Triglyceride to HDL cholesterol ratio and risk for gestational diabetes and birth of a large-for-gestational-age newborn

Background: Using oral glucose for glucose challenge test (GCT) and glucose tolerance test (GTT) is problematic, especially in early pregnancy when the pregnant woman is experiencing gastrointestinal complications. This research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) and the risk of gestational diabetes and large for gestational age (LGA) fetus for suggesting a more appropriate index for diagnosis of gestational diabetes. Methods: The present cross-sectional study investigated pregnant women visiting the Perinatal Clinic of Ayatollah Rouhani Hospital in Babol for prenatal care from September 2015-2016. The GCT was performed on these pregnant women at 24-28 weeks as a screening test and their lipid profile, including HDL-C and TG, was simultaneously assessed after eight to 14 hours of fasting. Results: Significant differences were observed between women with and without gestational diabetes in terms of mean triglyceride, HDL, LDL/HDL ratio, triglyceride/LDL ratio and triglyceride/HDL ratio. The cut-off point of TG/HDL in the GTT was 4.254 with a sensitivity of 79.07% and specificity of 78%. Conclusions: According to the results obtained, lipid profile can help predict the risk of gestational diabetes, especially TG/HDL ratio that has a high sensitivity to diagnose gestational diabetes, while, lipid indices could not predict birth of a LGA neonate

Prevalence and Factors related of psychiatric symptoms in low risk pregnancy

Background: Psychiatric disorders are associated with poor pregnancy outcomes both for mother and child. This study aimed to determine the prevalence and related demographic risk factors of psychiatric symptoms among the pregnant women in Babol City. Methods: This cross-sectional study was conducted in five private and public obstetrics clinics of Babol city. During routine appointments of prenatal care, 176 pregnant women filled in three questionnaires including; sociodemographic questionnaire, Edinburg Prenatal Depression Scale (EPDS), and Symptom Checklist-25 (SCL-25). Wilcoxon test, Spearman correlation, and multivariate logistic regression tests were used to interpret the data. Results: The prevalence of depressive disorders was 15.4 for Edinburg scores ≥13.  The overall rate of maternal psychiatric symptoms (global severity index or GSI scores ≥ 1.75) was 48.5. The prevalence of psychiatric symptoms was high; for 25 somatization, 258 anxiety, obsession-compulsion disorders or OCD 6.4, 8.8 interpersonal sensitivity, 5.3 phobia, 7.6 paranoid ideation, and 1.2 psychoticism. Multivariate logistic regression revealed that pregnant women with history of abortion in previous pregnancy were at risk of depressive symptoms more (β=3.18, CI 1.28-7.93, p=0.01) than those without history of abortion. Also, the only demographic factor related to psychiatric symptoms was the age of pregnant women; younger age was associated with higher symptom levels for GSI ((r=-0.17). Conclusion: The high prevalence of psychiatric symptoms, especially depressive symptoms, in pregnant women highlights the need for continued research on screening, identifying the risk factors, and developing effective treatments for mental disorders in pregnant women

Impact of preoperative vaginal preparation with povidone iodine on post cesarean infection

Background: Obtaining clinical methods in order to decrease the infectious morbidity of cesarean delivery is very important. The aim of this study was to determine the effect of preoperative vaginal preparation with antiseptic solution on post-caesarean infections. Methods: This study was conducted on 400 singleton term pregnant women undergoing elective cesarean delivery. The samples were randomized into two groups; experimental group, including women who received an additional preoperative vaginal cleansing with 10% povidone iodine; and a control group, including women who received only the standard abdominal preparation. All subjects received a single dose of prophylactic antibiotic and were investigated after cesarean delivery until the 6th postoperative weeks for postoperative fever, wound infection, or endometritis. Data were analyzed using SPSS software and the P value < 0.05 was considered significant. Results: The groups were similar in age, education level, body mass index, and parity. The operation variables such as the postoperative fever, wound infection, and endometritis were observed in the two groups, and the overall for these were found to be 6.0 %, 6.3%, and 6.5%, respectively. A total of 7.5% of the participants in the control group and 5.5% of the participants in the experimental group developed postoperative endometritis; but it was not statistically significant (relative risk= 0.86; 95% confidence interval, 0.61 –1.21; P=0.417). Also, there was no significant difference in postoperative fever, wound infection between these women with and without preoperative vaginal cleansing with povidone. Conclusion: The findings of the present study indicated that vaginal cleansing with povidone iodine immediately prior to elective cesarean delivery did not decrease the post-caesarean infection rates and the incidence of endometritis in low-risk women

