Maternal progesterone level in fetal growth restriction and its relationship with doppler velocimetry indices

To verify whether progesterone concentration is changed in the maternal serum of intra-uterine growth retardation [IUGR] pregnancies and to assess if there is a relationship between maternal progesterone and fetal Doppler velocimetry. Thirty-five patients with intrauterine growth retardation infants and thirty-seven pregnant women with appropriate for gestational age [AGA] fetuses were enrolled in the study. Maternal progesterone serum was determined. Doppler velocimetry of umbilical and middle cerebral arteries [MCA] were obtained in all fetuses. Maternal progesterone level in IUGR infants [58.49 +/- 7.06 ng/ml] had no significant difference with AGA fetuses [58.13 +/- 7.87 ng/ml] [p=0.96]. In the IUGR group, umbilical artery resistive index [RI], pulsatility index [PI] and systolic/ diastolic [S/D] ratio were higher than the normal group [p<0.001], and MCA RI [p value=0.014] and PI [p=0.012] were significantly less than the IUGR group. Besides, RI C/U in the IUGR group was significantly less than the normal group [p<0.001]. A negative significant correlation was detected between maternal progesterone level and MCA PI [r=-0.38] and RI [r=-0.38] in the AGA group. It seems that progesterone has no effect on fetal placental circulation and serum progesterone can not discriminate IUGR infants from AGA infants. Progesterone is a poor marker for placental dysfunction

[Prevalence of substance use among students of Guilan University of Medical Sciences [2005-2006]]

Regarding the high prevalence of substance use among youth, its destructive effects and consequent problems, this research was performed. to determine the prevalence of substance use among students of Guilan University of Medical Sciences [GUMS] This was a cross-sectional study carried out on a representative sample of 845 students of GUMS in 2006. The data such as demographic information and history of substance use were collected using a questionnaire which completed by every single student. Later, the data were analyzed by EPI 2002 software and chi-square and Fisher-Exact tests. Due to incomplete responses, 18 questionnaires were excluded. Out of a total of 827 students, 30.1% had a history of substance use at least once during their lives. The prevalence rate of each substance in use was: cigarette [26.36%], alcohol [17.04%], opium [3.86%], cannabis [2.78%], ecstasy [2.05%], heroin [1.08], crystal [0.84%], cocaine [0.84%], morphine [0.6%] and others [0.6%]. Substance use was significantly associated with male gender, higher age groups, living with friends or alone, and marital status. There were significant relationships between substance use during past 30 days and studying medicine and dentistry. In addition, a relationship between substance use; once or more during life and residency period, was observed. Our study demonstrated that the substance use among students of GUMS is considerably high and specific interventions seem to be necessary in preventing or reducing the rate of substance use in students

Acquired hemophilia as a cause of primary postpartum hemorrhage

A 32-year-old primigravid woman developed acquired factor VIII inhibitor after delivery. She presented with postpartum hemorrhage and large hematoma in episiotomy site. Laboratory examinations showed markedly prolonged activated partial thromboplastin time, low levels of factor VIII [8%], and factor VIII inhibitor [2 Bethesda units]. The bleeding was controlled successfully using combined treatment with factor VIII, intravenous immunoglobulin, steroids, and recombinant factor VIIa. Six months after delivery, factor VIII inhibitor was not present and factor VIII concentration increased to normal range. Acquired hemophilia is a life-threatening disorder. Precise screening of coagulation factors is essential for diagnosis of persisting postpartum hemorrhage

[Determination of effectvie factors on preeclampsia severity; the application of classification and regression trees]

Despite advances in medical sciences, preeclampsia and eclampsia are still among chief causes of maternal mortality worldwide. In this study, we used classification and regression trees to investigate the role of certain inherent and maternity care factors in severe preeclampsia. This study was done on 1643 pregnant women admitted at 4 hospitals in Iran with one of the 53 maternity complaints were enrolled in this study during 2005. Variables of socioeconomic status, history of pregnancy and diseases, health care visits numbers awareness of warning signs, and the body mass index before pregnancy were recorded in the analysis model as predictors, and preeclampsia severity was entered as the dependent variable. A non-parametric method, known as the classification and regression tree was used to predict the studied consequence. Model validation was done using subsets of the study sample. The results were compared with logistic regression analysis. The incidence of preeclampsia among the studied patients was 5.2%. In model 1, variables of frequent headaches and epigastric pain during pregnancy, the number of previous pregnancies, and the amount of maternal care received were predictive of severe preeclampsia. In model 2, only frequent headaches and the number of previous pregnancies were found predictive. Sensitivity for model 1 and 2 was 47.8% and 39.1%, respectively, and specificity was 96.8% and 93.6%, respectively. In logistic regression analysis, only frequent headache was related to severe preeclampsia [OR=2.5, CI 95%: 1.3-5.0]. This study showed that using of variables that can be measured during maternity care visits to predict severe preeclampsia. Regarding the simple interpretation of tree models and their application in clinical decision making, which can be used in different levels of the health care system

[Umbilical cord hematologic variables in different modes of delivery]

A variable hematological value without clinical sign of sepsis or hematological disorder is often observed in newborns. The purpose of this study was to investigate hematological measurements in umbilical cord vein of newborns delivered spontaneously or by cesarean section. We studied 150 pregnant women who delivered term normal infants. The patients were divided into two groups according to the route of delivery: vaginal [n=75] and cesarean section [n=75]. Immediately after delivery, umbilical cord blood samples were collected. Any possible relationship between mode of delivery, gestational age, gravidity, parity, sex, weight of the new born infant, and the duration of different phase of labor with the hematological parameters was investigated. We observed a significant increase in all hematologic parameters including hemoglobin and hematocrit levels and WBC, platelet and RBC counts in newborns delivered spontaneously [p<0.001]. The lymphocyte counts were similar in two groups. Male infants and newborns with higher gestational age showed a higher hemoglobin and hematocrit levels. Increased parity and gravidity correlated with a decrease in all hematological values of umbilical vein blood except of lymphocyte count [p<0.001]. Prolonged duration of first and second stage was associated with higher mean leukocyte, neutrophil, platelet, hemoglobin and hematocrit values. The mode of delivery, gestational age, parity, gravidity, sex and weight of newborn, and the duration of first and second stage of labor can influence on hematological parameters of umbilical cord blood