مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 4 (تیر 1400)

Uterine prolapse has been traditionally treated with vaginal hysterectomy and cuff suspension. Recently there is renewed interest in uterine conservation during prolapse surgeries. This study was performed with aim to evaluate the success rate and quality of life in women following one of three types of uterine sparing prolapse surgery.

This retrospective study was performed in Tehran Imam Khomeini Hospital in 2019. The data of 99 patients with uterine prolapse who underwent one of three types of uterine sparing surgery (Manchester, Sacrospinus Hysteropexy, Abdominal sacral Hysteropexy) during three years were reviewed and compared in terms of success rate and quality of life. 99 patients completed a valid questionnaire of quality of life after prolapse surgeries (Pelvic Floor Distress Inventory-20). The success rate after 12 months was evaluated as a primary outcome and the complications such as repeat surgery, using pessary  and feeling mass were evaluated as secondary outcomes. Data were analyzed by SPSS software (version 22) and ANOVA, Kruskal-Wallis and Chi-square tests were used. P < 0.05 was considered statistically significant.

The success rate of sacral hysteropexy was higher than two other groups (about 94%).The highest recurrence was in sacrospinous, in the Ba point ( -2.06± 0.506) and C point (-2.1±1.084) (p<0.01). The quality of life was similar in the Manchester and sacral hysteropexy group and was higher than sacrospinous group. Early complications after sacral hysteropexy were ileus and defecatory disorder.

All three uterine sparing prolapse surgeries had success rate of higher than 60%. All three surgical groups had a good quality of life and satisfaction 12 months after the procedure. The highest recurrence was in sacrospinous in Ba and C points. Finding mesh complications following sacral hysteropexy surgery requires long-term follow-up.

Gestational diabetes increases maternal and neonatal complications. Therefore, this study was performed with aim to examine the effect of the number of pregnancy cares on the reduction of maternal and neonatal complications in women with gestational diabetes.

This cohort study was performed in 2018-2020 on 119 mothers with gestational diabetes in Omolbanin hospital. The subjects in the two groups of pregnancy visits < 10 times and ≥10 times were compared in terms of neonatal complications such as overweight 90%, dystocia and maternal complications like preeclampsia. Data were analyzed using SPSS statistical software (version 23) and independent t-test and Mann-Whitney, Chi-square and Fisher tests. P< 0.05 was considered statistically significant.

In this study, among 119 pregnant women with gestational diabetes, 37 (31.09%) were in the group of pregnancy visits ≥ 10 times and 82 (68.90%) in the group of pregnancy visits < 10 times. The number of infants weighing more than 90 percent was 4 (10.8%) in the group of pregnancy visits ≥ 10 times and was 4 (4.9%) in the group of pregnancy visits < 10 times, which had no statistically significant difference (P=0.2). Mean fasting blood sugar of mothers in third trimester was 91.22 ± 75.14 mg/dl in the group of pregnancy visits ≥ 10 times and was 93.65 ± 30.23 mg/dl in the group of pregnancy visits < 10 times, which was similar in both groups (P=0.2). Also, the incidence of preeclampsia was 3 (6.2%) in the group of pregnancy visits ≥ 10 times and 5 (8.1%) in the group of pregnancy visits < 10 times, which was similar in the two groups (P=0.8). There was no significant difference between the two groups in terms of other maternal and neonatal consequences.

Increasing the number of pregnancy visits in women with gestational diabetes does not improve the maternal and neonatal outcomes.

Since periodontal disease is associated with chronic inflammation, it can be assumed that patients with periodontal disease have a higher risk of developing preeclampsia. Therefore, this study was performed with aim to determine the relationship between periodontal diseases and the risk of preeclampsia in pregnant women.

This case-control study was conducted in 2017-2019 on 100 pregnant women referred to Kermanshah Imam Reza Hospital in two groups of case (preeclamptic women) and control (normal pregnancy). The questionnaire was completed for each patient based on the required information including demographic information, periodontal parameters including bleeding on probing, plaque index, clinical attachment level, probing pocket depth. Data were analyzed using SPSS statistical software (version 20) and Mann–Whitney U and Student's t-tests. P<0.05 was considered statistically significant.

The study of periodontal indicators showed that there was no significant difference between the two groups in terms of bleeding on probing (P = 0.329), probing pocket depth index (P> 0.05) and clinical attachment level (P = 0.733). Only the plaque index was significantly lower in mothers with preeclampsia than mothers with normal pregnancies (P = 0.007).

