مجله زنان مامائی و نازائی ایران
سال بیست و یکم شماره 3 (خرداد 1397)

Amniocentesis is usually performed to genetically assess the fetus before birth. The most common complications associated with amniocentesis include the rupture of membrane (ROM), miscarriage, amniocentesis, as well as direct and indirect harm to fetus. The study aimed to evaluate the early and late complications of amniocentesis.
This cohort study was conducted on 1,000 pregnant women, who referred to the Perinatology Clinic of Ommolbanin Hospital in Mashhad, Iran during 2014-2016 to undergo amniocentesis by a perinatologist. To obtain 20 cc amniotic fluid, a needle was inserted into the gestational sac through the skin of the abdominal area of mothers using the ultrasound guidance. Subsequently, the researchers collected the data related to the early and late complications, pregnancy termination date, and neonatal complications through phone calls. Data analysis was performed in SPSS version 20 using Kolmogorov-Smirnov test.
From the evaluated neonates, 887 newborns (88.7%) were healthy. According to the results, spontaneous abortion, amniotic fluid leakage, spotting, amnionitis, and childbirth before 37 weeks of gestation were reported in 10 (1%), 16 (1.6%), 16 (1.6%), 2 (0.2%), and 173 (17.3%) of the cases, respectively. Furthermore, there were no reports of ocular, dermatologic and orthopedic complications in the study.
According to the results of the study, the most common early complications of amniocentesis were spotting and amniotic fluid leakage. Furthermore, preterm birth was the most common late complication of this procedure.

Sexual function disorders in infertile women may indirectly decrease the success rate of their treatment. Therefore, it is essential to eliminate such disorders in order to improve infertility treatment outcomes in women. Considering the lack of research on infertile women, the present study aimed to investigate the effects of sexual education skills on the outcome of infertility treatment in women.
This clinical trial was conducted on 20 infertile women with sextual function disorders aged 22-36 years, who referred to Motazedi Sterility Clinic in Kermanshah, Iran in 2016. Research units were selected via convenience sampling. Subjects were randomly divided into two groups of intervention and control group (10 women in each group). Women in the intervention group received training on sexual education skills (10 sessions), and the control group had no intervention. Data were collected using the sexual function index by Rosen et al. (2000). Data analysis was performed in SPSS version 19 using the Kolmogorov-Smirnov test, Mann-Whitney U test, paired t-test, and Fisher's exact test.
Sexual skill training improved the sexual function of infertile women (P=0.001). After three months, the number of pregnancies in the intervention group was higher compared to the control group although the difference was not statistically significant (P=0.291).
According to the results, sexual education skills could improve the sexual function of the infertile women. Therefore, it is recommended that sexual skill training be implemented as an effective cognitive-behavioral, non-pharmacological method to enhance sexual and reproductive health.

Alprazolam is a benzodiazepine with several applications due to its pharmacological effects. Alprazolam is mostly used in the treatment of anxiety disorders. Alprazolam affects the brain and many other organs. Due to the excessive use of this drug, especially by women, the present study aimed to investigate the effects of alprazolam on the growth and development of ovarian follicles in female rats.
This applied research was conducted on 24 adult female rats in 2015. Animals were randomly divided into four groups of six. In the first group, alprazolam was administered orally for 16 consecutive days (2 mg/kg). In the second and third group, alprazolam was administered orally for 16 consecutive days at doses of 4 and 6 mg/kg. Rats in the control group received water with the same volume and mode of administration at the same time as the test animals.
Histomorphological studies revealed that high doses of alprazolam (4 and 6 mg/kg) significantly decreased the number of graafian follicles (P According to the results, high doses of alprazolam affected the follicular development of rat ovaries and may have adverse effects on the fertility of female rats.

