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Preterm birth (PTB) is the common cause of neonatal mortality nationwide. The present study aimed to evaluate the efficacy of different doses of aspirin in preventing PTB in high-risk pregnant women. As secondary outcomes, other perinatal complications were compared. This double-blind randomized clinical trial was conducted on high-risk pregnant women with impaired placental perfusion diagnosed in the first trimester of pregnancy referring to the perinatal centers affiliated to Shiraz university of Medical Sciences between February 2020 and March 2021. The subjects were randomly divided in two groups administered with 150 or 80 mg aspirin every night from 11 to 13+6 weeks until 36 weeks or delivery. This study is registered in the Iranian Registry of Clinical Trials (IRCT20140317017035N6; http://www.irct.ir/). Univariate and multiple logistic regressions were applied using SPSS 22. A total of 101 subjects received 80 mg aspirin and 89 ones received 150 mg aspirin. The results of multiple analysis revealed a significantly lower odds of PTB (OR 0.4 (0.19, 0.99)) in the 150 mg group compared to the 80 mg group. As secondary outcomes, preeclampsia (PEC) and PEC with severe features (PECsf) were lower (OR 0.2 (0.06, 0.82) and 0.1 (0.01, 0.92), respectively); however, fetal age and neonatal weight were higher in the 150 mg group (OR 1.2 (1.04, 1.33) and 1.001 (1–1.001), respectively). The study findings indicated that, compared with 80 mg of aspirin, taking 150 mg of aspirin reduced PTB and perinatal complications in high risk pregnant women. [ABSTRACT FROM AUTHOR]

Objective: This is the first comprehensive review to focus on currently available evidence regarding maternal, fetal and neonatal mortality cases associated with Coronavirus Disease 2019 (COVID-19) infection, up to July 2020. Methods: We systematically searched PubMed, Scopus, Google Scholar and Web of Science databases to identify any reported cases of maternal, fetal or neonatal mortality associated with COVID-19 infection. The references of relevant studies were also hand-searched. Results: Of 2815 studies screened, 10 studies reporting 37 maternal and 12 perinatal mortality cases (7 fetal demise and 5 neonatal death) were finally eligible for inclusion to this review. All maternal deaths were seen in women with previous co-morbidities, of which the most common were obesity, diabetes, asthma and advanced maternal age. Acute respiratory distress syndrome (ARDS) and severity of pneumonia were considered as the leading causes of all maternal mortalities, except for one case who died of thromboembolism during postpartum period. Fetal and neonatal mortalities were suggested to be a result of the severity of maternal infection or the prematurity, respectively. Interestingly, there was no evidence of vertical transmission or positive COVID-19 test result among expired neonates. Conclusion: Current available evidence suggested that maternal mortality mostly happened among women with previous co-morbidities and neonatal mortality seems to be a result of prematurity rather than infection. However, further reports are needed so that the magnitude of the maternal and perinatal mortality could be determined more precisely. [ABSTRACT FROM AUTHOR]

β-thalassemia is a prevalent disease in Iran. The adverse effects of anemia on placental and neonatal outcomes have previously been shown. Women require additional iron during pregnancy and the anemia of women with β-thalassemia may adversely affect the neonatal outcome and increase placental abnormalities. In this study, we compared the placental histology and neonatal outcomes among pregnant women with and without β-thalassemia. In this population-based cross-sectional study, 144 pregnant women with β-thalassemia minor (case group) were compared to 142 women without β-thalassemia (control group). Women with singleton pregnancies over 20 weeks of gestation without pregnancy complications, anemia, collagen vascular diseases, or other hemoglobinopathies, all referred to hospitals affiliated to Shiraz University of Medical Sciences from March 2014 to February 2016, were included and maternal and neonatal data were extracted from medical records. After child birth, the placenta was evaluated for macroscopic and microscopic changes. The frequency of LBW was significantly higher in the case group than that in the control group (19.7 vs. 9.7%, respectively) (p =.019). Six in the case group had gross abnormalities of placenta, while none in the control group (p =.03) and the case group had a higher frequency of chorangiosis, calcification, syncytial knot, and umbilical cord position (p <.05). As β-thalassemia increases the chance of placental abnormalities, it is recommended to pay more attention to patients with β-thalassemia, especially during pregnancy, to prevent placental and neonatal adverse outcomes. [ABSTRACT FROM AUTHOR]

