مجله زنان مامائی و نازائی ایران
سال بیست و یکم شماره 5 (امرداد 1397)

Abortion means termination of pregnancy in any way before fetal viability. One type of abortion is missed abortion. In this case, termination of pregnancy is performed through medical or surgical methods. Surgery is an invasive procedure with many side effects. To reduce the side effects, different methods are used to ripen (prepare) the cervix before discharge abortion; one of these methods is the use of nitroglycerin. Therefore, this study was performed to compare cervical ripening with and without nitroglycerin before first trimester discharge abortion.
This randomized clinical trial was performed on 100 patients visiting the maternity ward of Ali ibn Abi Talib Hospital of Zahedan who were candidates for first trimester discharge abortion in 2015. The patients were randomly divided into two groups of placebo and nitroglycerin. Cervical ripening was measured by vaginal dilatators in the operating room and compared between the groups. To analyze the data, t-test, Chi-square test, and Mann-Whitney U test were run in SPSS, version 11.5. P-value less than 0.05 was considered statistically significant.
According to the results of this study, mean blood pressure was not significantly different between the two groups of vaginal nitroglycerin and placebo (P=0.86). However, a significant difference was observed between the two groups in terms of mean Bishop Score and mean of first needed dilatator (P The findings of this study showed that use of vaginal nitroglycerin is effective in cervical ripening before surgical termination of pregnancy.

Congenital anomalies are originated during the egg fertilization or embryonic development and can cause life-lasting disability, illness, or mortality. The aim of this study was to determine the prevalence of anomalies based on fetal indications using the abortion cases permitted by forensic medicine organization and their related factors.
This descriptive-analytic study was performed upon 550 mothers referring to the Mashhad Forensic Medicine Agency in 2015 due to fetal anomalies. The data collection tool was a checklist covering personal information, maternal pregnancy status, and fetal condition, which was designed using the opinions of professional experts. The data were analyzed in SPSS software (version 21) using Chi-square test. The confidence interval was considered at 95%.
The most common fetal anomalies observed in this study included central nervous system (CNS) anomalies (37.6%), followed by fetal renal (23.1%), genetic (14.7%), orthopedic (7.1%), gastrointestinal (6.1%), respiratory (6%), hematologic (5.9%), heart (4. 3%), and infectious (4%) disorders.
the most common fetal disorder was related to the central nervous system. This disorder, which is unrecoverable, affects the body during the whole lifespan. Regarding this, the provision of people with education and awareness in this respect will have a significant effect on the prevention of these disorders in the whole society. Given the fact that the abortion permission can be issued before 20 weeks of gestation, it is essential to enhance mother's awareness about paying attention to the risk factors and the importance of performing fetal health examinations.

Pain is a common and inevitable component of labor process and is considered as the most severe pain in human. Regarding the importance of reducing labor pain and prioritizing natural vaginal delivery, this study was conducted to determine the effect of localized cold treatment modality on labor pain in primiparous women.
This clinical trial was conducted among 80 primiparous eligible women eligible in Karaj Maternity Hospitals, Karaj, Iran. The samples were randomly assigned into two groups of control and intervention. To determine the severity of pain and duration of delivery, McGill's Pain Questionnaire was used. Data analysis was performed using independent samples and paired t-tests in SPSS software, version 19. P-value less than 0.05 was considered statistically significant.
There was a significant difference between the groups regarding the severity of pain, mean duration of first and second stages of labor, frequency distribution of satisfaction of the subjects, satisfaction with breastfeeding and cuddling (P0.05, P=0.43, and P=0.86, respectively).
Cold treatment modality was useful for controlling labor pain in comparison to routine care.

Screening for chronic diseases, such as cervical cancer is important in early diagnosis and prevention of the disease in women. Cervical cancer in Iran is the second leading cause of death due to sex-linked cancers. With this background in mind, this study conducted to improve the behavior of Pap smear screening.
This quasi-experimental study was performed in 2014 on 80 women aged 20-65 years old in Gonabad, Iran with active health records. The subjects were divided into the two groups of experiment and control, each containing 40 participants. The research units were the women at the stages of pre-contemplation, contemplation, preparation, and relapse of the transtheoretical model and did not have screening behavior. The test group received constructions based on health belief model toward improving the behavior of Pap smear screening. However, the control group received the regular trainings provided by the personnel in health centers about the behavior of Pap smear screening. A researcher-made questionnaire used to collect the data was completed pre- and three months post-intervention by the subjects. All the data were analyzed by independent t-test, paired t-test, Chi-square, and Fisher's exact test using SPSS version 20. P-value Before the educational intervention in the stages of behavior change, there was no significant difference between the two groups (P > 0.05). However, three months post-intervention, the difference between the experiment and control groups was significant in the stages of change in the Pap smear behavior screening (P Findings of this study demonstrated that training the pap smear screening behavior based on the models of health belief and change stages can affect the promotion of Pap smear screening behavior in women.

