Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2019 | Volume:21 | Issue:12|Papers Count:12

Introduction: Menopause is one of the crises in women’ s life and most women experience physical and psychological symptoms along with mood changes during this period. Among non-hormonal alternative treatments, medicinal herbs with phytoestrogen have been more considered. Therefore, the present study was conducted with aim to compare the effect of black Cohosh versus Vitagnus on the improvement of menopause symptoms. Methods: This double-blind clinical trial was performed on 135 menopausal women who were under the coverage of the health centers of Rafsanjan in 2015. The subjects were randomly assigned into three groups of black Cohosh, Vitagnus and control. Data about menopause symptoms were collected using MRS questionnaire before, four weeks and eight weeks after the intervention. Data were analyzed using SPSS software (version 18), and variance analysis, Chi-square, and Mann-Whitney tests. PResults: There was no significant statistical difference in the mean of total score of menopausal symptoms in the three groups of black Cohosh, Vitagnus and control before the intervention (p = 0. 85). Four and eight weeks after the intervention, there was a significant statistical difference between the three groups (p < 0. 001); so that the mean of total score of menopausal symptoms in two groups of black Cohosh and Vitagnus was less than the control group, and the mean of total score of menopausal symptoms in two groups of black Cohosh and Vitagnus had no significant difference (p>0. 05). Conclusion: Considering the effectiveness of both plants of black Cohosh and Vitagnus on the improvement of menopause symptoms, it is recommended to use this treatment, but the use of Vitagnus seems more affordable because it is a local plant in Iran.

Introduction: Arrest of descent is one of the major indications of cesarean delivery and two commonly used methods are Push and Pull methods. In this study, considering the complications and problems caused by cesarean section, and the necessity of an appropriate strategy to reduce these problems, and the problems created for full-arrest neonates, we determined the APGAR score of neonates and compared the maternal and neonatal outcomes in cesarean section by Pull and Push methods in order to improve the quality of life and reduce the neonatal complications. Methods: This cross-sectional study was performed on 126 women who had undergone an emergency cesarean section due to arrest of descent in Ali ibn Abi Talib Hospital of Zahedan in 2016-2017. The maternal outcomes (bladder injury, uterine extension, duration of hospitalization) and neonatal outcomes (Apgar score) in cesarean section by Pull and Push methods were collected using the forms containing these information. Data were analyzed by SPSS software (version 21), and descriptive tests, Chi-square and independent t-test. Results: The mean of 1 and 5 minutes Apgar score in Pull method was significantly higher than Push method (p <0. 001). Also, uterine extension in cesarean section by Pull method was significantly lower than Push method (p <0. 001). Conclusion: The pull method is superior to the push method due to lower complications and better maternal and neonatal outcomes.

Introduction: Pregnant women colonization with Group B Streptococcus (GBS) besides infecting the mother can increase the risk of preterm labor and transmission of bacteria to neonate during childbirth, which can cause sepsis and neonatal meningitis during the first 6 weeks of life. Therefore, this study was performed with aim to identify the colonization in pregnant women with Streptococcus agalactiae referred to two Isfahan by PCR after 4 and 24 hours of enrichment culture and comparing with phenotypic results. Methods: This descriptive study was performed on 200 pregnant women with gestational age of 35-37 weeks who had referred to Shahid Beheshti hospital in Isfahan during one year (2015) for monthly examinations. Sampling was done from the vaginal area (a third terminal) and rectum by sterile swabs separately. Collected specimens were transferred to enrichment broth medium and after 4 and 24 hours incubation, PCR method was performed. After 24 h, all specimens were evaluated using phenotypic methods. Also, sensitivity and specificity of molecular method were calculated. Data were analyzed by SPSS software (version 19), and logistic regression. PResults: Among 200 pregnant women, 22 (11%) were colonized using phenotypic and 27 (13. 5%) were colonized using PCR methods after 4 and 24 hours; no difference was observed between the results. According to the results of statistical tests, the sensitivity of molecular method after the mentioned times was 100% and the specificity were 97% and 95% for vaginal and rectal specimens, respectively. Conclusion: Using PCR method after 4 hoursincubation of enrichment medium not only increase the speed of the colonization detection in pregnant women with Streptococcus agalactiae, but also provides the opportunity to perform the antibiotic susceptibility tests after bacteria growth and chose the appropriate prophylaxis or treatment if needed.

