مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 3 (خرداد 1401)

One of the most important causes of cancer death in women is cervical cancer. Early detection of precursors or early stage disease is possible using low-cost and available screening approaches, and this is associated with a reduction in patients' mortality. This study was performed with aim to compare colposcopic findings and histological findings in colposcopic cervical biopsy specimens.

This cross-sectional study was performed in 2016-2017 on 200 patients referred to the gynecology and oncology clinic of Ghaem Hospital in Mashhad with colposcopic indications. These indications included abnormal Pop smear, post coital bleeding, abnormal appearance of cervix and vagina on examination, and existence of high-risk HPV virus in tests. If there was a history of abnormal Pap smear or biopsy due to suspected cervical lesions, the subjects were excluded from the study. Initially, the cause of colposcopy, Pap smear and HPV status were extracted using the information in the file. In the next stage, under the supervision of two gynecologists with oncology fellowship, colposcopy was performed and the findings during colposcopy were recorded. Finally, the data were analyzed with the pathological report. Data were analyzed by SPSS software (version 23).

Physician diagnosis at the end of colposcopy was abnormal in 162 patients (81.5%). As a result of colposcopic pathology, the results showed abnormal pathology in 120 patients (60%). The most common pathologies reported were CIN1 (87.4%), CIN2 (9.2%), and CIN3 (2.3%), respectively. There was a correlation between the colposcopic result and the pathological result in 21% of patients (n=42). The sensitivity of colposcopy compared to the pathological result was 89% and its specificity was 30%. The positive and negative predictive value of colposcopy was 65% and 64% compared to the pathological result.

Colposcopy has an acceptable sensitivity in the diagnosis of cervical pathological lesions, but has a low specificity. Therefore, this screening / diagnostic test can be used in one of the multi-stage screening stages (after the initial screening with Pap smear) and if there are any abnormalities during the colposcopy, biopsy be performed.

Prematurity is the most common risk factor for neonatal mortality, and various maternal risk factors have been identified for prematurity. Therefore, this study was conducted with aim to investigate the maternal risk factors for preterm delivery.

In this cross-sectional study from 2011 to 2020, the status of 981 mothers of premature infants who were admitted to the neonatal ward in Ghaem Hospital of Mashhad was examined. The information related to the study was designed through a researcher-made checklist in two sections. The first part included personal information about the mother (gestational age, maternal age, type of delivery, parity, maternal midwifery problems, underlying diseases, pregnancy complications, placental and membranes problems), the second part included information about the infant (age, first and fifth minutes Apgar score). Data were analyzed using SPSS software (version 22) and T-Test and Chi-square tests.

In the present study, 187 mothers (19.6%) had normal pregnancy status and 765 mothers (80.4%) had pregnancy problems. The most common maternal problems in the history was abortion (67 cases, 6.82%), placenta and umbilical cord was premature rupture of membranes (89 cases, 9.07%), complication of pregnancy was preeclampsia (256 cases, 26.09) and the underlying disease was hypertension (173 cases, 17.63%).

The results of this study showed that the most common problems for mothers of premature infants were maternal underlying diseases including complications of pregnancy, poor history of midwifery and placental and membranes problems. Therefore, one of the most important ways to control premature birth and its various problems is prevention, control, early diagnosis and appropriate treatment of problems and diseases of the mother before and during pregnancy and childbirth.

Most pregnant women are concerned about fetal abnormalities and screening tests. Pharmacological and non-pharmacological methods are used to control anxiety in pregnancy. But, there is still no suitable and ideal strategy to reduce anxiety in pregnancy and childbirth. Therefore, this study was performed with aim to compare the effect of foot reflexology and H7 point acupressure on anxiety in women undergoing amniocentesis.

This clinical trial study was performed in 2020on 84 pregnant women candidates for amniocentesis in sonography clinic in Birjand. Individuals were assigned to three groups: foot reflexology, H7 point acupressure and control. In the intervention groups, foot reflexology in the solar plexus and H7 point acupressure were performed by the researcher once 30 minutes before amniocentesis. Reflexology and acupressure were also performed by mothers during the waiting period for amniocentesis. The control group did not receive any intervention. Data collection tools were demographic and pregnancy questionnaires and Spielberger State Anxiety Scale. The Spielberger state questionnaire was completed before the intervention, immediately after and 10 days after amniocentesis and trait anxiety before the intervention and ten days after amniocentesis. Data were analyzed using SPSS software (version 16) and ANOVA, chi-square, analysis of variance with Bonferroni post hoc test and paired t-test. P<0.05 was considered statistically significant.

