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Unexplained recurrent spontaneous abortion (URSA) is characterized by two or more consecutive pregnancy losses before the 20th week of gestation with unknown etiology. Dysregulation of microRNAs (miRNAs) expression has been reported in reproductive diseases. This study aimed to compare differentially expressed miRNAs in the serum samples between URSA patients and healthy individuals. URSA cases were confirmed by a gynecologist. Peripheral blood sample was‏ gathered from 9 URSA patients, 15 normal pregnant, and 10 non-pregnant women without abortion history. After separating serum, the expression levels of the miR-101-3p, miR-517c-3p, miR-146b-5p, miR-221-3p, and miR-520 h were measured by qRT-PCR assay. The circulating level of miR-520 h in URSA patients was significantly up-regulated compared with healthy pregnant (P 0.01) and healthy non-pregnant (P = 0.002) women. Furthermore, miR-520 h expression was significantly different between healthy non-pregnant and pregnant women (P = 0.002). Statistical analysis indicated miR-146b-5p expression was significantly up-regulated in URSA patients compared to normal pregnant women (P = 0.018). However, the transcription level of miR-146b-5p was insignificantly different between normal non-pregnant women and the other two groups. Also, circulating levels of miR-101-3p, miR-221-3p, and miR-517c-3p were not significantly different in the studied groups. Statistical analysis showed significant correlations between both miR-221-3p and miR-517c-3p and other miRNAs (P 0.05). The circulating levels of miR-520 h and miR-146b-5p could be considered biomarkers for URSA diagnosis. Also, miR-517c-3p and miR-221-3p might play a regulatory role in other miRNAs expressions during pregnancy. Previous work, in contrary to our findings, claims that the expression levels of miR-221-3p, miR-101-3p, and miR-517c-3p increased in plasma and tissue samples of patients with URSA. However, our research for the first time indicates that the expression level of miR-520 h and miR-146b-5p in the serum of these patients has increased. Future investigations are necessary to confirm these findings.

The prevalence of infertility is increasing and worrisome. About 10 to 30% of infertility is classified as idiopathic or unexplained infertility (UI).TGF-β is multifunctional and immunoregulatry cy...

Objectives: To determine the effect of nimodipine on premature luteinizing hormone (LH) surge in women undergoing intrauterine insemination (IUI). Patients and Methods: Fifty-six infertile women participated in this randomized clinical trial after referring to Mahdiyeh hospital, Tehran, Iran and undergoing IUI treatment in 2017. Participants were randomly divided into nimodipine (n=34) and placebo (n=22) groups. The demographic and clinical profile of women were collected using a predesigned checklist. In the nimodipine group, 30 mg tablets were given to patients three times daily for 2 days. Finally, the serum levels of LH and estradiol were measured before and after the intervention. Results: Based on the results, the LH surge was observed in 8 (34.8%) women in the placebo group (P=0.04) while it was not detected in 29 (78.4%) women in the nimodipine group. There were no statistical differences in the serum levels of estradiol and LH between the 2 groups before the intervention. The serum levels of estradiol in both groups increased after intervention although this increase was not significant. Eventually, no statistical difference was found between the 2 groups in terms of fertility rate. Conclusions: In general, nimodipine can significantly reduce premature LH surge in patients undergoing IUI compared to the placebo group.

Advances in embryo culture conditions and the development of vitrification as a revolutionary cryopreservation method have allowed for routine use of blastocyst transfer in assisted reproduction technology (ART) cycles. Several vitrification/warming media and devices have been introduced for commercial use so far. The aim of this retrospective study was to compare post-warming survival rates and clinical outcomes of human blastocysts vitrified/warmed by two different commercial methods (CryoTouch and Cryotop) during ART cycles.This retrospective study assessed a total of 50 frozen embryo transfer (FET) cycles conducted on 56 warmed blastocysts between January 2018 and December 2020. Post-warming blastocyst survival rates and clinical outcomes including clinical pregnancy and live birth rates were calculated after single blastocyst transfer cycles.The results revealed no significant differences between two groups in post-warming survival rate (p-value=0.8381), clinical pregnancy rate (p-value=0.8157) and live birth rate (p-value=0.7041).Post-warming survival rates and clinical outcomes were comparable with no significant difference in blastocysts vitrified/warmed by CryoTouch and Cryotop commercial methods.

