مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 1 (فروردین 1401)

Gestational diabetes mellitus (GDM) is the most common problem in pregnancy and about 1-20% of pregnant women have GDM. Therefore, it is significantly importance to prevent and treat GDM. Numerous researchers have explored the possible risk factors of GDM. Vitamin D deficiency is one of these risk factors that has ambiguous results, therefore, this study was performed with aim to investigate the relationship between serum vitamin D levels and gestational diabetes.

This prospective study was conducted in 2017-2018 on pregnant women aged 15-40 years with inclusion criteria who referred to health services centers in Mashhad in first trimester of pregnancy for prenatal care. Data related to age and BMI was recorded. Then, 5 cc of blood was taken from all participants to measure 25-hydroxyvitamin D3. All participants underwent the Oral Glucose Tolerance Test (OGTT) at 24-28 weeks of gestation. Data were analyzed by SPSS software (version 16) and Independent t-test, Mann-Whitney, Chi-square and Fisher's exact test. P<0.05 was considered statistically significant

From 449 participants, 320 (71.2%) had lower than normal levels of vitamin D that 68 (15.1%) of participants suffered from vitamin D deficiency and 252 (56.1%) suffered from vitamin D insufficiency. In addition, 7 participants (1.6%) had the higher levels of vitamin D and 122 (27%) had normal vitamin D. Among the subjects, 41 (9.1%) developed gestational diabetes. The median of vitamin D levels within non-diabetic group was 22 ng/cc and 18 ng/cc for diabetic group, although there was difference, but the difference was not significant between the two groups (p=0.555).

Although vitamin D level was lower in GDM patients, but there was no relationship between vitamin D and gestational diabetes and both groups had vitamin D level lower than normal range.

Hypotension is a common complication of spinal anesthesia during cesarean section that available treatments do not completely eliminate this complication. Due to the low cost and ease of legs elevation, this study was performed with aim to evaluate the effect of leg's raising on reducing the incidence of maternal hypotension.

This double-blind randomized clinical trial study was performed in 2019-2020 on 101 pregnant women who were candidates for c/s under spinal anesthesia in Fatemiyeh Hospital of Hamadan University of Medical Sciences. The subjects were randomly assigned to the intervention group (raising legs after anesthesia) and control group (without raising legs). After the onset of anesthesia and at different times, systolic and diastolic blood pressure, the incidence of hypotension, bradicardia, nausea, vomiting and used atropin or ephedrin were recorded and compared in the two study groups. Data were analyzed by SPSS software (version 22) and Independent t-test and Chi square test. P<0.05 was considered statistically significant.

No significant difference was observed between the two groups in terms of mean systolic and diastolic blood pressure and heart rate at different times (P>0.05) and only the mean diastolic BP at 25 minutes was lower in the intervention group than the control group (P≤0.05). The incidence of nausea and vomiting was always lower in the intervention group than the control group, but the difference was not significant (P>0.05). The incidence of hypotension was 54% in the intervention and 60.8% in the control group, but the difference was not significant (P = 0.5).

The leg's raising after spinal anesthesia has no significant effect on hemodynamics indices including the occurrence of hypotension.

Eclampsia is defined as generalized tonic-clonic seizure in a pregnant woman with preeclampsia. Eclampsia is one of the leading causes of maternal and fetal mortality worldwide. This study was performed with aim to evaluate maternal and fetal complications in pregnancies with eclampsia in Ghaem Hospital of Mashhad.

In this cross-sectional study, all patients with a diagnosis of eclampsia who were admitted to Ghaem Hospital between June 2018 and June 2020 were included in the study. Maternal and fetal complications were assessed. For all patients, a checklist was completed by the researcher including information and history of underlying diseases, surgery, obstetrics, and maternal and neonatal complications. Data were analyzed by SPSS statistical software (version 16).

In this study, 51 patients with eclampsia were evaluated. The frequency percentage of eclampsia in Ghaem Hospital was 0.45%. Eclampsia before delivery was 66.7% and was higher than during and after delivery. Maternal complications included: increased rate of cesarean section (70%), postpartum bleeding (1.96%), liver disorders (1.96%), PRES syndrome (13.7%), HELLP syndrome (9.8%), DIC (1.96%), placental abruption (3.9%) and pulmonary edema (1.96%). Fetal complications were low Apgar (43.1%), low birth weight (41.1%), NICU admission (33.3%), preterm delivery (25.4%), IUGR (19.6%) and neonatal and fetal deaths (27.5%) that 4 cases were stillbirth and 10 cases died up to 7 days after birth. There was no maternal death.

