Comparing the effects of vaginal misoprostol, laminaria, and extra amniotic saline infusion on cervical ripening and induction of labor.

OBJECTIVE: This study aimed to compare the effects of vaginal misoprostol, laminaria, and extra-amniotic saline infusion (EASI) on cervical ripening. METHODS: This randomized controlled trial was conducted on 195 women with singleton pregnancies and unripe cervices. Participants were randomly allocated to 3, 65-person groups: a misoprostol, a laminaria, and an EASI group. The interventions in the misoprostol, laminaria, and EASI groups included a single 25-µg vaginal misoprostol suppository, an intracervical laminaria, and a transcervical Foley catheter, respectively. The groups were compared with each other regarding time intervals from labor induction to labor active phase and delivery, cervical dilation, Bishop scores 6 hours after induction, delivery type, length of hospital stay, and complications. RESULTS: There were no significant differences among the groups regarding maternal ages, gestational ages, body mass indices, baseline cervical dilations, and Bishop scores (P>0.05). Six hours after induction, the Bishop score and cervical dilation were significantly greater in the EASI group than in the other 2 groups (P<0.001). Moreover, time intervals from labor induction to labor active phase and delivery in the EASI group were significantly short (P<0.001). The rates of cesarean section, fetal distress, placental abruption, and meconium staining in the misoprostol group were significantly high (P<0.05), and the length of hospital stay in the EASI group was significantly short (P<0.001). CONCLUSION: EASI is a safer and more effective method for cervical ripening. Considering its inexpensiveness, easy accessibility, and greater effectiveness, EASI is recommended for cervical ripening. TRIAL REGISTRATION: Iranian Center for Clinical Trials Identifier: IRCT20170513033941N39.

Magnesium Sulfate and Clonidine; Effects on Hemodynamic Factors and Depth of General Anesthesia in Cesarean Section.

BACKGROUND: Making stable hemodynamic and also durable unawareness is a daily challenge in the setting of general anesthesia in women who undergo surgical delivery of neonate and have limitations to receive opioids derivatives. OBJECTIVES: We aimed to evaluate the effects of magnesium sulfate and clonidine on hemodynamic changes and depth of anesthesia and in mentioned mothers and also in neonatal APGAR index. METHODS: Current randomized, double-blind controlled trial study was conducted among a total of 360 pregnant females (38 - 41 weeks of gestation) who underwent elective cesarean section. Participants were randomly divided into three drug-receiving groups (equal 120 members): magnesium sulfate (30 mg/kg), clonidine (3 µg/kg), and placebo (0.9% NaCl). Patients' blood pressure, heart rate, cerebral state index (CSI) in specific time zones, and also late 24-hour recall were recorded. The CSI is an electroencephalographic monitoring method helping to assess the depth of anesthesia. Neonatal parameters, including APGAR score and umbilical venous blood sampling, were measured. RESULTS: Mean patients' age was 28 ± 4.5. A significant decreasing and stabilizing effect of magnesium sulfate and clonidine on hemodynamic parameters (blood pressure and heart rate) was revealed (P < 0.001). Evidence implied on deeper anesthesia (lower CSI) among drug receivers comparing to placebo (P < 0.001). None of the participants experienced a late 24-hour recall postoperatively. All neonates were healthy, and no decrease was reported in APGAR score at minutes 1 and 5. Umbilical blood gas analysis showed no signs of acidosis and/or hypoxemia. CONCLUSIONS: Adjuvant administration of either magnesium sulfate or clonidine is associated with hemodynamic stability and favorable unawareness in the setting of elective surgical delivery.

Cervical length versus vaginal PH in the second trimester as preterm birth predictor.

