Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2018 | Volume:21 | Issue:10 |Papers Count:16

Introduction: Candidates of cesarean section with a previous history of such surgery are at a higher risk of intra-abdominal adhesions in comparison to those having undergone vaginal delivery. Intra-abdominal adhesions lead to prolonged operative time, intraoperative hemorrhage, fetomaternal morbidity, and requirement of the help of other surgeons. Therefore, this study was conducted to study the characteristics of abdominal scars in order to predict and manage intra-abdominal adhesions before operation. Methods: This descriptive prospective study was conducted on 109 candidates of cesarean section with a previous history of such surgery in Taleghani Hospital, Tehran, Iran, in 2017. The data recorded for each patient included demographic characteristics, body mass index, abdominal scar characteristics, and severity of abdominal adhesion. The collected data were analyzed in SPSS software (version 22) using the Chi-square test and Mann-Whitney U test. P-value less than 0. 05 was considered statistically signifi cant. Results: Out of 109 participants, 36 (32. 02%) women had adhesion, 17 (15. 6 %) cases of whom had dense vascular adhesions or frozen pelvis. The analysis showed a significant difference between the filmy adhesion or non-adhesion group and adhesive adhesion or frozen pelvis group in terms of flat and non-flat scars (P=0. 042), scar height (P=0. 005), and depressed and non-depressed scars (P=0. 004). Conclusion: As the findings indicated, a depressed abdominal scar resulting from a previous cesarean delivery was correlated with the incidence and severity of intra-abdominal adhesions (P<0. 05).

Introduction: Gestational diabetes is one of the most important abnormalities occur over the 24 weeks of gestation. The recognition of the gestational diabetes factors can play an important role in the improvement of the pregnancy condition; therefore, this study was to investigate the relationship between serum vitamin D level and gestational diabetes mellitus in patients referred to Imam Hossein Hospital in Tehran, Iran, during 2015. Materials and Methods: In this cross-sectional study was conducted on 164 pregnant women in Tehran during 2015. Patients were tested for gamma-glutamyl transferase using a oral glucoseof 50 g and then a 3-hour glucose tolerance test was used. Individuals with diabetes mellitus were considered case group and individuals without gestational diabetes mellitus (control group). Blood samples were taken to determine and compare serum vitamin D level between the two groups. The data were analyzed using SPSS (version 21) through the Chi-square and independent t-test. Results: The mean values of 25-hydrozxy-vitamin D level were 29. 4± 19 and 24. 13± 13. 3 in the case and control groups, respectively. In this regard, the results of independent t-test revealed a significant difference between the two groups (P=0. 042). Moreover, the ROC curve analysis of vitamin D with a cut point of 20 indicated a sensitivity level of 53% and a specialty of 45%. Based on the results of this study, pregnant women with vitamin D deficiency are twice at risk of developing gestational diabetes, compared to their healthy counterparts. Conclusion: The low level of serum vitamin D is the independent risk factor for gestational diabetes mellitus. However, due to the limitations of this study it is essential to conduct further evaluations.

Introduction: Exercise can guarantee maternal health during pregnancy and after that by preventing excessive weight gain during pregnancy. The aim of this study was to investigate and compare the effect of 12 weeks aerobic training in the morning and evening routines on the body composition of pregnant women up to two months postpartum. Methods: This quasi-experimental study was performed on 90 pregnant women with the gestational age of 25-24 weeks in Mashhad in 1396. The participants were divided into three groups, including morning aerobic exercise (n=29), evening aerobic training (n=26), and control group (n=27). The training program consisted of 12 weeks of three sessions with a duration of 35-35 min (each session) and included a continuous walk. Exercise intensity was 60% of the maximum heart rate reserve (HRR) in primary sessions, which dropped to 45% HRR in the final sessions. The parameters of body fat percentage and body mass index (BMI) were measured at the beginning and end of the study. The data were analyzed using SPSS software (version 20), Kolmogorov-Smirnov test, T-test, and Analysis of variance (P≤ 0. 05). Results: Twelve weeks of aerobic training had an effect on the body fat percentage of the participants (P=0. 020), but there was no significant difference between the morning and evening exercises (P=0. 422). The selected aerobic exercise had an effect on the BMI index of the participants (P=0. 022), but there was no significant difference between the morning and evening exercises (P = 0. 293). Conclusion: The aerobic exercise protocol prevents hyperlipidemia in pregnant women and causes pregnant women to gain weight better during pregnancy.

