مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 9 (آبان 1400)

Neonatal sepsis is one of the most common causes of neonatal mortality. This study was performed with aim to evaluate the clinical symptoms, maternal and neonatal risk factors of definitive sepsis in neonates admitted to the neonatal intensive care unit.

This retrospective cohort study was conducted in 2011-2019 on 285 infants admitted to the NICU of Ghaem Hospital in Mashhad. Neonates with positive blood culture and at least one clinical symptom and laboratory result of sepsis were considered as definitive sepsis and entered the study. After confirming the diagnosis based on the blood culture and laboratory report, the researcher-made checklist containing maternal, neonatal, and laboratory characteristics of the neonates was completed. Data were analyzed by SPSS software (version 23) and independent t-test and Chi-square test. P<0.05 was considered statistically significant.

In this study, 35.44% of cases were diagnosed as early sepsis and 64.66% as late sepsis. The most common cause of fetal risk of early neonatal sepsis was preterm (86%) and the most common maternal risk factors for early neonatal sepsis were premature rupture of membrane (19.6%), preeclampsia (15.08%), hypertension (7.36%), chorioamnionitis (6.6%), and diabetes mellitus (4.56%). Duration of hospitalization, duration of mechanical ventilation, and duration of oxygen therapy were the risk factors for late sepsis. The most common clinical and laboratory symptoms were respiratory distress, hypotension, SPo2 loss, apnea, jaundice, abdominal distention, tachycardia seizures, high CRP (77%), thrombocytopenia (53%), leukocytosis (38%), coagulopathy (36%), and high ESR (22.3%).

The most common risk factor for early neonatal sepsis was prematurity before PROM. Therefore, controlling and eliminating the predisposing factors of PROM and prematurity may reduce the incidence of neonatal sepsis. The most common clinical symptom was respiratory distress and the most common laboratory symptom was positive CRP.

Following the high prevalence of gestational varicose veins and considering that lower limb exercises in pregnant women can be performed at home and doing such non-pharmacological interventions does not require special expertise, this study was performed with aim to evaluate six weeks of exercise on lower limb pain, quality of life and muscle fatigue in women with gestational varicose veins.

This randomized controlled clinical trial study was performed in 2019 on 24 pregnant women with gestational varicose veins referred to Alzahra Hospital in Tabriz. After randomly assigning participants in two groups of 12 subjects, the intervention group performed lower extremity exercises five times a day for six weeks. Pain intensity, muscle fatigue and quality of life in varicose veins were measured before and after the intervention. Data were analyzed by SPSS software (version 22) and dependent and independent t-test. P<0.05 was considered statistically significant.  

The pain intensity, quality of life and muscle pain showed statistically significant difference between these variables before the intervention (P>0.05), while the intragroup study of the results in the intervention group showed that pain intensity (P=0.001), quality of life (P=0.009) and muscle fatigue (P=0.005) were significantly associated with a decrease at the end of the intervention. On the other hand, the intergroup comparison showed that pain intensity (P=0.005), quality of life (P=0.001) and muscle fatigue (P=0.001) significantly reduced at the end of the intervention.

Six weeks of exercise program reduced pain intensity, muscle fatigue and increased quality of life in women with gestational varicose veins.

Episiotomy is associated with some complications such as pain, infection and discomfort of perineal sutures for mothers. This study was performed with aim to compare the complications of episiotomy repair in continuous versus interrupted suturing technique in primiparous women.

This single blind randomized clinical trial study was performed in 2017-2018 on 140 primiparous women referred for vaginal delivery in Niknfas maternity hospital in Rafsanjan city. The subjects were randomly divided into two groups (n=70 in each group). Repair of episiotomy was done in one group with interrupted and in another group with continuous suturing technique. The tools were demographic and midwifery characteristics form, visual analog scale and surgical site infection. Pain severity score, analgesia use, wound infection and discomfort stitches were assessed 2 hours, 3-5 days, 2 and 6 weeks after delivery. Data were analyzed using SPSS software (version 22) and Chi-square, Independent-t and Mann-Whitney tests. P<0.05 was considered statistically significant.

