Publications by authors named "Fatemeh Rahimi Sharbaf"

21 Publications

  • Page 1 of 1

Radiofrequency ablation for selective fetal reduction in complicated Monochorionic twins; comparing the outcomes according to the indications.

BMC Pregnancy Childbirth 2021 Mar 6;21(1):189. Epub 2021 Mar 6.

Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: To evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA).

Methods: This retrospective study included patients with complicated monochorionic diamniotic twins between 16 to 28 weeks who underwent selective reduction using RFA.

Results: During the study period, 143 women with complicated monochorionic twins underwent RFA including 52 with selective fetal growth restriction (sFGR), 48 with twin to twin transfusion syndrome (TTTS), 33 with major fetal anomalies in one of the twins, and 10 with reversed arterial perfusion sequence (TRAP). The overall survival was 71.3% (102/143). The procedures were technically successful in achieving selective termination in all cases. The mean ± SD of gestational age at the time of the procedure was 21.0 ± 2.3 weeks. The mean ± SD of gestational age at delivery was 34.6 ± 3.3 weeks. The mean ± SD of overall procedure-to-delivery time was 12 ± 1.7 weeks. The pregnancy success rates among sFGR, TRAP, TTTS and anomaly groups were 82.7, 80, 73 and 60.7% respectively. There were no maternal complications.

Conclusion: Radiofrequency ablation for fetal reduction in complicated monochorionic twin pregnancies appears to be a reasonable option. The pregnancy success rate following RFA selective reduction was highest among sFGR and TRAP groups and lowest in the anomaly group.
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http://dx.doi.org/10.1186/s12884-021-03656-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937193PMC
March 2021

Noninvasive Fetal Sex Determination by Real-Time PCR and TaqMan Probes.

Rep Biochem Mol Biol 2020 Oct;9(3):315-323

Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.

Background: Noninvasive fetal sex determination by analyzing Y chromosome-specific sequences is very useful in the management of cases related to sex-linked genetic diseases. The aim of this study was to establish a non-invasive fetal sex determination test using Real-Time PCR and specific probes.

Methods: The study was a prospective observational cohort study conducted from August 2018 to September 2019. Venous blood samples were collected from 25 Iranian pregnant women at weeks 7 to 25 of gestation. Cell-free DNA (cfDNA) was isolated from the plasma of samples and fetal sex was determined by SRY gene analysis using the Real-Time PCR technique. In the absence of SRY detection, the presence of fetal DNA was investigated using cfDNA treated with BstUI enzyme and PCR for the epigenetic marker RASSF1A.

Results: Of the total samples analyzed, 48% were male and 52% female. The RASSF1A assay performed on SRY negative cases also confirmed the presence of cell-free fetal DNA. Genotype results were in full agreement with neonate gender, and the accuracy of noninvasive fetal sex determination was 100%.

Conclusion: Fetal sex determination using the strategy applied in this study is noninvasive and highly accurate and can be exploited in the management of sex-linked genetic diseases.
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http://dx.doi.org/10.29252/rbmb.9.3.315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816785PMC
October 2020

Therapeutic role of enoxaparin in intra-uterine growth restriction: A randomized clinical trial.

J Gynecol Obstet Hum Reprod 2021 Jan 20;50(8):102070. Epub 2021 Jan 20.

Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Yas Hospital Complex, District 7, N Villa Rd, Tehran, Iran. Electronic address:

Objective: Intrauterine growth restriction is a leading cause of perinatal mortality and morbidity. Using enoxaparin may enhance the placental circulation and improve the intrauterine growth. This study was conducted to assess the efficacy and safety of enoxaparin in treatment of intra-uterine growth restriction.

Study Design: 125 women with intrauterine growth restriction were randomized to control group and intervention group (receiving routine high risk pregnancy prenatal care plus daily subcutaneous injection of 40 mg enoxaparin). Prolongation of pregnancy, fetal birth weight, fetal outcome and enoxaparin side effects were compared in 2 groups.