Maternal complications were: preterm pregnancy, cesarean section due to placental abruption or IUGR, HELLP syndrome, ICU hospitalization and maternal death, respectively. Fetal complications were: preterm delivery, IUGR and NICU hospitalization and intrauterine fetal death, respectively.

Down syndrome is considered as one of the most important causes of abortion. Considering to the high prevalence of this syndrome, it is necessary to study the frequency of non-abortion and awareness of the reasons and motivations of parents who do not attempt abortion and finally how these types of pregnancies result. This study was performed with aim to evaluate the outcomes of pregnancy and delivery in the infants with positive karyotype test results for Down syndrome.

This retrospective study was conducted in 2019 on 330 women with a positive fetal karyotype test results for Down syndrome between 2013-2018. Demographic information, parents’ decision and final outcome of pregnancy were recorded in a researcher-developed checklist. Data were analyzed by SPSS software (version 16). P<0.05 was considered statistically significant.

The results showed that 97% of parents with positive karyotype test result for Down syndrome decided to terminate the pregnancy, and 3% kept the fetus that Down syndrome occurred in them. Before the initiation of the study, 30% of these infants had died and 70% of them had survived up to mean of two years. Most of the parents who kept the babies showed feelings of regrets due to the economic problems and treatment challenges.

Given the incidence and sensitivity of the current plan of medical abortion, these results can confirm the validity of this approach and eliminate social sensitivities.

Unwanted pregnancies around the world due to the lack of support from families are a threat to the health of mother and child and one of the causes of increasing their mortality and a major obstacle to improve the productive and sexual health. This study was performed with aim to investigate the frequency of unwanted pregnancies and its related factors in the hospitals of Tabriz.

This cross-sectional study was performed in 2020 on 550 pregnant or newly delivered women who referred to the hospitals of Tabriz. Data collection tool was a researcher-made questionnaire consisting of 14 questions by interview including demographic data, past obstetrics history, wanted or unwanted pregnancies and contraception method. Data were analyzed by SPSS software (version 17) and Chi-square test. P<0.05 was considered statistically significant.

The frequency of unwanted pregnancies in the study population was 26.2%. The frequency of unwanted pregnancies was higher in women aged 41-50 years or women and/or spouses with undergraduate education. Prevalence of unwanted pregnancies was significantly related to female occupation, family income, and previous unwanted pregnancy history (P<0.001). The highest frequency of unwanted pregnancies was observed in individuals with withdrawal contraceptive method (P<0.001). There was significant relationship between unwanted pregnancy and the spouses’ opinion about use of contraceptive method and the level of his awareness about contraception (P<0.001).

In this study, more than a quarter of pregnancies were reported as unwanted and regarding to the problems of unwanted pregnancy, development of training programs to control this and accept pregnancies by families, even if unwanted, seems necessary.

One of the risk factors for low Apgar score at birth is duration of labor and its increase. Todays, various pharmachological and non-pharmachological methods are used to reduce labor pain and also the duration of labor. One of these effective methods is reflexology (hand message on feet) during labor which reduces labor pain. Therefore, this study was performed with aim to evaluate the effectiveness of this method on duration of labor and neonatal Apgar score and compare it with the routine care of hospital.

This quasi-experimental randomized controlled clinical trial study was performed in 2009-2010 on 88 pregnant women referred to Shahid Beheshti and Asgariyeh hospitals in Isfahan for vaginal delivery. The subjects were randomly divided into two groups of intervention (reflexology) and control (routine care). Data collection tool was a questionnaire consisting of two parts of personal characteristics (age, place of residence, occupation, education level) and gestational age and the second part was related to duration of labor and delivery outcome (first and fifth minute Apgar score). Data were analyzed by SPSS software (version 18) and Chi-square and variance analysis tests. P<0.05 was considered statistically significant.

