Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2019 | Volume:22 | Issue:10|Papers Count:12

Introduction: The rate of mortality and complications are greater in preterm neonates. Therefore, preterm delivery should be avoided. This study was performed with aim to compare the duration of pregnancy in the administration of progesterone suppository and Duphaston tablet in pregnant women with preterm labor after stopping delivery process. Methods: This randomized clinical trial was performed on 195 pregnant women aged 18 to 37 years old with single-pregnancy and diagnosis of preterm labor at the gestational age of 24 to 34 weeks with healthy membranes who were admitted to the hospitals of Mashhad University of Medical Sciences in 2018-2019. After treatment of preterm delivery, if the process of delivery was stopped, pregnant women were randomly divided into three groups: (64 in progesterone suppository group, 65 in Duphaston tablet group and 65 in control group). Dydrogesterone was given as a 10 mg tablet twice daily every 12 hours, and progesterone was given as 200 mg suppository daily. The increase in the duration of pregnancy from the start of treatment to delivery, gestational age at delivery and neonatal results including: birth weight, first and fifth minutes Apgar and NICU hospitalization were evaluated. Data were analyzed by SPSS software (version 23) and ANOVA, Kruskal-Wallis, and Chi-square tests. PResults: In comparison of the results of progesterone suppository and Duphaston tablet, mean neonatal weight in progesterone suppository group was 293± 115. 9 gr higher than Duphaston group (P=0. 03). Among progesterone suppository group and Duphaston tablets group compared to control group, the mean increase in the duration of pregnancy was 11. 83± 2. 8 days (P=0. 01) and 7. 2± 2. 8 days (P=0. 03), the mean weight of infants was 578. 9± 115. 9 gr (P=0. 01) and 285. 9± 115. 9 gr (P=0. 03), the mean of first minute Apgar score (P=0. 003) and fifth minutes Apgar score (P = 0. 01) was significantly higher; but the mean age of pregnancy termination was significantly higher in only progesterone suppository group than control (P=0. 01) and there was no significant difference in Duphaston tablet group compared to control (P=0. 07). Conclusion: Progesterone suppository and Duphaston tablet increased the duration of pregnancy and age of pregnancy termination, neonatal weight and mean of 1 and 5 minutes Apgar score; but progesterone suppository was more effective in increasing neonatal weight compared to Duphaston tablet.

Introduction: Hypertension in obese patients is more affected by spinal anesthesia than normal people. Due to the lack of study and recommendation of articles about comparison of ephedrine and phenylephrine in obese patients during cesarean section, this study was performed with aim to compare the effect of hypotension treatment due to spinal anesthesia with ephedrine and phenylephrine on the status of arterial blood gas and Apgar score during cesarean delivery in obese mothers. Methods: This randomized clinical trial was performed in 2016 on 100 pregnant women with BMI≥ 30kg/m2 (according to the formula) who were candidates for elective cesarean section in Tabriz Alzahra Hospital. Demographic characteristics and maternal and fetal status as well as analysis of arterial blood gases of umbilical artery were included in the researcher-made checklist. Data were analyzed by SPSS software (version 20) and t-test, Chi-square and Mann-Whitney U test. P< 0. 05 was considered statistically significant. Results: There was statistically significant difference between two groups in terms of HCO3-(P=0. 048), BE (P=0. 035), heart rate (P=0. 002), systolic (P=0. 003) and diastolic (P=0. 004) blood pressure during anesthesia and surgery; phenylephrine group had more stability. No significant difference was found between two groups in terms of other variables (blood pressure and arterial oxygen saturation) (P>0. 06) and neonatal Apgar score (first and fifth minutes) (P>0. 05). Conclusion: Phenylephrine leads to better and more effective treatment of hypertension than ephedrine in pregnant women with BMI≥ 30kg /m2 with spinal anesthesia; also neonatal complications such as metabolic acidosis have been less observed in obese patients treated with phenylephrine.

