فهرست مطالب

International Journal of Women s Health and Reproduction Sciences - Volume:6 Issue: 3, 2018
  • Volume:6 Issue: 3, 2018
  • تاریخ انتشار: 1397/05/20
  • تعداد عناوین: 27
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  • Sepideh Panjalipour, Zahra Bostani Khalesi, Seyedeh Noshaz Mirhaghjoo Pages 226-232
    Objectives
    The aim of the present study was to review female adolescents’ reproductive health needs (RHN).
    Materials And Methods
    We performed this systematic review using the Scopus, PubMed, Google Scholar and Science Direct databases as well as Magiran for English articles written by Iranian authors using the keywords “Female Adolescent”, “Reproductive Health”, “Reproductive Health Needs” and “Iran”.
    Results
    One hundred forty-eight references were identified. Two reviewers assessed the quality of the included studies. Twenty-five quantitative and qualitative studies met the inclusion criteria. All of the Iranian studies that investigated the RHN of female adolescents were entered the study. In 16 studies, an assessment was conducted using a questionnaire, 9 studies used semi-structured interviews. The results can be divided into 3 general groups of needs, including special educational needs, comprehensive counseling and adolescent-friendly services.
    Conclusions
    Our findings indicate that most adolescents have an unmet need for reproductive health services and services are not friendly. Therefore, it is suggested that future efforts should be directed toward need-based interventions to improve adolescent reproductive health.
    Keywords: Adolescence, Reproductive health, Needs assessments, Iran
  • Nasibeh Sharifi, Mahrokh Dolatian, Azita Fathnezhad, Reza Pakzad, Zohreh Mahmoodi, Fatemeh Mohammadi Nasrabadi Pages 233-239
    Objectives
    Low birth weight (LBW) affects newborns’ survival. It is also a credible sign of intra-uterine growth restriction and the most common health indicator for assessing neonates’ health conditions. The present study was conducted to determine the prevalence of LBW in Iran.
    Materials And Methods
    In this meta-analysis, we reviewed studies conducted in Iran through literature search in electronic databases including SID, Magiran, Irandoc, Iranmedex, PubMed [including Medline], Scopus, Web of Science, and Google Scholar. ‘Low birth weight’ and its synonyms were searched as keywords in English and Farsi languages to retrieve articles published from 2000 to 2016. Lastly, 20 articles were included in this study after appraisal using the tool of Hoy et al. The findings of the included studies were combined using a random model. The heterogeneity of reported prevalence among articles was also evaluated by Q test and I2 index. The data were analyzed by the STATA software.
    Results
    Total number of the samples was 43801 individuals. The prevalence of LBW was between 2.6%-18.9% in some Iranian studies. According to the random effects model, total prevalence of LBW in Iran was estimated 9% (95% CI, 7%-10%). Differences in prevalence of LBW in terms of year (b=-2 * 10-3, P = 0.154) and sample size (b=-4.02 * 10-6, P = 0.317) were not statistically significant.
    Conclusions
    Despite differences in the designs of the included studies, LBW had a high prevalence in Iran. Therefore, there is a need to adopt meticulous care policies during pregnancy. Further investigations on the risk factors of LBW are required to be conducted in different areas of Iran.
    Keywords: Low birth weight, Prevalence, Iran, Meta, analysis
  • Spring Cooper, Louise Bezzina, Hayden Fletcher Pages 240-247
    Objectives
    A development in the prevention of cervical cancer in women in Australia was the introduction of the human papillomavirus (HPV) vaccine, which was made available to young women as part of a national school-based vaccination program in 2007. Despite this advancement, Pap screening is still required to provide optimal protection from cervical cancer. The current study aimed to explore what young women know about HPV, HPV vaccination, and Pap screening guidelines. It further aimed to identify barriers and facilitators young women perceive to participating in screening, as well as factors influencing these perceptions.
    Materials And Methods
    Semi-structured interviews were conducted with 12 women who had been in school during the Australian HPV vaccination program and offered HPV vaccine, aged 18-25, until saturation around key themes was reached. Transcripts were analysed, letting themes emerge from the data.
    Results
    Key barriers and facilitators to pap screening were identified, as well as factors affecting the salience of these barriers and facilitators.
    Conclusions
    Findings have implications for the development of interventions to increase screening adherence and reduce the incidence of cervical cancer in this population.
    Keywords: Papillomavirus vaccines, Primary prevention, Papanicolaou test, Health education, Reproductive health
  • Cordula Schippert, Sarah Gentemann, Philipp Soergel, Ismini Staboulidou, Jan Simon Lanowski, Peter Hillemanns, Sudip Kundu Pages 248-254
    Objectives
    Ectopic pregnancy (EP), which is defined as the implantation of an embryo outside the uterine cavity, occurs with notable frequency in the first trimester (especially between the sixth and ninth weeks of gestation) and can cause severe intra-abdominal bleeding and death. Treatment options include salpingotomy with tubal preservation, transampullar expression of the EP (“milking” of the tube), wedge excision with the chance for tubal reconstruction in a subsequent surgery and partial or complete salpingectomy. Drug treatment with Methotrexate (MTX) is also an option.