The results showed that state anxiety immediately and 10 days after amniocentesis was significantly lower in the subjects of foot reflexology and acupressure than in the control group (p <0.001). The mean anxiety score at 10 days after amniocentesis was significantly lower in the acupressure group than in the foot reflexology (p <0.001). Trait anxiety 10 days after amniocentesis was significantly lower in the groups of foot reflexology and hand acupressure than in the control group and also in the group of hand acupressure compared to foot reflexology (p <0.001).

Both foot reflexology and H7 acupressure were effective in reducing amniocentesis anxiety separately, but the effect of H7 point acupressure was greater than that of foot reflexology.

About 70&% of women suffer of pelvic pain during pregnancy. The physiological processes characterizing this clinical entity remain obscure. Given the high prevalence of this pain, this study was performed aimed to investigate the risk factors associated with pelvic pain during pregnancy in pregnant women referred to Shahidan Mobini Hospital in Sabzevar.

This case-control study was done in 2018 on 120 pregnant women, of which 12 (10%) were at first trimester of pregnancy and 108 (90%) were at third trimester of pregnancy, in Shahidan Mobini Sabzevar Hospital. A researcher-made questionnaire that its validity and reliability were confirmed and standard checklist were used for data collection. The questionnaire consisted of two parts: demographic characteristics of the samples and questions related to the risk factors, and the checklist included the results of the samples' examinations to determine some risk factors. Data were analyzed using STATA software.

Among pregnant women with pelvic pain, 4 (10%) reported mild ligamentous looseness, 3 (7.5%) had a history of pelvic girdle trauma, 17 (43.1%) had a history of low back pain in previous pregnancy, 20 (50%) had a history of low back pain before pregnancy and 10 (25%) had unsatisfactory sexual activity. Results showed that there was a significant relationship between unsatisfactory sexual relations (P=0.008), history of low back pain before pregnancy (P=0.001) or in previous pregnancy (P=0.001) or pelvic pain during pregnancy. However, there was no significant relationship between pelvic pain and place of residence, smoking, ligamentous looseness, occupation and other risk factors (P≥0.05).

In this study, history of low back pain in previous pregnancy, history of low back pain before pregnancy, and unsatisfactory sexual activity were identified as risk factors for pelvic pain. Identification of these risk factors can be helpful in controlling the factors exacerbating pelvic pain during pregnancy and preventing movement restrictions in postpartum women.

One of the most common causes of maternal death worldwide is postpartum hemorrhage (PPH). So far, no study has been performed in Iran to compare the effects of polyvinyl alcohol and foam gel embolizers on menstrual pattern after uterine artery embolization. Therefore, this study was performed with aim to evaluate the efficacy and complications of uterine artery embolization (UAE) in patients with late PPH.

This quasi-experimental study was performed on 70 patients with late postpartum hemorrhage referred to the Isfahan Educational and Medical Centers, Al-Zahra and Khorshid hospitals in 2019-2020. In this study, 30 patients with foam gel embolizer and 40 patients with polyvinyl alcohol embolizer underwent uterine artery embolization. Patients were followed for 6 months; menstrual pattern and complications of UAE were compared in the two groups. Data were analyzed by SPSS statistical software (version 22) and Independent t-test, Chi-square and Fisher's exact test.  P<0.05 was considered statistically significant.

In this study, the clinical success rate was 91.4% and the technical success rate was 100%. The pattern of normal menstruation in the two groups after first three months was 61.7% and after the second three months was 91.4%. There was no significant difference between the two groups after six months of follow-up (p =0.18). The overall complication rate was 13.3%, of which 10.8% was post-embolization syndrome and 2.5% was local ischemia of the external genitalia.

UAE is an effective and safe method for treatment of women with late PPH.

Persistent pain after hysterectomy is unknown in the Iranian population and various factors, including ethnicity, are involved in its occurrence, the effect of which has not been studied in different parts of Iran; therefore, this study was performed with aim to evaluate the prevalence and predictors of persistent pain after hysterectomy.

This prospective cohort study was performed during April 2019 to March 2020 in the hospitals affiliated to Tabriz University of Medical Sciences. A total of 219 patients who were candidates for hysterectomy completed demographic tools, acute pain visual scale, persistent pain rating scale (NRS) and Beck depression. Finally, the prevalence of persistent pain after surgery was assessed using NRS and its predictors using logistic regression test. P<0.05 was considered statistically significant.

Prevalence of persistent pain after surgery was observed in 35 patients (15.98%).Based on the results of logistic regression, the variable of acute pain in the first hour as 2.11 times (1.85-2.32) and open surgery as 3.24 times (3.88-4.49) increases the risk of persistent postoperative pain.

