Pregnancy complications and neonatal outcomes in multiple pregnancies: a comparison between assisted reproductive techniques and spontaneous conception

This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies [ART] to spontaneous pregnancies. In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student's t test, chi square and logistic regression [p<0.05]. There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups [p<0.001]. The ART group had significantly higher preterm labor and premature rupture of membranes [PROM] whereas pregnanc-induced hypertension [PIH] was higher in the spontaneous group [p=0.01]. Newborn intensive care unit [NICU] admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome [RDS], NICU admission and Apgar score were independent predictors for neonatal complications. Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART

Nucleated red blood cells count in pregnancies with idiopathic intra-uterine growth restriction

Objective: Elevated nucleated red blood cell [NRBC] count is introduced as a potential marker of intra-uterine growth restriction [IUGR]. To investigate the probable association regardless of any known underlying disease, we aimed to study disturbances in NRBC count in infants experiencing idiopathic IUGR

Materials and methods: Twenty three infants regarded IUGR without any known cause were chosen to be compared to 48 normal neonates. Blood samples were collected instantly after birth and the same measurements were done in both groups

Results: NRBC count/100 white blood cells was significantly higher in the IUGR group [P value < 0.001]. pH measurements did not reveal any significant difference

Conclusion: Increased NRBC count in cases of idiopathic IUGR in absence of chronic hypoxia could strengthen its predictive value suggested in previous studies. It could help early IUGR detection and beneficial intervention

Dicephalic parapagus tribrachius conjoined twins in a triplet pregnancy: a case report

Dicephalic parapagus tribrachius conjoined twin is a very rare condition. We present a case of 5-days-old male dicephalic parapagus conjoined twins. The conjoined twins were diagnosed in 4[th] month of pregnancy by ultrasonography. The pregnancy terminates at 36 weeks by cesarean section and triplets were born. The babies were male conjoined twins and another healthy male baby. Many congenital defects of interest can now be detected before birth. Sever form of this malformation precludes postpartum life. It is supposed that with advances in screening methods for prenatal diagnosis these cases are terminated in first or second trimester of pregnancy

effect of paternal age on preterm births; a survey of 281 cases

To determine the effect of paternal age on preterm births in Iranian neonates. From January 2005 to January 2006, two hundred eighty one preterm neonates born in Mirza Kuchakkhan Hospital enrolled in this cross-sectional study. A structured questionnaire was applied for recording following data: birth weight, sex, gestational age, maternal age and paternal age. The study was limited to neonates whose maternal age was between 20 and 30 years to eliminate its confounding effect. Near 50% of fathers were between 30-39 years old and more than half of neonates had gestational age between 35-37 weeks. There were no relation between either paternal age [p= 0.1] or birth weight [p=0.5] and neonatal gestational age. In women with parity one, there was not significant difference between gestational age among different paternal age levels [p= 0.6] as well as women with parity two and three [p=0.2, p=0.3]. Paternal age has no effect on gestational age and birth

Comparison of two regimens of RhG-CSF in neutropenic neonatal septicemia: a randomized clinical trial

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals [Tehran, Iran]. The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10 micro g/kg/s.c. to neonates in group A and as 10 micro g/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups [P>0.05]. The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups [P>0.05]. The results of this study showed that administration of a single dose of RhG-CSF [10 micro g/kg] was effective in treating neonatal septicemic neutropenia

effect of ephedrine on fetal outcome in treatment of maternal hypotension caused by spinal anesthesia during cesarean section

Spinal anesthesia causes hypotension which is a physiologic component during cesarean section. Ephedrine is used for prevention and treatment of maternal hypotension during spinal anesthesia. The aim of this study is to evaluate the effect of transient hypotension which is normalized with ephedrine on fetal outcome. Eighty women with singleton pregnancies scheduled for elective cesarean section under spinal anesthesia were divided to two groups. The control group was women with normal BP, and case group were women with hypotension who received ephedrine. Two groups were compared for these variables: maternal BP and HR, nausea and vomiting, neonate Apgar and fetal cord blood gases. No difference was found between two groups for variables of age, BMI, weight, height, mean BP, mean HR, serum volume, fetal Apgar in 1 and 5 min and fetal cord fetal blood gases. Dosage of oxytocin used was significantly different between two groups [P-value = 0.003]. Transient hypotension which is treated by ephedrine does not have any effect on acid base situation of baby and treatment of hypotension with ephedrine in pregnant women is a safe procedure

