farideh movahed

Postpartum hemorrhage is one of the main causes of morbidity and mortality in pregnant mothers in the world. Uterine atony is the most common cause of early postpartum hemorrhage. Considering the positive effect of calcium on uterine contraction, hypocalcemia may play a role in uterine atony. This study was conducted with aim to investigate the relationship between total calcium level and uterine atony following vaginal delivery.

This prospective cohort study was conducted on 619 pregnant mothers with full-term singleton pregnancy with cephalic presentations that had referred to Qazvin Kowsar Hospital in 2022 for termination of pregnancy. 5 cc blood samples were taken from all mothers to determine total calcium levels. After delivery, atonic and non-atonic mothers were evaluated in terms of calcium levels. Data analysis was done using SPSS statistical software (version 24). P<0.05 was considered significant.

In this study, 45 women (7.3%) had uterine atony. The mean calcium level of mothers with uterine atony was 8.2±0.37 and non-atony mothers was 8.9±0.37 mg/dL (p<0.001). Also, 39 person (86.7%) of mothers with uterine atony had hypocalcemia (calcium level less than 8.5), while this rate was 9.9% in non-atony mothers and this difference was significant (p<0.001).

In the present study, the calcium level of mothers with uterine atony was lower than non-atony mothers. Therefore, measuring calcium levels can be useful for predicting uterine atony.

Patients with diabetes mellitus (DM) frequently experience urinary tract infections. Many studies indicated that diabetes patients experience higher treatment costs, morbidity, and death due to UTI as a result of the spread of resistant bacterial strains in hospitals. In the current study, we looked at how glycemic control affects diabetic patients' rates of UTI, the pathogens that cause them, the presence of multi-drug-resistant (MDR) and extensively drug-resistant (XDR) organisms, and the infections' relation to diabetes. Diabetes patients' midstream urine (MSU) samples were taken in a sterile, spotless, and dry wide-mouthed bottle. After following the standard methodology to collect and identify the organisms, disc diffusion antibiotic sensitivity tests were conducted. HbA1c measured for all patients. Using the SPSS 16.0 version, the data were examined. In the current study, 500 diabetic patients provided urine samples, after analyzing of urines it was revealed that189 (37.2%) of those individuals had UTI. Compared to 59 patients with managed glycemia, 130 individuals in the uncontrolled glycemic group experienced the most UTI cases. In both diabetic groups, females had a significantly higher prevalence of UTI than males (88.4% and 11.6%, respectively, 𝑃 < 0.004). 52.3% of women over 46 with uncontrolled glycemia experienced UTIs. The most common bacterial isolate, E. coli, displayed 58.4% MDR. These findings demonstrate that, regardless of age or gender, glycemic control in diabetes patients is essential for decreasing UTI rates. It should be noted that, the best empirical treatment for diabetic patients with UTI should involve regular monitoring of the uropathogenic susceptibility patterns.

This study aimed to compare the serum levels of C-reactive protein (CRP) and ferritin in the first trimester of pregnancy between normal and abnormal pregnant women (complicated with gestational diabetes) to determine if these chemicals have any predictive value in the diagnosis of gestational diabetes.

This prospective cohort study was carried out on 300 pregnant women attending the Prenatal Clinic of Kosar Hospital, Qazvin City, Iran, during 2017-2018. Based on Carpenter and Constant criteria, the pregnant women undertook an oral glucose tolerance test with 75 g glucose to diagnose gestational diabetes. We also measured the serum levels of CRP and ferritin in all the women in the first trimester. The obtained data were analyzed using SPSS software version 24. P<0.05 was considered statistically significant

A total of 40 pregnant women were found to have gestational diabetes. The levels of CRP and ferritin were slightly higher in women with gestational diabetes, although this increase was not statistically significant. Regarding the receiver operating characteristic curve, body mass index (BMI) could predict the incidence of gestational diabetes (72.5% sensitivity, 53.1% specificity, P=0.023). The higher BMI and CRP levels in the first trimester were also significantly associated with macrosomia, which could predict macrosomia with 75% sensitivity, 73.6% specificity for BMI (P=0.005), and 87.5% sensitivity, 58.1% specificity for BMI. 

There was no correlation between CRP and ferritin levels and gestational diabetes in the first trimester of pregnancy. BMI before pregnancy was the only variable related to gestational diabetes. Increased values of both CRP and BMI were associated with fetal macrosomia

Aneuploidies are of the most important fetal abnormalities. Diagnostic value and efficacy of NIPT assay in the groups with abnormal results for first trimester combined screening test is not well defined. Therefore, this study was performed aimed to survey the sensitivity and specificity of NIPT for aneuploidies diagnosis in women with moderate risk for trisomy at first trimester combined screening test.

