Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2018 | Volume:21 | Issue:2 |Papers Count:14

Introduction: Polycystic ovary syndrome (PCOS) is a complex endocrine disorder in women, and approximately 75% of women affected by PCOS are overweight. Angiopoietin-like protein 4 (ANGPTL4) is a potent inhibitor of lipoprotein lipase (LPL) enzyme. This protein is a determinant of plasma concentration and clearance of triglyceride. In this study, we aimed to evaluate the serum levels of ANGPTL4 in PCOS women with normal body mass index (BMI).Methods: A case-control study of 47 women visiting Abolfazle Clinic, affiliated to Bushehr University of Medical Sciences, was performed during 2015-2016. In this study, 25 PCOS women were assigned to the case group through simple non-probable sampling based on the Rotterdam 2003 criteria. Further, 22 healthy women were selected for the control group. Serum levels of all hormones were measured by the ELISA technique, and biochemical parameters were evaluated by an autoanalyser. The obtained data were analyzed using independent samples t-test, Mann-Whitney U test, and linear regression test in SPSS, version 16. P-values less than 0.05 were considered statistically significant.Results: The results of this study showed a significant increase in LH (P=0.003), LH/FSH (P=0.007), FBS (P=0.03), testosterone (P= 0.02), and prolactin (P=0.005) levels in the case group. There was no significant difference in the levels of ANGPTL4, insulin, HOMA-IR, low-density lipoprotein (LDL), HDL, HOMA-B, and creatinine between the groups. There was a significant negative correlation between serum level of ANGPTL4 and insulin logarithm (P=0.002), FBS (P=0.006), HOMA-IR logarithm (P=0.001), and BMI (P=0.03), but no correlation was found between ANGPTL4 and lipid parameters.Conclusion: We found no significant difference between the PCOS women with normal BMI and the controls regarding serum levels of ANGPTL4.

Introduction: Background & Objective: Anemia during pregnancy has a relatively high prevalence. Mild anemia is not associated with significant embryonic effects, whereas severe anemia (hemoglobin of<7) could adversely affect the mother and fetus and increase maternal and neonatal mortality. The present study aimed to evaluate the influential factors in the prevalence of anemia and the associated neonatal complications in pregnant women.Methods: This descriptive, cross-sectional study was conducted by reviewing 550 delivery records of the pregnant women referring to the health centers in Yazd, Iran during 2016-2017. Subjects were randomly selected from different parts of Yazd city. Data on pregnancy care were extracted from the medical records using a data collection. Anemia was defined as the hemoglobin levels of<11 and< 10.5 in the first and second semester, respectively. Data analysis was performed in SPSS version 16 using Chi-square and t-test at the significance level of P<0.05.Results: The prevalence of anemia among the pregnant women in Yazd city was 7.2%, including 25 cases (4.5%) in the first trimester, and 22 cases (4%) in the second trimester of pregnancy. No significant correlations were observed between anemia and maternal age, education level, occupation status, neonatal sex, mode of delivery, high-risk pregnancy and birth weight (P>0.05). However, the prevalence of anemia was significantly different in various regions of the city, and the neonates of anemic mothers had significantly lower head circumference compared to the neonates of the mothers without anemia (P<0.01).Conclusion: According to the results, the prevalence of anemia seems to be relatively lower in Yazd compared to the other regions in Iran, which could be attributed to the expansion of healthcare services and implementation of preventive intervention programs in these areas.

Introduction: The use of misoprostol and transcervical Foley catheter is an effective method in cervical ripening. According to the literature, there is a controversy surrounding the results of the comparison of these two methods and the combined method. This study was conducted to compare the individual and combined administration of misoprostol and transcervical Foley catheter in Ayatollah Mousavi Hospital, Zanjan, Iran, during 2013-14.Methods: This randomized clinical trial was carried out among 85 nulliparous women with the gestational age of 40 weeks or more and the Bishop score of equal to or less than 4 with less than two contractions every 10 min. The subjects were randomly assigned into three groups of misoprostol (n=30), transcervical catheter (n=30), and combined (n=25). The misoprostol group received the maximum dose of 100 µg of misoprostol in equally divided doses every 4 h. A transcervical Foley catheter 18 F, inflated with 50 cc of normal saline was inserted into the cervices of the participants in the transcervical catheter group. Additionally, the combined group were simultaneously treated with both methods. The time interval between the intervention and the onset of labor, duration of the latent and active phases, and method of delivery (cesarean section or natural vaginal delivery), and the rates of neonatal and maternal complications were compared in these three groups. Data analysis was performed using the Chi-squared test and one-way analysis of variance in the SPSS software, version 22. The P-value less than 0.05 was considered statistically significant.Results: No significant difference was observed between the groups in terms of the method of delivery, duration of the active phase, meconium, fetal distress, chorioamnionitis, and uterine tachysystole (P>0.05). However, the duration of latent phase was significantly shorter in the combined group compared to the misoprostol group (P=0.002, P=0.001). The duration of the first phase of labor was significantly shorter in the combined group in comparison to the transcervical Foley catheter group (P=0.009).Conclusion: Given the results, both methods were effective in cervical ripening; nevertheless, the combined method was more effective than using transcervical Foley catheter in shortening the duration of the first phase of labor.

