 (CI 95% 0.82 – 1.21), p = 0.026]. Varicose Veins [OR= 0.22 (CI 95% 0.56 – 0.87), p = 0.031], PROM / PPROM [OR= 0.33 (CI 95% 0.12 – 0.91), p = 0.032] and history of using OCP [OR= 0.36 (CI 95% 0.24 – 0.53), p = < 0.001] were the most missed risk factors for receiving VTE prophylaxis respectively. Conclusion: History of VTE, obesity, multiple pregnancy and age > 35 years were the most frequent risk factors for receiving VTE prophylaxis and varicose veins, PROM / PPROM and history of using OCP were the most missed risk factors for receiving VTE prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Traditional Persian Medicine (TPM) is an ancient medical system that provides suggestions to improve the health of mothers and children during pregnancy and labor. Persian physicians believed that these instructions made labor easier, safer, and less painful. Methods: The present randomized clinical trial was conducted among women at 33–38 weeks of pregnancy in Tehran, Iran. TPM instructions consisted of diet, bathing, and application of oil from the 38th week of pregnancy to the onset of labor. The primary outcome was the duration of the active phase of labor. Results: The mean duration of the active phase was 331.60 ± 151.48 min for the intervention group and 344.40 ± 271.46 min for the control groups, but it was not statistically significant. The active phase was significantly shorter in women who had better compliance (p=0.03). The need for oxytocin augmentation was 53.3% in the control group and 38.5% in the intervention group (p=0.17). The rate of perineal infection was 13% in the control group and 0% in the intervention group (p=0.11). Conclusions: The active phase was not different in the intervention and control groups, but it was shorter in compliant women. It is possible that prolonged use of these recommendations in combination with a sitz baths and a larger sample size could result in more significant outcomes. [ABSTRACT FROM AUTHOR]

The study was performed on pregnant women with a gestational age of 26-32 weeks of pregnancy, who had been admitted to the hospital with a confirmed diagnosis of premature rupture of membranes. In all eligible women, ultrasounds were performed for the evaluation of amniotic fluid index. Then, the women were divided into two groups according to amniotic fluid index of ≥5 cm and <5 cm. These women were followed and monitored up to delivery. The women of the two groups did not have significant difference between them according to age, gestational age at the time of ruptured membrane, body mass index, gravidity, parity, gestational age at delivery and route of delivery. Maternal morbidities including chorioamnionitis, placental abruption, uterine atony after delivery and retention of placenta did not show significant difference between the two groups. There was no significant difference between the two groups' amniotic fluid index <5 cm and amniotic fluid index ≥5 cm, regarding neonatal morbidities, except for neonatal sepsis and neonatal death, which were higher in the amniotic fluid index <5 cm group [7(14.6%) versus 1(2.3%), p = .039, RR = 7.7 (95%CI 0.04-0.06) and 11(30.9%) versus 2(4.7%), p = .013, RR = 6.095 (95%CI = 1.26-29.31)]. In the subgroups of two categories of gestational ages of 260-296 and 300-346, neonatal morbidities were higher in the amniotic fluid index <5 cm group. The results suggest that amniotic fluid index <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by preterm premature rupture of membranes. Impact statement What is already known on this subject? In a retrospective study in 1993, the relationship between oligohydramnios (which was defined as the largest single packet of fluid less than 2 × 2 cm) at the time of hospital admission, and the outcome of mother, foetus and neonates in a gestational age of less than 35 weeks of pregnancy was evaluated. In the oligohydramnios group, chorioamnionitis and funistis were more common. Also, the mean gestational age at the time of delivery and neonatal weight was less than that of the normal amniotic fluid group. According to these results, it was concluded that a low amniotic fluid volume in the women with preterm premature rupture of membranes (PPROM) can be considered as a prognostic factor in the cases of conservative management of PPROM. In contrast, the other study, which was performed on a larger sample size (290 patients), could not show more cases of amnionitis in the cases of amniotic fluid index (AFI) of less than 5 cm; however, the latency period was shorter in comparison with AFI of more than 5 cm. What do the results of this study add? Chorioamnionitis, placental abruption and uterine atony after delivery, retention of placenta and route of delivery did not show a significant difference between the two groups. Respiratory distress syndrome (RDS), need of surfactant and intubation, intra ventricular haemorrhage (IVH) and duration of neonatal intensive care unit (NICU) admission did not show a significant difference between the two groups; however, the rate of neonatal sepsis and neonatal death were higher in the AFI <5 cm group. What are the implications of these findings for clinical practice and/or further research? The results suggest that AFI <5 cm should be considered as a warning sign for predicting poor prognosis of pregnancy complicated by PPROM. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of copper (Cu) supplementation during pregnancy on the rupture of membranes and pregnancy outcomes.Methods: Study was conducted as a triple-blind randomized clinical trial. In one group, Cu in a dose of 1000 mg per day, and in the other group, placebo was prescribed orally from 16th week of pregnancy.Results: The women of the two groups did not have significant difference according to age, gestational age at recruitment, BMI, and socioeconomic conditions. There was no statistically significant difference between case and control group regarding the incidence of PPROM, PROM, preterm labor, vaginal bleeding during pregnancy, preeclampsia, and the incidence of placenta abruption. There was a 75% and 90% decrease in depressive symptoms in 2nd trimester and 3rd trimester in supplemented group, respectively. Also, there was a 45% and 80% decrease in anxiety symptoms in 2nd trimester and 3rd trimester in the supplemented group, respectively The rate of infection during pregnancy was significantly higher in control group (p = 0.046). There was no difference between the two groups according to neonatal outcomes.Conclusions: Cu supplementation during pregnancy could not influence positively on ROM; however, it could improve some mood status of the women. [ABSTRACT FROM AUTHOR]

