مجله زنان مامائی و نازائی ایران
سال بیست و سوم شماره 8 (آبان 1399)

Vaginal birth after cesarean is one of the methods used to reduce the increasing number of cesarean sections. This study was performed with aim to evaluate maternal and fetal complications in women who had successful vaginal delivery after cesarean.

This retrospective study was performed on 160 women who had successful vaginal delivery after one cesarean section with transverse uterine incision at Mashhad Omolbanin hospital in 2016-2018. Demographic data related to delivery and the infants' data were collected from the patients' records. Data was analyzed by SPSS software (version 11) Kolmogrov-Smirnov, Chi-square and t-test. p < 0.05 was considered statistically significant.

Among 160 patients, 141 cases (88.12%) had successful normal vaginal delivery and 19 cases (11.88%) had cesarean section. The two groups of success and failure of normal delivery after cesarean section had no significant difference in terms of mean maternal age (p= 0.18), body mass (p=0.07), gestational age (p= 0.15) and distance from previous cesarean section (p=0.07). The bishop score less than 6 was significantly higher in the failure group than in the success group (p=0.02). In the failure group, postpartum hemorrhage (p= 0.03) and NICU admission (p=<0.001) were significantly higher.

Vaginal delivery after cesarean is a safe delivery method and reduces maternal and fetal risks caused by repeated cesarean section.

Breast cancer is the most common cancer among women. Anxiety can weaken the body's immune system and make them vulnerable to the diseases such as coronavirus disease. This study was performed with aim to evaluate the level of anxiety caused by the new coronavirus (Covid-19) in patients with breast cancer during the coronavirus pandemic.

This descriptive cross-sectional study was performed in 2020 on 102 breast cancer patients in Jahrom. Data collection tools were Demographic Information Questionnaire and Coronavirus Disease Anxiety Scale (CDAS). Scoring range in this study was 0-54. Data were analyzed by SPSS software (version 21) and statistical tests of t-test and ANOVA or its non-parametric equivalent. p < 0.05 was considered statistically significant.

The mean score of anxiety caused by Covid-19 virus 19 in patients with breast cancer was 22.44±16.61, which is lower than average level. Among the components of anxiety, the mean score of psychological symptoms (36.81±24.38) in patients with breast cancer was higher than physical symptoms (12.76±11.73). No significant relationship was observed between other demographic variables and anxiety caused by Coronavirus 19 (P>0.05).

The results of the present study showed that the level of anxiety in women with breast cancer in Jahrom is lower than average level.

Delay in diagnosis of PABC (pregnancy associated breast cancer) is common and the lack of awareness of PABC may preclude timely imaging investigation or biopsy. This study was performed with aim to evaluate the mammographic and sonographic findings in women with PABC.

This retrospective cross-sectional study was conducted on 24 women with PABC during pregnancy and lactation in radiology ward of Imam Reza hospital, Mashhad university of Medical sciences in 2006-2018. The mammographic and sonographic features were assessed in 24 women with PABC. The diagnosis of PABC was performed after histological examination in all patients. Data were analyzed by SPSS software (version 22). p < 0.05 was considered statistically significant.

PABC was diagnosed in six patients (25%) during pregnancy and in 18 patients (75%) after delivery. The most common cause of admission was breast mass (83%). The most common finding in mammography examination was breast mass with microcalcification (40%). The most common finding in sonography was breast mass (83.3%). The most common manifestation in sonography was hypoechoic mass with non-uniform echogenesity with irregular margin and vertical orientation. Pathology finding showed ductal invasive carcinoma in 22 patients (91.66%), non-invasive carcinoma in one patient (4.16%) and inflammatory carcinoma in one patient (4.16%)

Ultrasound appearance of PABC may be different from that of breast cancer in non-pregnant women and ultrasound findings such as prominent cystic component, posterior enhancement, and parallel orientation are not uncommon findings in PABC. So, ultrasound findings may mimic benign breast lesion during pregnancy and lactation. Mammography and ultrasound are two complementary imaging methods in women with palpable mass during pregnancy and lactation.

