Evaluation of the Relationship Between Quantitative Ultrasound Findings and Morbidly Adherent Placenta.

Aim: The accuracy of ultrasound findings in predicting the incidence of morbidly adherent placenta has been evaluated previously. In this study, we assessed the sensitivity and specificity of different quantitative findings of color Doppler and grayscale ultrasonography in predicting morbidly adherent placenta. Material and methods: In this prospective cohort study, all pregnant women over 20 weeks of gestational age with anterior placenta and a history of previous cesarean section were evaluated for inclusion. Various ultrasound findings were measured. The non-parametric receiver operating characteristic curves, the area under the curve, and the cut-off values were assessed. Results: A total of 120 patients were ultimately included for analysis, of whom 15 had morbidly adherent placenta. The two groups were significantly different regarding the number of vessels. Based on color Doppler ultrasonography, in predicting the morbidly adherent placenta, more than two intraplecental echolucent zones with color flow had 93% and 98% sensitivity and specificity, respectively. According to grayscale ultrasonography, more than thirteen intraplacental echolucent zones had the sensitivity and specificity of 86% and 80% in predicting morbidly adherent placenta, respectively. Echolucent zone >11 mm at non-fetal surface had a sensitivity of 93% and a specificity of 66% in detecting morbidly adherent placenta. Conclusions: According to the results, the quantitative findings of color Doppler ultrasound have considerable sensitivity and specificity in detecting morbidly adherent placenta. More than two echolucent zones with color flow are recommended as the main diagnostic parameter indicating the presence of morbidly adherent placenta with a sensitivity of 93% and a specificity of 98%.

Effectiveness of postoperative oral administration of cephalexin and metronidazole on surgical site infection among obese women undergoing cesarean section: a randomized, double-blind, placebo-controlled, parallel-group study-phase III.

BACKGROUND: Cesarean section (CS) is the most frequently performed surgery in the United States. Compared to vaginal delivery, CS has a higher risk of maternal and neonatal mortality, morbidities, and complications, among which surgical site infection (SSI) is the most common. We aimed at evaluating the effectiveness of postoperative oral administration of cephalexin and metronidazole on SSI among obese women undergoing CS. METHODS: We conducted a randomized, double-blind clinical trial comparing the prophylactic effect of oral cephalexin and metronidazole vs cephalexin and placebo on SSI following CS among obese women. who had received preoperative prophylactic cephalosporin antibiotics. The study was conducted at the Ommolbanin Hospital, affiliated with Mashhad University of Medical Sciences from April 2019 to February 2020. RESULT: The participants were randomized into the intervention group (n = 210) and the control group (n = 210). At week-1 follow-up, the outcomes were significantly lower in the intervention group as compared to the control group in terms of fever (9% vs 19%, p = 0.003), abnormal discharge from the incision (serous: 8.6% vs 10.5%, purulent: 2.9% vs 16.7%, p < 0.001), incision separation (1% vs 7.1%, p = 0.001), and cellulitis (4.8% vs 13.3%, p = 0.002). At week-2 follow-up, there were no patients in the intervention group with fever, abnormal discharge from the incision, incision separation, or cellulitis and there was a statistically significant difference for fever, abnormal discharge from the incision, and incision separation between the two groups (p < 0.001, p = 0.001, p = 0.014, respectively). CONCLUSION: Post-operative administration of cephalexin and metronidazole for 48-h post-cesarean delivery among obese women, in addition to the standard pre-operative prophylaxis, reduced the overall rate of surgical site infection and wound infection symptoms in a 2-week follow-up. Trial registration The study protocol was approved by the Iranian Registry of Clinical Trials (IRCTID: IRCT20200608047685N2) on 2021-03-15.

Decellularization of human amniotic membrane using detergent-free methods: Possibilities in tissue engineering.