Introduction: self-medication of herbal medicines during pregnancy can create dangers for the mother and fetus. Considering the existence of common pregnancy problems among many pregnant women and since people think that herbs are harmlessness; this study was conducted to determine the prevalence of self-medication of medicinal plants in treatment of common pregnancy problems in women referred to health centers in Kashan. Methods: This cross-sectional descriptive-analytic study was performed on 300 pregnant and postpartum women referred to health centers of Kashan in 2018. Data collection tool was a researcher-made questionnaire which included demographic information and a checklist of herbal medicines for treatment of pregnancy common problems. Data were analyzed by SPSS software (version 17), and descriptive statistics and Chi-square test. P˂ 0. 05 was considered statistically significant. Results: According to the results of this study, 164 cases of women (57. 1%) had used the herbs to resolve the common problems during pregnancy without consulting and prescribing of physician. The most common problems for which the pregnant women used herbs to treat them were heartburn، constipation، nausea، and anemia. Conclusion: Considering the high prevalence of consumption of herbal medicine in resolving the common problems of women during pregnancy, the necessity of informing the public about self-medication of medicinal plants is felt.

Introduction: Bacterial vaginosis is the most common lower genital tract infection among women in reproductive age. Its causative agent is often the bacterium Gardnerella vaginalis which exists in synergism with other mostly anaerobic bacteria such as Atopobium vaginae, Mobiluncus curtisii and Megasphaera type I. The present study was conducted with aim of measuring molecular measurements (PCR) in the detection and diagnosis of bacterial vaginosis in women. Methods: This descriptive study was performed on 100 women referred to Obstetrics and Gynecology Clinics of Al-Zahra Hospital and private clinics in Rasht from September 2016 to October 2017. They were examined and tested for bacterial vaginosis. The presence of Gardnerella vaginalis was tested by five different laboratory methods based on Amsel criteria and molecular methods including determination of appearance characteristics, determination of pH, Whiff test, and observation of Clue cells in direct smear, conducting Polymerase Chain Reaction (PCR) using specific primers on DNA extracted from vaginal specimens. Data were analyzed using SPSS software (version 21) and Chi-square test. P<0. 05 was considered significant. Results: In this study, from a total of 100 suspected women who were examined for vaginal infection with use of Amsel method, 31 cases (31%) of vaginosis were confirmed. Using the molecular method of PCR in women with vaginosis (Amsel method), Gardnerella vaginosis was confirmed in 14 (45%) and Atopobioum vagine in 10 (32%). Conclusion: Using the PCR method showed that Gardenerella vaginalis and Atopobium vaginae play an important role in womenaged 18-35-year-old with bacterialvaginosis that indicates the role of these two bacteria in the development of bacterial vaginosis.

Introduction: Premenstrual syndrome is a set of physical and psychological symptoms which occur periodically during the secretory phase of the menstrual period. This study was performed with aim to compare the effect of Evening Primrose Capsule and vitamin B6 and placebo on the severity of premenstrual syndrome symptoms. Methods: This randomized double-blind clinical trial was conducted on 120 students with premenstrual syndrome at Hamadan University of Medical Sciences in 2016. The subjects were randomly divided into 3 groups of 40 cases and for two consecutive cycles, the first group received daily 2 tablets (40 mg) vitamin B6, the second group received evening primrose capsules (1000 mg) twice daily, and third group received daily 2 placebo, 14 days before menstruation up to 5 days after it. The severity of premenstrual syndrome symptoms was compared at the end of each cycle by daily status recording form. Data were analyzed by SPSS software (version 21) and Chi-square, ANOVA, paired t-test, and Tukey test. P<0. 05 was considered statistically significant. Results: Before intervention, the mean severity of symptoms in the group receiving vitamin B6 was 62. 54± 22. 17 and in the group receiving evening primrose capsules was 61. 45± 21. 25 that after the intervention decreased to 54. 08± 18. 15 and 21. 38± 9. 05, respectively, but in the placebo group, the severity of the symptoms before the intervention was 61. 21 ± 30. 12 and the severity of the symptoms increased after the intervention (62. 48 ± 19. 17). The severity of premenstrual syndrome symptoms had significant decrease only in the group of evening primrose capsule (P <0. 01). Conclusion: The evening primrose capsule significantly reduces the symptoms of premenstrual syndrome compared with vitamin B6 and placebo; therefore, due to the limited side effects observed, it can be useful in women with premenstrual syndrome.

