مجله زنان مامائی و نازائی ایران
سال بیست و یکم شماره 9 (آذر 1397)

IVF is a good option for Polycystic ovary syndrome patients who not respond to ovulation induction treatment. This study was performed with aim to compare pregnancy outcomes in PCOS patients undergoing IVF with long GnRH agonist versus flexible GnRH antagonist regimens. This randomized clinical trial study was performed on 96 infertile PCOS women candidates for IVF who referred to Milad Infertility Center in 2014. The patients were divided into 2 groups: long GnRH agonist and GnRH antagonist. Oral contraceptive pills were prescribed as pretreatment and recombinant FSH was given for ovarian induction. Data were analyzed by SPSS software (version 20) and Chi-square, Exact Fisher, and Mann-Whitney tests. P<0.05 was considered statistically significant. Two groups of GnRH agonist and GnRH antagonist were not significantly different in terms of pregnancy outcomes like chemical pregnancy (p=0.544), clinical pregnancy (p=0.6), abortion (p=1), and multiple pregnancy (p=0.688). The prevalence of Ovarian hyperstimulation syndrome was less in antagonist group versus agonist group that had statistically significant difference (p=0.0001). Dose of gonadotropins (p=0.344) and the number of days of gonadotropins consumption (p=0.236) were not significantly different between two groups. GnRH antagonist can be used in PCOS patient's candidates for IVF. The use of GnRH antagonist is not different in pregnancy outcome compared to GnRH agonist and only decreases the complications of infertility treatment.

One of the most important causes of death in premature infants is nosocomial infections, and skin can be one of the ways of infections enter to the body. Considering the role of sunflower oil with massage in reducing nosocomial infections, the present study was performed with aim to determine the effects local sunflower oil on the prevention of nosocomial infections in premature infants. This clinical trial was performed in 2016 on 60 premature infants (less than 34 weeks of gestation) admitted to the NICU department of Ghaem Hospital in Mashhad. The subjects were placed in two groups: sunflower massage (n=27) and control group (n=33). The body surface of these infants was covered with sunflower oil three times a day for 2 weeks and then twice for up to 28 days. When the baby is getting sick, blood counts, platelet count and white blood cells were measured. Also, after oiling the skin, the skin condition was evaluated on days 1, 3, 7, 14, 21 and 28. Data were analyzed by SPSS software (version 21) and with t-test and Chi-square test. P<0.05 was considered statistically significant. There was no significant difference between two groups of sunflower massage and control in terms of the results of primary blood culture (P = 0.67) and secondary positive blood culture (P = 0.15). The clinical status of the neonates' skin in the intervention group was significantly better in the whole period of the study than the control group (P<0.05). The mean hospital stay in the intervention group was about four days less than the control group (P = 0.039). In this study, the use of sunflower oil did not have a significant reduction in the prevention of nosocomial infections. However, due to the better condition of skin and less hospital stay in newborns of the intervention group, the routine use of sunflower oil can be helpful.

Today, modern lifestyle exposes women to a variety of vitamin deficiencies, and enzymes and hormones disorders, and then, obesity and overweight concerns. This study was performed with aim to determine the relationship between anthropometric index and serum level of vitamin D, calcium, magnesium, alkaline phosphatase, and parathyroid hormone. This correlational study was performed on 100 healthy women at reproductive age from Nov 2016 to Dec 2017 in Urmia. After obtaining the written consent and completing the questionnaire containing demographic information from the subjects, 10 ml of venous blood was taken after 12 hours of fasting. The levels of calcium, magnesium, vitamin D, parathyroid hormone and alkaline phosphatase and anthropometrics were measured. Data was analyzed using SPSS software (version 22) and correlation test and variance analysis. P< 0.05 was considered statistically significant. In this study, vitamin D had a negative correlation with all anthropometric indices, but this correlation was not statistically significant (P>0.05). Calcium and magnesium had no significant correlation with anthropometric indices. Alkaline phosphatase had a positive but insignificant correlation with all anthropometric indices (p>0.05). In this study, PTH value had a significant positive correlation with BMI (r = 0.21, p<0.05). Among the measured indices, parathyroid hormone had a significant correlation with body mass index, and although the serum level of magnesium and calcium had a desirable level in most cases, but unfortunately, more than half of the samples suffered from vitamin D deficiency. Therefore, it is recommended that interventional program be performed for women of reproductive age to improve their vitamin D status.42w

