Publications by authors named "Bahram Salmanian"

30 Publications

  • Page 1 of 1

Massive Transfusion Protocols in Obstetric Hemorrhage: Theory versus Reality.

Am J Perinatol 2021 May 14. Epub 2021 May 14.

Depatment of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

Objective:  Massive transfusion protocols are widely implemented in obstetrical practice in case of severe hemorrhage; however, different recommendations exist regarding the appropriate ratios of blood product components to be transfused. We report our extensive experience with massive component transfusion in a referral center in which the standard massive transfusion protocol is modified by ongoing clinical and laboratory evaluation.

Study Design:  A retrospective chart review of all patients who had massive transfusion protocol activation in a level 4 referral center for obstetrical practice was performed from January 2014 to January 2020. Data collected included the etiology of obstetrical hemorrhage, number of blood products of each type transfused, crystalloid infusion, and several indices of maternal morbidity and mortality. Data are presented with descriptive statistics.

Results:  A total of 62 patients had massive transfusion protocol activation, of which 97% received blood products. Uterine atony was found to be the most common etiology for massive hemorrhage (34%), followed by placenta accreta spectrum (32%). The mean estimated blood loss was 1,945 mL. A mean of 6.5 units of packed red blood cells, 14.8 units of fresh frozen plasma and cryoprecipitate, and 8.3 units of platelets were transfused per patient. No maternal deaths were seen.

Conclusion:  The ratios of transfused packed red blood cell to fresh frozen plasma/cryoprecipitate and of packed red blood cell to platelet units varied significantly from the fixed initial infusion ratio called for by our massive transfusion protocol resulting in universally favorable maternal outcomes. When rapid laboratory evaluation of hematologic and clotting parameters is available, careful use of this information may facilitate safe modification of an initial fixed transfusion ratio based on etiology of the hemorrhage and individual patient response.

Key Points: · Massive transfusion protocols in obstetrics follow fixed ratios of blood products.. · Actual usage of blood components is different than the standardized protocols.. · We recommend to modify the initial fixed transfusion ratio according to clinical response..
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http://dx.doi.org/10.1055/s-0041-1728833DOI Listing
May 2021

Placenta Accreta Spectrum: Correlation between FIGO Clinical Classification and Histopathologic Findings.

Am J Perinatol 2021 May 2. Epub 2021 May 2.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.

Objective:  Placenta accreta spectrum (PAS) covers a wide spectrum of placental adherence/invasion with varied clinical significance. Histopathologic examination is considered the confirmatory gold standard, but is only obtained sometime after definitive treatment. The International Federation of Gynecology and Obstetrics (FIGO) has published a new clinical classification that can be assigned at delivery, and we aimed to investigate the association between this new FIGO classification and histopathology and also to assess its correlation with maternal outcomes.

Study Design:  We studied a retrospective cohort of 185 subjects with histopathologically proven PAS managed at our referral center between September 2012 and January 2019. Two experienced surgeons retrospectively reviewed charts and assigned the FIGO grading based on findings reported at delivery. A third experienced reviewer adjudicated to determine the classification used for final analysis. Categorical outcomes were compared with the use of chi-squared and the Fisher exact test, as appropriate. A multivariate model was designed to adjust outcomes in different FIGO groups for the involvement of a formal multidisciplinary management team.

Results:  Among 185 subjects, there were 41 (22%) placenta accreta, 44 (24%) placenta increta, and 100 (54%) placenta percreta on histopathology. The inter-rater reliability was found to be substantial with Kappa = 0.661 ( < 0.001), and 95% confidence interval (CI): 0.449-0.872. There was a significant association between all histopathology groupings and the FIGO clinical classification ( < 0.001). However, we found no association between FIGO classifications and maternal complications.

Conclusion:  The new FIGO clinical classification is strongly associated with histopathologic findings. A better understanding of the depth and extent of invasion as afforded by the clinical classification system will help standardize reporting and future research.

Key Points: · PAS includes a wide spectrum of placental invasion with varied clinical significance.. · Histopathological examination is considered the confirmatory gold standard.. · The new FIGO clinical classification is strongly associated with histopathologic findings..
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http://dx.doi.org/10.1055/s-0041-1728834DOI Listing
May 2021

The risk of placenta accreta spectrum in women with in vitro fertilization in different populations.

Am J Obstet Gynecol 2021 Apr 24. Epub 2021 Apr 24.

Department of Obstetrics and Gynecology, Baylor College of Medicine, 6651 Main St., 10th Floor, BCM610, Houston, TX 77030. Electronic address:

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http://dx.doi.org/10.1016/j.ajog.2021.04.245DOI Listing
April 2021

In vitro fertilization as an independent risk factor for placenta accreta spectrum.

Am J Obstet Gynecol 2020 10 30;223(4):568.e1-568.e5. Epub 2020 Apr 30.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address:

Background: Placenta accreta spectrum is well known for its association with catastrophic maternal outcomes. However, its pathophysiology is not well defined. There have been emerging data that in vitro fertilization may be a risk factor for placenta accreta spectrum.

Objective: We investigated the hypothesis that in vitro fertilization is an independent risk factor for placenta accreta spectrum.

Study Design: A retrospective analysis of all deliveries in a prospective, population-based cohort (2012-2019) was performed in a tertiary academic center. Primary outcome variable was placenta accreta spectrum. Univariate analysis was performed on potential risk factors for predicting placenta accreta spectrum, and a multivariate model was designed to best fit the prediction of placenta accreta spectrum adjusted for risk factors such as cesarean delivery, placenta previa, age, and parity. History of previous cesarean delivery was known as a risk factor for both placenta previa and placenta accreta spectrum; hence, the interaction between "placenta previa" and "previous cesarean delivery" was included in the final model. Odds ratios were calculated as exponential of beta coefficients from the multivariate regression analysis.

