Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2020 | Volume:23 | Issue:2|Papers Count:12

Introduction: Since total abdominal hysterectomy is associated with heavy bleeding and increases the incidence of thrombosis, this study was performed with aim to evaluate the effect of physiotherapy with and without bandage on prevention of deep vein thrombosis in women candidate for total hysterectomy. Methods: This single-blind randomized clinical trial study was conducted on 32 candidates of total abdominal hysterectomy patients in the hospitals of Tabriz Medical Sciences in September 2019. The physiotherapy group received lower limb physiotherapy every 8 hours 2 days before surgery, and the other group received bandages on feet after physiotherapy. Thrombosis diagnostic tests were recorded for each individual in the relevant checklist. Data were analyzed by SPSS software (version 21) and Kolmogorov-Smirnov and independent t tests. PResults: Intergroup results of blood tests and thrombosis detectors before and after the intervention based on paired t-test indicated a statistically significant difference in all variables of RBC, Hgb, Hct, PCR, PT, PTT, INR, D-Dimer, Pr C, Pr S in the two groups (p<0. 05), whereas intragroup comparison of the results based on Independent t indicated no significant difference in the mentioned variables (p<0. 05). Conclusion: Physiotherapy with and without bandage has similar efficacy in preventing deep vein thrombosis in patients candidate for total abdominal hysterectomy.

Introduction: PI3K/Akt/mTOR pathway is important in inducing resistance to hormone therapy in patients with hormone positive breast cancer. One regulator of this pathway is the PTEN gene. This study was performed with aim to compare the expression of PTEN gene in hormone receptor positive breast cancer patients between patients with sensitive and resistant to tamoxifen. Methods: This cross-sectional and retrospective study was performed on 80 hormone receptor positive breast cancer patients who had referred to oncology clinics of Mashhad University of Medical Sciences from 2006 to 2016. Tissue samples of tamoxifen-sensitive and-resistant patients (recurrence/metastasis occurring during the first 5 years of adjuvant hormone therapy) were immunohistochemically evaluated for PTEN expression. Data were analyzed by SPSS software (version 16) and Independent t-test, U Mann-Whitney and chi-square tests. P<0. 05 was considered statistically significant. Results: In this study, 80 patients were evaluated in two groups of tamoxifen sensitive and resistant. The expression of PTEN in tamoxifen-sensitive and resistant patients was 97. 5% and 27. 5%, respectively (p=0. 001). However, in patients with more advanced lymph node involvement, the expression of PTEN was significantly reduced (p=0. 001), there was no significant relationship between PTEN expression and tumor size (p=0. 19), tumor grade (p=0. 14) and Her2/neu expression (p=0. 85). Conclusion: There is association between PTEN gene expression and tamoxifen resistance.

Introduction: Nodaways, exercise and physical activities are used as effective non-pharmacological treatment to minimize arterial stiffness and prevent cardiovascular disease. This study was performed with aim to compare the effect of aerobic and resistance training on arterial stiffness, inflammatory and anti-inflammatory factors in obese sedentary women. Methods: This clinical trial study was performed in 2018 on 27 obese women with an age range of 30-40 years in Mashhad. The subjects were randomly assigned into two groups of aerobic and resistance training. Aerobic exercise was hold with an intensity of 50-70% of the maximum heart rate reserve and resistance exercise programs with 60-85% intensity of one repetition maximum for 24 sessions every other day. Blood samples were taken and maximal oxygen uptake and arterial stiffness were measured at the beginning of the 1th, 13th and 24th sessions. Data were analyzed by SPSS software (version 22) and repeated-measures ANOVA, Friedman and Tukey tests. P<0. 05 was considered statistically significant. Results: Both aerobic and resistance exercise programs significantly increased maximal oxygen consumption, skeletal muscle mass and significantly decreased pulse pressure (p<0. 05). The effect of aerobic exercise on oxygen uptake was more than resistance training (p=0. 023), but there was no difference between the effect of both exercise programs on decreasing pulse pressure (p=0. 879). Changes in IL6 and IL10 were not significant in both aerobic and resistance exercise programs (p>0. 05). Conclusion: Both aerobic training and resistance exercise can have a positive impact on the structural properties of the artery wall of inactive obese women and can be used as a non-pharmacological treatment to minimize arterial stiffness and prevent cardiovascular disease.

