مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 2 (اردیبهشت 1400)

Spinal anesthesia is the most common method of analgesia for elective cesarean section. Nausea and vomiting in the patients can cause problem during the surgery. This study was performed with aim to compare the frequency of nausea and vomiting following spinal anesthesia using the drug combination of Bupivacain-Fentanyl and Bupivacain-Sufentanil in cesarean surgery.

This double-blind clinical trial study was performed in 2013 on 60 patients with term pregnancies who were candidate for cesarean under spinal anesthesia. Group F received 25 µg fentanyl while group S received 2.5 μg Sufentanil with 12.5mg intratechal Bupivacaine. The main complications were nausea and vomiting during and in the hours 1, 2 ,6, 12 and 24 after the surgery. Other investigated complications included hypotension, urinary retention and time of sensory block regression to the level of T8. Data were analyzed by SPSS software (version.16), and Chi-square test and Student t-test, Logistic regression and repeated data logistic. p < 0.05 was considered statistically significant.

The two groups were not significantly different in terms of rate of nausea (P=0.395) and vomiting during (P=0.5) and in hours 1, 2, 6, 12 and 24 after the surgery, hypotension (P=0.589), heart rate changes (P=0.105), urinary retention, the time of sensory block to T8 (P=0.556) and the time of returning motor block (P=0.787).

Using two medications of Fentanyl and Sufentanil in combination with hyperbaric Bupivacain had no impact on the frequency and prevalence of nausea and vomiting.

Hypothyroidism is a clinical syndrome due to thyroid hormones deficiency that can affect reproductive function. Regarding to the prevalence of hypothyroidism and infertility, this study was performed with aim to evaluate the role of hypothyroidism on uterine and ovarian morphology.

In this cohort study which was performed in the clinic of Kermanshah Imam Reza Hospital in 2017, 161 women with subclinical hypothyroidism were selected as exposed group based on TSH level and 161 healthy women were randomly selected as the control group. On the 14th day of the menstrual cycle, ultrasounds were taken from uterus and ovary in two groups and the data were recorded in special data collection form. Data were analyzed by SPSS software (version 16) and Fisher, Kolmogrov Smironov, and independent-t test. p < 0.05 was considered statistically significant.

There were menstrual irregularities (P=0.01), reduced number of pregnancies or lack of pregnancy (P=0.017), increased endometrial thickness (P=0.01), increased volume and number of follicles in the ovaries and reduced size of ovarian follicles (P=0.01) in the exposed group compared to the control group, however, hypothyroidism had no effect on the size of the uterus (P=0.406).  

Hypothyroidism, by increasing the size of the ovaries and the number of the follicles and reducing follicular size causes change in the morphology of the ovaries similar to PCOD, and can be a cause of menstruation irregularity in women of reproductive age.

Polycystic ovary syndrome (PCOs) is the most common endocrine disorder in women. Due to the fact that PCOS starts from adolescence, this study was conducted with aim to investigate the prevalence of this syndrome and its phenotypes based on Rotterdam criteria in adolescent girls in Mashhad.

This cross-sectional study was performed on 650 girls aged 14 to 19 years in public schools of Mashhad in 2018-2019. Sampling was performed as a multi-stage classified cluster. After completing the Individual and Demographic Information Questionnaire, if they had criteria for entering the study, a clinical examination was performed to investigate the clinical symptoms of hyperandrogenism, including hirsutism, acne, and hair loss with the male pattern, and if any of the above symptoms were positive, they were referred for hormonal tests and sonography. The diagnosis of polycystic ovary syndrome and its phenotypes was made based on Rotterdam criteria. Data were analyzed by SPSS software (version 22) and Chi-square and Fisher tests. P<0.05 was considered statistically significant.

Frequency of quadruple phenotypes of polycystic ovary syndrome based on Rotterdam criteria included phenotype A(clinical hyperandrogenism / biochemistry + polycystic ovary) was found in 3 people (7.7%), phenotype B (menstrual disorders + clinical hyperandrogenism / biochemistry) in 11 (28.2%), phenotype C (menstrual disorders + polycystic ovaries) in 14 (35.9%) and phenotype D (menstrual disorders + clinical hyperandrogenism / biochemistry + polycystic ovaries) in 11(28.2%). The overall prevalence of PCOs was 6.8% based on Rotterdam criteria.