Introduction: Preterm birth and its risk of recurrence have long-term consequences on families and communities. So evaluating epidemiologic and environmental factors is important to diagnose the women at risk for early delivery. The present study aimed to investigate the prevalence of preterm birth recurrence and related factors. Methods: This cross-sectional study was conducted on a total of 3763 pregnant women referred to Shahid Mostafa Khomeini's maternity hospital in Ilam during July 2015 to July 2016. In this study, sampling was carried out in a sequential method. Data were collected using interviews and medical records of the pregnant women. The data gathering tool was a researcher-made questionnaire containing 37 questions, including demographic variables, midwifery history, and maternal medical and fetal variables (i. e., gestational age, number of previous births, birth weight, Apgar score, perinatal death, congenital malformation, previous preterm labor, placental abnormalities, , history of abortion, history of hypertension and diabetes during pregnancy, history of trauma and surgery, uterine and cervical disorder, premature rupture of the membranes). The data were analyzed using SPSS software (version 19), Chi-square test, and t-test. Results: Out of 350 neonates, 82. 6% of them had no history of preterm labor, and 17. 4% of the newborns had a history of preterm birth. The most prevalent recurrence of preterm delivery was at the age of 30-40 years. There was a statistically significant difference between the age, education level, parity, genital infection, urinary tract infection, history of surgery, diabetes, fetal death, fetal malformation, and preterm birth recurrence (P<0. 05). Conclusion: Considering the high prevalence of preterm delivery in women with a history of preterm delivery, the prevention of this important complication of pregnancy can be performed by increasing clinical care and considering the causative factors.

Introduction: Postpartum hemorrhage is one of the most major problems that threaten the mothers' health and is regarded as one of the most important reasons for mortality especially in developing countries. So far, many studies have been conducted with regard to the effectiveness of chemical and herbal medicine on the decrease of postpartum hemorrhage. Given the importance of postpartum bleeding management for mother and child, this study aimed to evaluate the effect of grape seed powder on postpartum hemorrhage. Methods: This randomized controlled clinical trial study was performed on 120 pregnant women referred to Vali-e-Asr Maternity Hospital of Birjand in 2016. The mothers were randomly divided into four groups each one with 30 cases. The three groups received grape seed powder doses of 50, 100, and 150 mg and there was a placebo group. The capsules were taken by the mother with a glass of warm water after taking the pair. The volume of maternal hemorrhage was measured 24 hours after the delivery. Data were analyzed by SPSS software (version 16) using one-way analysis of variance, Tukey's test, and Bonferroni post hoc test. P-value less than 0. 05 was considered statistically significant. Results: In all four groups, the bleeding volume from the first to the third hour showed a significant decrease )P<0/001(. At the first, second, and third hours after the intervention, the highest volume of bleeding in the control group and the lowest volume of bleeding in the intervention group with 100 mg of grape seed were observed. In the control group, the highest volume of bleeding was 24 h and in the 150-mg group the lowest volume of bleeding was observed. There was a significant difference between the mean volume of 24 h bleeding in the four groups and the mean volume of bleeding in all groups was also significant in the control group )P<0/001(. Conclusion: Grape seed powder seems to be safe and effective for preventing postpartum hemorrhage and is recommended to use in the third stage of labor.

Introduction: As a stressor, labor pain requires special coping strategies. Acupressure is one of these strategies that may be effective in coping with labor pain. This study aimed to compare the effect of pressure on bladder-GV20 and gallbladder-GV20 points on the ability to cope with labor pain among the nulliparous females. Methods: This single-blind randomized clinical trial was conducted on 158 primiparous women referring to Um Al-Benin Specialized Women Hospital, Mashhad, Iran in 2017. The subjects were randomly assigned to three groups of acupressure regarding the bladder points, namely (BL5-BL8-BL9) and GV20 (intervention 1), gallbladder (GB8-GB16– GB17-GB18) and GV20 (intervention 2), and the control group. The first stage of labor included five (4 min) and four (5 min) pressure cycles on acupressure points in bladder and gallbladder in the first and second groups, respectively. In the second stage of labor, one pressure cycle on the same points were applied. The control group only received the routine cares. The ability to cope with the labor pain was measured using the observational coping behavioral questionnaire with labor pain before the intervention and then every 30 minutes until the completion of the second stage of labor. The data were analyzed in SPSS software (version 25. 0) using Fisher's exact test, one-way ANOVA, Tukey and non-parametric Kruskal Wallis test based on Dunn's approach with the Bonferroni and Friedman's correction. The P-value less than 0. 05 was statistically significant. Results: The results showed that the average scores of coping ability in the first and second stages of delivery were 16. 5± 1. 9, 17. 4± 2. 9 and 16. 9 ± 2. 2, 16. 8 ± 2. 2 in intervention groups one and two, respectively. There was a significant difference regarding the scores of the intervention groups and those of the control group (10. 4± 2. 4, 12. 0± 2. 7) (P<0. 05). However, no significant difference was observed within the two intervention groups in terms of the scores of coping ability (P> 0. 05). Conclusion: According to the findings of the study, pressure on bladder-GV20 and gallbladder-GV20 points can increase the levels of labor pain coping abilities in the first and second stages of labor. Therefore, this method can be recommended as a simple, non-invasive and complementary approach in labor.

