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Papers by sedigheh hantoushzadeh

Research paper thumbnail of Maternal death due to COVID-19

American Journal of Obstetrics and Gynecology, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Indicated and non-indicated antibiotic administration during pregnancy and its effect on pregnancy outcomes: Role of inflammation

International Immunopharmacology, 2020

The objective of this study was to compare the release of endotoxin and pro-inflammatory cytokine... more The objective of this study was to compare the release of endotoxin and pro-inflammatory cytokines as well as pregnancy outcomes after antibiotic exposure in healthy and bacterial infected pregnant rats. Thirty female Wistar pregnant rats were divided into five groups. Group A considered as control and received intraperitoneal saline 0.9% on 17th day of gestation or DG) and groups B and C treated with 20 mg/kg/day intravenous ceftriaxone and ceftazidime, respectively (DG: 18-20). Groups D and E received intraperitoneal E. coli and LPS on 17th DG respectively. Also, groups F and G received the same treatment as group D but they treated with the exact antibiotics mentioned for groups B and C (same dose and duration). Pregnancy outcomes as well as maternal sera levels of endotoxin, tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 were assessed using enzyme-linked immunosorbent assay. It was shown that group B had a higher IL-1β (P = 0.003) and TNF-α (P = 0.003) levels compared to the controls (CTC). Group C expressed a lower gestational duration (P = 0.007) as well as higher IL-6 (P = 0.025) and TNF-α (P < 0.001) levels CTC. Interestingly, both group B (P = 0.021) and C (P < 0.001) had a higher rate of endotoxin release CTC. Moreover, in group C, IL-6 (P < 0.0001 and r = -0.941) had a significant correlation with gestational duration. As the results showed, antibiotic administration in non-indication condition seems to be associated with significantly higher production of endotoxin and inflammatory cytokines which increase the risk of poor pregnancy outcomes.

Research paper thumbnail of Melatonin as fetal neuroprotection: Links and risks

Biomedical Journal, 2020

Peer review under responsibility of Chang Gung University.

Research paper thumbnail of Cesarean Hysterectomy due to Abnormal Placentation: Mortality and Morbidity in a Tertiary Center

Journal of Obstetrics, Gynecology and Cancer Research, 2019

Background & Objective: Due to increased rate of risk factors, the incidence of placenta accreta ... more Background & Objective: Due to increased rate of risk factors, the incidence of placenta accreta (PA) is increasing worldwide. This study aimed to investigate the important factors regarding the occurrence of PA, as well as outcomes and complications of Trans Abdominal Hysterectomy (TAH) in the patients with PA. Materials & Methods: The study was performed as an observational cross-sectional study. Between March 2011 and March 2017, 177 patients, known cases of PA that undergone TAH, were enrolled in our study. Extracted data include demographic characteristics, patient's medical history, surgical approach and complications, such as blood loss and urologic problems. Results: The average of maternal age and gestational age were 33.6±4.70 (range= 22-43) years and 34.6±3.16 weeks, respectively. Neither maternal age (P=0.652) nor BMI (P=0.659) had significant association with abnormal placentation. Previous history of dilation & curettage (D&C) was found in 34 patients that was not related to the occurrence of the PA (P=0.508).Twenty-one (11.9%) of the patients needed urological intervention that did not associated with placental position, skin and uterine incision (P=0.258, 0.410 and 0.219). There is no relation between amount of blood loss with gestational age (P=0.7) and number of C/S (P=0.4), gestational age (P=0.7), anesthesia (P=0.2), and curettage history (P=0.3). Conclusion: Our mortality and morbidity rate is much lower than reported ones, indicating the high-level ability, skill and knowledge of the surgeons.

Research paper thumbnail of The Diagnosis of Early Fetal Cardiac Changes of the Gestational Diabetic Mothers: Presenting the Preload Index

Iranian Journal of Pediatrics, 2019

Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to health... more Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to healthy ones by means of different indices and to determine which index can first represent the alterations. Methods: The study was conducted as an observational cross-sectional study, including 25 pregnant women with gestational diabetes as the cases and 50 healthy pregnant women as the controls. The preload index, left and right side myocardial performance index (MPI), Interventricular septal hypertrophy, the left and right side cardiac output were assessed in all the patients. Results: The gestational ages were 31.65 ± 8.02 and 31.64 ± 5.37 weeks in case and control group respectively, without any significant difference. Both of the left and right ventricular MPI did not differ statistically between the case and controls. The cases had a greater Interventricular septal hypertrophy but the cardiac output was similar. The preload index was higher in the fetuses of the gestational diabetic mothers. Conclusions: In our study, the MPI did not show any difference between the fetuses of the gestational diabetic mothers and nondiabetic ones; but, fetuses of gestational diabetic mothers had a greater value of PLI, representing early diastolic function changes in right heart even before the overt heart failure occurred. This could be a sign of vasculopathy in gestational diabetic mothers.