This prospective cohort study was performed in 2017-2018 on 447 women with singleton pregnancy and gestational age of 11 to 13 weeks and 6 days who had moderate risk for trisomy. NIPT analysis was done in all women with moderate risk (1/250 to 1/1500) and was compared with the results from karyotype and phenotype analysis in neonates. NIPT diagnostic accuracy for chromosomal abnormalities was calculated. Data were analyzed using SPSS statistical software (version 22).

Two cases with trisomy 21 (0.06%) and one case with trisomy 18 (0.03%) were diagnosed. These three cases were confirmed with amniocentesis and the pregnancy was ended. The neonates' analysis showed normal phenotype results in all of them and NIPT diagnostic accuracy for trisomy 21 and 18 was calculated 100%.

In addition to maintain combined screening test benefits, using NIPT is accompanied by high diagnostic accuracy for fetal chromosomal abnormalities assessment.

Curettage is one of the most common gynecological surgeries in women. Its complication is pain which increases dissatisfaction in patients. Therefore, it is necessary to find a way to treat this complication. This study was performed with aim to compare the effects of three methods of using lidocaine gel in the cervix, intrauterine injection of lidocaine, and a combination of two methods to reduce pain during curettage.

This clinical trial study was performed in 2017 on 120 patients candidates for curettage in Qazvin Kosar Hospital. Patients were randomly divided into three groups of topical lidocaine gel in the cervix, intrauterine injection of lidocaine and a combination of these two methods, and the drugs were prescribed before curettage. Vital signs and pain were recorded in patients and other information was collected by completing the questionnaire. Data analysis was performed using statistical software (version 22) and chi-square and ANOVA tests. P<0.05 was considered statistically significant.

The intrauterine and intra cervical injection of lidocaine (0.3±0.72) and then injection of intra cervical lidocaine (0.45±0.84) alone significantly reduced pain during curettage in women (P=0.04). On the other hand, no severe hemodynamic changes were observed in these patients. No complications such as nausea and vomiting and no instability of vital signs were observed in any of the groups (P>0.05).

Intrauterine administration along with addition of topical lidocaine gel to the cervix can be used as a simple, low-cost, and safe method as to control pain during and after curettage.

Polycystic ovary syndrome (PCOS) is a common disorder in women of childbearing age that can be associated with adverse pregnancy complications. The aim of this study was to compare the adverse pregnancy consequences between pregnant women with PCOS and control group in Qazvin.

In this study, 150 pregnant women with PCOS aged 18-35 years with gestational age of more than 20 weeks were selected as our case group based on Rotterdam criteria and our control group included 150 pregnant women without PCOS. The groups were compared in terms of pregnancy complications including gestational diabetes, preeclampsia, preterm delivery, low birth weight, and neonatal admission to the neonatal intensive care unit (NICU).

There were no significant differences between the two groups in terms of demographic data including age, weight, height and BMI. In the case group (PCOS) we found gestational diabetes in 33 cases (64.7%) (P=0.021), preeclampsia in 44 cases (67.7%) (P=0.002), and preterm delivery 70 in cases (75.3%) which indicated a significant difference between the case and control groups (P<0.0001). The case group had higher neonatal complications than control group in regard to low birth weight (40 cases, 64.5%, P=0.008) and NICU admission (30 cases, 66.7%, P=0.015).

The results of this study showed that PCOS, due to its metabolic effects, may increase the incidence of gestational diabetes, preeclampsia, preterm delivery, low birth weight or macrosomia and long term NICU admission

Despite the positive evidence on the effect of progesterone on protection of pregnancy in patients with threatened abortion, the results of studies regarding its drug type have been controversial. This study was performed with aim to compare the effect of vaginal progesterone and dydrogesterone on pregnancy outcome in cases with threatened abortion.

In this single-blind randomized clinical trial, 160 pregnant women with threatened abortion who referred to Qazvin Kowsar Hospital in 2018 were randomly assigned to receive dydrogesterone (Duphaston) 10 mg twice daily or vaginal progesterone (Cyclogest) 400 mg daily. Finally, pregnancy outcomes were compared between the two groups. Data were analyzed by SPSS software (version 18) and Chi-square, independent t-test and Mann-Whitney tests. P<0.05 was considered statistically significant.

