Lactate plasma level as a potential biomarker in early diagnosis of ectopic pregnancy: A case-control survey.

Introduction: A novel metabolomics survey proposed lactic acid as a diagnostic biomarker to detect ectopic pregnancy (EP). Here we investigate the plasma level of lactate for early diagnosis of EP as a potential biomarker. Methods: In a case-control study, the reproductive aged women with definite tubal EP (6-10 weeks' gestation), referred to our department during 2021-2022, considered as case group, and women with normal singleton pregnancy in the same gestational age as control group. After informed concept, demographic data (maternal and gestational age and parity) recorded and 5 mL venous blood samples were taken to detect the lactate plasma level. The data analyzed using SPSS software ver22. Results: Finally, 95 participations (50 in case and 45 in control group) enrolled. The clinical results showed that the most of case group were aged more than 35 years old with had higher parity and body mass index, but, no statistically significant difference showed up. On the other hand, although the lactate level was slightly higher in women with EP, but, the plasma lactate level did not statistically differ between the two study groups. Also, the logistic regression showed no relationship between the demographic variables and the lactate plasma level. Conclusion: It seems that the plasma level of lactate cannot be a diagnostic biomarker for EP.

Effects of maternal age on the mode of delivery following induction of labor in nulliparous term pregnancies: A retrospective cohort study.

Background and Aim: Increased maternal age at the time of pregnancy and labor is believed to have potential complications. To evaluate the effects of maternal age on the mode of delivery among nulliparous women with term pregnancies who underwent labor induction. Methods: In this retrospective cohort study, 313 women with the gestational age of at least ≥37 weeks, were enrolled. They were divided based on their maternal ages as: Group A < 35 years old (y/o) and Group B ≥ 35 y/o patients. Demographic features and other variables (i.e., past medical history, social history, indications and methods of labor induction, causes of cesarean delivery) were recorded from patients' files. Final outcomes were categorized as: primary (i.e., rate of cesarean section: C/S) and (b) secondary (i.e., duration of labor, postpartum complications, neonatal variables). All data were analyzed by the SPSS ver.21 software. Results: Median and interquartile ranges of gestational age were not significantly different, comparing the two groups (p = 0.415), although these variables were significantly different regarding maternal height among the two groups (p = 0.007). There was a significant relationship between the methods of labor induction among the two groups (p = 0.005). There was a prominent statistical relationship between (a) C/S deliveries and also (b) indications of C/S among the two groups (p = 0.004 and p = 0.033, respectively). Univariate logistic regression test revealed maternal age groups, neonatal weight, and history of underlying diseases had significant results (p < 0.05). Conclusions: Increased maternal age is associated with higher rates of CS among nulliparous women with term pregnancies who underwent labor induction.

Effect of vaginal washing before Misoprostol insertion on cervical ripening before induction of labor: A randomized single-blind clinical trial.

BACKGROUND: Vaginal pH is acidic in pregnancy, but there is no information about pH changes in pregnancy, and contradictory results have been reported from the effectiveness of Misoprostol at different vaginal pH. This study aimed to evaluate the effect of vaginal washing before Misoprostol insertion on cervical ripening before induction of labor in comparison with the control group. METHODS: This randomized single-blind clinical trial was performed on 148 pregnant women who were candidates for induction of labor. Subjects were randomly divided into two groups of intervention (vaginal washing with 20 cc of normal saline 0.9% before Misoprostol insertion) and the control group (without vaginal washing). Vaginal pH and Bishop scores were measured before and after the intervention. The two groups were compared in demographic-obstetric variables, the success rate of induction of labor, maternal and neonatal outcomes, and Misoprostol dose. RESULTS: After the intervention, there was no statistically significant difference between the pH before and after in the group with vaginal washing. There was no significant difference between the two groups in the type and duration of labor, and maternal and neonatal outcomes (P > .05). The frequency of normal delivery less than 12 hours in the intervention group was higher than in the control group. Although this difference was not statistically significant due to the small number of subjects, it is clinically significant. CONCLUSION: The results of the present study showed that vaginal washing with normal saline before Misoprostol insertion for induction of labor did not affect the success of induction and duration of labor.