Background Vitrification has become the method of choice for cryopreservation of human embryos and gametes. There are multiple commercial media, containing different combinations and concentrations of cryoprotectants, available for vitrification and warming procedures. The aim of this retrospective study was to compare post-warming survival rate and clinical outcomes of cleavage stage embryos vitrified/warmed using two different commercial methods (CryoTouch and Cryotop) during intracytoplasmic sperm injection/frozen embryo transfer (ICSI/FET) cycles. This retrospective study evaluated a total of 173 FET cycles performed on 446 warmed cleavage stage embryos between January 2018 and December 2020. Post-warming embryo survival rate and clinical outcomes including clinical pregnancy, implantation, and live birth rates were calculated. Results The results showed no significant differences between two groups in terms of post-warming survival rate (p value = 0.5020), clinical pregnancy rate (p value = 0.7411), implantation rate (p value = 0.4694), and live birth rate (p value = 0.5737). Conclusions Collectively, high successful rates were observed in outcomes of vitrified/warmed cleavage stage embryos using both CryoTouch and Cryotop commercial methods.

SummaryIn assisted reproductive technology (ART) programmes, approximately 10% of infertile patients have at least two or three repeated implantation failures (RIFs) after an in vitro fertilization (IVF) protocol. Successful implantation mainly depends on local immune tolerance mechanisms involving a spectrum of cytokines, interleukins and growth factors. The latter have played pivotal roles in the recruitment of immune cells (and notably T-lymphocyte cells). In total, 250 couples participating in frozen–thawed embryo transfer programme were incorporated in a randomized clinical trial (peripheral blood mononuclear cells (PBMC) subgroup: n=122; control subgroup: n=128). In the PBMC group, a blood sample was collected 5 days before the scheduled frozen–thawed embryo transfer; PBMCs were isolated using Ficoll separation and then cultured for 72 h. Two days prior to embryo transfer, 0.4 ml of cultured PBMCs were transferred into the patient’s uterus. Although the clinical pregnancy rate was higher in the PBMC group (34.4%) than in the control group (23.4%), this difference was not statistically significant (P=0.05 in a chi-squared test). Nevertheless, when we limited the analysis to patients with ≥3 RIFs (n=138), there was a significant difference in the clinical pregnancy rate between the PBMC group (38.6%) and the control group (19.7%; P=0.01). Our results imply that PBMC transfer can be part of effective fertility treatment for patients with RIF.

Background: Pinopods concentrations in endometrial surface is a marker of implantation. Estradiol valerate (EV) was used to change the adverse effects of Clomiphene Citrate (CC) on the endometrium. Objective: The goal was to assess whether there is a significant difference in the endometrial pinopods concentrations and other parameters after adding EV and progesterone to higher doses of CC. Materials and Methods: In this prospective randomized clinical trial, a total of 30 women who did not respond to 100 mg of CC from February 2016 to June 2016 were evaluated. They were divided into three groups: group I) received 150 mg of CC alone, group II) CC with EV, and group III) CC plus progesterone. On day 21 of the menstrual cycle, endometrial biopsy, a blood sampling, and a scanning by electron microscopy were performed. Results: On day 21 of the menstrual cycle, there was no significant difference in the pinopods concentrations (p = 0.641) and serum estrogen levels (p = 0.276) between groups. However, the Serum progesterone levels in group I was higher than the other two groups (p = 0.007) in the same day. Conclusion: Since the addition of EV and progesterone to higher dosages of CC did not change the pinopods concentration and serum estrogen levels on day 21 of the menstrual cycle, and the serum progesterone levels was higher in CC alone group (i.e. group I) compared to other groups, it can be concluded that the anti-estrogenic effects of CC just appear on the endometrium and not on the plasma levels. Key words: Ovulation induction, Clomiphene, Estradiol, Progesterone, Electron microscopy, Endometrium.

Background This study was performed to determine whether the use of ovulation induction drugs in treatment of infertility have a significant effect on the risk of breast cancer. Patients and Methods This case control study (928 cases, 928 controls), was performed in the gynecology and oncology clinics of Shahid Beheshti University of Medical Sciences between 2011 and 2013. Data were collected via in-person interviews using a questionnaire, which included demographic and gynecologic information. Statistical analysis was performed using SPSS statistics software version 20 (IBM Corp). Results The use of ovulation induction drugs was not significantly associated with an increased risk of breast cancer (odds ratio [OR], 1.13; 95% confidence interval [CI], 0.7-1.855) among women with infertility (OR, 1.28; 95% CI, 0.8-1.95). Conclusion We observed no statistically significant relationship between infertility and ovulation induction drugs with the risk of breast cancer, except for significant increases in the risk of breast cancer among patients who had used fertility drugs for >6 months.