Research paper thumbnail of Possible Cause of Inflammatory Storm and Septic Shock in Patients Diagnosed with (COVID-19)

Archives of Medical Research, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of The effects of progesterone therapy in pregnancy: vaginal and intramuscular administration

The Journal of Maternal-Fetal & Neonatal Medicine, 2019

This study was performed to evaluate the effects of vaginal versus intramuscular progesterone sup... more This study was performed to evaluate the effects of vaginal versus intramuscular progesterone supplementations on the mood, quality of life, and metabolic changes in pregnant women with history of previous preterm birth. Methods: This study was conducted as a prospective, randomized, open label, clinical trial evaluated 100 pregnant women who referred for prenatal visit, with 16-17 weeks of gestation from September 2014 through October 2015. The mothers were then randomly allocated into two groups: the vaginal progesterone group to receive 400mg Cyclogest vaginal suppositories (Actavis, UK limited, England) once daily, and the intramuscular progesterone group to receive weekly intramuscular injections of 250mg of 17-Hydroxyprogesterone Caproate (17-HPC) (Bayer Schering Pharma, Germany), starting from the 16th to the 35th weeks of pregnancy. demographics, medical and obstetrical history, sleeping disturbances, alteration in sexual desire, nausea/vomiting, serum levels of fasting blood sugar (FBS), high density lipoprotein (HDL), and low density lipoprotein (LDL) were evaluated, first and 8 weeks later. Results: 11 (11.2%) screened positive for psychosocial disorders; 25 (25.5%) had sleep disturbance, 11 (11.2%) had alteration in sexual desire, and 29 (29.6%) had nausea/vomiting upon enrolment. after two months of receiving daily vaginal progesterone there was a significant increase in the GHQ-28 score (p<0.001), and rates of positive screening for psychosocial disorders (p=0.001) in this group. No

Research paper thumbnail of Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 4, 2018

To assess the effects of previous cesarean delivery (CD) and placental location on second trimest... more To assess the effects of previous cesarean delivery (CD) and placental location on second trimester uterine artery Doppler indices in subsequent pregnancy and to assess the predictive values of abnormal Doppler findings for adverse pregnancy outcomes in women with previous CD. This prospective cohort study evaluated 400 gravida two pregnant women (200 with previous none medically indicated CD and 200 with previous normal vaginal deliveries (NVD)) who were referred for second trimester fetal anatomic survey. Uterine artery Doppler studies were performed in all participants who were then followed until delivery. Compared with women having prior NVD, women with prior CD had significantly higher rates of abnormal uterine artery pulsatility index (PI) (p < .001), and significantly more adverse pregnancy outcomes (p = .01). Among women with previous CD, all the measured adverse pregnancy outcomes occurred significantly more often in women with abnormal uterine artery Doppler indices (p...

Research paper thumbnail of Combined treatment with cervical pessary and vaginal progesterone for the prevention of preterm birth: A randomized clinical trial

Journal of Obstetrics and Gynaecology Research, 2016

Aim: We compared the effectiveness of a combined treatment involving cervical pessary plus vagina... more Aim: We compared the effectiveness of a combined treatment involving cervical pessary plus vaginal progesterone to vaginal progesterone alone in decreasing the rate of preterm birth in women with short cervix in the second gestational trimester. Methods: This prospective, open-label, randomized clinical trial was conducted on 144 pregnant women with singleton pregnancy who had a cervical length ≤ 25 mm, at 18-22 gestational weeks (GW). Seventythree patients were assigned to receive 400 mg of daily vaginal progesterone (group A), and 73 to receive cervical pessary plus 400 mg of daily vaginal progesterone (group B), until the 37th GW. The patients were then followed until delivery. Results: The rates of preterm birth were 16.4% in group A and 19.7% in group B, which were not statistically different (P = 0.6). There were no statistically significant differences in the rates of preterm birth at <37, <34, <32, and ≤26 GW between participants randomized to each group (P = 0.55). The rates of low-birthweight delivery were 17.8% in group A, and 23.9% in group B, which were not statistically different (P = 0.36). The rates of premature rupture of membranes, chorioamnionitis, the requirement for neonatal intensive care unit admission, and fetal and neonatal deaths were similar between the two groups. Conclusion: In pregnancies with short cervix at mid-pregnancy, combination therapy of cervical pessary plus daily vaginal progesterone does not have any additional benefit over daily vaginal progesterone alone in reducing the rate of preterm birth and adverse pregnancy outcomes.

Research paper thumbnail of 709: Uterine artery doppler ultrasound predictor of adverse pregnancy outcomes

American Journal of Obstetrics and Gynecology, 2017

Research paper thumbnail of The impact of gestational weight gain in different trimesters of pregnancy on glucose challenge test and gestational diabetes

Postgraduate medical journal, Jan 29, 2016

Assessing the effects of excessive weight gain before pregnancy, in the first and second trimeste... more Assessing the effects of excessive weight gain before pregnancy, in the first and second trimesters and in the month preceding glucose challenge test (GCT) on GCT results and gestational diabetes mellitus (GDM). This prospective cohort study evaluated 1279 pregnant women who were referred for their first prenatal visit in 2012-2015. Mother's body mass index (BMI) was recorded before pregnancy, during the first visit and every 4 weeks until 28 gestational weeks. All mothers underwent GCT at 28 weeks and when 1 h glucose ≥140 mg/dL (≥7.8 mmol/L), they were referred for a 100 g fasting glucose 3 h glucose tolerance test. Obesity and being overweight prior to pregnancy were associated with 2.8-fold and 1.5-fold higher rates of developing GDM (p<0.001, p=0.04) and 1.9-fold and 1.8-fold higher rates of having false-positive GCT results (p<0.001). First-trimester excessive weight gain was significantly associated with false-positive GCT in women who were lean, overweight and obes...

Research paper thumbnail of The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial

European Journal of Nutrition, 2015

depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p... more depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02). Conclusions Early iron supplementation in mothers with PPD significantly improves the iron stores and causes a significant improvement in PPD with a 42.8 % improvement rate during 6 weeks. Continued PPD might be related to the lower postpartum ferritin levels in untreated mothers.