Results: A total of 37,461 deliveries were included in this analysis, 5464 (15%) of which had a history of cesarean delivery, 281 (0.7%) had placenta previa in their index pregnancy, and 571 (1.5%) had in vitro fertilization pregnancy. The frequency of placenta accreta spectrum was 230 (0.6%). Independent risk factors for placenta accreta spectrum were in vitro fertilization pregnancy (adjusted odds ratio, 8.7; 95% confidence interval, 3.8-20.3), history of previous cesarean delivery (adjusted odds ratio, 21.1; 95% confidence interval, 11.4-39.2), and presence of placenta previa (adjusted odds ratio, 94.6; 95% confidence interval, 29.3-305.1). After adjustment for number of previous cesarean deliveries, the correlation persisted for in vitro fertilization (adjusted odds ratio, 6.7; 95% confidence interval, 2.9-15.6).

Conclusion: Our data suggested that in vitro fertilization is an independent risk factor for placenta accreta spectrum, although its relative clinical importance compared with that of the presence of placenta previa and history of cesarean delivery is small. The pathophysiology behind this relationship remains to be investigated.
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http://dx.doi.org/10.1016/j.ajog.2020.04.026DOI Listing
October 2020

Maternal outcomes in unexpected placenta accreta spectrum disorders: single-center experience with a multidisciplinary team.

Am J Obstet Gynecol 2019 10 4;221(4):337.e1-337.e5. Epub 2019 Jun 4.

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Electronic address:

Objective: In a 2015 Maternal-Fetal Medicine Units Network study, only half of placenta accreta spectrum cases were suspected before delivery, and the outcomes in the anticipated cases were paradoxically poorer than in unanticipated placenta accreta spectrum cases. This was possibly because the antenatally suspected cases were of greater severity. We sought to compare the outcomes of expected vs unexpected placenta accreta spectrum in a single large US center with multidisciplinary management protocol.

Study Design: This was a retrospective cohort study carried out between Jan. 1, 2011, and June 30, 2018, of all histology-proven placenta accreta spectrum deliveries in an academic referral center. Patients diagnosed at the time of delivery were cases (unexpected placenta accreta spectrum), and those who were antentally diagnosed were controls (expected placenta accreta spectrume). The primary and secondary outcomes were the estimated blood loss and the number of red blood cell units transfused, respectively. Variables are reported as median and interquartile range or number (percentage). Analyses were made using appropriate parametric and nonparametric tests.

Results: Fifty-four of the 243 patients (22.2%) were in the unexpected placenta accreta spectrum group. Patients in the expected placenta accreta spectrum group had a higher rate of previous cesarean delivery (170 of 189 [89.9%] vs 35 of 54 [64.8%]; P < .001) and placenta previa (135 [74.6%] vs 19 [37.3%]; P < .001). There was a higher proportion of increta/percreta in expected placenta accreta spectrum vs unexpected placenta accreta spectrum (125 [66.1%] vs 9 [16.7%], P < .001). Both primary outcomes were higher in the unexpected placenta accreta spectrum group (estimated blood loss, 2.4 L [1.4-3] vs 1.7 L [1.2-3], P = .04; red blood cell units, 4 [1-6] vs 2 [0-5], P = .03).

Conclusion: Our data contradict the Maternal-Fetal Medicine Units results and instead show better outcomes in the expected placenta accreta spectrum group, despite a high proportion of women with more severe placental invasion. We attribute this to our multidisciplinary approach and ongoing process improvement in the management of expected cases. The presence of an experienced team appears to be a more important determinant of maternal morbidity in placenta accreta spectrum than the depth of placental invasion.
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http://dx.doi.org/10.1016/j.ajog.2019.05.035DOI Listing
October 2019

Severe hypocalcemia during surgery for placenta accreta spectrum: The case for empiric replacement.

Acta Obstet Gynecol Scand 2019 10 23;98(10):1326-1331. Epub 2019 May 23.

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.

Introduction: We aimed to determine predictive factors for severe hypocalcemia in women with placenta accreta spectrum.

Material And Methods: Study of 123 women with histology-proven placenta accreta spectrum with cesarean hysterectomy between 2011 and 2017. Two groups were selected: Cases: critically low ("panic value") serum total calcium (≤7 mg/dL) and Controls: normal serum total calcium (≥8.5 mg/dL). Regression and receiver operating characteristic (ROC) analyses were performed to evaluate the potential associations.

Results: There were 13 women with critically low (cases) and 18 with normal calcium (controls). Baseline characteristics were not statistically different. The median estimated blood loss, units of red blood cells (RBCs) transfused and volume of crystalloid transfused, were higher in the low calcium group. Six out of 13 (46.2%) cases had received ≥4 units of RBCs during surgery vs 2 of 18 (11.1%) controls (P = 0.04). ROC analysis showed that estimated blood loss, units of RBCs transfused, and crystalloid transfused were associated with severe hypocalcemia and univariate regression analysis confirmed that estimated blood loss ≥1500 mL, RBC transfusion ≥4 units, and crystalloid transfused ≥4L were associated with severe hypocalcemia.

Conclusions: Intraoperative transfusion of ≥4 units RBCs is predictive of the development of severe hypocalcemia in placenta accreta spectrum patients experiencing active bleeding. Empiric replacement of 1 g CaCL is recommended for every 4 U RBC transfused.
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http://dx.doi.org/10.1111/aogs.13636DOI Listing
October 2019

Outcomes of Planned Compared With Urgent Deliveries Using a Multidisciplinary Team Approach for Morbidly Adherent Placenta.

Obstet Gynecol 2018 02;131(2):234-241

Divisions of Maternal-Fetal Medicine and Gynecologic Oncology and Inpatient Women's Service, Department of Obstetrics and Gynecology, the Department of Pediatrics and Neonatology, the Department of Urology, and the Division of Transfusion Medicine, Department of Pathology & Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.

Objective: To compare outcomes between planned and urgent cesarean hysterectomy for morbidly adherent placenta managed by a multidisciplinary team.

Methods: This is a retrospective case-control study of women with singleton pregnancies with antenatally suspected and pathologically confirmed morbidly adherent placenta who underwent cesarean hysterectomy between January 1, 2011, and February 30, 2017. Timing of delivery was classified as either planned (delivery at 34-35 weeks of gestation) or urgent (need for urgent delivery as a result of uterine contractions, bleeding, or both). The primary outcome variable was composite maternal morbidity. Logistic regression analysis was used to evaluate risk factors for urgent delivery.

