Exploring the postpartum pyrexia related to inherited coagulopathies in a cohort of Iranian women

Background: Postpartum pyrexia results from various causes with bacterial infection heading the list. However, there are many other possible causes such as bleeding. Congenital deficiency of the coagulation factors causes inherited coagulopathies most of which are rare. Following delivery, the reduction in coagulation factors puts these mothers at greater risk of postpartum excessive bleeding

Objectives: We aimed to assess postpartum pyrexia in bleeding disorder mothers

Methods: This study was conducted on 98 bleeding disorder patients and 199 controls. Using a standardized questionnaire, the data were collected by consulting a specialist. The subject's medical records during pregnancy and labor were also reviewed. Postpartum fever was defined as temperature > 38°C in the first 10 days after delivery excluding the first day. The data were analyzed using Chisquare statistical analysis and P < 0.05 was considered statistically significant

Results: Postpartum pyrexia was detected in 11.2% of the patients compared to 4% of the controls. The statistical analysis revealed a significantly higher incidence of postpartum fever among the coagulation disorder patients [P = 0.019]. Considering the infection, our data showed that in the patient group, fever was mostly due to [unknown] reasons other than infection

Conclusions: Our results revealed that besides hemorrhagic complications in inherited bleeding disorders, postpartum fever could also be a sign of threat. Early identification and diagnosis of these threats greatly improve the childbirth outcomes in high-risk mothers

Women's sexual and reproductive health care needs assessment: an Iranian perspective

Background: Reproductive health problems are a leading cause of women's ill health and mortality worldwide. There is a need to investigate sexual and reproductive health care needs in different societies and cultural contexts. Despite the success in health care promotion in the Iranian health care system, women still need to receive sexual health care and appropriate HIV/AIDS services. However, studies on the sexual and reproductive health care needs of Iranian women are lacking.

Aims: This study aimed to investigate the sexual and reproductive health care needs of women referred to health care centres in an urban area of the Islamic Republic of Iran.

Methods: We carried out a cross-sectional study in 2013 on 514 women living in an urban area in the north of the Islamic Republic of Iran. Taking into consideration ethical principles, data were collected using the Sexual and Reproductive Health Care Needs Assessment Questionnaire.

Results: The findings showed a greater need for the provision of care by practitioners in the sexual history and activities domain [73%] compared with other domains. Also, the woman's age and the location where she sought treatment and care for sexually transmitted infections were predictors of sexual activities needs.

Conclusions: Owing to the high prevalence of women's referral to health care centres seeking treatment of sexual disorders, there is a need for the provision of sexual counseling centres and services promoting women's reproductive health care

[Evaluating the Relationship between Early Pregnancy Maternal Blood Lead Levels and neonatal anthropometric indices and Apgar scores]

Backgrounds: Low values of neonates' anthropometric indices are considered as an important factor in increased neonatal mortality. This research tried to examine the relationship between early pregnancy blood lead levels of pregnant women and their neonates' anthropometric indices at birth.

Materials and Methods: This longitudinal prospective study was carried out on 1033 pregnant women referred to prenatal clinics in Tehran. Upon entry into the study, a blood sample was taken to determine lead levels, and a demographic questionnaire was filled out for all participants and they were followed up with routine prenatal care till delivery. Anthropometric indices were extracted from the neonatal cards. In statistical analysis, pvalues< 0.05 were considered significant.

Results: The mean blood lead levels in mothers were 4.7 +/- 4.9 MICRO SIGNg/dl. Considering the results obtained by Spearman's correlation, there was a significant negative relationship between blood lead levels of mothers and 5-minute Apgar scores [p=0.002, r=0.09]. However, no significant relationship between blood lead levels and other indices was found. To evaluate the true effects of maternal blood lead levels and potentially effective factors on anthropometric indices, in linear regression analysis, only gestational age at delivery had a significant relationship with all anthropometric indices and 5-minute Apgar score of neonates [p<0.01].

Conclusion: The results showed that early pregnancy maternal blood lead levels were not related to anthropometric indices at birth, and the only important factor for improvement of neonates' anthropometric indices, was higher gestational age at the time of delivery.

