Ultrasound detection of placenta accreta in the first trimester of pregnancy

Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality. Prenatal diagnosis of placenta accreta usually is made by clinical presentation, imaging studies like ultrasound and MRI in the second and third trimester. To determine accuracy of ultrasound findings for placenta accreta in the first trimester of pregnancy. In a longitudinal study 323 high risk patients for placenta accreta were assessed. The eligible women were examined by vaginal and abdominal ultrasound for gestational sac and placental localization and they were followed up until the end of pregnancy. The ultrasound findings were compared with histopathological examinations as a gold standard. The sensitivity, specificity, positive and negative predictive value of ultrasound were estimated for the first trimester and compared with other 2 trimesters in the case of repeated ultrasound examination. Ultrasound examinations in the first trimester revealed that 28 cases had the findings in favor of placenta accreta which ultimately was confirmed in 7 cases. The ultrasound sensitivity and specificity for detecting placenta accreta in the first trimester was 41% [95% CI: 16.2-62.7] and 88% [95% CI: 88.2-94.6] respectively. Ultrasound screening for placenta accreta in the first trimester of pregnancy could not achieve the high sensitivity as second and third trimester of pregnancy

comparison between sublingual misoprostol and intravenous oxytocin for inducing labor in women with term pregnancy

In this study efficacy of sub lingual Misoprostol was examined in comparison to Oxytocin [I.V.] for inducing of labor in term pregnancy. Seventy patients were allocated by blocked randomization to Groups A [n=35, sub lingual Misoprostol 25 micro g four hourly to maximum of 5 doses] and B [n=35, continuous Oxytocin infusion]. Delivery active phase and total labor phase were shorter with sublingual Misoprostol in comparison to intravenous Oxytocin [p< 0.001] and the rate of cesarean section was lower in Misoprostol group [p<0.04] but delivery latent phase, meconium staining, uterine hypertonisity and apgar score [1 and 5 minute] were similar in two groups. Sublingual Misoprostol is better than intravenous Oxytocin for induction of labor at term

[Titrated oral misoprostol solution compared with oxytocin for induction of labor in women with unfavorable cervix]

Uterine contractions and an appropriate cervix are two important factors in labor contributing to good pregnancy outcomes. Oxytocin and prostaglandins, such as misoprostol, are used for the induction of labor. Misoprostol is used for cervical ripening and labor induction. The aim of this trial was to compare the efficacy and safety of titrated oral misoprostol solution with oxytocin for labor induction in pregnant women with an unfavorable cervix. In this randomized double-blind clinical trial, 140 women with a gestational age of 34-42 weeks and an unfavorable cervix were recruited. The participants had an indication for labor induction and had been referred to the Women's Hospital in Tehran, Iran between January 2010 and January 2011. The participants were randomly assigned to receive 20 micro g/hour titrated oral misoprostol plus intravenous placebo or 6 mU/min oxytocin plus oral placebo. In case contractions were inadequate, the drug doses were gradually increased. Pharmacological complications, the mean interval from the start of induction till vaginal delivery and delivery type were monitored and analyzed in both groups. The mean interval from the start of induction till vaginal delivery in misoprostol group was shorter than the oxytocin group [11.07 +/- 3.42 vs. 14.87 +/- 3.21 hours, P=0.001]. The frequency of pharmacological complications and vaginal or cesarean deliveries were similar between the two groups [P>0.05]. Use of titrated oral misoprostol is a safe and effective method for labor induction in pregnant women with unfavorable cervix. Misoprostol is associated with a shorter interval from induction to vaginal delivery than oxytocin

Effect of metformin on diabetes mellitus prevention in pregnant women with risk factors

This study evaluated the efficacy and safety of metformin on prevention of gestational diabetes mellitus in women with high risk of GDM. Total number of 189 pregnant women aged between 25 to 35, and 10 to 14 weeks pregnancy, admitted to Mirza Koochakkhan Hospital, Tehran in January 2008 - January 2009 entered to this randomized controlled clinical trial. The women had one of the three risk factors; history of GDM, family history of diabetes, or BMI >/- 30 kg/m[2], with normal results in the glucose challenge test [GCT] or the glucose tolerance test [GTT]. Subjects were randomly split to two groups; 63 women [group A] who received metformin [500 mg, twice a day] and 126 women [group B] did not use metformin. Incidence of gestational diabetes was compared between two groups. The incidence of gestational diabetes was significantly different between two groups [%1.4 in group A,%15.4 in group B] [p<0.001]. The study also showed that the insulin requirement was significantly different between two groups after developing GDM [group A%3.6, group B%9.5, p=0.001]. Using Metformin can effectively reduce the incidence of GDM in pregnant women at risk