مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 2 (اردیبهشت 1401)

Proper management of labor and proper anesthesia is very important in order to create pain relief and maintain the health of mother and fetus during cesarean section. Therefore, this study was performed aimed to compare the effect of adding pethidine to 0.5% bupivacaine and 0.5% bupivacaine on pain intensity in women undergoing elective cesarean section with spinal anesthesia referred to Motahhari Hospital.

This double-blind randomized clinical trial study was performed in 2021 on 60 patients undergoing elective cesarean section referred to Motahhari Hospital in Jahrom. Using the random number table, the patients were randomly divided into two groups: bupivacaine-pethidine and ropivacaine-pethidine. Patients' pain was assessed during entry into recovery, exit from recovery, 2, 6, 12 and 24 hours after the surgery. Data were analyzed using SPSS software (version 21) and T-test, Mann-Whitney and Chi-square test. P<0.05 was considered statistically significant.

There was no significant difference between pethidine + ropivacaine and pethidine + bupivacaine groups in terms of pain at different times (P> 0.05), pain intensity after cesarean section during recovery and postoperative periods (P >0.05), and opiate use in 12 hours after the surgery (P >0.05).

There was no significant difference between the groups of pethidine + ropivacaine and pethidine + bupivacaine in terms of pain intensity. The anesthesiologist can use either ropivacaine or bupivacaine in spinal anesthesia, depending on the patient's condition.

The association between subclinical hypothyroidism (SCH) and gestational diabetes (GDM) is controversial. This study was performed with aim to compare the incidence of GDM in women with SCH and euthyroid women.

In this prospective study, data obtained from 1026 pregnant women (including 683 cases of euthyroid and 343 women with SCH) participating in the cohort study of Tehran thyroid and pregnancy (TTP) was used. Serum levels of thyrotropin (TSH), thyroxine (T4), T3-uptake, and thyroid peroxidase antibody (TPOAb) were measured at first visit of the first trimester of pregnancy; based on this, euthyroid and SCH women were identified. These two groups were evaluated for gestational diabetes. Data were analyzed using STATA software (version 13). The continuous variables were compared between the two groups using independent t-test and Mann-Whitney test, and categorical variables using chi-square test or Fisher's exact test. Log-binomial model was used to identify the effect of SCH and levothyroxine on GDM. P< 0.05 was considered statistically significant

There was no significant difference in the incidence of GDM in SCH women compared to the control group either in the unadjusted model or after adjusting for the effective risk factors. Also, there was no significant difference in the incidence of GDM between SCH with TPOAb+, SCH with TPOAb-, and euthyroid groups. The risk of GDM in the TPOAb positive group was not significantly different from TPOAb negative group. Serum TSH (p=0.9), T4 (p=0.8), T3-uptake (p=0.7), and TPOAb (p=0.4) levels were not significantly different between the GDM and non-GDM groups.

Although no significant association was found between GDM and SCH in this study, however, it seems that due to various factors affecting the incidence of SCH and GDM, such as different diagnostic criteria and reference values, proving this issue requires further studies.

Curettage is one of the most common gynecological surgeries in women. Its complication is pain which increases dissatisfaction in patients. Therefore, it is necessary to find a way to treat this complication. This study was performed with aim to compare the effects of three methods of using lidocaine gel in the cervix, intrauterine injection of lidocaine, and a combination of two methods to reduce pain during curettage.

This clinical trial study was performed in 2017 on 120 patients candidates for curettage in Qazvin Kosar Hospital. Patients were randomly divided into three groups of topical lidocaine gel in the cervix, intrauterine injection of lidocaine and a combination of these two methods, and the drugs were prescribed before curettage. Vital signs and pain were recorded in patients and other information was collected by completing the questionnaire. Data analysis was performed using statistical software (version 22) and chi-square and ANOVA tests. P<0.05 was considered statistically significant.

The intrauterine and intra cervical injection of lidocaine (0.3±0.72) and then injection of intra cervical lidocaine (0.45±0.84) alone significantly reduced pain during curettage in women (P=0.04). On the other hand, no severe hemodynamic changes were observed in these patients. No complications such as nausea and vomiting and no instability of vital signs were observed in any of the groups (P>0.05).