Enhancing the mothers' knowledge and proper education during pregnancy is of the important factors in preparing the mothers for the process of delivery. According to Bandura's social learning theory, self-efficacy refers to the individual's confidence in his ability to behave in a way leading to the desired outcome. This study was performed with aim to compare in-person counseling and phone support on delivery self-efficacy in primiparous women. This double-blind randomized clinical trial was conducted on 163 primiparous women aged 18-35 years old who referred to Zahedan health centers in 2017. Subjects were placed in three intervention and control groups. At 20-32 weeks of pregnancy, in-person counseling group received four sessions of 60 minutes counseling and phone support group received four sessions of 20 minutes phone counseling. Control group received routine cares. Data were collected using demographic questionnaire, delivery self-efficacy, and homework registration form. The pretest was completed at 20 weeks and posttest was completed at 34-36 weeks of pregnancy. Data was analyzed using SPSS software (version 19) and by non-parametric tests of Kruskal-Wallis and Wilcoxon. P<0.05 was considered statistically significant. Before the intervention, no significant difference was found among the groups in terms of self-efficacy scores. After the intervention, the mean score of self-efficacy increased in in-person counseling group (P <0.0001) than phone support group (P <0.001), but it did not significantly increase in the control group (P=0.57). In-person counseling is more effective than phone support n enhancing the delivery self-efficacy.

Since infertility affects quality of life and even couples' relationships, it is important to identify the variables affecting fertility. One of these cases is obesity in men and its relationship with infertility. Regarding the contradictory results of various studies, this study was conducted with aim to determine the relationship between body mass index and quality of sperm parameters. This cross-sectional study was performed on 200 women's husbands with inclusion criteria who referred to Infertility Clinic of Vali-e-Asr Tehran in 2015-2016. Individual data, height, weight and sperm results of the subjects were entered to the researcher-made questionnaire. Data were analyzed using SPSS (version 18) and Chi-square test. P<0.05 was considered statistically significant. More than 38.5% (n=77) of participant were in the normal BMI group. 47% (n=94) were overweight and 14.5% (n=29) were in the obese group. Based on the results, there was no significant relationship between sperm counts, sperm motility and sperm shape and BMI in the three groups of men based on BMI (p> 0.05). There is no significant relationship between BMI in three groups of men (based on BMI), with sperm analyses factors including sperm counts, sperm motility and sperm shape.

Primary dysmenorrhea is one of the common disorders of the reproductive system. Various methods are suggested for treatment of dysmenorrhea. This study was performed with aim to determine the effect of Menstrugloe capsule and Vitamin E on the intensity of primary dysmenorrhea. This double-blinded randomized clinical trial was performed in 2017 on 120 female students with primary dysmenorrhea at Hamadan University of Medical Sciences. The samples were randomly divided in three 40-member groups. The first group received 500 mg Menstrugole capsules, second group 200 mg Vitamin E, and third group placebo capsule every 8 hours, from the first day of starting pain for 3 days during two menstrual cycles. The intensity and duration of dysmenorrhea in each cycle was compared by multidimensional speech scale and McGill pain scale. Data was analyzed by SPSS software (version 21) and Chi-square, paired t-test, and ANOVA. P<0.05 was considered statistically significant. Before the intervention, the mean scores of duration and severity of symptoms of dysmenorrhea was homogenous in the groups, but after the intervention, according to ANOVA test, there was significant difference between the subjects (P<0.001) and it was less in the Menstrugole group. According to Chi-square test, after the intervention, the severity of dysmenorrhea based on McGill pain scale was significantly different in the three groups (P<0.001) and it was less in the Menstrugole group. The use of Menstrugloe capsule like vitamin E can reduce the intensity of primary dysmenorrhea; therefore, due to limited side effects, it can be useful in women with dysmenorrhea.

