ObjectiveThe objective of this study was to determine if second curettage was associated with a decreased need for the number of chemotherapy treatments compared to usual care.MethodsA pilot randomized controlled clinical trial was designed at Motahhari Referral Hospital in 2014. Fifty-two patients with low risk, nonmetastatic gestational trophoblastic neoplasm were assigned randomly to two arms. The interventional arm included a repeat uterine curettage, and the control group received standard care (chemotherapy). All participants were followed periodically over 6 months. Primary outcome was defined as the number of chemotherapy courses in each arm. Student’s t-test and receiver operator characteristics (ROC) curve were applied for statistical analysis as appropriate.ResultsFifty percent of participants who underwent re-curettage did respond to intervention with no further chemotherapy after 6 months of follow-up. The intervention arm had higher number of remissions without chemotherapy compared to those who received usual care. In the subgroup analysis, the ROC curve could predict the re-curettage treatment response by beta human chorionic gonadotropin (BhCG) level significantly. No complications were reported in the intervention arm.ConclusionSecond curettage is an alternative effective procedure to decrease the need for chemotherapy among patients with low risk, nonmetastatic gestational trophoblastic neoplasm. Further clinical trials with larger sample size may be needed to determine the effective role of second curettage among patients.

Objectives: Preeclampsia is a high prevalence complication in pregnancy and is responsible for 36% of maternal mortality worldwide. The offspring of mothers with preeclampsia face many problems after birth and in their lifetime. The fetal renal is one of the most vulnerable organs following maternal preeclampsia. In this regard, the present study investigated the relationship between the severity of preeclampsia and fetal renal artery resistance and pulsatility. Materials and Methods: In general, 91 pregnant women were included and divided into control and preeclampsia groups. The control group included 43 women with normal pregnancy and the preeclampsia group consisted of 48 pregnant women who suffered from preeclampsia and were classified into patients in severe and non-severe preeclampsia groups each containing 24 cases. Renal artery Doppler ultrasound was performed, and then the systole/diastole ratio (S/D), pulsatility index (PI), and resistance index (RI) were measured as well. Results: The S/D ratio, RI, and PI significantly decreased in the preeclampsia group (P<0.001) compared to the control group. The S/D ratio in severe preeclampsia was significantly lower in comparison with non-severe preeclampsia (P<0.001). Finally, the amniotic fluid index was related to the PI (P<0.05), and severe preeclampsia significantly increased the pregnancy termination before 34 weeks (P<0.001). Conclusions: Preeclampsia deceased the resistance of renal arteries by altering the fetal renal blood flow. These changes can intensify in patients with severe preeclampsia compared to non-severe preeclampsia.

Background and Objective: Diabetes mellitus and gestational diabetes are complications that may be associated with preterm premature rupture of the membrane (i.e. PPROM) during pregnancy. We have investigate the impact of gestational and overt diabetes on PPROM through a statistical campaign. Methods: This study was conducted in two parts: In the first part, the PPROM patients (211 cases) were classified into three groups, without diabetes (W/ODM=126 cases), gestational diabetes (GDM=69 cases consist of 44 cases under insulin therapy and 25 cases of diet controlled), and diabetes mellitus (ODM=16 cases). PPROM complications were studied and compared between these three groups. In the second part, GDM patients under insulin therapy or diet control were compared to W/ODM patients in terms of PPROM complications. Results: There were no significant statistical differences between the groups regarding pregnancy outcomes, except, for mean gestational age at rupture of membrane and delivery. For maternal outcomes, there were significant changes between groups in terms of labor duration, hospital stay after childbirth, and severe preeclampsia. Fetus and neonatal outcomes suggested that the newborn weight, neonatal hyperglycemia, Apgar score, revive need, infant death, and umbilical cord blood gas test results (except BE) were significantly different between the three groups. Results of the second part of the study, in terms of statistically significant differences between insulin therapy, diet control, and W/ODM are consistent with the first part, for all discussed factors. Conclusion: Results revealed that PPROM protocol management on PPROM cases who have gestational or overt diabetes is applicable and does not have any further risk.