International Journal of Women’s Health and Reproduction Sciences
Volume:2 Issue: 3, Spring 2014

Identification of severe acute maternal morbidity (SAMM) has gained importance in recent years in view of falling maternal death rates and thrust on improving quality of maternal health care. Although most of these events occur in developing countries, reporting system for SAMM is poorly developed in these regions. Aim of this study was to determine the incidence and direct causes of postpartum SAMM along with measuring of relevant new indicators on maternal health in an apex institute of India Hospital based cross sectional study conducted in India on 109 women with severe post partum complications. Outcome measures were SAMM or death. 99 women had SAMM and there were 10 maternal deaths. Eclampsia was the most common cause of SAMM, but case fatality ratio was higher for PPH. SAMM ratio was 16.22/1000 live births and mortality index was 9.17%. 1 out of every 10 women with SAMM dies in developing countries. Improving facility based care and prompt referral can be a short term measure to quickly reduce the number of maternal deaths. Facility based monitoring and reporting of severe maternal outcome is an important step for scaling up such efforts.

Infertility is one of the most prevalent problems among young couples especially in women with Polycystic Ovary Syndrome. In women, PCO is associated with lack of ovulation, abdominal obesity and insulin resistance. The aim of this study is to investigate the effect of nitric oxide with minimal stimulation in the treatment of infertility in women with PCOS. In a randomized single blind clinical trial (RCT), 120 women who had polycystic ovarian syndrome (PCOS), were with PCOS who were eligible to be studied were divided into two groups; study group and a control group (60 patients in each group) and the effects of Nitric Oxide with minimal stimulation on the treatment of infertility were investigated in the patients who were being treated with IUI. The mean age of the patients, who were 21 to 35 years old, was 28.3±4.2 years. In the study group, 43 cases (71.7%) and in the control group, 52 cases (86.7%) had ovulation. The difference between these two groups was statistically significant (p=0.03). The successful pregnancy rate was 10 cases (16.6%) in the study group and 8cases in the control group (13.3%), however this difference was not statistically significant (p=0.18). The difference between the two groups regarding mature follicles was not significant either (p=0.27), but the difference regarding the endometrial thickness on the gonadotropin administration day was statistically significant (p=0.02). According to the results and since there was not a significant difference between the two groups regarding the pregnancy rate, it can be concluded that employing nitric oxide tablets in addition to the common treatment, does not affect pregnancy rate in women with PCOS.

Effective pain therapy after cesarean section is essential for parturient comfort and to allow early ambulation to facilitate care of her infant. This study evaluated the analgesic effect of preventive 1gr intravenous paracetamol on postoperative pain and analgesic consumption during the 24 hours after cesarean section. One-hundred American Society of Anesthesiologists (ASA) I or II status parturient scheduled for elective cesarean section under spinal anesthesia. Patients received 1gr iv paracetamol into 100 ml normal saline (study group; n=50) or normal saline alone (placebo group; n=50) 20 minutes before the end of operation. Pain scores were lower in the study group in the Post anesthesia care unit (PACU) (p<0.001) and up to 4h after operation (p<0.001). Cumulative analgesic consumption was lower in the study group (p<0.001). Preventive administration of 1gr iv paracetamol reduces the intensity of pain in the PACU and until 4h after operation and analgesic consumption following cesarean section.

Neonatal sepsis with extended-spectrum beta-lactamase (ESBL) producing microorganisms is recognized increasingly in recent years. ESBL can be produced by various bacterial strains. This study was conducted to determine the prevalence of ESBL producing pathogens in neonatal sepsis and its impact on clinical outcome. A study was carried out from Jan 2012 to Jan 2013 in a referral university hospital. All neonates who had diagnosed as sepsis were enrolled in this study. Blood cultures were processed using the automated BACTEC 9120 system. Antibiotic resistance and beta-lactamase production of bacterial isolates was tested. All patients were followed till discharge. One hundred three neonates with gestation age 36.7±3.2 weeks were enrolled in this study and 56 cases (54%) were boys. The most common isolated gram negative pathogens were Klebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa. The rate for beta-lactamase production were 97.7% in Klebsiella pneumoniae, 81.3% in Acinetobacter, 85.7% in E. coli, 53.3% in Pseudomonas aeruginosa and 100% in Serratia. Thirty eight (35.9%) neonates were dead, that 34 of them were beta-lactamase producers. The mean duration of hospitalization were longer in patients infected with beta-lactamase producers (30.2±20.5 vs. 22.8±16.6 days P=0.05) and ESBL producing strains (29.13±20.39 vs. 19±9.84 P=0.05). ESBL production rate were determined 95.5% and 86.7% in Klebsiella pneumoniae by combined disk test (CDT) and double disk synergy test (DDST) method, respectively. These methods were positive for ESBL production in 78.6% and 64.3% of E. coli isolates, respectively. in our study, the high rate of beta-lactamase and ESBL production were determined for common isolated organisms in neonatal sepsis. Infection with ESBL producing pathogens was associated with longer hospital stay. CDT method was detected more ESBL producing pathogens than DDST method in our study. It is recommended future studies to determine the risk factors predisposing newborn infants with these pathogens.

