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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: 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: Ovarian cancer is the most common cause of cancer death from gynecological tumors in Iran. Despite the fact that intra-operative frozen section, which is widely used in diagnosis of ovarian tumors, there are problems associated with the diagnostic procedure in this setting. The aim of this study was to compare the intra-operative frozen section with the permanent histo-pathological sections in the diagnosis of ovarian cancer at Rouhani Hospital in north of Iran.

Methods:  The intra-operative frozen section diagnosis was conducted on 126 women with ovarian masses, who underwent surgery between January 2006 and July 2011. The results of the intra-operative frozen section were compared with those of the past histopathological diagnoses of permanent sections as the gold standard.

Results: The overall accuracy of intra-operative frozen section diagnosis was 94.4%. There were 0.9% cases with false-positive as well as 1.8% cases with false-negative. The sensitivity and specificity values were 66.7% and 100% for malignant tumors, 80.0% and 95.9 % for borderline tumors, and 99.1% and 90.0% for benign tumors, respectively. All inaccurate diagnoses were for the epithelial tumors.

Conclusion: The intra-operative frozen section diagnosis is a reliable method for the surgical management of the patients with an ovarian mass. Diagnostic problems can occur during the intra-operative frozen section examination. The clinicians and pathologists must be aware of the pitfalls of this method therefore, there is an urgent need to establish a good communication among them in order to obtain more accurate results.

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Background: Despite the fact that many studies have been published about the risk factors associated with gestational diabetes mellitus, its prevalence remains high. The aim of this study was to examine the relationship between the history of irregular menses and gestational diabetes mellitus among pregnant women.

Methods: This case-control study was conducted on 51 pregnant women with gestational diabetes mellitus in prenatal clinics of Ayatollah Rouhani hospital in Babol, Mazandaran, from January 1, 2014 to December 31, 2015. At first, women with family history of diabetes mellitus, pre-pregnancy diabetes mellitus, previous gestational diabetes mellitus, age >35 years, weight >110 kg were excluded from the study. Then, one random control was systematically selected for each case, which was matched for age. All statistical analyses were performed through SPSS (Version 22).  P-values less than 0.05 were considered statistically significant.

Results: Irregular menses was not associated with gestational diabetes. The mean menarche at age was lower among the women with gestational diabetes (p=0.03). There was a significant association between menarche at age and gestational diabetes (OR, 6.74; 95% CI, 1.41-32.17). Dysmenorrhea did not differ between subjects with and without menstrual irregularities.

Conclusion: We concluded that early menarche at age (<12 years) could be an important consideration for obstetricians, who adopt a selective screening approach to gestational diabetes.

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Background: Obtaining clinical methods in order to decrease the infectious morbidity of cesarean delivery is very important.  The aim of this study was to determine the effect of preoperative vaginal preparation with antiseptic solution on post-caesarean infections.

Methods: This study was conducted on 400 singleton term pregnant women undergoing elective cesarean delivery. The samples were randomized into two groups; experimental group, including women who received an additional preoperative vaginal cleansing with 10% povidone iodine; and a control group, including women who received only the standard abdominal preparation. All subjects received a single dose of prophylactic antibiotic and were investigated after cesarean delivery until the 6th postoperative weeks for postoperative fever, wound infection, or endometritis. Data were analyzed using SPSS software and the P value < 0.05 was considered significant.

Results: The groups were similar in age, education level, body mass index, and parity. The operation variables such as the postoperative fever, wound infection, and endometritis were observed in the two groups, and the overall for these were found to be 6.0 %, 6.3%, and 6.5%, respectively. A total of 7.5% of the participants in the control group and 5.5% of the participants in the experimental group developed postoperative endometritis; but it was not statistically significant (relative risk= 0.86; 95% confidence interval, 0.61 –1.21; P=0.417). Also, there was no significant difference in postoperative fever, wound infection between these women with and without preoperative vaginal cleansing with povidone.

Conclusion: The findings of the present study indicated that vaginal cleansing with povidone iodine immediately prior to elective cesarean delivery did not decrease the post-caesarean infection rates and the incidence of endometritis in low-risk women. 

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Background: According to a popular Iranian belief, Camphor can not only suppress libido but also decrease the function of the reproductive system. In this regard, this study was conducted to evaluate the role of Camphor in the number of embryos in mice.

