Abnormal Liver Function Tests in a Pregnant Woman with Metastatic Colon Adenocarcinoma: A Case Report

Introduction: Colon cancer is the third leading cause of cancer death in women. Symptoms of colon cancer, such as nausea, abnormal bowel movements, and rectal bleeding, overlap with the symptoms of pregnancy, which may lead to delays in diagnosis and treatment. In this study, a case of abnormal liver function tests in a pregnant woman with metastatic colon adenocarcinoma was reported.Case Presentation: A 26-year-old woman, nulligravid (gestational age: 28 weeks and 6 days) was referred to our hospital with suspected preeclampsia and the possible HELLP syndrome. In evaluation of laboratory tests, hemoglobin decreased and aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, bilirubin total, alkaline phosphatase increased. Ursodeoxycholic acid was prescribed to the patient due to impaired liver function tests and suspected cholestasis, and the patient was discharged due to the decline in liver function tests. After 18 days, the patient presented with a complaint of premature onset of labor pain, which was initially transferred to the operating room for emergency cesarean section due to fetal heart failure. After cutting the abdomen, a large amount of purulent fluid was removed and extensive adhesions were observed. Biopsy of lesions, metastatic adenocarcinoma in the intestine with metastases to the right ovary,peritoneum, liver and appendix was reported. Finally, PCR test for COVID-19 was positive and the patient died of sepsis.Conclusions: It is recommended that the occurrence of gastrointestinal symptoms, pruritus, pain and abnormal liver function tests in pregnancy be considered as an important alarm and also in the differential diagnosis of gastrointestinal malignancies

The Role of Uterine Artery Doppler Ultrasound in the Second Trimester in Predicting Preeclampsia

Background Preeclampsia is a specific pregnancy syndrome. Early diagnosis and proper administration of preeclampsia can lead to improved maternal and neonatal outcome. We aimed to investigate the uterine artery Doppler ultrasound in predicting the preeclampsia in women with a high-risk pregnancy. Materials and Methods This analytic study was conducted on 160 primigravida women with gestational age of 18 to 26 weeks referring to Ali-IEbne Abi Taleb hospital of Zahedan (Iran). The uterine artery Doppler was considered as abnormal if mean Pulsatility Index (PI) was higher as 95% for gestational age or bilateral notching was observed. All uterine artery sonography was performed by one expert sonographer and with one machine. Then the pregnancy outcomes (such as placenta abruption, postpartum hemorrhage, death, Neonatal Intensive Care Unit admission, low birth weight, preterm labor, etc.) were compared between the two groups. Results The mean age of pregnant women was 25.4±5.6 years old. Preeclampsia was seen in 37 (24.7%) of the women and healthy was seen in 113 (75.3%) of the women. A statistically significant difference was seen between the women with normal and abnormal Doppler sonography (P=0.001). The sensitivity of Doppler ultrasonography in predicting early onset, late onset and severe preeclampsia was 73.3 %, 62.5 %, and 100%, respectively. The specificity of Doppler ultrasonography in predicting early onset, late-onset, and severe preeclampsia was 64.4%, 66.1%, and 74.3%, respectively. Conclusion The findings of the study showed that uterine artery Doppler (Pulsatility Index) is useful in predicting the occurrence of preeclampsia in second trimester

The Quality of the Maternity Triage Process: a Qualitative Study

Introduction: There is no consensus on what the bases and criteria are for the dynamic process of maternity triage. Properly performing the maternity triage process requires reliable data to ensure the correct implementation of this process and the identification of existing deficiencies, and find strategies to modify, improve and enhance the quality of this process. Objective: The present study was conducted to explain the quality of the maternity triage process. Methods: The present qualitative study performed a directed content analysis on 19 maternity triage service providers and key informants selected through purposive sampling. The data were collected through semi-structured interviews in 2018 and analyzed using directed content analysis based on the Donabedian’s model. The accuracy and rigor of the qualitative data were then investigated and confirmed. Results: The participants identified the most important factors affecting the quality of the services provided in maternity triage as two categories of measures and care, and interactions and communication. The category of measures and care included two subcategories of examinations and obtaining a medical history. Conclusion: The present study comprehensively identified different dimensions of the quality of maternity triage services at different levels. The participants identified the quality of the maternity triage process as a multi-dimensional and important concept. Different dimensions of the maternity triage process are recommended that be addressed when designing and implementing maternity triage guidelines and instructions so as to maintain the quality of this process and satisfy their needs

Comparison of Developmental Status of Infants Less Than 24 Months Who Were Born from Mothers in High-Risk Age Groups

