Association between fetal liver diameter and glycemic control in pregnant women with gestational diabetes: A pilot study.

BACKGROUND: This study aimed to investigate the relationship between fetal liver length (FLL) and maternal glycemic status in pregnant women with gestational diabetes mellitus (GDM), as well as to determine whether FLL measurement in the third trimester is associated with neonatal outcomes. METHOD: A total of 51 singleton GDM pregnancies were included in this pilot study, and transabdominal ultrasound biometry and FLL measurements were performed between 34 and 36 weeks of gestation. Maternal indicators of glycemic control, including hemoglobin A1C (HbA1C), fasting blood sugar (FBS), and 2-h postprandial blood sugar were also evaluated during this period. The cases were followed up until delivery and maternal and neonatal outcomes were assessed to determine any correlation with FLL. RESULT: The results showed a significant positive correlation between FLL and HbA1C (r = 0.464, P = 0.001), FBS (r = 0.574, P < 0.001), 2-h postprandial blood sugar (r = 0.405, P = 0.002), and AC (r = 0.515, P < 0.001). Additionally, FLL was significantly associated with fetal birth weight (r = 0.408, P = 0.003) and birth weight (r = 0.460, P = 0.001). The FLL≥95th percentile group demonstrated a higher number of polyhydramnios (p = 0.007), macrosomia (p < 0.001), and maternal intensive care unit (ICU) admissions (p = 0.006). CONCLUSION: In conclusion, FLL measurement during third trimester of pregnancy is an indicator of maternal glycemic regulation and can be used as a predictor of macrosomia and neonatal birth weight in GDM pregnancies.

Vaccination effects on reducing COVID-19 complications in pregnancy: A large-scale report from Iran.

OBJECTIVE: The objective of this study was to evaluate the effects of maternal coronavirus disease 2019 (COVID-19) vaccination on preventing severe complications of COVID-19 in pregnant women. METHODS: A retrospective study was conducted in pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and/or for up to 6 weeks postpartum between September 1, 2021, to January 30, 2022. The data was retrieved from a national database. The pregnant women were divided into two groups of vaccinated and unvaccinated. The proposed outcomes (the need for hospitalization, intensive care unit admission, and mechanical ventilation and products of conception complications) were compared between the two groups. RESULTS: Approximately 90 000 pregnant women infected with COVID-19 were included in the study. The data of the vaccinated (19 922) and unvaccinated (70 147) groups were analyzed and compared. Pregnant patients in the vaccinated group had a significantly lower rate of hospitalization (21.2% vs 29.4%) (odds ratio [OR], 0.648 [95% confidence interval (CI), 0.625-0.673], P = 0.0001) and intensive care unit admission (3.7% vs 7.8%) (OR, 0.453 [95% CI, 0.382-0.535], P = 0.0001). The need for mechanical ventilation was also lower, although not statistically significant, in the vaccinated group than in the unvaccinated group (30 of 155 [19.4%] vs 418 of 1597 [26.2%]) (OR, 0.677 [95% CI, 0.448-1.024], P = 0.063). Cesarean section (54.3% vs 58.1%) (OR, 0.856 [95% CI, 0.751-0.977], P = 0.021) and stillbirth (0.4% vs 3.6%) (OR, 0.097 [95% CI, 0.026-0.252], P = 0.0001) were also significantly lower in the vaccinated patients. Most pregnant women in the vaccinated group (18 484-96.14%) received Sinopharm BIBP COVID-19 inactivated vaccine. No significant differences were seen in the effect of different types of COVID-19 vaccines on reducing COVID-19 complications in infected pregnant patients. CONCLUSION: Maternal COVID-19 immunization is effective in reducing COVID-19 complications in infected pregnant women.

Remdesivir in pregnant women with moderate to severe coronavirus disease 2019 (COVID-19): a retrospective cohort study.

Data on the efficacy of remdesivir in Coronavirus Disease 2019 (COVID-19) are limited in pregnant patients since they have been excluded from clinical trials. We aimed to investigate some clinical outcomes following remdesivir administration in pregnancy. This was a retrospective cohort study conducted on pregnant women with moderate to severe COVID-19. The enrolled patients were divided into two groups with and without remdesivir treatment. The primary outcomes of this study were the length of hospital and intensive care unit stay; respiratory parameters of hospital day 7 including respiratory rate, oxygen saturation, and mode of oxygen support; discharge until days 7 and 14, and need for home oxygen therapy. Secondary outcomes included some maternal and neonatal consequences. Eighty-one pregnant women (57 in the remdesivir group and 24 in the non-remdesivir group) were included. The two study groups were comparable according to the baseline demographic and clinical characteristics. Of the respiratory outcomes, remdesivir was significantly associated with a reduced length of hospital stay (p = 0.021) and also with a lower level of oxygen requirement in patients on low-flow oxygen [odds ratio (OR) 3.669]. Among the maternal consequences, no patients in the remdesivir group developed preeclampsia but three patients (12.5%) experienced this complication in the non-remdesivir group (p = 0.024). Furthermore, in patients with moderate COVID-19, the percentage of emergency termination was significantly lower in remdesivir group (OR 2.46). Our results demonstrated some probable benefits of remdesivir in respiratory and also maternal outcomes. Further investigations with a larger sample size should confirm these results.

