Publications by authors named "Homeira Vafaei"

47 Publications

Reply to: aspirin for the prevention of preeclampsia.

J Perinat Med 2022 Aug 3. Epub 2022 Aug 3.

Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.1515/jpm-2022-0311DOI Listing
August 2022

Effectiveness of pentoxifylline in severe early-onset fetal growth restriction: A randomized double-blinded clinical trial.

Taiwan J Obstet Gynecol 2022 Jul;61(4):612-619

Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Objective: Management of pregnancy complicated by severe early-onset fetal growth restriction (FGR) is one of the most challenging obstetrical issues. So far, there has not been a proven option for the treatment or improvement of this condition. Improper immune response during placentation leads to inadequate trophoblast invasion and impaired utero-placental perfusion. Pentoxifylline improves the endothelial function and induces vasodilation by reducing the inflammatory-mediated cytokines. We have evaluated the effect of Pentoxifylline on fetal-placental perfusion, neonatal outcome, and the level of oxidative stress markers before and after the intervention in the setting of severe early-onset FGR.

Materials And Methods: This study is a pilot randomized clinical trial on 40 pregnant women who had developed early-onset growth restricted fetus. Pentoxifylline and placebo were given with a dose of 400 mg per os two times daily until delivery. Serial ultrasound examination regarding fetal weight, amniotic fluid and also utero-placenta-fetal Doppler's were done. For the assessment of serum Antioxidant level, blood sampling was done once at the beginning of the study and again, at least, three weeks after the investigation. After delivery, umbilical-cord blood gas analysis, APGAR score at 1 and 5 min, NICU admission, and neonatal death were recorded and compared between the two groups.

Results: Utero-placenta-fetal Doppler's in the Pentoxifylline group did not significantly change compared to the control group. Fetal weight gain was significantly higher in the Pentoxifylline group before (996.33 ± 317.41) and after (1616.89 ± 527.90) treatment (P = 0.002). Total serum antioxidant capacity significantly increased in the Pentoxifylline group (p < 0.036). Average 5 min Apgar score was significantly higher (P < 0.036) and the percentage of babies admitted to NICU was significantly lower (P < 0.030) in the treated group.

Conclusion: Using Pentoxifylline in pregnancy affected by FGR might show promising effects. In this study, Pentoxifylline improved the neonatal outcome, increased fetal weight gain, and reduced neonatal mortality by decreasing the level of oxidative stress markers and cutting down the inflammatory cascade.
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http://dx.doi.org/10.1016/j.tjog.2021.12.003DOI Listing
July 2022

The effect of 150 and 80 mg doses of aspirin on preventing preterm birth in high-risk pregnant women.

J Perinat Med 2022 May 27. Epub 2022 May 27.

Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Preterm birth (PTB) is the common cause of neonatal mortality nationwide. The present study aimed to evaluate the efficacy of different doses of aspirin in preventing PTB in high-risk pregnant women. As secondary outcomes, other perinatal complications were compared.

Methods: This double-blind randomized clinical trial was conducted on high-risk pregnant women with impaired placental perfusion diagnosed in the first trimester of pregnancy referring to the perinatal centers affiliated to Shiraz university of Medical Sciences between February 2020 and March 2021. The subjects were randomly divided in two groups administered with 150 or 80 mg aspirin every night from 11 to 13+6 weeks until 36 weeks or delivery. This study is registered in the Iranian Registry of Clinical Trials (IRCT20140317017035N6; http://www.irct.ir/). Univariate and multiple logistic regressions were applied using SPSS 22.

Results: A total of 101 subjects received 80 mg aspirin and 89 ones received 150 mg aspirin. The results of multiple analysis revealed a significantly lower odds of PTB (OR 0.4 0.19, 0.99)) in the 150 mg group compared to the 80 mg group. As secondary outcomes, preeclampsia (PEC) and PEC with severe features (PECsf) were lower (OR 0.2 (0.06, 0.82) and 0.1 (0.01, 0.92), respectively); however, fetal age and neonatal weight were higher in the 150 mg group (OR 1.2 (1.04, 1.33) and 1.001 (1-1.001), respectively).

Conclusions: The study findings indicated that, compared with 80 mg of aspirin, taking 150 mg of aspirin reduced PTB and perinatal complications in high risk pregnant women.
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http://dx.doi.org/10.1515/jpm-2021-0668DOI Listing
May 2022

Prenatal diagnosis of diphallia in association with bladder exstrophy: a case report.

BMC Pregnancy Childbirth 2022 May 24;22(1):435. Epub 2022 May 24.

Dr vafaei perinatology center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Penile duplication or diphallia is a rare congenital anomaly with unclear pathophysiological cause. Most cases of diphallia are reported postnatally; however, today with the use of a high-resolution ultrasound device, in-uterine diagnosis of many congenital anomalies is possible.

Case Presentation: Herein we report a multiparous mother at 25 weeks of gestation who referred due to an abnormal cystic structure protruding from a large abdominal wall defect located below the umbilicus that was noted during a routine exam. Target scan revealed two penile-like protrusions with an empty scrotal sac and double bladder in an otherwise normal fetus, which was confirmed postnatally. Neonatal microarray study and karyotype were normal.

Conclusion: Diphallia could be detected prenatally as an isolated anomaly, associated with caudal duplication syndrome, or as an exstrophy-epispadias complex. As this is a rare congenital anomaly, all sonographers should be familiar with prenatal ultrasound features and associated anomalies, an important issue in prenatal counseling with parents, delivery planning, psychological support of the family, and postnatal management.
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http://dx.doi.org/10.1186/s12884-022-04746-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131630PMC
May 2022

Vaginal misoprostol and intravenous oxytocin for success of termination in the second-trimester intrauterine fetal demise: A randomized controlled clinical trial.

