مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 5 (امرداد 1398)

Ovarian function should control follicle development, steroidogenesis, and ovulation processes by ovarian external and internal hormonal signals. Sympathetic system Alpha and beta receptors play a role in regulation of theca and granulosa cells activity for folliculogenesis and steroidogenesis. This study was performed with aim to investigate the changes in expression of alpha 1, 2 and beta 2 adrenergic receptors gene of ovary cumulus in infertile women with polycystic ovarian syndrome (IVF candidate) and effect of clonidine on it. This case-control study was conducted in 2017 on two groups of control (healthy women donating oocytes) and case (patients with polycystic ovaries). Ovulation induction drugs were prescribed in two groups for ovulation growth. After oocyte puncture, the follicular fluid was collected with cumulus-oocyte collection.  The cumulus cells were isolated by enzyme and were cultured. RNA was then extracted from cumulus cells and its concentration was read by Nano-drop device. cDNA was synthesized and primer was designed for ADRB2 and ADRα1.2 gene expression and the gene expression was assessed by Real-time PCR technique. Finally, the effect of clonidine on protein level of ADRβ2 and ADRα1.2 genes in cumulus cells was investigated by immunocytochemistry technique (western blot) in two groups. The results of this study confirmed: 1) increasing of gene expression level in women with PCOS compared with control group and 2) efficacy of clonidine on gene expression. The severity of the drug efficacy on receptors gene expression was ADRα1 <ADRβ2 <ADRα2, respectively. The results of gene expression and immunocytochemistry showed that clonidine could significantly reduce gene expression of three adrenergic receptors, especially α2 in women with PCO, and therefore clonidine pharmacotherapy could be suggested.

Considering the importance of evaluating resistance index (RI) and peak systolic velocity (PSV) of fetal middle cerebral artery (MCA) in determining fetal distress and fetal diseases such as anemia, this study was performed with aim to investigate the effect of changes in fetal heart rate (FHR) during resting and activity on RI and PSV indices of fetal MCA. This analytical cross-sectional study was performed by sampling method on 192 pregnant women with gestational age of 16-39 weeks referred to Kermanshah Imam Reza Hospital in 2016. Doppler ultrasound was performed in two fetal resting and activity states, and MCA-RI, MCA-PSV and FHR level were measured. Data analysis was performed by SPSS software (version 22) and Wilcoxon and paired t-tests. P<0.05 was considered statistically significant. According to the results, FHR (3-15 beats) and fetal MCA-PSV were significantly higher during activity than resting, and MCA-RI was significantly lower during resting than activity (P<0.05). Also, MCA-RI and MCA-PSV had a significant relationship with FHR both during resting and activity (p <0.05). Therefore, increased FHR following activity significantly decreased MCA-RI (P<0.05) and significantly increased MCA-PSV (P<0.05). Increased FHR directly affects fetal MCA-PSV and MCA-RI parameters. This should be considered in detecting fetal distress and anemia.
Keywords: Fetal Heart Rate (FHR), Fetal middle cerebral artery, Peak Systolic Velocity (PSV), Resistance Index (RI), Ultrasonography

Infertility is one of the main concerns of human societies and PCOS is considered as the most common reason of women's infertility due to ovulation disorders. Infertility has been considered as the main cause of psychopathy disorders and reduced quality of life in PCOS patients. Exercise is a non-pharmaceutical method in treatment of PCOS that yoga is a recommended exercise for this disease. This study was performed with aim to determine the effect of 6 weeks yoga on the quality of life in infertile women with PCOS. This clinical randomized trial was performed on 61 infertile women with PCOS undergoing infertility treatment referred to the Tehran Sarem Hospital in 2015-2015. The qualified subjects were divided to two groups of case and control. Then, all the subjects completed the demographic profile and fertility questionnaires and modified PCOS questionnaire. Then, the case group performed yoga for 6 weeks and the control group did not receive any intervention. After 6 weeks, the questionnaires were again completed. Data were analyzed by SPSS software (version 21) and independent t-test, paired t-test, Mann-Whitney, Chi-square, Mac-Nemar, and Wilcoxon test. P<0.05 was considered statistically significant Yoga exercise for 6 weeks had significant effect on the scores of quality of life and Hirsotism (p=0.001), weight (p= 0.010), Acnea (p= 0.001), infertility (p= 0.001), Emotional (p<0.001), menstrual disorders (p<0.001) and total score (p<0.001). Yoga as a meditation exercise for 6 weeks can improve the score of quality of life in women with PCOS undergoing infertility treatment. Therefore, this exercise as an effective and low-cost method can be used for improvement of life quality in these women.

