مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 2 (اردیبهشت 1398)

From past time, breast cancer has been one of clinical and common problems among women. Given that chronic vitamin D deficiency is prevalent among most Iranian women, this study was performed with aim to examine the relationship between vitamin D serum level and 2 year survival without incidents such as metastasis and death among patients with breast cancer.  This cross-sectional retrospective study was performed on 360 patients with non-metastatic breast cancer in 2012-2017. Data collection tool was checklist. Serum levels of vitD were measured in early of breast cancer diagnosis before the start of non-surgical therapy (radio-oncology). The effects of vitD level on two year disease free survival was compared among patients with vitD deficiency and those with normal level of VitD. Data was analyzed by SPSS software (version 16) and Copplan and logRank tests and Chi-square test. 2year disease free survival was 91.3%. No significant difference was observed in 2year disease free survival between patients with vitD deficiency and those with normal level of VitD (p=0.313). However, survival time was higher in people with normal vitD serum levels, but this difference was not statistically significant (p>0.05). Although the results of current study did not show significant relationship between the effect of vitD level and disease free survival, but the number of good prognosis was more in patients with normal serum levels than those with low levels that indicates the clinical value.

Preterm birth is one of the most important complications of pregnancy, which has a significant impact on the health and mortality of neonates, so early diagnosis and prediction is vital. This study was performed with aim to investigate the relationship between amniotic fluid alpha-fetoprotein (αFP), alkaline phosphatase (ALP) and ferritin in the second trimester of pregnancy and preterm birth. 
This cross-sectional analytical study was performed on 60 subjects with gestational age of 15-20 weeks (mean of 17 weeks) who had performed amniocentesis due to positive first-trimester screening from September 2014 to February 2015. The levels of αFP, ALP and ferritin were tested using spectrophotometric and ELISA method in freeze samples of 40 subjects with term birth and 20 subjects with preterm birth. Data were analyzed by SPSS software (version 22) and t-test and Chi-square test. P<0.05 was considered statistically significant.
The mean amniotic fluid αFP in term and preterm birth was 382.14 ± 96.44 and 547.47 ± 122.83(ng/ml), respectively; the mean ALP in term and preterm birth was 27.35 ± 13.01 and 74.45±15.51 (IU/ L), respectively; and the mean ferritin was 382.14 ± 96.44, and 547.47±122.83 (ng/ml), respectively. The level of all three markers was significantly higher in preterm birth than term birth (p < 0.001).
There is significant and positive relationship between amniotic fluid αFP, ALP and ferritin levels with preterm birth that may help to increase our understanding of the pathophysiology of preterm birth. According to the results, it is recommended to perform further research with larger sample sizes.

Barberry has bioactive compounds with medicinal and therapeutic properties. Considering the adverse changes in liver enzymes following the exhaustive exercise, this study was performed with aim to evaluate the effect of Barberry juice consumption on serum levels of liver enzymes of Aspartate aminotransferase (AST), alkaline phosphatase (ALP) and Alanine aminotransferase (ALT) following one session of exhaustive exercise in active girls. This quasi-experimental study was conducted in 2017 on 20 active girls in Mashhad. The subjects were divided into two groups of supplementation (n = 10) and placebo (n = 10). After two weeks of supplementation (250 ml of Barberry juice and placebo), the subjects participated in an exhaustive exercise. The changes in liver enzymes (AST،ALP،ALT) were measured in three stages (basal state, after supplementation period, after exhaustive exercise). Data were analyzed using SPSS software (version 19) and Excel (2010), and independent t-test, repeated measures t-test and post-hoc test. P<0.05 was considered statistically significant. Barberry juice consumption significantly reduced AST (p=0.021), ALP (p=0.018) and ALT (p=0.014) in supplement group, and exhaustive exercise significantly increased all three enzymes in two groups. However, the range of changes in all three AST (p=0.021), ALP (p=0.019) and ALT (p=0.019) immediately after exhaustive exercise was significantly lower in the supplement group than the placebo group; the Barberry juice consumption could significantly prevent from the increase in the levels of AST, ALP and ALT immediately after the exhaustive exercise. Barberry juice supplementation can prevent the physiological increase in liver enzymes following exhaustive exercise in active girls and play an important role in the desired changes in liver enzymes.