Maternal health literacy during pregnancy can refer to the socio-cognitive skills, which determine the motivation and ability of mothers to understand and use beneficial information in order to maintain and promote health of themselves and their children. The present study aimed to determine the effects of an educational program based on self-efficacy theory and health literacy strategies on pregnancy outcomes at healthcare centers affiliated to Mashhad University of Medical Sciences, Mashhad, Iran.
This randomized clinical trial was performed on 76 pregnant women, who referred to the healthcare centers of Mashhad for routine pregnancy period checkups in 2015. The participants were assigned to the two groups of intervention and control. Data collection tools included a demographic questionnaire, maternal health literacy and pregnancy outcome questionnaire (MHLAPQ), and perceived dietary self-efficacy questionnaire. The questionnaires were completed by the participants, followed by implementation of the educational intervention for the test group according to a pilot study. Afterwards, the questionnaires were again completed immediately post-intervention, as well as within a three-month interval (follow-up). All the data were statistically analyzed by t-test, Chi-square, one-way analysis of variance (ANOVA), and repeated measures ANOVA using SPSS version 15. For all tests, P The findings of this study demonstrate that no significant difference was observed between the intervention and control groups in terms of maternal health literacy, self-efficacy, and pregnancy period cares pre-intervention (P>0.001). On the other hand, we reported a significant difference post-intervention regarding the mean scores of maternal health literacy and self-efficacy in the test group (P ≥ 0.001).
According to the results of this study, the designed educational intervention based on self-efficacy theory might improve maternal health literacy and promote normal birth weight in newborns.

Gestational diabetes mellitus is the most common metabolic disorder. Polycystic ovary syndrome (PCO) is one of the most important causes of infertility during the fertility period, resulting in preeclampsia and many maternal and fetal complications.
This case-control study was conducted on 152 pregnant women with preeclampsia admitted to the Maternity Ward of Shoushtar Al-Hadi Hospital in 2016-2017. The study population was assigned of case (n=76) and control (n=76) based on infliction with gestational diabetes mellitus and PCO. Data analysis was performed in SPSS (version 16) using Kolmogorov–Smirnov test, independent t-test, and Chi-square test. P-value less than 0.05 was considered statistically significant.
The mean ages of the mothers and pregnancy termination were 31±6 years and 34±5.02 months, respectively. There was a statistically significant difference between the two groups in terms of the history of PCO, infertility, gestational diabetes, and preeclampsia, as well as, body mass index (P Gestational diabetes mellitus and polycystic ovarian syndrome in the presence of preeclampsia are associated with a significant reduction in fetal intrauterine growth.

Labor is a painful and prolonged process. Applying an uncomplicated method to reduce the length of delivery and severity of pain can increase maternal satisfaction and decrease the rate of cesarean section. Topical magnesium sulfate is empirically used to improve the effacement and dilatation of the cervix. The purpose of this study was to examine the effect of improving these variables on the intensity of labor pain.
This double blind clinical trial was conducted among 60 nulliparous women with full-term pregnancy. The participants were randomly divided into two groups of 30 individuals. The patients in the magnesium sulfate group received 10 cc of magnesium sulfate 50% and the control group were treated by 10 cc of distilled water poured on the cervix in the beginning of the active phase. Thereafter, the labor progress was studied in the groups. At the beginning of the active phase and two hours later, the severity of pain was measured using visual analog scale. Data analysis was performed using independent samples t-test, Mann-Whitney U test, Chi-squared test, and Fisher's exact test in SPSS software, version 17. P-value less than 0.05 was considered statistically significant.
Prior to the intervention, the intensity of pain was not significantly different between the two groups. After 2 hours of intervention in the control group, the mean pain intensity significantly increased (P=0.04), while in the magnesium sulfate group, the pain intensity did not change significantly. Two hours after the intervention, the mean of effacement and dilatation in the magnesium sulfate group was higher (P˂0.001).
The application of topical magnesium sulfate reduced the duration of labor by improving the cervical condition. In addition, it reduces the intensity of labor pain. However, it did not have a negative effect on the severity of uterine contractions.

