Pouya Javadian

Perinatal outcome after fetoscopic release of amniotic bands: a single‐center experience and review of the literature

To present two successful cases of fetoscopic release of amniotic bands with umbilical cord involvement and provide a review of the literature on fetal intervention for amniotic band syndrome (ABS).

Comparative efficacy of probiotic yoghurt and clindamycin in treatment of bacterial vaginosis in pregnant women: A randomized clinical trial

Objective: This study was performed to determine the comparative efficacy of probiotic yoghurt and clindamycin in the treatment of bacterial vaginosis in pregnant women in the third trimester. Methods and materials: This randomized clinical trial was performed as an open-label study. 310 symptomatic patients with BV were recruited. Diagnosis of BV was through Amsel criteria. The patients were randomly assigned to receive either probiotic yoghurt (100 g twice a day/week) or orally administered clindamycin (300 mg twice a day/week). Results: Ten patients in probiotic group and 9 subjects in clindamycin group had symptom recurrence (p > 0.05). 132 patients in probiotic group and 105 subjects in clindamycin group had pH decrease (p < 0.0001). 140 patients in probiotic group and 141 subjects in clindamycin group had complete symptomatic cure (p > 0.05). Twelve patients in probiotic group and seven subjects in clindamycin group had preterm birth. Nine women in probiotic group and five subjects in clindamycin group had PROM (p > 0.05). Conclusions: According to the obtained results, it may be concluded that probiotics would have a good efficacy in the treatment of bacterial vaginosis in pregnancy leading to decreased burden of subsequent preterm birth.

Progesterone and threatened abortion: a randomized clinical trial on endocervical cytokine concentrations

The purpose of this study was to investigate the effect of vaginal progesterone on endocervical cytokine concentration in women at risk of threatened abortion. One hundred and sixty pregnant women with clinical symptoms of threatened abortion before the 20th week of pregnancy were randomly assigned to receive vaginal progesterone or placebo. Cervical fluids were collected and endocervical concentrations of different cytokines (IFNγ, TNFα, IL-8, IL-10 and IL-12) were analyzed before and one week after progesterone or placebo treatment. A significant decrease in IFNγ and increase in IL-10 in endocervical fluid was seen when the values were compared before and after progesterone treatment. However, there were no significant differences in pregnancy outcomes between the placebo and progesterone groups. We conclude that despite the failure of vaginal progesterone treatment to improve pregnancy outcomes, progesterone can induce a shift in the concentration of cytokines in endocervical secretions.

Congenital heart anomaly in newborns with congenital diaphragmatic hernia: a single-center experience.

To evaluate the impact of the presence of a congenital heart anomaly (CHA) and its potential contribution to morbidity and mortality in infants with congenital diaphragmatic hernia (CDH).

Betamethasone effects on the endocervical inflammatory cytokines in preterm labor: a randomized clinical trial.

OBJECTIVE This study aimed to investigate the effect of betamethasone treatment on the endocervical concentration of IL-1β, IL-4, IL-6, and TNF-α in preterm labor patients. STUDY DESIGN We studied 68 prime-gravid women in preterm labor between 34 and 37 weeks of gestation without clinical infection. Endocervical concentrations of inflammatory cytokines were assessed; immediately on admission and 48 h after administration of two doses of intramuscular betamethasone (12 mg/kg). Wilcoxon and Mann-Whitney tests along with χ(2) and Students t tests were utilized for statistical analysis. RESULTS In the betamethasone group IL-1β and TNF-α significantly decreased (P<0.001), and IL-6 and IL-4 increased (P: NS). Among patients delivered before or on the 7th day of admission IL-6 and TNF-α were higher at the most significant levels (P<0.001) compared to IL-1β and IL-4 (P: 0.001, 0.002 in respect). CONCLUSION Betamethasone can help induce the down regulation of endocervical inflammatory cytokines in patients with preterm labor.

Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature

Objective To review techniques and outcomes of different prenatal treatments for large placental chorioangiomas. Study Design Presentation of a case of laparoscopic-assisted laser coagulation and a systematic review of the literature for articles related to intervention for placental chorioangioma. Results A total of 37 cases of definitive (n = 23) and supportive therapy (n = 14) were evaluated, including one case treated in our center. Approximately 35% of the patients had a spontaneous preterm delivery in definitive treatment group versus 36% in the supportive group. The infant survival rates were 65 and 71% in the two groups, respectively. We further compared the two types of laser ablation (fetoscopic [n = 10] and interstitial [n = 4]). Approximately 30% of the patients in the fetoscopic and 25% in interstitial group, had a spontaneous preterm delivery. Survival rates were 60 and 100% in fetoscopic and interstitial groups, respectively. Conclusion Laser ablation and embolization of chorioangiomas via minimally invasive approach may prevent or reverse fetal hydrops due to high cardiac states. However, further studies are needed to refine the appropriate selection criteria that will justify the risk of this invasive in utero therapy for chorioangiomas.