Aim The purpose of the present study was to evaluate the diagnostic value of maternal serum high-sensitivity C-reactive protein (hs- CRP) measurement during the first trimester of pregnancy for predicting pre-eclampsia. Material and Methods A prospective cohort study was performed on 394 pregnant women who were at the gestational age of 8-13 weeks. In all women, serum hs- CRP was measured by latex agglutination test. The women were then monitored to delivery. We compared the hs- CRP of the two groups, those with and without pre-eclampsia. We used the receiver-operator curve for finding the optimum cut-off points. Results Out of 394 women, 42 cases (10.7%) were complicated by pre-eclampsia, of whom 23 women (56.1%) had severe pre-eclampsia. Mean serum hs- CRP of the pre-eclamptic group was higher than that of the normotensive group (7.06 ± 2.6 mg/L vs 3.6 ± 2.3 mg/L, P = 0.001). The receiver-operator curve showed a significant difference between the under-curve zone for the hs- CRP level with the reference line. Serum hs- CRP of 4 mg/L showed sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as 78.1%, 72.1%, 25%, 96.5% and 72.8%, respectively. Hs-CRP of more than 7 mg/L was found in 26 (61.9%) cases of pre-eclampsia and 22 (6.25%) normotensive pregnancies, which showed a significant difference ( P = 0.001, relative risk = 12.1, 95% confidence interval: 6.91-21.15). Hs-CRP of more than 7 mg/L was found in 17 (73.91%) cases of severe pre-eclampsia and 22 (6.25%) normotensive pregnancies, which showed a significant difference ( P = 0.001, relative risk = 9.35, 95% confidence interval: 4.48-19.52). Conclusion Hs- CRP measurements during the first trimester of pregnancy are helpful in predicting pre-eclampsia. [ABSTRACT FROM AUTHOR]

Aim The purpose of the present study was to evaluate vaginal fluid β-human chorionic gonadotrophin (β- hCG) for the diagnosis of preterm premature rupture of membranes ( PPROM). Material and Methods An observational cross-sectional study was performed on 123 pregnant women who were in the third trimester of their gestation (28-37 weeks). The patients were divided into three groups: (i) PPROM group (41 cases); (ii) suspected PPROM group (42 cases); and (iii) intact membranes control group (40 cases). Five milliliters of sterile normal saline was inserted into the posterior fornix of the vagina and then vaginal fluid was aspirated and sent to the laboratory for β- hCG measurement. Finally, the amount of β- hCG was compared in the three groups. Results β- hCG concentration was 7.71 ± 15.7 mIU/ mL in the intact membrane control group, 468.06 ± 366.34 mIU/ mL in the PPROM group and 176.43 ± 316.37 mIU/ mL in the suspected PPROM group, which showed a significant difference between the three groups ( P < 0.001). In order to find an optimal cut-off value for β- hCG, the receiver-operator curve was used and a cut-off value of 79.5 mIU/ mL with a sensitivity of 95% and specificity of 84% was determined to be optimal. Conclusion β- hCG was higher in the cases of PPROM and patients who were suspected to have PPROM, and may be used as a suitable, fast and reliable test for detecting rupture of membranes. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the value of fetal abdominal circumference (AC) measurement in pregnancies at 38-40 weeks of gestation and within 7 days of delivery to predict macrosomia. Material and Methods: A prospective cohort study was performed on 276 pregnant women who were admitted to the labor ward with gestational age between 38-40 weeks. In all eligible women an ultrasonographic measurement of AC was performed. The women were then monitored up to delivery. All neonatal weights were recorded. The ACs were then evaluated for babies with a neonatal weight of more than 4000 g and babies with a neonatal weight of more than the 90th percentile for gestational age. Results: Sixty-six neonates had a neonatal weight of more than 4000 g and 11 neonates had a birth weight of more than 4500 g. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for AC of more than 35 cm to predict a birth weight of more than 4000 g, were 97%, 54.5%, 40.3% and 98.3%, respectively, and of these 87.9%, 77.6%, 55.2% and 95.3% for AC of more than 36 cm. Percentages were 97.3%, 56.9%, 45.3% and 98.3%, for a birth weight of more than the 90th percentile for gestational age for AC of more than 35 cm, and 87.8%, 80.2%, 61.9% and 94.7% for AC of more than 36 cm for prediction of birth weight of more than the 90th percentile for gestational age. Conclusion: AC measurement at 38-40 weeks of gestation is a suitable index for estimating macrosomia. [ABSTRACT FROM AUTHOR]

Aim: Preterm delivery is a serious problem during pregnancy with remarkable neonatal adverse effects. Prediction of preterm delivery in women with preterm uterine contractions or signs of preterm labor is critical because if these women are identified they can be referred to tertiary centers. The present study aimed to evaluate the value of maternal serum urocortin concentration for predicting preterm delivery in women with signs of spontaneous preterm labor. Material and Methods: A cohort study was conducted on pregnant women at a gestational age of 28-36 weeks who were admitted to the labor ward with spontaneous preterm labor. A blood sample was obtained from all participants to measure serum urocortin. The women were monitored up to delivery and serum urocortin was compared between women with preterm delivery and those who delivered at term (37 weeks of gestation). Receiver Operating Characteristic (ROC) curve analysis was used to determine sensitivity and specificity if applicable. Results: One hundred and sixty pregnant women finished the study. One hundred and forty-eight (92.5%) of the women delivered preterm. Mean serum urocortin in the preterm delivery group was higher than in the term group, but without statistical significant difference (392.6 ± 29.23 vs 113.2 ± 11.0. pg/mL, respectively, P = 0.252). Area under the ROC curve was 0.6, which shows that this test is not appropriate for predicting preterm delivery in women with preterm labor. Conclusion: Serum urocortin could not predict women who delivered preterm among women with signs of preterm labor. [ABSTRACT FROM AUTHOR]

