The emerging roles of long non-coding RNA (lncRNA) H19 in gynecologic cancers.

Long non-coding RNA (lncRNA) H19 has gained significant recognition as a pivotal contributor to the initiation and advancement of gynecologic cancers, encompassing ovarian, endometrial, cervical, and breast cancers. H19 exhibits a complex array of mechanisms, demonstrating dualistic effects on tumorigenesis as it can function as both an oncogene and a tumor suppressor, contingent upon the specific context and type of cancer being investigated. In ovarian cancer, H19 promotes tumor growth, metastasis, and chemoresistance through modulation of key signaling pathways and interaction with microRNAs. Conversely, in endometrial cancer, H19 acts as a tumor suppressor by inhibiting proliferation, inducing apoptosis, and regulating epithelial-mesenchymal transition. Additionally, H19 has been implicated in cervical and breast cancers, where it influences cell proliferation, invasion, and immune evasion. Moreover, H19 has potential as a diagnostic and prognostic biomarker for gynecologic cancers, with its expression levels correlating with clinical parameters and patient outcomes. Understanding the functional roles of H19 in gynecologic cancers is crucial for the development of targeted therapeutic strategies and personalized treatment approaches. Further investigation into the intricate molecular mechanisms underlying H19's involvement in gynecologic malignancies is warranted to fully unravel its therapeutic potential and clinical implications. This review aims to elucidate the functional roles of H19 in various gynecologic malignancies.

Investigation of the Association of Abdominal Circumference Discord-ance and Estimated Fetal Weight Discordance in Twins with Birth Weight Discordance.

Background: Twin pregnancy is associated with a high risk of mortality and morbidity. It is necessary to estimate the weight difference of the fetuses with a reliable method to prevent possible complications. This study was conducted to compare the association between the Estimated fetal weight (EFW) discord-ance and the Abdominal Circumference (AC) discordance with birth weight in twins. Methods: This was a descriptive-analytical and retrospective study. The statistical population was all twin pregnant mothers referred to Imam Khomeini Hospital in Ahvaz from 2017 to 2019. The sample size was determined with a census (540 people). Based on AC , the size of head circumference (HC), femur length (FL), and the Biparietal Diameter (BPD), EFW was calculated. Then the EFW Dis-cordance and AC Discordance were calculated and compared with the birth weight. Data were analyzed using SPSS18. Unpaired, Two-Tailed T-test and Pearson correlation test were used. Results: The results showed that the mean discordance of fetal weight in twin pregnancies in the EFW method was 9.25%, in the AC method was 9.89% and finally, at birth, was 10.72%. The correla-tion of the weight difference between the two embryos in the AC method with the time of birth (r = 0.922 and P < 0.001) was higher than in the EFW method with the time of birth (r = 0.69 and P < 0.001) and finally, it was found that in detecting the discordance more than 20% and 25%, AC diagnostic power was good, but EFW was moderate. Conclusion: Therefore, to evaluate the weight and weight difference in twin embryos, the AC method has the appropriate accuracy and compatibility. Another major prospective study to evaluate the diagnostic performance of AC and EFW mismatch based on gestational age at scan, incision point, and maternal and placental characteristics to determine true ultrasound diagnostic accuracy in predict-ing growth mismatch in twin pregnancy and optimal post-case management option is needed.

The constitutively active pSMAD2/3 relatively improves the proliferation of chicken primordial germ cells.

In many multicellular organisms, mature gametes originate from primordial germ cells (PGCs). Improvements in the culture of PGCs are important not only for developmental biology research, but also for preserving endangered species, and for genome editing and transgenic animal technologies. SMAD2/3 appear to be powerful regulators of gene expression; however, their potential positive impact on the regulation of PGC proliferation has not been taken into consideration. Here, the effect of TGF-ß signaling as the upstream activator of SMAD2/3 transcription factors was evaluated on chicken PGCs' proliferation. For this, chicken PGCs at stages 26-28 Hamburger-Hamilton were obtained from the embryonic gonadal regions and cultured on different feeders or feeder-free substrates. The results showed that TGF-ß signaling agonists (IDE1 and Activin-A) improved PGC proliferation to some extent while treatment with SB431542, the antagonist of TGF-ß, disrupted PGCs' proliferation. However, the transfection of PGCs with constitutively active SMAD2/3 (SMAD2/3CA) resulted in improved PGC proliferation for more than 5 weeks. The results confirmed the interactions between overexpressed SMAD2/3CA and pluripotency-associated genes NANOG, OCT4, and SOX2. According to the results, the application of SMAD2/3CA could represent a step toward achieving an efficient expansion of avian PGCs.

