Publications by authors named "Maryam Kasraeian"

45 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

Assessment of educational intervention and Acupressure during labor on the mother's anxiety level and arterial oxygen pressure of the umbilical cord of infants (PO2). A randomized controlled clinical Trial.

J Educ Health Promot 2022 23;11:86. Epub 2022 Mar 23.

Department of Midwifery, Maternal-Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Science, Shiraz, Iran.

Background: Natural delivery is distressing, and the mother's anxiety in this condition can have negative impacts on the fetus, mother, and the delivery process. Hence, many women tend to use pharmacological or nonpharmacological methods for reduction of labor stress and anxiety. The aim was to assess the effect of supportive care and acupressure during labor on the mother's anxiety level and arterial oxygen pressure of the umbilical cord of infants.

Materials And Methods: This performed on 150 pregnant women were randomly assigned to two interventions and a control group in the delivery ward of the selected educational center of Shiraz University of Medical Sciences (Shoushtari Hospital) in Iran. Mothers' anxiety scores before (beginning of the active stage of labor) and after intervention (the end of the first stage of labor) were measured using Spielberger's questionnaire. Then, infants' cord blood samples for arterial blood gas and hematologic analyses were sent to the hospital's laboratory. After all, the data with SPSS version 16 and using Pearson's correlation coefficient, one-way ANOVA, were analyzed.

Results: The mean of anxiety score in the control group was 21.1% and in the supportive group and the acupressure group, respectively, decreased by 37.5% and 34.8%, respectively ( < 0.001). The mean of PO was also reported in the maternal supportive, acupressure, and control groups, 40.4 ± 8.8, 27.4 ± 2.8, and 18.1 ± 3.7, respectively. Additionally, a significant correlation was found between mothers' anxiety scores after the intervention and the mean of PO ( = 0.014).

Conclusion: The supportive care and acupressure at BL32 acupoint reduced mothers' anxiety and consequently improved fetal oxygenation. Therefore, these methods are recommended to be used during labor for improving birth outcomes.
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http://dx.doi.org/10.4103/jehp.jehp_685_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9093657PMC
March 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

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

J Obstet Gynaecol 2021 Sep 24:1-6. 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
September 2021

Complex Twisted Knots of Umbilical Cord in a Monochorionic-Diamniotic Twin Gestation: A Case Report.

Galen Med J 2020 16;9:e1878. Epub 2020 Sep 16.

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

Background: True knots and tight loops of umbilical cord can cause serious fetal complications in monochorionic-monoamniotic twins but are usually unexpected in Monochorionic-diamniotic twins because of the presence of the intertwin membrane. This report presents a case of monochorionic-diamniotic twin gestation with a complex cord knots.

Case Report: A 31-year-old G2Ab1 with monochorionic-diamniotic twin pregnancy in the gestational age of 30 weeks presented with ruptured membrane since 3weeks before delivery. At the delivery time, multiple umbilical cord knots was found.

Conclusion: Premature ruptured membrane can cause septostomy of the intertwin membrane, multiple umbilical cord knots and its complications. Therefore, these cases should be considered for evaluation of the presence of intertwin membrane and umbilical cord knots in each sonography examination.
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http://dx.doi.org/10.31661/gmj.v9i0.1878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343711PMC
September 2020

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

Antioxidant ameliorative effect of caffeic acid on the ectopic endometrial cells separated from patients with endometriosis.

Taiwan J Obstet Gynecol 2021 Mar;60(2):216-220

Biochemistry Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: Considering the role of oxidative stress in the development and progression of endometriosis, the ameliorative effect of caffeic acid treatment on ectopic, eutopic endometrial cells enzyme activities was investigated. We also determined the underlying cellular mechanisms.

Materials And Methods: Ectopic endometrial specimens were collected from women with confirmed cases of endometriosis (n = 10) and eutopic specimens from (n = 10) controls. Following endometrial cell isolation and culture, eutopic and ectopic endometrial cells were treated with caffeic acid. Then, reactive oxygen species (ROS) level, NAD(P)H quinone oxidoreductase 1 (NQO1), and Heme oxygenase 1 (HO-1) enzyme activities, nuclear factor erythroid 2-related factor 2 (Nrf-2) gene expression were measured.

Results: In ectopic endometrial cells, caffeic acid caused a significant elevation in Nrf-2 gene expression level, NQO1, and HO-1 enzyme activities. In addition, reduced ROS level was observed in caffeic acid-treated ectopic endometrial cells in comparison with the control. On the contrary, we did not observe any significant changes in caffeic acid-treated eutopic endometrial ones.

