Objective: To compare residual myometrial thickness (RMT) and cesarean scar defect (CSD) development after cesarean section using double-layer locked and unlocked closure techniques. Materials and methods: We conducted a randomized double-blinded trial comparing double-layer locked and unlocked uterine closure techniques following cesarean section in primiparous women. The locked technique involved continuous suturing of the full myometrial thickness in the first layer, followed by back-and-forth needle maneuvering on both sides of the incision for the second layer. The unlocked method included running suturing of two-thirds of the myometrial thickness in the first layer, followed by suturing the upper half of the myometrial thickness in the second layer. Transvaginal ultrasonography was performed one year post-cesarean section, with RMT as the primary outcome and scar depth and width as secondary outcomes. Independent t-test and Chi-square test were utilized for statistical analysis. Results: All 30 patients from the locked and 26 from the unlocked group in the follow-up were diagnosed with CSD (scar depth>2mm). The mean RMT for the unlocked and locked groups were 4.44±1.07mm and 4.12±0.48mm, respectively, showing no significant difference (p =0.14). There was also no significant difference in mean scar width between the locked and unlocked groups (3.68±1.44mm vs. 3.95±1.00mm, p =0.42). However, the mean scar depth was higher in the unlocked group (3.77±1.11 mm vs. 3.16±1.1mm, p =0.04). Conclusion: We have found no significant differences in the RMT and CSD prevalence between two-layered locked and unlocked uterine closure techniques, while the scar depth was greater in the unlocked group. Nonetheless, future randomized trials implementing larger sample sizes are required to precisely compare the outcomes of the double-layer locked and unlocked uterine suturing techniques
Objective: Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women.However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers. Material and Methods:This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS.Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected.In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, peak systolic velocity (PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler US.Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology.Results: Fifty-one women were enrolled with a mean age of 35.4±4.11years and 17 (33.3%)had severe bleeding.There were significant differences between median (range) bladder ; p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively.Thirty-four (66.66%) had hysterectomy.Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005),20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003),respectively. Conclusion:
Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics.
Meconium aspiration syndrome (MAS) is a life-threatening respiratory disease in infants born through meconium stained amniotic fluid (MSAF). The purpose of this study was to determine risk factors for MAS in the newborns of mothers who had meconium stained amniotic fluid in labour. A retrospective study of all full-term pregnancies with MSAF from May 2003 to October 2004 was designed at a teaching hospital. Development of MAS was the primary outcome. Maternal details, mode of delivery and neonatal details (Apgar score, reassuring or non-reassuring fetal heart rate tracing and birth weight) were evaluated. During the study period, there were 2,603 deliveries of whom 302 (11.6%) had MSAF. MAS developed in 64 of these infants (21.1%). Compared with healthy neonates with MSAF, those with MAS had higher rate of non-reassuring fetal heart rate (FHR) tracing, thick meconium and Apgar score ≤5 at 5 min. The neonatal birth weight was lower in the MAS group, maternal age, parity, gestational age and mode of delivery were not significantly different in the two group. We found the severity of meconium, low Apgar score at 5 min and non-reassuring FHR tracing was associated with MAS in MSAF pregnancies.