    Materials And Methods
    In this retrospective study, we analysed the data of patients who had been treated for an EP in the gynaecological department of Hanover Medical School, Germany, between 2006 and 2013.
    Results
    We observed a pregnancy rate of 73.1% in those who wanted to have children following EP treatment, and 33 women (28.2%) became pregnant a second time. The birth rate after EP increased from 67.1% in the first subsequent pregnancy to more than 80% in the second. The frequency of recurrent EP was 6.6% in the first pregnancy after surgery and 3% in the second.
    Conclusions
    These data are encouraging for EP patients, who have a good chance to conceive, whether spontaneously, after tubal reconstructive surgery or using in vitro fertilisation (IVF).
    Keywords: Ectopic tubal pregnancy, Sterility, Reproductive capacity, Recurrence rate, Frequency of recurrence
  • Kaname Takeda, Hiromi Yoshikata, Masumi Imura Pages 255-262
    Objectives
    A survey of falls during pregnancy conducted in the United States and Japan found that the frequency of falls increased with the progression of pregnancy. The purpose of this study was to analyze the posture control properties of women that fall during pregnancy.
    Materials And Methods
    Participants comprised 100 pregnant women (age, 20-30 years). Posture control was assessed during the second and third trimesters using 2 stabilometers to measure the ability to control upright posture. During the third trimester, participants were asked to complete a self-administered questionnaire on falls.
    Results
    Data were obtained from 82 subjects after excluding dropouts. Ten fallers were identified, resulting in a fall incidence of 12%. The fall group showed a 9.9% increase in abdominal girth from the second to third trimester, significantly greater than the 6.9% in the non-fall group. In the fall group, the rectangular area in the back, left and right was larger from the second trimester. In the third trimester, the stability limits of the fall group were significantly smaller than in the non-fall group.
    Conclusions
    The loosening of joints from second trimester and declines in equilibrium function and an abrupt increase in abdominal girth may cause shifts in recognition of how the body moves, such as estimation errors, thereby causing falls. For pregnant women, guidance, exercises promoting awareness of fall prevention, and accurate perception of the body need to be incorporated in the exercise from the second trimester.
    Keywords: Pregnant women, Posture control, Estimation error
  • Marefat Ghaffari Novin, Ashraf Moini, Sogol Niknezhad, Tohid Najafi, Mahsa Ghaffari Novin Pages 263-268
    Objectives
    Nitric oxide (NO) is a free radical that plays important roles in variety of physiological aspects of the female reproductive system. Pathophysiological findings revealed a potential role of the endothelial isoform of nitric oxide synthase (eNOS) enzyme in female reproductive disorders specifically in the endometrium. This study investigates the expression of eNOS in the endometrial tissue to study the potential role of this enzyme and its NO production in infertility of women with uterine myomas.
    Materials And Methods
    A total of 20 endometrial tissues were obtained, 10 infertile women with uterine fibroids and 10from normal and fertile women, 7 to 9 days after LH surge. Following fixation with paraformaldhyde, frozen sections of samples were prepared for semi-quantitative immunohistochemical evaluation using monoclonal anti-human eNOS antibody. Hematoxylin and eosin staining was used for histological dating of the samples
    Results
    Localization of eNOS was seen in glandular and luminal epithelium, vascular endothelium and stroma in both fertile women and infertile women with uterine fibroids. Despite the differences in immunoreactivity of luminal epithelium, vascular endothelium and stroma in both groups, higher levels of eNOS in glandular epithelium was statistically significant in women with uterine fibroids compared to the control group.
    Keywords: Nitric oxide, Endothelial nitric oxide synthase, Endometrium, Uterine myomas, Fibroids
  • Sedigheh Amir Aliakbari, Sanaz Safarzadeh, Fatemeh Bayat, Asiyeh Pormehr-Yabandeh, Sareh Dashti, Nasibeh Roozbeh, Mojdeh Banaei Pages 269-275
    Objectives
    The domestic violence rate is increasing. It is influenced by many factors. The present study aimed to determine the domestic violence level among Iranian women in Bandar Abbas in 2015.
    Materials And Methods
    The present study is an analytical cross-sectional research based on non-random sampling. The study was performed on 400 women who referred to the health centers in Bandar Abbas, from January to the end of September 2015. The study data were collected using demographic, obstetric and domestic violence questionnaires and were analyzed using SPSS version 22.0.
