Evaluation of serum biomarkers for detection of preeclampsia severity in pregnant women

Objectives: To determine serum biomarkers in detection of preeclampsia severity among pregnant women

Methods: Among 450 pregnant women with various severity of preeclampsia, serum biomarkers ofaspartate aminotransferase [AST], alanine aminotransferase [ALT], lactate dehydrogenase [LDH], hemoglobin [Hb], platelet count [PLT], uric acid, direct bilirubin, total bilirubin, creatinine, and alkaline phosphatase were compared using area under the Receiver operating characteristic [ROC] curve and Area Under the Curve [AUC]

Results: The mean age of women was 30.63 +/- 6.43 years and with mean gestational age of 34.69 +/- 3.97 weeks. The mean level of LDH, ALT, uric acid, and creatinine were significantly higher in the women with severe type of preeclampsia compared to those with mild type. LDH level had ROC and AUC of more than 0.80, with highest sensitivity, and moderatespecificityin comparison to other markers

Conclusion: Biomarkers such as ALT, uric acid, and LDH were shown to be prognostic in detection of theseverity of preeclampsia. LDH was demonstrated to significantly be a better prognostic test in detection of preeclampsia severity

Triage by cervical length sonographic measurements for targeted therapy in threatened preterm labor: a double blind randomized clinical trial

Background: preterm labor and birth are associated with several neonatal complications including respiratory distress syndrome and intraventricular hemorrhage. Differentiating true and false labor pain is a dilemma to obstetricians

Objective: to elucidate the role of cervical length measurement in prediction of birth in pregnant women with threatened preterm labor

Materials and Methods: in this double blind randomized clinical trial, 120 women with gestational age <34 wk who presented painful uterine contractions randomly assigned to undergo measurement of cervical length. Patients were registered in the hospital and a unit number was given. Based on the unit numbers, patients were randomly assigned to two groups using a computerized random digit generator. All participants were managed accordingly [n=65] or to receive tocolysis as planned [n=55]. Tocolysis was prescribed when cervical length was <15 mm while those with cervical length >/=15 mm were managed expectantly. Delivery within 7 days of the presentation was the primary outcome

Results: this RCT showed in case group, 78.9% of patient with cervical length <15 mm were delivered within 7 days and only 21.1% of them maintained their pregnancy. Of those with cervical length >/=15 mm, only 15.2% were delivered within the study period and the rest [84.8%] maintained their pregnancy [p<0.001]

Conclusion: "our results indicate that in women who presented preterm labor symptoms, cervical length measurement will result in decreased unnecessary tocolytic treatment. Women with cervical length >/=15mm should not receive tocolysis, however, withholding corticosteroid therapy in these patients needs further evidence

"Insulin resistance and homeostasis model assessment of beta-cell function in females with gestational diabetes mellitus: a comparison of aerobic and resistance trainings"

Objectives: Gestational Dabetes Mellitus [GDM] is a pregnancy-induced Impaired Glucose Tolerance [IGT] and insulin resistance occurs and diagnoses during pregnancy and gradually disappears after delivery. A mild to moderate physical activity is suggested as an adjuvant treatment for GDM; in addition, aerobic and resistance trainings might be effective in preventing or controlling GDM in the different manners. The current study aimed at comparing aerobic and resistance trainings plausible effects on insulin resistance and homeostasis model assessment of beta-cell function in females with GDM

Materials and Methods: A total of 34 females with GDM at 24[th] week of pregnancy undergoing insulin treatment were enrolled and randomly assigned into 3 groups; 12 subjects participated in an aerobic training program [3 day/week, 30 to 45 minute/day, 50% to 70% maximum Heart Rate [HR], 11 patients participated in a resistance training [3 day/week, 2 to 3 minutes set of 15 repetitions, 50% to 70% maximum HR], and 11 participants comprised the control group and not participated in any exercise program. Fasting blood samples were obtained from the subjects to assess clinical parameters

