Causes of Trauma in Pregnant Women Referred to Shabih-Khani Maternity Hospital in Kashan

Background: Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus. Objectives: The present study was conducted in Kashan in 2009–2010 to evaluate the causes of trauma in pregnancy. Patients and Methods: This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother’s occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions. Results: the causes of trauma included falling (9 cases (28.1%)), abdominal trauma (8 cases ( 25%)), spousal feud (3 cases (9.4%)), motorcycle accident (2 cases (6.25%)), car accident (2 cases (6.25%)), falling from a motorcycle (2 cases (6.25%)), falling or fainting resulting in head trauma (1 case (3.1%)), pain from crossing over a bump in the car (1 cases (3.1%)), and unspecified causes (4 cases (12.55%)). The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation. However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 (6.25%) cases and 1 (3.1%) case, respectively. Conclusions: Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence; therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women

Incidence of Neonatal Birth Injuries and Related Factors in Kashan, Iran

Background: Birth injuries are defined as the impairment of neonatal body function due to adverse events that occur at birth and can be avoidable or inevitable. Despite exact prenatal care, birth trauma usually occurs, particularly in long and difficult labor or fetal malpresentations. Objectives: This study aimed to investigate the incidence of birth injuries and their related factors in Kashan, Iran, during 2012-2013. Patients and Methods: In this cross-sectional study, all live-born neonates in the hospitals of Kashan City were assessed prospectively by a checklist included demographic variables (maternal age, weight, and nationality), reproductive and labor variables (prenatal care, parity, gestational age, premature rupture of membrane (PROM), fetal heart rate (FHR) pattern, duration of PROM, induction of labor, fundal pressure, shoulder dystocia, fetal presentation, duration of second stage, type of delivery, and delivery attendance), and neonatal variables (sex, birth weight, height, head circumference, Apgar score, and neonatal trauma). Birth trauma was diagnosed based on pediatrician or resident examination and in some cases confirmed by paraclinic methods. Statistical analyses were performed by chi-square, student’s t-test, and multiple logistic regression analyses using SPSS version 17. P ≤ 0.05 was considered statistically significant. Results: In this study, the incidence of birth trauma was 2.2%. Incidence of trauma was 3.6% in vaginal deliveries and 1.2% in cesarean sections (P < 0.0001). The most common trauma was cephalohematoma (57.2%) and then asphyxia (16.8%). In multiple logistic regression analyses, decreased fetal heart rate (FHR), fundal pressure, shoulder dystocia, vaginal delivery, male sex, neonatal weight, delivery by resident, induction of labor, and delivery in a teaching hospital were predictors of birth trauma. Conclusions: Overall, incidence of birth trauma in Kashan City was lower in comparison with most studies. Considering existing risk factors, further monitoring on labor, and delivery management in teaching hospitals are recommended to prevent birth injuries. In addition, careful supervision on students and residents' training should be applied in teaching hospitals

Comparing the effects of vaginal misoprostol, laminaria, and extra amniotic saline infusion on cervical ripening and induction of labor

Objective This study aimed to compare the effects of vaginal misoprostol, laminaria, and extra-amniotic saline infusion (EASI) on cervical ripening. Methods This randomized controlled trial was conducted on 195 women with singleton pregnancies and unripe cervices. Participants were randomly allocated to 3, 65-person groups: a misoprostol, a laminaria, and an EASI group. The interventions in the misoprostol, laminaria, and EASI groups included a single 25-μg vaginal misoprostol suppository, an intracervical laminaria, and a transcervical Foley catheter, respectively. The groups were compared with each other regarding time intervals from labor induction to labor active phase and delivery, cervical dilation, Bishop scores 6 hours after induction, delivery type, length of hospital stay, and complications. Results There were no significant differences among the groups regarding maternal ages, gestational ages, body mass indices, baseline cervical dilations, and Bishop scores (P>0.05). Six hours after induction, the Bishop score and cervical dilation were significantly greater in the EASI group than in the other 2 groups (P<0.001). Moreover, time intervals from labor induction to labor active phase and delivery in the EASI group were significantly short (P<0.001). The rates of cesarean section, fetal distress, placental abruption, and meconium staining in the misoprostol group were significantly high (P<0.05), and the length of hospital stay in the EASI group was significantly short (P<0.001). Conclusion EASI is a safer and more effective method for cervical ripening. Considering its inexpensiveness, easy accessibility, and greater effectiveness, EASI is recommended for cervical ripening. Trial Registration Iranian Center for Clinical Trials Identifier: IRCT20170513033941N39. © 2020 Korean Society of Obstetrics and Gynecology