Research paper thumbnail of Iodine-containing disinfectants in preparation for caesarean section: impact on thyroid profile in cord blood

Postgraduate Medical Journal, 2015

Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Cu... more Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Current evidence suggests that maternal exposure to these disinfectants results in thyroid dysfunction in the newborns, but its extent is not known. The purpose of this study was to explain the quality of the effect of these disinfectants on the thyroid function of newborns. This cohort study was performed on all the healthy mothers with a term pregnancy who underwent caesarean section in the obstetrics emergency department of an educational hospital affiliated with Tehran University of Medical Sciences from December 2013 to December 2014. We divided this 12-month period into two consecutive 6 months. Povidone-iodine 10% (PVP-I) and chlorhexidine gluconate 4% (CHX) were used in the first and second 6 months, respectively, for skin preparation before caesarean section and also for umbilical cord disinfection. Cord blood thyroid stimulating hormone (TSH) and thyroxine (T4) were assayed by the ELISA method. We included 326 cases in this study, 153 in the PVP-I group and 173 in the CHX group. The incidence of cord blood TSH ≥10 mIU/L and T4 ≤7.3 µg/dL was significantly higher in the PVP-I than the CHX group. Cord blood TSH concentration showed a significant positive correlation with cord blood T4 concentration in the CHX group. Through selection of cases with cord blood T4 &lt;13 µg/dL, we found a negative correlation between cord blood TSH and T4 concentration in the PVP-I group. It seems that PVP-I has the potential to cause false-positive screening-test results and increase recall rates, which should be evaluated in further studies. Iranian Registry of Clinical Trials (IRCT) number IRCT201204289568N1.

Research paper thumbnail of Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth

The Journal of Maternal-Fetal & Neonatal Medicine, 2015

Comparing the value of umbilical cord arterial blood gas (UC-ABG) analysis in the prediction of n... more Comparing the value of umbilical cord arterial blood gas (UC-ABG) analysis in the prediction of neonatal mortality and morbidity in the preeclamptic versus healthy pregnancies with preterm birth. Eight hundred sixteen preterm (born at &amp;amp;amp;amp;lt;37 gestational weeks) neonates with no other morbidities who were born by cesarean section were evaluated. Immediately after delivery, UC-ABG analysis was performed and the neonates were followed. Preeclamptic women had lower umbilical cord blood (UCB) pH (7.2 4 ± 0.1 versus 7.2 7 ± 0.08, p = 0.008) and higher UCB base deficit (BD) (3.5 ± 3.7 versus 2.2 ± 3.4, p = 0.005) compared with controls. In the preeclamptic group, UCB metabolic acidosis (pH &amp;amp;amp;amp;lt; 7.15 and B.D &amp;amp;amp;amp;gt; 8) was not independently associated with neonatal morbidity or mortality, while in the control group UCB metabolic acidosis was independently associated with low 10-min Apgar (OR, 4.9; 95%CI 1.37-18.03), respiratory distress syndrome (OR, 2.37; 95%CI 1.05-6.17), intraventricular hemorrhage (OR, 3.01; 95%CI 1.13-7.99), and neonatal mortality (OR, 17.33; 95%CI 4.51-66.53). The preterm neonates born to preeclamptic mothers have lower UCB pH and higher BD. In these neonates, UCB acidosis is not independently associated with any adverse neonatal outcomes. In contrast, in the preterm neonates born to healthy mothers, UCB metabolic acidosis is independently associated with neonatal mortality and morbidity.

Research paper thumbnail of Maternal Anxiety and the Second-Trimester Prenatal Screening: A Prospective Cohort Study

Fetal Diagnosis and Therapy, 2015

Objective: Assessing the effects of maternal anxiety on the markers and results of quadruple scre... more Objective: Assessing the effects of maternal anxiety on the markers and results of quadruple screening and on maternal anxiety after receiving positive results. Methods: This prospective cohort study evaluated 1,595 pregnant women referred for prenatal visits. Maternal state/trait anxiety levels were measured, then quadruple screening was performed by measuring serum α-fetoprotein (AFP), β-human chorionic gonadotropin, inhibin A, and unconjugated estriol (UE3). After receiving the results, the state/trait anxiety was remeasured. Amniocentesis was performed for screening-positive mothers. Results: High prescreening maternal anxiety was associated with lower rates of elevated AFP (OR, 0.27; 95% CI, 0.1-0.74) and elevated inhibin A (OR, 0.38; 95% CI, 0.15-0.98). High maternal anxiety was associated with higher rates of decreased UE3 (OR, 1.8; 95% CI, 1.06-3.08). There were no significant associations between prescreening maternal anxiety and the final screening or amniocentesis results...

Research paper thumbnail of Correlation of nuchal translucency and thyroxine at 11–13 weeks of gestation

Journal of Maternal-Fetal and Neonatal Medicine, 2013

Nuchal translucency (NT) thickness is one of the major screening markers during the first trimest... more Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones. NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges. An inverse relation was found between serum levels of maternal T4 with NT thickness (r = -0.128, p = 0.001) and CRL (r = -0.168, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). TSH and hCG were also found to be correlated (Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficient = -0.092, p = 0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively. Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.