The occipito-posterior fetal positions are the most common type of malposition of the occiput. Increasing maternal pain and need for epidural anesthesia are among the complications of this condition. Maternal position during labor can influence her pain intensity. This study aimed to investigate the effect of maternal position in the active phase of labor on the pain intensity and satisfaction.
This randomized controlled trial was conducted among 180 primiparous pregnant women with a singleton pregnancy and occipito-posterior fetal position referred to a maternity hospital in Ramhormoz, Iran, 2017. The samples were selected based on the purpose using a random number generating software. They were randomly assigned into three groups of semiprone position (n=45), knee-chest position (n=45), and control group (n=90). The control group gave birth in the supine position. From half an hour after randomization until delivery, all the participants were alternately (15 to 30 minutes per hour) located in defined positions. Data were collected using a visual analog scale for pain, observation, and examination of the record form. Data analysis was performed using Chi-squared and analysis of variance tests in SPSS software, version 24. The significance level was considered as P≤0.05.
According to the results, the intensity of pain in the intervention groups was significantly lower than the control group. Additionally, the satisfaction level of mothers in the intervention group was higher than the control group (P It seems that semiprone and knee-chest positions in mothers with occipito-posterior fetal position during the active phase and the second stage of labor were useful for relieving labor pain and increasing the satisfaction of mothers.

Postpartum depression is a serious temperamental and mental disorder. This condition seems to be affected by vitamins and minerals. Given the immediate effects of this disorder, the mother's inability to carry out maternal care, and the risks of suicide and infanticide and given that vitamin D receptors and hydroxylase enzymes are present in different regions of the brain, including amygdala this study was performed to determine the effect of vitamin D on postpartum depression treatment.
This case-control study was carried out in 2014 in Shahid Beheshti Hospital of Isfahan, Iran, on women who had given birth 30 days earlier. Depression was assessed using the Edinburg Questionnaire. The data were analyzed in SPSS, version 20, using independent t-test (to investigate age variable), Mann-Whitney U test (to examine the frequency distribution of education level), Pearson correlation, and Chi-square test (to investigate the frequency distribution of the route of delivery). P-value less than 0.05 were considered significant.
The mean serum level of vitamin D showed a significant reduction in the case group as compared to that in the control group (P As the findings indicated, postpartum depression was associated with the deficiency of vitamin D. regarding this; the use of vitamin D supplements during the prenatal period can be a proper way to prevent this disease.

Today in developing countries, use of herbal medicines during pregnancy is increasing. However, consumption of some plants may cause side effects in mother and fetus or lead to drug interactions. The aim of this study was to investigate the rate if using herbal medications during pregnancy and some of the related factors in Ahvaz, Iran.
This descriptive cross-sectional study was conducted on 219 mothers, who delivered and were hospitalized in Sina Hospital of Ahvaz in 2017. The questionnaires about background information and data regarding use of herbal medicines in pregnancy were completed for all the subjects on the first to second days post-delivery through interviews. All the data were analyzed by descriptive statistics and Chi-square test using SPSS version 16. For all the tests, P our findings revealed that 19.2% (n=42) of the subjects reported use of herbal medicines in their recent pregnancy. The highest frequency related to Thyme, Olive oil, and Peganum Harmala. The most common application indication was common cold and cough. The most frequent sources of information for individuals were family and friends and the least common was scientific books and journals. Moreover, 83.3% (n=35) of the participants did not inform their physician or midwife about using herbal medicines. There was a statistically significant relationship between the level of education and use of herbal medications (P=0.001).
According to the results, the rate of herbal medicines usage during pregnancy in women of Ahvaz is lower than many other studies in Iran. Most individuals apply non-scientific sources of information for using herbal medicines. Consequently, it seems necessary to increase the awareness of pregnant women concerning herbs, their use in pregnancy, and their side effects.