Abstract Introduction: Development in children is a qualitative change in their abilities. When children cannot acquire developmental skills according to age, it shows delayed development. Low and high maternal age during pregnancy is a kind of risk factor for developmental disorders in children. Methods: This is a cross-sectional descriptive comparative study that was performed on 400 women who had less than 19 and over 35 years old during pregnancy and now have 4-24-months infants that referred to health centers Kohgiluyeh and Boyer-Ahmad Province, Iran. Participants were selected through multi-stage random sampling. Data collection instruments were: A demographic, obstetric and the “Ages and Stages Questionnaires” for 4-24 months children. Data analysis was done by using the software SPSS 16, and independent t-test, chi-square and logistic-regression tests were used. Results: The prevalence of developmental delay in infants 4-24-months of mothers fewer than 19 and older than 35 years was 7 percent and 11 percent respectively. In mothers over 35 years old, all domains were higher than the others. In both groups of maternal age, the most delayed development was gross motor; the lowest prevalence of late event in a group of mothers less than 19 years was personal-social skills and in women over 35 years was problem-solving. Conclusions: Pregnancy in ages over 35 and less than 19 years are risk factors for the developmental delay of children and could be prevented by appropriate strategies and training

The Quality of the Maternity Triage Process: a Qualitative Study

Introduction: There is no consensus on what the bases and criteria are for the dynamic process of maternity triage. Properly performing the maternity triage process requires reliable data to ensure the correct implementation of this process and the identification of existing deficiencies, and find strategies to modify, improve and enhance the quality of this process. Objective: The present study was conducted to explain the quality of the maternity triage process. Methods: The present qualitative study performed a directed content analysis on 19 maternity triage service providers and key informants selected through purposive sampling. The data were collected through semi-structured interviews in 2018 and analyzed using directed content analysis based on the Donabedian’s model. The accuracy and rigor of the qualitative data were then investigated and confirmed. Results: The participants identified the most important factors affecting the quality of the services provided in maternity triage as two categories of measures and care, and interactions and communication. The category of measures and care included two subcategories of examinations and obtaining a medical history. Conclusion: The present study comprehensively identified different dimensions of the quality of maternity triage services at different levels. The participants identified the quality of the maternity triage process as a multi-dimensional and important concept. Different dimensions of the maternity triage process are recommended that be addressed when designing and implementing maternity triage guidelines and instructions so as to maintain the quality of this process and satisfy their needs

Evaluation of the Clinical and Laboratory Status of Pregnant Women with COVID-19

AbstractIntroduction: The prevalence of the COVID-19 virus has been very high, so that in a short period of time, due to its contagiousness, it has infected a large number of people around the world. Pregnant women are more sensitive to infectious diseases than the general population and are especially at risk of respiratory diseases and severe pneumonia. Considering the importance of mother and fetus management, assessment and management of pregnant women infected with COVID-19, the present study was conducted with the aim of investigating the clinical and laboratory status of pregnant women infected with SARS‐CoV‐2 referring to Imam Hassan and Bentolhoda hospital in Bojnurd.Methods: In this cross-sectional study, pregnant women with COVID-19 referred to Imam Hassan and Bentolhoda Hospital in Bojnurd between March 2020 and the beginning of Desember 2021 were studied. In order to collect information, an information form containing demographic and obstetric characteristics, evaluation of symptoms (fever, cough, abdominal pain, bloody secretions, rupture of fetal membranes in term pregnancy, chest tightness, asthma, fatigue, loss of appetite, headache, nausea and vomiting), laboratory status and outcomes pregnancy and childbirth was used. Statistical analysis was done with SPSS 24 software.Results: The age range of the studied women was 15-48 years and the average gestational age was 26.21±9.4 weeks. The type of delivery in 46.2% was normal vaginal delivery, 53.8% was cesarean section. LBW, admission to NICU, need for resuscitation, meconium-stained AF were 5.71%, 4.76%, 3.80%, 0.95%, respectively. The average number of referrals to the hospital due to COVID-19 in the studied women was 1.6 ± 1.1 times, the average number of days in the hospital was 5.1 ± 3.1 days, and the average number of days in the intensive care unit was 4.08±2.1 days. The most common clinical symptoms in the studied women were related to cough (76.19), dyspnea (72.38), fever (56.19), and myalgia (33.33).Conclusions: Based on the results obtained from this study, clinical symptoms and laboratory results in pregnant women with COVID-19 are similar to infected adults. Common symptoms of COVID-19 disease in pregnant women included fever, cough, and myalgia

The Relationship between Body Fat Distribution and Postmenopausal and Menopausal Women’s Quality of Life

Introduction: Considering the issue in the population of postmenopausal women, no study has been conducted in Iran so far on the relationship between body fat distribution and quality of life. This study aimed to investigate the correlation between body fat distribution and quality of life in menopausal women.Methods: The present descriptive study was conducted on 250 premenopausal and menopausal women aged 40-65 years. Samples were selected by a multi-stage random sampling method. Data were collected through a two-part questionnaire including demographic variables and a questionnaire on the postmenopausal women’s life quality in health centers. The data were analyzed using Statistical tests, distribution, frequency percentage mean score, Standard deviation, and independent sample t-tests.Results: The mean age of participants was 55.17 years. There was a statistically significant difference between the two forms of body fat distribution in the vasomotor domain (p = 0.021), the physical domain (p = 0.044), and the sexual domain (p = 0.001), but no statistically significant difference was observed for the psychological domain (p = 0.148).Conclusion: The results of the present study showed a significant difference in some aspects of the postmenopausal women’s life quality with pear-shaped and gynoid fat distribution