Introduction: The most important intervention to prevent the prolongation of the third stage of labor is the prescription of chemical drugs that have adverse effects despite their efficacy. Therefore, it seems necessary to seek for alternative methods with higher safety. Regarding this, the aim of the present study was to investigate the effects of immediate and continuous mother-neonate skin-to-skin contact (SSC) on the duration of the third stage of labor.Methods: This randomized clinical trial was conducted on 92 primiparous women who referred to Omolbanin Hospital in Mashhad, Iran. The participants were divided into two groups of SSC and routine care (RC). In the SSC group, at the end of the second stage of labor, the neonate was placed naked against his/her mothers’ skin in a prone position. In the RC group, the newborns were kept under a radiant heater, and after the repairing of the perineum, they were transferred to their mothers in a blanket. The data were analyzed in SPSS (version 14) using the Chi-square test and independent t-test test. The P-value less than 0.05 was considered statistically significant.Results: The duration of the third stage of labor was less than 5 min in 11 (23.4%) and 3 (6.7%) participants in the SSC and RC groups, respectively. Additionally, this duration was within 10-20 min in 6 (12.8%) and 13 (28.9%) subjects of the SSC and RC groups, respectively. Accordingly, there was a significant difference between the two groups in this regard (P=0.02). Furthermore, the SSC group had a significantly lower need for synthetic oxytocin after delivery as compared to the RC group (P=0.03).Conclusion: As the findings indicated, early mother-neonate SSC can shorten the length of the third stage of labor and reduce the need for a high dose of synthetic oxytocin and its complications. Therefore, this approach can be used a simple, cost-effective, efficient, and uncomplicated method to accelerate the third stage of labor and decrease the rate of postpartum hemorrhage, which is one of the main causes of maternal mortality and morbidity.

Introduction: Preeclampsia is a global health concern in women. Midwifery education is essential to acquiring the necessary skills to manage midwifery crises, such as preeclampsia and eclampsia. The present study aimed to compare the effects of simulation-based training, compilation training, and lectures on the cognitive skills of midwives in the management of preeclampsia and eclampsia.Methods: This clinical trial was conducted on 90 midwives employed in the hospitals in Mashhad, Iran in 2016. Participants were divided into three groups of simulation-based training, compilation training, and lecture using a random number table. The simulation group received training for six hours at the Center for Clinical Skills. Subjects in the compilation group were trained for four hours through lectures and an educational website for a week. Participants in the lecture group received training for six hours through lectures. Before and two weeks after the intervention, a cognitive skills test was performed on the midwives. Data analysis was performed in SPSS version 23 using descriptive statistics (frequency distribution, frequency percentage, standard deviation, mean), paired t-test, one-way ANOVA, Wilcoxon test, and Kruskal-Wallis test at the significance level of P<0.05.Results: Before the training, mean score of cognitive skills was not significant in the study groups (P<0.05), while it increased significantly in all the groups after two weeks of training (P<0.001). In addition, mean score of cognitive skills was significantly higher in the compilation training and lecture groups compared to the simulation-based training group (P<0.001). However, no significant difference was observed in the mean score of cognitive skills between the compilation training and lecture groups (P=0.869).Conclusion: According to the results, simulation, compilation, and lectures could effectively enhance the cognitive skills of midwives in the management of preeclampsia and eclampsia, while the improvement was more significant in the compilation training and lecture groups compared to the simulation group.Considering that compilation training is an active, learner-oriented method, it is recommended for the training of midwives in emergencies.

