مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 6 (شهریور 1398)

Ultrasound is a valuable diagnostic imaging modality in the clinical evaluation of breast masses. BIRADS (Breast Imaging Reporting and Data System) classification in ultrasound is an important and reliable method for assessment and estimation of the risk of malignancy in breast lesions. This study was performed with aim to evaluate the accuracy of the results of BIRADS classification (Grade 3 and 4) using sonography in evaluating the level of malignancy of breast masses and comparing it with pathology results. This study was performed on 139 patients referred to Imam Reza hospital, Omid Oncology hospital and some private clinics in Mashhad and evaluated the patients with palpable breast mass who were ultrasound candidates for further examination of the nature of mass in 2014-2016. Axilla breast ultrasound was performed by two radiology professors. Based on the classification of the American Radiology Society and BIRADS system, various degrees of breast masses malignancy were identified, and then the patients were referred for biopsy. The pathologic results were compared with ultrasound reports, and consistency of the results and accuracy of ultrasound were examined with statistical tests. Data were analyzed by SPSS software (version 16). Out of 37 biopsies of lesions with BIRADS-3 in ultrasound, two (5.4%) of the lesions resulted in malignant pathology. Out of 102 biopsies of lesions with BIRADS-4 in ultrasound, 65 (64%) resulted in benign pathology which indicates no consistency of pathology results with sonography in these cases. The sensitivity of the BIRADS-3 system for diagnosis of benign breast masses was 94% and its specificity was 64%. The sensitivity of the BIRADS-4 system for diagnosis of malignant breast cancers was 75% and its specificity was 79%. There was consistency between the results obtained from the classification by the BIRADS method and pathology; so regarding the relatively high accuracy of this method, radiologic-pathologic consistency can be used to determine how to follow the patients and choose the appropriate treatment method.

Causes of prolonged labor have been extensively studied. It has been previously proved that glucose is the main energy substrate for pregnant uterus. It is assumed that intravenous dextrose may shorten the length of labor; however there is no enough evidence in this regard. This study was performed with aim to compare labor duration and maternal-neonatal short-term outcomes in nulliparous women with vaginal delivery receiving intravenous normal saline or dextrose. In this double-blind randomized clinical trial, 300 nulliparous, singleton women in active phase of vaginal delivery were studied in Tabriz Alzahra educational center in 2013. The women were simple randomly divided into three similar groups: receiving intravenous normal saline 125 ml/h, receiving intravenous dextrose 5% 125 ml/h and control. Data were collected by maternal- pregnancy characteristics questionnaire (based on examination and mother's file) and fetal-neonatal outcomes questionnaire (based on examination and neonate's file). Data were analyzed using SPSS software (version 15), and one way ANOVA, Tukey post hoc test, Chi-square or Fisher exact test. P<0.05 was considered statistically significant. Mean duration of first stage of labor was similar in three groups (p = 0.69); however, mean duration of second stage (p<0.001), third stage (p<0.001) and total length of labor (p<0.001) were significantly lower in dextrose group. Prolonged labor (>12h) was significantly more common in control group (39%) than in dextrose group (5%) and normal saline group (10%) (p<0.001). Maternal and neonatal short-term outcomes were not significantly different between three groups (P>0.05). Total duration of labor in nulliparous term women with active vaginal labor is reduced by intravenous injection of 125 ml/h dextrose 5%.

Placental weight is one of the key determinants of its health and adequacy which is affected by some maternal fertility and biochemical properties. Therefore, this study was performed with aim to evaluate the relationship between maternal fertility characteristics and some blood markers with placental weight. This cross-sectional analytic study was conducted on 365 parturient women referred to Kazeroon Vali-E-Asr maternity in 2017. The individual and fertility characteristics of qualified women (maternal age, gestational age, maternal weight in early pregnancy, maternal height, parity, Hb & HCT level and placental weight) were collected via a researcher-made questionnaire, and the placentas were weighted by standard scale. Data were analyzed by SPSS software (version 21) and person correlation coefficient and multiple regression analysis. PResults The mean placental weight was 583±1.3 g, mean BMI was 25.1± 5.3 kg/m2, mean hemoglobin level was 12.75±.0.94 mg/dl and mean hematocrit level was 28.23± 2.92%. There was significant and positive relationship between maternal BMI, gestational age (P< 0.05), and placental weight. In addition, the multiple regression coefficients indicated that BMI and gestational age are positive predictors of placental weight (P < 0.001, β= 0.24, and β= 0.20, respectively) and explained an overall 10% of the variance in placental weight. However, the distribution of placental weight had no significant relationship with parity, maternal age, Hb and HCT levels. There was a significant relationship between placental weight with maternal BMI and gestational age. Therefore, in order to protect the proper function of the placenta, proper cares for favorable maternal BMI and proper weight gain and taking caution about pregnancy termination is recommended.