Risk Factors, Clinical Symptoms, Laboratory Findings and Imaging of Pregnant Women Infected with COVID-19 in North of Iran.

BACKGROUND: Due to the physiological changes in the body during pregnancy, the increased susceptibility to viral infections during this period and also the high prevalence of coronavirus disease 2019 (COVID-19) in the Guilan province, Iran, this study aimed to evaluate risk factors, clinical symptoms, laboratory findings and imaging of pregnant mothers with COVID-19. METHODS: In this descriptive study, 70 pregnant women aged 17-41 years with COVID-19 who were hospitalized from early March to late April 2020 were enrolled. Sampling was performed by census and from all hospitals in Guilan. The research instruments included a researcher-made questionnaire, including demographic characteristics, clinical symptoms, medical examinations, and paraclinical results. Data were analyzed with SPSS version 16. Frequency and percent were used to describe qualitative variables; for quantitative variables, if they were normally distributed, mean and standard deviation were used, and if they were non-normal, median and interquartile range (IQR) were used. RESULTS: The most severe symptoms recorded in mothers at the time of hospitalization were fever (47%), shortness of breath (16%) and cough (15%), respectively. One of 68 (1%) was in the severe stage of the disease and two mothers (2%) were in critical condition and admitted to the intensive care unit and finally died. Fifty-five of 66 women (83%) had lymphopenia, 22 of 42 (52%) tested positive on PCR, and 30 of 33 (90%) had an increase in lactate dehydrogenase (LDH) levels.Results showed that 15 of 32 patients who gave birth had preterm delivery (46%). CONCLUSION: The most common manifestations of the disease in pregnant women were fever, cough and shortness of breath, and in some cases muscle pain. The most common laboratory finding in infected mothers was lymphopenia. Complications of pregnancy and childbirth in women included an increase in cesarean delivery.

Relationship of Uterine Fibroids with Lipid Profile, Anthropometric Characteristics, Subcutaneous and Preperitoneal Fat Thickness.

BACKGROUND: Uterine fibroids (UFs) are the most common benign tumors of the uterus with an unknown etiology, affecting many women of reproductive age. We aimed to evaluate the association between UFs and anthropometric features, subcutaneous and preperitoneal fat thickness and lipid profile. METHODS: This is a case-control study conducted on 212 women who were available in the Al-Zahra specialized referral hospital from March 2018 to March 2019. Study variables including weight, height, waist and hip circumference were measured for all individuals. For patients with UFs, the size, number and location of fibroids were recorded. Also, subcutaneous and preperitoneal fat thicknesses were measured. Finally, the data were analyzed using the SPSS software ver.16.0. RESULTS: The most common complaint was abnormal uterine bleeding (AUB) in both groups. Most of the patients had a body mass index (BMI) of 25-30. There were significant differences between the two groups in terms of age (P = 0.0001) and waist circumference (P = 0.011). Cholesterol levels were much higher in the case group. Only age and low-density lipoprotein-cholesterol (LDL-C) levels in the case group were positively related to developing UFs, such that with advancing aging and increasing levels of LDL-C, the likelihood of experiencing UFs rose by 10% and 1.1%, respectively. Also, there were no significant differences between the two groups regarding in either preperitoneal fat thickness (PFT) or subcutaneous fat thickness (SFT). CONCLUSION: Our findings suggest that with aging and higher levels of LDL-C, the likelihood of developing UFs rises.

The Relation Between Free Testosterone and Components of Metabolic Syndrome in Women With Polycystic Ovary Syndrome.