The main goal of care services is provide and promote mankind's health. Patient satisfaction is recognized as an important parameter for assessing the quality of patient care services. Spatially mother's satisfaction from delivery is very important because it influence on family and society psychological health. The aim of this study was comparing maternal satisfaction about prenatal and postnatal cares in vaginal and cesarean section delivery at teaching and nonteaching hospitals of Tabriz/ Iran. This is a descriptive-comparative study. We selected 454 women who had been hospitalized for delivery in Alzahra, Talegani (teaching) and 29Bahman (nonteaching) Tabriz/Iran hospitals. For data collection, we used a questionnaire. Spss/ver13, Descriptive statistic, Independent t test, ANOVA and correlation tests were used for data analysis. Findings indicated the highest level of satisfaction in both kind of hospitals was about physical and the lowest one was about informational aspect in women who had vaginal delivery, accordingly these rates about cesarean section was about physical and about informational and emotional aspects in labor. The analysis of data showed significant difference between mother's satisfaction with all aspects of care in the teaching and non- teaching hospitals (P < 0.001). The results showed that the highest rank from mother's satisfaction was in the physical and the lowest rank was in informational category. Mothers were satisfied from vaginal delivery in all aspects. Rate of satisfaction in nonteaching were more than teaching hospitals.

Preterm Labor occurs in 11.8% of all pregnancies and is the most etiology of Neonatal morbidity without Anomalies and after intra partum congenital Anomalies is the second etiology of Neonatal mortality that has high economic & psychiatric cost. Premature infants have Neurotic complications and they are week about physical growth, practical cognitive and lesson tasks. One of usage drugs in prevention of preterm labor is Nefidipin. This research is a Double blind RCT. All of pregnant mothers with 26-34 weeks with signs of preterm labor have come to Alzahra & Talegani hospitals were research population. Research samples were 80 pregnant women that have eligibility criteria and treated with Sulphate mg & Nefidipin. Samples allocated randomly in 2 groups by use of rand list soft ware and block of 3 and 6.In group A were used Sulphate mg 4 g first and then 2g/h for 48 h and group B were used Nefidipin 20 mg first and 20 mg /half h after. Success of treatment was measured by Partograph & checklist. Data was analyzed by statistic tests and spss ver. 13. Neonatal complications such as 1 min Apgar and 5 min Apgar score, Sao2 and ABG in 2 groups, that treatment could not prevent contractions, have not significantly different. But there were significant different about Fetal complications such as bit to bit variation, decrease of fetal movement and dropt of base line of FHR (p≤ 0.05). Data showed that Nefidipine was more effective in comparison of Sulphate mg in suppress of uterus contractions and improve of feto-Neonatal outcomes that these will prevent further Growth & Development complications in Neonatal and this drug can be best supplement for Sulphate mg in suppress of preterm contractions of uterus.

The aim of this study was exploring sleep hygiene and its related factors among the elderly in Tabriz, Iran. This study was conducted on 100 elderly men and women over the age of 60 in Tabriz, Iran. This was a cross-sectional study which conducted on 100 men and women over 60 years old who were selected among four active retirement centers in Tabriz, Iran in 2010. A questionnaire consisting of four sections was used for data collection. Data was gathered on socio-demographic, personal, environmental and nutritional- pharmaceutical factors of sleep hygiene. Overall sleep hygiene was considered to be as optimal if the score of three domains was between 119 and 177, moderate with score 60- 118 and unfavorable with score 0-59. Descriptive statistics and chi-square tests were used to analyze the data. Most participants (74%) claimed that they wake up frequently during the night. Sleep hygiene in 16% of the participants was optimal and in 84% was moderate. Regarding personal, environmental and nutritional- pharmaceutical factors, sleep hygiene in 18%, 16% and 54% of the samples was optimal respectively. There was a significant relationship between gender, marital status, number of household, the amount of revenue, marital life satisfaction with sleep hygiene in the elderly (p<0.05). The findings revealed that only small number of participants enjoyed sleep hygiene. Considering the optimal impact of sleep hygiene and its importance in fixing sleep disorders, improving sleep hygiene through educational programs can decrease the sleep disorders and improve the quality of life.

