مجله زنان مامائی و نازائی ایران
سال بیست و یکم شماره 7 (مهر 1397)

Cervical ripening usually starts before the onset of labor contractions and is necessary for dilatation and embryo passage. Considering the importance of vaginal delivery and reduction of cesarean risk, cervical ripening in pregnant women is a priority for Gynecology. Therefore, this study was performed with aim to compare the effects of isosorbide mononitrate and estradiol on cervical ripening and labor induction and the complications of these two drugs. This double-blind randomized clinical trial was performed in 2016 on 99 pregnant women over 40 weeks of gestation who referred to Alavi hospital in Ardabil. Participants were randomly allocated in to three groups of isosorbide mononitrate, estradiol and placebo. The tablet were placed in the posterior fornix, out-patiently. All three groups were hospitalized after 12 hours. Because of Bishop scores (BS) less than 6, the previous doses were repeated in all groups. Examination of the cervix was performed every 2 hours and blood pressure and heart rate of the mother were checked every 4 hours. Data were analyzed by SPSS software (version 16), one way ANOVA, Chi-square and Kruskal-Wallis tests. P <0.05 was considered significant. The time of cervical ripening up to delivery was similar in Isosorbide and Estradiol groups (p=0.381), but it was significantly shorter in both groups than placebo group (p=0.016). Isosorbide and Estradiol also increased cervical Bishop Score. No significant difference was found between the groups in terms of duration of active phase of delivery (p=0.860). Despite of higher cesarean frequency in placebo group, no significant difference was observed between three study groups in terms of mode of delivery (p=0.484). The drug side effects were higher in Isosorbide and Estradiol groups compared to placebo. Isosorbide mononitrate and Estradiol changed Bishop Score as similar, and reduced the duration of ripening to delivery. Both drugs reduced the hospitalization time to delivery, cost of delivery induction, and improved delivery experience, without need to any aid instruments or surgery

Introduction Pre-menstruation syndrome (PMS) includes a set of physical and psychological symptoms before menstruation which causes disorder in the life process and activity of each woman. This survey was performed with aim to evaluate the effect of foot medical zone-therapy reflex on the intensity of PMS symptoms in the students of girls’ dormitories of Tehran University of Medical Science. This one blind randomized clinical trial was performed in 2010 on 120 students who were resident in the dormitories of Tehran university of medical sciences. The samples were randomly divided in 2 groups of cases and control (n=60 each group). Zone-Therapy Reflex was done in the case group.Data collection toolwasDickerson questionnaire which was completed in two menstruation cycles before treatment and two cycles during the treatment. Data was analyzed by SPSS software (version 15) and x2,exact Fisher and covariance analysis tests. P˂0.05 was considered significant.
Results In this research, the intensity of mood signs was decreased 25.2% after true Z-T reflex and 3.8% after no true Z-T reflex, physical signs 25.26% after true Z-T reflex and 3.4% after no true Z-T reflex, and behavioral signs 20% after true Z-T reflex and 18.30% after no true-T reflex , that mood (p=0.03) and physical (p=0.040) signs were considered statistically significant and improvement was observed in the signs, but no change was observed in behavioral signs.
Conclusion Zone therapy reflex improves physical and mood signs in PMS and due to very low side effects, good effectiveness and proper treatment can be one of the first therapy steps in women with PMS.

Thyroid peroxidase antibody (TPOAb) is the main risk factor for thyroid dysfunction during pregnancy and can be a marker of these disorders during pregnancy. This study was performed with aim to evaluate the frequency of positive thyroid peroxidase antibody and its related factors during pregnancy. This study is a secondary analysis which was performed based on the data available in prospective population based study of The Tehran Thyroid and Pregnancy Study. This study was performed on 2233 pregnant women (at first trimester of pregnancy) who referred to prenatal care centers under coverage of Shahid Beheshti University of Medical Sciences. Serum concentrations of T4، T-uptake، TSH and TPOAb were measured in pregnant women. Mother age، body mass index، parity، gestational age، individual or family history of thyroid dysfunctions، goiter، diabetes type 1 or other autoimmune disorders، history of infertility، abortion، preterm labor، or stillbirth were selected as probable risk factors. Data analysis was performed using STATA software (version 12). In this study، 214 cases (7. 9%) were TPOAb positive. Based on the logistic regression model، the chance of positive TPOAb in women with individual history of thyroid disease was 4. 48 times (95% CI: 2. 26- 8. 85) higher than those without this history (p <0. 05). No significant relationship was found between other factors (maternal age, BMI, parity, gestational age, thyroid medication, family history of thyroid dysfunction, history of infertility, history of abortion and history of preterm labor) and positive TPOAb (P>0. 05). The history of thyroid disorders is associated with positive TPOAb in pregnant women and this factor can be considered as a risk factor for the detection of thyroid autoimmune disorders