Objective: To assess the relationship between free testosterone level and components of MS in women with PCOS. Materials and methods: This is a cross-sectional study which was conducted on 215 women with PCOS. PCOS was diagnosed based on the Rotterdam criteria. Patients were divided into two subgroups of patients with and without MS based on ATP III criteria. In each subgroup, the association between individual components of MS with free testosterone was measured. Data were analyzed using SPSS software. Results: The prevalence of MS was 28.8% (n = 62). The mean level of free testosterone in patients with blood pressure ≥ 130/85 was significantly higher than those with blood pressure < 130/85 mm/hg. (p = 0.029) Also, in patients with diastolic blood pressure ≥ 85, the level of free testosterone was significantly higher than patients with diastolic blood pressure < 85. (p = 0.026). Results showed significant positive correlation between the level of free testosterone and cholesterol (p = 0.024). But no significant correlation was noted between levels of free testosterone and other variables. Conclusion: Regarding the relationship between blood pressure and high levels of free testosterone, it seems that regular blood pressure screening has a higher priority of concern comparing other complications for preventing cardiovascular adverse effects in women with PCOS and hyperandrogenism.

Level of Vitamin E in Follicular Fluid and Serum and Oocyte Morphology and Embryo Quality in Patients Undergoing IVF Treatment.

Objective: This study aimed to determine the relationship between vitamin E in the follicular fluid (FF) and serum with oocyte morphology and embryo quality. Materials and methods: A cross-sectional study was conducted on serum samples, FF samples, oocytes, and embryos collected from 50 women undergoing in vitro fertilization in the Alzahra Hospital, Rasht, Iran from March to August 2014. Vitamin E level was measured using HPLC. Oocyte morphology and embryo quality were evaluated during inverted optical microscopy. Results: Totally 434 oocytes and 199 embryos were examined. Most frequently the metaphase II (MII) oocytes were observed at the 0.35-1 mg/dl level of vitamin E in FF (89.2%) and the 1-5 mg/dl level of vitamin E in serum (86.1%). The odds of having MII oocytes at the level of 0.35-1 mg/dl (OR = 2.48, 95% CI = 1.24-4.94) and 1.5-2 mg/dl (OR = 2.51, 95% CI = 1.02-6.19) of vitamin E in FF was significantly higher compared to level of 2-7.4 mg/dl. The effect of vitamin E serum level on oocyte maturation was not significant. The odds of having embryo with Z1 or Z2 quality, at the 10-15 mg/dl level of vitamin E in serum (OR = 6.45, 95% CI = 1.18-35.22), compared to the 15-20 mg/dl level, was significantly higher. The effect of vitamin E levels in FF on the embryo quality was not significant. Conclusion: At certain levels of vitamin E in the FF, oocytes with higher maturation and at certain levels of vitamin E in serum, embryo with higher quality can be achieved.

Maternal serum uric acid level and maternal and neonatal complications in preeclamptic women: A cross-sectional study.

BACKGROUND: Preeclampsia is associated with maternal and neonatal complications. It has been indicated that increased uric acid might have a predictive role on preeclampsia. OBJECTIVE: We aimed to investigate the relationship between the level of uric acid with maternal and neonatal complications in women with preeclampsia. MATERIALS AND METHODS: In this cross-sectional study, 160 singleton preeclamptic women at more than 28 wk gestational age were included. Hemoglobin, hematocrit, platelet count, liver and uric acid tests, and maternal and neonatal complications were assessed. The severity of preeclampsia, placental abruption, preterm labor, thrombocytopenia, elevated alanine aminotransferase and aspartate aminotransferase (ALT and AST), HELLP syndrome, eclampsia and required hospitalization in the ICU was considered as the maternal complication. Fetal complications were: small for gestational age (SGA), intrauterine fetal death, hospitalization in the neonatal intensive care unit, and Apgar score <7 at five minutes. RESULTS: Of our participants, 38 women had severe preeclampsia (23.8%). The mean level of uric acid in women with severe preeclampsia was significantly higher than non-severe preeclampsia (p=0.031), also in those with an abnormal liver test (p=0.009). The mean level of uric acid in women with preterm delivery was significantly higher than women with term delivery (p=0.0001). Also, the level of uric acid had no effect on neonatal hospitalization in neonate invasive care unit. Based on logistic regression, the incidence of severe preeclampsia not affected by decreased or increased serum levels of uric acid. CONCLUSION: With higher level of uric acid in server preeclampsia we can expected more complications such as hepatic dysfunction and preterm delivery. Thus serum uric acid measurement can be helpful marker for severe preeclampsia.

