Assessment of the relationship between recurrent high-risk pregnancy and mothers' previous experience of having an infant admitted to a neonatal intensive care unit

High-risk pregnancies increase the risk of Intensive Care Unit [ICU] and Neonatal Intensive Care Unit [NICU] admission in mothers and their newborns. In this study, we aimed to identify the association between the recurrence of high-risk pregnancy and mothers' previous experience of having an infant admitted to NICU. We performed a cohort, retrospective study to compare subsequent pregnancy outcomes among 232 control subjects and 200 female cases with a previous experience of having a newborn requiring NICU admission due to intrauterine growth retardation, preeclampsia, preterm birth, premature rupture of membranes, and asphyxia. The information about the prevalence of subsequent high-risk pregnancies was gathered via phone calls. As the results indicated, heparin, progesterone, and aspirin were more frequently administered in the case group during subsequent pregnancies, compared to the control group [P<0.001]. Also, pregnancy-induced hypertension, preeclampsia, preterm labor, and gestational diabetes mellitus were more frequent in the case group, compared to the control group [P<0.05]. There was a positive correlation between recurrent high-risk pregnancy and previous experience of having a newborn requiring NICU admission. As the results indicated, mothers in the case group were at a higher risk for preeclampsia, preterm labor, and gestational diabetes mellitus, compared to the control group. Therefore, earlier diagnosis, prompt treatment, and prevention should be taken into account by physicians

Pregnancy complications and neonatal outcomes in multiple pregnancies: a comparison between assisted reproductive techniques and spontaneous conception

This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies [ART] to spontaneous pregnancies. In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student's t test, chi square and logistic regression [p<0.05]. There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups [p<0.001]. The ART group had significantly higher preterm labor and premature rupture of membranes [PROM] whereas pregnanc-induced hypertension [PIH] was higher in the spontaneous group [p=0.01]. Newborn intensive care unit [NICU] admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome [RDS], NICU admission and Apgar score were independent predictors for neonatal complications. Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART

Risk factors for post-cardiac surgery diaphragmatic paralysis in children with congenital heart disease

Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis [DP] in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics. This cross-sectional study, conducted in a 2-year period [2006-2008], included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated. Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months [28.2 +/- 33.4 months], 25 [5.5%] infants [60% male and 40% female, age range = 15 days to 132 months, 41.2 +/- 28.1 months] had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery. The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock-Taussig shunt surgery, respectively. Thirteen [52%] of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% [6 patients]. DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases

[Influence of GnRH analogue on body mass index in girls with precocious puberty: a prospective study]

Background: Gonadotropin-releasing hormone analog [GnRHa] therapy is used in central precocious puberty [CPP] worldwide and it is the treatment of choice for this condition

Many of the previous studies concerning the effect of gonadotropin-releasing hormone analog [GnRHa] therapy on height. Much less attention has been paid to changes in body weight. However, concerns have been expressed that CPP may be associated with increased body mass index [BMI] both at initial presentation and during GnRH agonist treatment, but it is controversial in some studies

Methods: We have retrospectively reviewed 52 female patients that the majority of them had CPP. We assessed height, height SDS, weight, weight SDS, BMI and BMI SDS. All patients were treated with GnRHa over 12 months. The variables were evalu-ated at 0, 6 and 12 months after initiation of treatment. 8 girls received growth hormone concomitantly. Also bone age and sexual maturity were measured. Bone age was assessed according to the Greulich-Pyle method and sexual maturation was classified according to the Marshall-Tanner method

Results: Before the initiation of therapy, the girls had a mean BMI SD score for chronological age of 0.80+/- 1.18 after 6 months of therapy BMI SDS was 0.82+/- 1.15 and after 12 months was 0.82+/-1.28 the P value is 0.909 and it is not The P= 0.66 and it is not statistically significant. Eight girls received growth hormone statistically significant. Height SD score for chronological age was 0.41+/- 1.65 before the initiation of therapy and was 0.4+/-1.65 after 6 months and 0.43+/- 1.60 after 12 months of therapy

concomitantly, in this group increasing height SDS is statistically significant P= 0.044 but increasing BMI SDS is not significant

Conclusion: Gonadotropin-releasing hormone analog [GnRHa] therapy in central precocious puberty [CPP] is safe for BMI and increasing of BMI is not significant, long- term follow-up study is required to elucidate whether GnRHa treatment affects adult obesity. Using growth hormone concomitantly, the effect on increasing height is significant

