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Introduction: Subclinical hypothyroidism is related to poor outcome of pregnancy, which is reported in more recent researches. The aim of this study was to determine the correlation between pre-conception of thyroid-stimulating hormone (TSH) level and pregnancy outcomes in patients undergoing in vitro fertilization (IVF).

 Methods: This retrospective cohort study was done on 115 IVF candidate patients undergoing long protocol of ovulation induction that became pregnant from 2007 to 2012. Pregnancy outcomes, including abortion rate, termination age of pregnancy and birth weight in women with low pre-conception TSH (≤2.5 mIU/L) and high pre-conception TSH (>2.5 mIU/L) were compared with each other.

Results: Among 115 pregnancies, 30.2% of the women had pre-conception TSH >2.5 mIU/L. Preterm delivery (<32 weeks) was higher in patients with a pre-conception TSH >2.5 than them with a pre-conception TSH ≤2.5 (P= 0.044). There was no statistically significant difference in abortion, pregnancy termination, and birth weight between two groups. A pre-conception thyroid-stimulating hormone level >2.5 mIU/L is associated with a lower gestational age at delivery in women undergoing in vitro fertilization.

Conclusion: The results of this research indicated that a pre-conception thyroid-stimulating hormone level >2.5 associated with preterm labor in women undergoing IVF. Therefore, it is suggested that screening for hypothyroidism before IVF could be have significant public health implications. 

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Background: Acute abdominal pain is a medium or severe abdominal pain that can lead to a life threatening for pregnant women and frequently requires urgent investigation and management. The aim of this study was to assess the causes and the presentation of acute abdomen among pregnant women admitted at the gynecology and an obstetrics ward of the hospital.

Methods: The present study was a cross sectional hospital based study among 118 pregnant women by face to face interview using a semi structured questionnaire. This study was conducted at the gynecology and an obstetrics ward of the hospital, Babol Iran, from April 2004 to February 2009. All analysis was performed with SPSS software.

Results: Mean age of women was 29.1±6 years. The frequencies of the most common diagnosis of the patients were ectopic pregnancy (73.7%), appendicitis (10.2%), respectively. The study found that 55.1% of respondents complained their pain lasting more than 24 hours. Besides, 81.4% of respondents felt pain in the supra pubic followed by with nausea/ vomiting. A total of 103 (83.9%) underwent with Salpingostomy and 12 (10.1%) were treated with appendectomy.

Conclusion: The study concludes that a large prospective study is needed in order to precise diagnosis of the acute abdomen in pregnant women by continual updating of availability of the gynecologists for the management of the acute gynecologic and obstetrics emergencies among pregnant women.

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Background: Despite many studies published in recent years concerning pathogenic mechanisms of pre-eclampsia, but this issue remains controversial. The aim of the present study was to compare C-reactive protein (CRP) level and fibrinogen concentration obtained from pregnant women with pre-eclampsia with those obtained from women with normal pregnancies. 

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Introduction: It is plausible that pregnancy may result in a decrease in the serum zinc concentration. The concentration of serum zinc is an important determinant of maternal complications. The aim of the current study was to identify serum zinc concentration and evaluate the possible correlation of this concentration with the length of first and second stage of labor in the pregnancy.

Methods: In an observational prospective study, 432 pregnant women, 18 to 35 years of age, from urban primary health care centers in Tehran (Iran) were selected through a multi-stage sampling method and sampling proportionate to size. The blood samples were obtained for the measurement of maternal serum of iron and zinc in healthy singleton pregnancy between 14 to 20 weeks of gestational age, which was accomplished through electro-thermal atomic absorption spectrometry and zinc the standard procedure, respectively. Meanwhile, the length of the stages of labor was also recorded. Serum zinc and serum iron concentrations during early pregnancy, which are associated with prolonged labor, were also analyzed.

Results: Maternal zinc and iron deficiency during pregnancy were found to be around 28.7% and 16.0%, respectively. The overall proportion of prolonged labor was 13.5%. The women with prolonged labor significantly had lower zinc concentration (p=0.03), However, there was no association between prolonged labor and zinc/ iron deficiency after adjusting for confounders.

Conclusion: The findings of the current study indicated that a high prevalence of zinc deficiency was identified among the pregnant women in the second stage of pregnancy. Therefore, it is important to emphasize the need for further research for the evaluation of potential risk factors for maternal complications.