OBJECTIVE: To evaluate diagnostic value of vaginal pH and cervical length measurement in the second trimester of pregnancy as a preterm labor (PTL) predictor. METHODS: During a prospective cohort study 438 uncomplicated singleton pregnant women between 18 and 24 weeks of gestation were assessed regarding vaginal PH and cervical length. Vaginal pH was measured using Ph-indicator strips and cervical length was determined using transvaginal ultrasound. The cut-off values for vaginal PH and cervical length were defined as 5 and <30 mm respectively. RESULTS: Vaginal pH of 5 and above was found in 162/438 women (37%) while cervical length <30mm was found in 38/438 (8.7%). The incidence of PTL < 37 weeks was 87/438 (19.9%) while the incidence of early (PTL <34 weeks) was 51/438 (11.6%). Predictive value of higher vaginal PH was significantly more (31%) than vaginal PH<5 (13%) in predicting PTL. As a result, alkaline vaginal PH significantly increases the odds of preterm labor (OR=3.06). Shortened cervical length is better predictor of PTL than higher vaginal PH with positive predictive value of 71% and negative predictive value of 85%. Cervical length less than 30 mm nearly 14-fold increases odds of preterm birth (OR=13.9). CONCLUSION: Compared to alkaline vaginal PH, shortened cervical length has better value to predict PTL overall. However, regarding early or late PTL, vaginal PH is more accurate to predict late PTL, while cervical length measurement is more appropriate to predict early PTL (<34 weeks).

Closure or non-closure of peritoneum in cesarean section: outcomes of short-term complications.

BACKGROUND: Cesarean section (CS) is one of the most frequently performed surgical procedures worldwide. The complications following a CS include fever, wound infection, post-operative pain and bleeding which are not usually found in a normal vaginal delivery. Traditionally, suturing of peritoneal layers for CS patients has been done, but in some studies it has been shown that this procedure could be eliminated without affecting the rate of morbidity. OBJECTIVES: The objective of this study was to assess the short-term outcomes of two different cesarean delivery techniques. PATIENTS AND METHODS: A total of 100 cases who underwent CS were randomly assigned equally to either closure of both the visceral and parietal peritoneum or no peritoneum closure. Duration of operation, pain scores, analgesic requirements, alterations in hemoglobin levels and febrile morbidity were assessed accordingly. RESULTS: Pain scores, analgesic requirements assessed at 24 hours and operation duration were significantly lower in the non-closure group as compared to the closure group. Febrile conditions and changes in hemoglobin levels were similar in both groups. CONCLUSIONS: Non-closure of both visceral and the parietal peritoneum when performing a CS produces a significant reduction in pain, fewer analgesic requirements and a shorter operation duration without increasing the febrile morbidity and changes in hemoglobin levels as compared to the standard methods.

Effect of daily consumption of probiotic yoghurt on lipid profiles in pregnant women: a randomized controlled clinical trial.

BACKGROUND: Due to enhanced fat storage primarily during the mid-pregnancy period, pregnancy is associated with elevated levels of lipid profiles. To our knowledge, no reports are available indicating the effects of probiotic yoghurt consumption on serum lipid profiles in pregnant women. OBJECTIVE: This study was designed to determine the effects of daily consumption of probiotic yoghurt on lipid profiles of Iranian pregnant women. METHODS: This randomized single-blinded controlled clinical trial was performed among 70 pregnant women, primigravida, aged 18-30 years old who were carrying singleton pregnancy at their third trimester. Subjects were randomly assigned to consume 200 g/d of conventional (n=33) or the probiotic group (n=37) for 9 weeks. The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus, enriched with probiotic culture of two strains of lactobacilli (Lactobacillus acidophilus LA5) and bifidobacteria (Bifidobacterium animalis BB12) with a total of min 1 × 10(7) colony-forming units. The conventional yoghurt contained the starter cultures of S. thermophilus and L. bulgaricus. Fasting blood samples were taken at baseline and after 9-weeks intervention to measure serum lipid profiles. RESULTS: Although consumption of probiotic yogurt for 9 weeks had been resulted in a significant reduction in serum total- (-53.7 mg/dL, p=0.001), LDL- (-35.2 mg/dL, p=0.006) and HDL-cholesterol levels (-9.8 mg/dL, p=0.002) as well as serum triglyceride concentrations (-42.8 mg/dL, p=0.029), no significant differences were found comparing probiotic and conventional yogurts in terms of their effect on serum lipid profiles. Within-Group differences in conventional yogurt group revealed a significant reduction in HDL-cholesterol levels (-8.4 mg/dL, p=0.005) and borderline significant reduction in serum total cholesterol concentrations (-21.6 mg/dL, p=0.08). CONCLUSION: In conclusion, consumption of probiotic yogurt among pregnant women could not affect serum lipid profiles as compared to the conventional yogurt.