Comparison of Parameters of Fetal Doppler Echocardiography Between Mothers with and Without Diabetes.

Background: The current study aimed to compare fetal myocardial function and ventricular thickness in diabetic and normal pregnancies. Methods: Women with singleton pregnancies in the second or third trimester who were referred for routine prenatal or anomaly ultrasounds within March 2020 to February 2021 were enrolled in the study. Women with a positive history of overt or gestational diabetes mellitus (GDM) were considered the case group (n = 50), and women without GDM were considered the control group (n = 50). The study did not include women with multifetal pregnancy, hypertension, intrauterine growth retardation, and polyhydramnios. A complete fetal Doppler echocardiography was performed to measure isovolumic relaxation time (IVRT), left myocardial performance index (MPI), E/A ratio, right and left ventricular wall thickness, and end-diastolic interventricular septal thickness (IVST). The data were analyzed using three types of decision tree (DT) algorithms, and the performance of each DT was measured on the testing dataset. Results: The frequency of IVRT > 41 milliseconds was significantly higher in the case group than in the control group. The mean MPI values were 0.53 ± 0.15 and 0.43 ± 0.09 (P < 0.05), respectively, and the mean IVST values were 3.3 ± 1.11 and 2.49 ± 0.55 mm (P < 0.05) in the case and control groups, respectively, but not different between the subjects with overt or GDM (P > 0.05). Additionally, in the case group, the mean left MPI values were 0.57 ± 0.18 and 0.49 ± 0.12 in participants with poor and good glycemic control, respectively (P = 0.12). Conclusions: Complete prenatal echocardiography performed in the second or third trimester is an appropriate tool for the diagnosis of fetal cardiac dysfunction in diabetic mothers and is suggested to perform for diabetic mothers, even those with good glycemic control.

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.

Is gross morphology of placenta, umbilical cord, and neonatal outcome in well-controlled gestational diabetes mellitus pregnancy different? A case-control study.

BACKGROUND: The relation of placental gross morphology and the outcome of pregnancies complicated with diabetes mellitus in comparison with healthy pregnancies is not known. Identifying significant differences in pregnancy outcomes in Gestational Diabetes Mellitus (GDM) and healthy pregnancies by the means of morphologic measurements can induce the use of antenatal ultrasonography of placental parameters to predict pregnancy outcomes. OBJECTIVE: This study aimed to evaluate the relationship between placental morphological parameters of the placenta and cord and the outcomes of pregnancies complicated with diabetes mellitus. MATERIALS AND METHODS: In this case-control study, which was conducted at two referral perinatology center in Tehran between March 2017 and November 2018, 60 pregnant women with GDM who were controlled with either diet or insulin as the case group and 60 pregnant women without GDM as the control group were enrolled. The study population were selected from patients who had their prenatal care and delivery in Mahdieh and Shohadaye Tajrish Hospital. The data was collected by taking sickness history, using data from patients files, and measuring of placental and newborn parameters after delivery. GDM was diagnosed either by 75 gr or 100 gr oral glucose tolerance tests. Placenta parameters, umbilical cord features, and newborn outcomes were compared between the two groups. RESULTS: Placental weight, diameter, number of lobes, thickness, placental weight to-newborn weight ratio, place of umbilical cord insertion, length, coiling, and diameter of the umbilical cord are similar in two groups. Newborn weight, NICU admission, ABG, and Apgar score are also the same in well-controlled GDM pregnancy and pregnancy without GDM. CONCLUSION: Good controlled GDM causes no difference in placental gross morphology and pregnancy outcome compared to a healthy pregnancy.

Maternal death due to COVID-19.

BACKGROUND: Despite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected. OBJECTIVE: To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease. STUDY DESIGN: We describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease. RESULTS: Among 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high- and low-risk familial/household members (n=33 members for comparison). CONCLUSION: We report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.

Effect of Single-Dose Methotrexate Treatment on Ovarian Reserve in Women with Ectopic Pregnancy Undergoing Infertility Treatment: A Single-Center Experience.