Introduction: Breast cancer is the most prevalent malignancy among females and the first leading cause of death from cancer in women. This highly heterogeneous disease is multifactorial. Mutations in BRCA1 and BRCA2 genes, which contribute to DNA repair, are the causes of 20-30% of hereditary breast cancers. Therefore, this study was conducted to determine the BRCA1 mutations in patient with breast cancer in South Khorasan Province, Iran, during 2015 to 2017.Methods: In this descriptive study, we collected 88 peripheral blood samples from patients with breast cancer, 11 of which had a positive family history of the disease. The BRCA1 gene was amplified in the DNA isolated from female patients using polymerase chain reaction (PCR) technique. Then, the BRCA1 mutations in exons 6, 13, and 20 were analyzed by PCR-single-strand conformation polymorphism (SSCP), silver nitrate staining, and DNA sequencing. Data analysis was performed using SPSS software, version 22.Results: In this study, no mutation was observed in the exons 6 and 20. In addition, a polymorphism was found in the exon 13. This variant (c.4308T>C) was detected in 28 patients, four of them (14.2%) had hereditary breast cancer. The frequency of the mutation was 36.3% and 31.1% in patients with hereditary and non-hereditary, respectively.Conclusion: In this study, BRCA1 gene mutations did not occur in exons 6 and 20. Additionally, a polymorphism rs1060915 in exon 13 of the BRCA1 gene was observed with the frequency of 31.8%.

Introduction: Females are sensitive and vulnerable during pregnancy in terms of mental health. Psychotherapy may be an effective intervention to improve the mental status of the mothers. Regarding this, the present study aimed to investigate the effect of cognitive-behavioral group therapy on depression during pregnancy.Method: This clinical trial was conducted on 60 pregnant women with the gestational age of 12-12 weeks, who referred to the health centers of Qazvin, Iran, within 2016-2017. All selected mothers had mild to moderate depression based on the Beck’s Depression Inventory. The participants were randomly divided into two groups of intervention (n=30) and control (n=30). The intervention group was subjected to cognitive-behavioral group therapy for six weeks, while the control group received no training. The Beck’s Depression Inventory was administered to all participants both immediately after the intervention and two months later as a post-test. The data were analyzed in SPSS software (version 23) using ANOVA and Chi-square test. P-value less than 0.05 was considered statistically significant.Results: According to the results of the Mann-Whitney U test, there was a significant difference between the intervention and control groups at the post-test (P=0.001) and follow-up (P£0.001). In addition, the results of ANOVA revealed a significant difference in the intervention group in terms of the reduction of depression symptoms (P£0.001) at the post-test and follow-up stages. However, no significant changes were observed in the control group in this regard.Conclusion: Cognitive-behavioral group therapy was effective in the improvement of depression in pregnant women.

Introduction: Physical activities based on combined exercises, central stability, and Kegel exercises are simple, cost-efficient methods to effectively improve the postpartum quality of life in primiparous women. The present study aimed to investigate the effects of Kegel, central, and combined stability exercises on the central muscle endurance and quality of life of primiparous women after episiotomy.Methods: This clinical trial was conducted on 36 primiparous women in Najafabad city, Iran in 2016. Subjects were randomly divided into three groups of Kegel exercises, central stability training, and combined exercises. Subjects in each group performed the training program for six weeks (three sessions per week). The studied variables included trunk muscle endurance and quality of life, which were measured before and after the intervention. In addition, the SF-36 questionnaire was used to assess the health-related quality of life in the subjects. Data analysis was performed in SPSS version 21 using Lone test, Kolmogorov-Smirnov test and analysis of variance, and P-value of less than 0.05 was considered statistically significant.Results: Combined exercises had the most significant effect on all the measured indices. Moreover, the effect of combined exercises on central muscle endurance was significantly higher compared to the Kegel and central stability exercises (P>0.05). However, no significant associations were observed between the training programs and quality of life, and there were no significant differences between the three methods in this regard (P<0.05).Conclusion: According to the results, combined exercises had the greatest impact on improving muscle endurance, followed by central stability exercises, which had a significant effect on central muscle endurance. However, no significant differences were observed between the three exercise modes in terms of the quality of life.

Introduction: Genitourinary tract infections are among the most common causes of infertility in men. These infections could also cause disorders in various parameters, such as the number, motility, viability, and morphology of sperms, as well as the function of the semen, epididymitis, and prostatitis. The present study aimed to determine the prevalence of the bacterial and viral infections associated with the herpes virus, Chlamydia trachomatis, and Mycoplasma genitalium in the seminal fluid of infertile men with unknown cause.Methods: In this descriptive-analytical study, 60 seminal fluid samples were collected from the infertile men referring to an infertility treatment center in Kerman, Iran during May-November 2016. Multiplex-PCR was carried out using specific primers to identify the herpes virus, Chlamydia trachomatis, and Mycoplasma genitalium. Data analysis was performed in SPSS.Results: Out of 60 tested samples, eight cases (13.3%) were positive for the investigated organisms. Among the positive samples, three cases (37.5%) had HSV-1, three samples (37.5%) had C. trachomatis, one case (12.5%) had M. genitalium, and one sample (12.5%) had HSV-2.Conclusion: Findings of the present study regarding the presence of bacterial and viral organisms in the seminal fluid could lay the groundwork for the screening of asymptomatic infections and appropriate treatment before initiating assisted reproductive therapy.

