Prediction of postnatal abnormal umbilical cord coiling by antenatal evaluation in pregnant women: Diagnostic accuracy study; a systematic review.

STUDY OBJECTIVE: Umbilical cord abnormalities increase neonatal morbidity and mortality. Considering uncertainties about the best time of an antenatal ultrasonography scan to evaluate the umbilical coiling index (UCI), this systematic review was designed to assess the diagnostic accuracy value of antenatal ultrasound assessments to predict abnormal postpartum UCI. METHODS: All observational, cross-sectional, case-control, cohort, and diagnostic accuracy studies up to March 26, 2022, were searched and assessed according to PRISMA guidelines in Ovid, Cochrane, Scopus, PubMed, Web of Science, Embase, Proquest, Science Direct, and Clinical Key databases, and Google Scholar search engine. RESULTS: The total number of 63 190 documents were retrieved from databases. The duplicates (19 272) were removed, 43 918 articles were screened for relevance, and 56 papers were selected for full-text evaluation, resulting in 14 qualified pieces subjected to the quality CASP tools for each type of study. Finally, six articles were evaluated, extracted, and confirmed. Overall, we had 16 evaluations (11 normal pregnancies, 4 gestational diabetes mellitus, and 1 group at risk for small gestational age), from which 9 and 7 were respectively performed in the second and third trimesters. Most of the evaluations considered both hypocoiling and hypercoiling. The sensitivity, specificity, and area under curves (AUCs) change range between the evaluations were 0.09-0.97, 0.59-0.96, and 0.262-0.84, respectively. CONCLUSION: Observing any coiling abnormalities in every trimester, both the second and third, is highly sensitive to predicting abnormal postnatal UCI (pUCI). Conclusively, any detected antenatal abnormality is worth attention. Both trimesters' evaluations are essential, and no superiority is seen for any of them. The systematic review revealed statistical and clinical heterogeneity; a meta-analysis was impossible.

Survival of very preterm infants in the Islamic Republic of Iran: A population-based retrospective cohort study.

Background: Estimation of the survival of very preterm infants is necessary to make decisions and design interventions in order to improve their quality of care. This survey aimed to estimate the survival of very preterm infants born at 23 up to 33 weeks of gestational age (GA) in Iran. Methods: This population-based retrospective cohort study included 8536 infants born before 33 weeks of GA, from March 21st to December 22nd 2013 in Iran. The primary data were extracted from the Iranian national maternal and neonatal registration network (IMAN). All infants who have been discharged alive, followed up by telephone contact up to one year after birth. The Kaplan-Meier and Log-rank tests were performed to estimate survival and to compare survivals, respectively, using SPSS version 26 and R 3.5.2 softwares. Results: The overall survival was estimated at 56.70% (95% C.I: 55.60%-57.80%) at the end of the follow-up period. Total death rate was estimated at 43.30% and was significantly decreased with increasing birth weight (p<0.0001). Survival was increased significantly with increasing GA (p<0.0001), from 5.7% at 23 weeks to 79.6% at 32 weeks. The estimated cumulative proportion of death until the end of the neonatal period had a decreasing trend and then had a steady trend until the end of the follow-up period. The hazard ratio of quadruple or more birth and GA were 1.46 (p=0.021) and 0.83 (p<0.001), respectively. Conclusion: The overall estimated survival of very preterm infants was not high. Even with modern perinatal technology and care, early deaths of very preterm infants were still common.