Chlamydial infection is a common infection. This bacterium can cause complications such as: pelvic inflammatory infection (PID), ectopic pregnancy, infertility and abortion. This study was performed with aim to evaluate the prevalence of Chlamydia trachomatis infection in women with a history of abortion referred to Bental-Hoda Hospital in Bojnurd.

This descriptive study was performed on 90 women with a history of abortion who had referred to the Bental-Hoda Hospital in 2019. The research tool was the questionnaire and the study's sample was blood which was transferred to microbiology laboratory for ELISA test. Patient's demographic information and medical history including age, number of pregnancies, number of abortions, place of residence and number of successful deliveries were collected. Data were analyzed using SPSS software (version 19) and Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.

The prevalence of Chlamydial infection was 12.2% (n = 11). There was no significant relationship between the test's result (Chlamydial infection) and patients' age (p=0.92). The mean age was 27.7± 7.8 years in patients with chlamydia positive infection and 27.9±7.6 years in patients with negative infection. Also, no significant relationship was found between gestational age, number of pregnancies, place of residence, number of abortions and number of successful deliveries with test's result (chlamydial infection) (p<0.05).

Since in this study, the prevalence of Chlamydia infection was 12.2% in women with a history of abortion, in order to reduce the burden of disease in the community and prevent its complications, screening for Chlamydia by ELISA method can be considered as a part of routine care programs before and during pregnancy in all health centers.

Many new studies related to peri-implantation period and maintenance of pregnancy suggest that microRNAs have fundamentally role in regulating critical pathways in early pregnancy loss and implantation failure. This study was performed with aim to evaluate the possible association between has-miR-125 T>C polymorphism and susceptibility to idiopathic recurrent pregnancy loss (RPL).

In this case-control study, 116 females with at least two or more recurrent pregnancy loss and 89 healthy women with a history of two successful pregnancies and without a history of miscarriage were evaluated. DNA molecule was extracted by RGDE method and genotyping was performed by ARMS Tetra method. Data were analyzed by SPSS software (version 22) and Chi-squared test. P<0.05 was considered statistically significant.

The frequency of TT, TC and CC genotypes of rs12976445 polymorphism were 50.86%, 42.25% and 6.89% and in women with RPL and were 58.43%, 39.33% and 2.24% in healthy women. There was no significant relationship between rs12976445 polymorphism and recurrent pregnancy loss (P=0.238).

No significant association was found between rs12976445 polymorphism and RPL.

Quarantine is medically very effective in protecting the public from disease. Given the significant role of women in forming the health behavior of the family, this study was performed with aim to investigate the level of knowledge, attitude, and practice of women in Sabzevar concerning home quarantine for prevention of the new coronavirus disease.

This cross-sectional study was performed on 605 women of Sabzevar in 2019. The study tool was a researcher-made questionnaire whose validity and reliability were approved. The range of scores in each dimension of the questionnaire was between 0 and 100. Data were collected by available and non-probabilistic sampling methods as virtual dissemination. Data were analyzed by SPSS software (version 16) and t-test, analysis of variance, Pearson correlation test, and linear regression test. P<0.05 was considered statistically significant.

The highest mean score of practice concerning the home quarantine program were observed in the age group upper 55years (82.58±22.31) and College education (70.77±21.95). The mean scores of women's knowledge, attitude, and practice concerning the home quarantine program were 73.45 ± 13.73, 80.74 ± 7.27, and 69.71 ± 22.14, respectively. Age (P =0.004, B =2.6), education level (P = 0.03, B = 4.45), and attitude (P = 0.03; B =0.27) had an increasing impact on women’s practice.

The level of knowledge, attitude, and practice about the implementation of home quarantine to prevent coronavirus disease was satisfied. However, despite the positive attitude of women about the implementation of home quarantine, their practice was not satisfied. This shows that given the role of women in improving the health behavior of the family, enhancing their skills and capabilities is essential.