Muscimol delays lipopolysaccharide-induced preterm delivery in mice: role of GABA A receptors and nitric oxide

Objectives: Immunologic processes are involved in preterm delivery (PTD). Considering the anti-inflammatory properties of muscimol (GABAA agonist), the effect of this drug was evaluated in lipopolysaccharide-induced PTD in mice. Methods: PTD was induced by two intraperitoneal injections of lipopolysaccharide (35 µg/kg; n = 11), on gestational day 15 (d15). Muscimol was administered twice on d14 and twice on d15 (1 h prior to each lipopolysaccharide injection; 0.05, 0.1, 0.2 mg/kg; intraperitoneally; n = 8–12). To assess the involved mechanisms, either bicuculline (GABAA antagonist; 0.1 and 1 µg/kg; intraperitoneally; n = 6–7) or Nω-nitro-l-arginine methyl ester (l-NAME; non-selective inhibitor of nitric oxide (NO) synthase enzymes; 2 mg/kg; intraperitoneally; n = 6) were administered 1 h before each muscimol administration on d14 and the first dose of muscimol on d15. Maternal plasma and amniotic fluid nitrite + nitrate levels, placental histopathologies and uterine contractions were assessed. Results: Muscimol (0.1 mg/kg) significantly decreased lipopolysaccharide-induced PTD rates from 100 to 50% and delayed delivery time from d16 to d18. Muscimol moderately increased maternal plasma and amniotic fluid nitrite + nitrate concentrations and decreased lipopolysaccharide-induced placental inflammation and surge in nitrite + nitrate levels. Contrary to bicuculline, l-NAME reversed the beneficial effects of muscimol. Muscimol did not affect myometrial contractions. Conclusions: Muscimol inhibits lipopolysaccharide-induced PTD through modulating NO release.

Effect of morphine on the reduced uteroplacental perfusion model of pre-eclampsia in rats

OBJECTIVES To investigate the effect of morphine on the reduced uteroplacental perfusion pressure (RUPP) model of pre-eclampsia in rats. STUDY DESIGN The abdominal aorta and ovarian arteries of pregnant rats were isolated and clipped on gestational day 14. The chronic morphine treatment group received naltrexone 5 mg/kg 1h before each dose of morphine. L-nitromonomethylarginine 2 mg/kg was administrated in the same pattern. The control group received saline 10 ml/kg. Systolic blood pressure, blood urea nitrogen (BUN), creatinine, creatinine clearance, urinary protein, urinary nitrite/nitrate excretion, and fetal and placental weights were determined. RESULTS Morphine significantly reduced systolic blood pressure, fetal and placental weights, plasma BUN, creatinine and urinary protein in RUPP rats compared with control rats. Urinary nitrite/nitrate excretion and creatinine clearance were significantly increased in response to morphine treatment. CONCLUSION Morphine reduced blood pressure and improved renal function in the RUPP model of pre-eclampsia, but this was associated with reduced fetal and placental weights.

Reference charts for fetal biometric parameters in twin pregnancies according to chorionicity

The objective of this article is to determine reference values for fetal biometric parameters in twin pregnancies and to compare these values between monochorionic and dichorionic pregnancies.

Elevated vaginal pH in the absence of current vaginal infection, still a challenging obstetrical problem

Abstract Objective: To assess the association of vaginal pH ≥ 5 in the absence of vaginal infection with systemic inflammation and adverse pregnancy outcome. Methods: Four-hundred sixty pregnant women completed the study, upon enrollment Vaginal pH was measured for all women, maternal and umbilical sera were obtained for determining C-reactive protein (CRP) and uric acid levels. Umbilical blood was tested for gas parameters, 1 and 5 min Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded. Results: Elevated vaginal pH was significantly associated with preterm birth (odds ratio (OR), 2.23; 95% confidence interval (CI), 1.04–4.76), emergency cesarean section (OR 2.57; 95% CI 1.32–5), neonatal resuscitation in the delivery room (OR 2.85; 95% CI 1.1–7.38), elevated cord base deficit (OR 8.01; 95% CI 1.61–39.81), low cord bicarbonate (OR 4.16, 95% CI 1.33–12.92) and NICU admission (OR 2.02; 95% CI 1.12–3.66). Increased vaginal pH was also significantly associated with maternal leukocytosis, hyperuricemia and elevated CRP levels in maternal and umbilical sera. Conclusions: Elevated vaginal pH in the absence of current vaginal infection still constitutes a risk for adverse pregnancy outcome which is mediated by systemic inflammatory response.