[ effect of tranexamic acid on pregnancy outcome and vaginal post-parturition hemodynamics]

Tranexamic acid, as an anti-fibrinolytic agent, has been shown to reduce bleeding, but its use has been limited in the scope of vaginal delivery. The purpose of this study was to examine the effect of tranexamic acid on pregnancy outcome and vaginal post-parturition hemodynamics. In a randomized, double-blind clinical trial, 200 primgravida pregnants were divided into the two groups [case and control]. The case group received IV tranexamic acid immediately post-parturition and the control group IV glucose 5%. Hemoglobin [Hb] on admission and 24 hours post-parturition were measured and Hb level drop more than 10% was considered as postpartum hemorrhage. The Hb status was evaluated through measuring blood pressure and heart rate. The pregnancy outcome measures [e.g. changes in Hb level, need for the additional uterotonic drugs, blood transfusion and surgery] were evaluated. There was a significant difference between the two groups in Hb level drop within the first 24 hours post-parturition. Moreover, no severe bleeding, blood transfusion and misoprostol administration were reported in the case group, but 4 cases in the control group. Tranexamic acid administration can effectively reduce post-partum bleeding and therefore prevent a further decrease in maternal Hb levels

[Frequency of group B capsular serotypes of Streptococcus using the multiplex PCR among the pregnant women in Kashan during 2011-2013]

Group B Streptococcus [GBS] has been described as an important pathogen in newborns and pregnant women. Maternal vaccination against GBS can reduce maternal GBS colonization and enhance antibody transfer to the fetus and also prevent the subsequent infections. Nine serotypes can be identified based on capsular polysaccharide: Ia, Ib, II-VIII. Due to the changes in serotypes' distribution pattern over time and also variation in different geographic areas, production of a universally optimal vaccine is impossible. This study aimed to evaluate the serotype distribution of GBS using the multiplex PCR among the pregnant women. This study was performed on 382 pregnant women. Vaginal swab samples were placed in the LIM selective medium and incubated at 37°C for 24 h. Then the samples were cultured in blood Agar medium and the GBS was identified and confirmed using the standard tests and gene encoding dlts, respectively. Capsular typing was performed using the multiplex PCR method to identify the Ia, Ib, II-VIII serotypes. Thirty-six [9.4%] out of 382 pregnant women were carriers of GBS. The most common types were III [32.14%], V [21.43%], and IV [14.3%], respectively. Types II and VIII were not identified in this study. Considering the high prevalence of III, V and IV serotypes in this study, they are potential sources for the production of multivalent GBS vaccines in near future

[Comparison between effects of intravenous labetalol and hydralazine on control of hypertension and maternal and neonatal outcomes in severe preeclamptic patients: a randomized clinical trial]

Severe preeclampsia and eclampsia are responsible for 25% of maternal mortality, especially in developing countries. Considering the importance of this complication, the present study aimed to compare between effects of labetalol and hydralazine on control of hypertension and the maternal and neonatal outcomes in severe preeclamptic patients. This clinical trial study was conducted on 190 severe preeclamptic patients classified into two groups [95 subjects in each group]. Two groups were randomly received hydralazine [5 mg intravenously, every 20 minutes, up to a maximum of five doses] or labetalol [at first 20 mg intravenously, and if not effective, 40, 80, 80, 80 mg respectively, every 20 minutes, up to a maximum of five doses]. In both groups, blood pressure and heart rate were recorded 20 minutes after drug administration. Blood pressure control, as well as the maternal and neonatal outcomes, compared between two groups. Maternal and neonatal outcomes were compared using chi-square, Fisher's exact, Mann-Whitney, and t tests. All significant differences were at p<0.05. Demographic characteristics and blood pressure control were similar in both groups, only five women in the hydralazine group and four women in labetalol group had persistent severe hypertension after maximum of five doses. Hypotension was not observed in both groups. Maternal tachycardia was similar in two groups. Others maternal and neonatal outcomes had no significant differences between two groups. According to the results of this study, the effect of labetalol and hydralazin is similar in the control of hypertension in severe preeclamptic patients and there isn't significant different in maternal and neonatal outcome in two groups

[Accordance between serum beta-hCG and vaginal ultrasonography in confirming a complete abortion]

Considering that there is no general agreement on use of misoprostol as the best method for the termination of pregnancy in first trimester, this study aimed to compare the vaginal ultrasonography and serum beta-hCG in the confirming of a complete abortion. This study was performed on 133 patients with a missed abortion or the blighted ovum diagnosed by vaginal ultrasonography, and a 12 week gestational sac admitted to Shabih-Khani hospital of Kashan in 2010. The patients' serum beta-hCG levels were measured. They were assessed for the tissue discharge [abortion] after taking one or two doses of vaginal misoprostol suppositories and the oral contraceptive pills prescribed after confirming the abortion. Then vaginal ultrasonography and the serum beta-hCG measurement were performed to diagnose the complete abortion in the second and fourth weeks of pregnancy. Among 133 patients, a complete abortion was diagnosed for 116 [87.2%] and 80 cases [60.15%] based on beta-hCG level and vaginal ultrasonography, respectively in the second week of pregnancy. In other cases, a complete abortion was diagnosed using both beta-hCG level and vaginal ultrasonography in the fourth week. Therefore, beta-hCG level was more effective [98.75%] than the vaginal ultrasonography to diagnose a complete abortion in the second week of pregnancy. The accordance between the two methods was 0.327 at the end of the second week of pregnancy. The measurement of beta-hCG level and vaginal ultrasonography are equally effective to confirm a complete abortion. Hence, to diagnose the complete abortion, determining the beta-hCG level followed by clinical examination is recommended

[Evaluating the diagnostic value of transvaginal ultrasonography for endometrial abnormalities in premenopausal women with abnormal uterine bleeding]

Abnormal uterine bleeding [AUB] is a common and serious problem in women of late reproductive age and an indication for endometrial biopsy as an invasive method. On assessing AUB, in some cases, even with the observation of normal thicker endometrium in ultrasonography, abnormal biopsy is reported. Thus, this study was carried out to assess the role of measuring endometrial thickness by transvaginal ultrasonography as a screening tool for premenopausal women with abnormal uterine bleeding. In this diagnostic study, 154 premenopausal women with AUB referred to Naghavi Clinic of Kashan University of medical sciences during 2010-11. Transvaginal ultrasonography was performed to assess endometrial thickness before the Pipelle endometrial biopsy at the first day of menstruation. The biopsies were then sent to a pathologist unaware of the results of transvaginal ultrasonography and finally, the Roc curve was utilized to determine the best cut-point. Forty-eight out of 154 cases [31.2%] had abnormal endometrium [hyperplasia 23.2%; polyps 3.9%; and asynchronous 3.9%]. The reported thickness of endometrium with the sensitiveity and specificity of 76.2% and 41.1% [PPV=33.6%, NPV=82.1%, LR+=1.29 and LR- =0.58] was 7 mm. Although endometrial thickness of