    Results
    The total degree of domestic violence was 54%. The most prevalent physical, psychological and sexual violence were shouting and swearing (41.4%) followed by request to have intercourse without your consent (30.8%) and slapping (25.7%). A significant relationship was observed between domestic violence and husband’s age, marital duration, the wife’s independent income as well as the family’s income, wife’s educational degree and wife’s job, husband’s addiction, marital satisfaction, a record of criminal conviction, and experience of violence in childhood (P
    Conclusions
    The most frequent type of violence against women was psychological violence in Bandar Abbas. Therefore, screening is recommended for women to improve their health condition.
    Keywords: Domestic violence, Violence against women, Torturing wife
  • Seyed Hosein Abtahi-Eivari, Maryam Moghimian, Malihe Soltani, Hamed Shoorei, Reza Asghari, Hossein Hajizadeh, Majid Shokoohi, Somayye Alami, Faezeh Khalife Ghaderi Pages 276-282
    Objectives
    Polycystic ovary syndrome (PCOS) has been considered as one of the most common endocrine diseases among the females in their regenerative age with a prevalence range of 5 to 21%. However, the purpose of the present study was to investigate the protective effect of Galega officinalis on metabolic as well as hormonal parameters in a rodent model of PCOS.
    Materials And Methods
    Thirty-two Wistar female rats were used (n=8/group) in the study consisting of healthy control and experimental groups. The experimental groups were divided into 3 subgroups, including rats with PCOS which received no treatment (G1), PCOS group in which G. officinalis extract was administered daily at a dose of 200 mg/kg/orally (G2) for 2 weeks, and PCOS group in which G. officinalis extract was administered daily at a dose of 400 mg/kg/orally (G3) for 2 weeks. In all experimental groups, a single intramuscular injection of estradiol valerate led to inducing PCOS. After the end of treatment period, rats in all of the studied groups were anesthetized with ketamine/xylazine (5/1 mg/kg), then the blood samples obtained and their serum samples were applied for testing the fasting blood sugar (FBS), insulin, aromatase, and follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estrogen. The ovaries of rats were removed and fixed for histopathological examinations.
    Results
    The serum levels of FBS, insulin, LH, FSH, and testosterone significantly increased in G1 in comparison to healthy rats (P
    Conclusions
    It seems that the extract of G. officinalis has a beneficial effect on the levels of the LH, FSH, testosterone, estradiol, aromatase, FBS, and insulin in alleviating the complications of PCOS.
    Keywords: Galega Officinalis, PCOS, Steroid hormones, Rat
  • Roshanak Vameghi, Sedigheh Amir Ali Akbari, Homeira Sajjadi, Firoozeh Sajedi, Hamid Alavimajd Pages 283-289
    Objectives
    Given the importance and prevalence of depression among women, this study aimed to test the correlation model between socio-economic status, anxiety, perceived stress, social support and women’s depression in reproductive age using path analysis.
    Materials And Methods
    This analytical cross-sectional study was conducted on 1065 women of reproductive age selected randomly from clinics affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran. Data were collected using demographic and socio-economic status questionnaires, the perceived stress and the social support Scales, Spielberger’s Anxiety Inventory and Beck’s Depression Inventory. The data were analyzed using SPSS version 19.0 and LISREL version 8.8.
    Results
    The final path model fitted well (GFI=1; RMSEA=0.09) and showed that socioeconomic status had direct (β=-0.22) and indirect effect (β=-0.0645), perceived stress had direct effect (β=0.22), social support had direct (β=-0.21) and indirect effect (β=-0.033), anxiety had direct effect (β=0.18) on depression, and overall, socioeconomic status had the greatest effects on depression (β=-0.2845).
    Conclusions
    According to the obtained results, screening for the examined variables is recommended to prevent and diagnose depression and promote health in women.
    Keywords: Socioeconomic status, Psychological factors, Depression, Social Support, Perceived Stress, Anxiety
  • Mahsa Saadati, Arezoo Bagheri, Adel Abdolahi Pages 290-296
    Objectives
    One of the features of fertility below replacement level is the increase of the first birth interval which has occurred at the same time with the rise of women’s marriage age in recent years in Iran. Since determination of factors affecting delay in childbearing can provide convenient approaches to prevent fertility decline, the aim of this study was to evaluate socio-economic factors influencing the first birth interval in married women in Tehran province, Iran.
    Materials And Methods
    In a cross-sectional study, 610 married women aged 15 to 49 years were selected by the stratified random sampling and a structured questionnaire was used in 2017. Women’s first birth intervals were compared in terms of some demographic and socio-economic factors by Kaplan-Meier (KM) estimates and Log-Rank test for univariate and Cox model for multivariate survival analysis using SPSS version 22.0.
    Results
    The mean of women’s first birth intervals was 3.181±0.101 years. Women’s educational level and social insecurity had significant effects on the first birth interval (P value
    Conclusions
    According to results, unless governments provide the condition of social security, reducing the interval between marriage age and childbearing will not be attained.