BACKGROUND One of the major problems in IVF is the poor response of the ovary to gonadotropins. ESRI and FSHR are two effective genes on controlled ovarian hyperstimulation (COH). OBJECTIVES Evaluating the correlation of alleles and genotypes of polymorphism (-29G/A) located in the FSH receptor gene and polymorphism (XbaI G/A) located in Estrogen receptor genes with the ovary's response would help to anticipate the results of ovulation in IVF cycles. METHODS In the present study, two hundred (200) blood samples were taken from infertile women aged 20 to 39 who were under IVF therapy. After DNA extraction from the samples, real-time PCR was performed using a specific probe-primer. RESULTS Statistical analysis revealed that the frequency of alleles and genotypes of polymorphisms (-29G/A) and (XbaI A/G) in women with normal to poor response did not have significant correlation.

Pre-eclampsia (PE) is a multifactorial pregnancy disorder, with serious consequences for both the mother and the fetus. Despite intense studies, the pathophysiology of PE remains enigmatic. Previous studies suggested that Treg dysfunction is involved in the pathogenesis of PE. We hypothesized that functional variants of the FOXP3 gene might be associated with PE via dysregulation of Treg cells. Of the 276 subjects, we genotyped three variants of FOXP3 by PCR-RFLP and Tetra ARMS-PCR methods. The genotypic frequencies of rs2232365 were found to be protective from the development of PE under codominant [odds ratio (OR) 0.49, 95 percent confidence interval (CI) 0.28-0.87, p-value = 0.043], dominant [odds ratio (OR) 0.54, 95 percent confidence interval (CI) 0.32-0.94, p-value = 0.027] and over dominant [odds ratio (OR) 0.57, 95 percent confidence interval (CI) 0.35-0.92, p-value = 0.02] models. Moreover, the rs3761548 conferred a risk of PE in recessive model [odds ratio (OR) 2.05, 95 percent confidence interval (CI) 1.08-3.88, p-value = 0.025]. However, no mutation was detected in FOXP3 exon2 in any of the studied samples. Based on our results, thought that FOXP3 variants may be an important contributor for the progression of PE in Iranian women.

Background: The purpose of triggering in ovulation induction is to induce the final maturation of oocytes and their release from the ovary for fertilization. Objective: The aim of the present study was to compare the effectiveness of gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (HCG) on the final maturation of oocytes and pregnancy rates in intrauterine insemination (IUI) cycles. Materials and Methods: In this randomized clinical trial, 110 infertile women who were selected for IUI entered the study. Ovulation induction was performed. Group I received 0.1 mg GnRH agonist as triggering and group II received 10,000 IU of HCG. The serum Estradiol (E2), Luteinizing Hormone (LH), and Follicle-Stimulating Hormone (FSH) levels were measured at 12 and 36 hr after injection. Results: LH surge was detected in all patients. LH levels at 12 and 36 hr after triggering was higher in Group I and it washed out earlier than group II (p=0.00). The pregnancy rate was higher in Group I, but the difference was not statistically significant (26.9% vs. 20.8%, respectively p=0.46). Also, the incidence of ovarian hyperstimulation syndrome was not different between the two groups (p=0.11). There was a significant difference regarding the estradiol levels at 36 hours after triggering (p=0.00). Conclusion: Effects of GnRH on endogenous LH surge is sufficient for oocyte releasing and final follicular maturation. Pregnancy rates and ovarian hyperstimulation syndrome incidence were not different between the groups. We suggest that GnRH agonists might be used as an alternative option instead of HCG in IUI cycles.