J Obstet Gynaecol Res 2022 Apr 8;48(4):966-972. Epub 2022 Mar 8.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Aim: To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD).

Methods: This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation.

Results: The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed.

Conclusion: Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment.
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http://dx.doi.org/10.1111/jog.15180DOI Listing
April 2022

Diagnosis pitfall of interstitial pregnancy: a case report of a term pregnancy with abnormal placentation.

BMC Pregnancy Childbirth 2021 Oct 18;21(1):699. Epub 2021 Oct 18.

Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Interstitial Pregnancy (IP) is a lethal condition due to high risk of sudden onset massive hemorrhage. Such conditions are managed as soon as diagnosed almost in the first trimester. There are a few case reports of IP conditions terminated after the second trimester. Herein, we introduce a term interstitial pregnancy complicated by abnormal placentation.

Case Presentation: In this case report, we introduce a 32-year-old lady, primigravida, with an undiagnosed IP that was in her 38 weeks of gestational with placenta increta. She developed with perforated IP presenting with acute abdomen and internal bleeding at 26 weeks of gestational age. However, with a misdiagnosis impression, she got stable in operation room. Then, the pregnancy continued till 36 weeks of gestational age that was misdiagnosed with cervical cancer in prenatal work-ups. Finally, during elective cesarean section at 38 weeks, an IP with placenta increta (placenta evading from the serosa to the myometrium of the uterus) was observed. The baby was healthy with no obvious anomaly or morbidity.

Conclusions: Physicians should be aware to detect IP in all trimesters and pay attention to the coexisting complications such as placenta accreta to manage them more accurately.
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http://dx.doi.org/10.1186/s12884-021-04153-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522083PMC
October 2021

Predictive value of vascular endothelial growth factor and placenta growth factor for placenta accreta spectrum.

J Obstet Gynaecol 2022 Jul 24;42(5):900-905. Epub 2021 Sep 24.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

This study aimed to assess the maternal features, Vascular Endothelial Growth Factor (VEGF) and Placenta Growth Factor (PLGF) in the Placenta Accreta Spectrum (PAS); then, to determine a predictive value of VEGF and PLGF in the PAS. This prospective case-control study was conducted on 90 pregnant women including 45 PAS, and 45 Normal Placenta (NP). Maternal age, gravidity, C/S, and serum levels of VEGF and PLGF were assessed between NP and PAS, and among NP and PAS sub-groups, including Placenta Accreta (PA), Placenta Increta (PI), and Placenta Percreta (PP). The Multi-gravidity, previous C/S, maternal age, and serum level of PLGF were significantly higher in the PAS group compared to the NP group OR = 42, 8.1, 1.17, and 1.002 (-value <.05 for all); however, there was no difference regarding serum level of VEGF (-value >.05). The same differences were seen among NP with PA, PI, and PP sub-groups (-value <.05 for all, but -value >.05 for VEGF). Placenta Previa was uniformly distributed across the PAS sub-groups (-value >.05), also the VEGF and PLGF serum levels did not differ between PAS with Previa and PAS without Previa groups (-value >.05). A valid cut-off point for PLGF was reported at 63.55. A predictive value of PLGF for the PAS patients is presented enjoying high accuracy and generalisability for the study population.Impact statement The Placenta Accreta Spectrum (PAS), in which the placenta grows too deep in the uterine wall, is responsible for maternal-foetal morbidity and mortality worldwide; so, the antenatal diagnosis of PAS is an important key to improve maternal-foetal health. Normal placental implantation requires a fine balance among the levels of angiogenic and anti-angiogenic factors, such as the Placenta Growth Factor (PLGF), the Vascular Endothelial Growth Factor (VEGF), and soluble Fms-like tyrosine kinase-1. However, there is still controversy regarding The PLGF and VEGF level changes in PAS patients. Despite traditional measuring the levels of PLGF and VEGF from the placenta at the time of delivery; in this study including 90 participants (28-34 weeks of gestation) the maternal serum levels of PLGF and VEGF were measured in advance (temporality causation), resulted in presenting a more valid cut-off point for PLGF in PAS group. In addition, the serum level of PLGF was significantly higher in the PAS and PAS sub-groups compared to the Normal Placenta group. Also, the Previa status of PAS patients did not affect the VEGF and PLGF serum levels. PLGF cut-off point derived from the maternal serum level could predict PAS validly and, if used as a screening test in an earlier pregnancy, the maternal-foetal morbidity and mortality would decrease.
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http://dx.doi.org/10.1080/01443615.2021.1955337DOI Listing
July 2022

Prevalence of single umbilical artery, clinical outcomes and its risk factors: A cross-sectional study.

Int J Reprod Biomed 2021 May 23;19(5):441-448. Epub 2021 Jun 23.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Single umbilical artery (SUA) is found in 0.5-6% of all pregnancies worldwide. Although the association of SUA with some congenital malformations is mainly accepted, its effect on pregnancy/neonatal outcomes is still controversial.

Objective: This is the first study aimed to approximate the SUA prevalence in southern part of Iran. SUA epidemiologic features accompanied by some of its effects on pregnancy/neonatal outcomes are investigated as well.

Materials And Methods: In this cross-sectional study, data from two referral centers in Southern Iran were analyzed. In total, 1,469 pregnancies, fetuses, and neonates were examined for epidemiological features associated with SUA. SUA was confirmed by pathological examination, while congenital anomalies were diagnosed by clinical, ultrasound, and echocardiographical examinations. Data on pregnancy outcome were recorded based on the patients' medical records.