Introduction: Approximately 80% of postmenopausal women suffer from hot flashes and night sweats. 25% of them report that these symptoms are the cause of poor quality of life. Drug treatments and hormone therapy, due to some complications and risks, are not the priority of use for the women, and they continue to spend the most of their time on keeping and taking care of other family members. This study was performed with aim to determine the effectiveness of self-compassion training on hot flashes and night sweats in postmenopausal women. Methods: This randomized clinical trial study was performed on 30 women aged 45-55 years in Tonekabon city who had natural menopause and referred in urban health centers in 2018. The subjects were randomly divided in to two groups of case and control (n=15 in each group). The experimental group received an 8-week self-compassion training program and the control group was placed on waiting list. Data were analyzed by SPSS software (version 22) and repeated measure covariance analysis. P<0. 5 was considered statistically significant. Results: The results showed a significant difference between the experimental and control groups after the intervention and follow-up regarding the frequency and severity of hot flashes and night sweats (P<0. 001). Conclusion: Self-compassion training is effective on menopausal hot flashes and night sweats, so it is suggested to be included in postmenopausal care program.

Introduction: As the active phase of labor, prolongation of the latent phase is associated with risks for the mother and fetus. Cervical status, determined by Bishop's score, is one of the factors that influence the duration of the latent phase. This study was performed with aim to determine the effect of topical magnesium sulfate in latent phase on Bishop Score, latent phase duration and delivery outcomes in primiparous women. Methods: This double-blind clinical trial study was conducted on 60 nulliparous women in Izadi hospital of Qom in 2018. The participants were randomly divided into two groups of magnesium sulfate and placebo (n=30 in each group). Before the intervention, vaginal examination was performed and Bishop's score was calculated. If Bishop's score was less than 5, the individual would be included in the study. In the intervention group, 10cc of magnesium sulfate 50% was administered during the examination and in the control group, 10 cc distilled water were poured on the cervix. Vaginal examination was done every 4 hours. Finally, the Bishop scores, duration of latent phase, and overall duration of latent phase until delivery were calculated and compared in the two groups. Data were analyzed by SPSS software (version 24) and Chi-square, Fisher, Independent t, and Mann-Whitney tests. P<0. 05 was considered statistically significant. Results: Before the intervention, there was not significantly different between the two groups in mean Bishop score (p= 0. 554). However, in subsequent examinations which were done 4 (p=0. 001) and 8 (p=0. 001) hour after the intervention, these differences were significant. Duration of latent phase in the intervention group was 636. 87± 455. 55 minutes and in the control group was 1209. 17± 688. 52 minutes (p=0. 004). Also, the total duration of labor was 1032. 54± 585. 20 minutes in the intervention group and 1524. 28± 531. 99 minutes in the control group (p=0. 001). Two groups had no significant difference in terms of other delivery outcomes (p≥ 0. 05). Conclusion: The use of topical magnesium sulfate at the beginning of the latent phase improves Bishop's score, thereby shortening the latent phase duration and subsequently shortening the labor duration.

Introduction: The effects of labor pain and hypoxia during delivery on the neonatal metabolic and endocrinological profile after birth, especially thyroid function hormones, are unknown. This study was performed with aim to determine the relationship between delivery method with thyroid function hormone levels and blood gases in the newborn cord at birth. Methods: This cross-sectional study was performed on 240 singleton and term pregnant women with no history of thyroid problems in Shahid Akbarabadi Hospital in Tehran, Iran, in 2018-2019. Subjects were divided into three groups of 80 cases based on mode of delivery: natural delivery, emergency cesarean delivery and elective cesarean delivery. Immediately after birth, thyroid stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) and also blood gases including umbilical vein oxygen pressure (PO2), carbon dioxide pressure (PCO2), oxygen saturation (O2saturation) and pH of neonates' cord were measured and their relationship with mode of delivery was evaluated. Data were analyzed by SPSS software (version 20) and variance analysis test, covariance analysis, Kruskal Wallis, and Tukey Test. PResults: Mean TSH level in emergency cesarean section group was higher than normal delivery group (P = 0. 001) and also higher than selective cesarean section group (P = 0. 034). Mean of TSH level was significantly different between normal delivery and elective cesarean section (P = 0. 001). Mean of pH and PO2 was higher in selective cesarean section group than normal delivery (p=0. 024, p=0. 001) and was also higher than emergency cesarean section group (P = 0. 014, p=0. 037). Also, mean serum level of cord PCO2 was significantly different between three groups (p=0. 1) and was significantly lower in selective cesarean section group than other two groups (p=. 001). Mean serum level of cord PCO2 was not significantly different between normal delivery group and selective cesarean group (p>0. 05). Conclusion: The present study showed that labor pain and hypoxia during delivery may increase TSH levels.

