Mitra Eftekhariyazdi; Manijeh Yousefi Moghaddam; Behnaz Souizi; Forough Mortazavi
Volume 19, Issue 9 , September 2017, , Pages 1-4
Abstract
Introduction: Cesarean rate increased in recent decades worldwide. One of the consequences of the increased cesarean rate and repeat cesarean is the significant increase in cesarean scar pregnancies (CSPs). Diagnosis of a CSP is more difficult when there is a heterotopic pregnancy in a non-assisted pregnancy.Case ...
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Introduction: Cesarean rate increased in recent decades worldwide. One of the consequences of the increased cesarean rate and repeat cesarean is the significant increase in cesarean scar pregnancies (CSPs). Diagnosis of a CSP is more difficult when there is a heterotopic pregnancy in a non-assisted pregnancy.Case Presentation: The patient was a 34-year-old G5P2L2Ab2 referred for spotting in Shahidan Mobini hospital, Sabzevar, Iran in 2016. She had a history of 2 cesareans and 2 abortions. Three ultrasounds were performed showing a gestational sac in the lower segment of the uterus with different diagnoses: 1) with hemorrhage over it, 2) with the 2nd gestational sac over it, which was diagnosed as missed abortion, and 3) with an echo-free and irregularly region supporting the 2nd sac or a clot in the lower part of the uterus. The increased local vascularity suggested a level of placenta accreta, partial mole, or trophoblastic reaction. Since the first diagnosis was missed abortion, curettage was performed. Due to the continuation of severe bleeding, abdominal hysterectomy was performed. The patient was discharged in good condition after 3 days.Conclusions: Heterotopic CSP does not have any specific symptoms, which caused it to be easily misdiagnosed. Physicians should use precise diagnostic tests in case of controversial test results.
Shirin Niromanesh; Mahboobeh Shirazi; Mitra Eftekhariyazdi; Mamak Shariat; Maryam Rabiei; Forough Mortazavi
Volume 19, Issue 4 , April 2017, , Pages 1-6
Abstract
Background: Diabetes mellitus may accompany and complicate a pregnancy, resulting in poor neonatal outcomes.Objectives: The aim of this study was to compare middle cerebral arterial (MCA) and umbilical arterial (UA) Doppler assessments for the evaluation of fetal well-being in mothers with pre-gestational ...
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Background: Diabetes mellitus may accompany and complicate a pregnancy, resulting in poor neonatal outcomes.Objectives: The aim of this study was to compare middle cerebral arterial (MCA) and umbilical arterial (UA) Doppler assessments for the evaluation of fetal well-being in mothers with pre-gestational or gestational diabetes mellitus.Methods: This cohort study was performed on 103 pregnant diabetic women, admitted for prenatal care to the department of gynecology and obstetrics of Jame Zanan hospital (Tehran, Iran) in 2015. Sampling was performed, using the convenience method. All women underwent one or more Doppler ultrasound examinations in the third trimester of pregnancy, which included blood flow measurement through umbilical and middle cerebral arteries. Women with abnormal UA or MCA Doppler test results were subjected to labor induction or cesarean section, according to different parameters. The outcomes included neonatal acidosis, oneand five-min Apgar scores, hypoglycemia, hypocalcaemia, neonatal intensive care unit (NICU) admission, gestational age at delivery, and neonatal death. Chi-square test, t-test or Fisher’s exact test, and logistic regression analysis were performed to analyze the data.Results: Based on the findings, poor outcomes were detected in 48 women. Nearly 17.5% and 9.7% of women had abnormal UA and MCA Doppler test results, respectively. In total, 62% of women gave birth via cesarean section. The UA Doppler test results were significantly related with hypoglycemia, respiratory distress syndrome (RDS), one-min Apgar score < 7, five-min Apgar score < 7, and NICU admission, while the MCA Doppler results were significantly associated with RDS and neonatal death (P < 0.05). The sensitivity of both tests ranged between 20% and 60%. Logistic regression analysis revealed that UA Doppler test could predict poor outcomes after fasting blood sugar control (P = 0.028, OR = 3.6, CI: 1.15 - 11.13).Conclusions: Both UA and MCA Doppler tests were associated with some neonatal outcomes. However, sensitivity of both UA and MCA assessments was low in the prediction of adverse neonatal outcomes. By the comparison of these two methods, we found that UA Doppler assessment is a better predictor of neonatal outcomes.