The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Data on the effects of coenzyme Q10 (CoQ10) supplementation on metabolic profiles among subjects with polycystic ovary syndrome (PCOS) are scarce. OBJECTIVE: This study was carried out to evaluate the effects of CoQ10 supplementation on glucose metabolism and lipid profiles in subjects with PCOS. DESIGN, PATIENTS AND MEASUREMENTS: This randomized, double-blind, placebo-controlled trial was conducted on 60 women diagnosed with PCOS. Subjects were randomly assigned into two groups to intake either 100 mg CoQ10 supplements (N = 30) or placebo (N = 30) per day for 12 weeks. Markers of insulin metabolism and lipid profiles were assessed at first and 12 weeks after the intervention. RESULTS: After 12 weeks of intervention, compared to the placebo, subjects who received CoQ10 supplements had significantly decreased fasting plasma glucose (-0·24 ± 0·51 vs +0·01 ± 0·44 mmol/l, P = 0·04), serum insulin concentrations (-7·8 ± 14·4 vs +6·0 ± 15·0 pmol/l, P < 0·001), the homeostasis model of assessment-estimated insulin resistance (-0·3 ± 0·6 vs +0·2 ± 0·6, P = 0·001), the homeostasis model of assessment-estimated B-cell function (-5·4 ± 9·5 vs +4·5 ± 9·9, P < 0·001) and increased the quantitative insulin sensitivity check index (+0·006 ± 0·009 vs -0·006 ± 0·01, P < 0·001). In addition, changes in serum total- (-0·10 ± 0·48 vs +0·19 ± 0·50 mmol/l, P = 0·02) and LDL-cholesterol concentrations (-0·15 ± 0·40 vs +0·14 ± 0·49 mmol/l, P = 0·01) in supplemented women were significantly different from those of women in the placebo group. When we adjusted the analysis for baseline values of biochemical parameters, age and baseline BMI, serum LDL-cholesterol (P = 0·05) became nonsignificant, and other findings did not alter. CONCLUSIONS: Overall, CoQ10 supplementation for 12 weeks among subjects with PCOS had beneficial effects on glucose metabolism, serum total- and LDL-cholesterol levels.

Association between BMI and gene expression of anti-Müllerian hormone and androgen receptor in human granulosa cells in women with and without polycystic ovary syndrome.

BACKGROUND: Anti-Müllerian hormone (AMH) is one of the most reliable markers of ovarian reserve. There is evidence which suggests that BMI may be associated with gene expression of AMH, AMH type II receptor (AMHR-II) and androgen receptor (AR) in human granulosa cells (GC) in women with and without polycystic ovary syndrome (PCOS). OBJECTIVE: To investigate the association between BMI and gene expression of AMH, AMHR-II and AR in human GC in women with and without PCOS. DESIGN, PATIENTS AND MEASUREMENTS: In a cross-sectional study, hormonal profiles were measured among 38 patients with PCOS and 38 subjects without PCOS aged 18-40. AMH, AMHR-II and AR mRNA levels were quantified in cumulus GC. Pearson correlation and multiple linear regressions were used to assess the relationships. RESULTS: Quantitative RT-PCR demonstrated that AMH and AMHR-II expression were negatively correlated with BMI (r = -0·39, P < 0·001 for AMH and r = -0·49, P < 0·001 for AMHR-II), whereas AR expression was positively correlated with BMI (r = 0·46, P < 0·001). CONCLUSIONS: There is a negative association between AMH, AMHR-II expression and BMI, and a positive association between AR expression and BMI in the GC of PCOS and non-PCOS women.

The effects of synbiotic supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes: a randomised, double-blind, placebo-controlled trial.

To the best of our knowledge, data on the effects of synbiotic supplementation on markers of insulin metabolism and lipid concentrations in patients with gestational diabetes mellitus (GDM) are scarce. The aim of the current study was to determine the effects of synbiotic supplementation on markers of insulin metabolism and lipid profiles in GDM patients. In total, seventy patients with GDM aged 18-40 years were assigned to two groups - the synbiotic group (n 35) and the placebo group (n 35) - in this randomised, double-blind, placebo-controlled trial. Patients in the synbiotic group received a daily capsule that contained three viable and freeze-dried strains: Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2×109 colony-forming units/g each) plus 800 mg inulin for 6 weeks. Fasting blood samples were collected at the beginning and week 6 to quantify related markers. After 6 weeks of intervention, compared with the placebo, synbiotic supplementation led to a significant decrease in serum insulin levels (-1·5 (sd 5·9) v. +4·8 (sd 11·5) µIU/ml, P=0·005), homoeostatic model assessment for insulin resistance (-0·4 (sd 1·3) v. +1·1 (sd 2·7), P=0·003) and homoeostatic model assessment for ß cell function (-5·1 (sd 24·2) v. +18·9 (sd 45·6), P=0·008) and a significant increase in quantitative insulin sensitivity check index (+0·01 (sd 0·01) v. -0·007 (sd 0·02), P=0·02). In addition, synbiotic intake significantly decreased serum TAG (-14·8 (sd 56·5) v. +30·4 (sd 37·8) mg/dl, P<0·001) and VLDL-cholesterol concentrations (-3·0 (sd 11·3) v. +6·1 (sd 7·6) mg/dl, P<0·001) compared with the placebo. Overall, the results of this study demonstrate that taking synbiotic supplements for 6 weeks among patients with GDM had beneficial effects on markers of insulin metabolism, TAG and VLDL-cholesterol concentrations.

