Background and purpose: Mizaj (temperament) is an important concept in Persian medicine that has many applications in the diagnosis, prevention, care, and treatment of many diseases. This study aimed to determine the relationship between placenta accreta and the state of the general and uterine temperament and Apgar score of newborns in mothers candidates for cesarean section. Materials and methods: A case-control study was performed in mothers who were candidates for caesarean section. The subjects included expectant mothers with placenta accreta (n= 33) and a control group (n= 66). Current general and uterine temperament were measured using Mojahedi and Tansas questionnaire. Demographic variables and Apgar score of newborns was measured using the Apgar International Standard Checklist Score. T-test and Chi-square were used to compare the data. Results: Demographic characteristics were similar between the two groups. In pregnant mothers with placenta accreta the mean scores for total warm-cold and wet-dry temperaments were 14. 81±, 1. 55 and 3. 72±, 1. 23, respectively. In the control group, these scores were 16. 81±, 4. 38 and 3. 39±, 0. 65, respectively (P<0. 002). The chance of placenta accreta in cold-tempered mothers was 8. 571 compared to warm-tempered mothers. The chance of placenta accreta in pregnant women with cold-tempered uterine was 15. 385 times higher compared to pregnant women with warm-tempered uterine. Those with dry uterus were 10. 35 times more likely to develop placenta accreta compared to mothers with wet temperament. The mean score for warm-cold tempered uterine in the placenta accreta group was 33. 27±, 2. 21 and for wet-dry tempered uterine was 11. 45±, 1. 58 and in the control group the scores were 39. 60±, 5. 20 and 13. 71±, 2. 16, respectively (P<0. 001). Conclusion: The chances of developing placenta accreta is higher in mothers candidate for Caesarean section with general and cold uterine temperament than in other temperamental conditions. Also, the chance of contracting placenta accreta is higher in mothers with wet general temperament and dry uterine temperament. Applying necessary measures based on the principles of Persian medicine is suggested for pregnant mothers in the early stages of pregnancy.

Background: Respecting gestational age and medical intervention at birth, Combined Apgar score, a new method proposed by American Academy of Pediatrics (AAP) may better evaluate neonatal condition at birth compared with conventional Apgar score. The combined Apgar consists of the Specified and the Expanded Apgar describe a more detailed condition at birth. In Expanded Apgar, administered intervention and in Specified Apgar, infant`s condition regardelless of gestational age and intervention are emphesised. To evaluate combined Apgar score in perinatal asphyxia, we compared conventional versus Combined Apgar scores to anticipated neonatal asphyxial complications.Methods: In a prospective cohort study, we assessed 464 neonates admitted in, Vali-e- Asr University Hospital, during one year from September 2012 to September 2013. We assessed neonates by Conventional and Combined Apgar scoring at 1, 5 and 10 minutes after birth. Asphyxia was recognized based on newborn`s records. Diagnostic criteria for asphyxia include, occurrence of metabolic or mixed acidosis, Apgar score less than three in 5th minute, occurrence of neurological complications like seizure, hypotonia, coma and multiple organ failure. Then we used SPSS V16 for data analysis and compare sensitivity between two methods of Apgar scoring.Results: From 2200 delivered neonates, we assessed 464 neonates.9.3% of studied neonates had Asphyxia, which equals 2% of live births. The Apgar score was lower in asphyxiated neonates by both methods (6±1 vs.9±1 according to conventional method and 9±1 vs.16±1 scored in combined method). Combined method was more sensitive than the Conventional Apgar scoring (99% vs.88%).Conclusion: In asphyxiated neonates sensitivity and specificity of combined Apgar were more than conventional Apgar. With respect to this study, better assessment could be achieved by combined Apgar score method instead of conventional Apgar.

Introduction: General and regional anesthesia can be used for pain relief in cesarean. All anesthetics have depressant effects on the CNS. Almost all of these drugs cross the placenta and affect the fetus. N20 may cross the placenta and cause narcosis and hypoxemia in fetus. Spinal anesthesia also has some advantages and disadvantages. Some studies have shown, in spite of high incidence of Academia in spinal Anesthesia, Apgar scores of these neonates is higher then, those of general anesthesia. So in this study a comparison was made on Apgar scores of neonates following these two methods.Method: This study is a randomized clinical trial. The subject were selected from elective sesarean candidates, and randomized into general and spinal anesthesia groups. Then Apgar scores were measured among infants. Spinal Anesthesia induced by lodocain 5% and general anesthesia induction was performed by thiopental and succinylcholine and maintained by N2O, O2 and halotan. Results: Mean Apgar scores were 8.99±0.61 and 9.89±0.31 at first and fifth minutes, respectively. Regarding the treatment groups, these values were respectively 9.11±0.67 and 9.92±0.28 at first and fifth minutes in spinal group and 8.70±0.54 and 9.89±0.35 in general anesthesia group. The groups differed significantly for first minute Apgar, but the was no significant difference at fifth minute Apgar.Conclusion: Since all anesthetic agents have depressant effects on CNS and pass through the placenta, so could cause narcosis and affect placental oxygenation. During spinal anesthesia, these agents has less role and undesired effects then Apgar scars of infants born by this method will be higher than general anesthesia. So it seems that spinal anestesia is more preferable than general anesthesia.