Introduction: Gestational diabetes is the most common medical condition in pregnancy. Since probiotics are viable microorganisms which have beneficial effects on microbial flora of the intestine, they affect glucose metabolism. Therefore, this study was performed with aim to determine the effect of probiotic capsule on the prevention of gestational diabetes in high risk pre-diabetes pregnant women. Methods: This double-blind clinical trial study was performed on 255 high risk pre-diabetic pregnant women in health centers covered by health center No. 2 of Mashhad in 2018. In the probiotic group and the placebo group, in addition to routine care, one probiotic capsule and placebo were daily prescribed respectively from 14-16 weeks of gestation for 12 weeks. Then, glucose tolerance test (OGTT) was performed at week 26-28. The research tools included demographic and midwifery information form, checklist of pregnancy diabetes screening tests, drug use checklist, examination form and satisfaction form. Data were analyzed using SPSS software (version 22), and Chi-square, One-way ANOVA, Kruskal – Wallis and Mann-Whitney tests. P<0. 05 was considered statistically significant. Results: 21 patients (26. 3%) in the probiotic group, 49 (59. 8%) in the placebo group, and 55 (67. 1%) in the control group had gestational diabetes (P<0. 001). Gestational diabetes in the intervention group was significantly less than the placebo and control group. The results of the Chi-square Pearson test for two by two comparison of the groups showed significant difference in gestational diabetes mellitus between probiotic group with placebo (P <0. 001) and probiotic group with control (P <0. 001). Gestational diabetes in the intervention group in significance level of lower than 5% was lower than the placebo and control group. Conclusion: The use of probiotic capsules can be recommended to high risk pregnant women in preventing gestational diabetes.

Introduction: Menorrhagia is one of the common gynecological problems and one of the reasons for iron deficiency anemia in women. Regarding to the lack of researches in this field, this study was performed with aim to determine the effect of hydro alcoholic extract of Achillea Milefolium (AM) on Menorrhagia. Methods: This triple-blind randomized controlled clinical trial was performed on 120 women with Menorrhagia referred to Valiasr medical center of Tehran University of Medical Sciences in 2016. Study instruments were demographic form, pictorial blood loss assessment chart (PBAC), weight and meter. After confirming Menorrhagia in basic cycle, the intervention group was treated with 150mg AM capsule and 500mg Mefenamic-acid capsules and the placebo group was treated with AM placebo capsules and Mefenamic-acid capsules every eight hours in seven days of menstruation for two consecutive months. In the next cycle, they were followed-up by the PBAC. Data were analyzed by SPSS software (version 19) and independent t-test, paired t-test, Repeated measurement variance analysis, Friedman, Wilcoxon, Mann-Whitney, Fisher and Chi-square tests (p<0. 05). Results: The intensity and duration of menstrual bleeding significantly decreased in both groups (p<0. 001). Reduction of intensity and duration of bleeding was significantly higher in the AM group (p<0. 001) and duration of bleeding in intervention group was insignificantly higher (p>0. 001). Although, intensity and duration of bleeding in both groups increased after the intervention compared with intervention period (p<0. 001), but was lower compared with before the intervention (p<0. 001). Conclusion: According to the effect of AM on reduction of menstrual bleeding, AM can be used in treatment of Menorrhagia.

Introduction: Today, for better assessment of midwifery care quality, in addition to maternal death, a useful supplementary indicator, called "maternal near miss" (MNM) is used. It means that mothers who have survived due to complications of pregnancy or childbirth. Limited studies have been conducted in this regard in Iran and no study has been performed in Khuzestan to evaluate this index. This study was performed with aim to determine the prevalence and factors related to MNM in Ahwaz hospitals in 2016. Methods: This cross-sectional study was performed on 3002 delivery in 5 state hospitals in Ahwaz, from 22 May until 25 July 2016. WHO criteria was used for MNM including potential life-threatening conditions (cardiovascular, respiratory, renal, blood, coagulation, hepatic, and neurological disorders) and criteria for severe maternal complications (severe postpartum haemorrhage, severe pre-eclampsia, eclampsia, sepsis/severe systemic infection, and uterus rupture). The prevalence of MNM and related factors were investigated. Data were analyzed by SPSS software (version 22) and Chi-square, Mann-Whitney test, t-test and logistic regression. P<0. 05 was considered statistically significant. Results: The prevalence of MNM was 29. 6 per 1, 000 live births. The most common direct causes of MNM cases were preeclampsia (49. 5%) and severe postpartum hemorrhage (38. 2%). 26 of MNM (29. 2%) were admitted in intensive care units. The lower gestational age (p <0. 001), lower education level (p <0. 008), and cesarean delivery (p <0. 001) were more likely to resulted in cases of MNM. Conclusion: As for the reasons of maternal death, preeclampsia and obstetrical hemorrhage were the main reasons for MNM. Cesarean and lower gestational age increase the likelihood of MNM.

