Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2017 | Volume:20 | Issue:8 |Papers Count:11

Introduction: Thyroid disorders are common in young women. Hypothyroidism has a broad clinical range of subclinical to severe disease along with various complications. Hypothyroidism in pregnancy causes many complications on pregnancy. Considering the contradictory results in this regard, this study was performed with aim to evaluate the prevalence of subclinical hypothyroidism and compare the complications of this disease in patients treated with or without levothyroxine.Methods: This cross-sectional and interventional study was conducted on 1, 000 pregnant women who referred to Prenatal Clinic of Imam Reza Hospital and the clinics of two gynecologist colleagues in Mashhad in 2012-2013.212 women with TSH>3 in the first trimester of pregnancy were selected and randomly divided into intervention (n=112) and control (n=100) groups. Individuals in the intervention group received 0.5 to 1.5 pills of levothyroxine from diagnosis until delivery. Patients were monitored until the end of pregnancy and complications of pregnancy were evaluated between the two groups. Data were analyzed using SPSS software (version 11.5), Chi-square and independent t-test. P<.05 was considered significant.Results: In this study, the prevalence of hypothyroidism was 21%. Based on Chi-square test, two groups did not show significant difference in terms of abortion, preeclampsia, preterm labor, Apgar score less than 7, and need for NICU admission (p>0.05). However, there was a significant difference between the two groups in terms of abruption, (P=0.015) and abruption was higher in untreated group. Based on the independent t-test, the weight of newborns was higher in the treated group and the two groups were significantly different (P=0.025).Conclusion: Hypothyroidism is a common disease in pregnancy and TSH is a prerequisite for pregnancy testing in order to prevent its complications when diagnosed.

Introduction: Oxidative stress plays an important role in the development of gestational diabetes mellitus (GDM). Overproduction of reactive oxygen species can result in serious cellular damages which can lead to important complications for mother and fetus. This study was performed with aim to investigate serum values of glutathione, paraoxonase and myeloperoxidase in GDM compared with normal pregnancy.Methods: This case-control study was performed on 30 women with GDM and 30 normal pregnant women referred to Asalian hospital of Khorramabad, Iran during 2014-2015. Two groups were matched in terms of age, gestational age and body mass index. The subjects were selected using convenience sampling method. Serum values of glutathione were measured by ELISA method and values of paraoxonase and myeloperoxidase were evaluated by colorimetric methods. Data were analyzed by SPSS software (version 19) and Independent t-test and logistic regression test. PResults: Fasting blood glucose was significantly increased in GDM compared with normal pregnancy (p<0.001). Serum levels of glutathione were significantly decreased in women with GDM compared with normal pregnant women (p=0.030). There were no significant differences in paraoxonase (p=0.225) and myeloperoxidase (p=0.602) activities between two groups. The results of logistic regression test showed that glutathione was significantly a negative risk factor for GDM and could have a protective role against GDM (p=0.045).Conclusion: In the current study, serum levels of glutathione were significantly decreased in GDM compared with normal pregnancy.

Introduction: Health system evolution plan has been of main corrections in in Iran's health system in the last previous years. Due to the importance of these interventions on the economic and performance of the hospital, this study was performed with aim to determine the effect of health system evolution plan and Tariff change based on relative values book on the performance of obstetrics and gynecology department in Imam Reza hospital in Mashhad.Methods: This cross-sectional descriptive study was conducted by Activity Based Costing in obstetrics and gynecology department of Imam Reza hospital in Mashhad in 2013-2015. For economic-performance analysis of obstetrics and gynecology department, three categories were used including: data related to cost, data related to income, and performance indexes. Data were extracted by data gathering forms and were analyzed using descriptive statistics by Excel Software and statistical descriptive methods (mean, standard deviation, percentage…).Results: Total income of this department has increased respectively by 54% and 75% after health system evolution and tariff change. The highest increase of income has related to operating room after tariff change (128%). After both health system evolution and tariff change, total expenditure of this department has increased respectively by 3% and 79%. Cesarean section rate has decreased about 2.3% after evolution.Conclusion: Evolution plan has positive effect on the performance and financial indicators of obstetrics and gynecology department of Imam Reza hospital. This effect was not equal among revenue and expenditure items.

Introduction: Stress urinary incontinence is a common problem among women, which negatively affects all aspects of a woman's life. This study was performed with aim to investigate the relationship between pelvic floor muscles’ strength and severity of urinary incontinence with quality of life in women with stress urinary incontinence.Methods: This cross-sectional study was performed on 126 women with stress urinary incontinence in Ahvaz in 2015-2016. To determine the type of incontinence and its severity, the questionnaires of urinary incontinence (QUID) and urinary incontinence severity index were used. Pelvic floor muscle's strength was evaluated manually. The quality of life was measured using a questionnaire of measuring quality of life in women with urinary incontinence (IQOL). Data were analyzed using SPSS statistical software (version 22) and Chi-square test.Results: In this study, there is a significant relationship between the severity of urinary incontinence and muscles' strength with quality of life (p<0.0001). It means that women with severe urinary incontinence and lower pelvic floor muscles’ strength had lower quality of life.Conclusion: Women with more severe form of urinary incontinence and weaker pelvic floor muscles have lower quality of life, thus it is essential to consider the strategies to strengthen pelvic floor muscles and improve urinary tract health.

Introduction: Failure to perform tasks such as reproduction, lead to a decrease in self confidence and increase of bereavement process. Structured consultation had emphasis on the experiences of women from abortion, return to normal life, and worry about the next pregnancy. This study aimed to the effect of Supportive care program on women's bereavement with early Miscarriage was designed.Methods and materials: This clinical trial was conducted involving 60 women with miscarriage women admitted to Omolbanin, Imam Reza and Ghaem Mashhad hospitals in 2016. Three sessions were held based on the Swanson theory for women in the intervention group. It was done routine cares in the control group. Baseline, 4 and 8 weeks after the abortion, Perinatal Bereavement Grief Scale were completed by women in both groups. Data using SPSS statistical software (v.11.5) and Independent t test, Mann-Whitney, Repeated measure ANOVA, Chi-square, Exact chi-square were analyzed. The p value less than 0.05 was considered significant.Results: The average score of bereavement in four and eight weeks post-abortion of women in the intervention group statistically significantly was less than in the control group (p<0.001). The results of repeated measure ANOVA showed that there was a statistically significant in the different bereavement score measurement of women in the intervention group (p<0.001) but there wasn' t statistically significant difference in the control group (p=0.899).Conclusions: Swanson theory-based structured program can decrease bereavement of women who have had a miscarriage.

Introduction: The rate of cesarean section in Iran is three times higher than standard and attention to the factors affecting decision making process of women to choose mode of delivery helps to recognize the causes of its high rate. This study was performed with aim to investigate the factors affecting decision making process of women to choose mode of delivery based on the Health Belief Model (HBM).Methods: This cross-sectional study was performed on 321 primigravid women who had normal and healthy pregnancy with gestational age of higher than 26 weeks in Gonabad from June 2014 to April 2017. Data collection tools included the questionnaire of personal and reproduction characteristics, the questionnaire of awareness about the advantages and disadvantages of vaginal delivery and cesarean section, the questionnaire of assessing HBM, and the questionnaire of choosing the mode of delivery. Data was analyzed by SPSS software (version16). P<0.05 was considered significant.Results: 238 women (74.1%) had selected vaginal delivery and 83 (25.9%) cesarean. Among the HBM constructs, two groups were significantly different in terms of perceived susceptibility (p=0.023) and perceived benefits (p=0.001), but there was no significant difference between two groups in terms of knowledge, perceived severity and perceived barriers (p>0.05). Two groups were not significantly different in terms of age, education and occupation of pregnant women (p>0.05), but a significant difference was found between those who had selected vaginal delivery and those who had selected cesarean in terms of sources of information about delivery mode (p=0.008).Conclusion: The main findings of this study showed a relationship between perceived susceptibility and perceived benefits with intended mode of delivery. This finding can be used in designing educational programs for pregnant women with more emphasis on significant structures of HBM.

Introduction: Interleukin 10 (IL-10) is an anti-inflammatory cytokine that its levels decrease in the presence of obesity and related diseases. Due to the lack of sufficient studies in this regard on healthy or patient obese women; this study was performed with aim to determine the effect of short term aerobic training on serum IL-10 in obese women.Methods: This study was performed in summer 2016 on 30 sedentary middle-aged obese females aged 30-40 years (30£BMI£36 kg/m2) in Tehran, Iran. Subjects were divided into experimental (n=15) and control (n=15) groups. Experimental group underwent an aerobic training program for 6 weeks, 3 sessions per week with 30-45 minutes at 60 to 75% of the heart rate max. Abdominal obesity and other anthropometrical markers. as well serum IL-10 were measured at 48 hours before and after exercise intervention. Data were analyzed by SPSS software (version 15) and independent-t and dependent-t tests. P<0.05 was considered significant.Results: Significant increase were observed in body weight, BMI, body fat percentage and abdominal obesity in experimental group (p<0.05). Also, serum IL-10 level significantly increased in exercise group (p=0.001).Conclusion: Short term aerobic training with moderate to high intensity leads to decreased obesity determinative indexes and increased serum IL-10 in obese females.

Introduction: Primary dysmenorrhea along with associated symptoms is followed by many consequences. According to Iranian Traditional Medicine point of view and the studies, oral and topical ginger are effective on primary dysmenorrhea. So this study was performed with aim to evaluate the effect of oral ginger capsule and topical ginger oil which are prepared by Maceration method on the associated symptoms of dysmenorrhea and comparing their effects.Methods: This single-blind randomized clinical trial was performed on 70 students with moderate and severe dysmenorrhea who were resident in dormitory of Tehran Shahid Beheshti University of Medical Sciences in 2016-2017. The associated symptoms of dysmenorrhea in these students were assessed with verbal multidimensional scoring system in first cycle. Then, the patients were randomized into two groups of oral and topical and they received drugs two days before the start of menstruation until first three days of menstruation over next three cycles. The oral group received one ginger capsule every 6 hours and the topical group applied 5 drops of ginger oil below the abdomen every 6 hours. The associated symptoms of dysmenorrhea were assessed and compared in each cycle based on verbal multidimensional scoring system. Data were analyzed by SPSS software (version 17) and Mann-Whitney and Wilcoxon tests. P<0.05 was considered significant.Results: Fatigue, bloat, headache, backache and leg cramps decreased in both groups compared to before the intervention (p<0.05). Nausea, vomiting and diarrhea decreased in oral group, and mood’s changes and leg pain decreased in topical group (p<0.05) after the intervention. Side effects were observed only in oral group (60%).Conclusion: Both forms of ginger reduced general and neurological symptoms of dysmenorrhea; the oral form decreased more gastrointestinal symptoms of dysmenorrhea and topical form decreased more musculoskeletal symptoms of dysmenorrhea. In addition, since topical form was better tolerated by patients, so it seems that topical ginger oil is a better choice for reducing the general and neurological symptoms of dysmenorrhea.

Introduction: Premenstrual syndrome (PMS) occurs in the luteal phase of menstrual cycle and is severe enough to interfere with the usual aspects of the life. Aerobic exercise and herbal drugs are effective to treat PMS. This study was performed with aim to evaluate the effect of aerobic exercise and consumption of curcumin on edema, estrogen and progesterone levels in patients with PMS.Methods: This double-blind randomized clinical trial was performed on 40 women with PMS at Tabriz in 2016. The subjects were divided into 4 groups: exercise, curcumin, training+curcumin and placebo. The training groups performed aerobic exercise for 8 weeks, 3 times in a week, and the other groups daily consumed 2 capsules containing 100 mg of curcumin or placebo from 7 days before the menstrual period up to 3 first days. Diagnosis of the syndrome was done prospectively by using the Dickerson questionnaire. Data were analyzed using SPSS software (version 21) and descriptive and inferential statistics. P<0.05 was considered significant.Results: Training, curcumin and their combination had no significant effect on the edema caused by PMS, but significantly reduced physical symptoms caused by PMS (P<0.05). Improvement of behavioral symptoms of PMS was seen only in exercise group and exercise+curcumin group (P=0.2). PMS mood symptoms in all three groups improved compared to before and after the intervention (P<0.05). Also, none of the interventions caused significant changes in serum levels of progesterone (P>0.05). However, estrogen levels significantly decreased in all 3 groups (P<0.05).Conclusion: Both aerobic exercise and curcumin are effective in improving the symptoms and hormones of PMS, but PMS syndrome is not equally affected by these two interventions. So, it is recommended that for obtaining best results, a combination of aerobic exercise and curcumin be used in women with PMS.

Introduction: Hyperemesis gravidarum is often accompanied by severe physical and mental stress. This type of vomiting can lead to complication and reducing the quality of life. This study was performed with aim to assess posttraumatic stress symptoms (PTSS) in pregnant women with and without Hyperemesis gravidarum.Methods: This case-control study was performed on 350 pregnant women with Hyperemesis gravidarum and 350 pregnant women without Hyperemesis gravidarum who referred to the clinics and hospitals of Taamin Ejtemaee of Mashhad in 2014-2015. Data was collected through interview with mothers and completing the standard questionnaires of IES15, PTSS10 and evaluation of negative life outcomes. Data were analyzed by SPSS software (version 20) and independent t-test, Chi-square, Fisher's exact test and U Mann-Whitney test. P<0.05 was considered significant.Results: The mean PTSS scores in case and control groups were 138±4 and 28±3, respectively, that independent t-test showed that the difference was statistically significant (P<0.001). Also, significant difference was found between case and control groups in terms of negative life outcomes especially regarding financial issues, marital status, professional issues, as well as regarding psychological and physical well-being (P<0.05).Conclusion: Pregnant women with Hyperemesis gravidarum are at more risk for developing PTSS and negative life outcomes compared to healthy pregnant women, so management and control of these patients seems to be necessary.

Introduction: Menopausedue to low estrogen levels is associated with an increased fat percentage and particularly visceral fat and it is directly related to the risk of coronary heart diseases; So, the aim of this study was to investigate the effect of eight weeks of aquatic aerobic training on lipid profile, Glucose, Insulin resistance and Apoprotein A and B in overweight postmenopausal women.Materials and Methods: This randomized clinical trial was performed on 26 postmenopausal women at Ferdowsi University of Mashhad in 2014. The subjects were randomly divided into two groups of Control and Exercise. The experimental group participated in Aquatic aerobic training for eight weeks. The three-point method and body composition device, as well as the Homa equation were used to determine the fat percentage, body mass index and insulin resistance, respectively. The related kits were also utilized for evaluation of cholesterol, low and high density lipoprotein, triglycerides, apolipoprotein A and B values. Analyze of data was done by SPSS software (version 16) and Kolmogorov-Smirnov test, dependent t-test and independent t-test. The value of p was considered significant as less than 0.05.Results: Regular aquatic aerobic training caused a significant decrease in levels of apolipoprotein A (p=0.001) and apolipoprotein B (p=0.019), LDL (p=0.06), total cholesterol (p=0.03), glucose (p=0.038) and insulin resistance (p=0.003) and a significant increase in HDL (p=0.015); in this group, TG also decreased which was not significant (p=0.72). In Control group, levels of apolipoprotein A (p=0.029) and B (p=0.026), declined significantly; in this group, it was observed an significant increase in TG levels (p=0.027) and insignificant increase in total cholesterol (p=0.30) and glucose (p=0.80); insulin resistance decreased which was not significant (p=0.61).Conclusion: The results indicate that eight weeks of aquatic aerobic training caused an improvement in some cardiovascular risk factors in overweight postmenopausal women and this kind of training is recommended to prevent the risk of atherosclerosis and cardiovascular diseases.