    Keywords: First birth intervals, Kaplan, Meier estimates, Cox model, Tehran, Iran
  • Aida Najafian, Marzieh Ghasemi, Neda Hajiha-Esfahani Pages 297-301
    Objectives
    Retained placenta in the third stage of labor causes complications that may threaten a mother’s life. In this clinical trial, we compared umbilical vein injection of misoprostol and oxytocin for managing the retained placenta in the women who had referred to Moheb-Yass and Shariati hospitals in Tehran and Bandar Abbas cities, Iran.
    Materials And Methods
    Between 2012 and 2015, 44 women with a long third stage of labor (retained placenta for more than 30 minutes) were chosen for this study. They were randomly divided into 2 groups: oxytocin and misoprostol groups (22 women in each group). In oxytocin group, oxytocin was injected into the umbilical vein with 50-unit concentration in 30 mL of normal saline. In misoprostol group, 800 µg of misoprostol was injected into the umbilical vein in 30 mL of normal saline. Placenta delivery time, bleeding after parturition, and hemoglobin drop were compared between the 2 groups.
    Results
    There was no significant difference between umbilical vein injection of misoprostol or oxytocin regarding spontaneous placental delivery in the mothers younger than 30 years old. Totally, spontaneous placental delivery was significantly more in the misoprostol group. This was magnified among women who were pregnant for more than 30 weeks.
    Conclusions
    Umbilical vein injection of misoprostol is more effective than that of oxytocin in managing the retained placenta in the third stage of labor.
    Keywords: Retained placenta, Misoprostol, Oxytocin, Umbilical vein
  • Yalda Jefride, Mojgan Barati, Kobra Shojaei, Sareh Aberoumand, Sara Masihi, Mohammad Momengaribvand Pages 302-306
    Objectives
    Cerebroplacental ratio (CPR) is a useful tool in differentiating at-risk non-SGA fetuses. The first CPR reported by Arbeille et al quantifies the redistribution of the cardiac output. In this study, we investigate CPR in non-SGA fetuses.
    Materials And Methods
    This descriptive-analytic study was carried out in Ahvaz from January 1, 2016 to January 1, 2017. In this study, CPR was evaluated in 230 pregnant women at 28 to 38 weeks of gestation, with the exception of pregnant women with SGA and multiple pregnancies. In this study, factors such as maternal age, parity (nullipara and multipara), history of abortion, cesarean delivery or vaginal delivery, an estimate of fetal weight (EFW), history of stillbirth, pregnancy conceived through assisted reproductive technology, and NT values were investigated.
    Results
    In this study, of 230 pregnant women with an EFW more than the 3rd percentile and singleton pregnancy, there were 22 women with a CPR below the 5th centile. There was no relationship between the fetal CPR and the maternal age, the number of maternal cesarean section, the number of mother’s vaginal deliveries and the parity, history of stillbirth, pregnancy conceived through assisted reproductive technology and NT values in the data analyzed.
    Conclusions
    In this study, 9.6% of the non-SGA fetuses had abnormal CPR (less than 5 percentile). There is no relationship between CPR and maternal age, parity (nullipara and multipara), history of abortion, cesarean section delivery or vaginal delivery, EFW, history of stillbirth, pregnancy conceived through assisted reproductive technology, and NT values.
    Keywords: Cerebroplacental ratio, Parity, Abortion, Vaginal delivery, Estimate of fetal weight, Nuchal translucency, Doppler study
  • Nazanin Rezaei, Fatemeh Janani, Nasibeh Sharifi, Fatemeh Omidi, Arman Azadi Pages 307-312
    Objectives
    Sexual function plays an important role in strengthening the marital relationship. Sexual issues affect individuals’ quality of life. This study aimed to investigate the association between the sexual function and the quality of life among postpartum women in Iran.
    Materials And Methods
    For this cross-sectional descriptive study, 380 postpartum women who had referred to 10 urban health care centers in the west of Iran were chosen. They were recruited using the randomized cluster sampling method. A checklist for socio-individual and maternal status of women, female sexual function index (FSFI) and SF-36 questionnaire were used for data collection. Descriptive and inferential statistics were used for data analysis via SPSS software.
    Results
    Most of the participants (76.3%) suffered from sexual dysfunction. Sexual desire was the most prevalent sexual dysfunction (79%). Moreover, the majority of the women achieved moderate scores in the subscales of the SF-36 questionnaire. The women with higher FSFI scores achieved higher scores in all SF-36 subscales. The Pearson correlation coefficient showed an appositive statistically significant linear correlation between the women’s general health and all dimensions of the FSFI except for pain during sexual relationships. The logistic regression analysis revealed that sexual function was a protective factor against the reduction of the quality of life, because quality of life was higher among the women with a higher level of sexual function compared to those with a lower sexual function (P
    Conclusions
    Sexual dysfunction in the postpartum period could adversely affect the women’s quality of life. While sexual problems are very common in the postpartum period, they are not reported in most cases. Health care providers should design appropriate programs such as extended postpartum counseling for the women in the postpartum period.