Results: Baseline characteristics were similar in 2 groups. Mean gestational age at delivery was 36.73(±2.71) in enoxaparin group and 36.85(±2.17) in control group which showed no statistically significant difference. Mean fetal birth weight had also no statistically significant difference in enoxaparin and control group (2370.16 ± 580.72 g versus 2456.07 ± 543.06 g). Rate of betamethasone administration, intubation, NICU admission, sepsis, necrotizing enterocolitis, intra-ventricular hemorrhage, hypoglycemia and low apgar score were similar in two groups. No major adverse effect was seen.

Conclusion: Enoxaparin did not prolong the pregnancy and fetal birth weight and did not improve the fetal outcome even in patients with impaired baseline Doppler findings.
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http://dx.doi.org/10.1016/j.jogoh.2021.102070DOI Listing
January 2021

Correlation of Maternal Stress Because of Positive Aneuploidy Screening Serum Analytes and Uterine Arteries' Doppler Ultrasound Index: A Prospective Cohort Study.

Int J Fertil Steril 2019 Jan 2;12(4):329-334. Epub 2018 Oct 2.

Maternal, Fetal and Neonatal Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

Background: Antenatal anxiety or maternal stress is a prevalent chronic mental disorder in pregnant women. We have assessed the effect of maternal stress from positive aneuploidy screening results on the changes in uterine artery blood flow.

Materials And Methods: We performed a prospective cohort (one sample) pilot study at a hospital in Tehran, Iran. A total of 60 pregnant women who were candidates for amniocentesis due to abnormal sequential screening test results entered the study. We conducted 2 standard psychological tests, the Spielberger's State-Trait Anxiety Inventory and the Beck Anxiety Inventory, to determine anxiety levels in the participants before amniocentesis and two weeks after amniocentesis. The uterine artery resistance index was also measured before and two weeks after amniocentesis. The level of maternal stress was compared with the uterine artery resistance index.

Results: Patients had a mean State Trait Anxiety Inventory score before amniocentesis of greater than 40, which meant that the mothers experienced high anxiety. There were no correlations between both inventories' anxiety scores and uterine artery blood flow before amniocentesis. However, two weeks after amniocentesis, we observed significant negative correlations between the State Anxiety (P=0.0041) and Trait Anxiety (P=0.010) Inventory scores and the uterine artery resistance indexes. Also, there was an association between the decreased right uterine artery resistance index and State Anxiety scores (P=0.036). There were significant correlations between State and Trait Anxiety scores and second trimester analytes of β-human chorionic gonadotropin (β-hCG, P<0.001), α-fetoprotein (P<0.001), and unconjugated estriol (P=0.048).

Conclusion: Maternal anxiety because of positive aneuploidy screening serum analytes and amniocentesis can affect perinatal outcomes via mood-based alterations in blood flow of the uterine arteries and the screening markers β-hCG,unconjugated estriol, and α-fetoprotein.
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http://dx.doi.org/10.22074/ijfs.2019.5359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186285PMC
January 2019

The effect of maternal forced exercise on offspring pain perception, motor activity and anxiety disorder: the role of 5-HT2 and D2 receptors and gene expression.

J Exerc Rehabil 2017 Oct 30;13(5):514-525. Epub 2017 Oct 30.

Razi Drug Research Center and Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

The effect of maternal forced exercise on central disorders in offsprings has been shown but the mechanism is still unclear. In this study, the role of 5-HT and D receptors in neuroprotective effects of maternal forced exercise on offspring neurodevelopment and neurobehavioral symptoms is evaluated. Sixty pregnant rats were trained by forced exercise and some behavioral and molecular aspects in their offspring were evaluated in presence of 5-HT and D receptors agonists and antagonists. The results showed that maternal forced exercise causes increase of pain tolerability and increase latency of pain perception in offspring in hot plate test, writhing test and tail flick test. Also maternal forced exercise causes decrease of depression and anxiety like behavior in offsprings. On the other hand, treatment of mothers by forced exercise in combination with 5-HT and D receptor antagonists inhibited the protective effects of forced exercise and cause disturbance in pain perception and tolerability and increase depression and anxiety in offsprings. Also expression of cyclic AMP response element binding protein (CREB) was changed in all experimental groups. In conclusion, our data suggested that maternal forced exercise causes neurobehavioral protective effect on offsprings and this effect might probably be mediated by 5-HT and D receptors and activation of gene expression.
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http://dx.doi.org/10.12965/jer.1734992.496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667597PMC
October 2017

Admission Test and Pregnancy Outcome.