Nausea and vomiting is one of common complications in pregnancy that not only affects the women's physical health, it can also have a negative impact on their psychological and social performance. Suggestions have been made to effect on the nausea and vomiting of pregnancy. There are different methods to control the nausea and vomiting of pregnancy. Therefore, this study was performed with aim to compare the effect of Ondansetron, Vitamin B6 and Ginger Rhizome on nausea and vomiting in pregnancy. This double-blinded randomized clinical trial was performed on 120 pregnant women with gestational age <16 weeks who had mild and moderate nausea and vomiting referred to health centers of Hamadan in 2017. The samples were randomly divided in four groups of 30 cases: Ondansetron (4 mg), Vitamin B6 (40 mg), Ginger Rhizome (250 mg), and placebo groups, two times per day for one week. Severity of nausea and vomiting was assessed before and after the study by nausea and vomiting questionnaires (PUQE). Data was analyzed by SPSS software (version 21) and using chi-square, paired t-tests and ANOVA. P <0.05 was considered significant. before the intervention, no significant difference was found in the four groups in the score of pregnancy nausea and vomiting (p=1.00). After the intervention, according to ANOVA test, the score of nausea and vomiting was significantly different between the Ondansetron, Vitamin B6 and Ginger Rhizome groups with placebo group (p<0.001). According to paired t-test, severity and duration of nausea and vomiting was significantly reduced in three treatments groups (p<0.001), and this decrease was less and significant in the ginger root group (P<0.001). Ginger Rhizome like as Ondansetron and vitamin B6 can reduce the severity and duration of nausea and vomiting; therefore its use in pregnant women can be helpful

Dysmenorrhea is one of the most common gynecological disorders; so that 50 to 70 percent of women suffer it. Dysmenorrhea is often treated by chemical drugs. However, studies showed that almost half of the population in industrialized countries is already using complementary medicine and alternative therapies. Therefore, this study was performed with aim to compare the effects of fennel and Gelofen on severity of primary dysmenorrhea. This clinical trial was performed on 72 students residing in dormitories of Islamic Azad University of Ardabil in 2016. Samples with grade 2 and 3 of primary dysmenorrhea were randomly divided in two groups of fennel and Gelofen receivers. The fennel group used 3-5 drop of fennel extract in water or tea three times per day during first 3 days of menstruation and Gelofen group used Gelofen capsule every 6 hours during this period. Both groups used this method for three consecutive cycles. Data collection tool included a dysmenorrhea severity questionnaire according verbal multidimensional scoring criteria. Data were analyzed using SPSS software (version 17) and t-test and chi-square. P < 0.05 was considered significant. Both fennel and Gelofen reduced the severity of pain from severe and moderate to mild and no pain, but there was no significant difference between the two groups of fennel and Glofen in improvement of dysmenorrhea (p>0.05). The use of both methods of fennel and Glofen was effective in reducing the pain of primary dysmenorrhea and pain reduction was similar in both groups. Regarding the high prevalence of dysmenorrhea in female, the use of fennel in the relief of dysmenorrhea is recommended

Fetal weight is an important criterion for assessing the neonate's health and taking clinical decisions. Johnson and Dare’s formula are the methods for estimation of fetal birth weight which are less used. This study was performed with aim to determine the diagnostic value of Johnson & Dare's methods in estimating the birth weight using the Rock curve. This cross-sectional study was performed on 147 full-term, cephalic, singleton pregnancies in the maternity of Nohon Dey and Taamin Ejtemaei hospitals of Torbat Heydariyeh in 2016. Before birth, Johnson and Dare formula was used to calculate fetal weight. After birth, all infants were weighed and then the true weight of infants was compared with the estimated weights. Data analysis was done with SPSS software (version 20) and by Kruskal–Wallis test, specificity and sensitivity formula, positive & negative predictive value. P<0.05 was considered statistically significant. There was no significant difference between Johnson & Dare methods with actual birth (P>0.05). The sensitivity of Johnson formula for estimation of fetal low birth weight and normal fetuses was 60% and for macrosomic fetuses was 71.43%. The sensitivity of Dare formula for estimation of fetal low birth weight and normal fetuses was 40% and for macrosomic fetuses was 85.71%. The area under the curve in the predictive model for two methods and in three weight groups of <2500 g (p=0.26), 2500-4000 g (p=0.26) and >4000 g (p=0.13) had no significant difference. Johnson and Dare formula in estimation of fetal weight especially in macrosomic fetuses can be good replacement for costly methods such as sonography. Also, Dare method can be used more than before in estimation of fetal weight because it is easy, fast and accurate