Research paper thumbnail of Effect of aspirin in prevention of adverse pregnancy outcome in women with elevated alpha-fetoprotein

The Journal of Maternal-Fetal & Neonatal Medicine, 2013

To evaluate the effect of low-dose aspirin in prevention of adverse pregnancy outcomes (APO) in w... more To evaluate the effect of low-dose aspirin in prevention of adverse pregnancy outcomes (APO) in women with second trimester alpha-fetoprotein (AFP) &amp;amp;amp;amp;amp;amp;amp;amp;gt;2.5 multiple of median (MOM) and to compare aspirin effect on women with normal and abnormal uterine artery (UtA) Doppler. The primary outcome was the adverse pregnancy outcome. This randomized controlled trial was conducted in singleton pregnant women, who had unexplained AFP &amp;amp;amp;amp;amp;amp;amp;amp;gt;2.5 MOM and gestational age between 15 and 18 weeks of gestation. They were assigned randomly to receive either aspirin (N = 65) or control (N = 68). UtA Doppler velocimetry studies were performed at the time of targeted ultrasonographic exam. Two groups were comparable regarding the maternal characteristics. The frequency of APO in aspirin and control groups were 26.1% versus 44.1% (p = 0.045), the frequency of preterm delivery before 34 weeks were 3.2% versus 22.0% in aspirin and control group, p = 0.001. Other outcomes were similar in both groups. The frequency of adverse outcomes in women with abnormal UtA Doppler was 39.1% in aspirin and 60.0% in control group, p = 0.556. Low-dose aspirin reduces APO and delivery before 34 weeks of gestation in pregnant women with unexplained elevated AFP.

Research paper thumbnail of Elevated vaginal pH in the absence of current vaginal infection, still a challenging obstetrical problem

The Journal of Maternal-Fetal & Neonatal Medicine, 2013

To assess the association of vaginal pH ≥ 5 in the absence of vaginal infection with systemic inf... more To assess the association of vaginal pH ≥ 5 in the absence of vaginal infection with systemic inflammation and adverse pregnancy outcome. Four-hundred sixty pregnant women completed the study, upon enrollment Vaginal pH was measured for all women, maternal and umbilical sera were obtained for determining C-reactive protein (CRP) and uric acid levels. Umbilical blood was tested for gas parameters, 1 and 5 min Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded. Elevated vaginal pH was significantly associated with preterm birth (odds ratio (OR), 2.23; 95% confidence interval (CI), 1.04-4.76), emergency cesarean section (OR 2.57; 95% CI 1.32-5), neonatal resuscitation in the delivery room (OR 2.85; 95% CI 1.1-7.38), elevated cord base deficit (OR 8.01; 95% CI 1.61-39.81), low cord bicarbonate (OR 4.16, 95% CI 1.33-12.92) and NICU admission (OR 2.02; 95% CI 1.12-3.66). Increased vaginal pH was also significantly associated with maternal leukocytosis, hyperuricemia and elevated CRP levels in maternal and umbilical sera. Elevated vaginal pH in the absence of current vaginal infection still constitutes a risk for adverse pregnancy outcome which is mediated by systemic inflammatory response.

Research paper thumbnail of Comparative efficacy of probiotic yoghurt and clindamycin in treatment of bacterial vaginosis in pregnant women: A randomized clinical trial

The Journal of Maternal-Fetal & Neonatal Medicine, 2011

This study was performed to determine the comparative efficacy of probiotic yoghurt and clindamyc... more This study was performed to determine the comparative efficacy of probiotic yoghurt and clindamycin in the treatment of bacterial vaginosis in pregnant women in the third trimester. This randomized clinical trial was performed as an open-label study. 310 symptomatic patients with BV were recruited. Diagnosis of BV was through Amsel criteria. The patients were randomly assigned to receive either probiotic yoghurt (100 g twice a day/week) or orally administered clindamycin (300 mg twice a day/week). Ten patients in probiotic group and 9 subjects in clindamycin group had symptom recurrence (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). 132 patients in probiotic group and 105 subjects in clindamycin group had pH decrease (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). 140 patients in probiotic group and 141 subjects in clindamycin group had complete symptomatic cure (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Twelve patients in probiotic group and seven subjects in clindamycin group had preterm birth. Nine women in probiotic group and five subjects in clindamycin group had PROM (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). According to the obtained results, it may be concluded that probiotics would have a good efficacy in the treatment of bacterial vaginosis in pregnancy leading to decreased burden of subsequent preterm birth.

Research paper thumbnail of Progesterone and threatened abortion: a randomized clinical trial on endocervical cytokine concentrations

Journal of Reproductive Immunology, 2013

The purpose of this study was to investigate the effect of vaginal progesterone on endocervical c... more The purpose of this study was to investigate the effect of vaginal progesterone on endocervical cytokine concentration in women at risk of threatened abortion. One hundred and sixty pregnant women with clinical symptoms of threatened abortion before the 20th week of pregnancy were randomly assigned to receive vaginal progesterone or placebo. Cervical fluids were collected and endocervical concentrations of different cytokines (IFN␥, TNF␣, IL-8, IL-10 and IL-12) were analyzed before and one week after progesterone or placebo treatment. A significant decrease in IFN␥ and increase in IL-10 in endocervical fluid was seen when the values were compared before and after progesterone treatment. However, there were no significant differences in pregnancy outcomes between the placebo and progesterone groups. We conclude that despite the failure of vaginal progesterone treatment to improve pregnancy outcomes, progesterone can induce a shift in the concentration of cytokines in endocervical secretions.