Introduction: Sleep disorders are of common problems during pregnancy. The rate of gestational diabetes (GDM) is increasing in Iran. Is gestational diabetes may cause sleep disorders during pregnancy? This study was performed with aim to compare sleep disorders in pregnant women with and without GDM. Methods: This comparative descriptive study was conducted on 240 pregnant women with gestational age of 22-32 weeks referring to health centers of Tehran ShahidBeheshti University of Medical Sciences in 2016. Case group consisted of 120 pregnant women with Fasting Blood Sugar>120 or Glucose Challenge Test>140 or abnormal Glucose Tolerance Test. Control group included 120 healthy pregnant women with normal blood sugar. Data collection tool were Pittsburgh Sleep Quality Index, Depression Anxiety Stress Scales-21 and demographic characteristic questionnaires which were completed through interview. Data were analyzed using SPSS software (version 16), Mann-Whitney test and independent t test. P<0. 05 was considered statistically significant. Results: Mean total sleep score was 17. 37± 5. 79 in healthy women and 13. 42± 9. 32 in women with GDM. Statistical significant difference was observed between two groups in terms of age, number of pregnancy and number of abortion (P<0. 05). Mean scores of depression, anxiety, and stress were higher in women with GDM. Statistical significant difference was observed between two groups in terms of subjective sleep quality (P=0. 005), sleep duration (P<0. 001), and total score of sleep quality (P<0. 001). Conclusion: Gestational diabetes can affect some dimensions of sleep. Sleep quality is lower in pregnant women with GDM than healthy pregnant women.

Introduction: Breech presentation is one of the most abnormal presentations of fetus at term pregnancy, and cesarean delivery is performed in most cases. Positioning techniques is one of the methods which is recommended to turn breech presentation into cephalic presentation. This study was performed with aim to determine the effect of knee-chest position on breech presentation turning to cephalic presentation in pregnant women. Methods: This randomized clinical trial was conducted on 84 pregnant women with breech presentation and gestational age of 34-36 years referred to health centers of Mashhad in 2016-2017. The subjects were randomly divided into intervention and control groups. The intervention group, in addition to routine prenatal care, performed knee-chest position for 10-15 minutes for ten days, three times daily. The control group received routine care. The data collection tool was personal characteristics and midwifery information form, recording the mother's knee-chest position, and follow-up form. The fetus presentation was screened immediately after intervention and during delivery in both groups. Data were analyzed using SPSS software (version 23), independent t-test, Chi-square, Fisher exact test, Mann-Whitney test and logistic regression. P < 0. 05 was considered statistically significant. Results: The results of logistic regression showed that immediately after the intervention, the mothers of the intervention group had 3. 8 times of the chances of fetus presentation turning to cephalic than the women in the control group (confidence interval: 1. 467-16. 415, OR=3. 8, P=0. 01). Also, this chance was 3. 43 times during delivery (confidence interval: 1. 095-10. 745, OR=3. 43, P=0. 034). Conclusion: The mother’ s knee-chest positioning can turn breech presentation to cephalic. Therefore, it is recommended to use this position along with other prenatal care for qualified mothers in health care centers.

Introduction: Postpartum hemorrhage is considered as one of the major causes of maternal mortality in the world. Identification of women at risk of postpartum hemorrhage prepares the medical team for faster therapeutic decisions which can reduce maternal complications. This study was performed with aim to identify the risk factors of vaginal delivery postpartum hemorrhage. Methods: This cross-sectional analytic study was performed on 600 women referred to Omol-Banin Hospital of Mashhad in 2017. After delivery, the researcher measured and recorded lost blood volume in mothers via plastic blood collection bags and pads within 4 hours after delivery. Data were analyzed by SPSS software (version 25) and Mann-Whitney, independent t, Chi-square, and Fisher Exact tests. P<0. 05 was considered statistically significant. Results: PPH occurred in 33. 3% of deliveries in this study. The results of the logistic regression test showed significant relationship between PPH and nulliparity (OR: 5. 987، CI: 1. 870-8. 821)، hemoglobin level (OR: 1. 849، CI: 1. 677-2. 890)، platelet levels (OR: 2. 955، CI: 1. 989-3. 001)، Afghan race (OR: 3. 645، CI: 1. 141-8. 644)، Barbarian race (OR: 5. 958، CI: 3. 452-6. 645)، history of PPH(OR: 4. 562، CI: 1. 570-6. 597)، preeclampsia(OR: 20. 126، CI: 3. 831-21. 114)، duration of the second stage (OR: 4. 452، CI: 2. 265-5. 674)and third stage(OR: 3. 620، CI: 1. 857-6. 325) of labor، consumption of Magnesium sulfate(OR: 67. 107، CI: 60. 471-69. 101)، uterine fundal pressure(OR: 4. 941، CI: 3. 305-5. 903)، use of vacuum(OR: 14. 123، CI: 10. 003-18. 831)، episiotomy(OR: 2. 143، CI: 2. 136-3. 349)، genital tract tears(OR: 17. 889، CI: 14. 152-18. 950), neonatal birth weight(OR: 4. 025، CI: 3. 641-6. 850)، placenta weight(OR: 3. 988، CI: 2. 980-3. 997)، and courage (OR: 15. 005، CI: 13. 520-15. 224) were each associated with an increased odds of PPH. Conclusion: The most important cause of postpartum hemorrhage is uterine atony and the most important risk factors are nulliparity، Afghan and Barbarian race، history of PPH، preeclampsia، increased duration of the second and third stage of labor، consumption of Magnesium sulfate، uterine fundal pressure، use of vacuum، genital tract tears، placenta weight، neonatal birth weight and courage.