Sexual dysfunction in patients with polycystic ovary syndrome and its affected domains

Background: Polycystic Ovary Syndrome [PCOS] is presented with characteristic complications such as chronic an ovulation, obesity, and hyperandrogenism which can affect sexual function in women of reproductive age

Objective: Herein we evaluated the frequency and predisposing factors of sexual dysfunction in infertile PCOS patients

Materials and Methods: In this cross-sectional study, 130 married women with a definite diagnosis of PCOS who were referred due to infertility were recruited. They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index [FSFI] questionnaire

Results: The frequency of sexual dysfunction was verified 57.7% in PCOS patients with the domains of desire and arousal being commonly affected in 99.2% and 98.5%of cases respectively. BMI had a significant effect on sexual desire and arousal [p=0.02] while the effect of hirsutism was significant on all domains [p<0.001 for total FSFI score] except for dyspareunia

Conclusion: PCOS patients markedly suffer from sexual dysfunction as comorbidity. It seems appropriate to screen all PCOS patients for sexual function with a simple short questionnaire such as FSFI. Targeted interventions could be considered to help improve their quality of life along with other treatments

Comparison effect of physiotherapy with surgery on sexual function in patients with pelvic floor disorder: a randomized clinical trial

Female sexual dysfunction is a common problem among general population, especially in urogynecological patient, and can lead to a decrease in quality of life and affect martial relationship. This study was compared the effect of surgical methods versus physiotherapy on sexual function in pelvic floor disorder. This randomized controlled trial was performed in Urogynecology clinic since August 2007 to December 2009 on 90 patients aged from 25-55 years with previous delivery, positive history of sexual dysfunction with stage <3 of pelvic organ prolapsed and divided in two groups. Group A [n=45] received standard rectocele repair and prineorrhaphy, group B [n=45] received physiotherapy for eight weeks twice a week [electrical stimulation, Kegel exercises]. The female sexual function index [FSFI] used to evaluate the sexual function in cases before and after intervention. Frequency of variable scores [libido, orgasm, dysparunia] included without disorder, frequently good, sometimes good, very much and extreme were compared between two groups. Libido and arousal were improved in both groups [p=0.007, p=0.001 respectively]. Orgasm and dyspareunia were improved in group B [p=0.001]. Dysparunia was more painful in group A. There was significant difference between two groups [improvement of orgasm and dysparunia in group B] [p=0.001]. It seems that physiotherapy is an appropriate method for treatment of sexual disorder in pelvic floor disorder.

Effect of piroxicam on ART outcome: a pilot study

One of the most important factors affecting success rates in assisted reproductive techniques [ART] besides the number of oocytes retrieved and high quality embryos derived from them is the technical aspects of embryo transfer. It seems that pretreatement with uterine relaxants can be helpful in preventing unpleasant cramps which can have an adverse effect on ART outcome. In this respect, some drugs such as prostaglandin inhibitors or sedatives have been evaluated but not confirmed yet remain controversial. This study was performed in order to assess the effect of administrating Piroxicam prior to embryo transfer on pregnancy rates in ART cycles. This pilot study was performed from August 2010 through December 2011 on 50 infertile women in ART cycles. Recombinant follicle stimulating hormone [rFSH] with a long gonadotropin releasing hormone [GnRH] analogue protocol were used for controlled ovarian hyperstimulation. The subjects were randomly allocated into two groups of 25 patients after obtaining written consent. Group A received a 10 mg Piroxicam capsule 30 minutes before embryo transfer and group B was the control group with no treatment. Data were analyzed by Chi-square and analysis of variance [ANOVA]. Pregnancy rate was 34% [n=17] totally, with 32% [n=8] in group A and 36% [n=9] in group B [p=0.75]. Uterine cramps were experienced by 4 women [16%] in group B, while none were reported by women in group A [p=0.037]. It seems that Piroxicam administration 30 minutes prior to embryo transfer cannot increase pregnancy rates, but can prevent or reduce uterine cramps after the procedure