Although no significant relationship was found between preeclampsia and maternal periodontal disease parameters, however, it is recommended that screening and prevention of periodontal disease in prenatal care be considered in order to improve maternal oral health and improve pregnancy outcomes through inter-professional collaboration.

Randomized controlled clinical trial studies are the most valuable types of studies that their proper design and accurate reporting are of particular importance in medical science. This study was performed with aim to critically evaluate the randomized controlled clinical trial studies in the Iranian Journal of Obstetrics, Gynecology and Infertility.

In this cross-sectional analytic study, the clinical trial articles of the Iranian Journal of Obstetrics, Gynecology and Infertility between 2009 and 2019 were collected and scored based on the latest edition of the Consort Checklist (2010) by three biostatisticians that their training's adequacy was confirmed by measuring the kappa agreement coefficient. The articles were scored, and based on the scores, they were classified into five categories: very poor to excellent. Data were analyzed by SPSS software (version 25) and descriptive statistics.

Out of a total of 1318 articles published during 11 years, 325 were clinical trials, among them only 6 articles (1.85%) were rated as excellent. The lowest and highest scores among the reviewed articles were 14 and 28 (maximum score was 37). The mean and standard deviation of the scores obtained in all articles was calculated as 19.05± 0.34. However, less attention was paid to the two main issues of randomization and blindness in the clinical trials.

Due to the importance of clinical trial studies, it is necessary to pay attention to the articles' quality based on the consort checklist. It is also suggested that authors of such articles pay more attention to the two essential foundations of clinical studies, randomization and blindness, to increase the generalization of the results.

Paying attention to dental and oral hygiene in vulnerable groups, including pregnant women, is important for protecting and maintaining maternal and fetal health. This study was performed with aim to determine the dimensions of health belief model Structures related to oral health behaviors among pregnant women in Kerman city.

This descriptive, analytical and cross-sectional study was performed on 138 pregnant women in health centers of Kerman city in 2018. Data collection tool was a researcher-made questionnaire based on health belief model consisting of four sections: demographic information, oral hygiene status, health belief model and assessment of gingival plaque index by Silness and loe Method. Frequency and relative frequency were calculated for each of the variables. Data were analyzed by SPSS software (version 19) and linear regression analysis and t-test. P< 0.05 was considered statistically significant.

The mean and standard deviation of participants' plaque index was 1.16±0.62, oral hygiene score was 13.49±2.04 and total score of health belief model questionnaire was 130.70±11.84. 61. The plaque index had significant relationship with perceived benefit (p<0.05). Also, there was a significant relationship between health belief model with education level, pregnancy week and type of insurance (p<0.05). A significant relationship was found between oral hygiene status with education level and pregnancy week (p<0.05)

Health performance and dental plaque index of pregnant women are in moderate range which is the result of fear from dental procedures. The total score of people's health belief model is also in the moderate range. So, attention to the beliefs and health aspects of pregnancy care and necessary education in this area is necessary and recommended.

Pelvic Organ Prolapse (POP) is one of the dysfunctions of the Pelvic Floor Muscles (PFM), with descending of pelvic viscera, vaginal wall, uterus, bladder and rectum. Regarding the role of PFM as part of the core muscles in body balance, it has been suggested that women with PFM dysfunctions may have a lower level of balance. Therefore, this study was performed with aim to compare the level of dynamic balance in non-postmenopausal women with and without POP in two positions of full and empty bladder.

This cross-sectional comparative study was performed in 2018 on 30 non-pregnant married women in the Rehabilitation School of Shahid Beheshti University of Medical Sciences. The subjects were divided in to three groups (n=10 in each group): with symptomatic POP, asymptomatic POP and without POP. After collecting demographic information, the pelvic inclination angle, and the dynamic balance in Antero-Posterior, Medio-Lateral planes as well as total balance index were assessed. Data were analyzed using SPSS statistical software (version 22) and Kolmogorov-Smirnov, one-way ANCOVA and Fisher's exact test. P<0.05 was considered statistically significant.

No significant differences were not found among three groups in terms of dynamic balance index with both full and empty bladder (p<0.05). Moreover, there were no significant differences among three groups regarding the pelvic inclination angle (p<0.05).

