Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2021 | Volume:23 | Issue:12|Papers Count:14

Introduction: The WHO application of ICD-10 to deaths during pregnancy, childbirth and the puerperium (ICD-MM) leads to a better understanding of maternal mortalities. This study was performed with aim to determine the causes of pregnant mothers' mortalities in the educational hospitals of Zahedan University of Medical Sciences using the ICD-MM. Methods: In this cross-sectional study which was conducted in 2019, 107 records of pregnant mothers' mortalities occurred in Zahedan in 2011-2018 were studied. The causes of deaths were coded using ICD-MM with three volumes of ICD-10 (The 10th revision of the International Statistical Classification of Diseases and Related Health Problems). Data were recorded in the data collection form and were analysed by SPSS software (version 15). Results: During 8-years of the study period, 107 cases of maternal mortality occurred. The maternal mortality ratio in the study population was 254 per 100, 000 live births and the mean age of dead pregnant mothers was 31. 7 ± 7. 3 years. Direct causes with 73. 8%, indirect causes with 20. 6%, unspecified causes with 2. 8% and coincidental causes with 2. 8% were responsible for maternal mortalities. Other obstetric complications with 22. 4%, obstetric hemorrhage and non-obstetric complications with 20. 6% had the most values in maternal mortalities between nine groups listed in the ICD-MM. Conclusion: Postpartum coagulation defects, puerperal sepsis, and other blood diseases and blood-forming organs and certain disorders involving the immune mechanism were three main causes of maternal mortalities in this study. Therefore, predicting hemorrhage and preparing to control it, such as rapid access to blood and its products, screening of pregnant mothers with blood diseases and providing them with specialized training and care, as well as paying more attention to postpartum care for at least 42 days after delivery, especially in cases of postpartum hemorrhage and infection, could be effective in preventing more maternal mortality.

Introduction: Diabetes interfere the glucose homeostasis and reduces physical fitness and brain health. This study was performed with aim to compare some physical fitness and physiologic factors in overweight diabetic and non-diabetic elderly women. Methods: This descriptive-analytical study was performed on 34 elderly women in Khorramabad city in 2019. One week before performing physical fitness tests, blood sample was taken in fasting state to measure serum levels of glucose, irisin, HbA1c and BDNF. Five days before doing the study, the subjects were familiarized with the method of performing the tests. Then, on the day of the study, some physical fitness tests special for the elderly were performed. Data were analyzed by Independent t-test and Pearson correlation coefficient test. P< 0. 05 was considered statistically significant. Results: There was no significant difference between the diabetic and non-diabetic groups in all physical fitness variables (p>0. 05). However, all physiologic variables showed a significant difference (p<0. 05). Also, in the non-diabetic group, there was a significant negative correlation between BDNF and HbA1c (p = 0. 0005 and r =-0. 824) and irisin and HbA1c (p = 0. 0005 and r =-0. 734) and a significant positive correlation between BDNF and irisin (p = 0. 004 and r = 0. 608). But in the diabetic group, there was a significant positive correlation between glucose and HbA1c (p =0. 028 and r =0. 586) and irisin and BDNF (p = 0. 0005 and r = 0. 853) and a significant negative correlation between glucose and irisin (P = 0. 015 and r =-0. 636), BDNF and HbA1c (p = 0. 002 and r =-0. 759) and irisin and HbA1c (p = 0. 002 and r =-0. 752). Conclusion: It seems that the level of physical fitness of overweight non-diabetic and diabetic elderly women is the same. But the non-diabetic group was better in physiological variables. Also, irisin plays more important role than BDNF in diabetes.

Introduction: According to some studies, magnesium in pharmacological concentrations has antithrombotic effects, causing platelet dysfunction in vitro and in vivo. This study was performed with aim to evaluate the effect of magnesium sulfate on blood coagulation status in pregnant women with preeclampsia. Methods: This cross-sectional study was performed in 2013-2014 on 56 pregnant women with mild preeclampsia. Platelet count and magnesium levels, bleeding time (BT), prothrombin time (PT), and activated partial thromboplastin time (aPTT) were measured before and two hours after magnesium sulfate injection. Data were collected and analyze by SPSS software (version 16) and paired t-test and Chi-square test. P<0. 05 was considered statistically significant. Results: Mean serum magnesium level in the patients was 4. 53 ± 0. 51 mEq/L. Mean platelet count of patients before and after prescribing magnesium were 176. 55± 43. 84 ×1000 vs 173. 25± 51. 51×1000, respectively; no significant difference was observed (P=0. 108). Mean PT (prothrombin time) before and after the treatment was 13. 36 ± 0. 69 seconds vs 13. 57± 0. 79 seconds, respectively. There was no significant difference between PT before and after treatment (P = 0. 059). Mean PTT (partial thromboplastin time) before and after the treatment was 38. 1± 2. 05 and 38. 26± 2. 92 seconds, respectively. There was no significant difference between PTT before and after treatment (P=0. 756). Mean BT of women before and after magnesium administration were 109. 55± 39. 7 vs 123. 48± 44. 87, respectively (P=0. 013). Conclusion: BT in therapeutic values increased in pregnant women after prescribing magnesium sulfate.