Introduction: Breast cancer is the most common malignancy and the second leading cause of death due to cancer in women following lung cancer. Ample evidence has shown the antitumor activities of curcumin in breast cancer in preclinical and clinical trials. The anticancer effects of curcumin include the inhibition of cancer cell formation, angiogenesis, and tumor growth. Due to the low absorption of curcumin in the gastrointestinal tract, as well as its low water solubility, rapid metabolism, and high excretion, curcumin has low bioavailability. Therefore, using formulated curcumin could increase its bioavailability. The present study aimed to evaluate the effects of curcumin and its nano-formulated compositions in the prevention and treatment of breast cancer.Methods: In this review, data were collected via searching in databases such as PubMed, Scopus, Google Scholar, and Magiran to identify the related English and Persian articles published until 2016 using keywords such as nano-forms, clinical study, cancer, breast, and curcumin. In total, 40 studies were identified and reviewed.Results: Using formulated curcumin could increase its absorption and bioavailability, while it also enhances its effects on cancer cells, including breast cancer cells. Therefore, nano-formulated curcumin was observed to be effective in the prevention and treatment of breast cancer.Conclusion: Considering the higher bioavailability of the formulated compounds of curcumin compared to its free form and the low toxicity of this herbal medicine, curcumin could be used in combination with other anticancer medications in the treatment of breast cancer.

Introduction: Globally, breast cancer is the most common malignancy causing extensive mortality in women. In most cases, there is no known risk factor for breast cancer. Extensive hormonal changes that occur during pregnancy appear to be involved in the etiology of breast cancer. Since identifying risk factorshelps with primary prevention and early diagnosis of breast cancer, this study was performed to systematically review studies about pregnancy-related variables and the risk of breast cancer in Iran and worldwide.Methods: In this systematic review, we searched PubMed, Google Scholar, Scopus, SID, and Science Direct databases using keywords of “pregnancy-related variables” and “breast cancer” to retrieve articles published during 2000-2017. Then, those articles that obtained a score of ³ 6 based on the Newcastle–Ottawa Scale were entered to the study. The results were reported qualitatively.Results: Fifty articles consisting of 26 case-controls and 24 cohort articles, which met the inclusion criteria, were investigated. Our evaluations indicated that among the factors examined, abortion and preeclampsia had a stronger relationship with breast cancer.Conclusion: History of abortion seems to increase the risk of breast cancer. Also, history of preeclampsia plays a protective role in breast cancer. Further studies are needed to examine the relationship of gestational diabetes and multiple gestations with breast cancer.

Introduction: Ovarian cancer is a common malignancy in women, the major presentations of which are gastrointestinal symptoms. The intra-abdominal metastasis of ovarian cancer often occurs in the peritoneal cavity, while cervical metastasis has rarely been reported. This study aimed to present the case of a metastatic epithelial ovarian cancer to the cervix.Case Report: A 58-year-old woman (gravida 3) was admitted with a history of postcoital bleeding in the oncology clinic of a teaching hospital affiliated to Mashhad University of Medical Sciences in 2016. Colposcopic examination was performed due to the abnormal appearance of the cervix, and pathology results confirmed squamous cervical cancer. Considering the early stage (II A) of the disease, the patient underwent a radical surgery. In laparotomy, due to the extent of the intra-abdominal metastasis similar to that of ovarian cancer, only omental biopsy was possible. The pathology report of the specimen showed the metastasis of the serous papillary adenocarcinoma of the ovary to the omentum. Furthermore, repeated review of the pathology of the cervical specimen was indicative of ovarian metastasis to the cervix. Due to the advanced stage of ovarian cancer, chemotherapy (taxol-carboplatin) was recommended, followed by standard optimal surgical cytoreduction. Afterwards, the patient was followed-up for ovarian cancer. After less than six months, she experienced pelvic and abdominal metastasis and is currently receiving palliative chemotherapy.Conclusion: Cervical metastasis is an unusual occurrence at presentation and during the progression of epithelial ovarian cancer. As an initial symptom of ovarian cancer, postcoital bleeding is rare and should be considered in the patients with cervical cancer who are at the risk of metastatic lesions from the adjacent tissues.