Introduction: Obesity and overweight are associated with many diseases. The effects of regular exercises or Chlorella on disease control have been also confirmed individually. The purpose of this study was to investigate the effect of aerobic training with Chlorella supplement on insulin resistance and serum ghrelin level in obese sedentary women. Materials and Methods: This randomized double-blind clinical trial was conducted on 32 obese women in Mahallat city, Iran, in 2017. The subjects were randomly assigned into four groups of exercise, supplementation with Chlorella, exercise plus supplementation, and control. Interventions were completed for 8 weeks. The daily intake of Chlorella was four 300 mg tablets (1 before breakfast, 2 before lunch, and 1 before dinner). The aerobic exercise program included running on a treadmill for 16 min with a maximum heart rate of 65% in the first week, which reached to 30 min and a maximum heart rate of 80% in the eighth week. Two days before and after the end of the interventions, blood samples were taken from all four groups in order to measure ghrelin, glucose, insulin, and insulin resistance. Data analysis was performed in SPSS software (version 16) using two-way and repeated measurements ANOVA. P-value less than 0. 05 was considered significant. Results: Glucose and insulin levels, as well as insulin resistance were significantly reduced in the exercise plus Chlorella and exercise groups, compared to those in the other two groups (P<0. 05). However, the levels and pattern of ghrelin changes were not significantly different among the four groups (P>0. 05). Conclusion: Aerobic exercises lead to the reduction of insulin resistance in obese women, but no significant effect was observed on ghrelin. On the other hand, Chlorella supplementation did not show any significant effect on any of the variables. The use of Chlorella supplement along with aerobic exercise also exerted no effect.

Introduction: Normal sexual functioning is a vital part of womens' sexual and mental health. In traditional medicine, squill oil is considered a warm oil in nature which causes the dilation of the blood vessels in genital areas leading to sexual arousal by increasing blood circulation. The aim of this study was to evaluate the effect of squill oil on the sexual function of women of reproductive age. Method: This double blind randomized clinical trial was conducted on 60 women aged 15-45 years not satisfied with their sexual function and referring to Obstetrics and Gynecology Clinic in Ghaem Hospital, Mashhad, Iran in 2016-2017. The study participants were randomly assigned to one of two groups; the experimental group received the intervention (i. e., squill oil) and the control group received placebo (i. e., olive oil) for 4 weeks. Female Sexual Function Inventory was used as the research instrument. The sexual activity of women before and after intervention was measured and the mean scores of the sexual function were compared within groups. The data were analyzed in SPSS software (version 21) using descriptive statistics, the Chi-square test, independent t-test, and Mann-Whitney U test. P value less than 0. 05 was considered significant. Results: According to the obtained results, there were no significant differences regarding the mean scores of sexual performance between the experimental and control groups before the intervention (P=0. 273). However, a statistically significant difference was observed within the two groups in that squill oil enhanced sexual performance in terms of sexual desire and arousal, humidity, and orgasm compared to placebo after 4 weeks (P<0. 0001). Conclusion: Squill oil improved sexual function and its components among women.

Introduction: It is widely reported that the complications of Caesarean-section (C-section) delivery are much more than the normal vaginal delivery (NVD) in Iran. The purpose of this study was to determine the effect of targeted education on the mode of delivery in pregnant women. Methods: A randomized controlled trial was conducted among 72 primiparous women at their 20-25 weeks of gestational age in Isfahan, Iran, during 2015. The sample was randomized into two groups of 36 people. A pre-test was performed using a questionnaire on knowledge, attitude, perceived self-efficacy, perceived social support, and intention to choose the delivery mode. The experimental group (including the women and their spouses) received specialized educational messages in a form of a computer file based on their scores obtained from each part of the pre-test data. At 37 weeks of pregnancy, post-test was administered to both study groups using the questionnaire and the mode of delivery was recorded in the questionnaire after the birth. The analysis of data was conducted using SPSS through the Chi-square test, independent t-test، and paired t-test. Results: Before the intervention, no significant difference was observed in terms of the studied variables between two the groups (P=0. 71). However, the mean score in the experimental group was higher than that of the control group after the intervention (P<0. 001). The definite decision to choose NVD in the experimental group also increased from 30. 6% to 58. 3% which was significantly more than that of the control group (P=0. 03). The frequency of NVD was significantly higher in the experimental group, compared to the control group (P=0. 04). Conclusion: The utilization of targeted educational messages through computer based on knowledge, self-efficacy, attitude, and perceived social support could result in NVD selection. Therefore, it is suggested to provide new strategies to offer educational messages, such as targeting education in community health centers.

