مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 8 (آبان 1398)

Abnormal uterine bleeding (AUB) is one common problem in perimenopausal women that should be carefully evaluated. Evaluation in terms of endometrial cancer and premalignant lesions is very important. This study was performed with aim to investigate the relationship between the findings of transvaginal sonography and pathology of endometrial curettage in women with abnormal uterine bleeding at perimenopause.

This descriptive-analytical study was conducted on 184 perimenopausal women aged 40-50 years with AUB in 2017. The patients underwent transvaginal sonography. D&C was done one week after sonography report if endometrial thickness was > 4 mm. Data collection tool was a self-made questionnaire. Demographic findings of the patients and the results of transvaginal sonography, and hystopathologic assessment of endometrium were recorded. Data were analyzed by SPSS software (version 20), and ANOVA and Kruskal-Wallis tests. P

The most common findings of transvaginal sonography was 37% normal, 30% increased thickness, and 20% endometrial polyp. About 47.3% of histopathologic findings were proliferative, then secretory and endometrial polyps and less than 5% of cases was malignant. There was only one case of adenocarcinoma with 6 mm endometrial thickness. In the estimation of the consistency of sonographic findings with D&C findings, there was significant agreement in abnormal and normal groups (P=0.004).

Major and malignant pathologies namely carcinoma and metaplasia can also be detected in cut-off levels less than 8 mm, even around 5 mm. Therefore, use of D&C along with TVUS in low cut-off levels less than 8 mm seems to be necessary.

Awareness of prevalence of chronic pain after breast cancer surgery and possible contributing factors in the continuation of pain after breast cancer treatment is essential in preventing this pain in improving the quality of life in patients with breast cancer. Therefore, this study was performed with aim to determine the relationship between BMI and chronic pain after breast surgery in women with breast cancer.

This descriptive-correlational study was conducted on 170 patients who had inclusion criteria in Tabriz hospitals from 2017 to 2018. VAS checklist was used to measure the intensity of postoperative chronic pain over six months and a checklist of chronic risk factors affecting chronic pain for research purposes. Data were analyzed by SPSS software (version 22) and Independent t-test, ANOVA, Chi-square and Fisher tests. P<0.05 was considered statistically significant.

The results indicated that chronic pain at all levels was associated with increased BMI, so that with increasing BMI, the chronic pain was also increased (P <0.001)

High BMI can be a risk factor for chronic pain after breast cancer surgery and attention to this index can be helpful in predicting chronic pain

Labor duration is of the factors affecting pregnancy outcomes and damages inflicted on mother and fetus. This study was performed with aim to compare the effects of transcutaneous electrical nerve stimulation (TENS) and pharmaceutical hyoscine - promethazine compound on duration of second phase of labor.

This two-group clinical trial was performed on 84 eligible pregnant women referred to Shahid Chamran Hospital of Kangavar division in 2017. The subjects were placed in two groups of TENS and hyoscine - promethazine (n=42 in each group). In medication group, 20 mg of hyoscine and 25 mg of promethazine were conjointly intramuscularly given at the onset of active phase. In TENS group, TENS device was used with 1 pair of upper electrodes being placed between L1-T10 and 1 pair of lower ones being placed between S2-S4 on both sides of spinal column. Duration of the second phase of labor was assessed in both groups. Data was analyzed by SPSS software (version 17), and Chi-square test, and independent t-test, and paired sample t test. P

Mean of contraction duration during the first phase of labor showed no significant difference between two groups (P=0.86). Also, two groups had no significant difference in terms of mean of contraction frequency (P=0.23). Duration of second phase of labor was 26.1  1.96 min in TENS group and 30.7  1.54 min in hyoscine-promethazine group, that no significant difference was observed between two groups (P=0.232).

The effect of TENS and Hyoscine-Promethazine combination on duration of second stage of labor was similar.

Sexual dysfunction in postmenopausal women may decrease their quality of life during this period. Therefore, regarding to the effect of phytoestrogens on the improvement of menopausal symptoms, this study was performed with aim to investigate the effect of red clover vaginal cream on sexual function in postmenopausal women.

This triple-blind clinical trial was conducted in 2018 on 76 postmenopausal women in Ahvaz. Women were randomly divided into two groups: receiving red clover vaginal cream (n=38) and placebo (n=38); they received one applicator of 5 gr vaginal cream every day for 8 weeks. Sexual function was assessed using female sexual function index (FSFI). Data were analyzed by SPSS software (version 22) and using independent t-test, Chi-square, Mann-Whitney, and Wilcoxon tests. P

The mean score of all areas of sexual function including: desire, arousal, vaginal moisture, orgasm, sexual satisfaction and pain during intercourse significantly increased after 8 weeks of intervention in both groups that changes were significantly greater in the red clover group (P<0.001). Before the intervention, the mean score of sexual function questionnaire was 9.91± 0.41in the red clover group and 9.77±0.28 in the placebo group; after 8 weeks of intervention, it reached to 28.98±1.72 in the red clover group and 17.59±0.51 in the placebo group. The difference was significantly higher in the red clover group than placebo group (p<0.001).

