Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2020 | Volume:23 | Issue:1 |Papers Count:14

Introduction: Considering that evaluation of fetal head station is difficult and determination by different people had no harmony, therefore, this study was performed with aim to evaluate the accuracy of station meter device (a simple device which is named as determining exact fetal head station that had invention certificate and is approved by Medical Equipment Office) and compare with vaginal examination by obstetrics' resident in order to avoid diagnostic errors. Methods: This cross-sectional study was performed in 2018-2019 on 150 primarous pregnant mothers in the active phase of labor at the maternity ward of Emam Reza and Omol Banin hospitals. At first, the mothers were examined by Obstetrics' resident and fetal head station was recorded in Form A without the knowledge of researcher assistance midwife. Then, the researcher assistance midwife determined the fetal head station with station meter device simultaneously without the knowledge of the result of vaginal examination, and recorded in form B. After data collection, fetal head station was compared in two groups, and correlation and agreement between these two methods were determined by Kapa and Wilcoxon and Spearman tests. Data were analyzed by SPSS software (version 23). P Results: In different fetal head stations, agreement between two measurement methods by Obstetrics' resident and station meter device with Kappa statistics test was 86% and significant (p <0. 001). Conclusion: The station meter device can be used with high reliability to determine the fetal head station and can be used for training the skills of fetal head station determination.

Introduction: One of the methods used in cesarean section is spinal anesthesia that have major role in cesarean section. One complication of spinal anesthesia is hypotension. This study was performed with aim to compare the effects of phenylephrine and ephedrine in the treatment of hypotension due to spinal anesthesia in pregnant women who are candidates for cesarean section. Methods: This randomized, double-blind, clinical trial study was performed on 74 healthy pregnant women candidate for ceasarian section under spinal anesthesia who referred to Firoozgar hospital in Tehran in 2017-2018. Patients were randomly assigned to two groups: phenylephrine or ephedrine. Patients received phenylephrine or ephedrine immediately after hypotension due to spinal anesthesia. During the surgery, hemodynamic variables including systolic, diastolic blood pressure and heart rate were measured every 5 minutes. After the removal of the baby, the umbilical cord blood gases were analyzed; first and fifth minutes Apgar score were recorded. Data were analyzed by SPSS software (version 21) and Repeated measures ANOVA. P<0. 05 was considered statistically significant. Results: There was no significant difference between systolic blood pressure in two groups during surgery (P>0. 05). The diastolic blood pressure during surgery at 5, 10, 15, 20, 25 and 30 minutes after the removal of the baby was significantly less in the phenylephrine group than Ephedrine group (P<0. 05). Heart rate of patients during surgery except minutes before spinal anesthesia, 6 min after spinal anesthesia, 40 and 45 after the removal of the newborn was significantly less in the phenylephrine group than ephedrine group (P<0. 05). First minute Apgar score was significantly higher in phenylephrine group than the ephedrine group (P<0. 05). Fifth minute Apgar score was not significantly different between the two groups (P >0. 05). There was no significant difference in the PH of newborns in two groups (P>0. 05). Conclusion: Both ephedrin and phenylephrine can be used in treatment of hypotension due to spinal anesthesia in pregnant women candidate for caesarean section, without any significant differences in control of systemic blood pressure and minimum effect on Apgar score.

Introduction: Group B streptococci (GBS) is as an important cause of perinatal morbidity and mortality. GBS is colonized in 10-30% of pregnant women in the vagina or rectum. Transfer of mother-to-child GBS during delivery may result in invasive infection in the newborn during the first week of life. This study was performed with aim to compare the prevalence of GBS in pregnant women with gestational age of 24-34 weeks with symptoms of preterm labor with and without rupture of the membrane. Methods: This case-control study was performed on 50 pregnant women with gestational age of 24-34 weeks referred to Imam Reza (AS) Educational and Medical Center of Kermanshah with signs of preterm delivery in 2016. The subjects were divided into two groups of with rupture of membrane (case) and without rupture of the membrane (control). From the study population, the GBS cultures were collected at admission time from the vagina and were transferred to the medium. The results of culture and demographic information of mothers were compared in two groups. Data were analyzed by SPSS software (version 20) and chi-square and t-test. P Results: There was no significant difference in maternal age (P=0. 246), gravidity (P=0. 523), gestational age (P=0. 716), and history of preterm delivery in previous pregnancies (P=0. 942) between two groups of with and without rupture of the membrane. 2 cases (8%) of mothers with rupture of membrane and 1 case (4%) of mothers without rupture of membrane had positive GBS cultures, and the overall prevalence of GBS was estimated 6%. Conclusion: The frequency of positive GBS culture is higher than in pregnant women with rupture of membrane than in pregnant mothers without rupture of membrane.