Stress during pregnancy can be associated with adverse outcomes including preterm birth and intrauterine growth retardation. This study was performed with aim to evaluate the relationship between maternal stress and pregnancy outcomes in pregnant women referring to health centers in Qazvin. This longitude prospective study was performed on 239 pregnant women with singleton pregnancy at 24-28 gestational weeks referred to Qazvin health centers in 2018. The subjects of exposed group obtained score > 23, while non-exposed group obtained score < 23 from Cohen's perceived stress questionnaire. The outcomes were preterm birth (before 37 weeks) and neonatal outcomes. Mothers were followed up until delivery, then checklist was completed at the time of birth. Data were analyzed by SPSS software (version 24) and t-test, Chi-square and logistic regression. P<0.05 was considered statistically significant. There was significant relationship between preterm delivery, birth weight, neonate's height and head circumference, respiratory distress, and neonatal jaundice with mother's stress during pregnancy (P <0.05). Perceived stress in pregnant women can cause preterm delivery and adverse neonatal outcomes.
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Amniotomy is usually used to induce or strengthen labor, and can affect labor progression if it was at suitable time. This study was performed with aim to compare delivery outcomes on nulliparous women in two groups of early and late amniotomy.
  This clinical trial study was performed on 70 nulliparous women referred to Amol medical educational center of Imam Ali Hospital in 2016-2017. Nulliparous women with spontaneous labor were divided into two groups: early amniotomy (≤4 cm) and late amniotomy (>≤4 cm). Data collection tool was a checklist including the characteristics of the research units, the form of partogragraphy and assessment of first, second, third stages of labor and neonate. Individual characteristics, oxytocin infusion, stages of labor and neonatal Apgar score were collected by these tools. Data were analyzed by SPSS software (version 20) and independent t-test and Chi-square test. P<0.05 was considered statistically significant. There was significant difference between two groups in mean duration of first and second stages of labor (p <0.001, p = 0.025, respectively). Duration of first stage of labor was longer in early amniotomy group and duration of second stage was longer in late amniotomy group. However, two groups had no significant difference in mean of duration of third stage of labor (p = 0.078). First and fifth minutes Apgar score of neonates was not significantly different between two groups (p = 1). Although early and late amniotomy had same effect on neonatal outcomes, but late amniotomy (standard) decreased duration of labor in nulliparous women.

Visfatin is an Adipokine secreted from adipose tissue that seems to be related to weight gain during pregnancy. Therefore, this study was performed with aim to determine the relationship between serum visfatin levels in pregnancy with anthropometric indices and maternal gestational weight gain. This cohort study was conducted on 56 pregnant women aged 18-40 years at first trimester of pregnancy who had referred to populous health comprehensive centers for prenatal care from December 2015 to September 2016. Pregnant women were divided in terms of BMI before pregnancy to two groups: A (normal BMI) and B (BMI higher than normal). Serum visfatin level was measured in gestational age of 6-12 and 15-20 weeks by ELISA method. Data collection method included observation, examination and interview with patient using the questionnaire in three parts: personal information, maternal medical and obstetric history, and fetal variables, laboratory results. Data was analyzed by SPSS software and Chi-square, Mann-Whitney, Wilcoxon Signed Rank Test, Regression and Spearman ranking correlation tests. P<0.05 was considered statistically significant. Mean serum visfatin significantly increased from first to second trimesters in both groups (Pa=0.005, Pb=0.001 in A and B groups, respectively). Mean serum visfatin levels at second trimester was significantly higher in B group than A group (p=0.04). Maternal weight gain during second trimester of pregnancy was significantly higher in A group compared with B group (p=0.03). In group A, second trimester visfatin levels had positive and significant relationship with third trimester BMI (p=0.01, r= 0.54). An incremental pattern of maternal plasma visfatin concentration with pregnancy progression in pregnant women with normal BMI may be a function of incremental changes in visceral adipose tissue, which contributes to increased flexibility of maternal metabolism in pregnancy and reduced incidence of metabolic diseases.