Objective: Controlled Ovarian Stimulation (COS) for In-Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) is considered as an assisted reproduction technology. There are established structural and biological differences between both ovaries which may affect their responsiveness to COS. Whether the right or the left ovary responds superior to COS is a question which is unresolved in the literature. Study design: The present study was conducted as a prospective observational to make a comparison between right and left ovaries’ oocytes based on oocyte quality and follicular fluid estradiol level. A total of 100 infertile women who had referred to Infertility and Reproductive Health Research center at Shahid Beheshti University of Medical Sciences, Tehran, Iran, were investigated. Results: The total number of very good and good oocytes were 63.01% vs. 50.3%, and immature and interstitial oocytes were 36.99% vs. 49.6% in the right and the left ovaries, respectively. There were no significant differences between oocyte rates between the two ovaries (P > 0.05). Conclusion: Good and very good quality oocytes and fertilization rate (P

Objectives Pre-eclampsia (PE) is a disorder of pregnancy characterized by high blood pressure and proteinuria. Transforming growth factor beta-1 (TGF-β1) is an important replicated PE candidate gene, and few studies have evaluated the direct association of TGF-β polymorphisms and risk to PE. The aim of this study was to investigate the association between three SNPs of TGF-β1 and serum level of this cytokine in PE patients and controls. Design and methods In this study the polymorphisms of the TGF-β1 gene at the coding region, and positions 29T→C (Leu 10 Pro), 74G→C (Arg 25 Pro) and 788C→T (Thr 263 Ile) were studied in 123 PE and 120 normal subjects using PCR-restriction fragment length polymorphism PCR-(RFLP) and amplification refractory mutation system (ARMS)-PCR methods. Moreover, serum TGF-β1 was determined by enzyme-linked immunosorbent assay (ELISA) technique. Results At positions 74G→C and 29T→C the genotypes and allele frequencies showed no significant differences between PE patients and normal controls ( P =0.3 and P =0.5 respectively). While in the case of position 788C→T both genotypes and allele frequencies were significantly different between PE patients and controls ( P =0.02). Haplotype analysis on three polymorphic sites showed no significant differences between PE and control individuals ( P =0.8). TGC and CGC haplotypes were the most frequent in both studied groups. The mean serum TGF-β1 level was significantly higher (62.73ng/ml) in PE patients compared with pregnant (47.01ng/ml) and non-pregnant (40.68ng/ml) control groups ( P =0.0001). Conclusions The results of this study suggest that TGF-β1 gene 788C→T polymorphism is an important factor mediating the casual pathway of preeclampsia.

To compare the use of carbetocin and oxytocin in the prevention of postpartum hemorrhage after cesarean section.The present study was a prospective double-blind randomized controlled clinical trial performed in two university-based hospitals in Tehran, Iran. Two hundred and twenty women with the gestational age of more than 37 weeks, who needed cesarean operation, participated in the study. Patients were assigned to receive either a single 100 μg IV dose of carbetocin or a standard 30-international unit IV infusion of oxytocin during 2 h after delivery of placenta. The primary outcome measures were postpartum hemorrhage requiring additional uterotonic drugs, bleeding volume, and the hemoglobin drops.There were meaningful differences in carbetocin versus oxytocin group regarding the hemoglobin drops (1.01 versus 2.05, p = .01), bleeding volume (430.68 CC versus 552.6 CC, p .001), uterine massages frequency (3.7 versus 4.26, p .001), and uterine height at 2, 4, and 24 h (p .001). Oxytocin side effects were significantly higher in comparison with the carbetocin except pruritus which was observed in 27% of patients in the carbetocin versus no cases in the oxytocin group.It may be concluded that carbetocin is a good alternative modality to conventional uterotonic agents such as oxytocin for the prevention of postpartum hemorrhage after cesarean sections. Registration ID in IRCT: NCT02079558.

Background Providing equitable maternal care to migrants is a seriously challenging task for hosting countries. Iran, the second-most accessed country for refugees from Afghanistan, has achieved maternal health improvement. However, Afghan women with near-miss morbidity faced pre-hospital delays and disparity in maternal care at hospitals. This study explores experiences of maternal care among Afghan women surviving near-miss morbidity to increase insight into healthcare improvements for migrants. Methods A qualitative study was conducted at university hospitals in Tehran, from April 2013 to May 2014. A total of 11 Afghan women and 4 husbands were interviewed when women recovered from near-miss morbidity that occurred around the childbirth period. Mothers were identified prospectively using the WHO maternal near-miss approach. Thematic analysis was used along with a data-driven approach to organize data guided by the ‘three delays model’ theoretical framework. Results Mistreatment in the form of discrimination and insufficient medical attention were key experiences. Participants commonly perceived poor women–professional communication and delays in recognizing obstetric complications despite repeated care-seeking. Financial constraints, costly care, lack of health insurance, and low literacy were experienced barriers to accessing care to a lesser extent. Non-somatic consequences of near-miss morbidity affected mothers and families for extended periods. Conclusions Near-miss survivors’ experiences provided remarkable insights into maternal care of Afghans in Iran. The challenge for the health system and professionals is to provide equitable care with dignity and improve communication skills with caring attitudes toward ethnic minorities. Antenatal visits provide the best and most appropriate opportunities to tackle health illiteracy in Afghan women.

