Peptic ulcer perforation after cesarean section; case series and literature review

BACKGROUND: Peptic ulcer perforation in the early post-cesarean period is rare but may result in maternal mortality. CASE PRESENTATION: Four cases of post-cesarean peptic ulcer perforation are presented. In all four patients, presentations include peritoneal signs such as acute abdominal pain and progressive distention, hemodynamic instability and intraperitoneal free fluid by ultrasound. Laparotomy and repair were done in all 4 cases. There were 2 maternal deaths. We also have reviewed English literature for the similar cases reported from 1940 to March 2019. CONCLUSION: New onset tachycardia, abdominal pain and progressive distension after cesarean section without congruent changes in hemoglobin should raise concerns for intra-abdominal emergencies including perforated peptic ulcer. Early use of ultrasound should be considered to assist in diagnosis. Coordinated care by an obstetrician and a general surgeon is necessary in presence of any unusual postoperative abdominal pain. Early recognition of the disease is imperative to limit the surgical delay and to improve the outcomes

Effect of the Fractional CO2 Laser on the Quality of Life, General Health, and Genitourinary Symptoms in Postmenopausal Women With Vaginal Atrophy: A Prospective Cohort

Introduction: After menopause women experience vaginal atrophy related to hormonal changes and estrogen deficiency. The purpose of this paper was to evaluate the effect of the fractional CO2 laser on the quality of life, vaginal atrophy symptoms, and urine incontinency in menopause women.Methods: This prospective study was conducted among 140 women from 2017 to 2018 in Yas hospital, Tehran University of Medical Sciences. They encountered the fractional microablative CO2 laser system three times at four-week intervals. The short form of the Health Questionnaire (SF-12) and the Female Sexual Functional Index (FSFI) questionnaire were utilized to assess the participants’ quality of life. Also, the standard measuring tools including the vaginal health index (VHI) and International Consultation on Incontinence Questionnaire (ICIQ) Form were used to evaluate the vaginal atrophy symptoms.Results: The quality of life improved significantly in somatic, social function, and mental health. In the sexual context, arousal and satisfaction status improved significantly. Also, the frequency of urinary incontinence, enuresis, urgency, and the leak improved significantly (P < 0.05). Among the scale variables for urinary function, it was seen that the urgency impact had no improvement. All vaginal indices improved (P < 0.05).Conclusion: The fractional CO2 laser can be effective in treating vaginal atrophy and urinary symptoms. Besides, it improved the quality of life and the sexual function o

Comparison and Evaluation of the Low-Level Laser and the Red and Blue LED Effects on Wound Healing in Rabbit

Introduction: Wound healing is a dynamic, interactive process to achieve the restoration of skin integrity and proper function after damage. Applying a low-level laser (LLL) and light emitting diodes (henceforth LEDs) is introduced in previous studies to accelerate the process of wound healing. The aim of this study is to compare the effect of the LLL and LEDs on wound healing in rabbits.Methods: Full thickness same size square excision wounds were created on the dorsum of the rabbits. Twenty rabbits were randomly divided into four groups, according to the treatment received. Group 1: the AlGalInP (aluminium gallium indium phosphide) laser (4 J/cm²); group 2: the red LED (30 J/cm²); group 3: the blue LED (60 J/cm²) and group 4, as the control group, was not irradiated. After 30 days, the wounds were evaluated both morphologically and histopathologically. Statistical significance was defined as a P value of less than 0.05.Results: All interfering methods including the LLL and LEDs had better outcome compared with the control group of both sizes and histopathologic features. The red laser group showed better results compared to the control group and either the LED groups. Comparing LEDs, the red LED performed better than the blue LED.Conclusion: This study confirmed the significant effects of the LLL and LEDs on wound healing. Comparing the LLL and LED, the LED may be a better choice, especially for bedridden or debilitated patients. The LED may also more cost effective in wound healing in comparison with the LLL

Comparing Two Methods of Rectal Diclofenac Administration for Pain Management in Second Trimester Abortion: A Randomized Clinical Trial