Since sexual violence is not known in Iranian society, undesirable consequences of this type of violence are also unclear. Therefore, this study was performed with aim to investigate the prevalence of sexual violence in women with improved breast cancer mastectomy. This descriptive cross-sectional study was performed on 320 women with improved breast cancer breast cancer mastectomy in educational hospitals of Tabriz University of Medical Sciences in 2018. Sexual violence of women with breast cancer was assessed by Sexual Violence Questionnaire. Data were analyzed with SPSS software (version 22) and descriptive statistical methods and Kolmogorov-Smirnov, linear regression and Spearman tests. P <0.05 was considered statistically significant. Mean of sexual violence was 51.35 ± 9.53 and in level of "average sexual violence". Among sexual violence areas, the area of "wife's contempt during sexual intercourse" with score of 14.11 ± 1.03 had obtained the highest score. Sexual violence had correlation with age (P=0.003), history of cancer recovery (P=0.049), patient’s education (P=0.013) and her husband education (P=0.001) and patient’s general health status (P=0.001). Sexual violence is moderate in women with breast cancer after mastectomy.

The quality of life in patients with polycystic ovary syndrome is affected by wide variables. Various studies have shown that these patients are at high risk of depression and anxiety. The most important symptoms of polycystic ovary syndrome include hirsutism, acne, and increased androgen hormones. This study was performed with aim to evaluate the relationship between levels of androgen hormones, hirsutism, and acne with depression and anxiety in women with polycystic ovary syndrome. This case-control study was performed on 53 patients with polycystic ovary syndrome selected by Rotterdam criteria, and 50 healthy women as control group in Tehran Arash Hospital in 2015-2016. The tools of data collection were questionnaire of demographic information, Beck Depression and Anxiety questionnaire, Ferriman - Gallwey Score to assess the degree of hirsutism, Global Acne Grading System, clinical features of hyperandrogenism and laboratory tests’ results (Total testosterone, free testosterone, sex hormone binding globulin). Data were analyzed by SPSS software (version 21) and T-test, Chi-square, and Pearson Correlation Coefficient. P<0.05 was considered statistically significant. Mean scores of acne (p=0.02), hirsutism (p<0.001), total testosterone (p=0.008), and free testosterone (p=0.01) were meaningfully higher in patient group than control group. Mean Sex Hormone Binding Globulin level was not significant different in case and control groups (p=0.3). Mean scores of depression (p=0.001) and anxiety (p=0.01) in patient group (20.35±9.82 and 17.35±10.44) were significantly higher than control group (14.46±8.40 and 12.40±9.65). No significant relationship was found between total scores of acne, hirsutism, total testosterone, free testosterone and sex hormone binding globulin with depression and anxiety (p>0.05). Significant increase in the scores of anxiety and depression in patient group compared to control group can be indicative of depressed and anxious mood in patients with polycystic ovary syndrome.