The association of POP as one of the dysfunctions of pelvic floor muscle is not confirmed by postural stability. Further studies using the motion analysis system and simultaneous recording of electrical muscle activity are recommended.

Sexual satisfaction is a key factor in quality of life that depends on several factors including healthy, pleasant and painless sexual relations. Treatment of sexual dysfunction should be given special attention due to the impact on the relationship between couples and family stability. This study was performed with aim to determine the effect of inhalation of Elaeagnus angustifolia flower essence on dyspareunia and sexual satisfaction of women at reproductive age.

This three-group randomized clinical trial study was performed on 99 women referring to health centers in Mashhad in 2019-2020. The study's units were assigned into three groups. The first group used the essence for 4 weeks, 3 times a day for 20 minutes each time and the second group once only 20 minutes before intercourse as inhalation and the third group did not receive any intervention. The Sexual Function Index (FSFI) was completed before the intervention and at the end of the 4th week after the intervention in all three groups. Data were analyzed by SPSS software (version 21) and one-way analysis of variance, Chi-square and Kruskal-Wallis tests. P<0.05 was considered statistically significant.

The mean score of sexual pain after the intervention in the first intervention group was 4.3±0.8, in the second intervention group was 4.7±0.7 and in the control group was 4.0±0.8. Based on the results of the intra-group test, the intervention was significantly increased only in the second intervention group (p<0.05). The mean score of sexual satisfaction after the intervention in the first intervention group was 4.2±0.7, in the second intervention group was 4.7±0.9 and in the control group was 3.8±0.5. Based on the results of intra-group test, the intervention was significantly increased only in the second intervention group (p<0.001).

Inhalation of Elaeagnus angustifolia essence 20 minutes before intercourse can effectively increase sexual satisfaction by reducing pain and discomfort during sexual intercourse. Therefore, it can be used as an affordable herbal supplement with minimal side effects.

Infertility is one of the factors which have a significant effect on the sexual performance of couples, especially women. Infertility can affect sexual activity in infertile couples. On the other hand, ovulation stimulation therapies for infertility treatment can inhibit estrogen and thus reduce women's sexual function and satisfaction. Therefore, this study was performed with aim to determine and compare the sexual performance and satisfaction of women treated with two types of ovulation stimulant drugs: clomiphene and letrozole.

This two-group analytical study was performed on 80 infertile women referred to infertility centers in Isfahan province in 2019. The research tools were the questionnaires of Beck, sexual function and sexual satisfaction, which were completed twice before and after receiving clomiphene and letrozole. Data were analyzed by SPSS software (version 22) and Independent t-test, Mann-Whitney, Chi-square, Paired t-test, Wilcoxon and Friedman tests. P<0.05 was considered statistically significant.

In intra-group comparison, there was no statistically significant difference before and after drug administration in the variables of sexual satisfaction (p=0.053) and sexual function (p=0.057), but in inter-group comparison, there was a statistically significant difference in sexual function of the clomiphene group (P <0.001); lower sexual function was reported after clomiphene use than before its use, but in terms of sexual satisfaction in the clomiphene group, no significant difference was reported before and after receiving the drug (p>0.05). There was no significant difference in letrozole group before and after drug administration in both variables of sexual function and satisfaction (p=0.053).

The score of sexual performance decreased in the clomiphene group, but sexual satisfaction did not show any difference in any of the groups. In other words, women's sexual function is affected by many factors, one of which is the use of assisted reproductive drugs, including clomiphene. Clomiphene inhibits vaginal moisture by inhibiting estrogen, which can cause pain and reduce sexual arousal, orgasm, and libido in women. For this purpose, it is recommended that active people in the field of infertility pay attention to this issue.

Many women suffer from bloating and abdominal distension after cesarean section. This study was performed with aim to investigate the effect of Anethum graveolenseed extract on intestinal function after cesarean section.

This single-blind clinical trial study was performed on 80 cesarean section women in the hospitals of Mashhad University of Medical Sciences in 2019. Pregnant women were divided into intervention and control groups. The intervention group received Anethum graveolenseed extract 4 hours after cesarean section. Intestinal function was measured before the intervention up to 12 hours after cesarean section. It was measured using visual scale of bloating, tape meter and check list containing the first time of hearing intestinal sounds, flatulence and excretion. For the control group, only the intestinal function was measured as the intervention group. Data were analyzed using SPSS software (version 24) and Mann-Whitney, independent t, Chi-square, and Fisher's exact tests. P<0.05 was considered statistically significant.

