atiyeh javaheri

Gestational diabetes mellitus (GDM) is a prevalent complication during pregnancy that poses risks to both maternal and fetal health. This study aims to elucidate the intricate relationship between stress and the development of GDM, highlighting how stress-related hormonal fluctuations and behavioral changes—such as increased cortisol levels, inflammation, disrupted sleep patterns, and poor dietary choices—contribute to insulin resistance and glucose dysregulation. We examine the influence of stress on hormonal and lifestyle factors associated with GDM and evaluate interventions that manage stress-related metabolic disturbances. Elevated levels of stress hormones (like cortisol and adrenaline) and inflammatory markers (such as IL-6 and TNF-α) are linked to an increased risk of GDM due to their detrimental effects on insulin sensitivity. Our findings suggest that effective interventions, including mindfulness practices, cognitive-behavioral therapy, and regular physical activity, can reduce cortisol levels and enhance glucose regulation. This underscores the necessity of addressing both the metabolic and psychological dimensions of GDM. Current evidence supports the integration of stress-reduction strategies—such as mindfulness, cognitive-behavioral therapy, and exercise—into GDM management, as they can improve glycemic control by lowering cortisol and enhancing insulin sensitivity. Recognizing stress as a modifiable risk factor for GDM is crucial for improving maternal and fetal outcomes, emphasizing the importance of incorporating stress management into GDM prevention and treatment protocols.

To our knowledge, there is scant research on the use of rehabilitative ultrasound imaging (RUSI) method for evaluating bladder base displacement in pregnant women. The RUSI is a non-invasive and simple method that assesses the function of pelvic floor muscles (PFM) based on the movement of the bladder base.

This study aims to assess the reliability of the RUSI for the assessment of PFM function in pregnant women during voluntary muscle contractions.

In this cross-sectional study, 18 pregnant women with different gestational ages participated. The amount of bladder base displacement during PFM contraction was assessed in all women and considered an indicator of PFM function. The test re-test reliability was evaluated using the intraclass correlation coefficient (ICC) and Bland-Altman plot. The percentages of standard error of measurement (SEM%) and minimal detectable change (MDC%) were also calculated.

The mean amount of bladder base displacement during PFM contraction at time points 1 and 2 was 4.89±1.43 and 4.81±1.41, respectively. The ICC was 0.989 (95% CI, 0.969%, 0.996%), which indicates excellent reliability. The Bland-Altman plot showed that all the points were within the 95% limits of agreement with no considerable trend or bias. The SEM% and MDC% were 3.09% and 8.41%, respectively.

The intra-rater reliability of the RUSI to assess PFM function in pregnant women is high, and can be useful for further studies on the PFMs in pregnant women.

Endometriosis is a multifocal gynecologic disorder during the fertility period in women. Magnetic resonance imaging (MRI) is an important diagnostic modality for this disease and can be used either alone or along with transvaginal ultrasonography.

This study aims to compare the accuracy of pelvis MRI in pelvic deep endometriosis with laparoscopic findings in women referred to Shahid Sadoughi hospital in one year.

This cross-sectional study was conducted on 40 women suspicious of endometriosis who referred to Shahid Sadoughi hospital, Yazd, Iran from November 2020-2021. Based on clinical findings and history, participants were referred to the imaging center for pelvic MRI. Finally, the results of MRI and diagnostic laparoscopy were compared with pathologic findings.

The sensitivity and specificity of MRI for pelvic endometriosis were 94.8% and 20%, respectively. Also, the positive predictive value and negative predictive value of MRI were 90.2% and 33.3%, respectively.

Laparoscopy is still the gold standard of endometriosis diagnosis, but MRI with susceptibility-weighted imaging sequence is the best noninvasive diagnostic method.

Preterm premature rupture of membranes (PPROM) is one of the important causes of perinatal mortality. This study aimed to compare the effects of azithromycin and erythromycin on pregnancy outcomes in mothers with PPROM.

In this clinical trial study, patients diagnosed with PPROM between 24 and 34 weeks were treated with two drug regimens. Group A (n = 30) received oral azithromycin one-gram single dose and Group B (n = 30) received oral erythromycin 400 mg every 6 hr for 7 days. In addition, both groups were treated with intravenous ampicillin 2 grams every 6 hours for 48 hours and then amoxicillin 250 mg orally every 8 hours for 5 days. Primary outcomes including latency period and clinical chorioamnionitis and secondary outcomes including the type of delivery, amniotic fluid stained with meconium, postpartum endometritis, neonatal sepsis, baby's birth weight, and live birth rate were compared between the two groups.