The alteration of the uterocervical angle (UCA) has been proposed to play an important role in spontaneous preterm birth (sPTB). The aim of this systematic review and meta-analysis was to evaluate the evidence on the UCA predictive role in sPTB. In this study, PubMed, Web of Science, Scopus, and Google scholar were systematically searched from inception up to June 2020. Inter-study heterogeneity was also assessed using Cochrane's Q test and the I2 statistic. Afterward, the random-effects model was used to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Eleven articles that reported second-trimester UCA of 5,061 pregnancies were included in this study. Our meta-analysis results indicate that a wider UCA significantly increases the risk of sPTB in following cases: all pregnancies (WMD = 15.25, 95% CI: 11.78–18.72, p < 0.001; I2 = 75.9%, p < 0.001), singleton (WMD = 14.43, 95% CI: 8.79–20.06, p < 0.001; I2 = 82.4%, p < 0.001), and twin pregnancies (WMD = 15.14, 95% CI: 13.42–16.87, p < 0.001; I2 = 0.0%, p = 0.464). A wider ultrasound-measured UCA in the second trimester seems to be associated with the increased risk of sPTB in both singleton and twin pregnancies, which reinforces the clinical evidence that UCA has the potential to be used as a predictive marker of sPTB. [ABSTRACT FROM AUTHOR]

Objective: Polyhydramnios can lead to maternal and fetal complication during pregnancy, so diagnosis and management can decrease some perinatal complications.Study Design: One hundred and fourteen singleton pregnancies were diagnosed with idiopathic polyhydramnios in the department of obstetrics at Shiraz University of Medical Sciences between January 2000 and January 2011 and were compared with 114 normal pregnancies for their perinatal outcome. Variables include birth weight, admission to neonatal intensive care unit (NICU), meconium staining, respiratory distress, fetal death, neonatal death, low 1-min and 5-min APGAR score, primary cesarean section (C/S), preterm delivery (<37 weeks), postpartum bleeding, and placental abruption.Results: Low birth weight (<2500 g), macrosoma (>4000 g), NICU admission, fetal distress, fetal death, lower 1-min and 5-min APGAR score, preterm delivery, and neonatal death were higher in the case group. However, meconium staining and malpresentation were equal between the two groups. Except for prematurity and 1-min and 5-min APGAR scores, there were no significant differences in other maternal or fetal outcomes considering the severity of polyhydramnios.Conclusion: Idiopathic polyhydramnios should be considered as a high-risk pregnancy that warrants close surveillance. More studies should be done to detect the best time and interval of fetal surveillance in these patients. Chromosomal and torch studies can determine the definite cause of polyhydramnios. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia is a disorder of pregnancy without any specific reasons that characterized by high blood pressure and large amounts of protein in the urine. This disorder is caused by multiple factors and finding any factor related to this disorder can help on time prevention of this disease. Objective: In this study, serum levels of calcium (Ca), magnesium (Mg) and zinc (Zn) were evaluated in preeclampsia women and compared to normotensive ones. Materials and Methods: This was a case-control study on 40 normotensive pregnancies as controls, 20 mild and 20 severe preeclamptic pregnancies as case groups. The women were studied in their 28-40 weeks of pregnancy. Simple random sampling was done based on inclusion and exclusion criteria and data were collected by blood sampling. Results: The serum Ca levels of 4.96±0.62, 4.89±0.34, 5.05±0.35 mg/dL, Mg levels of 0.83±0.08, 0.85±0.11, 0.84±0.11 mg/dL and Zn levels of 107.55±22.74, 108.00±22.40, 107.50±22.30 mg/dL was detected in normotensive, mild and severe preeclampsia, respectively. Statistical analysis revealed that there were no significant differences between three groups in serum levels of Ca (p=0.6), Mg (p=0.827) and Zn (p=0.997). Conclusion: The findings of this study showed that the assessment of serum Ca, Mg and Zn levels does not have any clinical values for predicting and/or managing of preeclampsia. However, based on the positive relationship between serum Ca and Mg concentration and the severity of preeclampsia in this study, we recommend assessment of serum levels of these two mineral elements as indices of the severity of preeclampsia. [ABSTRACT FROM AUTHOR]

Abstract Ethnopharmacological relevance There is limited evidence about the role of herbal and traditional medicine in pregnancy-related insomnia. Extant documents on traditional Persian medicine refer to many plants which could induce sleep and which were used by pregnant women. In Iran, local herbal shops continue to provide these herbs to pregnant women to treat insomnia. One such herb is Lactuca sativa L. The aim of this study was to evaluate the effects of lettuce seed on pregnant women for the treatment of insomnia. Methods and materials In a prospective randomized clinical trial, 100 pregnant women with insomnia aged 20–45 years were assigned to receive capsules containing 1000 mg of lettuce seed or a placebo daily for two weeks. The main outcome was the quality of sleep, which was measured using the Pittsburgh Sleep Quality Index (PSQI). Results Each group contained 50 participants. An improvement in the PSQI score was significantly greater in patients receiving lettuce seed than those receiving the placebo. Linear regression analysis showed that, after controlling for the other variables, the average sleep score of the experimental group was significantly lower than for the placebo group (p = 0.03). Conclusions The findings of this study suggest that lettuce seed decreased insomnia during pregnancy and could be recommended as a safe natural remedy for treatment of pregnancy-related insomnia. Graphical abstract fx1 [ABSTRACT FROM AUTHOR]