Methods: In this study, 40 male and 80 female albino mice, weighing 30-35 g, were randomly divided into 8 groups, including a control group, a sham group that received the vehicle only (olive oil), and six experimental groups that received Camphor. Three experimental groups received camphor by p.o. (gavage) and the other three experimental groups received camphor by i.p. (intraperitioneal) in doses of 10, 20, and 40 mg/kg for 15 days. Mating was confirmed after coupling a male with a female mouse. Vaginal plaque was also considered for mating. Embryos were examined during the period of gestation.

Results: The mean number of embryos in control, sham, and received Camphor (10, 20, and 40 mg/Kg) by o. p. were 9.7 ± 4.6, 7.3 ± 4.3, 9.9 ±4.7, 8.6 ± 5.2, and 8.3 ±4.8, respectively. The mean number of embryo in received Camphor (10, 20, and 40 mg/Kg) by i. p. were 7.6 ± 5.4, 8.3 ± 3.4, and 7.3 ± 6.2, respectively. There were no significant differences in the number of embryos between control, sham, and experimental groups in both groups.

Conclusion: Further investigations with more focus on the effect of Camphor on sexual behavior in mice need to be carried out.

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Background: The basic pathophysiologic phenomenon in testicular torsion, a common urologic emergency, is ischemia followed by reperfusion. In this study, we evaluated the effect(s) of simvastatin (SIM), a lipid lowering agent with antioxidant and anti-inflammatory properties, on mouse epididymal sperm fertilizing potential and the subsequent in vitro embryo development in experimentally-induced unilateral testicular ischemia-reperfusion (IR).

Methods: Adult male mice were divided into four groups (n = 6, each). Following anaesthesia, IR was induced by clamping the left testicular vessels with an atraumatic microvascular clamp for 30 minutes in the IR group. In IR+SIM group, in addition, the mice received SIM (20 mg/kg per day) orally for 3 days starting from the day of induction of the experimental IR. A vehicle-treated control group and a SIM-only treated group were also included. Ipsilateral and contralateral epididymal sperms fertilizing capacity was analyzed in four groups after 35 days.

Results: Significant reduction in fertilization as well as blastulation rates were observed in the IR group. However, the SIM treatment considerably attenuated the IR-induced negative alterations in the above-mentioned parameters.

Conclusion: These findings revealed the repro-protective effects of SIM on the murine model of IR through the inhibition of oxidative injuries and inflammatory reactions.

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Background: Shortening the interval between the onset of labor and delivery is useful for both mothers and fetuses. The aim of the study was to investigate the effect of dexamethasone on the augmentation and the duration of labor in prolonged latent phase of labor.
Method:  The design of the study was a randomized double-blind clinical trial design, which was conducted in delivery center of Rouhani hospital in Babol (Iran). A total 121 nulliparrous women with a singleton pregnancy and cephalic presentation at 40–42 gestational weeks in prolonged latent phase were randomly assigned to receive 2 ml ampoule dexamethasone 4 mg/mL (the intervention group) and 2 ml ampoule of sterile water for injections (the control group), which were both intramuscularly administered. Then, the Then, the augmentation of labor with the use of intravenous oxytocin infusion (Caspian Tamin Company Iran) (2.5 m units/ per minute) began in both groups. The primary outcome was the duration of time between the onset of augmentation and the second stage of labor.
Results: The duration of time between the onset of labor augmentation and the second stage of labor (hours) was 5.6±1.9 in the study group, whereas it was 7.7±1.5 in controls with a significant difference (p ≤ <0.001). In the study group, the duration of time between the onset of labor augmentation and the active phase of labor was lower than that of the control group (p= 0.02).  In addition, the duration of the second stage of labor (p <0.001) and the third stage (p <0.001) was lower in the study group compared with that of the control group.
Conclusion: It is imperative that midwives administer dexamethasone to improve the prolonged latent phase in women during the labor.

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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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Background: Aging is accompanied by changes in muscle strength, which is characterized by the rapid decrease of muscle mass and the increase of body fat. The aim of the present study was to evaluate the muscle mass in Indian post- menopausal women.
Methods: One hundred relatively healthy post-menopausal women within the age range of 50-55 were recruited for this study. The body mass index (BMI), girth measurement, skinfold measurement, and waist-hip ratio were the outcome measures used in this study.
Results: The BMI of women was 28.8 ± 3.4 kg/m². The average prevalence of changes in girth measurements in post-menopausal women was 38%, and the average prevalence of changes in skinfold measurement in post-menopausal women was 43.8%.
Conclusions: The present study concluded that the score muscle mass was below average in most post-menopausal women.  It is highly recommended that the estimation of muscle mass in menopause clinics and the interventions for the prevention of muscle loss are urgently necessary for post-menopausal women. 