Incidence and etiology of chylothorax after congenital heart surgery in children

Chylothorax is a rare but serious postoperative condition with a high rate of morbidity and may lead to the mortality of children undergoing congenital heart disease [CHD] surgery. This study evaluated the specific surgical procedures associated with the higher risk of postoperative chylothorax. We assessed 435 cases undergoing CHD surgery between April 2003 and May 2006. We detected postoperative chylothorax in 6 patients. The diagnosis of chylothorax was established based on the presence of an odorless fluid with the characteristic milky appearance of the fluid [except when the patients were fasting in the immediate postoperative period], a triglyceride level greater than 110 mg/dL or between 50 and 110 mg/dL with a pleural fluid white cell count greater than 1000, and more than 80% lymphocytes on differential when the pleural fluid was not chylous. Over a 37-month period, 435 [mean age = 51.6 months; 232 males] patients underwent various types of surgical procedures for CHD; 6 patients developed chylothorax after the Fontan operation; one patient died due to severe chylothorax; 3 patients were managed by nutritional modifications, diuretics, and thoracocentesis; and 2 patients required thoracic duct ligation. The Fisher exact test analysis showed a significant association between the Fontan operation and postoperative chylothorax [p value < 0.0001]. Our study showed a significant association between the Fontan surgery and chylothorax

Risk factors for neonatal mortality among very low birth weight neonates

The objective of this study is to determine risk factors causing increase in very low birth way [VLBW] neonatal mortality. The medical files of all neonates weighing <1500 gram, born in Vali-e-Asr hospital [2001-2004] were studied. Two groups of neonates [living and dead] were compared up to the time of hospital discharge or death. A total of 317 neonates were enrolled. A meaningful relationship existed between occurrence of death and low gestational age [P=0.02], low birth weight, lower than 1000 gram [P=0.001], Apgar score <6 at 5[th] minutes [P=0.001], resuscitation at birth [P=0.001], respiratory distress syndrome [P=0.001] need for mechanical ventilation [P=0.001], neurological complications [P=0.001] and intraventricular hemorrhage [P=0.001]. Regression analysis indicated that each 250 gram weight increase up to 1250 gram had protective effect, and reduced mortality rate. The causes of death of those neonates weighting over 1250 gram should be sought in factors other than weight. Survival rate was calculated to be 80.4% for neonates weighing more than 1000 gram. The most important high risk factors affecting mortality of neonates are: low birth weight, need for resuscitation at birth, need for ventilator use and intraventricular hemorrhage

[Serum zinc level in infertile women with and without polycystic ovary syndrome: a comparative study]

We are in new era of knowledge and treatment of women with PCOS. We should find management modalities that can improve their life quality. Due to high prevalence of PCOS, and zinc deficiency in Iran, importance of antioxidants such as zinc on treatment and improvement of PCOS complications, and due to the disadvantages of the current treatment for the disease [i.e. OCPs], finding an efficient alternative therapy with no or less side effects seems to be as important as some methods for changing the life style of these women. This study was performed to assess zinc levels in PCOS versus non PCOS patients to determine if zinc can be helpful in PCOS management. This is a case-control study which was performed from January 2012-2013 in 100 infertile women aged 20-45 years who were referred to Vali-e-Asr infertility clinic. Fifty patients had PCOS according to Rotterdam Criteria [case group] and 50 were infertile women without PCOS [control group]. In both group, serum Zinc levels were determined and the data was gathered using the SPSS software and analyzed by descriptive [percent, mean, standard deviation] and analytical x[2], ANOVA, Mann-Whitney and Correlation]. Results did not show a significant difference between case group and control group in respect to serum Zinc levels [P>0.05]. Due to no difference between case group and the control one in zinc levels, it seems that zinc supplementation in PCOS patients is not necessarily useful or of clinical importance. Obviously studies with larger sample size can probably define the role of zinc in these patients.

[Resistance pattern of bacterial agents causing ophtalmia neonatorum]