A great number of women undergo some variations in menopause due to the decreased release of estrogen. These changes may result in the reduction of sexual desire. Regarding this, the aim of the present study was to assess the effect of fenugreek vaginal cream on sexual satisfaction and dyspareunia in menopausal women.
This double-blind randomized control trial was carried on 60 postmenopausal women referring to the healthcare center No. 1 of East Ahvaz, Iran, with the complaint of sexual dissatisfaction and dyspareunia in 2016. The participants were randomly assigned into two groups of intervention (n=30) and placebo (n=30). The intervention group received one applicator of fenugreek vaginal cream %5 once a day (5 g/day) for 8 weeks. The placebo group was also provided with the placebo administered within the same period. The research instruments included the Larson sexual satisfaction questionnaire measuring sexual satisfaction and an information form evaluating dyspareunia filled out before and after the intervention. Finally, the data were analyzed by using independent and paired sample t-test, Chi-square test, and Mann-Whitney U test in SPSS (version 22). P-value less than 0.05 was considered statistically significant.
According to the results,the intervention and placebo groups showed a significant difference in terms of the mean sexual satisfaction after the intervention (74.18±1.94-51.1±2.02) (P As the findings indicated, the application of fenugreek vaginal cream was effective in the reduction of dyspareunia and enhancement of sexual satisfaction in postmenopausal women.

Metabolic syndrome is considered as a risk factor for cardiovascular diseases and diabetes and its prevalence increases at an alarming rate. Therefore, the study aimed to evaluate the effect of six weeks of Pilates training along with Vitamin E supplementation on some markers of metabolic syndrome in female overweight adolescents.
This clinical trial was conducted on 30 female adolescents aged 15-18 years in Mahallat, Iran. The subjects were randomly divided into three groups of six weeks Pilates, six weeks of Pilates vitamin E and control. Exercises with minimum duration of 30 minutes were performed three days a week. Physiological and anthropometric indices, as well as lipid profiles and glucose level of the participants were measured in the pre-test and post-test stages through blood sampling. Data analysis was performed in SPSS version 22 using paired t-test, ANCOVA, and Bonferroni post hoc test. In addition, P-value below 0.05 was considered significant.
In this research, while no significant changes were observed in levels of LDL, HDL and TG of the subjects in the Pilates and vitamin E group (P≥0.05), the levels of TG (P=0.022) and glucose (P=0.001) and waist-to-hip ratio (WHR) significantly decreased after the intervention. Moreover, levels of LDL (P=0.001), TG (P=0.002), cholesterol (P=0.013), glucose (P=0.001) and WHR (P=0.004) significantly decreased in the Pilates group, whereas no significant changes were observed in the level of HDL (P≥0.05). In the control group, no significant changes were observed in the levels of LDL, HDL, TG, cholesterol and WHR of the subjects (P≤0.05). Comparison of the groups revealed a significant difference between the Pilates and control groups in terms of the levels of LDL (P=0.18) and cholesterol (P=0.024).
According to the results of the research, Pilates training can lead to the control of lipid profile, WHR, and glucose level in overweight female adolescents. Furthermore, Pilates training along with vitamin E supplementation had similar impacts and no significant difference was observed in this regard.

Breast cancer is a common malignancy and a major cause of death in women. Viruses are considered as one of the risk factors associated with breast cancer. Herpes simplex virus-1 (HSV-1) and HSV-2 are involved in the pathogenesis of cancer. The present study was conducted to determine the frequency of HSV-1 and HSV-2 in the blood samples of patients with breast cancer using multiplex-polymerase chain reaction (M-PCR) technique.
This cross-sectional study was conducted on 60 breast cancer patients within 2014-2015. The infection with HSV-1 and HSV-2 was investigated by M-PCR. All data were analyzed using SPSS software (version 18).
Out of the 60 blood samples obtained from patients with breast cancer, 6 (10%) and 3 (5%) samples were positive for HSV-1 and HSV-2, respectively.
herpes simplex virus, especially HSV-1, can play a role as a cofactor in the incidence of breast cancer, so further studies are recommended in this area.