Results: The prevalence of SUA was 3.47% (95% CI: 2.6-4.6%). Fetal anomalies including renal, cardiac, and other congenital anomalies, intrauterine fetal death, early neonatal death, low birth weight, low placental weight, and preterm birth were significantly higher in the SUA group (OR = 68.02, 31.04, 16.03, 3.85, 11.31, 3.22, 2.70, and 2.47, respectively). However, the maternal multiparity was lower in the SUA group (OR = 0.65; 95% CI: 0.44-0.98).

Conclusion: A significant association was observed between SUA and increased risk of intrauterine fetal death and early neonatal death, as well as low birth weight and preterm birth. Obstetrical history of the mother like parity was identified as an important predictor of SUA. Further investigations are suggested on risk stratification of neonates in this regard.
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http://dx.doi.org/10.18502/ijrm.v19i5.9253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261099PMC
May 2021

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women.

BMC Womens Health 2021 06 15;21(1):243. Epub 2021 Jun 15.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting.

Methods: All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study.

Results: A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period.

Conclusion: Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.
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http://dx.doi.org/10.1186/s12905-021-01389-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207599PMC
June 2021

The impact of betamethasone on fetal pulmonary, umbilical and middle cerebral artery Doppler velocimetry and its relationship with neonatal respiratory distress syndrome.

BMC Pregnancy Childbirth 2021 Mar 6;21(1):188. Epub 2021 Mar 6.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results.

Methods: Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted.

Results: When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not.

Conclusions: The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.
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http://dx.doi.org/10.1186/s12884-021-03655-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937237PMC
March 2021

The Novel Ultrasonographic Marker of Uterocervical Angle for Prediction of Spontaneous Preterm Birth in Singleton and Twin Pregnancies: A Systematic Review and Meta-Analysis.

Fetal Diagn Ther 2021 Feb 8:1-7. Epub 2021 Feb 8.

Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain.

The alteration of the uterocervical angle (UCA) has been proposed to play an important role in spontaneous preterm birth (sPTB). The aim of this systematic review and meta-analysis was to evaluate the evidence on the UCA predictive role in sPTB. In this study, PubMed, Web of Science, Scopus, and Google scholar were systematically searched from inception up to June 2020. Inter-study heterogeneity was also assessed using Cochrane's Q test and the I2 statistic. Afterward, the random-effects model was used to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Eleven articles that reported second-trimester UCA of 5,061 pregnancies were included in this study. Our meta-analysis results indicate that a wider UCA significantly increases the risk of sPTB in following cases: all pregnancies (WMD = 15.25, 95% CI: 11.78-18.72, p < 0.001; I2 = 75.9%, p < 0.001), singleton (WMD = 14.43, 95% CI: 8.79-20.06, p < 0.001; I2 = 82.4%, p < 0.001), and twin pregnancies (WMD = 15.14, 95% CI: 13.42-16.87, p < 0.001; I2 = 0.0%, p = 0.464). A wider ultrasound-measured UCA in the second trimester seems to be associated with the increased risk of sPTB in both singleton and twin pregnancies, which reinforces the clinical evidence that UCA has the potential to be used as a predictive marker of sPTB.
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http://dx.doi.org/10.1159/000510648DOI Listing
February 2021

Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study.

BMC Pregnancy Childbirth 2021 Jan 30;21(1):99. Epub 2021 Jan 30.

Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5-7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes.

Methods: In this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests.

Results: Preeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%.

Conclusion: Although chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.
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http://dx.doi.org/10.1186/s12884-021-03576-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847032PMC
January 2021

Episiotomy wound healing by Commiphora myrrha (Nees) Engl. and Boswellia carteri Birdw. in primiparous women: A randomized controlled trial.

J Ethnopharmacol 2021 Jan 21;264:113396. Epub 2020 Sep 21.

Box Hill Hospital, FRANZCOG, Eastern Health, Victoria, Australia. Electronic address:

Ethnopharmacological Relevance: Traditional Persian medicine manuscripts refer to plants such as Commiphora myrrha (Nees) Engl. (myrrh) and Boswellia carteri Birdw. (frankincense), which could be used to improve wound healing process. Since that time, local midwives in Iran continue to provide these herbs to precipitate episiotomy wound healing.

Aim Of The Study: To investigate the efficacy and safety of myrrh- and frankincense-based sitz-baths on episiotomy wound healing in primiparous women.

Materials And Methods: This randomized controlled trial was conducted on 90 primiparous women with singleton pregnancies after normal vaginal delivery at Hafez hospital affiliated to Shiraz University of Medical Sciences from July to October 2019. Study participants were randomly allocated in three groups (2 intervention groups and 1 control group). Women in intervention groups were assigned to receive either 10-min sitz-bath of myrrh extract or frankincense extract twice a day for 1 week. While the women in control group received the betadine sitz-bath for the same period of time. The main outcome was the episiotomy wound healing, which was measured using the REEDA scale before intervention, on 2nd and 7th postpartum days.

Results: An improvement in the episiotomy wound healing was significantly greater in patients receiving myrrh than those receiving the frankincense or betadine on 2nd (p = 0.003 and p < 0.001) and 7th (p = 0.043 and p = 0.015) postpartum days. However, the total REEDA score was not statistically different between the frankincense and betadine groups on 2nd and 7th postpartum days (p > 0.05).

Conclusion: The present results suggest that myrrh was more efficient than frankincense and betadine in healing of the episiotomy wound and could be recommended as a safe natural therapy.
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http://dx.doi.org/10.1016/j.jep.2020.113396DOI Listing
January 2021

Treatment of women's sexual dysfunction using Apium graveolens L. Fruit (celery seed): A double-blind, randomized, placebo-controlled clinical trial.

J Ethnopharmacol 2021 Jan 22;264:113400. Epub 2020 Sep 22.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Ethnopharmacological Relevance: Traditional manuscripts refer to plants such as Apium graveolens L. Fruit (celery seed), which could be used to improve sexual function among women. Since that time, local herbal shops in Iran continue to provide this herb as a natural aphrodisiac product.

