مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 6 (شهریور 1400)

Abnormal placental adhesion is often associated with severe life-threatening bleeding that requires peri-delivery emergency hysterectomy and can increase the risk of complications such as Disseminated intravascular coagulation, respiratory distress and renal failure for mother. This study was performed with aim to investigate the maternal and neonatal complications in patients with abnormal placental adhesion.

This cross-sectional study was performed on 70 pregnant women with abnormal placental adhesion in the educational hospitals of Mashhad University of Medical Sciences in 2017-2018. Patients with abnormal placental adhesions who were diagnosed through Doppler or MRI and given a clinical diagnosis during cesarean section and then confirmed in pathology results entered the study. Data collection tool was a researcher-made checklist. Based on the pathology sample, the patients were divided into 3 groups of abnormal placental adhesions. Maternal and neonatal complications were evaluated for each group based on the amount and degree of adhesion. Qualitative data were reported as frequency and percentage. Chi-square test was used to compare their frequency distribution. One-way analysis of variance and Kruskal-Wallis tests were used to compare the means of quantitative variables. P<0.05 was considered statistically significant.

The most common complication in all three groups was prepartum hemorrhage that the difference between three groups was not significant (p=0.571). There was no significant difference between three forms of adhesion groups in urinary system complications(p=0.294) ,transfusion(p=0.29), neonatal NICU admission and death(p= 0.44).

Perineal injury is a common complication of vaginal delivery that can affect women's physical, mental and social health. This study was performed with aim to determine the prevalence of third and fourth degree of perineal laceration during delivery and some related factors.

In this retrospective analytical -descriptive study, information was extracted from the records of mothers who gave birth during 2015-2017. The control group consisted of 129 mothers who did not have severe rupture and were selected by systematic randomization among vaginal deliveries performed during the mentioned years. After collecting information about the factors related to the perineal laceration, data were analyzed by SPSS software (version 18) and Chi-square and Fisher Exact and independent t tests. P<0.05 was considered statistically significant.

Among 8814 vaginal deliveries performed during the relevant years, there were 32 cases of third and fourth degree of perineal laceration (0.363%), of these, 22 cases were noli par (68.8%). In comparison between the case (n=32) and control (n=129) groups, the work experience of the delivery agent (p<0.02), instrumental delivery (p<0.023) and the duration of the second stage of labour (p<0.0001) were more in the case group.

Third and fourth degree of perineal lacerations are associated with the second stage of longer labour and instrumental labour that requires the presence of a labour agent with a longer work experience.

Acute fatty liver of pregnancy (AFLP) has been noticed due to high mortality rate for mother and fetus. However, the cause and pathogenesis of AFLP are unclear, and the absence of specific symptoms precludes early diagnosis and effective treatment. Therefore, this study was performed with aim to investigate the pregnancy outcomes in patients with acute fatty liver of pregnancy.

This cross-sectional descriptive study was performed in 2013-2018. A total of 1475 records of women suspected to acute fatty liver of pregnancy, HELLP syndrome, severe pre-eclampsia and Thrombotic Thrombocytopenic Purpura (TTP) who were hospitalized in the university hospitals of Mashhad were selected and evaluated. Chief complaints at admission, laboratory data and pregnancy outcomes were evaluated. Data were analyzed by SPSS software (version 23).

A total of 34 records with diagnosis of AFLP were included in this study. Nausea and vomiting (94.11%), abdominal pain (94.11%) and hypertension (52.94%) were three main complaints in these patients, respectively. Laboratory test showed an increase in bilirubin, liver enzymes, coagulation tests, creatinine and a decrease in albumin and platelet count. Mean gestational age at the time of pregnancy termination was 34.2±2.04 weeks. We found 5 cases of maternal and 4 cases of neonatal mortality. Mean recovery time was 6.03±2.53 days.

AFLP is associated with maternal mortality and the complications like multi organ failure, Diseminated intravascular coagulation, preterm labor, postpartum hemorrhage, and neonatal mortality. Since in this study, the most common complications of patients with AFPL were nausea, vomiting and abdominal pain, it is recommended to evaluate all pregnant women in third trimester who refer with these symptoms for diagnosis of AFLP.

Increasing oxidative factors and reducing antioxidants is one of the main causes of breast cancer.The purpose of this study was to investigate the effect of eight weeks of aerobic exercise and pomegranate juice on serum enzyme levels related to the Oxidant-Antioxidant system of women saved from breast cancer.

