Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2018 | Volume:21 | Issue:4 |Papers Count:17

Introduction: Pregnancy at a young age is considered high-risk, and the prevalence of teenage pregnancy has been reported to be on the rise. The present study aimed to evaluate the pregnancy outcomes in primigravid adolescents.Methods: This cross-sectional study was conducted at Ghaem Hospital in Mashhad, Iran during July 2012-2013. Sample population consisted of primigravid women aged 12-19 and 20-35 years at delivery. In total, 100 primigravid adolescents and 200 primigravid adults aged 20-35 years were enrolled in the study. A researcher-made questionnaire including the demographic characteristics, gestational age, and other variables (medical history, medical condition of the subjects at the current pregnancy, and neonatal status) was completed by the researcher for the subjects. Data analysis was performed in SPSS version 14 using Chi-square, Fisher’s exact test, and Mann-Whitney U test, and P-value of less than 0.05 was considered statistically significant.Results: Mean gestational age in the adolescents and adults was 38.35±3.15 and 37.2±3.08 weeks, respectively (P<0.05). No significant differences were observed between the groups in terms of the pregnancy outcomes (P>0.05), and only preeclampsia was significantly more prevalent in the adults compared to the adolescents (P<0.05). Neonatal outcomes (birth weight and Apgar scores) were significantly better in the adolescent mothers compared to the adults (P<0.05), while no significant differences were observed in terms of congenital anomalies, intrauterine death, and neonatal mortality (P>0.05). In addition, no significant differences were observed between the groups regarding intended/unwanted pregnancies and smoking habits (P>0.05).Conclusion: Considering the favorable perinatal outcomes of teenage pregnancies, recommendations for early pregnancy may be rational, even in adolescent mothers.

Introduction: Physical activity is one of basic solutions in the control and treatment of diabetes. Nevertheless, any kind of physical activity has different mechanisms in diabetic patients. Therefore, the aim of the present study was to compare the effect of aqua and resistance trainings on blood adiponectin, lipid profile, insulin, and glucose in patients with gestational diabetes mellitus (GDM).Methods: This randomized clinical trial was conducted in January, 2015 on 34 women with gestational diabetes referred to Motahari Clinic and Primatology Clinic of Hafez Hospital. The subjects were divided in three groups of aqua and resistance trainings and control. During 6 weeks, aqua and resistance training groups trained three 30-45-min sessions per week. The participants in the control group had just their daily activity. The levels of adiponectin, total cholesterol, high-density lipoprotein, triglyceride, fasting blood sugar, and insulin requirement were measured. The blood samples were collected in fasting status at the pre- and post-intervention phases. Data analysis was performed using t-test, analysis of covariance, one-way analysis of variance, and Bonferroni post-hoc test. P≤0.05 was considered statistically significant.Results: Aqua training had significant effect on increasing adiponectin and decreasing total cholesterol, triglyceride, and insulin requirement (P£0.05). Resistance training had significant effect on the reduction of high-density lipoprotein, insulin requirement, and fasting blood sugar (P£0.05). Additionally, aqua training rather had more effect on reduction of triglycerides in comparison to resistance training (P£0.05).Conclusion: Aqua training had more positive effect on adiponectin and lipid profile in women with gestational diabetes in comparison to resistance training.

Introduction: Globally, second-trimester abortion accounts for 10-15% of all abortions and is responsible for two-thirds of abortion-related complications. Misoprostol is known as a powerful and effective medication for the termination of pregnancy in the second trimester. Several studies with different results were carried out into the proper dosage of misoprostol; however, there is no consensus about its proper dosage. This study was performed to compare the efficacy of two doses of vaginal misoprostol for second-trimester abortion.Methods: This randomized clinical trial was conducted among 100 pregnant women, who were hospitalized for second-trimester abortion. They were randomly assigned into two groups in the Department of Obstetrics and Gynecology, Ali ibn Abi Talib Hospital, Zahedan, Iran, 2013. The subjects in the first and second groups received vaginal misoprostol in the doses of 400 µg given every 3 hours and 600 µg given every 6 hours up to five doses, respectively. Data were collected using a form containing the received dose, abortion interval, and complications. Data analysis performed using Chi-squared and t-test. P<0.05 was considered statistically significant.Results: The mean age of participants was 58.5±5.5 years old; and all the abortions were successful. In the first group, total administered dose was significantly lower than the other group (P<0.001). Additionally, in the first group, the complications and abortion intervals were less than other group; nevertheless, there was no significant difference between them (P=0.108).Conclusion: Both studied doses of misoprostol had similar effects and the rate of complication was the same. Nonetheless, the dose of 400 mg was preferred due to need to lower total dose and shorter abortion interval.

