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Background and Aim: Ovarian torsion is one of the rare causes of emergency surgeries during pregnancy. Heterotopic pregnancy is a rare type of pregnancy characterized by embryo implantation in two different locations. occurence of these two complications at the same time is a very rare condition. In this study, we present a rare case of heterotopic pregnancy accompanied by ovarian torsion.
Patient presentation: A 33-year-old woman with fourth pregnancy presented with abdominal pain and spotting. Based on the last menstrual period, the gestational age was estimated as 7 weeks and 4 days. Ultrasound results revealed a heterotopic pregnancy with a live embryo in the uterus, a live embryo in the fallopian tube, and abundant fluid in the abdomen. Because of the patient’s unstable vital signs, she was operated and we detected a ruptured right tubal pregnancy with a 5 cm ovarian cyst on the same side and two-folded adnexal torsion. Resolution of the torsion, right salpingectomy and removal of the ovarian cyst were performed. Two days after the operation, the intrauterine embryo had no sign of heart activity; therefore, two doses of misoprostol were prescribed for the patient and curettage was performed. The patient was discharged on the next day with a good general condition.
Conclusion: The simultaneous occurance of heterotopic pregnancy and ovarian torsion is a rare condition. In these cases, early diagnosis will help to preserve the ovaries and future fertility and also at the same time, maintain the intrauterine pregnancy.
Keywords: Heterotopic pregnancy, Ovarian torsion, Ovarian cyst, Pregnancy.
 
Received: Nov 8, 2017     Accepted: May 22, 2018

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Background and Aim: Group B Streptococcus (GBS) is a major contributor to maternal and neonatal death. GBS colonization in the mother can be transient or intermittent, which is why its examination during delivery is more valuable than screening at lower gestational age. The aim of this study was to compare the complications of premature delivery with term ones in positive cases of GBS by PCR method, which has a higher sensitivity and specificity.
Material and Methods: This study provides a cross-sectional study of 160 births. Eighty women with gestational age 28 to 36 weeks and 6 days (preterm group) and 80 women with gestational age 37 to 41 weeks (term) admitted in gynecology ward of Imam Reza Hospital, affiliated to Mashhad University of Medical Sciences since March 2016 to September 2016 were investigated. Separate vaginal swabs were obtained from each person to detect GBS by PCR. The two groups were compared in terms of the prevalence of GBS and maternal and neonatal complications.
Results: The prevalence of GBS was 9.4%, which included. 12.3% of mothers of preterm group and 6.3% of mothers of the term group. The frequency of bacteriuria was 40% -50% (P <0.001), pyelonephritis 0% -20% (P = 0.039), and metritis 60% -70% (P <0.001) in preterm and term groups with positive PCR assays, respectively. The prevalence of otitis was 40% -40% (P = 0.039), meningitis 20% -40% (P <0.001), pneumonia 60%
-80% (P <0.001 ), sepsis 20% - 50% (P <0.001), respiratory distress 40% -80% (P <0.001), apnea 20% -40% (P <0.001), hypotension 0% -30% (P < 0.001) and hospitalization in NICU 40% - 100% (P <0.001) in the infants of the preterm and term group with PCR positive test in mother, respectively.
Conclusion: Maternal and neonatal complications are more common in GBS positive cases in preterm pregnancies than in term pregnancy. PCR testing is required for diagnosing in premature labor.


 

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Background and Aim: The aim of this study was to determine the relationship between cord arterial blood gas (ABG) indices and early neonatal complications in neonates born with fetal distress and also the threshold level of measured values ​​for the risk assessment of complications.

Materials and Methods: 221 mothers with fetal distress who met our inclusion criteria participated in this 12 month cross-sectional study in Mashhad University of Medical Sciences from 2015 to 2016 . Blood samples were taken from umbilical artery of the neonates after birth. Early perinatal complications and their association with PH and BE at birth and 8 hours later and also the diagnostic values of the afore mentioned values were evaluated.

Results: 221 pregnant mothers at 37-41 weeks of gestation (mean gestational age of 38 weeks and 4 days) who had developed fetal distress during hospitalization were entered into the study. Seizure (p<0/01), jaundice (p<0/015), gasterointestrinal complication (p<0/01) ,NICU haspitalization ≥ 1 week (p< 0/001) were significantly higher in the neonates with PH<7/2. Seizure (p<0/01), gastero intestinal complication ( p=0/049). NICU hospitalization ≥ 1 weak (p<0/001) were significantly higher in the neonates with BE < -14. The highest diagnostic accuracy rates for respiratory complications (85%) was related to BE measured 8 hours after birth. The highest diagnostic accuracy rates for seizure (88%) and gastrointestinal (77%) complications were related to PH measured 8 hours after birth. But for renal complications (82%) and jaundice (60%) it was associated with PH at birth.

Conclusion: PH and BE can be used as reliable predictors for some early neonatal complications.

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Background and Aim: Most studies showed that low cord blood pH was associated with short-term mortality as well as long-term neurological disorders, but few studies showed associations between high cord blood lactate and adverse short-term outcomes. This study aimed to determine the association between umbilical cord blood lactate during the first hour of birth in infants with 5^th-minute Apgar scores <7 and short-term neonatal complications.
Materials and Methods: In this cross-sectional study, 49 pregnant women over 37 weeks gestation referred to the maternity wards of Academic Hospitals of the Mashhad university of medical sciences with the onset of labor, whose neonates scored below 7 in 5^th-minute Apgar, were included after obtaining informed consent, by convenient sampling method. Preliminary information was recorded. Also, a blood sample was taken from the umbilical artery and its pH, pCO2, bicarbonate, and lactate levels were measured. The neonatal outcomes and complications and outcomes (discharge or infant death) were evaluated.
Results: Overall, 25 male (51.0%) and 24 female neonates (49.0%) with a mean gestational age of 39.3±1.1 weeks were studied. Cord blood lactate concentrations were significantly higher in neonates with hypoxic-ischemic encephalopathy, intubation-ventilation, hypothermia, meconial aspiration, NICU admission, and those who died compared with the opposite groups (P<0.05). The best lactate cut-off point for predicting hypoxic ischemic encephalopathy and intubation was 4.55mg/dl, while for predicting neonatal death it was 6.19mg/dl with 100% sensitivity and 97.4% specificity.
Conclusion: Umbilical cord blood lactate measurement can be a highly accurate measure of neonatal outcome and early complications that can greatly help with the health status assessments of infants with adverse Apgar scores at birth, their prognosis, and management.