Hysterectomy laparotomy and acute postoperative pain are independent risk factors for persistent pain after hysterectomy. Identifying high-risk patients before surgery, including patients with pain sensitivity, may provide a unique opportunity to reduce persistent postoperative pain.

Based on the Millennium Development Goals, the maternal mortality rate should be reduced by two-thirds of 2010 until 2030 (in Iran below 10 per 100,000 live births). Since it is necessary to identify the risk factors of death and survive the near death mothers, this study was performed with aim to evaluate the ratio of severe maternal outcome and its related factors.

This cross-sectional study was performed in an academic hospital of Mashhad in 2019-2020. Pregnant women and women who in the first 42 days after delivery (puerperium) suffered from a severe complication but survived, and also cases that led to maternal death entered the study by census method. Using a checklist of the Ministry of Health organization, demographic data, risk factors, pregnancy complications, outcome of complications, vital interventions and ICU admission and outcomes of pregnancy and mother were extracted from the patient's file.

During one year, severe maternal outcome ratio was 50.26 per 1000 live births and near death mothers ratio was 45.60 per 1000 live births. The most common risk factors were hypertension (22%) and bleeding in the current pregnancy (19%), and the most common life-threatening complications were severe bleeding during pregnancy and postpartum (32%), and severe preeclampsia (22%). The most common critical intervention used was ICU admission (62%) and blood/blood products transfusion (37%). The most common organ failure was respiratory disorders (29%) and coagulopathy (20%). The most common cause of death was COVID-19 (30%).

Hypertension and bleeding are the most important risk factors during pregnancy and the most important life-threatening complications in cases of near death mothers. With proper prevention and treatment measures and education of mothers and medical team, the mortality due to these complications can be reduced.

Sexual function is a part of human life and behavior and is a multidimensional phenomenon that is influenced by a variety of biological, psychological, and social factors. Estradiol is the hormone which is directly related to the level of sexual function. Prevalence of Covid 19 virus causes severe mental and physical stress which may result in reduced sexual function. This study was performed aimed to determine the association between serum estradiol levels and stress score with sexual function in women referred to Shohadaye Yaftabad Hospital (simultaneously with the outbreak of coronavirus).

This correlational study was performed in 2021 on 223 pregnant women aged 18-35 years referred to the gynecology clinic of Shohadaye Yaftabad Hospital (simultaneously with the outbreak of coronavirus). The women underwent venous blood sampling in the follicular phase and then completed the demographic characteristics (including personal information), the Sexual Function Index (FSFI), and the DOS Stress Questionnaire. Data were analyzed using SPSS software (version 21) and Pearson correlation test and one-way analysis of variance. P<0.05 was considered statistically significant.

According to the Pearson correlation test, the mean of the total score of sexual function had a significant inverse correlation with stress (p <0.001, r =0.983). In other words, the more stress reduced the score of sexual function. Also, based on this test, estradiol levels have a positive correlation with sexual function (p =0.001, r = -0.223).

According to this research, the stressful conditions including the coronavirus pandemic resulted in reduction of sexual function and estradiol levels.

In the recent years, yoga has been considered by researchers as a safe and effective method in promoting the physical and mental health of pregnant women. This study was conducted with aim to determine the effect of yoga on the fear of childbirth and childbirth self-efficacy in primigravida women.

This randomized controlled trial study was performed on 70 primigravid women referred to the comprehensive health centers of Hamadan in 2020. Participants completed the demographic information questionnaire, the Childbirth Attitude Questionnaire (CAQ), and the Childbirth Self-efficacy Inventory (CBSEI), and then were randomly assigned to the control and intervention groups. Women in the intervention group performed 6 sessions of yoga exercises, and then they performed these exercises at home three times a week. The questionnaires were again completed by both groups at 36 weeks of gestational age. Data were analyzed using Stata software and Independent t-test, Chi-square, Fisher's exact test and analysis of covariance. P<0.05 was considered statistically significant.

The fear of childbirth scores in the intervention group was lower than the control group after the intervention (27.94±4.40 and 38.11±4.40, respectively). In contrast, the childbirth self-efficacy score in the intervention group was higher than the control group after the intervention (57.66±4.40 and 50.13±4.40, respectively).

Performing yoga exercises can reduce the fear of childbirth and increase the self-efficacy of childbirth in primigravid women.

Menopause is a physiological period in a woman's life that is accompanied by symptoms or complications which may need treatment. This study was conducted with aim to consolidate the existing knowledge to evaluate the effect of fennel on sexual health of postmenopausal women.