Mean of intensity of bloating was significantly different between the intervention and control groups (p<0.001). There was no statistically significant difference between the two groups in mean scores of abdominal distension (p<0.05). The mean time of hearing first intestinal sounds, flatulence and excretion after the surgery was significantly different between the intervention and control groups (p<0.001).

Consumption of dill seed drops improves the intestinal function after cesarean section.

Routine use of episiotomy is not recommended for women giving birth naturally. However, several studies in the Middle East have reported that it has high prevalence, but there is no general estimate. This study was performed with aim to review the prevalence and met-analysis of episiotomy in the Middle East based on studies conducted in this field.

To search for articles, the databases of SID, Magiran, Medline, Science Direct, Scopus, Web of Science, Embase, ProQuest and google scholer search engines using the keywords of prevalence, epidemiology, frequency, incidence, rate and episiotomy in both languages of Persian and English and all possible combinations were searched with AND and OR operators. Calculation of heterogeneity of the studies was evaluated using I2 index and Bag test was used to examine the bias.

Twelve articles with a sample size of 69171 were reviewed. The overall prevalence of episiotomy was 67% (95% CI: 55-78). Using the random effect model, the risk of episiotomy in primiparous women was two times than multiparous women, which was statistically significant (RR = 2.01, 95% CI: 0.87-4.63, p <0.001; I2 = 99.99). Oxytocin use was also associated with an 80% (60-95%) prevalence of episiotomy.

Due to the high rate of episiotomy in the Middle East, despite the standard set by the World Health Organization, there is an urgent need for planning to reduce this rate. Therefore, it is recommended to use effective methods to reduce the need for episiotomy in primiparous women and to avoid unnecessary clinical interventions such as using oxytocin.

External genital warts caused by human papillomavirus are the most common sexually transmitted infections. There are many treatment options for genital warts that can help the doctor, but many patients tend to use a home-based treatment. Green tea extract (syncatchin) is an herbal remedy for external genital warts that can be used by the patient. This study was performed with aim to systematic review the studies related to green tea in the treatment of genital warts.

In this review study, the relevant articles were selected in the databases of Pubmed, Scopus, Siencedirect, Proquest, and Google Scholar in 2000-2019 with different combinations of "green tea" and "genital wart" keywords. From a total of 21 articles, 9 articles related to the purpose were selected.

Among the studied articles, 9 studies were analyzed in two groups of placebo and syncatin ointment 15% and 10%. In all studies about complete recovery of all genital warts, there was no statistically significant difference between 15% and 10% syncatchin ointment, but this difference was significant compared to placebo group. There was less number of warts recurrences at the end of treatment in the Sincatchin group compared to placebo group.

Green tea extract is known as an effective and safe drug with less side effects and recurrence rate in the treatment of genital warts.

Sometimes couples refer with complaints of long-term infertility, while their main problem is vaginismus and inability to have  intercourse. This study reports the treatment of a patient with severe lifelong vaginismus using a cognitive-behavioral approach.

The couple with a history of 18 years of marriage, childless, had requested the use of assisted reproductive techniques for having a child. At first visit, due to the woman's inability to perform the vaginal examination and the history of fear of intercourse, they were referred to the sexual health clinic for treatment of vaginismus. The woman had a history of hymenectomy under anesthesia, which was ineffective in resolving the problem. Woman's anxiety and embarrassment of expressing the problem, her reluctance of treatment with a male doctor, and the husband's fear of having child due to the death of his mother during childbirth were the factors in the persistence of vasinismus during these years. The 18 years vaginismus was resolved with cognitive-behavioral therapy in less than 3 months. Spontaneous pregnancy occurred 3 months after treatment of vaginismus.

Taking an accurate sexual history and encouraging the couple to treat vaginismus prevents invasive assisted reproductive techniques. Prolonged vaginismus should not cause the couple and the therapist to be disappointed with the treatment. The happy and hopefull mood of the therapist in the counseling session, having patience and calmness, designing the treatment in accordance with the couple's lifestyle, paying attention to the husband's feelings and gaining his companionship in the treatment and promoting couple's self-confidence and self-management are among the success factors of vaginismus treatment. Also, continuous follow-up and giving positive feedback to the patient in cyberspace will speed up and continue the treatment process.