Introduction: Given the importance of assisted reproductive therapies and achieving a pregnancy leading to live birth, as well as the importance of the used treatments and the various studies which have been performed so far, this study was performed with aim to evaluate the relationship between endometrial pattern and serum progesterone levels at the day before the onset of progesterone suppository in embryo transfer cycles in women referred to Infertility Center of Zahedan. Methods: This cross-sectional study was performed on 50 women who had undergone IVF for any reason and their embryos were frozen in infertility center of Zahedan University of Medical Sciences in 2019. The patients were treated with progesterone suppository 400 mg at morning and 400 mg at evening intra rectally. Demographic data, endometrial pattern and thickness ultrasound, serum progesterone level at the day before the onset of progesterone suppository and serum BHCG levels 14 days after embryo transfer were recorded. Data were analyzed by SPSS statistical software (version 24) and Chi-square and Mann-Whitney tests. P<0. 05 was considered statistically significant. Results: IVF outcome was positive in 13 cases (26%). 23 patients (46%) had homogenous endometrial pattern and 27 (54%) had three-line pattern. Serum progesterone level were significantly lower in patients who had positive BHCG than patients who had negative BHCG (p <0. 001). Conclusion: Among women undergoing IVF, serum progesterone levels and also endometrial pattern (homogenous or three-line) was different. Serum progesterone level before the onset of treatment was related to the pregnancy outcome (positive or negative), as well as in women with lower progesterone levels in day before the start of progesterone suppositories, treatment with progesterone suppository could lead to better pregnancy outcomes following IVF, which is a novel and important finding.

Introduction: Polycystic ovary syndrome affects 5-10% of women of reproductive age and is characterized by irregular menstruation, hyperandrogenism, and ovarian cysts. Iranian traditional medicine products can be effective in treatment of this syndrome. This study was performed with aim to evaluate the effect of compound honey syrup on the polycystic ovary syndrome induced by estradiol valerate in female rats. Methods: In this experimental study conducted by traditional medicine and matria medica research center of Shahid Beheshti University of Medical Sciences in animal laboratory of Shahid Beheshti University of Medical Sciences on female rats in 2017, the compound honey syrup (Ma-ol-asal) (containing honey, cinnamon, ginger, saffron, cardamom, galangal, nutmeg, mace and mastic) was used. Thirty female rats were classified into five groups of cases: negative control, positive control, and three treatment groups (receiving two doses of compound honey syrup (1ml/kg and 2ml/kg) and metformin). Polycystic ovary syndrome was induced by injection of Estradiol valerate. At the end of intervention, the rats were euthanized, hormones were measured, and the ovarian histology was examined. Data were analyzed by SPSS software (version 24) and Kruskal-Wallis and Dunn-Bonferroni tests. p < 0. 05 was considered statistically significant. Results: At the end of the study, weights of ovaries in the metformin and Ma-ol-asal 2 groups were higher than the untreated group. There was no change in body weight or abdominal fat. There was a significant increase in levels of progesterone in three treatment groups (P=0. 002) and significant reduction of estrogen in the metformin group compared to the untreated group (P=0. 021). There was significant reduction of number of ovary cysts in Ma-ol-asal 1 group (P=0. 001), and significant increase in the number of Corpus luteum, and antral follicles in Ma-ol-asal 1 and 2 groups compared to the untreated group (P=0. 010). The number of graph follicles did not differ significantly in the groups (P=0. 083). Conclusion: Compound honey syrup was effective in improving hormonal and histological status in polycystic ovary syndrome as much as metformin and was more effective in some cases.