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Introduction: The benefits of male involvement in pregnancy have recently gained recognition. The aim of this study was to explore the prevalence of Iranian men’s attendance during pregnancy and its association with socio-demographic factors in Babol, Iran. This study also aimed to improve the male involvement in maternal health in Iran.

Methods: In a cross sectional study, a total number of 600 pregnant women, attending the antenatal clinics in both public and private medical centers from Feb. to Sep. 2015, were selected through a systematic random sampling method. A semi-structured questionnaire comprising 10-item, two-choice questions (Yes-No) elicited information about the men’s attendance at antenatal clinic, their help with household chores, their attendance at counseling sessions, and their paying for the pregnancy service bills.

Results: According to the results, 414 husbands under study (69.0%) accompanied their wives to the antenatal clinic during the pregnancy. Nearly, less than half of the husbands (42.5%) helped their wives with household chores during pregnancy. After adjusting for suspected confounding factors, the OR of Iranian men’s attendance at antenatal clinic for men with special job was  2.76 (95% CI, 1.26 - 6. 05 P = 0.011), and for men with low educational level, it was 0.404 (95% CI, 0.18 - 0.90 P = 0.026). In addition, the OR of Iranian men’s at household chores for men with special job was 2.60 (95% CI, 1.43 - 4. 74 P = 0.002), and for men with educational level between 7 to 12 years, it was 0.404 (95% CI, 0.18 - 0.90 P = 0.002). No significant associations were found between Iranian men’s attendance in pregnancy with the age of men and women, income, residence status, education of women, job of women, birth order, or pregnancy intention.

Conclusion: The findings of this study indicated that the Iranian men’s attendance in pregnancy is low. The Iranian Ministry of Health should strive to provide adequate guidelines for the development of male involvement in pregnancy.

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Introduction: Many women nowadays postpone their first pregnancy to the fourth or fifth decades of their lives, which could emanate from social, economic and educational factors. This study was an attempt to evaluate the pregnancy and neonatal outcomes in women at 40 years of age or above.

Methods: In this retrospective study, we compared the pregnancy outcomes for women over the aged 40 with those of age group under the age of 40 years. The maternal and obstetrical data, from August 2009 to August 2013, were all obtained from hospitals obstetrical documents. The Chi-square test and the T-Test were used to determine the relationship between the qualitative and the quantitative variables.

Results: During the four years, a total number of 160 women, aged 40 or above gave birth, among which 25% was nulliparous. The mean age at delivery for the elderly group was 42.4 ± 2.1, which can be compared with the mean age of women (26.7± 4.7) under the age of 40. The gestational diabetes (p= 0.0001), gestational hypertension (p = 0.022), and polyhydramnios (p=0.010) occurred more often in women aged 40 or above. It is worth mentioning that the occurrence of anemia in the third trimester in the elderly group was lower than that of the younger group (8.8% vs. 23.1%) (p= 0.024). The preeclampsia, preterm labor, low birth weight, oligohydramnios, bleeding, emergency Cesarean section, and urinary tract infection were all similar in the two age groups.

Conclusion: This study showed that the adverse pregnancy outcomes were significantly higher in the women aged 40 years or above when compared with those of younger women. Therefore, there is an urgent need to provide more frequent prenatal care for the elderly women in primary health care centers.

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Introduction: Nausea and vomiting in early pregnancy is a common complaint, affecting approximately 50-80% of pregnant women. The aim of this study was to determine the effect of the severity of nausea and vomiting from pregnancy on the quality of life during the first trimester of pregnancy.

Methods: An analytical study was conducted on pregnant women with nausea and vomiting from pregnancy (NVP) during their first 12 weeks. These pregnant women were receiving prenatal care at the prenatalogy ward of Rouhani Hospital, which is affiliated to Babol University of Medical Sciences. The women were asked to complete a visual analogue scale questionnaire to report their intensity of nausea within the last 24 hours. The severity of NVP was measured by a structured questionnaire. A Health-Related Quality of Life for Nausea and Vomiting during Pregnancy (NVPQOL) questionnaire was also used to measure the quality of Life of pregnant women with NVP. Low scores in all domains of NVPQOL and the overall quality of life evaluation mean better quality of life. A total number of 80 women with NVP, who were within the age range between 18 to 35, were randomly selected for the purpose of this study.

