BackgroundWomen from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable attributes of MNM.MethodsAn MNM audit study was conducted from 2012 to 2014 at three university hospitals in Tehran. Auditors evaluated the quality of care by reviewing the hospital records of 76 MNM cases (54 Iranians, 22 Afghans) and considering additional input from interviews with patients and professionals. Main outcomes were frequency of suboptimal care and the preventable attributes of MNM. Crude and adjusted odds ratios with confidence intervals for the independent predictors were examined.ResultsAfghan MNM faced suboptimal care more frequently than Iranians after adjusting for educational level, family income, and insurance status. Above two-thirds (71%, 54/76) of MNM cases were potentially avoidable. Preventable factors were mostly provider-related (85%, 46/54), but patient- (31%, 17/54) and health system-related factors (26%, 14/54) were also important. Delayed recognition, misdiagnosis, inappropriate care plan, delays in care-seeking, and costly care services were the main potentially preventable attributes of MNM.ConclusionsAfghan mothers faced inequality in obstetric care. Suboptimal care was provided in a majority of preventable near-miss events. Improving obstetric practice and targeting migrants’ specific needs during pregnancy may avert near-miss outcomes.

Overutilization of cesarean section clearly influenced the causes of maternal near-miss. A lack of health insurance had a measurable impact on near-miss morbidity. Tailored interventions for reducing unnecessary cesarean section and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes.

Vaginal progesterone has a potential beneficial effect in postponing of preterm labor by suppression of prostaglandins cascades. Although different studies evaluated the use of progesterone for preterm birth, the exact effect of which on prolongation of pregnancy remains unclear. Seventy two women who underwent preterm labor were managed by magnesium sulfate. Then they were randomly assigned to continue pregnancy either by applying vaginal progesterone (400 mg) until delivery or without using any drug. Gestational age mean at the time of delivery (P = 0.039) and postponing delivery mean time (P = 0.048) were significantly higher in progesterone group. Comparison of neonatal outcomes between two groups of patients showed meaningful benefits of progesterone in increasing of neonatal weight, reduction of low birth weight babies, and lowing neonate admitted in NICU.

Objective To evaluate fetal behaviour in breech and cephalic fetuses at term, using a computerised fetal Design An observational study.Setting Pregnancy Assessment Centre, University Hospital, Nottingham.Sample Twenty-six breech and 58 cephalic fetuses between 36 and 41 weeks.Methods Behaviour (fetal heart rate and activity) was recorded with the use of Doppler ultrasound. The duration of recording was 60 minutes or more in all but four recordings (minimum 49 minutes). Main outcome measuresBehavioural criteria studied were 1. the relative percentage time spent in low and hgh variation fetal heart rate patterns; 2. the duration and recurrence of fetal activity; 3. the number of accelerations in low and high fetal heart rate variation; and 4. the number of fetal behavioural state transitions.Results Breech fetuses differed from the cephalic group in that they were lighter than the cephalic fetuses (median 3105 g vs 3400 g; P < 0.01) and were born to older mothers (median maternal age 30 years us 28 years; P < 0.01). No significant differences were found in rates of movement, numbers of accelerations and time exhibiting low and high fetal heart rate variation. However, breech fetuses exhibited significantly more state transitions (median 5.2h vs 3.69h; P = 0.01). ConclusionsThis study shows that breech fetuses are neurologically different from their cephalic counterparts in otherwise healthy pregnancies, and that subtle behavioural differences can be demonstrated in utero using this computerised method.behaviour program.

The study was performed to evaluate the expression of some proapoptotic genes for early prognosis of ovarian cancer. Twenty-four fresh frozen ovarian tumor and 9 normal ones were considered for real-time polymerase chain reaction. CASP8 and BAD genes were decreased in tumoral tissues. Downregulation of CASP8 and BAD genes in ovarian cancer may be an important cause for ovarian cancer. Background: Ovarian cancer as the most lethal gynecologic malignancy in women is poorly detected during early stages of carcinogenesis. Therefore, there is an emergent need to look for specific and sensitive biomarkers for early diagnosis of ovarian cancer. Materials and Methods: In this study, we performed real-time polymerase chain reaction (PCR) to evaluate the expression of six proapoptotic genes, CASP8, BAK, APAF1, BAX, BID, and BAD, which contain CpG islands in their promoter regions. Afterward, the significantly downregulated genes were investigated by HpaII-PCR and methylation-specific PCR (MSP) to determine the methylation status between tumoral and adjacent normal tissues. Results: The real-time PCR results in 24 tumoral and 9 normal adjacent tissues showed decreased expression of CASP8 and BAD genes in tumoral relative to normal samples. Furthermore, the methylation analysis showed no significant methylation between tumoral and normal samples. Conclusion: Taken together, this could be concluded that downregulation of CASP8 and BAD genes in ovarian cancer may be as important causes for ovarian cancer carcinogenesis via inducing resistance to apoptosis; however, the downregulations are not due to promoter hypermethylation.