Metabolic Syndrome in Patients with Polycystic Ovary Syndrome in Iran.

BACKGROUND: The prevalence of metabolic syndrome (MetS) in polycystic ovary syndrome (PCOS) has been studied in different populations, but their results were so controversial regarding Iranian women. These controversial data indicated the need for more investigation of MetS characteristics in PCOS patients in our population. So this study aimed to evaluate the clinical and laboratory characteristics and metabolic features of patients with PCOS in Rasht. MATERIALS AND METHODS: This prospective cross sectional study was conducted on 215 PCOS women who lived in Rasht, north of Iran, from March 2010 to July 2012. The participants were then divided into two groups of women with MetS (n=62) and women without MetS (n=153). The diagnosis of PCOS and MetS were based on the Rotterdam 2003 criteria and the Adult Treatment Panel III (ATP III) criteria, respectively. Demographic characteristics, fertility characteristics, family history and laboratory findings were assessed. RESULTS: The prevalence of MetS in women with PCOS was 28.8%. In PCOS women of both groups, the waist circumference (WC) exceeded 88cm in 72.6%, hypertension [systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥130/85mm Hg] was prevalent in 9.3%, fasting blood sugar (FBS) level was ≥110 mg/dl in 6%, triglycerides (Tg) level were ≥150 mg/dl in 47%, and high-density lipoprotein (HDL) level was <50 mg/dl in 86%. The values of WC, SBP, DBP, body mass index (BMI), ovarian size, Tg, cholesterol, FBS, 2-hour blood sugar, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly greater in PCOS women with MetS than women without MetS. Also HDL and luteinizing hormone (LH) levels in women with MetS were significantly lower than women without MetS. CONCLUSION: Prevalence of MetS in PCOS women was 28.8%, indicating that this value is higher than other studies conducted on PCOS women in Iran and other studies conducted on general population in Iran. PCOS women are considered as a high-risk population for MetS. The special strategies are required to prevent MetS and its associated complications in PCOS women.

Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index.

BACKGROUND: Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. OBJECTIVE: The purpose of this study was to compare the pregnancy outcomes of a borderline versus normal AFI. MATERIALS AND METHODS: This cross-sectional study was carried out on a total of 235 pregnant women referred to Alzahra Medical Center between 2009-2011. Women with a singleton pregnancy in third trimester were enrolled into this study; of these subjects, 141 cases were in normal AFI group and 94 cases in borderline AFI group. Adequate information was obtained from the patients' medical record and the groups were compared on maternal and fetal complications. Data analysis was performed by using SPSS. RESULTS: The mean maternal age in borderline AFI group was 25.96±5.92 years and in normal AFI group was 27.88±6.5 years (p=0.023). Maternal outcomes such as preterm delivery and labor induction in women with borderline AFI were considerably higher than those in normal group (p=0.01 and p=0.001). There were no significant differences between the two groups in terms of high blood pressure, preeclampsia, diabetes and neonatal respiratory distress. The borderline AFI group had higher rate of neonatal complications such as Apgar score of less than 7 (p=0.004), IUGR (0.0001), LBW (0.001), and crucial need to NICU (0.003). CONCLUSION: Findings indicated that there are statistical differences between adverse outcomes in borderline AFI group and normal group. This article extracted from M.D. thesis. (Samira Naimian).