Mean first and fifth minutes Apgar scores after birth was not statistically significant between the two groups (P<0.001). The length of active phase of labor was significantly different between the two groups. In the reflexology group, the length of active phase of labor was shorter than this time in routine care group, but this difference was not significant during the second (p=0.29) and third stages (p=0.27)

Foot reflexology directly reduce the labor duration and labor pain which is effective in contribute to shorten the prevalence of asphyxia and improving the Apgar score.

In several studies, the effect of evening primrose and castor oil on bishop score and delivery outcomes have been investigated, but comparing their effects is questionable. This study was performed with aim to compare the effect of oral castor oil and evening primrose at the same time with induction of labor on Bishop score and some delivery outcomes in pregnant women.

This triple-blind randomized clinical trial study was performed in 2019 on 114 pregnant women referring to Niknafs maternity hospital of Rafsanjan. The subjects were randomly divided into two intervention group. The first intervention group received two capsules of 1000 mg of evening primrose and the second received 6 capsules of castor oil concurrently with labor induction. Bishop's score information and delivery outcomes were collected using the hospital records. Data were analyzed by SPSS software (version 16) and analysis of variance in repeated measures, Chi-square, and independent t-tests. P<0.05 was considered statistically significant.

The mean and standard deviation of evening primrose and castor oil in each group were effective on the bishop score two hours after induction (5.02 ± 1.42, 5.36 ± 1.69, respectively) (P=0.542) and four hours after induction (7.32 ± 1.94, 7.63 ± 1.58, respectively) (P=0.492) and the difference was statistically significant. Comparison of mean differences within each group of evening primrose capsules and castor oil was significant (P<0.001). There was no statistically significant difference between the two groups in terms of bishop score, type of delivery, Apgar score, first and fifth minutes, length of first and second stage of labor (P>0.05).

There was no statistically significant difference between evening primrose and castor oil on cervical ripening and pregnancy outcomes at the same time as labor induction, therefore, the use of one is not superior to the other.

Dysmenorrhea is one of the most common disorders of the female reproductive system that causes the inability of a person to perform daily activities and disorders in communication with family members. Therefore, this study was performed with aim to evaluate the effect of leech and cupping therapy in comparison with LD contraceptive pill on the improvement of dysmenorrhea.

This randomized clinical trial study was performed in 2020-2021 on 40 women with primary dysmenorrhea. The subjects were divided into two intervention groups. In the intervention group1, after menstruation, leeches and cupping therapy for 3 sessions (each week) in each month was performed for two months.  In the intervention group 2, the LD pill was taken for 21 days from the first day of menstruation and after 7 days, the next pack was started. Pain levels before the intervention, first, second and third months after the intervention were measured using a VAS questionnaire. In this study, the intervention was performed for two months, but the subjects were followed up for three months. Data were analyzed by SPSS software version 16) and Mann-Whitney, Friedman, Chi-square and Independent t-tests. P<0.05 was considered statistically significant.

The mean pain intensity in the first, second and third months after the intervention was higher in the LD contraceptive pill group than the leech and cupping therapy group and the two groups were significantly different in the second (P=0.048) and third (P=0.022) months, but in the first month after the intervention, there was no statistically significant difference (P=0.061).

The use of leeches and cupping therapy in specific areas of the ankle, back and uterus in comparison with LD contraceptive pills reduces the severity of menstrual pain.

Iron deficiency anemia reduces the activity of thyroperoxidase and thus inhibits the production of thyroid hormone. Therefore, this study was performed with aim to determine the relationship between complete blood count parameters with the level of thyroid stimulating hormone in pregnant women.

This descriptive-analytical cross-sectional study was performed in 2018 on 130 pregnant women who had referred to community health centers covered by Gonabad University of Medical Sciences for first prenatal care. Data were collected at maternal referral, using a checklist containing demographic information of maternity (maternal age, education, occupation, gestational age, etc.) and first trimester pregnancy test results. Data were analyzed by SPSS software (version 16) and Kolmogorov-Smirnov, Spearman correlation and Pearson correlation tests. P<0.05 was considered statistically significant.

Mean TSH of women was 1.95± 1.24 mlu/l and mean total Hb was 12.81±1.08 g/dl and mean total MCHC was 23.89±1.34 g/dl. In multivariate model, none of the variables had a significant statistical relationship with TSH and only the MCHC variable had a significant relationship with TSH (P = 0.041).