In the current study, the latency period was significantly higher, while postpartum endometritis and laboratory-confirmed neonatal sepsis were significantly lower in the azithromycin group than in the erythromycin group. Other outcomes did not show significant differences between the two groups.

Azithromycin is more effective than erythromycin in the increased latency periods and decreased postpartum endometritis and neonatal sepsis in women with PPROM. Therefore, azithromycin can be a suitable alternative to erythromycin in the treatment of PPROM.

 Mirror syndrome is a rare disorder in which fetal hydrops is associated with maternal edema, proteinuria and hypertension. Its pathogenesis is unclear and it is frequently mistaken for preeclampsia, even though distinguishing features can be identified and placentomegaly is consistently observed. It is associated with an increase in fetal mortality and maternal morbidity.

 we report an uncommon case of mirror syndrome, which appeared in 22 weeks and 4 days in multi parous pregnant women that characterized by complaints of headache, swollen limbs and hemorrhoids. And According to ultrasound, hydrops fetalis was confirmed and the decision was made to terminate the pregnancy. Our report is an interesting example of an unusual form of Mirror syndrome for several reasons which ultimately leads to hysterectomy. First due to mirror syndrome in a patient suffering from hemorrhoids and lack of hypertension. Then Due to the association of mirror syndrome with uncontrollable bleeding, following medical treatment to terminate the pregnancy and finally curettage and hysterectomy. and then concurrent multiple ovarian cysts in the right ovary with a size of 10 cm and left ovarian edema and presence of ascites, serosis uterine, and bladder, uterine and ovarian edema at the time of hysterectomy.

 mirror syndrome is associated with an increase in perinatal mortality and maternal morbidity. SO in order to improve midwifery management in cases of mirror syndrome, reduce fetal mortality and maternal morbidity and recognize concurrent unknown disorders, we must carefully examine all the symptoms of the mother and take treatment as soon as possible and, if necessary, consider delivery.

Background and Aims :

Diastasis of Rectus Abdominis (DRA) is defined as the separation of two bulks of the Rectus Abdominis Muscle and is highly related to pregnancy and childbirth. Because of the lack of enough knowledge about DRA, the present study aimed to review the articles on the prevalence, risk factors, and consequences of DRA in women.

Methods:

 A search strategy using Google Scholar, PubMed, ScienceDirect, and Scopus from 2000 to 2021 was developed with keywords related to DRA and its prevalence, risk factors, consequences, and evaluation methods.

Results:

 Finally, 28 articles were selected. A literature review showed that the most common site for DRA is above the navel and its prevalence in pregnant women is 30-70%. Increasing maternal age and more deliveries increase the risk of DRA. However, factors, such as type of delivery, multiple births, and lack of exercise have also been suggested as risk factors. Consequences of DRA include changes in the appearance of protruding abdomen and decreased strength of the trunk muscles. Pelvic floor dysfunction and low back pain can also be associated with DRA.

Conclusion:

 A significant percentage of women experience DRA after childbirth. This condition can cause problems for the mother, such as pain, deformity, or decreased strength of the trunk muscles.

Most pregnant women with COVID-19 develop less severe form of the disease, with few cases of severe maternal morbidity and mortality, or perinatal deaths. This meta-analysis was conducted to evaluate the frequency of miscarriage in pregnant women affected by the SARS-COV-2 infection.

A comprehensive search was performed in online databases to identify all relevant studies published up to 5th March 2021. Case-control studies and case series reported the frequency of miscarriage in pregnant women with COVID-19 was selected.

A total of 22 studies with 8591 infected pregnant women and 141 abortions were selected. The frequency of miscarriage was 3.9% (95% CI 0.023-0.063) in infected pregnant women with COVID-19. It had the highest frequency in Asian (6.3%) followed by European (2.9%), West-Asian (2.5%) and Caucasian (2.3%) infected pregnant women. Moreover, stratified analysis by country showed that the frequency of miscarriage is the highest in Chinese (11.3%) followed by Italy (11.2%), India (2.7%), Turkey (2.2%), USA (1.2%) and France (0.9%) infected pregnant women.

Our pooled data revealed that the frequencies of miscarriage in pregnant women with SARS-COV-2 infection were 3.9%.

