Effect of misoprostol with and without evening primrose (Oenothera biennis) on induction of missed abortion.

Objective: To determine whether addition of evening primrose to a misoprostol-based abortion regimen can increase the success of abortion. Materials and Methods: In this randomized clinical trial., 148 women referring to Niknafas Hospital in Rafsanajn with diagnosis of missed abortion were randomly allocated into two 74-subject groups. The intervention group used 2000 mg vaginal evening primrose capsules the night before the hospitalization, while the control group did not receive any medication. Both groups received an initial dose of 800 µg of vaginal misoprostol after admission and the next dose was given three hours later if necessary. Results: The two groups had significant differences in terms of full abortion, consistency and dilatation of cervix, duration between the first dose of misoprostol until the ejection of fetus, the misoprostol dose administered, and the level of vaginal bleeding during the hospitalization. They had no significant differences regarding curettage, duration of hospitalization, or side effects. The mean pain score had no significant difference between the two groups, though the score was lower in the intervention group (p>0.05). Conclusion: Administration of vaginal evening primrose before vaginal misoprostol was found to be more effective compared to misoprostol alone in missed abortion.

Anesthesia technique and serum cytokine concentrations in the elective cesarean section.

BACKGROUND: Anesthesiologists should obtain the best technique for cesarean section (CS). This study designed to compare the effect of general anesthesia (GA) and spinal anesthesia (SA) on immune system function in elective CS. MATERIALS AND METHODS: This descriptive study was performed on forty candidates for elective CS. They were randomly divided into GA and SA groups. The serum concentrations of interleukin (IL)-4, IL-6, IL-10, and IL-17 and interferon-gamma (IFN-γ) were measured using ELISA method prior to anesthesia (T0), immediately after the uterine incision (T1), 2 h post CS (T2), and 24 h post CS (T3). Data were analyzed using descriptive statistics and Chi-square, independent t-test, and repeated measures. RESULTS: No significant differences were observed between the GA and SA groups regarding the serum levels of IL-4, IL-6, IL-10, IL-17, and IFN-γ. The serum levels of transforming growth factor beta (TGF-ß) in the SA group were significantly (P = 0.003) more than that of the GA group at T3. CONCLUSION: According to the angiogenesis properties of TGF-ß, it seems that SA probably affects the rate of recovery more than that of the GA.

The effect of walking during late pregnancy on the outcomes of labor and delivery: A randomized clinical trial.

BACKGROUND: Exercising during pregnancy has various benefits for the mother and the fetus, but there are controversial results about its effect on labor and delivery. Therefore, the present study was conducted to evaluate the effect of walking during late pregnancy on the outcomes of labor and delivery. MATERIALS AND METHODS: The present randomized clinical trial was conducted on 102 pregnant women who were referred to the comprehensive health service centers of Rafsanjan and were selected using convenient sampling method and randomly were allocated into two groups from August 2018 to February 2019. The intervention group performed walking from the 34th week of pregnancy until the time of delivery 4 times per week, each time for 40 min. The control group just received the routine prenatal care. Information about the outcomes of delivery were gathered from the participants' medical files in the hospital and were analyzed using SPSS software version 22 and Chi-square and independent t-tests. RESULTS: The results indicated that the Bishop score of the intervention group was significantly higher than the control group (P < 0.05). Furthermore, regarding the duration of the third phase of delivery, spontaneous labor, induced labor, cesarean section , and instrumental delivery, a statistically significant difference was observed between the intervention and the control groups (P < 0.05). There was no statistically significant difference between both the groups regarding the duration of the first and the second stages of delivery and Apgar score at 1st and 5th min (P > 0.05). CONCLUSIONS: Walking during late pregnancy could improve Bishop score, increase spontaneous onset of labor, and decrease induction, cesarean, and instrumental delivery without having any adverse effect on the neonate's Apgar score.

Effect of Different Anesthetic Techniques on Cytokine Gene Expression in Patients who Underwent Elective Cesarean Section.

Cesarean section (CS) is an important challenge for a pregnant woman and her newborn. The most common anesthesia techniques used for CS are general anesthesia (GA) and spinal anesthesia (SA). This study was designed to compare the modulation of genes whose expression level is indicative of the immune system following exposure to GA and SA. The present study was performed on 40 women who were scheduled for elective CS receiving GA or SA. The expression levels of the relative mRNA of Interleukin (IL)-4, IL-6, IL-10, IL-17, Interferon (IFN)-γ, and tumor growth factor (TGF)-ß before anesthesia (T0) and 24 hours post-anesthesia (T1) were analyzed by real-time polymerase chain reaction (RT-PCR) technique.  Twenty-four hours post-anesthesia, the expression levels of IL-10, IL-17, and IFN-γ genes were decreased while the expressions of IL-4, IL-6, and TGF-ß genes were upregulated in two groups, however, the differences were not significant. The mRNA level of IL-4 was increased in the SA group significantly. The post-CS mRNA levels of IL-4 in the SA group may indicate that SA is more appropriate than GA for the initiation of tissue repair pathways.

