Maternal serum uric acid level and maternal and neonatal complications in preeclamptic women: a cross-sectional study

Background: Preeclampsia is associated with maternal and neonatal complications. It has been indicated that increased uric acid might have a predictive role on preeclampsia

Objective: We aimed to investigate the relationship between the level of uric acid with maternal and neonatal complications in women with preeclampsia

Materials and Methods: In this cross-sectional study, 160 singleton preeclamptic women at more than 28 wk gestational age were included. Hemoglobin, hematocrit, platelet count, liver and uric acid tests, and maternal and neonatal complications were assessed. The severity of preeclampsia, placental abruption, preterm labor, thrombocytopenia, elevated alanine aminotransferase and aspartate aminotransferase [ALT and AST], HELLP syndrome, eclampsia and required hospitalization in the ICU was considered as the maternal complication. Fetal complications were: small for gestational age [SGA], intrauterine fetal death, hospitalization in the neonatal intensive care unit, and Apgar score <7 at five minutes

Results: Of our participants, 38 women had severe preeclampsia [23.8%]. The mean level of uric acid in women with severe preeclampsia was significantly higher than non-severe preeclampsia [p=0.031], also in those with an abnormal liver test [p=0.009]. The mean level of uric acid in women with preterm delivery was significantly higher than women with term delivery [p=0.0001]. Also, the level of uric acid had no effect on neonatal hospitalization in neonate invasive care unit. Based on logistic regression, the incidence of severe preeclampsia not affected by decreased or increased serum levels of uric acid

Conclusion: With higher level of uric acid in server preeclampsia we can expected more complications such as hepatic dysfunction and preterm delivery. Thus serum uric acid measurement can be helpful marker for severe preeclampsia

Comparison of sexual dysfunction in women with infertility and without infertility referred to Al-Zahra hospital in 2013-2014

Background: One of the affected aspects in infertile women that have not been given sufficient attention is sexual function. Sexual function is a key factor in physical and marital health, and sexual dysfunction could significantly lower the quality of life. Aim of this study was to assess the comparison sexual dysfunction in women with infertility and without infertility, admitted to Al- Zahra Hospital

Objective:We decided to assess the prevalence of women sexual disorders in fertile and infertile subjects, admitted to Al-Zahra Hospital

Materials and Methods:149 fertile and 147 infertile women who referred to infertility clinic of Al-Zahra Hospital during 2013-2014 were entered this crosssectional study and Female Sexual Function Index questionnaire [FSFI] had been filled by all the cases. Most of women were married for 6-10 years [35.5%] and mean marriage time in participants was 9.55 +/- 6.07 years. Data were analyzed using SPSS software Ver. 18 and Chi[2] P test and logistic regression model has been used for analysis

Results: Results showed significant differences between desire [p=0.004], arousal [p=0.001], satisfaction [p=0.022] and total sexual dysfunction [p=0.011] in both groups but in lubrication [p=0.266], orgasm [p=0.61] and pain [p=0.793] difference were not significant

Conclusion:Some of sexual dysfunction indices are high in all infertile women. Our findings suggest that infertility impacts on women's sexual function in desire, arousal, satisfaction and total sexual dysfunction. Health care professional should be sensitive to impact that diagnosis of infertility can have on women's sexuality

Predictive value of maternal serum beta-hCG concentration in the ruptured tubal ectopic pregnancy