Gestational diabetes mellitus (GDM) is a complex metabolic disorder of pregnancy with a strong genetic predisposition. GDM is associated with complications during pregnancy and increased risk of type 2 diabetes later in mothers and develops a vicious cycle of metabolic diseases for future generations. Evidence is accumulating that women with genetic variants at transcription factor 7-like 2 (TCF7L2) gene are more susceptible to GDM. The aim of the current meta-analysis was to assess the association of the TCF7L2 polymorphisms with GDM risk.

PubMed, Web of Science, Embase, SID and CNKI databases were searched to identify relevant studies up to November 01, 2020. Using the fixed-effect or random-effect model, the pooled odds ratio and its corresponding 95% confidence interval were computed.

A total of 38 case-control studies including 24 studies with 6021 cases and 13289 controls on rs7903146, eight studies with 2404 cases and 2615 controls on rs12255372 and six studies with 1357 cases and 2858 controls on rs7901695 polymorphism were selected. Pooled data showed that there was a significant association between the TCF7L2 rs7903146, rs12255372 and rs7901695 polymorphisms and an increased risk of GDM in whole population. Stratified analysis showed that the TCF7L2 rs7903146 polymorphism was associated with GDM in Caucasian, mixed and Chinese women, but not in Asians. Moreover, the TCF7L2 rs12255372 polymorphism was associated with GDM in Asians and Caucasians women with GDM.

The combined data indicated that the TCF7L2 rs7903146, rs12255372 and rs7901695 polymorphisms were associated with a significant risk of GDM in whole population, especially in Caucasian women.

The aim of this meta-analysis was to estimate the prevalence of cesarean section (CS), preterm birth, stillbirth, and low birth weight deliveries (LBWD) in pregnant women with SARS-COV-2 infection.

All relevant studies were searched up to 30 February 2021.

A total of 47 studies with 5970 infected pregnant women were included. There were 1010 CS, 55 stillbirths, 524 preterm birth, and 82 with LBWD. Pooled data showed that the prevalence of CS, preterm birth, stillbirth, and LBWD among women with SARS-COV-2 infection was 29.6% (95% CI 0.081-0.160), 2.1% (95% CI 0.081-0.160), 11.5% (95% CI 0.081-0.160), and 2.1% (95% CI 0.081-0.160), respectively. Stratified analysis revealed that these pregnancy outcomes among Asian women were higher than Caucasians.

Our combined data revealed that the CS prevalence (29.6%) was the highest followed by preterm birth (11.5%), stillbirth (2.1%), and LBWD (2.1%) among women with COVID-19.

To date, some cases of perinatal transmission of severe acute respiratory syndrome coronavirus-2 (SARS‐CoV‐2) have been reported. However, it is unanswered if these occurred via the trans-placental or the trans-cervical route or through environmental exposure.

To address this question, we conducted this study to review the current state of knowledge about the transplacental transmission of COVID-19.

There are no known placental findings associated with the COVID-19 infection. The possibility of intrauterine infection has been based mainly on the detection of IgM in the neonatal blood. Real time-PCR tests on amniotic fluid, placenta, and cord blood are required to ascertain the possibility of intrauterine vertical transmission.

There is currently no sufficient and convincing evidence about the transplacental transmission of SARS-COV-2 infection in pregnant mothers. However, the paucity of placental expression of ACE-2 involved in the cytoplasmic entry of SARS-CoV-2 may explain its relative insensitivity to transplacental infection.

The publisher has been informed of an error that occurred on pages 113-120 (Vol. 18; No. 2) which the study type in the title must be changed to “non randomized clinical trial”. The publisher wishes to apologize for this error. The online version of the article has been updated on April 16, 2021 and can be found at http://journals.ssu.ac.ir/ijrmnew/ article-1-1422-en.html (doi.org/10.18502/ijrm.v18i2.6423).

Varicella-zoster virus (VZV) infection during pregnancy can treat the health of mother and fetus. The present study was aimed to determine the prevalence of VZV IgG antibodies among pregnant women living in Yazd, Iran.

In this cross-sectional, all pregnant women referred to Baghayipour clinic of Yazd city were participated. IgG Antibodies against VZV were detected by the enzyme-linked immunosorbent assay (ELISA) test. Demographic data of each woman, including age, self-reported history of chickenpox, education and place of residency were collected using a questionnaire. The collected data was analyzed by SPSS software version 20. 