Introduction: Dysmenorrhea is a common disorder that manifests during the menstrual cycle, causing cramps in the lower abdomen. The discomfort interferes in the daily activities of the individual. The present study aimed to evaluate the effects of fenugreek seeds on the severity and duration of pain in primary dysmenorrhea in the students at Hamadan University of Medical Sciences, Iran.Methods: This randomized, controlled clinical trial was conducted on 100 students at Hamadan University of Medical Sciences in 2016. The subjects were equally divided into two groups of intervention (Fenugreek seeds) and control (placebo). Medications were administered for two months. Data were collected using demographic questionnaires, McGill pain questionnaire, and multidimensional speech scale before the intervention and one and two months after the medication administration. Data analysis was performed in SPSS version 19 using independent and paired t-test and Chi-square at the significance level of <0.05.Results: In the group receiving Fenugreek seeds, mean duration and severity of primary dysmenorrhea pain decreased significantly at the end of the first and second cycle of the intervention (P<0.01). Moreover, mean number of the analgesics used in the intervention group significantly reduced compared to the control group at the end of the first and second cycle of the intervention, while the mean number of menstruating days increased with a significant difference (P<0.01).Conclusion: Considering the positive impact of fenugreek seeds on reducing the severity and duration of the symptoms of primary dysmenorrhea with fewer side-effects than chemical drugs, it is recommended that this herbal compound be used in the treatment of this disorder.

Introduction: Gestational diabetes mellitus (GDM) is defined as glucose intolerance, which presents during pregnancy for the first time. It is important due to its complications for pregnant woman and fetus. The aim of this study was to identify the risk factors of GDM in Ahvaz, Iran.Methods: This descriptive analytic, prospective, and case-control study was conducted on 195 pregnant mothers hospitalized in Imam Khomeini Hospital, Ahvaz, Iran, 2014. A total of 65 patients were assigned into the control group and 130 patients with GDM were selected. Data was collected by a researcher using a self-constructed questionnaire including blood group, height, weight changes, blood glucose, and demographic data. Data were analyzed using SPSS software, version 19, Chi-Squares, t-test, and logistic regression analysis.Results: There was no significant difference between the case and control groups in terms of blood group and height variables. However, a significant relationship was observed between abnormal weight gains since the beginning of pregnancy until the gestational age of 24-28 weeks and GDM.Conclusion: The weight gain of mothers during pregnancy is important. Therefore, early diagnosis of GDM and reducing its complications is possible by identifying the risk factors.

Introduction: Multiple sclerosis (MS) is the most common autoimmune disease that often affects women within the reproductive age. Among the common clinical complaints in these women is variety of menstrual disorders. Thus, we aimed to examine menstrual disorders and related factors in women with MS.Methods: A descriptive cross-sectional study was performed among 172 women with MS who visited the Neurology Specialized Clinic in Tehran, Iran, during 2016-2017. The participants filled out a questionnaire consisting of demographic (e.g., age, educational level, economic status, disease duration, vitamin D consumption duration, and Expanded Disability Status Scale [EDSS]) and disease characteristics (age at menstruation, duration of each period, interval between two periods, the amount of bleeding, presence or lack of presence of pain, and menstruation pain score). Data were analyzed by using SPSS version 22 and multiple logistic regression model, Chi-square test, and Spearman correlation coefficient. P-value less than 0.05 was considered significant.Results: Overall, 88 patients (51.2%) experienced irregular menstruation patterns, and 116 patients (67.5%) had some forms of menstruation disorders. Multiple logistic regression reflected statistically significant correlations between disability score (b=0.702, P=0.001), moderate (b=2.561, P<0.001) and high (β=2.730, P<0.001) menstrual bleeding, duration of vitamin D intake (b=-0.187, P=0.048), dysmenorrhea (b=1.246, P=0.006), age of the menarche (b=-0.298, P=0.05) and menstrual pattern (b=1.912, P<0.001) with menstrual disorders. Spearman correlation and Chi-square revealed the significant relationship of menstruation pattern, dysmenorrhea, and amount of bleeding with menstrual disorders, which corroborated the results of regression.Conclusion: The results of the present study showed that menstrual disorders have high prevalence in women with MS. Our results also indicated that factors such as duration of vitamin D intake, menstrual bleeding, menarche, menstrual pattern, dysmenorrhea, and EDSS affect menstrual disorders.