One of the most common infections in neonatal period is ophthalmia neonatorum. In this study, the bacterial agents, drug resistance and susceptibility of bacterial agents were studied. In this study a total of 72 newborns with ophthalmia neonatorum admitted in Bahrami Hospital in Tehran during the years 2008-2011 were continuously enrolled in a case series, descriptive study. Demographic data, including age, sex, cause of admission and culture of discharge from the eyes and its antibiogram, as well as experimental treatments and treatment outcomes were collected. Forty four infants [61.1%] were males and 28 [38.9%] were females and the mean age on admission was 11.6 +/- 7.7 days. In 51 patients [70.8%] the onset of ophthalmia neonatorum was prior to admission. More than 56% of cases with ophthalmia neonatorum were associated with sepsis. On the other hand, positive blood culture was detected in 15.3% of cases. Among 72 neonates with ophthalmia neonatorum, 26 [36.1%] had a positive culture of the eye discharge. The most common causes of bacterial agents were Staphylococcus aureus [46.1%] [12 of 26 cases]. Other causes included streptococcus species [23%], Pseudomonas [15.3%], E-coli [11.5%] and Haemophilus influenza [3.8%]. The most frequent causes of drug resistance were Ampicillin, Penici-llin, Cefixime, and Ceftazidime [100% resistance]. The most sensitive antibiotics were vancomycin and imipenem [100% sensitivity]. Based on the conventional treatment, clinical response to local gentamicin was approximately 60%. Sulfacetamide was associated with no clinical response in 40% of cases. The antibiogram and clinical response to empiric treatment showed that resistance to ampicillin and some third generation of cephalosporine was 100%. Aminoglycosides' sensitivity was more than 50% locally and systemically. Our recommendation is performing eye discharge culture before antibiotic treatment. More studies with numerous cases should be done for better definition of bacterial resistance.

[Maternal factors in newborns breast feeding jaundice: a case control study]

Background: Neonatal jaundice, especially breast feeding jaundice is one of the most common causes of neonatal readmission during the first month of life. Breast feeding jaundice may be due to decreased milk intake with dehydration and/or reduced caloric intake. The aim of this Study was to determine maternal risk factors of breast feeding jaundice in order to prevent it than before

Methods: This case- control study was performed at Bahrami University Hospital, Tehran, Iran and involved 75 term exclusively breast fed newborns admitted for hyperbilirubinemia, with a weight loss greater than 7%, with one positive lab data as: serum Na and ge 150meq/lit, urine specific gravity> 1012, serum ureaandge 40mgr/dl, without assigned cause for hyperbilirubinemia. They were compared with 75 matched controls with weight loss less than 7%, without dehydration and a known cause of hyperbilirubinemia

Results: In comparison with control group, in neonates with breast feeding jaundice, inappropriate feeding practice [P<0.033], delayed onset of lactation [P<0.0001], inverted nipple [P<0.001] were significantly higher. In our study, there was no significant difference between two groups in education level of mother, learning breast feeding practice before and after delivery, method of delivery [cesarean or vaginal delivery], primiparity or multiparity and use of supplements [water or glucose water]

Conclusion: This study shows need for special attention and follows up of mothers and neonates at risk for breast feeding jaundice, especially those with inverted nipples or undergraduate for successful breast feeding. On the other hand this study shows encouraging mothers for early lactation especially in the first hour of life decreases the risk for this kind of jaundice

Prevalence of immunity to toxoplasmosis among Iranian childbearing age women: systematic review and meta-analysis

Our information regarding immunity to toxoplasmosis among reproductive age women is indeterminate and there is significant variation between reported results; it is necessary to perform a Meta-analysis study on subjects to obtain required findings and develop preventive measures accordingly Estimation level of immunity to toxoplasmosis in reproductive ages. All published papers in main national and international databases were systematically searched for some specific keywords to find the related studies up to 2012. We selected only original articles that either reported percentage of positive anti toxoplasma IgG or total anti toxoplasma antibody by using ELISA or IFAT method [provided that the titer >/= 1.20 is considered positive for IFAT] in childbearing age women. Studies involved a total of 13480 participants. The maximum and minimum reported prevalence rates of anti-toxoplasma IgG antibody using IFTA serological method were 21.8% and 54%; and using ELISA serological method were 23% and 64%, respectively. The overall estimation for prevalence of anti-toxoplasma IgG antibody using IFTA serological method was 34.5% [95% CI: 28.5-40.5]; and using ELISA method was 37.6% [95% CI: 30.4-44.9]. The overall estimation for prevalence of anti-toxoplasma total antibody was 39.9% [95% CI: 26.1-53.7]. In Iran, screening of toxoplasma is not routinely performed yet, while the incidence of toxoplasmosis is too high to justify routine screening. Prenatal screening can help to identify mothers susceptible to infection. Screening for the presence of antibodies allows primary prevention of toxoplasmosis infection where eating habits and hygiene practices have clearly been identified as risk factors

