مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 3 (خرداد 1398)

Postoperative pain management is one of the most important challenges in Cesarean Section surgeries. Preventive analgesia is an effective approach in controlling this pain. This study was performed with aim to evaluate the efficacy of preventive analgesia and side effects of using acetaminophen, meperidine, and their combination after elective cesarean section under spinal anesthesia. This double-blind randomized study was conducted on 120 full-term pregnant women with ASA class I undergoing elective Cesarean Section under spinal anesthesia at Shiraz Hafez hospital in 2017. The patients were randomly divided into three groups of each containing 40 patients. After delivery, during the clamping of umbilical cord and before the end of surgery, the drugs were injected to the patients. The patients received 15 mg/kg intravenous acetaminophen, 0.5 mg/kg intravenous meperidine, and a combination of them, respectively. After clamping the umbilical cord, the groups were compared in terms of postoperative pain severity and complications. Data were analyzed by SPSS software (version 22) and ANOVA and Chi-square tests. P<0.05 was considered statistically significant. The mean score of pain severity during the first six hours after the operation was significantly lower in the acetaminophen group compared to the meperidine group (P<0.001). The mean score of pain severity, duration of recovery, and time interval between the initial and the next administration of additional analgesics doses was significantly lower in meperidine plus acetaminophen group compared with other groups (P<0.001). Moreover, incidence of postoperative headache was significantly higher in meperidine group and shivering was significantly higher acetaminophen group (P=0.005). Acetaminophen had a higher efficacy in postoperative pain management compared to meperidine, and their combination had greater analgesic effect and lower side effects.

Precocious puberty can cause important physical and psychiatric complications, although timely diagnosis and treatment can prevent these complications. The gonadotropin-releasing hormone stimulation test is the diagnostic test for central precocious puberty that due to the limitation and invasiveness of the test, this study was performed with aim to evaluate the complementary role of pelvic ultrasound as a noninvasive and cost benefit test for diagnosis of precocious puberty. This cross-sectional study was performed on 15 girls aged < 8 years who had referred by their parents with complain of secondary sexual characteristic to the pediatric endocrinology clinic of Imam Reza and Ghaem hospitals in Mashhad in 2018. In addition to the measurements of height and weight and BMI, gonadotropin-releasing hormone stimulation test was performed for the subjects. Girls with LH levels ≥ 5 IU / L were referred to the radiology department of Imam Reza hospital for pelvic ultrasonography. Pelvic ultrasonography was performed by radiologist using a conventional full-bladder 2- to5-MHz transducer. Length, width and height of the uterus, uterus volume, length, width, height and volume of the ovaries were measured. Then, the results were compared with ultrasonography of 15 subjects as control group. Data were analyzed by SPSS software (version 16) and t-test and Mann-Whitney test. P<0.05 was considered statistically significant. There was significant difference between case and control groups in terms of all criteria of sonography (p=0.001), except for transverse diameter of the left ovary that there was no significant difference between the two groups (p= 0.102). The best criterion among the criteria was the volume of the right ovary (with area under the curve = 0.871) and then uterus volume (with area under the curve = 0.864) and uterus length (with area under the curve= 0.851). Ultrasonography can be considered as a useful method for the diagnosis of central precocious puberty in girls, although additional survey on larger population is needed to confirm the accuracy of this method.

Treatment seeking in pelvic organ prolapse is influenced by socio-cultural components. Studies show that in the field of urinary-genital diseases, women are less likely to seek treatment and self-care behaviors. This study was performed with aim to explain the facilitators and barriers to treatment seeking in women with pelvic organ prolapse (POP). This qualitative study was conducted on 15 women with POP referring to gynecologic clinics of Ghaem and Imam Reza Hospital in Mashhad in 2018. Data collection with semi-structured deep interviews continued until data saturation was achieved. All interviews were audio-taped and accurately typed, and then data were analyzed using conventional content analysis of Greinham approach with MAXqda software. After categorizing and coding the data among total obtained themes, two main themes were extracted. Facilitators to treatment seeking has eight subcategories: understanding the support of the spouse and family, the recommendations of the health team to the treatment, understanding the exacerbation of symptoms, positive experiences of treatment in the community, believing the need for treatment at an early age, fear of future complications, hardship of religious duties and disturbing sexual intercourse.Barriers of seeking treatment have nine sub-categories including: lack of knowledge about POP, personal reluctant to referring for treatment, accessibility and affordability of treatment, negative experiences of treatment in people around them, economic-financial status, shame on speak about genital problems, factors related to children and family, lack of support and companion and occasional relative improvement of symptoms of the disease. The facilitators and barriers of treatment-seeking among women with pelvic organ prolapse which are identified in this study help them to understand health needs and can be considered as an important issue for designing the effective interventional and consulting programs by planners and providers of reproductive health services.