BACKGROUND: The aim of this study was evaluation of the impact of single-dose methotrexate (MTX) treatment on ovarian reserve in women with ectopic pregnancy (EP) undergoing infertility treatment in Iranian population. MATERIALS AND METHODS: This prospective cohort study was done between March 2015 and March 2017 in Tehran General Women Hospital, Tehran, Iran. We enrolled 20 patients with EP who conceived during infertility treatment and received a single-dose MTX (50 mg/m2) intramuscularly. Serum anti-Mullerian hormone (AMH), 17 beta-estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) on transvaginal ultrasonography, were evaluated before and 8 weeks after administration of MTX. RESULTS: AMH did not significantly vary after the administration of MTX, compared to before treatment value (P=0.36). FSH, E2 and AFC changes were not statistically significant, while increment of LH was significant (P=0.02). CONCLUSION: Results indicated that single-dose MTX treatment did not reduce ovarian reserve in women with EP. Further randomized controlled clinical trial studies with larger sample sizes, by using multiple dosages of MTX, and with long-term follow up are suggested to be done.

Non-invasive prenatal test to screen common trisomies in twin pregnancies.

OBJECTIVES: Recent years have witnessed a shift from invasive methods of prenatal screening to non-invasive strategies. Accordingly, non-invasive prenatal testing (NIPT) using cell-free fetal DNA in maternal plasma has gained a considerable deal of interest from both geneticists and obstetricians. Efficacy of this method in identification of common aneuploidies has been extensively assessed in singleton pregnancies. However, a limited number of studies have addressed the twin pregnancies. In this context, the present study is aimed at identification of the efficacy of NIPT in twin pregnancies. METHODS: NIPT was performed on twin pregnancies to screen trisomies 13, 18 and 21. Pregnant women referring to Nilou Clinical Laboratory between March 2016 and December 2018 were included in this research. RESULTS: In the current study, a total 356 twin pregnancies were screened in search for trisomies 13, 18 and 21. 6 cases exhibited positive NIPT results in which the presence of trisomies 13, 18 and 21 was confirmed by fetal karyotype in 1, 2 and 2 cases, respectively. One twin pregnancy showed normal karyotype. The combined false-positive rate for these trisomies was 0.28%. No false negative case was observed. The combined sensitivity and specificity of NIPT in twin pregnancies were 100 and 99.7%, respectively. CONCLUSION: The results of the current study verify the feasibility, sensitivity and specificity of NIPT in twin pregnancies.

Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section.

OBJECTIVES: To assess the effects of previous cesarean delivery (CD) and placental location on second trimester uterine artery Doppler indices in subsequent pregnancy and to assess the predictive values of abnormal Doppler findings for adverse pregnancy outcomes in women with previous CD. STUDY DESIGN: This prospective cohort study evaluated 400 gravida two pregnant women (200 with previous none medically indicated CD and 200 with previous normal vaginal deliveries (NVD)) who were referred for second trimester fetal anatomic survey. Uterine artery Doppler studies were performed in all participants who were then followed until delivery. RESULTS: Compared with women having prior NVD, women with prior CD had significantly higher rates of abnormal uterine artery pulsatility index (PI) (p < .001), and significantly more adverse pregnancy outcomes (p = .01). Among women with previous CD, all the measured adverse pregnancy outcomes occurred significantly more often in women with abnormal uterine artery Doppler indices (p < .001). CONCLUSIONS: CD seems to be associated with increased risks of impaired placental function and circulation and adverse pregnancy outcomes in the subsequent pregnancy, particularly in women with anteriorly located placenta near the previous uterine scar.

Correlation of Maternal Stress Because of Positive Aneuploidy Screening Serum Analytes and Uterine Arteries' Doppler Ultrasound Index: A Prospective Cohort Study.

BACKGROUND: Antenatal anxiety or maternal stress is a prevalent chronic mental disorder in pregnant women. We have assessed the effect of maternal stress from positive aneuploidy screening results on the changes in uterine artery blood flow. MATERIALS AND METHODS: We performed a prospective cohort (one sample) pilot study at a hospital in Tehran, Iran. A total of 60 pregnant women who were candidates for amniocentesis due to abnormal sequential screening test results entered the study. We conducted 2 standard psychological tests, the Spielberger's State-Trait Anxiety Inventory and the Beck Anxiety Inventory, to determine anxiety levels in the participants before amniocentesis and two weeks after amniocentesis. The uterine artery resistance index was also measured before and two weeks after amniocentesis. The level of maternal stress was compared with the uterine artery resistance index. RESULTS: Patients had a mean State Trait Anxiety Inventory score before amniocentesis of greater than 40, which meant that the mothers experienced high anxiety. There were no correlations between both inventories' anxiety scores and uterine artery blood flow before amniocentesis. However, two weeks after amniocentesis, we observed significant negative correlations between the State Anxiety (P=0.0041) and Trait Anxiety (P=0.010) Inventory scores and the uterine artery resistance indexes. Also, there was an association between the decreased right uterine artery resistance index and State Anxiety scores (P=0.036). There were significant correlations between State and Trait Anxiety scores and second trimester analytes of ß-human chorionic gonadotropin (ß-hCG, P<0.001), α-fetoprotein (P<0.001), and unconjugated estriol (P=0.048). CONCLUSION: Maternal anxiety because of positive aneuploidy screening serum analytes and amniocentesis can affect perinatal outcomes via mood-based alterations in blood flow of the uterine arteries and the screening markers ß-hCG,unconjugated estriol, and α-fetoprotein.

