Is the surge in cesarean section rates during the COVID-19 pandemic truly substantiated?

BACKGROUND: Cesarean section (C-section) rates, deemed a critical health indicator, have experienced a historical increase. The advent of the COVID-19 pandemic significantly impacted healthcare patterns including delays or lack of follow-up in treatment and an increased number of patients with acute problems in hospitals. This study aimed to explore whether the observed surge is a genuine consequence of pandemic-related factors. METHODS: This study employs an Interrupted Time Series (ITS) design to analyze monthly C-section rates from March 2018 to January 2023 in Kurdistan province, Iran. Segmented regression modeling is utilized for robust data analysis. RESULTS: The C-section rate did not show a significant change immediately after the onset of COVID-19. However, the monthly trend increased significantly during the post-pandemic period (p < 0.05). Among primigravid women, a significant monthly increase was observed before February 2020 (p < 0.05). No significant change was observed in the level or trend of C-section rates among primigravid women after the onset of COVID-19. CONCLUSION: This study underscores the significant and enduring impact of the COVID-19 pandemic in further increasing the C-section rates over the long term, the observed variations in C-section rates among primigravid women indicate that the COVID-19 pandemic had no statistically significant impact.

Fresh or Frozen Embryo Transfer in The Antagonist In Vitro Fertilization Cycles: A Retrospective Cohort Study.

BACKGROUND: Gonadotropin-releasing hormone antagonist (GnRH-ant), widely adopted protocol, is more in line with the physiological processes, and induces a shorter and more cost-effective ovarian stimulation. In order to assess the success rate of embryo transferring (ET) in the antagonist in vitro fertilization (IVF) cycles, we compared the fresh ET with the frozen ET outcomes. MATERIALS AND METHODS: In this retrospective cohort study, one hundred five cases of ET of the infertility clinic of the Besat hospital (Kurdistan, Iran) between March 2014 to March 2020 that were treated with antagonist cycle (both fresh and frozen) were analyzed. The difference between the two groups in baseline data and reproductive outcomes were evaluated using Independent sample t test, Mann-Whitney U test, Chi-squared test, and Fisher's exact test in SPSS software (version 22). RESULTS: Out of 105 cases, 48 and 57 were in the fresh and frozen ET groups, respectively. The participants age was 35.75 ± 4.9 Y. In the fresh ET group, and 33.98 ± 5.1 Y in the frozen ET group. The percentage of chemical pregnancy was 12 (25%) in the fresh ET group and 15 (26.3%) in the frozen ET group (P=0.8); Clinical pregnancy rate was 11 (22.9%) in the fresh ET group and 11 (19.3%) in the frozen ET group (P=0.6); the rate of abortion in the fresh ET group was 3 (6.3%, P=0.2), and in the frozen ET group was 8 (14%, P=0.2); and the live birth rate was 9 (18.8%) in the fresh ET group, in comparison with 7 (12.3%) in the frozen ET group (P=0.3). CONCLUSION: Not statistically significant, the percentage of chemical pregnancy and abortion were higher in the frozen ET group. The percentage of clinical pregnancy and live birth were higher in the fresh ET group.

Group B Streptococci and Trichomonas vaginalis infections in pregnant women and those with spontaneous abortion at Sanandaj, Iran.

BACKGROUND AND OBJECTIVES: Group B Streptococcali (GBS) is an important factor in newborn deaths in developed and developing countries. Trichomoniasis is one of the most prevalent sexually transmitted diseases (STDs) in the world, which is caused by protozoan Trichomonas vaginalis (T. vaginalis). The present study compares the frequency of GBS and T. vaginalis genital infections in pregnant women, women with spontaneous abortion, as well as its role in spontaneous abortion. MATERIALS AND METHODS: In this case-control study, 109 women were included with spontaneous abortion with gestational ages between 11-20 weeks and 109 pregnant women with gestational ages between 35-37 weeks in Sanandaj, Iran. DNA was extracted by endocervical swabs and subjected to PCR assays. The independent t-test was used; and for comparing other qualitative variables in each group, the Chi-Square Test was used. RESULTS: The age of the women ranged from 19-43 years (29.6 ± 5.9) and in the control group the age range was from 19-42 years (27.8 ± 4.87). The rate of prevalence of Group B Streptococcal infection in the control group was 3.6%; and in the patient group there were 7.2% with the rate of prevalence of T. vaginalis in both groups as zero. CONCLUSION: The present study showed that there is no relationship between GBS infections (P-value = 0.235) and T. vaginalis.

A PRISMA systematic review and meta-analysis on Chlamydia trachomatis infections in Iranian women (1986-2015).

