[ effect of maternal anemia and umbilical cord cortisol level on birth weight and length]

Background and Aims: Maternal anemia in pregnancy is a considerable risk factor for both mother and fetus. Growth retardation, intra uterine fetal death, maternal cardiovascular symptoms and reduction in blood supply are among outcomes of maternal anemia. Since there are different reports about the relationship between low maternal hemoglobin level and low birght weight, the precent study was designed to determine the relationship of maternal iron deficiency in pregnancy and umbilical cord cortisol level with neonatal weight and length

Methods: This cross-sectional study was done on 500 pregnant women reffered for elective cesarean. At first, blood sample was taken for determining hemoglobin level. Then, in anemic ones [Hb<11], blood sample was taken to determin iron deficiency indices. After cesarean, blood sample was taken for determining the umbilical cord cortisol level. Data were analyzed through SPSS 20

Results: In mothers with normal hemoglobin, neonate's weight and length were significantly higher [P=0.030, P=0.039]. Umbilical cortisol level had a significant relationship with birth weight and length [P=0.001, P=0.001], but there was no significant correlation between maternal hemoglobin level and umbilical cord cortisol level

Conclusion: Maternal anemia changes the angiogenesis in placental vessels and causes growth retardation and pregnancy complications due to creating stress in mother and increasing CRH. The results of this study highlight the importance of maintaining the hemoglobin level in normal range with prescription of iron products in iron deficiency anemia and removing the risk factors of maternal hemoglobin increment. Due to the meaningful relation between umbilical cord cortisol with birth weight [direct relation] and length [indirect relation], more studies about the maternal anemia, maternal cortisol and another factors influencing on umbilical cord cortisol level are suggested

[Frequency of dysplastic and cancerous Pap smear and genotyping of human papillomavirus by DNA probe techniques in Kerman, Iran]

Around the world, cervical cancer is the second most common cancer in women. Today, screening programs have reduced morbidity and mortality rates of this disease. Epidemiological and molecular studies have shown that certain types of the human papillomavirus are carcinogen types and the primary cause of cervical cancer. HPV type 16 and 18 are the most common high-risk types. In this study, frequency of different HPV genotypes in women who referred for a routine visit to an outpatient clinic of Kerman University of Medical Sciences, Iran, has been obtained by DNA probe technique. Our study is a cross-sectional, analytic study on 20000 Pap smear samples over four consecutive years among women in reproductive ages [15-50 years] referred to University centers and private institutions in Kerman, Iran. All samples were collected in the laboratory of Afzalipour, and Bahonar Hospitals, and private institutions. The typical samples of dysplasia and cancer were reviewed by two pathologists and a pathology assistant according to the World Health Organization standards. The samples were examined after DNA extraction and molecular DNA probe technique. 62 cases of 82 Pap smear samples were dysplastic and 20 samples were diagnosed as squamous cell carcinoma [SCC]. Moreover, 20 cases [32.2%] of dysplastic Pap smears and 12 cases [60%] of SCC samples were HPV positive. A total of 32 patients [39%] were positive for HPV. Of all samples only two were genotype 18 [25.6%], one was a mixture of 16 and 31 genotypes, and the remaining were all genotype 16 [93.75%]. In the comparison between dysplasia severity [mild, moderate, and severe] and the HPV status [+ or -], and also the relation between age and status of HPV and the severity of dysplasia no relations were found. However, there was a significant relation between detection [dysplasia, SCC] and the HPV status, and also the relation between age and type of lesion diagnosis. Based on the findings of our study and the Iranian culture, prevalence of HPV infection among women with cervical cancer is less common than in other countries. HPV type 16, which is a carcinogenic genotype, was the predominant genotype

[ prevalence of hypothyroidism based on risk factors in pregnant women referred to Shahid Dadbin Clinic, Kerman, Iran]

Since at early pregnancy [<20 week] fetal thyroid gland is undeveloped, normal development of the Fetal brain is highly dependent on maternal thyroid hormones. There are excessive adverse perinatal outcomes associated with overt and subclinical hypothyroidism such as increase of Abortion, preeclampsia, placenta Abruption, LBW, preterm labor, impaired fetal neuropsychological development and low IQ scores. The aim of this study was to determine the prevalence of hypothyroidism and its relationship with some known risk factors among pregnant women with gestational age<20 wk. A total of 620 pregnant women referred to Dadbin clinic [Kerman/Iran] for their first prenatal care before the 20th week of gestational age were studied for TSH and FT4 levels by Elexis method. A questionnaire including known risk factors of hypothyroidism was filled out for each participant. The prevalence of both clinical and subclinical hypothyroidism and its probable association with some risk factors were studied. The prevalence of hypothyroidism was 10.15% [clinical=2.25% and subclinical=7.9%]. Except for allergy, no relationship between hypothyroidism and considered risk factors was found. Due to the high prevalence of hypothyroidism [clinical and subclinical] and its neonatal and maternal outcomes, hypothyroidism screening in all pregnant women as one of the routine prenatal cares is suggested

[Prevalence of various phenotypes of polycystic ovarian syndrome among high school girls of Shiraz [2009]]

