مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 4 (تیر 1401)

Aneuploidies are of the most important fetal abnormalities. Diagnostic value and efficacy of NIPT assay in the groups with abnormal results for first trimester combined screening test is not well defined. Therefore, this study was performed aimed to survey the sensitivity and specificity of NIPT for aneuploidies diagnosis in women with moderate risk for trisomy at first trimester combined screening test.

This prospective cohort study was performed in 2017-2018 on 447 women with singleton pregnancy and gestational age of 11 to 13 weeks and 6 days who had moderate risk for trisomy. NIPT analysis was done in all women with moderate risk (1/250 to 1/1500) and was compared with the results from karyotype and phenotype analysis in neonates. NIPT diagnostic accuracy for chromosomal abnormalities was calculated. Data were analyzed using SPSS statistical software (version 22).

Two cases with trisomy 21 (0.06%) and one case with trisomy 18 (0.03%) were diagnosed. These three cases were confirmed with amniocentesis and the pregnancy was ended. The neonates' analysis showed normal phenotype results in all of them and NIPT diagnostic accuracy for trisomy 21 and 18 was calculated 100%.

In addition to maintain combined screening test benefits, using NIPT is accompanied by high diagnostic accuracy for fetal chromosomal abnormalities assessment.

Female infertility is a condition in which despite efforts over a year, they are unable to conceive. The present study was performed aimed to compare the effect of palm pollen herbal regimen (relying on the beneficial properties of date pollen for infertility treatment) with letrozole + tamoxifen drug regimen in the treatment of infertile women.

This double-blind clinical trial study was performed in 2019 on 128 infertile women living in Jahrom city. Subjects were divided into two groups: letrozole + tamoxifen drug regimen and palm pollen herbal regimen. The control group received the letrozole + tamoxifen infertility treatment regimen and the experimental group received a plant-based palm pollen diet in the form of 500 mg capsules 3 times daily from the third day of menstruation. The results were collected based on ultrasound and blood tests. Data were analyzed using SPSS software version 21 and descriptive and inferential statistical tests at the significant level of P <0.05.

The number of follicles, follicle size, endometrial thickness, FSH and LH significantly increased in both control and test groups. But these increases were greater in the control group. However, the results of HCG - test showed that 14 cases (21.87%) in the control group and 10 cases (15.62%) in the experimental group were positive. While HCG - ß with twins was seen in only 4 cases (6.25%) in the experimental group; there were no cases of twins in the control group (P=0.15). There was no significant relationship between pregnancy status between the control and test groups (P> 0.05).

The consumption of palm pollen increases the number and size of follicles and endometrial thickness, although the increase in these factors was less than the group receiving letrozole + tamoxifen, but there was no difference between the two groups in success rate of clinical pregnancy, indicating that this drug combination has the capacity to conduct more extensive research for drug development.

Childbirth is not satisfactory for some women and is associated with pain, fear and suffering. The present study was conducted aimed to investigate the effect of Knee- chest position on pain intensity and duration of labor in nulliparous women.

This randomized clinical trial study was performed in 2020 on 100 nulliparous women admitted to the maternity ward in the south of Kerman province. Individuals were randomly divided into two groups of normal posture and Knee-chest position (n=50 in each group). For women who were in the Knee-chest position group, at the beginning of the active phase (dilatation 4cm), they were in Knee-chest position intermittently (for 15 minutes every hour) until the complete cervical dilatation. Data were collected by personal information questionnaire and pain visual scale and delivery progress form (partograph). Data were analyzed by SPSS software (version 26) and Independent t-test, chi-square and Fisher's exact test. P<0.05 was considered statistically significant.

according to independent t-test, chi-square and Fisher's exact tests, the mean pain intensity in the intervention group (Knee-chest position) was significantly lower than the control group (normal position) (p <0.001). Also, the progression of labor in the mothers of the intervention group was significantly faster compared to the control group; duration of delivery in the intervention and control groups was 4.48±1.04 and 7.16±1.7, respectively (p <0.001). The level of mothers' satisfaction with the position status during delivery process was higher in the intervention group than in the control group (p<0.001).

The Knee-chest position in nulliparous women during the active phase of labor is beneficial in reducing labor pain and accelerating labor progression. Therefore, it is recommended that this condition be used as a routine non-pharmacological care in maternity wards.

Preeclampsia refers to high blood pressure and protein in the urine after the 20th weeks of pregnancy. Some studies show that the location of the placenta in pregnancies can predict the occurrence of preeclampsia, preterm delivery and fetal growth restriction. The present study was performed aimed to investigate the relationship between placental site and occurrence of preeclampsia.

This cross-sectional and prospective study was performed in 2019 on 325 pregnant women with 18 to 22 weeks gestational age in Kosar Hospital in Qazvin. Questionnaire information included placenta location, gestational age, neonatal sex, fetal growth restriction, and preterm delivery. Then, the location of the placenta was determined by ultrasound and the placenta with anterior, posterior, and fundus positions was included in the central group and the right and left lateral placenta in the lateral placenta group. Data were analyzed using SPSS software (version 22) and chi-square and logistic regression tests. P<0.05 was considered statistically significant.