Iran J Med Sci 2017 Jul;42(4):362-368

Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: The admission test (AT) has been carried out for many years, but there are still debates about the prognostic value of the test. Therefore, we aimed to examine the value of the AT in predicting the adverse outcome in neonates.

Methods: In this cross-sectional study, 425 pregnant women with normal vaginal delivery were studied between2009 and 2014at Vali-e-Asr Hospital. Based on the results, the women were divided into 2groups of normal and abnormal ATs. All the patients were followed up until the birth of their baby, when the status of mother and neonate was determined. The main outcomes of the study were cesarean rate, neonatal intensive care unit (NICU) admission, fetus demise, neonatal acidosis, and Apgar score. The independent -test, chi-square test, Fisher exact test, and logistic regression were used for statistical analysis. The data were analyzed using SPSS (version 17).

Results: Of 425 pregnant women studied, 142 (33.4%) had abnormal ATs with a mean age of 29 (±4.5) years. Multivariate analysis showed that an abnormal AT was able to predict the incidence of cesarean section, intrauterine growth restriction, turned cord, and Apgar<7, but it could not predict neonatal death and hypoxia.

Conclusion: The AT was shown to be a useful screening test with risk factors such as oligohydramnios, bloody amniotic fluid, meconium amniotic fluid, intrauterine growth restriction, and turned cord. Additionally, the test was also able to predict NICU admission and the need for cesarean section, but it could not predict the occurrence of neonatal death.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523043PMC
July 2017

Conjoined twins in a monochorionic triplet pregnancy after in vitro fertilization: a case report.

Iran J Reprod Med 2015 Nov;13(11):729-32

Department of Pathology, Women Moheb Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Monozygotic monochorionic triplet pregnancy with conjoined twins is a very rare condition and is associated with many complications.

Case: In this study, we describe a monochorionic-diamniotic triplet pregnancy after in vitro fertilization with an intracytoplasmic sperm injection. At a gestational age of 6 weeks and 4 days of pregnancy one gestational sac was observed, and at a gestational age of 12 weeks and 2 days, triplets with conjoined twins were diagnosed. After consulting with the parents, they chose fetal reduction of the conjoined twins. Selective feticide was successfully performed by radiofrequency ablation at 16 weeks of pregnancy. Unfortunately, the day after the procedure, the membrane ruptured, and 1 week later, all fetuses and placenta were spontaneously aborted.

Conclusion: Monochorionic triplet pregnancy with conjoined twins is very rare. These pregnancies are associated with very serious complications. Intra cytoplasmic sperm injection increases the rate of monozygotic twinning and conjoined twins. Counseling with parents before IVF is very important.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695689PMC
November 2015

The combination route versus sublingual and vaginal misoprostol for the termination of 13 to 24 week pregnancies: A randomized clinical trial.

Taiwan J Obstet Gynecol 2015 Dec;54(6):660-5

Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: The goal of this study was to compare the effectiveness of misoprostol via sublingual and vaginal administration versus the combination route in the termination of 13 to 24 week pregnancies.

Materials And Methods: One hundred and ninety-five patients, divided into three groups, were enrolled in this study. In the vaginal group, two 200-μg misoprostol tablets were inserted into the posterior fornix every 4 hours for 48 hours. In the sublingual group, patients took two 200-μg misoprostol tablets every 4 hours for up to 48 hours. In the combination group, two 200-μg misoprostol tablets were inserted within the posterior fornix followed by the administration of 400 μg misoprostol sublingually every 4 hours for a period of 48 hours. Efficacy was defined as a successful termination without the need for any interventions.