Results: The results of covariance analysis indicated a significant difference on insulin plasma levels [P=0.031] and insulin resistance index [the homeostasis model assessment-estimated insulin resistance [HOMA-IR] [P=0.008] among the groups. The resistance training program significantly reduced the level of fasting blood sugar [P=0.031] and increased HOMA-beta [P=0.031]

Conclusion: The exercise can offer a different method to patients with GDM, which benefit from several molecular pathways, and also can be proposed as a framework to design effective GDM treatment regimens and prevention programs. However, further consecutive studies are required in order to achieve the deeper and conclusive findings and obtain the mechanisms underlying the changes on the GDM acquired by exercise

Comparison of the hyaluronic acid vaginal cream and conjugated estrogen used in treatment of Vaginal Atrophy of menopause women: a randomized controlled clinical trial

Background: Vaginal atrophy is a common complication in menopause which does not improve with time and, if untreated, can affect the quality of life for women. The aim of this study was to compare the effectiveness of the vaginal cream of hyaluronic acid and conjugated estrogen [Premarin] in treatment of vaginal atrophy

Methods: This study was a randomized controlled clinical trial on 56 menopausal women with symptoms of vaginal atrophy; they were randomly allocated to two groups [recipient conjugated estrogen and hyaluronic acid]. The severity of each sign of atrophy was evaluated by visual analog signals [VAS] and on the basis of a four point scale. Also to recognize the cellular maturation with pap smear and the maturation degree were calculated according to the formula and scores 0-100. As to the vaginal PH, we used PH marker band, the rate of which was divided into 4 degrees. Data were analyzed using SPSS, version 20, and P?0.05 was considered as significant

Results: The results of this study showed that the symptoms of vaginal atrophy compared with the baseline level were relieved significantly in both groups. Dryness, itching, maturation index, PH and composite score of the vaginal symptoms were relieved significantly in both groups [P<0.001]. Dyspareunia in Premarin [P<0.05] and hyaluronic acid [P<0.001] decreased compared with pretreatment. Urinary incontinence only showed improvement in the hyaluronic acid group [P<0.05]. Improvement in urinary incontinence, dryness, maturation index [P<0.05] and composite score of vaginal symptoms [P<0.001] in the hyaluronic acid group was better than those in the Premarin group

Conclusion: According to the results of the present study, hyaluronic acid and conjugated estrogen improved the symptoms of vaginal atrophy. But hyaluronic acid was more effective and this drug is suggested for those who do not want to or cannot take local hormone treatment

comparative study of potassium hydroxide versus CO[2] laser vaporization in the treatment of female genital warts: a controlled clinical trial

Background: genital warts are the most common viral sexually transmitted disease affecting 1% of the population. A prospective, open-label controlled trial was performed to compare topical 5% potassium hydroxide [KOH] solution with CO[2] laser in the treatment of female genital warts

Methods: seventy patients were enrolled in the study after convenience sampling. Right-sided lesions of the patients were treated by CO[2] laser every 3 weeks. The left-sided lesions of the same patients were treated by topical 5% KOH solution twice a day using a toothpick with cotton wrap on the tip. The patients were visited at 3, 6, and 9 weeks after initiation of the treatment and followed up for 6 months after the last visit

Results: out of seventy patients, sixty three completed the study and were analyzed. A total of 56 KOH treated-patients [88.9%] showed complete response. On the other hand, 56 laser-treated patients [88.9%] presented complete clearing of the lesion. There was not any difference in response to both modalities of treatment. Complications of KOH solution and CO[2] laser were 24% and 19% respectively [P>0.05], but serious adverse events were not observed. The patients under KOH treatment displayed a recurrence rate of 11.1% [7 cases], while the same patients with CO[2] laser therapy demonstrated a recurrence rate of 7.9% [5 cases] [P=0.54]

Conclusion: topical 5% KOH solution was as effective as CO[2] laser in the treatment of female genital warts. There was not any serious complication in the application of KOH solution. This could be used as a new treatment for genital warts

Relaxation therapy on fetal outcomes in complicated pregnancies suffering sleep disorders: a randomized clinical trial