Results: The mean total score of NVPQOL was 95.5±15.69. The total quality of life score in women with severe nausea (p = 0.003) and sever vomiting (p = 0.029) was higher than that of the mild/moderate group. A statistically significant result was found in the mean scores of the fatigue domains between the women with mild/moderate and severe nausea groups (P = 0.001). The women with severe vomiting also had significantly higher mean scores of the physical symptoms (P = 0.027) and limitation (P = 0.027) domains compared with those with low/moderate vomiting.

Conclusion: The finding showed that the NVPQOL score was correlated with the severity of NVP symptoms. It is, therefore, very important that we, in our clinical practices, consider the impact of NVP on Iranian woman's quality of life in order to provide them with optimal management in case the need arises.

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Many women with polycystic ovary (PCO) are obese. These women have lower clinical pregnancy rates when compared with their lighter counterparts.  We hereby present a case of an obese PCOs woman, who referred to our clinic, underwent a microinjection, and failed in pregnancy. Then, she was recommended to have a change of lifestyle and lose weight along taking insulin-sensitizer medicines. In the following 6 months, she lost 19 Kilograms and referred to us with a spontaneous pregnancy. The object of this report was to determine the role of insulin intolerance medicines and lifestyle improvement on enhancing the rate of pregnancy in the PCOs obese women.

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Background: It is evident that seasonal changes can affect the function of animal reproductive system, and human reproductive system is no exception in this regard. These changes can be attributed to the effect of light during different seasons, especially on the reproductive system of females. There are, on the other hand, many reports that indicate no significant relation between seasons and the fertility rate of pregnancy and implantation. The aim of the present study was to clarify different views in case of seasonal effects on the rate of fertility and pregnancy.

Methods: The present study was conducted on 1287 couples at the Infertility Center, Babol University of medical sciences. The couples received embryos after intracytoplasmic sperm injection (ICSI) was included in the study. The participants were divided into five groups based on their age (18-23, 24-28, 29-33, 34-38 and 39-43). The level of significance was set at p < 0.05.

Results: Women who received embryos were between the age range of 18 and 43. It should be mentioned that the range of pregnancy in different seasons was different,  and that the maximum number of pregnancies happened in autumn. Most pregnancies happened in 28 to 33 year olds. The quality of embryos was better in autumn than other seasons.

Conclusion: The results indicated that seasonal changes can have an effect on the pregnancy rate through ICSI technique.

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Background: Engaging pregnant women in selecting the delivery type has been recognized as an important factor for world health. The aim of this study was to assess the validity and reliability of the Iranian version of Low Literacy Decisional Conflict Scale (DSC-LL) in Iran.
Methods: The English version of DCS-LL was translated and administered to 54 women eligible for selecting the type of delivery. The quantity content validity, the Content Validity Rate (CVR) and Content Validity Index (CVI) were examined. The reliability of the scale was assessed by two methods of internal consistency and test–retest via intra-class correlation coefficient, and Pearson correlation coefficient.
Results: All 10 items had CVR points ranging from 0.8 to 1.0. The scores on the four subscales of this scale revealed high internal consistency (Cronbach's alpha= 0.847). Test-retest reliability via Intraclass Correlation Coefficient (ICC) (ICC=0.981) and Pearson’s correlation coefficient (r=0.083) was significant at the level of P<0.001.
Conclusion: The results showed that the Iranian version of DCS-LL is a valid, reliable and appropriate tool to be administered to pregnant women for selecting the type of delivery. However, further studies are needed to evaluate the influence of health literacy on this scale.
 

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It is widely assumed that Gitelman syndrome is a rare genetic disorder with such electrolyte imbalance as hypokalemia and hypomagnesaemia. The impact of hypothyroidism on Gitelman syndrome and its management is not clear. In this case study, a hypothyroid young woman referred to our endocrine clinic for muscle cramp after the hypothyroidism management. Based on Laboratory and clinical findings, the woman was diagnosed to have been suffering from Gitelman syndrome and the treatment with magnesium, potassium and oral Spironolactone began immediately. After two years of treatment, the woman experienced a successful planned pregnancy.