Outcome of fetuses with soft markers: results of 3016 cases in Ahvaz city.

Background: Although soft markers may be seen as normal variants, they are important due to their association with chromosomal and congenital abnormalities. Methods: This cross-sectional descriptive-analytical study was done on 3016 women who referred for perinatal care. Fetuses with any of soft markers including thickened nuchal fold (TNF), mild pyelectasis (MP), choroid plexus cyst (CPC), single umbilical artery (SUA), mega cisterna magna (MCM) and mild ventriculomegaly (MVM) were followed during pregnancy and birth. Data analysis was carried out using SPSS for Windows (version 22). Data were analyzed using chi-square and T-test. A p-value <0.050 was considered statistically significant. Results: 285 (9.4%) fetuses with soft markers Including 148 (4.9%) fetuses with CPC, 118 (3.9%) fetuses with MP, 2 (0.1%,) fetuses with isolated TNF, 8 (0.3%) fetuses with isolated MVM, 4 (0.13%) fetuses with SUA, 4 (0.13%) fetuses with MCM were identified, and one fetus had TNF and MVM simultaneously. In cases with CPC, no abortion or major structural abnormalities were observed and all 148 neonates had normal phenotypes at birth. Among 118 cases with MP, one case had a major cardiac disorder, and 2 cases of abortions (1.7%) were reported (p=0.481). 83 cases (70.3%) were male and 35 cases (29.7%) were female (p=0.021) and all neonates had a normal phenotype. Both pregnancies with isolated TNF resulted in abortion. Of the 8 cases with isolated MVM, two cases had major structural abnormalities. 2 cases of abortion were reported and all infants had a normal phenotype. In one case, that fetus had TNF and MVM simultaneously. Amniocentesis showed no aneuploidy. No major structural abnormalities were observed in fetuses with SUA. One case of abortion was reported. Among the three births, two pre-term births were reported, and all three infants had normal phenotype. In four cases with MCM, no major structural abnormality was observed and all four neonates had normal phenotype. Conclusion: In cases without association with other structural abnormality, mothers who have fetuses with CPC or MP should be reassured that the pregnancy outcomes are generally favorable.

Diagnostic evaluation of uterine artery Doppler sonography for the prediction of adverse pregnancy outcomes.

BACKGROUND: Increased impedance to flow in the uterine arteries assessed by value of the Doppler is associated with adverse pregnancy outcomes, especially pre-eclampsia. We investigated the predictive value of a uterine artery Doppler in the identification of adverse pregnancy outcomes such as 'pre-eclampsia' and 'small fetus for gestational age' (SGA). MATERIALS AND METHODS: Three hundred and seventy-nine women, with singleton pregnancy, between 18 and 40 years of age, without risk factors, randomly underwent Doppler interrogation of the uterine arteries, between 16-22 weeks of gestation. Those who had a mean pulsatility index (PI) of >1.45 were considered to have an abnormal result, and were evaluated and compared with those who had normal results for adverse pregnancy outcomes, including pre-eclampsia and small for gestational age. The relationship between the variables was assessed with the use of the chi-square test. RESULTS: There were 17 cases (4.5%) of abnormal uterine artery Doppler results and 15 of them (88.2%) developed pre-eclampsia and four cases (23.5%) had neonates small for gestational age. For predicting pre-eclampsia, the mean uterine artery PI had to be >1.45, had to have a specificity of 95.5% (95% CI, 70-92%), a sensitivity of 79% (95% CI, 43-82%), a negative predictive value (NPV) of 98.9% (95% CI, 72-96%), and a positive predictive value (PPV) of 88.2% (95% CI, 68-98%). In the case of 'small for gestational age' it had to have a specificity of 96.5% (95% CI, 42-68%), a sensitivity of 57% (95% CI, 53-76%), an NPV of 99.2% (95% CI, 70-92%), and a PPV of 23.5% (95% CI, 30-72%). CONCLUSION: Uterine artery Doppler evaluation at 16-22 weeks of gestation might be an appropriate tool for identifying pregnancies that may be at an increased risk for development of pre-eclampsia and small fetus for gestational age.