Introduction: Regarding to high prevalence of breast cancer, it is important to find strategies for early, rapid, convenient and accessible diagnosis. After screening and detecting a lesion in the breast, the type of lesion and the degree of malignancy should be determined. This study was performed with aim to evaluate the concordance between sonographic and histologic findings in breast lesions under core needle biopsy. Methods: This cross-sectional prospective study was performed on 149 patients referred to Omid Hospital, Mashhad University of Medical Sciences who underwent core needle biopsy from breast lesions during 2015 to 2018. Patients who had BI-RADS 3, 4, and 5 and according to the surgeon's recommendation required biopsy of the lesion underwent ultrasonically guided biopsy. Also, the lesions which had a malignant sonographic view, but were placed in the benign lesions group after core needle biopsy and histologic examination, were evaluated with excision. Data were analyzed using SPSS software (version 22) and descriptive statistics (frequency distribution table and frequency percentage). Results: The histological findings of BI-RADS 3 lesions were completely benign (11 cases). The frequency of malignancy in lesions with BI-RADS 4 was 31% (39 cases). All cases with BI-RADS 5 were malignant according to histological finding. 8 (44%) of 18 cases with BI-RADS 4b lesions that were benign according to needle biopsy findings were malignant in excisional biopsy findings. Conclusion: In cases that breast lesions are BI-RADS 4b in sonography and the results of core needle biopsy showed benign lesions, additional histological diagnostic evaluation is recommended to rule out malignancy. More studies with higher sample sizes are recommended to confirm the results of this study.

Introduction: Cerebral vein thrombosis is a rare cerebrovascular disorder. Pregnancy and postpartum are associated with an increased risk of cerebral vein thrombosis due to hypercoagolopathy state. With regard to serious morbidity and mortality and the importance of pregnancy and postpartum period, special attention should be given to this disorder in this period. This study was performed with aim to determine the clinical signs and maternal and neonatal outcomes of cerebral vein thrombosis during pregnancy and postpartum period. Methods: This retrospective study was performed on 30 women with cerebral vein thrombosis during pregnancy and postpartum period in Mashhad Ghaem Hospital from 2011-2016. Data collection tool was a researcher-made questionnaire. Demographic data, initial clinical symptoms, affected sinus, infarct and hemorrhage, and maternal and neonatal mortality were collected. Data were analyzed by SPSS software (version 16) and paired t-test. P < 0. 5 was considered statistically significant. Results: Cerebral vein thrombosis was diagnosed in 13 women (43. 3%) during pregnancy and in 17 (56. 7%) during postpartum period. Primary manifestation in more than half of patients was headache (57. 7%). The upper sagittal sinus was the most common (70%) and the right sigmoid sinus was the rarest involved sinus (16. 6%). Among patients with cerebral vein thrombosis, 4 patients and one fetus died that all 4 patients had hemorrhagic infraction. Conclusion: Considering the importance of pregnancy and postpartum period, rapid diagnosis and timely treatment of cerebral vein thrombosis, especially pay attention to the symptom of headache, is important to improve the prognosis.

Introduction: In obstetric triage, women who referred with obstetric complaints and those with acute or emergency situation are first evaluated. Waiting time is one of the important factors that should be considered in the management and organization of the healthcare section. So far, the exact waiting time for emergency care and obstetric triage in Iran has not been estimated. Therefore, this study was performed with aim to determine mean waiting time for obstetrics triage in Tehran. Methods: This cross-sectional study was performed in 2018 on 9238 patients referred to obstetric triage of educational and medical hospitals in Tehran. Triage was actively performed using 5-level obstetric triage form (level 1: require immediate intervention, level 2: high risk requiring, levels 3: aassessment at the earliest opportunity, level 4: no acute problem, level 5: requires only one visit or consultation), In this research, a checklist containing personal, obstetrics, and also recording the time of triage and obstetric triage form was used. Data were analyzed by SPSS software (version 20) and descriptive statistical tests and ANOVA. P<0. 05 was considered statistically significant. Results: Mean total waiting time in morning, evening and night shifts were 22. 35 ± 3. 60, 18. 12 ± 3. 67 and 19. 15 ± 3. 67 min, respectively. ANOVA test showed no significant difference between mean waiting time based on working shifts per day (p = 0. 122) and month (p = 0. 473). Mean waiting time in level 2, 3, 4 and 5 of obstetric triage were 2. 73± 0. 40, 5. 3± 1. 13, 5. 76± 1. 69, 5. 96± 1. 20 min, respectively. Conclusion: Mean total waiting time for obstetric triage clients is somehow higher than the recommended rate. It is recommended to modify the process of service delivery to the clients of obstetrics triage in order to reduce the waiting time and achieve to the standard.