Limited data are available evaluating the effects of omega-3 fatty acids supplementation on gene expression involved in the insulin and lipid-signaling pathway in women with polycystic ovary syndrome (PCOS). This study was conducted to evaluate the effects of omega-3 fatty acids supplementation on gene expression involved in the insulin and lipid signaling pathway in women with PCOS. This randomized double blind, placebo-controlled trial was done among 60 women aged 18-40 years old and diagnosed with PCOS according to the Rotterdam criteria. Participants were randomly assigned into 2 groups to receive either 1 000 mg omega-3 fatty acids from flaxseed oil containing 400 mg α-linolenic acid (n=30) or placebo (n=30) twice a day for 12 weeks. Gene expressions involved in the insulin and lipid-signaling pathway were quantified in blood samples of PCOS women with RT-PCR method. Quantitative results of RT-PCR demonstrated that compared with the placebo, omega-3 fatty acids supplementation upregulated peroxisome proliferator-activated receptor gamma (PPAR-γ) mRNA (p=0.005) in peripheral blood mononuclear cells of women with PCOS. In addition, compared to the placebo, omega-3 fatty acids supplementation downregulated expressed levels of oxidized low-density lipoprotein receptor (LDLR) mRNA (p=0.002) in peripheral blood mononuclear cells of women with PCOS. We did not observe any significant effect of omega-3 fatty acids supplementation on expressed levels of glucose transporter 1 (GLUT-1) and lipoprotein(a) [Lp(a)] genes in peripheral blood mononuclear cells. Overall, omega-3 fatty acids supplementation for 12 weeks in PCOS women significantly improved gene expression of PPAR-γ and LDLR.
Introduction: Management of seriously ill patients infected with new corona virus (SARS-CoV-2) is challenging especially in pregnancy and postpartum state. Case presentation: A 39- year-old primigravid critically ill woman with acute respiratory distress (ARDS) due to confirmed SARS-CoV-2 infection underwent urgent cesarean delivery (a healthy neonate) at 33 weeks and 5/7 of pregnancy. She received treatments including hydroxychloroquine, antivirals and broad-spectrum antibiotics while she was intubated for mechanical ventilation. In spite of all treatments, she developed a critical course after the mild primary clinical improvement. Convalescent plasma transfusion as a rescue treatment was performed and led to an improvement in her general condition and delayed gradual recovery in respiratory function after two months. Conclusion: The promising role of early treatment with convalescent plasma transfusion in seriously ill pregnant women infected with SARS-CoV-2, needs to be elucidated by further randomized studies.
Objectives: To investigate the preferred method and education subjects among gynecologists and obstetricians to find the gaps between the current and expected states of continuing medical education (CME). Methods: An online self-administered questionnaire was sent to Iranian gynecologists and obstetricians. Three main parts of the questionnaire were demographic information, general skills such as stress management, legal knowledge, and documentation, and specialized skills such as medical and surgical management. The level of clinical capability, the need for further training, and the preferred training method, virtual, theoretical, or bedside in private or academic centers, were asked and reported. Results: Two hundred and eighty-six general gynecologists and obstetricians participated in this survey. The majority (87.3%) of them were not academic staff. Nearly 70% of the participants could perform common procedures in obstetrics, general gynecology, infertility, oncology, and urogynecology, although more than two-thirds felt they needed more training. The lowest level of preparedness was in urogynecology skills, while the highest level of educational needs was reported in infertility. Surprisingly, the preferred method of education for the most specialized skills was bedside training in academic centers. Conclusions: Despite time constraints and COVID-19 restrictions, most clinicians are keen to receive more education, and in most cases, their preferred method is bedside training in academic centers. Therefore, proper strategic planning based on different fields of obstetrics and gynecology to design practical and bedside CME courses seems necessary.