Aim Of The Study: This study aimed to evaluate the efficacy and safety of celery seed for the treatment of female sexual dysfunction.

Methods And Materials: In this parallel, randomized, double-blinded clinical trial, 80 women were assigned to receive either 500 mg of celery seed or placebo 3 times a day for a period of 6 weeks (n = 40 per group). The female sexual function index (FSFI) questionnaire was used to evaluate women's sexual function before and after treatment.

Results: At the end of the sixth week, an improvement in the total FSFI score was significantly greater in celery seed-treated women than those receiving the placebo (P < 0.001). Increased total FSFI score is mainly contributed by improvement in the sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), and pain (p = 0.033) domains at the endpoint of study. No serious side effects were noticed in both groups during the study period.

Conclusion: It seems that celery seed improved sexual function in women and could be used as a safe, well-tolerated, and effective herbal medicine in women with sexual dysfunction.
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http://dx.doi.org/10.1016/j.jep.2020.113400DOI Listing
January 2021

COVID-19 and maternal, fetal and neonatal mortality: a systematic review.

J Matern Fetal Neonatal Med 2022 Aug 16;35(15):2936-2941. Epub 2020 Aug 16.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: This is the first comprehensive review to focus on currently available evidence regarding maternal, fetal and neonatal mortality cases associated with Coronavirus Disease 2019 (COVID-19) infection, up to July 2020.

Methods: We systematically searched PubMed, Scopus, Google Scholar and Web of Science databases to identify any reported cases of maternal, fetal or neonatal mortality associated with COVID-19 infection. The references of relevant studies were also hand-searched.

Results: Of 2815 studies screened, 10 studies reporting 37 maternal and 12 perinatal mortality cases (7 fetal demise and 5 neonatal death) were finally eligible for inclusion to this review. All maternal deaths were seen in women with previous co-morbidities, of which the most common were obesity, diabetes, asthma and advanced maternal age. Acute respiratory distress syndrome (ARDS) and severity of pneumonia were considered as the leading causes of all maternal mortalities, except for one case who died of thromboembolism during postpartum period. Fetal and neonatal mortalities were suggested to be a result of the severity of maternal infection or the prematurity, respectively. Interestingly, there was no evidence of vertical transmission or positive COVID-19 test result among expired neonates.

Conclusion: Current available evidence suggested that maternal mortality mostly happened among women with previous co-morbidities and neonatal mortality seems to be a result of prematurity rather than infection. However, further reports are needed so that the magnitude of the maternal and perinatal mortality could be determined more precisely.
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http://dx.doi.org/10.1080/14767058.2020.1806817DOI Listing
August 2022

The effect of aspirin on preeclampsia, intrauterine growth restriction and preterm delivery among healthy pregnancies with a history of preeclampsia.

J Chin Med Assoc 2020 Sep;83(9):852-857

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Due to the significance of preeclampsia (PE) and its adverse outcomes in the health of both mother and newborn, the present study was carried out to investigate the effect of aspirin on preventing the occurrence of PE, intrauterine growth restriction (IUGR), and preterm delivery in women with a previous history of PE.

Methods: The present clinical trial was conducted on 90 pregnant women with a previous history of PE referred to the Khalij Fars Hospital in Bandar Abbas, Hormozgan Province Iran from April 2017 to August 2018. The subjects of the study were randomly assigned into two groups of intervention and control to receive either 80 mg of aspirin or placebo daily during the pregnancy. Patients' information was obtained and recorded upon entering the study, follow-up visits, and childbirth.

Results: Among participants who entered the clinical trial, 86 patients (95.6%) completed the study. During the pregnancy, systolic blood pressure increased by 8.25 ± 14.83 and 19.06 ± 18.33 mmHg in aspirin and placebo groups, respectively (p = 0.001). Also, the same happened with diastolic blood pressure (6.12 ± 11.46 vs 13.48 ± 13.95 mmHg, p = 0.010). The rate of PE was equal to 27 (62.8%) and 38 (88.4%) in the aspirin and placebo groups, respectively (aOR = 0.23, p = 0.013). In the aspirin group, the rate of IUGR was equal to 27.9% compared with 25.6% of newborns in the control group (aOR = 1.18, p = 0.750). Similarly, there was no significant difference in the rate of preterm delivery between the two groups (p = 0.061).

Conclusion: The findings of the present study conducted exclusively on women with previous documented PE revealed that taking aspirin may have a preventive effect on PE in the current pregnancy.
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http://dx.doi.org/10.1097/JCMA.0000000000000400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478204PMC
September 2020

Obstetrics Healthcare Providers' Mental Health and Quality of Life During COVID-19 Pandemic: Multicenter Study from Eight Cities in Iran.

Psychol Res Behav Manag 2020 17;13:563-571. Epub 2020 Jul 17.

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

Background: The coronavirus disease of 2019 (COVID-19) pandemic has become the most challenging issue for healthcare organizations and governments all over the world. The lack of evidence-based data on the management of COVID-19 infection during pregnancy causes an additional stress for obstetrics healthcare providers (HCPs). Therefore, this study was undertaken to evaluate depression, perceived social support, and quality of life among obstetrics HCPs.

Materials And Methods: This cross-sectional multicenter study was conducted in eight cities in Iran. During the study period, 599 HCPs were separated into direct, no direct, and unknown contact groups according to their exposure to COVID-19-infected pregnant patients. The Patient Health Questionaire-9 (PHQ-9), Multidimensional Scale of Perceived Social Support (MSPSS), and Short Form-36 (SF-36) were used to assess depression, perceived social support, and quality of life.

