عوارض مادری

One of the factors affecting the outcome of pregnancy is the primary body mass index (BMI) and the amount of weight gain during pregnancy. This study aimed to check the relationship between mother's initial body mass index and weight gain in pregnancy with pregnancy outcomes.

This cross-sectional study was conducted on 455 pregnant women referred to Afzalipour Hospital in Kerman, Iran, from August 2021 to August 2022. These pregnant women were included in the study through easy and accessible sampling. The mother's initial weight was recorded through the mother's health card. The height of the mother was measured using a standard meter and the final weight of the mother before delivery was measured using a standard scale available in the department. Other information of the mothers was extracted from their records. Weight gain during pregnancy and initial body mass index were calculated and divided into four categories, less than normal, normal, overweight and obese. Maternal-fetal complications were included in the information registration form. Descriptive and analytical statistical methods and SPSS version 24 software were used to analyze the data.

The average age of women was 27.56±6.82 years. Body mass index of more than 40% of them (44.4%) was normal (19.8-26) and more than 45% of them were overweight 11.5-16 (45.5%). There was a significant relationship between initial body mass index and weight gain during pregnancy (P=0.001), gestational diabetes (P=0.001) and newborn weight (P=0.019). There was also a significant relationship between weight gain during pregnancy with premature birth (P=0.001), vaginal delivery (P=0.001), gestational diabetes (P=0.001) and newborn Apgar (P=0.001).

High body mass index of the mother and weight gain during pregnancy can cause complications in the mother and the fetus. Therefore, prenatal care should be done more carefully and health care providers should place mothers who have abnormal body mass index and inappropriate weight gain in pregnancy in the high-risk group and under special care to minimize maternal and fetal complications.

Considering the importance of complications caused by cesarean sections performed during the second stage of labor for both the mother and the newborn, as well as its impact on future pregnancies, the purpose of this study is to investigate the complications associated with cesarean sections during the second stage of labor.

Materials & Methods :

In this case-control study, the case group includes patients who underwent cesarean section in the second stage of labor, and the control group includes patients who underwent elective cesarean section. Finally, the clinical findings obtained between the two groups of cases and controls were analyzed.

Out of 60 mothers in this study, 30 were in the control group and 30 were in the intervention group. The duration of hospitalization for the control and intervention groups was 2.94 ± 1.14 days and 4.03 ± 1.35 days, respectively. Statistically, the difference between the two groups was significant (P = 0.002). Additionally, the average volume of bleeding, as indicated by the number of sterile gauzes used, was 7.9 ± 1.3 gauzes in the control group and 13.9 ± 2.8 gauzes in the intervention group. The difference in the volume of bleeding between the two groups was statistically significant (P < 0.001).

Cesarean section in the second stage of labor is associated with higher maternal complications compared to elective cesarean sections. These complications include a higher rate of hemodynamic instability and blood pressure disorders, more bleeding, a higher blood transfusion rate, extension of unintentional uterine incision, uterine atony, sepsis, fever, more antibiotic treatment, more admissions to the ICU, longer hospitalization days after cesarean section, need for hysterectomy, longer operation time, re-laparotomy, postoperative pyrexia, and wound infection.

One of the goals of the third millennium development is maternal and neonatal health. One of the harmful factors of health is natural disasters. This study was performed aimed to determine maternal complications in Kermanshah earthquake in 2017.

This cross-sectional study was conducted on 850 women who had delivery in Imam Khomeini hospital of Eslam Abad Gharb. The earthquake group included the women who had delivered in the earthquake of 2017 and the non-earthquake group included the women who were delivered in the same hospital in 2016. All data obtained from patients' records. Data were analyzed by SPSS software (version 21) and Independent t-test, and Mann-Whitney test, Chi-square and Fisher exact test. P<0.05 was considered statistically significant.

In women who had delivered in an earthquake, prevalence of maternal complications included preterm labour in 99 (22.3%), premature rupture of membrane in 30 (7.05%), caesarean section in 179 (42.1%), postpartum hemorrhage in 42 (9.9%), gestational hypertension in 24 (5.6%) and abortion in 11 (2.58%). In women who had delivered in 2016, there were preterm labor in 51 (11%), premature rupture of membrane in 12 (2.8 %), caesarean section in 153 (36%), postpartum hemorrhage in 20 (5%), gestational hypertension in 9 (2.1%) and abortion in 2 (0.5%). There were significant differences between the two groups in all cases (P<0.05).

Natural disasters such as earthquakes can increase maternal complications. Therefore, necessary precautions and health care should be increased in the event of a natural disaster.

