مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 8 (مهر 1400)

Oral health indicators such as DMFT and the use of denture have significant impact on the quality of individual and social life in women. This study was performed with aim to assess the prevalence of DMFT index and denture use according to fertility status in women of Shahedieh cohort study.

This descriptive-cross sectional study was conducted in 2019 on the data from Shahedieh cohort study with the participation of 4935 women in the age range of 35 to 70 years. Variables related to fertility status such as: pregnancy, number of pregnancies, duration of breast feeding, and menopause were derived from Shahedieh questionnaire after permission. Prevalence of DMFT index and denture use was recorded in these participants. Data were analyzed using SPSS software (version 22) and statistical tests of Chi-square, T-test and ANOVA. P<0.05 was considered statistically significant.

The frequency of denture use was higher in non- pregnant women and women with the history of more than 4 pregnancies. Pregnant women had significantly lower DMFT than non-pregnant women (P= 0.051). With increasing the number of pregnancies and duration of breast feeding, DMFT index increased significantly (P-value =0.0001).

Due to the very high average level of DMFT index and high prevalence of denture use in women of the present study, identification of risk factors related to oral health and adoption of preventive policies and interventions by health officials are crucial in the study area.

Shoulder dystocia is one of the obstetric emergencies which is associated with significant fetal and maternal complications. This study was performed with aim to evaluate the frequency of shoulder dystocia and its relationship with maternal factors and fetal parameters.

This descriptive cross-sectional study was performed on 7148 files of pregnant mothers referring to the maternity ward of Ali Ibn-e Abitaleb Hospital of Zahedan in 2015-2019. Necessary information such as maternal age, gestational age, sex of the newborn, birth weight and height, and having or not having of shoulder dystocia were extracted from the files of women in the hospital archive and were analyzed using SPSS software (version 22).

In this study, the files of 7148 pregnant women who had normal vaginal delivery (NVD) in Ali Ibn-e Abitaleb Hospital during 2015-2019 were evaluated. Among the, 64 newborns had shoulder dystocia and the frequency of shoulder dystocia was 0.89%. Moreover, 44 (66%) of women were over 30 years old and 39 (59%) of newborns were male. Also, 56 (87.5%) of infants weighed more than 4000 g and 15 (23%) of mothers had diabetes.

The frequency of shoulder dystocia was 0.89% and maternal age, fetal weight and gender are risk factors for shoulder dystocia. Considering these risk factors, timely cesarean section can prevent maternal and neonatal complications due to dystocia.

Due to the high prevalence of vitamin D deficiency, especially in lactating women and the importance of self-care of these mothers to ensure adequate concentration of vitamin D, this study was performed with aim to determine the effect of vitamin D supplementation with self-care on its serum level in lactating mothers.

This randomized clinical trial study was performed in 2019 on 70 lactating mothers with serum vitamin D deficiency (D3 <30 ng / mL) referred to the health centers in Takab city. Concentration of 25OHvit. D3 Serum of all mothers was measured twice at baseline and 3 months after the end of intervention. By block randomization sampling method, the subjects were divided into two groups of 35 people (experimental and control). Self-care training was conducted for the intervention group in 4 sessions, with 7 days interval, in face to face form and telephone follow-up. Data were analyzed by SPSS software (version 16) and independent t-test and Mann-Whitney test. P<0.05 was considered statistically significant.

The two groups were homogeneous in demographic variables before the intervention. There was significant increase in vitamin D3 concentration in the intervention group compared to the control group after self-care training (p <0.001).

In addition to prescribing a vitamin D-rich diet to lactating mothers, sels-care and psychological induction of self-care behaviors are effective in taking vitamin D supplements in breastfeeding mothers.

Gestational diabetes is a disorder of carbohydrate and glucose metabolism that is first seen during pregnancy. Gestational diabetes, in addition to maternal complications, also causes adverse effects in children. Considering that increasing the level of physical activity has an important effect on reducing the complications of diabetes, this study was conducted with aim to evaluate the effect of exercise at home during the Covid-19 pandemic on serum levels of insulin markers in women with gestational diabetes.