Comparison the effects of oxytocin and methylergonovine in elective caesarean section under spinal anesthesia.

PURPOSE: In order to prevent postpartum hemorrhage in caesarean section under spinal anesthesia, patients routinely receive oxytocin. In this study we compared the efficacy of Methylergonovine and Oxytocin on hemodynamic stability and bleeding amount in caesarean section. MATERIALS AND METHODS: In this randomised controlled trial study, 80 patients candidate for elective caesarean section under spinal anesthesia divided to two groups: 40 patients in control group received oxytocin and 40 ones in case group received methylergonovine. RESULTS: There was no differences between groups in Mean age, baseline hemodynamic values, after spinal anesthesia and recovery (except diastolic blood pressure min 20), time of uterine atony, dizziness; nausea and vomiting. After drug administration (oxytocin and methylergonovine), systolic blood pressure in minutes 1, 10, 15 and diastolic blood pressure in minutes 1, 3, 20 increased in case group statistically more than control group. In control group, heart rate in minutes 1, 5 increased significantly more than the other group. Mean arterial blood pressure in minutes 1, 3, 5, 10, 15 reduced significantly more than in control group. Need to vasoconstrictor drug statistically was less in case group (p < 0.0001). CONCLUSION: Methylergonovine induced significantly more hemodynamic stability. Adverse effects were similar between two groups. We recommend the use of methylergonovine in patients with caesarean section under spinal anesthesia because of its hemodynamic stability and low need to vasoconstrictor drugs.

Prevalence of various human papillomavirus (HPV) genotypes among women who subjected to routine Pap smear test in Bushehr city (south west of Iran) 2008-2009.

BACKGROUND: Some genotypes of human papillomaviruses can infect the genital tract and they are important infectious agents which their oncogenicity is regardable. Thus the aim of this study was to determine the prevalence of various genital human papillomaviruses (HPV) among women being subjected to routine pap smear test in Bushehr city of Iran. RESULTS: Based on the collected data, 11(5.5%) samples were detected positive for HPV DNA and 189(94.5%) samples out of 200 samples were detected negative for HPV DNA. Meanwhile 4(2%) samples detected positive for HPV DNA by PCR were detected positive for HPV by pap smear test as well. On the other hand 5 samples which were detected positive for HPV by pap smear test didn't have HPV DNA after being tested by PCR method. Among the 11 positive samples 7 samples were identified as HPV-16, 3 samples were HPV-18 and one was HPV-53. CONCLUSION: Regarding the prevalence of highly carcinogen genotypes of HPV in our study determination of genital HPV prevalence among the normal population of women of Bushehr city is recommended.

Can fresh embryo transfers be replaced by cryopreserved-thawed embryo transfers in assisted reproductive cycles? A randomized controlled trial.

PURPOSE: Controlled ovarian hyperstimulation has been shown to advance endometrial maturation and adversely affects implantation in ART. It has been reported that there is a better embryo-endometrium synchrony in frozen-thawed embryo transfer cycles than fresh embryo transfer cycles. The objective of this study was to compare ongoing pregnancy rates between fresh ET and FET cycles. METHODS: In an open prospective, controlled study, the patients who were classified as high responders, were randomized to either fresh ET or FET. The embryos in FET group were cryopreserved with vitrification by Cryotop method. RESULTS: A total of 374 patients were included, 187 of which were randomized to FET and 187 to fresh ET. There were 39% (n = 73) ongoing pregnancy in FET group compared with 27.8% (n = 52) in fresh ET group[odds ratio = 1.66;95% confidence interval = 1.07-2.56; p = 0.02]. CONCLUSIONS: FETs can be performed instead of fresh ETs to improve the outcome of ART in highly selected patients.

