Background and Aim:Hypothyroidism affects 2-3% of pregnant women. This study aims to develop a mobile self-care program to enhance self-management and health outcomes for these women. Methods:The present study is a developmental and applied research that was conducted in three stages at the Yas Hospital's Women's Clinic and Pregnancy Care Center affiliated with Tehran University of Medical Sciences in 2023. In the first stage, the informative elements of the program were determined through a review of previous studies and a survey of 20 obstetricians and endocrinologists. In the second stage, a prototype of the mobile-based application was developed. In the third stage, the designed application was evaluated by 10 medical informatics and technology specialists using Nielsen's standard usability questionnaire. The questionnaire results were analyzed using descriptive statistics and SPSS 16 software. Results:In the first stage, 58 informative elements and 9 vital capabilities were identified for the self-care application, and then the application was designed using Java programming language in two sections: user registration and main page, which includes medical information, medical records, tests, and reminders (doctor's appointments, medication and supplement intake, and laboratory tests). Overall, the usability test results of the self-care application by experts showed that the usability of this application for pregnant women with hypothyroidism was evaluated at an acceptable level. Conclusions:Mobile applications enhance awareness, improve health, and provide essential tools for disease management in pregnant women, reducing complications and benefiting the health of mothers and newborns.

The potential association between SARS-CoV-2 infection and placental dysfunction represents a critical area of investigation, with significant implications for understanding fetal health, perinatal mortality, and morbidity. This prospective case-series study aimed to comprehensively compare placental pathological changes between pregnant women with confirmed SARS-CoV-2 infection and unexposed controls. Conducted at Mahdieh Medical Center in Tehran, Iran, the research involved 62 pregnant women, of which 32 were COVID-19 positive. Placentas from both groups underwent detailed histopathological evaluation to assess structural and inflammatory changes. The investigation focused on identifying potential morphological alterations that might indicate viral impact on placental tissue. The results revealed no statistically significant differences in several key pathological parameters, including mem-brane hemorrhage, villous edema, chorioangiosis, peripheral infarction, and overall unremarkable pathology. However, two notable variations emerged: a significantly higher acute inflammatory response in COVID-19 placentas and a significantly lower calcification rate in the same group. While these findings suggest potential placental modifications associated with SARS-CoV-2 infection, the researchers cautiously concluded that the observed changes were insufficient to conclusively demonstrate direct viral placental transmission. The study underscores the complexity of COVID-19's impact on pregnancy and emphasizes the critical need for further comprehensive investigations to fully elucidate the virus's pathological effects on placental and fetal tissues. The research contributes valuable insights into the potential mechanisms of SARS-CoV-2 interaction with placental tissue, providing a foundation for future studies and highlighting the importance of continued surveillance and research in understanding the virus's comprehensive reproductive implications.

Tuberculosis (TB) is a significant problem worldwide. The rate of active tuberculosis in pregnancy is rising and it is a significant cause of maternal mortality during pregnancy. This study is about a young woman who was suffering from TB peritonitis, which is rare, with a highly progressive clinical course following the spontaneous abortion of 16-week gestation that refers to abdominal pain. Our case received a diagnostic laparotomy that showed several small-scale implants on the peritoneum and viscera. Histopathology revealed chronic caseating granulomas with necrosis. With the possible diagnosis of tubercu-losis anti-mycobacterial therapy was started and she received these drugs for 6 months. The patient’s clinical manifestations completely disappeared and the chest CT scan was normal after treatment. The diagnosis of peritoneal tuberculosis is challenging and it could be made by CT imaging, explorative laparoscopy, evaluation of biopsies from specimens and culture, or PCR from ascites fluid or infected tissues.

Heterotopic pregnancy, a rare form of pregnancy, can occur Simultaneously intrauterine and extrauterine. This can be a life-threatening condition and can be easily overlooked if undiagnosed. The patient was a 27-year-old woman, gravid3, para1, live1 and abortion1, at 10 weeks and 1 day by last menstrual period who went to the emergency room complaining of pain in the lower abdomen form 3 days ago. Pelvic ultrasound revealed both live intrauterine and extrauterine pregnancy by gestational age based on the Crown-rump length diameter, 9 weeks and 3 days with moderate to severe hemoperitoneum. The heterotopic pregnancy diagnosis is difficult and requires a high index of suspicion.