The effects of Vitamin D supplementation on withdrawal symptoms and the expression of inflammatory cytokines and insulin in patients under methadone maintenance treatment: A randomized, double-blind, placebo-controlled trial

Background: Hypovitaminosis D may be related to some metabolic vulnerable, including metabolic disorders associated with inflammatory cytokines and insulin resistance in subjects undergoing methadone maintenance treatment (MMT). Objectives: This study aimed to determine the impact of vitamin D intake on withdrawal symptoms and genetic response related to inflammatory cytokines and insulin in patients treated with MMT. Methods: This investigation was performed on 40 subjects under MMT to consume either 50,000 IU vitamin D supplements (n = 20) or placebo (n = 20) every 2 weeks for 12 weeks, between April and June 2017 in Kashan, Iran. The clinical opiate withdrawal symptoms (COWS) were evaluated to examine withdrawal scale and gene expression at baseline and after the a 3-month intervention. Statistical analysis of the data was performed using SPSS 18 with Fisher's exact test, t-test, chi-square, and ANCOVA. Also, P values < 0.05 were considered statistically significant. Results: The results of our study showed that compared with the placebo, taking vitamin D downregulated interleukin-1 (IL-1) expression (P = 0.01) in peripheral blood mononuclear cells (PBMCs) of patients under MMT. In addition, consuming vitamin D increased peroxisome proliferator-activated receptor gamma (PPAR-γ) expression (P = 0.01). Administration of vitamin D did not change COWS and IL-8 and tumor necrosis factor-alpha (TNF-α) expression. Conclusions: According to the results of the present study, vitamin D can be recommended as an adjunct to MMT which may elevate the quality of life and decrease methadone side effects. Copyright © 2020, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

The effects of Vitamin D supplementation on withdrawal symptoms and the expression of inflammatory cytokines and insulin in patients under methadone maintenance treatment: A randomized, double-blind, placebo-controlled trial

Background: Hypovitaminosis D may be related to some metabolic vulnerable, including metabolic disorders associated with inflammatory cytokines and insulin resistance in subjects undergoing methadone maintenance treatment (MMT). Objectives: This study aimed to determine the impact of vitamin D intake on withdrawal symptoms and genetic response related to inflammatory cytokines and insulin in patients treated with MMT. Methods: This investigation was performed on 40 subjects under MMT to consume either 50,000 IU vitamin D supplements (n = 20) or placebo (n = 20) every 2 weeks for 12 weeks, between April and June 2017 in Kashan, Iran. The clinical opiate withdrawal symptoms (COWS) were evaluated to examine withdrawal scale and gene expression at baseline and after the a 3-month intervention. Statistical analysis of the data was performed using SPSS 18 with Fisher's exact test, t-test, chi-square, and ANCOVA. Also, P values < 0.05 were considered statistically significant. Results: The results of our study showed that compared with the placebo, taking vitamin D downregulated interleukin-1 (IL-1) expression (P = 0.01) in peripheral blood mononuclear cells (PBMCs) of patients under MMT. In addition, consuming vitamin D increased peroxisome proliferator-activated receptor gamma (PPAR-γ) expression (P = 0.01). Administration of vitamin D did not change COWS and IL-8 and tumor necrosis factor-alpha (TNF-α) expression. Conclusions: According to the results of the present study, vitamin D can be recommended as an adjunct to MMT which may elevate the quality of life and decrease methadone side effects. Copyright © 2020, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

Performance, kinetic, and biodegradation pathway evaluation of anaerobic fixed film fixed bed reactor in removing phthalic acid esters from wastewater