Factors causing timely referral for fetal echocardiography in the final diagnosis of congenital heart malformations: A cross-sectional study.

Background: Congenital heart disease (CHD) is one of the most frequently inherited illnesses associated with adverse outcomes. Objective: This study aimed to determine the referral cause for fetal echocardiography in the final diagnosis of major CHD. Materials and Methods: In this cross-sectional study, the data of 1772 pregnant women, referred to a diagnostic clinic during 2017-2020, were reviewed. Data were collected from participants on maternal age, gestational age, history of previous child's heart disease, body mass, the order of birth of children (baby birth rank), type of woman's disease, history of poor midwifery, and nuchal translucency (NT). Results: Of the 1772 pregnant women, only 33 women (1.8%) had a fetus with CHD major. Abnormality in ultrasound (57.6%), history of abortion (36.4%), increased NT and gestational diabetes (18.2%) and gestational diabetes (18.2%) were identified as the most common referral reasons for fetal echocardiography in these women. Other reasons included a previous child with Down syndrome (12.1%), a previous child with heart disease (12.1%), a history of stillbirth (12.1%), hypothyroidism (12.1%), taking medication during the pregnancy period (9.0%), no underlying disease (9.0%), multiple pregnancies (6.0%), diagnosis with high-risk fetal heart disease (3.0%), high-risk combined aneuploidy screening test in the first trimester (3.0%), in vitro fertilizationpregnancy (3.0%), and having a child with an intellectual disability (3.0%). Conclusion: According to the results, it can be concluded that ultrasound abnormality, abortion, increased NT and gestational diabetes are the most important factors for referring pregnant women for fetal echocardiography.

Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study.

Background: Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy. Objective: This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS. Materials and Methods: In this retrospective cross-sectional study, the records of 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women were divided into 2 groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation, or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization were compared between groups. Results: In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 ± 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent a hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine preservative surgeries in terms of the need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization. Conclusion: The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS.

Correlation between assisted reproductive technology-induced pregnancy and fetal cardiac anomalies.

OBJECTIVE: To investigate the incidence of fetal heart defects in assisted reproductive technology (ART)-induced pregnancies compared to natural pregnancies as well as to detect their fetal and maternal risk factors associated with ART. METHODS: In this retrospective cohort study, we collected data from the medical records belonging to 2877 pregnant women's fetuses, who underwent fetal echocardiography for various reasons, including ART, over the last 3 years. RESULTS: There were no major cardiac anomaly in the ART-induced pregnancies, while it was seen in 1.32% of natural pregnancies; so, ART did not increase the risk of major cardiac anomalies. However, the incidence of fetal mild cardiac anomalies among fetuses derived from ART-induced pregnancies (51.43%) was significantly higher than that of natural pregnancies (44.43%, p=0.03). None of the ART-induced pregnancies had a history of a child with cardiac disease (vs. 7.56% in natural pregnancies). Also, the increased nuchal thickness (NT) and extra-cardiac anomalies were significantly more prevalent among natural pregnancies, indicating a significant negative correlation between ART and these two risk factors [χ2=10.24, r: -0.06, 95% CI(-0.0974 to -0.0221) and χ2=47.25, r: -0.129, 95% CI(-0.1656 to -0.0913), p<0.01, respectively]. The adjusted odds ratio of developing fetal mild cardiac anomalies were 1.37 times higher greater for ART-induced pregnancies compared to natural pregnancies [95% CI(1.072-1.769), p=0.01]. CONCLUSIONS: Although the likelihood of developing fetal mild cardiac anomalies was 1.37 times higher for ART-induced pregnancy compared to natural pregnancy, ART did not increase the risk of major cardiac anomalies Although the likelihood of developing fetal mild cardiac anomalies was 1.37 times higher for ART-induced pregnancy compared to natural pregnancy, ART did not increase the risk of major cardiac anomalies.

The comparison of predictive value of cervical length in singleton spontaneous preterm labor with in vitro fertilization pregnancies: A cohort study.