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Background: Despite the fact that there are various methods for the treatment and prevention of maternal anemia, there are still many pregnant women affected by anemia-related health problems and contributing factors. The aim of the study was to assess the knowledge, attitude, and practice of pregnant women with regard to the prevention of iron deficiency anemia (IDA) in public hospitals of Harar, Eastern Ethiopia.
Methods: This cross-sectional study was done on 128 pregnant women, who referred to public hospitals in Harar, Eastern Ethiopia for antenatal care. Sample selection was based on random sampling. The anemia status of the pregnant women was determined by measuring their hemoglobin and ferritin serum levels. The data was collected using a close-ended, semi-structured questionnaire.
Results: According to the results, 68% of the participants had no IDA. Most of them had heard about anemia and defined it. The majority of them knew the causes and the preventive methods (58.6%). Most of them had a positive perception of the consumption of folic acid, family planning, feeding on regular meals. Most of them (59.4%) took folic acid during pregnancy, and 56.3% fed on fiber-rich food.
Conclusion: This study found that around one-third of the pregnant women had IDA.  So it is vital to promote health education, involve private health institutions and husbands. Health facilities and stakeholders should, therefore, work on increasing the awareness, positive perception and skill necessary for the prevention of IDA.

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Background: Gestational weight gain during pregnancy is supposedly associated with the increased risk of some adverse outcomes. Thus, assessing the trend of gestational weight gain and its associated risk factors for each population may reduce the related harms. We examined the trend of gestational weight gain and some of its associated risk factors in a sample of Iranian pregnant women.
Methods: From five health centers in Isfahan, 458 pregnant women were selected through a multi-stage sampling method. The gestational weight gain was measured nine times during pregnancy. The latent growth curve model was used to investigate the trend of gestational weight gain and a random effects model was used to identify the factors affecting gestational weight gain during pregnancy.
Results: The mean weight at the baseline was 58.7 ± 0.1 kg. It increased by a mean of 301 ± 0.0 grams per week. The pre-pregnancy weight (p<0.001) and parity (p<0.001) had a significant indirect effect, and mother's height (p=0.028) had a significant direct effect on gestational weight gain. Mother's age showed no significant effect on weight gain during pregnancy.
Conclusion: More than 50% of our sample had an abnormal weight gain. Thus, according to the criteria proposed by the American Institute of Medicine (IOM), it is vital to promote the knowledge of women and health care providers and raise their awareness about the determinants of abnormal gestational weight gain and their consequences.

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Background: This study aimed to identify patterns of physical activity in pregnancy contributions to the development of adverse pregnancy outcomes.
Methods: In a prospective study, physical activity of 374 pregnant women was measured using Pregnancy Physical Activity Questionnaire (PPAQ) during the first half and the second half of pregnancy. Pregnancy outcomes were recorded as birth weight, preterm delivery, hypertension without proteinuria, preeclampsia, mode of delivery, and gestational diabetes.
Results: There was a significant decrease in values of self-reported physical activity from the first half of pregnancy to the second half of pregnancy in light (P <0.001), moderate (P <0.001), vigorous (P= 0.029), total (P <0.001) intensity. The women with the highest tertile of total physical activity in the first half of pregnancy had significantly lower adjusted odds (OR: 0.07, 95% CI: 0.02-0.32) of having a macrosomia newborn and higher adjusted odds (OR: 6.44, 95% CI: 1.38-30.14) of having a low birth weight infant. The risks of cesarean section for women in the highest category of total physical activity in the second half of pregnancy was higher those in the lower and lowest category (OR: 1.89, 95% CI: 0.29-3.36).
Conclusion: It is necessary to emphasis on physical activity guideline for reduction of pregnancy complications.

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Background: Medical management of miscarriage in the first trimester is performed with multiple-medication regimens. We aimed to compare the efficacy and complications of combined regimen of letrozole and misoprostol with misoprostol alone for first trimester medical abortion.
Methods: A retrospective cohort study was conducted at Babol University of Medical Sciences for medical abortion at gestational age less than 12 weeks. All pregnant women in the first trimester with indications for abortion between 2014 and 2015 and treated by the combined regimen of letrozole and misoprostol or misoprostol alone were included in this study. The successful complete abortion, the frequency need for curettage, the induction-abortion interval, drug complications, hemoglobin, and hematocrit ratio were all retrieved from the patients’ documents.
Results: During the study period, 110 pregnant women were admitted to our hospital for medical abortion at the first trimester and were considered for medical management. Of these, 40 women received letrozole 7.5 mg for two days, followed by misoprostol 800 mcg vaginally. Seventy women received only misoprostol 800 mcg vaginally. Follow-up for abortion was usually done 24 hours after the medical management.  The successful complete abortion rate in the combined regimen of letrozole and misoprostol was more than that of the misoprostol alone group (75.0% vs. 31.4%; P= 0.001). The frequency need for curettage (P=0.001) and the mean induction-abortion interval (P= 0.021) were lower in combined regimen of letrozole than misoprostol alone group. The drug complications, hemoglobin ratio and hematocrit ratio were similar between the groups.
Conclusion: Our study suggested that letrozole enhances the misoprostol effect in the first trimester of pregnancy termination and decreases some of its complications.