Menopause is the most critical period with unfavorable changes in anthropometric and metabolic parameters which is associated with Cardiovascular disease risk. Metabolic syndrome has a key role in causing cardiovascular disease and has been a major problem in many countries. According to various studies, the increased ferritin level is associated with metabolic syndrome and those with higher ferritin levels are at more risk of metabolic syndrome. Therefore, due to the high prevalence of metabolic syndrome in Iran, this study was performed with aim to investigate the relationship between serum ferritin levels and metabolic syndrome. This cross-sectional study was conducted on 165 menopausal women referred to the 17 Shahrivar health center and health center No. 8 of Ahvaz in 2013. Demographic information questionnaire was completed for the subjects; for the evaluation of the components of metabolic syndrome, blood pressure was measured twice with interval of 10 minutes after a break and their mean was considered. Waist circumference (WC) was measured. HDL, triglycerides, cholesterol, serum ferritin and FBS tests were done after 12 hours of night fasting on serum of patients. Data were analyzed using SPSS software (version 19) and Chi-square test, ANOVA, Pearson and Spearman correlation coefficients. P In this study, 58 patients (35.2%) had metabolic syndrome. The mean serum ferritin levels in women with metabolic syndrome were 34.53 ± 25.45 and in women without metabolic syndrome was 33.56± 23.12. There was a significant relationship between body mass index, waist circumference, blood glucose, plasma triglyceride, lipid profile and metabolic syndrome (p<0.05). But no significant relationship was found between metabolic syndrome and age, metabolic syndrome and serum ferritin (p>0.05). There is no significant relationship between serum ferritin levels and metabolic syndrome.

Menorrhagia refers to heavy menstrual cycles in which bleeding has or prolonged. Menorrhagia is a common cause for referral to gynecology clinics and about 30% of women at reproductive age experience it. Heavy menstrual bleeding has a negative impact on the quality of life in terms of physical, psychological and social health. Therefore, this study was performed with aim to determine the effect of hydro alcoholic extract ofAchillea Millefoliumon women's menorrhagia.
This triple-blind clinical trials study with control group was performed on 90 women who referred to health clinics, Arak University of Medical Sciences in 2015-2016. After one cycle of controlling menstrual bleeding, the subjects were randomly assigned to two groups of test and control. For both groups, 2 Mefenamic acid capsule (250 mg) was administered every 8 hours from the first day of menstruation up to the end of it for seven days for two consecutive cycles. For test group, in addition to Mefenamic acid, 2 Achillea Mille folium capsules was administered every 12 hours from the first day of menstruation up to the end of it for seven days. In control group, combination of mefnamic acid and placebo was administered with same dose and order. Data on the amount and duration of menstrual bleeding were analyzed using PBLAC chart. Data were analyzed using SPSS software (version20) and independent t-test, Mann-Whitney and Friedman tests. P<0.001 was considered statistically significant.
In the inter-comparison of the amount and duration of menstrual bleeding before and after treatment, the amount of bleeding was significantly reduced (p<0.001); this decrease was significantly more in Achillea Mille folium group than the control group (p=0.036). The duration of menstrual bleeding was also significantly reduced in both groups (p<0.001). The decrease in duration of menstrual bleeding was significantly more in Achillea Mille folium group than the control group (p=0.042).
The hydro alcoholic extract ofAchillea mille folium capsule is effective in reducing the
amount and duration of menstrual bleeding in women of reproductive age. Achillea mille folium due to less complications and no hormonal effects can be effective in treatment of menorrhagia.

Episiotomy is one of the common surgeries in midwifery that despite its small size may cause complications such as inflammation, infection or pain like any other wound. Frankincense due to anti-inflammatory effects is used in many cases, including pain relief and wound healing. This study was performed with aim to evaluate the effect of Frankincense ointment on pain intensity and episiotomy wound healing in primiparous women.
This experimental and three-blinded-study was performed on 95 primiparous women with vaginal delivery and mid lateral episiotomy in Mahdieh hospital of Tehran in 2017-2018. The subjects were divided into two groups of Frankincense ointment (intervention group) and placebo (control group). Demographic and obstetric questionnaire, health status forms, pain scale (VAS), perineal evaluation Index (REEDA) and drug complications questionnaire were used to evaluate the subjects. The ointments were used every 12 hours and for 10 days from the first day after delivery. Evaluation of pain intensity, perineal repair and drug complications were performed on days 1,5, and 10 after delivery. Data were analyzed using SPSS software (version 21) and Mann-Whitney, Chi-square and Fischer tests. P<0.05 was considered statistically significant.
 On the first day after birth, no significant differences were observed between two groups in terms of mean score of REEDA (P=0.752) and pain intensity (P=0.50). The mean score of REEDA in the intervention group on fifth and tenth days were 2± 1.62 and 0.95 ± 0.99, respectively, and in the control group were 4.04 ± 2.38 and 2.52 ± 2.05, respectively; these differences were significant (P=0.026, P<0.001). The mean of pain intensity on the fifth and tenth days in the intervention group were 2 ± 1.23 and 0.95 ± 0.50, respectively, and in the control group were 3.16± 1.57 and 1.97 ± 1.17, respectively. In both groups these differences were statistically significant (P=0.030, P<0.001).
Frankincense ointment with anti-inflammatory properties is effective in the episiotomy wound healing and pain reduction.