The pain severity score and discomfort stitches was lower in continuous group than interrupted group (p<0.05). Use of analgesia at these times was not significantly different between the two groups (p>0.05). Wound infection in 3-5 days and 2 weeks after delivery was lower in continuous group (p<0.05). Also, the repair time, number of threads and lidocaine used ampoules were less in the continuous method (p <0.05).

Pain intensity, discomfort stitches and episiotomy infection were less in continuous method compared to interrupted repair; it seems cost-effective due to less use of threads and analgesia.

Menstrual bleeding is a reflection of periodic secretion endometrial loss due to decreased estradiol and progesterone production. In traditional medicine, ginger is described as a menstrual blood enhancer. This study was performed with aim to compare the oral and topical effect of ginger on the rate of menstrual bleeding in girls with regular menstruation.

This single-blind randomized clinical trial study was performed on 70 female students living in the dormitory of Shahid Beheshti University in 2016-2017. Subjects were divided into two groups: capsules and ginger oil (n=35 in each group). Both groups consumed the drug for three consecutive menstrual cycles from two days before menstruation until the first three days of menstruation. The Higham chart (PBAC) was used to determine the amount of menstrual bleeding. Data were analyzed by SPSS software (version 17) using Mann-Whitney U and Friedman tests. P< 0.05 was considered statistically significant.

The two groups were similar in terms of bleeding volume at the beginning of the study (P=0.38). The mean volume of bleeding in the first cycle in the ginger capsule group was 104.91 ± 64.01, and reached to 102.26 ± 57.2 in the fourth cycle of intervention, which was not significant (p= 0.8). In the ginger oil group, the mean volume of bleeding in the first cycle was 92.8 ± 46.44 and in the fourth cycle 101.88 ± 71.14, which was not significant (p= 0.4).

Ginger oil was not different from ginger capsules in the amount of menstrual bleeding in girls with regular menstruation; ginger oil and ginger capsule alone did not affect menstrual bleeding.

Given the importance of sexual issues in women's lives and being affected by various factors such as pregnancy and diabetes, and the existence of limited research on sexual function in women with gestational diabetes, this study was performed with aim to compare sexual function of women with gestational diabetes and low risk pregnant women in third trimester of pregnancy.

This descriptive-analytical study was performed on 300 women with gestational diabetes  low-risk pregnant women in the clinics affiliated to Mazandaran University of Medical Sciences in 2019. Demographic data were collected using researcher-made Demographic-Midwifery Questionnaire, and data related to sexual function using Female Sexual Function Index questionnaire  Data were analyzed by SPSS software (version 23) and Independent t-test, Mann Whitney, Chi-square and Multiple linear regression. P<0.05 was considered statistically significant.

In this study, 131 (87.3%) of women with gestational diabetes and 52 (34.67%) of low-risk pregnant women had sexual dysfunction. Gestational diabetes causes a significant decrease in sexual desire score (P< 0.001), lubrication score (p=0.006), satisfaction score (P< 0.001) and a significant increase in pain score (p=0.01).

Most women with gestational diabetes had sexual dysfunction; gestational diabetes predicts sexual function in pregnant women. Therefore, evaluation of sexual function should be a part of the usual assessment of women with gestational diabetes.

Vaginismus is one of the sexual dysfunctions in women. Emotional regulation refers to the actions which are used to change or modify an emotional state. This study was performed with aim to compare the effect of mindfulness- based cognitive therapy and cognitive behavior therapy on cognitive emotion regulation in women with vaginismus.

This quasi-experimental study was performed in 2018 on 45 women with vaginismus referred to Rahyab Psychology Counseling Clinic in Mashhad. The subjects were randomly divided into three groups of 15 people including two intervention groups and one control group. The women of one intervention group received cognitive-behavioral techniques and the other group received mindfulness-based cognitive therapy; the control group did not receive any intervention. The research tools were demographic questionnaire and cognitive emotion regulation questionnaire. Data were analyzed by SPSS software (version 20) and multivariate and univariate analysis of covariance and Bonferroni post hoc test. P<0.05 was considered statistically significant.

