Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2018 | Volume:21 | Issue:1 |Papers Count:18

Introduction: Postpartum hemorrhage is the most common cause of maternal mortality, which requires proper management through effective measures. The present study aimed to assess the effect of education based on the simulation of the actual cases of maternal deaths on the skills of gynecology residents in the management of postpartum hemorrhage.Methods: This interventional study was conducted on 35 gynecology residents receiving rotational training in Omolbanin Hospital (R) in Mashhad, Iran in 2015. Data were collected using a questionnaire for identifying the symptoms of abnormal bleeding after delivery, estimation of blood volume, and appropriate measures. Moreover, the actual cases of maternal mortality were assessed in several sessions, and proper training was provided on the management of postpartum hemorrhage in each case. After six months, the questionnaires were completed by the residents again. Data analysis was performed in SPSS version 16 using paired t-test and one-way ANOVA at the significance level of P<0.05.Results: Mean scores of the residents before and after the training were 12.88±2.21 and 16.91±2.68, respectively (P<0.001). Mean scores of the residents of the first (P=0.009), second (P<0.001), third (P=0.004), and fourth year (P=0.001) showed significant differences before and after the training. However, no significant differences were observed in the scores of the residents after the intervention compared to before the intervention in terms of the academic year (P=0.538).Conclusion: According to the results, training based on the simulation of the actual cases of maternal deaths could enhance the skills and confidence of gynecology residents in the effective management of postpartum hemorrhage.

Introduction: The postpartum period refers to the first six weeks after delivery, which is associated with significant stress and sleep disorders in women. The present study aimed to evaluate postpartum sleep quality and the influential factors in women.Methods: This cross-sectional study was conducted on 200 women in the postpartum period referring to the health centers in Zanjan, Iran in 2014. Data collection tools were demographic questionnaires, Pittsburgh Sleep Quality Index (PSQI), and Edinburgh Postnatal Depression Scale (EPDS). Data analysis was performed in SPSS version 16 using the Chi-square test, Pearson’s correlation-coefficient, and Spearman’s correlation-coefficient. P-value of less than 0.05 was considered significant.Results: Mean score of postpartum sleep quality was 7.74±2.31, and 62.5% of the women had low sleep quality during this period. Frequency of waking due to infant’s crying (r=0.41; P<0.001) and feeding of the infant (r=0.46; P<0.001) had the most significant correlations with poor sleep quality. In addition, a significant association was observed between maternal depression and poor quality sleep (r=0.16; P=0.03). Among the demographic characteristics, maternal education level (r=-0.37; P=0.004), occupation status of the spouse (P=0.03), age (r=0.28; P=0.02), and maternal occupation status (P=0.03) had significant correlations with sleep disturbance.Conclusion: Considering the poor sleep quality in the women, it is recommended that proper interventions be provided for the prevention and diagnosis of postpartum sleep disorders in addition to the routine care procedures.

Introduction: Breast cancer is the most common cancer among women. Mammography is the standard method for breast cancer screening, while it has lower sensitivity in the patients with dense breasts.Therefore, women with dense breasts could be screened with other imaging modalities, such as ultrasound. The present study aimed to evaluate the ultrasonography findings in the women with dense breasts in mammography.Methods: This cross-sectional, descriptive-analytical study was conducted on all the women with dense breasts in mammogram screening at Imam Reza Hospital in Mashhad, Iran during March 2015-February 2016. Ultrasonography findings of each patient were recorded, including fibrocystic or mass changes, description of mass imaging, and sonographic BI-RADS. Data analysis was performed in SPSS version 16 using the Chi-square test at the significance level of P<0.05.Results: Among 150 patients enrolled in the study, breast ultrasonography findings were completely normal in 51 cases (34.0%) (BI-RADS 1). On the other hand, cysts or fibrocystic changes were detected in 71 patients (47.33%), four patients (2.67%) had possible benign tumors (BI-RADS 3), and possible malignant tumors (BI-RADS 4 or 5) were observed in nine cases (16.0%).Conclusion: Considering the large number of the masses detected in the ultrasound examination of the patients with dense breasts, invisibility of these tumors in mammography, and the critical role of early diagnosis in the reduction of breast cancer mortality, it is recommended that adjunct ultrasound examination be routinely performed in the patients with dense breasts on the mammogram, especially those with a positive family history of breast cancer.

