History and Objectives: Due to complications of pregnancy and labor and several reports on the association of BMI with outcome of pregnancy, the present study is performed in order to determine relationship between maternal BMI with complication of pregnancy and labor on the pregnant women referred at the Shabikhani Hospital in Kashan between years of 1998-1999. Material and Methods: A cohort study was performed on 450 nulliparous pregnant women without previous systemic diseases. The individuals were referred to hospital for prenatal care in the first trimester and delivery. Women were divided into three groups (150 individuals); based on the body mass Indecies (BMI) as BMI < 19.8, BMI =19.8-26, and BMI> 26. Prenatal complication such as hypertension, hospitalization before delivery, weight gain in pregnancy, premature rupture of membrane, decreased fetal movement, preterm labor, post date pregnancy and labor pain was recorded. Intrapartum and postnatal complication was studied with the index of stimulation of labor with oxytocin, type of delivery, maternal hemorrhage during delivery, duration of hospitalization, apgarscore and weight of newborns. Statistical analysis was performed using Ki-square test and Fisher exact test. Results: Three groups were matached for age and porous. Hypertention was present in 10.7% of women with BMI<19.8 and 18.7% women with BMI=19.6-26 and 38.6% women with BMI>26 (p<0.0001). Oxytocin stimulation of labor above groups was 28.7%, 41.3% and 42.7% (p<0.02), and abdominal delivery was 22%, 18.6% and 51.4% (p<0.0001). Conclusions: Deviation of normal BMI in pregnancy causes increase in complication of pregnancy and delivery. Due to the importance of public health of pregnant women special attention must be paid to increase in maternal weight in reproductive age in order to lower these complication.  

BACKGROUND AND OBJECTIVE: Reflecting the wide variability of assisted reproduction technologies, the incidence of twin and higher order multiple gestation is increased which associated with complications and prenatal and maternal morbidity and mortality. The purpose of this study was to compare fetal and maternal complication in twin and singleton pregnancies. METHODS: This prospective study was performed on 108 twin pregnant women (case group) and 201 singleton pregnant women who referred to Babol Yahyanejad hospital during 2001-2003. Data related to patients were recorded in a questionnaire and the complication rate in both groups was compared. T-test and fishers exact test were used when appropriated. FINDINGS: Frequency of twin pregnancy was 1.4%. Preterm delivery was 60.2% in twin and 2.7% in singleton (p<0.05). Low birth weight and growth retardation was in 45.8% and 38.4% of twin and 7.5% and 10% of singleton, respectively. It was statistically significant (p<0.05). Frequency of placental abruption, previa, preeclampsia, fetal anomaly and death were not statistically significant. CONCLUSION: Results show that fetal complications such as preterm delivery, growth retardation and low birth weight were seen with higher frequency in twin pregnancies compared to singleton pregnancies. Since, this may cause high prenatal morbidity and mortality, therefore more attention is required to reduce complication.

Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP).Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths.Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours.Conclusion: The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.

Background and Objectives: Severe maternal anemia is accompanied with increasing the risk of low birth weight (LBW), still birth, spontaneous abortion and preterm delivery. This study was aimed to determine the association between maternal hemoglobin and hematocrit levels with neonatal pregnancy complications at birth via logistic regression model.Material & Method: A cross-sectional study was conducted with 903 women who were admitted -to Babol Yahyanejat hospital for delivery in 2004. Mothers with twin delivery, diabetes, severe bleeding before and during delivery and mothers with apparent congenital neonates were excluded. The standard blood examination was carried out before delivery for measuring maternal hemoglobin and hematocrit levels. The data related to maternal age, sex of infant, residence area, maternal education, number of pregnancy, parity, number of visits for prenatal cares, type of delivery and the neonatal pregnancy outcomes (LBW, preterm, the need for special care and apgar score in the first minute) were collected by using questionnaires and hospital charts. In statistical analysis, the multiple logistic regression model was used to determine the adjusted odds ratio of the effect of low and high hemoglobin and hematocrit (versus moderate) levels on the risk of pregnancy outcomes. The odds ratio and its 95% confidence interval were estimated after adjusting the effect of maternal age, maternal education, residence area, number of pregnancy, sex of infant and the number of prenatal visits.Results: The maternal hematocrit in 15.4 percent of subjects was 33 or less. 58.8% of subjects were 33-40 and 25.8% were more than 40 years old. The maternal hemoglobin level in 6.4% of subjects was less than 10.5. In 61.9% of subjects it was 10.5 to 13, while in 31.7% it amounted to more than 13. The prevalence of LBW was 10.17%. Further more, the pre-maturity was 14.5% in neonates with maternal Hb of less than 10.5. These rates were almost two times greater than those subjects with Hb of 10.5-13. The adjusted odds ratio of hematocrit of less than 34, compared to hematocrit of 34-40, on the risk of LBW was 1.4 times (95%CI: 6.65-2.99). On the other hand, the adjusted odds ratio for the risk of pre-maturity was 1.25 times (95% CI: 0.62-2.64). However, the adjusted OR for the risk of need for special cares was 1.57 times (95%CI: 0.72-3.4). It was 1.65 times (95% CI: 0.72-3.4) for the effect of Hb less than 10.5 (compared to Hb of 10.5-13) on the risk of LBW. This effect was 2.37 times (95%CI: 1.01-5.57) on the risk of special - cares and hospitalization it was 1.57 times (95%CI: 0.57-4.38). Conclusion: It can be concluded that the low and high hematocrit levels in pregnant women increase the risk of pre-maturity and LBW. Thus, it may require further considerations in prenatal management of pregnant women.