Measurement of serum beta-hCG concentration commonly used to diagnose tubal ectopic pregnancy [EP] and follow up patients treated conservatively. The aim of this study was to determine the predictive value of maternal serum beta-hCG concentration in ruptured tubal ectopic pregnancy to help physicians identify those women who are at greatest risk. This is a cross-sectional study conducted on all women with a diagnosis of tubal ectopic pregnancy who were treated in Alzahra Hospital, in Rasht, from March 2002 to February 2011. The data was collected for each woman from medical records and included age, parity, gravidia, gestational age, primary level of serum beta-hCG, rupture status, past history of pelvic inflammation disease, EP, abortion, and intrauterine contraceptive device use. Women with tubal rupture were compared to those without rupture. Statistical analysis was conducted by SPSS 19 for Windows. A total of 247 cases of tubal ectopic pregnancy were recorded during the study period. One hundred and ninety seven [79.8%] were cases with unruptured EP and 50 patients [20.2%] were cases with ruptured EP. The mean level of beta-hCG was significantly higher in patients with ruptured EP compared to patients with unruptured EP [p=0.03]. Logistic regression analysis revealed that >1750 IU/ml of beta-hCG levels [OR: 1.41; 95% CI: 1.18-1.68] was the significant risk factors for tubal rupture. Higher beta-hCG levels seem to be significant risk factors for rupture of a tubal EP

Predictive value of aspartate aminotransferase and alanine aminotransferase levels in vaginal fluid for the diagnosis of premature rupture of membranes

Preterm premature rupture of membranes [PPROM] occurs in 3% of pregnancies and 30-40% of preterm labors are related to this problem. Early diagnosis of PPROM is very important due to its impact on pregnancy outcomes. To determine the diagnostic value of aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes as a non-invasive and available test. A total of 148 pregnant women between the 26th-36th gestational weeks were enrolled in the study. 74 patients were in PROM group and 74 in control group. AST and ALT levels in vaginal fluid were measured in each group. Mann Whitney U-test was used to compare AST and ALT levels in each group. The mean of AST level in vaginal fluid was 12.77 +/- 10.06 in PROM group vs. 6.91 +/- 10.92 in control group [p<0.001], while there were no significant difference between ALT levels in PROM group 1.51 +/- 3.17 and control group 0.89 +/- 1.15 [p=0.49]. Optimal cut point of AST for the diagnosis of PROM was 4.5 IU/L in this study. The sensitivity, specificity, positive and negative predictive values were 82.4%, 63.5%, 69.32% and 78.33% respectively. According to the findings of this study, measurement of AST level in vaginal fluid can be used as a reliable test for diagnosis of PROM, but there is no good cut point for ALT level that can be practically used

relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor

Vaginal bleeding is a common complication during pregnancy, which is observed in about 1/4 of pregnancies and in half of cases can lead to abortion. If vaginal bleeding happens during pregnancy some adverse pregnancy outcomes, including perinatal mortality and morbidity, low birth weight and preterm delivery will be increased. The aim of this study was to determine the relationship between vaginal bleeding and its characteristics in the first and second trimester of pregnancy and preterm labor. This is a case-control study conducted on 440 pregnant women referred to Al-Zahra Hospital in Rasht, Iran. Data were collected by a form. The form included demographic characteristics and confounding factors, the occurrence of bleeding during pregnancy and its features. Data were analyzed by T test, chi square and logistic regression in SPSS 16. Findings showed that vaginal bleeding was associated with 3 times increased risk of preterm delivery [OR: 3, 1.84-4.89]. Also, findings showed that bleeding characteristics including bleeding time, frequency, severity and intensity was significantly associated with preterm labor. According to significant association between vaginal bleeding and preterm delivery, it seems that performing some interventions to prevent preterm labor could be appropriate.

Comparison of nucleated red blood cells in the umbilical cord of term neonates in healthy women and women with preeclampsia

Background: asphyxia is a common cause of perinatal mortality in 5-10% of all births worldwide. The present parameters for determining perinatal asphyxia, e.g. preeclampsia, cannot be considered as markers per se, and require auxiliary markers, e.g. increased number of nucleated red blood [NRBC] cells, for early diagnosis of perinatal asphyxia

Objective: in this study, we evaluated the mean NRBC count in preeclampsia and to determine the usefulness of the NRBC as independent prognostic factors of perinatal complications