Results: Obstetrics and gynecology specialists had significantly higher social functioning and general health scores compared to other HCPs (residents/students or nurses/midwives). Depression was negatively correlated with most of the domains of quality of life, regardless of the COVID-19 contact status of the study participants. Social support, however, was positively correlated with some domains of quality of life, such as physical functioning, energy/fatigue, and emotional well-being, among staff members who had either direct contact or no contact with COVID-19 patients.

Conclusion: During the COVID-19 outbreak, the depression score among obstetrics HCPs was negatively associated with quality of life. Social support, however, had a reinforcing effect on quality of life.
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http://dx.doi.org/10.2147/PRBM.S256780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373406PMC
July 2020

Wi-Fi (2.4 GHz) affects anti-oxidant capacity, DNA repair genes expression and, apoptosis in pregnant mouse placenta.

Iran J Basic Med Sci 2020 Jun;23(6):833-840

Stem Cell Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: The placenta provides nutrients and oxygen to embryo and removes waste products from embryo's blood. As far as we know, the effects of exposure to Wi-Fi (2.4 GHz) signals on placenta have not been evaluated. Hence, we examined the effect of prenatal exposure to Wi-Fi signals on anti-oxidant capacity, expressions of CDKNA1, and GADD45a as well as apoptosis in placenta and pregnancy outcome.

Materials And Methods: Pregnant mice were exposed to Wi-Fi signal (2.4 GHz) for 2 and 4 hr. Placenta tissues were examined to measure the MDA and SOD levels. To measure SOD, CDKNA1, GADD45a, Bax, and Bcl-2 expressions were compared by real-time PCR analysis. TUNEL assay was used to assess apoptosis in placenta tissues. The results were analyzed by one-way analysis of variance (ANOVA) using Prism version 6.0 software.

Results: MDA and SOD levels had significantly increased in exposed Wi-Fi signal groups (-value< 0.05). Also, quantitative PCR experiment showed that SOD mRNA expression significantly increased in Wi-Fi signal groups. The data showed that CDKN1A and GADD45a genes were increased in Wi-Fi groups (-value<0.05). The quantitative PCR and the TUNEL assay showed that apoptosis increased in Wi-Fi groups (-value<0.05).

Conclusion: Our results provide evidence that Wi-Fi signals increase lipid peroxidation, SOD activity (oxidative stres), apoptosis and CDKN1A and GADD45a overexpression in mice placenta tissue. However, further experimental studies are warranted to investigate other genes and aspects of pregnancy to determine the role of Wi-Fi radiation on fertility and pregnancy.
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http://dx.doi.org/10.22038/ijbms.2020.40184.9512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351435PMC
June 2020

Patients' self-reported factors influencing cervical cancer screening uptake among HIV-positive women in low- and middle-income countries: An integrative review.

Gynecol Oncol Rep 2020 Aug 5;33:100596. Epub 2020 Jun 5.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Cervical cancer is among the most common causes of cancer-related deaths in low- and middle-income countries (LMICs). Despite the strong evidence regarding cervical cancer screening cost-effectiveness, its utilization remains low especially in high risk populations such as HIV-positive women. The aim of this review was to provide an overview on the patient-reported factors influencing cervical cancer screening uptake among HIV-positive women living in LMICs. We systematically searched EMBASE, PUBMED/MEDLINE and Web of Science databases to identify all quantitative and qualitative studies investigating the patient-reported barriers or facilitators to cervical cancer screening uptake among HIV-positive population from LMICs. A total of 32 studies met the inclusion criteria. A large number of barriers/facilitators were identified and then grouped into three categories of personal, social and structural variables. However, the most common influential factors include knowledge and attitude toward cervical cancer or its screening, embarrassment, fear of cervical cancer screening and test results, patient-healthcare provider relationship, social support, screening costs and time constraints. This review's findings highlighted the need for multi-level participation of policy makers, health professionals, patients and their families in order to overcome the barriers to uptake of cervical cancer screening among HIV-positive women, who are of special concern in LMICs.
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http://dx.doi.org/10.1016/j.gore.2020.100596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292910PMC
August 2020

The effect of mother's β-thalassemia minor on placental histology and neonatal outcomes.

J Matern Fetal Neonatal Med 2022 May 4;35(10):1907-1914. Epub 2020 Jun 4.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: β-thalassemia is a prevalent disease in Iran. The adverse effects of anemia on placental and neonatal outcomes have previously been shown. Women require additional iron during pregnancy and the anemia of women with β-thalassemia may adversely affect the neonatal outcome and increase placental abnormalities. In this study, we compared the placental histology and neonatal outcomes among pregnant women with and without β-thalassemia.

Material And Methods: In this population-based cross-sectional study, 144 pregnant women with β-thalassemia minor (case group) were compared to 142 women without -thalassemia (control group). Women with singleton pregnancies over 20 weeks of gestation without pregnancy complications, anemia, collagen vascular diseases, or other hemoglobinopathies, all referred to hospitals affiliated to Shiraz University of Medical Sciences from March 2014 to February 2016, were included and maternal and neonatal data were extracted from medical records. After child birth, the placenta was evaluated for macroscopic and microscopic changes.

Results: The frequency of LBW was significantly higher in the case group than that in the control group (19.7 vs. 9.7%, respectively) ( = .019). Six in the case group had gross abnormalities of placenta, while none in the control group ( = .03) and the case group had a higher frequency of chorangiosis, calcification, syncytial knot, and umbilical cord position ( < .05).

Conclusion: As -thalassemia increases the chance of placental abnormalities, it is recommended to pay more attention to patients with -thalassemia, especially during pregnancy, to prevent placental and neonatal adverse outcomes.
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http://dx.doi.org/10.1080/14767058.2020.1774540DOI Listing
May 2022

Effect of Acupuncture on Pregnancy-Related Insomnia and Melatonin: A Single-Blinded, Randomized, Placebo-Controlled Trial.