Objective: The Apgar score as a proven useful tool for rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies.Methods: This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad Hospital, which is affiliated to Babol University of Medical Sciences. Apgar score at 1 and 5 minutes after birth was taken and an umbilical cord blood gas analysis was done immediately after birth in both groups. Mothers came with a labor pain and were divided into high-risk and low risk if they have had any perinatal risk factors. Other data like gestational age, birth weight, need for resuscitation and admission to the newborn ward or neonatal intensive care unit was gathered by a questionnaire for comparison between the two groups. P-value less than 0.05 was considered being significant.Findings: The gestational age and birth weight were the same in high-risk and low risk mothers. Mean umbilical artery blood pH in high-risk mothers was significantly lower than in low risk mothers (P=0.004). Mean Apgar scores at 1 and 5 minutes were significantly lower in high-risk mothers than in low risk mothers (P<0.05). According to the Kendal correlation coefficient there was no significant correlation between Apgar score at 1 and 5 minutes and umbilical cord pH in low risk group (r=0.212, P=0.1). But in high-risk group there was significant correlation between Apgar score at 1st and 5th minute and the umbilical cord pH (r=0.01, P=0.036 and r=0.176, P=0.146, respectively).Conclusion: Combination of Apgar score and umbilical cord pH measurement in high-risk pregnant mother could better detect jeopardized baby.

Background and aim: Neonatal Apgar, at the beginning of childbirth, is one of the most important causes of postnatal death. The aim of this study was to compare the effect of thiopental with that of propofol on neonate Apgar and on their mothers.Methods: In this clinical double blind trial, seventy women undergoing elective cesarean section were randomly divided into two equal groups. In the first group, general anesthesia was induced by interavenous (IV) injection of 5mg/kg thiopental and 2mg/kg of succinyl choline per kg of mother weight. After intubations, 0.4g of atracurium per kg was used. In the second group, general anesthesia was initially induced using 2 mg of each propofol and succinyl choline and followed by injection of propofol, 0.1mg/min per kg of mother weight. Neonates Apgar in the first and fifth minutes and post operation complications in the mothers were recorded in both the groups. Data were analyzed using independent t, X2, and Fisher tests.Results: Neonate’s Apgar in the fifth minute after birth was 10 in 97.2% of group one and 100% of group two (P>0.05). There was a significant decrease in mothers systolic blood pressure in propofol group 4 minutes after anesthetic induction. In the group two, who received propofol, the post operative opioid usage and mean recovery time were significantly less than group one (P<0.01).Conclusion: The results of this study showed that induction of anesthesia using propofol would decrease the time of maternal recovery and also reduce the amount of drug required for mother at the first two hours post-operation with no effect on decreasing neonate Apgar.

Background and Objectives: Delivery is one of the greatest events in the life of a pregnant woman. Although it is considered to be a natural phenomenon, it is potentially dangerous. Entonox gas used for pain relief and is reasonably effective in labor analgesic practice. The purpose of this study was to compare the Apgar score of the neonates were born to mothers who treated with entonox gas with those who their mothers did not received this gas.Materials and Methods: In this semi-experimental study, 270 pregnant women hospitalized at the labor ward of Shahidan Mobini Hospital of Sabzavar were included using simple available sampling method. They were then separated into two groups, case and control, based on their specifications. The data gathering tool for this study was a questionnaire of "investigating the effect of entonox gas as a no-pain labor agent on Neonates’ Apgar" which is individually filled out for each patient by obstetrician colleagues. The Apgar scores of infants were recorded at 1st, 5th, and 20th minutes. The statistical analysis of data was performed by t -test, Chi-Square and Fisher tests using SPSS software.Results: That there were no significant differences between the two groups in terms of age, pregnancy period, and using labor induction. The Apgar scores of the case group at 1st, 5th, and 20th minutes postpartum were significantly higher than the control group (p<0.05).Conclusion: Regarding the importance of controlling pain during delivery and its effect on reducing the mother’s stress, using of entonox gas can be a good option for relieving pain during delivery moreover, it can improve the Apgar score.

Background: In Iran, general anaesthesia is more common than other anaesthetic methods in caesarean section and it is the first choice for pregnant mothers. So, we designed this study to compare the effect of isoflurane and propofol on mother’s awareness and Apgar score in the neonatal delivered by selective caesarean section.Methods: In this double blind clinical trial study, 90 pregnant women (18-35-years old) with American Society of Anesthesiology (ASA) classification 1 or 2, who were condidate for selective caesarean, randomly assigned to two groups. Induction of anaesthesia was provided by propofol and succinylcholine in the same way, and maintenance of anaesthesia was provided by propofol in group 1 (100 mg/kg/min) and with isoflurane 1 MAC (Minimum alveolar concentration) in group 2 to maintain Bispectral index score (BIS) between 45 and 60. For statistical analysis t and chi-square tests were used.Findings: There was not a significant difference between the two groups in basic information, neonatal Apgar scores, and hemodynamic changes. 7 of 90 patients had dreams after being awakened (8.9 vs 6.7 percent in propofol and isoflurane groups, respectively) but no significant difference was detected.Conclusion: There was not a significant difference between two groups in Oncidence of awareness, neonatal Apgar scores, and hemodynamic changes which correlated with other studies. Although, more studies with larger sample size needed to compare the effect of these two drugs.

Background: The Apgar score (Appearance, Pulse, Grimace, Activity, and Respiration) of newborn babies immediately after birth is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol rather thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score, mothers’ nausea, vomit and time necessary for mothers’ recovery.Materials and Methods: In this double-blind clinical trial, a total of 230 healthy women who were volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical except the anesthesia induction drug. Babies’ Apgar score 1 and 5 minutes after birth and recovery period, mothers’ nausea and vomiting after operation were recorded.Results: Apgar score I minute 1 (p=0.041) and Apgar score in minute 5 (p=0.034) for propofol group were meaningfully higher than those for thiopental group. Recovery time from anesthesia was not different meaningfully in two groups (p=0.67). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather thiopental group (p=0.028).Conclusion: It seems that in cesarean operations, after sufficient fluid therapy, propofol can be a proper drug to achieve anesthesia. Moreover it exerts less impact on cesarean babies’ Apgar and stimulates lower levels of nausea and vomiting in mothers.