Comparing maternal and neonatal prooxidant-antioxidant balance during delivery

Objective: Oxidative stress (OS) is due to a disturbance in the balance between the production of free radicals and antioxidant defense, resulting in a predominance of free radicals over endogenous anti-oxidant defenses. OS may have many causes. Pregnancy, and especially delivery, are associated with increased OS. The relationship between maternal and infant prooxidant-antioxidant balance (PAB) is unclear. Therefore, the aim of the present study was to compare PAB in mother and baby pairs. Material and Methods: This cross-sectional study was conducted in 104 mothers and normal term infants during 2017-2020. PAB was measured in healthy mothers before delivery and in umbilical cord samples after delivery. Data on the infant characteristics including age, gestational age, birth weight, Apgar score, and maternal history including the duration of mother's education, weight of the last month, and gravidity were collected using a researcher-made questionnaire. The cord and maternal PAB were compared by statistical methods. Results: In this study, the mean PAB of the neonates and mothers was 30.76 and 214.87 HK, respectively. The results revealed a moderate association between the PAB neonate and maternal PAB before delivery but it was not significant. Conclusion: Overall, the level of oxidants and antioxidants reduced during pregnancy and before delivery, and it was found that the relative incidence of neonatal PAB increases by increasing maternal PAB.

The effect of plantain syrup on heavy menstrual bleeding: A randomized triple blind clinical trial.

Given the importance of heavy menstrual bleeding (HMB), we investigated the effect of plantain syrup on HMB. This randomized clinical trial was performed on 68 women with HMB who were referred to the traditional medicine clinics of Mashhad University of Medical Sciences. The intervention group received placebo capsule and plantain syrup, whereas the control group received mefenamic acid capsule and placebo syrup in the first 5 days of menstruation for three menstruation cycles. Patients were asked to complete pictorial blood assessment chart one cycle before the intervention and three intervention cycles. Hemoglobin was measured at the beginning and at the end of the study. The results showed that the bleeding duration and severity diminished in both groups. No significant difference was observed between two groups in severity of bleeding after intervention (Cohen's d = .24), but duration of bleeding in mefenamic acid group was reduced significantly in comparison with plantain group (Cohen's d = .57). Although mean hemoglobin alterations in mefenamic acid group had a significant difference before and after the intervention, there was no significant difference between the two groups in mean hemoglobin alterations postintervention. Plantain syrup could be suggested as a complementary treatment for HMB, but further studies are required.

First Trimester Uterine Rupture, a Rare but Life-Threatening Event: A Case Report.

Uterine rupture often occurs in the third trimester of pregnancy or during labor. Its occurrence in early pregnancy and in the absence of any predisposing factors is very rare. Untimely diagnosis and a low index of suspicion could be life-threatening. Here we report the case of a 29-year-old woman with a history of two previous cesarean sections. An ultrasound report revealed a dead fetus in the abdominal cavity at 14 weeks into the abdominal cavity due to a rupture at the site of the previous cesarean scar. Awareness of probable diagnosis of uterine rupture in a pregnant woman with abdominal pain could be important for timely diagnosis and proper management.

Sublingual Misoprostol versus Foley catheter for cervical ripening in women with preeclampsia or gestational hypertension: A randomized control trial.

BACKGROUND: Delivery is the only definite cure for hypertensive disorders. Therefore, cervical ripening and labor induction are important to achieve favorable outcomes. OBJECTIVE: This Randomized Control Trial (RCT) is aimed to compare the effects of sublingual misoprostol and Foley catheter in cervical ripening and labor induction among patients with preeclampsia or gestational hypertension. MATERIALS AND METHODS: A total number of 144 women with preeclampsia or gestational hypertention with indication of pregnancy termination, who were referred to academic hospitals of the University of Medical Sciences in Mashhad, Iran, between March 2015 and December 2016, were randomly divided into two groups. In group one (n = 72), 25 µg of misoprostol tablet was administrated sublingually every 4 hr up to six doses. In group two (n = 72), a 16F Foley catheter was placed through the internal cervical os, inflated with 60 cc of sterile saline. RESULTS: There were no significant differences between groups regarding the demographic characteristics, primary bishop score, and pregnancy termination indication. The cervical ripening time (primary outcome) (8.2 vs 14.2 hr, p < 0.00), induction to delivery interval (15.5 vs 19.9 hr, p < 0.00), and vaginal delivery before 24 hr (63.9% vs 40%, p = 0.03) were significantly different between the two groups. There was no significant difference between groups in view of oxytocin requirement (p = 0.12), neonatal Apgar score (p = 0.84), or neonatal intensive care unit admission (p = 78). CONCLUSION: This trial showed that the application of sublingual misoprostol, compared to the Foley catheter, can reduce cervical ripening period and other parameters related to the duration of vaginal delivery. This misoprostol regimen showed inconsiderable maternal complications.

