The Rate of Cesarean Section and Newborn Apgar score In Two Types Of Physiological Delivery and Facilitated Delivery in Mothers with First Pregnancy.

INTRODUCTION: Labor pain is often severe and its lack of relief can have a bad effect on the mother's physiological condition. Accurate measurement and appropriate treatment of pain is an important problem. There are several choices for the control of labor pain, however, each method has its own risks and benefits regarding its efficiency and availability; therefore, the aim of this study was to compare the rate of cesarean section and newborn Apgar in two types of physiological delivery and facilitated delivery among mothers with first delivery. MATERIALS AND METHODS: This case-control study was conducted on mothers aged 18-35 who went to the hospital to give birth. In the present study, 8 sessions (90 minutes each session) were held to prepare mothers from 20 to 37 weeks of pregnancy. Candidate mothers for physiological labor were hospitalized without intervention and in the active phase of labor, and their labor stages were planned physiologically. The pain intensity of mothers was asked using a scale (VAS) during labor every half hour (according to the pain scale from 0 to 10). The average score of pain during the first and second stages, type of delivery, amount of postpartum bleeding, length of the stage of delivery, infection, and fever after delivery, Apgar score of the baby, perineal status, mother's satisfaction and the rate of hospitalization of the baby in NICU were recorded. Furthermore, the level of satisfaction with childbirth was evaluated with the help of Mackey's standard satisfaction questionnaire. RESULTS: The average age of the physiological delivery and facilitated delivery groups was 26.37 ± 5.23 years and 26.58 ± 5.79 years, respectively. Physiological delivery significantly required less conversion to cesarean section. The most common etiology was caesarean section in the physiologic labor group, and a drop in NST was reported in the facilitated group. The analysis of the results demonstrated no significant difference between the etiology of cesarean section and the study groups. The Apgar score in the physiological group was significantly better than the facilitated group. There is no significant relationship between the study group and the amount of bleeding during delivery. Furthermore, there was no significant relationship between the study group and the incidence of postpartum infection. The rate of NICU admission in the facilitated group was found to be significantly higher than physiological delivery. CONCLUSION: The results of this study revealed that the rate of caesarean section, the rate of need for NICU, newborns' Apgar score, and the rate of mothers' satisfaction in physiological delivery group were significantly different from the other groups, but the rate of wound infection and the amount of postpartum bleeding in the two groups showed a significant difference.

Effect of cell-free fetal DNA on spontaneous preterm labor.

Inflammatory phenomenon, including cell-free fetal DNA (cffDNA), is one of the various causes of preterm delivery. Always, there is a trend in the prediction and prevention of preterm labor. Herein, the aim of this study is to assess the value of cffDNA levels in serum of pregnant women for prediction of spontaneous preterm labor. A case-control study with nonrandomized convenience sampling was conducted. One hundred women qualifying for the study were enrolled. The participants were divided into two groups of healthy nulliparous pregnant women (n = 50) and nulliparous pregnant women experiencing preterm labor (n = 50). Then, venous blood was sampled from each participant and its plasma was separated and analyzed. The mean age of women in the experimental group was 22.90 years with the standard deviation of 4.04, while in the control group these two values were 23.78 and 4.37, respectively. In the experimental group, 29 patients (58%), and in the control group, 27 patients (54%) had cffDNA. The mean of the counted DNA in the experimental group was 2080/03 with the standard deviation of 909/792 while the same values for the control group were 1183/26 and 620/720, in the same order. The statistical analysis revealed that this difference was meaningful at P = 0.001. Furthermore, in the experimental group, cffDNA increased with increase in the age and the difference was meaningful. Finally, increasing pregnancy age in the experimental group led to an increase in the number of cffDNA (P = 0.001). The results of this study indicated that the cumulative frequency of preterm labor for women with positive cffDNA was significantly higher. High levels of cells' DNA in the serum of pregnant mothers increase the risk of spontaneous preterm labor. These observations may have implications for preterm labor.

MTHFR C677T and eNOS G894T variants in preeclamptic women: Contribution to lipid peroxidation and oxidative stress.

OBJECTIVES: We aimed to investigate the association between methylenetetrahydrofolate reductase (MTHFR) C677T and endothelial nitric oxide synthase (eNOS) G894T polymorphisms with lipid peroxidation, total antioxidant capacity (TAC) and the risk of preeclampsia in preeclamptic women. DESIGN AND METHODS: We screened a sample of 198 unrelated women with mild and severe forms of preeclampsia and 101 unrelated women with normal pregnancy with the eNOS and MTHFR variants using PCR-RFLP method. Also, the serum malondialdehyde (MDA) and TAC levels were determined using HPLC and commercial kits, respectively. RESULTS: The frequency of combined genotypes of MTHFR CT and TT (CT+TT) and T allele tended to be higher in severe preeclamptic women compared to controls. There was no significant difference for eNOS G894T genotype and allele frequencies between patients and controls. A significantly higher level of triglycerides was observed in the presence of combined genotypes of MTHFR CT and TT and also eNOS GT and TT (GT+TT) in preeclamptic women compared to controls with the same genotype. Also, the presence of MTHFR TT genotype in severe preeclamptic women was significantly associated with the increased serum MDA level compared to CC genotype. In severe preeclamptic women the presence of CT and combined genotypes of CT and TT was significantly associated with the decreased TAC level compared to CC genotype. Also, a higher MDA level was observed in mild preeclamptic women with eNOS TT genotype compared to those with GG genotype but the difference was not significant. CONCLUSION: The present study indicates that MTHFR C677T polymorphism through affecting on TG level, lipid peroxidation and oxidative stress might be involved in the pathogenesis of severe preeclampsia.

Thrombophilic mutations and susceptibility to preeclampsia in Western Iran.

The aim of the present study was to investigate the frequency and the possible association between thrombophilic mutations of factor V Leiden (FVL) and prothrombin G20210A with preeclampsia among Kurdish population of Western Iran. We studied 198 women with preeclampsia including 128 women with mild and 70 women with severe forms and 101 healthy pregnant women with uncomplicated pregnancy. Among cases there were 23 women with early onset preeclampsia and 175 cases with late-onset preeclampsia. The sample was genotyped by polymerase chain reaction-restriction fragment-length polymorphism using Mnl I and Hind III for FVL and prothrombin G20210A, respectively. The frequency of heterozygous FVL mutation was 7.6% among all preeclamptic women (8.6% in mild and 5.7% in severe preeclamptic women) and 7.9% in controls (P > 0.05). However, the prevalence of heterozygous FVL were 10.5 and 3.9% among severe preeclamptic women with early onset and late-onset preeclampsia, respectively (P > 0.05). The prevalence of prothrombin G20210A were 1.6, 2.9, and 3% among women with mild preeclamsia, severe preeclampsia and controls, respectively (P > 0.05). The level of serum triglycerides (TG) was significantly higher among women with preeclampsia compared to healthy pregnant women that was not associated with the two thrombophilic mutations. Our results indicate that neither FVL nor prothrombin G20210A could be a risk factor for preeclampsia in our population. However, high prevalence of FVL in preeclamptic women with early onset compared to those with late-onset preeclampsia may suggest a role for this mutation in predisposition to early onset preeclampsia that need to be confirmed with larger sample size.