Association of the Low Pregnancy-Associated Plasma Protein A and Pregnancy Complications in the First Trimester: A Prospective Cohort Study

Background and Aims: This study aimed to assess the association between the low maternal serum of pregnancy-associated plasma protein-A (PAPP-A) during the first trimester and pregnancy outcomes. Materials and Methods: We conducted a prospective cohort study of 118 pregnant women undergoing first-trimester screening between 2016 and 2017 at Taleghani and Imam Hussein hospital in Tehran, Iran. We recorded demographic data and blood samples were to analyze the value of PAPP-A, based on which we divided the participants into two groups: PAPP-A>10 percentile as a control group and PAPP-A≤10th percentile as a study group. The pregnancies underwent follow-up observations for obstetric complications during pregnancy. Chi-square or Fisher exact test and Mann-Whitney U test were applied to analyze data by SPSS 26. Results: In this study,118 pregnant women were enrolled. Our results show a significant association between low PAPP-A (<10th percentile) and preterm labor, small for gestational age (SGA), hypertension, preeclampsia (P<0.05), but no statistically significant difference was found between low PAPP-A and stillbirth. Demographic data, including age, gravida, parity, BMI, had no relationship with low PAPP-A, significantly (P>0.05). Conclusion: Low PAPP-A is associated with adverse outcomes; thus, measuring the PAPP-A within the first trimester is suggested for timely management

Comparison of the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean section pain; a randomized clinical trial

Background and aims: Postoperative pain after cesarean section is one of the important issues in gynecology. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are two of the drugs that are used for cesarean pain management. Considering the adverse effects of opioids in the mother and the baby, NSAIDs are preferred in the post-cesarean pain management. This study was designed to compare the effect of oral diclofenac potassium (Cataflam) with diclofenac sodium suppository on postoperative cesarean pain.Materials and Methods: This randomized clinical trial was conducted on patients who underwent cesarean section in Taleghani Hospital during 2019. Patients were randomly divided into two groups based on flipping coin. The first group received 100 mg of oral diclofenac potassium every 6 hours and the second group received 100 mg of diclofenac sodium suppository every 6 hours. The pain was assessed 30 minutes, 2 hours, 6 hours, 12 hours, 18 hours and 24 hours after the intervention using visual analogue scale (VAS) before and after analgesics.Results: Eighty-four patients were included in the final analysis. The mean of VAS during the intervention in the diclofenac sodium suppository group and in the Cataflam group was 3.42 ± 2.1 and 1.93 ± 2.4 respectively (P value = 0.011). Twenty-eight among 46 patients who received opioids due to severe pain (66.7%) were in the diclofenac suppository group and 18 of them (42.9%) were in the Cataflam group (P value = 0.021).Conclusion: Diclofenac potassium tablets and diclofenac sodium suppository can reduce the post cesarean pain. The efficacy of diclofenac potassium tablets (Cataflam) is significantly higher than the diclofenac suppository; however, the complication rate was not significantly different

The Effect of Reproductive Factors on Coronary Artery Disease in Women

Abstract Introduction: There is a sex discrepancy in cardiovascular physiology. In this study, we aimed to investigate the effect of female reproductive factors on coronary artery disease (CAD) beyond the known CAD risk factors. Methods: In a case-control study, women referred to Tehran Heart Center for coronary artery angiography from 2012 to 2014 were enrolled. Of these, 80 premenopausal and 100 postmenopausal females with CAD in angiography were randomly selected as cases and 80 premenopausal and 100 postmenopausal females without CAD in angiography were selected as controls. A questionnaire including reproductive history and known CAD risk factors was filled for every subject. Analysis was performed separately for pre and postmenopausal women and a final adjustment for coronary artery disease risk factors was done. Results: Among reproductive factors, oligomenorrhea (OR= 6.72) was a significant risk factor for CAD in premenopausal women and history of oral contraceptive (OCP) use had a protective effect on CAD in pre and postmenopausal woman (OR= 0.24 and 0.20, respectively). Conclusions: Since oligomenorrhea has a strong association with insulin resistance and diabetes, a conventional risk factor of CAD, women with oligomenorrhea should be treated not only for cyclic irregularity but also for prevention of CAD

