Maternal and fetal outcome of burn during pregnancy: 3rd report from Kermanshah, Iran.

OBJECTIVE: Burn injuries in the course of pregnancy can lead to significant complications and mortality for both mother and fetus. Mortality and morbidity depend on the severity of burn. The current article is the third report authored on burn during pregnancy from Kermanshah, Iran. METHOD: The present descriptive analytic study seeks to review the entire number of files belonging to the pregnant women with burn injury admitted in the Burn Ward of Imam Khomeini Hospital in Kermanshah during the period 2012-2020. Demographic data and fetal and maternal complications and outcome were extracted. Chi-square test was applied to analyze quantitative parameters statistically, and probit regression analysis was performed to calculate the Lethal Area 50% (LA50%) index. RESULTS: Thirty-seven patients with mean age of 32 ± 6.07 years and mean gestational age of 19.5 ± 10.47 years were enrolled. Fifteen (40.5%) patients had undergone less than 25% total burn surface area (TBSA), 5 (13.5%) 25%-50%, and 17 (45.9%) more than 50%. Maternal mortality was 16 (43.2%). Fetal complications included premature labor in 4, abortion in 14, and intrauterine fetal death in 7 cases. LA50% was calculated as 54%. CONCLUSION: Burn during pregnancy has a high rate of maternal and fetal mortality. These complications are highly related to severity of burn and TBSA. Preventive measures can play an important role in decreasing complications.

Gene variants and haplotypes of Vitamin D biosynthesis, transport, and function in preeclampsia.

Objective: To find whether the gene variants and haplotypes of cytochrome (CYP) 27B1 (1α-hydroxylase), group-specific component (GC) that is a vitamin D binding protein, vitamin D receptor (VDR), peroxisome proliferator-activated receptor γ (PPARγ) and retinoid-X receptor (RXR) affect the risk of preeclampsia. Methods: In a case-control study 100 women with preeclampsia and 100 healthy pregnant women were investigated for gene variants and haplotypes of vitamin D biosynthesis, transport, and function using the polymerase chain reaction-restriction fragment length polymorphism method. Results: The frequency of gene variants of PPARγ Pro12Ala and RXR -α (A/G, rs749759) were not significantly different comparing patients and controls. The TT genotype of CYP 27B1 (G > T) was associated with 2.2-fold (95% CI 1.04-4.7, p = 0.039) increased risk of early-onset preeclampsia. Also, the TT genotype of GC rs7041 (T > G) increased the risk of preeclampsia [OR = 2.13 (95% CI 1.09-4.17, p = 0.027)]. The VDR ApaI GT genotype elevated susceptibility to preeclampsia (OR = 2.55, p = 0.04). Further, the presence of VDR ApaI GT+TT genotype was associated with higher levels of body mass index, and systolic blood pressure, and lower level of 25 (OH)-D3. In the presence of haplotype CYP T, VDR T, and RXR A (TTA) compared to haplotype GTG the risk of preeclampsia was 6.71-fold (p = 0.044). Conclusions: The present study indicated an association between the CYP 27B1, GC, and VDR ApaI variants with the risk of preeclampsia. Also, the variants of the latter polymorphism influenced BMI, blood pressure, and vitamin D levels.

No evidence for a major effect of three common polymorphisms of the GPx1, MnSOD, and CAT genes on PCOS susceptibility.

AIM: Polycystic ovary syndrome (PCOS) is one of the prevalent endocrine-metabolic disorders. It is proposed that oxidative stress contributes to PCOS susceptibility and its metabolic associations. The current study aimed to investigate the influence of GPx1 (rs1050450), MnSOD (rs4880), and Catalase (rs1001179) variants with PCOS susceptibility, for the first time. METHODS: In a case-control study, 350 Kurdish female volunteers (175 PCOS patients and 175 healthy controls) from Western Iran were studied. Genotyping for GPx1 and MnSOD were done using PCR-RFLP and for CAT the allele-specific PCR method was used. RESULTS: The percentage of patients suffering from hirsutism, acne, and acanthosis among patients with PCOS were 44.6%, 30.3%, and 14.9%, respectively. Distribution of alleles among patients suffering from PCOS versus healthy women was 'Pro' (69.1% vs 68.8%) and 'Leu' (31.4% vs 31.2%) for Gpx1, 'Ala' (61.43% vs 56.57%) and 'Val' (38.57% vs 43.43%) for MnSOD, and 'C' (83.43% vs 84.57%) and 'T' (16.57% vs 15.43%) for CAT. CONCLUSION: GPx1 (rs1050450), MnSOD (rs4880), and CAT (rs1001179) variants might not be a risk factor for PCOS.