Materials and Methods: this was a cross-sectional study in order to compare the NRBC in the umbilical cord of term neonates born to 50 mothers with preeclampsia and 150 normal mothers. The exclusion criteria were mother's affliction with complications of pregnancy and inexact last menstrual period. The variables under study were maternal and neonatal data. The count of NRBC was determined with standard laboratory procedures in the blood samples from umbilical cord of the neonates. The acquired data were fed into SPSS 16 software and analyzed using statistical tests

Results: the mean value of NRBC count was significantly higher in preeclamptic women [p<0.0001]. The average 1[st] and 5[th] minute Apgar scores were significantly higher in normal mothers [p<0.001]

Conclusion: increase of NRBC in neonates born to mothers with preeclampsia may be due to chronic hypoxia; this group of neonates has increased risk and requires more precise and extensive care during delivery and after birth in order to have reduced mortality and complications during the neonatal period

Survey of predictive value of 4-hour urine collection for diagnosis of proteinuria in preeclampsia

Measuring the 24-hour urine protein >/= 300 mg is the standard threshold value for diagnosis of preeclampsia. This study was intended to determine if a patient's 4-hour urine protein correlate with the 24-hour value for diagnosis of preeclampsia. This was a cross sectional study performed on 84 women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1+ and BP >/= 140/90 at Al-zahra Educational Hospital in Rasht [Iran] from May 2007 to January 2008. Urine samples were collected within 24 hours in successive periods: The first 4-hour and the next 20-hours urine, in separate containers. The protein contents of 4-hour and 24-hour urine samples were calculated. Data were analyzed by intra-class correlation coefficient, and Receiver Operating Characteristic [ROC] curve. The ROC curve showed the cut-off point of 55.5 for 4-hour urine protein. The correlation between 4- and 24-hour urine protein excretions identified that most women [about 85.1%] with protein excretion rate of 300 mg/24h or more [with preeclampsia] had the same amount of protein of 55.5 or more in their 4-hour urine excretion [p<0.001]. Also, most of them [about 83.7%] with a total urinary protein excretion of less than 300 mg/24h [no preeclampsia] had a protein excretion rate of less than 55.5 mg/4h. This study showed 4-hour protein collection can be used as acceptable substitute for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia and the cut-off point for 4-hour urine protein is 55.5 mg

Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index

Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. The purpose of this study was to compare the pregnancy outcomes of a borderline versus normal AFI. This cross-sectional study was carried out on a total of 235 pregnant women referred to Alzahra Medical Center between 2009-2011. Women with a singleton pregnancy in third trimester were enrolled into this study; of these subjects, 141 cases were in normal AFI group and 94 cases in borderline AFI group. Adequate information was obtained from the patients' medical record and the groups were compared on maternal and fetal complications. Data analysis was performed by using SPSS. The mean maternal age in borderline AFI group was 25.96 +/- 5.92 years and in normal AFI group was 27.88 +/- 6.5 years [p=0.023]. Maternal outcomes such as preterm delivery and labor induction in women with borderline AFI were considerably higher than those in normal group [p=0.01 and p=0.001]. There were no significant differences between the two groups in terms of high blood pressure, preeclampsia, diabetes and neonatal respiratory distress. The borderline AFI group had higher rate of neonatal complications such as Apgar score of less than 7 [p=0.004], IUGR [0.0001], LBW [0.001], and crucial need to NICU [0.003]. Findings indicated that there are statistical differences between adverse outcomes in borderline AFI group and normal group

impact of different time intervals between hCG priming and oocyte retrieval on ART outcomes