Introduction: Sleep is one of the necessities of life and sleep disorder has undesirable consequences. This study was performed with aim to investigate sleep disorders and some individual related factors in pregnant women referred to health centers in Mashhad. Methods: This cross-sectional study was performed on 285 pregnant women referred to Mashhad health centers in 2019. Petersburg Sleep Quality Questionnaire was used to assess the sleep quality of individuals. Data were analyzed by SPSS software (version 16) and Pearson correlation coefficient and one-way ANOVA tests. P<0. 05 was considered statistically significant. Results: The mean age of pregnant women was 27. 73± 5. 37 years and the mean total score of sleep quality was 12. 37± 2. 80 and the rate of sleep disturbance in the pregnant women was 285 (100%). The results of Pearson correlation coefficient showed no significant relationship between demographic variables and sleep quality (P >0. 05). Conclusion: Sleep disorder has high prevalence in pregnant women. Therefore, to improve the sleep quality of pregnant women, in addition to routine prenatal care, a program should be design for diagnosis, etiology and treatment of this disorder.

Introduction: Premature rupture of membranes (PROM) is not only a major medical problem but also a social and economic problem. According to the results of some studies, Vitamin D deficiency during pregnancy and labor may play a role in premature rupture of membranes by mechanism of inflammation in the placenta. Considering to the high prevalence of vitamin D deficiency in pregnancy and lack of knowledge about of the determinants of premature rupture of membranes, this study was performed with aim to investigate the relationship between maternal vitamin D levels with premature rupture of membranes. Methods: This case-control study was performed on 200 pregnant women with gestational age of 28-41 weeks who referred to Ardabil Alavi Hospital in 2018. 100 pregnant women with premature rupture of membranes were selected as the case group and 100 pregnant women without rupture of membranes as the control group. Blood samples were taken from both groups to measure serum levels of 25-Hydroxy Vitamin D. Demographic information, laboratory data, history and type of maternal delivery were collected. Data was analyzed by SPSS software (version 20) and Chi-Square and T-tests. P<0/05 was considered statistically significant. Results: Serum level of vitamin D in the case group was 22/73 ± 11/87 nanomoles per liter and in the control group was 25/16 ± 12/48 nanomoles per liter; the difference between two groups was not statistically significant (p=0/09). Conclusion: There was no association between maternal vitamin D levels and premature rupture of membranes. Further research with a larger number of samples and complete control of the intervention agents is needed to investigate the relationship between maternal vitamin D levels and the occurrence of premature rupture of membranes.

Introduction: Chlamydia trachomatis and Mycoplasma genitalium are of the main causes of womens' genital tract worldwide. These two bacteries cause urethritis, cervicitis, and pelvic inflammatory disease, which can lead to infertility in women. This study was performed with aim to determine the prevalence of these two infections in infertile women and its effect in IVF treatment failure. Methods: In this study, cervical swab sampling was performed from 100 infertile patients referred to infertility treatment center of Razavi hospital and Milad infertility center in Mashhad. The swabs were then immediately placed in a Screw Cap Test Tubes containing thioglycollate medium and transferred to the laboratory. The incubation was performed at 37C for 18 hours and then the tubes were centrifuged. The resulting precipitate was transferred into the microtubule, and after 3 washes, DNA extraction was performed by boiling. Finally, the supernatant was used for PCR (Uniplex PCR) separately with specific primers for each of these bacteria Results: The results showed that 23 samples were positive for Chlamydia trachomatis and most cases of IVF failure were related to this group (17 cases). Only one specimen was positive for Mycoplasma genitalium which was related to a patient with IVF failure. Conclusion: Considering the prevalence of Chlamydia trachomatis and and Mycoplasma genitalium, screening is impotrant in infertile women who suffer from relatively severe conditions and high costs of infertility treatment, including IVF. So, it is suggested that before any infertility treatment, the patients be monitored for the presence of these bacteries and receive antibiotic treatment if the result was positive.