Due to the prevalence of four phenotypes of polycystic ovary syndrome and the similarity of symptoms with clinical manifestations of adolescence, it is better to start the diagnosis and treatment of this syndrome from adolescence.

Various factors such as childbirth and breastfeeding can affect women's sexual function, it is important to know about sexual problems and related factors in the postpartum period. This study was performed with aim to determine the factors related to sexual function of lactating women with decreased sexual desire.

This descriptive study was performed in 2018 on 104 lactating women at 2-6 months postpartum with decreased sexual desire in Sonqor health centers. Data collection tools included demographic and midwifery questionnaire, Decreased Sexual Desire Screener (DSDS) and Female Sexual Function Index (FSFI). Data were analyzed by SPSS software (version 24) and Mann-Whitney test, Pearson correlation coefficient, mean and standard deviation. P<0.05 was considered statistically significant.

The results of Pearson correlation coefficient showed a significant inverse correlation between age and total score of sexual function, sexual desire, sexual arousal, orgasm and sexual satisfaction (P <0.05). There was also a significant inverse correlation between the number of pregnancies with sexual desire and sexual arousal (P <0.05) and between the number of live children with sexual desire (P <0.05). There was no statistically significant correlation between sexual function with marriage age, infant's age, the interval between recent pregnancies and income (P >0.05).

Age, number of pregnancies and number of live children are inversely correlated with sexual function, so that the score of sexual function decreases with increase in age, the number of pregnancies and the number of live child. There was no statistically significant correlation between sexual function with marriage age, infant's age, the interval between recent pregnancies and income.

Considering the sensitive morale of patients undergoing in vitro fertilization, there is controversy regarding the severity of pain experienced after oocyte retrieval, the appropriate analgesic drug and the time of its administration in these patients. This study was performed with aim to compare the time of administration of diclofenac suppository on post-operative pain after transvaginal oocyte retreival under general anesthesia.

This clinical trial study was performed on 70 female candidates for oocyte retrieval at Infertility Center of Fatemieh Research Hospital in 2018. The subjects were randomly divided into two groups of A and B (n=35 in each group). Group B received 100 mg diclofenac suppository 15 minutes before oocyte extraction from follicle and group A  immediately after oocyte extraction from ovarian follicles. Pain severity was assessed using visual analogue scale of pain (VAS) after recovery at 15, 30, 60, 90, 120 minutes. Data were analyzed by SPSS software (version 16). T-test was used to compare the mean of data with normal distribution; otherwise nonparametric Mann-Whitney test was used.  Chi-square test (Fisher Exact test) was used to compare the qualitative data. P<0.05 was considered statistically significant.

Both groups had no significant difference in terms of mean age, education level, number of retrieved oocytes, duration of anesthesia, anesthetic drug and hemodynamic status (P > 0.05). 25 patients in group B (71.4%) and 32 in group A (91.4%) had abdominal or vaginal pain after anesthesia (P = 0.03). The mean of total pain intensity in group B was less than group A in the first 120 minutes after anesthesia; there were significant differences at 15 and 90 minutes after anesthesia (P=0.032, P=0.017, respectively). Nausea and vomiting were observed in 4 patients (11.4%) of group B and 3 (8.6%) of group A (P= 0.690). None of the patients had post-operative bleeding.

Administration of diclofenac sodium suppository prior to oocyte extraction from follicle was more effective in patients' analgesia than administration after oocyte extraction from follicle.

Regional anesthesia is the method of choice in cesarean section. Intravenous sleeping pills used to induce anesthesia quickly cross the placenta and cause fetal respiration depression. This study was performed with aim to compare the low dose of propofol with midazolam on the maternal hemodynamics symptoms and neonatal Apgar in women undergoing spinal anesthesia in cesarean section.

In this double-blind randomized clinical trial study which was performed in Jahrom in 2013, 42 patients with anesthesia classes I and II underwent spinal anesthesia and were placed in two equal groups of injection of propofol 20 mg and midazolam 1.5 mg along with spinal anesthesia. Symptoms of maternal hemodynamics were measured at 1, 3, 5, 10, 15, 30, and 60 minutes after spinal anesthesia and neonatal apgar at 1 and 5 minutes after birth. Data were analyzed by SPSS software (version 21) and Mann-Whitney test. p < 0.05 was considered statistically significant.

There was no significant difference between midazolam and propofol groups in terms of systolic and diastolic blood pressure, Blood O2 saturation, and hear rate at different times and neonatal Apgar (P> 0.05).