Research paper thumbnail of Maternal death due to COVID-19

American Journal of Obstetrics and Gynecology, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of Indicated and non-indicated antibiotic administration during pregnancy and its effect on pregnancy outcomes: Role of inflammation

International Immunopharmacology, 2020

The objective of this study was to compare the release of endotoxin and pro-inflammatory cytokine... more The objective of this study was to compare the release of endotoxin and pro-inflammatory cytokines as well as pregnancy outcomes after antibiotic exposure in healthy and bacterial infected pregnant rats. Thirty female Wistar pregnant rats were divided into five groups. Group A considered as control and received intraperitoneal saline 0.9% on 17th day of gestation or DG) and groups B and C treated with 20 mg/kg/day intravenous ceftriaxone and ceftazidime, respectively (DG: 18-20). Groups D and E received intraperitoneal E. coli and LPS on 17th DG respectively. Also, groups F and G received the same treatment as group D but they treated with the exact antibiotics mentioned for groups B and C (same dose and duration). Pregnancy outcomes as well as maternal sera levels of endotoxin, tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6 were assessed using enzyme-linked immunosorbent assay. It was shown that group B had a higher IL-1β (P = 0.003) and TNF-α (P = 0.003) levels compared to the controls (CTC). Group C expressed a lower gestational duration (P = 0.007) as well as higher IL-6 (P = 0.025) and TNF-α (P < 0.001) levels CTC. Interestingly, both group B (P = 0.021) and C (P < 0.001) had a higher rate of endotoxin release CTC. Moreover, in group C, IL-6 (P < 0.0001 and r = -0.941) had a significant correlation with gestational duration. As the results showed, antibiotic administration in non-indication condition seems to be associated with significantly higher production of endotoxin and inflammatory cytokines which increase the risk of poor pregnancy outcomes.

Research paper thumbnail of Melatonin as fetal neuroprotection: Links and risks

Biomedical Journal, 2020

Peer review under responsibility of Chang Gung University.

Research paper thumbnail of Cesarean Hysterectomy due to Abnormal Placentation: Mortality and Morbidity in a Tertiary Center

Journal of Obstetrics, Gynecology and Cancer Research, 2019

Background & Objective: Due to increased rate of risk factors, the incidence of placenta accreta ... more Background & Objective: Due to increased rate of risk factors, the incidence of placenta accreta (PA) is increasing worldwide. This study aimed to investigate the important factors regarding the occurrence of PA, as well as outcomes and complications of Trans Abdominal Hysterectomy (TAH) in the patients with PA. Materials & Methods: The study was performed as an observational cross-sectional study. Between March 2011 and March 2017, 177 patients, known cases of PA that undergone TAH, were enrolled in our study. Extracted data include demographic characteristics, patient's medical history, surgical approach and complications, such as blood loss and urologic problems. Results: The average of maternal age and gestational age were 33.6±4.70 (range= 22-43) years and 34.6±3.16 weeks, respectively. Neither maternal age (P=0.652) nor BMI (P=0.659) had significant association with abnormal placentation. Previous history of dilation & curettage (D&C) was found in 34 patients that was not related to the occurrence of the PA (P=0.508).Twenty-one (11.9%) of the patients needed urological intervention that did not associated with placental position, skin and uterine incision (P=0.258, 0.410 and 0.219). There is no relation between amount of blood loss with gestational age (P=0.7) and number of C/S (P=0.4), gestational age (P=0.7), anesthesia (P=0.2), and curettage history (P=0.3). Conclusion: Our mortality and morbidity rate is much lower than reported ones, indicating the high-level ability, skill and knowledge of the surgeons.

Research paper thumbnail of The Diagnosis of Early Fetal Cardiac Changes of the Gestational Diabetic Mothers: Presenting the Preload Index

Iranian Journal of Pediatrics, 2019

Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to health... more Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to healthy ones by means of different indices and to determine which index can first represent the alterations. Methods: The study was conducted as an observational cross-sectional study, including 25 pregnant women with gestational diabetes as the cases and 50 healthy pregnant women as the controls. The preload index, left and right side myocardial performance index (MPI), Interventricular septal hypertrophy, the left and right side cardiac output were assessed in all the patients. Results: The gestational ages were 31.65 ± 8.02 and 31.64 ± 5.37 weeks in case and control group respectively, without any significant difference. Both of the left and right ventricular MPI did not differ statistically between the case and controls. The cases had a greater Interventricular septal hypertrophy but the cardiac output was similar. The preload index was higher in the fetuses of the gestational diabetic mothers. Conclusions: In our study, the MPI did not show any difference between the fetuses of the gestational diabetic mothers and nondiabetic ones; but, fetuses of gestational diabetic mothers had a greater value of PLI, representing early diastolic function changes in right heart even before the overt heart failure occurred. This could be a sign of vasculopathy in gestational diabetic mothers.

Research paper thumbnail of Possible Cause of Inflammatory Storm and Septic Shock in Patients Diagnosed with (COVID-19)

Archives of Medical Research, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of The effects of progesterone therapy in pregnancy: vaginal and intramuscular administration

The Journal of Maternal-Fetal & Neonatal Medicine, 2019

This study was performed to evaluate the effects of vaginal versus intramuscular progesterone sup... more This study was performed to evaluate the effects of vaginal versus intramuscular progesterone supplementations on the mood, quality of life, and metabolic changes in pregnant women with history of previous preterm birth. Methods: This study was conducted as a prospective, randomized, open label, clinical trial evaluated 100 pregnant women who referred for prenatal visit, with 16-17 weeks of gestation from September 2014 through October 2015. The mothers were then randomly allocated into two groups: the vaginal progesterone group to receive 400mg Cyclogest vaginal suppositories (Actavis, UK limited, England) once daily, and the intramuscular progesterone group to receive weekly intramuscular injections of 250mg of 17-Hydroxyprogesterone Caproate (17-HPC) (Bayer Schering Pharma, Germany), starting from the 16th to the 35th weeks of pregnancy. demographics, medical and obstetrical history, sleeping disturbances, alteration in sexual desire, nausea/vomiting, serum levels of fasting blood sugar (FBS), high density lipoprotein (HDL), and low density lipoprotein (LDL) were evaluated, first and 8 weeks later. Results: 11 (11.2%) screened positive for psychosocial disorders; 25 (25.5%) had sleep disturbance, 11 (11.2%) had alteration in sexual desire, and 29 (29.6%) had nausea/vomiting upon enrolment. after two months of receiving daily vaginal progesterone there was a significant increase in the GHQ-28 score (p<0.001), and rates of positive screening for psychosocial disorders (p=0.001) in this group. No