This semi-experimental study was performed on 40 pregnant women with gestational diabetes and 24-28 gestational age referred to the clinic of Shahid Heydari in Nahavand in 2020. The subjects were randomly divided into two groups (n=20 in each group). The intervention group performed the selected exercises at home using univariate cache for eight weeks and three days a week for 20 to 40 minutes every day; the control group had no physical activity during this period. Then, through blood sampling, the serum level of fasting blood sugar and insulin was measured. Data were analyzed using SPSS software (version 21) and Shapiro–Wilk test, Levon's test, paired t-test, and independent t-test. P<0.05 was considered statistically significant.

In this study, eight weeks of selected exercises at home could have a significant increase on fasting insulin levels (-2.482±1.036 vs. 0.116±0.626) and significant decrease on FBS levels (45.550±14.978 vs. -0.150±6.823) in pregnant women in the intervention group compared to the control group (P<0.001). While these exercises did not show a significant effect on the variables of insulin sensitivity and insulin resistance in the intervention groups compared to the control group after eight weeks of selected exercises (P>0.05).

The eight weeks of exercise at home using univariate caches based on the presented protocol regarding to the principle of overload and increasing resistance (with moderate intensity), have a significant effect on insulin levels in pregnant women with gestational diabetes.

Marital satisfaction in pregnancy is one of the determining factors in the survival of cohabitation and pregnancy nausea and vomiting can lead to decreased marital satisfaction. This study was performed with aim to evaluate the effect of nausea and vomiting control training based on the Ottawa Nutrition Guide on marital satisfaction of pregnant women.

This randomized clinical trial study was conducted on 44 pregnant women who referred to comprehensive health service centers of Gonabad in 2019. Participants were randomly assigned to the control and test groups. The training sessions were held based on the Ottawa Nutrition Guide in the test group. The research tools included three questionnaires of demographic information, Enrich marital satisfaction and Rhodes Nausea and Vomiting Scale that were completed before and four weeks after the intervention in two groups. Data were analyzed by SPSS software (version 19) and Independent t-test, Chi-square and Pearson correlation coefficient. P<0.05 was considered statistically significant.

The research units before the intervention did not have a statistically significant difference in terms of mean Rhodes score (P = 0.28). After the intervention, the mean score of the research units in Rhodes criterion in the experimental group was significantly lower than the control group (P <0.001). Also, before the intervention, total marital satisfaction and most of its components except financial management (P = 0.01), in the control group was significantly higher than the experimental group (P <0.05). Also, there was a statistically significant difference between the two groups in terms of marital satisfaction after the intervention (P<0.001). Comparison of marital satisfaction in the two groups indicated that the mean score of total marital satisfaction in the experimental group was higher than the control group (P<0.001). In intragroup comparison, marital satisfaction in the experimental group after the intervention had a higher mean (p <0.001), but in the control group, the mean of marital satisfaction decreased significantly (p <0.05).

Using the Ottawa Nutrition Guide to reduce nausea and vomiting during pregnancy increases the marital satisfaction of pregnant women.

Pregnant women are one of the main groups that should be considered during the Covid-19 pandemic. By knowing the pregnant women's worrying experiences in this period, we can achieve the strategies to improve the health and quality of life and to plan for improving prenatal care. This study was performed with aim to explore the perception and experience of pregnant women in the face of COVID 19 pandemic.

This qualitative study was carried out in Comprehensive Health Services centers in Urmia-Iran during May to October 2020. Data were collected using 14 individual in-depth semi-structured telephone interviews. Participants were selected among pregnant women through purposeful sampling, until data saturation was reached. Data were analyzed through conventional content analysis approach using the MAXQDA software (version 10).

From analyzing data, 580 primary codes and four main categories including: "lifestyle change(change in daily activities, isolation and social distancing), "experienced psychological effects" (pregnancy health concerns, fear of family members getting sick, financial stress and confusion over information dissemination), "seeking support" (need of support from relatives, need of support from health personnel), and "change in the prenatal care process"(not referring to government centers, reduction in number of prenatal care)were emerged.