Both mindfulness-based cognitive therapy and cognitive-behavioral therapy methods were effective on improving the cognitive emotion regulation dimensions of women with vaginismus compared to the control group (P = 0.0001). Considering the comparison of the differences between the means of the two intervention groups with the control group, mindfulness-based cognitive therapy has a greater effect on the dimensions of cognitive emotion regulation than cognitive-behavioral therapy (P <0.01).

Although both mindfulness-based cognitive therapy and cognitive-behavioral therapy have were effective on the cognitive emotion regulation in women with vaginismus, but the effect of mindfulness-based cognitive therapy is greater than cognitive-behavioral therapy.

Nausea and vomiting in pregnancy is one of the most common problems during pregnancy. Given that there is no research on the use of a combination method of acupressure and antiemetic drugs in reducing nausea and vomiting in pregnancy, therefor, this study was performed with aim to compare the effect of ondansetron and K-K9 Acupressure with ondansetron in nausea and vomiting of pregnancy.

This randomized clinical trial study was performed in 2018-2019 on 84 pregnant women referred to Ahvaz teaching hospitals. The subjects were randomly divided in two groups of ondansetron with K-K9 acupressure and ondansetron alone. The severity and frequency of nausea and vomiting were recorded by Rhodes questionnaire for 8 days. At days of 1-5 days, both groups received ondansetron tablets 4 mg and in the ondansetron with K-K9 acupressure group in addition to ondansetron tablets, K-K9 acupressure was performed by the research unit. There was no intervention in the two groups on days 6-8. Data were analyzed using SPSS software (version 22) and independent t-test, Chi-square, paired t-test, and repeated measures. P<0.05 was considered statistically significant.

During the intervention, there was significant difference between the two groups in the mean severity of vomiting (P˂0.001) and the mean severity of nausea (P = 0.01), but no significant difference was found between the two groups in the mean number of nausea (P = 0.08) and the mean number of vomiting (P = 0.05). Need to hospitalization and additional drug was less in ondansetron with K-K9 acupressure group, and also satisfaction of treatment was higher.

Ondansetron and K-K9 acupressure is more effective in reducing the severity of nausea and vomiting. Therefore, it is recommended to use ondansetron and K-K9 acupressure to reduce nausea and vomiting during pregnancy.

Back and pelvic pain is one of the most common problems during pregnancy. Acupressure is one of the treatment strategies. Therefore, this study was performed with aim to determine the effect of electro-acupressure of LI4 and LI11 on the severity and disability of in pregnant women with low back and pelvic pain.

This randomized clinical trial study was performed on 101 pregnant women with low back and pelvic pain referred to Booeinzahra health centers from April to November 2020. The subjects were divided into intervention and control groups using block random allocation. The intervention group participated in 12 sessions of electro-acupressure on Heogu and Quchi from 26 to 32 weeks of pregnancy. The control group received standard prenatal care. The Roland Morris Disability Questionnaire and Visual Analogue of Pain were completed in both groups before, 2 and 4 weeks after the intervention. Data were analyzed using R software and mixed effects model tests and post hoc test. P< 0.05 was considered statistically significant.

The results of the study showed that 4 weeks intervention significantly reduced pain intensity (6.42 ± 0.83, 3.00 ±1.04) and disability (14.62 ± 1.29, 7.9±2.22) in the intervention group compared to the control group (P <0.001).

Electrical stimulation of Hugo and Kochi needles during pregnancy can improve the severity of pelvic and low back pain and disability; it is recommended as a non-pharmacological method for low-risk pregnant women.

Hirsutism refers to the abnormal and excessive hair growth, with a pattern similar to the male pattern in women. It is possible that dietary intake and body weight are associated with hirsutism, so the present study was conducted with aim to evaluate and compare dietary intake and anthropometric indices in women with hirsutism and healthy women.

This case-control study was performed in 2020 on 84 women with hirsutism (case) and 168 healthy women (control) in Shoushtar city. Participants were assessed by the food frequency questionnaire, about the usual number of units consumed from each food group, including cereals, dairy products, protein, fruits and vegetables in the last year. Data were analyzed by SPSS statistical software (version 19) and independent t-test, Mann-Whitney and Chi-square tests. P < 0.05 was considered statistically significant.