Background & Objective: Pain is the most common side effect of induced medical abortion. However, the optimal analgesia method remains as a clinical challenge. This study aimed to compare the efficacy of two methods of administration of diclofenac as a prophylactic or a therapeutic in pain management in induced second-trimester medical abortion. Materials & Methods: This randomized clinical trial study was conducted upon pregnant women who were candidates for induced medical abortion and referred to a tertiary educational hospital between October 2019 and December 2020. Participants were divided into two groups based on the mode of diclofenac administration, which was either simultaneously with the first dose of misoprostol or after beginning of the pain. Pain severity, induction-to-abortion time interval, total misoprostol dosage, Hemoglobin concentration, length of hospitalization, and size of retained pregnancy products by ultrasound, and the cumulative dose of opioid usage were compared between the groups. Results: The severity of pain which was measured by a visual analog scale (VAS), residual of conceived products, hospitalization days, and the total misoprostol dosage were significantly lower (P\u3c0.05) in the prophylaxis compared to the treatment group. Conclusion: Simultaneous administration of diclofenac with misoprostol as prophylactic method of pain management may be an optimal method in induced medical abortion in the second trimester

Maternal mortality following thromboembolism; incidences and prophylaxis strategies.

BACKGROUND: Thromboembolism is one of the main causes of maternal mortality, which can be prevented in many cases. The present study was designed to investigate the incidence and prophylaxis strategies for maternal mortality following thromboembolism in postnatal. METHODS: In this case series study, the data of the mortality cases were extracted according to the ethical and security standards of the Ministry of Health of the country and compared with a healthy control group. The thromboembolism risk factors measured and scored using a questionnaire entitled the evaluation of risk factors for maternal mortality following thromboembolism during pregnancy, labor, or post-partum . RESULTS: The maternal mortality rate was 16 per 100,000 live births. Among 297 mortality cases, 27 (9%) death were due to thromboembolism. The mean gestational age was 32.5 weeks. Dyspnea (88.8%) and tachycardia (18.5%) were found as common clinical manifestations in these patients. Sixteen cases (59.3%) did not get heparin, 6 (22.2%) received single dose and 5 (18.5%) received two doses and more. In these 11 cases, 5 (45%) patients received heparin before surgery, 1 after surgery, and 5 before and after surgery. Twenty cases deceased in the first hours after delivery and the rest after 2 to 12 days. The average score of risk for thromboembolism based on Royal College of Obstetricians & Gynecologist (RCOG) guideline was 4.6. CONCLUSION: It seems that one of the most important cause of maternal mortality in this study was the lack of recognition of high-risk patients and the lack of prescription for prophylaxis with heparin and this clearly explains the need for accurate screening of high-risk mothers, designing a standard form and the care and treatment of these patients

The association between fetal renal artery indices in late pregnancy and birth weight in gestational diabetes mellitus: A cohort study

Background: Estimation of the fetal birth weight and diagnosis of small for gestational age in the fetuses of women with gestational diabetes mellitus (GDM) are currently imprecise. Objective: We aimed to evaluate the association between fetal renal artery Doppler indices and neonatal birth weight in women with GDM in late pregnancy. Materials and Methods: This cohort study recruited 246 pregnant women from Shariati Hospital in Tehran, Iran, in two GDM and healthy control groups. Participants underwent weekly Doppler ultrasounds in the late pregnancy period (37-40 wk) to determine the Doppler indices of the umbilical artery, middle cerebral, and renal arteries. Fetal growth indices including biparietal diameter, abdominal circumference, head circumference, and femur length were also recorded and compared between the two groups. Results: Fetal growth indices and estimated fetal weight were not significantly different between the two groups. Neonatal birth weight was significantly higher in the GDM group (p < 0.01). The GDM group had significantly higher renal artery indices (resistance index: p = 0.01, pulsatility index [PI]: p = 0.03, and systolic/diastolic ratio [S/D]: p = 0.01) compared to the control group. Also, there was an inverse linear correlation between umbilical indices and birth weight (PI: p = 0.01, S/D: p < 0.01), and between renal artery indices and birth weight (resistance index: p = 0.02, PI: p = 0.01, and S/D: p = 0.03). In the control group, only umbilical artery PI had an inverse linear correlation with birth weight (p = 0.03) and there was no correlation between renal artery indices and birth weight. Conclusion: Using Doppler hemodynamic indices of the renal artery in late pregnancy in women with GDM can be helpful for early detection of hypoxic fetuses, who are at risk of being small for gestational age or having intrauterine growth restriction, even when of normal weight. Key words: Fetus, Gestational diabetes mellitus, Infant, Middle cerebral artery, Renal artery, Doppler ultrasound, Umbilical artery

Platelet to lymphocyte and neutrophil to lymphocyte ratio in the first trimester of pregnancy, are they useful for predicting spontaneous miscarriage? A case-control study