Results: One hundred thirty patients underwent hysterectomy. Sixty (46.2%) required urgent delivery. Composite maternal morbidity was identified in 34 (56.7%) of the urgent and 26 (37.1%) of the planned deliveries (P=.03). Fewer units of red blood cells and fresh frozen plasma were transfused in the planned delivery group (red blood cells, median interquartile range 3 [0-8] versus 1 [0-4], P=.02; fresh frozen plasma, median interquartile range 1 [0-2] versus 0 [0-0], P=.001). Rates of low Apgar score and respiratory distress syndrome were higher in the urgent compared with the planned delivery group (5-minute Apgar score less than 7, 34 [59.6%] versus 14 [23.3%], P<.01; respiratory distress syndrome, 34 [61.8%] versus 16 [27.1%], P<.01). A history of two or more prior cesarean deliveries was an independent predictor of urgent delivery (adjusted odds ratio 11.4, 95% CI 1.8-71.1).

Conclusion: Women with morbidly adherent placenta requiring urgent delivery have a worse outcome than women with planned delivery. Women with morbidly adherent placenta and two or more prior cesarean deliveries are at increased risk for urgent delivery. In such women, scheduling delivery before the standard 34- to 35-week timeframe may be reasonable.
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http://dx.doi.org/10.1097/AOG.0000000000002442DOI Listing
February 2018

Cyanotic congenital heart disease following fertility treatments in the United States from 2011 to 2014.

Heart 2018 06 16;104(11):945-948. Epub 2017 Nov 16.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.

Objective: To examine the risk for cyanotic congenital heart diseases (CCHDs) among live births in the USA, resulting from various forms of infertility treatments.

Methods: This study is a cross-sectional analysis of live births in the USA from 2011 to 2014. Infertility treatments are categorised into two of the following groups on birth certificates: assisted reproductive technology (ART) fertility treatment (surgical egg removal; eg, in vitro fertilisation and gamete intrafallopian transfer) and non-ART fertility treatment (eg, medical treatment and intrauterine insemination). We compared the risk for CCHD in ART and non-ART fertility treatment groups with those infants whose mothers received no documented fertility treatment and were naturally conceived (NC).

Results: Among 14 242 267 live births from 2011 to 2014, a total of 101 494 live births were in the ART and 81 242 resulted from non-ART fertility treatments. CCHD prevalence in ART, non-ART and NC groups were 393/100 892 (0.39%), 210/80 884 (0.26%) and 10 749/14 020 749 (0.08%), respectively. As compared with naturally conceiving infants, risk for CCHD was significantly higher among infants born in ART (adjusted relative risk (aRR) 2.4, 95% CI 2.1 to 2.7) and non-ART fertility treatment groups (aRR 1.9, 95% CI 1.6 to 2.2). Absolute risk increase in CCHD due to ART and non-ART treatments were 0.03% and 0.02%, respectively. A similar pattern was observed when the analysis was restricted to twins, newborns with birth weights under 1500 g and gestational age of less than 32 weeks.

Conclusions: Our findings suggest an increased risk for CCHD in infants conceived after all types of infertility treatment.
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http://dx.doi.org/10.1136/heartjnl-2017-312015DOI Listing
June 2018

Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center.

J Matern Fetal Neonatal Med 2019 Mar 5;32(6):906-909. Epub 2017 Nov 5.

a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , Baylor College of Medicine and Texas Children's Hospital , Houston , TX , USA.

Objective: The objective of this study is to compare patient outcomes between planned and emergent cesarean deliveries for placenta previa without morbidly adherent placenta.

Study Design: All patients with confirmed, persistent placenta previa (without morbidly adherent placentation) who underwent the surgery between January 2010 and April 2016 were included in this retrospective study. Primary outcome was composite maternal morbidity defined as the presence of at least one of the followings: death, red blood cell (RBC) transfusion, hysterectomy, reoperation, hospital stay >7 d, ureteral injury, bowel injury, or cystotomy.

Results: Three hundred and four patients with placenta previa were identified during the study period, of whom 154 (50.65%) had an antenatal and 10 (3.28%) had an intraoperative diagnosis of morbidly adherent placenta. One hundred and forty patients met the inclusion criteria. Eighty (57.1%) underwent planned cesarean delivery (planned cesarean delivery (PCD) group), and 60 (42.8%) required emergent cesarean delivery due to uterine contractions and/or bleeding (emergent cesarean delivery (ECD) group). Baseline characteristics were similar between the two groups except for the gestational age at delivery (36.0 weeks (36.0, 37.0) in PCD versus 34.0 weeks (32.0, 36.0) in ECP, p < .001). Composite maternal morbidity was not significantly different between two groups: 11 (18.3%) in ECD and 10 (12.5%) in PCD (p = .35) Conclusions: In our referral tertiary centre, emergent and planned cesarean deliveries for placenta previa without morbidly adherent placenta have similar maternal outcomes. In patients without significant hemorrhage, delivery may be safely deferred until 36-37 weeks.
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http://dx.doi.org/10.1080/14767058.2017.1395014DOI Listing
March 2019

Outcome and Treatment of Antenatally Diagnosed Nonimmune Hydrops Fetalis.

Fetal Diagn Ther 2018 24;43(2):123-128. Epub 2017 Jun 24.

Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Hospital Pavilion for Women, Houston, TX, USA.

Introduction: The objectives of this study were to evaluate the outcome of nonimmune hydrops fetalis in an attempt to identify independent predictors of perinatal mortality.

Material And Methods: A retrospective cohort study was conducted including all cases of nonimmune hydrops from two tertiary care centers. Perinatal outcome was evaluated after classifying nonimmune hydrops into ten etiological groups. We examined the effect of etiology, site of fluid accumulation, and gestational age at delivery on postnatal survival. Neonatal mortality and hospital discharge survival were compared between the expectant management and fetal intervention groups among those with idiopathic etiology.