Introduction: Apoptosis is one of the etiologies of sperm DNA damage. Considering the crucial role of micro RNAs in multiple pathophysiological processes, the possibility of controlling the apoptosis process in sperm DNA by micro-RNAs has been proposed. This study was performed with aim to investigate the relationship between sperm DNA fragmentation and expression level of miR-15a/16 and Anti-apoptotic BCL-2 gene. Methods: This experimental study was performed on 30 patients referred to Tehran Taleghani Hospital infertility center in 2017. After 2-3 days of abstinence, semen was collected and analyzed based on WHO criteria. Sperm preparation was performed using density gradient centrifugation technique. To assess sperm DNA fragmentation, Sperm Chromatin Structure Assay was carried out and based on the level of DNA fragmentation, the samples were divided into two groups: DFI ≥ 30% and DFI<30%. The expression level of miR-15a/16 and BCL-2 was measured by quantitative Real Time-PCR. Data were analyzed using SPSS software (version 22) and independent t-test. The gene expression level was analyzed using REST 2009 software. P < 0. 05 was considered statistically significant. Results: A significantnegative relationship was found between DFI ≥ 30% with motility and normal morphology of spermatozoa (p<0. 05). The expression level of miR-15a/16 was significantly increased, and the expression level of BCL-2 gene was significantly decreased in patients with DFI ≥ 30% compared with DFI<30% (p<0. 05). Conclusion: Decreased expression of BCL2 following increased miR-16-1 leads to increased sperm DNA fragmentation. Assessment of miR-15a and apoptosis-related gene can be proposed as a diagnosing tool to ensure of sperm DNA integrity in male factor infertility cases in future.

Introduction: Spontaneous abortion is the most common complication of pregnancy. Identifying the associated factors can play an important role in preventing it and improving pregnancy outcomes. Some studies have suggested an association between vitamin D deficiency in pregnancy and abortion. Therefore, this study was performed with aim to compare serum levels of vitamin D in threatened-abortion patients and women with normal pregnancy. Methods: This case-control study was performed in 2016 on 46 pregnant women referred to Loghman Hakim and Mahdieh hospitals in Tehran in two groups of threatened-abortion and normal pregnancy less than 20 weeks. Blood samples of the subjects were assessed for vitamin D serum level. Data were analyzed using SPSS software (version 16) and independent t-test, Mann-Whitney, and chi-square tests. P<0. 05 was considered statistically significant. Results: The mean of 25(OH)D concentration was 22. 49 ± 9. 22 ng/ml in case group and 30. 36 ± 10. 03 ng/ml in control group and there was a significant difference between the two groups (p = 0. 008). Conclusion: Serum 25(OH)D levels in threatened-abortion pregnant women are lower than in women with normal pregnancy. Low serum levels of vitamin D can be considered as a risk factor for threatened-abortion.

Introduction: The prevalence of nipple pain is reported to be 34-96% which is among the common causes of early breastfeeding stopping. Lanolin is the recommended treatment to improve nipple pain. The anti-inflammatory and analgesic properties of boswellia have been approved. Therefore, this study was performed with aim to determine the effect of boswellia and lanolin ointment on nipple pain intensity in lactating women. Methods: This triple-blind randomized clinical trial was performed in 2018 on 68 lactating women with pain intensity of > 3 in pain visual scale in Mashhad. The subjects were placed in two groups of lanolin and boswellia ointment. The correct method of lactation and drug use were taught to the two groups. The score of nipple pain was recorded by the researcher before the intervention, on day three and eight after the intervention. Data were analyzed by SPSS software (version 21) and T, Fisher, Chi-square and Wilcoxon statistical tests. P<0. 05 was considered statistically significant. Results: Before the intervention, mean pain severity in the two groups of lanolin and boswellia ointment was not significantly different (P = 0. 23). On the seventh day after the intervention, mean pain severity was not significantly different in the two groups of lanolin and boswellia ointment (P = 0. 40). But on the third day, mean of pain severity was significantly different between the two groups of lanolin and boswellia ointment (p <0. 001) and pain intensity was lower in boswellia group than lanolin group. In intra-group comparison, mean pain intensity after the intervention (3rd and seventh day) was lower than the pre-intervention stage, which was statistically significant (P <0. 001). Conclusion: Boswellia ointment and lanolin are same effective in reducing nipple pain.