Frequency of cesarean section was 27 (33.7%) in the dydrogesterone group and 25 (31.2%) in the vaginal progesterone group (P = 0.736). In general, the incidence of preterm labor was 97 (60.6%) and there was no significant difference between the two groups (P >0.05). In addition, incidence of preeclampsia, gestational diabetes mellitus, placenta previa and intrauterine fetal death as well as neonatal weight were not significantly different between the two groups (P >0.05). Finally, maternal and neonatal complications showed no significant difference between the two groups (P = 0.675).

Pregnancy outcomes after administration of dydrogesterone are not different with vaginal progesterone in the treatment of threatened abortion.

In this study, thyroid dysfunction in women with gestational diabetes mellitus was examined and compared to that in healthy pregnant women referred to Kowsar Hospital in Qazvin in 2017 and 2018.

In this case-control study, 100 women with gestational diabetes mellitus and 100 non diabetic healthy pregnant women who referred to Kowsar Hospital in Qazvin from 2017 to 2018 were selected using the convenience sampling method, and their serum thyroxine, anti-TPO, and TSH levels were determined and compared. Moreover, Apgar scores and anthropometric variables were compared between the two groups.

In the present study, there were statistically significant differences between the groups in terms of the TSH level (P=0.012), assessed by the independent t-test, the thyroxine (P=0.0001) and anti-TPO (P=0.008) levels, both examined by the Mann-Whitney test, which associated with high levels of TSH and anti-TPO and low levels of thyroxine in the diabetic group. No differences were found regarding the Apgar scores and anthropometric variables between the groups (P>0.05).

Overall, according to the obtained results, it can be inferred that thyroid dysfunction, realized as hypothyroid with high anti-TPO levels, was more prevalent in women with gestational diabetes mellitus compared to healthy pregnant women.

Preterm labor (PTL) is considered as one of the main causes of fetal mortality worldwide. Therefore, prevention of PTL is one of the main goals of midwifery care. The present study was conducted to determine the effect of vaginal progesterone suppository on the prevention of PTL. In this randomized clinical trial, 200 singleton pregnant women at 24 -34 weeks of gestation with diagnosis of PTL were treated with IV magnesium sulfate and corticosteroid. In the intervention group (n=100),in addition to the above mentioned drugs, progesterone suppository (200 mg) was administered at the start of treatment and every12 hours until discontinuation of uterine contractions. After successful tocolysis, use of progesterone suppository continued until the end of the 34thweek.Midwifery outcome including the interval between the onset of tocolysis and discontinuation of uterine contractions and the occurrence of labor, the gestational age at the time of delivery and neonatal outcome were recorded in the two groups. The mean intervals between the start of tocolysis and discontinuation of uterine contractions were 6.33±3.78 and 6.72±3.07 hours (p=0.432) in the control and intervention groups respectively. Also, the intervals between successful tocolysis and delivery were 35.1±21.9 and 36.7±25.1 days respectively (p=0.634).There was no significant difference between the two groups in terms of gestational age at the time of delivery and neonatal outcome. Although neonatal mortality in the control group was twice that in the intervention group, the difference was not significant (p=0.194). The present study showed that vaginal progesterone suppository had no effect on the prevention of PTL.

Adequate levels of progesterone and efficient uteroplacental circulatory system are considered as two important factors in maintaining normal pregnancy. Conspicuously, increased vascular resistance in the uterine artery can lead to severe complications including threatened abortion by an impairment to the embryo’s blood supply. This study was conducted to determine whether vaginal progesterone suppository administration effect on uterine artery resistance in women with threatened abortion. This interventional pre-experimental study was done in Kosar hospital of Qazvin (Iran) within 2016-2017. 51 pregnant women with vaginal bleeding were entered in the study who had alive singleton fetus with 7 to 12 gestational age and closed cervix. Initially mean pulsatility index (PI) and resistance index (RI) were determined in uterine arteries on both sides by color Doppler sonography. Then, 400 mg vaginal progesterone suppository was administered for 14 days. Using color Doppler sonography, the mean PI and RI of uterine arteries were recorded again and the mean of PI and RI were evaluated before and after using vaginal progesterone suppository. The mean of RI in uterine arteries on both sides was 0.68±0.07 before treatment and decreased to 0.55±0.08 after treatment (P<0.001). Also before intervention, the median of PI in uterine arteries on both sides was 1.17 (1.05 and 1.48) which decreased to 0.95 (0.77 and 1.14) after treatment (P <0.001). Vaginal progesterone suppository administration reduced uterine artery resistance by improving RI and PI index in women with threatened abortion.