Premature rupture of membrane (PROM) is a common complication in midwifery and a serious consequence during pregnancy. This event can cause 18-20% prenatal mortality and 21.4% prenatal morbidity. Therefore, it is essential to use methods that can predict PROM. Regarding this, the purpose of the present study was to investigate the relationship between striae gravidarum and PROM among the primigravid women.
This predictive correlational study was conducted on 600 primigravidwomen with the gestational age of 35-37 weeks in Bojnourd, Iran. The study population was selected through convenience sampling technique. The participants were monitored and followed up until delivery, and thereafter divided into two groups of with PROM and without PROM. The data were collected using physical examination, interview, telephone follow ups, and patients’ medical records. In addition, the severity of striae gravidarum was determined by the Atwal scale. Data analysis was performed in SPSS (version 17) using descriptive statistics, Kolmogorov-Smirnov, Man-Whitney U test, Chi-square test, and logistic regression. P-value less than 0.05 was considered statistically significant.
According to the results, 445 (74.2%) participants had striae gravidarum, and PROM occurred in 22.3% of the cases (n=134). The results of the logistic regression test showed that the females with severe striae gravidarum were 2.617 times more prone to the incidence of PROM, compared to those without striae gravidarum (P=0.010).
According to the findings, the severity of striae gravidarum can be used as an indicator to predict the incidence of PROM. In order to prevent from such an event, the midwives and gynecologists can provide the mothers having severe striae gravidarum with proper recommendations in this regard.

Compliance with ethical principles is one of the main components in midwifery profession, affecting the personal, professional and social performance of midwives. Given the fact that adhering to professional ethics leads to the accountability of the healthcare team, the study aimed to determine the observance of codes of professional ethics in midwifery by midwives working in gynecology and maternity wards and some related factors in hospitals affiliated with Isfahan University of Medical Sciences, Isfahan, Iran.
This descriptive cross-sectional study was conducted on 42 midwives working in maternity wards and 31 midwives working in gynecology wards of hospitals affiliated with Isfahan University of Medical Sciences. The data collection tool was a self-report questionnaire consisting of two sections, including demographic characteristics and a researcher-made questionnaire based on codes of professional ethics using a five-point Likert scale. Data analysis was performed in SPSS software (version 18) using independent t-test, Pearson’s and Spearman’s correlation coefficients, and one-way analysis of variance. Moreover, P-value below 0.05 was considered significant.
In this research, mean score of adhering to professional ethics codes in midwives working in maternity wards was 80.5±14.7, whereas it was 85.1±12.02 in midwives in gynecology wards. According to the results of Spearman’s correlation coefficient, a direct association was observed between the mean score of compliance with the ethical codes and knowledge about the midwifery codes of professional ethics (P=0.02, r= 0.273).
Results of the study emphasized the need to increase training courses on midwifery code of ethics for midwives working in maternity and gynecology wards.

Awareness of the incidence of abortion in Iran is essential to promoting maternal health. Therefore, it is of paramount importance to estimate the rate of induced abortion. The present study aimed to investigate the rate, causes, and changes associated with induced abortion during 2009-2014.
This survey was conducted using the abortion data collected from two fertility surveys preformed in 2009 and 2014 on a respective sample of 2,934 and 3,012 married women aged 15-49 years in Tehran, Iran. The incidence of abortion was estimated based on the age-specific abortion rate, general abortion rate, total abortion rate, and abortion ratio.
During 2009-2014, total abortion rate reduced from 0.16 to 0.14 cases per woman, while the general abortion rate decreased from 5.5 to 4.4 cases per 1,000 women, and the annual rate of abortion declined from 11,500 to 11,400 cases. Assuming the estimated abortion rate in Tehran as a national average rate, it is estimated that approximately 101,000 abortions are performed in Iran annually. Moreover, about 9% of known pregnancies are reported to be terminated in Tehran. Mean age at abortion is 33.5±6.3 years, and the rate of induced abortion is comparatively higher among the women with academic education, proper employment, favorable socioeconomic status, and low religious tendencies, as well as the migrants of urban areas and those with no or one living child. The proportion of abortions for non-medical reasons was found to increase from 69% in 2009 to 82% in 2014. In addition, half of the induced abortions were due to withdrawal failure; however, only one-third of the women with withdrawal failure switched to modern contraceptives after abortion.
According to the results, the high prevalence of induced abortions in Iran highlights the need for effective family planning services and counseling in order to prevent unintended pregnancies among women.