Considering the results of the study and no difference between the two groups in terms of neonatal Apgar and fluctuations of maternal hemodynamic variables, it can be concluded that under normal conditions, low doses of propofol and midazolam for cesarean section clinically have no significant difference on neonatal Apgar and hemodynamic variables; both drugs can be used depending on the condition and experience of the anesthesiologist.

Women experience many complications due to the physical and psychological changes of menopause. One of the most important of these complications is depression. Due to the side effects of chemical drugs, the use of herbal remedies has been considered by women today. This study was performed with aim to determine the effect of oral capsule of ocimum basilicum leaf extract on depression in menopausal women.

This triple-blind two-group randomized clinical trial study was performed on 60 menopausal women referred to Mashhad health centers in 2019-2020. Women eligible for the study received one 500 mg capsule of ocimum basilicum leaf extract or placebo for one month. Depression was assessed before and after the intervention with DASS21 tool. Data were analyzed by SPSS software (version 21) and independent t-test, Mann-Whitney, Wilcoxon. P < 0.05 was considered statistically significant.

Before the intervention, the mean score of depression in the ocimum basilicum group was 8.8± 6.3 and in the placebo group was 8.6 ±6.3, which was not statistically significant and the two groups were homogeneous (P = 0.904). After the intervention, the mean score of depression in the ocimum basilicum group (5.9± 5.3) was significantly lower than the placebo group (9.2 ± 6.2) (P = 0.049). The difference in the score of depression after the intervention compared to before the intervention decreased by 2.8 ± 4.5 in the ocimum basilicum group and increased by 0.6 ± 2.4 in the placebo group and this difference was statistically significant (P <0.001).

Consumption of basil leaf extract capsules led to decrease in depression score in menopausal women. Therefore, it can be used as medicinal plant to reduce depression in menopausal women.

Sexual dysfunctions are relatively prevalent in female patients with multiple sclerosis (MS) and affect their quality of life. This study was performed with aim to evaluate the effect of Bupropion on sexual function in women with multiple sclerosis.

This randomized controlled clinical trial study was performed in 2019 on 60 women with relapsing and remitting MS, receiving routine MS treatment and had sexual dysfunction. The subjects were divided to two groups of 30 persons receiving Bupropion and placebo. Multiple sclerosis intimacy and sexuality questionnaire, female sexual function index, fatigue severity scale and Beck depression questionnaire were filled out for all the patients before, 4 and 8 weeks after the interventions initiation. Data were analyzed by SPSS software (version 20) and Analysis of variance (AOVA) and repeated measure tests. P<0.05 was considered statistically significant.

Multiple sclerosis intimacy and sexuality scores 8 weeks after the intervention were significantly lower in bupropion group (9.96±45.85) compared to placebo group (53.56±11.46) (P= 0.007). Also, the score of depression in the two stages after the intervention in the bupropion group (11.26 ± 23.03) was lower than the placebo group (37.86 ± 13.43) and decreased during the intervention (p <0.0001). FSFI score and its subscales showed an improvement in bupropion group (2.67±25.88) compared with placebo group (17.44±2.8) which indicated continuity of effectiveness of Bupropion independently from depression and fatigue scores alteration during treatment (p<0.001).

The results of the present study showed the effectiveness of bupropion on improvement of sexual function in female patients with MS.

Preeclampsia is one of the pregnancy complications and is a multiple organ disorder that occurs in 3 to 5 percent of all pregnancies in western countries. Regarding to the involvement of the autonomic and sympathetic systems in pathophysiology of preeclampsia, the role of stress is highlighted in exacerbating the condition. Since the role of factors such as domestic violence is raised in the incidence or exacerbation of preeclampsia, and with regard to the growth and prevalence of domestic violence in the country, this study was performed with aim to determine the association between domestic violence and preeclampsia.

This case-control study was performed on110 post-partum women in two groups of 55 subjects (preeclampsia and non-preeclampsia) in Beasat hospital of Sanandaj in 2017. Demographic data were collected using researcher-made Demographic-Midwifery questionnaire, and then data related to domestic violence using World Health Organization domestic violence questionnaire. Data were analyzed using SPSS software (version 22) and t-test, Mann-Whitney and Chi-square tests. P <0.05 was considered statistically significant.