Effects of Chlamydia trachomatis infection on fertility; a case-control study

Nowadays, Chlamydia trachomatis is known as a causative agent of infertility. Because of, asymptomatic nature of infection, many may suffer from its lasting complications such as infertility. This study was performed in Tehran during April 2007 to April 2008 to compare the prevalence of Chlamydia trachomatis infection in fertile and infertile women using ELISA and PCR methods. Overall, 234 infertile and 223 pregnant women, as the fertile group, participated in this hospital-based case-control study. After completing an informed consent form and the questionnaire, first catch urine and blood sample were obtained for PCR and ELISA [IgG, IgM] tests, respectively. Logistic regression analysis was used to control possible confounding factors, and determine adjusted odds ratio of infertility due to the infection. PCR results revealed that 29 [12.4%] of the infertile and 19 [8.5%] of the fertile women were positive for C. trachomatis infection [p=0.440]. IgG was positive in 21 [9.0%] of the infertile and 11 [5.0%] in the fertile group [p=0.093]. IgM assays identified that 2 [0.9%] of the infertile and 4 [1.8%] of the fertile women were positive for the micro-organism [p=0.375]. We found no significant differences among fertile and infertile women for Chlamydia trachomatis infection. Nevertheless, molecular techniques which are more sensitive, more specific and non-invasive can be used to detect C. trachomatis infection

effects of healthy diet in pregnancy

To evaluate the importance of observing healthy habits by pregnant women that influences different aspects of mother and fetus health, we assessed the change in dietary behavior, and cigarette smoking after distributing the guidelines among 485 prenatal care patients. The subjects were pregnant women who enrolled in health care centers of Tehran University from September, 18, 2010 to July 21, 2012. At first the standard questionnaires including questions about socio demographic factors and also their dietary behavior, and cigarette smoking were filled out. Then we gave them the guideline. After 2 months the participants received the similar questionnaires. The change in their behavior was evaluated comparing the 2 series of questionnaires by SPSS-16 analysis methods. Totally 1.9% of participants met fruit and vegetable guidelines before education and 5.6% after that [3.7% rise] [p < 0.0001]. In studied group 99% met cigarette smoking guidelines before and 100% after education. There was a meaningful association between the amount of fruit and vegetables consumption before and after pregnancy [p < 0.0001]. According to the significant effect of education, we can apply it as an effective way of improving the healthy behaviors in our society. Furthermore, discovering related factors to healthy behavior can lead to addressing the most appropriate [needy, necessitous, deserving] group of population for education

Caffeine consumption and incidence of hypertension in pregnancy

To study the effects of caffeine consumption on incidence of pre-eclampsia and gestational hypertension. In a case-control study, two groups of pregnant women were selected as follows: one group included 40 women suffering from hypertension in pregnancy, while the other group comprised 100 healthy pregnant women. Inclusion criteria for both groups were normal BMI [19-22] before pregnancy, no high-risk age group [18 -35 years] for preeclampsia, no underlying disease, no history of abortion, and regular prenatal care. We evaluated the amount an duration of caffeine consumption in both groups. In nine [25.5%] mothers of preeclampsia group and15 [15.8%] mothers of healthy pregnant group were observed to consume excessive amount of tea [more than four cups a day]. In the preeclampsia group, excessive consumption of tea was seen, but this difference [difference in what??] was not significant. Among 21 [51%] mothers in preeclampsia group and 64 [64.7%] mothers in the other group, there is not a significant relation in drinking different types of caffeine, like dark coca, soft drinks, or coffee with occurring of preeclampsia. After evaluation the obtained data, we did not observe any relationship between the risk of preeclampsia and consumption of different types of caffeine [tea, coffee, or soft drinks]. Perhaps, more holistic and broader studies in this area are required

[Comparison of sexual function between nulliparous with multiparous pregnant women]

Pregnancy can conflict with sexual function that can be affected by physical and psychological changes during pregnancy. The aim of this study was to compare sexual functions between nulliparous and multiparous pregnant women referred to health centers in Eastern district of Guilan. This cross-sectional study was carried out in Guilan during 2009-2010. We used convenient sampling method to select 554 pregnant women. Data were gathered using a questionnaire including demographic characteristics, sexual function and fear of harm to fetus. The SPSS-16 was used to analyze the data by the Mann-Whitney U and Generalized linear models. The level of significance was set at 5%. There was no significant difference between nulliparous and multiparous pregnant women regarding sexual function in the first and second trimesters of pregnancy [P=0.353, P=0.251]. There were significant differences between nulliparous and multiparous pregnant women regarding sexual desire [P=0.002], arousal [P=0.01], orgasm [P=0.01], pain [P=0.02] and sexual function total score [P=0.016]. There was significant difference between nulliparous and multiparous pregnant women regarding sexual function [P=0.008]. Sexual counseling and rehabilitation programs should be compiled as part of the comprehensive care of prenatal care especially for multiparous pregnant women

frequency of pelvic floor dysfunctions and their risk factors in women aged 40-55