The effect of VDR gene polymorphisms and vitamin D level on blood pressure, risk of preeclampsia, gestational age, and body mass index.

We investigated the influence of vitamin D receptor (VDR) polymorphisms and vitamin D level on the blood pressure and the risk of preeclampsia. In a case-control study, 200 pregnant women, including 100 individuals with preeclampsia along with 100 healthy pregnant women, were studied for VDR FokI, TaqI, and BmsI polymorphisms and serum 25 (OH)-D level using polymerase chain reaction-restriction fragment length polymorphism method and commercial kit, respectively. The mean level of 25 (OH)-D in preeclamptic patients was significantly lower (16.6 ± 4.2 ng/mL, P < 0.001) compared with controls (19.6 ± 3.8 ng/mL). Among all women, a significantly higher systolic blood pressure and before-pregnancy body mass index and also lower gestational age were observed in the presence of 25 (OH)-D level < 20 ng/mL compared with the 20 to 30 ng/mL. A significantly higher frequency of VDR FokI C allele in preeclamptic patients (83%) than controls (74%) was associated with a 1.72-fold increased risk of preeclampsia. In all the studied individuals, the systolic and diastolic blood pressures were significantly higher in the presence of the FokI CC genotype compared with the TC and TT+TC genotypes. Neither VDR Taq1 nor VDR BmsI was associated with the risk of preeclampsia. The haplotype FokI C, TaqI C and BmsI A (CCA) compared with haplotype CTG increased the risk of preeclampsia by 1.4-fold (P = 0.33). Our study suggests an association between VDR FokI polymorphism and an insufficient serum level of 25 (OH)-D with the risk of preeclampsia and also the influence of insufficient 25 (OH)-D level and VDR FokI polymorphism on maternal factors, including blood pressure.

A comprehensive postpartum follow-up health care program for women with history of preeclampsia: protocol for a mixed methods research.

BACKGROUND: Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women's life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. METHODS: This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. DISCUSSION: It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is effective, it could be included in the postpartum health care guidelines. TRIAL REGISTRATION: IRCT20170927036445N2 Registered 10 March 2018.

Association between Asymptomatic Bacteriuria and Pre-Eclampsia.

Asymptomatic bacteriuria is one of the most common and important bacterial infections during pregnancy and can result in progressive infections and endanger maternal as well as fetal health. In this study, we assessed the relationship between asymptomatic bacteriuria and pre-eclampsia. In this case-control study, pregnant women who presented to Imam Reza Hospital in Kermanshah in 2013-14 were studied. The minimum sample size was calculated as 125 pregnant women in each group with a total of 250 subjects. There were 125 women with pre-eclampsia and 125 women without pre-eclampsia (control group). Matching was done for age, gestational age, and parity between case and control groups. Matching was verified by a P value of 0.061 for maternal age and gestational age and 0.77 for parity. The statistical analyses were done by applying the chi-squared test and determining odds ratio (OR) for having bacteriuria in univariate logistic regression as well as multivariate regression with adjusting the effect of maternal age, gestational age, and parity. Pyuria and bacteriuria were significantly more common in pre-eclampsia group than in control group. The results showed that a significant association existed between asymptomatic bacteriuria and pre-eclampsia. The rate of asymptomatic bacteriuria was 6.8 times higher in women with pre-eclampsia compared to those without pre-eclampsia. Further studies are required for better clarification of association between asymptomatic bacteriuria and pre-eclampsia.

Vaginal flatus and the associated risk factors in Iranian women: a main research article.