In response to rapid fertility reduction over the recent decades in Iran, pronatalist policies was introduced in 2014 and significant changes has occurred in the family planning programs in the country, while it is not clear enough what influences these policies have had on pattern of using contraceptive methods. This study was performed with aim to determine the role of pronatalist policies in the pattern of using contraceptive methods, as well as the attitudes of women towards changes in the access, quality, cost and advocacy of contraceptive methods after introduction of these polices. This descriptive-analytic and comparison study is a population-based survey which was conducted among 454 married women aged 15-49 years in Sanandaj in 2016. Data collection was performed using a researcher-made questionnaire. Last contraception used (n=454) was compared to corresponding method used in the Demographic Health Survey of Kordestan (n=260) in 2010. The women’s attitude towards changes in the provision, quality and cost of contraceptive methods were evaluated and the factors associated to the women’s attitude were also assessed using t-test and Chi-square test. P<0.05 was considered statistically significant. Over the period of 2010-2016, the prevalence of modern methods was reduced from 81.2% to 64.7%, while the prevalence of withdrawal method increased from 19% to 36%. A reduction was shown in the prevalence of women's tubal ligation (from 24.4% to 4%). The prevalence of using IUD and condom was clearly increased from 19% to 26.3% and from 11% to 15.1%, respectively. In 2016 survey, a reduction was reported in the access, quality, and advocacy and informing of contraceptive methods and the cost of providing contraceptive methods had increased compared to two years ago from the viewpoints of women at reproductive age. Women from lower socio-economic status were more concerned of rising cost and reduced quality of contraceptive methods. The pattern of contraceptive methods has been changed from safe to unsafe methods. Adverse health consequences of restriction of family planning due to new population policies will be greater for vulnerable groups of the society that needs more attention by health policymakers and appropriate interventions.

Headache is one of the complications of spinal anesthesia in various surgeries. Spinal anesthesia has a major role in cesarean section. This study was performed with aim to investigate the effect of semi-sitting position on headache after spinal anesthesia in women undergoing elective Cesarean Section. This interventional study was performed on 110 pregnant women with cesarean section at Rafsanjan Nikanfas Hospital in 2018. In recovery time, the subjects were placed into two groups: head position in 30 degree and flat position. The incidence and intensity of headache was assessed using the pain Visual Analogue Scale in the first, second and third days after the surgery. Data were analyzed by SPSS software (version 18) and independent t-test, Chi-square test and Two-way Repeated Measures ANOVA. P Mean of headache severity in the group with flat head position in the first, second and third days was 0.98 ± 2.41, 0.87 ± 2.16 and 0.78 ± 1.92, respectively, and in the group of 30 degrees head position was 1.41 ± 2.89, 1.30 ± 2.70 and 1.12 ± 2.33, respectively. The severity of pain in both groups was significantly decreased on different days (p <0.0001), although there was no significant difference between the two groups (p =.379). Flat head positioning during recovery of spinal anesthesia in women undergoing elective cesarean section decreased the severity of postoperative headache compared with head position at 30 degrees, although this difference was not statistically significant.

Neuropathic pain can be one of the main causes of decreased sleep quality, and undesirable sleep quality has negative effects on quality of life and treatment continuation. This study was performed with aim to evaluate neuropathic pain and factors affecting sleep quality in women with breast cancer after radiotherapy. This descriptive-correlational study was performed from 21March 2017 to 20February 2019 on women with breast cancer undergoing radiotherapy in Imam Reza Educational Center, Tabriz University of Medical Sciences. The tools included demographic characteristics, VAS pain questionnaire, and Pittsburgh Sleep Disorders Questionnaire which measured neuropathic pain and sleep status. Data was analyzed by SPSS software (version 20) and multivariate regression test. P <0.05 was considered statistically significant. Mean of pain severity in patients participating in the study was 06.55±1.03 and mean score of sleep was 12.29±3.20. According to regression results, the variables of age (P=0.012), pain intensity (P=0.001), mastectomy (P=0.011), lymph nodes removal (P=0.03), number of radiotherapy sessions (P=0.003), history of chemotherapy (P=0.002) and stage of disease (P=0.01) significantly predicted sleep disorder. Prevalence of neuropathic pain after radiotherapy in women with breast cancer was high in this study, and this pain was the predictor of sleep disorder in these women.

Nausea and vomiting are among the most common gastrointestinal complaints of women at beginning of pregnancy that can cause many social and individual problems. Since no study was found on the effect offoot solar plexus reflexology on nausea and vomiting of pregnancy in Iran, this study was performed with aim to evaluate the effect of solar plexus reflexology on severity of nausea and vomiting at first half of pregnancy. This randomized clinical trial was conducted on 73 pregnant women at 8-20 weeks of pregnancy who referred to one of the health care centers of Najafi, Amiralmomenin and Vahdat, Mashhad in 2018. The subjects were randomly divided into two groups of reflexology (n=36) and control (n=37). This study was conducted for 10 days in three steps; the scores of nausea and vomiting were measured by Rhodes Index. No intervention was done on days 1 to 3. On days 4 to 7, intervention group received one session of foot reflexology daily for 20 minutes with emphasis on solar plexus point, and the control group received only routine care. On days 8 to10, no intervention was performed. Data were analyzed by SPSS software (version 25) and variance analysis, Chi-square and independent t-test. P<0.05 was considered statistically significant. The changes in mean score of nausea, vomiting and retching after the intervention had significant decrease in the intervention group compared to control group as 0.36 unit ( p = 0.04 ), 0.77 unit ( p< 0.001) and 0.46 unit ( p= 0.004), respectively. Foot solar plexus reflexology has positive effect on gestational nausea, vomiting and retching. Since gestational nausea and vomiting is common and reflexology is safe, the use of this technique is recommended in pregnancy.