Intrauterine administration along with addition of topical lidocaine gel to the cervix can be used as a simple, low-cost, and safe method as to control pain during and after curettage.

The prevalence of acute renal failure during pregnancy varies from country to country. Although the prevalence of acute kidney injury (AKI) during pregnancy has decreased in recent years, it is still one of the most leading causes of mortality in pregnant women. Due to the lack of accurate data in this field in Sistan and Baluchestan province, this study was performed aimed to investigate the causes and prevalence of AKI in pregnant women referred to Ali Ibn Abitaleb Hospital in Zahedan.

This cross-sectional descriptive and retrospective study was performed on 15397 files of pregnant women referred to Ali Ibn Abitaleb Hospital in Zahedan in 2017-2018. The files of patients with at least 2 times of creatinine higher than 0.87 and/or oligoanuria longer than 12 hours were evaluated. Among them, 318 cases diagnosed with AKI entered the study; meanwhile, various causes of AKI in pregnancy were studied. Data were analyzed using SPSS software (version 20) and student t-test and Mann-Whitney test. P<0.05 was considered statistically significant.

Among 15397 live births during one year, 318 cases of AKI (2.065%) and 39 patients (12.26%) required dialysis; in addition, 20 (6.28%) cases of death were reported. The most common causes of renal failure were preeclampsia (34%), sepsis (18.6%) and hemorrhagic shock (13.8%).

The prevalence of AKI in pregnant women in Ali Ibn Abitaleb Hospital of Zahedan was high. The most important causes were preeclampsia, sepsis and hemorrhagic shock and a significant number of them needed dialysis. The maternal mortality rate was also relatively high. Due to the high rate of birth in this province and the risk of AKI, health control of pregnant women should be performed with more accuracy and attention.

Labor self-efficacy has an important role in increasing the ability of mother to adapt to childbirth and decreasing the tendency for cesarean section. This study was performed aimed to determine the effect of motivation and ability to select mode of delivery on labor self-efficacy in previous cesarean section mothers.

This two-group clinical trial study was performed in 2020 on 62 pregnant women with previous cesarean section referred to Mashhad Comprehensive Health Centers. The subjects were randomly divided into intervention and control groups. In the intervention group, individual counseling based on Fogg model was performed at 28-30 weeks of pregnancy. The two groups completed the demographic characteristics form and the researcher-made questionnaire on motivation and ability of the Fogg model and the delivery self-efficacy questionnaire at the beginning and two weeks after the end of the intervention. Data were analyzed by SPSS software (version 25) and independent t-test, paired t-test and Mann-Whitney test. P<0.05 was considered statistically significant.

There was a statistically significant difference in the mean score of motivation and ability in 34-36 weeks of pregnancy in the intervention (2.79±0.52) and control (2.33±0.31) groups (p <0.001). There was a statistically significant difference in the mean score of labor self-efficacy in the groups of intervention before (4.17±2.08) and after (4.92±2.10) the intervention (p =0.012).

Increasing the level of motivation and the ability to choose mode of delivery increases the labor self-efficacy.

Non-stress test is the most widely used primary method for assessing fetal health. The mother's mental state affects the fetal heart rate pattern. As maternal anxiety increases, fetal movements and beat to beat variability decrease. Acupressure releases enkephalins such as serotonin and endorphins and reduces maternal stress and anxiety levels. Therefore, this study was performed aimed to determine the effect of H7 point acupressure on fetal heart rate pattern in stress-free test.

This randomized clinical trial study was performed in 2020-2021 on 60 nulliparous mothers with gestational age of 37-42 weeks in Birjand Valiasr Hospital. The subjects were randomly assigned to two groups of intervention and pseudoacupressure. In the intervention group, point H7 acupressure was touched in each hand for 2.5 minutes and in the control group, a false point in the hand was touched. Non-stress test was performed for 20 minutes before and after the intervention. Data were analyzed using SPSS software (version 16) and Chi-square, Independent t-test, paired t-test, Mann-Whitney and Wilcoxon tests. P<0.05 was considered statistically significant.