    Keywords: Quality of life, Sexual dysfunction, Postpartum, Childbirth, Delivery, Iran
  • Hajar Pasha, Zahra Basirat, Mahbobeh Faramarzi, Farzan Kheirkhah, Soraya Khafri Pages 313-320
    Objectives
    This study aimed to evaluate the predictive factors of antidepressant response and remission to bupropion extended-release (BUP ER) or psychosexual therapy (PST) among infertile women with sexual dysfunction (SD).
    Materials And Methods
    As a randomized controlled clinical trial, this prospective study was carried out on 3 groups of BUP ER (n = 31), PST (n = 31), and control (n = 31) in infertile women with SD in Babol, Iran during 2014-2015. Logistic regression was used to detect predictors of antidepressant response and remission.
    Results
    Antidepressant response and remission rates were 58.1% and 54.8 % respectively in the PST group. Of the infertile women in the BUP group, 41.9% reached response and remission by the end of the study. The results for PST contained 2 predictors: occupation in response and remission (odds ratio [OR] = 0.171, P = 0.036; OR = 0.1, P = 0.013; respectively), and frequency of sexual intercourse in response (OR = 0.124; P = 0.040). The results for BUP contained three predictors: baseline severe depression level in remission (OR = 0.044, P = 0.010), economic status in response and remission (OR = 5.850, P = 0.027), and age difference of spouses in response (P = 0.031).
    Conclusions
    Depression screening and physician notification of demographic, reproductive and clinical predictors of antidepressant response and remission are necessary for selecting effective treatment interventions.
    Keywords: Antidepressant, Psychotherapy, Bupropion, Response, Remission, Infertility, Predictor
  • Reza Sadeghi, Narges Khanjani, Ahmad Naghibzadeh-Tahami, Zohreh Karimian Kakolaki Pages 321-327
    Objectives
    Type A influenza is an upper respiratory tract disease. This study evaluated the efficiency of education based on the Health Belief Model (HBM) in promoting the knowledge, attitude and practice (KAP) of pregnant women about preventing influenza type A in Sirjan, Kerman.
    Materials And Methods
    This was a quasi-experimental study. The population under study were 200 pregnant women who visited the health centers of Sirjan. These people were randomly divided into intervention (n = 100) and control (n = 100) groups. The educational intervention was conducted over two 60-minute sessions. Information was collected through a questionnaire (71 questions) before the intervention and three months after it. Chi-square test, Fisher exact test, independent t test, paired t test and Pearson correlation coefficient were calculated.
    Results
    After the intervention, the knowledge score increased in both groups; this was probably due to the routine training programs at those centers, but significant increases in attitude and practice were only observed in the intervention group (P
    Conclusions
    HBM was effective in promoting the KAP of pregnant women in Sirjan for preventing type A influenza. Therefore, HBM can be used to help prevent influenza A in the pregnant women.
    Keywords: Influenza type A, Health belief model, KAP, Pregnant women
  • Mohammadreza Miri, Hakimeh Malaki Moghadam Pages 328-334
    Objectives
    The time-interval between marriage and first childbirth (IMF) can affect fertility and pave the way for decreased fertility in future. This study aimed to determine the effective factors on the time of first childbirth in married women of Birjand, Iran.
    Materials And Methods
    This was a retrospective and prospective cohort study incorporating a total of 180 couples from Birjand who were married in 2011. The data were collected by a checklist and subsequently assessed using survival analysis in STATA13 software.
    Results
    From among the participants, 55.2% had a child and the rest were censored. The man’s age at the time of marriage, the interval between marriage contract to marriage ceremony, type of marriage, wife’s place of birth, application of modern methods of contraception, family income per month, and tendency to have a son were the determining factors affecting IMF.
    Conclusions
    More than half of the freshmen admitted to universities across the country are women who will seek employment after they are graduated. Considerations must be made so that they can have their desired number of children, suitable education, and employment.
    Keywords: First birth interval, Childbirth, Survival analysis, Kaplan–Meier survival estimate, Cox regression
  • Sedigheh Pakseresht, Pegah Rasekh, Ehsan Kazemnejad Leili Pages 335-341
    Objectives
    The present study aimed at comparing the physical health and maternal-fetal attachment in the women with planned and unplanned pregnancies.
    Materials And Methods
    This was a descriptive-comparative study including 300 pregnant women (165 planned and 135 unplanned pregnancies) with mean age of 29.8±5.8 (age range of 16-50 years old) who had referred to the prenatal clinic of a hospital from September to October, 2016. The maternal–fetal attachment was analyzed using frequency distribution of attachment scores which did not follow the normal distribution of the subscale totally and specifically. Therefore, to compare the scores of the 2 groups, non-parametric tests were used. To calculate the percentage of physical health of the groups, proprietary test was used.
    Results
    Unplanned pregnancy was assumed as a predictor of physical health because it made women susceptible to health complications (poor health) 5.42 times more than other variables. In 2 groups of the women with planned and unplanned pregnancies, the attachment score was significantly different between the planned and unplanned pregnancy groups.