Recurrent abortion is defined as three or more spontaneous miscarriages before first trimester of pregnancy. Protein C, S, Antithrombin III deficiency is of the min factors of this disease. The presence of antiphospholipid antibodies, such as Lupus Anticoagulant, antiphospholipid, anticardiolipineand and B2 glycoprotein can lead to recurrent abortion.  This study was performed with aim to determine the serum level of these factors in women with recurrent abortion. This cross-sectional study was performed in 2017 on 80 women with recurrent abortion who had abortion at first trimester of pregnancyand had referred to gynecology clinic. Clotting method was used to determine theprevalence of deficiency of natural anticoagulant proteins.ELIZA method was used to determine the presence of antibodies ofantiphospholipidsyndrome. Data were analyzed by SPSS software (version 22) and t-test. P Activated Protein C-Resistance was found in 21.3% of cases, prevalence of PS deficiency and PC deficiency individually with 8.8%, component PSD and PCD in 3.7% and AT-III deficiency in 1.3% of patients. Presence of LAC in our patients was 3.8%. The prevalence of APA, LAC, ACA and B2 microglobulin were 2.5%, 3.8%, 1.3 and 2.5% respectively. APC-R was the most common deficiency of natural coagulant inhibitors in women with recurrent abortion who referred to clinical laboratory of Bagheatalah general hospital in Tehran.

Cancer is one of the most common causes of death in the world and breast cancer is known as the second leading cause of death in women worldwide. Breast cancer is a heterogeneous tumor; various studies have shown that angiogenesis plays an important role in progression and development of cancer. Clinical studies have been performed on the relationship between anti-angiogenic drugs along with chemotherapy in improvement of breast cancer treatment. This review article was performed with aim to evaluate the effect of anti-angiogenic drugs along with chemotherapy in breast cancer treatment. In this review study, the related articles were searched in databases of Scopus, PubMed, ISI and Google scholar by the key words including “Breast cancer”, “Anti-angiogenic drug”, ” Chemotherapy” and “Angiogenesis” in Mesh between 2000-2018. No time limitation was considered in selection of the articles. Selection of the articles was based on use of anti-angiogenic drugs along with chemotherapy or as part of chemotherapy drugs in breast cancer treatment. At the end of study, data were analyzed qualitatively. According to the studies’ results, it was determined that use of anti-angiogenic drugs in improving breast cancer treatment could be more investigated. VEGF and VEGFR inhibitors have shown different clinical effects that could be due to differences in dosage, method of consumption or drug interactions. Although anti-angiogenic drugs have positive role in improving breast cancer treatment, since different results in doses and method of consumption of these drugs were observed in clinical trials, performing more studies in this regard is required. In general, it seems that these drugs in combination with standard chemotherapy agents could be a good candidate for treatment and increasing survival rate in breast cancer patients.

Endometriosis is a common gynecologic problem which can lead to destruction of a woman's life. Some pharmacological techniques and surgical resection are effective in treating endometriosis pain, but are associated with high recurrence rate. This narrative review study was performed with aim to evaluate the efficacy of some complementary therapies on the control of endometriosis complications. In this review, the related articles were reviewed by searching the databases such as Pubmed, Cochrane, Scopus, Web of Science, Uptodate, SID, Irandoc, Magiran, and as well as Google Scholar search engine without time limitations up to February 2019. Search was conducted using the keywords of “Endometriosis”, “Complementary Therapies”, “Acupuncture”, “Massage”, “Herbal Medicine”, “Transcutaneous Electric Nerve Stimulation” and their Persian equivalent. According to search strategy, 8702 articles were found in the first stage, ultimately, among them, 12 articles had inclusion criteria to enter the current review. Based on the findings of these studies, the use of acupuncture and herbal medicine have significant effect on the improvement of endometriosis parameters such as pelvic chronic pain, dyspareunia, dysmenorrhea and infertility. In addition, the results of two studies about comparison of herbal medicine and routine chemical drugs used in endometriosis treatment indicated the equality of their effects in reducing pain and improving fertility. The effect of massage therapy and use of transcutaneous electric nerve stimulation on pain management in these patients was confirmed in two separate studies. The findings of present study indicate the positive effects of acupuncture, medicinal herbs, massage therapy and transcutaneous electric nerve stimulation in managing the complications of endometriosis. Therefore, the use of these therapeutic approaches and referral of patients to complementary medicine specialists is suggested as one of the most important priorities in the management of endometriosis complications.