Eclampsia is defined as generalized tonic-clonic seizure in a pregnant woman with preeclampsia. Eclampsia is one of the leading causes of maternal and fetal mortality worldwide. This study was performed with aim to evaluate maternal and fetal complications in pregnancies with eclampsia in Ghaem Hospital of Mashhad.

In this cross-sectional study, all patients with a diagnosis of eclampsia who were admitted to Ghaem Hospital between June 2018 and June 2020 were included in the study. Maternal and fetal complications were assessed. For all patients, a checklist was completed by the researcher including information and history of underlying diseases, surgery, obstetrics, and maternal and neonatal complications. Data were analyzed by SPSS statistical software (version 16).

In this study, 51 patients with eclampsia were evaluated. The frequency percentage of eclampsia in Ghaem Hospital was 0.45%. Eclampsia before delivery was 66.7% and was higher than during and after delivery. Maternal complications included: increased rate of cesarean section (70%), postpartum bleeding (1.96%), liver disorders (1.96%), PRES syndrome (13.7%), HELLP syndrome (9.8%), DIC (1.96%), placental abruption (3.9%) and pulmonary edema (1.96%). Fetal complications were low Apgar (43.1%), low birth weight (41.1%), NICU admission (33.3%), preterm delivery (25.4%), IUGR (19.6%) and neonatal and fetal deaths (27.5%) that 4 cases were stillbirth and 10 cases died up to 7 days after birth. There was no maternal death.

Maternal complications were: preterm pregnancy, cesarean section due to placental abruption or IUGR, HELLP syndrome, ICU hospitalization and maternal death, respectively. Fetal complications were: preterm delivery, IUGR and NICU hospitalization and intrauterine fetal death, respectively.

Vaginal birth after cesarean (VBAC) is one of the strategies developed to control the growing number of cesarean sections and is still under investigation. In this study, we investigated the neonatal and maternal complications of VBAC. 

In this cross-sectional study, all pregnant women with a history of cesarean section who decided to have VBAC from 2019 to 2020 were included in the study. Demographic information and postpartum outcomes including success rate of VBAC, its maternal and neonatal complications, and causes of VBAC failure were assessed. 

255 pregnant women with a mean age of 31.95 years and BMI of 29.98 kg/m2 were present on study. The mean time elapsed since the last delivery was 5.57 years. VBAC was successful in 77.6% of cases and  lack of delivery progress and lack of response to induction  were the cause of 85.5% of failures. VBAC was uncomplicated in 97% of  mothers and 95.5% of neonates. The average Apgar score of the first and fifth minutes was 8.99 and 10, respectively. The most common maternal complication was bleeding (2%) and the most common neonatal complication was RDS (3%). No case of mortality or uterine rupture was observed. 

VBAC is successful in 77.6% of cases and in unsuccessful cases, decline FHR and failure to descent are the most common causes of failure. Also, VBAC-born neonates have a favorable Apgar score and blood gas analysis, and in more than 95% of cases, there are no maternal or neonatal complications.

Abnormal placental adhesion is often associated with severe life-threatening bleeding that requires peri-delivery emergency hysterectomy and can increase the risk of complications such as Disseminated intravascular coagulation, respiratory distress and renal failure for mother. This study was performed with aim to investigate the maternal and neonatal complications in patients with abnormal placental adhesion.

This cross-sectional study was performed on 70 pregnant women with abnormal placental adhesion in the educational hospitals of Mashhad University of Medical Sciences in 2017-2018. Patients with abnormal placental adhesions who were diagnosed through Doppler or MRI and given a clinical diagnosis during cesarean section and then confirmed in pathology results entered the study. Data collection tool was a researcher-made checklist. Based on the pathology sample, the patients were divided into 3 groups of abnormal placental adhesions. Maternal and neonatal complications were evaluated for each group based on the amount and degree of adhesion. Qualitative data were reported as frequency and percentage. Chi-square test was used to compare their frequency distribution. One-way analysis of variance and Kruskal-Wallis tests were used to compare the means of quantitative variables. P<0.05 was considered statistically significant.

The most common complication in all three groups was prepartum hemorrhage that the difference between three groups was not significant (p=0.571). There was no significant difference between three forms of adhesion groups in urinary system complications(p=0.294) ,transfusion(p=0.29), neonatal NICU admission and death(p= 0.44).

Gestational diabetes increases maternal and neonatal complications. Therefore, this study was performed with aim to examine the effect of the number of pregnancy cares on the reduction of maternal and neonatal complications in women with gestational diabetes.