The red clover has beneficial effects on sexual function in postmenopausal women. Therefore, it is recommended as an alternative treatment.

The fetal heart rate monitoring is actually the first test to evaluate the health of fetus. Mother's mental condition impacts the fetal heart rate pattern. Acupressure acts on the basis of acupuncture points, and according to neuro-hormonal theory, acupressure secretes enkephalin and reduces the level of stress and anxiety of the mother. Therefore, this study was performed with aim to determine the effects of acupressure, LV3 point on fetal heart rate parameters and fetal movements during non-stress test.

This clinical trial was performed on 84 nulliparous women with gestational age of 40-42 weeks in Bojnurd Bentolhoda hospital in 2018. The subjects were randomly divided into intervention and control groups. In the intervention group, pressure was applied on the LV3 point in each leg for 2.5 min and in the control group, around the point was touched. Fetal non-stress test was performed for 20 minutes in two steps for 10 min. Data was analyzed by the SPSS software (version 24), and Chi-square, Fisher exact and independent t-tests. P

In the intervention group, mean difference of the variables of baseline fetal heart rate, the number of increase in baseline fetal heart rate, the increase in baseline fetal heart rate, and the number of fetal movements were statistically significant and was more in the second10 minutes after the intervention than the first10 minutes (p<0.05). Mean difference of the variables of increase in baseline fetal heart rate and the number of fetal movements during the first and second stages was more in the intervention group than the control group, and  this difference was statistically significant (p<0.05).

Acupressure can improve fetal heart rate parameters and movements, and decrease the false non-reactive cases due to maternal stress and unnecessary interventions following it.

Effacement and dilatation are important factors affecting the progress and duration of labor. Impairment in their progression can disrupt the normal progress of labor and lead to maternal and neonatal complications. For many years, topical magnesium sulfate has been used experimentally for labor progression in Iran. Therefore, this study was performed with aim to determine the effects of topical magnesium sulfate on progression of effacement, dilatation and duration of labor in nulliparous women.

This double-blind randomized clinical trial was conducted on 72 nulliparous women with term pregnancy that had referred to Tehran Mahdieh hospital for delivery from March 2016 to September 2017. The participants were randomly divided into two groups of magnesium sulfate and placebo (n=36 in each group). In the magnesium sulfate group (intervention), 10 cc of magnesium sulfate 50%, and in the control group, 10 cc of distilled water was poured on the cervix in the beginning of the active phase, and the labor progress was assessed in two groups. Data were analyzed by SPSS software (version 17) and using independent t-test, Mann-Whitney, Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.

Mean duration of active phase of first stage of labor was 1.75±1.13 hours in magnesium sulfate group and 3.85±1.87 hours in placebo group, that was 2.10 hours longer than magnesium sulfate group (P=0.001). The drop-in hemoglobin levels was significantly lower in magnesium sulfate group than in the control group (P=0.022). The number of normal vaginal delivery was higher in magnesium sulfate group, but this difference was not statistically significant (P=0.429). There were no significant differences between two groups in terms of neonatal Apgar score, ruptures in birth canal and the mother’s postpartum conditions (p>0.05).

The use of topical magnesium sulfate on the cervix in the active phase improves effacement and dilatation and shortens the duration of labor. Since there are very few studies on this subject, performing further studies are recommended.

Episiotomy is of common surgical procedures in midwifery and is followed by complications including inflammation, edema, approximation of the wound and perineal pain. In past, Myrtus communis plant has been used to treat wounds and relieve pain. This study was performed with aim to investigate the effect of M. communis cream on wound healing and episiotomy pain severity.

This double-blind clinical trial was conducted on 100 nulliparous women in Zabol Amiralmomenin Ali Hospital from July to November 2018. The participants randomly received Myrtus Communis cream or placebo and used the encoded creams 2 times a day for 10 days. Demographic and obstetrics questionnaire, health status form, analgesic used, Numeric pain rating scale, Reeda scale and drug side effects table were used to assess the individuals. Then, the pain severity and recovery rate were examined on the first 2 hours, fifth and tenth day after delivery. Data were analyzed by SPSS software (version 23) and Mann-Whitney, independent-t, and Chi-square tests. P<0.05 was considered statistically significant.