Research paper thumbnail of Uterine artery Doppler ultrasound in second pregnancy with previous elective cesarean section

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 4, 2018

To assess the effects of previous cesarean delivery (CD) and placental location on second trimest... more To assess the effects of previous cesarean delivery (CD) and placental location on second trimester uterine artery Doppler indices in subsequent pregnancy and to assess the predictive values of abnormal Doppler findings for adverse pregnancy outcomes in women with previous CD. This prospective cohort study evaluated 400 gravida two pregnant women (200 with previous none medically indicated CD and 200 with previous normal vaginal deliveries (NVD)) who were referred for second trimester fetal anatomic survey. Uterine artery Doppler studies were performed in all participants who were then followed until delivery. Compared with women having prior NVD, women with prior CD had significantly higher rates of abnormal uterine artery pulsatility index (PI) (p < .001), and significantly more adverse pregnancy outcomes (p = .01). Among women with previous CD, all the measured adverse pregnancy outcomes occurred significantly more often in women with abnormal uterine artery Doppler indices (p...

Research paper thumbnail of Combined treatment with cervical pessary and vaginal progesterone for the prevention of preterm birth: A randomized clinical trial

Journal of Obstetrics and Gynaecology Research, 2016

Aim: We compared the effectiveness of a combined treatment involving cervical pessary plus vagina... more Aim: We compared the effectiveness of a combined treatment involving cervical pessary plus vaginal progesterone to vaginal progesterone alone in decreasing the rate of preterm birth in women with short cervix in the second gestational trimester. Methods: This prospective, open-label, randomized clinical trial was conducted on 144 pregnant women with singleton pregnancy who had a cervical length ≤ 25 mm, at 18-22 gestational weeks (GW). Seventythree patients were assigned to receive 400 mg of daily vaginal progesterone (group A), and 73 to receive cervical pessary plus 400 mg of daily vaginal progesterone (group B), until the 37th GW. The patients were then followed until delivery. Results: The rates of preterm birth were 16.4% in group A and 19.7% in group B, which were not statistically different (P = 0.6). There were no statistically significant differences in the rates of preterm birth at <37, <34, <32, and ≤26 GW between participants randomized to each group (P = 0.55). The rates of low-birthweight delivery were 17.8% in group A, and 23.9% in group B, which were not statistically different (P = 0.36). The rates of premature rupture of membranes, chorioamnionitis, the requirement for neonatal intensive care unit admission, and fetal and neonatal deaths were similar between the two groups. Conclusion: In pregnancies with short cervix at mid-pregnancy, combination therapy of cervical pessary plus daily vaginal progesterone does not have any additional benefit over daily vaginal progesterone alone in reducing the rate of preterm birth and adverse pregnancy outcomes.

Research paper thumbnail of 709: Uterine artery doppler ultrasound predictor of adverse pregnancy outcomes

American Journal of Obstetrics and Gynecology, 2017

Research paper thumbnail of The impact of gestational weight gain in different trimesters of pregnancy on glucose challenge test and gestational diabetes

Postgraduate medical journal, Jan 29, 2016

Assessing the effects of excessive weight gain before pregnancy, in the first and second trimeste... more Assessing the effects of excessive weight gain before pregnancy, in the first and second trimesters and in the month preceding glucose challenge test (GCT) on GCT results and gestational diabetes mellitus (GDM). This prospective cohort study evaluated 1279 pregnant women who were referred for their first prenatal visit in 2012-2015. Mother's body mass index (BMI) was recorded before pregnancy, during the first visit and every 4 weeks until 28 gestational weeks. All mothers underwent GCT at 28 weeks and when 1 h glucose ≥140 mg/dL (≥7.8 mmol/L), they were referred for a 100 g fasting glucose 3 h glucose tolerance test. Obesity and being overweight prior to pregnancy were associated with 2.8-fold and 1.5-fold higher rates of developing GDM (p<0.001, p=0.04) and 1.9-fold and 1.8-fold higher rates of having false-positive GCT results (p<0.001). First-trimester excessive weight gain was significantly associated with false-positive GCT in women who were lean, overweight and obes...

Research paper thumbnail of The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial

European Journal of Nutrition, 2015

depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p... more depression had higher rate of iron deficiency compared to the improved mothers (27.1 vs. 4.5 %, p = 0.02). Conclusions Early iron supplementation in mothers with PPD significantly improves the iron stores and causes a significant improvement in PPD with a 42.8 % improvement rate during 6 weeks. Continued PPD might be related to the lower postpartum ferritin levels in untreated mothers.

