The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization.

OBJECTIVES: Miscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage. METHODS: We conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anxiety and Depression Scale and Perinatal Grief Scale (PGS), which has three subscales (active grief, difficulty coping, and despair) and were measured before the intervention and at four-months post-miscarriage. RESULTS: The results of pre-tests in the follow-up of the trial suggested that the participants who received BSP reported significant reductions in the mean scores of active grief (-34.2±9.7 vs. 28.1±-6.9), difficulty coping (27.1±6.4 vs. 23.3±4.3), despair (28.0±8.4 vs. 22.8±5.2), and total PGS (89.6±23.1 vs. 74.4±15.3), in contrast to participants in the control group who did not report such results. Further, the results of generalized estimating equations models revealed that brief supportive psychotherapy caused a significant decrease in the level of factors including active grief, difficulty coping, despair, total perinatal grief, anxiety symptoms, and depressive symptoms in subjects in the experimental group compared to those in the control group after miscarriage. Also, the frequency of anxiety symptoms (13.5% vs. 60.5%), depressive symptoms (32.4% vs. 71.1%), and grief symptoms (10.8% vs. 65.8%) was found to be significantly lower in the group receiving psychotherapy than in the control group at four-months follow-up. CONCLUSIONS: Administration of BSP session during the first 24 hours of hospitalization for women with miscarriage can be considered a reliable method to prevent anxiety symptoms, depression symptoms, and perinatal grief at four-months follow-up.

Correlation of pregnancy outcome with quadruple screening test at second trimester.

BACKGROUND: Abnormal levels of the markers AFP, hCG, and uE3 could be useful in predicting adverse pregnancy outcomes. This study was designed to determine the correlation between second trimester maternal serum markers and adverse pregnancy outcome (APO). METHODS: In this historical cohort study, we randomly followed 231 obstetric patients with quadruple screening test in 14-18 weeks of gestation from March 2012 to March 2013 in a medical laboratory in Babol, Iran. We measured maternal serum levels of alphafetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A. The risk of adverse pregnancy outcomes (APOs) were then compared between patients with negative and positive test results. We used Chi-square and Fisher-exact tests for qualitative variables and t-test for quantitative variables. Demographic differences between the two groups were minimized by applying logistic regression. RESULTS: The risk of having an APO such as pre-eclampsia (p=0.008), fetal growth restriction (p=0.028) and premature rupture of membrane (p=0.040) increased significantly in patients with abnormal markers. CONCLUSION: Abnormal results of quadruple screening test could be associated with APO in women with normal appearing fetus.

Assessment of cervical length by transvaginal ultrasonography to predict preterm delivery in twin pregnancy.

OBJECTIVE: In singleton pregnancy, short cervix is associated with the risk of spontaneous preterm delivery (SPD). On the other hand, twin pregnancy increases rate of preterm delivery, so this study was designed to evaluate the transvaginal sonographic (TVS) measurement of cervical length (CL) to predict preterm birth in twin pregnancy. METHODS: This prospective cohort study was performed on 80 twin pregnant women whom the length and funneling of their cervix were evaluated between 22-24 gestational weeks by (TVS). They referred to us at the early signs of labor. Then the gestational age at delivery was recorded. The Fisher exact test and the odds-ratio was used to determine the association between CL and SPD. RESULTS: Thirty-four (42.5%) women had SPD. Cervical funneling happened in 7.5% of cases and SPD occurred in all women with funneling. There was a significant correlation between CL ≤ 30 mm and SPD (66.7% versus 35.5%, p = 0.029) Also, the risk of SPD was enhanced 3.6 times with CL ≤ 30 mm, CI 95% (1.1-11). CONCLUSION: We recommend TVS for assessment of CL between 22-24 weeks for prediction of SPD in twin pregnancy.

Outcomes of 19 pregnant women with brucellosis in Babol, northern Iran.

From April 2000 to March 2010, 19 pregnant women with brucellosis were evaluated, treated and followed up. Ten (53%) pregnant women had spontaneous abortions. Six of eleven (55%) women infected in the first trimester had a spontaneous abortion. After treatment, all subsequently became pregnant and gave birth to normal babies. Among 13 patients who received cotrimoxazole plus rifampin, only four (31%) aborted and nine mothers had normal term deliveries. Two patients with recurrent abortions had brucellosis and became pregnant and gave birth after treatment. The brucellosis screening program for pregnant women and those with spontaneous abortion is necessary in brucellosis endemic regions.

Mid-trimester uterine artery Doppler ultrasound as a predictor of adverse obstetric outcome in high-risk pregnancy.