The aims of this study were to determine the frequency of urinary and fecal incontinence and their determinants in pre-menopausal and menopausal women in Iran. This one-year cross-sectional study was performed on 304 women aged 40-55 who were admitted to women's clinic at Imam Khomeini Hospital. Symptoms of urinary, gas, and fecal incontinence and pelvic organs prolapse were diagnosed by a specialist through examination and a questionnaire. Patients were divided into two groups of with and without [urinary, gas, and fecal] incontinence symptoms. The probable risk factors of these disorders were studied and registered in the questionnaire and compared using t-test, chi-squared test, and regression of quantitative and qualitative variables. Generally, 129 [42%] out of 304 women had pelvic floor dysfunction [urinary and fecal incontinence, and pelvic organs prolapse]. Risk factors including menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first child's birth weight were compared between the two groups using chi-squared and t tests. There was a statistically significant difference between the two groups [P=0.000] as risk factors were more frequently observed in women with incontinence symptoms. Some risk factors of pelvic floor dysfunction are menopause, hormone therapy, history of hysterectomy, inactivity, age, BMI, and first child's birth weight. Therefore, some strategies should be included in women's health education programs to prevent the above-mentioned risk factors

Prediction of fetal anemia by different thresholds of MCA-PSV and delta-OD in first and second intrauterine transfusions

Our aim was to compare different thresholds of middle cerebral artery peak systolic velocity [MCA-PSV] and amniotic fluid delta optical density [Delta-OD] with fetal hemoglobin [Hb] during first and second intrauterine transfusions [IUT]. We determined serial MCA-PSV and Delta-OD in 27 red blood cell alloimmunized fetuses who needed IUT. Before the second IUT, MCA-PSV was measured. The sensitivity and specificity of MCA-PSV and Delta-OD were calculated and compared with fetal hemoglobin levels. From 27 fetuses, first time IUT MCA-PSV with a normal median value [MOM] cutoff of > 1.29 detected 60% of the moderate and 100% of the severe anemia cases. MCA-PSV of MOM > 1.5 detected none of the moderate and 93% of severe anemia cases. Delta-OD detected 50% of moderate anemic and 80% of severe anemic cases. At the second IUT, 91% of severe anemia cases were confirmed by MCA-PSV with MOM > 1.5 whereas MCA-PSV with MOM > 1.29 confirmed all cases. One case of moderate anemia was detected by MCA-PSV of MOM > 1.29 and none were detected by MCA-PSV with MOM > 1.5. Different thresholds of MCA-PSV have higher sensitivity and specificity for detecting moderate and severe fetal anemia compared with Delta-OD. It also has a high sensitivity at the second IUT

Levonorgestrel-releasing IUD versus coper IUD in control of dysmenorrhea, satisfaction and quality of life in women using IUD

The levonorgestrel-releasing IUD can help the treatment of dysmenorrheal by reducing the synthesis of endometrial prostaglandins as a conventional treatment. This study was performed to assess the frequency of dysmenorrheal, satisfaction and quality of life in women using Mirena IUDs as compared to those using copper IUDs. This double-blind randomized clinical trial was performed between 2006 and 2007 on 160 women aged between 20 to 35 years who attended Shahid Ayat Health Center of Tehran, and they were clients using IUDs for contraception. 80 individuals in group A received Mirena IUD and 80 individuals in group B received copper [380-A] IUD. Demographic data, assessment of dysmenorrheal, and follow-up 1, 3 and 6 months after IUD replacement were recorded in questionnaires designed for this purpose. To assess the quality of life, SF36 questionnaire was answered by the attending groups, and to assess satisfaction, a test with 3 questions was answered by clients. Dysmenorrheal significantly was decreased in both groups six months after IUD insertion as compared to the first month [p<0.001]. However, statistically, Mirena reduced dysmenorrheal faster and earlier compared to cupper IUD [<0.003]. There isn't any significant difference between these two groups in satisfaction and quality of life outcomes. There is no difference between these two groups in terms of the satisfaction and quality of life, therefore the usage of Mirena IUD is not a preferred contraception method