The human amniotic membrane (HAM) is widely used as a natural scaffold in tissue engineering due to its excellent biological characteristics, including anti-microbial, anti-inflammatory, low immunogenicity, and pro-angiogenic properties. This study aimed to develop simple and cost-effective protocols for the decellularization of HAM (d-HAM) using detergent-free methods, i.e., mechanical force (brushing) and physical treatment (heating 45-55 °C). The effectiveness of the methods of interest was compared with a chemical-based approach (EDTA + NaOH + NH4Cl). The prepared d-HAMs were characterized using a series of physico-chemical, mechanical, and biological evaluations. The results from DAPI staining revealed that the chemical method could completely remove epithelial cells from HAM, while the two other approaches only reduced the number of epithelial cells. All three decellularization methods led to a sharp reduction (P < 0.001) in the DNA content of the tissue samples (< 50 ng/mg). Histological evaluations showed the preservation of the d-HAMs' integrity along with the conservation of collagen and glycosaminoglycans (GAGs). Although the chemical method caused the lowest mechanical deterioration (3.55 MPa in ultimate tensile stress), the mechanical method preserved the highest hydroxyproline levels (3.13 mg/mL). On the other hand, the physical method (heating to 45 and 50 °C) encouraged cell proliferation more than the chemical and mechanical approaches. All of the samples proved to be suitable for cell attachment and could induce cell migration. In conclusion, the present study showed that the use of detergent-free protocols is applicable for the decellularization of HAM, and the obtained tissues may be considered as inexpensive dressings for numerous tissue engineering applications.

Clinical features and risk factors associated with acute respiratory distress syndrome in pregnant women diagnosed with COVID-19: a multi-center case-control study.

OBJECTIVES: The aim of this study was to evaluate differences in clinical features and laboratory parameters in critically ill pregnant women with acute respiratory distress syndrome (ARDS) compared to moderate and severe pregnant women with coronavirus disease-2019 (COVID-19) but without ARDS. METHODS: This was a retrospective multicenter study of all pregnant women with COVID-19 diagnosed with ARDS between February 15, and May 1, 2020 in nine level III maternity centers in Iran (ARDS group). The control COVID-19 pregnant women were selected from 3 of 9 level III maternity centers between March 15 and April 20, 2020. Univariate statistics were used to look at differences between groups. Cluster dendrograms were used to look at the correlations between clinical and laboratory findings in the groups. A value of p <.05 was considered statistically significant. RESULTS: Fifteen COVID-19 infected women with ARDS were compared to 29 COVID-19 positive and ARDS negative control (moderate: (n = 26) 89.7% and severe: (n = 3)10.3%). The mean maternal age (35.6 vs. 29.4 years; p = .002) and diagnosis of chronic hypertension (20.0% vs. 0%, p = .034) were significantly higher in the ARDS group. There was no significant difference between the two groups in their presenting symptoms. The ARDS group had a significantly higher prevalence of tachypnea (66.6% vs. 10.3%, p = .042) and blood oxygen saturation (SpO2) <93% (66.6% vs. 10.3%, p = .004) at presentation. Relative lymphopenia (lymphocyte ratio < 10.5%, 66.6% vs. 17.2%, p = .002), lymphocytes to leukocytes ratio (11.3% vs. 17.7%, p = .010), and neutrophils to lymphocytes ratio (NLR) >7.5 were significantly different between the two groups (all p < .05). CONCLUSION: Our data demonstrate that symptom-based strategies for identifying the critically ill pregnant women with SARS-CoV-2 are insufficient; however, vital signs and laboratory data might be helpful to predict ARDS in critically ill COVID-19 pregnant patients.

Affective temperaments and the risk of gestational diabetes mellitus.