The knee joint osteoarthritis is one of the important causes of disability and is more frequent in menopausal women. Phonophoresis is a therapeutic method using ultrasound to enhance percutaneous absorption of drugs. This study was aimed at evaluating the therapeutic efficacy of dexamethasone phonophoresis in the management of knee osteoarthritis in elderly women. 55 women aged 56.03±5.7 years who had mild or moderate knee osteoarthritis were randomly allocated into 3 groups. First group (n=18) received ultrasound (as control group), second group (n=18) received phonophoresis of 4mg dexamethasone ampoule and third group (n=19) received phonophoresis of 0.4% dexamethason gel. All groups were treated with an ultrasound program using stroking technique, pulse mode, 1.5 W/cm2, 5 minutes per session for 10 sessions. Visual Analog Scale (VAS) for pain severity and Western Ontario and McMaster universities Osteoarthritis Index (WOMAC) and the time up and go test (TUG) were evaluated before and after treatment in all groups. The VAS, total WOMAC and TUG scores were significantly improved after treatment in all groups (P<0.001). The group receiving phonophoresis of dexamethasone ampoule showed more significant effects in reducing pain and improving function and mobility among three groups. Our results indicated that both ultrasound and phonophoresis of dexamethasone are effective methods in pain relief and improving function in mild and moderate knee osteoarthritis but phonophoresis of dexamethasone ampoule is better than the other treatments and it is suggested as an available method for treatment of knee osteoarthritis symptoms.

This is a cohort study that investigated the incidence, severity and risk factors of Urinary Incontinence during pregnancy and postpartum in nulliparous women. In this cohort study, 441 nulliparous women were studied. The women were followed up from the beginning of pregnancy until the postpartum period. The prevalence of urinary incontinence was determined among them. Risk factors that could play a significant role were analyzed using questionnaires. In this study, 441 nulliparous women with an average age of 28.1 ± 3.7 years were studied. The prevalence of urinary incontinence in the third trimester of pregnancy was 39.4% and it was 31% in the postpartum period. Vaginal delivery, maternal weight, and fetal weight (> 4 kg) were the most important risk factors for increasing the incidence rate of urinary incontinence. In this study, age had no role in incontinence. The severity of incontinence in 26.6% of the participants over 5 was based on visual analogue scale (VAS) scoring. Urinary incontinence is one of the common disorders during pregnancy and postpartum period that can affect quality of women life significantly. Type of delivery and maternal and fetal weights are the most important risk factors for increasing this disorder. Unlike previous studies, age did not play any role in incontinency in this study.

Polycystic ovary syndrome (PCOS) is the most frequent cause of female infertility, affecting about 4% to 8% of women in the age of procreation. For evaluation the protective effects of omega-3 polyunsaturated fatty acid on ovarian structure in experimental PCO induced by estradiol-valerat, this research was done. Wistar female rats (n=40) were allocated into four groups, one control (n=10) and three test groups (n=30), that one group received omega-3 (60 mg/rat/orally/daily), second and third groups were induced PCO by single injection of estradiol-valerate (16mg/ kg/ i.m), third group also received omega-3 (240 mg/kg) for 60 consequence days. Animals were kept in standard conditions. On day 60, the ovarian tissue of Rats in whole groups were removed and prepared for pathological analysis. vacuolated area and rough endoplasmic reticulum expanded, de-granulated, disorganized were seen in PCO groups; however, these side effects decreased in the groups that received omega-3 significantly (p<0.05) in comparison to experiment groups and ovarian weights in PCO experimental decreased significantly (p<0.05). Results revealed that administration of omega-3 could significantly treat PCO. This suggested that polyunsaturated fatty acid could diminish negative side effects of PCO on ovary tissue.