Acute obstetric and gynecologic emergencies among pregnant women in a tertiary care hospital, Iran

Background: Acute abdominal pain is a medium or severe abdominal pain that can lead to a life threatening for pregnant women and frequently requires urgent investigation and management. The aim of this study was to assess the causes and the presentation of acute abdomen among pregnant women admitted at the gynecology and an obstetrics ward of the hospital. Methods: The present study was a cross sectional hospital based study among 118 pregnant women by face to face interview using a semi structured questionnaire. This study was conducted at the gynecology and an obstetrics ward of the hospital, Babol Iran, from April 2004 to February 2009. All analysis was performed with SPSS software. Results: Mean age of women was 29.1±6 years. The frequencies of the most common diagnosis of the patients were ectopic pregnancy (73.7%), appendicitis (10.2%), respectively. The study found that 55.1% of respondents complained their pain lasting more than 24 hours. Besides, 81.4% of respondents felt pain in the supra pubic followed by with nausea/ vomiting. A total of 103 (83.9%) underwent with salpingostomy and 12 (10.1%) were treated with appendectomy. Conclusion: The study concludes that a large prospective study is needed in order to precise diagnosis of the acute abdomen in pregnant women by continual updating of availability of the gynecologists for the management of the acute gynecologic and obstetrics emergencies among pregnant women

Women’s satisfaction in early versus delayed postcaesarean feeding: A one-blind randomized controlled trial study

Background: The early postoperative feeding after caesarean section (C- section) has remained controversial. This study was designed to evaluate the safety and efficacy of early versus delayed postcaesarean section oral feeding regarding gastrointestinal complications and patients postoperative satisfaction after C- section. Methods: This clinical trial study was conducted on 200 pregnant women undergoing planned C-section under spinal anesthesia (Registration Number: IRCT: 138712211760N1). Women were randomly divided in two groups group A (early feeding group) comprised of 101 patients who were encouraged to take oral fluid. If they tolerated, they continue semi-solid and solid foods starting 2 h after caesarean section. Group B (delayed feeding group) comprised of 99 patients who were given oral fluid 8 h after surgery. After beginning of feeding the patients’ tolerance, first flatus, first defecation, beginning of regular diet, the length of hospital stay and also patient satisfaction level were evaluated in each group by visual scale analog (VAS). Results: The mean time of the first passage of flatus was 10.2±1.7 hours for the early oral feeding group versus 10.7±1.6 hours for the delayed feeding group and the difference was significant (P=0.03). Duration to first defecation and length of hospital stay as well as patient satisfaction level did not differ significantly between the two groups.  Conclusion: The results of this study suggest early postcaesarean feeding. It is well tolerated and helps return normal feeding habits