Introduction: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder with oxidative stress in women of reproductive age. Oxidative stress is an important factor in the development of insulin resistance. Some nutrients are linked to oxidative stress. This study was performed with aim to determine the relationship between insulin resistance and dietary intake of vitamins D and E in PCOS subgroups. Methods: This case-control study was performed in 2015-2016 on 151 women with PCOS who were divided into four groups according to Rotterdam diagnostic criteria (D (H+O) = 37, C (P+O) = 40, B (H+P)= 33, A (H+P+O) = 41 and 31 women in the control group). Daily intake of vitamin D and vitamin E was assessed using a 168 items PPQ food frequency questionnaire. Insulin resistance was diagnosed with HOMA index (Cut off> 2. 5). Data were analyzed by SPSS software (version 22) and Kruskal-Wallis, one-way ANOVA, Chi-square and Spearman tests. P<0. 05 was considered statistically significant. Results: In the subgroups of A, D and control group, a significant negative relationship was observed between HOMA insulin resistance index with vitamin D (P = 0. 022), (P = 0. 049) and (P = 0. 025), respectively and with vitamin E (P = 0. 036), (P = 0. 001) and (P = 0. 001), respectively. In the subgroups of B and C, no relationship between HOMA insulin resistance index with vitamin D and vitamin E (P> 0. 05). Conclusion: Due to the relationship between insulin resistance and vitamins D and E in PCOS subtypes, it is recommended to increase the intake of vitamins D and E to improve health parameters in PCOS subjects.

Introduction: Physical activity and exercise through different mechanisms can promote health in individuals. The body's bone tissue can alter glucose and fat metabolism under the influence of physical activity and exercise. Therefore, this study was performed with aim to investigate the effect of high intensity interval training (HIIT) on serum levels of under-carboxylated osteocalcin, insulin resistance and lipid profile in overweight girls. Methods: This randomized controlled clinical trial study was performed on 24 overweight female students (body mass index: 28. 58± 2. 38) in Shahid Chamran University of Ahvaz in 2020. The subjects were randomly divided into two groups of 12-member: HIIT and control. The training group practiced for 6 weeks (3 sessions per week), while the control group did not have any regular physical activity. Blood samples were obtained for measurement of serum level of Osteocalcin, glucose, insulin and lipid profile (48 hours before and after the intervention period). Data were analyzed by SPSS software (version 23) and paired-t and independent t-test. P<0. 05 was considered statistically significant. Results: Performing high intensity interval training for 6 weeks led to an increase in serum levels of under-carboxylated osteocalcin (P=0. 045), significant decrease in glucose (P=0. 026), insulin resistance (P=0. 036), triglycerides (P=0. 017) and LDL (P=0. 04) in overweight girls; while, no significant changes were observed in other components of lipid profile (total cholesterol and HDL) (P≥ 0. 05). Conclusion: Performing high intensity interval training led to a significant improvement in insulin resistance and some features of the lipid profile (triglycerides and LDL). This may be due to an increase in the endocrine function of the bone (under-carboxylated osteocellin).

Introduction: The complication caused by estrogen deprivation during menopause has negative effects on women's quality of life. The use of food-based strategies based on Iranian traditional medicine is one of the suggested strategies to relieve menopausal sign and symptoms and finally improves their quality of life. Therefore, this study was performed with aim to determine the effect of food-based strategies based on Iranian traditional medicine on women's quality of life during menopause. Methods: This two-group clinical trial study was performed on 57 postmenopausal women in 2018. Two health comprehensive service centers of Chardah-Masoum and Imam Hassan were randomly selected from health center (No 2) as the intervention and control group, respectively. Then, the eligible women were sampled by convenience. In the intervention group, food-based strategies of Iranian medicine were educated in three sessions of 60-90 minutes during 3 week. The control group received routine care of the health center. Two groups were followed up for 2 monthsin adherence to orders. Data was collected through Menopause Specific Quality of Life Questionnaire (MENQOL), Beck Anxiety and Depression Inventory and Mizaj questionnaire. Data were analyzed by SPSS software (version 16) and independent t-test, Chi-square, Mann-Whitney, and Wilcoxon tests. p < 0. 05 was considered statistically significant. Results: There was no statistically significant difference between quality of life, depression, anxiety and mizaj of women in the two groups before the intervention (p>0. 05). But after the intervention, decreased scores showed an improvement in quality of life and depression in the intervention than the control groups (p <0. 001). Conclusion: The use of food-based strategies increases the quality of life in menopausal women. So, it is suggested for management of the signs of menopause.