There was no significant relationship between domestic violence by husband and preeclampsia (P = 0.203). The risk of preeclampsia in the case of domestic violence and physical violence was 1.5 times than control group, sexual violence was 1.6 times than control group, and psychological violence was 1.2 times than control group. There was no significant association between physical, sexual and mental violence with preeclampsia (P=0.328, P=0.473 and P=0.606, respectively).

No significant relationship was found between the incidence of preeclampsia and the types of violence.

Gillian- Barre- Syndrome (GBS) and Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) are immune-mediated disorders of peripheral nervous system which presented with progressive symmetrical muscle weakness, deep tendon reflexes and sensory symptoms. This review study was performed with aim to investigate the effects of pregnancy and postpartum period on immune mediated neuropathies and also the effects of these neuropathies on the prognosis of pregnancy and treatment of these diseases during this period.GBS evolves acutely in 2 to 4 weeks and in two third of cases, there is a history of viral or bacterial infections before the onset of symptoms. CIDP is a chronic auto-immune disorder that progresses at least for 8 weeks in comparison to GBS that evolves in 4 weeks.In this article, we reviewed the effects of pregnancy and postpartum period on these diseases as well as the effects of GBS and CIDP on pregnancy and postpartum period in different articles performed in recent years and collected the appropriate treatments of these disorders during the pregnancy and postpartum period. This article could be a proper guideline for neurologists and obstetrics and gynecologists to treat and predict the prognosis of mothers with immune-mediated neuropathies.

Many immune mediated neuromuscular disorders occur in women at childbearing ages. Incidences of these disorders may affect the pregnancy and childbirth. Also, pregnancy may have influences in the symptoms and treatment of the mentioned disorders. GBS and CIDP are among the most important immune-mediated peripheral nervous system disorders. Recognizing the effects of GBS and CIDP during pregnancy and postpartum period and the effects of pregnancy on the process of these two disorders is so important.

Mammography is the gold standard for diagnosis of breast cancer. But in recent years, other methods such as the Breast Light and thermography have been raised in cancer screening. There are conflicting results about the accuracy of these methods. This review study was performed with aim to determine the diagnostic accuracy of the diagnosis of two methods of breast light and thermography in breast cancer screening.

To achieve the studies, the search was conducted between 1900-2019 on the electronic databases of SID, Google scholar, Pubmed, Cochran, Scopus, Web Of Sciences using the keywords of Mammography, Ultrasound, Breast light, Thermography, Breast Cancer. Participants in the study were all women referred to medical centers who were evaluated by thermography and Brest Light method. The main inclusion criteria included the published articles on sensitivity, specificity, positive predictive value and negative predictive value of thermography and Brest Light methods. Insufficient data of articles and inappropriate and out-of-study content were considered as exclusion criteria. The STARD checklists were used to assess the full-text of the articles, and finally 9 articles which met the inclusion criteria were selected.

In the assessment of various studies comparing sensitivity, specificity, positive and negative predictive value of two methods of Breast light and thermography with other methods (mammography, ultrasound and clinical examination of the breast) showed that Bright light method had the sensitivity of 85.56% -93%, specificity of 53.4%-73.3%, the positive predictive value of 91.4%-93.5% and negative predictive value of 29.7%-77.8%. Thermography method had the sensitivity of 100%, specificity of 68.68%-95.3%, positive predictive value of 15.8% - 41.1% and negative predictive value of 99.1%-100%.

Bright light method has low specificity and although thermography method has high sensitivity, but the specificity and positive predictive value of the method is low, therefore these two methods can be used as an auxiliary method beside mammography or ultrasound.

Free radicals play a double role in the body based on their physiological level and can be beneficial or harmful. This review study was performed with aim to evaluate the cellular and molecular mechanisms of oxidative stress on spermatogenesis and oogenesis and the role of using antioxidant in improving fertility in men and women.

In this review study, the issues related to the role of free radicals and antioxidants on male and female fertility disorders were searched in the Persian and English databases including: Elsevier, Scopus, Irandoc, SID, Iran medex, Sciencedirect, Pubmed, GoogleScholar and Web of Science using the keywords of free radicals, male infertility, female infertility, and antioxidants without any time limitation. Finally, 63 studies entered the review study.

The excessive production of free radicals in the male reproductive system causes damage to DNA, RNA, and sperm membranes, and ultimately disrupts spermatogenesis. It also causes disorders in the female genital tract including defect in oocyte development and maturation, follicular growth and function of corpus luteum.

According the results of previous studies, using antioxidants may remove the harmful effects of free radicals on male and female fertility.