A total of 300 pregnant women with mean age of 28±6 years (age range: 18-46 years) were screened for VZV antibodies that 283 cases (94.3%) were seropositive. The prevalence of VZV antibodies among pregnant women in age groups of 14–23, 24–33, 34–44 years was 96.8%, 93.3% and 95%, respectively. The prevalence of VZV antibodies was not significantly associated to the educational level, place of residence, and history of infection with chickenpox.   Positive predictive value (PPV) and negative predictive value (NPV) of self-reported history of varicella were 94.2% and 4.4%, respectively.

The prevalence of varicella-zoster IgG antibodies among pregnant women living in Yazd was higher than in other regions of Iran. Performing the routine vaccination against VZV is suggested to protect mother and fetus from possible complications caused by the virus.

Endometriosis is generally considered as a benign condition; however, there is a possibility for it to become cancerous. miR-125b is upregulated in both endometriotic tissues and serum samples of women with endometriosis but its potential targets in endometriosis are still not fully understood.

The role of miR-125b in the regulation of TP53 expression in endometriosis was tested with a bioinformatics approach. In addition, the expression of miR-125b and TP53 in both eutopic (Eu-p) and ectopic endometrium (Ec-p) in the endometrium tissues of women with endometriosis was compared to those in the normal endometrium tissues of controls (Normal).

In this case-control study, the Eu-p and Ec-p samples were collected from 20 women who underwent laparoscopic surgery, and the normal endometrium tissues were collected from 20 controls with no evidence of endometriosis. For bioinformatics approach, a protein-protein interaction network was constructed based on co-expressed potential targets of miR-125b. Quantitative polymerase chain reaction technique was used for the measurement of miR125b and TP53 expression.

Our results showed that miR-125b was significantly overexpressed in Ec-p (p-value: 0.021). In addition, there was a significant TP53 under expression in both the Ec-p and Eu-p samples compared with the Normal tissues (p-value: 0.003).

The negative correlation between miR-125b and TP53 as well as a noticeable decreased expression of TP53 in both Ec-p and Eu-p samples may be interpreted as the roles of miR-125b/TP53 axis in the pathogenesis of endometriosis. In addition, these findings and bioinformatic analyses imply a possible role of miR-125b in cancer-like features of endometriosis.

Asherman’s syndrome (AS) is a rare reproductive abnormality, resulting in endometrial collapse due to aggressive or recurrent endometritis and/or curettage.

We aimed to assess the effectiveness of using platelet-rich plasma (PRP) to lower the recurrence rate of intrauterine adhesions (IUAs) following hysteroscopy.

In this non-randomized clinical trial, women aged 20-45 years with AS diagnosed by sonohysterography, 3D sonography, hysteroscopy, or uterosalpingography between May 2018 and September 2018 were included. Participants (n = 30) were divided into case and control groups. Following hysteroscopic adhesiolysis, a Foley catheter was placed into the uterine cavity in all women. After two days, the catheter was removed, and 1-mL PRP was injected into the uterine cavity of women in the PRP (case) group, while the control received no PRP. All controls and subjects underwent diagnostic hysteroscopy 8-10 weeks following the intervention to assess the IUAs according to the American Society for Reproductive Medicine scoring system.

Our results did not reveal any significant difference in the menstrual pattern of either the control or test groups before or after treatment (p = 0.2). Moreover, the IUA stage in both studied groups before and after treatment was similar (p = 0.2). The duration of menstrual bleeding in both studied groups before and after treatment was also similar.

PRP cannot change the menstrual pattern or development of postsurgical AS, as evaluated by follow-up hysteroscopy.

Controlling postpartum pain affects maternal care of baby and mother's return to normal life. Studies have shown the effect of pressure on the 3- liver point in reducing uterine-induced pain, such as menstrual pain. Therefore, this study was performed with aim to evaluate the effect of 3-liver pressure point on postpartum severity of pain.

This controlled randomized clinical trial study was performed on 150 mothers who had normal delivery and complained of postpartum pain in the postpartum ward of Shahid Sadoughi Hospital in Yazd in 2017-2018. Mothers were randomly divided into three groups of 3-liver pressure point (n=50), Sham group (n=50) and Ibuprofen group (n=50). All three groups received oral Ibuprofen 400 mg every 6 hours up to 24 hours if they had moderate or severe pain. In the 3-liver pressure point group (intervention group), the pressure was applied to the 3-liver point for 10 minutes on each foot, and in the Sham group, the same pressure was applied to the ectopic point. The Control group received medication only (routine care). Pain was measured every 6 hours before, 30 and 120 minutes after each intervention. Data analysis was performed using SPSS software (version 16) and tests of Chi-square, Friedman, Kruskal Wallis, Wilcoxon, and GEE)Generalized Estimation Equations (. P<0.05 was considered statistically significant.