INTRODUCTION AND HYPOTHESIS:Conflicting results have been reported on the effect of vitamin D supplementation on urinary incontinence (UI). Therefore, the aim of this study was to evaluate the effect of consuming vitamin D oral supplements on improving urge UI (UUI) in postmenopausal women with vitamin D deficiency.METHODS:This randomized clinical trial was conducted in 2019-2020 in postmenopausal women with UUI or nocturia more than once at night with vitamin D levels less than 30 ng/ml. After recording the severity of UI and its impact on the patient's daily life, patients were randomly divided into two groups of 45 patients: one taking vitamin D3 (50,000 IU) tablets and one taking placebo weekly for 8 weeks.RESULTS:There was no significant difference between the two groups in terms of the severity of UI and the frequency of nocturia before treatment. However, after treatment, in the vitamin D group, the severity of UI and the frequency of nocturia significantly reduced. Before treatment, the impact of UI on patients' daily life was reported to be high in more than 70% of patients in both groups, which was not significantly different; however, after treatment, its impact was significantly reduced in the vitamin D group.CONCLUSIONS:The findings of the present study showed that in postmenopausal women with UUI or nocturia, weekly use of vitamin D 50,000 IU tablets for 8 weeks can reduce the severity of UI and the frequency of nocturia, and reduce their impact on disruption in daily life.

Tuberculosis Peritonitis after spontaneous Abortion: A Case ReportAbstract:Introduction: Tuberculosis (TB) is a significant problem worldwide. The rate of active tuberculosis in pregnancy is rising and it is a significant cause of maternal mortality during pregnancy.Case presentation: This study is about a young woman who was suffering from TB peritonitis, which is rare, with a highly progressive clinical course following the spontaneous abortion of 16-week gestation that refer with abdominal pain. Our case received a diagnostic laparotomy that showed several small-scale implants on the peritoneum and viscera. Histopathology revealed chronic caseating granulomas with necrosis. With the possible diagnosis of tuberculosis anti-mycobacterial therapy was started and she received these drugs for 6 months. The patient’s clinical manifestations completely disappeared and chest CT scan was normal after treatment.Conclusion: The diagnosis of peritoneal tuberculosis is challenging and it could be made by CT imaging, explorative laparoscopy, evaluation of biopsies from specimens and culture or PCR from ascites fluid or infected tissues.Key words: TB, peritoneal tuberculosis, extra pulmonary tuberculosis, acute abdomen, pregnancy1. Introduction Tuberculosis (TB) is a significant problem worldwide. About 25% of whole world population are estimated to be infected with mycobacterium tuberculosis. Although it is a preventable and treatable disease, but according to the WHO reports, TB infected about 10 million cases and claimed 1.5 million lives in 2018.(1) It was estimated that the rate of active tuberculosis in pregnancy is rising in United States(2). Most of these pregnant women lived in Africa and Southeast Asia(3). TB is a significant cause of maternal mortality during pregnancy. Pregnancy-related complications contain increased spontaneous abortion rate, being smaller relative to the weeks of pregnancy, suboptimal weight gain in pregnancy, labor before 37 weeks of pregnancy, low birth weight, and enhance neonatal mortality. Delay in the diagnosis of this infection is an independent factor that is associated with both enhanced obstetric morbidities and preterm labor by four- and nine-folds, respectively (4). While TB mainly affects the lungs, about 33% of TB cases might suffer from extra pulmonary disease. The peritoneum is an usual extra pulmonary site of TB.(5)We presented a woman with a 16-week spontaneous abortion who referred to our emergency ward with the feature of acute abdomen as the first sign of tuberculosis, a rare case of tuberculosis peritonitis.2. Case Presentation A 20-year-old G2P1Ab1 woman who aborted spontaneously a 16 week pregnancy at home in 11 days ago, referred to our hospital with general abdominal pain from 10 days ago. The abdominal pain was intensified and associated with nausea, vomiting, anemia and, massive ascites. She had a complaint of anorexia, fainting, and sweating. On the physical examination; PR=120/min, BP=90/60mmHg, RR=18/min, OT=38̊ and O2sat=97% and she had abdominal distension with diffuse tenderness and guarding especially in the lower abdomen, and positive cervical motion tenderness that suggested a hemorrhage or massive ascites. Transvaginal ultrasonography confirmed the presence of ascites. (Figure 1-2). Laboratory data revealed Hb=5/6 gr/dL, white blood count were 6100, C reactive protein= 3+ and ESR=120. In addition UA, UC and PCR for covid 19, were sent due to abdominal pain and corona virus pandemic. The results of tests performed to evaluate renal function and level of hepatic transaminase did not indicate unusual values.The patient subsequently underwent diagnostic laparotomy due to suspicious unsafe abortion in history, abdominal examination, and severe anemia with the probable diagnosis of acute abdomen. Laparotomy revealed 3liters thick yellow pus in the abdominopelvic cavity and substantial adhesions between viscera, and several small-scale nodular implants on the surface of peritoneal, liver, and stomach. Intestine, omentum, mesentery, uterine, ovaries and fallopian tubes were normal except for inflammation. Irrigation of abdominopelvic cavity and adhesiolysis were done. There was no specific site for the purulent ascites in exploration. Tissue samples from the peritoneum, omentum and lymph nodes were sent to pathology and some tissue samples and ascetic fluid were sent for the microbiology, cytology and PCR for tuberculosis examinations. The patient was treated with intravenous broad-spectrum antibiotics till 72 hours. Tissue samples of pathological study showed granulomatous inflammation and samples for smear and culture and cytology revealed negative findings. In addition, covid19 PCR was reported negative.According to large amount of intraperitoneal pus without a specified source and granulomatous inflammation on pathology report (figure 3), with the probable diagnosis of tuberculosis, PPD and Chest radiography were done. PPD was negative but CXR revealed patchy consolidations.Despite 72hours of antibiotic therapy, there was no improvement in clinical condition so according to the laboratory findings and medical records, thoracic computed tomography (CT) scan was performed for further evaluation of the ascites etiology (figure 4). Bilateral pleural effusion, atelectasis, pulmonary parenchymal consolidations and sub plural patchy consolidation were seen. Abdominopelvic Ultrasonography was normal. With the possible diagnosis of tuberculosis anti-mycobacterial therapy with isoniazid, rifampin, pyrazinamide, and ethambutol was prescribed and the patient received these drugs for 6 months till complete the course of treatment. The patient’s clinical manifestations completely disappeared and chest CT scan was normal after treatment.