The covid-19 pandemic has significant potential in changing lifestyle, routine prenatal care and psychological status in pregnant women. Therefore, it is necessary for midwives to provide virtually and by telephone the necessary training and counseling about self-care and reducing anxiety and stress for pregnant women.

Stress urinary incontinence is a common problem among adults in the community and is more frequent in women. Its incidence increases with increasing age, the number of pregnancy and body mass index (BMI). Exercise therapy has an important role in the treatment of stress urinary incontinence. Therefore, this study was performed with aim to evaluate the effect of Kegel exercises on pain, urinary incontinence and strength of pelvic floor muscles in women with stress urinary incontinence and back pain.

This quasi-experimental study was performed in 2019 on 30 women with stress urinary incontinence and low back pain in the age range of 35-50 years. The subjects were placed in two equal groups of 15 experimental and control. In order to evaluate the pain, urinary incontinence, urinary incontinence diagnosis form and the pelvic floor muscle strength, the Visual Analogue Scale, and Oxford Form were used, respectively. The experimental group performed Kegel exercises for eight weeks (3 sessions of 30 to 45 minutes per week). Data were analyzed by SPSS software (version 22) and Shapiro wilk, Leven, paired t-test and one-way analysis of covariance. P<0.05 was considered statistically significant.

The findings of the present study showed that eight weeks of kegel exercises reduced pain, urinary incontinence and increased pelvic floor muscle strength in women with stress urinary incontinence and back pain in the experimental group compared to the control group (P≤0.05).

Kegel exercises reduce pain, urinary incontinence and increase strength of pelvic floor muscles in women with stress urinary incontinence and back pain, so it is recommended as a non-invasive and low cost intervention to control urinary incontinence.

About 8 to 26% of women suffer from postpartum depression. Therefore, this study was performed with aim to evaluate the effect of auriculotherapy in anxiety reduction points on postpartum depression in nulliparous women.

This randomized clinical trial study was performed on 166 women who were admitted to labor ward in Kamkar hospital in 2018. The subjects were assigned to the intervention and control groups. Auriculotherapy in stress and anxiety reduction points was performed in dilatation 4-6 cm, 6-8 cm and finally 6 hours after delivery. Thus, acupuncture on ear was done between the contractions for 30 seconds in both ears at intervals of 10 minutes. Then in the second stage, depression was assessed between 10-15 days after delivery by Beck questionnaire. Data were analyzed by SPSS software (version 21) and Chi-square and Independent t-test. P<0.05 was considered statistically significant.

According to the results, 72 (96%) in the intervention group and 66 (91.7%) in the Auriculotherapy group had minor depression, but mild and moderate depression in the intervention group was less than the control group (p = 0.549).

This study did not show a reduction in maternal depression with acupressure on the ear. It is recommended to examine other points of pressure in the ear and also this intervention should be done for a longer period in terms of performing acupressure on the ear and following more than a period of 14 days.

Nausea and vomiting are common complaints of women during pregnancy.Relaxation is a set of neuromuscular exercises that can be used as a non-pharmacological treatment for nausea and vomiting in pregnancy.This study was performed with aim to determine the effect of Benson relaxation on the severity of nausea and vomiting in pregnant women referred to the comprehensive health centers in Hamadan.

This controlled clinical trial with pre-test-post-test design was performed in 2019 on 100 primigravida women with 6-10 weeks of gestational age referred to the comprehensive health centers in Hamadan. The subjects were randomly divided into two groups of intervention and control (n=50 in each group). PUQE-24 questionnaire was completed for both groups before the intervention. The intervention group, in addition to routine pregnancy care, received relaxation techniques for 4 weeks. At the end of 4 weeks, the subjects in the intervention and control groups completed the questionnaire again. Data analysis was performed using stata (software 13) and Chi-square, Fisher's exact, Wilcoxon and Mann-Whitney. P<0.05 was considered statistically significant.

The mean score of nausea and vomiting before the intervention was not significantly different between the intervention and control groups (P>0.05). The mean scores of nausea and vomiting in the intervention group before and after the intervention decreased from (8.30±1.60) to (5.30±2.65) which was statistically significant (P<0.001), also changed from (8.38±1.51) to (7.39±1.70) in the control group and this difference was statistically significant (P=0.01). After the intervention, the severity of nausea and vomiting in the intervention group was significantly lower than the control group and the difference was statistically significant (P<0.001).