Sudden Bilateral Sensorineural Hearing Loss Following Postpartum Hemorrhage: A Case Report.

The prevalence of bilateral sudden sensorineural hearing loss (SSNHL) is less than 5% and the etiology of most cases is unknown. Due to many structural and functional similarities between the kidney and inner ear, many conditions, diseases, and drugs have both renal and cochlear effects and toxicities. There are several reports of SSNHL in patients with CRF, uraemic patient, hemodialysis treatment, and ARF. Here, we report a rare manifestation of SSNHL following severe postpartum hemorrhage that has simultaneous renal failure and cochlear impairment. The patient was a 22-year-old primigravida woman with term pregnancy who after delivery and episiotomy hematoma and postpartum hemorrhage subsequently suffered from kidney failure, oliguria, and SSNHL that occurred after 3 days of delivery. In conditions such as severe postpartum bleeding leading to acute renal involvement, the possibility of simultaneous involvement of cochlea due to hypoxia or received drugs should be considered.

Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: A survey of 82 cases.

BACKGROUND: Placenta adhesive disorder (PAD) is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities. OBJECTIVE: The purpose of this study was to compare the accuracy of color Doppler ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of PADs. MATERIALS AND METHODS: In this is cross-sectional study, Eighty-two pregnant women who were high risk for PAD underwent color Doppler ultrasound and MRI after 18 weeks of gestation. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P<0.05 was considered statistically significant. RESULTS: Mean maternal age was 31.42±4.2 years. The average gravidity was third pregnancy. 46% of patients had placenta previa. The history of the previous cesarean section was seen in 79 cases (96%). The diagnosis of placenta adhesive disorder was found in 17 cases (21%). Doppler sonography sensitivity was 87% and MRI sensitivity was 76% (p=0.37). Doppler sonography specificity was 63% and MRI specificity was 83% (p=0.01). CONCLUSION: Women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity.

Clomiphene citrate versus letrozole with gonadotropins in intrauterine insemination cycles: A randomized trial.

BACKGROUND: Clomiphene citrate is one of the effective drugs for infertility treatment due to oligo-ovulation or anovulation. Intrauterine insemination (IUI) is one of more adherent methods for treatment of infertile cases which is followed by controlled ovarian hyperstimulation (COH). OBJECTIVE: the aim of this study was to evaluate Clomiphene citrate versus letrozole with gonadotropins in IUI cycles. MATERIALS AND METHODS: In this prospective randomized trial, 180 infertile women who were referred to Milad Hospital were selected. The first group received 5 mg/day letrozole on day 3-7 of menstrual cycle. The second group received 100 mg/day Clomiphene in the same way as letrozole. In both groups, human menopausal gonadotropin was administered every day starting on day between 6-8 of cycle. Ovulation was triggered with urinary Human Chorionic Gonadotropin (5000 IU) when have two follicles of ≥16 mm. IUI was performed 36 hr later. RESULTS: The number of matured follicles, cycle cancellation, and abortion were the same in both groups. Endometrial thickness was higher at the time of human menopausal gonadotropin administration in letrozole group. Chemical and clinical pregnancy rates were much higher in letrozole group. Ovarian hyperstimulation was significantly higher in clomiphene group. CONCLUSION: Letrozole appears to be a good alternative to clomiphene citrate with fewer side effects.

Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy.

INTRODUCTION: Regarding to the recent advances in assisted reproductive techniques (ART), twin and multiple pregnancies have increased during past years. OBJECTIVE: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy. MATERIALS AND METHODS: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group (n=96) and ART group (n=31). Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications (preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation (IUGR), postpartum hemorrhage), neonatal outcomes (weight, first and fifth minute Apgar score, Neonatal Intensive Care Unit (NICU) admission, mortality, respiratory distress, and icterus) were recorded using a questionnaire. RESULTS: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death (IUFD) were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes (weight, 1(st) and 5(th) min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus). CONCLUSION: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART.

