effect of vitamin E and aspirin on the uterine artery blood flow in women with recurrent abortion: a single-blind randomized controlled trial

Background: Recurrent spontaneous abortion has high incidence rate. The etiology is unknown in 30-40%. However high uterine artery resistance is accounted as one of the recurrent abortion reasons

Objective: The objective of the current study was to determine the impacts of vitamin E and aspirin on the uterine artery blood flow in women having recurrent abortions due to impaired uterine blood flow

Materials and Methods: This randomized clinical trial was conducted on 99 women having uterine pulsatility index [PI] more than 2.5 and the history of more than two times abortions. The candidates were categorized into three groups; receiving aspirin, only vitamin E, and aspirin+vitamin E. After 2 months, uterine PIs were compared with each other

Results: All drug regimens caused an enhancement in uterine perfusion with a significant decline in uterine artery PI value. The women receiving vitamin E in accompanied with aspirin had the least mean PI of the uterine artery [p<0.001]. The total average PI score of the right and left uterine arteries in groups receiving vitamin E in accompanied with aspirin was lower than the two counterparts significantly [p<0.001]

Conclusion: Vitamin E, aspirin and especially their combination are effective in improving uterine artery blood flow in women with recurrent abortion due to impaired uterine blood flow. More well-designed studies are needed to find out whether the enhancement of uterine perfusion may lead to a better pregnancy outcome

Cervical length versus vaginal PH in the second trimester as preterm birth predictor

To evaluate diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor [PTL] predictor. During a prospective cohort study 438 uncomplicated singleton pregnant women between 18 and 24 weeks of gestation were assessed regarding vaginal PH and cervical length. Vaginal pH was measured using Ph-indicator strips and cervical length was determined using transvaginal ultrasound. The cut-off values for vaginal PH and cervical length were defined as 5 and <30 mm respectively. Vaginal pH of 5 and above was found in 162/438 women [37%] while cervical length <30 mm was found in 38/438 [8.7%]. The incidence of PTL < 37 weeks was 87/438 [19.9%] while the incidence of early [PTL <34 weeks] was 51/438 [11.6%]. Predictive value of higher vaginal PH was significantly more [31%] than vaginal PH<5 [13%] in predicting PTL. As a result, alkaline vaginal PH significantly increases the odds of preterm labor [OR=3.06]. Shortened cervical length is better predictor of PTL than higher vaginal PH with positive predictive value of 71% and negative predictive value of 85%. Cervical length less than 30 mm nearly 14-fold increases odds of preterm birth [OR=13.9]. Compared to alkaline vaginal PH, shortened cervical length has better value to predict PTL overall. However, regarding early or late PTL, vaginal PH is more accurate to predict late PTL, while cervical length measurement is more appropriate to predict early PTL [<34 weeks]

Ultrasound detection of placenta accreta in the first trimester of pregnancy

Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality. Prenatal diagnosis of placenta accreta usually is made by clinical presentation, imaging studies like ultrasound and MRI in the second and third trimester. To determine accuracy of ultrasound findings for placenta accreta in the first trimester of pregnancy. In a longitudinal study 323 high risk patients for placenta accreta were assessed. The eligible women were examined by vaginal and abdominal ultrasound for gestational sac and placental localization and they were followed up until the end of pregnancy. The ultrasound findings were compared with histopathological examinations as a gold standard. The sensitivity, specificity, positive and negative predictive value of ultrasound were estimated for the first trimester and compared with other 2 trimesters in the case of repeated ultrasound examination. Ultrasound examinations in the first trimester revealed that 28 cases had the findings in favor of placenta accreta which ultimately was confirmed in 7 cases. The ultrasound sensitivity and specificity for detecting placenta accreta in the first trimester was 41% [95% CI: 16.2-62.7] and 88% [95% CI: 88.2-94.6] respectively. Ultrasound screening for placenta accreta in the first trimester of pregnancy could not achieve the high sensitivity as second and third trimester of pregnancy

Causes of trauma in pregnant women referred to Shabih-Khani maternity hospital in Kashan

Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus. The present study was conducted in Kashan in 2009-2010 to evaluate the causes of trauma in pregnancy. This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother's occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions. The causes of trauma included falling [9 cases [28.1%]], abdominal trauma [8 cases [25%]], spousal feud [3 cases [9.4%]], motorcycle accident [2 cases [6.25%]], car accident [2 cases [6.25%]], falling from a motorcycle [2 cases [6.25%]], falling or fainting resulting in head trauma [1 case [3.1%]], pain from crossing over a bump in the car [1 cases [3.1%]], and unspecified causes [4 cases [12.55%]]. The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation. However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 [6.25%] cases and 1 [3.1%] case, respectively. Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence; therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women