Many studies have shown that medicinal herbs despite several therapeutic effects, sometimes can have many side effects for the fetus and even lead to miscarriage. Celery (Apiumgraveolens) is a medicinal plant in traditional medicine with numerous therapeutic effects. However, there is no information regarding its effects on the fetus; therefore, this study was performed with aim to evaluate the effects of hydro alcoholic extract of celery leaves on Balb/c mice embryo. This interventional study was performed from June 20 to 10 July 2016 on 20 female mice which were buy from the animal center of Yazd Shahid Sadoughi University of Medical Sciences in histology laboratory of the Anatomy Department of Shahid Sadoughi University of Medical Sciences in Yazd. 20 female mice after mating were randomly divided into 4 groups. Control group received distilled water (gavage) and experimental groups 1، 2 and 3 were received 200mg/kg of the celery hydro alcoholic extract during the first, second, and third weeks of pregnancy, respectively. In 20th day of pregnancy, caesarean surgery was done and the number of absorbed embryos were counted and were considered as abortion. Furthermore, the embryos weight and heights were measured. Data were analyzed by SPSS software (version 21) and one-way ANOVA and LSD test. P The number of live fetuses was similar in the control group and the experimental group 1 (receiving extract during the first weeks of pregnancy), but had difference with other groups. Only 1 aborted fetus was observed in experimental group 3 (receiving extract during third weeks of pregnancy). Also, the embryos weight and heights were significantly decreased in the groups receiving extract (p˂0. 05). Celery extract has abortifacient effect and can cause morphological changes in embryo, so it is suggested to evaluate the effect of this herb in pregnant women.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine diseases with hyperinsulinemia in women. Infertility with prevalence of 15% is one of the major problems in the society. Therefore, this study was performed with aim to evaluate the effect of 8 weeks of TRX and omega-3 supplementation on serum visfatin levels and insulin resistance in women with PCOS. This clinical trial study was performed in 2017 on 28 patients with polycystic ovary syndrome in Isfahan. Participants were randomly divided into four groups: TRX training, omega-3 supplementation, exercise-supplementation, and control. The supplement and combination groups received 56 capsules of omega-3 supplement 1 gr (360 mg of EPA and 280 mg of DHA). The exercise and combination groups received an exercise program TRX including 10 minutes warm-up, 45 minutes TRX training and 10 minutes of cool-down. The control group was only followed up without any intervention. Blood samples were taken before and after 8 weeks of intervention to determine the serum levels of visfatin, fasting glucose, insulin and insulin resistance. Data analysis was performed using SPSS software (version 21) and by correlated t-test and variance analysis. P < 0.05 was considered statistically significant. After 8 weeks of intervention, weight loss in the TRX group was significantly higher than that of the supplement and control groups (p <0.05). The difference in mean fasting blood glucose level before and after the intervention was significant in the exercise, supplementation and control groups (p <0.05). Also, the difference in mean of insulin before and after the intervention was significant in the exercise, supplementation and combination groups (p <0.05). The difference in mean of insulin resistance before and after the intervention was significant in all 4 groups (p <0.05). Changes in serum visfatin levels were significant before and after the intervention in the exercise, supplementation and combination groups (p <0.05). Eight weeks of TRX training and the use of omega-3 supplementation due to weight loss and insulin resistance can be effective in controlling and improving the complications of polycystic ovary syndrome in women.

Diastasis recti is defined as separation of the two bellies of the rectus abdominis muscles more than 2 to 2.7 cm which could affect the abdominal activities such as breathing, urination and delivery, and may change the body posture and make the lumbar and sacral regions susceptible to injury. Regarding the importance of therapeutic exercises in treatment of diastasis recti, this study was performed with aim to investigate the effect of strengthening training of oblique muscles on inter-recti distance and thickness of abdominal muscles in women with diastasis recti. This randomized controlled clinical trial was performed on 32 women with diastasis recti and at least six months since delivery who referred to physiotherapy center of Hazrate Zainab clinic of Noor city in 2017. The inter recti distance and the thickness of the abdominal muscles before the intervention was determined by ultrasound at rest. In the intervention group, strengthening training of oblique muscles was conducted at home for six weeks .The control group did not do any specific exercises. After six weeks, the inter recti distance and abdominal muscle thickness were measured again using ultrasound at rest. Data was analyzed by SPSS software (version 22) and t-test, Mann-Whitney, Paired t test, and Wilcoxon test. The inter recti distance after six weeks of training in the intervention group showed a significant decrease (p=0.001 and p=0.03 in upper and lower umbilicus). The thickness of the oblique muscles and the transverse abdominal muscles in both side was significantly increased after six weeks in the intervention group (p<0.05). In the control group, there was no significant change in the inter recti distance and the thickness of the abdominal muscles. Strengthening training of oblique muscles reduces inter-recti distance and increase the thickness of the oblique muscles as well as the transverse abdominal muscles in women with diastasis recti.

Cesarean section is one of the most common gynecological surgeries and pain is one of the most common problems after that. The silver nanoparticles with anti-inflammatory mechanism may be useful in reducing pain. Therefore, this study was performed with aim to determine the effect of silver nanoparticles (Nivasha ) spray on the intensity of cesarean wound pain. This triple-blind randomized controlled clinical trial was performed on 92 women with cesarean section in Mashhad Omolbanin educational hospital in 2017. Research units were randomly assigned in 3 groups. In two groups, Nyvasha and placebo spray was used on the caesarian wound twice a day for 10 consecutive days and each time 3 puffs; the control group didn’t receive any drug. The intensity of pain was measured 20-28 hours after cesarean section and on the 5th and 10th days after it by Visual Analogue Scale. Data was analyzed by SPSS software (version 16) and Chi-square test and Kruskal Wallis test. P 0.05 was considered statistically significant. After the intervention, the mean of pain intensity on day 5 in the silver nanoparticles, placebo, and control groups were 2.2 ± 1.1, 4.8 ± 1.3, 4.7±1.3 and on day 10 in the silver nanoparticles, placebo and control groups were 0.1 ± 0.4, 2.4 ± 1.5 and 2.0 ± 1.6, respectively. There was statistically significant difference in the pain intensity reduction in the silver nanoparticles group compared to the other two groups (P<0.001), however there was no significant difference between placebo and control group on day 5 (P = 0.84) and on day 10 (P = 0.37). Regarding the decrease in the intensity of cesarean section pain after the intervention, spray silver nanoparticles (Nivasha) is recommended as a suitable drug for reducing post-cesarean section pain in mothers.