Evaluation of Maternal-Neonatal Outcomes in Vaginal Birth After Cesarean Delivery Referred to Maternity of Academic Hospitals.

Objective: To evaluate the maternal and neonatal complications of vaginal birth after cesarean section (VBAC). Materials and methods: This cross sectional study was conducted in Mashhad University of medical sciences. Eighty women with previous cesarean section who were candidate for VBAC were enrolled the study. Patients were followed up for 6 weeks after delivery. The complication of VBAC was compared between successful or unsuccessful VBAC cases. Data was analyzed by SPSS version 16. Results: VBAC success rate was 91%. Post-partumhemorrhage occurred in 2.7% of woman with successful VBAC and 1.3% of CS cases. Maternal and neonatal death did not happen during our study, and none of our cases experienced uterine rupture, dystocia and neonatal tachypnea. Neonatal complications include NICU admission and neonatal resuscitation frequency in VBAC and CS were 6.8% and 57.1%, respectively (p = 0.002). Birth weight of neonates in successful VBAC was 2940 ± 768 grams and 3764 ± 254 grams in unsuccessful VBAC and this difference was significant (p = 0.007). Mean maternal admission duration in VBAC and CS were 1 ± 0.1 days and 2 ± 0.4 days (p < 0.001). Successful breastfeeding rate were higher in VBAC patients (95.8%) in comparison with CS (42.9%) and this difference was statistically significant (p = 0.002). Conclusion: Our results revealed that VBAC can be considered as a safe maternal and neonatal delivery method in patients with past CS women.

Vaginal versus sublingual misoprostol for labor induction at term and post term: a randomized prospective study.

We want to compare the efficacy and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor. This randomized clinical trial was performed on 140 women with medical or obstetric indications for labor induction. The patients were randomly divided into two groups: vaginal and sublingual administration of misoprostol. In first group, 25 µg misoprostol was placed in the posterior fornix of the vagina and second group received 25 µg misoprostol sublingually, every 6 hours for 24 h. Maternal and neonatal outcomes were analyzed. There was no significant difference in the demographic characteristics between two groups. The main indication for cesarean section in both groups was fetal distress, followed by absence of active labor progress. Evaluation of cesarean indication was not significantly different in two groups; including fetal distress, absence of active labor, uterine over activity and failure to progress. The maternal complication in sublingual group included residual placenta (2%), tachysystole (2%), vomiting (12%), atoni (3.3%) and abdominal pain (5.5%), although there was no significant difference between two groups. Sublingual misoprostol is as effective as vaginal misoprostol for induction of labor at term. However, sublingual misoprostol has the advantage of easy administration and may be more suitable than vaginal misoprostol.

Comparison of serum levels of Tri-iodothyronine (T3), Thyroxine (T4), and Thyroid-Stimulating Hormone (TSH) in preeclampsia and normal pregnancy.

BACKGROUND: The physiological changes in thyroid gland during pregnancy have been suggested as one of the pathophysiologic causes of preeclampsia. OBJECTIVE: The aim of this study was comparison of serum levels of Tri-iodothyronine (T3), Thyroxine (T4), and Thyroid-Stimulating Hormone (TSH) in preeclampsia and normal pregnancy. MATERIALS AND METHODS: In this case-control study, 40 normal pregnant women and 40 cases of preeclampsia in third trimester of pregnancy were evaluated. They were compared for serum levels of Free T3 (FT3), Free T4 (FT4) and TSH. The data was analyzed by SPSS software with the use of t-student, Chi-square, Independent sample T-test and Bivariate correlation test. p≤0.05 was considered statistically significant. RESULTS: The mean age was not statistically different between two groups (p=0.297). No significant difference was observed in terms of parity between two groups (p=0.206). Normal pregnant women were not significantly different from preeclampsia cases in the view of FT3 level (1.38 pg/ml vs. 1.41 pg/ml, p=0.803), FT4 level (0.95 pg/ml vs. 0.96 pg/ml, p=0.834) and TSH level (3.51 µIU/ml vs. 3.10 µIU/ml, p=0.386). CONCLUSION: The findings of the present study do not support the hypothesis that changes in FT3, FT4 and TSH levels could be possible etiology of preeclampsia.