Emerging and hazardous environmental pollutants like phthalic acid esters (PAEs) are one of the recent concerns worldwide. PAEs are considered to have diverse endocrine disrupting effects on human health. Industrial wastewater has been reported as an important environment with high concentrations of PAEs. In the present study, four short-chain PAEs including diallyl phthalate (DAP), diethyl phthalate (DEP), dimethyl phthalate (DMP), and phthalic acid (PA) were selected as a substrate for anaerobic fixed film fixed bed reactor (AnFFFBR). The process performances of AnFFFBR, and also its kinetic behavior, were evaluated to find the best eco-friendly phthalate from the biodegradability point of view. According to the results and kinetic coefficients, removing and mineralizing of DMP occurred at a higher rate than other phthalates. In optimum conditions 92.5, 84.41, and 80.39% of DMP, COD, and TOC were removed. DAP was found as the most bio-refractory phthalate. The second-order (Grau) model was selected as the best model for describing phthalates removal

A Study on Traumatic Injuries of Female Genital Tract, Kashan-Iran, 2005-2006

Background: Considering special physical, psychological and social importance of traumatic injuries to female genital tract, this study was carried out to determine the causes and characteristics of injuries of this system. Materials and Methods: This descriptive study was conducted on 21 patients operated upon for non-obstetrical injuries between March 2005 and March 2008 in Shabihkhani University Hospital, Kashan, Iran. The patients' data including age, mechanism, location, and kind of injury, and type of operation was extracted, recorded and analyzed. Results: Of 12825 surgeries, 21 cases (0.16) had traumatic complications. M ean age of the patient population was 19.2 ± 12.8, and most of the cases were seen in the age group 19 to 35 years. In 33.3 of cases more than one part were damaged. Labia major, labia minor, fourchette and clitoris had been injured equally, each in 14.3. Fall and intercourse were the most frequent causes of trauma (28.6). Conclusion: Although it seems that the incidence of genital trauma in women is low, these kinds of injuries may result in many physical and psychological problems particularly in young girls while they are often preventable

Incidence of perineal trauma in normal spontaneous vaginal delivery in Shabih-khani Maternity Hospital of Kashan during 2007-9

Background: Trauma to genital tract is a common complication of normal vaginal delivery and may result from episiotomies, spontaneous lacerations or both. The aim of this study was to determine the incidence of perineal trauma in normal spontaneous vaginal delivery in patients admitted to Kashan Shabih-khani Maternity Hospital. Materials and Methods: All women having normal vaginal delivery at Kashan Shabih-khani Maternity Hospital from October 2007 to September 2009 were enrolled to this descriptive-analytical retrospective study. Data were collected from hospital charts and analyzed by chi-square test.Results: Severe (third or fourth) degree tears were seen in 0.16 of cases, 0.14 of which accompanied episiotomy. First and 2nd degree tears without episiotomy happened in 90.3 and 9.6, respectively. Type of trauma is correlated to the birth weight of the baby (P=0/001). Conclusion: Episiotomy has no significant beneficial effect on prevention of perineal trauma. so, it is recommended that episiotomies to be avoided unless for exceptional cases

Epidemiology of Trophoblastic pregnancy in Dr. Beheshti Hospital of Tehran, 1995-98

History and Objectives: Trophoblastic pregnancy is one of the high risk pregnancies which considering its frequency and importance and its side effects if it is not diagnosed, requires extensive investigation. The present study is carried out in order to determine epidemiology of trophoblastic pregnancy in Dr. Shaheed Beheshti hospital of Tehran in 1995-1998. Materials and Methods: A descriptive study is carried out on trophoblastic patients. Diagnosis was based on bHCG, sonography and pathological findings. Patient's data pertaining to age, number of pregnancies, clinical signs, laboratory data, radiologic and pathologic findings, type of disease and treatment were recorded. Statistical analysis was performed on information gathered. Results: 48 patients were in 28±8.5 group, with 20-25 age interval. 30 patients (62.5) had mole pregnancy and 18 cases (37.5) had trophoblastic tumor pregnancy. 93 of mole pregnancies were considered high risk. Conclusion: Large number of patients were high risk (93) and it seems resistance to therapy compared to other groups. Therefore, further studies are required to determine the etiologic and epidemiology and treatment of the disease