BACKGROUND: Despite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected. OBJECTIVE: To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease. STUDY DESIGN: We describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease. RESULTS: Among 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high-and low-risk familial/household members (n¼33 members for comparison). CONCLUSION: We report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.

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Objectives So far, various etiologies have been stated for Intra-uterine growth restriction (IUGR) with a wide variety of pathways involved in their pathogenesis. Among these pathways, impaired angiogenesis, inflammation, and oxidative stress are among the most important ones. Curcumin has raised notable attention due to its anti-inflammatory and antioxidant activity in different in-vitro studies and clinical trials. The present study aimed to investigate the possible potentials of Curcumin for pregnancies complicated by IUGR through different physiological mechanisms. Methods A narrative review study was conducted (Iran; 2020). The implemented Mesh-based keywords were “Curcumin” OR “Turmeric” AND “Therapeutic effect” AND “Side effect” OR “Adverse effect” OR “Teratogenic effect” OR “Teratogenicity” AND “Pregnancy” AND “Intra-uterine growth restriction” OR “Intra-uterine growth retardation” AND “Inflammation” AND “Oxidative stress” AND “Angiogenesis”. Cochrane Library, PubMed, Up to date, Scopus, and Google Scholar databases were used as academic search engines. Results Reviewing the included studies showed the dual effects of curcumin on angiogenesis depend on the type of angiogenesis: physiological or pathological. Interestingly, the present study evaluated the current knowledge on the effects of curcumin on IUGR demonstrating acceptable potentials. Also, we tried to gather studies that had evaluated the safety of curcumin during pregnancy. Conclusion Gathering all the data, it seems curcumin could be an acceptable candidate for future animal and human studies on IUGR.

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Background Coronavirus disease 2019 (COVID-19) still is a global emergency. According to the studies, pregnant women are of the at risk populations and any underlying disease(s) might even worsen their condition. The aim of this study is reporting a complex case of immune thrombocytopenic purpura (ITP) during pregnancy who has been diagnosed with COVID-19 as well as suspicion of HELLP syndrome. Case presentation A 24-year-old woman with a platelet count of 6000/mL and resistance to conventional therapies was referred. A day after starting 0.5 g/day of methylprednisolone for her, fever and a decrease in SpO2 presented. According to the paraclinical investigations, COVID-19 was diagnosed and the conventional COVID-19 treatments started for her (the methylprednisolone pulse stopped). Due to the increased liver enzymes and low platelet count, with suspicion of HELLP syndrome, cesarean section surgery was performed which resulted in a healthy neonate. Then, the methylprednisolone pulse was restarted for and she developed an increase in the platelet count. Conclusion It is not clear how COVID-19 and pregnancy affected the patient’s condition and the underlying disease; however, it seems the delivery and/or restarting the methylprednisolone pulses caused improvement in her condition.

Background: Cancer is the most common disease in the present century and the number of affected children is increasing. It can cause many problems for family caregivers. This study assessed the correlation between social support and care-giving burden among parents of children with cancer. Methods: This cross-sectional descriptive study was conducted by convenience sampling method on 230 parents (115 mothers and 115 fathers) referring to Oncology Clinic and Oncology Ward  in Yazd Shahid Sadoughi Hospital (Iran) from March to August 2020 (Covid-19 Pandemics). Researchers asked the patients' parents to answer the questionnaires. The data were gathered by the demographic questionnaire, Care Burden Scale (CBS), and Social Support Scale and analyzed with SPSS21 using Pearson correlation coefficient, Chi-square, and Analysis of Variance (ANOVA) (P=0.05). Results: The mean of the care burden of parents was 52.19 2.48 and the social support of them was higher than that (78.78± 13.21). There was no significant correlation between social support and domains of general strain (P=0.90), disappointment (P=0.52), emotional involvement (P=0.53), environment (P=0.95), and isolation (P=0.40) of the care burden. Conclusions: There was no correlation between social support and care burden in the parents of children with cancer.  Other factors may be involved in care burden of the parents. More research  is needed with more samples in the future.

Background: Estimation of the fetal birth weight and diagnosis of small for gestational age in the fetuses of women with gestational diabetes mellitus (GDM) are currently imprecise. Objective: We aimed to evaluate the association between fetal renal artery Doppler indices and neonatal birth weight in women with GDM in late pregnancy. Materials and Methods: This cohort study recruited 246 pregnant women from Shariati Hospital in Tehran, Iran, in two GDM and healthy control groups. Participants underwent weekly Doppler ultrasounds in the late pregnancy period (37-40 wk) to determine the Doppler indices of the umbilical artery, middle cerebral, and renal arteries. Fetal growth indices including biparietal diameter, abdominal circumference, head circumference, and femur length were also recorded and compared between the two groups. Results: Fetal growth indices and estimated fetal weight were not significantly different between the two groups. Neonatal birth weight was significantly higher in the GDM group (p < 0.01). The GDM group had significantly higher renal artery indices (resistance index: p = 0.01, pulsatility index [PI]: p = 0.03, and systolic/diastolic ratio [S/D]: p = 0.01) compared to the control group. Also, there was an inverse linear correlation between umbilical indices and birth weight (PI: p = 0.01, S/D: p < 0.01), and between renal artery indices and birth weight (resistance index: p = 0.02, PI: p = 0.01, and S/D: p = 0.03). In the control group, only umbilical artery PI had an inverse linear correlation with birth weight (p = 0.03) and there was no correlation between renal artery indices and birth weight. Conclusion: Using Doppler hemodynamic indices of the renal artery in late pregnancy in women with GDM can be helpful for early detection of hypoxic fetuses, who are at risk of being small for gestational age or having intrauterine growth restriction, even when of normal weight. Key words: Fetus, Gestational diabetes mellitus, Infant, Middle cerebral artery, Renal artery, Doppler ultrasound, Umbilical artery.

Background: Estimation of fetal weight during pregnancy plays an important role in prenatal and intrapartum care and is more important in pregnancies after 37 weeks to determine the type of delivery. The aim of this study was to compare and evaluate the accuracy and diagnostic value of two-dimensional ultrasound and clinical examination in estimating fetal weight and pregnancy outcomes. Materials and Methods: This cross-sectional study was conducted on 300 pregnant women without abnormal fetuses and pregnancies after 37 weeks; mothers who had a normal delivery or cesarean section were evaluated by the available method. The weight of the fetus was estimated before and after delivery, using ultrasound and clinical examination. Newborns were classified into five groups based on their fetal weight. Analysis of collected data was performed with SPSS software. Results: The mean age of the patients was 31 years and the mean weight of the neonates was 3450 g. At a weight of less than 3000 g, ultrasound and clinical evaluation were strongly correlated with the actual weight of the infant, but at weights of more than 3500 and 4000 g, weight estimation with ultrasound was highly accurate, and clinical examination had poor accuracy. In lower weights, square errors were fewer in both ultrasound and clinical examination, in comparison with higher weights. In higher weights, ultrasound is more reliable, and the diagnostic accuracy of clinical examination is reduced. Conclusion: Estimation of fetal weight with prenatal ultrasound is highly accurate. Clinical examination is more accurate in determining the weight of small fetuses and does not pay much attention to the diagnosis of macrosomic fetuses and even leads to overestimation, while ultrasound is much more accurate in diagnosing fetal macrosomia.