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The case report: The coexistence of physiological changes during pregnancy and infection can sometimes create challenges in the management of these patients. In this report, a term pregnant woman with COVID-19 infection was admitted to the ICU and underwent cesarean section (C-section) under intrathecal anesthesia according to the patient's condition. Severe respiratory distress occurred to the patient on the first day after (C-section), and the patient's pulmonary parameters were measured with a non-invasive ventilation monitor. It gradually improved during the four days after the C-section.  The C-section reduced the lung performance for 24 hours in a patient with COVID-19 infection, but eventually the lung symptoms improved.

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Background: Weakened pelvic floor muscles can affect the female sexual response cycle phases: desire, arousal, lubrication and orgasm. The aim of this study was to evaluate the relationship between pelvic floor muscle strength and sexual function in non-pregnant women and examine the influence of the number of pregnancies.
Methods: This observational study was conducted on 48 pregnant women (24 primigravid and 24 multigravid women with the age range of 25 to 40 years in Belagavi city. The Female Sexual Function Index (FSFI) questionnaire was used to evaluate the sexual function. The floor muscle strength was evaluated by vaginal using the oxford scale. Spearman correlation tests was used to check the strength and direction of the linear relationships between pairs of variables.
Results: The mean age of the women was 37.08±5 years. Female sexual function was positively correlated with pelvic floor muscle strength (rho= 0.50, P= 0.001). Pelvic floor muscle was negatively correlated with age (rho= -0.37, P= 0.010) and parity (rho= -0.52, P= 0.001). In addition, female sexual function was negatively correlated with age (rho= -0.41, P= 0.004) and parity (rho = -0.52, P= 0.001).
Conclusion: The results suggest that multigravida women have lower pelvic floor muscle strength and worse sexual function than primigravid women.

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The case report: Pancreatic pseudocyst is an encapsulated collection of enzymatic fluid with a well-constructed inflammatory wall bounded by fibrous tissues. However, this remains a rare occurrence in the setting of pregnancy, occurring in as low as 1 in 60,000 gravidas. With such a dearth in the obstetric presentation of pancreatic pseudocysts, no standard treatment guidelines to cater to the condition have been established. In this report, a 24-year-old patient was presented with upper abdominal pain, fever, and nausea in the 24th week of gestational age, which was later affirmed as a pancreatic pseudocyst on magnetic resonance imaging (MRI). The MRI abdomen demonstrated a well-defined cystic mass measuring 9.5 x 6.0 cm with smooth margins, suggestive of a pancreatic pseudocyst. The patient underwent successful ultrasound (U/S)-guided pseudocyst drainage at 33rd weeks of gestation. Following close antenatal monitoring, she safely delivered a viable male infant at 36th weeks via an emergency cesarean section (C-section).

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Background: Pregnant women have supposedly been among the most vulnerable groups since the onset of COVID-19 crisis. Some of the complications of COVID-19 are expected to be more severe in pregnant women, which could be attributed to physiological changes occurring during pregnancy. The aim of this study was to determine the clinical as well as laboratory characteristics of pregnant women with COVID-19 infection.
Methods: In this retrospective study, the medical records of all pregnant women with COVID-19, who were admitted in a tertiary hospital in Iran over the period between March and November 2020, were meticulously reviewed. The clinical and laboratory characteristics of 42 pregnant women with RT-PCR confirmed COVID-19 infection were assessed. Statistical analyses were performed on Stata 16.0. All statistical tests were two-tailed at the significance level of P < 0.05.
Results: At the time of the study, 42 pregnant women had the symptoms of COVID-19 and were hospitalized. The most common clinical signs of COVID-19 were: fever (69.0%), fatigue (31.0%), dyspnea (28.6%), and pharyngalgia (23.8%). In addition, the most common laboratory symptoms were: an increase in C-reactive protein (CRP) (69.0%), leukocytosis (66.7%), and lymphocytopenia (66.7%). Ground glass opacity (GGO) was a common (83.3%) finding in long computed tomography (CT scan).
Conclusion: The finding of this study indicated that most common clinical symptoms and laboratory parameters in pregnant women with COVID-19 were similar to those of non-pregnant women with COVID-19 infection as reported by other researchers.

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