مجله زنان مامائی و نازائی ایران
سال چهاردهم شماره 6 (دی 1390)

Preeclampsia is a specific syndrome in pregnancy, which the definite cause and treatment is still not known. Isosorbide dinitrate, a nitric oxide donor vasodilator drug, is proposed to be effective in decreasing high blood pressure in pregnant women with severe preeclampsia. In this study, effect of oral isosorbide dinitrate in preventing of develop mild preeclampsia to severe preeclampsia in pregnant women was evaluated. In a randomized clinical trial all pregnant women with mild preeclampsia who were admitted in prenatal ward of Akbarabadi or Firoozgar hospital of Tehran during March 2007- June 2009, were investigated. Individuals were investigated as cases (treated with oral isosorbide dinitrate) and controls (without any drug therapy) and compared based on systolic and diastolic blood pressure and time of developing severe preeclampsia. Data was analyzed using SPSS software (version 16) by t-test Independent. The difference between the systolic and diastolic blood pressures at the beginning of the study and after 24 hours were respectively 20.22±8.94 and 9.11±3.10 mmHg in the case group and 3.55±6.14 and 1.11±6.40 mmHg in control group (p<0.001). The mean delay in developing severe preeclampsia in case and control groups were respectively 29.89±27.34 and 7.89±8.15 days (p<0.001). Oral isosorbide dinitrate delays developing severe preeclampsia in patients with mild preeclampsia and is effective in the treatment of hypertension due to mild preeclampsia.

Body image is one of the most important issues in women's mental health and due to its relationship with physical, cognitive and emotional aspects of women’s life; it can predict their healthy or unhealthy behaviors. According to some research reports, women’s negative or positive body image can affect their marital relationships. Considering the impact of infertility on both body image and marital adjustment and the lack of evidence regarding the relationship of these two variables in infertility, this study aimed to investigate the relationship of body image with marital adjustment in infertile women in 2010 in Mashhad.

This correlational study was carried out on 130 infertile women referred to Montaserie Infertility Research Center in Mashhad who were selected through convenient sampling. Research tools were consisted of valid and reliable demographic questionnaire including personal and infertility-related information, modified Younesi Body Image Questionnaire and Spanier marital adjustment scale (DAS) which were completed by subjects. Data analysis was carried out by SPSS software (version 15/5) using t-tests, one way ANOVA, and Spearman and Pearson correlation test.

93/1% of women reported positive body image and 76/9% had high marital adjustment. There was a direct correlation between the overall score of body image with marital adjustment (P<0/001). There was also a direct correlation between the scores of body image subscales including body in loneliness (P= 0/001), real body (P=0/014), public image of body (P=0/016), spouse image of body (P<0/001) and spouse family image of body (P<0/001) with marital adjustment. However, this relationship was not observed between the subscale of ideal body and marital adjustment.

The presence of a direct correlation between body image and marital adjustment could guide developing educational or counseling programs particularly for infertile women who suffer from marital disputes.

Abnormal uterine bleeding (AUB) is one of the most common gynecologic problems. The existence of a post tubal ligation syndrome has been debated for decades and there are still discussions on the presence or absence of menstrual abnormalities related to tubal ligation. This study was performed with the aim of evaluating the probable difference of tubal ligation frequency between women with AUB and individuals who doesn’t have such abnormalities. In this case-control study conducted in Bu-Ali hospital gynecology clinic in Tehran during April 2009- June 2001, 300 women with the chief complaint of AUB were compared to 313 women without AUB. Subjects were selected by available sampling method. A questionnaire containing the demographic data, the characteristics of menstrual cycles and the contraception method was completed for each subject. Data was analyzed by using SPSS 11.5 software and Chi-square, one-way ANOVA, Pearson and Mantel-Haenszel tests. The incidence of previous tubal ligation was higher in women with AUB than the control group (22.3% versus 13.4%. OR: 1.85, 95% CI: 1.21- 2.8, P=0.004). This difference was also significant after adjustment for age and parity (for parity: OR=1.66, P= 0.028 and for age OR: 1.69, P=0.02). The incidence of previous tubal ligation was higher in women with one abnormal menstrual characteristic out of five criteria (27.3% versus 14.22%. OR: 1.91, 95% CI: 1.22- 3.01, P= 0.03). Results show that there is relationship between tubal ligation and menstrual problems. Further prospective cohort studies with long term follow up are suggested.

Normal morphological features and size of the maternal pelvis are important prerequisitesto vaginal delivery. Advanced methods of pelvimetry are expensive and not widely available in developing countries. Clinical pelvimetry is an inexpensive method of assessing the pelvic capacity and is widely used. The objective of this study was to determine the diagnostic accuracy of clinical pelvimetry in identifying small pelvis in nulliparous women.