Nat Sci Sleep 2020 13;12:271-278. Epub 2020 May 13.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: The aim of the current study is to evaluate the efficacy and safety of acupuncture on sleep quality and overnight melatonin secretion, measured as urinary 6-sulfatoxymelatonin, in pregnant women.

Patients And Methods: This randomized, parallel, single-blinded (participant), controlled trial was conducted on 72 pregnant women with insomnia. Study participants were randomly assigned to either the intervention, 10 sessions of acupuncture treatment over a 3-week period, or control group by block randomization (1:1). Patients in both groups were evaluated at baseline and post-treatment (third week) using the Pittsburgh Sleep Quality Index (PSQI) score (as the primary outcome) and urinary 6-sulfatoxymelatonin.

Results: Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline (=0.169 and =0.496). At the end of the study period, treatment with acupuncture significantly improved the PSQI score (<0.001) with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level (=0.020) with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits.

Conclusion: Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.
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http://dx.doi.org/10.2147/NSS.S247628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231755PMC
May 2020

COVID-19 pneumonia and pregnancy; a systematic review and meta-analysis.

J Matern Fetal Neonatal Med 2022 May 19;35(9):1652-1659. Epub 2020 May 19.

Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The new SARS-CoV-2 originated from Wuhan, China is spreading rapidly worldwide. A number of SARS-CoV-2 positive pregnant women have been reported. However, more information is still needed on the pregnancy outcome and the neonates regarding COVID-19 pneumonia.

Material And Methods: A systematic search was done and nine articles on COVID-19 pneumonia and SARS-CoV-2 positive pregnant women were extracted. Some maternal-fetal characteristics were extracted to be included in the meta-analysis

Results: The present meta-analysis was conducted on 87 SARS-CoV-2 positive pregnant women. Almost 65% of the patients reported a history of exposure to an infected person, 78% suffered from mild or moderate COVID-19, 99.9% had successful termination, 86% had cough, and 68% had fever ( = .022 and  < .001). The overall proportions of vertical transmission, still birth, and neonatal death were zero, 0.002, and, 0.002, respectively ( = 1,  = .86, and  = .89, respectively). The means of the first- and fifth-minute Apgar scores were 8.86 and 9, respectively ( < .001 for both). The confounding role of history of underlying diseases with an estimated overall proportion of 33% ( = .03) resulted in further investigations due to sample size limitation. A natural history of COVID-19 pneumonia in the adult population was presented, as well.

Conclusion: Currently, no evidence of vertical transmission has been suggested at least in late pregnancy. No hazards have been detected for fetuses or neonates. Although pregnant women are at an immunosuppressive state due to the physiological changes during pregnancy, most patients suffered from mild or moderate COVID-19 pneumonia with no pregnancy loss, proposing a similar pattern of the clinical characteristics of COVID-19 pneumonia to that of other adult populations.
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http://dx.doi.org/10.1080/14767058.2020.1763952DOI Listing
May 2022

Efficacy and safety of myrrh in patients with incomplete abortion: a randomized, double-blind, placebo-controlled clinical study.

BMC Complement Med Ther 2020 May 12;20(1):145. Epub 2020 May 12.

Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Myrrh (Commiphora myrrha (Nees) Engl.) has a long history of traditional use as a herbal medicine for different purposes. In ancient traditional Persian manuscripts, it has been noted that myrrh may act as uterine stimulant and probably cause complete abortion. However, there is no evidence to verify this comment. Therefore, the current study was carried out to evaluate the efficacy and safety of Myrrh in the treatment of incomplete abortion.

Materials And Methods: In a randomized double-blinded placebo controlled clinical trial, 80 patients with ultrasound-documented retained products of conception (RPOC) were assigned to receive capsules containing 500 mg of Myrrh oleo-gum-resin or a placebo three times a day for 2 weeks. The existence of the retained tissue and its size were evaluated by ultrasound examination at the beginning and end of the study.

Results: After 2 weeks, the mean diameter of the RPOC in the Myrrh group was significantly reduced compared with the placebo group (P < 0.001). Meanwhile, the rate of successful complete abortion was 82.9% in the intervention group and 54.3% in the placebo group (P = 0.01). The patients in both groups reported no serious drug-related adverse effects.

Conclusion: This study shows that Myrrh is effective and safe in the resolution of the RPOC and may be considered as an alternative option for treatment of patients with incomplete abortion. However, further studies on active compounds isolated from myrrh and their uterine stimulant effects are needed.

Trial Registration: This study was retrospectively registered at Iranian Registry of Clinical Trials (www.irct.ir) IRCT code: IRCT20140317017034N7.
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http://dx.doi.org/10.1186/s12906-020-02946-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218551PMC
May 2020

Benign prostatic hyperplasia treatment using plasmonic nanoparticles irradiated by laser in a rat model.

Biomed Pharmacother 2020 Jul 31;127:110118. Epub 2020 Mar 31.

The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran. Electronic address:

Objective: In the current study we have stimulated the efficacy of plasmonic nanoparticles (NPs) by laser hyperthermia to achieve a less invasive method for tumor photothermal therapy of benign prostatic hyperplasia (BPH).

Methods: The levels of apoptosis on induced BPH in rats were assessed after treatment and revealed and recorded by various assayed. Moreover, the expression of caspases was considered to demonstrate the apoptotic pathways due to laser induced plasmonic NPs.

Results: In the Laser + NPs group prostate size of induced BPH decreased. Laser + NPs also decreased prostate specific antigen in comparison with the BPH groups. Furthermore, Laser + NPs attenuated BPH histopathologic indices in the rats. Laser + NPs induced apoptosis in prostatic epithelial cells via caspase-1 pathway.