Results: A total of 142 subjects were available for analysis. Generally, nonimmune hydrops carried 37% risk of neonatal mortality and 50% chance of survival to discharge, which varies markedly based on the underlying etiology. Ascites was an independent predictor of perinatal mortality (p value = 0.003). There was nonsignificant difference in neonatal mortality and hospital discharge survival among idiopathic cases that were managed expectantly versus those in whom fetal intervention was carried out.

Discussion: The outcome of nonimmune hydrops varies largely according to the underlying etiology and the presence of ascites is an independent risk factor for perinatal mortality. In our series, fetal intervention did not offer survival advantage among fetuses with idiopathic nonimmune hydrops.
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http://dx.doi.org/10.1159/000475990DOI Listing
August 2018

Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time.

Am J Obstet Gynecol 2017 06 16;216(6):612.e1-612.e5. Epub 2017 Feb 16.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.

Background: Morbidly adherent placenta (MAP) is a serious obstetric complication causing mortality and morbidity.

Objective: To evaluate whether outcomes of patients with MAP improve with increasing experience within a well-established multidisciplinary team at a single referral center.

Study Design: All singleton pregnancies with pathology-confirmed MAP (including placenta accreta, increta, or percreta) managed by a multidisciplinary team between January 2011 and August 2016 were included in this retrospective study. Turnover of team members was minimal, and cases were divided into 2 time periods so as to compare 2 similarly sized groups: T1 = January 2011 to April 2014 and T2 = May 2014 to August 2016. Outcome variables were estimated blood loss, units of red blood cell transfused, volume of crystalloid transfused, massive transfusion protocol activation, ureter and bowel injury, and neonatal birth weight. Comparisons and adjustments were made by use of the Student t test, Mann-Whitney U test, χ test, analysis of covariance, and multinomial logistic regression.

Results: A total of 118 singleton pregnancies, 59 in T1 and 59 in T2, were managed during the study period. Baseline patient characteristics were not statistically significant. Forty-eight of 59 (81.4%) patients in T1 and 42 of 59 (71.2%) patients in T2 were diagnosed with placenta increta/percreta. The median [interquartile range] estimated blood loss (T1: 2000 [1475-3000] vs T2: 1500 [1000-2700], P = .04), median red blood cell transfusion units (T1: 2.5 [0-7] vs T2: 1 [0-4], P = .02), and median crystalloid transfusion volume (T1: 4200 [3600-5000] vs T2: 3400 [3000-4000], P < .01) were significantly less in T2. Also, a massive transfusion protocol was instituted more frequently in T1: 15/59 (25.4%) vs 3/59 (5.1%); P < .01. Neonatal outcomes and surgical complications were similar between the 2 groups.

Conclusion: Our study shows that patient outcomes are improved over time with increasing experience within a well-established multidisciplinary team performing 2-3 cases per month. This suggests that small, collective changes in team dynamics lead to continuous improvement of clinical outcomes. These findings support the development of centers of excellence for MAP staffed by stable, core multidisciplinary teams, which should perform a significant number of these procedures on an ongoing basis.
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http://dx.doi.org/10.1016/j.ajog.2017.02.016DOI Listing
June 2017

Single-step transepithelial photorefractive keratectomy in myopia and astigmatism: 18-month follow-up.

J Cataract Refract Surg 2016 11;42(11):1570-1578

From the Bina Eye Hospital (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), theTransPRK Research Center (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), and the Universal Council of Ophthalmology (Adib-Moghaddam, Soleyman-Jahi, Salmanian, Omidvari, Adili-Aghdam, Noorizadeh), Universal Scientific Education and Research Network, Tehran, Iran; the Department of Ophthalmology and Visual Sciences (Eslani), University of Illinois at Chicago, Chicago, Illinois, USA.

Purpose: To evaluate the long-term quantitative and qualitative optical outcomes of 1-step transepithelial photorefractive keratectomy (PRK) to correct myopia and astigmatism.

Setting: Bina Eye Hospital, Tehran, Iran.

Design: Prospective interventional case series.

Methods: Eyes with myopia with or without astigmatism were evaluated. One-step transepithelial PRK was performed with an aberration-free aspheric optimized profile and the Amaris 500 laser. Eighteen-month follow-up results for refraction, visual acuities, vector analysis, higher-order aberrations, contrast sensitivity, postoperative pain, and haze grade were assessed.

Results: The study enrolled 146 eyes (74 patients). At the end of follow-up, 93.84% of eyes had an uncorrected distance visual acuity of 20/20 or better and 97.94% of eyes were within ±0.5 diopter of the targeted spherical refraction. On vector analysis, the mean correction index value was close to 1 and the mean index of success and magnitude of error values were close to 0. The achieved correction vector was on an axis counterclockwise to the axis of the intended correction. Photopic and mesopic contrast sensitivities and ocular and corneal spherical, cylindrical, and corneal coma aberrations significantly improved (all P < .001). A slight amount of trefoil aberration was induced (P < .001, ocular aberration; P < .01, corneal aberration). No eye lost more than 1 line of corrected distance visual acuity. No eye had a haze grade of 2+ degrees or higher throughout the follow-up.

Conclusions: Eighteen-month results indicate the efficacy and safety of transepithelial PRK to correct myopia and astigmatism. It improved refraction and quality of vision.

Financial Disclosure: None of the authors has a financial or proprietary interest in any material or method mentioned.
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http://dx.doi.org/10.1016/j.jcrs.2016.08.029DOI Listing
November 2016

Trends in the delivery route of twin pregnancies in the United States, 2006-2013.

Eur J Obstet Gynecol Reprod Biol 2016 Oct 24;205:120-6. Epub 2016 Aug 24.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Pavilion for Women, Houston, TX, United States. Electronic address:

Objectives: To determine the trends of cesarean delivery rate among twin pregnancies from 2006 to 2013.

Study Design: This is a population-based, cross-sectional analysis of twin live births from United State birth data files of the National Center for Health Statistics for calendar years 2006 through 2013. We stratified the population based on the gestational age groups, maternal race/ethnicity, advanced maternal age (AMA) which was defined by age more than 35 years and within the standard birth weight groups (group 1: birth weight 500-1499g, group 2: birth weight 1500-2499g and group 3: birth weight >2500g). We also analyzed the effect of different risk factors for cesarean delivery in twins.