In this blinded randomized control trial which was conducted in rasht in 2019, 40 women with breast cancer were selected who were randomly were assigned into four equal groups control groups (n=10), pomegranate juice (n=10), aerobic exercise (n=10) and aerobic exercise and pomegranate juice (n=10). The aerobic exercise group and the aerobic exercise and pomegranate juice group, performed training programs including 8 weeks and 3 sessions per week with intensity 50 to 70% of the maximal heart rate for 60 to 90 minutes of training. Two groups of pomegranate juice consumers received 100 cc of pomegranate juice before each training session. In order to investigate the variables of research (MDA, SOD, GPX), blood samples were collected 48 hours before and after the intervention in fasting state. The obtained data was analyzed using of one-way analysis of variance (ANOVA) and bonferroni post hoc test analysis. The significant level was P<0/05

The results showed that 8 weeks of aerobic exercise caused a significantly decreased MDA levels and significantly increased SOD and GPX levels in women with breast cancer (P = 0/0001).aerobic exercise without use of pomegranate juice, only led to a significant decrease in MDA (P=0.0001) level, and pomegranate juice consumption alone, no significant changes were observed at the three variables investigated in women with breast cancer.

According to the results, Aerobic exercise and consumption of pomegranate juice simultaneously, reduce oxidative factors and increase anti-oxidant factors in women Rescued from Breast Cancer

Dyspareunia or pain during intercourse is one of the problems which some women experience. This problem becomes more severe during pregnancy. Therefore, this study was performed with aim to investigate dyspareunia and its relationship with estrogen changes and sexual dysfunction in pregnant women.

This descriptive cross-sectional study was performed in 2018-2019 on 50 pregnant women referring to obstetrics and gynecology clinics and also clinical psychologists in Mashhad who had dyspareunia as the case group and 50 normal and non-infected pregnant women as the control group. Also, pregnant women were at the interval between the fourth and fifth months of pregnancy. Data collection tool included demographic information, the structured clinical interview measurement tool for disorders I and II and DSM-IV, the standard Female Sexual Function Index sexual performance questionnaire, and disease-related information included in the researcher-made checklist. Data were analyzed using SPSS statistical software (version 16) and Pearson correlation coefficient test. P<0.05 was considered statistically significant.

The results showed that the mean score of total sexual function in the clinical group was 6.84±5.65 and the score of dyspareunia was 5.46±4.22; the scores of the case group were much higher than the control group. Also, the level of estrogen in pregnant women with dyspareunia decreased compared to pregnant women without dyspareunia and was 21.68±12 12.04 in the case group and 36.21±18.12 in the control group that significant difference was found between the two groups in terms of estrogenic changes.

Low estrogen level is effective in causing dyspareunia. Also, the history of dyspareunia was associated with sexual dysfunction; so that the total score of sexual function and estrogen level was lower in the patient group than the normal group. What increases the prevalence of dyspareunia is a history of sexual dysfunction. In general, women in the control group had better score in sexual function and lower score in painful intercourse, and had no particular problem.

Sleep is one of the most important life needs which plays an essential role in health. Domestic violence, especially physical violence, affects sleep quality. This study was performed with aim to determine the relationship between physical violence and sleep quality disorders in pregnant women.

This cross-sectional study was performed in 2019 on 200 pregnant women referred to the affiliated centers of Shahid Beheshti University of Medical Sciences in Tehran. Demographic data were collected using researcher-made Demographic-Midwifery Questionnaire, data related to domestic violence using World Health Organization Domestic Violence questionnaire and data related to sleep quality using Pittsburgh Sleep Quality Questionnaire. Data were analyzed by SPSS software (version 23) and Independent t-test, Chi-square and Spearman correlation coefficient. P<0.05 was considered statistically significant.

In this study, 70 samples (35.2%) had poor sleep quality and the highest and lowest frequency of physical violence was: pushing (16%) and heating (4%). There was a statistically significant relationship between sleep quality and physical violence (p<0.001). The correlation coefficient of physical violence with sleep quality disorders was r = 0.149 (p=0.049).

Considering the positive relationship between physical violence and sleep disorders, it is recommended that screen and identify the cases of domestic violence during pregnancy in those who refer with complaints of sleep disorders. Therefore, counseling, formulating and implementing the women's empowerment programs in the case of violence will promote their health.

