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Background:Birth injuries are defined as the impairment of neonatal body function due to adverse events that occur at birth and can be avoidable or inevitable. Despite exact prenatal care, birth trauma usually occurs, particularly in long and difficult labor or fetal malpresentations.Objectives:This study aimed to investigate the incidence of birth injuries and their related factors in Kashan, Iran, during 2012-2013.Patients and Methods:In this cross-sectional study, all live-born neonates in the hospitals of Kashan City were assessed prospectively by a checklist included demographic variables (maternal age, weight, and nationality), reproductive and labor variables (prenatal care, parity, gestational age, premature rupture of membrane (PROM), fetal heart rate (FHR) pattern, duration of PROM, induction of labor, fundal pressure, shoulder dystocia, fetal presentation, duration of second stage, type of delivery, and delivery attendance), and neonatal variables (sex, birth weight, height, head circumference, Apgar score, and neonatal trauma). Birth trauma was diagnosed based on pediatrician or resident examination and in some cases confirmed by paraclinic methods. Statistical analyses were performed by chi-square, student’s t-test, and multiple logistic regression analyses using SPSS version 17. P ≤ 0.05 was considered statistically significant.Results:In this study, the incidence of birth trauma was 2.2%. Incidence of trauma was 3.6% in vaginal deliveries and 1.2% in cesarean sections (P < 0.0001). The most common trauma was cephalohematoma (57.2%) and then asphyxia (16.8%). In multiple logistic regression analyses, decreased fetal heart rate (FHR), fundal pressure, shoulder dystocia, vaginal delivery, male sex, neonatal weight, delivery by resident, induction of labor, and delivery in a teaching hospital were predictors of birth trauma.Conclusions:Overall, incidence of birth trauma in Kashan City was lower in comparison with most studies. Considering existing risk factors, further monitoring on labor, and delivery management in teaching hospitals are recommended to prevent birth injuries. In addition, careful supervision on students and residents' training should be applied in teaching hospitals.

Perineal trauma can lead to short- and long-term complications for the mother. The purpose of this study was to determine the incidence of perineal trauma and its related factors. In this cross-sectional study, the maternal, neonatal, obstetric and childbirth information for all women who delivered in Kashan city hospitals was studied. Data were analysed using the Chi-square test, the t-test and logistic regression. The incidence of perineal trauma was 84.3%. Ninety-five percent of the primiparous women and 43.9% of the multiparous women had an episiotomy ([p value<.001], AOR = 24.4). The chance of birth trauma in the cases of younger maternal age, increasing gestational age, induction of labour, fundal pressure, Iranian nationality and nulliparity are increased. The incidence of perineal trauma in this study was high and should be minimised with a limited use of an episiotomy. It is recommended that midwives and obstetricians pay more attention to the women at risk. Impact Statement What is already known on this subject? Perineal trauma is common in vaginal delivery. Scientific literature shows several predictors of perineal trauma such as maternal age, parity, induction of labour, gestational age and birth weight, etc.; although in other studies some of these variables were not associated with perineal trauma. Considering that the findings about the factors associated with birth injuries are controversial, we decided to assess the incidence of perineal trauma and its risk factors during childbirth. What the results of this study add? This study indicated a high incidence of perineal trauma and agrees with the existing literature that maternal age, parity, the induction of labour, gestational age, fundal pressure and nationality are associated with perineal trauma; however, other factors were not found as predictors in our study. What the implications are of these findings for clinical practice and/or further research? Our results agreed with the existing literature regarding some predictors of perineal trauma but not for birth weight, foetal distress, second stage duration, hospital type, etc. This data could be used to implement protocols for reducing the rate of a routine episiotomy, considering too the high risk women for the prevention of perineal trauma.

Data on the effects of selenium supplementation on clinical signs and metabolic profiles in women at risk for intrauterine growth restriction (IUGR) are scarce. This study was designed to assess the effects of selenium supplementation on clinical signs and metabolic status in pregnant women at risk for IUGR. This randomized double-blind placebo-controlled clinical trial was performed among 60 women at risk for IUGR according to abnormal uterine artery Doppler waveform. Participants were randomly assigned to intake either 100 μg selenium supplements as tablet (n = 30) or placebo (n = 30) for 10 weeks between 17 and 27 weeks of gestation. After 10 weeks of selenium administration, a higher percentage of women in the selenium group had pulsatility index (PI) of <1.45) (P = 0.002) than of those in the placebo group. In addition, changes in plasma levels of total antioxidant capacity (TAC) (P < 0.001), glutathione (GSH) (P = 0.008), and high-sensitivity C-reactive protein (hs-CRP) (P = 0.004) in the selenium group were significant compared with the placebo group. Additionally, selenium supplementation significantly decreased serum insulin (P = 0.02), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (P = 0.02), and homeostatic model assessment for B-cell function (HOMA-B) (P = 0.02) and significantly increased quantitative insulin sensitivity check index (QUICKI) (P = 0.04) and HDL-C levels (P = 0.02) compared with the placebo. We did not find any significant effect of selenium administration on malondialdehyde (MDA), nitric oxide (NO), fasting plasma glucose (FPG), and other lipid profiles. Overall, selenium supplementation in pregnant women at risk for IUGR resulted in improved PI, TAC, GSH, hs-CRP, and markers of insulin metabolism and HDL-C levels, but it did not affect MDA, NO, FPG, and other lipid profiles.Clinical trial registration number http://www.irct.ir : IRCT201601045623N64.

Background:Preeclampsia is one of the leading causes of maternal mortality and morbidity. Its prevalence varies between 10-25% among high-risk pregnant patients.Objectives:The aim of this study was to determine whether treatment with acetylsalicylic acid (ASA) reduces the incidence of preeclampsia among pregnant women with abnormal uterine artery flow.Patients and Methods:In this double-blind, placebo controlled trial, 80 high-risk pregnant women with preeclampsia, who had abnormal findings on Doppler ultrasonography at 12-16 weeks of pregnancy (unilateral notch with RI ≥ 0.65 or bilateral notch with RI ≥ 0.55), were randomly divided into two groups; the intervention group was treated with ASA tablet 80 mg, one tablet per day, and the control group was given placebo. Then patients were followed until the end of their pregnancy period, and pregnancy outcomes, including development of preeclampsia, the intrauterine growth retardation (IUGR), prematurity, type of delivery, birth weight, and Apgar score at one and five minutes were assessed. Data were analyzed using the student's t-test, chi-square or Fisher's exact test, and multivariate logistic regression. P values less than 0.05 were considered statistically significant.Results:There were no significant differences between the two groups in terms of baseline characteristics. There was a significant difference between the ASA and placebo groups in the incidence of preeclampsia (2.5% versus 22.5%), adjusting for the neonatal and maternal covariates.Conclusions:ASA prophylaxis can be used for prevention of preeclampsia in high-risk patients with abnormal uterine artery.