Endometrial cancer is the fifth most common cancer in females worldwide. One of the most important risk factors for endometrial cancer is obesity. The relationship between obesity and endometrial cancer is due to the exposure to biological agents produced in the adipose tissue. In general, the presence of lipids is essential for the growth and development of cancer cells. Given the limited studies regarding the association between lipid profile and endometrial cancer and their contradictory results, the present systematic review and meta-analysis was conducted to bridge this gap.
For the purpose of the study, the studies related to the issue of interest and published until November 2017 were searched in Google Scholar search engine and several international databases, including PubMed, Elsevier, Scopus, web of knowledge, and SID, by two authors independently. The search process was accomplished using the following keywords alone or in combination: "lipid", "lipoprotein", "cholesterol", "LDL cholesterol", "HDL cholesterol", "triglyceride", "dyslipidemia", "endometrial cancer", "endometrial carcinoma", and "endometrial neoplasm". The MOOSE instruction was employed to perform and report this meta-analysis. The data were analyzed using Stata statistical software, version 14.
A total of 369,649 subjects participated in the eight reviewed studies, 2,809 of whom were inflicted with endometrial cancer, while the rest were healthy. The combined estimates of the relative risk for total cholesterol and high-density lipoprotein (HDL) cholesterol were 1.21 (95% CI: 0.98-1.45) and 1.11 (95% CI: 0.74-1.48), respectively. This value was obtained as 1.09 (95% CI: 1.10-1.71) and 1.47 (95% CI: 1.10-1.85) for the highest low-density lipoprotein (LDL) and triglyceride levels, respectively, compared to the lowest levels.
As the findings indicated, serum triglyceride levels were associated with endometrial cancer. However, this cancer showed no relationship with total cholesterol, HDL, and LDL levels.

Adiponectin is a hormone from adipokine family, which releases from adipose tissue cells and has many biological roles. According to the literature, the level of this hormone reduces in obese individuals. Several studies have investigated the relationship between adiponectin and gynecological diseases. However, no study reviewed the role of adiponectin hormone in fertility and sterility. Therefore, the aim of this study was to review the literature regarding adiponectin hormone role in fertility and sterility.
This study reviewed 18 articles which were searched in the reputable online databases, including PubMed, Science Direct, and Iran Medex. The searches were performed using keywords, such asadiponectin, fertility, sterility, and ovulation among the papers published during 1996-2018. We classified the studies and considered P Adiponectin is one of the hormones that affect the reproductive system.Ovulation disorders (e.g., PCO and hypothalamic amenorrhea), metabolic syndrome, insulin resistance, and infertility are associated with reduced adiponectin level. On the other hand, treatments for infertility, including ovulation induction, IVF, and ICSI are accompanied by increase in adiponectin level. Therapy is more likely to be successful in subjects with higher adiponectin.
Regarding the positive effects of adiponectin and its basic role in fertility and sterility, it is possible to measure and evaluate this hormone for management and follow-up of fertility and sterility. Consequently, further attention and research about this hormone seems to be necessary.

From among gynecologic cancers, epithelial ovarian cancer (EOC) is the leading cause of mortalities due to gynecologic cancers in the United States, constituting 3.6% of all types of gynecologic cancers. A major reason for this poor treatment outcome is that most EOC patients are frequently diagnosed in advanced stages of the disease. A standard management for EOC patients involves a primary cytoreductive surgery followed by adjuvant chemotherapy if needed. However, primary breast cancer is one of the most common malignancies in women, and metastasis of other cancers to the breast is relatively rare.
Here, we report the case of a 70-year-old patient who five years ago had undergone laparotomy due to post-menopausal bleeding, adnexal mass, and elevated CA125. With the diagnosis of metastatic papillary serous, she underwent primary cytoreductive surgery and adjuvant chemotherapy. Regarding the history of ovarian cancer diagnosed five years ago, and further examination of this suspicious lymph node, and rejection of the risk of breast cancer, the patient was examined for the risk of metastasis. In biopsy and immunohistochemistry study, metastatic lymph node was diagnosed with the origin of epithelial ovarian cancer, and the patient was treated with beta-taxol carboplatin, and the size of the axillary lymph node shrank.
Regarding the unusual nature of recurrence of ovarian cancer as isolated axillary lymph node involvement, this report emphasizes the importance of considering metastasis in the axilla and its differential diagnosis from breast cancer in patients with a history of ovarian cancer, since prognoses and treatments are different for each diagnosis.