This cohort study was performed in 2018-2020 on 119 mothers with gestational diabetes in Omolbanin hospital. The subjects in the two groups of pregnancy visits < 10 times and ≥10 times were compared in terms of neonatal complications such as overweight 90%, dystocia and maternal complications like preeclampsia. Data were analyzed using SPSS statistical software (version 23) and independent t-test and Mann-Whitney, Chi-square and Fisher tests. P< 0.05 was considered statistically significant.

In this study, among 119 pregnant women with gestational diabetes, 37 (31.09%) were in the group of pregnancy visits ≥ 10 times and 82 (68.90%) in the group of pregnancy visits < 10 times. The number of infants weighing more than 90 percent was 4 (10.8%) in the group of pregnancy visits ≥ 10 times and was 4 (4.9%) in the group of pregnancy visits < 10 times, which had no statistically significant difference (P=0.2). Mean fasting blood sugar of mothers in third trimester was 91.22 ± 75.14 mg/dl in the group of pregnancy visits ≥ 10 times and was 93.65 ± 30.23 mg/dl in the group of pregnancy visits < 10 times, which was similar in both groups (P=0.2). Also, the incidence of preeclampsia was 3 (6.2%) in the group of pregnancy visits ≥ 10 times and 5 (8.1%) in the group of pregnancy visits < 10 times, which was similar in the two groups (P=0.8). There was no significant difference between the two groups in terms of other maternal and neonatal consequences.

Increasing the number of pregnancy visits in women with gestational diabetes does not improve the maternal and neonatal outcomes.

Aneuploidy screening before birth is essential prenatal care for all pregnant women, regardless of maternal age. Prenatal screening allows prenatal treatment of the fetus and proper pregnancy management. This study was performed with aim to determine the adverse pregnancy in pregnant women with positive aneuploidy screening at first and second trimester or combination of them.

This cohort study was performed on 423 pregnant women from April 2017 to June 2019. Demographic, fertility, and laboratory data were recorded from the prenatal file or maternal self-report during prenatal care receiving, and then, the pregnant women were placed in two groups of women with positive and negative serum aneuploidy screening in terms of adverse pregnancy outcomes. Data were analyzed by SPSS software (version 23), and Chi-square, T-test and crude and adjusted logistic regression. P < 0.05 was considered statistically significant.

In this study, 423 pregnant women in terms of adverse pregnancy outcomes were placed in two groups of pregnant women with positive and negative serum aneuploidy screening. Mean age in the positive and negative serum aneuploidy screening groups were 33.08 ± 5.77 and 29.54 ± 5.85, respectively (P = 0.001). The incidence of abortion, preeclampsia, intrauterine growth restriction and NICU admission was higher in screen-positive group compared to screen-negative group. The crude odds risk ratio of adverse pregnancy outcomes in screen-positive women (OR = 1.87 (1/15- 3/03) P = 0.04 and adjusted risk odds after controlling for maternal age, body mass index and parity was OR = 1.79 (1.09 -2.96) P = 0.02.

Adverse pregnancy outcomes are higher in women with positive aneuploidy screening. Further studies are needed to determine the sensitivity and specificity and accuracy of positive aneuploidy screening.

Preeclampsia is one of the most important complications of pregnancy which complicates 5-8 percent of all pregnancies and is associated with increased maternal and fetal complications. This study aimed to determine the prevalence of preeclampsia and its fetal and maternal complications in pregnant women referring to the maternity ward of the Zabol-based Amiralmomenin Hospital.
This is a retrospective, descriptive study conducted on the files of 2000 pregnant women referred to Amiralmomenin Hospital in Zabol. The data collection tools consisted of a two-part form that covered demographic and obstetric data as well as maternal and fetal complications of preeclampsia. Data were presented in descriptive statistics.
The prevalence of preeclampsia in Zabol was 6.5%. The frequency of the major maternal complications include liver dysfunction 13.1%, renal disorders 3.1%, transfusion 4.6%, thrombocytopenia 2.3%, visual impairment 2.3%, stillbirth 0.8% and HELLP syndrome 0.8%. Fetal complications involve prematurity 29.2%, amniotic fluid meconial 12.3%, and Apgar score below 7 at birth 7.7%.
Given the prevalence of preeclampsia and its complications for the mother and the fetus, proper care during pregnancy should be provided in order for early detection and prevention of adverse effects.