Cesarean or Cesarean Epidemic?

Due to advances in surgical procedure, anesthesia techniques, blood transfusion and antibiotic therapy, the technique of cesarean section has been progressing over the time. However, cesarean section is still a risk-specific operation, with long-term and shortterm consequences for the mother and neonate. The rate of cesarean surgery is constantly growing due to both justifiable and nonjustifiable medical and non-medical reasons. There is evidence indicating that efforts are made in many countries to reduce the rate of cesarean delivery. In this review article, we try to assess the frequency of cesarean section in different countries, especially Iran. We searched several keywords, including cesarean section prevalence, cesarean section rate, world, delivery, Iran and health policies within the newest articles published in Google Scholar, PubMed, and ISI/Web of Sciences, as well as Iranian databases (Magiran, SID), from January 2017 to April 2019. The results show that there is still a high prevalence of C-section. In Iran, the highest rate of cesarean was in Tehran province (62.1%-72.1%) and the lowest was in Sistan and Baluchestan province (12%). It appears necessary to plan for effective interventions in terms of painless vaginal delivery, improving the quality of vaginal delivery services, proper culture and education.

The expression of HoxB5 and SPC in neonatal rat lung after exposure to fluoxetine.

OBJECTIVE: Approximately 10% of pregnant women suffer from pregnancy-associated depression. Fluoxetine, as a selective serotonin reuptake inhibitor, is being employed as a therapy for depressive disorders. The present study aimed to determine the effects of fluoxetine on neonatal lung development. METHODS: Thirty pregnant Wistar rats (weighing 200-250 g) were treated daily with 7 mg/kg fluoxetine from gestation day 0 to gestation day 21, via gavage. The control group received a similar volume of distilled water only. Following delivery, the newborns and their lungs were immediately weighed in both of the groups. The right lung was fixed for histological assessments while the left lung was used for evaluation of the expression of SPC and HoxB5 by the real-time polymerase chain reaction method. RESULTS: Results have indicated that even though the body weight and the number of neonatal rats in both groups were the same, the lung weight of neonates exposed to fluoxetine was significantly different compared to the control group (P<0.05). Expression of both genes was increased, nonetheless, only elevation of HoxB5 was significant (P<0.05). Histological studies demonstrated that lung tissue in the fluoxetine treatment group morphologically appears to be similar to the pseudoglandular phase, whereas the control group lungs experienced more development. CONCLUSION: According to the upregulated expression of HoxB5 concerning histological findings, results of the present study showed that fluoxetine can influence lung growth and may in turn lead to delay in lung development. So establishment of studies to identify the effects of antidepressant drugs during pregnancy is deserved.

The effects of oral fluid intake an hour before cesarean section on regurgitation incidence.

BACKGROUND: The fear of aspiration of gastric contents and its life-threatening disadvantages in patients have encouraged many medical practitioners to follow conservative policies for clear fluid/liquid and solid intake from midnight to the time of surgery. These policies have been pursued more severely in case of pregnant women, leading the physicians to follow "nil per os" policy. The aim of this study was to determine and compare the incidence of regurgitation in two groups of pregnant women during general anesthesia for cesarean section, with standard fasting policy and taking clear fluid an hour prior to the induction of anesthesia. MATERIALS AND METHODS: This clinical trial was conducted for a period of 21 months in Nik-Nafs Maternity Hospital of Rafsanjan. The pregnant women who were candidates for elective cesarean section were registered for the study. All women fasted from midnight, and then were randomly assigned to one of the two groups. Those in the case group received 150 ml of clear liquid containing 10% carbohydrate about an hour before the induction of anesthesia. The occurrence of regurgitation was assessed by inserting the turnsole paper into the pharynx. Finally, the data of 411 cases were analyzed by descriptive methods. RESULTS: There was one case of regurgitation (0.69%) in the control group and one case (0.36%) in the case group, and no case of aspiration. CONCLUSIONS: There was no evidence to suggest that taking clear fluids about 1 hr before cesarean section will increase the risk of regurgitation. It confirms the safety of following more flexible fasting policies preoperatively, in addition to oral fluid intake, in case of parturients.

Differential expression of CXC chemokines CXCL10 and CXCL12 in term and pre-term neonates and their mothers.

BACKGROUND AND AIM: Pre-term delivery is a mostly unknown frequent disorder worldwide. This project aimed to investigate the circulating levels of CXCL12 (SDF-1) and CXCL10 (IP-10) in cord blood of term and pre-term delivered fetuses and their corresponding mothers. MATERIAL AND METHODS: Cord and peripheral blood samples were collected from 50 pre-term and 50 term infants and their mothers. Serum levels of CXCL12 and CXCL10 were measured by ELISA. RESULTS: The findings of this study indicated that the circulating levels of CXCL10 were elevated in mothers bearing pre-term infants, while CXCL12 was only increased in pre-term infants. CONCLUSION: The results suggested that the pathophysiological status of both mother and infant are involved in prematurity. Moreover, these findings suggest an inflammatory response in pre-term labor, which probably is controlled by inducible chemokines such as CXCL10.