Admission test and pregnancy outcome

Background: The admission test [AT] has been carried out for many years, but there are still debates about the prognostic value of the test. Therefore, we aimed to examine the value of the AT in predicting the adverse outcome in neonates

Methods: In this cross-sectional study, 425 pregnant women with normal vaginal delivery were studied between2009 and 2014at Vali-e-Asr Hospital. Based on the results, the women were divided into 2groups of normal and abnormal ATs. All the patients were followed up until the birth of their baby, when the status of mother and neonate was determined. The main outcomes of the study were cesarean rate, neonatal intensive care unit [NICU] admission, fetus demise, neonatal acidosis, and Apgar score. The independent t-test, chi-square test, Fisher exact test, and logistic regression were used for statistical analysis. The data were analyzed using SPSS [version 17]

Results: Of 425 pregnant women studied, 142 [33.4%] had abnormal ATs with a mean age of 29 [+/-4.5] years. Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction, turned cord, and Apgar<7, but it could not predict neonatal death and hypoxia

Conclusion: The AT was shown to be a useful screening test with risk factors such as oligohydramnios, bloody amniotic fluid, meconium amniotic fluid, intrauterine growth restriction, and turned cord. Additionally, the test was also able to predict NICU admission and the need for cesarean section, but it could not predict the occurrence of neonatal death

Successful local and systemic medical treatment of cesarean scar pregnancy and a subsequent term pregnancy after treatment: a case series

Treatment of cesarean scar pregnancy [CSP] is controversial. The objective of this study was to report our successful experience in the medical treatment of CSP with potassium chloride [KCl] and methotrexate. Case: This is a case series of six patients between 6-12 gestational weeks with the diagnosis of CSP. In five cases the fetus was alive and in one case, despite being at a gestational age of 12 weeks based on CRL, there was no fetal heart activity. In four of these cases, an ultrasound- guided KCl injection in the heart was performed on four living fetuses and then systemic methotrexate was administered. In two other cases, methotrexate was injected into the gestational sac and subsequently the systemic methotrexate was administered. During follow-up, the patients were stable and no complications occurred. Additionally, serum beta human chorionic gonadotropin [Beta-NCG] was negative between five to 11 weeks later. One of the patients became pregnant one year later. Her pregnancy continued without any complication and she was delivered by cesarean section at the gestational age of 38 weeks. During caesarean section, it was noticed that the appearance of previous cesarean scar was normal and there was no scar. Based on our experience, the combination of systemic Methotrexate with local Methotrexate or KCl is feasible and can be performed as an outpatient procedure and is successful in the treatment of CSP

Conjoined twins in a monochorionic triplet pregnancy after in vitro fertilization: a case report

Background: Monozygotic monochorionic triplet pregnancy with conjoined twins is a very rare condition and is associated with many complications

Case: In this study, we describe a monochorionic-diamniotic triplet pregnancy after in vitro fertilization with an intracytoplasmic sperm injection. At a gestational age of 6 weeks and 4 days of pregnancy one gestational sac was observed, and at a gestational age of 12 weeks and 2 days, triplets with conjoined twins were diagnosed. After consulting with the parents, they chose fetal reduction of the conjoined twins. Selective feticide was successfully performed by radiofrequency ablation at 16 weeks of pregnancy. Unfortunately, the day after the procedure, the membrane ruptured, and 1 week later, all fetuses and placenta were spontaneously aborted

Conclusion: Monochorionic triplet pregnancy with conjoined twins is very rare. These pregnancies are associated with very serious complications. Intra cytoplasmic sperm injection increases the rate of monozygotic twinning and conjoined twins. Counseling with parents before IVF is very important

Tuberculosis endometritis presenting as A leiomyoma

Genitourinary tuberculosis is a common extrapulmonary manifestation of tuberculosis. Taking into consideration that genitourinary tuberculosis may be associated with a diversity of presentations, its diagnoses may be difficult. A young woman with an initial presumptive diagnosis of a uterine leiomyoma presented with abdominal pain and a pelvic mass that after further investigations, she was diagnosed with genital tuberculosis

prevalence of group B streptococcus colonization in Iranian pregnant women and its subsequent outcome

Group B streptococcus colonization in pregnant women usually has no symptoms, but it is one of the major factors of newborn infection in developed countries. In Iran, there is a little information about the prevalence of maternal colonization and newborns infected by group B streptococcus. In order to find the necessary information to create a protocol for prevention and treatment of group B streptococcus infection in newborns, we conducted a study of its prevalence among Iranian pregnant women and its vertical transmission to their newborns. This is a cross-sectional descriptive and analytic study performed at Prenatal Care Clinic of the Sarem Hospital from 2009 to 2011. The pregnant women with the gestational age of 35-37 weeks were enrolled in the study. The vaginal culture for group B streptococcus was done for 980 mothers based on our protocol. Among 980 mothers, 48 were shown positive vaginal culture; however, 8 cases among these 48 mothers were positive for both vaginal and urine culture. Babies with mothers showing positive vaginal culture were screened for infection using complete blood count /blood culture [B/C] and C-reactive protein [CRP]. Then, a complete sepsis workup was performed for babies with any signs of infection in the first 48 hours after birth, and they received antibiotic therapy if necessary. All collected data were analyzed [SPSS version 15]. Among 980 pregnant women with vaginal culture, 48 cases had positive group B streptococcus cultures among which 8 mothers also had positive group B streptococcus urine culture. Our findings revealed that 22 [50%] symptomatic neonates were born from the mothers with positive vaginal culture for group B streptococcus. About 28 of them [63%] had absolute neutrophil count more than normal, and 4 [9.1%] newborns were omitted from the study. Therefore, 50% of neonates showed clinical feature, whereas para-clinical test was required to detect the infection for the rest of neonates who showed no signs or symptoms. The colonization of group B streptococcus in Iranian women is significant, while 50% of newborns from mother with positive vaginal culture were symptomatic after birth; therefore, screening of newborns for group B streptococcus infection is recommended to become a routine practice in all healthcare centers in Iran

Association of G71R mutation of the UGT1A1 gen with neonatal hyper bilirubinemia in the Iranian population

Jaundice with indirect hyperbilirubinemia is one of the most common neonatal problems that occur in 60% of term and 80% of preterm neonates but the causes are mostly unknown. It is suggested that race plays an important role in the prevalence of hyperbilirubinemia. It is a common problem in Iran that worries both parents and pediatricians. It has been found that a mutation in the UGT1A1 gene is responsible for structural changes in an encoded enzyme which reduces the function of the enzyme. This is a case-control study carried out in Ghaem Educational Hospital, Mashhad University of Medical Sciences from December 2007 for the period of one year. 26 healthy neonates tested for indirect hyperbilirubinemia within first week after full-term delivery and 53 healthy neonates without hyperbilirubinemia as a control group were included. Genomic DNA extracted using 2 cc blood sample followed by RFLP-PCR for detection of G71R mutation of UGT1A1 gene have been performed. SPSS software [version 16], t- test and chi square analysis have been used for statistical analysis of obtained data. 4.3% of the hyperbilirubinemic group was homozygotes for mutation in UGT1A1 and 26.1% were heterozygotes while 69.6% had no mutation. 21.3% of the control group had the mutation with 4.3% being homozygote and 17% being heterozygote. Frequency of G71R mutation in the hyperbilirubinemia group was not significantly more than that in the control group among Iranian newborns. This finding suggests that G71R mutation may not contribute to the development of neonatal hyperbilirubinemia in Iranian newborns. It is recommended to establish further studies using well-designed inclusion criteria and more specialized mutation analysis techniques which cover all types of probable mutations in G71R gene