Women with hirsutism had significantly higher weight (P = 0.019) and BMI (P = 0.018) than the control group. Consumption of high and medium-fat dairy (P = 0.034) and ice cream (P = 0.041), cakes and biscuits (P = 0.049) was significantly higher in hirsutism group compared to the controls.

Reducing the consumption of medium and high fat dairy products along with a healthy lifestyle and maintaining a normal weight has an effective role in prevention of hirsutism.

Preeclampsia is one of the major causes of maternal mortality and morbidity, and its prevention is one of the most challenging topics in obstetrics. Magnesium supplementation has been suggested as a way to prevent preeclampsia; therefore, this systematic review study was conducted with aim to determine the effect of magnesium supplementation on the prevention of preeclampsia.

In this systematic review to find relevant clinical trial articles, databases of Scopus, PubMed, Embase, and Web of Science were used. The keywords of Preeclampsia, Pregnancy Toxemia, Dietary Supplement, Supplement, Supplementation, Magnesium, Intervention study, Clinical Trial, Clinical Studies, Randomized Clinical, and Controlled Clinical Trials were searched with Boolean operators (OR, AND) without time limitation until February 2, 2021. The inclusion criteria were oral magnesium supplementation and English language studies. There were no geographical restrictions. The quality of the articles was assessed with Cochran collaboration's tool (Risk of bias) and "Review Manager program" software (RevMan 3.5). Data were analyzed qualitatively.

Finally, 7 articles with a sample size of 2111 people were included in the study. Magnesium supplementation was used as magnesium citrate, magnesium aspartate, Effervescent magnesium, magnesium, and a multivitamin containing 200 mg of magnesium. The result showed that magnesium supplementation in low-risk individuals with hypomagnesemia reduces the incidence of preeclampsia.

It seems that taking magnesium supplements in low-risk pregnant women with hypomagnesemia can be effective in preventing preeclampsia; however, the studies with high quality and sufficient sample size are recommended for definitive conclusions.

Dural arteriovenous fistula is a rare neurological disease. In this study, a case of maternal death due to dural arteriovenous fistula was reported. 

The patient was a 19-year-old woman, G2 P2 who complained of memory impairment (forgetfulness) and headache 38 days after cesarean section and referred on outpatient basis, while she could not remember the names of her husband and child, and saw the lines but was not able to read. According to the results of the CT scan and the urgent need for intensive care, she was transferred to the ICU with the diagnosis of a neurologist. On the sixth day of hospitalization, the patient suffered from generalized tonic-clonic seizures and loss of consciousness. Initial drug therapy was performed and emergency CT scans were requested. Severe cerebral edema was reported on CT, which could be due to subarachnoid or pseudo-subarachnoid hemorrhage. CT angiography, MRI and MRV revealed a dural arteriovenous fistula. The patient underwent surgery the same day. Three days after the surgery, the patient suffered a cardiac arrest, which was immediately followed by CPR, cardiac massage, and medication, which unfortunately was not successful after 45 minutes of CPR, and the patient died.

Women who suffer from postpartum headaches should be evaluated accurately and quickly. In addition, the occurrence of seizures in pregnant women and the initial diagnosis of eclampsia should not prevent the physician from paying attention to other important and deadly differential diagnoses.

One of the variants of the placenta is the placenta fenestrate. In rare cases, the central part of the placental disc is missing. In some cases, there is a real hole in the placenta. A porous placenta may be mistaken for a placental cotyledon after delivery. In the present study, a case of placenta fenestrate was reported.

The patient was 31year old woman, G3L2, with a gestational age of 39 weeks who had complained of labor pains and referred to the emergency department of Hazrat Umm Al-Banin Gynecology Hospital. Following a normal delivery, the baby girl was born with Apgar 9-10, weighing 3780 gr and seemingly healthy. Spontaneous departure of the placenta occurred 15 minutes after birth. On examination of the placenta, the placenta was a discoid plate in the center of which there was no part of the cotyledon in the form of a hole 3 cm in diameter, complete placental membranes covered the entire surface of the placenta, and the umbilical cord was connected to the placenta as a marginal joint.

Familiarity with a fenestrate placenta can help prevent mistake in postpartum examinations. Therefore, it is recommended to pay attention to the characteristics of different types of placenta in postpartum examination.