Introduction: Nurses and staff of operating room are exposed to several occupational exposures; some of these exposures may have adverse influences on their reproductive health. Therefore, this study was performed with aim to evaluate occupational exposures and preterm birth history in operating room staff and nursing wards of Isfahan teaching hospitals. Methods: This descriptive study was performed on 300 women working in nursing wards and operating room of Isfahan educational hospitals in 2017 to 2018. Data collection tool was a questionnaire. The questionnaire included demographic and fertility information, occupational status, and adverse pregnancy outcomes during the last pregnancy. Data were analyzed by SPSS software (version 16) and T-test, Chi-square and Mann-Whitney tests. PResults: In this study, 29 (19. 3%) of women working in operating room and 24 (16%) of women working in nursing wards had a history of preterm delivery at last pregnancy that was not significantly different (P = 0. 45). 111 operating room staff (74%) experienced more than 3 hours of standing and 42 (28. 1%) experienced over 44 hours of work per week. The operating room group was more exposed to anesthetic gases, sterilizing agents, and stressful environments that was statistically significant (P< 0. 05). Despite the difference in most adverse occupational situations, no statistically significant difference was found between two groups in terms of preterm delivery risk (P = 0. 45). Conclusion: Regarding the frequency of undesirable occupational situations in both groups, especially the operation room group, no significant difference was found between two groups in the incidence of preterm labor. Therefore, it is suggested that a similar study be carried out with a larger sample size and, if possible, at national level and as a prospective cohort.

Introduction: Puberty is the period of developmental changes from childhood to adulthood and the acquisition of fertility. The time of puberty likely affects future risks such as cancer, metabolic syndrome and cardiovascular diseases. Many evidences point to the role of environmental exposure in changing the time of puberty. This review article was performed with aim to investigate the effect of lead on pubertytime in girls and boys based on the studies performed in this field. Methods: In this review article, English and Persian articles related to observational studies which were indexed in databases of Embase, PubMed, Scopus, ISI Web of Science, SID, and Google Scholar during 2000-2018 with different combinations of the keywords of "lead” and "Puberty" were selected from Medical Subject Headings (MESH). From 182 reviewed articles, 12 articled related to the aim were selected based on inclusion and exclusion criteria and quality of reporting articles according to STROBEchecklist. Results: 12 articles were classified in two domains of lead effects on the puberty of girls and boys. The results of most studies showed that there was a statistically significant association between blood lead levels in girls, especially high levels, with delayed appearance of menarche, development of breast and growth of pubic hair. In boys, there was a statistically significant association between blood lead levels, especially high levels, with a delay in the process of puberty, including increased testicular mass and growth of pubic hair. Conclusion: Lead can affect the natural process of puberty, and especially is effective in delaying puberty of girls and boys.

Introduction: Asherman syndrome (uterine adhesion) occurs due to injuries to the basal layer of endometrium that is usually caused following surgeries of uterine such as curettage and myomectomy. In the next pregnancy, obstetrical complications such as abortion, placenta pravia and acreta may be increased. Case presentation: In this study, a case of amenorrhea after one uncomplicated caesarean section is reported. She had spontaneous pregnancy after treatment with three times histroscopy. In the next pregnancy, she developed severe adhesion to the myometrium, resulting in severe hemorrhage and hysterectomy. Conclusion: Ashman syndrome may be caused following an uncomplicated cesarean section and may increase the chance of obstetrical complications in next pregnancy.