Polycystic ovary syndrome [PCOS] is the most common endocrine disorder in women and cause of infertility due to lack of ovulation. The symptoms of PCOS are observed during puberty and it is assumed that the weight gain during this period to be associated with this syndrome. To determine the prevalence of phenotypes of polycystic ovary syndrome in adolescents in Shiraz. This was a cross-sectional study in which 3190 female adolescents aged between 14 to 18 years, randomly selected from high schools in Shiraz, were studied. Diagnosis of PCOS was achieved through taking history and examination based on presence of oligomenorrhea [six times menstrual cycles or less in one year], clinical signs of hyperandrogenism including hirsutism [Ferriman-Gallway scores of 6 or more], severe acne, male pattern hair loss, and ultrasonography. The hormone dehydroepiandrostandion sulfate levels were measured for all subjects. Data were analyzed using the chi square test and Fisher's t exact-test. The prevalence of PCOS phenotypes were as follows: clinical hyperandrogenism and oligomenorrhea 19.9% [29 cases], clinical hyperandrogenism and polycystic ovary 30.8% [45 cases], oligomenorrhea and polycystic ovary 29.5% [43 cases], and clinical hyperandrogenism with oligomenorrhea and polycystic ovary 14.5% [21 cases]. The frequency of highest levels of dehydroepiandrostandion sulfate was observed in patients with oligomenorrhea and hyperandrogenism. The risks of sex hormones turmoil, psychological effects of skin symptoms [acne and hirsutism], and numerous side-effects of this syndrome make it necessary to perform an early investigation in target population

Accuracy of ultrasound, clinical and maternal estimates of birth weight in term women

Accurate prenatal estimation of birth weight is useful in the management of labour and delivery. This study compared the accuracy of ultrasound, clinical and maternal estimates of fetal weight in 246 parous women with singleton, term pregnancies admitted for scheduled caesarean section. The sensitivity and specificity of predicting birth weight by ultrasound measures were 12.6% and 92.1%, by clinical palpation were 11.8% and 99.6% and by maternal estimate were 6.3% and 98.0% respectively. Clinicians' estimates of birth weight in term pregnancy were as accurate as routine ultrasound estimation in the week before delivery. Parous women's estimates of birth weight were more accurate than either clinical or ultrasound estimation

[Comparison of the diagnostic accuracy of pipelle biopsy, dilatation and curettage and hystrectomy in detection of endometrial lesions]

The current study has been designed to compare the diagnostic value of pipelle sampling as a simple and cost effective method with that of more complicated and expensive methods in the detection of pathologies in abnormal uterine bleedings. In 60 patients scheduled for hysterectomy due to persistent uterine bleeding, endometrial sampling was done twice, once with pipelle and then by D and C prior to the hysterectomy. First the pathological reports of pipelle and D and C specimens were compared with each other and then both were compared with hysterectomy as the gold standard. In all cases pipelle was passed to the uterine cavity without any need for cervical dilatation and anesthesia. The most frequent results in all tree kinds of sampling were proliferate endometrium and early secretary phase respectively. According to the pathological reports, pipelle and D and C in 89% of the cases, pipelle and hysterectomy in 80% of the cases and D and C and hysterectomy in 90% of the cases showed agreement, that shows so significant difference in diagnostic accuracy among three methods. Considering high agreement between pathological reports of pipelle biopsy as an outpatient method and those of D and C and hysterectomy, pipelle sampling is suggested as the first diagnostic procedure, while D and C and hysterectomy that necessitate anesthesia and take more time and expense should be reserved for just special cases

[Comparing the accuracy of ultrasonic, clinical and mother, fetal weight estimation in pregnant women in Kerman]

Estimation of fetal weight is very important in preventing delivery complications and also in selecting delivery method. This is specially important in potential macrosomia, IUGR and also preterm labor. The objective of this study is to compare the accuracy of ultrasonic, clinical and mothers, fetal weight estimation in pregnant women in Kerman. In this cross sectional study 246 women with singleton, term pregnancies admitted for cesarean section within the following week, were studied. Estimation of fetal weight [EFW] was done using sonography and then by two obstetricians and one senior resident who were unaware of the other clinical and ultrasonic results. Mothers' estimation of their baby weight was also asked. Statistical analysis was done by paired T and Chi square tests. We also used ROC [Radar Operating Characteristics] curve to compare the accuracy of different tests. Fetal birth weight was 3339 +/- 443 gr. In the 2500-4000 gr birth weight the sensitivity of predicting clinical birth weight was 11.8% with 99.6% specificity and for sonographic EFW was 12.6% with 92.1% specificity. Clinical estimation of birth weight in term pregnancy is as accurate as routine ultrasonic estimation obtained in the preceding week of delivery

[ case report of missed abortion in cervical pregnancy]

Naturally, blastocyte implants in the uterine cavity. Implantation of blastocyst in any other place is considered an ectopic pregnancy, which is in more than 95% a tubal pregnancy. Cervical ectopic pregnancy is a rare type of ectopic pregnancy in wich blastocyte is implanted in the cervical canal. Therefore due to serious risks of cervical pregnancy, all obstetricians facing first-trimester vaginal bleedings should consider it as a differential diagnosis. In this article a case report of missed cervical pregnancy in a 32-year old woman is presented. The patient complained of temporary vaginal bleeding during the last 25 weeks. Sonography had been performed twice; the first one in the 12[th] week of gestation showing no fetal echo and the second in 22[nd] week of gestation showing a 27x 12 mm mass and fluid in the endometrium. With the diagnosis of missed abortion suction curettage was performed at 25[th] week of gestation and it was lead to laparatomy due to active hemorrhage and clinical picture of deterioration of vital signs. During laparatomy, a dilated cervix completely invaded by throphoblasts was observed. Hysterectomy was performed with ovarian preservation as a final management. Pathologic findings showed complete implantation of placenta in the end cervix