Relationships between maternal copper and iron serum levels with pregnancy outcomes and relationship between their maternal and cord levels

This study aimed to assess the relationships between iron and copper levels in maternal and cord serums together and with pregnancy outcomes. An Analytical cross-sectional study was conducted among 370 pregnant women in labor and their neonates in Maryam, Akbarabadi and Imam hospitals in Tehran, Iran. Copper concentrations were measured using the standard atomic absorption spectrophotometer method and Iron concentrations were measured by a kit through RA 1000 method. Data were collected using a questionnaire and were analyzed using Spearman correlation, Chi-square and Logistic regression tests. The mean copper concentrations in the maternal and cord bloods at delivery were 114.52 +/- 37.4, 22.4 +/- 11.6 [microg/dl], respectively. The Iron levels were 119.2 +/- 64, 164.3 +/- 65.3 [microg/dl], respectively. Of all the mothers, 54.3% had copper deficiency, 1.1% Iron deficiency and of all the newborns, 44.7% had copper deficiency and 3.5% Iron deficiency. The Spearman Correlation analysis showed significant positive correlations between concentrations of each element in maternal serum with cord serum and also between maternal iron with maternal copper, and maternal iron with cord copper. The Chi-square analysis showed that there was a significant relationship between maternal copper deficiency and gestational hypertension [P<0.001]. There were no significant relationships between these trace element levels at delivery with premature rupture of membranes and preterm labor. Logistic regression analysis showed a significant negative relationship between maternal copper levels and gestational hypertension [odds: 0.98, 95%CI: 0.97-0.99]. Maternal copper deficiency was rather high in the participants of the study [54.3%], and was related to incidence of gestational hypertension. These findings illustrated importance of trace elements during pregnancy. Providing suitable dietary recommendations and giving supplements during pregnancy can help to decrease maternal and fetal mortality and morbidity

[Translation and psychometric properties of the Iranian version of the premenstrual symptoms screening tool [PSST]]

The Premenstrual Symptoms Screening Tool [PSST] is a simple user friendly screening tool to identify women who suffer from severe PMS [Premenstrual Syndrome]/PMDD [Premenstrual Dysphoric Disorder] and who are likely to benefit from treatment. This study aimed to develop and validate PSST in Iran. The English language of the PSST was translated into Persian [Iranian language] and was used in this study. A forward-backward translation procedure was followed to develop the Iranian version of the questionnaire. A random sample of women students aged 18 and over completed the questionnaire in Tehran, Iran. Statistical analysis was performed to test the reliability and validity. In all, 498 individuals were included in the study. The mean age of the participants was 23.05 [SD=3.29] years and the mean days of cycle and bleeding was 29.48 [SD=4.5], 6.27 [SD=1.3] days respectively. In general the questionnaire received wellby participants and reliability standards was satisfactory [Cronbach's alpha=0.9 and intra-class correlation=0.8]. Content Validity Ratio [CVR] and Content Validity Index [CVI] obtained, were 0.7 and 0.8 respectively, which were higher than our selected standards [0.62 and 0.79 respectively]. This study of the Iranian version of PSST proved that it is an acceptable, reliable and valid measure of PMS

[ relationship between Serum C-reactive protein levels in early pregnancy and preeclampsia onset]

Preeclampsia is one of the most common medical complications during pregnancy that can be a major cause of prenatal morbidity and mortality. One of the most studied biomarkers in the prediction of preeclampsia is C-reactive protein. The objective of this study was to assess the relationship between maternal serum CRP concentrations in early pregnancy and the onset of preeclampsia during the gestational period. In this prospective cohort study, serum CRP levels were measured in 400 pregnant women in their 20th week of gestation. They were all followed up till delivery. The data were finally analyzed statistically. After controlling for the effects of maternal age [<19 and>35 years], multiple regression analysis for primiparity, supplementary calcium intake, BMI and CRP depicted a statistically significant relationship between CRP levels and mild [OR=1.71, 95% CI=1.39-2.11] and severe [OR=2.45, 95% CI=1.80-3.34] preeclampsia onsets. Among all the aforementioned variables, only supplementary calcium intake was significantly effective in the prevention of preeclampsia. In ROC curve analysis, the CRP cut-off point in moderate preeclampsia was 5.35 mg/l [with 94% sensitivity and 81% specificity], and in severe preeclampsia it was 5.45 mg/l [with 94.4% sensitivity and 82.5% specificity]. It seems that CRP can help identify pregnant women who are at high risks of preeclampsia but larger studies are needed to establish a definitive relationship