Introduction: The measurement of the lower uterine segment (LUS) thickness before labor predicts hazardous complications of vaginal birth after cesarean section (VBAC). Vaginal birth after cesarean is one of the most effective methods used to reduce the incidence of cesarean section. Therefore, this study was carried out to evaluate the diagnostic value of sonographic measurement of lower uterine segment (LUS) thickness in uterine rupture during cesarean section and its associated factors in women with and without previous cesarean section.Methods: This prospective cohort study was conducted among 168 pregnant women in two groups of with and without the history of cesarean section (84 individuals per group) referred to Ardabil Alavi Hospital, Ardabil, Iran, in 2016. The thickness of the LUS was determined through transabdominal ultrasonography between the gestational ages of 36 to 40 weeks. At the time of cesarean section, the thickness of the women’s LUS and newborns’ weight and Apgar score were measured and recorded.Additionally, uterine rupture was recorded in patients with the past history of cesarean section. Moreover, the relationship between the LUS thickness and maternal age, gestational age, the indication for previous cesarean section, interdelivery interval, embryo weight, and abnormalities of erythrocyte were determined. Data analysis was performed using descriptive statistics and t-test in SPSS software, version 16.Results: According to the pre-operative assessments, the LUS thickness in the women with and without the history of cesarean section were 4.26±1.99 mm and 6.11±1.6 mm, respectively (P˂0.001). According to the findings obtained from sonography before and during the operation, there was a significant difference between the groups in terms of LUS thickness (P<0.001). Furthermore, there was a significant Difference between the interdelivery interval and uterine rupture and LUS thickness (P<0.001). However, no significant difference was observed between LUS thickness and maternal age, gestational age, women’s body mass index, and 5-minute Apgar score (P>0.05). Based on the results, the LUS thickness of 1.8 mm was considered as the critical cutoff value for predicting uterine rupture.Conclusion: The measurement of LUS thickness is a non-invasive technique to predict the uterine rupture, which leads to increased rate of VBAC.

Introduction: Postpartum morbidities are among the most important health problems across the world. However, the frequency and types of these morbidities remain unclear. The present study aimed to evaluate postpartum morbidities and the influential factors in the women in Gonabad city, Iran.Methods: This cross-sectional study was conducted in Gonabad city, located in the northeast of Iran, during 2015-2016. Subjects included 158 pregnant women referring to the community health center in Gonabad for prenatal care. Data on the pregnancy period were collected using the general health questionnaire (GHQ-28) and demographic questionnaires, and the scale of postpartum morbidities was used two months after delivery. Data analysis was performed in SPSS version 16 using the Kolmogorov-Smirnov test and Chi-square at the significance level of P<0.05.Results: The most common postpartum morbidities included pain in the C-section sutures (69%), fatigue (50%), backache (46.5%), episiotomy pain (46.5%), and sleep disturbance (44.4%). Moreover, statistically significant correlations were observed between headaches and feeding method (P=0.038), constipation and low maternal age (P=0.027), flatulence and mode of delivery (P=0.018), pain in C-section sutures and high maternal age (P=0.017), episiotomy pain and low maternal age (P=0.008), urinary frequency and maternal occupation (P=0.029), sore nipples and low maternal age (P=0.013), sore nipples and exclusive breastfeeding (P=0.040), and dysuria and neonatal weight (P<0.0001).Conclusion: According to the results, the most common postpartum morbidities were pain in C-section site, fatigue, backache, episiotomy pain, and sleep disturbance. Considering the high frequency of these morbidities, it is recommended that accurate postpartum examinations be performed, focusing on the timely diagnosis and treatment of these problems.

Introduction: Breast cancer is considered as a serious health concern worldwide. The early diagnosis of this disease plays an important role in reducing its associated mortality rate. Regarding this, the present study was conducted with the aim of investigating the role of training in changing the breast self-examination behavior among the females living in Gonabad, Iran.Method: This field trial was conducted on 140 married women within the age range of 20-49 years in Gonabad in 2016. The study population was selected using simple random sampling technique, and then assigned into two groups of control and intervention. The intervention group was subjected to breast self-examination training. The breast self-examination behavior was investigated using the Stages of Change Model. The participants filled out a questionnaire, covering the demographic information and the stages of changes, before, immediately after, and three months after the educational intervention. The data were analyzed in SPSS (version 20) using statistical tests, such as repeated measures ANOVA, Student’s t-test, Chi-square test, and multivariate ANOVA. P-value less than 0.05 was considered statistically significant.Findings: According to the results, the majority of the women in both intervention and control groups were in pre-contemplation and contemplation stages prior to the intervention. The results of the Chi-square test revealed no significant difference in change stages before the intervention (P=0.609). However, immediately and three months after the training, most of the subjects in the intervention group moved to action and maintenance stages, while in the control group, the majority of the women were in pre-contemplation and contemplation stages.Conclusion: As the findings indicated, educational intervention based on the stages of change model was effective in the improvement of breast self-examination behaviors. Moreover, training based on this model could lead to the promotion of screening behaviors depending on the stage of changes at which the women are.