Abnormal oocyte morphology has been associated with the hormonal environment to which the gametes are exposed. In this study, we evaluated the oocytes morphology, fertilization rate, embryos quality, and implantation rate resulted of retrieved oocytes in different times after human chorionic gonadotrophin [HCG] administration. A total of 985 metaphase II oocytes were retrieved 35, 36, 37 and 38 h after the injection of HCG as groups 1, 2, 3, and 4 respectively. Oocyte morphology was divided into [I] normal morphology, [II] extracytoplasmic abnormalities, [III] cytoplasmic abnormalities and [IV] intracytoplasmic vacuoles and in each group, oocytes were evaluated according to this classification. Extracytoplasmic abnormalities were encountered in 17.76% and 31.1% of these oocytes [groups 3 and 4 respectively, p=0.007] in comparison with 12.23% group 2. Cytoplasmic abnormalities in group 4 were higher than other groups. 23.88% [p=0.039] and 43.25% [p=0.089] of resulted 2PN [two pronucleus] from groups 3 and 4 showed grade Z3 respectively in comparison to group 2 [16.44%]. Normal and various categories of abnormal oocytes did not differ regarding fertilization and cleavage rates [p=0.061]. However, group 4 showed significant difference in the rate of embryos fragmentation [grade III and IV embryo] in comparison with group 2 [40.96% vs. 24.93%, p=0.078]. The pregnancy rate was higher in G2 and G3 groups [28.5 and 24.13% respectively]. Oocyte retrieval time following HCG priming affected on oocyte morphology, 2PN pattern and embryos qualities subsequently. Both good quality embryo formation and pregnancy outcomes were noticeably higher when oocytes were retrieved 36 h after HCG priming in ART program

Evaluation of serum creatine phosphokinase in diagnosis of tubal ectopic pregnancy compared with intrauterine pregnancy and threatened abortion

Vaginal sonograghy and serial beta-hCG are the most common diagnostic methods for ectopic pregnancy but about 50% of cases are initially misdiagnosed. In tubal pregnancy the zygote lies next to the muscular layer, and this invasion causes an increase in creatine phosphokinase [CPK] in blood. assessment of CPK and its isoenzyme CPK-MB as a diagnostic marker for tubal pregnancy. In this case-control study, 111 women between 16-40 years in first-trimester pregnancy admitted to emergency ward of Rasht Alzahra hospital with abdominal pain or vaginal bleeding were included and according to sonography and beta-hCG divided into 3 groups [N=37]: tubal pregnancy [1], threatened abortion [2] and normal pregnancy [3]. Blood samples were taken for totalCPK and CPK-MB before any invasive procedure. Mean total CPK level were 96.27 +/- 63.9 u/lit [group 1], 55.37 +/- 14.1 u/lit [group 2] and 48.94 +/- 19.2 u/lit [group 3] and was significantly higher in tubal pregnancy compared to other groups. Mean CPK-MB levels in 3 groups were 15.62 +/- 5.2 u/lit, 17.32 +/- 6.9 u/lit, and 15.1 +/- 4.7 u/lit, respectively which was not significant. It seems that determination of total CPK can enhance the diagnostic value of tubal pregnancy

The prevalence of polycystic ovary syndrome [PCOS] in high school students in Rasht in 2009 according to NIH criteria

Polycystic ovary syndrome [PCOS] is the most common endocrine disorder in women associated with many reproductive, endocrine, metabolic and cardiovascular dysfunctions. This study aimed to determine the prevalence of PCOS among high school students in Rasht. In a cross-sectional study, 1850 students were selected by a multi-stage cluster sampling from all high schools in Rasht. The inclusion criteria were: age 17-18 years, menarche from 10-16 years, normal prolactin and thyroid stimulating hormone [TSH] values, no history of anatomical malformation, no use of medication or hair-removal techniques, and a history of oligo- or amenorrhea. PCOS was diagnosed if both menstrual dysfunction and clinical hyperandrogenism were detected. Mean age of subjects was 17.2 +/- 0.7 years and the age of menarche was 12.8 +/- 0.9 years. Of all students, 378 [20.4%] had oligomenorrhea and PCOS was diagnosed in 210 [11.34%] according to the National Institute of Health [NIH] definition. PCOS subjects, mean body mass index [BMI], waist circumference, and waist/hip [W/H] ratio were 21.1 +/- 3.6, 73.4 +/- 8.0 cm and 0.77 +/- 0.05, respectively. A family history of diabetes mellitus type 2 was reported in 24.7% of subjects. The prevalence of PCOS in this study was similar to the international estimates of 10-20% in Caucasians. A long-term follow-up is needed to compare the accuracy of clinical determination of the disease versus diagnosis based on hormonal and/or sonographic assessments

study of menarcheal age in northern Iran [Rasht]