Hypovitaminosis D during pregnancy is suggested to have a link with complications in both mother and infant. We aimed to evaluate the efficacy of two doses of vitamin D3 supplementation during pregnancy on maternal and cord blood vitamin D status, inflammatory biomarkers, and maternal and neonatal outcomes. A total of 84 pregnant women (gestational age of <12 weeks) were randomly allocated to one of two groups: (a) 1,000‐IU/d vitamin D and (b) 2,000 IU/d. Biochemical assessments (25‐hydroxycalciferol (25(OH)D), hs‐CRP, and cell‐culture supernatant concentrations of IL‐1β, IL‐6, and TNF‐α) of mothers were performed at the beginning and 34 weeks of gestation. Assessments of infants at delivery comprised cord blood serum concentrations of 25(OH)D, hs‐CRP, IL‐1β, IL‐6, TNF‐α, birth sizes, and Apgar score. Circulating concentrations of 25(OH)D increased in both intervention groups with more increment in 2,000 IU/d than in 1,000 IU/d (46.7 ± 30.7 vs. 24.0 ± 21.07 nmol L−1, P = .001). Concentrations of TNF‐α decreased significantly in group 2,000 (−913.1 ± 1261.3 ng L−1, P = .01). The cord blood concentration of IL‐6 in group 2,000 IU/d, compared with 1,000 IU/d, was significantly lower (25.9 ± 32.0 vs. 4.6 ± 1.4 ng L−1, P = .03). The birth sizes including weight, length, and head circumference of the infants of group 2,000 IU/d were significantly higher than the infants' of group 1,000 IU/d. Supplementation with 2,000‐IU/d vitamin D3 is more effective than 1,000 IU/d in pregnant women in terms of increasing circulating 25(OH)D, ameliorating pro‐inflammatory markers notably TNF‐α in mother and IL‐6 in cord blood, and improving neonatal outcomes including the birth sizes. [ABSTRACT FROM AUTHOR]

The article discusses a study that used randomized response technique and unmatched count technique to estimate the prevalence of induced abortion among a sample of married women in Tehran, Iran. A convenience sampling method was used to recruit a sample of patients attending clinics between August and December 2013. The study's protocol was authorized by the Ethics Committee of Tehran University of Medical Sciences. The study was limited to patients of one public hospital in Tehran.

Background: Toll-like receptor (TLR)-mediated inflammatory processes are supposed to be involved in pathophysiology of spontaneous abortion and preterm labor. Here, we investigated functional responses of human endometrial stromal cells (ESCs) and whole endometrial cells (WECs) to lipopolysaccharide (LPS) and lipoteichoic acid (LTA). Methods: Endometrial tissues were obtained from 15 cycling women who underwent laparoscopic tubal ligation. Modulation of TLR2, TLR4 and MyD88 expression and production of pro-inflammatory cytokines by WECs and ESCs in response to LPS and LTA were assessed. Results: WECs and ESCs expressed significant levels of TLR4 and MyD88 transcripts but, unlike WECs, ESCs failed to express TLR2 gene. Regardless of positive results of Western blotting, ESCs did not express TLR4 at their surface as judged by flow cytometry. Immunofluorescent staining revealed intracellular localization of TLR4 with predominant perinuclear pattern. LPS stimulation marginally increased TLR4 gene expression in both cell types, whereas such treatment significantly upregulated MyD88 gene expression after 8 hr (p<0.05). At the protein level, however, LPS activation significantly increased TLR4 expression by ESCs (p<0.05). LTA stimulation of WECs was accompanied with non-significant increase of TLR2 and MyD88 transcripts. LPS and LTA stimulation of WECs caused significant production of IL-6 and IL-8 in a dose-dependent manner (p<0.05). Similarly, ESCs produced significant amounts of IL-6, IL-8 and also TNF-α in response to LPS activation (p<0.05). Conclusion: Our results provided further evidence of initiation of inflammatory processes following endometrial TLR activation by bacterial components which could potentially be harmful to developing fetus. [ABSTRACT FROM AUTHOR]

Background: Oral cavity has been proposed as an important reservoir of H.pylori, being implicated in bacterial transmission through oral-oral route. However, some investigators believe that the newborn acquires H.pylori from mother through vaginal delivery. In this study, oral and vaginal yeasts were examined for the intracellular occurrence of H.pylori and their possible role in bacterial transmission. Methods: Sixty nine oral and vaginal yeasts from expecting mothers (39 oral and 30 vaginal) and seven oral yeasts from neonates(6/46 vaginal delivery, 1/43 cesarean) were identified and studied by light and fluorescent microscopy for observing the intracellular bacterium-like bodies(BLBs). Whole DNAs of yeasts were recruited for detection of H.pylori-specific genes. Urea breath test (UBT) was performed for detection of H.pylori infection in mothers. Stool antigen test (SAT) was used for detection of H.pylori antigens in infants' stool at birth and six months of age. Results: Oral yeasts were isolated more frequently from normally-delivered neonates. The frequency of H.pylori genes in mothers' vaginal yeasts was significantly higher than in mothers' oral yeasts. A significant correlation was found between the occurrence of H.pylori genes in vaginal yeasts and that in neonates' oral yeasts, occurrence of H.pylori genes in mothers' vaginal yeasts or neonates' oral yeasts, and UBT +results in mothers. Conclusion: C.albicans which colonizes the oral cavity of neonates through vaginal delivery or contact with environment or health care workers could be an important reservoir of H.pylori. Vaginal yeasts are more potent in accommodating H.pylori than oral yeasts. Accordingly, vaginal yeast is proposed as the primary reservoir of H.pylori which facilitates H.pylori transmission to neonates. [ABSTRACT FROM AUTHOR]