Conclusion: Caffeic acid can protect the endometrial cells against oxidative stress and might be able to prevent the progression of endometriosis and its related complications, such as pain and infertility.
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http://dx.doi.org/10.1016/j.tjog.2020.12.003DOI Listing
March 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

In utero xenotransplantation of mice bone marrow-derived stromal/stem cells into fetal rat liver: An experimental study.

Int J Reprod Biomed 2020 Sep 20;18(9):701-712. Epub 2020 Sep 20.

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

Background: Animals can play an important role in preparing tissues for human through the development of xenotransplantation protocols. The most common problem with liver transplantation like any other organ transplantation is organ supply shortage.

Objective: To evaluate the in utero xenotransplantation of mouse bone marrow-derived stromal/stem cells (BMSCs) to the liver of rat fetus to produce mouse liver tissue.

Materials And Methods: BMSCs were isolated and confirmed from enhanced green fluorescent protein (eGFP)-genetic labeled mice. Using a microinjection protocol, mice BMSCs were injected into the liver of rat fetuses in utero on day 14 of pregnancy. After birth, livers were collected and the presence of mice eGFP-positive cells in rat livers was evaluated through polymerase chain reaction.

Results: The eGFP mRNA was detected in the liver of injected infant rats. BMSCs of adult mice were capable to remain functional probably as hepatocyte-like cells in liver of infant rats after in utero xenotransplantation.

Conclusion: BMSCs have the potential for intrauterine xenotransplantation for the treatment of liver dysfunction before birth. This method can also be used for xenoproduction of liver tissue for transplantation.
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http://dx.doi.org/10.18502/ijrm.v13i9.7665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521162PMC
September 2020

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

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

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

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

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

The effect of aromatherapy on mental, physical symptoms, and social functions of females with premenstrual syndrome: A randomized clinical trial.

J Family Med Prim Care 2019 Sep 30;8(9):2990-2996. Epub 2019 Sep 30.

Department of Midwifery, Maternal - Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: This study was designed to compare the effect of aromatherapy with Rosa Damascena and Citrus Aurantium blossom on psychological and physical symptoms and social functions of females with premenstrual syndrome.

Materials And Methods: This double-blind clinical trial was conducted on 95 students. They were randomly divided into three aromatherapy groups (aromatherapy with 4% concentration of Rosa Damascena and 0.5% concentration of Citrus Aurantium blossom essential oil) and aromatherapy with sweet almond oil (as control group). Premenstrual Symptoms Screening Tool questionnaire (PSST) was completed before and during the first and second month of the intervention. Data were analyzed by SPSS software version 22.

Results: After intervention, the scores of mental symptoms decreased in all three groups and this decrease was significant in both Citrus Aurantium ( = 0.004) and Rosa Damascena groups ( = 0.007). The score of physical symptoms was decreased in all three groups but it was significant only in the Rosa Demecensa group ( = 0.042). The reduction of effect of symptoms on social function was observed in two intervention groups which were significant only in Rosa Damascena group ( < 0.001).

Conclusion: Essential oils of Rosa Damascena and Citrus Aurantium were both effective in improving the symptoms of premenstrual syndrome but the effect of Rosa Damascena, with regard to improvement of symptoms of premenstrual syndrome was more than that of Citrus Aurantium in all psychological, physical, and social aspects.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_452_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6820386PMC
September 2019

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

Combination Effect of Caffeine and Caffeic Acid Treatment on the Oxidant Status of Ectopic Endometrial Cells Separated from Patients with Endometriosis.

Iran J Med Sci 2019 Jul;44(4):315-324

Biochemistry Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Endometriosis is a common gynecological disease in which oxidative stress is a potential factor. Caffeine and caffeic acid are present in various foods and beverages with anti-oxidant, anti-inflammatory, and anti-carcinogenic properties. In this study, we aimed to investigate the ameliorative effects of caffeine, caffeic acid, and caffeine+caffeic acid treatments on oxidative stress in ectopic endometrial cells taken from patients and eutopic ones from women without endometriosis.

Methods: In this experimental study, eutopic and ectopic endometrial cells were obtained from biopsies of women free of disease (n=10) and patients with endometriosis (n=10) who referred to Shiraz reference hospitals (2017-2018). Both eutopic and ectopic endometrial cells were divided into four groups: Treated with caffeine, with caffeic acid, with caffeine+caffeic acid, and the control. Also, antioxidant enzyme activities and the levels of glutathione (GSH) and malondialdehyde (MDA) were determined in each group. The data were analyzed using independent sample t test and one-way ANOVA followed by Tukey post-hoc test.

