Tehran University Medical Journal

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Estimating fetal weight in utero, for better management of pregnancy and appropriate timing of delivery especially in high-risk pregnancies is necessary. Our purpose to evaluate a simple method in estimating fetal weight in Iranian pregnant patients and also to compare was with a previous western study. This study was carried out in Arash hospital, Tehran university of medical sciences in 1996-99. In a descriptive-analytic study that was done prospectively on 464 pregnant patients, ultrasonic measurement of biparietal diameter (BPD), mean abdominal diameter (MAD), and femur length (FL) performed close to delivery was conducted. Birth weight also was identified. Statistical analysis was done using multiple linear regression on the data and also student's T-test for comparison. Mean birth weight was 2320 gr. The outcome of linear regression analysis was the following model: Weight (gr)=95.8×FL (cm)+25×MAD (cm)-15.6×BPD (cm)-4632.1. The effect of all parameters were statistically significant (P<0.02). A fetal weight estimating table was also developed. T-test analysis showed a significant difference (P<0.05) in some final ranks of table (Weight estimations>4000 gr) in comparison with the Rose and Mc callum study. Our study showed that ultrasound using the sum of BPD, MAD and FL is a precise method in fetal weight estimation. Application of other biometric measurements may be needed for better elucidation especially in small and large for gestational age fetuses.

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To determine the therapeutic dose of Mg according to BMI, serum level of calcium, creatinin and albumin a cross sectional study were carried on 150 cases of preeclampsia (100 mild, 50 sever type) in Valei-Asr Hospital through the years 1378-79. All of eligible patients had given a single dose of 4 gr Mg, sulfate intravenously, then had continued with 20 gr/lit, 28 drop/min through IV infusion. Mild and sever preeclampsia cases were similar about the mean serum level of calcium and Mg. Before beginning of treatment, but were significantly different about the mean of serum level of creatinin and albumin (P=0.0001). In univariat analysis there was significant direct correlation between serum level of Mg 6 hours after beginning of treatment with serum level of creatinine and albumin, and significant association with BMI (P<0.05). So the serum level of Mg in end of treatment, (P<0.05) in multivariate regression analysis, the serum level of Mg in 6 hours after and end of treatment was correlated positively with serum level of creatinine and albumin and negatively with BMI. Serum level of Mg 6 hours after=-0.2+0.8 (Alb. Level) +2.99 (creat level) –0.22 (BMI). Serum level of Mg in end of treatment=-0.2+0.8 (Alb. Level) +3.3 (creat level) –0.24 (BMI).

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Introduction: Thyroid diseases are one of the most common endocrine diseases. Incidence of thyroid diseases in women is ten times more than men. Menstrual irregularities and fertility is occasionally the first sign of thyroid diseases.

Materials and methods: In a prospective study, 325 thyroid patients were evaluated in Emam hospital. Incidence and type of menstrual irregularities were evaluated in these patients.

Results: 55.8 percent of hypothyroid patients had normal pattern ob bleeding. 44.2 hyper thyroid patients had menstrual irregularities which were in the form of oligomenorrhea and 41.7 percents of hypo-thyroid patients were irregular in the form of polymenorrhea, oligomenorrhea and menorrhagia.

Conclusion: In these patients, menstrual irregularities cured by treatment of thyroid diseases and reduced surgical interventions.

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Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory.

Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40), elective C/S under general anesthesia (n=35) and C/S under spinal anesthesia (n=25). Duration of anesthesia and its effect on blood gas and infants apgar were assessed.

Results: In the first group (vaginal delivery) mean blood gase parameters were pH=7.3064.73, pO2=25.246.87, HCO3=20.562.03, Apgar=8.820.38 and pCO2=41.826.57. In the second group (general anesthesia) mean blood gaze parameters were: pH=7.3044.73, pO2=38.7014.02, pCO2=43.265.87, HCO3=21.1113 and apgar score=8.170.7. In the third group (spinal anesthesia) mean blood gaze parameters were: pH=7.3014.50, pCO2=44.14.99, HCO3=21.382.15, pO2=26.625.5 and apgar=8.600.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO With increasing duration of anesthesia, pO2 was reduced. Between the type of delivery and anesthesia duration with PH, pO2, pCO2 and HCO3 were not meaningful relationship (P<0.05).

Conclusion: There was no significant difference between type of delivery and umbilical blood gas parameters. Neonatal apgar score in NVD is higher than the other groups. With increasing duration of general anesthesia in C/S, umbilical po2 is reduced.

