Rise in cesarean section rate over a 30-year period in a public hospital in Tehran, Iran

Numerous studies show a growing trend in cesarean section rates throughout the world, including Iran. However, existing evidence in our country is scant and previous reports are restricted to short time periods. The aim of the current study is to measure the trend in cesarean sections [CS] rates over the past 30 years in a referral hospital in Tehran. We routinely collected data on the demographic characteristics of all women who gave birth in the hospital during the study period. The mode of delivery and the personnel in charge of delivery has like wise been recorded for each birth during the study period. The data were extracted from medical records and entered into a structured checklist. The rate of CS out of all deliveries increased from 14.3% in 1979 to 22.7% in 1989, 52.5% in 1999, and 85.3% in 2009 [P< 0.001]. The most common reason for CS was a repeated section. The percentage of vaginal deliveries performed by midwives has not changed significantly and the number of both midwives and obstetricians per 1000 births has increased, from 2.8 to 15.4 midwives per 1000 births and from 5.5 to 23.0 obstetricians per 1000 births. Immediate strategies should be adopted to prevent the rising trend and increasing number of unnecessary CS in Iran

[HELLP syndrome: after delivery and favorable response to corticosteroid therapy: a case report in Bank Meli Iran hospital]

HELLP syndrome is a multisystem disease and a pregnancy complication consisting of Hemolysis, Elevated Liver enzyme level and low Platelet count. [1] We report on a patient with postpartum presentation. The patient was a 28 years old female at 30th wee, of her third pregnancy referred to bank melli hospital complaining of fever, chills, dysuria and frequency and admitted with diagnosis of urinary tract infection. After few days disease was progressed and abnormal laboratory tests ensued. Due to worsening general condition the pregnancy was terminated. After delivery platelet count decreased and she met all criteria of HELLP syndrome and received corticosteroid and the disease improved. Pathogenesis of HELLP syndrome is vague and there are different hypotheses all common in endothelial damage, vasospasm and coagulation system activation. This syndrome can present in the third trimester of pregnancy [%69] or after delivery [%31]. In most patient with post partum presentation, the disease is manifested during the first 48 hours after delivery. Corticosteroid therapy in all patient with complete HELLP syndrome [hemolysis, elevated liver enzyme level and low platelet count] is recommended. We reported on patient with complete HELLP syndrome presented post partum and good response to corticosteroid therapy