Obstetric Triage Scales; a Narrative Review

Introduction: The growing demand for high-quality obstetric care and treatment has led to the advent and development of a field known as obstetric triage. The present review study aimed to examine the development of tools and criteria for obstetric triage services. Methods: In this narrative review, two authors searched for related articles using the keywords of “obstetric triage, gynecology triage, perinatal Triage, maternity triage, midwifery triage†AND “tool, index, scale, questionnaire, systemâ€. With Persian and English language limitation, searches were performed in Scopus, Google Scholar, Scientific Information Database, ProQuest, Medline, Embase and Web of Science databases for articles published from 2000 to 2018. Results: Out of the 289 articles reviewed in this study, 8 articles met the eligibility criteria. Out of these 8 articles, 6 were dedicated to introducing a tool designed and only 2 introduced an obstetric triage system. The obstetric triage tools and systems covered included Emergency Severity Index (ESI), Obstetric Triage Acuity Scale (OTAS), Birmingham symptom specific obstetric triage system (BSOTS), Maternal Fetal Triage Index (MFTI), Florida Hospital Obstetric Triage Acuity Tool, self-assessment questionnaire for gynecologic emergencies (SAQ-GE) and Perinatal Emergency Team Response Assessment (PETRA). Overall, the validity and reliability of the studied method were investigated and found to be acceptable in only 5 of the reviewed studies. Conclusion: The review showed the lack of consensus on how to devise a single standardized tool or system for obstetric triage. The comparison of different obstetric triage tools and systems demonstrated the need for a standardized and widely-approved system with high validity and reliability and standard definitions for obstetric triage to determine the right priority and waiting times of obstetric care services

The Correlation Between the Emotional Intelligence and Attitude Toward Educational Field and Job Prospects in Midwifery Students of Tehran City in 2018

Introduction: Students' attitudes toward their educational field and job prospects are significantly necessary for their educational system. Midwifery is one of the essential fields in health, and students of this field are the pillars of protecting health in the future. This research aims at the determination of the relationship between emotional intelligence and attitude toward the educational field and job prospects in Midwifery students. Methods: This research was conducted as descriptive-sectional research with 251 midwifery bachelor students in the universities of medical sciences in Tehran city in 2018. The sampling method includes three inventories of demographic information, attitude toward the educational field, job prospects, and emotional intelligence. Statistical data were analyzed using SPSS (vr.16) software. Results: 57.8% and 62.9% of people neither agree nor disagree about the midwifery field and job prospects of this field, respectively. The positive correlation was observed between emotional intelligence and self-management with the educational field and job prospects. There was a negative relationship between the educational years of the spouse with an attitude toward the educational field. The negative relationship was observed between the educational year, mean high school average, and the mark of attitude toward the job prospects. Conclusions: Although most midwifery students are interested in this field and job, some wrong decisions and policy-makings have disappointed them. It is essential to change policies and make significant decisions according to the significant role of the midwife in the health and necessity of motivation in the present and future performance of students

The Effect of Peer Education on Health Promotion of Iranian Adolescents: A Systematic Review

Background: Peer education is one of the most effective strategies for changing behavior in adolescents, which provides the unique learning opportunities for promote health behaviors. The aim of this study was to systematically review the effect of peer education on health promotion of Iranian adolescents. Materials and Methods:  In this systematic review, all interventional studies were searched from Web of Science, Scopus, Embase, Cochrane, Medline (via PubMed) as English databases and SID, Magiran and Irondoc as Persian databases using keywords such as  "adolescent, teenager, student, peer group, education, health and Iran" between January 2000 to October 2018. Two reviewer studied the full text of the articles and their main findings were extracted and categorized. The quality of the articles were checked and verified using the Effective Public Health Practice Project (EPHPP) tool. Results: Finally, 20 articles (with total 6,652 adolescents) which met inclusion criteria were investigated and reviewed systemically in four categories including the effect of peer education on prevention of diseases, mental health, nutritional behaviors, and prevention of high-risk behaviors in adolescents. In all categories, the results showed the equal or greater effect of peer education on knowledge, attitude, practice, self-efficacy and health behavior of adolescents compared to other methods such as education by teacher, health personnel, lecture, pamphlet and booklet. Only effect of education by the physician was more than peer education. Conclusion: According to the results, peer education improves the knowledge, attitude, health behavior, and self-efficacy of adolescents and as a result, it will promote the adolescent health