Objective: To assess variations in the presentation and clinical implications of pre-eclampsia between Iranian and Afghan mothers at a maternity center in Tehran., Methods: We conducted a cross-sectional study of Iranian and Afghan mothers diagnosed with pre-eclampsia. Data were collected from March 2021 to February 2023 at a maternity center in Tehran, Iran. Demographic information, clinical characteristics, and laboratory findings were extracted from medical records. Statistical analyses were employed to compare differences between Iranian and Afghan mothers, including Mann-Whitney U, Pearson χ 2 tests, and logistic regression models., Results: We included 822 pregnant women with pre-eclampsia, predominantly Iranian (75.5%) and Afghan (24.5%). Regarding the multivariate logistic regression model, Iranian mothers were older, with a higher proportion over 35 years. Although Afghan mothers showed higher gravidity counts and greater gestational ages at delivery, they had lower rates of hypothyroidism. Iranian women were more often categorized as obese than Afghan women, and the difference was statistically significant. Serum levels of alkaline phosphatase were significantly greater in Afghan women., Conclusion: Pre-eclampsia poses significant maternal health risks, especially among Afghan refugees in Iran. Variances in age, gravidity, and hypothyroidism prevalence highlight the need for tailored healthcare strategies. Addressing cultural barriers and implementing targeted interventions can improve maternal and fetal outcomes in these populations., (© 2024 International Federation of Gynecology and Obstetrics.)

Background: Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. Thus, this study aimed to compare the success rate of vaginal birth by using trans-labial ultrasound and vaginal examination, and vaginal examination only in pregnant women with labor induction., Methods: This was a comparative study including 392 eligible pregnant women with labor induction attending to a teaching hospital affiliated with Iran University of Medical Sciences from April to October 2018 in Tehran, Iran. Women were randomly assigned to two groups; the trans-labial ultrasound plus vaginal examination (group A), and the vaginal examination only (group B). Women were included in the study if they satisfied the following criteria: singleton pregnancy, 37 to 42 weeks of gestational age, fetal head presentation, a living fetus with no abnormalities, uncomplicated pregnancy, and no previous cesarean section or any uterine surgery. We used a partograph for both groups to assess the fetal head position and the fetal head station. In group 1, the Angle of Progression (AoP) and Rotation Angle (RA) were also assessed. Finally, the success and progression of vaginal delivery in two groups were compared by predicting the duration of delivery and mode of delivery., Results: The findings showed that 8.68% of women in the trans-labial plus vaginal examination group delivered by cesarean section, while 6.13% in the vaginal examination only group delivered by cesarean section (P = 0.55). In women with cesarean section in positive fetal head stations, Angle of Progression (AoP) was significantly decreased ranging from 90 to 135 degrees compared to women who delivered vaginally (135-180 degrees; P <  0.001). In addition, the Rotation Angle (RA) was significantly decreased in women with cesarean section ranging from 0 to 30 degrees compared to women who delivered vaginally (60-90degrees; P <  0.001). Further analysis indicated that a higher risk of cesarean section was associated with vaginal examination only as compared to trans-labial ultrasound plus vaginal examination (HR: 8.65, P <  0.001)., Conclusion: Angle of Progression (AoP) and Rotation Angle (RA) indexes might be useful parameters to predict labor progression and successful vaginal delivery among women undergoing labor induction., (© 2023. The Author(s).)

Objective: To evaluate the risk factors for severe maternal outcome (SMO) in Afghan immigrant women., Methods: Women with potentially life-threatening conditions (PLTC) were selected. Then risk factors for those PLTC which led to SMO (maternal near-miss or maternal death) were evaluated. In addition, risk factors for those SMOs occurring on hospital admission or during the first 12 hours after admission to the hospital (SMO12) were evaluated., Results: Parity ≥3 (adjusted odds ratio [aOR] 3.24, 95% confidence interval [CI] 1.62-6.50, P = 0.03), low literacy level in mother (aOR 2.99, 95% CI 1.16-5.01, P = 0.03), inadequate prenatal care (aOR 2.74, 95% CI 1.2-3.87, P = 0.01), multigravidity (gravidity ≥5: aOR 2.62, 95% CI 1.31-4.53, P = 0.03), lack of health insurance (aOR 2.52, 95% CI 1.25-4.02, P = 0.01), and low literacy level in husband (aOR = 1.49, 95% CI 1.15-2.9, P = 0.02) were the risk factors for SMO in women with PLTC. Inadequate prenatal care (aOR 4.2, 95% CI 2.05-8.25, P = 0.04), low literacy level in mother (aOR 3.38, 95% CI 1.32-6.65, P = 0.04), parity ≥3 (aOR 2.69, 95% CI 1.16-4.7, P = 0.04), and lack of health insurance (aOR 2.13, 95% CI 1.25-3.67, P = 0.03) were risk factors for SMO12., Conclusion: There was a higher rate of SMO and SMO12 cases among Afghan immigrant women., (© 2022 International Federation of Gynecology and Obstetrics.)