Low birth weight (LBW) is a very sensitive and useful index for child's health. Therefore, evaluation of the related risk factors is very noticeable. So, this study was performed with aim to determine the relationship between maternal cardiovascular diseases risk factors and low birth weight risk in neonates. This case-control study was conducted in 2018 on 250 newborn infants, of which 125 with low birth weight were considered as case group and 125 with normal weight as control group. They were randomly selected from eligible individuals. Data were analyzed by statistical tests including crosstab, t-test, Chi-square and logistic regression with regard to error less than α = 0.05. Some risk factors of maternal cardiovascular diseases including physical inactivity (P = 0.007), exposure to smoke and tobacco (P = 0.005), triglyceride (P = 0.008), cholesterol (P = 0.028), salt intake (P = 0.004), inadequate consumption of fruit (P = 0.05), inadequate consumption of vegetables (P = 0.03), and consumption of fast food and drinks (P = 0.01) had significant relationship with LBW in neonates. According to the results of this study, some maternal risk factors of cardiovascular diseases such as exposure to tobacco smoke and smoking, salt intake, fast food and drinks, lack of fruits and vegetables consumption, lack of activity and high levels of triglyceride can be considered as risk factors for LBW.

Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. Complementary medicine with a comprehensive and holistic approach in treating the diseases has become more popular in many countries. Since ancient times, leech therapy has been used to treat many diseases in Iranian traditional medicine. The present study was conducted with aim to review Iranian traditional medicine about leech therapy in polycystic ovary syndrome. In this review study, the issues related to polycystic ovary syndrome and leech therapy were studied in Iranian traditional medicine sources such as Qanun, kholasat al-hekmeh, Exir-e-aazam and Mofarrah al-gholub. Then, searching was performed in databases of PubMed, Google Scholar, Scopus, SID, and Magiran using the keywords such as “leech”, “leech therapy”, “Hirudo medicinalis”, “Hirudins” with “polycystic ovary syndrome”, “uterus”, and “oligoamenorrhea”. The review papers and clinical trial studies were searched in Persian and English languages without any time limitation, and the related materials were extracted and categorized. The symptoms of PCOS such as the enlargement and stiffness of the ovaries and oligoamenorrhea were reported in ITM references entitled as “Ehtebas tams”. Leech therapy is useful in treatment of these patients by reducing the ovarian swelling, causing menstruation, eliminating waste material, as well as antioxidant and anti-inflammatory effects. Leech therapy can be used as a complementary treatment in patients with polycystic ovarian syndrome.

Regarding recent advances in infertility treatment and extended use of gamete donation, it is necessary to increase the awareness of health care providers about legal and religious aspects of oocyte and sperm donation in order to have an effective consultation. Therefore, this review article was done with aim to evaluate the studies performed on the legal and religious counseling aspects of gamete donation in Iran. This review study is the result of reviewing the published evidences regarding different aspects of gamete donation in Iran from 2006 to 2018 in Persian databases of SID, Iran Medex, and English databases of Pub Med, CINAHL, and Google Scholar. For data collection, searching was done on the articles which had the key words of "oocyte donation", "gamete donation", "sperm donation", "counseling", "law ", and "religion" alone or in combination in the title or text as Persian and English. In this review study, 27 studies which were extracted from 304 studies related to legal and religious aspects of gamete donation were reviewed. In Iranian law, various aspects of oocyte and sperm donation are not clear. There is disagreement between Shia scholars regarding gamete donation and is not accepted by the majority Sunni scholars. Due to legal issues such as inheritance and Relative ambiguity, the need for continuous and comprehensive counseling is emphasized The law of Iran has been silent regarding gamete donation, and jurisprudents also disagree on the legitimacy of this issue. Therefore, formulation of a comprehensive and accessible guide consultancy to answer the law and jurisprudence question of couples who need donated gametes is necessary by the legal and treatment system of the country.

Cervical failure is one of the causes of early childbirth and neonatal death in the second and third trimesters of pregnancy. Most women with cervical failure can be effectively treated with cervical cerclage. Trans-abdominal cerclage is an effective and efficient method in patients with short cervix, history of preterm labor and history of unsuccessful transvaginal cerclage. In this study, a rare case of successful trans-abdominal cerclage is reported. The patient was a 43-year-old woman with history of cesarean section, curettage and one unsuccessful transvaginal cerclage. The patient underwent laparoscopic trans-abdominal cerclage surgery at 12th week of pregnancy due to the probability of preterm delivery, short cervical length and failure of transvaginal cerclage. The patient was subjected to cesarean section at 34th weeks of gestation due to uterine contractions and a healthy baby was born. Since trans-abdominal cerclage has a tremendous effect on patients with a history of preterm labor, and the patients' satisfaction with this method is very high, this surgical technique is strongly supported.