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Takahashi D, Fujino Y, Sato T, Kuramoto A, Kawakami S, Ito M, Goto K. Timing of Elective Cesarean Section and Neonatal Outcomes in Term Singleton Deliveries: A Single-Center Experience. Am J Perinatol 2024; 41:e2776-e2785. [PMID: 37607591 DOI: 10.1055/a-2158-5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the timing of elective cesarean sections at 37 to 41 weeks from a tertiary hospital in Japan. The primary outcome was the rate of adverse neonatal outcomes, especially focusing on neonates delivered at 38 weeks of gestation. STUDY DESIGN The study population was drawn from singleton pregnancies delivered following planned cesarean birth at the Fukuda Hospital from 2012 to 2019. Information on deliveries was obtained from the hospital database, which contains clinical, administrative, laboratory, and operating room databases. RESULTS After excluding women with chronic conditions, maternal complications, indications for multiple births, or a neonate with an anomaly, 2,208 neonates remained in the analysis. Among adverse neonatal outcomes, the rate was significantly higher in neonates delivered at 37 weeks of gestation (unadjusted odds ratio [OR] = 13.22 [95% confidence interval [CI]: 6.28, 27.86], p < 0.001) or 38 weeks of gestation (unadjusted OR = 1.82 [95% CI: 1.04, 3.19], p = 0.036) compared with neonates delivered at 39 to 41 weeks. The adjusted risk of any adverse outcome was significantly higher at 380-1/7 weeks (adjusted OR = 2.40 [95% CI: 1.35, 4.30], p = 0.003) and 382-3/7 weeks (adjusted OR = 1.89 [95% CI: 1.04, 3.44], p = 0.038) compared with neonates delivered at 39 to 41 weeks, respectively. CONCLUSION Our findings suggest that elective cesarean sections might be best scheduled at 39 weeks or later. When considering a cesarean at 38 weeks, it appears that 384/7 weeks of gestation or later could be a preferable timing in the context of reducing neonatal risks. However, as the composite outcome includes mostly minor conditions, the clinical significance of this finding needs to be carefully interpreted. KEY POINTS · Timing of elective cesarean sections from 37 to 41 weeks was evaluated in a Japanese tertiary hospital.. · Neonates delivered at 37 and 38 weeks had higher adverse outcome rates compared with 39 to 41 weeks.. · Scheduling elective cesarean sections at least 384/7 weeks or later may reduce neonatal risk..
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Affiliation(s)
- Daijiro Takahashi
- Division of Neonatology, Fukuda Hospital, Kumamoto, Japan
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomoki Sato
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Akitaka Kuramoto
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Shoichi Kawakami
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Masaharu Ito
- Division of Obstetrics and Gynecology, Fukuda Hospital, Kumamoto, Japan
| | - Kei Goto
- Division of Pediatrics, Fukuda Hospital, Kumamoto, Japan
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Hoshino M, Shinozaki H, Kitahara Y, Kameda T, Hayashi K, Ogawa S, Itoh M, Iwase A. Optimal timing of elective repeat cesarean deliveries of term singleton pregnancies: A multicenter cross-sectional study. Taiwan J Obstet Gynecol 2022; 61:317-322. [PMID: 35361394 DOI: 10.1016/j.tjog.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Cesarean deliveries must be optimally timed to minimize their effects on mothers and neonates. This study aimed to determine the optimal timing of elective repeat cesarean deliveries to reduce the incidence of neonatal respiratory disorders and of emergent cesarean deliveries. MATERIALS AND METHODS This multi-center, cross-sectional, retrospective analysis evaluated data on the maternal and neonatal outcomes of 856 singleton pregnancies scheduled for elective repeat cesarean deliveries at 37-39 weeks' gestation. The emergent cesarean delivery and neonatal respiratory disorder risks were analyzed according to the scheduled cesarean delivery times. RESULTS The elective cesarean delivery rates were 91.0% during the first and 92.6% during the second half of the 37th week of gestation, 88.7% during the first and 82.9% during the second half of the 38th week of gestation, and 62.5% during the first and 33.3% during the second half of the 39th week of gestation. The neonatal respiratory disorder rates were 21.8% for elective cesarean deliveries during the first half of the 37th week of gestation and approximately 8% for elective cesarean deliveries during the second half of the 37th week until the first half of the 38th week of gestation. No neonatal respiratory disorders occurred among the babies delivered by elective cesarean deliveries during the 39th week of gestation. CONCLUSION For improved maternal and neonatal outcomes in the Asian population, it may be better to perform scheduled elective repeat cesarean deliveries from the second half of the 37th week of gestation until the 38th week of gestation following confirmation of gestational age by early first trimester ultrasonography.