Introduction: The presence of apelin in hypothalamus indicates the potential role of this hormone in the balance of energy and food intake. According to apelin’ s protective role on obesity, this study was performed with aim to investigate the relationship between serum apelin-36 with mother's anthropometric indices at 18-24 months postpartum. Methods: In this nested case-control study, serum apelin-36 levels of 42 pregnant women was measured during 28-32 weeks of gestation and the first 24 hours after delivery using ELISA in 2014-2016. After delivery, the participants were divided in to two subgroups based on mode of delivery; vaginal delivery group and cesarean section group. Anthropometric indices were measured two times; third trimester of pregnancy and then 18-24 months after delivery. Data were analyzed by SPSS software (version 21) and independent t and paired t-test, Chi-square, regression, and Pearson correlation test. P<0. 05 was considered significant. Results: Mean of serum apelin-36 level after vaginal delivery had a nearly significant reduction compared with third trimester of pregnancy (P=0. 05). Serum level of apelin-36 after cesarean delivery had negative significant relationship with BMI (P = 0. 007, r =-0. 57) and waist circumference (P = 0. 003, r =-0. 62) at postpartum follow-up. Linear regression analysis revealed that serum apelin-36 after caesarian delivery was a significant independent predictors of BMI at postpartum follow-up (P< 0. 01). Apelin-36 had no significant relationship with anthropometric parameters in vaginal delivery group (P> 0. 05). There was no significant difference in mean of anthropometric indices between two groups including: total pregnancy weight gain (P = 0. 51), third trimester BMI (P = 0. 11), BMI (P = 0. 19), waist circumference (P = 0. 21), systolic (P = 0. 22) and diastolic blood pressure (P = 0. 34), weight retention (P = 0. 37) at postpartum follow-up. Conclusion: Maternal serum apelin-36 level had negative significant relationship with maternal body mass index and waist circumference in cesarean section group. However, this mechanism is not completely known.

Introduction: Fear of childbirth increases obstetrical interventions, and causes complications for mother and fetus and is one of the important factors affecting the increased rate of cesarean. This study was performed with aim to investigate the effects of childbirth preparation classes program on fear of normal vaginal delivery measured with Wijma Delivery-Expectancy questionnaire. Methods: This randomized clinical trial study was performed on 132 nulliparous women in Sabzevar Health Centers during 2017-2018. The subjects were randomly divided into two groups of intervention and control. The intervention group participated in childbirth preparation classes and the control group received only the routine prenatal care. Wijma Delivery Expectancy Questionnaire (W-DEQ) Version A&B was completed before and after the intervention and 14 days after delivery by the mothers. Data were analyzed by SPSS software (version 22) and t-test and Repeated Measurement Variance Analysis. P<0. 05 was considered statistically significant. Results: The mean total score of questionnaire and all the factors except the fear of fetal injury were significantly higher in the intervention group than the control group (p <0. 05). Also, the scores of all factors except fear of fetal injury increased in the intervention group from pre-test to post-test and follow-up (P <0. 05). The scores of fear of fetal injury in the intervention group decreased in post-test while in the control group decreased after childbirth; comparison of means showed difference between two groups (p=0. 01). Conclusion: Childbirth preparation classes held in Sabzevar increased the fear of childbirth. Therefore, the content of this training course must be assessed.

Introduction: Physical activity has a beneficial effect on liver enzymes concentration. Also, patients with subclinical hypothyroidism have high levels of liver enzymes. Therefore, this study was performed with aim to investigate the effect of 5 months aerobics exercise with low to moderate intensity on serum levels of liver enzymes in subclinical hypothyroidism women. Methods: This semi-experimental study with pre-test and post-test design was performed on 25 subclinical hypothyroidism women in Abdanan city in 2016. The subjects were divided into three groups: drug-exercise, exercise, and drug. Aerobics exercise training consisted of 3 sessions (60 min) per week for 5 months. The drug group was inactive persons who took only LT4 tablets. Levels of ALT, AST and ALP were measured in three groups after 5 months. Data were analyzed using SPSS software (version 24) and correlated t-test and one-way ANOVA test. P Results: Aerobics exercise with low to moderate intensity resulted in non-significant changes in serum levels of ALT (p=0. 054), AST (p=0. 065) and ALP (p=0. 108) in subclinical hypothyroidism women. Conclusion: According to the findings of the present study, 5 months aerobics exercise with low to moderate intensity leads to non-significant changes in serum liver enzymes of ALT, AST, and ALP in subclinical hypothyroidism women. Thus, 5 months aerobics exercise does not affect the improvement of non-alcoholic fatty liver in subclinical hypothyroidism women.