Most adnexal masses found in pregnancy are simple benign cysts less than 5 cm in diameter. On the other hand, the majority of persistent adnexal masses 5 cm or greater in diameter are mature teratomas. Malignant transformation occurs in 0.2 to 2 percent of mature teratomas, and squamous cell carcinoma arising from ectoderm is the most common secondary neoplasm. The mucinous cystadenocarcinoma transformation is very rare. We presented a 38-year-old G2Ab1 woman at 32 weeks of gestation with a huge, rapid growth adnexal mass who came to our emergency department due to severe preeclampsia, stage 1 of IUGR, and borderline AFI. After 48 hours of expectant management, a cesarean section associated with unilateral salpingooophorectomy was done, and the histopathology of the cyst revealed mature teratoma that was focally involved with mucinous cystadenocarcinoma. The complete surgical staging was done, and due to the stage of disease (1C1), she received adjuvant chemotherapy, and she has remained disease-free in her last follow up after one year.

Background: Since early December 2019, the Coronavirus Disease 19 (COVID-19) infection has been prevalent in China and eventually spread to other countries. There are a few published cases of COVID-19 occurring during pregnancy and due the possibility of mother-fetal vertical transmission, there is a concern that the fetuses may be at risk of congenital COVID-19. Methods: We reviewed the risk of vertical transmission of COVID-19 to the fetus of infected mothers by using data of published articles or official websites up to March 4, 2020. Results: A total of 31 infected pregnant mothers with COVID-19 were reported. No COVID-19 infection was detected in their neonates or placentas. Two mothers died from COVID-19-related respiratory complications after delivery. Conclusions: Currently, based on limited data, there is no evidence for intrauterine transmission of COVID-19 from infected pregnant women to their fetuses. Mothers may be at increased risk for more severe respiratory complications.

One of the most common benign tumors in reproductive age women is mature Teratoma. We reported a 35-year-old woman who presented with abdominal pain, nausea, vomiting, and fever. The patient underwent laparotomy with the probable diagnosis of ovarian torsion. The evidence in the peritoneal cavity revealed chemical peritonitis due to the spontaneous rupture of the dermoid cyst.