Background: Ovarian carcinoma is the most common malignancy in women and is a cancer with a 15% - 50% prevalence in the world. Human papilloma virus (HPV) is considered a factor in cervical and ovarian cancer (OCa) and is related to squamous cell carcinoma in the cervical region. The effect of fixedinfectionmaycause chronic inflammation, in the cancer of ovaries it has received very rare attention, although a background of pelvic inflammatory disease (PID) in a case-control study is associated with a higher risk for ovarian carcinoma. HPV-16 is one type of HPV and the most common and important cause of cervical carcinoma in the developed world. Objectives: The aim of this investigation was to evaluate the incidence of HPV-16 in patients with OCawhoreferred toImamHossein hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Methods: In this case-control study that was conducted since May 2015 to October 2015 in Tehran, 140 samples were studied which were obtained from patients with OCa. After obtaining the samples from OCa tissue by a pathologist, for DNA extraction, samples were transferred to the laboratory of the university. DNA was extracted with Kit (intron biotechnology Co. Korea) according to the manufacturer’s instructions. To confirm the presence of HPV-16 in the samples of OCa, specific primers for the L1 gene of HPV were designedandstandardPCRmethodwasused for the detection of HPV.PCRproduct wassequenced toconfirmthe presence of HPV-16. Results: Out of 140 samples of OCa, 70 (50%) samples were malignant cancer and 70 (50%) were benign cancer as the control group. Out of 70 malignant samples 25 (36.0%) were HPV-16 positive. 2.8% of the tissue samples of the control group were positive for HPV-16. Conclusions: These results show a feasible role of HPV-16 in the carcinogenesis of OCa. According to these results, infection with HPV may play a relative role in the spread of OCa or it could comfort its development.

Background: Chlamydia trachomatis (C. trachomatis) is the most common sexually transmitted bacterial infectious disease in the world. Moreover, it plays a role in spontaneous abortion. The accuracy of PCR in detection of C. trachomatis infections has been shown in several studies. Objectives: The frequency of spontaneous abortion and known side effects and statistics vary in Chlamydia trachomatis infection in women with spontaneous abortion and different ways to identify and determine the prevalence of Chlamydia trachomatis are used. Materials and Methods: Four sterile Dacron swabs were used to collect specimens from endocervix and vagina from women with miscarriage. DNA was extracted by AccuPrep Genomic DNA extraction kit. The nested PCR procedure was performed with two pair primers. This study was conducted on women referred to Medical Centers of Tehran, Iran in 1391. Results : The number of intercourses per week and history of miscarriage can be known as the risk factors of abortion. Frequency of C. trachomatis in endocervix was 13.25%; the amount of vaginal infection among this group was 19%. Conclusions: Nested PCR as a sensitive Chlamydia trachomatis detection test and endocervical specimens has been offered to detect this bacterium in spontaneous abortion. Besides, C. trachomatis screening among pregnant women can be suggested to prevent abortion.

Preeclampsia (PE) is a pregnancy associated disorder characterized by hypertension and proteinuria, which causes neonatal and maternal morbidity and mortality. The Th1/Th2 cytokine paradigm of the immune adaptation in pregnancy is now expanded to include Th1/Th2/Th17 and regulatory T (Treg) cells. Among cytokines, TGFβ1 has properties that justify evaluation of its role in PE etiopathology. In this investigation the polymorphisms of the TGFβ1 gene at promoter region, positions -800G→A and -509C→T, were studied in 142 PE and 140 normal pregnant female subjects using PCR-RFLP. Additionally, serum TGFβ1 was determined by ELISA. At position -800G→A genotypes and allele frequencies showed no significant differences between PE patients (GG 73.9%; GA 21.1%; AA 4.93%) and normal control (GG 70%; GA 28.6%; AA 1.4%) women. However the AA genotype at this position was more frequent in PE patients than in the control group. At -509C→T position, genotypes and allele frequencies showed no significant differences between PE patients and control individuals. The CC genotype at -509C→T position was more prevalent in PE patients than in the control group. The mean serum TGFβ1 level was significantly higher (62.14 ng/ml) in PE patients compared with pregnant and non-pregnant control groups (and 47.01 and 40.68 ng/ml, respectively). In conclusion, the promoter region polymorphisms of TGFβ1 may not be associated with PE, but serum levels of this cytokine may contribute to the etiopathology of PE.