The fundal placenta compared to the anterior placenta reduced the incidence of fetal growth restriction (P=0.044). The posterior placenta compared to the anterior placenta increased the incidence of preterm labor (P=0.041). In the present study, there was no significant relationship between placental location and the occurrence of preeclampsia (P= 0.680).

Ultrasound to determine the location of the placenta in the first months of pregnancy can predict the occurrence of pregnancies prone to preterm labor and fetal growth retardation, but placental location cannot be predictive of preeclampsia.

Primary dysmenorrhea is painful menstrual cramps without a pathological cause which is more common in reproductive age. According to Persian medicine, the cause of primary dysmenorrhea can be changes in Mizaj (Temperament). This study was performed aimed to evaluate the general temperament and uterine temperament of patients with primary dysmenorrhea.

This descriptive-analytical case series study was performed on 104 female students with primary dysmenorrhea living in the dormitories of Shahid Beheshti University of Medical Sciences of Tehran in 2015-2016. The questionnaire of personal information, general temperament and uterine temperament was completed by the researcher and the frequency of general temperament and uterine temperament was evaluated. Data were analyzed by SPSS software (version 17). Quantitative variables were expressed with mean and standard deviation and frequency of qualitative variables with number and percentage.

The total age range of the samples was 19 to 43 years with a mean of 23.03 ± 3.91 and the mean body mass index of the participants was 22.22 ± 3.06 kg/m2.The results showed that the highest frequency of general temperament in all patients with primary dysmenorrhea was moderate (47.1%) and dry (39.4%). The highest frequency of uterine temperament in all patients with primary dysmenorrhea was cold (91.3%) and wet (73.1%).

According to the results of this study, the highest frequency of general temperament in patients with primary dysmenorrhea was moderate and dry and considering the higher prevalence of cold and wet temperament in the uterus of women with primary dysmenorrhea, it can be said that the presence of this type of distemperament in women can be a predictor of primary dysmenorrhea. Also, by using preventive and therapeutic measures of this distemperament based on traditional medicine texts, it is possible to treat primary dysmenorrhea with a new approach.

Drug addiction causes complications such as preterm delivery, miscarriage, intrauterine growth retardation, prenatal mortality, placental abruption, preeclampsia, premature rupture of membranes, increased cesarean section and congenital anomalies. Therefore, this study was performed aimed to investigate the prevalence of substance abuse and pregnancy outcomes.

This study was conducted in two stages, initially a cross-sectional study was performed in all pregnant women referred to the maternity ward of Ayatollah Rouhani Hospital in Babol from April 2017 to March 2019. Then, a historical cohort study was conducted in which the subjects were divided into two groups: 112 addicted pregnant women and 224 non-addicted pregnant women. Data collection tool was a researcher-made checklist including: demographic information, maternal complications, and fetal-neonatal complications. Data were analyzed using SPSS software (version 21) and T-test and Chi-square test. P<0.05 was considered statistically significant.

The prevalence of addiction was 1.66% among 6713 pregnant women during these three years. Maternal, fetal and neonatal complications showed a significant increase among addicted mothers compared to the control group (P = 0.0001). Premature rupture of membranes in 44 women (39.28%) and preterm delivery in 32 (28.57%) were the most common complications. The chance of premature rupture of the amniotic sac was 9.09 times with a 95% confidence interval (0.058-0.211) and the chance of preterm delivery was 5 times higher with a 95% confidence interval (0.107-0.388) in addicted mothers. The chance of respiratory distress in infants born to addicted mothers was 10 times higher with a 95% confidence interval (0.058-0.227).

Addiction during pregnancy is associated with many maternal, fetal and neonatal complications, so it is recommended that a comprehensive and specific program be performed for diagnostic, treatment and rehabilitation measures, especially to reduce the damage caused by addiction for women.

Preconception care in order to maintain and promote maternal health has been designed and the criteria for measurement of personnel's performance are determined by the client's satisfaction. Therefore, the present study was conducted aimed to determine how to provide pre-pregnancy services and women's satisfaction.

This descriptive study was performed in 2020 on 280 women of reproductive age who had referred to 8 health centers in Shahroud to receive preconception care. The tool used in this study was the midwifery demographic form of the research unit and the self-report questionnaire of women at reproductive age in the field of health personnel performance and the questionnaire of satisfaction with the preconception care. Data were analyzed by descriptive statistics and SPSS software (version 20). P<0.05 was considered statistically significant.

The results showed that there is no standard index to determine the quality of pre-preconception care. Also, these cares are provided incompletely. The most performance offered by the staff was in the field of folic acid consumption and the lowest was in mental health and sexual health education. However, 97% of women were satisfied and very satisfied with the care provided in the health centers.