OBJECTIVE: Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy. The current study aimed to investigate the possibility of a relationship between affective temperaments and GDM. METHODS: This ethically approved cross-sectional study was conducted on 120 pregnant women with impaired glucose tolerance and 120 healthy pregnant women, all of whom were admitted to hospitals affiliated with Mashhad University of Medical Sciences for delivery during 2019. Depression Anxiety Stress Scale (DASS)-21 and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto-questionnaire (TEMPS-A) were used to gather data. Mann-Whitney test was used to compare data between the two groups. A multivariate binary logistic regression model with maternal age, body mass index, and multiparity as the covariates was used to assess factors associated with GDM. RESULTS: Outcomes of TEMPS-A showed significantly higher scores of anxious and irritable temperaments in the GDM group compared to the control group (p = 0.014 and 0.023, respectively). Multivariate regression showed anxious temperament to be the sole independent predictor of GDM (odds ratio = 1.09, 95%confidence interval = 1.030-1.153; p = 0.003). DASS-21 anxiety score was also significantly higher among patients with GDM (p = 0.002). Severity of anxiety and stress according to DASS-21 was also significantly greater in patients with impaired glucose tolerance (p < 0.001 and p = 0.016, respectively). CONCLUSIONS: It is ostensible that affective temperaments, especially anxious temperament, are potentially associated with the development of GDM and impaired glucose metabolism during pregnancy.Key pointsThe association of affective temperaments with pregnancy complications has drawn compelling interest.The findings of this study showed significantly higher scores of anxious and irritable temperaments in GDM patients.GDM patients also showed significantly higher levels of anxiety compared to controls.Predominance of anxious temperament can be a potential risk factor that contributes to the development of GDM.Monitoring for GDM is especially recommended in pregnant women with predominant anxious and irritable temperaments.

Play and Learn for Surgeons: A Serious Game to Educate Medical Residents in Uterine Artery Ligation Surgery.

Objective: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality. Surgical interventions, such as uterine artery ligation and utero-ovarian arteries ligation (UAL and UOAL), are considered as effective methods to control PPH. Owing to PPH's severe outcomes, various educational tools have been developed to train surgical residents. A potential educational medium for this purpose could be serious digital games. In this pilot study, we assessed the usability and effectiveness of a serious game to promote the surgical skills of UAL/UOAL among obstetrics and gynecology (OB/GYN) residents. Methods: We designed and developed the Play and Learn for Surgeons (PLS) game to train OB/GYN residents. We assessed and compared the usability challenges of PLS before and after revising the game. To assess the effectiveness of PLS, residents were allocated randomly in control and intervention groups. Surgical skills of the residents were assessed pre- and post-test using the Objective Structured Assessment of Technical Skills checklist. Setting: This pilot study took place at the OB/GYN wards of Omolbanin Hospital (Mashhad University of Medical Sciences) and Imam Ali Hospital (Zahedan University of Medical Sciences) in Iran. Participants: Thirteen subject matter experts (nine OB/GYN experts and four senior clinical assistants) participated in the user interface design and usability assessment of PLS. Total of 46 OB/GYN residents participated in the educational effectiveness analysis of PLS. All participants were female with mean ages of 40.6, 29.9 and 28.0 years for OB/GYN experts, assistants, and residents, accordingly. Results: All participants completed the study. PLS significantly improved the skills of residents for UAL (P-value = 0.018) and UOAL (P-value <0.001) procedures. Conclusion: Serious games can be an effective and affordable approach in training OB/GYN residents for UAL and UOAL procedures. Approval number: (# IR.MUMS.fm.REC.1396.345) Trial registration number: (# IRCT2017092436366N1).

Perceived Risk in Women with High Risk Pregnancy: A Qualitative Study.

BACKGROUND: Risk perception in high-risk pregnancies influences the mothers' adherence to medical treatments and recommendations. Because of the lack of information about the women's perception of risk, the aim of this study was to explain perception of risk in high-risk pregnancies. MATERIALS AND METHODS: This qualitative study was conducted on 25 women with a high-risk pregnancy in educational hospitals of Mashhad, Iran, from August 2017 to August 2018. Data were collected through semi-structured interviews and data saturation was reached after 29 interviews. Data collection and analysis were simultaneously carried out using the qualitative content analysis method adopted by Elo and Kyngäs in MAXQDA software. RESULTS: Data analysis resulted in the four main categories of perception of risk control ability (risk controlling through experience, risk tolerance through relying on a higher power, and risk tolerance to reach family goals), wrong estimation of risk (wrong calculation of possible risks based on wrong beliefs and knowledge, and incorrect risk estimation caused by misunderstanding), possibility of mutual vulnerability of pregnancy and risk condition (possibility of vulnerability of the fetus to risk factors, and possibility of the mother's vulnerability to risk factors), and induced risk (risk induced by negative experiences, induced threat of unknown pregnancy outcome, and fear of ambiguous medical terms). CONCLUSIONS: The results of this study promoted our understanding of risk perception in women with high-risk pregnancies. Therefore, it will help to establish a-Z better link between women with a high-risk pregnancy and the health team, enhance and improve maternal and fetal care.