Comparison of vaginal misoprostol with foley catheter for cervical ripening and induction of labor.

At times, despite an unripe cervix, induction of labor may be needed. In these cases, a safe and suitable method should be considered for cervical ripening and pregnancy termination. The aim of this study is the comparison of vaginal misoprostol with Foley catheter for cervical ripening and induction of labor. This randomized clinical trial was performed on 108 pregnant women who had referred to the teaching hospitals of Mashhad University of Medical Sciences during a time period of September 2007 to March 2008. These women were randomly divided into two groups: Misoprostol (including 49 patients) and Foley catheter (including 59 patients). For the first group, 25 microgram vaginal misoprostol was administered every 4 h up to maximum 6 doses. For the second group, Foley catheter 18 F, inflated with 50 cc of sterile water, was placed through the internal os of the cervix. Data was analyzed using SPSS software. p < 0.05 was considered statistically significant. Two groups were similar in the view of demographic characteristics, cesarean indications, maternal and fetal outcomes and neonatal outcomes. Vaginal delivery was significantly higher in misoprostol group (89.9 vs. 62.7, p < 0.01). The mean of delivery time was significantly shorter in misoprostol group (11.08 ± 5.6 vs. 13.6 ± 16.0 h, p < 0.05). In the cases of pregnancy termination and unripe cervix, two methods of misoprostol and Foley catheter were considered suitable, but it seemed that misoprostol decreases the delivery time and was needed for the cesarean section.

Misoprostol alone or in combination with methotrexate for termination of pregnancy at first trimester.

Abortion is an important problem in obstetrics throughout the world. The common and standard method for pregnancy termination at first trimester is surgery (curettage). Nowadays, an effective method of pregnancy termination at first trimester is medical treatments. The aim of this study is to compare misoprostol alone or in combination with methotrexate for pregnancy termination at first trimester. This study is a randomized clinical trial. A total of 200 pregnant women at first trimester were randomizedly divided into two groups for termination of pregnancy. The first group received 800 µg vaginal misoprostol. If conceptus residual remained, the same dose of misoprostol was repeated. The second group received 50 mg/m² intramuscular methotrexate, and then 800 µg vaginal misoprostol was administered after 72 h. If conceptus residual remained, the same dose of misoprostol was repeated after 24 h. Abdominal ultrasonography was performed at seventh day for both groups. Should conceptus residual remained or if pregnancy continued, curettage was performed. The results were analyzed statistically in terms of chi-square, and student's t-test, using the SPSS software. A P-value equal or smaller than 0.05, was considered statistically significant. In this study, 83% of the first group and 81% of the second group had successful abortion. There was a significant correlation between the dose of misoprostol and abortion (P = 0.001) and between type of pregnancy and need for curettage (P < 0.000) in both groups, but there was no significant correlation between gestational age and the numberof doses administered (P = 0.932).In conclusion it seems that pregnancy termination by misoprostol alone or in combination with methotrexate is a safe and cost-effective method.

Medical abortion at first trimester of pregnancy with misoprostol.

OBJECTIVE: To evaluate the efficacy of medical abortion at first trimester of pregnancy with vaginal misoprostol. METHODS: This is a descriptive analytic study. It was performed on 100 women at first trimester of pregnancy referred to teaching hospitals related to the Medical Sciences of Mashhad University, Mashhad, Iran for termination of pregnancy in 2006. Each patient received first dose of misoprostol (800 microg/vaginal), the second dose (800 microg/vaginal) was administered 24 hours after the first dose if expulsion of conceptus was not successful and curettage was performed if product of conception remained. RESULTS: From 100 patients, 83 women (83%) had successful complete abortion, and 17 cases required curettage. Among them, pregnancy was terminated in 55 (62%) with first dose of misoprostol and 28 (34%) of them required second dose. No important side-effects were noted due to vaginal misoprostol treatment. CONCLUSION: Termination of pregnancy by medical methods at first trimester of pregnancy with vaginal misoprostol is safe, cost effective, and without side-effects.