Comparison of mild stimulation and conventional stimulation in ART outcome.

PURPOSE: To provide a treatment for particular condition that is the most effective treatment with the least risk and cost for the patient we compared the efficacy of using clomiphene 100 mg + delayed low dose gonadotropin + flexible GnRH antagonist administration for ovarian stimulation protocol and GnRH agonist + gonadotropin for stimulation protocol in IVF outcome. METHODS: Clinical outcome of 243 women with regularly menstruation who were candidate for IVF. They had undergone stimulation with GnRH agonist and gonadotropin (group A) or clomiphene citrate, gonadotropin and GnRH antagonist (group B). Main outcome was ongoing pregnancy. RESULTS: There were no significant difference in mean age, cause of infertility, basal FSH, BMI, duration of infertility, endometrial thickness on the day HCG administration in two groups. The number of recovered oocytes, obtained embryos, transferred embryos, peak of estradiol on the day HCG administration and OHSS were significantly higher in group A. Significantly more patients in control group had embryos for cryopreservation. There were no significant difference in clinical pregnancy rate and ongoing pregnancy rate between two groups. CONCLUSION: Clomiphene + delayed low dose gonadotropin + flexible GnRH - antagonist stimulation is an acceptable alternative protocol for IVF in patients with regularly menstruation.

Local injury to the endometrium on the day of oocyte retrieval has a negative impact on implantation in assisted reproductive cycles: a randomized controlled trial.

PURPOSE: To evaluate the effect of local injury to the endometrium on the day of oocyte retrieval on implantation and pregnancy rates in assisted reproductive cycles. METHODS: In a prospective controlled trial, a total of 156 patients, <38 years old, in their first in vitro fertilization (IVF) cycle were randomized. In 77 patients, two small endometrial samples from anterior and posterior walls of uterus were obtained with a Novak curette on the day of oocyte retrieval and in 79 patients no intervention was performed. RESULTS: The experimental and control patients were matched regarding women's age, body mass index, basal FSH, duration and etiology of infertility, treatment protocol, number of retrieved oocyte, endometrial thickness, percentage of intracytoplasmic sperm injection performance, fertilization rate, the percentage of patients with good and top quality embryos, and the number of embryos transferred. The implantation rate (7.9 vs. 22.9%), clinical (12.3 vs. 32.9%; odds ratio = 0.25; 95% confidence interval = 0.12-0.66; p < 0.05) and ongoing pregnancy (9.6 vs. 29.1%; odds ratio = 0.25; 95% confidence interval = 0.10-0.64; p < 0.05) rates were significantly lower in experimental group, compared with 79 controls. CONCLUSION: According to the results of this study, local injury to the endometrium on the day of oocyte retrieval disrupts the receptive endometrium and has a negative impact on implantation and IVF outcomes.

Comparing GnRH agonist long protocol and GnRH antagonist protocol in outcome the first cycle of ART.

PURPOSE: This prospective study evaluated the efficacy of gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison with the GnRH agonist protocol in the first cycle of assisted reproductive technique (ART). METHODS: We randomized 235 patients undergoing ART for the first time. The first group was stimulated with a standard long protocol and the second group stimulated with GnRH antagonis. RESULTS: There was no statistically significant difference in the age, infertility cause, basal FSH, BMI, the number of oocytes retrieved, number of M2 oocytes, embryo obtained and endometrial thickness between the two groups. But Serum estradiol, consumption of gonadotropins and ovarian hyperstimulation syndrome were significantly lower in the antagonist protocol. Cancellation rate of embryo transfer due to poor-quality embryo in the antagonist protocol was higher, but it was not significant. There was no significant difference in the clinical pregnancy and ongoing pregnancy between the two groups. CONCLUSION: GnRH-antagonist is an effective, safe, and well-tolerated alternative to agonist in the first cycle of ART.