BACKGROUND: Chlamydia trachomatis (CT) is the cause of genital tract infections in women. Some evidence has shown the role of this infection with CT in spontaneous abortions. The purpose of this study is to study the frequency of CT infection in Iranian women. METHODS: This study was performed based on PRISMA guidelines. A total of 75 articles published in Google Scholar, PubMed, ISI Web of Science, Biological abs, Iranmedex, SID, and Scopus databases were found (1986-2015) using the following keywords: CT in women, CT and Iranian women, CT and infection in Iran, CT and pregnancy in Iran, CT and preterm delivery in Iran, CT and preterm labor in Iran, CT and fertility in Iran, CT and infertility in Iran, and CT and abortion in Iran. Finally, 40 studies from different regions of Iran were included. Statistical analyses were performed using R3 and STATA 12. RESULTS: From 1986 to 2015, the lowest rate of prevalence was from 2010 to 2011 (3.9%) and the highest prevalence rate was in 2009 (69.39%) in northern Iran. Fixed effects for different parts of Iran (North, South, East, and West) were Pooled proportion: 0.13 (95% confidence interval [CI] = 0.12-0.14) and for samples (cervical, vaginal, urine, and blood) the pooled proportion was = 0.14 (95% CI = 0.12-0.14). CONCLUSION: CT infection in this study was prevalent in urine samples and the rate of CT was observed from culture methods in comparison to other methods. Because women with CT play an important role because of sexual activity for transmission and untreated women are at risk of developing sequels. Also, most studies in Iran use sensitive polymerase chain reaction tests for the detection of genital CT infections.

The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia.

INTRODUCTION: Preeclampsia is a pregnancy-specific syndrome. One of the hypotheses concerning the etiology of preeclampsia is vitamin D deficiency during pregnancy. METHOD AND MATERIALS: The present study is a randomized controlled clinical trial which aims to determine the effect of vitamin D supplement on reducing the probability of recurrent preeclampsia. 72 patients were placed in control group while 70 patients were randomized to the intervention group. The intervention group received a 50000 IU pearl vitamin D3 once every two weeks. The control group was administered placebo. Vitamin D or placebo was given until the 36th week of pregnancy. RESULTS: The patients in intervention group have significantly lower (P value = 0.036) probability of preeclampsia than patients in the control group. The risk of preeclampsia for the control group was 1.94 times higher than that for the intervention group (95% CI 1.02, 3.71). CONCLUSION: The intended intervention (i.e., prescription of vitamin D) has a protective effect against recurrent preeclampsia. Vitamin D supplementation therapy in pregnancy could help in reducing the incidence of gestational hypertension/preeclampsia. REGISTRATION: This study has been registered in Iranian Registry of Clinical Trials (IRCT) site with ID number IRCT2017010131695N1.

Maternal Outcomes Associated with Caesarean versus Vaginal Delivery.

INTRODUCTION: To choose the best mode of delivery (vaginal versus caesarean section) still remains a contentious issue. Caesarean section is a major abdominal surgery with its related medical, anesthetic and surgical complications. Maternal mortality and morbidity is higher in caesarean section compared with vaginal delivery. The most common causes of maternal mortality during caesarean section are due to anesthesia, bleeding and infection. AIM: The aim of this study was to determine the mode of delivery and maternal outcomes in Sanandaj's hospital, Iran, during one year. MATERIALS AND METHODS: The study population included all women who were admitted for delivery in Sanandaj's Hospital. Data collection instrument was a researcher made questionnaire. Data were entered into SPSS version 20.0 and analyzed using Chi-square test. Desired outcomes were entered into multiple logistic regression models. For estimating the parameters and increasing the level of significance we used bootstrap to generate 1000 samples. RESULTS: During the study, a total of 5984 deliveries were conducted in Sanandaj Hospital, of which 3423 (57.20%) were vaginal (vaginal, vaginal + episiotomy, instrumental delivery) and 2561 (42.80%) were caesarean section. The results showed a statistically significant association between delivery mode and demographic variables such as age, occupation and level of education; whereas, no significant association was found between place of residence and parity. CONCLUSION: The finding of this study showed that caesarean section delivery rate in Sanandaj was 42.80% in 2012-2013 which is higher than caesarean section rate recommended by WHO. Also, there was a relationship between mode of delivery and maternal outcomes.

A seroprevalence and relationship survey of brucellosis between pregnant women and women with spontaneous abortion in Iran.