BACKGROUND: Preterm labor (PTL) is one of the most important factors in neonatal mortality. Some studies have revealed a reverse relationship between cervical length (CL) and PTL, however, further evidence is needed to confirm it. OBJECTIVE: To investigate the predictive value of CL in spontaneous and in vitro fertilization (IVF) pregnancies. MATERIALS AND METHODS: This prospective cohort study was performed on 154 pregnant women from 16-26 wk of gestation with singleton fetus in spontaneous delivery (n = 77) and IVF pregnancies (n = 77) and followed up until delivery. Women with multiple pregnancy, placenta previa, cerclage, and congenital anomalies were excluded from study. The cut-off determination was done according to the Roc analysis. RESULTS: The mean CL in term delivery and PTL groups were 37 ± 7 mm and 31 ± 6 mm, respectively (p < 0.001). The frequency of PTL in spontaneous and IVF pregnancies were 7.8% and 23.27%, respectively (p = 0.007). According to the Roc analysis, the best cut-off for normal pregnancy was ≤ 36 mm with the negative predictive value of 97.9%, the positive predictive value of 11.4%, sensitivity 83.3%, and specificity of 46.5%. While for the IVF group, the cut off was ≤ 30 mm, with a negative predictive value of 88.4%, positive predictive value of 57.8%, sensitivity of 63.2%, and specificity of 86%. CONCLUSION: In this study, IVF had a significant direct correlation with PTL. CL also had a significant indirect relationship with PTL.

The effect of low glycemic index diet on the reproductive and clinical profile in women with polycystic ovarian syndrome: A systematic review and meta-analysis.

BACKGROUND: Treatment for polycystic ovary syndrome (PCOS) usually initiates with a series of lifestyle modifications such as diet, weight loss, and exercise. AIMS: We, therefore, conducted this meta-analysis to systematically review and evaluate the possible benefits of LGD on a range of anthropometric, clinical, and biochemical parameters in women with PCOS. METHODS: We performed a systematic search through major indexing databases, including Scopus, Pubmed/Medline, ISI web of science, Embase, Cochrane central, and CINAHL (1966-April 30, 2021) using key concepts of PCOS. RESULTS: Of 935 initial publications, 542 remain after duplicates removal. Then, 141 records were removed at the title and abstract screening level. After excluding 392 literatures, we finally included 8 articles. The final selected studies included 412 overweight and obese individuals with PCOS (207 cases in LGID group and 205 patients in comparators) with a mean age of 21-32 years. Measured emotional health (3 studies, 132 participants, SMD: -1.97; 95%CI:-3.54, -0.40, P = 0.01, I 2 = 89%) and body hair (3 studies, 132 participants, SMD: -0.40; 95%CI:-0.46, -0.35, P < 0.0001, I 2 = 0%), were found to be significantly lower in women in LGD vs control diet groups. Moreover, infertility (3 studies, 132 participants, SMD: 1.45; 95%CI: 0.30, 2.61, P = 0.01, I 2 = 79%) was significantly higher in women in LGD vs control diet groups. CONCLUSION: The present meta-analysis has shown that LGD may play a significant role in reducing the risk and improving the clinical and biochemical features of PCOS. So far the evidences for choosing the best dietary modalities for PCOS are not strong to make a definite recommendation.

Pluripotent Stem Cells: Cancer Study, Therapy, and Vaccination.

INTRODUCTION: Pluripotent stem cells (PSCs) are promising tools for modern regenerative medicine applications because of their stemness properties, which include unlimited self-renewal and the ability to differentiate into all cell types in the body. Evidence suggests that a rare population of cells within a tumor, termed cancer stem cells (CSCs), exhibit stemness and phenotypic plasticity properties that are primarily responsible for resistance to chemotherapy, radiotherapy, metastasis, cancer development, and tumor relapse. Different therapeutic approaches that target CSCs have been developed for tumor eradication. RESULTS AND DISCUSSION: In this review, we first provide an overview of different viewpoints about the origin of CSCs. Particular attention has been paid to views believe that CSCs are probably appeared through dysregulation of very small embryonic-like stem cells (VSELs) which reside in various tissues as the main candidate for tissue-specific stem cells. The expression of pluripotency markers in these two types of cells can strengthen the validity of this theory. In this regard, we discuss the common properties of CSCs and PSCs, and highlight the potential of PSCs in cancer studies, therapeutic applications, as well as educating the immune system against CSCs. CONCLUSION: In conclusion, the resemblance of CSCs to PSCs can provide an appropriate source of CSC-specific antigens through cultivation of PSCs which brings to light promising ideas for prophylactic and therapeutic cancer vaccine development.