Introduction: Vaginal atrophy is one of the most common postmenopausal symptoms affecting the quality of life among postmenopausal women. Although the use of estrogen is effective in the improvement of these symptoms, it is associated with various complications. Regarding this, the present study was conducted with the aim of examining the effect of Glycyrrhiza glabra (licorice) vaginal cream on the mental symptoms of vaginal atrophy in postmenopausal women.Methods: This double-blind clinical trial was carried out on 70 postmenopausal women referring to the health centers of Izeh city in Khuzestan Province, Iran, in 2017. The women diagnosed with vaginal atrophy were randomly assigned into two groups of intervention and placebo (n=35 per group). The intervention group received licorice 2% vaginal cream for 8 weeks. The symptoms of vaginal atrophy, including irritation, itching, dyspareunia, and vaginal dryness, were examined using a self-assessment four-point Likert scale (none=0, mild=1, moderate=2, and severe=3) before and 2, 4, and 8 weeks after the intervention. The data were analyzed in SPSS (version 22) using one-way ANOVA and Chi-square test. P-value less than 0.05 was considered statistically significant.Results: The results indicated that the licorice group experienced a significant improvement in the symptoms of vaginal atrophy after the intervention, compared to that before the intervention (P<0.001). The licorice vaginal cream led to a significant decrease in the mental symptoms of atrophy (i.e., itching, irritation, vaginal dryness, and dyspareunia) in the licorice group, compared to those in the placebo group (P<0.001).Conclusion: The application of licorice vaginal cream led to a decrease in the mental symptoms of vaginal atrophy (i.e., itching, irritation, vaginal dryness, and dyspareunia). Therefore, the use of this cream can be helpful for the women suffering from vaginal atrophy.

Introduction: Postpartum pain or painful uterine contractions is an important postpartum problem, and its relief could improve breastfeeding and mother-infant interactions. Medicinal herbs could be used to relieve postpartum pain with fewer side-effects and better acceptability compared to chemical medications. The present study aimed to compare the effects of the combination of Nigella sativa (Kalonji) and mefenamic acid and mefenamic acid alone on postpartum pain in multiparous women.Materials and Methods: This randomized double-blind clinical trial was conducted on 100 multiparous women with natural delivery, who complained of moderate-to-severe postpartum pain in 2017. The women were randomly assigned to two groups of Kalonji-mefenamic acid (n=50) and placebo-mefenamic acid (n=50). Severity of postpartum pain was measured using the visual analogue scale (VAS) two hours after delivery, and mothers with the pain score of ³4 were enrolled in the study. Women in the intervention group received mefenamic acid capsules (250 mg) with a Kalonji capsule (500 mg), and the control group received mefenamic acid capsules (250 mg) with a placebo. Severity and duration of pain were measured before and one hour after each medication administration using the VAS. Data analysis was performed in SPSS version 22 using independent and paired t-test, Chi-square, and Mann-Whitney U test. P-value of less than 0.05 was considered statistically significant.Results: Severity of postpartum pain reduced more rapidly and significantly in the Kalonji-mefenamic acid group compared to the placebo-mefenamic acid group (P<0.001).Conclusion: According to the results, combination of Kalonji and mefenamic acid could be used as an effective herbal remedy in the women with postpartum pain.

Introduction: Postpartum hemorrhage is one of the major causes of maternal mortality, especially in the developing countries. Some studies have shown the positive effects of Plantago on postpartum hemorrhage. We conducted this study to determine the effects of Plantago syrup on postpartum hemoglobin and hematocrit levels in low-risk women in terms of postpartum hemorrhage.Methods: A double-blind, randomized, clinical trial was carried out on all the women who had gone through normal vaginal delivery in Ganjavian Maternity Clinic of Dezful, Iran, in 2017. The participants were randomly assigned to intervention and placebo group (n=50 per group). Immediately after placental expulsion, the intervention group received 100 cc of Plantago extract 20% and infusion of 20 U of oxytocin in 1 L of Ringer’s solution, and the control group was given 100 cc of placebo syrup and infusion of 20 U of oxytocin in 1 L of Ringer’s solution. Hemoglobin and hematocrit levels were measured in all the participants 6 h postpartum. To analyze the data, independent t-test, Fischer’s Exact test, Mann-Whitney U test, Kendall rank correlation coefficient, Chi-squared test, and repeated measures analysis of variance (ANOVA) were run in SPSS, version 17.Results: There was a significant difference between the two groups in terms of hemoglobin and hematocrit reduction. Before the intervention, the mean levels of hemoglobin and hematocrit in the intervention group were 12.60±3.8 g/dl and 36.69±3.3%, respectively, and in the control group, they were 12.25±1.1 g/dl and 38.06±3.4%, respectively (P>0.005). After the intervention, the mean reduction in hemoglobin level in the intervention and control groups was 1.17±0.4 and 2.19±0.6 g/dl, respectively (P=0.001).Conclusion: Oral Plantago syrup played a significant role in lowering the mean reduction in hemoglobin and hematocrit levels after delivery. The use of this syrup could help prevent the complications of postpartum anemia.