Depression is one of the most common problems during pregnancy and after delivery. Research has shown that aromatherapy reduces women's mood disorders. Regarding the biological condition of postpartum period and reduced hormonal levels, this study was conducted with aim to evaluate the effect of orange scent on the prevention of postpartum depression. This clinical trial was performed in 2017 on 100 women who had delivery and had admitted to the gynecology section of Omolbanin hospital. The subjects were randomly divided to aromatherapy and control groups. The intervention group, in addition to receiving routine care, from the second day after delivery up to six weeks inhaled three drops of orange essence on the hanky every 12 hours. On days 10, 30, 42 after delivery, the Edinburgh Depression Inventory was completed in both groups. Those who obtained the score more than 12 in the questionnaire were referred to a psychiatrist and depression was diagnosed with clinical interview and based on the diagnostic criteria of DSM -4. Data was analyzed by SPSS software (version 16) and with statistical tests of Chi-square, repeated measures variance analysis, and Exact Fisher test. P<0.05 was considered statistically significant. The mean score of depression was significantly reduced in the intervention group than the control group and the prevalence of depression at the end of the study was 0% in the aromatherapy group and 22.2% in the control group (p<0/001). Inhalation of orange scent in postpartum period is effective in preventing postpartum depression.

Trauma averagely affects one per 12 pregnancies and is a major non-obstetric cause of mortality among pregnant women, as well as fetal outcomes. Considering the change in therapeutic approaches base on several studies on the management of trauma in pregnancy, it is necessary to update the provided care. Therefore, this review study was performed with aim to collect the optimal care for pregnant patients with trauma using an evidence-based approach based on the most updated articles and guidelines. In this review study, all articles and guidelines were searched without time limitation in databases such as Irandoc, Magiran, Scopus, Up-to-date, Science direct, Google Scholar, PubMed, Web of science, Cochrane Library, CINAHL, and Medline using the keywords such as “Trauma” and “pregnancy” and their Persian equivalents by two researchers. After searching, the content of all available articles and guidelines was evaluated to find the most relevant evidence. Based on the results of the reviewed studies and guidelines, assessment and management of traumatized pregnant women requires a coordinated approach from a team of professionals. Furthermore, in all reviewed articles, the primary objective of treating victims of trauma in pregnancy was to stabilize the mother's condition and then evaluation of the fetus condition. Primary care of pregnant women similar to that of non-pregnant women is based on the principles of Advanced Cardiac Life Sup port (ACLS). Some of the unique aspects of this procedure include early intubation, resuscitation in the left lateral decubitus position or with manual displacement of uterus, and performing perimortem cesarean section. Routine screening of women for domestic violence, recommending the correct use of a seat belt and not turning off the airbag while driving are from the important strategies to reduce the traumatic effects in pregnancy. According to the evidence, management of trauma in pregnancy should be done as a team and with regard to specific aspects and changes of this period. The use of strategies to prevent trauma also have a significant role in reducing the effects of this complication in pregnancy.

Trauma is considered as one of the important factors of high risk pregnancies. Trauma is the most important cause of mortality among pregnant women and then fetus. The death caused by trauma during pregnancy is preventable; therefore knowledge regarding the immune principles of treating a pregnant mother is necessary. In this report, a beaten pregnant woman by shotgun is presented which in spite of a high risk pregnancy and longtime anesthesia, the mother and fetus condition return stable by proper and timely management of gynecologist and anesthesiologist,. The case is a 38 year-old women with gestational age of 32 weeks that a bullet was shot to her jaw and was ejected from the other side in Nov 2016. The bullet was also hit the shoulder area and the patient was intubated following shortness of breath. Three days later, the patient undergone general anesthesia with the presence of a gynecologist for 3 hours in order to perform Tracheostomy and jaw surgery and orthopedic surgery, and eventually the mother was recovered successfully. In the next day, because fetus condition was instable, emergency cesarean section was performed and finally the mother and neonate were discharged with good condition. In many cases, the death caused by trauma in pregnancy is preventable. When trauma happens, at first, the mother should be stabilized, then the monitoring of the fetus and uterine contractions are important part of dealing with trauma and the increased chance of mother and fetus health after the second trimester of pregnancy.