Results: There were 1,079,102 infants born of twin gestations in the U.S. from 2006 to 2013, representing a small but significant increase in the proportion of twin births among all births (3.2% in 2006 versus 3.4% in 2013). The rate of cesarean delivery in twin live births peaked at 75.3% in 2009, and was significantly lower (74.8%) in 2013. The rate of the twin live birth with the breech presentation increased steadily from 26.3% in 2006 to 29.1% in 2013. For the fetus of the twin pregnancy presented as breech, the cesarean delivery rate peaked at 92.2% in 2010, falling slightly but significantly in the ensuing 3 years. The results demonstrated that the decrease in cesarean delivery rate was due to fewer cesareans in non-Hispanic white patients; all other ethnic subgroups showed increasing rates of cesarean delivery throughout the study. Gestational diabetes, gestational hypertension, previous cesarean delivery and breech presentation were all significant risk factors for cesarean delivery during the entire study period. Induction of labor and premature rupture of the membranes were associated with lower rates of cesarean delivery in twins.

Conclusion: The recent decrease in the cesarean delivery rate in twin gestation appears to be largely attributable to a decline in cesarean among pregnancies complicated by breech presentation in non-Hispanic white women, and may reflect a health care disparity that deserves further research.
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http://dx.doi.org/10.1016/j.ejogrb.2016.08.031DOI Listing
October 2016

Reply.

Am J Obstet Gynecol 2016 Jan 25;214(1):137-8. Epub 2015 Sep 25.

Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY.

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http://dx.doi.org/10.1016/j.ajog.2015.09.070DOI Listing
January 2016

Perinatal management of fetal supraventricular tachycardia complicated by maternal pertussis.

BMJ Case Rep 2015 Jul 7;2015. Epub 2015 Jul 7.

Baylor College of Medicine, Houston, Texas, USA.

Prenatal pertussis has become a concern once again with the reappearance of the disease in the USA. A 30-year-old mother whose pregnancy was complicated with fetal arrhythmia was referred for further evaluation in the third trimester. After initial treatment with antiarrhythmic medications due to continued irregular rhythm, she was revisited for persistent hacking cough at 38 weeks gestational age. PCR examination confirmed pertussis diagnosis. Owing to increased risk of digoxin toxicity with concurrent antibiotic administration, antiarrhythmic medication was discontinued. Delivery was induced 2 days after the initiation of azithromycin therapy to prevent the transmission of the disease to the neonate. A well-planned delivery in a patient with prenatal diagnosis prevents neonatal infection while considering the obstetrical dilemma for concurrent management of the intrauterine arrhythmia and antibiotic administration.
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http://dx.doi.org/10.1136/bcr-2015-209909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499762PMC
July 2015

Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.

Am J Obstet Gynecol 2015 Jun 29;212(6):736-9. Epub 2015 Apr 29.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.

Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization.
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http://dx.doi.org/10.1016/j.ajog.2015.03.049DOI Listing
June 2015

Prenatal Diagnosis of Renal Vein Thrombosis: A Case Report and Literature Review.

Fetal Diagn Ther 2016 10;39(3):228-33. Epub 2015 Mar 10.

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Houston, Tex., USA.

Background: Renal vein thrombosis (RVT) is a well-characterized condition among neonates; however, this complication is rarely diagnosed prenatally.

Methods: In this report, we describe a fetus with unilateral RVT and summarize the literature regarding prenatal diagnostic criteria and postnatal prognosis. We searched the English, French and Spanish literature (MEDLINE, PubMed and EMBASE) for cases with prenatal diagnosis of RVT.

Results: Including our case, a total of 23 fetuses with fetal RVT were reviewed in the present study. All cases were diagnosed in the third trimester, and the survival rate among these cases was 63%. Enlargement of the kidney was the most commonly associated initial ultrasound finding. The only ultrasound finding significantly associated with mortality was the presence of bilateral RVT.

Discussion: The etiology of fetal RVT is still unclear. Considering the large number of cases with RVT that manifest in the first days of life, prenatal diagnosis of this condition has relevance.
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http://dx.doi.org/10.1159/000375372DOI Listing
January 2017

Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin-twin transfusion syndrome: a single center study.

Prenat Diagn 2015 Apr 1;35(4):376-81. Epub 2015 Mar 1.

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.

Background: The objective of our study was to compare outcomes following laparoscopically assisted procedure (LAP group) with those seen following a standard approach used in patients with either an anterior placenta (SAP group) or posterior placenta (SPP group).

Method: This was a retrospective review of all the cases of twin-twin transfusion syndrome treated in our fetal center from October 2011 to July 2013. Technical characteristics of the procedure, perinatal survival outcome, and maternal morbidity were compared.

Results: The laser procedure time was significantly longer in the SAP group (44 ± 10 min) in contrast with SPP (19.3 ± 13.9 min, p < 0.001) and LAP group (32 ± 11 min, p: 0.012). Preterm premature rupture of membranes (PPROM) before 32 and 34 weeks of pregnancy was significantly more common with LAP versus SAP and SPP (90 vs 33.3 and 70.8% for 32 weeks respectively, p: 0.015; 100 vs 50 and 79.1% for 34 weeks respectively, p: 0.021). In terms of maternal morbidity and neonatal outcome, there were no significant differences between the three groups.

Conclusion: LAP may be useful in cases where SAP is not feasible. Despite the increased risk of PPROM with LAP, perinatal survival and maternal outcomes are similar to that seen in SAP and SPP patients.
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http://dx.doi.org/10.1002/pd.4552DOI Listing
April 2015

Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach.

Am J Obstet Gynecol 2015 Feb 27;212(2):218.e1-9. Epub 2014 Aug 27.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.

Objective: The purpose of this study was to test the hypothesis that a standardized multidisciplinary treatment approach in patients with morbidly adherent placenta, which includes accreta, increta, and percreta, is associated with less maternal morbidity than when such an approach is not used (nonmultidisciplinary approach).