Results: The success rate, after 24-48 hours, was not significantly different among the three groups. It was significantly higher within the first 12 hours of misoprostol administration within the sublingual group (p = 0.031). Nonetheless, the overall failure rate was not significantly different between three groups. The mean duration of abortion was shortest among the sublingual group (655 ± 46 minutes), p = 0.005, and the number of misoprostol tablets administered was lower when compared to the other groups (5.9 ± 0.3), p = 0.001. The duration of abortion and the number of misoprostol tablets used significantly varied in the cases in which the patient had a history of a previous normal vaginal delivery (NVD; p = 0.007). The average number of tablets administered was the lowest in the sublingual group. The prevalence of fever among the NVD cases were significantly higher in the combination group (p = 0.008). Overall, of all the methods, patients preferred the sublingual route (p = 0.001).

Conclusion: Sublingual misoprostol has a higher efficacy when compared to the vaginal and combination methods.
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http://dx.doi.org/10.1016/j.tjog.2014.07.010DOI Listing
December 2015

Ultrasound detection of placenta accreta in the first trimester of pregnancy.

Iran J Reprod Med 2014 Jun;12(6):421-6

Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran.

Background: Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality. Prenatal diagnosis of placenta accreta usually is made by clinical presentation, imaging studies like ultrasound and MRI in the second and third trimester.

Objective: To determine accuracy of ultrasound findings for placenta accreta in the first trimester of pregnancy.

Materials And Methods: In a longitudinal study 323 high risk patients for placenta accreta were assessed. The eligible women were examined by vaginal and abdominal ultrasound for gestational sac and placental localization and they were followed up until the end of pregnancy. The ultrasound findings were compared with histopathological examinations as a gold standard. The sensitivity, specificity, positive and negative predictive value of ultrasound were estimated for the first trimester and compared with other 2 trimesters in the case of repeated ultrasound examination.

Results: Ultrasound examinations in the first trimester revealed that 28 cases had the findings in favor of placenta accreta which ultimately was confirmed in 7 cases. The ultrasound sensitivity and specificity for detecting placenta accreta in the first trimester was 41% [95% CI: 16.2-62.7] and 88% [95% CI: 88.2-94.6] respectively.

Conclusion: Ultrasound screening for placenta accreta in the first trimester of pregnancy could not achieve the high sensitivity as second and third trimester of pregnancy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111891PMC
June 2014

Normal and indeterminate pattern of fetal cardiotocography in admission test and pregnancy outcome.

J Obstet Gynaecol Res 2014 Mar;40(3):694-9

Aim: The aim of this study was to evaluate the prognostic value of normal and indeterminate patterns of cardiotocography in admission test (AT) and pregnancy outcome.

Material And Methods: A prospective study enrolled 818 intrapartum singleton pregnancies with gestational age of >34 weeks, in the latent phase and with intact membrane. Cases were divided into the high- and low-risk groups. Non-Stress Test was interpreted according to the 2008 National Institute of Child Health and Human Development workshop. Adverse pregnancy outcomes were compared between groups based on AT interpretation.

Results: Out of 818 patients, 492 (60%) were categorized as low-risk and 326 (40%) as high-risk pregnancies. In low-risk patients, 410 (83.3%) had normal and 82 (16.7%) had indeterminate AT. These figures were 249 (76.4%) and 77 (23.6%) in high-risk patients, respectively, and two cases (0.6%) had abnormal AT. In both groups, thick meconium staining, non-reassuring fetal heart rate pattern, cesarean section and cesarean section due to non-reassuring fetal heart rate pattern were significantly more frequent in indeterminate AT than normal ones (P < 0.001). In high-risk pregnancies with indeterminate AT, the risk of low birthweight and neonatal intensive care unit (NICU) admission increased. The positive predictive value was less than 30% in predicting thick meconium staining, non-reassuring fetal heart rate pattern, PH ≤ 7.2 and NICU admission in both groups. Overall, negative predictive value of AT for neonatal death and NICU admission was 100% and 96%, respectively.