Clinician's and women's perceptions of individual barriers to vaginal birth after cesarean in Iran: A qualitative inquiry.

BACKGROUND: High rate of repeat cesarean section and its complications are the results of cesarean tsunami in the last two decades in Iran. Vaginal birth after cesarean (VBAC) is an important alternative for repeat cesarean. However, the rate of VBAC in Iran is very low subject to some organizational and individual barriers is very low. This study explored the clinician's and women's perceptions of individual barriers to achieve VBAC. METHODS: In this conventional content analysis, 28 semi-structured interviews and one focus group discussion was conducted with health care providers including gynecologists, midwives and family physicians as well as prior cesarean section mothers attended one of the women's hospitals in Mashhad, Iran in 2017. Participants were selected through purposive sampling considering the strategy of maximum variation. Data were analyzed according to Graneheim and Lundman (2004) method using MAXQDA.10 software. RESULTS: The theme of "obstacles to acceptance and committed actions" emerged from two categories of "psychological barriers" and "operational barriers". Psychological barriers included 'sense of danger", "financial displeasure" and "negative attitude"; whereas, operational barriers consisted of 'barriers to decision making' and 'indolence'. CONCLUSION: Improving women's attitude via maternity care promotion, creating supportive environment, informing mothers about choice of birth mode and empowering them in shared decision making could influence women's VBAC request. Also organizing VBAC care team and creating motivations in medical team and hospital directors through reporting of research project outcomes on safety and benefits of VBAC could affect the VBAC rate.

Knowledge Valuation by Iranian Women with High-Risk Pregnancy: A Qualitative Content Analysis.

BACKGROUND: Gaining adequate knowledge about high-risk pregnancy (HRP) and correct understanding of the condition, empowers women to improve the use of prenatal care, practice better self-care, and reduce the risk of pregnancy complications. The present study aimed to assess the valuation of knowledge by Iranian women with HRP. METHODS: The present qualitative study was conducted on 25 women with HRP from August 2017 to August 2018 at various educational hospitals in Mashhad, Iran. The data were collected through in-depth semi-structured interviews. The data collection process continued until data saturation. The data were analyzed using the conventional content analysis method and MAXQDA software (version10.0). Data collection and data analysis were conducted concurrently. RESULTS: Based on the analysis of the interviews, two main categories and eight sub-categories were extracted. The main categories were "Positive valuation of credible problem-relevant knowledge" and "Avoidance of misleading and stressful information". The results showed that various factors had a positive impact on knowledge gathering, namely personal and other people's experiences, obtaining need-based information, sympathetic advice from others, and faith-based health recommendations. On the other hand, factors that had a negative impact were related to the type of information that caused stress, was unreliable, inefficient or incompatible with personal goals. CONCLUSION: The findings of the present study would help health care providers to offer suitable and empathetic counseling to women with HRP. Providing valid and accessible sources of information will lead to faster and timely referrals of such patients.

Health Care System Barriers to Vaginal Birth after Cesarean Section: A Qualitative Study.