Prenatal and postnatal echocardiography in NT fetuses with normal karyotype.

INTRODUCTION: Targeted fetus echocardiography at midpregnancy can detect major defects in major cardiovascular organs. The present study aimed to evaluate prenatal and postnatal echocardiography in fetuses with increased nuchal translucency (NT) with normal karyotype. METHODS: In this retrospective study, data on the screening of fetuses in pregnant women between 2014 and 2015 were evaluated. The fetuses at the gestational age were 14-11 weeks, and NT ≥ 95 percentile (or 3 mm). For all fetuses with increased NT, follow-up anomaly scan was performed at 18-22 weeks of pregnancy, while fetal echocardiography was performed at weeks 16-19 of pregnancy. The results were analyzed by Statistical Package for the Social Sciences (version 22) and the level of significance was less than 0.05. RESULTS: A total of 26.27% of the fetuses were diagnosed with prenatal heart defects and confirmed after birth. The strongest relationship was observed between increased NT and the diagnosis of prenatal heart defects at 2.5-5.3 mm. The increased NT was higher in younger mothers. Moreover, increased NT was higher in mothers with less body mass index. CONCLUSION: By measuring NT in the 11-13 weeks of pregnancy and considering the risk factors, it is possible to evaluate the probability of cardiac abnormalities in the fetus and perform the necessary diagnostic evaluations for high-risk cases.

Association Between Fetal Middle Cerebral Artery and Umbilical Artery Doppler Ratio with Fetal Distress in 38-40 Weeks of Gestation.

BACKGROUND AND OBJECTIVE: Knowing the factors affecting fetal distress is of particular importance in improving prognosis in newborns. The study aimed to determine the relationship between fetal middle cerebral artery pulsatility indexes and umbilical artery Doppler ratio with fetal distress at 38-40 weeks of gestation. MATERIALS AND METHODS: In this prospective cohort, 181 consecutive pregnant women with 38-40 weeks of gestational age were selected by a non-random convenience sampling method from January 2016 to January 2017. Women with labor pain and embryos with chromosomal and structural disorder were excluded. Color Doppler sonography was done for all of them, and the association of this ratio with fetal distress consequently was assessed as well. RESULTS: In this study, abnormal amniotic fluid index (AFI) (1.1%), low birth weight (< 2500 g) (5.5%), emergency cesarean (11.6%), neonatal intensive care unit (NICU) admission (12.2%), low 5th minute Apgar (< 7) (0.6%), abnormal fetal monitoring (10.5%), fetal distress (11.6%), meconium aspiration syndrome (10.5%), and respiratory distress (3.9%) were present. The mean cerebroplacental ratio was 1.9. There was a significant association between low fetal middle cerebral artery pulsatility index and umbilical artery Doppler ratio with fetal distress, abnormal monitoring, and urgent cesarean (P = 0.006). The cutoff 1.94 led to sensitivity, specificity, positive predictive value, and negative predictive value of 80.95, 50, 17.5, and 95.2%, respectively. CONCLUSION: It may be concluded that in our study a cutoff for fetal middle cerebral artery to umbilical artery ratio of 1.94 at 38 weeks was considered statistically significant in predicting fetal distress at 38-40 weeks. However, further studies with larger sample size and multi-center sampling would develop more definite results for wider application.

Value of Pregnancy-Associated Plasma Protein-A for Predicting Adverse Pregnancy Outcome.