Introduction: Gestational diabetes is a common complication during pregnancy, affecting maternal and fetal outcomes. Considering the increasing prevalence of gestational diabetes around the world, in the present study, we aimed to assess fetal and maternal outcomes in pregnant diabetic women.Methodology: In this cross-sectional study, 85 women with gestational diabetes (gestational age>28 weeks), admitted to the maternity ward, were enrolled, along with 160 women with a normal pregnancy, who met the inclusion criteria (i.e., no history of diabetes, chronic diseases, endocrine disorders, or steroid use). By using a questionnaire, the required information, i.e., demographic data, medical information, gestational age, Apgar score, and adverse pregnancy outcomes such as preeclampsia, premature rupture of membranes, postpartum hemorrhage, macrosomia, stillbirth, and hypoglycemia, was recorded. The gathered data were analyzed using SPSS.Results: The mean age of diabetic and healthy mothers was reported to be 30.4±5.01 and 27.2±4.03 years, respectively; a statistically significant difference was found between the two groups (P<0.02). Also, the meansystolic and diastolic pressure, body mass index, and cesarean section were more prevalent in diabetic mothers (P=0.01); the two groups were significantly different in this regard. Furthermore, fetal complications such as macrosomia, stillbirth, and hypoglycemia were more common among diabetic subjects, compared to their healthy counterparts (P<0.01).Conclusion: Among maternal and fetal complications, gestational hypertension and cesarean section were more common in diabetic cases. Also, fetal complications such asmacrosomia, stillbirth, and hypoglycemia were more prevalent in newborns of diabetic women. Therefore, implementation of educational programs, screening of diabetic mothers, and attention to the associated complications seem essential. Overall, all these complications highlight the importance of gestational diabetes prevention.

Diabetes mellitus is one of the most common endocrine diseases during pregnancy. In order to compare maternal and Neonatal camplications in diabetic pregnant versus nondiabetic pregnants, a retrospective study was conducted at the obstetric department of Vali-E-Asr university hospital during 1370-1375 which included of 96 diabetic and 100 nondiabetic pregnant patients, the latter being accidentally chosen among 18000 pregnant women who has been reffered this center.The results showed that all maternal and obstetrical complications were higher in diabetic pregnant women with a C/S (cesarean section) rate of 71.3%, Preeclampsia 16.5%, hypertension 24.3% and poly hydramnios 4.3%. There was significant statistical difference (P=0.0001) between the two groups in all the above mentioned parameters except hydramnios. C/S was the most common maternal complication with a rate of 39.1% due to macrosomia compared with the control group with a C/S prevalence of 13% due to previos C/S.A significant statistical difference (P=0.0001) between the case and contol group was also observed in the frequency of macrosomia and metabolic disorders in newborns infants. Hypoglycemia (25.2%) was the most common metabolic disorder in the case group.Based on the results achieved, it can be concluded that although nowadays, maternal and perinatal complication have decreased substantially in diabetic pregnant patients, pregnancy in still associated with higher risks in this group.

