This prospective study aimed to estimate the incidence and associated factors of severe maternal morbidity in southeast Iran. During a 9-month period in 2013, all women referring to eight hospitals for termination of pregnancy as well as women admitted during 42 days after the termination of pregnancy were enrolled into the study. Maternal near miss conditions were defined based on Say et al.'s recommendations. Five hundred and one cases of maternal near miss and 19,908 live births occurred in the study period, yielding a maternal near miss ratio of 25.2 per 1000 live births. This rate was 7.5 and 105 per 1000 in private and tertiary care settings, respectively. The rate of maternal death in near miss cases was 0.40% with a case:fatality ratio of 250 : 1. The most prevalent causes of near miss were severe preeclampsia (27.3%), ectopic pregnancy (18.4%), and abruptio placentae (16.2%). Higher age, higher education, and being primiparous were associated with a higher risk of near miss. Considering the high rate of maternal near miss in referral hospitals, maternal near miss surveillance system should be set up in these hospitals to identify cases of severe maternal morbidity as soon as possible.

Accurate prenatal estimation of birth weight is useful in the management of labour and delivery. This study compared the accuracy of ultrasound, clinical and maternal estimates of fetal weight in 246 parous women with singleton, term pregnancies admitted for scheduled caesarean section. The sensitivity and specificity of predicting birth weight by ultrasound measures were 12.6% and 92.1%, by clinical palpation were 11.8% and 99.6% and by maternal estimate were 6.3% and 98.0% respectively. Clinicians' estimates of birth weight in term pregnancy were as accurate as routine ultrasound estimation in the week before delivery. Parous women's estimates of birth weight were more accurate than either clinical or ultrasound estimation. Précision de l'estimation échographique, clinique et maternelle du poids du bébé à la naissance chez des femmes enceintes à termeRÉSUMÉ L'estimation anténatale du poids à la naissance est utile au niveau de la gestion du travail et de l'accouchement. Cette étude a comparé la précision de l'estimation échographique, clinique et maternelle du poids du foetus chez 246 femmes pares, enceintes d'un seul enfant, et ayant mené leur grossesse à terme, admises pour une césarienne programmée. La sensibilité et la spécificité de la prédiction du poids à la naissance au moyen de l'échographie étaient de 12,6 % et 92,1 % respectivement, alors qu'elles étaient de 11,8 % et 99,6 % pour la palpation clinique et de 6,3 % et 98,0 % pour l'estimation maternelle. Pour les grossesses à terme, les estimations du poids à la naissance par les cliniciens étaient aussi précises que les estimations échographiques habituellement réalisées la semaine avant l'accouchement. Les estimations des femmes pares étaient plus précises que celles des cliniciens et de l'échographie.

Uterine contractions at the end of pregnancy lead to dilatation of cervix and the expulsion of the fetus from the birth canal. Myometrial contractions are a very painful and unpleasant experience for mothers. The aim of the obstetrician is to decrease the length of labor and labor pains as much as possible by careful control of the phases of labor. In the case of severe labor pains resulting from uterine contractions, the administration of narcotic drugs such as pethidine (meperidine) 1 is indicated. 1Pain and anxiety can affect the progress of delivery by increasing the release of catecholamines and Cortisol. Noradrenaline increases uterine contractions while Cortisol and adrenaline decrease them. In many cases, severe labor pain and anxiety resulting from that can increase the release of adrenaline and Cortisol and lead to a decrease in contractions and consequently a prolonged labor.2 In some cases, pain and anxiety cause ineffective contractions. These contractions are severe with short intervals, but fail to have any progressive effect.2 Pethidine decreases the concentration of catecholamines in blood and by that means seems to increase the speed of delivery. 3Considering the effects of pethidine on cervical smooth muscle and on changes in cervical consistency, 4 as well as previous observations showing the effect of pethidine on the relief of labor pain, we decided to study parturients referred to the obstetrics and gynecology department at Kerman Medical Sciences University Hospital (Kerman, Iran) to obtain a more accurate picture of the effects of pethidine. Patients and MethodsIn this randomized, double-blind clinical trial we sought to determine the effects of pethidine on relief of labor pain, uterine contractions and infant Apgar score. Case (pethidine-administered) and control groups (placeboadministered) were similar in mean age, length of time from marriage to pregnancy, job and place of residency. The required number of subjects, based on a pilot study and considering a power=90%, d=7% and error=5%, was determined as 44 in each group. Subjects were eligible for entry if they were primiparous, had a term-pregnancy (gestational age• 37 weeks), spontaneous labor pains, no narcotic addiction, not a high-risk pregnancy (e.g., preeclampsia, eclampsia, heart-respiratory problems or fetal distress), and at the start of the active phase of delivery (5-cm cervical dilatation) (2).Selected subjects were divided randomly into the case and control groups. The case group received 75 mg pethidine by intramuscular injection 1,3, 5-10 and the control group received the same volume (1.5 mL) of normal saline as a placebo. The first researcher injected patients at the beginning of the active phase (5-cm cervical dilatation). Before injection, the second researcher recorded the vital signs of the mother, including blood pressure, heart and respiratory rate, and the fetal heart rates, duration, and intervals of uterine contractions. The second researcher took the measurements again 45 minutes after injection of pethid...

Based on these findings, the sensitivity and specificity of diagnosis of breast tumors made by Behvarzes was 95.8% and 99.56%, respectively, compared with those made by specialists. Considering the obtained results, the screening program for breast tumors by Behvarzes can be very helpful in early diagnosis of breast tumors.

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