ABSTRACT
Objective@#The aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. @*Methods@#Two review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, metaanalysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. @*Results@#In this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. @*Conclusion@#Results of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH.Systematic Review Registration International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610
ABSTRACT
Objective@#The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. @*Methods@#This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. @*Results@#Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). @*Conclusion@#Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.Trial RegistrationIranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4
ABSTRACT
Objective@#The aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. @*Methods@#Two review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, metaanalysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. @*Results@#In this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. @*Conclusion@#Results of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH.Systematic Review Registration International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610
ABSTRACT
Objective@#The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. @*Methods@#This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. @*Results@#Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). @*Conclusion@#Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.Trial RegistrationIranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4
ABSTRACT
Preterm birth [PTB] is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm [26-37 weeks] infants [n=1612] born alive in Shahid Akbar-abadi university hospital, during one year period [April 2010-2011]. These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights [LBW] and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age [GA] of 30 weeks and the youngest infants was a 970 gram female with GA of 25 weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation [CPR], need to neonatal intensive care unit [NICU] admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight [VLBW] and extremely low birth weight [ELBW], were risk factors for mortality in preterm neonates Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000 grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant
Subject(s)
Humans , Female , Male , Survival Rate , Infant Mortality , Perinatal MortalityABSTRACT
There is an increased prevalence of maternal substance abuse during pregnancy in younger women in all socioeconomic classes and races. Our aim was to determine the prevalence and correlates of self-reported substance abuse among pregnant women and obstetric complications or neonatal outcomes in Iran. This retrospective cohort study is covering a five year period on medical records of pregnant women attending the maternity unit of four major hospitals [Mahdieh, Taleghani, Imam Hossein and Akbarabadi Hospitals]. Women who reported using opium, heroin, crack, cannabis or methamphetamine were compared with women with no reported history of drug abuse for obstetric complications and prenatal morbidity and neonatal mortality. From 100,620 deliveries substance abuse was recorded for 519 women giving a prevalence of 0.5%. Opium was the most prevalent substance abused followed by crack [a mix of heroin and amphetamines]. The exposed group had significantly more obstetric complications including preterm low birth weight and postpartum hemorrhage than the non-exposed group. The exposed group had significantly worse prenatal outcomes including more admissions to intensive care unit and higher infant mortality than the non-exposed group. None of the women in the exposed group was on methadone treatment at time of delivery. Risks of maternal and neonatal complications were increased in substance using pregnant women, especially preterm birth and low birth weight. We recommend a multidisciplinary team to provide methadone maintenance therapy for substance using pregnant women and urinary screen of all pregnant women presenting to hospital
ABSTRACT
Right bundle branch block [RBBB] is considered as an important predictor of poor outcome in patients with acute myocardial infarction, but the prognostic implication of RBBB in patients with suspected coronary artery disease [CAD] is unclear. Furthermore, the association between RBBB and incidence of CAD also its influence on the severity of stenosis in coronary arteries has not been established. This study was designed to assess the relationship between RBBB and the presence and the severity of CAD in patients with suspected CAD. The study population consisted of 172 patients with RBBB and 174 patients with normal resting electrocardiography [ECG]. Severity of CAD was defined as estimated Gensini score according to the degree, quantity and distribution of lesions in angiographic study. According to our study based on angiographic investigations, in patients with RBBB the prevalence of CAD was 77.3 percent versus 70.1 percent in patients with normal resting ECG [P=0.13]. Also, there was no significant association between the presence of RBBB and magnitude of Gensini score [OR=0.87, P=0.62]. However, male gender and history of diabetes mellitus were associated with higher Gensini score [OR=3.41; 95% CI: 1.96-5.93, P<0.0001 and OR=3.22; 95% CI: 1.77-5.87, P<0.0001 respectively]. This study suggests that although RBBB was associated with more severity of stenosis in left coronary system [LAD and LCX], but as a whole there was no association between RBBB and the presence and severity of CAD
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Aged , Coronary Artery Disease/diagnosis , Coronary Artery Disease/epidemiology , Electrocardiography , Coronary AngiographyABSTRACT
Substance abuse is a major public health issue in all over the world. The types and ingredients of drugs used in our country are different from other countries. The study was conducted to determine relationship between substance abuse during pregnancy, and perinatal complications in Iran. A retrospective cohort study was carried out over a 6 years period on all the substance user pregnant women [519 cases] and 519 non users attending 4 major educational university hospitals labor ward. All the substance user pregnant mothers abusing heroin, opium, crack, cannabis, crystal, methadone, and polydrug were included and compared to non-exposed ones. Our study demonstrated a 0.5% prevalence of substance abuse in pregnant women. Opium [62.6%] was the most prevalent substance followed by crack [20.3%]. Pre-term birth was higher in all substance user groups, the most in crack group [45.8%] with relative risk of 2.55. Neonatal abstinence syndrome developed in 38.7% of infants born of addicted mothers [40.4% crack, 38.6% opiates, 35.3% crystal and 45.5% poly drug use]. Neonatal birth weight of infants of mothers using crack, opium and polydrug were significantly lower to non users [P<0.05]. Neonatal Intensive Care Unit [NICU] admission in substance using mothers was significantly higher than non-users [P < 0.001]. Neonatal death was 10.1% in crack group [RR=3.48] and 5.8% in opium user group [RR=2.79] with significant difference with non-users [P<0.05]. The frequent types of substances used during pregnancy in our country are different from others [opium was the most prevalent substance]. Subsequently the frequencies of the complications during pregnancy are different. Substance abuse during pregnancy has increased risk of pre-term birth, Small for Gestational Age, NICU admission and neonatal death
ABSTRACT
Women 35-39 years old have a 2-3 fold higher risk of pregnancy-related death than women in their twenties, and the risk is even more dramatic for women 40 years and older. The aim of this study was to investigate the association of maternal age with risk of adverse pregnancy and mother outcomes in our setting, Tehran, Iran. In this retrospective observational hospital-based study, 538 nulliparous women were assessed. The association between maternal age and various pregnancy and neonatal outcomes were reported. Data were extracted from the database of Akbar Abadi hospital in Tehran from 2001-2006 records. Univariate and multiple logistic regression analyses were performed to investigate the association between maternal age and various relevant outcomes. Women aged 35 years or older had an increased percentages of gestational hypertension [18.8% vs 9.6%; p=0.02] and diabetes in pregnancy [3.7% vs 1.4%; p=0.08] compared with women younger than 35 years. There were no differences between the two age groups in Agar score at 1 min, antepartum hemorrhage, preterm labor, PROM, fetal distress, perinatal death, and postpartum hemorrhage. Advanced maternal age was shown to be independently associated with low birth weight, preterm labor and rate of cesarean delivery