Endometrial cancer is the most common gynecologic malignancy in developed countries. The incidence of endometrial cancer is increasing in Iran. The risk of endometrial cancer is related to estrogen levels that breastfeeding reduces it. This study was performed with aim to compare breastfeeding duration in women with endometrial cancer and women without endometrial cancer.

This retrospective case-control study was performed on 240 women referring to the hospitals of Shahid Beheshti University of Medical Sciences, Tehran in 2017. The case group included women with endometrial cancer and the control group was women without endometrial cancer. Data was collected by interview and completion of demographic and fertility characteristics, medical records and endometrial cancer information. Data were analyzed by SPSS (version 21) and Chi-Square, independent T-Test, Mann-Whitney and ROC curve. P< was considered statistically significant.

24 women (20%) in case group and 41 women (34%) in control group reported the history of breastfeeding. The mean duration of breastfeeding in the case group was 58.58±22.19 months and in the control group were 72.61±15.38 months. The duration of breastfeeding in the case group was significantly shorter than the control group (p = 0.004).

Women with endometrial cancer had shorter duration of breastfeeding, so breastfeeding training must be noticed as postpartum care.

Breast cancer is one of the most common malignancies in the world. Although the etiology of breast cancer is not completely known, but exposure to Human papilloma virus (HPV) is suggested as a risk factor for breast cancer. This study was performed with aim to investigate the presence of HPV-DNA in tissue samples of healthy and breast cancer women in Khuzestan province.

In this retrospective study conducted in 2018, 40 paraffin blocks were collected from patients with diagnosis of breast malignancy and 20 healthy paraffin blocks from those without malignant lesion (Fibro adenoma) in Khuzestan province. After DNA extraction, amplification of beta-actin housekeeping gene was done for evaluation of DNA purity. The presence of DNA-HPV16,18 was examined by polymerase chain reaction (PCR) using virus specific primers. Data were analyzed by SPSS software (version 16) and Cramer test. P<0.05 was considered statistically significant.

DNA-HPV16 was detected in 25 cases of 40 breast cancer samples (%62.5), and DNA-HPV 18 was detected in 10 cases of 40 breast cancer samples (%25). None of the 20 control samples showed the presence of DNA-HPV16 and DNA-HPV18. Statistically, the Cramer index for HPV16 and HPV18 infection in cancer sample was calculated 0.598 and 0.316, respectively.

There is a significant relationship between breast cancer and HPV16,18 virus infection in women of Khuzestan province.

Endometriosis is a chronic inflammatory disease which affects fertility. This study was performed with aim to evaluate the clinical role of surgical intervention and assisted reproductive technology (ART) in infertile women with endometriosis on the basis of recent clinical guidelines.

In this review study, the published articles in the databases of PubMed, Science direct, Scopus, Google scholar were searched using the keywords of "endometriosis" and / or "endometrioma" and / or "assisted reproductive technology" and / or "infertility" and / or "laparoscopy" and / or "cystectomy" and / or "surgery" and/ or "guideline" from January of 2000 to November 2019. All guidelines published in English in the field of laparoscopy and surgery in endometriosis and infertility were reviewed.

Until now, 6 international guidelines have been published in this field and we reviewed these articles in the present study. According to the recent evidences, laparoscopy is not routinely performed prior to ART and its clinical application is to diagnose mild from moderate endometriosis; however surgical resection is considered if mild endometriosis is present, as it may improve the spontaneous pregnancy rate. In the case of more severe types of disease (endometrioma and deep penetrating endometriosis), the benefits of pre-ART surgery are still unclear and its risks and benefits should be assessed.

Based on the available guidelines, it is suggested that decision for surgery in infertile women with endometriosis should be made individually and on the basis of the patient’ selection, age and ovarian reserve, association with annoying symptoms, other causes of infertility, location of lesion and possible risk of repeated surgery.

Postpartum weight retention has a significant effect on obesity, chronic disease, and adverse maternal, fetal, and neonatal outcomes. Nowadays, social factors are of the basic causes of health and disease. The present systematic review was conducted with aim to investigate the relationship between social determinants of health and postpartum weight retention in Iranian studies.