There was no significant difference between two groups in terms of demographic and obstetric variables and pain severity in first 2 hours after delivery (p>0.05). The mean difference of pain severity on the fifth (p=0.009) and tenth day (p=0.012) after delivery was significant in M. communis cream and placebo cream groups, and the severity of pain was less pain in M. communis cream group. The mean of Reeda score group on the 5th day after delivery was 1.70 ± 1.09 in the M. communis cream group and 2.94 ± 1.51 in the placebo cream group (p<0.001), and on the tenth day after delivery was 1.04 ± 0.854 in the M. communis cream group and 2.06 ± 0.620 in the placebo cream group that was statistically significant (p<0.001).

M. communis cream due to its healing properties accelerates the healing of episiotomy wound and reduces the severity of pain.

Several studies have evaluated the association between maternal thyroid dysfunction during pregnancy and neurocognitive development in children. The important role of maternal thyroid hormones in all stages of the brain development in children is undeniable. Despite performed studies, there is still insufficient evidence on the beneficiary effect of the levothyroxine treatment in pregnant women with thyroid dysfunctions in terms of neurodevelopmental outcomes of children. This systematic review was performed with aim to evaluate the effects of treatment with levothyroxine in pregnant women with thyroid dysfunctions on neurocognitive development in children.

In this systematic review, databases of PubMed, Web of Science, Wiley, Google Scholar, Science Direct and Scopus were searched with appropriate keywords for the English related article from 1950 to 2019. This study used randomized clinical trials, cohort, case-control studies and case report. Among 343 related articles in initial search, 9 eligible studies were finally evaluated.

From 9 studies in this field, seven studies showed that administration of levothyroxine in mothers with thyroid dysfunctions had no significant effect on children's cognitive function or other neurodevelopment indicators; only a case report and a study on 13 samples showed that treatment improved the children neurocognetive indicators.

Treatment with levothyroxine in pregnant women with thyroid dysfunctions has no significant effect on neurodevelopment of children.

Sexual problems are among the most important outcomes of rheumatoid arthritis in the affected women. Incidence of this disease in women is reported 2-3 times higher than that in men. This systematic review and meta-analysis was carried out to investigate the influence of rheumatoid arthritis on women's sexual function.

In this systematic review and meta-analysis, the published articles in the databases, such as Web of Science, Cochrane, PubMed, Scopus, Magiran, SID, and Google Scholar, were searched using the English keywords of “Sexual dysfunction, Sexual behavior, Sexual problems, Rheumatoid arthritis, Sexual functioning, Sexual activity, and Sexual disorder” and their Persian equivalents until December 2018. Data analysis was done using STATA (version 14.1). The I2 index was used to assess the heterogeneity between the studies, and the random effects model was applied to pool the data and perform meta-analysis.

A total of 16 articles were included in the systematic review, and 10 articles with 1580 participants were included in the meta-analysis. Meta-Analysis results showed that based on the random effects model, rheumatoid arthritis leads to the decrease of female sexual function (SMD=-1.01; 95% CI: (-1.24, -0.77); P=0.001) , (RR=1.95; 95% CI: (1.65, 2.30); P<0.0001).

Rheumatoid arthritis leads to the reduction of female sexual function. Therefore, healthcare providers should consider this group of patients for the incidence of female sexual problems and design and implement programs to promote their sexual function.

Various maternal obstetrical complications may occur following each type of delivery. One of these rare but important and problematic complications is orogenital fistula. The incidence of different types of orogenital fistula following delivery is more common in cesarean section and only few cases have been reported following normal vaginal delivery. In this article, a case of vesicouterine fistula after normal vagina delivery is reported.

The patient was a 31-year-old woman with third pregnancy and history of two previous normal vaginal deliveries without complication who had referred to the emergency ward of Mashhad Imam Reza hospital because of labor pain at gestational age of 38 weeks. Delivery progressed from the initial dilation 5 cm and effacement 60% within 2 hours of admission by spontaneous contractions. After delivery of head and shoulders, dystocia occurred during expulsion of abdomen due to large palpable abdominal mass in the fetus; and delivery was done with difficultly. Approximately 10 days after delivery, the patient referred with complaint of malodor watery discharge from vagina. After performing the methylene blue test, diagnosis of the vesicouterine fistula was confirmed by cystography. Urinary foley catheterization was inserted for the patient for 3 months and after re-performing cystography, vesicouterine fistula was completely repaired without need to surgery.

Vesicouterine fistula is of the rarest types of urogenital fistula which is often occurred following cesarean section and sometimes after normal vaginal delivery. One of the risk factors of vesicouterine fistula following vaginal delivery is “labor dystocia”. Many cases of vesicouterine fistula are treated by conservative management and surgery is not needed.