Multiple Sclerosis (MS) is a chronic disease of the demyelination of central nervous system which is characterized in the nerve by the disruption in the transmission. Considering to the effects of different exercises to help in decreasing the disease' symptoms in MS patients, this study was performed with aim to compare the effects of ball exercises in water and Pilates on the speed and endurance of walking, balance, fatigue and quality of life in women with MS. This applied and semi-experimental study was performed on 31 MS women with EDSS£4 who were resident in Mashhad and had referred to MS institute of Mashhad in 2016. The subjects were placed in three groups of ball exercises, Pilates, and control. The participants exercised three times a week for 8 weeks. Speed test data (10m walk test), walking durability (2-minute test), and Equilibrium test (BBS) were measured by time-meter. Fatigue test (FFS) questionnaire was used to measure the fatigue of patients and also pulsometer was used to measure the intensity of Pilates training programs and ball exercises in water (from 40-70% of maximum heart rate). Data was analyzed by SPSS software (version 18) and multivariate analysis of variance analysis, dependent-t, and Tukey follow-up test. P< 0.05 was considered significant. Speed of walking was significantly increased in the group of ball exercises in water (P<0.001), while this increase was not significant in Pilates group (P=0.132). Endurance of walking and balance were significantly increased in the groups of ball exercises in water (P= 0.008, P-0.001) and Pilates (P= 0.009, P=0.002). Fatigue was significantly decreased in the groups of ball exercised in water (P= 0.004) and Pilates (P= 0.019). Quality of life was significantly increased in the groups of ball exercised in water (P= 0.000) and Pilates (P= 0.001). However, there was no significant difference between the two groups in all the indices. The control group didn’t show changes in any indices. In terms of the measured indices, no changes have been observed in control group (P≥0.05). The information can be helpful and useful in designing the exercise programs for he patients with MS. Ball exercises in water and Pilates exercises along with drug therapies can improve the balance indexes, fatigue, speed and endurance of walking and quality of life in patients with MS, and with a targeted increase in the intensity and volume of activity, physical capacity, and quality of life of patients will increase

Patients have to change their behavior due to increased self-care needs. Also, family caregivers due to their critical role in rehabilitation of patients with physical and mental disabilities, can help patients to improve their abilities. This study was performed with aim to determine the relationship between the caregivers' health literacy and the behavior of patients with Multiple Sclerosis. This descriptive correlational study was performed on 76 women with MS and 76 caregivers in Bojnourd in 2016. Collection of data related to MS women were performed by using demographic information questionnaire, Test of Functional Health Literacy in Adults [TOFHLA] health literacy and patient behavior assessment. Data analysis was performed using SPSS software (version 16), and Pearson and spearman correlation and regression tests. P<0.05 was considered significant. In this study, the mean level of health literacy was 64.26 ± 13.95, that 24 cases (15.8%) had enough health literacy, 40 (52.6%) had borderline health literacy and 12 (31.6%) inadequate health literacy. The mean score of behavior was 23.67 ± 5.89. Correlation test showed a positive and significant relationship between caregivers' health literacy and the behavior of women with MS (P<0.001,r=0.35). The level of caregivers' health literacy was borderline and inadequate that can be as a warning to health care providers, so it is necessary that more pay attention to health literacy in health promotion programs