Introduction: Vitamin D deficiency is associated with maternal and fetal complications; accordingly, it is of significant importance to investigate the treatment of this deficiency. There is still no clear optimal protocol for the treatment of vitamin D deficiency or for the proper dose of this supplementation and its effects on mothers and infants, which has led to controversies about the safety and effectiveness of vitamin D supplements during pregnancy. Despite the importance of this issue, there are few studies addressing high doses of vitamin D, such as 50, 000 units of vitamin D3. Therefore, this systematic review aimed to investigate the effects of 50, 000 units of vitamin D on pregnant women. Methods: This systematic review was performed on the Persian and English articles reporting the effect of vitamin D on pregnant women published during 2010-2017. The search process was accomplished through searching databases, such as PubMed, Science Direct, IranMedex, and Irandoc using the keywords of vitamin D in pregnancy, vitamin D deficiency, and clinical trials. In the initial search, 8648 articles were found; however, after employing the inclusion and exclusion criteria 8 articles were under the investigations. Results: Studies were conducted on a total of 2011 pregnant women, out of whom approximately 992 received 50, 000 units of vitamin D. In these studies, high dose of vitamin D had a significant relationship with the increase of maternal serum levels and the decrease in the maternal and neonatal complications, which included lower level of gestational diabetes, reduction of premature labor, and increase of baby weight, compared to mothers with vitamin D deficiency. Conclusion: The 50, 000 units of vitamin D in pregnant mothers with vitamin D deficiency increases serum level, compared to lower doses of vitamin D. This dose can be considered as a safe dose both for mothers and neonates.

Introduction: Reference laboratory values undergo major changes during pregnancy and if they were defined according to non-pregnant women laboratory reference values, can lead to inappropriate decisions and have adverse effects on pregnancy. Because of the physiological changes in the body of pregnant women, the reference values are not standardized in the medical diagnostic labs. Therefore, the present study was conducted to determine the reference values of biochemical, hematological and hormonal tests during pregnancy. Methods: In the present study, the articles were extracted from SID, Google Scholar, ISI, MedLib, and PubMed databases. Our research was performed without any time or language limitation. Results: In our study, 46 diagnostic laboratory values differentiated in pregnant women were extracted from 21 reports. These changes were found in complete blood count, coagulation proteins, alkaline phosphatase, albumin, urea-creatinine, and hormones, such as aldosterone, cortisol, estradiol, progesterone, testosterone prolactin, and human chorionic gonadotropin. Conclusion: Examination of laboratory values in pregnant woman showed that there were significant differences in the laboratory values between the pregnant and non-pregnant women. So the recognition of these differences could be useful in the prevention of making incorrect decisions by physicians and pregnant women.

Introduction: Postpartum hemorrhage is associated with highest rate of mortality and has many known etiologies. Inner myometrial laceration is one of the rare etiologies that lack of diagnosis can lead to maternal mortality. This report introduced a rare case of postpartum hemorrhage due to inner myometrial laceration. Case presentation: The patients were a 35-year-old woman (gravida 3 and live 2) referred to the hospital due to term pregnancy and premature rupture of membrane for pregnancy termination. Normal vaginal delivery was done following labor induction. After delivery of a 3700 gr neonate, severe postpartum hemorrhage occurred which was unresponsive to medical treatment and uterotonic drugs; she was transferred to operating room and hysterectomy was performed. Then, she was transferred to ICU. On the first day of Intensive Care Unit admission, the patient was complicated by ventricular tachycardia and bradycardia, and finally cardiopulmonary arrest. CPR was done, but it was unsuccessful, and the patient was expired. Pathological assessment revealed inner myometrial laceration at the posterior uterine wall. Conclusion: Considering inner myometrial laceration as one of the important and controllable causes of postpartum hemorrhage can lead to the diagnosis of this complication