Introduction: Aromatherapy is a historical method in ancient Persia. Recent scientific findings have confirmed that herbal fragrances are affect human sexuality and fertility. According to the references of the Persian Traditional Medicine, odorous drugs are used in the treatment of sexual dysfunction and infertility in various forms. The present study aimed to review this therapeutic approach in the references of Persian Traditional Medicine in comparison with recent findings.Methods: This review was conducted via searching in Persian Traditional Medicine references, including Avicenna Canon of Medicine, Al-Aghraz-al-Tibbiya, Tebe-Akbari, Sharhe Asbab va Alamat, Exir-e-Azam, Makhzan al-Adwiyah, Tohfe Hakim Momen, and Qarabadin-e-Salehi using keywords such as Booidan or Shomoomat (smell) and Bu (odor). In addition, the recent findings in this regard were obtained from electronic databases such as PubMed and Google Scholar through searching for scientific terms, as well as keywords such as aromatherapy, infertility, and sexual disorders.Results: In Persian Traditional Medicine, odorous materials could be used via smelling, topical application, incense, and smoke for the treatment of sexual dysfunction. For instance, hot smells (musk, jasmine, and narcissus) could enhance sexual desires, whereas cold smells (Egyptian lotus, camphor, and myrtle) have been shown to reduce the libido. In this regard, special emphasis has been placed on the use of aromatic substances (cinnamon, cardamom, and nutmeg) in the treatment of uterine diseases, especially oligomenorrhea.Conclusion: According to the results of the review, adherence to the recommendations of Persian Traditional Medicine regarding the use of odorous materials in the treatment of nervous disorders and improvement of the reproductive system could lay the groundwork for novel clinical trials.

Introduction: Clinical trials in the field of menopause play a critical role in producing valid evidence due to the importance of women’s health in the family and society. The results of clinical trials could be used in the evidence-based medicine in case they have a good quality and precise methodology. Therefore, this study aimed to evaluate the quality of clinical trials published by Iranian authors regarding the effects of complementary medicine on menopausal symptoms.Materials and Methods: This descriptive study assessed the clinical trials published during 2007-2016 concerning the impact of complementary medicine on menopausal symptoms. The articles of Iranian journals indexed in SID, Iranmedex, Irandoc, Magiran, and Google Scholar were selected. Several keywords were utilized for searching, including menopause, complementary medicine, massage therapy, acupressure, herbal medicine, and clinical trials. Finally, 47 out of 238 retrieved articles were critically appraised using the Consolidated Standards of Reporting Trials (CONSORT) checklist 2010. The maximum and minimum score that each article could obtain was 37 and zero, respectively. All the data were analyzed using descriptive statistics by SPSS version 16.Results: The findings of present study demonstrated that the mean score of overall quality for the reviewed articles was 23.93±3.94 with the maximum and maximum scores of 16 and 33, respectively. It was revealed that among the 47 clinical trials, sample size calculation, randomization method, type and method of blinding, and the method for generating a random allocation sequence were mentioned in 21 (44.68%), 20 (46.5), 19 (40.42), and 35 (74.46%) studies, respectively. In addition, the used statistical methods were also noted in 46 (97.87%) studies. In the qualitative assessment, the highest mean score was obtained for the introduction and the least for the materials and methods parts.Conclusion: According to the results of this study, the clinical trials published in Iranian medical journals are moderate in terms of study design and reporting method. Consequently, it is recommended that the editors, referees, and researchers of clinical trials, apply a standard guideline for designing and reporting the results of clinical trials. Moreover, the necessary steps for trainings in this regard should be considered.

Introduction: Catatonia is a neuro-psychological syndrome characterized by motor, behavioral, emotional, and vegetative symptoms. This phenomenon can occur in primary psychological disorders and in association with neurological and other general medical diseases. Postpartum catatonia is a rare condition. In this research, we reviewed the presentation, diagnosis, and treatment of a case of postpartum psychosis with catatonia.Case presentation: A 21-year-old woman was presented with mutism, waxy flexibility, unresponsiveness and fever 10 days after delivering a healthy neonate. Assessments were made to exclude meningoencephalitis and other possible underlying medical disorders. After the investigations, a perinephric abscess was found in abdominal sonography. Despite the percutaneous abscess drainage, antibiotic therapy and treatment of fever, other symptoms continued. After catatonia diagnosis, the patient was treated with oral lorazepam, which significantly improved the signs of this disease. However, appearance of psychotic signs (e.g., delusions, hallucinations, and suicide thoughts) led to the diagnosis of postpartum psychosis and treatment of the patient with antipsychotic medications. Furthermore, she was candidate of electroconvulsive therapy to accelerate the pace of recovery. The patient responded dramatically to electroconvulsive therapy.Conclusion: Catatonia is a rare complication of medical and psychological disorders, which can be seen in postpartum period. Early diagnosis and treatment of postpartum catatonia is crucial for maternal and neonatal health.