A significant percentage of women in reproductive age experience some menstrual- related mood and physical disorders called Premenstrual syndrome (PMS). The symptoms of this syndrome can affect the various aspects of person’s life. This study was performed with aim to evaluate the effect of Chamomile capsule on premenstrual syndrome symptoms relief in students. This double blind randomized clinical trial study was conducted on 118 students residing in dormitories of Guilan University of Medical Sciences in 2017 who suffered from moderate to severe premenstrual syndrome. Chamomile group received 250 mg of Chamomile powder and the subjects in placebo group received placebo 3 times a day from 7 days before menstruation until menstrual bleeding started for one cycle. Data collection tool was Premenstrual Symptoms Screening Tool (PSST). Data was analyzed by SPSS software (version 23), and independent t and paired t-test. P<0.05 was considered significant. before treatment, two groups of Chamomile and placebo was not significantly different in the overall severity of premenstrual syndrome symptoms (p> 0.05). After treatment, mean score of physical, psychological and overall severity of premenstrual syndrome symptoms significantly decreased in both groups (p <0.05). However, Chamomile was more effective than placebo in relieving severity of physical, psychological and total symptoms of premenstrual syndrome (p <0. 05). Using of Chamomile plant effectively reduces the severity of psychological, physical and total symptoms of premenstrual syndrome

Iodine therapy after surgery is the gold standard treatment in patients with differentiated thyroid cancer. It is important to evaluate the effect of this treatment on future pregnancies of women who received iodine therapy. This review article was performed with aim to evaluate the pregnancy complications in patients who received iodine therapy with diagnosis of DTC. In this nonsystematic explanatory review article, three medical databases including ISI Web of Knowledge, Pubmed and Google Scholar were searched for related articles with the keywords of: thyroid AND (carcinoma OR cancer OR neoplasm) AND (iodine OR 131 OR radioiodine) AND (pregnan* OR labor OR parity OR gravid*). The English articles which published from 1950 were searched. Review articles, case reports and cross-sectional studies were excluded. Finally 7 articles included in the review. Based on the 7 relevant studies, intrauterine fetal death, preterm labor, congenital malformation, low birth weight and neonatal death at first year of birth were similar in the studied groups. However, the differences between the studied groups in some studies were related to total number of abortions, induced abortions and lower incidence of live birth. The risk of pregnancy complications is not higher in women who received iodine therapy. The lower incidence of live birth and higher incidence of induced abortion in some studies can be related to mental and psychological effect of fear of iodine therapy impact on pregnancy in patient, physician, or the people around her

Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune, chronic disease with multi-organ involvement with a remitting and relapsing course that mainly affects women. One of the most important challenges for women affected by SLE is the adverse impacts of the disease on Sexual function. This systematic review and meta-analysis was conducted with am to investigate the effects of lupus on women's sexual function. In this systematic review and meta-analysis study, both Persian and English articles were searched in databases of PubMed, Magiran, Scopus, SID, Google scholar using the keywords of "Systemic Lupus Erythematosus", "Sexual functioning", "sexual activity", "sexual disorder" and their Persian equivalents during 2000 up to December 2017. Data analysis was performed with STATA software (version 14.1). I2 test was used to assess the heterogeneitybetween studies and the random effects model was applied to pool data and perform meta-analysis. A total of 8 articles of 515 studies about the impact of lupus on women's sexual function were extracted, of which 4 studies were included in the quantitative analysis. The findings of included studies into meta-analysis showed that based on the random effects model, systemic lupus erythematosus decreased women's sexual function )RR= 1.58; 95% CI: 1.10-2.25; p=0.001). Considering the negative impact of lupus on women's sexual function, findings of this study can be a basis for designing and implementation of sexual health programs for this group of women so that lead to promotion of their sexual health

preeclampsia is one of the rare symptoms of molar pregnancy and is more prevalent in pregnancies with large volumes of abnormal trophoblastic tissue. Preeclampsia is associated with hypertension and proteinuria and rarely occurs in patients with Hydatidiform mole. Since in most cases, molar pregnancy is diagnosed by sonography at first trimester of pregnancy, the possibility of gestational trophoblastic disease should be considered in all patients with preeclampsia in first trimester of pregnancy. The aim of this report is to introduce a case of hydatidiform molar pregnancy with preeclampsia in 6th weeks of pregnancy.
Case report: A 15-year-old primigravid female with 6 weeks of menstrual retardation and diagnosis of molar pregnancy with increase of β-HCG titers, proteinuria and upper extremity edema was referred to emergency of maternity ward of an academic hospital, Mashhad University of Medical Sciences in 2017. Preeclampsia was confirmed. After curettage, hydatidiform mole was diagnosed. Preeclampsia associated with molar pregnancy was diagnosed. After mole curettage, blood pressure reached to normal and edema and other symptoms were gradually improved. Preeclampsia is one of the rare symptoms in molar pregnancy. Considering that in most cases molar pregnancy is diagnosed with ultrasound in the first trimester of pregnancy, it is recommended that hydatidiform mole should be considered in all patients with preeclampsia in early pregnancy