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Background: A variable hematological value without clinical sign of sepsis or hematological disorder is often observed in newborns. The purpose of this study was to investigate hematological measurements in umbilical cord vein of newborns delivered spontaneously or by cesarean section.
Methods: We studied 150 pregnant women who delivered term normal infants. The patients were divided into two groups according to the route of delivery: vaginal (n=75) and cesarean section (n=75). Immediately after delivery, umbilical cord blood samples were collected. Any possible relationship between mode of delivery, gestational age, gravidity, parity, sex, weight of the new born infant, and the duration of different phase of labor with the hematological parameters was investigated.
Results: We observed a significant increase in all hematologic parameters including hemoglobin and hematocrit levels and WBC, platelet and RBC counts in newborns delivered spontaneously (p<0.001). The lymphocyte counts were similar in two groups. Male infants and newborns with higher gestational age showed a higher hemoglobin and hematocrit levels. Increased parity and gravidity correlated with a decrease in all hematological values of umbilical vein blood except of lymphocyte count (p<0.001). Prolonged duration of first and second stage was associated with higher mean leukocyte, neutrophil, platelet, hemoglobin and hematocrit values.
Conclusion: The mode of delivery, gestational age, parity, gravidity, sex and weight of newborn, and the duration of first and second stage of labor can influence on hematological parameters of umbilical cord blood.

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Background: Vaginal vault prolapse is a significant longer-term complication in patients undergoing hysterectomy. An important cause is generally acknowledged to be weakness in the uterosacral and cardinal ligaments. Vaginal delivery is known to be a risk factor, and obesity and menopause are predisposing factors. Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex prolapse. Infracoccygeal sacropexy, also known as posterior intravaginal slingplasty, is a useful and less-invasive procedure, with low morbidity. The aim of this study is to confirm the efficacy, safety and long-term outcome of infracoccygeal sacropexy for the treatment of vault prolapse.
Methods: In a prospective observational study, we performed infracoccygeal sacropexy to treat 26 patients who had at least grade 3 symptomatic vault prolapse secondary to transvaginal hysterectomy. Data collection included anatomic outcome, and intra- and post-operative complications.
Results: The mean patient age was 67 years. The mean operation time was 30 minutes and mean blood loss was 130 ml. No intraoperative rectal perforation was seen, and all patients were discharged within 24 hours of surgery. The symptomatic cure of prolapse rate, urgency, nocturia and pelvic pain was 96.2%, 88.8%, 92.6% and 77% orderly. Only one tape rejection occurred in one of the 26 patients.
Conclusion: Our initial experience with infracoccygeal sacropexy shows an efficacy similar to other more established surgical techniques for the cure of vault prolapse, but with less surgical morbidity. Therefore, the procedure is found to be efficient and safe, with shorter operation times, reduced postoperative complication and shorter hospital convalescence.

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Background: Preterm labor is a major contributor to neonatal morbidity and mortality and results in increased obstetric and pediatric care costs. The purpose of this study was to assess the effects of vaginal progesterone for maintenance therapy following treatment of threatened preterm labor for preventing preterm birth.
Methods: The study included 70 singleton pregnant women with preterm labor with intact membranes. Patients were randomized to receive either maintenance vaginal progesterone therapy (n=37) administered (400 mg) daily or no treatment (controls, n=33) after discontinuation of acute intravenous tocolysis.
Results: The two groups were similar with at respect to maternal age, race, parity, gestational age at admission, bishop score, and preterm delivery risk factors .Compared to the control group, the mean ±SD time gained from initiation of maintenance therapy to delivery (36/1117/9 versus 24/5227/2) (meanSD) days, p=0.037) and the gestational age at delivery (36.071.56 vs. 34.51.3 weeks, p=0.041) were higher in the vaginal progesterone maintenance therapy group. No significant differences were found with recurrent preterm labor 13 (35.1%) versus 19 (57.6%), p=0.092. Respiratory distress syndrome 4 (10.8%) versus 12 (36.4%) p=0.021, Low birth weight10 (27%) versus, 17 (51.5%) p=0.04, birth weight (3101.54±587.9gr versus r 2609.39±662.9gr, p=0.002) were significantly different between the two groups.
Conclusion: The gestational age and time gained from initiation of maintenance therapy to delivery were longer in women receiving vaginal maintenance tocolysis with progesterone and improve perinatal outcomes. However, maintenance therapy did not decrease the recurrence of preterm labor episodes.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Zinc is one of the elements necessary for growth and health in human. Some evidences indicate that zinc deficiency is one of real difficulties for the public health in both developed and developing countries. Since the pregnant women are more at risk of zinc deficiency, the objective of this study was to determine the rate of zinc deficiency in pregnant women in the 3 trimesters and to compare these data with that of the healthy controls.
Methods:  This research was an analytic- descriptive study which was done on 677 pregnant women in 3 Trimesters and 140 non pregnant groups who referred to clinic of Tehran University. Blood sample were taken And serum zinc was assessed By Enzymatic technique.
Results:  The prevalence of zinc deficiency is 16% in pregnancy and 0% in non pregnant women with a significant difference between two groups (p<0.001). Zinc deficiency had no relation to mother's age, gestational age, Iron supplementation, Parity and mothers BMI. Hemoglobin level showed a direct relation to zinc deficiency and was grossly found to be more prevalent in Hb levels less than 12 (CI: 1/36-4/26, OR=2/4).
Conclusion: Acording to the finding of presented study, zinc deficiency is more prevalent in Hb<12 inspite of iron supplementation. Iron and zinc supplements in pregnancy period seem to be more effective for Hb repair in each case.

