Determinants of caesarean birth on maternal demand in the Islamic Republic of Iran: a review

The phenomenon of caesarean birth on demand has gained attention, particularly as a first caesarean birth appears to be strongly predictive of subsequent caesareans. Identification of reasons behind caesarean birth on demand is important for planning effective interventions. Therefore, this review reports the factors involved in the tendency of women to undergo caesarean birth, based on studies in the Islamic Republic of Iran. Several keywords including caesarean delivery, childbirth, causes, maternal request/demand, and patient choice were used to search Medline, PubMed, Ovid, Scientific Information Database, Magiran, Google and Google Scholar. The search was conducted on Persian and English language articles, with no time limitation. Using content analysis, the factors influencing caesarean section were divided into 3 categories: maternal, social and healthcare giver. According to the high prevalence of caesarean section, it is important to design and implement effective programmes and interventions with consideration of the key reasons that lead women to opt for unnecessary caesarean section

Expression of placental growth factor mRNA in preeclampsia

Background: preeclampsia [PE] is a serious complication of pregnancy with hallmarks of incomplete placentation, placental ischemia and endothelial dysfunction. Imbalance between vascular endothelial growth factor [VEGF], placenta growth factor [PlGF] and their receptors play important role in pathophysiology of PE

Objective: this study was aimed to asses PlGF mRNA expression in placenta of women affected with PE

Material and Methods: in this cross-sectional study, expression of PlGF mRNA was evaluated in 26 mild PE cases, 15 severe preeclamptic women and 20 normotensive controls. Patients were sub-classified as early onset PE [9] and late onset [32]. After RNA extraction, PlGF expression was quantified with qRT-PCR

Results: the results of PlGF mRNA expression between mild-severe, and early-late onset PE patients showed no statistically significant difference compared with the control group [p=0.661, p=0.205 respectively]

Conclusion: despite we found no distinct differential expression of PlGF mRNA in placental tissue of PE patients compared with control women, but according to decreased level of this angiogenic factor in PE even before clinical onset of the disease, determining molecular mechanisms related to reduced secretion of PlGF into the maternal circulation may be useful for future therapeutics

Accuracy of Soluble Endoglin for Diagnosis of Preeclampsia and its Severity

Background: The use of biomarkers for diagnosis of Preeclampsia [PE], a life-threatening pregnancy disorder, could reduce serious complications of this disease. In this study, we investigated dysregulation of endoglin [Eng] expression and diagnostic accuracy of soluble endoglin [sEng] in PE patients

Methods: For this case-control study, 26 mild and 15 severe preeclamptic women along with 20 normotensive controls were recruited. The expression level of Eng [the co-receptor of TGF-[31] was evaluated using qRT-PCR

Also, the serum concentration of soluble Eng and expression of membranous Eng were determined by ELISA and immunohistochemistry

Results: A significant up-regulation in Eng mRNA and sEng levels was observed in PE patients versus normal controls. Immunohistochemistry [IHC] showed up-regulation of membranous Eng staining in syncytiotrophoblast and cytotrophoblast cells of PE patients

The serum levels of sEng were significantly increased in all patients [mild, sever, early- and late-onset] as compared to healthy pregnant women [P<0.001]. Receiver-operating characteristic [ROC] curve analysis revealed that sEng had the highest accuracy in distinguishing PE from normal pregnancies with cut-off value of 20.4, sensitivity of 92.1%, specificity of 90%, and area under the curve [AUC] of 0.94 [95% Cl: 0.88-1.00]

Conclusions: Our data showed that the up-regulation of Eng mRNA along with its membranous and soluble form in PE patients leads to defect in angiogenesis pathway. Also, the results of this study revealed sEng potential as a marker for diagnosis of PE and its severity

The imbalaace in expression of angigenic and anti- angiogenic factors as candidate predictive biomarker in preeclampsia

Preeclampsia is an importait pregnancy disorder with serious maternal and fetal complications uliich its etiology has not been conlpletely understood yet. Early diagxosis and management of disease could reduce its potential side effects. The vascular endothelial growth Factor [VEGF] family including VEGF-A is the most potent endothelial growth factor which induces angiogenesis and endotheha1 cell proliferation and has basic role in vasculogenesis. VEGF and its tyrosine kinase receptors [Fltl and 1U]R] are major factors for fetal and placental aigiogenic development. Finding mechanisms involved in expression of angiogenic factors may lead to new prognostic and therapeutic points in management of preeclampsia. Recent researches, has shown capability of some antiangiogenic factors as potential candidate to be used as early predictors for preeclampsia. Soluble fins-like tyrosin lcinase-1 [sFltl] is a truncated splice variant of the membrane-bound VEGF receptor Fltl, that is produced by the placenta and it can bind to angiogenic gsowth factors and neutraliz, their effects. It is also observed that the ratio of sFItl to placental growth factor is valuable as prognostic marker. In this review, VEGF family member's role in angiogenesis is evaluated as biomarkers to be used for prediction of preeclampsia.

Evaluation the frequency of factor V leiden mutation in pregnant women with preeclampsia syndrome in an Iranian population

Role of genetic factors in etiology of preeclampsia is not confirmed yet. Gene defect frequency varies in different geographic areas as well as ethnic groups. In this study, the role of factor V Leiden mutation in the pathogenesis of preeclamsia syndrome among the pregnant population of northern shore of Persian Gulf in Iran, were considered. Between Jan. 2008 and Dec. 2009, in a nested case control study, pregnant women with preeclamsia [N=198] as cases and healthy [N=201] as controls were enrolled in the study. DNA were extracted from 10 CC peripheral blood and analyzed for presence of factor V Leiden mutation in these subjects. The maternal and neonatal outcomes of pregnancy according to the distribution of factor V Leiden were also compared among cases. In total, 17[8.6%] of cases and 2 [1%] of controls showed the factor V Leiden mutation. The incidence of factor V Leiden was typically higher in preeclamsia women than control group [OR: 9.34%95 CI: 21.12-41.01]. There was no difference in incidence rate of preterm delivery <37 weeks [OR: 1.23%95 CI: 0.38-4.02], very early preterm delivery <32 weeks [OR: 1.00%95 CI: 0.12-8.46], intra uterine fetal growth restriction [IUGR] [OR: 1.32%95 CI: 0.15-1130], and the rate of cesarean section [OR: 0.88%95 CI: 0.29-2.62] among cases based on the prevalence of factor V Leiden mutation. The pregnant women with factor V Leiden mutation are prone for preeclampsia syndrome during pregnancy, but this risk factor was not correlated to pregnancy complications in the studied women