Unfavorable Bioshop score, a score pre-labor of cervical ripening, is a marker for screening delayed labor. This study aimed to determine maternal and neonatal outcomes in full-term pregnancy with unfavorable Bishop score.
In a cross-sectional study, 400 full-term pregnant women were selected and Bishop score was determined at labor induction. All mothers and neonates were followed until discharged from hospital and maternal and neonatal outcomes in those with low Bishop score were investigated.
Findings: The mean Bishop score was 5.9 ± 2.1; 174 (39.9%) and 262 mothers (60.1%) had unfavorable and favorable Bishop score, respectively. The mean Bishop score was higher in normal delivery. In addition, Bishop score was different based on causes of cesarean, the results of oxytocin challenge test (OCT), and preeclampsia. The mean Bishop score was lower in mothers with post-partum hemorrhage.
According to increase of maternal and neonatal complications, pregnant women with unfavorable Bishop score must be hospitalized; so, the risk of these complications, including neonatal asphyxia would be reduced.

¬Urinary tract infection is one of the most common bacterial infections during pregnancy and has also been implicated as a risk factor for adverse maternal and prenatal ¬¬outcomes. The aim of our study was to determine the relation between maternal urinary tract infection and adverse maternal, prenatal outcomes in pregnant women of Ardabil, Iran.

¬This retrospective-case-control study was conducted on¬ prenatal file records of pregnant women in Ardabil (2011). ¬¬The pregnant women ¬who had a positive urine culture in their prenatal files¬ (N= 211) ¬were considered as a case ¬group and ¬232¬ ones without urinary tract infection as a control. Using a research- made questionnaire, the data related to present pregnancy and prenatal information was collected and analyzed by KrusKal Wallis, Chi- Square and Fisher statistical tests. Results¬: Maternal age of under 25 (%61.6 vs. 56.5), body mass index of more than 30 (%18.3 vs. 15.6), primigravida (%55 vs. 48.8), hypertension (%2.4 vs. 1.3), hyperemesis Gravidarum (%14.8 vs. 12.6), frequency ¬and dysuria¬(%1.9 vs. 0.9), low birth weight (%95.4 vs. 93.2), congenital malformation (%3.5 vs. 1.8), artificial milk feeding (%6.5 vs. 2.7), neonatal death (%0.9 vs. 0.0) are higher in urinary infection group, however the differences are not statistically significant. Other maternal and prenatal adverse outcomes such as diabetes, pre-eclampsia, hemoglobin level, prematurity, abortion and stillbirth have not significant relation with urinary infection.

Because of low level of adverse maternal or prenatal outcomes reported in our study, we conclude that screening and treatment of urinary tract infection in Ardabil health service is ¬appropriate; therefore, ¬no change is needed for present ¬screening¬ or treatment processes.

Preterm premature rupture of membrane (PPROM) is the rupture of the membrane before labor and prior to the 37th week. PPROM is a common complication of pregnancy with numerous adverse effects on both the mother and the infant. Identifying the risk factors for PPROM and methods for its early diagnosis and treatment will dramatically decrease the side effects. This study aimed at evaluating the outcome of pregnancies complicated by PPROM. This descriptive، analytic، cross-sectional study lasted for six months. It included 57 patients who were admitted to Shahid Beheshti Hospital (Isfahan، Iran) due to rupture of membrane in 28th-34th weeks of pregnancy. Patients were physically examined and asked for their history and symptoms. The collected data was analyzed with chi-square tests. The prevalence of PPROM، cesarean section، tachycardia، fever، and more than 15000/ml leukocytosis was 2. 3، 52. 7، 74. 0، 95. 0، and 66. 0 percent، respectively. Distress، sepsis، and death were observed in 21. 0، 3. 0، and 1. 7 percent of the neonates، respectively. No cases of pneumonia or hyaline membrane disease were detected. There was not a significant relationship between sex and PPROM. Our findings were similar to those of previous research. However، considering the importance of PPROM، larger studies in different areas are required for diagnosis and treatment of PPROM to prevent preterm birth.