Background: In 15% of all clinical pregnancies, a miscarriage can occur, but the exact cause of this phenomenon is not fully understood. However, it is believed that a faulty placenta, which triggers an inflammatory response in the mother’s body, may be one of the causes. Medical literature has increasingly focused on 2 indicators of inflammation, the plateletlymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR). Despite this, there has yet to be a study conducted that examines the rates of PLR and NLR in cases of miscarriage. Objective: This study aims to determine whether there is an increase in complete blood count inflammatory parameters such as NLR and PLR in women who experience miscarriages. Materials and Methods: This retrospective case-control study was conducted from March 2021 to March 2022, across 3 academic hospitals in Tehran, Iran. A total of 240 participants were enrolled comprising individuals with either miscarriages or normal pregnancies (n = 120/each). Data were collected from the medical records of participants aged between 18-42 yr old, with gestational age ranging from 6-13 wk. The demographic information, including age, body mass index, parity, history of abortion, number of abortions, number of living children, hematocrit and hemoglobin levels, platelet distribution width (PDW), PLR, NLR, mean platelet volume, and platelet were extracted from their records. The gestational age was also recorded. Results: A total of 240 participants were recruited for the study. PDW, NLR, PLR, and lymphocyte values were higher in the miscarriage group compared to the healthy normal pregnant women (p < 0.001). Mean platelet volumes were found to be lower in the miscarriage group compared to the healthy normal pregnant women (p < 0.001). Conclusion: Although, no statistically significant difference was observed in the hemoglobin, hematocrit, platelets, and neutrophils in these 2 groups of pregnant women. The higher inflammatory markers including PDW, NLR, and PLR could potentially aid in the speculation of defective placentation as a contributing factor to the development of miscarriage. Measurement of these markers may be useful to predict pregnancy leading to miscarriage. Key words: Spontaneous abortion, Inflammation, Neutrophils, Lymphocytes, Blood platelet, Pregnancy

Hysterosalpingography Findings in Infertile Women and Their Relationship with Demographic Variables: A Retrospective Study

Background: Hysterosalpingography is a vital diagnostic method for identifying anatomical causes of infertility, often used as a cost-effective screening test. This study aimed to investigate hysterosalpingography results in infertile women.Methods: A quantitative, descriptive, and analytic cross-sectional study was conducted on 180 infertile couples referred to Ghadir Maternal and Child Hospital in Shiraz, Iran between February and July 2015-2016. Data were collected from patient records and hysterosalpingography findings. A questionnaire encompassing demographic information and hysterosalpingography results was utilized. Qualitative and quantitative variables were described using frequency and mean± standard deviation. Data were analyzed using Kolmogorov-Smirnov normality test, Chi-square, and generalized linear models via IBM SPSS version 22.Results: Hysterosalpingography (HSG) revealed that 145 women (80.6%) exhibited normal uterine and tubal findings, while 35 women (19.4%) displayed abnormal results (classified as normal and abnormal HSG findings). Women with abnormal hysterosalpingography were observed to have a higher likelihood of primary infertility (OR=3.8, 95%CI (1.427-10.10), P=0.008). Furthermore, the study assessed the impact of Body Mass Index (BMI) and identified that women in the abnormal HSG group had a higher body mass index (OR=0.89, 95%CI (0.794-0.992), P=0.035).Conclusions: Tubal adhesion stemming from undiagnosed and untreated sexual infections can lead to primary infertility. Limited resources may hinder timely detection and treatment access, exacerbating the issue. The correlation between obesity and infertility could be attributed to an unhealthy lifestyle in low-income families. Encouraging health education within low to middle-income communities is recommended to prevent sexually transmitted infections and promote healthier lifestyles, ultimately reducing the incidence of primary infertility

Lethal multiple pterygium syndrome in a newborn, a case report

Key Clinical Message Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies, joint contracture, and skin webbing (pterygia). This disorder is fatal before birth or shortly after birth. We reported a case of lethal multiple pterygium syndrome with multiple anomalies including pterygia involving the axilla, bilateral antecubital fossa, and groin. Arthrogryposis involving multiple lower and upper extremities joints. Cleft palate, microstomia and limitation of mouth opening, webbed neck, asymmetric small and narrow chest, ambiguous genitalia, depressed and wide nasal bridge, antemongoloid slant, low‐set, malformed, and posteriorly rotated ears, pterygia, syndactyly and camptodactyly of hands and rocket bottom feet. LMPS is a congenital genetic disease with multiple anomalies that is fatal in the second and third trimesters of pregnancy or shortly after birth. With genetic testing and counseling, it can be prevented from recurring in subsequent pregnancies