Conclusions: Altogether, the approach and findings from this study can be applied to introduce the laser irritated NPs method as a novel and less invasive therapy for patients suffering from BPH.
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http://dx.doi.org/10.1016/j.biopha.2020.110118DOI Listing
July 2020

The use of vaginal progesterone as a maintenance therapy in women with arrested preterm labor: a double-blind placebo-randomized controlled trial.

J Matern Fetal Neonatal Med 2022 Mar 26;35(6):1134-1140. Epub 2020 Mar 26.

Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The efficacy of maintenance tocolytic therapy after successful arrest of preterm labor remains controversial. The purpose of this study was to evaluate the efficacy of 400 mg of daily vaginal progesterone (cyclogest) after successful parenteral tocolysis to increase latency period and improvement of neonatal outcomes in women with threatened preterm labor.

Materials And Methods: In this randomized, double-blind, placebo-controlled trial, 85 participants were randomly allocated to either 400 mg daily of vaginal progesterone ( = 45) or placebo ( = 40) until 34 weeks of gestation. The primary outcomes were the time until delivery (latency period) and cervical length after 1 week of treatment. Secondary outcome were GA on delivery, type of delivery, incidence of low birth weight, perinatal morbidity and mortality.

Results: Longer mean latency until delivery (53.6 ± 16.8 versus 34.5 ± 12.9) days  = .0001; longer mean of gestational age on delivery (37.5 ± 2.2 versus 34.2 ± 2.1) weeks  = .0001; cervical length after 1 week of treatment (27.5 ± 5.5 versus 20.7 ± 3.1) mm  = .0001; low birth weight 12 (29.3%) versus 19 (57.6%)  = .01; and NICU admission 9 (22%) versus 15 (45.5%), were significantly different between the two groups. No significant differences were found between neonatal death 1 (2.4%) versus 2 (6.1%),  = .43; RDS 5 (12.2%) versus 8 (24.2%),  = .17; and need to mechanical ventilator 2 (5.4%) versus 6 (18.2%)  = .136, for the progesterone and placebo groups, respectively.

Conclusion: Daily administration of 400 mg vaginal progesterone after successful parenteral tocolysis may increase latency preceding delivery and improves cervical shortening and neonatal outcome in women with preterm labor. Further confirmatory studies are warranted.
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http://dx.doi.org/10.1080/14767058.2020.1743662DOI Listing
March 2022

Successful Surgical Separation of Thoraco-Omphalopagus Symmetrical Conjoined Twins in Iran: Two Case Reports.

Iran J Med Sci 2020 Mar;45(2):143-147

Student Research Committee, Department of Otorhinolaryngology, Shiraz University of Medical Science, Shiraz, Iran.

Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enough to undergo separation. Treatment of this uncommon condition presents both surgical and anesthetic challenges. The management of rare anomalies is difficult even for skilled surgeons. Therefore, it is logical to use the knowledge gained from previous experiences. We herein present the first successful surgical separation of two pairs of thoraco-omphalopagus conjoined twins at the Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran). In both cases, the neonates had separate hearts and common pericardium. Contrast-enhanced computed tomography of two sets of twins showed fusion of sternum, pericardium, diaphragm, and left lobe of liver. Critical steps of the surgical separation were identified and contingency plans were made for possible partial liver donation and cross-circulation between twins. The separation procedure and reconstruction of the abdominal wall were successfully performed. Both pairs of twins, now 6- and 8-year-old, are healthy and have normal growth and are under follow-up.
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http://dx.doi.org/10.30476/ijms.2019.81060.DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071550PMC
March 2020

Association of Maternal and Umbilical Cord Blood Lipid Parameters with Uterine and Fetal-Placental Blood Flow in Hypertensive and Normotensive Pregnancies.

Int J Womens Health 2020 28;12:115-125. Epub 2020 Feb 28.

Eastern Health, Box Hill Hospital, FRANZCOG, Box Hill, Victoria, Australia.

Purpose: There is a growing evidence suggesting that hypertensive disorders of pregnancy (HDP), especially preeclampsia, are associated with an increased risk of cardiometabolic disease for both mother and child later in life. The objective of this study was to determine the association of maternal and umbilical cord blood (UCB) lipid profiles with uterine and fetal-placental blood flow at the third trimester of pregnancy.

Patients And Methods: A total of 1,135 women were prospectively followed through pregnancy and data for 812 mother-newborn pairs, including 170 HDP ‎developed subjects and ‎642 ‎normotensive subjects were analyzed at the end of the study. Maternal serum and UCB triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and non-HDL-C levels were compared between HDP and normotensive groups; moreover, the association between lipid parameters and abnormal pulsatility indices (PIs) of uterine (UtA), umbilical (UA), and middle cerebral (MCA) arteries was evaluated with multivariate regression analysis models. The same analyses were carried out on subgroups of HDP (preeclampsia vs gestational hypertension).

Results: The mean TG, TC, LDL-C, and non-HDL-C levels were significantly higher in mother-newborn pairs of the HDP group compared to the normotensive group. In the HDP group, maternal TG and non-HDL-C levels were shown to have a significant association with abnormal UtA-PI (p<0.001 and p=0.039, respectively). We also found a positive significant association of fetal hypertriglyceridemia with abnormal UA-PI and MCA-PI in the HDP group (p=0.042 and p=0.021, respectively). However, no such associations were observed in normotensive mother-newborn pairs. Similar trends were observed in preeclamptic subjects after subgroup analysis.

Conclusion: Maternal TG and non-HDL-C levels as well as fetal TG level are significantly associated with disturbed uterine and fetal-placental blood flow in HDP.
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http://dx.doi.org/10.2147/IJWH.S233029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054007PMC
February 2020

Introducing an efficient model for the prediction of placenta accreta spectrum using the MCP regression approach based on sonography indexes: how efficient is sonography in diagnosing accreta?