BACKGROUND: Approximately half of mothers give birth by cesarean section in Iran and two-thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strategy but its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBAC in health care system. MATERIALS AND METHODS: In this qualitative study, 26 semi-structured individual interviews with maternity care providers and mothers with prior cesarean section as well as one focus group discussion with maternity care providers were conducted. Interviews and focus group discussions were tape-recorded, transcribed verbatim and analyzed with conventional content analysis developed by Graneheim and Lundman using MXQDA10 software. RESULTS: Barriers to VBAC in health care system identified in the main category of "the climate of restriction, fear and discourage" and eight subcategories including: "defective access to specialized services," "insufficient encouragement system," "modeling in cesarean section," "physician-centeredness in VBAC," "fear of legal responsibilities," "imposed policies," "marginalization of midwives," and "unsupportive birth team." CONCLUSIONS: To remove barriers of VBAC in health care system, appropriate strategies including establishment of specialized VBAC counseling centers, performance-based incentive policies, cultural development and promotion of natural childbirth, promoting of teamwork culture, shared decision making, improvement of knowledge and skills of maternal care providers and implementation of clinical guidelines, should be considered. Future research could be focused on the effect of implementing these strategies to decrease repeat cesarean section rate.

Is gestational hypertension associated with affective temperaments?

Objective: Gestational hypertension (GH) is an important pregnancy complication. Sparse studies have shown a correlation between this complication and psychological disorders in patients. In this study, we aimed to assess the possible association between affective temperaments and GH.Methods: This cross-sectional study was conducted on women with GH hospitalized in hospitals affiliated with Mashhad University of Medical Sciences, compared with healthy women admitted for normal delivery in the same centers during the study. Data were collected via Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A) and Depression Anxiety Stress Scale (DASS) 21.Results: TEMPS-A revealed that scores anxious (P < 0.001) temperament was significantly higher in GH patients than in controls. Anxious temperament scores ≥9 were independently associated with GH (odds ratio = 2.768, 95% confidence interval = 1.586-4.832; P < 0.001). Moreover, the mean depression, anxiety, and stress scores in DASS-21 were significantly higher in the GH patients compared with controls (P = 0.014, P < 0.001, P < 0.001, respectively).Conclusion: Affective temperaments, particularly anxious temperament, can be potentially involved in the development of GH and its cardiovascular risk during pregnancy.

Measurement Model of Women's Preferences in Obstetrician and Gynecologist Selection in the Private Sector: Exploratory and Confirmatory Factor Analysis.

BACKGROUND: The purpose of this study is to construct and validate a measurement model of women's preferences in Obstetrician and Gynecologist (OB/GYN) selection in the private sector of non-clinical parameters. METHODS: This methodological study included 462 respondents in OB/GYN's offices to a researcher-made questionnaire. The patients visited 57 offices of OB/GYNs in the city of Mashhad in Iran and completed women's preferences in OB/GYN selection questionnaire over a 2-month period from January to February 2018. Exploratory Factor Analysis (EFA) was conducted to verify the instrument's construct validity. Confirmatory Factor Analysis (CFA) was used to test whether the data fit our hypothesized model obtained from EFA model. RESULTS: The first draft of the questionnaire was prepared with 118 items based on literature review. The outcome of content validity assessment was a 51-item questionnaire. Scale-Content Validity Index (S-CVI) turned out to be 0.80. The results of EFA yielded an instrument with 33 items in six domains, which explained 52.657% of the total variance of the questionnaire. With performing CFA, the 6-factor model with 29 items demonstrated a good fit with the data (CFI=0.952, CMIN/DF=1.613, RMSEA=0.036). Availability and Accessibility, Communicational Skills, Office Environment, Recommendation by Others, Special Services, and Cost and Insurance were found to define the women's preferences in OB/GYN selection in private sector, Iran. CONCLUSION: The developed measurement model considers the patient's preferences that influence decision-making process on OB/GYN selection. It can provide useful knowledge for OB/GYNs and policymakers to design appropriate and efficient marketing strategies according to the consumer preferences priority.

The Effect of Acupressure on the Severity of Nausea, Vomiting, and Retching in Pregnant Women: A Randomized Controlled Trial.