The MCHC variable had a significant relationship with TSH, but the other blood parameters had no significant relationship with TSH level. It is recommended that further studies be performed in the future to determine the relationship between these two variables.

Despite many advances in midwifery, proper management of labor pain is still one of the major problems related to women's health. This study was performed with aim to compare the effect of the two methods of massage and aromatherapy with salvia essence on labor pain severity in nulliparous women.

This single-blind parallel randomized controlled clinical trial study was done in 2019 on 96 nulliparous pregnant women referred to the delivery ward of Besat hospital in Sanandaj. The subjects were randomly divided into three groups: aromatherapy and massage therapy with salvia essence and control. Data collection tools were a researcher made questionnaire and Numeric pain raiting scale. With the onset of dilatations of 4-5, 7-6 and 8-10 cm of the cervix and during contractions, in the aromatherapy group, a cloth soaked in 10 drops of salvia essence was used and massage with this essence was used in massage group for 20 minutes. Control group did not receive any intervention. Pain intensity was measured at the onset of dilatations and 20 minutes later in three groups. Data were analyzed using SPSS software (version 22) and Chi-square and analysis of variance for repeated measures tests. P<0.05 was considered statistically significant. 

Mean pain intensity scores after the intervention in intervention groups in different dilatations of the cervix showed a significant difference with before intervention (P=0.001), but in the control group, this difference was not significant (P>0.05). Before intervention, there was no significant difference between two intervention groups with the control group in terms of the mean pain intensity scores in dilatations of 4-5 (P = 0.131), 6-7 (P = 0.05) and 8-10 cm of cervix (P= 0.243), but the difference was significant after the intervention (P=0.001) and this difference was not significant between the two intervention groups (P=0.917).

Massage and aromatherapy methods with saliva essence significantly reduced the mean severity of labor pain in various dilatations and as a nonpharmacological method of reducing labor pain is recommended to nulliparous women with the inclusion criteria of this study.

Premenstrual syndrome is one of the most common menstrual disorders in women at reproductive age. This syndrome affects women’s quality of life and reduces their efficiency. On the other hand, the main cause is not known, various factors such as lifestyle, type of nutrition, and hormones affect it. Since vitamins and minerals have been suggested as possible factors affecting the severity of symptoms of this syndrome, so this study was conducted with aim to investigate the effect of vitamins and minerals on the symptoms of the syndrome.

In this narrative review study, to find the related studies, databases of SID, PubMed, and Google Scholar were searched according to the keywords including premenstrual syndrome, premenstrual syndrome symptoms, minerals, and vitamins from 1980 to 2020. The clinical trial and review studies which were published and the language of them was English or Persian were selected.

Some vitamins such as vitamin E, B6, D and some minerals such as magnesium, zinc, and calcium have a positive effect on the symptoms of premenstrual syndrome.

Since the optimal consumption of vitamins and minerals promotes general health, the results of this narrative review by identifying the challenges in this area, leads to the recognition and use of effective minerals and vitamins to reduce the symptoms of premenstrual syndrome.

Pseudotumor Cerebri (PTC) is a condition characterized by increased intracranial pressure (ICP). It is mainly found in overweight women of childbearing age. In this study, a case of PTC in pregnancy was reported.

The patient was a 26-year-old pregnant woman weighing 70 kg in the 19th week of pregnancy with symptoms of diplopia, headache, and transient visual obscuration who referred to the gynecologist. The gynecologist checked the patient for pregnancy poisoning and after tests, it was determined that she did not have pregnancy poisoning. After referring the patient to an ophthalmologist, the patient was diagnosed with PTC. The treatment form the neurologist's view was drug therapy or LP that the gynecologist did not allow to use drug and LP treatment was selected for the patient. During pregnancy, the patient underwent LP for 9 times. During pregnancy, no drug was prescribed for psedotomor cerebri due to obstruction by a gynecologist and the disease was controlled only by LP. The patient underwent cesarean section under spinal anesthesia by diagnosis of a anesthesiologist and the baby weighed 3400 g was born with a first minute Apgar score of 9 and a fifth minute Apgar score of 10.

Although the pathology of psedotomor cerebri has not been fully identified yet, but various treatment methods have been mentioned to prevent the progression of this disease. In the present study, the reported patient was controlled with regular follow-ups and performing LPs. The maternal and fetal complications following somatomerber were well controlled.