One of the most critical stages of women's life is menopause. However, Menopause is associated with emotional and social crises. Benson sedation affects physical and mental signs and symptoms. This study was performed with aim to determine the effectiveness of Benson relaxation method on menopausal complications in women.

This randomized clinical trial study was performed on 80 postmenopausal women who referred to the health centers in Mashhad in 2019. The subjects were randomly assigned to two groups of intervention and control (n=40 in each group). The intervention group, in addition to routine care, practiced Benson relaxation method in 8 sessions (once a week), and the control group received routine care. The questionnaires were completed for both intervention and control groups at the beginning of the intervention and one week after the end of the last session. The tools were the questionnaire of the severity of menopausal symptoms, sexual function and quality of life. Data were analyzed by SPSS software (version 16) and Independent t-test, Mann-Whitney, Chi-square or Fisher, and Wilcoxon test. P<0.05 was considered statistically significant.

According to Mann-Whitney test, there was no statistically significant difference between the experimental and control groups before the intervention in terms of the score of severity of menopausal symptoms (p= 0.164) and sexual function (p= 0.172) and the two groups were homogeneous. In contrast, the experimental and control groups had a statistically significant difference in terms of quality of life (p= 0.002). Mann-Whitney test showed a statistically significant difference between the experimental and control groups after the intervention in terms of the score of severity of menopausal symptoms (p <0.001), sexual function (p = 0.021) and quality of life (p = 0.001). It was better in the intervention group.

Benson relaxation intervention has an important role in increasing the quality of life and reducing menopausal symptoms and sexual function. It is a safe, effective, and inexpensive way to control the symptoms of postmenopausal women.

Constipation is one of the most common digestive problems in pregnant women which is commonly associated with hemorrhoids. Patients' non-compliance with lifestyle modification recommendations leads to failure of treatment with this method. Although therapeutic properties of coconut oil on constipation are discussed, but its scientific documentation has not been reported; therefore, this study was performed with aim to determine the effect of coconut oil ointment on the symptoms of constipation in pregnant women with hemorrhoids.

This randomized clinical trial study was performed on 60 pregnant women who referred to Mashhad Comprehensive Health Service Centers in 2018-2019. Eligible individuals were divided into two groups. The control group received only lifestyle modification recommendations, while the intervention group in addition to these recommendations used an applicator of coconut oil ointment twice a day for two weeks. The improvement of constipation symptoms including need for straining during defecation, hard stools and defecation less than 2 to 3 times a week was assessed using the Constipation Questionnaire in Pregnancy. Data were analyzed using SPSS software (version 16) and Chi-square, Fisher exact and Cochran tests. P< 0.05 was considered statistically significant.

The frequency of need for straining during defecation on the fourteenth day after the intervention in pregnant women in the coconut oil ointment group was significantly lower than the control group (p <0.05). In the intragroup comparison, it was found that in the group of coconut oil ointment, the difference in the need for straining during defecation and hard stools according to the day of measurement was significantly different (P <0.001), while in the control group, the difference in the need for straining during defecation and hard stools according to the day of measurement was not significant (p <0.05). In the intragroup comparison, defecation less than 2 to 3 times a week, although clinically was associated with a decrease in the coconut oil ointment group, but this decrease was not statistically significant (p=0.050).

Coconut oil ointment is effective in improving the symptoms of constipation in pregnant women with hemorrhoids, so its use is recommended in these people.

Trauma is the first cause of mortality due to non-obstetric causes in pregnant women. There is a limited knowledge on mechanisms of trauma in pregnancy. Therefore, this study was performed with aim to determine the frequency, type and outcomes of trauma in pregnancy period in patients referring to the major trauma center in Guilan.

This retrospective cross-sectional study was conducted using the data registered in triage unit of Poursina Teaching center, Guilan from July 2017 when the Hospital Information System was being implemented for the first time. Using complete enumeration, all mothers with trauma histories until July 2018 (n=138) were entered into the study. They were then interviewed via telephone about the maternal and fetal outcomes after discharge, and 77 mothers answered. Data were analyzed using SPSS software (Version 21).