INTRODUCTION: Nausea and vomiting are common problems during pregnancy. Previous studies have shown that stimulation at Neiguan (PC6) acupoint can be effective in controlling pregnancy-induced nausea and vomiting. However, more evidence is required for approving this method on controlling pregnancy-induced nausea and vomiting. The aim of this study was to determine the efficacy of PC6 acupoint pressure stimulation on the severity of nausea, vomiting, and retching in pregnant women. METHOD: This randomized, multi-center clinical trial was conducted on pregnant women referring to Health Centers and Ommolbanin Hospital in Mashhad, Iran, during December 2016 to September 2017. Women with first singleton pregnancy and below 12 weeks were included. Patients were randomly allocated into three groups of (1) PC6 pressure (4 times a day, for 10 min), (2) sham acupressure, and (3) medication with vitamin B6 and metoclopramide. Assessment of severity of nausea, vomiting, and retching was done based on the Rhodes Index on the first and fifth day (before and after the intervention). Pearson chi-square test, one-way ANOVA, Kruskal-Wallis, and Wilcoxon tests were used for statistical analysis using SPSS version 18. This clinical trial was registered at the Iranian Registry of Clinical Trials (IRCT) with the code IRCT201512187265N6. RESULTS: Ninety patients with a mean age of 26.40 ± 4.73 years were studied in 3 groups of 30. There was no significant difference between the 3 groups in terms of the severity outcomes before the intervention, while, after the intervention, the three groups were significantly different on the fifth day in terms of vomiting frequency, distress from retching, distress from vomiting, duration of nausea, distress from nausea, amount of vomiting, frequency of nausea, and frequency of retching (p < 0.001 for each outcome). According to the linear regression analysis, the correlation between occupation with vomiting frequency (beta coefficient = 0.252) and nausea severity (beta coefficient = -0.213) was statistically significant. CONCLUSION: It seems that PC6 acupoint pressure can reduce the severity of nausea, vomiting, and retching in pregnant women.

A Survey of Venous Thromboembolism (VTE) Prophylaxis in Obstetrics Patients in Iran.

Objective: The purpose of the present study was a survey of venous thromboembolism (VTE) prophylaxis in obstetrics patients in Iran. Materials and methods: A national, multicenter, non-interventional, prospective study was performed on 1000 women at 11 different parts of Iran. Primary outcome was to assess the situation of VTE prophylaxis in pregnant and postpartum women and the secondary outcome was risk stratification in obstetrics patients and to evaluate the guideline adherence in physician's practice of VTE prophylaxis. Results: 1,036 women entered the final analysis. The three main VTE risk factors before hospitalization were BMI > 30 kg/m2, history of oral contraceptive (OCP) use, and the age over 35.VTE risk factors upon enrollment were detected in 780 (75.28%) patients. 219 women (28.07%) were deemed eligible for drug prophylaxis, however, only 37 women (17%) received it. A total of 113 (10.9%) patients received VTE prophylaxis, of which 76 (67.25%) women had no clear indications. Concordance between theory and practice was detected with a Cohen's Kappa coefficient to be 0.74 (p < 0.001), which fell within "good agreement". Multivariate analysis for association between VTE prophylaxis and VTE risk factors showed that history of VTE [OR = 9.06 (CI 95% 1.16 - 70.8) p = 0.036] was the most frequent risk factor for receiving VTE prophylaxis followed by obesity (BMI > 30 Kg/m2); [OR = 3.74 (CI 95% 1.79 - 5.69), p = <0.001], multiple pregnancy [OR= 2.81 (CI 95% 1.70 - 4.64), p = < 0.001] and age > 35 years; [OR =1.09 (CI 95% 0.82 - 1.21), p = 0.026]. Varicose Veins [OR= 0.22 (CI 95% 0.56 - 0.87), p = 0.031], PROM / PPROM [OR= 0.33 (CI 95% 0.12 - 0.91), p = 0.032] and history of using OCP [OR= 0.36 (CI 95% 0.24 - 0.53), p = < 0.001] were the most missed risk factors for receiving VTE prophylaxis respectively. Conclusion: History of VTE, obesity, multiple pregnancy and age > 35 years were the most frequent risk factors for receiving VTE prophylaxis and varicose veins, PROM / PPROM and history of using OCP were the most missed risk factors for receiving VTE prophylaxis.

A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE).