Introduction: Breast engorgement is considered as one of the most common postpartum problems and one of the main causes of stopping breast feeding. It may be involved in nipple pain, nipple injury, and breast infections. Therefore, this study was performed with aim to determine the effect of Ginger warm compression on the severity of breast engorgement. Methods: This clinical trial study was performed on 76 lactating women with breast engorgement referred to the obstetrics clinic and gynecology department of Imam Reza Hospital (Mashhad) in 2018. The subjects were randomly divided into two groups: Ginger warm compress and routine care. Severity of engorgement was determined by engorgement severity standard index. The treatment was performed three days a day for two days in both groups. Data related to the severity of engorgement before and after the intervention was analyzed by SPSS software (version 22) and Mann-Whitney, T-Paired, Independent T-test, Chi-square and ANOVA tests. P<0. 05 was considered significant. Results: Two groups were homogeneous in terms of the mean score of the severity of breast engorgement before the intervention. There was no significant difference between the two groups in the severity of right (p = 0. 329) and left (p = 0. 549) breast engorgement. The mean of total engorgement after intervention in right and left breast decreased in Ginger compression group and control group, but the effect of breast engorgement severity in Ginger compression group was significantly higher than control group(p<0. 001). Conclusion: Ginger compression is more effective than routine care in decreasing the severity of breast engorgement symptoms in lactating women.

Introduction: Antibodies against Human leukocyte antigen (HLA) is produced following blood transfusion, pregnancy or organ transplants. These antibodies are involved in abortion and even present in non-allommunized healthy people. Anti-HLA antibodies lead to some complications of blood transfusion; therefore, this study was performed with aim to determine the frequency of HLA antibodies among blood donors focusing on females (with and without previous pregnancy and abortion). Methods: In this descriptive survey which was performed in 2016, 214 blood donors referring to Tabriz blood transfusion center with age range of 18-62 years, including 57 females (26. 6%) with age range of 23-59 years (mean age of 38. 7 ± 9. 3 years) and 157 male (73. 4%) with age range of 18-62 years (mean age of 36. 2 ± 9. 7 years) were evaluated. Panel Reactive Antibody (PRA) test by test by lymphocytotoxicity with complement (CDC) method was used to evaluate anti-leukocyte antibodies. Demographic information and the number of pregnancy/abortion were recorded in information forms. Data were analyzed by SPSS software (version 16) and Chi-square and Pearson correlation coefficient. PResults: 23 cases (10. 75%) including 22 females (8 without and 14 with previous pregnancy and abortion) and one male had positive results for PRA, and the others were negative. The frequency of positive results of PRA were higher in women (P <0. 0001). No relationship was found between these antibodies and pregnancy number, but the frequency of HLA antibody and PRA positive cases was significantly different between women with and without history of abortion (P <0. 001) and was significantly associated with the number of abortion (r=0. 52, p<0. 0001). Conclusion: The number of abortion affects sensitization or immunization during pregnancy. Increasing the number of abortions increases the likelihood of immunization. These antibodies were seen in healthy subjects without history of pregnancy and even in men. The decision to evaluate the plasma of men and women without previous pregnancy prior to injection requires cost-benefit studies.

introduction: Urinary incontinence is one of the priorities in the field of health because it has a significant impact on quality of life. Women with incontinence problem usually live in silence. Awareness of the precise prevalence rate will help to perform the proper interventions at the right time. Therefore, this study was performed with aim to determine the prevalence of urinary incontinence in Iranian women. Methods: In this systematic review and meta-analysis, the articles were searched in databases of Pubmed, Scopus, Magiran, SID, Cochran, and Google Scholar by the keywords of urinary incontinence, prevalence, frequency, women, stress urinary incontinence, urge urinary incontinence, Mixed incontinence, and all the possible combinations with OR, AND. Chi-square and I2 indices were used to calculate heterogeneity of studies. Egger and Begg tests were used to evaluate the release bias. Data were analyzed by Stata software (version 11). Results: A total of 10 studies entered to the study which had 5008 participants. The estimation of the overall prevalence of urinary incontinence was 46% (confidence interval of 95%: 30-62), stress urinary incontinence was 34% (confidence interval of 95%: 27-42), urge urinary incontinence was 19% (confidence interval of 95%: 12-26), and mixed urinary incontinence was 24% (confidence interval of 95%: 11-37). Conclusion: The overall incidence of urinary incontinence in Iranian women is 46%, which indicates the urgent need for attention to this problem.