In this systematic review, Persian and English observational articles (cohort, case-control, cross-sectional) were searched in databases of PubMed, Google Scholar, Scopus, Embase, Web of Science, SID, Magiran, Irandoc using the different combination of keywords related to “Social determinants of health” And “postpartum weight retention” obtained from Medical Subject Headings (MeSH) from 2000 to 2019. The articles were selected based on the inclusion and exclusion criteria. The quality of selected studies was evaluated using the Newcastle–Ottawa Scale.

From 485 reviewed articles, eight studies were selected. Social determinants of health were classified into structural and intermediate groups based on the WHO model. The structural determinants included education, occupation, income, and residence area. Intermediate determinants were classified into three domains of behavioral factors, biological factors, and psychosocial factors based on this model. According to the results of the reviewed studies, a statistically significant relationship was observed between postpartum weight retention with mother's education, exercise, postpartum functional status, exclusive breastfeeding, formula feeding, pre-pregnancy weight, gestational weight gain, parity, mode of delivery, age, depression, and anxiety.

The results of the current systematic review illustrated the impact of structural and intermediate social determinants of health- including women's education and factors in behavioral, biological, and psychosocial domains- on postpartum weight retention. This result confirms the need for health authorities and staff to pay more attention to these influencing factors along with other medical factors to help prevent or reduce the extent of this problem and its complications.

Vasomotor symptoms occur in approximately 75% of menopausal women. Hot flash is the main reason of women's referring to receive menopausal care. Estrogen therapy is the most effective way to treat symptoms; given the known risks of hormone therapy, many women are interested to use herbal medicines for treatment of menopausal symptoms including hot flushes. Therefore, this study was performed with aim to evaluate the clinical trials conducted to evaluate the effectiveness of herbal medicines for treatment of hot flashes.

In this review study, to find the related articles, the databases of SID, Pubmed, Scopus and Web of Science were searched using the keywords of Menopause, Herbal medicine, medicine and Hot flash from 2002-2019. The articles which were performed as clinical trial were selected.

31 randomized clinical trials were identified. These studies had investigated Vitagnus (2), soybean (4), Black cohosh (3), Ginkgo biloba (2), sage (4), Valerian (2), Flaxseed (2), red clover (5), Hypericum perforatum (1), evening primrose (2), fenugreek (1) and passion flower (1), and one study was also done as combination. It seems that phytoestrogens and lignans found in these plants can reduce the severity and duration of hot flashes with minimal side effects.

Overall, the findings of this study showed that herbal medicine which belongs to phytoestrogens or lignans like as Vitagnus, licorice, soy, red clover, flax seeds, sage, passion flower, valerian, Hypericum and evening primrose can lead to improvement of hot flashes, but further studies in larger populations are needed.

Spleen is an immunologic organ and has critical role in prevention of capsulated microorganism infection. Accessory spleen after splenectomy is important due to this immunologic effect. On the other hand, accessory spleens should be considered in differential diagnosis of abdomino-pelvic masses. In this report, we present a rare case of pelvic mass with final diagnosis of autoimplantationof accessory spleen on the mesentery of the rectum.

The patient was a 32-year-old nulligravidarum woman with history of primary infertility and previous splenectomy due to spleen trauma in childhood without the history of hospitalization due to infection. The imaging results showed solid and hypervascular pelvic mass following IVF assessment.
The patient was admitted in Gynecology Oncology Surgery Section in Emam Khomeini hospital, Tehran University of Medical Sciences. She underwent laparotomy, and the result due to the frozen section pathology, was reported as accessory spleen.

Abdominopelvic masses with normal serum tumor marker, especially in patient with previous trauma and splenectomy, should be considered in differential diagnosis of accessory spleens, and should be confirmed with exact assessment by nuclear scan or laparoscopy, so that by accidental resection of these kind of masses the immunological safety of patients wouldn't be at risk.