In recent years, much more attentions have been focused on siRNA-based gene therapy. This approach is based on PTGS (Post-transcriptional gene silencing). Due to some defects in viral vectors, non-viral vectors have been used to deliver nucleic acids into target cells. Although, transfection efficiency in non-viral vectors is less than viral ones, but safety of non-viral vectors is much more. Characteristic features of siRNA, such as high compatibility, application in low doses and its versatility make it suitable in the gene therapy field. However, some challenges, such as stimulating immune system and Off-target silencing will be remain. In this review article, we express bottlenecks existing in siRNA Delivery into target cells. According to the information, with further development of siRNA Delivery in the future, it could be a promising approach in treatment for a variety of genetic diseases.

Introduction: Postpartum depression is a mood disorder that depends on several factors and weakens the mother-child relationship, has a negative impact on mental health, quality of married life and family members. The aim of this study was to achieve postpartum depression and neonatal Apgar score in Normal Delivery with and without pain. Materials and Methods: The method of the present study is quantitative and applied, using the method of correlation and structural equations. In terms of time, this study was conducted in the spring of 1400, and during this study, 120 women who referred to health centers in Qom who had passed one month to forty days after Delivery were examined. The research instruments were Edinburgh Depression Inventory and Demographic Information. Spss-25 software was used for analysis and Smart Pls was used for path analysis. Results: The mean and standard deviation of depression in this sample was 12. 7. 7. 05. Moderate to moderate postpartum depression was reported. Neonatal Apgar score, neonatal sex, Normal Delivery with and without analgesia do not play a significant role in depression. Conclusion: In order to prevent this disorder, it is recommended to implement educational and support programs for mothers and wives during pregnancy and after Delivery, and to prevent the complications of this disorder by timely referral of mothers.

Introduction Postpartum pelvic hematomas are classified as vulvovaginal, paravaginal and retroperitoneal hematomas. Retroperitoneal hematoma is the most uncommon condition after Normal vaginal Delivery. In the present study, a rare case of large retroperitoneal hematoma after uncomplicated vaginal Delivery is reported. Case presentation The patient was a 25-year-old woman P1L1 who was admitted to a university hospital of Mashhad in July 2021 for pregnancy termination due to preeclampsia. She developed dizziness while walking 24 hours after uncomplicated Normal vaginal Delivery. CT-scan showed large retroperitoneal hematoma. Conclusion In the case of any abNormal findings in vital signs after Delivery, the diagnosis of pelvic hematomas, especially large retroperitoneal hematoma, should be considered. Prompt diagnosis and treatment of this complication can reduce the risk of maternal morbidity and mortality.

Background: The osteitis pubis is an inflammatory-noninfectious disease of the pubic symphysis, which is rarely reported in the postpartum period after Normal vaginal Delivery. Misdiagnosis of this disease can leave the patient disabled with a poor quality of life Case report: The case in the present study was a 35-year-old woman, admitted two days after giving birth, due to severe pain in the hypogastric and groin regions. Movement aggravated the pain in a way that disabled the patient. The pelvic radiograph showed pubic symphysis dislocation, and osteitis pubis was clinically diagnosed. Therefore, conservative treatment was prescribed for her, including relative bed rest, nonsteroidal anti-inflammatory drugs (PRN, maximum TDS), physiotherapy, and pelvic binder, for two weeks. After this period, her pain decreased gradually and in the next follow-up, which was one month later, she had no limitation of motion. Conclusion: Though it seems to be a simple disease, osteitis pubis can cause profound motion disability. Early diagnosis and treatment can prevent complications, such as joint stiffness and chronic pain.

Injuries to the genitourinary organs are complications of vaginal Delivery. We report a patient with no history of surgery presented 4 days postpartum with distended tender abdomen and peritoneal sign and renal failure. Abdominal X-Ray showed a large amount of ascites. In laparotomy 3.5 liter of urine was in cavity and laceration of 3 cm in the dome of bladder was seen. Repair was done. By reviewing the record, this is the fourth case of bladder rupture after Normal vaginal Delivery without previous history of cesarean section. In the postpartum patient presenting with ascites and azotemia, intraperitoneal bladder rupture should be suspected.

INTRODUCTION: There is a controversy about the effect of increasing venous hydration on the duration of Normal Delivery. With respect to the importance of this subject, various studies have been performed. The aim of the present study was determing the effect of overhydration on the duration of Normal Delivery. MATERIALS & METHODS: The statistical popultion included 52 women who referred to obstetric department of Sanandaj Besat hospital for Normal Delivery. These women divided randomly into control and treated groups. The type of study was double blind randomized clinical trial. After the beginning of active phase of labour, 250cc/h ringer lactate in treated group and 125cc/h in control group was administered intravenously by an experiencd midwife and labour process was evaluated. Data was analysed using k2 and t-tests.RESULTS: The results of this study showed no significant difference between the means of active phase time, stage II and III of labour in two groups. The mean of labour time was 232.1 ± 94.8min in treated group and 240.2 ± 108 min in control group.CONCLUSION: According to the results of this study venous hydration does not affect Normal Delivery time. Extensive studies with more samples are recommended.