Introduction: Trichomoniasis is the most common non-viral sexually transmitted infection which is associated with several complications. Propolis is a bee product and contains tanen, flavonoids and volatile oils, so it has antiprasitic activity. This study was performed with aim to compare the effect of propolis gel and metronidazole tablet on dyspareunia. Methods: This clinical trial study was conducted in 2019 on 102 non-pregnant married women with complains of Trichomoniasis clinical symptoms referred to the gynecology clinics in Isfahan. They were divided into two groups of experiment (propolis gel) and control (metronidazole tablet). Participants were treated for 7 days. Dyspareunia was assessed using the visual pain scale (VAS) with a range of 0-10. Data were analyzed by SPSS software (version 20) and independent T-test, fisher exact test, ANCOVA and Chi-square tests. P<0. 05 was considered statistically significant. Results: During all steps of the study, no significant differences were observed between the two groups in type and mean severity of pain. However, after adjustment of dyspareunia pre-intervention and 2 weeks after the intervention, the score of dyspareunia in the experiment group was 0. 882 lower than the control group; this difference was statistically significant (P=0. 009). In the experiment group, all of participants with post coital bleeding/spotting were completely treated, while no improvement was observed in the control group. Conclusion: Vaginal gel containing propolis extract has positive therapeutic effect on dyspareunia. It has least effect on the vaginal epithelium, without GI and neurologic side effects.

Introduction: The effectiveness of various medicinal plants on clinical and non-clinical symptoms of PCOS has been investigated. This study was performed with aim to determine the efficacy of cinnamon on PCOS in a systematic review. Methods: In this systematic review study, the studies were searched in the Iranian and international databases of PubMed, Scopus, Web of science, Cochrane library, Magiran, SID, and IranDoc in February 2020. The terms of "polycystic ovary syndrome", "cinnamon" and "medicinal plant" were used for the searching process. In this study, a variety of experimental and semi-experimental human and animal studies with aim to evaluate the effect of cinnamon on PCOS were entered to the study. Results: In this systematic review study, 588 articles were reviewed, and finally, eight original human research articles, 1 article as an article presented in the congress, and 3 animal articles had the inclusion criteria. In terms of primary outcome, one study had reported a significant improvement in the frequency of menstrual cycles (improvement in oligomenorrhea status), six studies had reported a significant improvement in metabolic indicators, and one study had reported a decrease in Anti-mullerian hormone levels. Animal studies had reported improvement in metabolic indicators, hormonal levels, and follicle maturation. Conclusion: The majority of human and animal studies indicated that cinnamon consumption can be useful in improving metabolic indicators and some clinical symptoms in patients with PCOS. Therefore, more clinical trial studies are recommended to be performed for determining its efficacy and dose.

Introduction: Abnormal placental implantation with bladder invasion is a rare obstetric complication, which can be accompanied with severe maternal and fetal morbidity. Gross hematuria is a rare manifestation of these syndromes, placenta percreta. Awareness of rare and unusual manifestations of placenta accrete syndromes is crucial for effective and timely management of this condition. In this report, a case of placenta percreta with manifestation of gross hematuria is introduced. Case presentation: The patient was a 32-year-old pregnant woman at 17 weeks of gestation and a history of two previous cesarean sections who was evaluated with MRI following gross hematuria and suspicion of abnormal placental adhesion. Hysterectomy was performed with the diagnosis of placenta percreta and due to severity of placental invasion. Conclusion: In the evaluation of a pregnant woman with gross hematuria, even as very early, especially with history of previous cesarean sections, awareness of probable diagnosis of placenta percreta with urinary tract involvement is needed for timely diagnosis and proper management.

Introduction: Didelphys uterus is one of the rare cases of mullerian anomalies that in most cases, remains asymptomatic until pregnancy and delivery. In women with mullerian anomalies, pregnancy and delivery are associated with more complications such as preterm labor that requires more attention to such pregnancies. Most cases of pregnancies in Didelphys uterus are reported in the left cavity. Ultrasound and MRI can be used to diagnose it. Case presentation: The patient was a 21 year old female with history of dyspareunia and one spontaneous abortion at 38 weeks of pregnancy who referred to the maternity complaining of amniotic fluid leakage and labor pain. Longitudinal vaginal septum was diagnosed during the vaginal examination. The patient underwent a cesarean section due to thick meconium-stained amniotic fluid far from delivery and a healthy term baby was born. Didelphys uterus was seen and the fetus was in the right cavity. Conclusion: Despite the high incidence of pregnancy complications in pregnancies with mullerian anomalies, sometimes these pregnancies continue without complications until term.