Background: Sleep disorders like snoring, mouth breathing, and insomnia are frequent in pregnancy and studies have shown that poor sleep is linked to obstetric complications. Muscle relaxation technique is an effective method used for improving sleep quality. The purpose of this study was to determine the effect of muscle relaxation technique on fetal outcomes in complicated pregnancies with sleep disorders

Methods: This study was performed as a clinical trial on 160 pregnant women who suffered from preeclampsia and gestational diabetes. The participants filled the Pittsburgh Sleep Quality Index [PSQI] in order to measure the quality and patterns of their sleep. The participants with the total score of 5 or more were included in the present study. Intervention group were asked to use muscle relaxation technique twice a week at home for 8 weeks alongside the routine care. Study variables included sleep quality, Apgar scores, birth weight, levels of Interleukin- 6 [IL- 6], as well as umbilical cord PH and PO2

Results: The mean score of PSQI before the intervention was 9.28+/-4.16 and 9.18+/-3.06 in the intervention and control groups without a significant difference [P=0.6], respectively. However, PSQI global score of the experimental group was smaller than the control group at the end of the study [P<0.001]. Also, birth weight [P=0.04], Apgar score [P=0.01], and umbilical cord blood po2 [P=0.03] and PH [P=0.01] were higher, and IL-6 [P=0.04] was smaller in the experimental group compared to the control group

Conclusion: The results of this study showed that muscle relaxation, as a simple, inexpensive and safe method, can improve the fetal outcomes such as birth weight, Apgar score, cord blood po2, and cord blood PH, and also it leads to lower IL-6 in complicated pregnancies

Comparison of abnormal cervical cytology from HIV positive women, female sex workers and general population

Sex workers and HIV seropositive women are at high risk of abnormal cervical cytology. The objective of this study was to compare the cervical cytology among three groups of women: active sex workers, HIV-infected women, and general population in Iran. This was a cross-sectional study performed in Hazrat Zeinab, Lavan clinics and drop in center [DIC] in Shiraz, Iran. This study was performed from October 2009 to October 2011. A total of 266 patients were assigned into three groups: sex-workers [85], HIV positive patients [100], and general population [81]. Pap smear was performed for all participants from the exocervix and endocervix, using a plastic Ayres's spatula and cytobrush. The samples were sent to a pathology center, using a liquid-based media. The risk of cervical infection in sex workers and HIV positive women was greater than the general population [OR=5.47, 95% confidence interval [CI]:2.24, 13.40], [OR=3.71, 95% CI:1.52, 9.09], respectively. The frequency of abnormal cervical cytology in the HIV positive and sex worker groups was higher than the general population [OR=6. 76, 95% CI:2.25, 20.32], [OR=3. 80, 95% CI:1.19, 12.07], respectively. Low-grade squamous intraepithelial lesion [LSIL] and high-grade squamous intraepithelial lesion [HSIL] were associated with CD4 cell count<200I106/L, P=0.021 and P<0.001, respectively. Vaginal infections were seen more often in the sex worker group, and abnormal cervical cytology was greater in the HIV positive group

effect of maternal relaxation training on reactivity of non-stress test, basal fetal heart rate, and number of fetal heart accelerations: a randomized controlled trial

Relaxation-training, as an anxiety-reducer intervention, plays an important role in fetal health. The present study aimed to analyze the effect of maternal relaxation on stress test [NST], basal fetal heart rate, and number of fetal heart accelerations. In this randomized controlled trial, 84 pregnant women were randomly divided into two groups of teaching relaxation and control groups in 2012. In the intervention group, 60-90 minute classes were held every week lasting for 4 weeks. Besides, home practice charts were given to the mothers and researchers controlled the home practices by phone calls every week. The control group received routine prenatal care. In the 4[th] week, NST was performed in the intervention group 30 minutes before and after the 4[th] session. In the control group, NST was done in the 4[th] week. The quantitative variables in the two groups were compared through ANOVA and Chi-square test. The results of paired t-test showed that relaxation could improve the NST results [P=0.01]. Mean and standard deviation of basal fetal heart rate was 138.95 +/- 8.18 before the intervention and 133.07 +/- 6.9 after the intervention. Paired t-test also showed that relaxation reduced the basal fetal heart rate [P=0.001]. Mean and standard deviation of the number of fetal heart accelerations was 1.5 +/- 0.8 before the intervention and 2.2 +/- 0.9 after it. The results of paired t-test also showed that relaxation increased the number of fetal heart accelerations [P=0.001]. Relaxation could improve the NST results, reduce the basal fetal heart rate, and increase the number of fetal heart accelerations. Therefore, relaxation is recommended during pregnancy