The event of menarche is an exceptional phenomenon, which occurs once in a lifetime. It is the precursor of future fertility. The onset of menarche is mainly dependent on genetic factors, however geographical and nutritional factors among other factors have been attributed to the events of menarche. The aim of this study is to determine the age of onset of menarche and the factors which induce it in northern Iran. This is a cross sectional study which will assess the onset of menarche in girls between the age of 11-16 years. The subjects were either in middle or high school and had experienced menarche within 6 months prior to the study. This study revolves around 600 girls who were selected using stratified randomized sampling techniques. The data was collected in the form of a questionnaire which focused on age, weight [was measured to the nearest 0.1 kg using a balance beam scale], height [was measured to nearest 0.1 cm with a manual height board], and Body Mass Index [BMI: kg/m2] was used as an index of relative weight. Principal Component Analysis [PCA] was applied to analyze Socio-economic Status [SES]. The defined standard age of the first menstrual event was applied as the standard. The data collected was analyzed using the Statistical Package for the Social Sciences [SPSS.10] statistical analysis software and the Chi-square and Analysis of Variance [ANOVA] tests were applied. In an effort to establish the factors associated with the age of menarche, multivariate analysis was performed based on linear logistic regression which was performed using a model where all the variables changing the risk estimated by more than 10%. Statistical significance was determined at P<0.05. The mean age at menarche was observed to be 12.99 +/- 1.33 yrs [ranging from 10.16 to 15.91 yrs]. The study showed that menarche occurred during the summer for 270 [45%] patients making it the most common season for menarche while winter was the least common season. The mean age of menarche was delayed in patients from low SES groups and it occurred earlier in patients from high SES. In girls with low BMI, menarche occurred earlier in comparison to girls with high BMI. There was a significant correlation between session and age of menarche [p<0.05]. There was no significant relationship statistically between BMI and age of menarche [p>0.05]. Linear regressions showed no significant effect of BMI on the age of menarche but there was a significant correlation between season and SES on the age of menarche. The age of menarche and the most common seasons for menarche were similar to previous studies. Results from this study showed that the age of menarche decreased with higher SES. And also the age of menarche in girls with high and low BMI occurred earlier. However, previous studies showed that it occurred earlier in high BMI and later in low BMI. It appears that genetic and environmental factors have influenced these differences

Cytogenetic analysis in couples with recurrent spontaneous abortion

Recurrent abortion is a difficult medical problem happening in about 1-2% of fertile women. Most spontaneous miscarriages which happen in the first and second trimesters are caused by chromosomal abnormalities. The present study tries to find the rate of chromosomal abnormalities in couples with recurrent pregnancy loss. In total 165 couples were referred to genetic counselling clinic with a history of at least three previous abortions. In all women antibodies against toxsoplasmose, rubella and cytomegalovirus [CMV] were analysed by ELIZA. In 88 couples karyotyping was conducted by analysis of G and/or C banding. Metaphase spreads were made from phytohaemaglutinin-stimulated peripheral lymphocytes using standard cytogenetic techniques. The chromosomal status was analyzed using CytoVision Ultra ver.4.0 from Applied Imaging. The CHI[2]-test and ANOVA were used for statistical evaluation. The level of p<0.05 was considered as significance. Most of the patients had 3 repeated abortions [61.2%]. Cytogenetic analysis performed for 88 couples and karyotypes of 12.5% of them were abnormal. The majority of them had monosomy X [6.82%], followed by balanced translocation [2.27%]. The number of female carries chromosomal abnormality exceeded significantly than of male. Coefficient of inbreeding in more than 50% of couples had fifth degree of relationship [89 out of 165]. Our results showed that 12.5% of the couples with missed abortion had an abnormal karyotype, with no other abnormality. Cytogenetic findings in spontaneous aborted specimens could provide valuable information for genetic counseling and prenatal care in future pregnancies in couples with a history of repeated pregnancy loss