Nausea and vomiting is one of the most common problems in pregnancy. Since many researchers have considered the effective role of anxiety or depression in the incidence of nausea and vomiting in pregnancy, relaxation probably can decrease nausea and vomiting in pregnant women through increasing the calmness. Therefore, this study was performed with aim to determine the effect of muscle relaxation on nausea and vomiting in pregnant women.
This randomized clinical trial was conducted on 66 pregnant women at gestational age of 6-12 weeks with nausea and vomiting of pregnancy who referred to two selected health centers in Mashhad in 2018. The subjects were randomly assigned to intervention and control groups. After holding two sessions of progressive muscle relaxation training within one week for the intervention group, the units performed the exercises for 4 weeks at home. The researcher did not give any training to the control group. The tools used in this study included Rhodes Nausea and Vomiting Index, and Depression, Anxiety and Stress Questionnaire (Dass-21). Data analysis was done using SPSS software (version 25) using Mann-Whitney, independent t-test, repeated measures analysis, and Friedman tests. P<0.05 was considered statistically significant.
The mean score of nausea, vomiting and gagging and the total score of nausea, vomiting and gagging in the intervention group before the study were 4.6 ± 2.3, 3.2 ± 2.3, 2.7 ± 1.7, and 10.6±5.0, and after the study were 2.8 ± 1.4, 1.8 ± 1.3, 1.6 ± 0.9, and 6 ± 2.8, respectively. In the control group, the mean score of nausea, vomiting and gagging and the total score of nausea, vomiting and gagging before the study were 4.4 ± 2.1, 2.3 ± 2.4, 2.8 ± 1.8, 9.5 ± 1.7, respectively, and after the study were 3.8 ± 1.6, 2.3 ± 1.9, 2.7 ± 2, and 8.8±4.8, respectively. The results of statistical tests showed that the mean score of nausea, vomiting, gagging and total score of nausea, vomiting, and gagging of pregnant women significantly decreased in the intervention group during all stages of measurement (p <0.001); while in the control group, there was no significant decrease in some stages of measurement (p >0.05).
Progressive muscle relaxation can reduce the severity of nausea, vomiting and gagging in pregnant women by reducing anxiety, stress and depression. Therefore, since it has no complications and is convenient to do it, this method is recommended as a way to reduce the incidence of nausea and vomiting in pregnancy.

Inactive lifestyle is a very important risk factor for the development of many diseases, including metabolic syndrome. In aging, in addition to aging-related problems, some elderly people develop metabolic syndrome, which is more common in women than men. The metabolic conditions of the body play a major role in the emergence and progression of this disease. This study was performed with aim to investigate the effect of 8 weeks of circuit training on body weight, blood pressure and Cholesterol levels and liver enzymes in elderly women with metabolic syndrome in Khorramabad city. This semi-experimental study was performed in 2017 on 18 elderly women with metabolic syndrome at Farzanegan rehabilitation center in Khorramabad. During the daily routine activities, the subjects participated in 8-week circuit training protocol which performed 3 sessions per week. The fasting blood sample was taken from the subjects 24 hours before the training protocol and 48 hours after the training protocol. Body weight, blood pressure, serum cholesterol and liver enzymes were measured. Data was analyzed by SPSS software (version 24) and Kolmogrov-Smirnov and correlated t-test. P The results showed a significant decrease in serum AST (p =.043) and cholesterol (p =.033) levels, systolic blood pressure (p =0.001) and body weight (p =0.001) and BMI (p=0.001), and non-significant decrease in serum levels of ALT (p =0.487) in comparison with pre-test values in elderly women with metabolic syndrome. The circuit training in elderly women with metabolic syndrome has beneficial effects on serum concentration of AST, ALT and cholesterol; also it reduces systolic blood pressure and body weight, therefore can promote their health.