One of the most common causes of fetal anemia is red cell alloimmunization. The standard treatment in fetuses with anemia is intrauterine transfusion (IUT); but this approach may have adverse effects, or sometimes it is not available or even possible. Therefore, immune modulating approaches such as therapeutic plasma exchange (TPE) and the use of intravenous immunoglobulin should be implemented to avoid or delay IUT. We report here the successful management of a case of D alloimmunization in pregnancy solely with TPE, without the need for IUT. The patient was a 33-year-old G4, L2, and D1, who had a history of alloimmunization in her previous pregnancy. TPE was initiated at 17 weeks gestation and was repeated weekly. Altogether, 20 times of plasma exchange were performed and a normal fetus was delivered at week 37.

Emotional and Cognitive Experiences of Pregnant Women Following Prenatal Diagnosis of Fetal Anomalies: A Qualitative Study in Iran.

BACKGROUND: Pregnant women are often ill-prepared for the health of their unborn child in the case of abnormal findings, and experience several difficulties following the detection of fetal anomalies. Therefore, this study was conducted to explore the emotional and cognitive experiences of pregnant women following prenatal diagnosis of fetal anomalies in Mashhad, Iran. METHODS: This qualitative conventional content analysis study was designed through two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual semi-structured in-depth interviews, from 25 pregnant women with a prenatal diagnosis of fetal anomalies. RESULTS: Four categories and 10 subcategories emerged. Category one, grief reactions during the time of diagnosis, contained two subcategories: shocked and panicked, and distressed and disbelieved.Category two, perinatal loss through a pregnancy termination, contained four subcategories: guilt and shame during pregnancy termination, loss of their expected child, suffering and emotional distress process, and unmet needs by health professionals. Category three, fears of recurrence in future pregnancies, had two subcategories: worried about inadequate prenatal care in the future pregnancies and worried about abnormal fetus in next pregnancies. Finally, Category four, a dilemma between hope and worries contained two subcategories: hope for normality and worried about future. CONCLUSION: It is important to monitor emotional reactions of women following prenatal anomaly diagnosis. So, training clinicians and health-care professionals for proper response to grief reaction in post therapeutic abortion is essential.

Diagnosis of Acute Toxoplasmosis by IgG and IgM Antibodies and IgG Avidity in Pregnant Women from Mashhad, Eastern Iran.

BACKGROUND: We aimed to evaluate the diagnosis of acute toxoplasmosis by IgG avidity test in pregnant women. METHODS: In this cross-sectional study, 250 blood samples were collected from pregnant women with the first month of their pregnancy referring to health centers of University in Mashhad during 2016. Samples were centrifuged at 3000 rpm for 5 min for separation of serum and were kept in the -20 until use. To detection of acute and chronic toxoplasmosis, anti-Toxoplasma antibodies (IgG and IgM, and IgG avidity tests were performed using ELISA. Then, data analyzed using SPSS software by Frequency, Pearson Chi-Square, Likelihood Ratio, and Exact tests. And P<0.05 was statistically considered as significant. RESULTS: Total prevalence of IgG and IgM was 23.2% and 7.2%, respectively. A significant correlation was observed between the mean age and IgG level (P<0.05). It was not found any correlation between the history of raw meat consumption, cats keeping, education, and residency site. Moreover, 16 people (6.4%) had IgM antibody, of which, 10 cases (62.5%) with low avidity for IgG and 1 people (6.2%) with moderate avidity and 5 cases (31.3%) with high avidity for IgG. Moreover, 76% of pregnant women were seronegative. CONCLUSION: More than half of the women (62.5%) with positive IgM antibody in their serum had a low avidity for IgG which revealed an acute infection among pregnant women. Toxoplasma infection should be considered as an important factor that affects the pregnancy and IgG avidity as an important test for screening the women who need the treatment.

Biallelic variants in KIF14 cause intellectual disability with microcephaly.