Factors affecting the successful embryo transfer

The main factors affecting pregnancy and implantation rates are uterine receptivity, embryo quality, and transfer efficiency. Embryo transfer [ET] is the last step of critically important procedure of in vitro fertilization [IVF] and probably the least successful step in Assisted Reproductive Technology [ART] treatment cascade; though simple in most of the cases, it may pose to be the most difficult in some. No matter how good the IVF laboratory culture environment is, the physician can ruin everything with a carelessly performed embryo transfer. The entire IVF cycle depends on delicate placement of the embryos at the proper location near the middle of the endometrial cavity. Pregnancy rates will be significantly increased with the following procedures: 1. Trial transfer 2. Avoiding the initiation of uterine contractility by using soft catheters, gentle manipulation and by avoiding touching the fundus. 3. Removal of cervical mucus, wash and lavage of cervix with culture media. 4. Ultrasound-guided ET with full bladder. 5. Deposition of the embryo 2 cm below the uterine fundus. 6. Examination of catheter following transfer for retained embryos, blood and mucus. Slow withdrawal of the embryo transfer catheter, the use of a fibrin sealant, bed rest after embryo transfer, sexual intercourse and routine administration of antibiotics following embryo transfer remained to be studied by randomized clinical trials [RCTs]

Comparison of the success rate of letrozole and clomiphene citrate in women undergoing intrauterine insemination

This study was conducted to compare the success rate of daily administration of aromatase inhibitor letrozole at a dose of 5 mg when administrating clomiphene citrate [CC] 100 mg daily in women undergoing superovulation and IUI. This prospective randomized trial was done in Research and Clinical Center for Infertility [Shahid Sadoughi University], Yazd, Iran. Ninety-five patients with unexplained and mild male factor infertility were studied. Using a computer-generated random table, the patients were randomized into two groups, which were treated with 5 mg of letrozole daily [42 patients, 42 cycles] or 100 mg of CC daily [53 patients, 53 cycles]. The data were analyzed using Student's t-test and chi square test. The mean age and duration of infertility in both groups were similar. There was a significant difference between the two groups in the total numbers of follicles during stimulation [5.45 +/- 4.2 in CC group vs. 3.07 +/- 2.1 in letrozole group] [P = 0.01]. No significant difference in the endometrial thickness was found between the two groups [letrozole group = 6.9 +/- 2.2, CC group = 7.8 +/- 1.8]. The mean levels of LH and FSH in both groups were similar. P value of difference in hormone levels between two groups were 0.33 and 0.47, respectively, but there was a significant difference in mean E2 levels between the two groups [241.28 +/- 167.537 in letrozole group vs. 867.34 +/- 296.689 in CC group] [P = 0.018]. The mean number of gonadotropin ampules used in both groups was the same. Pregnancy rate per cycle was 9.5% in the letrozole group and 5.7% in the CC group [P = 0.6]. Two out of the three pregnancies in the CC group [66.6%] and one out of the four pregnancies in the letrozole group resulted in a miscarriage [25%]. One twin pregnancy [33%] occurred in the letrozole group and none in the CC group. Ovarian hyperstimulation syndrome [OHSS] did not occur in either of the two groups. In IUI, superovulation with clomiphene citrate and letrozole was associated with similar pregnancy rates, but the miscarriage rate was higher with clomiphene citrate