The mean of maternal age was 29.24±5.25 years and mean gestational age was 20.92±10.12 weeks. The most common mechanism of trauma was falling (35.5%) and then traffic accidents (31.9%), other mechanisms (sharp objects penetrating in the limbs, falling of the object on the person, dog bite, etc.) (21%), violence (10.9%) and self-immolation (0.7%). In terms of frequency, the most reported fetal outcomes were without outcome (87%), preterm birth (7.8%) and abortion (5.2%), respectively; the most common maternal outcomes were reported as uncomplicated (67.5%), bleeding (11.7%), bone fractures (11.7%), uterine contractions and cervical dilatation (9.1%).

The most common type of trauma during pregnancy was falling. Preterm birth and abortion were the fetal outcomes and vaginal bleeding, bone fracture, uterine contraction, and cervical opening were dangerous maternal outcomes which are reported. Future programs should prioritize trauma prevention in pregnancy and follow-up of maternal outcomes after discharge from trauma center.

Vaginal birth is considered a safe mode of birth for most women who have had a prior caesarean with a transverse incision. However, most women who had a previous caesarean rarely choose vaginal delivery. The present study was performed with aim to explain the beliefs of women with a history of previous cesarean section regarding vaginal birth after cesarean in order to provide some suggestions for future interventions to increase vaginal delivery.

This qualitative study framed by the Theory of Planned Behavior was conducted in the governmental hospitals of Urmia, Iran in March-February 2017. Data were collected using 24  in-depth semi-structured individual interviews.  Participants were selected among  pregnant and postpartum women with a history of cesarean section through purposeful sampling, until data saturation was reached. Data were analyzed through directed content analysis approach using the MAXqda software (version 10).

The findings were grouped into three themes namely: "attitude towards vaginal birth after cesarean" (Vaginal birth as a fast and cost-effective method of delivery, sense of danger about maternal-fetal harm), "normative beliefs towards vaginal birth after cesarean" (the emphasize of important people towards vaginal birth after cesarean, women's impression of vaginal birth after cesarean in the community) and "control beliefs towards vaginal birth after cesarean" (Individual and social barriers and facilitator).

Women's attitudes, subjective norms, and control beliefs influence choosing vaginal childbirth after cesarean section. Education based on the theory of planned behavior could be considered with the aim of promoting vaginal delivery after cesarean section.

Polycystic ovary syndrome is the most common endocrine disorder among women of childbearing age and the most common cause of infertility due to anovulation. To treat the side effects of this disease, a wide range of chemical drugs are prescribed. Today, due to the effectiveness of herbal medicines and their low side effects, the tendency to use herbal medicines has increased. This study was performed with aim to determine the role of herbal medicines in polycystic ovary syndrome in animal studies.

In this review study, the databases of Web of Science, Google Scholar, ScienceDirect, Scopus, PubMed, ProQuest, and EMBASE were searched using Persian and English keywords of polycystic ovary syndrome, medicinal herbs, systematic review, traditional medicine, clinical trial, case control, and female infertility in the period of 1990-2020. Initially, 875 articles were found, and finally, 38 articles which were in accordance with the objectives of the study were fully evaluated, and among them, 14 related articles were included in the study, and were reviewed.

According to the results, several herbal medicines such as five-fingered plant, fennel, black cumin, chicory, licorice, yellow aloe, mountain tea, green tea, grape seed, black seed, and Caligum comosum can be effective in treatment of many problems caused by polycystic ovary syndrome.

The use of medicinal herbs with antioxidant, anti-inflammatory and hormonal balance can be used as a substitute or supplement for chemical drugs effective in polycystic ovary syndrome and a major factor in the treatment or reduction of complications of polycystic ovary syndrome.

The common etiology of hydatid cysts in the world is Echinococcus granulosus. The first organ that is usually involved is liver, and the common GI manifestations are abdominal pain, hepatomegaly, anorexia, vomiting and jaundice. Pelvic cavity is rarely involved initially and the symptoms that patients often present are because of the pressure to adjacent organs such as bladder or rectum and bowel.

A 22 years old woman with anorexia and hypogastric pain was admitted in Imam Reza hospital in Mashhad. In abdominopelvic sonography, a cystic lesion with fine septa and low level echoes was seen in pelvic cavity and in CT scan a cystic lesion with fat density was seen in pelvic cavity. The patient was taken to operating room with possibly diagnosis of dermoid cyst of left ovary, but during operation, hydatid cyst was seen in pelvic cavity and was confirmed by pathology.

In endemic countries for hydatid disease, the hydatid cyst should be considered in differential diagnosis of any cystic lesion in any organ.