Background: The IL-10 -1082 G > A polymorphism has been reported to be associated with a risk of recurrent pregnancy loss (RPL) with inconsistent results. Thus, to clarify the effect of the polymorphism on the susceptibility to RPL, a meta-analysis was performed. Methods: A systematic literature search in PubMed, Web of Science, Scopus and SciELO was performed to identify the relevant studies published up to December 20, 2019, and related information was extracted. Results: A total of 17 case-control studies with 3,224 RPL cases and 3,295 controls were selected. Pooled data revealed that IL-10 -1082 G > A polymorphism was significantly associated with risk of RPL in the global population. Moreover, subgroup analysis indicated a significant association in Caucasians, but not in Asian or mixed populations. Conclusions: Our pooled data highlights that IL-10 -1082 G > A polymorphism is a risk factor for RPL susceptibility in the global population, especially in Caucasians.

Background: Since early December 2019, the Coronavirus Disease 19 (COVID-19) infection has been prevalent in China and eventually spread to other countries. There are a few published cases of COVID-19 occurring during pregnancy and due the possibility of mother-fetal vertical transmission, there is a concern that the fetuses may be at risk of congenital COVID-19. Methods: We reviewed the risk of vertical transmission of COVID-19 to the fetus of infected mothers by using data of published articles or official websites up to March 4, 2020. Results: A total of 31 infected pregnant mothers with COVID-19 were reported. No COVID-19 infection was detected in their neonates or placentas. Two mothers died from COVID-19-related respiratory complications after delivery. Conclusions: Currently, based on limited data, there is no evidence for intrauterine transmission of COVID-19 from infected pregnant women to their fetuses. Mothers may be at increased risk for more severe respiratory complications.

Background: Genetic causes that contribute to recurrent pregnancy loss (RPL) are not fully understood. The aim of this study was to evaluate the association of five polymorphisms at MMP-2, MMP-3, and MMP-9 genes with risk of RPL. Methods: The study comprised 250 women with RPL and 250 healthy controls. The MMP-2 (rs243865, rs2285053), MMP-3 (rs35068180), and MMP 9 (rs3918242, rs17576) polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Results: A significant association was found between MMP-3 rs35068180 polymorphism and RPL risk. There was no significant association between RPL and polymorphisms at MMP-2 (rs243865, rs2285053) and MMP 9 (rs3918242, rs17576) genes. Conclusion: MMP-3 rs35068180 polymorphism may modulate RPL risk in Iranian women. There is no evidence to suggest that MMP-2 (rs243865, rs2285053) and MMP 9 (rs3918242, rs17576) polymorphisms are associated with RPL risk.

Cardiopulmonary complications have been observed after the evacuation of benign hydatidiform mole which can lead to substantial morbidity and mortality. We report a 30-years-old woman who came to our outpatient department of obstetrics and gynecology at 9 weeks gestational age with sonography which represented molar pregnancy. Evacuation of the mole was done under spinal anesthesia as an elective procedure. The patient had a complaint of dyspnea, 6 hours after evacuation. CXR showed some reticular opacity in the field of both lungs with increased Broncho vascular marking. CT angiography showed pulmonary edema with subsegmental atelectasis in the base of both lungs without any pattern of pulmonary thromboembolism. Pulmonary edema was regressed by administering frusemide and conservative management after 8 days of ICU admission. She was discharged on the 10th postoperative day in satisfactory and stable condition.

Background: The Gail model has been widely used for estimation of absolute risk of breast cancer development. The original model and most of the validation studies have been performed among western populations and controversial results have been reported regarding the applicability of this model in Asian populations. Our aim was to investigate the performance of this model in Iranian women. Methods: In a cross-sectional study, a total of 280 patients with breast cancer and 280 participants with normal screening results were enrolled as case and control groups, respectively. Risk factors used in the latest version of the Gail model were compared between the two study groups. Gail score was calculated by using Breast Cancer Risk Assessment Tool and based on the cut-off point of 1.67, patients were categorized in order to assess model performance. Results: In total, 560 patients with a mean age of 43.07±8.60 years were enrolled. Comparison of different risk factors between the two groups revealed significant associations of patients’ age (P < 0.001), age at first pregnancy (P = 0.022), previous history of breast biopsy (P < 0.001) and atypical hyperplasia (P = 0.002) with risk of breast cancer. No association was found between age at menarche (P = 0.115) or first-degree family history (P = 0.117) and increased risk. Considering the Gail score for 5-year risk of breast cancer development, the difference between the two groups failed to reach significance (P = 0.052). The sensitivity and specificity of the model were 13.9% and 94%, respectively. Conclusions: Based on the current findings, it can be suggested that employing the current version of the Gail model for breast cancer risk assessment will underestimate the risk of cancer development in Iranian women.