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Background: Tramadol is a synthetics 4-phenyl-piperidine analogue of codeine used for treating moderate to severe pain. Tramadol is a FDA pregnancy category C medication which induces release of serotonin and inhibits the reuptake of norepinephrine. Chronic use of this drug during pregnancy may lead to physical dependency and withdrawal syndrome in the neonate.
Case presentation: We report the newborn of a woman admitted in the delivery ward of Mostafa Khomeini Hospital in Tehran, Iran in 2011. The mother suffered from chronic low back pain and headache and frequently took tramadol during pregnancy. The infant had a gestational age of 38.5 w, a birth weight of 2950 gr and an Apgar score of 9/10 at 1 and 5 minutes after birth.
The first signs of withdrawal syndrome occurred after 24 h with nausea, vomiting, poor feeding, and tremor. Later, agitation, tremor, hyprertonicity, and repeated multifocal myoclonus, and generalized tonic-clonic seizures developed. Clinical signs of withdrawal syndrome waned under phenobarbital therapy.
Conclusion: Drug withdrawal syndrome should be considered in the neonates of pregnant mothers who chronically take tramadol. Tramadol administration during pregnancy should be restricted to carefully selected cases.

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Background: Hypernatremic dehydration in neonate is a serious potentially life treating can damage the central nervous system. The aim of this study was to determine the clinical and laboratory signs of hypernatremic dehydration in term infant. Methods: A cross sectional study was performed from April 2010 to March 2012 in 111 neonates with sodium>145 mmol/l who were admitted at the Mostafa Khomeini and Hazrat Zainab Hospitals in Tehran, Iran. The incidence of clinical and laboratory findings and relationship between some risk factors influencing the severity of hypernatremia were reviewed. The patients were subdivided in two groups: Na<150 mmol/l (group 1) and Na≥150 mmol/l (group 2). Premature infants less than 37 weeks, congenital malformations, formula fed, sepsis and organic disease were excluded. The Student’s t-test, Mann-Whitney U test and Chi-square test were used for statistical data analysis. P<0.05 were considered significant. Results: One hundred and eleven of 2015 (5.2%) patients had hypernatremia. Fifty eight (52.25%) infants were male and sodium ranging was from 146 to 175 mmol/l with an average of 150.3 mg/dl. The most common clinical findings in both groups 1 and 2 were lethargy (81%, 84.5%), fever (74.1%, 73.6%), poor feeding (67.3%, 73.6%), weight loss (60.2%, 84.9%) and a decrease in urine volume (31%, 52.8%). Oliguria, restlessness, seizures, weight loss, orange urine, pathologic hyperbilirubinemia were significantly higher in group 2 than group 1 (P<0.05). There was correlation between severity of hyprnatremia and weight (P=0.022) and age of neonate (P=0.046), time of first feeding (P=0.016), serum creatinie>1.5 mg/dl (P=0.016) and bilirubin level (P=0.01). The relationship between type of nutrition, type of delivery, parity, maternal age, sex, gestational age, discharge, maternal education level were not significant. Conclusion: Sufficient attention to the warning signs of hypernatremia such as lethargy, weight loss, oliguria, poor feeding, fever, restlessness and determination of serum sodium levels in suspected cases can significantly reduce the potential complications of hypernatremic dehydration in neonate.

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Background: Diabetes can cause undesirable changes in structure of the placenta, re-sulting increase in size and weight of placenta. The aim of this study was, to investigate the placenta weight, size and birth weight of infants in pregnant women with controlled gestational diabetes compared with normal pregnancy. Methods: This study was conducted from October, 2012 to February, 2014 in two dif-ferent hospitals, Valiasr and Shariati Hospitals in Tehran. Sixty-seven healthy singleton pregnant and 42 pregnant women with diabetes were selected during 26-28 weeks of gestational ages. Glucose tolerance tests (GTT) were performed to evaluate blood glu-coses. Blood glucoses were controlled in diabetic cases very well. Length and width of the placentas were measured using ultrasonography during pregnancy. After termina-tion of pregnancy, placental weights were measured and recorded using weighting scale with 10 gram accuracy by someone who didn't know about diabetes status. Baby weights were measured after birth and initial stabilisation. Results: In this study, there were no significant differences between gestational diabe-tes mellitus (GDM) and healthy groups in Body Mass Index (BMI) factors. There was no statistically significant differences between the mean weight of infants born with gestational diabetes and control groups. There were no statistically significant differ-ences between the mean placental weights between two groups. Ratio of the placental weights to the birth weights between the two groups were not statistically significant. The mean placental length, width and placenta length times by width in two groups had no significant differences, but the mean gravidities in healthy group was 1.7910 and in gestational diabetes mellitus was 1.9762 that are significantly different (P=0.0217). The mean parities respectively were 0.6567 and 0.8100 which was not sig-nificantly different (P=0.0183). Conclusion: The present study has shown there was no significant differences between fetal and placental weights in normal pregnancies and women with controlled gesta-tional diabetes.