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Affiliation(s)
- Masamichi Hoshino
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan; Iwajuku Clinic, 1506-3 Azami, Kasakakemachi, Midori, Gunma, 379-2311, Japan
| | - Hiromitsu Shinozaki
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan.
| | - Yoshikazu Kitahara
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Kameda
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Kunihiko Hayashi
- Graduate School of Health Sciences, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8514, Japan
| | - Shota Ogawa
- Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Itoh
- Japan Community Health Care Organization, Gunma Chuo Hospital, 1 Chome-7-13 Kouncho, Maebashi, Gunma, 371-0025, Japan
| | - Akira Iwase
- Graduate School of Medicine, Gunma University, 3 Chome-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan
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The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stylianou-Riga P, Boutsikou T, Kouis P, Kinni P, Krokou M, Ioannou A, Siahanidou T, Iliodromiti Z, Papadouri T, Yiallouros PK, Iacovidou N. Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case-control study. Ital J Pediatr 2021; 47:129. [PMID: 34082803 PMCID: PMC8176707 DOI: 10.1186/s13052-021-01086-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care. Supplementary Information The online version contains supplementary material available at 10.1186/s13052-021-01086-5.
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Affiliation(s)
- Paraskevi Stylianou-Riga
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus. .,Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus. .,Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Theodora Boutsikou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Marina Krokou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Andriani Ioannou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Tania Siahanidou
- Neonatal Unit, First Department of Pediatrics, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, "Archbishop Makarios III" Hospital, Nicosia, Cyprus
| | - Panayiotis K Yiallouros
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, 2029 Aglantzia, Nicosia, Cyprus
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Timing of term elective cesarean section and adverse neonatal outcomes: A multi-center retrospective cohort study. PLoS One 2021; 16:e0249557. [PMID: 33819296 PMCID: PMC8021177 DOI: 10.1371/journal.pone.0249557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background Rate of cesarean section (CS), including elective CS has globally increased. Studies have found that term elective CS before 39 weeks of gestation is associated with increased risk of adverse respiratory outcomes. Objective To determine the rate of elective CS and examine the association between timing of elective term CS and adverse neonatal outcomes in a large population of Lebanese women. Methods A Multi-Center Study was conducted using data from the National Collaborative Perinatal Neonatal Network database. Simple and multivariable logistic regression models were used to examine the association between timing of term elective CS and adverse neonatal outcomes. Some of the neonatal adverse outcomes we examined included respiratory distress syndrome, admission to the NICU, and a composite of respiratory outcomes. Results A total of 28,997 low risk mothers who delivered through primary and repeat elective CS were included in the study. Uncomplicated elective planned term CS constituted 25% of all CS deliveries in Lebanon. Primary and repeat CS at 37 weeks of gestation increased the odds of most of the studied adverse neonatal outcomes. There were few associations between CS and adverse neonatal outcomes at 38 weeks of gestation. Conclusions Term primary and repeat cesarean delivery prior to 39 weeks of gestation is associated with respiratory and other adverse neonatal outcomes. Delaying birth 1–2 weeks till 39 weeks of gestation can prevent 64–77% of adverse respiratory outcomes.
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Ferrari AP, Almeida MAM, Carvalhaes MABL, Parada CMGDL. Effects of elective cesarean sections on perinatal outcomes and care practices. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to verify the effects of elective cesarean sections on perinatal outcomes and care practices, as compared to vaginal deliveries. Methods: cohort study with 591 mothers and their babies, developed in a medium-sized city in the state of São Paulo, Brazil. Data were collected from hospital records and by interviews at the neonatal screening unit in the city from July 2015 to February 2016. Data regarding childbirth, newborns, sociodemography, and current gestational history were obtained from each mother. The associations of interest were evaluated with Cox regression analyses adjusted for the covariates identified through the results of bivariate analyses presenting a statistical significance level ofp<0.20. In adjusted analyzes, relationships were considered significant ifp<0.05, with relative risk being considered as the measure of effect. Results: if compared to women who had vaginal deliveries, those who were submitted to elective cesarean sections were at a higher risk of not having skin-to-skin contact with their babies in the delivery room, of not breastfeeding in the first hour of life, and of having their babies hospitalized in a neonatal unit. Conclusions: reducing the number of elective cesarean sections is essential to foster good neonatal care practices and reduce negative neonatal outcomes.
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Toker E, Turan Z, Omaç Sönmez M, Kabalcioğlu Bucak F. Why have the numbers of cesareans increased globally? The factors that affect women's decisions about cesarean delivery in Turkey. J Matern Fetal Neonatal Med 2019; 33:3529-3537. [PMID: 31303073 DOI: 10.1080/14767058.2019.1644311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The aim of this research is to investigate the factors that prevent women choosing vaginal delivery, and to identify the reasons underlying the increasing rate of cesarean births.Materials and methods: The study was carried out as descriptive cross-sectional research. The sample group consists of 591 women who gave birth via cesarean delivery at a state hospital. Research data was collected using a questionnaire and through face-to-face interviews by researchers. The data was presented as frequency, mean, and analyzed chi-square test, binary logistic regression.Results: The average age of the participating women was 26.49 ± 0.2, the majority were primary-secondary school graduates (70.6%) and housewives (97.0%). About 87.3% of the participants opted for cesarean delivery following medical advice due to medical reasons, and others intentionally chose this method for specific reasons including fear of vaginal delivery, tubal ligation, or a desire to plan a specific birthdate. The findings of the logistic regression model indicate that the increase in number of prenatal care appointments and the time of deciding on the type of delivery approaches the time of delivery increased the medical advice-based cesarean delivery rate (respectively; OR: 1.390, p = .001; OR: 1.850, p = .000), and that having had a previous delivery with the aid of a midwife reduced the likelihood of medical advice-based cesarean delivery (0.233, p = .001). These correlations were also found to be significant in the chi-square test (p < .05).Conclusions: The attitudes of health professionals, women's demands and the time allowed for making decisions about cesarean delivery have an effect on preferences regarding cesareans.