Abstract Background Mistreatment during labour and childbirth is a common experience for many women around the world. A picture of the nature and types of mistreatment; and especially its influencing factors has not yet been identified in Iran. This study aimed to explore the manifestations of mistreatment and its influencing factors in maternity hospitals in Tehran. Methods A formative qualitative study was conducted using in-depth face-to-face interviews between October 2021 and May 2022 in five public hospitals. Participants included women, maternity healthcare providers, and managers at hospital and Ministry of Health levels. Participants were selected using purposive sampling. Recorded interviews were transcribed verbatim and thematically analyzed with a combined deductive and inductive approach using MAXQDA 18. Results A total of 60 interviews were conducted. Women experienced various forms of mistreatment during labour and childbirth, including verbal abuse, frequent and painful vaginal examinations, neglect and abandonment, lack of supportive care, denial of mobility and pain relief, and physical abuse. Four main themes were identified as the drivers of mistreatment: (1) individual-level factors (healthcare providers perception about women’s limited knowledge on childbirth process, untrained companions, mismatched expectations of women for care, and discrimination based on ethnicity or low socioeconomic status); (2) healthcare provider-level factors (healthcare provider stress/stressful working conditions, healthcare providers with limited personal experience of pregnancy and childbirth, neglect of midwives' identities by doctors, poor educational contents and curriculum, and low salary and lack of incentive); (3) hospital-level factors (lack of staff, lack of supervision and control, type of hospital, inadequate physical structures); and (4) national health system-level factors (lack of access to pain management during labour and childbirth and perceptions about forced vaginal birth in public hospitals). Conclusions There are multiple level drivers for mistreatment which requires multifaceted interventions. These interventions should emphasize training of pregnant women and their companions, training healthcare providers, encouraging and managing work shifts, strengthening the position of midwives in public hospitals. Moreover, continuous monitoring of the performance of providers, increase staff numbers and improvement of physical space of the maternity wards, as well as implementation of the related guidelines, including painless childbirth, should also be considered.
Assessing the effects of excessive weight gain before pregnancy, in the first and second trimesters and in the month preceding glucose challenge test (GCT) on GCT results and gestational diabetes mellitus (GDM).This prospective cohort study evaluated 1279 pregnant women who were referred for their first prenatal visit in 2012-2015. Mother's body mass index (BMI) was recorded before pregnancy, during the first visit and every 4 weeks until 28 gestational weeks. All mothers underwent GCT at 28 weeks and when 1 h glucose ≥140 mg/dL (≥7.8 mmol/L), they were referred for a 100 g fasting glucose 3 h glucose tolerance test.Obesity and being overweight prior to pregnancy were associated with 2.8-fold and 1.5-fold higher rates of developing GDM (p<0.001, p=0.04) and 1.9-fold and 1.8-fold higher rates of having false-positive GCT results (p<0.001). First-trimester excessive weight gain was significantly associated with false-positive GCT in women who were lean, overweight and obese before pregnancy (all p<0.001). When these women kept gaining excessive weight during the subsequent period the risk of developing GDM was significantly increased regardless of their pre-pregnancy BMI (p=0.03). When these women adhered to the recommended weight gain during the subsequent period, the risk of developing GDM was not increased, however the risk of having false-positive GCT remained high (p<0.001).Elevated pre-pregnancy BMI independently increases the risk of GDM and false-positive GCT. First trimester weight gain is the most important predictor of GCT and GDM regardless of pre-pregnancy BMI. The weight gain during the subsequent period affects the risk of developing GDM only in women with excessive first-trimester weight gain.
Forty-one Streptococcus agalactiae isolates collected from pregnant women at 35–37 weeks of gestation were analysed for their capsular types, antimicrobial resistance determinants, distribution of virulence factors and genetic relatedness using PCR and multiplex PCR. Capsular type III was predominant (65.8%), followed by capsular type II (14.6%), Ib (7.3%), and V(4.9%). All isolates were susceptible to penicillin, vancomycin, linezolid and quinupristin-dalfopristin. Resistance to tetracycline, erythromycin and clindamycin were found in 97.6%, 24.4%, and 14.6% of isolates, respectively. The most common antimicrobial resistance gene was tetM found in 97.6% of the isolates followed by ermTR and ermB found in 12% and 7.3% of isolates, respectively. The most common virulence gene was hly (100%), followed by scpB (97.6%), bca (97.6%), rib (53.65%) and bac (4.9%). The insertion sequence IS1548 was found in 63.4% of isolates. By multi locus variable number of tandem repeat analysis (MLVA) typing, 30 different allelic profiles or MLVA types (MTs) were identified. The most frequent was the MT1 (5/41, 12.2%) and followed by MT2 (4/41, 9.75%). Our data revealed that population structure of these isolates is highly diverse and indicates different MLVA types.
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