    Conclusions
    Unplanned pregnancy makes less maternal-fetal attachment and causes insufficient care as well as insufficient nutrition during pregnancy which in turn leads to unhealthy status in mother and child. Hence, to tackle this problem, reproductive health counseling, education, encouragement and problem-solving in various fields including psychological support of mothers in prenatal care and acceptance of parental role are recommended.
    Keywords: Unplanned pregnancy, Physical health, Maternal, fetal attachment
  • Ameneh Safarzadeh, Ali Navidian, Neda Dastyar Pages 342-349
    Objectives
    Sexual decency is one of the false beliefs among women about sexual function, and women who have this belief choose an inactive and passive sexual role. The present study aimed to investigate the effect of decisiveness-based sexuality counselling on sexual function among married female students at the University of Sistan and Baluchestan.
    Materials And Methods
    This quasi-experimental study used a pre-test-post-test design and was conducted on 80 married female students who were selected and randomly assigned to the intervention (n = 40) or control (n = 40) groups. The data collection tool was Rosen’s Sexual Function questionnaire. The intervention group, after the pre-test, took part in four sessions of assertiveness-based sexual counselling weekly across 2 sessions of 90 to 120 minutes. Both groups filled out the questionnaires after the end of the waiting period (2 months) (post-test). Chi-square, covariance and independent paired t tests were used to compare the means of the quantitative variables in the 2 groups.
    Results
    The results showed that the mean score on the sexual function index increased in the intervention group after sexual counselling and decreased in the control group. An independent t test also showed that the difference in mean scores on the sexual function index after sexual counselling in the intervention and control groups was not significant. However, the mean change in the total index score was significantly different in the 2 groups (P = 0.0001).
    Conclusions
    The assertiveness-based sexual counselling method significantly influenced sexual function and expression of sexual rights and reduced the shame and contempt that women in the study felt. It is safe to admit that this method can be used as a way to promote sexuality and to establish a more intimate relationship in marital life.
    Keywords: Sexual function, Sexual counselling, Students
  • Azra Azmoudeh, Zahra Shahraki, Fatemeh-Sadat Hoseini, Firoozeh Akbari-Asbagh, Fatemeh Davari-Tanha, Forough Mortazavi Pages 350-355
    Objectives
    In vitro fertilization (IVF)success depends on many factors whose independent roles have not been fully investigated. The aim of this study was to evaluate the role of associated factors in women undergoing IVF in Iran.
    Materials And Methods
    In a prospective cohort study, 160 women who referred to infertility center of Moheb-Yas hospital for IVF between March 2015 and March 2016 were enrolled. A long ovarian stimulation protocol was administered using a gonadotropin-releasing hormone agonist (GnRH). Anti-Mullerian hormone (AMH), progesterone, estradiol, and endometrial thickness were measured. Two expert embryologists categorized blastocysts as good or poor. Pregnancy was judged by serum human chorionic gonadotropin measurement 14–15 days after embryo transfer.
    Results
    Mean age of the cases was 32 years and mean body mass index (BMI) was 20 kg/m2. Clinical pregnancy rate was 20.6%. A significant relationship was found between IVF success and AMH, the number of FSH injections, endometrial thickness, grade of the embryos, and the number of embryos produced. Logistic regression analysis showed that only AMH > 0.6 was an independent predictor of IVF success (odds ratio [OR] = 6.22, CI [2.4-16.2]). Further analysis showed a significant relationship between AMH level and IVF success in women ≤35.
    Conclusions
    The overall success rate of IVF/ET was 20.6%. AMH is a significant predictor of IVF success and may be an important factor in IVF success in young women.
    Keywords: Infertility, In vitro fertilization, Embryo research, Anti, Mullerian hormone, Iran
  • Farzaneh Soltani, Manizheh Majidi, Fatemeh Shobeiri, Parisa Parsa, Ghodratollah Roshanaei Pages 356-362
    Objectives
    Improving the maternal health requires an understanding of the men’s level of knowledge as well as the attitude about participation in their wives’ perinatal care in different societies. The present study aims to investigate men’s knowledge and attitude about participation in their nulliparous wives’ perinatal care.
    Materials And Methods
    In this descriptive cross-sectional study, 300 husbands of nulliparous women completed the questionnaire of “men’s knowledge and attitude about participation in prenatal care”, in a referral perinatal care clinic in Hamadan, Iran, in 2015.
    Results
    The level of knowledge about the wives’ perinatal care in more than half of the men (58 %) was poor and in nearly half of them (41.7%) was moderate. Based on different aspects of the perinatal care, the knowledge level of 59.7%, 69.7%, 52.3 %, 63.3%, 64.7%, 66.7%, 51.7%, 62%, 84%, and 78.7% of the men was poor in the physical changes, general health, nutrition, exercise, sexual health, risk signs, mental and psychological changes in pregnancy, delivery, puerperium, and neonatal care, respectively. None of the men had good knowledge about the aspects related to postpartum care (including puerperium and neonatal care). Further, the majority of men (65.3%) had a positive attitude towards participation in perinatal care.