Introduction: Breast cancer is the most common cancer diagnosis among women across the world. Successful breast cancer treatment depends on the early diagnosis of the disease. Mammography is a ‘gold standard’ screening method for breast cancer. The present study aimed to evaluate the demographic factors and health beliefs associated with screening mammography in the female employees aged 35 years and more in the state and Azad schools of medical sciences in Abadan, Iran.Methods: This descriptive study was conducted on 90 female employees in Abadan School of Medical Sciences and School of Nursing and Midwifery at Islamic Azad University of Abadan in 2017. Participants were selected via census sampling. Data collections tools were demographic and health beliefs questionnaires. Data analysis was performed in SPSS version 21 using Spearman’s and Pearson’s correlation-coefficient, and P-value of less than 0.05 was considered significant.Results: Significant associations were observed between the frequency of mammography and perceived sensitivity, as well as the education level of the spouse and perceived sensitivity (P=0.003). Mean perceived barriers in the subjects with a history of breast cancer in the first-degree relatives was higher compared to the perceived barriers in those with no history of breast cancer in their first-degree relatives. Moreover, mean perceived sensitivity was higher in the employees with a degree in medical sciences compared to those educated in humanities.Conclusion: According to the results, lack of knowledge on mammography was the main cause of the low rate of this screening method among the studied women. Therefore, it is recommended that codified educational programs be implemented in order to raise awareness regarding breast cancer screening.

Introduction: Recent findings show that increased dietary protein intake could significantly reduce the body weight and fat mass in overweight individuals. The present study aimed to investigate the effects of one session of progressive training after two modes of whey protein supplementation on the maximal fat oxidation (MFO), Fatmax, and insulin resistance in overweight women.Methods: This clinical trial study was conducted with a pretest-posttest design on an experimental group consisting of 15 overweight women in Mashhad, Iran in 2016. At 7-10 day intervals, Fatmax, MFO, and insulin resistance index were measured in three stages of no whey protein consumption and at 30 and 75 minutes after whey protein loading during one session of progressive training until failure. Data collection tool was the ELISA kit. Data analysis was performed in SPSS version 16.0 using the analysis of variance (ANOVA), and P-value of less than 0.05 was considered significant.Results: No significant differences were observed in the MFO and Fatmax in the three stages of the study (P>0.05). However, the insulin resistance index was significant in the three stages compared to the fasting state (P<0.05), and the highest rate of insulin resistance was noted at the end of the second stage.Conclusion: According to the results, whey protein supplementation at 30 and 75 minutes before progressive training has no effect on the MFO and Fatmax, while it could increase insulin resistance.

Introduction: Anxiety before colposcopy causes pain and discomfort during the procedure. Auriculotherapy could be an effective approach to reduce anxiety. The present study aimed to evaluate the effect of auriculotherapy with vaccaria seeds on the anxiety in female colposcopy candidates.Methods: This single-blind clinical trial was conducted on 61 women referring to Ghaem Hospital in Mashhad, Iran for colposcopy in 2017. The research units were selected via random allocation and classified into two groups of intervention and placebo. In the intervention group, vaccaria seeds were attached to the acupoints (shenmen, relaxation, tranquilizer, and endocrine) of the patients three days before colposcopy. The patients were asked to press each point for one minute three times a day. In the placebo group, labels without seeds were attached to unrelated points to anxiety. Anxiety levels were measured before and after the intervention (immediately before colposcopy) using Spielberger's state-trait anxiety inventory. Data analysis was performed in SPSS version 22 using independent and paired t-test, Mann-Whitney U test, and Wilcoxon test at the significance level of P<0.05.Results: After the intervention, mean scores of state anxiety were 44.5±9.9 and 49.2±7.8 in the intervention and placebo groups, respectively, and a significant difference was observed between the groups in this regard (P=0.041). In addition, mean score of trait anxiety were 43.80±8.77 and 47.9±8.35 in the intervention and placebo groups, respectively, showing a significant difference between the groups (P=0.049).Conclusion: According to the results, auriculotherapy could effectively reduce the anxiety of the subjects after the intervention. Therefore, auriculotherapy is recommended as a beneficial approach to decrease anxiety in colposcopy candidates.

Introduction: Low birth weight (LBW) (<2500 grams) is a significant contributing factor to infant mortality. Inadequate intake of healthy food during pregnancy could adversely affect the growth and health of the fetus, and unhealthy dietary patterns during pregnancy are among the main risk factors in LBW. Given the importance of children's health, the present study aimed to compare the dietary patterns during pregnancy in the mothers of the infants with LBW and normal weight in the south of Tehran, Iran.Methods: This case-control study was conducted in 2015 on 262 healthy mothers referring to a health center in the south of Tehran, Iran. The participants had given birth within the past three months at the time of the study. Data on the demographic characteristics and dietary patterns of the subjects were collected using a questionnaire. Major dietary patterns were determined using principal component analysis. Data analysis was performed in SPSS version 22 using independent sample t-test and Chi-square to evaluate the correlations between the quantitative and qualitative variables, respectively. P-value of less than 0.05 was considered significant.Results: The rate of LBW was higher in the mothers with unhealthy dietary patterns during pregnancy. In addition, significant correlations were observed between birth weight and maternal education level, occupation status, and healthy dietary patterns (P<0.05).Conclusion: According to the results, adherence to a healthy diet during pregnancy could have a positive effect on pregnancy outcomes and reducing the risk of LBW.