Study Objective: To assess the efficacy of prostaglandin F2α (PGF 2α ) in hysteroscopic myomectomy of submucous myomas., Design: Single-blind, randomized clinical trial study., Setting: Teaching hospital, affiliate of Iran University of Medical Sciences, Tehran, Iran., Patients: Forty-four patients with symptomatic submucous myomas were randomly assigned to the intervention group (n = 21; 1 excluded owing to myoma not identified on pathologic examination) and the control group (n = 22)., Interventions: In the intervention group, PGF 2α was injected into the cervix twice: before the beginning of the surgery and after the resection of the intrauterine portion of the submucous myoma. TIn the control group, the myomas were resected without the PGF 2α injection. The same procedure was performed in the control group without the PGF 2α injection., Measurements and Main Results: There were no differences in the demographics, size, or type of myomas among the groups at baseline. Although the proportion of complete removal of the submucous myomas in the intervention group (PGF 2α ) was higher (20/23 myomas or 87%) than that in the control group (15/23 myomas or 65.2%), the difference was not significant (p = .1). The number of 1-step complete removal of large submucous myomas (>5 cm) in the PGF 2α group was significantly higher than that in the control group (8/10 myomas [80%] vs 2/8 myomas [25%], p = .03). The mean duration of operative time was significantly longer in the intervention group than in the control group (p = .01). The intervention group experienced more days of postoperative bleeding than the control group (p = .001). There were no differences regarding the length of stay at the hospital or hemoglobin levels between the groups (p = .07)., Conclusion: In the current study, injection of PGF 2α was beneficial for 1-step complete resection of large (>5 cm) submucous myomas via hysteroscopic myomectomy., (Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Pregnancy outcomes are affected by many different factors. One of the influential factors on pregnancy outcomes is the male partner as an important person to mother's wellbeing. Objective: The aim of the present study was to investigate the effects of male partner's role including socioeconomic support, emotional support, accompanying pregnant women during prenatal care visits (PNC) and labor, and the level of pregnant women's satisfaction from their partners' support and involvement during pregnancy on pregnancy outcomes. Method: Two hundred first gravid pregnant women with mean age of 23.2 ± 4.3 were studied. Primary outcomes were total maternal and neonatal adverse outcome (TMNAO), total maternal adverse end result (TMAE), and total neonatal adverse outcome (TNAO), regardless of the type of outcomes. Preterm labor and delivery; premature rupture of membrane (PROM) and preterm premature rupture of membrane (PPROM); preeclampsia and eclampsia; placental abruption; chorioamnionitis; stillbirth; meconium passage; maternal death; postpartum hemorrhage; poor progression labor; abnormal vaginal bleeding in third trimester of pregnancy; low birth weight and neonatal need for CPR or intubation, neonatal anomaly, NICU admission, and neonatal mortality were also analyzed as subgroup outcomes. Results: One hundred twenty-seven (63.5%) participants showed a kind of total maternal and neonatal adverse outcome (TMNAO), 72 (36%) deliveries resulted in a kind of neonatal adverse outcome (TNAO), and 104 (52%) of participants had a kind of maternal adverse end result (TMAE). Iranian fathers showed a significantly higher rate of TMNAO than Afghan fathers did (82 versus 69%, odds ratio: 2.9, 95% CI 1.0-7.8, p : .01). Mother's nationality showed the same result (82 versus 64%, odds ratio: 2.6, 95% CI 0.9-6.8, p : .03). Iranian fathers showed a significantly higher rate of TMAE than Afghan fathers did (79 versus 58%, odds ratio: 2.7, 95% CI 1.1-6.3, p : .01). Mother's nationality showed the same result (78 versus 60%, odds ratio: 2.4, 95% CI 1.0-5.6, p : 0.02). Neonates with Iranian fathers showed significantly more TNAO than those with Afghan fathers (50 versus 31%, odds ratio: 2.21, 95% CI 0.9-5.5, p : .04). The same trend was observed among Iranian mothers in comparison to Afghan mothers (50 versus 32%, odds ratio: 2.11, 95% CI 0.9-4.6, p : .06). Of mother's age, mother's BMI, father's age, father's BMI, and mother's nationality, only father's BMI contributed significantly to the binary logistic regression model ( n  = 116, R 2 : 9%, p : .028). It was found that for each decreased unit in BMI, the risk of TNAO was increased by 16%, p : .03. Moreover, Father's family history of preeclampsia resulted in a higher prevalence of total neonatal adverse outcome (TNAO) in comparison with lack of such family history (87 versus 43%, odds ratio: 8.9, 95% CI 1.1-74.5, p : .02). Besides, mothers' participation in prenatal care (PNC) visits, assessed by caregivers, was significantly more satisfactory in neonates without any adverse outcome than those with neonatal adverse outcomes (median (IQR) = 2 (1-2) versus 2 (2-3), p : .04). PROM, pre-eclampsia, NICU admission, neonatal intubation, low Apgar score minute 0, and low Apgar score minute 5 were significantly more prevalent in participants revealing positive father's family history of pre-eclampsia. Regarding psychosocial exposures, placental abruption was more prevalent in mothers with exposure to verbal aggression versus non-exposed ones (9 versus 2%, odds ratio: 4.0, 95% CI 0.9-24.6, p : .04). Moreover, a weak positive association between neonatal gestational age at birth and quality of mother's participation in PNC visits ( r : +0.3, p : .01) as well as mother's satisfaction from father's commitment to PNC visits was found ( r : +0.1, p : .03). Conclusion: Male partners may play a key role in pregnant women and fetus's heath.