Study Design: A retrospective cohort study was conducted with patients from 3 tertiary care hospitals from July 2000 to September 2013. Patients with histologically confirmed placenta accreta, increta, and percreta were included in this study. A formal program that used a standardized multidisciplinary management approach was introduced in 2011. Before 2011, patients were treated on a case-by-case basis by individual physicians without a specific protocol (nonmultidisciplinary group). Estimated blood loss, transfusion of packed red blood cells, intraoperative complications (eg, vascular, bladder, ureteral, and bowel injury), neonatal outcome, and maternal postoperative length of hospital stay were compared between the 2 groups.

Results: Of 90 patients with placenta accreta, 57 women (63%) were in the multidisciplinary group, and 33 women (37%) were in the nonmultidisciplinary group. The multidisciplinary group had more cases with percreta (P = .008) but experienced less estimated blood loss (P = .025), with a trend to fewer blood transfusions (P = .06), and were less likely to be delivered emergently (P = .001) compared with the nonmultidisciplinary group. Despite an approach of indicated preterm delivery at 34-35 weeks of gestation, neonatal outcomes were similar between the 2 groups.

Conclusion: The institution of a standardized approach for patients with morbidly adherent placentation by a specific multidisciplinary team was associated with improved maternal outcomes, particularly in cases with more aggressive placental invasion (increta or percreta), compared with a historic nonmultidisciplinary approach. Our standardized approach was associated with fewer emergency deliveries.
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http://dx.doi.org/10.1016/j.ajog.2014.08.019DOI Listing
February 2015

Does early second-trimester sonography predict adverse perinatal outcomes in monochorionic diamniotic twin pregnancies?

J Ultrasound Med 2014 Sep;33(9):1573-8

Department of Obstetrics and Gynecology, Stony Brook Medicine, Stony Brook, New York USA (M.B.A., P.O., R.F.); Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, New York USA (M.B.A., A.M.V., M.R.C.); Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut USA (W.A.C., S.F.R., Al.A.S.); Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas USA (S.H., P.J., R.R., H.S.-H., B.S., M.A.B., Al.A.S.); Department of Obstetrics and Gynecology, George Washington University, Washington, DC USA (Am.A.S.); Sidra Medical and Research Center, Doha, Qatar (P.O.); Hartford Hospital, Hartford, Connecticut USA (R.F., A.B.); Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine USA (J.W., G.M.); Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts USA (S.F.R.); Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA (S.F.R.); Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont USA (M.M., S.D.); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (J.J.); and Department of Preventive Medicine, University of Southern California, Los Angeles, California USA (A.O.).

Objectives: To determine whether intertwin discordant abdominal circumference, femur length, head circumference, and estimated fetal weight sonographic measurements in early second-trimester monochorionic diamniotic twins predict adverse obstetric and neonatal outcomes.

Methods: We conducted a multicenter retrospective cohort study involving 9 regional perinatal centers in the United States. We examined the records of all monochorionic diamniotic twin pregnancies with two live fetuses at the 16- to 18-week sonographic examination who had serial follow-up sonography until delivery. The intertwin discordance in abdominal circumference, femur length, head circumference, and estimated fetal weight was calculated as the difference between the two fetuses, expressed as a percentage of the larger using the 16- to 18-week sonographic measurements. An adverse composite obstetric outcome was defined as the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction, twin-twin transfusion syndrome, intrauterine fetal death, abnormal growth discordance (≥20% difference), and very preterm birth at or before 28 weeks. An adverse composite neonatal outcome was defined as the occurrence of 1 or more of the following: respiratory distress syndrome, any stage of intraventricular hemorrhage, 5-minute Apgar score less than 7, necrotizing enterocolitis, culture-proven early-onset sepsis, and neonatal death. Receiver operating characteristic and logistic regression-with-generalized estimating equation analyses were constructed.

Results: Among the 177 monochorionic diamniotic twin pregnancies analyzed, intertwin abdominal circumference and estimated fetal weight discordances were only predictive of adverse composite obstetric outcomes (areas under the curve, 79% and 80%, respectively). Receiver operating characteristic curves showed that intertwin discordances in abdominal circumference, femur length, head circumference, and estimated fetal weight were not acceptable predictors of twin-twin transfusion syndrome or adverse neonatal outcomes.

Conclusions: In our cohort, only second-trimester abdominal circumference and estimated fetal weight discordances in monochorionic diamniotic twin pregnancies were predictive of adverse composite obstetric outcomes. Twin-twin transfusion syndrome and adverse neonatal outcomes were not predicted by any of the intertwin discordances measured.
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http://dx.doi.org/10.7863/ultra.33.9.1573DOI Listing
September 2014

Nucleated red blood cells count in pregnancies with idiopathic intra-uterine growth restriction.

J Family Reprod Health 2014 Jun;8(2):77-81

School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR). To investigate the probable association regardless of any known underlying disease, we aimed to study disturbances in NRBC count in infants experiencing idiopathic IUGR.

Materials And Methods: Twenty three infants regarded IUGR without any known cause were chosen to be compared to 48 normal neonates. Blood samples were collected instantly after birth and the same measurements were done in both groups.

Results: NRBC count/100 white blood cells was significantly higher in the IUGR group (P value < 0.001). pH measurements did not reveal any significant difference.

Conclusion: Increased NRBC count in cases of idiopathic IUGR in absence of chronic hypoxia could strengthen its predictive value suggested in previous studies. It could help early IUGR detection and beneficial intervention.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064766PMC
June 2014

On-line pachymetry outcome of ablation in aberration free mode TransPRK.

Eur J Ophthalmol 2014 Jul-Aug;24(4):483-9. Epub 2014 Mar 17.

Bina Eye Hospital, Tehran - Iran.

Purpose: There are many independent factors that influence the outcome of refractive surgeries, consisting of patient characteristics and environmental factors. We studied the accuracy of central ablation depth compared to online pachymetry results.

Methods: A total of 153 eyes that underwent TransPRK at Bina Eye Hospital, Tehran, Iran, were evaluated from November 2010 to January 2012 in a retrospective cross-sectional study. The relevant data were registered and bivariate correlations and linear regression association were investigated statistically.