Episiotomy is the most prevalent obstetrical procedure with the purpose of either widening vaginal outlet or helping the fetus to deliver as soon as possible with the most feto-maternal safety. The aim of this study is to find out the effects of topical phenytoin cream on wound repair in primiparous women. One-hundred-thirty primiparous mothers were referred to Kowsar Hospital in Qazvin province participated in this clinical trial. Sixty-five participants were assigned in each of intervention and control groups. The intervention group was treated with topical 1% Phenytoin cream and 10% povidone-iodine (betadine) solution and the control group received placebo and betadine solution.
Wound irrigation with betadine was performed as the routine order in the hospital, three times daily and two centimeters of topical phenytoin or placebo cream, were applied to the wound twice daily. The rate of episiotomy repair was measured by REEDA index in the first 24 h, the fifth and the tenth puerperal day. Data analyses were done t-test and chi-square test and Mann-Whitney. In the first 24 h, it was 6.43 ± 2.15 in the intervention group versus 6.52 ± 5.09 in the control group with no significant difference. However on The 5th day, it appeared 4.56 ± 3.01 in the intervention group versus 6.54 ± 2.98 in the control group (p < 0.001), likewise it was 5.82 ± 2.83 in the control group on the tenth day (p < 0.001). Significant difference was detected both in the 5th and 10th postpartum days. The result of this trial suggested that 1% phenytoin cream speeds-up the wound healing process; therefore it could be applied for accelerating episiotomy repair.

Labor induction is one of the most public ways carried out global for delivering mothers. The aim of labor induction is to encourage uterine contractions before the spontaneous onset of labor, resultant in vaginal delivery misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Regarding the importance and lack of similar researches in Iran, this research was done to compare the efficacy of buccal and sublingual misoprostol for labor induction in pregnant women.
This study was conducted as a randomized double-blind clinical trial from March 2017 to February 2018. In this survey, 200 women were randomly assigned to receive 50 µg buccal misoprostol and sublingual (100 buccal and 100 sublingual) in Kosar Hospital, Qazvin University of Medical Sciences, Iran. The maternal and fetal complications, Bishop score, and time of pain onset and its interval with labor were monitored in two groups and the findings were analyzed.
Research variables were age, gestational age, BMI, number of previous pregnancy, neonatal weight, total dose, Bishop score 1, Bishop score 6, oxytocin, and delivery type. The results showed that there were no differences between Bishop score 6 (P=0.07), and 1 (P=0.36), total dose (P=0.58), neonatal weight (P=0.43), number of pregnancy (P=0.67), BMI (P=0.67), and pregnancy weak (P=0.108) of sublingual group and buccal group. About 43 patients (43%) in buccal and 64 (64%) in sublingual group had vaginal delivery (P=0.05). The frequencies of maternal and fetal complications were similar between two groups.
It can be concluded that there is no difference between efficacy of sublingual and buccal misoprostol in pregnancy results, maternal, and fetal complications, however, it seems that the sublingual group is more effective than buccal group due to the significant amount of vaginal delivery, achieving vaginal delivery in less than 24 hours, and less need for oxytocin.

Pregnancy and delivering a baby are the most important achievements occurring in a woman`s life and her family. Although it is a physiologic event, there would happen some complications that could mostly be prevented by prenatal care. The objective of this study was to assess the relationship of the first trimester maternal hemoglobin and fetal birth weight.
This descriptive- analytical study was performed on 3000 pregnant women of 18 to 40 years old with less than 12 weeks of gestational age, referred to health centers in Qazvin province. Hemoglobin measurements were performed by routine laboratorial tests and then recorded in the questioners; afterward, the mothers were followed throughout the gestation period up to the delivery term. Then, the fetal birth weights were recorded. Anemia was defined as Hb Findings: This study presented that 11.4% of babies had low birth weights (Discussion & This study demonstrated that lower birth weight babies in anemic mothers were more prevalent. Therefore, pre-gestational screening and anemia treatment is highly recommended in women of reproductive age.