Conclusions: Indeterminate patterns of cardiotocography can predict adverse pregnancy outcomes and when facing this condition, obstetricians should act cautiously.
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http://dx.doi.org/10.1111/jog.12226DOI Listing
March 2014

Conservative management of cervical ectopic pregnancy: systemic methotrexate followed by curettage.

Arch Gynecol Obstet 2013 Sep 23;288(3):687-9. Epub 2013 Mar 23.

Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Cervical ectopic pregnancy is among the rarest clinical conditions happening in women of reproductive age. Yet its management can cause a high rate of morbidity. Therefore, conservative treatment of this condition is a matter of debate.

Material And Methods: Hereby we present two cases of cervical ectopic pregnancies that were managed successfully with a conservative approach.

Conclusion: Cervical ectopic pregnancy can be managed successfully with systemic Metotroxsate followed by curettage.
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http://dx.doi.org/10.1007/s00404-013-2807-yDOI Listing
September 2013

Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial.

Diabetes Res Clin Pract 2012 Dec 12;98(3):422-9. Epub 2012 Oct 12.

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Aims: To evaluate the effect of metformin and insulin in glycemic control and compare pregnancy outcome in women with gestational diabetes mellitus (GDM).

Methods: This randomized controlled trial was conducted in GDM women with singleton pregnancy and gestational age between 20 and 34 weeks who did not achieve glycemic control on diet were assigned randomly to receive either metformin (n=80) or insulin (n=80). The primary outcomes were maternal glycemic control and birth weight. The secondary outcomes were neonatal and obstetric complications.

Results: Two groups were comparable regarding the maternal characteristics. Two groups were similar in mean FBS (P=0.68) and postprandial measurements (P=0.87) throughout GDM treatment. The neonates of metformin group had less rate of birth weight centile >90 than insulin group (RR: 0.5, 95% CI: 0.3-0.9, P=0.012). Maternal weight gain was reduced in the metformin group (P<0.001). Two groups were comparable according to neonatal and obstetric complications (P>0.05). In metformin group 14% of women needed to supplemental insulin to achieve euglycemia.

Conclusion: Metformin is an effective and safe alternative treatment to insulin for women with GDM. This study does not show significant risk of maternal or neonatal adverse outcome with the use of metformin.
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http://dx.doi.org/10.1016/j.diabres.2012.09.031DOI Listing
December 2012

Normal ranges for fetal femur and humerus diaphysis length during the second trimester in an Iranian population.

J Ultrasound Med 2012 Jul;31(7):991-5

Iranian Fetal Medicine Foundation, Tehran, Iran.

Objectives: Shortening of the fetal long bones is a sonographic soft marker for screening of Down syndrome in the second trimester that can be influenced by ethnicity. The purpose of this study was to provide normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.

Methods: This cross-sectional study was performed on 3011 singleton fetuses at 15 to 28 weeks' menstrual age. The relationship between menstrual age and both femur and humerus diaphysis length was determined, and percentile values for each menstrual week were provided.

Results: The median femur diaphysis length ranged from 18.05 mm at 15 menstrual weeks to 52.20 mm at 28 menstrual weeks, and the mean humerus diaphysis length ranged from 17.65 mm at 15 menstrual weeks to 48.10 mm at 28 menstrual weeks. There was a linear relationship between menstrual age and both femur diaphysis length (R² = 0.957) and humerus diaphysis length (R² = 0.941).

Conclusions: We have provided normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.
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http://dx.doi.org/10.7863/jum.2012.31.7.991DOI Listing
July 2012

Prediction of fetal anemia by different thresholds of MCA-PSV and Delta-OD in first and second intrauterine transfusions.