History of menstrual disorders associated with gestational diabetes mellitus

Background: Despite the fact that many studies have been published about the risk factors associated with gestational diabetes mellitus, its prevalence remains high. The aim of this study was to examine the relationship between the history of irregular menses and gestational diabetes mellitus among pregnant women. Methods: This case-control study was conducted on 51 pregnant women with gestational diabetes mellitus in prenatal clinics of Ayatollah Rouhani hospital in Babol, Mazandaran, from January 1, 2014 to December 31, 2015. At first, women with family history of diabetes mellitus, prepregnancy diabetes mellitus, previous gestational diabetes mellitus, age >35 years, weight >110 kg were excluded from the study. Then, one random control was systematically selected for each case, which was matched for age. All statistical analyses were performed through SPSS (Version 22). P-values less than 0.05 were considered statistically significant. Results: Irregular menses was not associated with gestational diabetes. The mean menarche at age was lower among the women with gestational diabetes (p=0.03). There was a significant association between menarche at age and gestational diabetes (OR, 6.74; 95% CI, 1.41-32.17). Dysmenorrhea did not differ between subjects with and without menstrual irregularities. Conclusion: We concluded that early menarche at age (<12 years) could be an important consideration for obstetricians, who adopt a selective screening approach to gestational diabetes

The effect of dexamethasone therapy on prolonged latent phase of labor: a randomized double-blind clinical trial

Background: Shortening the interval between the onset of labor and delivery is useful for both mothers and fetuses. The aim of the study was to investigate the effect of dexamethasone on the augmentation and the duration of labor in prolonged latent phase of labor. Method: The design of the study was a randomized double-blind clinical trial design, which was conducted in delivery center of Rouhani hospital in Babol (Iran). A total 121 nulliparrous women with a singleton pregnancy and cephalic presentation at 40–42 gestational weeks in prolonged latent phase were randomly assigned to receive 2 ml ampoule dexamethasone 4 mg/mL (the intervention group) and 2 ml ampoule of sterile water for injections (the control group), which were both intramuscularly administered. Then, the Then, the augmentation of labor with the use of intravenous oxytocin infusion (Caspian Tamin Company Iran) (2.5 m units/ per minute) began in both groups. The primary outcome was the duration of time between the onset of augmentation and the second stage of labor. Results: The duration of time between the onset of labor augmentation and the second stage of labor (hours) was 5.6±1.9 in the study group, whereas it was 7.7±1.5 in controls with a significant difference (p ≤ <0.001). In the study group, the duration of time between the onset of labor augmentation and the active phase of labor was lower than that of the control group (p= 0.02). In addition, the duration of the second stage of labor (p <0.001) and the third stage (p <0.001) was lower in the study group compared with that of the control group. Conclusion: It is imperative that midwives administer dexamethasone to improve the prolonged latent phase in women during the labor

Depressive symptoms and psychological distress from antenatal to postnatal period in women with high-risk pregnancy: A prospective study during the COVID-19 pandemic

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental disorders in postnatal period remains unknown. Aim: The study aimed to determine the extent to which the COVID-19 pandemic may aggravate depressive symptoms and psychological distress of women with high-risk pregnancy in postnatal period. Methods: This prospective cross-sectional study was conducted on women with complicated pregnancies from antenatal to postnatal period. In the first phase, from December 2019 to January 2020 (before the beginning of the COVID-19 pandemic), 122 pregnant women filled in the Edinburgh Postnatal Depression Scale (EPDS) and Brief Symptom Inventory 53-items (BSI-53). In the second phase, with the start of the COVID-19 pandemic from February to June, 30% of the participants (41/122) completed three questionnaires: EPDS, BSI-53, and the posttraumatic stress disorder (PTSD) scale in postpartum period. Results: During the COVID-19 pandemic, from antenatal to postnatal period, the depression score of EPDS, total scores, all the subscales of BSI-53, and global severity index-53 increased in women with high-risk pregnancy. Furthermore, the persistence of antenatal depression occurred in 85.7% of the participants, and the onset of postnatal depression occurred in 80% of them. About 12% of the women also experienced PTSD symptoms during the postnatal period. Conclusion: The COVID-19 pandemic may aggravate the prevalence and persistence of postnatal depression in women with high-risk pregnancy. The study calls for clinical implementation to identify and help women with mental disorders in postnatal period, especially women experiencing complicated pregnancies