effect of education on sexual health of women with hypoactive sexual desire disorder: a randomized controlled trial

Sexuality constitutes an important part of women's life. Healthy and proper sexual functioning is one of the signs of physical and mental health. The present study aimed to identify the effect of education on sexual health of women with hypoactive sexual desire disorder. In this randomized clinical trial, 80 married women at reproductive age were randomly divided into a control and an education group. These women participated in this study based on selfreporting of having hypoactive sexual desire disorder. After six weekly educational sessions regarding sexual health, percentage of changes in sexual desire was assayed using Hurlbert index of sexual desire. Independent and paired t-test and Chi-square test were used to analyze the data. After the intervention, a significant difference was found between the two groups regarding the sexual desire score [P<0.001]. The results also showed a significant difference within groups in this regard [P<0.001]. According to the results of this study, it seems that educational intervention regarding sexual health was effective for the women with hypoactive sexual desire disorder. Thus, establishing sexual health education units in different health centers is highly necessary. These centers can help couples to promote their sexual knowledge and treat their sexual dysfunctions

Effect of massage therapy on labor progress and plasma levels of cortisol in the active stage of first labor

Anxiety and stress during labor increase plasma level of cortisol hormone and slow down the progress of delivery. The purpose of this study is to investigate the effects of massage therapy on the progress of labor and plasma level of cortisol in nulliparous women in labor. In this experimental study, 30 subjects were selected voluntarily among nulliparous women aged 20 to 30 years in active labor phase. They, then, divided into two equal experimental and control groups randomly. The experimental group in the active phase [dilated 3-4 cm] to transitional phase [dilated 8-10 cm] received massage therapy. The massage was done for 10 minutes with 10 minutes rest in between sets. Meanwhile, control group received no intervention. Next, labor duration and plasma level of cortisol hormone were evaluated by drawing blood of parturient women. Results were analyzed using independent t-test and paired t-test. The mean age of control and experimental groups were, 23.9 +/- 30 and 23.6 +/- 4.0 years, respectively. In terms of educational level, 10% in both groups were under diploma, 23.3% and 24.3% of subjects in control and experimental groups, in turn, had diploma, and 16.7% and 15.7% in control and experimental groups possessed bachelor degree, respectively. The results from statistical analysis showed that labor duration and level of cortisol hormone had significant reduction in experimental group than control group [p

Comparison of attachment and relaxation training effects on anxiety in third trimester and postpartum depression among primipara women

Reducing maternal anxiety has a critical role in maternal and fetal mental and physical health. This study aimed to assess the effect of two anxiety reducing techniques including relaxation and maternal-fetal attachment training on anxiety in third trimester and postpartum depression among primipara women. In this clinical trial, 126 pregnant women were randomly selected and divided into three groups including relaxation training, maternal-fetal attachment skills training, and control group. The participants completed a demographic questionnaire, the Spillberger and Beck questionnaires and written consents at baseline. The participants completed the questionnaires after the intervention too. The one way ANOVA and paired /-test were used to analyze the data. At baseline, the mean total anxiety, state and trait anxiety and depression scores were not significantly different between the groups. The ANOVA showed differences in the mean score of anxiety after the intervention [P=0.03] in the intervention groups. There were statistically significant differences between the attachment and control groups [P=0.001]; and the relaxation and control groups [P<001] in terms of the mean score of state anxiety. The ANOVA showed a reduction in the mean score of state anxiety after intervention in the attachment [P=0.02] and relaxation groups [P=0.01]. There was significant difference after the intervention in the mean score of maternal depression [P=0.002] between the attachment and relaxation groups with the control group [P=0.01, P=0.01; respectively]. Attachment and relaxation trainings can reduce maternal anxiety and post-partum depression. Pregnancy visit is an important opportunity to screen maternal anxiety and prevent post-partum depression using simple and non-expensive training programs