Results: The mean age was 29 ± 5 years. Distribution of refractive errors was as follows: compound myopic astigmatism 123 (80.4%), simple myopia 24 (15.7%), and mixed astigmatism 6 (3.9%). Mean ambient temperature and humidity levels intraoperatively were 23.49 ± 1.16°C and 28.91 ± 6.16%, respectively. There was a significant difference (p<0.001) between the preassumed central ablation depth (131.68 ± 32.72 µm) and the net level of ablation depth (measured by online pachymetry, 168.04 ± 41.47 µm). Temperature and humidity levels were not in any statistically significant correlation with the net amount of difference found. The backward linear regression was done to reveal the association between ablation depth and several variables.

Conclusions: This study showed that there is deviation in optical coherence pachymetry online measurements done with SCHWIND AMARIS laser. Ambient temperature and humidity levels intraoperatively do not influence the outcome. However, basic structural characteristics of patients along with change in refractive index and corneal shrinkage because of corneal dehydration are associated with the differences.
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http://dx.doi.org/10.5301/ejo.5000422DOI Listing
October 2014

Fetal cardiac tamponade in a case of right-side congenital diaphragmatic hernia.

Obstet Gynecol 2014 Feb;123(2 Pt 2 Suppl 2):447-450

Divisions of Maternal Fetal Medicine and Fetal Intervention, Department of Obstetrics and Gynecology, and the Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, the Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, and the Department of Radiology, Baylor College of Medicine, Houston, Texas.

Background: Intrafetal fluid collection is a rare ultrasound finding in fetuses with right-side congenital diaphragmatic hernia.

Case: Our patient had a fetus with a large right-side congenital diaphragmatic hernia with a significant amount of the fetal liver herniated into the chest. At 31 weeks of gestation, the fetus had significant ascites and high-pressure intrathoracic fluid accumulation, hydrops fetalis, deviation of the mediastinum, and tamponade-like physiology that compromised cardiac function. Ultrasound-guided fetal thoracoamniotic and peritoneal amniotic shunt placement markedly improved the fetal cardiac function and resolved the hydrops. The patient delivered at 34 weeks of gestation because of preterm labor and the neonate had an uncomplicated diaphragmatic hernia repair 3 days after delivery.

Conclusion: Fetal thoracoamniotic shunting in selected cases of congenital diaphragmatic hernia with hydrops may improve the prognosis.
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http://dx.doi.org/10.1097/AOG.0000000000000098DOI Listing
February 2014

The Phase 2 Study of "(TOX) Preoperative Chemotherapy" Response Rate and Side Effects in [Locally Advanced Operable Gastric Adenocarcinoma] Patients With Docetaxel, Oxaliplatin and Capcitabine.

Iran J Cancer Prev 2013 ;6(3):133-40

Clinical Research Center, Milad Hospital, Tehran, Iran.

Background: Early stage gastric cancer diagnosis has ensued different approaches in resection strategies. In order to increase the proportion of cases which have undergone radical resection or have reduced the recurrence rate, different pre-operative treatments have introduced. Here, we have verified an active preoperative chemotherapeutic regimen in locally advanced gastric cancer patients.

Methods: Forty nine patients who have found eligible to enter this phase 2 trial have treated with oxaliplatin 100 mg/m2 IV, docetaxel 50 mg/m2 IV, plus capecitabine 625 mg/m2 PO (TOX). Clinical staging has been following the first 2 cycles of induction chemotherapy. Patients that have further undergone radical surgery, have evaluated for pathological response rate.

Results: Anemia (10.2%), nausea (10.2%) and vomiting (6.1%) were the most frequent grade 3 or 4 adverse effects. Regarding the pathologic staging, 6 patients (12.2%) had complete response (95% CI 3% to 21.4%), 18 of them (36.7%) had partial response (95% CI 23.2% to 50.2%), then 3 patients (6.1%) had stable disease (95% CI 0%-12.8%). Among the patients who had surgery, 22% had pathologic complete response.

Conclusion: Preoperative chemotherapeutic regimen of TOX seems to be an active and safe neoadjuvant therapy in non metastatic gastric cancer. It should further be considered with concurrent radiotherapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142926PMC
September 2014

Nuchal translucency and cardiac abnormalities in euploid singleton pregnancies.

J Matern Fetal Neonatal Med 2014 Mar 19;27(5):495-9. Epub 2013 Jul 19.

Department of Obstetrics and Gynecology, University of Connecticut Health Center , Farmington, CT , USA .

Objective: To investigate different cut-off levels of nuchal translucency (NT) to predict abnormal cardiac findings (ACF) in second trimester ultrasound examination and confirmed postnatal congenital heart defects (CHD) in euploid pregnancies.

Methods: A retrospective analysis was performed on singleton pregnancies examined in our ultrasound units from 2006 to 2011. Fetuses with an abnormal karyotype were excluded. Different cut-off levels of NT thickness were analyzed to evaluate its performance to detect the ACF on second trimester ultrasound (2nd US) examination and also the CHD detected in neonatal follow-up evaluation of ACF cases.

Results: Of the 12,840 cases, a total number of 8541 euploid pregnancies were included in the study. Thirty-three had ACFs detected by 2nd US (3.86/1000). The mean NT thickness was found to be higher in fetuses with ACFs (p < 0.0001). Of 33 ACFs, 17 (52%, 1.99/1000) had major CHDs in neonatal follow-up. The area under the ROC curves for NT thickness to predict ACFs and CHDs were 0.67 and 0.65, respectively.

Conclusions: Higher NT thickness is associated with higher risk of ACF. NT is a weak predictor of ACF and major CHD; however, fetuses with an unexplained increase in NT measurement should be referred for further cardiac investigations.
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http://dx.doi.org/10.3109/14767058.2013.819336DOI Listing
March 2014

Correlation of nuchal translucency and thyroxine at 11-13 weeks of gestation.

J Matern Fetal Neonatal Med 2013 Nov 17;26(16):1586-9. Epub 2013 Apr 17.

Maternal-Fetal & Neonatal Research Center and Breast Feeding Research Center, Tehran University of Medical Sciences , Tehran , Iran .

Objective: Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones.

Methods: NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges.