Research paper thumbnail of Iodine-containing disinfectants in preparation for caesarean section: impact on thyroid profile in cord blood

Postgraduate Medical Journal, 2015

Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Cu... more Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Current evidence suggests that maternal exposure to these disinfectants results in thyroid dysfunction in the newborns, but its extent is not known. The purpose of this study was to explain the quality of the effect of these disinfectants on the thyroid function of newborns. This cohort study was performed on all the healthy mothers with a term pregnancy who underwent caesarean section in the obstetrics emergency department of an educational hospital affiliated with Tehran University of Medical Sciences from December 2013 to December 2014. We divided this 12-month period into two consecutive 6 months. Povidone-iodine 10% (PVP-I) and chlorhexidine gluconate 4% (CHX) were used in the first and second 6 months, respectively, for skin preparation before caesarean section and also for umbilical cord disinfection. Cord blood thyroid stimulating hormone (TSH) and thyroxine (T4) were assayed by the ELISA method. We included 326 cases in this study, 153 in the PVP-I group and 173 in the CHX group. The incidence of cord blood TSH ≥10 mIU/L and T4 ≤7.3 µg/dL was significantly higher in the PVP-I than the CHX group. Cord blood TSH concentration showed a significant positive correlation with cord blood T4 concentration in the CHX group. Through selection of cases with cord blood T4 &lt;13 µg/dL, we found a negative correlation between cord blood TSH and T4 concentration in the PVP-I group. It seems that PVP-I has the potential to cause false-positive screening-test results and increase recall rates, which should be evaluated in further studies. Iranian Registry of Clinical Trials (IRCT) number IRCT201204289568N1.

Research paper thumbnail of Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth

The Journal of Maternal-Fetal & Neonatal Medicine, 2015

Comparing the value of umbilical cord arterial blood gas (UC-ABG) analysis in the prediction of n... more Comparing the value of umbilical cord arterial blood gas (UC-ABG) analysis in the prediction of neonatal mortality and morbidity in the preeclamptic versus healthy pregnancies with preterm birth. Eight hundred sixteen preterm (born at &amp;amp;amp;amp;lt;37 gestational weeks) neonates with no other morbidities who were born by cesarean section were evaluated. Immediately after delivery, UC-ABG analysis was performed and the neonates were followed. Preeclamptic women had lower umbilical cord blood (UCB) pH (7.2 4 ± 0.1 versus 7.2 7 ± 0.08, p = 0.008) and higher UCB base deficit (BD) (3.5 ± 3.7 versus 2.2 ± 3.4, p = 0.005) compared with controls. In the preeclamptic group, UCB metabolic acidosis (pH &amp;amp;amp;amp;lt; 7.15 and B.D &amp;amp;amp;amp;gt; 8) was not independently associated with neonatal morbidity or mortality, while in the control group UCB metabolic acidosis was independently associated with low 10-min Apgar (OR, 4.9; 95%CI 1.37-18.03), respiratory distress syndrome (OR, 2.37; 95%CI 1.05-6.17), intraventricular hemorrhage (OR, 3.01; 95%CI 1.13-7.99), and neonatal mortality (OR, 17.33; 95%CI 4.51-66.53). The preterm neonates born to preeclamptic mothers have lower UCB pH and higher BD. In these neonates, UCB acidosis is not independently associated with any adverse neonatal outcomes. In contrast, in the preterm neonates born to healthy mothers, UCB metabolic acidosis is independently associated with neonatal mortality and morbidity.

Research paper thumbnail of Maternal Anxiety and the Second-Trimester Prenatal Screening: A Prospective Cohort Study

Fetal Diagnosis and Therapy, 2015

Objective: Assessing the effects of maternal anxiety on the markers and results of quadruple scre... more Objective: Assessing the effects of maternal anxiety on the markers and results of quadruple screening and on maternal anxiety after receiving positive results. Methods: This prospective cohort study evaluated 1,595 pregnant women referred for prenatal visits. Maternal state/trait anxiety levels were measured, then quadruple screening was performed by measuring serum α-fetoprotein (AFP), β-human chorionic gonadotropin, inhibin A, and unconjugated estriol (UE3). After receiving the results, the state/trait anxiety was remeasured. Amniocentesis was performed for screening-positive mothers. Results: High prescreening maternal anxiety was associated with lower rates of elevated AFP (OR, 0.27; 95% CI, 0.1-0.74) and elevated inhibin A (OR, 0.38; 95% CI, 0.15-0.98). High maternal anxiety was associated with higher rates of decreased UE3 (OR, 1.8; 95% CI, 1.06-3.08). There were no significant associations between prescreening maternal anxiety and the final screening or amniocentesis results...

Research paper thumbnail of Correlation of nuchal translucency and thyroxine at 11–13 weeks of gestation

Journal of Maternal-Fetal and Neonatal Medicine, 2013

Nuchal translucency (NT) thickness is one of the major screening markers during the first trimest... more Nuchal translucency (NT) thickness is one of the major screening markers during the first trimester that could be influenced by several factors. Here, we investigated the association between NT thickness and thyroid related hormones. NT thickness was measured with transabdominal ultrasound in 643 pregnant women between 11 and 13 weeks of gestation. Maternal thyroxine (T4), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were evaluated. Bivariate correlations were assessed and thyroid profile was subcategorized with regard to the calculated reference ranges. An inverse relation was found between serum levels of maternal T4 with NT thickness (r = -0.128, p = 0.001) and CRL (r = -0.168, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). TSH and hCG were also found to be correlated (Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficient = -0.092, p = 0.019). Prevalence of maternal hypothyroidism and subclinical hypothyroidism were 1.1% and 3.7%, respectively. Thyroid function tests are found to independently influence NT measurements in the first trimester. Assessment of hormones such as thyroxine could optimize the interpretation of screening tests for pathological conditions during pregnancy.