Objective: Umbilical cord abnormalities increase fetal morbidity and mortality. This study was designed to compare antenatal umbilical coiling index (aUCI) in gestational diabetes mellitus (GDM) and non-gestational diabetes mellitus (non-GDM) pregnancy, considering uncertainties about the best time to perform antenatal ultrasonography scan., Materials and Methods: In this prospective study, 246 parturients were included, 123 with GDM and 123 with non-GDM pregnancy. Gestational diabetes was confirmed at 24-28 weeks of gestation (WG) using one-step strategy. An anatomical ultrasound survey of placenta and umbilical cord was performed at 18-23 as well as 37-41 weeks of gestational age., Results: At 18-23 WG, the frequency distribution (10th, 90th percentiles, mean ± SD) of the aUCI in the GDM and non-GDM groups were (0.13,0.66,0.32 ± 0.19) and (0.18,0.74, 0.4 ± 0.31) respectively. These values were (0.12,0.4, 0.25 ± 0.11) in the GDM group at 37-41 WG and (0.17,0.43, 0.29 ± 0.11) in the non-GDM group. A significant relationship was detected between UCI value and GDM/non-GDM groups at both antenatal evaluations (18-23 WG; P = 0.002, 37-41WG; P < 0.001). A significant association at 18-23 WG was found between GDM/non-GDM groups and aUCI categorization (hypocoiling <10th, normocoiling 10th-90th and hypercoiling >90th) (P = 0.001). However, hypocoiling were significantly more frequent in GDM than non-GDM in both antenatal evaluations (P < 0.001, P = 0.006)., Conclusion: Antenatal UCI in pregnancy complicated by GDM were lower in comparison with non-GDM pregnancy. The most abnormal pattern of coiling in gestational diabetes was hypocoiling in both trimesters. In addition, 18-23 WG is the best time to perform ultrasound scan to detect aUCI and umbilical cord pattern., (Copyright © 2018. Published by Elsevier B.V.)

Background: To assess the association of maternal hyperuricemia with adverse pregnancy outcome and neonatal metabolic, neurologic and respiratory disturbances in normotensive singleton pregnant women., Method: This prospective multicentric cohort study was conducted on 404 normotensive singleton pregnant women who were admitted for delivery in Vali-Asr and Akbar-Abadi teaching hospitals of Tehran University of Medical Sciences, Tehran, Iran. Upon enrollment maternal and umbilical sera were obtained for determining uric acid levels. 1 and 5 minutes Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded. In case of NICU admission a neonatal blood sample was drawn for determining uric acid, blood sugar and bilirubin levels. An intracranial ultrasound imaging was also carried out for the admittd neonates for detecting intraventricular hemorrhage., Results: Maternal hyperuricemia (uric acid one standard deviation greater than the appropriate gestational age) was independently associated with preterm birth (odds ratio (OR), 3.17; 95% confidence interval (CI), 2.1 - 4.79), small for gestational age delivery (OR, 1.28; 95% CI, 1.04 - 2.57), NICU admission (OR, 1.65; 95% CI, 1.12 - 2.94) and neonatal IVH (OR, 8.14; 95% CI, 1.11 - 87.1)., Conclusions: Maternal hyperuricemia in normotensive singleton pregnant women is significantly associated with preterm and SGA delivery and the development of neonatal IVH.

Objective: To investigate the prevalence of restless legs syndrome (RLS) during pregnancy and to evaluate factors associated with RLS in a population of Iranian pregnant women., Methods: In the present cross-sectional study, 443 consecutive pregnant women admitted for delivery underwent an interview within 2 days of parturition. The diagnosis of RLS was established by the 4 criteria of the International Restless Legs Syndrome Study Group (IRLSSG). The severity of RLS was assessed through the IRLSSG Rating Scale., Results: Seventy-nine (17.8%) women met the RLS diagnostic criteria, with most (74.7%) having RLS of moderate severity. The mean RLS duration before delivery was 3.1 ± 2.1 months among 69 (87.3%) women; 10 (12.7%) had RLS onset before pregnancy. Sleep disturbances including insomnia and early awakening were significantly more common among women with RLS than among those without (P < 0.001), and the frequency of cesarean delivery was also significantly higher (58.2% versus 44.5%, P = 0.027; odds ratio 2.4). There were no significant differences between the 2 groups in terms of age, number of pregnancies, folate and iron supplementation, hemoglobin level, and neonatal anthropometric data., Conclusion: Restless legs syndrome is common during pregnancy and is associated with poor sleep and an increased risk of cesarean delivery., (© 2013.)

Objective: Significant changes in thyroid function occur during pregnancy which can complicate the interpretation of thyroid function tests. Therefore, normative gestational related reference ranges for thyroid hormones tests are required. The aim of this study was to determine the reference ranges for free triiodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) in Iranian pregnant women., Methods: This study was a cross-sectional observational study conducted in the Obstetrics and Gynecology department, Akbarabadi University Hospital. A single blood sample from 584 pregnant women was analyzed for thyroid function. Serum levels of TSH, FT4, FT3, total T4 (TT4), T3 resin uptake (T3RU) and anti-thyroid peroxidase antibody (TPO Ab) were measured. Urinary iodine was determined in some cases. Reference intervals based on 2.5th and 97.5th percentiles were calculated., Results: The composition of reference population comprising 584 women included 162 in first trimester and 422 in the third trimester. The 2.5th and 97.5th percentiles values were used to determine the reference ranges for FT3, FT4, TT4, T3RU and TSH. These values were T3 1.4 and 2.9 pmol/L, FT4 7.1 and 18 pmol/L, TT4 7.2 and 13.5 µg/dL and TSH 0.5 and 3.9 µg/L, respectively. The level of urinary iodine in 80.5% of the subjects was less than normal., Conclusions: Serum levels of thyroid hormones are different in Iranian population that could be due to racial differences or differences in iodine intake.