After the intervention, the variables of number of non-stress test cases, number of fetal heart rate increase, number of fetal movements, and beat to beat variability were significantly different in the intervention group compared to the control group and also compared to before the intervention (p<0.001). But the mean variable of fetal heart rate in the two groups after the intervention was not significantly different than before the intervention (P = 0.732).

Acupressure can improve fetal non-stress test and its parameters.

The most common cancer known worldwide that causes widespread mortality of women is breast cancer. One of the less known risk factors in women is hyperinsulinemia. Since identifying the risk factors help primary prevention and early detection of breast cancer, this study was performed aimed to determine the relationship between gestational diabetes and breast cancer in women referred to the hospitals of Tehran Shahid Beheshti University of Medical Sciences.

This comparative study was conducted on 450 women (n=150 in case group, n=300 in control group) referring to the hospitals of Tehran Shahid Beheshti University of Medical Sciences. Case group consisted of women with breast cancer based on pathologic record and physician diagnosis that at least one year has passed from their disease and control group were women without breast cancer who referred to other clinics in the same centers. Women were collected through interview and completing the questionnaire. Data were analyzed by SPSS software (version 24) and Independent t-test, Chi-square, chance ratio and logistic regression. P<0.05 was considered statistically significant.

In case group, 30 (20%) and control group 17 (5.7%) had history of gestational diabetes. There was significant relationship between breast cancer and gestational diabetes (OR=3.64, CI= 95%, P<0.001,1.78-7.43), body mass index(OR=1.11,CI= 95%, P<0.001, 1.04-1.18) and age (OR=1.13, CI= 95%, P<0.001, 1.09-1.16). In women with a history of gestational diabetes, the risk of breast cancer was 3.64 times higher than the other of women (P<0.05).

Gestational diabetes can be regarded as a risk factor for breast cancer. It is suggested that gestational diabetes be used as an early indicator in the detection of breast cancer.

Endometriosis is a multifactorial disease. Limited studies have been published on the relationship between nutritional factors and endometriosis. This study was performed with aim to determine the association between dietary intake and anthropometric indices with endometriosis.

This case-control study was performed in 2020-2021 on 317 women aged 18 to 49 years in Tehran. Endometriosis was diagnosed using laparoscopy and women were divided into case (n=107) and control (n=210) groups. Food intake was assessed using a semi-quantitative and reliable food frequency questionnaire including 168 food items and analyzed with N4 nutrition software. Data were analyzed using SPSS software (version 22) and logistic regression test. P<0.05 was considered statistically significant.

The probability of endometriosis was significantly lower for women in the highest tertile of body mass index than in the first tertile (OR=0.5, CI: 0.20-0.92, P <0.001). After adjusting for confounding variables, women in the upper tertile of intake for vegetables, fruits, fish, legumes, seeds and nuts and liquid oils had a lower likelihood of endometriosis (P <0.05). However, women in the upper tertile of intake for dairy products, red meat, processed meats, organ meats, and solid oils and fats were significantly more likely to be suffering from endometriosis (P <0.05).

A significant inverse relationship was observed between endometriosis and intakes of vegetables, fruits, fish, legumes, seeds and nuts and liquid oils. However, intake of dairy products, red meat, processed meats, organ meats, and solid oils and fats had a significant direct association with endometriosis.

Labor pain is one of the most severe pains which a woman experiences during childbirth. Therefore, due to the importance of reducing labor pain and performing normal vaginal delivery, the present study was conducted aimed to compare the effect of oral consumption of honey-saffron syrup with date syrup on labor pain in nulliparous women.

This randomized clinical trial study was performed in 2019 on 180 primiparous women referring to the maternity ward of Besat Hospital in Sanandaj. The subjects were randomly divided into three groups: honey saffron syrup, date syrup and placebo group. Inclusion criteria were: nulliparous women, 4 cm dilatation of the cervix, age 18-35 years, and singleton pregnancy. The above fluids were given at the beginning of the study (dilatation of 4 cm) and then every 30-60 minutes until the end of the active phase of the first stage of labor according to the patient's desire. Pain assessment line was used to evaluate the severity of labor pain. Data were analyzed using SPSS software (version 24) and analysis of variance, Chi-square and Repeated Measurement tests. P<0.05 was considered statistically significant.