Stress urinary incontinence is a disabling disease that affects the lives of women and requires solutions. Therefore, this study aimed to evaluate the effect of exercise on stress urinary incontinence in women.
In this review study, information related to the effects of exercise on stress urinary incontinence in women were searched in Persian and English in the databases of clinical trials registry centers, including Elsevier, ProQuest, UpToDate, Scopus, Magiran, Irandoc, SID, Iran medex, Sciencedirect, Pubmed, GoogleScholar and web of science using keywords of urinary incontinence, stress urinary incontinence, exercise, and elderly and their Persian equivalents. The search was based on a mesh during 2000-2017.
In total, 23 interventional studies, including clinical trials and quasi-experiments, which were published during 2000-2017 and met the inclusion criteria, were assessed. In the review conducted on women with different age groups from across the world, most studies have reported a positive relationship between exercise and stress urinating incontinence.
Based on the published studies, following exercises are effective in prevention and treatment of stress urinary incontinence in women: regular daily pelvic floor muscle exercises, co-contraction of the muscles of the pelvic floor and central trunk or transverse abdominal, gymnastics, Pilates, exercise of pelvic floor muscles along with biofeedback intravaginal or perineal, pelvic floor muscles training using a muscles shocking device or electrical stimulation, Valsalva, physical fitness, Paula's Exercise, Kegel Exercise, training of the gluteal and adductor thigh muscles, Tensberger's exercises, physiotherapy, isometric exercises, and exercise in water.

Osteoporosis is a silent epidemic in the current era. While several studies in Iran have estimated the prevalence of osteoporosis at 8-77% in postmenopausal women, no rough estimate has been reported in this regard. The present study aimed to estimate the prevalence of osteoporosis in postmenopausal women in Iran.
This meta-analysis was conducted via searching in databases such as IranMedex, SID, Magiran, IranDoc, Medlib, ScienceDirect, Pubmed, Scopus, Cochrane, Embase, Web of Science, Medline, and Google Scholar using authentic Persian and English keywords, such as osteoporosis and postmenopausal, without a time limit for the studies published until 2017. Two researchers identified the relevant articles and extracted the data independently. Heterogeneity of the retrieved studies was assessed using the I2 index. Data analysis was performed in STATA software version 11 using the random effects model through a meta-analysis.
In total, 50 studies performed on 38,161 subjects were reviewed. The prevalence of osteoporosis in postmenopausal women in Iran was 32% (95% CI, 26-39%), and the prevalence of low bone density was estimated at 51%. The prevalence of osteoporosis was reported to be 32% in the lumbar spine, 21% in the spine, 25% in femoral neck, and 21% in the hip. Additionally, the prevalence of low bone density in the lumbar spine, spine, femoral neck, and hip was 39%, 29%, 26%, and 39%, respectively. Meta-regression showed no significant association between the prevalence of osteoporosis in postmenopausal women and year of the studies.
According to the results, about half of Iranian menopausal women have low bone density, which is a considered to be a significant predisposing factor for the incidence of osteoporosis and its complications.

Bladder exstrophy is a rare congenital anomaly due to midline anterior abdominal wall defect, causing a series of genitourinary and muscular malformations, which demands surgical correction. Women with bladder exstrophy are fertile and able to have normal children without this disease. However, successful pregnancy and delivery is rare in females with this condition and many complications can occur. Planned Cesarean section at term is considered the most appropriate mode of delivery. In this research, a case with bladder exstrophy, who experienced natural delivery without trauma to the genitourinary system, was introduced.
Our case was a 36-year-old pregnant woman with a history of multiple corrective surgical procedures due to bladder exstrophy, who referred to the hospital with labor pain and rupture of members at 39 weeks of gestation. She had a successful vaginal delivery without complications with the use of sublingual misoprostol and intravenous oxytocin.
Although cesarean section is the most common mode of delivery for pregnant women with bladder exstrophy, it could be associated with risks, including multiple pelvic adhesions due to several corrective surgeries. Therefore, natural vaginal delivery with proper monitoring can be an appropriate method for pregnancy termination in this disease.