Kinesin proteins are critical for various cellular functions such as intracellular transport and cell division, and many members of the family have been linked to monogenic disorders and cancer. We report eight individuals with intellectual disability and microcephaly from four unrelated families with parental consanguinity. In the affected individuals of each family, homozygosity for likely pathogenic variants in KIF14 were detected; two loss-of-function (p.Asn83Ilefs*3 and p.Ser1478fs), and two missense substitutions (p.Ser841Phe and p.Gly459Arg). KIF14 is a mitotic motor protein that is required for spindle localization of the mitotic citron rho-interacting kinase, CIT, also mutated in microcephaly. Our results demonstrate the involvement of KIF14 in development and reveal a wide phenotypic variability ranging from fetal lethality to moderate developmental delay and microcephaly.

Induction of labour in term premature rupture of membranes; oxytocin versus sublingual misoprostol; a randomised clinical trial.

Premature rupture of the membranes (PROM) occurs in about 8-10% of pregnancies and its most important complication is chorioamnionitis, so labour induction has an important role in this situation. This study was performed to compare oxytocin and sublingual Misoprostol for labour induction in PROM cases with term pregnancy. A total of 270 pregnant women who had spontaneous rupture of membrane and unripe cervix were enrolled. The first group underwent Oxytocin infusion according to low-dose standard protocol and the second group received 25 µg sublingual Misoprostol every 4 h. Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in misoprostol group (p < .05). Although, some maternal side-effects were significantly higher in misoprostol group (p < .001), but 5 minute Apgar score was significantly better in this group. In conclusion, sublingual misoprostol was associated with better neonatal outcomes was more effective than oxytocin for labour induction in PROM cases. Impact statement What is already known on this subject: PROM occurs in about 8-10% of pregnancies; about 60% of these cases are term pregnancies. Most experts recommend early induction of labour in term PROM cases with an eye towards avoiding increased morbidity and mortality. Oxytocin is the most frequently used agent that is administered intravenously for the purpose of labour induction. Misoprostol is an alternative to oxytocin and is simpler to use, as it is administered via the oral, buccal, sublingual, rectal and vaginal routes rather than intravenously. What do the results of this study add: Time interval from induction to the beginning of active phase of labour was similar in both groups. Second stage of labour was significantly shorter in the misoprostol group. Although, some maternal side-effects were significantly higher in misoprostol group, the 5 minute Apgar score was significantly better in this group. What are the implications of these finding for clinical practice and/or further research: Sublingual misoprostol for induction of labour in PROM cases is more effective than oxytocin and its neonatal outcomes are better. Due to its easy prescription and better labour outcomes, sub lingual misoprostol may be a better choice for labour induction in PROM cases.

A Data Model for Teleconsultation in Managing High-Risk Pregnancies: Design and Preliminary Evaluation.

BACKGROUND: Teleconsultation is a guarantor for virtual supervision of clinical professors on clinical decisions made by medical residents in teaching hospitals. Type, format, volume, and quality of exchanged information have a great influence on the quality of remote clinical decisions or tele-decisions. Thus, it is necessary to develop a reliable and standard model for these clinical relationships. OBJECTIVE: The goal of this study was to design and evaluate a data model for teleconsultation in the management of high-risk pregnancies. METHODS: This study was implemented in three phases. In the first phase, a systematic review, a qualitative study, and a Delphi approach were done in selected teaching hospitals. Systematic extraction and localization of diagnostic items to develop the tele-decision clinical archetypes were performed as the second phase. Finally, the developed model was evaluated using predefined consultation scenarios. RESULTS: Our review study has shown that present medical consultations have no specific structure or template for patient information exchange. Furthermore, there are many challenges in the remote medical decision-making process, and some of them are related to the lack of the mentioned structure. The evaluation phase of our research has shown that data quality (P<.001), adequacy (P<.001), organization (P<.001), confidence (P<.001), and convenience (P<.001) had more scores in archetype-based consultation scenarios compared with routine-based ones. CONCLUSIONS: Our archetype-based model could acquire better and higher scores in the data quality, adequacy, organization, confidence, and convenience dimensions than ones with routine scenarios. It is probable that the suggested archetype-based teleconsultation model may improve the quality of physician-physician remote medical consultations.