BACKGROUND: It is suggested that pregnancy-associated plasma protein-A (PAPP-A) levels below the fifth percentile or less than 0.4 multiples of the median (MoMs) during the first trimester are closely associated with higher risk for neonatal abnormalities. We assessed the value of PAPP-A within the first trimester for predicting pregnancy outcome. METHODS: In a historical cohort study, we assessed 8460 consecutive pregnant women recruited for chromosomal abnormalities screening within the first trimester at Fertility Infertility and Perinatology Research Center, in Ahvaz Jundishapur University of Medical Sciences between April 2014 and April 2015. The women were categorized into two groups: pregnant women with PAPP-A levels below 0.4 multiples of MOM (n = 237) and those with higher levels of PAPP-A (n = 237). RESULTS: The median value of MOM PAPP-A was 0.82 ± 0.78, with 237 women having MOM PAPP-A lower than 0.4. Compared to women with MOM PAPP-A higher than 0.4, those with lower MOM PAPP-A had higher mean age, lower gestational age and lower birth weight. The prevalence of small for gestational age (SGA) was higher in women with MOM PAPP-A <0.4 compared to others. According to the ROC curve analysis, MOM PAPP-A <0.4 had a high value for predicting SGA. Best cutoff value for MOM PAPP-A to predict SGA was shown to be 0.25, yielding a sensitivity of 84.7% and a specificity of 68.6. CONCLUSION: Measuring the serum level of MOM PAPP-A during the first trimester is a valuable marker for predicting adverse outcomes of pregnancy such as SGA.

Assessemnt of nasal bone in first trimester screening for chromosomal abnormalities in Khuzestan.

BACKGROUND: Fetal nasal bone assessment is a non-invasive procedure that helps provide even greater assurance to patients undergoing their first trimester risk assessment for aneuploidies. Absence or presence of this factor is different in some races. OBJECTIVE: The study was aimed to evaluate nasal bone in the first trimester of pregnancy in the indigenous population of Khuzestan Province, and to monitor its value in the diagnosis of chromosomal abnormalities. MATERIALS AND METHODS: This study was conducted on 2314 pregnant women between 17-43 years old who referred for first trimester screening for chromosomal abnormalities. Gestational age was between 11-13w + 6 days. Nuchal translucency (NT), fetal heart rate (FHR), crown rump length (CRL), and maternal age and maternal blood serum factors (Free HCG) and pregnancy-associated plasma protein-A (PAPP-A) and nasal bone were assessed. Finally the risk of trisomies was calculated. The statistical tests are based on the relationship between chromosomal abnormality and the presence or absence of the nasal bone. RESULTS: In 114 cases we could not examine the nasal bone. Also, in 20 cases missed abortion happened without knowing the karyotype. 2173 cases were delivered normal baby, and in seven cases chromosomal abnormalities were diagnosed. Nasal bone was absent in all three cases with trisomy 21 and six of 2173 cases with normal phenotype (0.3%). With use of the Fisher exact test (p=0.0001), a significant correlation was found between the absence of the nasal bone and the risk of chromosomal abnormality. CONCLUSION: Inclusion of the nasal bone in first-trimester combined screening for aneuploidies achieves greater detection rate especially in Down syndrome.

Comparison of complications of chorionic villus sampling and amniocentesis.

BACKGROUND: A significant number of pregnancies are associated with the cytogenetic abnormalities of the fetus. Amniocentesis and chorionic villus sampling (CVS) are procedures used for prenatal genetic diagnosis. In this study, we compare the safety and complications of mid-trimester amniocentesis and transabdominal CVS. MATERIALS AND METHODS: This analytic cross-sectional study was performed in 308 patients from 2.11.2007 to 26.10.2009. We had 155 cases of amniocentesis, which we performed in weeks 15-23 of pregnancy; and 153 cases of CVS, which we performed during weeks 10-14 of pregnancy. RESULTS: There were 2 cases (1.2%) of premature rupture of membrane (PROM) in amniocentesis which occurred 1 and 10 days after the procedure and caused pregnancy loss before 20 weeks. We had 1 case (0.7%) of abortion in CVS, which occurred 10 days after the procedure. Additionally, there was 1 case of amniotic fluid leakage (0.7%) in which, after admission to the hospital and observation, leakage was stopped and the pregnancy continued normally. CONCLUSION: In this study, we had more complications with amniocentesis cases than CVS. CVS is a procedure performed in the earlier stages of pregnancy and its complications are less than amniocentesis. We suggest CVS to be the procedure of choice for genetic diagnosis.

Detection of neural tube defect in the first and second trimester of pregnancy by ultrasound in Imam Hospital, Ahwaz between December 2008-2010.

