مجله زنان مامائی و نازائی ایران
سال چهاردهم شماره 3 (امرداد و شهریور 1390)

Pain after outpatient diagnostic gynecologic laparoscopy, has different causes, so postoperative analgesia is important especially in order to patients early discharge. This study aimed to evaluate the efficacy and side effects of preoperative single dose rectal Naproxen in reducing postoperative pain and analgesic requirement in patients undergoing diagnostic gynecologic laparoscopy under general anesthesia. In this randomized clinical trial, forty healthy women undergoing diagnostic laparoscopy with general anesthesia were randomly allocated into two groups of 20 persons. About 60 minutes before operation, 500 mg Naproxen was administered rectally in study group (Naproxen Group) and the control group received placebo. Postoperative pain was evaluated immediately after arrival to recovery room and 1, 3, 6 hours postoperatively using visual analogue scale. Time to first analgesia administration, number of patients requiring additive analgesia and the other postoperative side effects were also controlled and recorded. Data were analyzed by nondependent T, χ2 and Fisher tests using SPSS software (version 15). Visual analogue scale scores were significantly lower in Naproxen group immediately and 3 hours after operation, (p<0.05) but not at 6 hours later (p>0.05) compared to placebo. The time to first analgesic requirement was longer in Naproxen group than placebo group (p<0.05). Postoperative analgesic requirement were lower in patients of Naproxen group than placebo group. Other side effects were not seen in both groups. Based on the above results we can conclude that prophylactic administration of rectal Naproxen could be effective on postoperative analgesia after diagnostic gynecologic laparoscopy and can lower analgesic requirement in postoperative period.

Shoulder pain is one of the patient complaints after cesarean section. The aim of this study was to estimate the prevalence of shoulder pain and its association with elective cesarean section in patients with general anesthesia. An observational cross-sectional study was conducted with statistical society of 930 patients in Emam Reza and Emam Zaman hospitals in Mashhad using random sampling of 332 participants. To assess the prevalence of shoulder pain in elective cesarean with general anesthesia, a questionnaire was designed that consisted of age, existence or non existence of pain, severity of pain (severe, moderate or mild) occurrence of pain in right or left shoulder, and location of intravenous catheter. Statistical analysis was done using SPSS version 14, by independent t-test, chi-square and fisher exact tests. The prevalence of shoulder pain in elective cesarean section was found to be 131 patients(39.45%). There was a positive correlation between pain range (without pain, mild, moderate, severe) and side of painful shoulder. The most prevalent rate of shoulder pain was in right shoulder with moderate severity (p<0.05). There was a positive correlation between the prevalence of shoulder pain after cesarean section and each gynecologist and the number of her cesarean section (p<0.05). The present study highlights the significance of shoulder pain in elective cesarean with general anesthesia that is more in right shoulder with moderate severity.

This study was conducted to compare the effects of letrozole (5mg) and clomiphene citrate (100 mg) in treatment of infertility in patients with polycystic ovary syndrome. This clinical trial carried out on total 100 infertile women with polycystic ovary syndrome refered to Asali hospital and private clinic in 2008 and were randomized into two group of 50 that treated with 5 mg letrozole or 100 mg clomliphen citrate from day 3 to 7 of menstrual cycle. Transvaginal ultrasound usually was performed on day 12-16 of the cycle, and more often as needed to monitor the number and mean size of developing follicles in each ovary, and the endometrial thickness. Data were analyzed by t-test and chi-square test using SPSS version 15. P-value less than 0.05 defined asstatistically significant. The means of ages, body mass index, and duration of infertility in both groups were similar. The total numbers of follicles were significantly higher in the clomiphene citrate group compared to letrozole group (2.32 1.58 vs. 1.30 0.50). Endometrial thickness was greater in the letrozole group compared to clomiphene citrate group (9.71 1.27 mm vs. 6.08 3.06 mm). The duration of stimulation was similar in two groups. Ovulation occurred in 44 (88%) of 50 patients in the letrozole group and clomiphene citrate group that was not significantly different. Letrozole and clomiphene citrate usage resulted in similar pregnancy rates. The results of this study showed that Letrozole could be used as a good alternative for clomiphene citrate for treatment of infertile women with polycystic ovary syndrome.

Mycoplasma Hominis and Ureaplasma Urealiticum are bacterial floras of vagina. In some studies their role in vaginal infections is emphasized but there are differences of opinions. This study was carried out to determine the prevalence and role of genital Mycoplasmas in women with vaginal infections in northern city of Iran, Gorgan. Thisstudy was done by evaluation vaginal discharge of 235 women with vaginal infections who were referred to Gorgan Deziani Hospital in 2007. Diagnosis of infection type was done by Amsel method, clinical observations and microscopic evaluations. Diagnosis of Mycoplasma was done with culture in PPLO Broth and Agar media, and PCR with specific primers of 16S rDNA of Mycoplasma Hominis species and the primer of urease gene of Ureaplasma Urealiticum. SPSS software used to record the data and they were analyzed by χ2 and t-test. p<0.05 was considered as significant. Mycoplasma was isolated in vaginal discharges of 30 women (12.8%). Its prevalence in woman with bacterial vaginosis was 14.3% and 11.9% in women with vaginitis. Mycoplasma Hominis was isolated in 18 women (7.7%) and Ureaplasma Urealiticum in another 18 (7.7%) of them. 6 (20%) women were contaminated with both M. Hominis and U. Urealiticum at the same time. Over 83% of women with Mycoplasma had higher than 4.5 pH discharge and the average age of women with Mycoplasmas was significantly more than the women without Mycoplasmas (34.2 years vs. 30.9 years). The mean number of white blood cells and Lactoform bacteria in women contaminated with Mycoplasma and without Mycoplasma was 3.2 compared to 6.5, and 7.4 compared to 42.1 respectively. These differences were statistically significant (p<0.05). Prevalence of genital Mycoplasma in women with vaginal infections is lower than expected and this issue is not directly related to the type of vaginal infection. The reduced number of white blood cells and Lactobacill, PH>4.5 of vaginal discharge and older age of women could increase the probability of Mycoplasma infection.