Results: Caffeic acid, but not caffeine treatment demonstrated a decrease in MDA level (P<0.001) as well as an increase in GSH level (P<0.001) and antioxidant enzyme activities in ectopic endometrial cells. Also, the treatment of the cells with caffeine+caffeic acid caused similar effects as those ectopic cells treated with caffeic acid.

Conclusion: According to the findings of the present study, caffeic acid reduced oxidative stress which may alleviate the complications associated with endometriosis. However, more investigations are needed for evaluating the efficiency and safety of caffeic acid.
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http://dx.doi.org/10.30476/IJMS.2019.44970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661517PMC
July 2019

Development and Pilot Testing of a Mobile Based Patient Decision Aid for Childbirth Decision Making.

Stud Health Technol Inform 2019 ;261:223-229

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

Introduction: Patient Decision Aids (PtDA) facilitates Shared Medical Decision-Making (SDM). This study aims to facilitate the childbirth decision-making process by a decision aid mobile application.

Method: The model development process for decision aids was used and a master group supervised it. The assessment of study was made by a face-to-face interview and prototype was also developed for it. Then Alpha test was performed with 10 pregnant women and 10 experts. 60 pregnant women and 9 clinical professionals participated in a beta test.

Result: The modules of our PtDA consisted of health record, decision aid, educational content, frequently asked questions and help. The result of alpha test revealed that this system had high usability. After increasing intervention, the intervention group had more knowledge of women in comparison with the control group. Moreover, the reduction of decisional conflict in the intervention group was statistically significant compared with the control group. In addition, the preference for women was changed from cesarean section (CS) to vaginal delivery in the intervention group. In the beta test, the result of the ultimate usability evaluation showed that this system was usable and easy.

Conclusion: According to the results, it seems that PtDAs can be effective for empowering women in order to choose the mode of delivery.
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September 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

Evaluation of serum biomarkers for detection of preeclampsia severity in pregnant women.

Pak J Med Sci 2018 Jul-Aug;34(4):869-873

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

Objectives: To determine serum biomarkers in detection of preeclampsia severity among pregnant women.

Methods: Among 450 pregnant women with various severity of preeclampsia, serum biomarkers ofaspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), hemoglobin (Hb), platelet count (PLT), uric acid, direct bilirubin, total bilirubin, creatinine, and alkaline phosphatase were compared using area under the Receiver operating characteristic (ROC) curve and Area Under the Curve (AUC).

Results: The mean age of women was 30.63±6.43 years and with mean gestational age of 34.69±3.97 weeks. The mean level of LDH, ALT, uric acid, and creatinine were significantly higher in the women with severe type of preeclampsia compared to those with mild type. LDH level had ROC and AUC of more than 0.80, with highest sensitivity, and moderatespecificityin comparison to other markers.

Conclusion: Biomarkers such as ALT, uric acid, and LDH were shown to be prognostic in detection of theseverity of preeclampsia. LDH was demonstrated to significantly be a better prognostic test in detection of preeclampsia severity.
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http://dx.doi.org/10.12669/pjms.344.14393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115551PMC
September 2018

Double-blind randomized placebo-controlled trial on efficacy and safety of Lactuca sativa L. seeds on pregnancy-related insomnia.

J Ethnopharmacol 2018 Dec 30;227:176-180. Epub 2018 Aug 30.

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

Ethnopharmacological Relevance: There is limited evidence about the role of herbal and traditional medicine in pregnancy-related insomnia. Extant documents on traditional Persian medicine refer to many plants which could induce sleep and which were used by pregnant women. In Iran, local herbal shops continue to provide these herbs to pregnant women to treat insomnia. One such herb is Lactuca sativa L. The aim of this study was to evaluate the effects of lettuce seed on pregnant women for the treatment of insomnia.

Methods And Materials: In a prospective randomized clinical trial, 100 pregnant women with insomnia aged 20-45 years were assigned to receive capsules containing 1000 mg of lettuce seed or a placebo daily for two weeks. The main outcome was the quality of sleep, which was measured using the Pittsburgh Sleep Quality Index (PSQI).

Results: Each group contained 50 participants. An improvement in the PSQI score was significantly greater in patients receiving lettuce seed than those receiving the placebo. Linear regression analysis showed that, after controlling for the other variables, the average sleep score of the experimental group was significantly lower than for the placebo group (p = 0.03).

Conclusions: The findings of this study suggest that lettuce seed decreased insomnia during pregnancy and could be recommended as a safe natural remedy for treatment of pregnancy-related insomnia.
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http://dx.doi.org/10.1016/j.jep.2018.08.001DOI Listing
December 2018
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