The comparison of insulin resistance frequency in patients with recurrent early pregnancy loss to normal individuals

<p>Abstract</p> <p>Background</p> <p>Patients with ≥ 3 recurrent spontaneous miscarriages are classified as having RSM. Polycystic ovary syndrome (PCOS) is associated with insulin resistance (IR). The purpose of this study is to evaluate the association of IR and RMS.</p> <p>Methods</p> <p>Present case- control prospective study was performed on 100 women in control group (with a history of at a live birth and no history of one more abortion) and study group (with a history of ≥ 3 RMS) who were not diabetes and PCOS. Two groups matched in base of age and body mass index. Blood was withdrawn from the case and control patients for the determination of the fasting blood glucose (FG), fasting insulin (FI) levels and ultrasonography was performed on all the patients.</p> <p>Results</p> <p>The observed differences between age, FG and FG to FI ratio levels in case and control groups were not significant (<it>p </it>> 0.05) but it was significant about fasting insulin (<it>p </it>= 0.0119). FI of < 20 <it>μu/ml </it>or ≥ 20 <it>μu/ml </it>in case and control group was significant (Chi-square: 4.083, p: 0.0433, odds ratio: 4.4386, CI95% = 1.1541 to 17.0701), whereas the difference between absolute and proportional frequency of patients with FG to FI ratio of < 4.5 and ≥ 4.5 in case and control groups was not significant (Chi-square: 2.374, <it>p </it>= 0.123).</p> <p>Conclusion</p> <p>Current study showed that in women with RPL, in Iranian race like Americans, frequency of insulin resistance in high, therefore there is a probability of the degree of insulin resistance in women with RPL.</p

Effect of maternal body mass index on pregnancy outcome and newborn weight

<p>Abstract</p> <p>Background</p> <p>Maternal obesity has been associated with adverse pregnancy outcomes, such as pre-eclampsia, eclampsia, pre- and post-term delivery, induction of labor, macrosomia, increased rate of caesarean section, and post-partum hemorrhage. The objective of this study was to determine the effect of maternal Body Mass Index (BMI) on pregnancy outcomes.</p> <p>Methods</p> <p>1000 pregnant women were enrolled in the study. In order to explore the relationship between maternal first trimester Body Mass Index and pregnancy outcomes, participants were categorized into five groups based on their first trimester Body Mass Index. The data were analyzed using Pearson Chi-square tests in SPSS 18. Differences were considered significant if p < 0.05.</p> <p>Results</p> <p>Women with an above-normal Body Mass Index had a higher incidence of pre-eclampsia, induction of labor, caesarean section, pre-term labor, and macrosomia than women with a normal Body Mass Index (controls). There was no significant difference in the incidence of post-term delivery between the control group and other groups.</p> <p>Conclusion</p> <p>Increased BMI increases the incidence of induction of labor, caesarean section, pre-term labor and macrosomia. The BMI of women in the first trimester of pregnancy is associated with the risk of adverse pregnancy outcome.</p

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

Role of scaling combination of risk factors in clinical and imaging findings during pregnancy in predicting placenta accreta spectrum

Background: Placenta accreta is one of the known causes of maternal mortality and morbidity. If diagnosed before delivery, appropriate actions can be taken. The aim of this study was to investigate the role of scaling combination of risk factors in predicting placenta accreta spectrum (PAS). Methods: In this cross-sectional study, 120 pregnant women with two criteria and more of placenta previa in their ultrasound, underwent MRI. Clinical scores (history of surgery, cesarean section, previa, etc.) and paraclinical scores (ultrasound and MRI) were recorded and combined. In cases of hysterectomy, pathological examination was performed. The results were compared and analyzed using SPSS Version 22. The significance level was less than 0.05. Results: Of the120 studied patients, 90 (75) women were diagnosed with placenta previa in which, 32(36) patients had placenta accreta and 12 patients had placenta accreta without placenta previa. The mean ultrasound score in women without and with placenta accreta were 0.05&#177;0.32 and 2.43&#177;1.83 (p&#60;0.001). The mean MRI score in women without and with placenta accreta were 0.05&#177;0.27 and 2.07&#177;2.02, respectively. The cut-off point, sensitivity and specificity were 0.50, 100 and 93.4, respectively. The mean clinical score without and with placenta accreta were 1.97&#177;1.32 and 4.89&#177;3.21, respectively. The cut-off point, sensitivity and specificity were 2.50, 70 and 80, respectively. The cut-off point of combination score, sensitivity and specificity were 3.50, 89, 83. Conclusion: The results of the present study showed that the most specific test to confirm the definitive diagnosis of placenta accreta is paraclinical score, alone

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

Accuracy of intra-operative frozen section in the diagnosis of ovarian mass

Introduction: Ovarian cancer is the most common cause of cancer death from gynecological tumors in Iran. Despite the fact that intra-operative frozen section, which is widely used in diagnosis of ovarian tumors, there are problems associated with the diagnostic procedure in this setting. The aim of this study was to compare the intra-operative frozen section with the permanent histo-pathological sections in the diagnosis of ovarian cancer at Rouhani Hospital in north of Iran. Methods:  The intra-operative frozen section diagnosis was conducted on 126 women with ovarian masses, who underwent surgery between January 2006 and July 2011. The results of the intra-operative frozen section were compared with those of the past histopathological diagnoses of permanent sections as the gold standard. Results: The overall accuracy of intra-operative frozen section diagnosis was 94.4%. There were 0.9% cases with false-positive as well as 1.8% cases with false-negative. The sensitivity and specificity values were 66.7% and 100% for malignant tumors, 80.0% and 95.9 % for borderline tumors, and 99.1% and 90.0% for benign tumors, respectively. All inaccurate diagnoses were for the epithelial tumors. Conclusion: The intra-operative frozen section diagnosis is a reliable method for the surgical management of the patients with an ovarian mass. Diagnostic problems can occur during the intra-operative frozen section examination. The clinicians and pathologists must be aware of the pitfalls of this method therefore, there is an urgent need to establish a good communication among them in order to obtain more accurate results