Fetal laceration injury at caesarean delivery

The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during caesarean delivery. Total deliveries, caesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in four university hospital. The gestational age, the presenting part of the fetus, the type of incision, and maternal age and parity were recorded. Caesarean deliveries were divided into elective and emergency procedures. Fetal lacerations were grouped according to the location and the need for surgical intervention. Of 19217 deliveries, 8840 women were delivered by caesarean birth [46%]. Neonatal records documented 87 accidental fetal lacerations. Of these accidental lacerations, 16 needed surgical repair and 62 recovered by dressing. Head and neck was the most common site of laceration [64.1%]. The overall rate of accidental fetal laceration per caesarean delivery was 0.88%. The rate of emergency caesarean was 45 [56.69%] and for elective procedures was 33 [42.4%]. The risk for fetal accidental laceration was higher in foetuses who underwent emergency caesarean birth [P<0.001]. Fetal accidental laceration may occur during caesarean delivery and its incidence is significantly higher during emergency caesarean delivery. The patient should be counselled about the occurrence of fetal laceration during caesarean delivery to avoid litigation

[Clinical, epidemiological, and molecular evaluation of SMA type I in Iran [a pilot study]]

Spinal muscular atropies are common [genetically determined] disorders. They are heterogeneous both in genetic and phenotypic characteristics. Prevalence of disease was reported between 1 in 6000 to 1 in 25000 in different populations. So, carrier frequency should be 1 in 40 to 1 in 80 in those people. Deletion of both copies of SMA, gene was detected in more than%90 of SMA patients. According to present data there were not any epidemiological study and data in Iran regarding SMAs. So, we do not have accurate information about prevalence, incidence of disease and its carrier frequency. Because of high rate of consanguinity it should be high. With this background, we decided to carry this pilot study out, to determine prevalence, incidence, carrier rate, along with consanguinity rate, clinical spectrum, and molecular abnormality in the affected cases. In a 2 years period, 30734 live-born babies followed, 4 patient affected to SMA type I were detected. Prevalence of SMA I in this population was 1 in 7683, and carrier frequency was 1 in 43. At least 2 third of the newborn babies were product of consanguineous marriages

Neonatal ovarian cyst: a case report

Ovarian cysts are the most frequent, prenatally diagnosed intra-abdominal cysts. Prenatal ultrasonography allows diagnosis of ovarian cysts and may suggest antenatal complications. The management of fetal ovarian cysts is still controversial despite the improvement in prenatal diagnosis with ultrasonography. Some studies suggest an aggressive management, while others plead for a conservative one. We report on the first successfully treated large neonatal ovarian cyst from Iran. She was a normal-term infant with respiratory distress due to the large size of the ovarian cyst diagnosed prenatally. We didn't find any other related anomaly in the neonate. Neonatal simple ovarian cysts are rare, but may cause complications. Most small simple cysts regress spontaneously; surgical intervention is reserved for complicated or large size ovarian cysts

Predicting the risk of preterm laborby second trimester measurement of maternal alpha-fetoprotein levels and a risk factor scoring system

Preterm labor [delivery after 20 weeks and before 37 weeks of gestation] is the leading cause of prenatal mortality in developed countries. Many women who have preterm labor have abnormally high plasma levels of a-fetoprotein in early pregnancy.This study was designed to evaluate the ability of this biochemical test and a clinical risk factor scoring system to prospectively discriminate pregnancies at high risk for preterm delivery. In nested case control study six-hundred women were studied prospectively from the early second trimester until delivery. There were sixty women in the study group [those with preterm delivery] and sixty women in the control group [those with term delivery]. A plasma level sample was collected during the second trimester, between 17 and 30 week's gestation. Then a-fetoprotein was determined in both groups.The mean AFP level was 196.75 +/- 151.48 IU/mL in the study group and85.98 +/- 55.90 IU/mL in the control group, both of which were statistically significant [p<0.001']. The mean infants age was 33.11 +/- 3.40 weeks in the study group and 38.83 +/- 0.86 weeks in the control group [p<0.001] and mean of birth weight was 1988 +/- 672.33 gr in the study group and 3241.50 +/- 405.98 gr in the control group [p<0.001]. The risk factor scoring system was >10 in 17% of women in the study group and in 8% of women in the control group. The sensitivity, specificity, PPV and NPV of this test was 78%, 65%, 69.10 and 75% respectively. The accuracy of the test, LR+ and LR- were 71%, 2.24 and 0.333 respectively.The combination of measurement of maternal serum AFP in the second trimester associated with a risk factor scoring system provides a more accurate indicator of the risk of preterm delivery and therefore may be of use in targeting prevention strategies