Introduction: During obesity, inflammatory markers such as ferritin and C-reactive protein are increased, which is a major mechanism of atherosclerosis and insulin resistance. Regular exercise and medication can reduce these factors and reduce the risk of chronic diseases. This study was performed with aim to compare the effect of 12 weeks of high intensity interval training (HIIT) and use of borage (Echium amoenum L. ) on serum CRP and ferritin levels in overweight and obese women. Methods: This randomized clinical trial study was performed on 40 overweight and obese women in 2018. The subjects were randomly divided into four groups of 10 cases in each group (Exercise-Supplement, Exercise, Supplement and Control). Blood samples were collected and analyzed before and after 12 weeks to measure the levels of CRP and ferritin. A high intensity interval training program (85-95% of maximal heart rate) was performed three times a week for 12 weeks, and groups that used Echium amoenum daily received 4 g dissolved in 250 ml of water, for 12 weeks. Data were analyzed by SPSS software (version 21) and Paired t-test and covariance tests and Shapirowilk and Levin tests. P Results: After 12 weeks HIT training, serum ferritin levels increased after the intervention compared to the pre-intervention, so that this increase was significant in the training group (p=0. 033) and Echium amoenum group (p=0. 016), but was not significant in the training-Echium amoenum group (p=0. 323) and control group (p=0. 612). Also, CRP decreased after the intervention compared to the pre-intervention, so that this decrease was significant in the training group (p=0. 05) and Echium amoenum group (p=0. 001), but was not significant in the training-Echium amoenum group (p=0. 196) and control group (p=0. 571). Conclusion: Performing severe intermittent exercise along with use of Echium amoenum supplementation by reducing CRP and increasing serum ferritin level can improve the complications and diseases caused by obesity. It has also had an impact on general obesity.

Introduction: Despite many promising advances in recent years, our standing about the onset, progression, and metastasis of breast cancer is not yet complete. However, it is believed that hormones in women may also play an import role in the onset and progression of breast cancer. Therefore, this study was performed with aim to investigate the relationship between prolactin level and breast cancer in menopausal and pre-menopausal women. Methods: This case-control study was conducted on 100 women with breast cancer referred to Breast Cancer Center of Peymanieh Hospital (Jahrom University of Medical Sciences) in two groups of breast cancer (25 menopausal and 25 pre-menopausal women) and control group (25 menopausal and 25 pre-menopausal women) in 2018. Serum prolactin levels were measured by ELISA and malondialdehyde method manually and by reaction with thiobarbituric acid. Data were analyzed using SPSS software (version 21) and Chi-square and Mann-Whitney tests. P<0. 05 was considered statistically significant. Results: Two groups were homogeneous in terms of mean of age, weight, height, duration of marriage, time of first delivery and number of offspring (p >0. 05). There was no significant relationship between increased prolactin level and breast cancer in menopausal women (p = 0. 425). There was no significant relationship between increased prolactin hormone and breast cancer in pre-menopausal women (p = 0. 867). There was no significant difference between menopausal women with breast cancer and control group in the frequency of TSH (p = 0. 378). Conclusion: There was no significant relationship between increased prolactin hormone and breast cancer in menopausal and pre-menopausal women. However, elevated serum levels of TSH were more common among those with breast cancer than healthy controls, but the difference was not significant. However, further investigation is needed in this regard.

Introduction: Uterine anomalies are caused by impairment in the formation, evolution, or defect in the connection of Mullerian bud in the embryonic period, and the prevalence of these disorders is 2% to 4% in the population of women of reproductive age. Unicornuate uterus is one of the types of uterine anomalies in which one of the Mullerian ducts has normal growth, and therefore a normal cavity is formed along with the uterine and vascular tract, but different degrees of growth disturbance is seen in the other Mullerian duct (from no growth to existence of rudimentary horn with or without cavity and so on). One of the complications of uterine development disorders is pregnancy in rudimentary horn. Case presentation: The patient was a 17-year-old woman with ectopic pregnancy in non-communicating rudimentary horn of unicornuate uterus that was mistakenly diagnosed as an ectopic pregnancy in a normal fallopian tube and treated with methotrexate and was referred as a persistent ectopic pregnancy and no response to methotrexate for surgical treatment. The patient underwent laparoscopy and then with diagnosis of pregnancy in the unrelated anterior horn, the pregnancy products and the left tube were removed and the left ovary was preserved. The patient was discharged after 2 days with good general condition. Conclusion: In the case of initial diagnosis of ectopic pregnancy, precise follow-up should be performed in terms of decrease in beta-HCG circulation; in the case of no increase in beta-HCG or if beta-HCG was stable despite methotrexate treatment, further investigations through Ultrasound, MRI, laparoscopy, and hysteroscopy be performed to diagnose uterine anomalies. The presence of uterine rudimentary horn in cases of stable ectopic pregnancy, despite being rare should be considered as one of the possible cases and the patient is transferred to operation room with previous preparation.