Introduction: Maternal mortality during childbirth is a well-known indicator of the quality of maternity services that reflects the level of development of a country. Moreover, it is associated with various social, economic and cultural levels of a country. Admissions to the Intensive Care Unit (ICU) may be considered an objective indicator of severe maternal diseases. One of the most important health indicators is to reduce maternal mortality and the significance of examining the reasons for its occurrence. Therefore, this systematic review aimed to investigate the reasons why pregnant women are admitted to the ICUs. Methods: The search process was conducted through the Google Scholar, PubMed, Magiran, Science Direct and SID databases. The search was originally conducted in January 2018 and updated in February 2018. The keywords searched were ICU and Intensive Care Unit, which in combination with Pregnancy, Pregnant Women and Obstetric Patients searched the published studies from the beginning until 2018. Results: According to the findings, hemorrhage and preeclampsia are the most common causes of hospitalization of pregnant women in the ICUs. Based on the findings of this study, hemorrhage with an incidence rate of 7 to 62% was the most common admission causes of pregnant women to the ICUs in Asian countries. The second reason for pregnant women referral to the ICUs was preeclampsia and eclampsia (2 to 25%). Other common causes for the ICU admissions during pregnancy included sepsis, HELLP syndrome, peripartum cardiomyopathy, cerebral palsy syndrome, and acute fatty liver of pregnancy. Conclusion: Bleeding and preeclampsia, sepsis, HELLP syndrome, peripartum cardiomyopathy, embolism of cerebral palsy and acute fatty liver of pregnancy are the most common causes of hospitalized pregnant women.

Introduction: Several controversial evidences have been recently reported on the use of prostate-specific antigens in the diagnosis of polycystic ovary syndrome (PCOS). This systematic review and meta-analysis study was performed with aim to determine the levels of prostate-specific antigens (PSA) in patients with PCOS. Methods: In this systematic and meta-analytical review, an electronic search was conducted in the databases of PubMed, Web of Science, Scopus, and Cochran Library. EndNote X6, Stata 14, and Review Manager 5. 3 were used to manage the searched articles, data analysis, and quality evaluation. Begg's test and Egger's test were used to evaluate the publication bias. Results: In this study, 17 studies with 1, 467 participants were included. Meta-analysis results showed that the amount of Prostate specific antigen in PCOS patients was significantly higher than the control group (Standardized mean difference: 1. 83, 95% CI: 1. 26-2. 39; P<0. 001), and the mean of fPSA was significantly higher in the PCOS group than the control group (Standardized mean difference: 1. 25, 95% CI: 0. 38-2. 12, P=0. 005). Conclusion: The results of this study showed that serum levels of PSA were higher in PCOS patients. It seems that racial differences and differences in assay techniques can affect the levels of PSA levels in PCOS patients. Measurement of the level of this antigen can be helpful in the diagnosis of PCOS.

Introduction: Fibroma is a sex cord-stromal tumor of ovary, a benign tumor and due to the source of stromal, it cannot produce CA125. CA125 is produced from epithelial cells of the peritoneum, Pleural, pericardium, endocervix, endometrium and fallopian tubes. In this article, a rare case of fibroma with increased CA125 levels is reported. Case presentation: The patient was a 48-year-old nulligravida woman with regular menstrual cycles, with a history of infertility that had undergoing IVF; during an ultrasound, a left ovarian mass was detected. The mass was solid with size of 160×100×90 mm in the left ovary and due to its association with high ascites, pleural effusion, and high CA125; she was admitted to the Imam Khomeini Hospital of Tehran. Conclusion: Increased CA125 levels and its association with adnexa masses, ascites and pleural effusion are the manifestations of malignant ovarian masses. Increased CA125 is not necessarily associated with malignancy, however, it should be considered as a differential diagnosis of Meigs' syndrome which is associated with benign ovarian fibroma masses. Evaluating the cytology of ascites and sending the mass to the pathology of frozen section during surgery should be used to prevent extensive surgeries and loss of fertility. In this patient, fibrothecoma was diagnosed based on Frozen and fibroma was a definitive diagnosis based on pathology.