Objective To evaluate the effect of oral contraceptive on the serum free prostatic specific antigen (PSA) in women with polycystic ovary syndrome (PCOD) compared with cyproterone compound. Materials and methods In this randomized clinical trial, 60 hirsute PCOD patients that referred to Imam Hossein hospital were enrolled. Baseline Ferriman–Gallway score (FG), body mass index (BMI), free PSA, 17-hydroxy progesterone (17-OHP), free testosterone, and dehydroepiandrestandione sulfate (DHEAS) were measured. Then patients were divided randomly into two groups. One group received oral contraceptive pill (OCP) and the other one ate cyproterone compound (Diane). Hormonal profile and Ferriman–Gallway scores were evaluated again after 3months. Results Baseline FG score was 10.78±2.4 vs. 11.5±2.3 in OCP and cyproterone compound group, respectively. FG score was reduced after 3months to 8.06±2.5 vs. 9.2±2.3, respectively ( P value=0.000). There was no significant difference in FG score reduction after the treatment between two groups ( r >0.05). Baseline PSA was 0.201±0.3 in OCP group and 0.097±0.12ng/ml in cyproterone compound group and after the treatment was decreased in both groups significantly 0.135±0.24 vs. 0.059±0.05ng/ml, respectively, but the mean reduction of score was the same for both groups ( r >0.5). Free testosterone reduced more in OCP group (2.48±1.3ng/ml to 2.24±1.0ng/ml, P value=0.03) than cyproterone compound (2.00±1.2 to 1.64±0.9ng/ml, P value=0.1). There was no statistical differences observed in 17-OHP and DHEAS after the treatment in both groups ( P value >0.5). Conclusion Serum free PSA and free testosterone and FG score were decreased after treatment with OCP and cyproterone compound but there was no preference between the two groups of anti-androgen treatment.

INTRODUCTION: Cesarean section carries a substantial risk of maternal near-miss morbidity. The aim of this study was to determine the frequency causes risk factors and perinatal outcomes of maternal near-miss at three university hospitals with a high rate of cesarean section in Tehran Iran. MATERIAL AND METHODS: An incident case-control study was conducted from March 2012 to May 2014. The modified WHO near-miss criteria were used to identify cases. A control sample of 1024 women delivering at the study hospitals was recruited to represent the source population. Near-miss ratio crude and adjusted odds ratios with confidence intervals were assessed. RESULTS: Among 12 965 live births 82 mothers developed near-miss morbidities and 12 died. The maternal near-miss ratio was 6.3/1000 live births. Severe postpartum hemorrhage (35% 29/82) severe preeclampsia (32% 26/82) and placenta previa/abnormally invasive placenta (10% 8/82) were the most frequent causes of maternal near-miss. Women with antepartum cesarean section (adjusted odds ratio 7.4 95% confidence interval 3.7-15.1) and co-morbidity (adjusted odds ratio 2.3 95% confidence interval 1.4-3.8) uninsured Iranians (adjusted odds ratio 3.4 95% confidence interval 1.7-7.1) and uninsured Afghans (adjusted odds ratio 4.7 95% confidence interval 2.4-9.2) had increased risks of near-miss morbidity. Stillbirth and extremely preterm birth were the most prominent adverse perinatal outcomes associated with maternal near-miss. CONCLUSIONS: Overutilization of cesarean section clearly influenced the causes of maternal near-miss. A lack of health insurance had a measurable impact on near-miss morbidity. Tailored interventions for reducing unnecessary cesarean section and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes.