Plasma total antioxidant capacity and its related factors in Iranian pregnant women.

OBJECTIVE: To determine the plasma total antioxidant capacity (TAC) and its related factors in pregnant Iranian women attending maternity clinics. METHODS: In a cross-sectional study carried out in Naghavi Maternity Clinic, Shaheed Beheshti Specialty and Subspecialty Polyclinic and 10 antenatal centers, affiliated to Kashan University of Medical Sciences, Kashan, Iran, we determined the plasma TAC and its related factors including maternal age, weight, and body mass index (BMI) at the beginning, thirteenth, and twenty-first to twenty-fourth weeks of pregnancy, and gestational age at the twenty-first to twenty-fourth weeks of pregnancy in 137 primigravid pregnant women, 18-30 years old from October 2010 to March 2011. We used multiple linear regression to assess the relationship between TAC and its related factors. RESULTS: Plasma TAC in the twenty-first to twenty-fourth weeks of pregnancy was 0.75+/-0.11 mmol/l. The BMI at the beginning was 25.06+/-4, 25.72+/-4.13 at the thirteenth, and 26.95+/-4.19 kg/m2 at the twenty-first to twenty-fourth weeks of pregnancy. Multiple regression analysis showed that gestational age was inversely associated with the plasma TAC (beta: -0.234, p=0.007). Regression analysis also suggested a trend toward significant association between maternal age and plasma TAC (beta: 0.150, p=0.080), but there was no association between other variables and plasma TAC. CONCLUSION: Gestational age was inversely correlated with plasma TAC and maternal age had a trend toward significant association with TAC in 18-30 year-old Iranian pregnant women in their sixth month of pregnancy.

Assessment of the relationship of vitamin D with serum antioxidant vitamins E and A and their deficiencies in Iranian pregnant women.

OBJECTIVE: To assess the relationship between vitamin D and serum antioxidant vitamins E and A, and their deficiencies in pregnant women. METHODS: This cross-sectional study was carried out in the maternity clinic of Naghavi Specialists and Subspecialities Polyclinic, affiliated to Kashan University of Medical Sciences Kashan, Iran between April 2008 and August 2009. One hundred and forty-seven pregnant women were recruited. Vitamin D, A, and E status were assessed using serum at 5-9 months of pregnancy. The prevalence of vitamin deficiency was reported using defined cutoff values. Correlations between vitamin D and vitamins A and E were reported. Data were compared using the analysis of variance and coefficient correlation linear Pearson's. The relative difference between the groups were considered statistically significant (p<0.05). RESULTS: Serum concentrations of vitamin D were 7.2 +/- 2.31, 17.72 +/- 5 and 33.05 +/- 0.94 ug/ml, for vitamin E 2.15 +/- 1.3 and 8.07+/- 2.3 ug/ml, and for vitamin A 0.16+/- 0.05 and 0.46+/-0.13. We used the defined cutoff values in determining vitamins D, A, and E deficiency. The prevalence of vitamin D deficiency was 95.8%, vitamin A was 7%, and vitamin E was 58.6%. The correlation coefficient between serum vitamin D and vitamin E shows an inverse relationship (r=0.24, p=0.004). CONCLUSION: Extent vitamins D, A, and E deficiency among pregnant women is a major public health problem in Kashan, Iran.