The use of corticosteroids is one of the methods put forward for the strengthening and speeding up the process of labor. After identification of glucocorticoid receptors in human amnion, the role of corticosteroids in starting the process of labor has been studied in numerous studies. The purpose of this study was to determine the effect of intravenous Dexamethasone on preparing the cervix and on labor induction. A randomized, clinical, and double – blind trial was conducted on 172 women divided into a control and an experimental group. The inclusion criteria were that they had to be primparous, in or before the 40th week of pregnancy, and with Bishop scores (B.S.s) of or lower. The exclusion criteria were diabetes, preeclampsia, macrosomia, twin pregnancy, rupture of the membrane (ROM), breech, and women suffering from background diseases. The B.S.s of the women was measured in charge of the study, and each woman was intravenously injected with eight milligrams of Dexamethasone or eight milligrams of distilled water. Four hours after the injections, the B.S.s of the participants was measured, and they were put under the conditions of labor induction using oxytocin. Information was collected in checklists A and B. The patients were compared with respect to B.S., the time the induction started, the average interval between the start of induction and the beginning of the active phase of childbirth, and the average length of time between the start of the active phase and the second stage of childbirth.The first and five minutes Apgar scores of the two groups of women were compared. The frequencies, the means, and the standard deviations were calculated using the SPSS – 16 software, and analysis of the results was performed with the Student’s t- test and the chi-square test with P<0.05. There were no statistically significant differences between the two groups in terms of their age, period of pregnancy, and B.S. at the start of the study. The average B.S. of women four hours after the injections with Dexamethasone was 5.9 ± 1.57 and the corresponding figure for women in the control group was 4.6 ± 1.72. These figures were significantly different at P<0.001. The average interval between labor induction and the start of the active phase in the group injected with Dexamethasone was significantly less than that of the control group 2.87±0.93 versus 3.80± 0.93 at P<0.001). The average duration of the active phase of the second stage of childbirth was 3.47±1.10 hours in the experimental group and 3.6 ± 0.99 hours in the control group at P<0.49. These two figures were not significantly different. The Apgar scores of the first and fifth minutes after the birth of the children of the two groups of women were not significantly different. It was found that intravenous Dexamethasone improves the Bishop score of the cervix and thus causes softening of the cervix and reduces the length of time between labor induction and the start of the active phase of childbirth.

In previous studies، the relationship between body mass index (BMI)، weight gain during pregnancy، pregnancy outcome and preterm delivery is inconsistent. The aim of this study was to determine the association between body mass index and weight gain during pregnancy with preterm delivery. This analytical study was performed in Qazvin province during 2010 and 2011. 1650 pregnant woman aged 18 to 35 years old with gestational age less than 12 weeks were selected. 274 subjects were excluded due to underlying diseases، premature rupture of membrane (PROM) or incomplete prenatal care. Body Mass Index (BMI) were measured. Weight gain during pregnancy and preterm labor (before 37 weeks of gestation) were documented. Data were analyzed by T-Test and Chi-square test. The incidence of preterm delivery in women with lower BMI was higher than other pregnant women، but the difference was not statistically significant. The incidence of preterm delivery in normal weight and overweight women with weight gain during pregnancy less than recommended was higher than others (P=0. 02، P=0. 01). Our results in this study showed the BMI and weight gain during pregnancy were significant in predicting preterm delivery. This study showed that there is an association between BMI and abnormal weight gain during pregnancy with preterm delivery. Therefore، education programs، health services and nutrition consultation are recommended for women in reproductive age.

Background and Premature rupture of membrane (PRÔM) is a common and challenging issue in obstetrics. Ëarly diagnosis of PRÔM and the consequent infection has a pivotal role in proper management of patients. The detection of PRÔM is easier in a case with visible vaginal fluid، but is difficult when trivial amount of vaginal fluid presents. Ïn this study، we aimed to assess the diagnostic value of LDH and creatinine in vaginal fluid for detecting PRÔM. Pregnant women were recruited in the third trimester (28-42 weeks) when attending prenatal care unit at Kowsar Ëducational hospital، Ghazvin، Ïran during 2008. Ünder sterile condition، vaginal fluid was collected using speculum. Fern test was performed and adequate vaginal fluid was aspirated from posterior fornix to measure LDH and creatinine. 223 pregnant women with mean age of 25. 4±5. 5 (16-43) years were recruited into this study. The mean of gestational age was 37. 6±3. 2 weeks. Visible vaginal fluid was detected in 72 (32. 3%) while Fern test was positive in 56 (25. 1%). Visible vaginal fluid detected by a specialist is considered as a gold standard test. Üsing RÔÇ curve analysis from SPSS، we have found that a cutoff point of >180 Ü/L for vaginal fluid LDH level is a reasonabl diagnostic value for PRÔM at sensitivity of 85%، specificity of 80%، PPV of 66. 3%، NPV of 91. 6% and an accuracy of 81%. The same analysis on vaginal creatinine using a cutoff point of >0. 9 mg/dl showed diagnostic value with sensitivity of 72%، specificity of 35%، PPV of 34. 7%، NPV of 72. 6% and accuracy of 47%. Çonclusion: Vaginal fluid LDH at a cutoff point of >180 Ü/L is clinically a useful diagnostic test for detection of PRÔM.