Background: Brucellosis is one of the most prevalent diseases common between humans and animals. It is also called Malta fever, Undulant fever and Mediterranean fever. This disease is spread by consuming milk and its unpasteurized derivatives. Clinical symptoms of brucellosis in humans are fever, chills, headache, muscular pain, tiredness, loss of appetite, joint pain, weight loss, constipation, sore throat, and dry cough. The present study aimed at surveying the seroprevalence of brucellosis in pregnant women and those women who suffered from spontaneous abortion. Methods: This case- control study was conducted in Sanandaj (Iran) in 2016 and included 2 groups of pregnant women: one group included 160 pregnant women and the other included 160 women who suffered from spontaneous abortion. Then, the participants were asked to fill out the questionnaire. After receiving permission from an obstetrician, a 10-cc blood sample was taken from each person to be used in the Rose Bengal, Wright, 2ME, and Coombs tests. Independent samples t test and Chi-square test were used to analyze the data and compare the groups. Results: Mean±SD age of women in the case group was 30.9±7.3 years, while it was 27.74±5.41 years in control women. The Rose Bengal, Wright, and 2ME prevalence for both groups was negative, but the Coombs and Wright tests score was 33 (20.6%) in pregnant women and it was 27 (16.9%) in women who experienced spontaneous abortion. No meaningful relationship was observed between spontaneous abortion and brucellosis (p= 0.39). Conclusion: Even though the present study did not find a meaningful relationship between spontaneous abortion and brucellosis (p=0.39), high brucella seroprevalence rates between both groups of women indicated that screening tests should be considered before gestation as an appropriate therapeutic strategy.

Comparison of the Effect of Clomiphene- Estradiol Valerate vs Letrozole on Endometrial Thickness, Abortion and Pregnancy Rate in Infertile Women with Polycystic Ovarian Syndrome.

INTRODUCTION: Clomiphene citrate is the first-line therapy for ovulation induction in Polycystic Ovarian Syndrome (PCOS). This drug binds and blocks estrogen receptors and thought to have an anti estrogenic effect on endometrium volume, thus may have adverse effect on fertility. AIM: This study aimed to compare the effect of Clomiphene citrate plus Estradiol Valerate with Letrozole on endometrial thickness, abortion and pregnancy rate in infertile women with PCOS undergoing ovulation induction. MATERIALS AND METHODS: This was a randomized double blind clinical trial study on 100 women with PCOS, with an endometrial thickness less than 7mm in spite of follicles greater than 18mm after administration of Clomiphene citrate 100mg/d from 3(th) to 7(th) day of menstruation. They were randomly divided in two groups. Group A received 100mg Clomiphene citrate from day 3 to day 7 of menstruation and 4 mg Estradiol Valerate after the 8(th) day of menstruation until 14(th) day. Group B treated by 5mg Letrozole from day 3 to 7 of menstruation with placebo from 8(th) to 14(th) day of menstruation. In both groups endometrial thickness was measured by transvaginal sonography in the 14(th) day of menstruation. Data were analysed using SPSS Ver.18.0. RESULTS: The mean age was 30.34 years in group A and 29.62 years in group B (p=0.381). The number of infertility years in group A was 3.73 years and in group B was 3.85 years. There was no significant relationship statistically between the two groups in terms of mean age and infertility years (p=0.99). Endometrial thickness in group A was 7.26mm and in group B was 8.17 mm. Pregnancy rates in group A and group B was 32% and 16% respectively. There was significant relationship statistically between the two groups in terms of endometrial thickness and pregnancy rates (p=0.021 and p=0.05). There was no abortion in group A and 5 cases had abortion in group B, there was a significant relationship between the two groups statistically (p=0.028). CONCLUSION: Letrozole increased endometrial thickness and pregnancy rate in infertile women, therefore its administration is recommended.

Comparing the outcomes of physiologic delivery with non-physiologic delivery group.

BACKGROUND: The main purpose of physiologic delivery is to rely on mother's body for childbirth. In physiologic delivery method pregnant women attend delivery preparation classes and they learn how to overcome fear and pain. This study compares delivery outcomes among women who participated in physiologic delivery with those who had undergone non-physiologic delivery. METHODS: All patients referred for physiologic delivery were assessed. Exclusion criteria were lack of PROM, post date, cephalopelvic disproportion, multi-fetal pregnancy, Meconium stain, blood pressure above 90/140, placenta previa and previous record of cesarean. Data was entered in SPSS 16 software and Fisher and Chi-square tests were used to compare vaginal laceration, episiotomy and Apgar score between two groups. RESULTS: Twelve out of 73 pregnant women (16.4%) in physiologic delivery group and 27 out of 69 pregnant women (39.1%) in non-physiologic delivery group needed episiotomy (P = 0.002). Ten patients (13.7%) in physiologic delivery group and seven persons (10.1%) in the non-physiologic delivery group were suffering from vaginal laceration (P = 0.51). There was no significant statistical difference between newborns' Apgar score in two groups. CONCLUSIONS: Physiologic delivery can reduce the need for episiotomy without any further complications.