Background: The preeclampsia / eclampsia is one of the most serious condition peculiar to pregnancy, which defined as occurrence of hypertension, proteinuria in pregnancy and convulsion in eclamptic women. There are major risk for eclamptic and pre eclamptic women due to maternal and fetal complications. Materials and Methods: In a prospective study, preeclamptic and eclamptic patients who were visited at Shariati hospital were divided into two groups due to having proper prenatal care or not. maternal and fetal complication were studied in that two group. maternal variables were included: incidence of preterm labor, eclampsia, mode of delivery, long term hospitalization, need for ICD, need to antihypertrnsive drugs over postportum, insistence of hypertension up to 6 weeks, postpartum trombocytosis, incidence of cesarean section due to abruptio placenta and IUGR , elevation of serum creatinine, incidence of HELLP syndrome and death of mother Fetal variables were included incidence of IUGR and IUFD, pre term delivery and for need NICD. Relationship of demographic characteristics such as maternal age, parity, educational level, mode of delivery, presence of underlying disease, and educational level of person who referred the patient were studied. Results: These variables except of educational level, and referral level were There was statistically significant difference between incidence of all of variables, in exception of mode of delivery. That means incidence of complications is lower in group with adequate prenatal care. Conclusion: It seems that adequate prenatal care can reduce or obligate maternal and fetal complication in hypertensive disorders in pregnancy.

BACKGROUND AND OBJECTIVE: HELLP syndrome is a serious presentation of pre-eclampsia and eclampsia during pregnancy and its diagnosis is difficult because of lack of specific features. This syndrome is associated with prenatal and neonatal morbidity and mortality. The aim of the present study was to compare the maternal and neonatal outcomes of HELLP syndrome with preeclampsia in Yahyanejad hospital (Babol, Iran) in the past ten years.METHODS: This cross-sectional study was performed on all patients with pre-eclampcia/eclampcia who were hospitalized in Yahyanejad hospital during 10 years. Primary data, clinical and laboratory data, prenatal and maternal complications included (cesarean section, placental abruption, need to blood transfusion, liver hematoma, pulmonary edema, acute renal failure, DIC, brain hematoma and infection, intra-abdominal hemorrhage, ARDS and maternal mortality) and neonatal complications included (preterm neonates, IUGR, NICU admission and neonate mortality) were compared.FINDINGS: In this study, from 445 patients who were evaluated, 361 patients (81.3%) with mild preeclampsia, 83 patients (18.7%) with severe pre eclampsia and 1 (%0.2) with eclampsia were hospitalized in primary diagnosis, that 12 patients (2.7%) had HELLP syndrome symptoms. Cases of placental abruption, liver hematoma, pulmonary edema, need to blood transfusion, acute renal failure, DIC and maternal mortality in patients with HELLP syndrome was significant in compared to preeclampsia (p<0.05). Neonatal complications included preterm neonates, IUGR, NICU admission in patients with HELLP syndrome were significant in compared to preeclampsia (p<0.05). Also no case of brain hemorrhage and infection, ARDS, intra-abdominal hemorrhage, IUFD and neonatal mortality was reported.CONCLUSION: According to the results of this study, maternal and fetal complications in patients with HELLP syndrome can be prevented and this could be result of early diagnosis and appropriate management.

Introduction: Exchange transfusion (ET) is an effective mode of therapy in the treatment of hyperbilirubinemia, but is associated with some complications in 5-10% of the patients, especially in preterm newborns. The most important complications following exchange transfusion are: Acidosis, thrombocytopenia, hypocalcemia, hyponatremia, hypoglycemia and transmitting infectious agents. This study aims to determine some complications of exchange transfusion in neonatal hyperbilirueinemia in NICU of 22 Bahman 22nd Hospital in order to promote its safety and efficacy.Materials and Methods: In this study neonates with undergone exchange transfusion due to hyperbilirubinemia were evaluated over a period of 36 months in NICU of 22 Bahman 22nd Hospital from July 2005 to July 2008 in Mashhad. The questionnaires were completed according to the by patients’ data. The data were then and analyzed for statistical results.Results : Of the 28 neonates who entered the study, 3 required more than one ET. complication of ET occurred in 24 neonates (85.7%).The most common complications were being metabolic acidosis (67.9%) and thrombocytopenia (50%).Conclusion: In order to avoid complications following exchange transfusion, it should be emphasized to have laboratory tests done. For instance, tests of platelet count and arterial blood gases are needed so that in cases of complications, the available information can facilitate the treatment. They can be treated on time.