Results: An inverse relation was found between serum levels of maternal T4 with NT thickness (r = -0.128, p = 0.001) and CRL (r = -0.168, p < 0.001). TSH and hCG were also found to be correlated (Spearman's correlation coefficient = -0.092, p = 0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively.

Conclusion: Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.
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http://dx.doi.org/10.3109/14767058.2013.784259DOI Listing
November 2013

A clinical randomized trial on endocervical inflammatory cytokines and betamethasone in prime-gravid pregnant women at risk of preterm labor.

Iran J Immunol 2012 Sep;9(3):199-207

Maternal-Fetal & Neonatal Research Center and Breastfeeding Research Center; Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran, e-mail:

Background: There are strong evidences suggesting the secretion of different cytokines in cervical fluid during preterm labor. Betamethasone is widely administered for several reasons in preterm conditions.

Objective: To Investigate the possible effect of betamethasone on endocervical cytokine concentration of women at risk of preterm labor.

Methods: In a randomized clinical trial of 80 prime-gravid women in preterm labor between 34 and 37 weeks of gestation, cervical fluids were collected. Endocervical concentration of inflammatory cytokines were analyzed before and 48 hours after betamethasone treatment for the evaluation of IL-8, IL-17, IFN-γ and TGF-β. Wilcoxon and Mann-Whitney tests were employed for statistical analysis. χ2 and Student's t tests were used whenever needed.

Results: All the measured cytokines showed significant changes in the betamethasone treated group. IL-17 (p=0.001), IL-8 (p=0.001), and IFN-γ (p<0.05) decreased significantly, while TGF-β had a significant increase (p<0.05). In the patients who delivered before or on the 7th day of admission, IL-17, IL-8, and IFN-γ levels were all significantly higher. However, TGF-β decreased significantly in the same samples in the betamethasone treated group (p<0.05).

Conclusion: Betamethasone significantly decreases the endocervical pro-inflammatory cytokine concentrations in patients with preterm labor.
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http://dx.doi.org/IJIv9i3A6DOI Listing
September 2012

High plasma homocysteine and insulin resistance in patients with polycystic ovarian syndrome.

Iran J Reprod Med 2011 ;9(3):223-8

School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: Polycystic ovarian syndrome (PCOS) is a common disease among women in fertility ages and cause severe insulin resistance. Hyperhomocysteinaemia is said to be among the features of PCOS that could influence its outcome.

Objective: This study aimed to investigate whether hyperhomocysteinaemia exists in PCOS and if it is related to insulin resistance in the affected patients.

Materials And Methods: This prospective study was carried out in a university based fertility clinic. Sixty four PCOS patients and 50 normo ovulatory controls were reviewed for fasting glucose, insulin, homocysteine, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) plasma levels in the blood sample of the 3(rd) day of their menstrual cycle. Insulin resistance was determined with the fasting glucose (mmol/L) to insulin (mIU/L) ratio and HOMA-IR (Homeostasis model assessment-Insulin resistance). Independent-samples T-test and linear regression test were utilized to analyze the obtained data.

Results: Homocysteine levels compared between PCOS patients and control group showed a significant difference. PCOS group was divided into insulin resistant (IR) (LogHOMA-IR≥0.57) and non insulin resistant (NIR) patients. The IR group had significantly higher homocysteine (p-value=0.02), fasting insulin and glucose levels (p-value<0.001) rather than NIR group.

Conclusion: PCOS patients have a leaning toward hyperhomocysteinaemia and insulin resistance. Insulin resistant patients are found to have higher homocysteine level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575758PMC
September 2015

Betamethasone effects on the endocervical inflammatory cytokines in preterm labor: a randomized clinical trial.

Int Immunopharmacol 2011 Aug 23;11(8):1116-9. Epub 2011 Mar 23.

Department of Perinatology, Vali-e-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: This study aimed to investigate the effect of betamethasone treatment on the endocervical concentration of IL-1β, IL-4, IL-6, and TNF-α in preterm labor patients.

Study Design: We studied 68 prime-gravid women in preterm labor between 34 and 37 weeks of gestation without clinical infection. Endocervical concentrations of inflammatory cytokines were assessed; immediately on admission and 48 h after administration of two doses of intramuscular betamethasone (12 mg/kg). Wilcoxon and Mann-Whitney tests along with χ(2) and Student's t tests were utilized for statistical analysis.

Results: In the betamethasone group IL-1β and TNF-α significantly decreased (P<0.001), and IL-6 and IL-4 increased (P: NS). Among patients delivered before or on the 7th day of admission IL-6 and TNF-α were higher at the most significant levels (P<0.001) compared to IL-1β and IL-4 (P: 0.001, 0.002 in respect).

Conclusion: Betamethasone can help induce the down regulation of endocervical inflammatory cytokines in patients with preterm labor.
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http://dx.doi.org/10.1016/j.intimp.2011.03.008DOI Listing
August 2011

Stress urinary incontinence: pre-pregnancy history and effects of mode of delivery on its postpartum persistency.

Int Urogynecol J 2011 Jun 2;22(6):651-5. Epub 2010 Dec 2.

Vali-asr Reproductive Health Research Center and Maternal-Fetal &Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction And Hypothesis: We aimed to determine the prevalence of mild stress urinary incontinence (SUI) 1 year postpartum in relation to mode of delivery and pre-pregnancy SUI.

Methods: This cohort study was performed on 618 primiparous women who delivered by elective cesarean section and NVD. Development of SUI during pregnancy till 12 months after delivery was studied. Frequency of mild SUI among patients with and without pre-pregnancy SUI was compared at the ante-partum (RR, 5.75), 40 days postpartum (RR, 9.3), 3 months postpartum (RR, 10.1), 6 months postpartum (RR, 10.1), and 12 months postpartum (RR, 16.8).

Results: Regarding the mode of delivery, incidence of SUI showed significant difference at 40 days, 3 and 6 months postpartum in both patients with and without pre-pregnancy history of SUI (P<0.05, all groups).

Conclusion: The mode of delivery had significant effect on the persistency of SUI up to 6 months postpartum, while pre-pregnancy SUI revealed such effect till 1 year.
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http://dx.doi.org/10.1007/s00192-010-1335-6DOI Listing
June 2011