Arch Iran Med 2012 Mar;15(3):162-5

Department of Obstetrics and Gynecology, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Our aim was to compare different thresholds of middle cerebral artery peak systolic velocity (MCA-PSV) and amniotic fluid delta optical density (Delta-OD) with fetal hemoglobin (Hb) during first and second intrauterine transfusions (IUT).

Methods: We determined serial MCA-PSV and Delta-OD in 27 red blood cell alloimmunized fetuses who needed IUT. Before the second IUT, MCA-PSV was measured. The sensitivity and specificity of MCA-PSV and Delta-OD were calculated and compared with fetal hemoglobin  levels.

Results: From 27 fetuses, first time IUT MCA-PSV with a normal median value (MOM) cutoff of > 1.29 detected 60% of the moderate and 100% of the severe anemia cases. MCA-PSV of MOM > 1.5 detected none of the moderate and 93% of severe anemia cases. Delta-OD detected 50% of moderate anemic and 80% of severe anemic cases. At the second IUT, 91% of severe anemia cases were confirmed by MCA-PSV with MOM > 1.5 whereas MCA-PSV with MOM > 1.29 confirmed all cases. One case of moderate anemia was de-tected by MCA-PSV of MOM > 1.29 and none were detected by MCA-PSV with MOM > 1.5.

Conclusion: Different thresholds of MCA-PSV have higher sensitivity and specificity for detecting moderate and severe fetal anemia compared with Delta-OD. It also has a high sensitivity at the second IUT.
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http://dx.doi.org/012153/AIM.0011DOI Listing
March 2012

Comparison of the efficacy of nifedipine and hydralazine in hypertensive crisis in pregnancy.

Acta Med Iran 2011 ;49(11):701-6

Department of Obstetrics & Gynecology, Women Hospital, Tehran University of Medical Sciences, Iran.

Intravenous hydralazine is a commonly administered arteriolar vasodilator that is effective for hypertensive emergencies associated with pregnancy. Oral nifedipine is an alternative in management of these patients. In this study the efficacy of nifedipine and hydralazine in pregnancy was compared in a group of Iranian patients. Fifty hypertensive pregnant women were enrolled in the study. A randomized clinical trial was performed, in which patients in two groups received intravenus hydralazine or oral nifedipine to achieve target blood pressure reduction. The primary outcomes measured were the time and doses required for desired blood pressure achievement. Secondary measures included urinary output and maternal and neonatal side effects. The time required for reduction in systolic and diastolic blood pressure was shorter for oral nifedipine group (24.0 ± 10.0 min) than intravenus Hydralazine group (34.8 ± 18.8 min) (P ≤ 0.016). Less frequent doses were required with oral nifedipine (1.2 ± 0.5) compared to intravenus hydralazine (2.1 ± 1.0) (P ≤ 0.0005). There were no episodes of hypotension after hydralazine and one after nifedipine. Nifedipine and hydralazine are safe and effective antihypertensive drugs, showing a controlled and comparable blood pressure reduction in women with hypertensive emergencies in pregnancy. Both drugs reduce episodes of persistent severe hypertension. Considering pharmacokinetic properties of nifedipine such as rapid onset and long duration of action, the good oral bioavailability and less frequent side effects, it looks more preferable in hypertension emergencies of pregnancy than hydralazine.
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March 2012

Conservative management of placenta increta: case report and literature review.

Acta Med Iran 2011 ;49(6):396-8

Department of Gynecological Oncology, School of Medicine, Tehran University of Medical Sciences, Mirza Koochak-Khan Hospital, Tehran, Iran.

Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and β-hCG assessment. Serum β-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta.
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December 2011

Normal ranges of fetal nasal bone length during the second trimester in an Iranian population.

Prenat Diagn 2011 Apr 3;31(4):401-4. Epub 2011 Feb 3.

Maternal Fetal Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To provide a normal reference range for nasal bone length (NBL) during the second trimester of pregnancy in an Iranian population.

Methods: This cross-sectional study was performed on 3201 fetuses at 15 to 28 weeks of gestational age (GA). Both singleton and twin fetuses were evaluated. The relationship between NBL and GA was determined and percentile values for each gestational week were provided.