Background: In this study, the characteristics of menstrual cycle in shift workers employed in the pharmaceutical industry are investigated., Method: This study was conducted in a pharmaceutical industrial complex in Tehran in 2012. 406 female workers in packaging units were studied on the menstrual cycle characteristics. The studied workers were divided into two groups of shift workers and non-shift workers and were compared in terms of the frequency of menstrual disorder (short-term cycle, long-term cycle, irregular cycle and bleeding during menstrual cycle) as well as hormonal values (FSH, LH, TSH, and Prolactin)., Results: The odds ratio (OR) for menstrual disorder in the shift workers was 5.54 (95% CI=2.78-11.02) compared to the non-shift workers. The mean difference of hormonal values (except prolactin) between shift workers and non-shift workers was not significant (P>0.05)., Conclusion: This study suggests that shift work may disrupt the menstrual cycle.

Objective: To compare the dermatoglyphic characteristics of women with and without breast cancer., Study Design: Case-control study. One hundred and thirty women=130 women with histopathologically confirmed breast cancer (case group) were compared with 127 women in the same age group but without breast cancer (control group). Fingerprints of the two groups were compared in terms of whorl, loop and arch patterns., Results: The loop pattern was most common in both groups [68 women (52.3%) in the case group and 58 women (45.7%) in the control group], followed by the whorl pattern [60 women (46.2%) in the case group and 64 women (50.4%) in the control group]; the difference was not significant (p=0.337). The number of whorl patterns and the breakdown by classification group did not differ significantly between the two groups. In addition, no significant difference was found in the dermatologlyphic patterns of the women with breast cancer with and without a family history of breast cancer., Conclusion: No difference was found in the dermatoglyphic characteristics of women with and without breast cancer. As such, this does not appear to be an effective screening method for women at risk for breast cancer., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: To evaluate the impact of mild to moderate maternal zinc deficiency on birth weight of offsprings in a group of Iranian pregnant population., Materials and Methods: One hundred forty pregnant subjects with no history of medical complications during pregnancy and without any inter-current illness enrolled in the study. Serum zinc concentration, ferritin, hemoglobin, iron, and total iron binding capacity (TIBC) were measured at the time of delivery. The receiver operator characteristic (ROC) curve analysis used to determine plasma zinc cutoff value for comparison., Results: Of 140 live neonates, 30% were below 2500 g. Mean serum zinc concentration was 56.60 ± 17.91 μg/dl which indicated mild to moderate zinc deficiency. None of the subjects were anemic. There was an inverse statistically significant relationship between maternal serum zinc concentration and neonatal birth weight., Conclusion: In this group of Iranian pregnant subjects with mild to moderate zinc deficiency, we observed no relationship between low maternal zinc status and low birth weight infants.

This study evaluated some risk factors for pre-eclampsia, which is one of the most problematic complications of pregnancy. This was a retrospective case control study conducted on 318 pre-eclamptic women (case group) and 318 women who were normotensive at the time of delivery as the control group. Evaluated factors were: maternal age, gestational age, nuliparity, mother's educational status, maternal body mass index (BMI), maternal hemoglobin and blood Rh, familial history of pre-eclampsia, history of pre-eclampsia in a previous pregnancy, marital relations, urinary infection (UTI) during the present pregnancy, season of delivery, and method of contraception. Risk factors for pre-eclampsia were: UTI (P=0.04); history of pre-eclampsia during previous pregnancy (P=0.003), and winter season (P=0.001). Maternal age of more than 20 years, high educational status of mother, parity more than one, and oral contraceptive pills were protective for pre-eclampsia. After adjusting for all possible confounding factors using multiple logistic regression, only preexisting pre-eclampsia (P=0.004) was a risk factor, whereas parity more than three (P=0.007) and anemia (P=0.01) were protective for pre-eclampsia. The rate of cesarean delivery was more common in the pre-eclamptic group (245 cases, 77%) than the control group (85 cases, 26.7%). The one minute Apgar score of neonates less than 8 was more common in the case group (28.6% vs. 47.4%, P<0.001). Gestational age at the time of delivery was lower in the case group (36.48±3.4 weeks vs. 37.12±3.3 weeks, P<0.001). Awareness of risk factors of pre-eclampsia can help to monitor patients, ensure earlier diagnosis and predict which patients are more likely to develop pre-eclampsia.