    Conclusions
    In the present study, the emphasis was put on the need for training the men interested in participating in various perinatal cares, especially physical changes during pregnancy, prenatal nutrition, risk signs during pregnancy, and maternal as well as neonatal postpartum cares.
    Keywords: Perinatal care, Men, Participation, Knowledge, Attitude
  • Maryam Rahmani, Samira Heydari, Azamsadat Mousavi, Nasrin Ahmadinejad, Shilan Azhdeh, Majid Shakiba Pages 363-368
    Objectives
    In this study we aimed to evaluate diagnostic accuracy of magnetic resonance imaging (MRI) and transvaginal sonography (TVS) in identifying the depth of myometrial invasion and cervical involvement and also their relationship with the uterine arteries resistance index (RI) and pulsatility index (PI) in endometrial carcinoma.
    Materials And Methods
    We performed a prospective study on 45 women with histologically confirmed diagnosis of endometrial carcinoma. The study was performed from October 2009 to December 2012. All the patients were evaluated by 3T MRI and TVS and transvaginal color Doppler sonography of uterine arteries. All the patients underwent hysterectomy and the result of imaging and pathologic studies were compared.
    Results
    Mean age was 54.5 ± 10.8 years (33 to 77 years), mean gravid was 3.93 ± 2.8 and the mean parity was 3.9 ± 2.5. The pathology results indicated 29 patients (64.4%) in stage IA and 16 patients (35.6%) in stage IB. Mean endometrial thickness in stage IA patients was 18.4±14.4 mm and in stage IB patients was 38.5±11.5 mm. TVS also showed positive predictive value (PPV) of 76.5%, negative predictive value (NPV) of 88.9%, sensitivity of 81.3%, specificity of 85.7%, and accuracy of 84.1% for assessment of the depth of myometrial invasion in endometrial carcinoma. We found PPV of 86.7%, NPV of 92.3%, sensitivity of 86.7%, specificity of 92.3%, and accuracy of 90.2% for MRI study.
    Conclusions
    TVS can evaluate the depth of myometrial invasion with an acceptable accuracy when MRI is not available or cost-effective, or when MRI is contraindicated. Both preoperative MRI and TVS can predict low risk patients (less than 50% of myometrial invasion) accurately; thereby avoiding lymphadenectomy in these patients.
    Keywords: Endometrial cancer, Transvaginal sonography, Doppler ultrasonography, Magnetic resonance imaging, Myometrial invasion
  • Katayon Vakilian, Maryam Kheiri, Abed Majidi Pages 369-373
    Objectives
    Pregnancy significantly affects sexual performance due to the occurrence of biological, psychological, and physiological changes in women. This study aimed to evaluate the effect of cognitive-behavioral approach to sexual counseling on the female sexual performance during pregnancy.
    Materials And Methods
    This randomized clinical trial was conducted on 100 pregnant women referred to the clinics of Arak, Iran. The participants were selected using single-stage cluster sampling technique. The data were collected using the standard sexual function questionnaire and a researcher-made questionnaire, which was related to the misbeliefs about sexual intercourse during pregnancy (MSIP). The subjects were randomly allocated to the intervention and control groups using randomized blocks. The intervention group was provided with seven 90-minute counseling sessions, whereas the control group only received the routine information provided by the healthcare staff. The data analysis was performed using the student’s t test, chi-square test, and paired t test in the SPSS software version 16.0.
    Results
    According to the results, out of 100 subjects, 22 cases received the sexual function score of
    Conclusions
    It seems that the cognitive-behavioral sexual counseling did not significantly improve the sexual function by teaching about misconceptions and facilitating behaviors to deal with the problems of pregnancy. In other words, consultation resulted in no biological or psychological changes and could not promote the sexual performance of the participants. However, the subjects reported increased sexual satisfaction after the counseling sessions.
    Keywords: Cognitive, behavior, Counseling, Education, Pregnancy, Sexual function
  • Simin Atashkhoei, Fariba Nikan, Reza Kardan, Hojjat Pourfathi Pages 374-379
    Objectives
    This study aimed to investigate the analgesic efficacy and safety of preventive administration of 2 g of paracetamol compared with 1 g for the management of postoperative pain in the patients undergoing gynecologic laparoscopic procedures.
    Methods and Materials: This double-blind study was conducted on 92 women who were randomly assigned into two groups: paracetamol 2 g (study group; n=46) and 1 g (control group; n=46) into 100 mL normal saline, infused over 15 minutes in the end of surgery. Abdominal and shoulder pain scores were recorded in post-anesthesia care unit (PACU), 1, 2, 3, 6, 12, and 24 hours after the operation. The time of first request for analgesic and the values of liver enzymes were recorded.