In this double blind prospective analytical study (December 2008 and June 2009) 527 nulliparous women who referred to the Ommolbanin hospital of Mashhad, entered the study. Clinical pelvimetry was performed at the admission and the capacity of pelvic inlet, mid-pelvis and pelvic outlets were determined. Data were analyzed by SPSS 11.5 software and fisher exact test and Chi- square test were use for comparison of pelvic capacity in the two groups.

Flat sacrum (p=0/003), ischial spine distance less than 10cm (p=0/000), convergent pelvic wall (p=0/000), the pupic arc size less than 2 fingers (p=0/000) and the distance between the ischial tuberosities less than 9 cm (p=0/000) were observed more in the dystocia group. The combination of inlet measurements had the best sensitivity (33/3%). The combination of outlet and the combination of mid-pelvic measurements had the lowest sensitivity (4.6%).

Clinical pelvimetry is not an accurate method for indentifying small pelvis in nulliparous women and trial of labor should not be put aside on the base of clinical pelvimetry results.

Pelvic prolapse is one of the most common disorders with a great impact on women’s quality of life. This study was performed with the aim of developing and evaluating a simple screening method for identification of pelvic organ prolapse among general population of women. In this cross-sectional study, first a pilot study was carried out on 200 women who referred to Reproductive Endocrinology clinic for annual gynecologic examination. The standard Pelvic Floor Disorder Inventory questionnaire was filled up for subjects and their pelvic floor prolapse was assessed using standard pelvic examination. Then, the pelvic organ prolapse screening instrument (POPSI) was developed that contained 4 selected questions. At the second phase of the study, the sensitivity and specificity of the selected questions was evaluated in 954 women who were selected by proportionate cluster sampling. Data was analyzed by SPSS 15 using independent t-test, Chi-square test and logistic regression. Pelvic Floor Disorder Inventory had 45/5% sensitivity and 87/4% specificity in general population for identification of pelvic prolapse. The selected question of “urinary incontinence after laughing, sneezing or coughing” had 40.7% sensitivity and 80% specificity in assessing the pelvic floor prolapse. Although screening based on symptoms is an appropriate choice for investigating women with pelvic prolapse and can facilitate community based studies, it seems that it lacks sufficient sensitivity in general population and have better efficacy in women who are more aware of such disorders and symptoms.

Breastfeeding is one of the main factors in health and survival of infants. According to the type of delivery, mother's breastfeeding pattern may be different. The aim of this study was to compare the patterns of breastfeeding in women with normal vaginal delivery and cesarean section. This cross sectional study was conducted in 2009 on 197 mothers after labor in Vali-e-Asr educational-treatment center affiliated to Fasa University of Medical Sciences. After selection of mothers by purposive sampling method, their feeding patterns were assessed using the LATCH breastfeeding chart system according to direct observation. Data were analyzed by SPSS (version 15) software using t-test independent, Mann-Whitney test and Chi-square test. Mean of gestational age in cesarean group was 38.8±1.7 week and in vaginal delivery group was 39.5±1.0 week (p= 0.004). Gender and weight of the newborns didn’t have any significant difference in vaginal delivery and cesarean groups. The score of breastfeeding pattern in the cesarean group (8.0±1.5) was statistically higher than vaginal delivery group (9.3±0.8) (p=0.001). The type of delivery correlates with the breastfeeding pattern. Mothers with cesarean delivery need more support and help in breastfeeding in the first days after delivery in comparison with mothers who experience vaginal delivery. Assessment of mothers’ breastfeeding pattern can be used in determining breastfeeding problems and applying appropriate nursing interventions.

Episiotomy is the most common incision in midwifery. Perineal pain due to episiotomy has always been a distressing problem for women. Recently, there has been an increased interest in using complementary medications that has caused more attention to traditional pain redactor products such as Bromelain. The aim of present study was to determine the effect of oral bromelain on perineal pain in primiparus women. In this double-blind clinical trial that was performed in 2009 in Amir-al-momenin hospital of Ahwaz, 82 women were randomly selected and divided in two groups of bromelain or placebo and randomly received medication and placebo packages. The initial dose was given 2 hours after delivery. One tablet was given three times daily for six days. Episiotomy pain was measured by VAS scale at the first 24hr, 3th, 7th and 14th day after delivery. Number of consumed analgesic tablets was also recorded. Data were analyzed by independent t-test, Chi-square test and Mann-Whitney U test using SPSS 15 test. Perineal pain significantly reduced in bromelain group at the first 24 hr and on the 3th day after delivery (P<0.05), but there weren’t significant difference between bromelain group and placebo group on the 7thday and 14th day after delivery. The number of analgesic tablets consumed had significant difference between the two groups (P<0.05). Bromelain has effect on episiotomy pain and reduces the consumption of analgesics; therefore, its postoperative use is suggested for pain reduction.