Factors related to unwanted pregnancies and abortion in the northern district of the city of Tehran, Iran.

The aim of this study was to investigate the levels and determinants of unwanted pregnancies and therapeutic and elective induced abortions in an Iranian sample of women. This study was conducted from the beginning of 2013 to the end of July 2013, using data from 950 women aged 15-45 years. To evaluate the relationship of independent variables to the number of unwanted pregnancies, a negative binomial regression model was used. A multinomial logistic model was used to investigate the relationship of the history of at least one unwanted pregnancy to therapeutic and elective induced abortion. The prevalence of unwanted pregnancy among participants was 19.2 percent (n = 182). Among those with a history of unwanted pregnancy, eighteen had had at least one induced abortion (14.5 percent of the total abortions reported). Having enough knowledge about the intrauterine device during unprotected intercourse on average was associated with a 57 percent reduction in unwanted pregnancies (mean odds ratio = 0.43, 95 percent Confidence Interval (CI): 0.11-0.93). Given the high rates of complications following unwanted pregnancies and associated maternal health threats, timely identification and training of women at risk, as well as the development of appropriate attitudes regarding reproductive health, may help avoid such pregnancies and their complications.

Pregnancy Screening before Diagnostic Radiography in Emergency Department; an Educational Review.

In modern medical practice, there is an increasing dependence on imaging techniques in most medical specialties. Radiation exposure during pregnancy may have serious teratogenic effects to the fetus. Therefore, checking the pregnancy status before imaging women of child bearing age can protect against these effects. Lack of international regulations and standard protocols exposes the patient to unexpected fetal radiation effects and the health professionals to medicolegal suits. Recently, the American Academy of Radiology and the European community of Medical Ionizing Radiation Protection released national guidelines regarding pregnancy screening before imaging potentially pregnant females. However, different methods of pregnancy screening exist among different radiology centers. This review aims to discuss the most recent guidelines for imaging females of childbearing age and highlight the need for an international regulation to guide pregnancy screening before diagnostic radiation exposure.

Vaginal misoprostol versus intravenous oxytocin for the management of second-trimester pregnancies with intrauterine fetal death: A randomized clinical trial.

AIM: The aim of this study was to compare vaginal misoprostol versus intravenous (i.v.) oxytocin in the management of pregnancies with second-trimester intrauterine fetal death (IUFD). METHODS: This randomized clinical trial was conducted on 85 pregnant women with IUFD and unripe cervix who were admitted for labor induction. Forty were randomly allocated to receive 200 mcg vaginal misoprostol every 12 h, and 45 were randomly assigned to receive high-dose i.v. oxytocin (starting from 6 mU/min to reach the maximum dose of 40 mU/min). This study is registered at www.irct.ir (IRCT201307159568N5). RESULTS: The induction-to-delivery interval in the misoprostol group (10.5 ± 5.3 [range 4-27] h) was significantly lower than that in the oxytocin group (14 ± 6.8 [range 4-30] h) (P = 0.009). The total hospital stay in the misoprostol group (22.6 ± 9.5 [range 12-48] h) was significantly lower than that in the oxytocin group (35.3 ± 16.4 [range 12-72] h) (P = 0.000). Although the successful induction rate was higher in the misoprostol group, this was not significant (95% vs 86.7%, P = 0.1). Placenta retention occurred more in the oxytocin group (20% vs 5%, P = 0.03). CONCLUSION: Both vaginal misoprostol and high-dose i.v. oxytocin are highly effective in labor induction in second-trimester pregnancies with IUFD and an unripe cervix. However, vaginal misoprostol seems to be superior to i.v. oxytocin.

Ectopic pregnancy within a cesarean scar resulting in live birth: a case report.

Implantation of an embryo within the scar of a previous cesarean delivery is one of the rare forms of ectopic pregnancy (EP). There are two types of such pregnancies:   type 1, in which the embryo starts to progress towards the uterine cavity and may result in live birth despite the high risk of a hemorrhage occurring during birth, and type 2, which consists of pregnancies in which the embryo is embedded deep within the cesarean scar (CS) and grows towards the bladder and abdominal cavity, which is very dangerous and needs to be terminated immediately. There are very few cases in the literature reporting live birth as a result of such pregnancies. Here, we present a 41-year-old single gravid woman who had been treated for infertility at our institute and had eventually conceived through embryonic transfer freezing. At six weeks, a transvaginal scan showed the presence of an EP within the CS but despite this finding the pregnancy was continued to term.