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Affiliation(s)
- Eylem Toker
- Department of Midwifery, Faculty of Health Sciences, Kahramanmaraş Sutcu Imam University, Kahramanmaraş, Turkey
| | - Zekiye Turan
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Mehtap Omaç Sönmez
- Department of Nursing, Faculty of Health Sciences, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
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Huang K, Yan S, Wu X, Zhu P, Tao F. Elective caesarean section on maternal request prior to 39 gestational weeks and childhood psychopathology: a birth cohort study in China. BMC Psychiatry 2019; 19:22. [PMID: 30642307 PMCID: PMC6332907 DOI: 10.1186/s12888-019-2012-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/04/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The recommendation of non-indicated caesarean section (CS) after 39 gestational weeks has been announced based on evidence of maternal and infant physiological effects. The potential psychological risks have not been acknowledged. This study aims to investigate emotional and behavioral problems in pre-school children born with elective CS (ECS) on maternal request prior to 39 weeks. METHODS Pregnant women within 12 gestational weeks between November 2008 and October 2010 were invited to participate in the China-Anhui Birth Cohort Study (C-ABCS). They were asked to complete a self-administered questionnaire respectively in 1st and 3rd trimester of pregnancy to collect basic maternal characteristics. Pregnant complications and delivery modes were abstracted from medical notes. Their singleton live births were followed up at preschool age. Strengths and Difficulties Questionnaires (SDQ) were completed by parents to assess children's emotional and behavioral problems. A total of 3319 mother-child pairs were put into the final analysis. Descriptive analysis and binary logistic regression analysis were used to assess the impact of delivery modes on abnormalities in SDQ dimensions at various gestational ages. RESULTS The prevalence of ECS on maternal request prior to 39 weeks, at 39-40 weeks, and after 41 weeks was 16.6, 23.7 and 15.9%, respectively. Compared with those born vaginally, children born with ECS on maternal request were more likely to have total difficult problems (RR 1.519, 95% confidence interval 1.077 to 2.142). ECS on maternal request was the independent predictor of emotional problems (3.479, 1.676 to 7.222) and total difficult problems (2.172, 1.175 to 4.016) in children born prior to 39 gestational weeks. CONCLUSION Children delivered by ECS on maternal request have an increased risk to have emotional and behavioral problems prior to 39 gestational weeks at preschool age. The potential psychological implication prior to 39 weeks has been added to the roster of impacts of ECS on maternal request. Further research is needed to probe the potential biological mechanisms.
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Affiliation(s)
- Kun Huang
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Shuangqin Yan
- Ma’anshan Maternal and Child Health Center, No 72 Jiashan Road, Ma’anshan, Anhui Province China
| | - Xiaoyan Wu
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Peng Zhu
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
| | - Fangbiao Tao
- School of Public Health, Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, Anhui Province China
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Pirjani R, Afrakhteh M, Sepidarkish M, Nariman S, Shirazi M, Moini A, Hosseini L. 'Elective caesarean section at 38-39 weeks gestation compared to > 39 weeks on neonatal outcomes: a prospective cohort study. BMC Pregnancy Childbirth 2018; 18:140. [PMID: 29739452 PMCID: PMC5941590 DOI: 10.1186/s12884-018-1785-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to compare neonatal complications in scheduled cesarean sections (CS) between 38 and 39 gestational weeks with CS performed after 39 gestational weeks in Iranian low -risk pregnant women. Methods In this cohort study, 2086 patients were enrolled based on the inclusion and exclusion criteria. The neonates were evaluated in terms of the following items: transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), sepsis, need for NICU hospitalization, birth weight, birth height, head circumference, and the first minute and fifth minute Apgar score. Several multiple logistic regression models were performed for each response variable (adverse outcome) separately. Results The incidence of NICU admission was significantly higher in neonates born at 38–39 gestational weeks than those who were born after 39 gestational weeks. No significant differences were found in the incidence of neonatal sepsis, TTN, and RDS between the two groups. Conclusion According to our study results, elective CS at 38–9 weeks’ gestation is associated with a higher rate of TTN and NICU admission in comparison with elective CS performed after 39 completed gestational weeks.
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Affiliation(s)
- Reihaneh Pirjani
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Shahin Nariman
- Department of Pediatrics, Arash women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Shirazi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashraf Moini
- Obstetrics and Gynecology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR., Tehran, Iran
| | - Ladan Hosseini
- Research development center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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