Objective: To evaluate the effect of pelvic floor muscle training (PFMT) or Kegel exercise with and without assistance by a resistance device (Kegelmaster device) on the urinary incontinence in women., Study Design: A randomized clinical trial was performed on 91 women with the complaint of urinary incontinence. In the assisted pelvic floor muscle training (APFMT) group (n=41), after complete training, Kegelmaster device were used twice daily for 15 min each session, for a total duration of 12 weeks. In the pelvic floor muscle training (PFMT) group (n=50) after complete training, kegel exercises were done (including perineal muscle contractions for 6-8s with 6s rest in between), twice daily for 15 min each session and for a total duration of 12 weeks. These two groups were then compared according to the scores of special questionnaires for quality of life, strength of pelvic floor muscles, capability to participate in social activities, severity of urinary incontinence, and the number of involuntary urine passage, taken before, and after 1 and 3 months after finishing interventions., Results: 85 women out of 91 women finished the study (46 in the PFMT group and 39 in the APFMT group). Strength of pelvic floor muscles, capability to participate in social activities, score of quality of life according to three world questionnaires of IQOL (incontinence Quality Of Life), IIQ (Incontinence Impact Questionnaire), UDI (Urogenital Distress Inventory), showed no difference between the two groups 1 and 3 months after interventions. Pair t test showed a significant improvement in both groups 1 and 3 months after intervention, according to IQOL score (P=0.000), UDI score (P=0.000), IIQ score (P=0.000), strength of pelvic floor muscles, (P=0.000), capability to participate in social activities (P=0.000), severity of urinary incontinence (P=0.000) and the number of involuntary urine passage (P=0.000)., Conclusion: Pelvic floor muscle training with or without Kegelmaster show no apparent difference to each other, however, these two methods are effective for improvement of urinary incontinence in women., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: Oral contraceptive pills (OCPs) are one of the most effective reversible and accessible contraceptives, and patient acceptance for their use depends partly on the unfavorable adverse effects. The present study compared the two kinds of OCPs (monophasic; levonorgestrel (LNG)-ethinyl estradiol (EE) 150/30 versus triphasic; LNG-EE 50-75-125/30-40-30) for adverse effects and patient satisfaction., Study Design: A randomized clinical trial was performed on 314 women who used OCPs for the first time, as their contraception, for 6 months. Overall, 1884 cycles were studied. In the monophasic group (n=159 who finally finished the study), monophasic pills LNG-EE 150/30mcg, and in the triphasic group (n=155 who finally finished the study), triphasic pills LNG-EE 50-75-125/30-40-30 mcg were used. Statistical analysis was performed using SPSS 10: Chi square test, Fisher exact test and Student's t-test were used., Results: There were no significant differences between the two groups for common side effects, including nausea, headache, nervousness, facial hyperpigmentation (chloasma), and body weight (increase or decrease) but breakthrough bleeding and spotting (BTB/S) were less in the triphasic group, occurring in 30 cycles (18.86%) versus 10 cycles (6.45%), P=0.009*. Patient satisfaction for the two OCPs was similar and high. The rates of side effects were low., Conclusion: It seems that the monophasic and triphasic pills are similar according to patient satisfaction and side effects; therefore there is no benefit of one over the other except for BTB/S, for which triphasic is superior., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Postpartum haemorrhage is one of the most important causes of maternal death., Objectives: To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour., Methods: A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group (n=100), 10IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group (n=100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss., Findings: Mean blood loss during the third stage of labour was 216.93+/-165.16 ml and 232.12+/-150.35 ml in the intervention and control groups, respectively; the difference was not significant (p=0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62+/-324.7 ml and 327.27+/-255.99 ml in the intervention and control groups, respectively; p=0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69+/-5.51 mins and 6.34+/-5.03 mins; p=0.028)., Conclusions: Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour., (Copyright 2008 Elsevier Ltd. All rights reserved.)

Objective: To evaluate some of the risk factors of complete molar pregnancy., Study Design: A case-control study was performed on 91 cases of complete molar pregnancy (case group) and 295 cases of normal, term pregnancy with a live neonate (control group). Then the maternal age, parity and gravidity, blood group and Rh, history of molar pregnancy, consanguinity, history of spontaneous abortion, contraception method and nationality (Afghan or Iranian) were compared in the 2 groups., Results: History of molar pregnancy (OR [odds ratio], 95% CI 5.7 [1.2-25.61), spontaneous abortion (OR, 95% CI 2.1 [1.7-2.61), maternal age > 35 years old (OR, 95% CI 2.3 [1.3-3.9]) and < 20 years old (OR, 95% CI 1.6 [1.4-1.9]), consanguinity (OR, 95% CI 1.3 [1.1-1.51) and Iranian nationality (OR, 95% CI 1.9 [(1.5-2.4]) were found to be risk factors for molar pregnancy., Conclusion: History of molar pregnancy and spontaneous abortion, maternal age > 35 and < 20, consanguinity and nationality may be risk factors for molar pregnancy.

Introduction: Gestational diabetes mellitus (GDM) is the most common metabolic disorder that occurs during pregnancy. Knowing the risk factors for GDM is thus particularly important., Objective: To evaluate the relationship between GDM and a history of polycystic ovarian syndrome (PCOS)., Methods: A case-control study was conducted involving 188 pregnant women. Ninety-four cases had GDM based on an impaired glucose tolerance test (GTT) and the other 94 cases (control group) were pregnant women without GDM. The subjects in each group were questioned regarding a history of PCOS (i.e., a history of oligomenorrhea and hyperandrogenism) and then their health documentation's were reviewed and those women whose documentation's were complete (sonologic and hormonal evidences for PCOS) entered the study. The relationship between GDM and a history of PCOS was then evaluated., Results: The women with GDM had a history of PCOS more often than the control group of women (15 cases of PCOS in GDM group vs. 6 cases of PCOS in the control group, P=0.03), but regarding body mass index, a history of PCOS were not shown to have a significant relationship with GDM. Regarding the number of pregnancies, a history of PCOS had a significant relationship with GDM (P=0.05)., Conclusions: GDM has a relationship with a history of PCOS, therefore in women with a history of PCOS, the risk of GDM should be considered.