In this review study, to find the clinical trial studies which evaluated the effect of fennel (oral, inhaled or vaginal) on sexual health of postmenopausal women, the databases of PubMed/Medline(NLM), SCOPUS, Web of Sciences, ProQuest, The Cochrane library, and Google scholar were searched from 2000 to 2021 with no language restrictions with the keywords of "Sexual Satisfaction", "Sexual function", "Sexual life", "fennel", "Menopause" and related terms. The primary outcome was evaluation of sexual health in postmenopausal women. Studies which their full text was in Persian or English entered the study. The Cochran checklist was used to assess the quality of studies.

Seven studies with 570 postmenopausal women included in this review according to inclusion criteria. Based on the results, the positive effect of fennel in various forms of inhaled, oral and vaginal alone or in combination with other herbal medicines on the sexual health of postmenopausal women has been reported in six studies. Only one study comparing it with citalopram found no effect of fennel.

It seems that fennel is a drug which affects sexual health in postmenopausal women. In future studies on fennel, it is suggested that the evaluation of side effects and cost-effectiveness be considered.

One of the most common causes of male infertility is Varicocele abnormality. Men with a family history of varicocele are at higher risk for these disorders. As a result, genetic and molecular factors may play an important role in the pathogenesis of varicocele associated with infertility. Therefore, this review study was performed with aim to investigate the role of candidate genes and their molecular mechanisms and the role of genetics in the development or exacerbation of varicocele.

In this review article, to find the related studies, the Latin (PubMed, Google Scholar) and Persian (SID and Magiran) databases were searched without time limitation in a period of 4 years using the keywords of "Varicocele, Male Infertility and Gene".

Mutations or polymorphisms of probable candidate genes including GST, TNP1,2, hoGG1, NOS3, MTHFR ACP1, P53 and POLG have different effects on sperm, spermatogenesis and varicocele in general.

So far, several genes have been investigated as possible candidates for the occurrence and progression of varicocele in different populations of the world, each of which has shown various effects on the pathophysiology of varicocele. Therefore, the correctness or wrongness of the hypothesis (the effect of genetics on varicocele) is still unclear due to the lack of coordination of evidence.
 

Coexistence of malignant phyllodes tumor and invasive ductal carcinoma in a breast lesion is a very rare medical condition. In this study, a case of coexistence of invasive ductal carcinoma and malignant phyllodes tumor in a single breast mass was reported.

The patient was a 39-year-old woman with a mass in left breast. On the requested ultrasound, the image of a heterogeneous hypovaco mass with an irregular margin with size of 30 × 17 × 24 mm was seen. The patient was candidate for complete removal of the breast and axillary lymph nodes. In the histologic evaluation, an invasive ductal carcinoma with malignant phyllodes component was diagnosed which was confirmed by immunohistochemistry. In immunohistochemical study, ER, PR, HER2 were negative in carcinomatous component and CK was negative in phyllodes stromal component, also KI67 index was 35%. In the evaluation of axillary lymph nodes, one out of 7 lymph nodes involved by invasive ductal carcinoma. The patient was referred for adjuvant chemotherapy using four cycles of doxorubicin, cyclophosphamide every two weeks, and four cycles of paclitaxel every two weeks and then adjuvant radiotherapy. In 20 month follow-up, she was alive with no evidence of disease recurrence.

Although coexistence of malignant phyllodes and invasive ductal carcinoma of the breast is very rare, but in breast carcinoma with abnormal microscopic findings, due to the diagnostic and therapeutic importance, the concurrent presence of other breast neoplasms such as phyllodes tumor should be considered.

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technique for entering a sperm into the oocyte. In this study, a case of complete molar pregnancy which occurred following two frozen- embryo subsequent to ICSI was reported.

The patient was a 36 years pregnant woman with 5 weeks' gestation following the transfer of two embryos who referred to Armaghan Infertility Center in Mashhad in January 2020 complaining of severe vaginal bleeding. The 6 weeks ultrasonography found two gestational sacs, one with viable fetus and one massive and empty. At this time, β-hCG value was 40,000 IU/ml. Therefore, twin pregnancy was identified. Spotting continued for two weeks. B-hCG value was >100,000 IU/ml and ultrasound showed molar pregnancy and missed abortion. Therefore, with diagnosis of twin pregnancy with complete hydatidiform mole, the patient underwent suction curettage. Histological examination confirmed the diagnosis of complete hydatidiform mole.

Complete hydatidiform mole may happen after ICSI and this method cannot eliminate the incidence of molar pregnancy. Therefore, complete hydatidiform mole should be considered in pregnancy following ICSI which is associated with vaginal bleeding, large gestational sac and high serum β-hCG.