Soheila Akbari

We herein report first Iranian families with spastic paraplegia 35 and 49 and claim that TECPR2 gene causes complicated spastic paraplegia 49 with or without sensory autonomic neuropathy. In addition, we show how coexistence of SPG49 and griscelli syndrome can lead to misdiagnosis.

Background. Legal abortion is a challenge from the viewpoint of ethics and religion. The present study was conducted to investigate the frequency of fetal and maternal indications of legal abortion and also the maternal characteristics in Lorestan Province of Iran. Methods. As a descriptive cross-sectional study, all the cases with issued permits for legal abortion were selected by a census during 20172019. Descriptive data analysis was used to report the results. Event rates with Poisson 95 confidence intervals (CIs) were calculated based on the regional population. Results. A total of 305 cases were selected. The mean age of the mothers was 31.61±7.48 years, and the mean of gestational age was 15.76±2.80 weeks. Demographically, most cases were from Khorramabad city (101 cases) followed by Borujerd (51 cases) and Doroud (46 cases). The overall event rate was 1.732 per 10,000 individuals (95 CI: 1.5431.938) of the general population of the region per 3 years. Fetal disturbance of the brain and spine was the most prevalent reason of abortion (24.92, 95 CI: 19.6331.19) followed by Down syndrome (19.34, 95 CI: 14.7324.95), hydrops fetalis (12.79, 95 CI: 9.0917.48), and anencephaly (12.79, 95 CI: 9.0917.48). Conclusion. From each 10,000 individuals of the population, one to two cases of legal abortion were screened per 3 years. More than 90 of cases had fetal indication. In cities with lower event rates, we should plan for better screening.

Background Toxoplasma gondii is one of the major causes of abortion in pregnant women. Most cases of abortion occur in the acute phase of infection and early pregnancy. The purpose of this study was to investigate the association between spontaneous abortion and seropositive status of toxoplasmosis in women with first-time spontaneous abor- tion. Materials and Methods This research is a case-control study on 240 serum samples from women experiencing spon- taneous abortion for the first time as the case group, and 240 serum samples from women who had a normal delivery with no history of abortion as the control group. The level of anti-Toxoplasma gondii IgM and IgG antibodies were assessed in serum samples using ELISA. To separate the acute and chronic infections, all IgM-positive samples in both groups and IgG-positive samples of the case group were examined using IgG avidity. Results The Toxoplasma IgM antibody was detected in 3.3% (8/240) of the case group and 0.4% (1/240) of the con- trol group, which was a statistically significant difference between the two groups [P=0.019, odds ratio (OR)=10.266]. Of all samples 47.5% and 46.3% of the case and control groups were positive for Toxoplasma IgG antibody, respec- tively. Seven out of 8 (87.5%) IgM-positive serum samples from the case group had low IgG avidity, indicating acute infections, whereas all IgG-positive sera and 1 IgM-positive serum, which was related to the control group, showed a high IgG avidity, indicating chronic infections. Conclusion Maternal acute toxoplasmosis during pregnancy is raised as one of the factors that increase the chance of spontaneous abortion. The necessary health training, especially on the parasite transmission ways to women before marriage, as well as the serological test in women before and during pregnancy is recommended. Polymerase chain reaction (PCR) and IgG avidity assays should be performed in the medical diagnostic laboratories for accurate distin- guishing of the initial infection of toxoplasmosis in the pregnant women.

Background: Maternal health improvement is one of the eight goals of the third millennium development, set in 2000. Pregnancy complications are the most important causes of maternal mortality worldwide. Proper and qualified health care access is one the most important factors for reducing maternal and neonatal mortality rates. Objectives: This study aimed to determine quality of peripartum care in Lorestan province in 2013. Materials and Methods: This was a descriptive cross-sectional study, in which quality of peripartum care was assessed among 200 women (sample size was determined according to other studies), referred to Lorestan province public hospitals. Quality assessment according to the WHO was used for the framework of structure, process and outcome. Data was collected by a researcher-made checklist, developed based on the administered instructions by Iran Health Ministry. The checklists were filled by observation. The calculated quality scores were expressed as percentage. SPSS version 18 was used for data analysis. Results: The mean percentages of compatibility with desirable situation were 54%, 57% and 66% in first, second and third stage of labor, respectively. The lowest scores were related to: Leopold maneuvers in the first stage, hand washing in the second stage and pulse control in the third stage of labor. Conclusions: Quality of peripartum care is moderate in Lorestan province, therefore, continuous evaluation of quality of care by administrators and hospital staff is essential to improve this quality and will ultimately result in maternal and neonatal health improvement. Keywords: Peripartum; Health Care Quality; Iran

Aim: The aim of this study was to evaluate the prognostic value of normal and indeterminate patterns of cardiotocography in admission test (AT) and pregnancy outcome.Material and Methods: A prospective study enrolled 818 intrapartum singleton pregnancies with gestational age of >34 weeks, in the latent phase and with intact membrane. Cases were divided into the high‐ and low‐risk groups. Non‐Stress Test was interpreted according to the 2008 National Institute of Child Health and Human Development workshop. Adverse pregnancy outcomes were compared between groups based on AT interpretation.Results: Out of 818 patients, 492 (60%) were categorized as low‐risk and 326 (40%) as high‐risk pregnancies. In low‐risk patients, 410 (83.3%) had normal and 82 (16.7%) had indeterminate AT. These figures were 249 (76.4%) and 77 (23.6%) in high‐risk patients, respectively, and two cases (0.6%) had abnormal AT. In both groups, thick meconium staining, non‐reassuring fetal heart rate pattern, cesarean section and cesarean section due to non‐reassuring fetal heart rate pattern were significantly more frequent in indeterminate AT than normal ones (P < 0.001). In high‐risk pregnancies with indeterminate AT, the risk of low birthweight and neonatal intensive care unit (NICU) admission increased. The positive predictive value was less than 30% in predicting thick meconium staining, non‐reassuring fetal heart rate pattern, PH ≤ 7.2 and NICU admission in both groups. Overall, negative predictive value of AT for neonatal death and NICU admission was 100% and 96%, respectively.Conclusions: Indeterminate patterns of cardiotocography can predict adverse pregnancy outcomes and when facing this condition, obstetricians should act cautiously.

Background: In spite of the beneficial effect of iron supplementation in iron-deficient pregnant women, iron supplementation may not be needed for women who are iron replete or not anemic. Moreover, the theoretical possibility of adverse effects, such as oxidative damage, from administration of iron supplements during pregnancy has been raised. Objective: To determine the effect of prophylactic iron supplementation on iron status and birth outcomes among nonanemic pregnant women. Methods: A randomized, triple-blind clinical trial was conducted. One hundred forty-eight nonanemic pregnant women with hemoglobin > 110 g/L, serum ferritin > 12 μg/L, and gestational age < 20 weeks were randomly assigned to receive either ferrous sulfate (60 mg elemental iron) (n = 70) or placebo (n = 78) until delivery. Hemoglobin concentration and serum ferritin were measured by electronic counter and radioimmunoassay, respectively. Data were analyzed by independent t-tests, ANCOVA, and repeated measures. Results: At delivery, the incidence of iron deficiency was significantly lower in the iron than in the placebo group. There were no significant differences between the two groups in maternal hemoglobin and ferritin concentrations at delivery or in the infant's birthweight, birth length, or length of gestation. Conclusions: Iron supplementation during pregnancy in nonanemic women with low serum ferritin may have benefits beyond the prevention of iron-deficiency anemia.