Homocysteine, vitamin B12 and folate levels in premature coronary artery disease

BACKGROUND: Hyperhomocysteinemia is known as an independent risk factor of atherosclerosis, but the probable role of hyperhomocysteinemia in premature Coronary Artery Disease (CAD) is not well studied. The aim of this study was to assess the role of hyperhomocysteinemia, folate and Vitamin B12 deficiency in the development of premature CAD. METHODS: We performed an analytical case-control study on 294 individuals under 45 years (225 males and 69 females) who were admitted for selective coronary angiography to two centers in Tehran. RESULTS: After considering the exclusion criteria, a total number of 225 individuals were enrolled of which 43.1% had CAD. The mean age of participants was 39.9 +/- 4.3 years (40.1 +/- 4.2 years in males and 39.4 +/- 4.8 years in females). Compared to the control group, the level of homocysteine measured in the plasma of the male participants was significantly high (14.9 +/- 1.2 versus 20.3 +/- 1.9 micromol/lit, P = 0.01). However there was no significant difference in homocysteine level of females with and without CAD (11.8 +/- 1.3 versus 11.5 ± 1.1 micromol/lit, P = 0.87). Mean plasma level of folic acid and vitamin B12 in the study group were 6.3 +/- 0.2 and 282.5 +/- 9.1 respectively. Based on these findings, 10.7% of the study group had folate deficiency while 26.6% had Vitamin B12 deficiency. Logistic regression analysis for evaluating independent CAD risk factors showed hyperhomocysteinemia as an independent risk factor for premature CAD in males (OR = 2.54 0.95% CI 1.23 to 5.22, P = 0.01). Study for the underlying causes of hyperhomocysteinemia showed that male gender and Vitamin B12 deficiency had significant influence on incidence of hyperhomocysteinemia. CONCLUSION: We may conclude that hyperhomocysteinemia is an independent risk factor for CAD in young patients (bellow 45 years old) – especially in men -and vitamin B12 deficiency is a preventable cause of hyperhomocysteinemia

Maternal plasma lipid profile and risk of spontaneous preterm labor study in a sample of Iranian women in 2019

Background: Neonatal problems and adverse outcomes may be minimized by up to 90–75% when preterm delivery is diagnosed early and managed properly. This study aimed to determine the association of maternal plasma lipid indices with the occurrence of spontaneous preterm labor. Material and Methods: This matched pair case–control study was performed on 80 pregnant women referred to a teaching hospital in Tehran for childbirth in 2019. The lipid profile was assessed in women with spontaneous preterm labor and term birth. According to age, Body Mass Index (BMI), pregnancy number, employment status, and educational level, the women in each group were paired. Data were analyzed using an independent-samples t-test, Mann–Whitney U-test, Chi-square, linear regression, and conditional logistic regression. Results: Mean serum levels of total cholesterol, triglycerides, and low-density lipoprotein were all significantly higher in the case group compared with the control group (p < 0.05). The conditional logistic regression test confirmed that this association remained significant even after adjusting the effect of potentially confounding factors such as maternal age and body mass index. In addition, in linear regression the increased levels of triglyceride, total cholesterol, and low-density lipoprotein were found to be associated with 3.33-fold (1.32.–5.32 95% CI, P < 0.001), 2.94-fold (1.60–3.14 95% CI, P = 0.002), and 2.46-fold (1.31.–2.91 95% CI, P = 0.006) increased risk of preterm labor, respectively. Conclusions: High triglyceride, total cholesterol, and low-density lipoprotein serum levels may be linked to an increased chance of spontaneous preterm labor, which might be considered a risk factor for this pregnancy problem

A cytogenetic study of couples with repeated spontaneous abortions

<b>Background</b> <b>and Objective :</b> The frequency of chromosomal aberrations in Iran is not definitely known. This study determined the frequency of chromosomal aberrations in a series of couples with two or more spontaneous abortions and compared the findings with that reported from other countries. <b>Methods</b> : This was a descriptive study conducted on 100 couples with recurrent abortions. Both partners were karyotyped as part of the primary investigation. Other probable causes of abortion were also investigated. <b>Results</b> : Chromosomal aberrations were found in 8 (8&#x0025;) of the females and 5 (5&#x0025;) of the males. The prevalence of chromosomal abnormalities was as follows: 4 (30.8&#x0025;) balanced reciprocal translocations, 3 (23&#x0025;) Robertsonian translocations, 3 (23&#x0025;) pericentric inversions, 1 (7.7&#x0025;) paracentric inversion, 1 (7.7&#x0025;) chromosomal marker, and 1 (7.7&#x0025;) polymorphism 9qh&#x002B;. <b>Conclusions</b> : The pattern of chromosomal aberrations was similar to that reported in other studies, but the prevalence of chromosomal aberrations was higher