BACKGROUND: Central nervous system malformations are the second most common congenital malformations after congenital heart diseases. These malformations are associated with many instances of morbidity and mortality which underline the importance of prevention and their early diagnosis. OBJECTIVE: The objective of this study is the diagnosis of neural tube defect (NTDs) in the first trimester and its comparison to second trimester diagnoses in order to reduce the complications associated with late pregnancy terminations and its costs. MATERIALS AND METHODS: This study was a trans-sectional study. A total number of 1074 patients who referred to Imam Khomeini Hospital were enrolled in this study. During the 11(th)-13(th) (+6 days) gestational week the patients were screened sonographically; subsequently they were re-scanned for fetal anomalies during 18(th)-20(th) gestational week, and we followed the babies after birth. Considering that Intracranial Translucency (IT) was introduced in the newer researches, it was, too, measured in 125 of the cases. RESULTS: In a total number of 1074 patients we had one patient with an anencephalous fetus whom was diagnosed in the first trimester of pregnancy. In the second trimester, we detected one case of myelomenigocele; when we referred to this patient's first trimester sonography, there was no visible IT. In the 125 cases in whom the IT length was measured, it was normal; the 2(nd) trimester sonographies in these patients were also normal. CONCLUSION: It must be noted that the diagnosis of NTD is more accurate in the second trimester of pregnancy. Consequently it is recommended that in high risk patients, the second trimester sonography be performed transvaginally, and in an earlier gestational age (14(th)-16(th) gestational weeks).

Effect of hysteroscopy before intra uterine insemination on fertility in infertile couples.

Uterine disorders like usual infertility factors (male factor, ovarian and tubal problems of women) may affect the outcome of infertility treatment in infertile patients. In our clinical trial, 110 couples diagnosed with infertility were candidate for intra uterine insemination (IUI). The patients were divided randomly into two equal groups (n = 55): In group one (control group), patients without hysteroscopy underwent ovulation induction by clomiphene citrate and hCG followed by intrauterine insemination. The second group (experiment group), patients were undergoing hysteroscopy before intra uterine insemination on the day 21 of the cycle and due to abnormal findings, going under surgical treatment if they needed. The rates of pregnancy complications in patients were evaluated. The age, BMI, kind of infertility, duration of infertility, number of previous trial, duration of stimulation, the type of procedures used and semen analysis (TMC, Motility and morphology of sperm) were similar for both groups and no statistically significant differences emerged at all between them. In experimental group, hysteroscopy revealed pathology in the uterine cavity in 26 out of 55 cases. The overall rates of clinical pregnancy were higher in experimental group compared to the control group. The findings from this study showed that the use of hysteroscopy as a diagnostic or therapeutic procedure before IUI, can increase the rate of pregnancy and finally decrease the failure rate of infertility treatment and perinatal complications in infertile couples.

Evaluation of nuchal translucency measurement in first trimester pregnancy.

BACKGROUND: A significant number of pregnancies, particularly in women with previous histories of infertility, are associated with fetal abnormalities. Methods such as the nuchal translucency (NT) measurement enable us to identify more pregnancies with chromosomal abnormalities. MATERIALS AND METHODS: This analytic cross-sectional study was performed in 446 pregnant women at 11-14 weeks gestation, from 2009 to 2010 in the Fetal Medicine Unit of Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences. All NT measurements were performed by a certified sonographer using the Fetal Medicine Foundation (FMF) recommended protocol. FMF first trimester software was used for primary and secondary (adjusted) risk calculation. RESULTS: The average maternal age was 28.5 years and 15% of mothers were ≥35 years of age. The average crown rump length (CRL), gestational age and NT thickness were 61.7, 12.4 weeks and 1.75 mm, respectively. There were 20 cases with increased adjusted risk (4.04%) and 4 cases of documented abnormal karyotype. CONCLUSION: In our study increased adjusted risk was 4.04%.Documented abnormal karyotype were 0.9% and 28% of total and high-risk groups who accepted amniocentesis, respectively. In this study, 50% of women with high-risk results and about half of those with abnormal karyotypes were seen in women under age 35. Knowing these risks is of utmost importance in pregnancy, particularly in patients with infertility histories.