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Background: Surgery and pain increases cortisol levels with inducing hormonal responses. By reducing stress, adverse effects of cortisol can be controlled and accelerated the healing process. Religious practices like listening to Quran have important roles in reducing anxiety. Moreover, the level of cortisol hormone of the blood is one of the best indicators of the stress level. The aim of this study was to investigating the effect of listening to Quran on the plasma cortisol level of the umbilical cord in cesarean with spinal anesthesia.

Methods: A clinical trial study was designed and conducted on sixty primigravid mothers who were hospitalized to deliver their first baby by elective caesarian operation, 30 of them were selected as intervention group and 30 of them were selected as control group. For the subjects of the intervention group, the personal information questionnaires were completed and their vital signs were recorded. Also, their blood was sampled for measuring cortisol level. Then they listened to Quran. After spinal anesthesia, vital signs were recorded and the blood of umbilical cord was sampled for measuring the cortisol level. For the subjects of the control group, all the steps were done except listening to Quran. Two groups were statistically homogenous in the variables of age, gestational age, systolic blood pressure and diastolic blood pressure, pulse rate and cortisol levels before the intervention. The mean and SD cortisol in intervention group before and after listening to the Quran were 39.08±10.71 versus 41.10±5.05.

Results: The reduction of cortisol level of the intervention group (who listened to Quran) was significantly greater than of the control group P=0.035. Systolic blood pressure of the intervention group in the operating ward had statistically significant reduction relation to the systolic blood pressure before operation P=0.043. However systolic blood pressure of the control group in the operating ward had not statistically significant reduction relation to the systolic blood pressure before operation P=0.357. Listening to Quran has no effect on diastolic blood pressure and pulse rate.

Conclusion: Listening to Quran before caesarean affects the change of plasma cortisol level and the systolic blood pressure.

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Background: Blood transfusion is common in infants. Due to the weakened immune system of newborns and the risk of blood transfusion complications, it is necessary to pay more attention following or after to blood transfusion. The aim of this study was to evaluate the frequency and risk factors of blood transfusions in hospitalized neonates.

Methods: A cross-sectional study was performed on 1106 infants admitted in the neonatal intensive care unit (NICU) of Mustafa Khomeini University Hospital, Tehran, Iran, from spring 2009 to 2012. Frequency and the reason for of blood components transfusion including fresh frozen plasma, platelets, whole blood, packed red blood cells, cryoprecipitate and relationship with gestational age, sex, birth weight, Apgar score, duration of hospitalization, use of mechanical ventilation were assessed. Statistical analysis was performed with SPSS statistical software, version 16 (IBM, Armonk, NY, USA) and statistical test, chi-square test, independent t-test and analysis of variance (ANOVA).

Results: Among 1106 infants admitted to the neonatal intensive care unit, 221 infants (%19.98) received blood products. 82 of all (37%) were female and 139 (%63) were female. 113 (51%) of neonate were preterm and 108 (48%) were term. From 361 times of blood transfusions, 121 infant (54.75%) received at least one blood product. The frequency of blood transfusion was between 39 and 1 times, with an average of 3.65 times per infant. Frequency of fresh frozen plasma infusion was 173 (47.9%), packed cell 122 (33%), platelet 32 (8.8%), cryoprecipitate 20 (5.1%) and whole blood 3 unit (0.83%). The most common causes for fresh frozen plasma transfusion was replacement therapy 140 (80%), for packed cell, to correct symptomatic anemia 68 (55.6%), for platelet transfusions was to prevent bleeding in  neonates with thrombocytopenia 20 (62.5%) and cryoprecipitate for bleeding caused by DIC in 18 infant (90%). There was significant relation between frequency of blood transfusions with gestational age (P=0.002), birth weight (P=0.01), cause of hospitalization (P=0.001) using of ventilator (P=0.002), and length of hospital stay (P=0.001).

Conclusion: With attention to the guidelines of blood transfusions and controlling factors affecting premature birth and low weight infants, reducing length of hospital stay and duration of mechanical ventilation, frequency and complications of blood transfusion can be effectively decreased.