Introduction: Mothers and children are the most vulnerable members of every society. As a result many deaths occur in these two groups, so caring for these two groups is very important. Today, it is believed that the health of an infant is related to the health of their mother. Maintaining a healthy weight before pregnancy, and optimal weight gain during pregnancy by appropriate and sufficient nutrition, are two effective measures for the prevention of low birth weight.To provide successful health interventions, it is essential to design and implement effective health education programs. Successful education also depends on the proper use of theories and models in health education. The Health Belief Model is a model that illustrates the relationship between beliefs and health, and it is based on the hypothesis that preventive health behavior consists of personal beliefs. The aim of this study was to assess the effects of training on the Health Belief Model on dietary behaviors of a sample of pregnant Iranian women. Materials and Methods: This study was a randomized controlled clinical trial, involving 130 pregnant women who attended two health care centers of Shahid Beheshti University of Medical Sciences. Data was collected by a structured questionnaire in three parts and seven sub-scales (including demographic characteristics, knowledge and dietary behaviors) based on the Health Belief Model. Principles of education were based on the Health Belief Model and performed twice during two-hour sessions in the intervention group. Women in the control group received routine care and did not receive training on the above model. In order to evaluate the intervention, the previously mentioned questionnaire was administered one month after completion of the intervention, and filled by participants in both groups. Data were analyzed by SPSS software and reported with diagrams and tables. Results: The mean score for each variable before the intervention, except for the performance guide variable, was not significantly different between the two groups (p

Background: To identify the prevalence of behavioural (Pre-pregnancy), obstetrical and medical risks of pregnancy in Iranian women. Methods: A total of 2993 postpartum women who delivered in 23 randomly selected hospitals of six provinces were enrolled in this nationwide cross-sectional study. A structured questionnaire was completed based on interviewees’ self-reports and medical record data, consisting of socio-demographic characteristics, behavioural, obstetrical and medical risks, before and during pregnancy. Results: Less than 6.0% had no health insurance and 5.0% had no prenatal visit before labour. Unintended pregnancy was reported by 27.5% of women. Waterpipe and/or cigarette smoking was reported by 7.1% of them and 0.9% abused opiates during pregnancy. Physical abuse by husband in the year before pregnancy occurred in 7.5% of participants. The rate of cesarean section was 50.4%. Preterm birth, low birth weight, and stillbirth were seen in 6.8, 7.7, and 1.2% of deliveries respectively. The most frequent medical risk factors were urinary tract infection (32.5%), anemia (21.6%), and thyroid disease (4.1%). Conclusion: More effort should be devoted by health policymakers to the establishment of a preconception counselling (health education and risk assessment) and surveillance system; although obstetrical and medical risks should not be neglected too.

Background Apical surfaces of human endometrial epithelium and endothelium are key elements for the initiation of molecular interactions to capture the blastocyst or leukocyte, respectively. The L-selectin adhesion system has been strongly proposed to play an important role in the initial steps of trophoblast adhesion and promotion of integrin-dependent processes, ultimately culminating in the establishment of the embryo-maternal interface. On the basis of these facts, we hypothesized a novel role for pinopodes as the first embryo-fetal contact sites to contain the highest subcellular expression of L-selectin ligand suggesting its role in early adhesion as predicted. Thus, the objective of this study was therefore to determine the subcellular pattern of distribution of the L-selectin ligand (MECA-79) in human endometrial apical membrane region during the window of implantation. Methods Endometrial biopsies of secretory phases from fertile females ranging in age between 25 and 42years were studied using several approaches, including scanning electron microscopy (SEM), immunostaining for light microscopy and transmission electron microscopy (TEM), and immunoblotting as well as statistical analysis of the area-related numerical densities of immunoreactive MECA-79-bound nanogolds to detect the expression pattern and the subcellular distribution pattern of L-selectin ligand (MECA-79) in human endometrium during the window of implantation. Results The endometrial biopsies were scored according the dating criteria of Noyes et al. by an experienced histologist. The SEM images of the midluteal phase specimens revealed that fully developed pinopodes were abundant in our samples. HRP-immunostaining and immunofluorescent staining as well as immunoblotting revealed that MECA-79 was expressed in the midluteal phase specimens. The results of immunogold TEM illustrated the expression of MECA-79 in human pinopodes in the midluteal phase and a higher area-relate numerical density in pinopodes compared to that of the uterodome-free areas. Conclusions This is the first demonstration of the subcellular localization of MECA-79 in the human pinopodes which may indicate a novel role for pinopodes to be capable of shear-stress-dependent tethering-type adhesion in the initial phases of human embryo implantation.