Considering the effect of Benson's relaxation on reducing nausea and vomiting in pregnancy, its training is recommended for all pregnant women in the first trimester of pregnancy.

When the follicle reserve, which is developed solely during the fetal period, is depleted, women enter menopause. Adverse uterine conditions can affect the ovarian follicles and thus the age of menopause. Considering the widespread consequences of menopause and its effects on women's life, this review study was performed with aim to investigate the association between the fetal environment and menopausal age.

In this review study, articles were searched in databases of Scopus, Science direct, Pubmed, Web of Science, Uptodate, Magiran, and SID without time limit and with English and Persian language limitations and using the keywords of menopause, birth weight, gestational age, famine. Findings were examined in 4 thematic areas (birth weight, twins, gestational age at birth and famine exposure in fetal life).

After revising 3100 articles, the results of 13 articles which had inclusion criteria were reviewed. None of the studies reported statistically significant association between low birth weight, gestational age and risk of famine during pregnancy with menopausal age. Two studies have reported an association between high birth weight and earlier menopausal age. Although studies of twins have shown no significant association between birth weight and menopausal age in twins, there are indications that twins with primary ovarian insufficiency experience premature menopause.

The changes in fetal environment may be related to menopausal age. Since premature menopause leads to shorter reproductive life and increased disease in women, it is recommended that more studies be performed in this regard to investigate the effects of fetal life on menopausal age.

Hepatic Hemangioma in infants is a mass with good prognosis which can be followed by life threatening complications such as heart failure with high output, Kasabach-Merritt Syndrome and hydrops. In other cases with no fetal, maternal and placental causes for poly hydramnios, hepatic Hemangioma should be considered. In this report, a case of large infant's liver hemangioendothelioma complicated with mild polyhydramnios is presented that led to the improvement of infant by intervention and timely treatment.

The patient was a 35 years old woman para 2 with one previous cesarean section. She referred with mild Poly hydramnios in 27th week of gestation. A 56×61 mm sized hypo echogenic & hetrogenic hepatic mass contained with  micro calcification particles in the posterior right liver lobe was diagnosed for the fetus. At 36th week of gestation, planned cesarean was done. After urgent ultrasound, the baby was operated and resection of the tumor was performed. Pathological report showed hepatic hemangioendothelioma. The infant undergone ……. treatment due to the residue. During next follow up, baby was completely recovered and had normal growth & development.

In the cases of diagnosis of poly hydramnios and echogenic mass probably with hepatic origin, then Hepatic Hemangioendothelioma may be considered for the infant. Clinical evaluation and early intervention if needed should be performed to prevent cardiovascular complication, and pregnancy termination should be performed to prevent infantile sever complication as soon as lung maturation. Urgent surveillance should be performed immediately after delivery. We should have needed preparation because this tumor is treatable in many cases.

Tubo-ovarian abscess is one of the final stages in acute pelvic inflammatory disease which may be occurred after uterine manipulation or after surgery and is very rare. Even with the development of antibiotic covering and medical care, the rate of mortalities resulted from tubo-oavariane abscess rapture due to septic shock and peritonitis are about 10%. Therefore, early diagnosis and treatment are very important. In this study, a case of tubo-oavarine abscess fistula to vagina is reported.

The patient was a 44 years old woman who experienced abdominal hysterectomy surgery six months ago and hospitalized for one week due to pelviperitonitis sings but after discharge, she was repeatedly referring because of infection Leukorrhea and pain. Finally, because of abdominal pain and secretions from the vagina, she underwent laparoscopy. Tubo-oavariane abscess with fistula to the vagina was observed and the secretions were suctioned and its viscosity was released. Then, ooforectomy and salpingectomy were carried out.

In the case of treatment-resistance Leukorrhea after hysterectomy, tubo-oavarine abscess and frequent infection through fistula to vagina should be taken into consideration and diagnostic laparoscopy can be helpful to select a suitable treatment.