Results: NBL measurement was obtained in 98% of singleton and 96% of twin fetuses. There was a linear relationship between GA and NBL both in singleton (R(2) = 0.62) and in twin (R(2) = 0.74) fetuses. There was no significant difference between twins regarding NBL (p = 0.18).

Conclusion: We have provided the normal reference range for NBL during the second trimester in an Iranian population. NBL in singleton and twin fetuses is similar and there is no significant difference between twins regarding NBL.
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http://dx.doi.org/10.1002/pd.2704DOI Listing
April 2011

Seat belt use during pregnancy in Iran: attitudes and practices.

Chin J Traumatol 2010 Oct;13(5):275-8

Sina Trauma Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Seat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use.

Methods: In this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis.

Results: The mean age of study subjects was 27.3 years ± 5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 % of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy.

Conclusions: The prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic.
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October 2010

Middle cerebral artery peak systolic velocity and ductus venosus velocity in the investigation of nonimmune hydrops.

J Clin Ultrasound 2009 Sep;37(7):385-8

Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: This study was performed to investigate the cause of nonimmune hydrops fetalis by measuring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) and velocity waveforms of the ductus venosus (DV) with Doppler.

Methods: This cross-sectional study was done on 19 pregnancies referred to three university teaching hospitals for further investigation of nonimmune hydrops fetalis in 2007 and 2008. The MCA-PSV and DV velocity waveforms were recorded in all fetuses. Anemia was investigated in cases with MCA-PSV values greater than 1.50 MoM (multiple of the median). Cardiovascular causes and chromosomal abnormalities were investigated in fetuses with abnormal DV velocity.

Results: Four of 19 fetuses had MCA-PSV values greater than 1.50 MoM. The causes of anemia were cytomegalovirus, parvovirus B19 infections, congenital heart disease, and Turner syndrome. Four cases had reversed flow in the DV; three of them had congenital heart disease on echocardiography; and one had a normal echocardiogram, but an abnormal karyotype was detected.

Conclusion: Assessment of the MCA-PSV and DV velocity waveforms during sonographic examination of fetuses with nonimmune hydrops fetalis may improve our knowledge about the etiology of this condition.
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http://dx.doi.org/10.1002/jcu.20613DOI Listing
September 2009

Acardiac fetus with large intestine only. A case report.

Fetal Diagn Ther 2008 16;24(4):353-6. Epub 2008 Oct 16.

Departement of Obstetrics and Gynecology, Mirza Koochak Khan Hospital, Tehran, Iran.

Acardiac twin syndrome is a rare complication affecting monozygotic twins, where one twin fails to develop normally and completely. In this report, we present an acardiac fetus that was seen for evaluation at 26 weeks of gestation. Initial routine ultrasound examination suggested anomalies. The first detailed ultrasound demonstrated a normal fetus with appropriate growth plus an acardiac twin with a hypoplastic lower limb with subcutaneous edema and intestine-like organ near it. The pregnancy was followed with serial ultrasonography and spontaneous delivery occurred at term. A normal infant was born, and after delivery of the placenta, at the chorionic plate of the placenta there was a sac with diminished fluid, containing some loops of the intestine. A thin cord of one vascular channel was attached to the common placenta. In our literature review, this type of acardiac fetus has not been reported previously.
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http://dx.doi.org/10.1159/000163077DOI Listing
April 2009

Rh alloimmunization and term delivery.

Arch Iran Med 2007 Jan;10(1):111-3

Department of Obstetrics and Gynecology, Mirza Kochak Khan Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Nowadays management of severe Rh alloimmunization consists of serial determination of middle cerebral artery peak systolic velocity, amniocentesis, cordocentesis, and in many instances intrauterine transfusion. We present a case of severe Rh alloimmunization who, for the first time in Iran, was delivered at term after several intrauterine transfusions.
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http://dx.doi.org/07101/AIM.0025DOI Listing
January 2007