Background: A variety of endocrine disorders can complicate pregnancy. Diabetes insipidus although uncommon, may have devastating effect on pregnancy outcome, if unrecognized and untreated. The etiology of diabetes insipidus is often unknown, many cases are likely autoimmune, with lymphocytic infiltration of the posterior Pituitary gland. Massive polyuria, caused by failure of the renal tubular concentrating mechanism, and dilute urine, with a specific gravity 1.005, are characteristic of diabetes insipidus. The diagnosis of diabetes insipidus relies on the finding of continued polyuria and relative urinary hyposmolarity when water is restricted. Most Women require increased doses Desmopressin Acetate during pregnancy because of an increased metabolic clearance rate stimulated by placental Vasopressinase. By this same mechanism, subclinical diabetes insipidus may become symptomatic during pregnancy. Transient diabetes insipidus is associated with acute fatty liver and HELLP syndrome as well as twin gestation. Increased placental Vasopressinase activity, along with insufficient liver degradation in HELLP syndrome and acute fatty liver, may unmask this condition. Diabetes insipidus in pregnancy is rare. The disease results from inadequate or absent antidiuretic hormone (vasopressin) production by the posterior pituitary gland. The increased glomerular filtration rate seen in pregnancy may increase the requirement for antidiuretic hormone. Case presentation: We present a 39 years old woman, gravida3 para3, was admitted to Akbarabadi Teaching Hospital in September 2013. She was admitted due to polyuria, malaise, thirst with slight fever, six days after Normal vaginal Delivery. The urine volume was 8 lit/day and the specific gravity (S.G.) of the urine was 1.010. The urine osmolarity was lower than the plasma osmolarity. Electrolyte serum examination showed hypernatremia. The patient received 5 µg/day of synthetic vasopressin, in the form of l- deamino-8-Darginine vasopressin (DDAVP). This drug was given as intranasal spray in doses 0.25 mg twice daily. Plasma electrolytes and fluid status monitored carefully with initiation of therapy. DDAVP was used because it was not degraded by vasopressinase. Treatment was continuing, when the symptoms of central Diabetes insipidus resolve and urinary concentrating ability was preferred. Maximum urinary osmolality over the next 11 hours was assessed, 730 mosm/kg was considered Normal.Conclusion: Close attention to electrolyte and fluid balance is important in the postpartum period. The symptoms of transient vasopressin-resistant diabetes insipidus resolve in few days to a few weeks after vaginal Delivery or when hepatic function returns to Normal.

Background & objective: One of the objectives of health reform plan in Iran is to reduce the rate of cesarean section Delivery. This needs research and use of results to improve the maternal and neonatal outcomes. The aim of this study was to compare the maternal and neonatal outcomes after Normal vaginal and cesarean section Delivery in hospitalized low-risk mothers in Arash Hospital in Tehran, Iran.Methods: In this prospective cohort study, 1900 low-risk pregnant women, with 37-40 weeks of gestational age, referring to the emergency department and being hospitalized for Delivery were included. The data were collected from two groups of patients (Normal vaginal Delivery and cesarean section Delivery). Data on wound infection, abNormal postpartum hemorrhage, decrease of hemoglobin, transfusion requirement, injuries to the genitourinary system, fever until 10 days after Delivery, neonatal respiratory complications, NICU admission, jaundice and obstetric injuries were collected by a questionnaire.Results: From 1900 pregnant women, 62.1% had cesarean Delivery and 37.9% had Normal vaginal Delivery. The reasons for cesarean Delivery included repeated cesarean (68%), failure to progress (18.1%), and fetal distress (13.9%). Wound infection (p=0.004), abNormal postpartum hemorrhage (p=0.042) and low hemoglobin (p<0.001) were more frequent in cesarean Delivery group than in Normal vaginal Delivery group. But obstetric injuries were higher in Normal vaginal Delivery group (p<0.0001). There was no difference between the two groups in terms of fever ten days after Delivery and blood transfusion requirement. For neonatal outcomes, transient neonatal tachypnea (p=0.032), neonatal respiratory distress syndrome (p=0.002), and NICU admission (p<0.0001) were more frequent in cesarean Delivery group than in Normal vaginal Delivery group. There was no difference between the two groups in neonatal jaundice rate and neonatal injuries.Conclusion: Due to the high rate of cesarean section Delivery in our country and higher rate of maternal and neonatal complications after cesarean section Delivery, appropriate strategies are required to be applied to decrease unnecessary cesarean section Delivery and increase Normal Delivery with minimum maternal and neonatal complications.

Introduction: Pelvic inflammatory disease (PID) is defined as an acute and subclinical infection of the upper genital system, including the uterus, fallopian tubes, ovaries, and ligaments. It can lead to various complications, such as salpingitis, endometritis, oophoritis, perihepatitis, peritonitis, and tubo-ovarian abscess (TOA). Case Presentation: In our case, a 22-year-old Afghan woman presented with generalized pain in the abdomen and pelvis, accompanied by vaginal discharge and fever, following 17 days of Normal vaginal Delivery (NVD) and septic shock. She had no previous history of PID. Abdominal ultrasonography revealed a significant amount of free fluid in the paracolic grooves and pelvis, along with a perforated mass on the right adnexa. As a result, she underwent laparotomy and right adnexectomy. A 10-day course of meropenem and vancomycin was prescribed, and the woman was discharged with oral antibiotics. Conclusions: Tubo-ovarian abscess following NVD is a rare condition that can occur in patients with preterm premature rupture of membranes (PPROM) and episiotomy. Therefore, it is essential to prescribe antibiotics in cases involving episiotomy and rupture of the membranous.

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous woman with total uterine inversion after a Normal vaginal Delivery. A 28-years-old, gravid 3, pregnant woman was admitted to the hospital in the first stage of labor. She had a past medical history of curettage due to abNormal vaginal bleeding following her second vaginal Delivery and the present pregnancy proceeded without complications. After the Delivery, due to the history of placental adhesion, umbilical cord traction was avoided and after 20 min, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist and a subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta accreta and the placenta was found completely adherent at the fundus. Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before Delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in the third stage of labor to manage the possibility of inversion.