Research in Medicine

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Background: Gestational diabetes is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Approximately 4% of pregnancies are affected by diabetes mellitus, 90% of which represent gestational diabetes mellitus (GDM). Detection of GDM permits the identification of women who are at risk for development of type 2 diabetes mellitus later in life. Appropriate treatment may reduce the risk of fetal and neonatal complications. One of the risk factors identified recently is "irregular menstruation". Several studies have reported the relationship between irregular menstruation and insulin resistance. The aim of this case-control study was determination of relationship between irregular menstruation and gestational diabetes. Materials and methods: Pregnant women who were referred to prenatal clinics affiliated to Endocrinology and Metabolism centers of Shariati and Taleghani hospitals, and Iran Endocrinology and Metabolism institute, were studied. Mothers were interviewed by trained members of the study team and relevant information recorded on a structured questionairre. Sampling was performed by convenience method. Case group including 60 women with gestational diabetes and control group comprising of 60 women without gestational diabetes were matched for age, parity, BMI, family history of diabetes, history of still-birth, or delivery of a previous malformed newborn. Demographic characteristics, history of irregular menstruation and its etiology were compared between the two groups. We excluded subjects with history of fetal macrosomia (weight>4500 g), pre-pregnancy diabetes, diabetes in previous pregnancy, smoking before or during pregnancy, recurrent abortion and preterm delivery. Results: Demographic characteristics and etiology of irregularity were similar between cases and controls. Irregular cycles were more prevalent in the case group, (36.7% vs. 15.0 %, P=0.007, Odds Ratio=3.28, CI=95%, 1.40-7.90 ). Conclusion: A history of irregular menstrual cycles was a significant independent predictor of gestational diabetes mellitus. If selective screening is implemented for gestational diabetes mellitus, such history should be considered in the decision of whom to test.

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Background: Premature rupture of membranes (PROM), occurs in 2-25% of pregnant women. Traditionally, clinical and laboratory tests utilized for the diagnosis of PROM are fraught with both false positive and false negative results caused by various factors that result in an equivocal or delayed diagnosis. The absence of a non-invasive 'gold standard' for the diagnosis of PROM has led to the search for alternative biochemical markers. This research has been conducted to compare the diagnostic power of qualitative and quantitative HCG of cervicovaginal washings for the diagnosis of PROM.s Materials and methods: This Diagnostic-Experimental study was undertaken with cervico-vaginal samples collected from singleton pregnancies between 14-41 weeks of gestation. Totally 86 pregnant women referred to Vali-Asr Hospital, Zanjan, in 2006, were enrolled in this study. Subjects were divided in two groups: 43 subjects with confirmed PROM (amniotic fluid pooling (+), nitrazine paper test (+), and fern test (+)), and 43 women in the control group (amniotic fluid pooling (-), nitrazine paper test (–), and fern test (-)). Washings were then collected from the posterior vaginal fornix with the use of 5 ml of sterile saline irrigation and aspiration techniques. We measured HCG levels with the ELISA test. Result: The median HCG levels were 250.60 (mIU/mL) and 6.2 (mIU/mL) in PROM and control group respectively. With, 22 (mIU/mL) set as a cutoff value on the receiving operating characteristic curve, (ROC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.3, 97.7, 97.6, 95.5 and 96%, respectively. Conclusion: Quantitative HCG measurement of cervico-vaginal washings was an accurate test for the diagnosis of PROM in our study.

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Abstract Background: Regarding to prevalence and complications of no- or mis- diagnosis of premature rupture of membrane (PROM), and also high rate of false positive and negative results of traditional diagnostic methods, this study was designed to evaluate diagnostic values of urea and creatinin values of cervicovaginal discharges in determining of PROM in pregnant women referred to Khatam-ol-Anbia hospital, Gonbad, Iran in 2008. Methods: In a clinical trial- diagnostic study, 84 pregnant women with gestational age of 20-41 weeks and chief complaint of watery vaginal discharge were studied. They divided in two groups of PROM (n=42) and intact membrane (n=42) matched by gestational age. Secretions of posterior phornix of vagina were collected by 5 milliliter normal saline. Urea value was measured by enzymatic photometry or urease, and creatinin value was determined by Jaffee synthetic chemical colorimetry. Data were analyzed by descriptive and analytic statistics. Results: Urea value of cervicovaginal secretions in PROM and control groups was 14.7±4.27 and 2.9±1.5 mg/dL, respectively. Regarding to cut-off of 7 mg/dl, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of urea of cervicovaginal discharge was 100 percent in diagnosis of PROM. Creatinin value of cervicovaginal secretions in PROM and control groups was 1.4±0.4 and 0.2±0.1 mg/dL, respectively. Regarding to cut-off of 0.55 mg/dl, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of creatinin of cervicovaginal discharge was 100 percent in diagnosis of PROM. Conclusion: It seems that measuring urea and creatinin of cervicovagal discharge can be used as a simple, new, rapid and reliable method to diagnose premature rupture of membrane in pregnant women. KEYWORDS: premature rupture of membrane, Urea, Creatinin, Cervicovaginal discharge.

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Backgrounds:Given the high prevalence of thyroid disorders during pregnancy and the importance of these disorders in pregnant women and studies on the relationship between thyroid dysfunction during pregnancy and adverse pregnancy outcomes, still there is no consensus on effectiveness of screening all women in early pregnancy regarding thyroid dysfunction and among the international scientific communities recommend the targeted high-risk case finding approach to identify these disorders in pregnancy. The purpose of this study is to compare universal screening with targeted high-risk case finding for diagnosis of thyroid disorders in Iranian pregnant women.

Materials and Methods: The present study is a cross-sectional study that was carried out on 1600 pregnant women in their first trimester. After data collection using questionnaires, their risk status in terms of thyroid disorders was estimated by the check lists of risk factors. Then, their incidence to thyroid disorders was characterized based on clinical examinations and measuring serum levels of T4, TSH, TPOab and T-uptake. The prevalence of thyroid disorders were identified and the predictive risk factors of thyroid disorders were determined by regression analysis.

Results: The study was conducted on 1,600 pregnant women, the prevalence of thyroid disorders was 36.5% (n=584). According to the results of hormonal tests in the high-risk group 42.9% (n = 386) and in the low-risk group 28.3% (198 patients) were diagnosed with a type of thyroid disorders. Among the risk factors, history of thyroid drug use, family history of thyroid disorders and Previous history of a thyroid disorder, were significant prognostic factors (p<0.005).

Discussion: It seems that with lack of universal screening about one-third (33.9%) of women with thyroid disorders are not diagnosed during pregnancy. Further studies are recommended.