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Background: The objective of this study was to compare clinical findings and inflammation indicator levels between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) in an instructional setting.
Methods: In this prospective study, 80 total hysterectomy procedures were performed at the gynecology clinic of Imam Hossein Medical Center, Tehran, Iran over the period between January 2017 and October 2019. Patients were divided into two groups according to the type of operation. Forty patients underwent TLH (TLH group) and 40 patients underwent TAH (TAH group). Surgery-related outcomes and inflammatory mediators were both assessed before and 24 hours after the surgery.
 Results: We observed significantly lower operation bleeding (P <0.001), postoperative lower c-reactive protein (CRP) (P <0.001), higher length of surgery (P <0.001), and higher anesthesia duration (P <0.001) in TLH group compared to TAH group. There were no statistically significant difference between groups regarding post-operation transfusion, adverse events, polymorphonuclear leukocytes (PMN) count, white blood cell (WBCs) count  and platelet (PLT) count, as well as the homoglubin (Hb) levels.
Conclusion: Our study results show that the TLH can be safely performed in our instructional setting and it decreases intraoperative bleeding and postoperative day one CRP levels compared to the TAH method.

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Background: Implantation failure in assisted reproductive technologies (ART) remains a challenge. Granulocyte-macrophage colony-stimulating factor (GM-CSF) may enhance embryo implantation, but its efficacy needs more investigation. This study aimed to assess if adding GM-CSF to thawed embryo culture could improve implantation rates in frozen embryo transfer cycles.
Methods: One hundred rats were randomly assigned to GM-CSF or control groups at Avicenna Infertility Clinic, Tehran. Control group had standard embryo culture; GM-CSF group had embryos cultured in Embryogen® with GM-CSF. Pregnancy outcomes were assessed via serum β-HCG levels post frozen embryo transfer (FET) and ultrasonography at gestational week seven.
Results: No significant difference in blastocyst formation rates was found between groups. Positive beta-HCG levels were 36% in control and 40% in GM-CSF groups. Gestational sacs were detected in 36% of control and 34% of GM-CSF group during weeks 5-6. Clinical pregnancy rates were 32% in control and 30% in GM-CSF groups.
Conclusion: GM-CSF in embryo culture of thawed embryos shows no significant impact on blastocyst formation or pregnancy outcomes. However, interventions like these may enhance fertility treatments, warranting larger-scale clinical trials for further exploration.

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Background: The COVID-19 pandemic has wrought significant repercussions on lives worldwide. Pregnancy, a period marked by profound physiological changes, renders women susceptible to fluctuations in various biological parameters. The study aimed to fill this void by examining the levels of inflammatory markers, as well as liver and renal function tests, in pregnant women suffering from COVID-19.
Methods: This study was conducted to investigate inflammatory markers such as C-reactive protein (CRP), D-dimer, lactate dehydrogenase (LDH), white blood cell (WBC), as well as liver function tests (LFT) and renal function tests (RFT) in pregnant women afflicted with COVID-19. We enrolled 52 COVID-19-positive women (cases) alongside 48 COVID-negative women (controls) who underwent delivery at Dr. D. Y. Patil Hospital and Research Institute in Kolhapur, India. All participants underwent COVID-19 testing via reverse transcription polymerase chain reaction (RT-PCR) methodology.
Results: The findings revealed that a majority of cases exhibited elevated WBC counts compared to controls (78.8% versus 27.1%), with D-dimer levels higher in 61.5% of cases versus 12.5% of controls. LFT and RFT abnormalities were observed in 51.9% of cases versus 20.8% of controls. Moreover, LDH and CRP levels were elevated in 71.2% and 90.4% of cases, respectively, in contrast to 16.7% and 10.4% of controls, respectively. Statistical analysis underscored a significant association between deranged laboratory parameters and COVID-19 positivity.
Conclusion: The study underscores the potential exacerbation of inflammatory responses to COVID-19 among pregnant women with preexisting chronic conditions, which may precipitate liver damage. Thus, prioritizing inflammation and liver health management in the treatment regimen for pregnant women with COVID-19, especially those with chronic comorbidities, emerges as imperative.