There was no statistically significant difference between the three groups in terms of mean pain intensity at the beginning of the active phase before the intervention (P=0.690). After the intervention, there was a statistically significant difference between the three groups at the end of the active phase (P<0.001), the second stage (P<0.001) and the third stage of labor (P<0.001). Also, pain intensity in the second stage of labor was lower in the date syrup group compared to the honey-saffron syrup group (P=0.015. But, there was no statistically significant difference between the two intervention groups at the end of the active phase (P=0.928) and the third stage of labor (P=0.652).

Consumption of honey-saffron syrup and date syrup are both effective in reducing labor pain, but date syrup in the second stage of labor is more effective than honey-saffron syrup and it can be used instead of drug interventions to reduce labor pain.

Very limited studies have been performed on the relationship between periodontal disease and its effect on pregnancy outcomes; therefore, this study was performed aimed to investigate the relationship between periodontal disease and low birth weight, preterm delivery, preterm delivery with low birth weight and preeclampsia.

This review study was performed by searching for the articles published in the period 2000 to 2020 with searching for the keywords of pregnancy, outcome, adverse, low weight, birth, abortion, preterm delivery, preeclampsia and periodontal in Pubmed, Scopus, Science Direct and Cochrane and Google Scholar and Embase in English language (lack of Persian article).

A total of 47 articles entered the final stage and found the relationship between periodontal disease and low birth weight, preterm delivery, preterm delivery with low birth weight and preeclampsia that can increase the risk of these complications.

Periodontal diseases can increase the risk of low birth weight, preterm delivery, preterm delivery with low birth weight and preeclampsia

Combining research results with clinical practice has become a challenge. The critical appraisal helps make decisions. For this purpose, this study was performed aimed to critical evaluate the published clinical trials on "the effect of herbal medicine on striae gravidarum".

  In this critical review, the clinical trials articles published between 1972 and 2017 about the effect of herbal medicine on striae gravidarum were searched in the electronic scientific databases including Web of Science, PubMed, Embase, Scopus, Google Scholar and Persian articles in SID, Magiran, Goggle Scholar, using the keywords (Striae gravidarum OR Striae OR Stretch Marks) AND (Prevention OR Treatment OR Control) AND (Cream OR Gel OR Oil) and (Striae or pregnancy striae or pregnancy lines) and (prevention or treatment or control) and (Cream or gel or oil). The lasted edition of the CONSORT checklist (2018) was used. The scoring range was 0-45. The articles based on the scores were classified into three categories: poor, moderate and good. Data were analyzed by SPSS software (version 22) and descriptive statistics.

Out of the 14 articles reviewed, the overall compliance of the quality of the reviewed articles was estimated 46% with the Consort 2018 criteria. In general, the biggest shortcoming was in the participation of stakeholders and then the method of work. The overall mean score of the articles was 20.86±7.18 from a minimum and a maximum of 9-33.

The quality of the clinical trial reports on the effect of using herbal products on reducing pregnancy striae is not appropriate and desirable. Since the biggest shortcoming was in the method, it is recommended to solve these problems by using statistics and methodology experts and standard tools such as consort for self-evaluation of articles.

Listeriosis is an infection if not be diagnosed in time, fetuses and newborns can be affected. So the aim of this study was to identify the features of listeriosis accurately, including clinical findings, laboratory diagnosis, and type of treatment in pregnant women and infants, in order to increase the awareness of health care system to help reduction of abortions and stillbirth’s rates in the community.

Searching was started using scientific databases such as PubMed, Scopus, Google Scholar, ISI and using the keywords Listeriosis, Pregnant Women, Newborn, Health Care System. English and Persian articles on listeriosis infection in pregnant women and infants by 2021 were searched. Then, based on the inclusion and exclusion criteria, the articles were selected.

According to this study most common effects of listeriosis on pregnant women were included: fever, flu-like symptoms, gastrointestinal and urinary disorders respectively. In addition, the effects of listeriosis on fetus were abortion, stillbirth, and in newborns, premature birth, respiratory infection and meningitis were most important effects.

According to the results of this study, listeriosis has severe effects on fetuses and infants, so knowledge about its symptoms and complications in pregnancy is important and can be an important step towards increasing reproductive health indexes and preventing abortion, stillbirth and Infant disease in the community.