    Results
    During 24 hours after surgery, the prevalence of postoperative abdominal pain was 52.17% and 89.13% (P 0.05).
    Conclusions
    Administration of both doses of paracetamol at the end of surgery was effective on postoperative pain; however, the best pain relief was obtained by paracetamol 2 g with no side effects.
    Keywords: Gynecologic surgery, Laparoscopy, Postoperative pain, Paracetamol
  • Mojgan Mirghafourvand, Jamileh Malakouti, Sakineh Mohammad Alizadeh Charandabi, Fatemeh Faridvand Pages 380-385
    Objectives

    Determining the effective factors on breastfeeding self-efficacy can be helpful in designing the promoting interventions for this behavior. The aim of this study was to evaluate the predictors of breastfeeding self-efficacy in mothers referred to health centers of Tabriz, Iran, in 2015.

    Materials And Methods

    This cross-sectional study was conducted on 220 mothers breastfeeding 4-to-6-month babies. Cluster sampling was used in this study. Breastfeeding self-efficacy scale (BSES), The Iowa Infant Feeding Attitude Scale (IIFAS), social support via Personal Resource Questionnaire (PRQ-85) and researcher-made questionnaire of knowledge were used to collect data. Multivariate linear regression model was used to determine the predictors of breastfeeding self-efficacy.

    Results

    Mean (standard deviation) of breastfeeding self-efficacy was 138.7 (11.9) out of the achievable score range of 33-165 and about 90% of the women had high breastfeeding self-efficacy. There was a significant statistical correlation between breastfeeding self-efficacy and social support, knowledge and attitude (P

    Conclusions

    According to the important role of breastfeeding in maternal health, providing strategies to enhance knowledge, improve attitude, and sensitize community deems essential; as these important factors affect breastfeeding self-efficacy.

    Keywords: Breastfeeding self, efficacy, Social support, Knowledge, Attitude, Iran
  • Zahra Alamooti, Lakshmi Bayi Sushama Pages 386-389
    Objectives
    Incidental finding of an asymptomatic giant ovarian mass is unusual during pregnancy. Addressing such voluminous cysts laparoscopically is controversial, and a challenge to the surgeon. This article describes on how we tackled a 27-cm ovarian cyst using the ovarian wall itself as the endobag.
    Case Presentation
    A 32-year-old lady was referred to Obstetrics and Gynecology Department at 9 weeks of gestation with missed miscarriage and an incidental finding of a huge ovarian cyst by ultrasonography. After evaluation and obtaining informed consent, laparoscopy was performed. We elaborate here on how this huge mass was excised laparoscopically, minimizing intraperitoneal spillage by using the ovarian wall itself as endobag. The histopathology report confirmed a mature cystic teratoma. The postoperative period was uneventful.
    Conclusions
    Many surgeons have a phobia to tackle giant ovarian cysts laparoscopically, due to fear of malignancy and spillage of contents, despite the inherent advantages of the minimal access surgery. We hope that this case report will add to the increasing evidence on the safety and efficacy of tackling such giant cysts laparoscopically.
    Keywords: Giant ovarian cyst, Dermoid cyst, Ovarian wall, Endobag, Laparoscopy
  • Forough Forghani, Abolfazl Mehdizadeh Kashi, Kambiz Sadegi, Mania Kaveh, Mehrangiz Ghafari Pages 390-392
    Objectives
    Uterine leiomyosarcoma (LMS) is a rare cancer originated from smooth muscle lining the walls of the uterus. LMS is known as an aggressive tumor with high mortality and morbidity rates compared to other uterine cancers, despite the disease stage at the time of diagnosis. In most cases, LMS has been misdiagnosed as benign uterine leiomyoma following hysterectomy or myomectomy.
    Case Presentation
    We present a 53-year-old G7 L7 woman who was referred to our clinic for abnormal uterine bleeding (AUB) for 6 months. On physical examination, we found an abdominal mass that had grown rapidly in the last 4 months. The computed tomography (CT) scan results showed a heterogeneous mass extending from the epigastric region to the pelvic area. Following an exploratory laparotomy, histopathology report confirmed the diagnosis of LMS. Her uterus, Fallopian tubes and ovaries were removed during a surgery, and she was referred to a gynecologic oncologist for possible chemotherapy.
    Conclusions
    We found that the surgery was the only treatment for LMS. Although there is a faint possibility to diagnose LMS before surgery, in the patient with uncertain diagnosis and suspicious of LMS, analysis of LDH and LDH3 levels along with dynamic gadolinium- diethylenetriamine penta-acetic acid (Gd-DTPA) enhanced magnetic resonance imaging (MRI) is recommended.
    Keywords: Uterine leiomyosarcoma, Gynecologic oncologist
  • Jose Arriola-Montenegro, Victor Cutimanco-Pacheco, Edward Mezones-Holguin Page 393