Introduction: The spontaneous onset of labor and delivery are influenced by several factors. However, labor sometimes does not start on the due date. This would result in increased maternal and fetal complications and costs. Many studies have investigated the effective treatments for labor induction. The present study was performed to systematically review the studies examining the effective interventions to induce labor in Iran.material: This systematic review was conducted on the clinical trials published in the Persian and English languages. The searching process was performed in several databases, including Google scholar, Scopus, IranMedex, SID, Medlib, Magiran, IRCT, and PubMed, using the following English keywords and their Persian equivalents: “Labor”, “Labor induction”, “Delivery”, “Initiation of labor”, “Clinical trial”, and “Labor pain”. The articles, which obtained the score of ³ 3 based on Jadad criteria, were entered to the study. The data were analyzed through qualitative methods.Results: The searching process resulted in the inclusion of 29 clinical trials, 23 and 6 cases of which investigated pharmacological treatments (including 17 chemical drugs and 6 herbal drugs) and non-pharmacological treatments, respectively. According to the results of the reviewed articles, misoprostol was found to be a more effective treatment for the induction of labor than other methods. In addition, among the herbal remedies, Peganum harmala, Descurainia sophia, chamomile, and castor oil and among the non-pharmacological methods, Laminaria were reported to have a positive effect on labor induction.Conclusion: There are many types of pharmacological and nonpharmacological treatments for the induction of labor. Misoprostol was reported to be more effective in labor induction in the majority of the retrieved articles, revealing positive results in this regard. Furthermore, the use of Peganum harmala, Descurainia sophia, chamomile, castor oil, and Laminaria were proposed as effective methods for the induction of labor. However, the confirmation of the efficacy of these methods requires the implementation of further studies with a stronger methodology.

Introduction: Reflexology is a non-pharmacological pain relief method, the effects of which remain unclear on obstetric interventions. This systematic review and meta-analysis aimed to assess the effect of reflexology on the length of labor.Methods: A literature search was performed in databases such as Cochrane, Medline, PubMed, Scopus, Web of Science, Ovid, Google Scholar, SID, MagIran, IranMedex, and Irandoc using various keywords, including foot massage, childbirth, delivery, natural delivery, vaginal delivery, length of labor, length of delivery, massage therapy, reflexology, labor, labour, randomized clinical trial, and reflex, as well as all the possible combinations. All the clinical trials published during 2000-June 2017 were reviewed in the study. The Jadad scale was used to assess the quality of the retrieved articles.Results: Out of 616 articles (Persian and English) and after removing the repetitive and irrelevant contents, six clinical trials were assessed in this systematic review and meta-analysis. The selected studies were conducted in Iran and Egypt. The results of the meta-analysis revealed that reflexology has a positive effect on reducing the length of the first stage of labor (RR: -0.67; 95% CI: -1.09--0.25; df =3; P=0.02). However, it exerts no effects on the length of the second stage (RR: -3.77; 95% CI: -8.18-0.64; df =2; P=0.22) and third stage of labor (RR: -1.94; 95% CI: -3.47--0.41; df=2; P=0.09).Conclusion: According to the results, reflexology could reduce the length of the first stage of labor, while further investigation on adequate sample sizes is required to evaluate its effects on the second and third stage of labor.

Introduction: Cesarean scar ectopic pregnancy is rare and is associated with serious complications if not treated early. Among treatment methods, the expectant treatment is associated with high risk for failure and complications. In patients with stable beta-human chorionic gonadotropin (bhCG) titers<5000, gestational age<8 weeks, and absence of fetal heart tones, administration of systemic methotrexate is associated with high success rate compared to surgical methods, and it is more likely to preserve fertility. In this article, we present a case of cesarean scar ectopic pregnancy treated with a single dose of methotrexate.Case presentation: The patient was a 33-year-old woman (gravidity: 3, parity: 2, gestation: 7 weeks and 4 days) with history of two cesarean sections. She was admitted with abdominal pain, spotting, transvaginal ultrasonography based on a gestational sac implanted in cesarean scar, and bhCG titers of 3900. According to the patient's clinical condition, she was candidate for medical treatment and received one dose of methotrexate, then bhCG titers progressively reduced, and the patient was discharged in good general condition.Conclusion: Medical treatment of cesarean scar ectopic pregnancy, in addition to efficacy and reduction of complications, can preserve fertility in the patient.