Objective. The aim of the study was to determine the prevalence of vaginal flatus and some related risk factors in Iranian women. Methods. After conducting a pilot study, a sample size of 1000 subjects of 18 to 80 years was determined; of those 58 were unable to cooperate for various reasons. Age, parity, marital status, birth history, body mass index, and the weight of the largest newborn were collected. After a full gynecologic examination looking for pelvic organ prolapse, patients were asked about vaginal flatus and the frequency and time of occurrence. The results were studied using the chi-square test and independent t-test considering an alpha error of less than 0.05. Results. The prevalence of vaginal flatus was mainly 20% in this study, but embarrassment was observed in 5.7% of these women. 4% in the group were with no history of sexual contact (virgin). Vaginal flatus mostly started after vaginal delivery (45%) or spontaneously (34%); however, it was also reported after cesarean section and other pelvic operations. The most common activity leading to vaginal flatus was intercourse (54%); however, the time which had resulted in more inconvenience for the patients was during physical activities (92%). BMI and age were significantly lower in the patients (P < 0.0001). The grade of prolapse was lower in the patients (P < 0.0001). Conclusion. Low age, low body mass index, and vaginal delivery can affect the incidence of a noisy vagina.

Comparison of "push" and "pull" methods for impacted fetal head extraction during cesarean delivery.

OBJECTIVE: To compare maternal and neonatal outcomes associated with the "push" and "pull" methods for impacted fetal head extraction during cesarean delivery. METHODS: A prospective study was conducted at Imam Reza Hospital, Kermanshah, Iran, from April 2006 to March 2008. After failed vacuum extraction, women with obstructed labor caused by impacted fetal head were randomly assigned to deliver via the push method (n=35) or the pull method (n=37). The outcomes investigated included operation time, operative blood loss, incidence of extension of the uterine incision, and postpartum fever. Data were analyzed using χ(2) and Student t tests. RESULTS: Mean operative time and incidence of extension of the uterine incision were significantly increased in the group that delivered via the push method (P<0.001). There were no significant differences in the other maternal and neonatal morbidities between the groups, although there was 1 case of neonatal femoral fracture in the pull group. CONCLUSION: Although the pull method may lead to some neonatal complications, it is associated with lower maternal morbidity than the push method when used for impacted fetal head extraction during cesarean delivery.

Multiple-dose vaginal misoprostol and single-dose misoprostol plus oxytocin for termination of second-trimester pregnancy.

OBJECTIVE: To compare 2 different methods-multiple doses of misoprostol and a combination of misoprostol and oxytocin-for termination of pregnancy in the second trimester. METHODS: Between 2006 and 2008, 120 women undergoing termination of second-trimester pregnancy in 2 hospitals in Kermanshah, Iran, were enrolled in a randomized trial comparing 2 treatments. In each treatment group, an initial vaginal dose of 600 µg of misoprostol was placed in the posterior fornix. After 6 hours, an intravenous infusion of concentrated oxytocin was given to women in group A, and 400 µg of vaginal misoprostol was given every 6 hours to women group B, up to a maximum of 4 doses. The outcomes were compared via χ(2) and independent t tests. RESULTS: Within 30 hours, 96.7% of women in group A and 96.7% of women in group B delivered successfully. The average duration between induction and delivery time was 12.3±6.0 hours in group A and 12.1±6.0 hours in group B (P>0.05). CONCLUSION: The use of misoprostol with oxytocin, and multiple doses of misoprostol gave similar results for termination of pregnancy in the second trimester.

Effect of magnesium sulfate on Doppler parameters of fetal umbilical and middle cerebral arteries in women with severe preeclampsia.

OBJECTIVE: To assess the effect of injecting magnesium sulfate on Doppler parameters of fetal umbilical and middle cerebral arteries (MCA) in women with severe preeclampsia. MATERIALS AND METHODS: A total of 21 patients with severe preeclampsia admitted to Imam Reza Hospital, Kermanshah (Iran), were evaluated. Before and after administration of magnesium sulfate, Doppler ultrasound scan was carried out to measure fetal middle cerebral artery and umbilical artery blood flow. Paired t-test was used for statistical analysis. RESULTS: After injection of magnesium sulfate, the mean resistivity index (RI)-umbilical, and pulsatility index (PI)-cerebral showed a statistically significant reduction (P < 0.001). The cerebroumbilical C/U ratio increased after the intervention (P < 0.001). The PI-umbilical (P = 0.1) and pre- and post-RI-cerebral (P = 0.96) did not have statistically significant changes. CONCLUSIONS: Infusion of magnesium sulfate significantly decreases the flow in the fetus RI-umbilical and PI-MCA, and it increases C/U ratio indices in color Doppler ultrasound.