Cervical ripening for labor induction is one of the obstetrical problems. The aim of this study was to compare the efficacy profile of isosorbide mononitrate with low dose syntocinon for cervical ripening at labor. The study population was nulliparous women referred to Shahid Sadoughi Hospital of Yazd in 2008-2009. 100 primigravid women were randomly assigned to two groups that received either vaginal isosorbide mononitrate tablets 40 mg (n= 50) or low-dose syntocinon (n= 50) with simplification method. Effectiveness of each agent was the cervical ripening effect and the time from initiation of the treatment to delivery that were compared between two groups. Efficacy and safety outcomes were compared in two groups. Data were analyzed by t-test and Fisher’s exact test with SPSS software version 15. The results showed that there were no significant differences between the two groups regarding mean of age and gestational age (with sonography and Last Menstrual Period). Mean of cervical ripening time was 36.13±4.057 hours in isosorbide mononitrate group and 36.28±3.886 hours in low–dose syntocinon group (P=0.876). There was no significant difference in mode of delivery (cesarean or vaginal) between two groups. The most common side effect in isosorbide mononitrate group was light headache (70%) and in low-dose syntosinon group it was tachysystole/hypertone (4%). One and five minute’s neonatal apgar were similar in two groups. Use of vaginal isosorbide mononitrate was as effective as low dose syntocinon in cervical ripening can be used as an effective, simple, low cost and safety method in cervical ripening.

Cesarean section delivery is more dangerous than normal delivery for mother and neonate. In many cases wrong beliefs, norms, and unawareness persuade and determine mode of delivery. The aim of this study was to determine women's beliefs, behavioral intention, and predictive factors for requesting cesarean section. This descriptive-analytical study was performed on 346 pregnant women referred to Hamedan health centers and obstetrics clinic. Samples were randomly selected and data related to the demographic variables, beliefs and behavioral intention toward delivery method, and predictors of willingness to select cesarean method were collected using questionnaire and interview. Data were analyzed by SPSS version 11. Willingness to perform an elective cesarean section was 50.2% versus 44.2% for normal delivery. Main reasons to perform a cesarean section were: Obstetrician's suggestion (49.4%, n=86) and having painless delivery (36%, n=63). Logistic regression revealed that, previous cesarean, tube ligation after cesarean section, planned delivery, spouse' willingness and safety of neonatal were determinant factors in cesarean section (p<0.05). Rising mothers’ literacy, employment, increase in age, and first pregnancy increased the requests for cesarean section in pregnant women (p<0.05). By identifying, modifying and improving women's beliefs to normal vaginal delivery and also providing standard conditions for normal delivery could reduce rate of non-medical causes of cesarean section. Providing educational and counseling services for families by health centers and mass media is suggested.

Dystocia means difficult labor or childbirth, a period of non progression of labor≥4 hours after the cervix has dilated 3 cm due toabnormal presentation, birth canal stenosis or uterine dysfunction. In traditional Iranian medicine, dystocia is defined as “difficult birth" or "Osrolveladeh". This study aimed to review causes of dystocia in the Iranian traditional medicine and classic medicine. In Iranian traditional medicine texts, risk factors for dystocia included maternal cause, fetal cause, uterus and membranes organ around uterus, and external causes. This study is a literature review as result of continuous study on 6 credible books in traditional Iranian medicine. At first, causes of "difficult birth" or "Osrolveladeh" obtained from 6 credible books in traditional Iranian medicine then for each causes, related scientific themes in classic medicine were searched and obtained from Pubmed, SID, Ovid, Iran doc, Science direct databases using the following key words: dystocia, labor, malposition, newborn macrosomia, from 1995 to 2011. Causes of "difficult birth" or "Osrolveladeh" in Iranian traditional medicine included maternal, fetal, uterus and membrane, organs around the uterus, and external causes that compared with causes of "dystocia" in classical medicine. All dystocia causes mentioned in Iranian traditional medicine are proved by classic medicine, but some causes exist in Iranian traditional medicine that are not in the classic medicine so these causes need to be studied.

Perimenstrual distress symptoms is one of the most common menstrual disorders these symptoms affect women's quality of life and cause decrease in economic productivity of a country and it is a useful parameter for research on occupational effects on reproductive health of women. The purpose of this study is to evaluate the rate of job stress in midwifes and its relationship with perimenstrual distress. This descriptive correlational study was carried out in 150 midwives employed in the hospitals and health centers of Mashhad thatwere eligibleforinclusionin thestudy, by two-stage sampling method. Participants completed questionnaires about Karasek Job content and demographic form at the beginning of the study and daily menstrual distress questionnaire during two consecutive menstrual periods. Data were analyzed by statistical tests such as independent t-student, one way ANOVA, Mann–Whitney, chi-square, correlations, and linear regressions using SPSS version 14. The results of this study showed that the midwives had 21.3% mild work stress, 19.3% moderate work stress and 59.3% severe work stress and there was a significant positive correlation between work stress with perimenstrual distress (p<0/001,r=0/54). Work stress caused increase perimenstrual distress.