Postpartum pain is one of the common problems in mothers، and mothers tend to use medicinal plants for soothing the pain. In recent years، the clinical performance، according to evidence، was noticed. Therefore، this clinical trial was designed and implemented to determine the effects of Zataria multiflora Boiss capsule and Ibuprofen on postpartum pain. This randomized double-blinded clinical trial was performed on 100 mothers that had natural vaginal birth in Imam Khomeini hospital in Ahwaz in 2016. The women were randomly assigned into two groups of Zataria multiflora Boiss capsule and Ibuprofen. Then, the subjects received one capsule every 6 h for 24 h. The pain intensity was studied before each intervention and 1 h after that using the numerical scale of pain. The data were analyzed by SPSS software (version 18) and statistical tests, including Mann-Whitney U test، t-test، Chi-square test, and Repeated measures. P-value less than 0.05 was considered statistically significant. In this study, both groups had no statistically significant difference in the interventions, such as the age، number of delivery, and weight of neonate (P>0/05). Comparing the mean scores of postpartum pain intensity between the two groups after the fourth intervention showed no significant difference (P=0/057), and in both groups, the intensity of postpartum pain decreased. According to the results of the present study, Zataria moltiflora Boiss capsule similar to Ibuprofen can decrease the postpartum pain intensity.

Primary dysmenorrhea is one of the common causes of decreased efficiency at work, education, and reduced quality of life in women. Therefore, this study was performed with aim to determine the effect of Teucrium polium L. capsules on the changes of pain intensity and duration among patients with primary dysmenorrhea. This triple-blind, controlled, randomized clinical trial was performed on 70 female students with primary dysmenorrhea in selected dormitories of Shahid Beheshti University in 2014. The subjects were randomly divided in two intervention and control groups. During first three days of menstrual period, the intervention group was treated with Teucrium polium L. capsules every 6 hours, and the control group received the starch powder capsules during two consequent months. The associations between duration and intensity of dysmenorrhea pain in different time periods were determined based on Bayesian network and data were analyzed statistically using Pair-copulas. Data analysis was performed using SPSS software (version 20) and R (versions 1, 3, 4 (and independent t test, Mann-Whitney test, and pair-copula Bayesian network model. Given the fitting model, the patients who experienced high-intensive pain before the intervention had very high decrease of pain during the first month using Teucrium polium L. capsules (λ1=0). In the subjects with the lowest pain duration (3 days), there was no significant effect after using capsules in the first month (λ1=0.51, λu=0.51), but the significant effect of capsules was recorded in the second month for these patients. Teucrium polium capsule can be considered one of the drugs with high effect for the treatment of primary dysmenorrhea, because this drug has very high decreasing effect for patients who suffer from intensive and long duration menstrual pain.

Endometrial cancer is the most common gynecological malignancy in women worldwide. The rate of endometrial cancer is increasing in Iran. Various factors affect the incidence of endometrial cancer. The role of gestational diabetes in these factors is unclear. Therefore, this study was performed with aim to compare the history of gestational diabetes in women with endometrial cancer and healthy women.
This retrospective analytical study was performed on 360 women referring to hospitals of Shahid Beheshti University of Medical Sciences in Tehran in 2017. Data was collected by interview and completing the questionnaire of demographic, fertility characteristics, medical records and endometrial cancer information. Data were analyzed by SPSS software (version 21) and Chi-square, independent t-test, Odds ratio and Logistic Regression. P<0.05 was considered statistically significant.
In this study, 29 women (8%) had history of gestational diabetes that 17 women (14.2%) were in case group and 12 (5%) in control group. There was significant difference between two groups of women with endometrial cancer and healthy women in terms of gestational diabetes (p<0.05).
History of gestational diabetes increases the risk of endometrial cancer; therefore it can be used for primary prevention and early diagnosis of endometrial cancer.

Vaginitis candidiasis is one of the common causes of women's referral to health centers, which disrupts the patient's quality of life. Considering the antifungal effects of honey and cinnamon and the tendency to use medicinal plants and natural substances, this study was performed with aim to investigate the effect of honey cinnamon vaginal cream on the improvement of candida vaginitis symptoms. This triple-blind randomized clinical trial was conducted on 100 patients in Hamedan during 2018. Patients with clinical complaints of vaginal discharge, burning and itching with a positive culture for vaginitis candidiasis were divided into two groups of honey cinnamon vaginal cream and clotrimazole vaginal cream (n=50 in each group). One week after treatment, the patients were assessed through examination and culture. The research tools were information forms and a checklist of clinical observations, microscope, pH paper, and culture medium. Data were analyzed by SPSS software (version 20) and independent t-test, Mann-Whitney, Chi-square, Fisher exact, and McNemar test. P< 0.05 was considered statistically significant. In both groups, the symptoms improved after treatment compared to pre-treatment (P <0.001). In honey cinnamon vaginal cream group, burning was significantly less than the clotrimazole group (P = 0.008). The culture results of the two groups were similar after treatment (P=0.461). The honey cinnamon vaginal cream was effective in improving the symptoms of vaginitis candidiasis and it can be advisable to use it as an alternative to the clotrimazole vaginal cream.