Prediction of high ovarian response to controlled ovarian hyperstimulation: anti-Müllerian hormone versus small antral follicle count (2-6 mm).

PURPOSE: To evaluate the predictive value of basal serum anti-müllerian hormone level and small antral follicle count for high ovarian response to controlled ovarian hyperstimulation. METHODS: A total of 159 patients were prospectively included. Basal serum anti-müllerian hormone and small antral follicle count (2-6 mm) were measured. RESULTS: Small antral follicle count and anti-müllerian hormone have similar predictive accuracy for high ovarian response with area under curve of 0.961 and 0.922, respectively. The sensitivity and specificity for prediction of high ovarian response were 89% and 92% for small antral follicle count and 93% and 78% for anti-müllerian hormone at the cutoff values of > or = 16 and > or = 34.5 pmol/l, respectively. CONCLUSIONS: Small antral follicle count and anti-müllerian hormone are equally accurate predictors of high ovarian response and facilitate determination of the optimal strategy for controlled ovarian hyperstimulation.

Hypertensive Disorders in Pregnant Women Receiving Fertility Treatments.

Hypertensive disorders (HDs) as the most prevalent medical problem during pregnancy, predispose the patient to a lot of comorbidities and may even cause maternal or fetal death. The rate of infertility has been increasing in recent decades. So, we collected and summarized data about the co-existence of these two entities and found that HDs are somewhat more common in women receiving fertility treatments regardless of pathophysiologic correlation of infertility and hypertension or older age and chance of multiple pregnancies.

Comparison of the pregnancy outcomes between the medical and surgical treatments in tubal ectopi pregnancy.

BACKGROUND: Various treatments have been proposed to treat ectopic pregnancy, but their impact on future pregnancies is still the subject of controversy. OBJECTIVE: The aim of this study is to compare the medical and surgical treatment methods and their impact on the subsequent fertility results and complications in women with a history of ectopic pregnancy. MATERIALS AND METHODS: In this analytical, cross-sectional study, 370 women with the history of ectopic pregnancy, (treared with single dose of methotrexate or salpingectomy by laparotomy), that referred to Al-Zahra Hospital, Rasht, Guilan between 2009 to 2013 were enrolled. 147 women responded to the phone call. The age, the number of women that needed to drug for pregnancy, fertility rate and the fertility outcomes were studied. RESULT: 147 women responded to the call and between them, 114 women tried to get pregnant again after the ectopic pregnancy treatment. They were agreed to the participate in the study. The mean age of the patients was 28.56±5.63 yr. The fertility rates in the medical and the surgical groups were 56.6% and 47.61%, respectively (p=0.141). There were no significant differences in the poor consequences of pregnancy among the two groups; ectopic pregnancy (p=0.605), miscarriage (p=0.605), and prematuredelivery (p=0.648). 15.1% in the medicinal group and two patients 12.5% in the surgical group had received fertility treatment in order to get pregnant (p=0.135). There was no significant difference in two groups. CONCLUSION: It seems that surgical treatment depending on the underlying variables of each patient, can be used such as medical treatment, without worrying about its effect on fertility.

The effects of magnesium supplementation on gene expression related to inflammatory markers, vascular endothelial growth factor, and pregnancy outcomes in patients with gestational diabetes.