Diabetes is one of most important medical diseases in pregnancy and value of Glycosylated hemoglobin A1C (HbA1c) showed mean of blood glucose in 4-8 weeks ago in these patients. In different studies significant relation were seen between HbA1c and incidence of complications in pregnancy. Aim of this study is to investigate correlation of maternal, perinatal, and neonatal outcomes with mean of HbA1c in insulin dependent diabetic women. This prospective study was performed on 31 insulin dependent diabetic women who cared in Khorasan diabetic research center in year 2004. First demographic characteristic and obstetrical history of participations recorded. Value of HbA1C was measured in three trimesters of pregnancy and subjects divided into four groups based on mean of HbA1C. Fetal and neonatal complications include abortion, congenital malformations, macrosomia, fetal death, hypocalcaemia, hypoglycemia, respiratory distress and so maternal complication include pre eclamsia, polyhydroamnios, preterm labor, retinopathy and type of delivery were studied. Relation between mean of HbA1c and maternal, perinatal and neonatal outcomes statistical analyzed by using SPSS software version 11.5 and t-test. P value less than 0.05 considered significant. Mean of maternal age was 24.5 years that 41.9% women were primigravid. About half of participations (41.9%) had HbA1C equal or higher than 10% and only in 12.9%, HbA1C was in normal range (4.6%-7.6%). There were not significant relation between mean value of HbA1C and maternal and fetal complications including abortion, fetal death, macrosomia, congenital malformation, respiratory distress and so preeclampsia, polyhydroamnios and retinopathy but most of these complications were accompanied with HbA1C higher than 10%. Only respiratory distress syndrome was accompanied with normal value of HbA1C. Relation between preterm labor and HbA1C was significant. (p=0.034). No hypocalcemia was seen in any of neonates who were born of these women. Incidence of fetal, neonatal and maternal complications except hypocalcemia and respiratory distress was related to level of HbA1C more than normal. But relation between preterm labor and level of HbA1C was significant.

Background and Thrombocytopenia is the most common disorder in pregnancy after anemia, and occurs in 10 percent of pregnancies. Thrombocytopenia in pregnant women may be associated with maternal and neonatal morbidity. Because of the diagnosis of thrombocytopenia is effective in patient's treatment and according to its complications in pregnancy, this study was performed to determine the incidence, causes and complications of thrombocytopenia in pregnancy. In this prospective study, all pregnant women with gestational age of 24< weeks and referred for termination of pregnancy to shahid yahyanejad and Ayatollah Rohani hospitals in Babol, selected and women who had the tests in microliters platelets less than 150,000 per microliters were enrolled. Cause of thrombocytopenia, method of delivery, maternal and neonatal complications in these patients collected were recorded. Platelet count less than 100,000 in microliters as severe thrombocytopenia was considered. Then enter the data and statistical software SPSS 18 cases were analyzed. During the study period, 4589 pregnancies were examined, of which thrombocytopenia was reported in 239 pregnancies and the incidence of thrombocytopenia in pregnancy was 5.2%. Cause of thrombocytopenia were in 222 patients (%92.9) thrombocytopenia of pregnancy, in 11 patients (% 4.6) ITP, 5 patients (half percent) of preeclampsia and one patient (% 0.4) had HELLP syndrome. 6 pregnancies (2.5 %) was associated with IUFD. maternal complications occurred only in one patients with ITP, that It was bleeding during and after of delivery. No neonatal complications occurred in newborns of women with thrombocytopenia. The results of this study, gestational thrombocytopenia, the most common cause of thrombocytopenia in pregnancy and are considering this cause complications for the patient and the fetus did not have, but these diagnose should be differenthied from other diagnosis such as Hellp syndrome or preeclampsia that these need the urgency termination of pregnancy for prevension of complication.

Obesity is a risk factor for pregnant women and fetus، undoubtedly. Maternal obesity is one of the important risk factors related to maternal and fetal mortality followed with extensive range of medical complications. The purpose of this study was the evaluation of maternal، fetal and neonatal complications according to BMI in women referred to Shiraz health choice centers. This descriptive study was done on 860 delivered women admitted in post partum ward of Hafez and Zeinabieh hospitals in Shiraz. Women were divided in 2 groups according to preconception of BMI: Group 1 with normal weight (19. 8< BMI≤25)، and group 2 with abnormal weight (BMI>25). Participants were studied for age، parity، pregnancy complications، parturition and neonatal complications. Mean age was 26. 9±5. 39 yrs. 68. 3% (608) of women had normal BMI and 31. 7% (282) had abnormal BMI. The most common complication during pregnancy was back pain 25. 4% (226). The prevalence of back pain، high blood sugar، hypertension، induced labor، post partum hemorrhage، post partum infection، duration of hospitalization، cesarean section and neonatal apnea were higher in abnormal weight group than normal weight group which the difference of variables was significant between two groups (p<0. 05). The most odds ratio was post partum infection which the possibility of post partum infection in abnormal weight group was 179. 8 times in compare to the normal weight group (95% CI: 85. 5-378). Obesity is an important risk factor in pregnant women followed with adverse maternal، neonatal and fetal outcomes.