Research paper thumbnail of Effect of aspirin in prevention of adverse pregnancy outcome in women with elevated alpha-fetoprotein

The Journal of Maternal-Fetal & Neonatal Medicine, 2013

To evaluate the effect of low-dose aspirin in prevention of adverse pregnancy outcomes (APO) in w... more To evaluate the effect of low-dose aspirin in prevention of adverse pregnancy outcomes (APO) in women with second trimester alpha-fetoprotein (AFP) &amp;amp;amp;amp;amp;amp;amp;amp;gt;2.5 multiple of median (MOM) and to compare aspirin effect on women with normal and abnormal uterine artery (UtA) Doppler. The primary outcome was the adverse pregnancy outcome. This randomized controlled trial was conducted in singleton pregnant women, who had unexplained AFP &amp;amp;amp;amp;amp;amp;amp;amp;gt;2.5 MOM and gestational age between 15 and 18 weeks of gestation. They were assigned randomly to receive either aspirin (N = 65) or control (N = 68). UtA Doppler velocimetry studies were performed at the time of targeted ultrasonographic exam. Two groups were comparable regarding the maternal characteristics. The frequency of APO in aspirin and control groups were 26.1% versus 44.1% (p = 0.045), the frequency of preterm delivery before 34 weeks were 3.2% versus 22.0% in aspirin and control group, p = 0.001. Other outcomes were similar in both groups. The frequency of adverse outcomes in women with abnormal UtA Doppler was 39.1% in aspirin and 60.0% in control group, p = 0.556. Low-dose aspirin reduces APO and delivery before 34 weeks of gestation in pregnant women with unexplained elevated AFP.

Research paper thumbnail of Elevated vaginal pH in the absence of current vaginal infection, still a challenging obstetrical problem

The Journal of Maternal-Fetal & Neonatal Medicine, 2013

To assess the association of vaginal pH ≥ 5 in the absence of vaginal infection with systemic inf... more To assess the association of vaginal pH ≥ 5 in the absence of vaginal infection with systemic inflammation and adverse pregnancy outcome. Four-hundred sixty pregnant women completed the study, upon enrollment Vaginal pH was measured for all women, maternal and umbilical sera were obtained for determining C-reactive protein (CRP) and uric acid levels. Umbilical blood was tested for gas parameters, 1 and 5 min Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded. Elevated vaginal pH was significantly associated with preterm birth (odds ratio (OR), 2.23; 95% confidence interval (CI), 1.04-4.76), emergency cesarean section (OR 2.57; 95% CI 1.32-5), neonatal resuscitation in the delivery room (OR 2.85; 95% CI 1.1-7.38), elevated cord base deficit (OR 8.01; 95% CI 1.61-39.81), low cord bicarbonate (OR 4.16, 95% CI 1.33-12.92) and NICU admission (OR 2.02; 95% CI 1.12-3.66). Increased vaginal pH was also significantly associated with maternal leukocytosis, hyperuricemia and elevated CRP levels in maternal and umbilical sera. Elevated vaginal pH in the absence of current vaginal infection still constitutes a risk for adverse pregnancy outcome which is mediated by systemic inflammatory response.

Research paper thumbnail of Comparative efficacy of probiotic yoghurt and clindamycin in treatment of bacterial vaginosis in pregnant women: A randomized clinical trial

The Journal of Maternal-Fetal & Neonatal Medicine, 2011

This study was performed to determine the comparative efficacy of probiotic yoghurt and clindamyc... more This study was performed to determine the comparative efficacy of probiotic yoghurt and clindamycin in the treatment of bacterial vaginosis in pregnant women in the third trimester. This randomized clinical trial was performed as an open-label study. 310 symptomatic patients with BV were recruited. Diagnosis of BV was through Amsel criteria. The patients were randomly assigned to receive either probiotic yoghurt (100 g twice a day/week) or orally administered clindamycin (300 mg twice a day/week). Ten patients in probiotic group and 9 subjects in clindamycin group had symptom recurrence (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). 132 patients in probiotic group and 105 subjects in clindamycin group had pH decrease (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). 140 patients in probiotic group and 141 subjects in clindamycin group had complete symptomatic cure (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Twelve patients in probiotic group and seven subjects in clindamycin group had preterm birth. Nine women in probiotic group and five subjects in clindamycin group had PROM (p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). According to the obtained results, it may be concluded that probiotics would have a good efficacy in the treatment of bacterial vaginosis in pregnancy leading to decreased burden of subsequent preterm birth.

Research paper thumbnail of Progesterone and threatened abortion: a randomized clinical trial on endocervical cytokine concentrations

Journal of Reproductive Immunology, 2013

The purpose of this study was to investigate the effect of vaginal progesterone on endocervical c... more The purpose of this study was to investigate the effect of vaginal progesterone on endocervical cytokine concentration in women at risk of threatened abortion. One hundred and sixty pregnant women with clinical symptoms of threatened abortion before the 20th week of pregnancy were randomly assigned to receive vaginal progesterone or placebo. Cervical fluids were collected and endocervical concentrations of different cytokines (IFN␥, TNF␣, IL-8, IL-10 and IL-12) were analyzed before and one week after progesterone or placebo treatment. A significant decrease in IFN␥ and increase in IL-10 in endocervical fluid was seen when the values were compared before and after progesterone treatment. However, there were no significant differences in pregnancy outcomes between the placebo and progesterone groups. We conclude that despite the failure of vaginal progesterone treatment to improve pregnancy outcomes, progesterone can induce a shift in the concentration of cytokines in endocervical secretions.