Magnesium has been introduced as one of the micronutrients with several metabolic benefits, mainly anti-inflammatory properties. The aim of this study was to evaluate the effects of magnesium supplementation on gene expression of inflammatory markers, vascular endothelial growth factor (VEGF), and pregnancy outcomes in women diagnosed with gestational diabetes mellitus (GDM). This randomized, double-blinded, placebo-controlled trial was conducted among 36 women, aged 18-40 years old, diagnosed with GDM. Study participants were randomly allocated into two groups to receive either 250 mg/day magnesium oxide (n = 18) or placebo (n = 18) for six weeks. Gene expression related to inflammatory markers and VEGF was assessed using peripheral blood mononuclear cells (PBMCs) of women with GDM, via RT-PCR method. Quantitative results of RT-PCR demonstrated that magnesium supplementation downregulated gene expression levels of interleukin-8 (IL-8) (P = 0.03) and tumor necrosis factor-α (TNF-α) (P = 0.006) and upregulated gene expression levels of transforming growth factor beta (TGF-ß) (P = 0.03) in PBMCs of women with GDM, compared with placebo. Magnesium supplementation did not significantly affect gene expression of IL-1 and vascular endothelial growth factor. Additionally, magnesium administration resulted in a lower incidence of newborn hyperbilirubinemia (11.1% versus 44.4%, P = 0.02) and newborn hospitalization (11.1% versus 44.4%, P = 0.02) compared with placebo. Overall, magnesium supplementation for six weeks significantly decreased gene expression levels of IL-8 and TNF-α, and increased TGF-ß in women with GDM. Therefore, magnesium supplementation might be recommended to decrease metabolic complications in women with GDM, due to its beneficial effects on gene expression of inflammatory markers.

Association of -460C/T and +405 G/C polymorphisms of vascular endothelial growth factor gene and susceptibility to ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of assisted reproduction treatment. Many substances are involved in the regulation of the vascular permeability, which have been concerned to cause OHSS. Vascular endothelial growth factor (VEGF) has emerged as one of the main angiogenic factors, which could be responsible for increased vascular permeability. OBJECTIVE: In this study the association of vascular endothelial growth factor -460C/T and +405 G/C polymorphisms and susceptibility to ovarian hyperstimulation syndrome was evaluated. MATERIALS AND METHODS: In this cross sectional study, VEGF gene polymorphisms were amplified by Polymerase chain reaction- Restriction Fragment Length Polymorphism in 75 women with established OHSS (case group) and 85 normoresponder (control group) which received conventional ovarian stimulation regimen. RESULTS: There was no significant difference in the frequency of -460 C/T polymorphism between cases and controls (p=0.85). The frequency of +405 G/C polymorphism was significantly higher in the OHSS women (p=0.03, OR=2.44; 95% CI=1.23-4.82). CONCLUSION: In women who developed OHSS, VEGF gene polymorphism +405 could be effective. Two of the polymorphisms -460 C/T and +405 G/C were reported to be associated with increased VEGF basal promoter activity. However, only +405 G/C gene polymorphisms were more frequent in cases than controls.

Probiotic supplementation and the effects on weight loss, glycaemia and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial.

The aim of the current study was to assess the effects of probiotic supplementation on weight loss, glycaemia and lipid profiles in women with polycystic ovary syndrome (PCOS). In a randomized, double-blind, placebo-controlled trial, 60 women with PCOS were randomized to receive probiotic capsule (n = 30) or placebo (n = 30) for 12 weeks. Consumption of probiotic supplements resulted in a significant reduction in weight (-0.5 ± 0.4 vs. +0.1 ± 1.0 kg, p = 0.004) and BMI (-0.2 ± 0.2 vs. +0.03 ± 0.4 kg/m2, p = 0.004) compared with the placebo. In addition, compared with the placebo, probiotic administration was associated with a significant decrease in fasting plasma glucose (-2.4 ± 8.4 vs. +2.1 ± 7.0 mg/dL, p = 0.02), serum insulin concentrations (-2.0 ± 5.8 vs. +1.6 ± 5.0 µIU/mL, p = 0.01), homoeostasis model of assessment-insulin resistance (-0.5 ± 1.4 vs. +0.3 ± 1.1, p = 0.01), homoeostatic model assessment-beta cell function (-7.5 ± 22.3 vs. +6.3 ± 21.7, p = 0.01), serum triglycerides (-13.3 ± 51.3 vs. +13.6 ± 37.1 mg/dL, p= 0.02) and a significant increase in quantitative insulin sensitivity check index (QUICKI) (+0.006 ± 0.01 vs. -0.005 ± 0.02, p = 0.01). When we adjusted the analysis for baseline values of biochemical parameters, age and baseline BMI, except for QUICKI (p = 0.08), other findings did not alter. We found that probiotic supplementation among PCOS women for 12 weeks had favourable effects on weight loss, markers of insulin resistance, triglycerides and VLDL-cholesterol concentrations.