Effect of different maternal metabolic characteristics on fetal growth in women with gestational diabetes mellitus

Fetal growth in diabetic pregnancies is a complex process and probably abnormalities in other metabolic pathways such as protein and lipid, as well as carbohydrate are responsible for delivering of macrosomic newborn. The purpose of this study was to investigate the association between fetal growth and different maternal metabolic parameters in women with gestational diabetes mellitus [GDM] in comparison to control group. This was a prospective cohort study conducted between March 2011 and May 2012, on 112 pregnant women with GDM and 159 healthy pregnant women. In order to determine of lipids or lipoproteins changes during pregnancy and to investigate any possible effects on fetal growth, lipid components, glucose and insulin levels were obtained in maternal serum three times in third trimester. Maternal serum glucose, total cholesterol [TC], low and high density lipoprotein [LDL-c, HDL-c] levels did not show any significant difference between two groups. While insulin, homeostasis model assessment-insulin resistance [HOMA-IR] and triglyceride [TG] values were detected to be significantly higher in the GDM cases especially after 32 weeks of gestation [p<0.001]. After adjustment for confounding variables, maternal hypertriglyceridemia remained as a significant risk factor for delivering large for gestational age [LGA] newborns [p=0.04]; and according to spearman test the increase of TG level was correlated with increase of insulin resistance and HOMA-IR [p<0.001, CI: 0.312]. Due to positive correlation of hypertriglyceridemia and hyperinsulinemia with newborn weight, it is possible to assume that elevated TGs levels in GDM cases is a reflection of variation in maternal insulin levels

Cushing's syndrome during pregnancy secondary to adrenal adenoma

Pregnancy rarely occurs in untreated cases of Cushing's syndrome [CS], because most of them are infertile due to significant maternal and fetal complications during pregnancy. Diagnosis of CS may be difficult during pregnancy. Since physiological changes of pregnancy are overlapped by classical presentation and biological confirmation of CS. Therefore the high clinical suspicious is needed for diagnosis. We present a 33 years old pregnant woman with a history of chronic hypertension from 10 years ago that referred to Imam Khomeini hospital for uncontrolled hypertension, gestational diabetes and fetal tachycardia at the 30 weeks of gestation. After initial studies abdominal MRI detected a 43 x 35 x 29 mm right adrenal mass. She was treated by anti-hypertensive drugs. But at 31.5 weeks of gestational age cesarean section was performed due to sever preeclampsia. Then two weeks after delivery open right adrenalectomy was carried out without any complications and in the histopathological evaluation benign adrenocortical adenoma was reported. CS is associated with considerable fetal and maternal morbidity and mortality. Selection of treatment method is variable and it depends on gestational age. Medical and surgical approaches have been used in managing CS in pregnancy. Surgical treatment is the first choice for CS which is recommended at the second trimester and in the late pregnancy medical treatment is preferred

Comparing of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles

Clomiphene citrate [CC] an agonist and antagonist of estrogen, is the first line treatment in ovarian stimulation. Anti-estrogenic effect of CC in endometrial thickness and cervical mucus has negative effect on pregnancy rate. Letrozole is an Aromatase Inhibitor has been seen that has acceptable pregnancy rate compared to CC. The aim of this study was to compare the efficacy of letrozole and clomiphene citrate [CC] with gonadotropins for ovarian stimulation in women candidate for intrauterine insemination [IUI]. One hundred sixty patients eligible to IUI therapy enrolled in this study. Patients randomized to two groups: group A [received letrozole-gonadotropin] and group B [received CC-gonadotropin]. In group A [n=80] letrozole was given on days 3-7 of the menstrual cycles. In group B clomiphen citrate was given like letrozole combined with human menopausal gonadotropin [hMG] administered every day starting on day 8. Ovulation was triggered with urinary HCG when the leading follicle [s] reached 18 mm in diameter. A single IUI was performed 36-40 hours later. The ovarian stimulation response [E[2] levels and number of follicles, clinical pregnancy and endometrial thickness] was primary outcome. Both groups were similar in demographic characteristics. There was a significantly lower peak serum E[2] level in the letrozole group compared with CC. [236 +/- 86 Vs. 283 +/- 106 pg/mL, respectively; p<0.002]. The number of mature [>18 mm] preovulatory follicles was significantly higher in CC group than letrozole group [2.2 +/- .68 Vs. 2.02 +/- 0.63 respectively; p=0.025]. Endometrial thickness measured at the time of hCG administration was significantly higher in letrozole group. [9.08 +/- 1.2 mm Vs. 8.1 +/- 1.9 mm; p=0.0001]. The clinical pregnancy rate was comparable between two groups. Letrozole is a good and cost-effective alternative to CC in IUI cycles

effects of delivery in water on duration of delivery and pain compared with normal delivery

To assess the effects of delivery in water, as a normal way of delivery without intervention, in reducing the pain and duration of delivery. This is a clinical trial studying a community of Gravida one and two pregnant women at the gestational age of 38-42 weeks, referred to Asalian hospital. The sample volume was 100 cases, equally divided in two groups of routine delivery and delivery in water. The pain and duration of delivery were analyzed using K-square, Kruskal-wiallis, and mann whitney, with pv<0.05 considered significant. The findings show that the average duration of active delivery was 3.1 hrs +/- 0.8 in the delivery in water group, significantly lower than that of the other group, that is, 4.7 hrs +/- 0.8 [p<0.05]. Also the average of the second phase of delivery was 0.53 hrs +/- 0.22 in the delivery in water group, significantly lower than that of the routine group, that is, 0.88 hrs +/- 0.43 [p<0.05]. The amount of pain was measured in both groups using the visual analog score, yielding 3.53 +/- 0.79 in delivery in water, and 6.9 +/- 1.7 in the other group, which indicates a significant decrease in pain in delivery in water [p<0.05]. This study indicates that delivery in water may be a suitable, nonmedical, and non invasive alternative, because it reduces the pain and duration of delivery