OBJECTIVE: The aim of this study was to assess uterine artery Doppler ultrasonography efficiency in prediction of adverse pregnancy outcome in high-risk pregnancies. MATERIALS AND METHODS: We selected 70 pregnant women who were high risk for development of preeclampsia, abruption, low birth weight (LBW), and preterm delivery during their pregnancy, and Doppler ultrasonography was performed for them in 18-24 gestational weeks for evaluation of uterine artery notching. Absence of diastolic flow in uterine artery waves was defined as notching. The women were divided into two groups: with notching (Group A) and without notching (Group B), then they were compared for complications such as preeclampsia, abruption, LBW, and preterm delivery. RESULTS: In 70 high-risk pregnant women, 27 women (39.2%) were in Group A and the others were in Group B. The birth weight in Groups A and B was 2,897.5 ± 757.15 and 3,248.39 ± 374.27, respectively. In our study, 15 patients were delivered before 37 gestational weeks (preterm labor). Preeclampsia, abruption, and LBW were significantly higher in the group with positive notching, but preterm delivery did not show any statistical difference between the two groups. CONCLUSION: According to the results, uterine artery Doppler ultrasonography had high negative predictive value for prediction of preeclampsia, abruption, and LBW. Therefore, absence of uterine artery notching in mid-trimester evaluation of high-risk pregnant women may predict better pregnancy outcome. We recommend Doppler ultrasonography for all high-risk pregnant women in second trimester for prediction of pregnancy outcome.

Comparison of maternal and neonatal serum leptin levels in preeclampsia and normal pregnancy.

BACKGROUND: Leptin is a protein product of obesity gene and is synthesized mainly by adipose tissue. OBJECTIVE: The aim of this study was to determine maternal and neonatal serum leptin levels in term preeclamptic and normal pregnancies. MATERIALS AND METHODS: This cross sectional study was performed on 37 preeclamptic and 40 normotensive term pregnant women without other disease. Serum level of leptin was measured in all of pregnant mothers and after delivery, their neonates. This study was performed in Babol Yahyanejad Hospital from March 2006 to December 2006. RESULTS: Infants with preeclamptic mothers had significantly lower leptin level than control group (p=0.02). There was no significant difference in serum leptin levels between normal and preeclamptic women (p=0.749). CONCLUSION: According to the results, it would be concluded that leptin level in infants of preeclamptic mothers is lower than infants of normal mothers. This can only confirm the diagnosis of disease after birth but it cannot predict the preeclampsia.

Pregnancy outcome of chorionic villus sampling on 260 couples with beta-thalassemia trait in north of Iran.

Chorionic villus sampling (CVS) is a new method and its true risk of fetal loss and complications is not still clearly determined. The objective of this study was to review the clinical pregnancy outcome of transabdominal CVS (TA-CVS) performed on women with minor beta thalassemia. TA-CVS performed on 300 women with a singleton pregnancy and we could follow 213 women until delivery. Data regarding induced legal abortion, spontaneous abortion, vaginal leakage, Vaginal bleeding and deformity of extremities (limb reduction) were obtained by questionnaire in five years. All CVS were performed by one operator. The mean gestation at time of CVS was 82.4 +/- 11.3 days. 79.2% of the procedures were made between 10-13 completed weeks and in other women (20.7%) TA-CVS was performed at 13-16 weeks. The majority (86.9%) required only one puncture. There were 47 pregnancy terminations because of fetal major beta thalassemia diagnosis (18 %). The rate of spontaneous abortion in our study was over ally (1.4%) and in two patients vaginal bleeding was noticed. We didn't find any vaginal leakage and limb reduction in our survey. TA-CVS is an accurate and safe procedure in experienced hands. It should be considered as one of the safe available procedures for women who require prenatal genetic diagnosis and wish to receive earlier diagnostic information for probable termination of pregnancy.

Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy.

OBJECTIVE: The Apgar score as a proven useful tool for rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies. METHODS: This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad Hospital, which is affiliated to Babol University of Medical Sciences. Apgar score at 1 and 5 minutes after birth was taken and an umbilical cord blood gas analysis was done immediately after birth in both groups. Mothers came with a labor pain and were divided into high-risk and low risk if they have had any perinatal risk factors. Other data like gestational age, birth weight, need for resuscitation and admission to the newborn ward or Neonatal Intensive Care Unit was gathered by a questionnaire for comparison between the two groups. P-value less than 0.05 was considered being significant. FINDINGS: The gestational age and birth weight were the same in high-risk and low risk mothers. Mean umbilical artery blood pH in high-risk mothers was significantly lower than in low risk mothers (P=0.004). Mean Apgar scores at 1 and 5 minutes were significantly lower in high-risk mothers than in low risk mothers (P<0.05). According to the Kendal correlation coefficient there was no significant correlation between Apgar score at 1 and 5 minutes and umbilical cord pH in low risk group (r=0.212, P=0.1). But in high-risk group there was significant correlation between Apgar score at 1(st) and 5(th) minute and the umbilical cord pH (r=0.01, P=0.036 and r=0.176, P=0.146, respectively). CONCLUSION: Combination of Apgar score and umbilical cord pH measurement in high-risk pregnant mother could better detect jeopardized baby.