Osteoporosis is a major health problem in women throughout the world. Based on the available evidence, delivery can play an important role in women's bone mineral density. Therefore, this study was performed with aim to determine the correlation between parity and bone mineral density through systematic review and. In this systematic review and meta-analysis study, for finding the related articles, the databases of PubMed, Scopus, Cochran library and Web of Science databases were searched without time limitation and with English language restriction by using of the keywords of Parity and Bone Mineral Density (BMD) or Bone Mineral Content or bone density. The adapted Newcastle-Ottawa Scale was used to assess the quality of the cross-sectional articles. Funnel plot and Egger's test was used for publication bias assessing. Q-test and I2 index were used for evaluation of heterogeneity. Fisher’s 𝑟-to-𝑧 transformation was calculated for the studies. In this study, a total of 1336 papers were reviewed and 11 studies involving 5141 women were included in this meta-analysis. The decreasing trend in lumbar spine, femur and total hip BMD was observed in women with parity ≥5 compared to non-parity women. In nulliparous women, the mean of BMD in lumbar spine was (M:0.93 ,95%CI;0.75-1.11, Phetrogeneity <0.001), in femur (M:0.84 95%CI;0.60-1.09, Phetrogeneity <0.001) and in hip (M:0.86, 95%CI;0.84-0.89, Phetrogeneity =0.001). The mean of BMD in postmenopausal women was lower in lumbar, femur and hip. In African women, the mean of BMD in three sites were higher. There was no reverse moderate correlation between parity and lumbar BMD -0.22 (95% CI -0.14, -0.30) and hip BMD -0.21 (95% CI -0.12, -0.29). The mean BMD was higher in nulliparous women. There was inverse correlation between lumbar BMD and hip BMD with parity, but because of high heterogeneity in analyzed subgroups, performing cohort studies is recommended.

ntroduction: Folic acid is an important nutrient for maintaining and improving health and its deficiency during pregnancy increase the risk of spontaneous abortion, neural tube defects, preeclampsia, placental abruption, preterm labor, low birth weight and anemia. These risks can be prevented by increasing folic acid intake during pregnancy and pre-conception. Therefore, this study was performed with aim to determine the level of knowledge and consumption of Folic acid in pregnancy and pre-conception through meta-analysis. In this systematic review and meta-analysis study, for finding the related articles, the Persian and English journals which were indexed in databases of SID, Iranmedx, Irandoc, Magiran, Scopus, and PubMed were searched with Mesh keywords up to August, 2018. I2 index was used to assess the heterogeneity in the studies. Data were analyzed by meta-analysis method using random effects model. Of the 2366 articles found in the primary search, 16 articles were selected for systematic review and meta-analysis. In the meta-analysis, according to the random effects model due to heterogeneity 97% , these results were estimated: hearing the name of folic acid by women in 84.8% (77.5-90.1), knowledge of women from the role of folic acid in 37.2% (27.5-48.1), knowledge of the time of taking folic acid in 27.3% (17.9-39.3), knowledge of the correct dose of folic acid in 75.2% (63.3-84.2), use of Folic acid during pregnancy in 74% (65.2-81.6), use of folic acid in pre-pregnancy in 18.3 % (12.6-25.9), regular consumption in 47% (7.8-90.3), and irregular consumption of folic acid in 40.9% (9.1-82.7). The level of knowledge of women at reproductive age about folic acid complementary and its valuable role in pregnancy is not desirable. Since health personnel are the most important source of information on the use of folic acid, so they have to work more efforts in this regard to increase the level of women's knowledge.

Interstitial pregnancy is a dangerous and challenging ectopic pregnancy. Despite different diagnostic methods, the early detection of interstitial pregnancy is very difficult and misleading. Interstitial ectopic pregnancy tends to severe bleeding, so that incorrect diagnosis leads to life threatening of patient. The aim of this study was to introduce a case of interstitial ectopic pregnancy (Corneal) with placenta Increta in the second half of pregnancy. A 23-year-old woman G2 with history of previous cesarean section, at 23 weeks of pregnancy with complaints of abdominal pain, nausea and vomiting after sexual intercourse referred to Izadi educational Hospital. Regarding drop in vital signs, oliguria, generalized tenderness and ultrasound reports of abdominal blood, the patient was transferred to the operating room. On the left, interstitial ectopic pregnancy was torn with placenta Increta. The embryo was removed, but the placenta was placed in the cornea to the cervix and to the broad ligament. Hysterectomy was performed due to the placenta Increta. Ultimately, the diagnosis and immediate treatment saved the patient's life. The pathological study showed placenta Increta. Intrauterine ectopic pregnancy is one of the rare diseases. Since interstitial pregnancy is located in a place full of vessels, any rupture can lead to catastrophic and life threatening bleeding. Interstitial pregnancy requires accurate diagnosis and immediate treatment. Proper and timely intervention therapy can prevent serious complications and reduce maternal mortality and mortality.