Flavonoids include a large number of plant-based polyphenolic compounds with antioxidant, anti-estrogenic, anti-mutation, and anti-proliferative effects. This study was conducted to evaluate the relationship between endometriosis and dietary flavonoid intake among Iranian women referring to Arash Hospital, Tehran, Iran,from May 2016 to February 2017. This case-control study was conducted on 156 women (78 women diagnosed with endometriosis after laparoscopy and 78 healthy women) in Arash Hospital. The dietary data of the subjects were obtained using a 147-item semi-quantitative Food Frequency Questionnaire a year before the interview. The USDA tables were used to determine the type and amount of flavonoids per 100 g of each food item. Data were analyzed using the Chi-square، t-tests, and logistic regression model. After the adjustments of the confounding variable, it was revealed that individuals who had a higher intake of total flavonoids ‎(P=0.001)‎ were less likely to have endometriosis‎. Among the subgroups of flavonoids, the only intake of flavanone ‎(P=0.04)‎ was significantly associated with ‎endometriosis risk. Regarding different food groups, flavonoid was significantly lower in the dairy product ‎(P=0.02), adviser ‎(P=0.001), and fruit ‎(P=0.03), compared to that of the control group. Regarding the influence of flavonoid intake on endometriosis pathogenesis, it can be concluded that a higher intake of flavonoids can contribute to the prevention and control of endometriosis. Therefore, it is recommended to conduct counseling sessions about the benefits of flavonoid intake for such patients.

Infertility is one of the most common problems in the world. In addition to recent attention to complementary drugs and alternative medicine for treatment of infertility, such as male infertility, the effect of some herbal medicines on sperm parameters has been studied. This systematic review and meta-analysis was conducted with aim to investigate the effect of Tribulus Terrestris on male fertility. In this systematic review, the databases of PubMed ،Web of science ، google scholar , Scopus , Cochrane, Sid , Magiran, and Iranmedex were searched using the keywords of “Tribulus Terrestris”, “Fertility”, “Infertility”, “Oligo Azoospermia “and “Sperm parameters” without time and language limitation. All the articles published until 30 Nov 2017 were included in the study. Finally, nine articles were included that four articles were export in Meta-analysis process. Data were analyzed by comprehensive software (version 2). Cochran test and I2 index were used to assess the heterogeneity of the articles. out of 1075 obtained articles, nine articles were entered to the systematic study that four article were export in Meta analysis process. The combination of data showed that the use of Tribulus Terrestris in men was accompanied by an increase in the parameters of sperm concentration and improved sperm morphology and sperm motility. Tribulus Terrestris is effective on the sperm parameters and sexual function in men and can be used as complementary medicine along with other treatments in infertility with male factors.

Mastalgia is one of the most common causes of women referring to treatment centers that regarding its importance, proper administration of the drug is important. Due to the complications of chemical drugs, the patients' tendency to use complementary medicine has been increased. This systematic review and meta-analysis was conducted with aim to evaluate and summarize the results of clinical trials on the effects of herbal medicines and dietary supplements on mastalgia in Iran. This systematic review and meta-analysis evaluated the effect of herbal medicines and supplements on Mastalgia by searching the articles using the keywords of mastalgia, complementary medicine, herbal medicine, their English in Persian and English journals indexed in SID, Iranmedx,  Irandoc, Magiran, Scopus,  Pubmed  and Google scholar from 2007 until 2019. The Jadad scale was used to evaluate the quality of the articles. The inclusion criteria were: the randomized controlled trials (RCTs) on mastalgia and exclusion criteria were: no access to the full text and the existence of more than one intervention in each group and lack of control group. In this study, 14 articles with inclusion criteria were evaluated which had antioxidant, flavonoid, anti-inflammatory and analgesic properties and had a good effect on mastalgia relief. The obtained data supports the use of Vitagnus and vitamin E for the treatment of mastalgia. In addition, cotton seed also provided good results. The results of the meta-analysis on three studies showed no significant difference between vitamin E and Evening Primrose (p = 0.648). Among all the above mentioned methods, Vitagnus and Vitamin E have more evidence for use in the treatment of mastalgia. Further studies are needed to apply other methods.

Arthrography is a rare congenital disorder which is identified with joint involvement, muscle weakness and fibrosis and sometimes is accompanied with a series of cholestasis renal tubes abnormalities and bone disorder. Arthrography has no definite treatment, but rehabilitation for improvement of organs' function is possible. In this study, a case of male embryo with Arthrography and decision for abortion in 21st weeks of pregnancy is reported. The patient was a 34-year-old woman with fourth pregnancy, second parity and history of spontaneous abortion. The screening tests were normal embryo in the first and second stages, but regarding the findings of one-way hydronephrosis, one-way coronary cyst, two-way fierce club in the examination of fetal organs, relative reduction in fetal movements and bilateral articulation, amniocentesis was performed and arthrography was detected. The mother was hospitalized at gestational age of 21 weeks and 4 days and underwent abortion. After receiving misoprostol and oxytocin, she was unresponsive and hysterotomy was performed and the placenta and embryo were removed. Arthrography is a congenital disorder that due to the occurrence of abnormalities and problems, early and timely diagnosis before delivery should be considered. This syndrome is detectable by ultrasound and therefore, it is recommended that screening and imaging measures, and prenatal care be performed more sensitively especially in high risk pregnant women.