BMC Pregnancy Childbirth 2020 Feb 17;20(1):111. Epub 2020 Feb 17.

Shiraz Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: For the first time, we aimed to introduce a model for prediction of placenta accreta spectrum (PAS), using existing sonography indices.

Methods: Women with a history of Cesarean sections were included. Participants were categorized "high risk" for PAS if the placenta was previa or low-lying. Sonography indices including abnormal placental lacuna, loss of clear zone, bladder wall interruption, myometrial thinning, placental bulging, exophytic mass, utero-vesical hypervascularity, subplacental hypervascularity, existence of bridging vessels, and lacunar flow, were registered. To investigate simultaneous effects of 15 variables on PAS, Minimax Concave Penalty (MCP) was used.

Results: Among 259 participants, 74 (28.5%) were high risk and 43 individuals had PASs. All sonography indices were higher among patient with PAS (p < 0.001) in the high risk group. Our model showed that utero-vesical hypervascularity, bladder interruption and new lacunae have significant contribution in PAS. Optimal cut off point was p = 0.51 in ROC analysis. Probability of PAS for women with lacunae was between 96 and 100% and probability of PAS for women without lacunae was between 0 to 7%, therefore accuracy of the proposed model was equal to 100%.

Conclusions: Using the introduced model based on three factors of abnormal lacuna structures (grades 2 and 3), bladder wall interruption and utero-vesical vascularity, 100% of all cases of PASs are diagnosable. If supported by future studies our model eliminates the need for other imaging assessments for diagnosis of invasive placentation among high risk women with previous history of Cesarean sections.
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http://dx.doi.org/10.1186/s12884-020-2799-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027273PMC
February 2020

Effects of prophylactic iron supplementation on outcome of nonanemic pregnant women: A non-randomized clinical trial.

J Chin Med Assoc 2019 Nov;82(11):840-844

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

Background: The aim of the current study was to investigate the effects of prophylactic iron supplementation on the pregnancy outcome of nonanemic pregnant women in a sample of Iranian population.

Methods: This non-randomized clinical trial was conducted during a 2-year period in obstetrics clinics of Shiraz, southern Iran. We included a sample of singleton pregnancies registered in our clinics. Those with comorbidities were excluded. Serum ferritin was measured at baseline and participants were classified accordingly: those with normal serum ferritin levels (≥30 µg/dL) who received standard prophylactic iron supplementation during the pregnancy (Group 1); those who had minor thalassemia and elevated serum ferritin levels (≥30 µg/dL) who did not receive prophylactic iron supplementation or those with normal ferritin levels (≥30 µg/dL) who refused to receive iron supplementation due to gastrointestinal upset (Group 2); and those with iron deficiency anemia with low serum ferritin levels (<30 µg/dL) who received standard iron supplementation during pregnancy (Group 3). All the participants were followed to the delivery and maternal and neonatal outcomes were recorded and compared between three study groups.

Results: Overall we included 30 pregnant women in each group with mean age of the participants was 28.66 ± 6.02 years. There was no significant difference between three study groups regarding gestational age at delivery (p = 0.250), birthweight (p = 0.893), Apgar at 1 (p = 0.532) and 5 (p = 0.590) minutes, and route of delivery (p = 0.590). The overall rate of maternal complication of the pregnancy was comparable between the three study groups (p = 0.188). However, those in group 1, had significantly higher rate of gestational diabetes mellitus (GDM) when compared to other two groups (p = 0.038).

Conclusion: Prophylactic iron supplementation in pregnant women with normal ferritin levels is associated with increased risk of GDM. Other pregnancy and neonatal outcomes are not affected by the prophylactic iron supplementation.
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http://dx.doi.org/10.1097/JCMA.0000000000000184DOI Listing
November 2019

Positive effect of low dose vitamin D supplementation on growth of fetal bones: A randomized prospective study.

Bone 2019 05 21;122:136-142. Epub 2019 Feb 21.

Resident of Obstetrics and Gynecology, Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

The effect of vitamin D supplementation on growth of fetal bones during pregnancy is unclear. The aim of this study was to assess the effect of low dose vitamin D supplementation during pregnancy on bony anthropometric aspects of the fetus. In this prospective randomized trial, 140 patients were divided into two equally matched groups according to age, 25(OH)D level, exercise, and dietary intake. Then 1000 IU per day vitamin D supplement was given to the intervention group while the control group received placebo. Then crown-rump length (CRL) and femur length (FL) during the first trimester and humerus and femur lengths as well as their proximal metaphyseal diameter (PMD), midshaft diameter (MSD) and distal metaphyseal diameter (DMD) in the second and third trimester were measured using ultrasonography technique. Finally, no significant difference was observed for CRL (p = 0.93). Although FL was not statistically significant in the first trimester (p = 0.54), its measurement in the intervention group and the control group in the second (28.87 ± 2.14 vs. 26.89 ± 2.08; p ≤0.001) and the third (65.31 ± 2.17 vs. 62.85 ± 1.94; p ≤0.001) trimesters was significantly different. Femoral PMD, MSD, and DMD measurement increased more in the intervention group in comparison with the control group with P values <0.05. HL measurement in the intervention group and the control group in the second (28.62 ± 1.94 vs. 27.23 ± 2.08; p ≤0.001) and the third (61.29 ± 2.84 vs. 59.85 ± 1.79; p ≤0.001) trimesters revealed significant differences. Humeral PMD, MSD, and DMD measurement increased in the intervention group in comparison with the control group with P values <0.001 for all. It is suggested to prescribe low dose vitamin D (1000 IU per day) from early pregnancy with possible increment in length and diameter of femur and humerus bones of the fetus.
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http://dx.doi.org/10.1016/j.bone.2019.02.022DOI Listing
May 2019
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