The postpartum pain severity after the intervention were statistically significantly different in each group (p <0.001). The mean of postpartum pain severity decreased as 0.34 over time. The mean pain score in the 3-liver point group was 0.8±0.23 lower than the control group (p=0.001). The mean pain score in the 3-liver point group was 0.0±64.3 lower than the sham group (p = 0.035). But there was no significant difference between the sham and control groups (p = 0.468).

Acupressure at 3-liver point is effective in relieving postpartum pain and it can be used like other pressure points affecting postpartum pain.

Context: Pelvic masses are a prevalent cause for referral to gynecologic oncology departments to evaluate the possibility of benign or malignant conditions. Pelvic mass often was found in pelvic examinations among females with ovarian. Tumor markers are advantageous biomarker in tumor diagnosis. Evidence Acquisition: We performed a computerized search in Medline/PubMed databases and Google Scholar with key words: “Cancer antigen 125 (CA125), Human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), Risk of malignancy index (RMI), and Pelvic mass”. The usage of tumor marker CA125 alone is associated with serious limitations like low sensitivity for early or stage I disease and lack of specificity especially in pre-menopausal women. Serum HE4 is a good biomarker for discriminating ovarian cancer from benign pelvic disease, but could be affected by several factors including pregnancy, age, and smoking. ROMA has a high sensitivity, specificity, and negative predictive value to predict the presence of ovarian cancer in women with a pelvic mass. RMI could differentiate between benign and malignant pelvic masses, but RMI expression was higher in women with 55 years or more. According to the results of this study, combination of these biomarkers or at least 2 or 3 biomarkers are suggested for early stage diagnosis of pelvic mass with high sensitivity and specificity.

Congenital anomalies are conditions of prenatal origin that arepresent at birth, potentially impacting an infant's health, development and survival. The birth of a newborn with congenital anomalies imposes financial and emotional burdens on families. The aim of this study was to investigate the epidemiology of congenital anomalies in 2014 in Zabol, Iran.

This cross-sectional study was carried out in the AmirAl-Momenin Hospital between May of 2013 and April 2014. All the live born were included, and we have examined all newborns for the presence of congenital anomalies.

During the twelve months, 9,309 newbornswere included to the study. Of them,72 (0.8%) newborns were affected with a congenital malformation. The congenital anomalies affected significantly higher proportion of male newborns(66.7%) than female newborns (33.3%).Among Of them, musculoskeletal system abnormalities account for 45.9% of the total abnormalities allocating the highest frequency to itself. Subsequently, central nervous system abnormality (19.4%), gastrointestinal anomaly (15.3%), urinary tract abnormality (9.7%), chromosomal abnormality (2.8%), and multiple anomalies (1.4%) were frequent, respectively.

This study showed that prevalence of congenital anomalies isrelativelyhigh in Zabol city.The results of this study identify the necessity ofgenetic counseling and early diagnosisto prevention, care and surveillance.

A few studies have been conducted to explore the association of MTHFR A1298C (rs1801131) polymorphism with preterm birth risk, the results remain inconsistent. Therefore, we conducted a meta-analysis to derive a more systematic estimation of the association.

Relevant studies were searched by PubMed, EMBASE, CNKI, and Google Scholar up to June 2018. The strength of the association of MTHFR A1298C polymorphism with preterm birth was calculated by odds ratios (OR) with 95% confidence interval (95%CI).

A total of nine case-control studies with 1,609 cases and 14,981 controls were included. Pooled results showedthat there was no significant association between MTHFR A1298C polymorphism and preterm birth risk under all five genetic models in overall. However, in the stratified analysis of ethnicity, a significant association between MTHFR A1298C polymorphism and preterm birth risk was observed in the Asians under four genetic models, i.e., allele (C vs. A: OR=0.960, 95% CI 0.543-0.871, P =0.002), heterozygote (CA vs. AA: OR=0.887, 95% CI 0.024-0.457, P =0.003), dominant (CC+CA vs. AA: OR=0.965, 95% CI 0.534 -0.935, P =0.015) and recessive (CC vs. CA+AA: OR=0.923, 95% CI 0.026-0491,P =0.004), but not in Caucasians.

This meta-analysis suggested that MTHFR A1298C polymorphism is not associated with preterm birth risk in overall population. However, MTHFR A1298C polymorphism plays an important role in preterm birth development in Asian population.

Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae).

To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy.

In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups.

Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02).

With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae.