Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2019 | Volume:21 | Issue:11 |Papers Count:15

Introduction: Systemic lupus erythematosus (SLE) is a common autoimmune disease and predominantly affects fertile women. This disease is associated with multisystem involvement and has high risk for both the mother and the fetus. One of the major risks for SLE mothers is the occurrence of disease flare during pregnancy. Some studies have shown that SLE flares more during pregnancy, but the conclusion of others is quite the opposite. Therefore, this study was performed with aim to determine the feto-maternal outcome in pregnant women with SLE. Methods: This retrospective study was performed on 38 pregnant women with lupus who were hospitalized in Obstetrics and Gynecology ward of Kermanshah Imam Reza hospital in 2008-2012. The renal parameters including creatinine and urinary protein excretion, hemoglobin and platelet levels, and also pregnancy outcomes-preeclampsia, eclampsia, abortion, preterm delivery, mode of delivery, infant's weight and stillbirth were recorded. Data collection tool was a questionnaire which was designed based on the main goals of the study. Data were analyzed by SPSS software (version 16) and descriptive statistics index. P<0. 05 was considered significant. Results: In this study, there was cesarean section in 27 patients (73. 68%), abortion in 8 (21. 05%), intrauterine deaths in 2 (2. 64%), hypertension in 9 (23. 68%) and eclampsia in 1 (2. 63%). Preterm delivery occurred in 22 patients (57. 89%). Mean 24-hour urine protein was 185. 321 mg and mean of birth weight was 2248. 57 gr. Conclusion: Lupus and pregnancy are associated with pregnancy unfavorable outcomes including preeclampsia, preterm delivery, high occurrence of cesarean section and abortion.

Introduction: Portal infection is one of the complications that can affect the results of chemotherapy and need to other treatments. Therefore, researchers recommend that caution should be exercised until the reasons for this request have been identified and no action has been taken to control and eliminate them. Therefore, the present study aimed to investigate the prevalence of related infections and port-specific factors in women with common cancer under chemotherapy. Methods: This study was conducted on 85 patients with prevalent cancers among women and port candidates for chemotherapy in Tabriz hospitals in 2015. Clinical signs and laboratory tests (measuring white blood cell and erythrocyte sedimentation levels) confirming port-based infection were recorded in researcher-made checklists. Subsequently, the data were analyzed by SPSS software (version 19) using the descriptive statistics and independent t-test. P-value less than 0. 05 was considered statistically significant. Results: A total of 13 patients suffered from port infection after the port was placed. There was a significant relationship between the number of chemotherapy sessions (P=0/002), the number of days of in-situ port (P=0/001), and the number of hospital stay days between the two groups with or without infection after the port placement (P=0/001). Conclusion: The high prevalence of infection in the port site (15%) in this study can affect the duration of chemotherapy and the trust of team members and patients. Therefore, it is suggested not to refer to the results of the present study in decision-making for port insertion in chemotherapy. On the other hand, being aware of the extent of port-related infection in the present study can change the policies of the hospitals and physicians to control the infection and lead to finding optimal ways of using it.

Introduction: Recently, there have been some reports about the antifungal and antimicrobial effects of Satureja bachtiarica. This study aimed to determine the effects of Clotrimazole-Satureja bachtiarica vaginal cream and compare with those of Clotrimazole vaginal cream in patients with vaginal candidiasis. Methods: This randomized double-blind clinical trial was carried out on 80 women of childbearing age that referred to Hajar Hospital in Shahrekord, Iran. The cases in the first group received Clotrimazole-Satureja bachtiarica vaginal cream and in the second group, the patients received Clotrimazole vaginal cream. Clinical and laboratory signs and symptoms were recorded at baseline and after the treatment by questionnaires and forms. Both groups were treated for 7 days. The data were analyzed in SPSS software (version 21) using paired t-test, Chi-square test, repeated measures, and independent t-test. P-value less than 0. 05 was considered statistically significant. Results: The results of the present study showed that the amount of vaginal discharge (P=0. 0001), dysuria (P=0. 014), and vaginal itching (P=0. 048) in the Clotrimazole-Satureja group were significantly less than those of the Clotrimazole group. There was no significant differences in the erythema of the vulva and vagina (P=0. 108), as well as dyspareunia (P=0. 118), between the Clotrimazole-Satureja group and the Clotrimazole group. No significant correlation was observed between the recarturrent and the studied groups (P=0. 130). Conclusion: The results of this study showed that the therapeutic effects of Clotrimazole-Satureja bachtiarica vaginal cream were not only similar to those of Clotrimazole vaginal cream but also more effective at improving the symptoms of vaginal candidiasis. Therefore, the use of this cream is suggested for the treatment of vaginal candidiasis infection.

Introduction: Nausea and vomiting can reduce the quality of life of pregnant women. Identifying the related factors and how we can relieve them can play an important role in the care of pregnant women. Therefore, the present study was conducted with aim to determine the factors affecting the severity of nausea and vomiting during pregnancy and how it is controlled by mothers. Methods: This descriptive study was performed on 160 pregnant women with gestational age of 6-20 weeks and single pregnancy who had referred to Hamadan health centers in 2014. Data were collected by using the researcher-made questionnaire including the questions about demographic characteristics, fertility, how to control nausea and vomiting, and the questionnaire of assessing nausea and vomiting in pregnancy. Data were analyzed by SPSS software (version 16) and Fisher Exact test. P < 0. 05 was considered significant. Results: According to the results of the study, the severity of nausea and vomiting was mild in 79 cases (49. 4%), moderate in 75(46. 9%) and severe in 6 (3. 7%). Maternal age, mother's occupation, gestational age and time of day were associated with severity of nausea and vomiting (P<0. 05). 89 (56. 2%) of the research units were looking for a remedy for their problem by using of herbal compounds and medicine. Vitamin B6 and mint extract were most used. 80 (50%) of women did not use any medicines due to their fear of injury to the fetus. Conclusion: Variables such as maternal age, mother's occupation, gestational age and time of occurrence of nausea and vomiting during the day were related to the severity of nausea and vomiting. Vitamin B6 and Mint extract had the most intake for relieving nausea and vomiting during pregnancy.

Introduction: Acinetobacter baumannii is one of the primary causes of nosocomial infections. Furthermore, the increment of antibiotic resistance has raised concerns about the proper therapeutic approach to this problem. This study aimed to determine the susceptibility of A. baumannii to colistin and imipenem through minimal inhibitory concentration (MIC). Methods: In this study, 2745 samples (2745 plate) were collected from patients in different wards of Ghaem Hospital and Imam Reza Hospital in Mashhad between October 2015 and September 2016. In the case of a specimen was wound, after disinfection of the wound surface using a sterile swab from the inferior part of the sample, middle stream urine was collected in sterile container, and the bronchial specimen was taken by the doctor by syringe. In this study, 100 A. baumannii were isolated from 100 hospitalized patients at Imam Reza and Ghaem hospitals of Mashhad, By Biochemical tests (Kligler iron agar, Lysine, urea indole) diagnostic and then disc diffusion method, and E-test strips were utilized to evaluate infection, antibiotic susceptibility, and MIC, respectively. . Results: The obtained results of disc diffusion showed that all isolates were resistant to imipenem, which was also confirmed by E-test strips. Moreover, all isolates were sensitive to colistin. The obtained colistin MIC was 0. 25μ g/ml for one sample and ≤ 2μ g/ml for others; which were considered sensitive according to the Clinical and Laboratory Standards Institute standards. Conclusion: The high resistance of A. baumannii to imipenem was indicative of resistance pattern changes of this bacteria and insufficiency of the mentioned antibiotic for treatment. However, colistin is still effective and should be prescribed more carefully to prevent resistant strains spread.

Introduction: Childbirth is a physiological process that must be accomplished without any interventions. The main objective of this study was to evaluate the effects of prenatal preparation classes on the duration of labor and delivery type in primiparous women. Methods: This clinical trial was conducted on 100 primiparous women referring to the Sabalan Hospital in Ardabil, Iran, for prenatal care and delivery in 2017. The subjects were randomly assigned into two groups of intervention (n=50) and control (n=50). The intervention group participated in childbirth preparation classes (from 20th to 37th weeks of gestation) for eight 2-hour sessions implemented biweekly by a midwife. The control group received only usual pregnancy care. Trainings in the intervention group included the anatomy and physiology of women's genital organ, modifiable activity during pregnancy, personal health, abdominal breathing, nutrition, high-risk pregnancy, mental health, types of delivery, postpartum problems, newborn, and breastfeeding. After the initiation of labor, the duration of active phase, second stage of labor, and method of delivery were recorded by the researcher for both groups. The data were analyzed in SPSS software (version 18) using t-test, Chi-square, and Fisher’ s exact test. P-value less than 0. 05 was considered statistically significant. Results: The results of the study showed that the prenatal preparation classes reduced the duration of delivery (P<0. 001) and rate of cesarean section (P=0/023). Conclusion: Prenatal preparation classes led to the reduction of labor duration and rate of cesarean section. Therefore, it is suggested to implement these preparation classes at a wider scope in prenatal care centers.

Introduction: Episiotomy is one of the most common surgical procedures in women. The pain caused by episiotomy is always stressful and has negative effects on women's functions. The aim of this study was to assess the effect of Aloe Vera gel on perineal pain and wound healing after episiotomy among primiparous women. Methods: This study was a randomized double-blinded controlled clinical trial was conducted on 80 women referred to Tamin Ejtemaee Hospital, Hamadan, Iran, in 2017. The participants were divided into the intervention (Aloe Vera gel, n=40) and control (normal saline, n=40) groups. The REEDA questionnaire, and Visual Analog Scale were used before and 3, 7, 10 days after the intervention. The data were analyzed in SPSS software (version 21) through the Chi-square test, duplicate measurement, and independent and paired samples t-tests. Results: The results showed no significant differences between the two groups in terms of the mean scores of episiotomy pain and wound healing before the intervention (P<0. 05). However, there was a significant difference between the two groups based on independent t-test after intervention (P<0. 001). The results showed that Aloe Vera gel reduced pain and healed episiotomy ulcer, compared to the normal saline. Conclusion: The use of Aloe Vera gel, compared to normal saline, reduces pain and accelerates episiotomy ulcer healing with no side effects; therefore, it can be beneficial for women.

Introduction: Gestational diabetes is the most common medical condition during pregnancy. Early diagnosis and preventive and therapeutic measures reduce the short-term and long-term complications of mother, fetus and infant. This study was performed with aim to determine the relationship between un-conjugated estriol and gestational diabetes. Methods: This case-control study was conducted on 60 pregnant women with gestational diabetes mellitus (case group) and 120 healthy pregnant women (control group) referred to Mahdieh and Taleghani hospitals of Tehran in 2017-2018. Triple test was performed for the samples in 14-17 weeks of gestation and oral glucose tolerance test with 75 g glucose was performed in 24-28 weeks of gestation. Data were collected by interview. Data were analyzed using SPSS software (version 17) and independent t-test, Chi-square, Mann-Whitney, and logistic regression. P < 0. 05 was considered significant. Results: Mean and standard deviation of un-conjugated estriol in case group was 1. 17 ± 0. 61 and in control group was 1. 02 ± 0. 47 MOM. The level of un-conjugated estriol was significantly higher in the case group than the control group (p = 0. 011). Conclusion: Increased level of un-conjugated estriol in early pregnancy can be suggested and evaluated as a new diagnostic test for gestational diabetes. Therefore, performing the necessary measures can reduce its complications by early identification of at-risk women.

Introduction: The rate of bleeding is associated with impaired synthesis of endometrial prostaglandins, especially PGE2. One of the most common causes of anemia in women is menstrual bleeding. Bromelain, an enzyme found in pineapple, has anti-inflammatory effects and reduces prostaglandin E2 in inflammatory regions. This study was performed with aim to compare the effects of Bromelain and Mefenamic acid on the amount of menstrual bleeding. Methods: A double-blind randomized clinical trial was conducted on 90 students with primary dysmenorrhea in dormitories of Velayat University of Iranshahr in 2017. The students were monitored for two cycles with Higham chart in terms of the rate of bleeding. Then, they were randomly assigned to two groups: Bromelain (n=32) and Mefenamic acid (n=34). The Higham chart was completed to measure menstrual bleeding in two cycles of control and two cycles of intervention. The subjects received 250mg capsules of Bromelain or 250mg capsules of Mefenamic acid, if needed, they received two interventional cycles every 6 hours during the first three days. Data was analyzed by SPSS software (version 22) and Mann-Whitney, Paired t-test and independent t-test. P <0. 05 was considered significant. Results: The results of Paired t-test showed significant difference in the amount of bleeding after intervention in the Bromelain group (P = 0. 036), but this difference was not significant in the Mefenamic acid group (P = 0. 088). The difference between the mean of bleeding in two cycles of intervention compared to the two cycles of control was-6. 79 ± 17. 57 in the bromelain group and was-5. 36 ± 17. 57 in the Mefenamic acid group that showed no significant difference (P = 0. 744). Conclusion: Consumption of Bromelain for reducing menstrual bleeding has no difference with Mefenamic acid in primary dysmenorrhea.

Introduction: Nausea and vomiting is one of the most common complains during pregnancy, which often occur as one of the first signs of pregnancy after the first rebound of the menstrual period. There is a strong pattern of depression, anxiety, and stress in women with severe nausea and vomiting of pregnancy. Many women become physically, socially and psychologically isolated and their quality of life is affected. This study was performed with aim to investigate the effect of combination of psychological counseling and acupressure with couple therapy approach on the severity and duration of nausea and vomiting in pregnant women. Methods: This clinical trial was performed on 92 pregnant women with gestational age of 6 to 10 weeks and on their husbands in 2016. For the intervention group, in addition to the routine prenatal care, three 90 minutes sessions of psychological counseling and acupressure were held; but the control group only received routine prenatal care. Then, data were collected before and after the intervention by Rhodes index. Data were analyzed by SPSS software (version 22) and Chi-square, one-way ANOVA and covariance analysis. p <0. 005 was considered significant. Results: The severity and duration of nausea and vomiting significantly decreased in the intervention group compared to the control group (p<0. 001). Conclusion: The combination of psychological counseling and acupressure can reduce the duration and severity of nausea and vomiting.

Introduction: Assessing the labor progress is one of the primary and important cares during childbirth. The methods used to evaluate the progress of labor should have the least damage to the mother and the fetus. This review study was performed with aim to assess the methods of labor progress. Methods: In this review study, the Persian and English articles which were published during 1997 to 2018 and were indexed in databases of PubMed, Magiran, Google Scholar, Iranmedex, Irandoc and SID with keywords of progress of labour, vaginal examinations, cervical dilatation, and purple line were searched. The articles which had inclusion criteria entered to the study and were qualitatively analyzed. Results: A total of 43 studies which were extracted from 385 articles related to the assessing the progresses of labor were studied. The results of articles performed in this field were divided in three general categories including: determination of cervical dilation by vaginal examination, methods which consisted of several indicators such as maternal behavioral and physiologic changes, and discoloration of the skin between the buttocks (purple line). Conclusion: Vaginal examination is not the only method to evaluate the progress of labor and midwifes can use a set of signs and symptoms including observation of the purple line and measuring it, assessing the changes in the number of respiration, behaviors, voices, movements and positions of the mother during labor in order to reduce the number of vaginal examinations and therefore improve the mother and fetus healthy in clinical practice.

Introduction: Uterus rupture during pregnancy is a fatal complication or is associated with severe maternal and fetal complications. In some cases, due to the lack of timely diagnosis of uterus rupture, the patient will refer with bad state that in the case of early diagnosis, faster intervention can be performed Case Report: In this report, two cases of uterine rupture were introduced; the first case of uterine rupture occurred following motor trauma and fetal death and vaginal delivery, and the patient referred with metrite symptom and omentom herniation to ruptured uterus, and the second case, rupture of the uterus was due to pressure on the fundus during delivery in the patient without uterine scar, which referred as delayed due to the intestinal herniation to the uterus with acute abdomen obstructive symptoms. Conclusion: It is recommended that in patients with abdominal trauma, especially with fetal death, and in patients who have infant infected with blood, after delivery, despite the completeness of the placenta and absence of bleeding, an intrauterine assessment in terms of uterus rupture be performed with hand, and faster intervention be done in the case of diagnosing rupture uterus.