effect of sperm morphology on IUI outcome in cases with unexplained and male factor infertility

Although intrauterine insemination [IUI] is one of the most common methods which is used for male factor and unexplained infertility, the relative influence of various semen parameters on the likelihood of a successful outcome is controversial. Several semen parameters have been evaluated as predictors of a successful outcome with intrauterine insemination. To evaluate the effects of sperm morphology on the success rate of IUI. This was a prospective study of 200 couples who underwent IUI cycles of ovarian stimulation in Shiraz University of Medical Sciences. The patients were chosen in 2 groups, group A: 100 patients with 20% normal sperm morphology [unexplained infertility]. The other semen parameters were normal in both groups. Total clinical pregnancies were 10.5% [pregnancy rate / cycle]. There was not any difference between two groups in rate of pregnancy and also pregnancy outcome. Intrauterine insemination used for treating male factor infertility has not shown excessive advantage when normal sperm morphology in semen analysis is more than 20% in comparison with

Terbutaline versus salbutamol for suppression of preterm labor: a randomized clinical trial

Preterm labor [PTL] is a common medical problem during pregnancies and is associated with neonatal mortality and morbidity. Beta-adrenergic agonists are among the most commonly used tocolytic agents. The aim of this study was to compare the effectiveness, safety and adverse effects of terbutaline with those of salbutamol in the prolongation of pregnancy beyond 48 hours and until 37 weeks of gestation. Two hundred women with PTL were randomly assigned to receive subcutaneous terbutaline [250 micro g] or intravenous salbutamol [0.1 mg] followed by oral terbutaline [20 mg/d] or oral salbutamol [24 mg/d] as maintenance. The efficacy, side effects and complications after 48 hours and until 37 weeks of gestation were analyzed and compared. There was no significant difference between the two groups in success rate within 48 hours [P= .091]. Gestational age at delivery [P=.031] and the number of days for which the gestation was prolonged [P=.024] were significantly higher in those receiving terbutaline. Adverse effects, including tachycardia [P=.007] and anxiety [P=.006], were experienced more in the salbutamol group. Birth weight was significantly lower in the salbutamol group [P=.001]. Terbutaline provided more effective tocolysis with fewer adverse effects and a better neonatal outcome. However, terbutaline and salbutamol are equally effective in the first 48 hours

Prevalence of asymptomatic bacteriuria among pregnant women in Shiraz, Iran

To determine the frequency of asymptomatic bacteriuria in pregnant women referred to a University College Hospital in Shiraz, Iran for perinatal care, and also to determine the relation between asymptomatic bacteriuria and pyuria. This cross-sectional case series study included 389 healthy pregnant women who were referred to Hafez Hospital, Shiraz, Iran, antenatal care unit for regular perinatal care between May and August 2007. A specimen from each candidate was collected and processed following the standard microbiological technique. All the subjects were evaluated for bacteriuria. The mean age of the patients was 26.3 +/- 4.2 years. The prevalence of asymptomatic bacteriuria was 5.1%. From 75 [19.2%] patients who had >/= 5 pus cells in high power field, only 12 [16%] had positive urine culture. The most common isolated microorganism was Escherichia coli [70%] followed by Staphylococcus aureus [20%] and Group B Streptococcus [5%].We found a rate of bacteriuria in our cohort of asymptomatic pregnant subject that is well within the reported range from the literature. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. To prevent asymptomatic bacteriuria complications, all pregnant women should be screened at the first antenatal visit