Adolescence is a unique period in life cycle. During this period, adolescents face with many behavioural challenges. This study aimed to determine adolescent girl's practice regarding puberty and menstrual hygiene, as well as its relationship with socio-demographic characteristics. This cross-sectional study was conducted on 1017 female students who were studying at second and third grade of secondary schools in Tabriz, 2013. Samples were selected randomly. Questionnaires used in the study were the practice and socio-demographic questionnaires. General linear model was used to determine predictors of practice. Mean (SD) of practice score in adolescent girls was 64.2 (12.1) from attainable score of 0-100. More than half of students (56.7%) had moderate practice. According to adjusted general liner model, variables of being in second class, having a father with elementary education or illiterate, living in undesirable economic status, having peer groups and friends as main source of information, having insufficient information about puberty had negative relationships with practice score. While, there was a positive relationship between age at menarche and practice score (p<0.05). The findings show that the practice of adolescents about puberty and menstrual hygiene is moderate. Thus, it is necessary to educate the girls about puberty and menstrual hygiene to enable them to have a healthy reproductive life in future.

Acute Myocardial Infarction (AMI) has traditionally been considered a disease affecting mostly men, yet women are increasingly at risk due to the obesity and diabetes. This study used archival data on hospital discharges from the cardiac care unit (CCU) to examine the AMI risk factors and its management among female patient's presentations at emergency rooms (ER) ended at CCU with a concurrent diagnosis of AMI and to compare the results with men of the same diagnosis. The study was conducted as a prospective cohort survey among patients admitted to CCU. All patients in that ward admitted with documented diagnosis of AMI and positive troponin results were obtained from the study. Some characteristics of the patients such as age, gender, education, risk factors, outcome, cardiac enzymes recorded by one of the researchers at the first day of the admission. Then those patients were followed up until discharge, either referring to another facility or death. Statistical analyses were performed with SPSS for Windows version 13.0. The data was analyzed by descriptive and inferential statistics. A total of 182 patients 140 men (68.6%) and 42 women (20.6%)) admitted with AMI were enrolled in the study. Women on average had 2 years age difference and had a greater prevalence of hypertension. Men had more previous myocardial revascularization procedures and more often were smokers. There were no difference in previous admission, death, or need for CAG (Coronary angiography). The awareness needs to be directed towards eliminating the disparities within the female population and heart disease. In this study any important and significant differences were not shown between male and female AMI management.

The human ovary is characterized by early senescence and the end stage of ovarian activity is termed menopause. The age at which menopause occur is between 45 and 55 years world wide. The objective of this pilot study is to determine the age at menopause by using a model of FSH over age in women of sub urban region around Chennai, India. The subjects include 500 patients of age between 30 and 36 yrs with BMI ranging from 24-28.After recording their general profile and history, blood samples were obtained by venipuncture and hormone FSH was estimated on the day 3 of the menstrual cycle. Based on functional dependence of FSH in the form of exponential relation with age, a model was proposed. Using least square approximation the beta values were calculated. With the help of beta values and using the cut off value of 40 IU/ml for FSH, this predicted model determined the age of menopause as 44.6yrs in women of sub urban region around Chennai. The age of menopause is different in various region worlds wide. According to this pilot study the suburban women of Chennai, attain menopause at an age of 44.6 years. Further exploration should be done to alleviate the role of diet, life style and ethnic variation on menopausal age and the impact of chronic disease like osteoporosis during the period of menopause.

Tetra-amelia is known as an anomaly characterized by the absence of all four limbs. It is a rare congenital anomaly, with an incidence of 1.5-4 per 100,000 births. It occurs as a result of developmental interruption between 24th and 36th days after fertilization. Its etiology is not well known. It may be observed isolated or associated with other anomalies. In this paper, we present an interesting case of an intra-uterine diagnosed tetra-amelia male fetus with the recurrence in the previous two more male fetuses in the same family. Tetra-amelia syndrome observed in all three male fetuses of a couple with blood relationship is presented. The first two male newborn died just after birth due to prematurity in 28th and 32nd weeks. The third male fetus was in 23nd weeks of the intrauterine life. There was no exposure to teratogenic agents in this pregnancy. It detected that the third male baby had subcutaneous edema, intra-abdominal ascites and lateral ventricle enlargement in cranium. Since tetra-amelia due to genetic inheritance based on X chromosome was suspected, the family was offered the options of termination of pregnancy, karyotype analysis and genetic consultation.