The results of the study showed that women of childbearing age were not aware of the content of prenatal care, because despite the poor performance of staff, they reported high satisfaction with receiving care, so patients' satisfaction is not sufficient to measure the quality of care.

Anxiety and fear of childbirth is one of the biggest concerns of pregnant women that may lead to the pain and prolonged delivery. Regarding to the midwives' treatment and supportive roles, this study was performed aimed to evaluate the effect of the presence of doula on the fear and anxiety of natural childbirth in pregnant women.

This randomized clinical trial study was conducted in 2018 on 80 pregnant women in the Hakim Hospital, Neishabour. In the intervention group, doula was with the women from the beginning of labor until one hour after the placenta was removed, doula performed supportive measures for them. But the control group received only routine care. In both groups, the Hamilton Anxiety Rating Scale and the Hartmann Childbirth Attitude Questionnaire were completed in three stages. Data were analyzed by SPSS software (version 20) and Independent t-test, chi-square, analysis of variance with repeated measures. p>0.05 was considered statistically significant.

There were no significant differences between the two group regarding individual socio-demographic, midwifery, the mean score of anxiety and fear of childbirth at the time of entering the delivery ward (P>0.05). The presence of a doula significantly reduced the mean score of anxiety and fear of childbirth in the active phase of labor and one hour after placental remove in the intervention group compared with the control group (P<0.001).

The presence of doula in the delivery wards as a simple and non-invasive intervention can reduces anxiety and fear of natural childbirth in pregnant women.

Pain and anxiety as predictable features of abortion process can reduce the quality of clinical care. Therefore, this study was performed aimed to determine the effect of acupressure at LI4 point of pain and anxiety during abortion.

This randomized clinical controled trial studywas done in 2021 on 120 women during abortion hospitalized in Niknafs maternity hospital in Rafsanjan. The subjects were equally divided into three groups of intervention, touch and control. In the intervention group, acupressure at LI4 point was applied bilaterally during 10-second periods of pressure and 2-second rest for 20 minutes. In the touch group, the above point was touched without pressure. Before, immediately and half an hour after the intervention, pain and anxiety scores were measured by Visual Analog Scale(VAS) and Spielberger state anxiety questionnaire, respectively. Data were analyzed by SPSS software (version 22) using one-way analysis of variance (ANOVA), Kruskal-wallis, Repeated Measurement. P< 0.05 was considered statistically significant.

The results showed that the three groups were similar in demographic characteristics, except for the number of abortions and deliveries. After adjusting the effect of the number of abortions and deliveries, the mean score of pain within the groups (time effect) (p = 0.291), and between the groups (group effect) (p = 0.572) and the trend of pain score changes between the groups in consecutive measurement times (p = 0.262) were not significantly different. After adjusting the effect of the number of abortion, number of delivery and baseline anxiety score, comparison of the trend of changes in anxiety scores of the three groups in two consecutive measurement (interaction effect of time and group) did not show a statistically significant difference (p = 0.896).

Based on the results of this study, acupressure intervention could not manage the pain and anxiety of women during abortion.

One of the goals of the third millennium development is maternal and neonatal health. One of the harmful factors of health is natural disasters. This study was performed aimed to determine maternal complications in Kermanshah earthquake in 2017.

This cross-sectional study was conducted on 850 women who had delivery in Imam Khomeini hospital of Eslam Abad Gharb. The earthquake group included the women who had delivered in the earthquake of 2017 and the non-earthquake group included the women who were delivered in the same hospital in 2016. All data obtained from patients' records. Data were analyzed by SPSS software (version 21) and Independent t-test, and Mann-Whitney test, Chi-square and Fisher exact test. P<0.05 was considered statistically significant.

In women who had delivered in an earthquake, prevalence of maternal complications included preterm labour in 99 (22.3%), premature rupture of membrane in 30 (7.05%), caesarean section in 179 (42.1%), postpartum hemorrhage in 42 (9.9%), gestational hypertension in 24 (5.6%) and abortion in 11 (2.58%). In women who had delivered in 2016, there were preterm labor in 51 (11%), premature rupture of membrane in 12 (2.8 %), caesarean section in 153 (36%), postpartum hemorrhage in 20 (5%), gestational hypertension in 9 (2.1%) and abortion in 2 (0.5%). There were significant differences between the two groups in all cases (P<0.05).

Natural disasters such as earthquakes can increase maternal complications. Therefore, necessary precautions and health care should be increased in the event of a natural disaster.

One of the most common complaints in menopause is sleep disorders. Today people are more likely to use complementary and alternative medicine for their treatment. The present study was performed aimed to evaluate the clinical trials on the use of medicinal herbs in the treatment of menopausal sleep disorders in Iran.

In this narrative review study, databases of SID, Irandoc, Magiran, Google Scholar, PubMed, Scopus, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature were searched using the keywords of Clinical trials, Medicinal plants, Menopause, Menopause symptom and Sleep disorder. The full text of 32 articles from 2000 to 2020 has been used to write this article. 

In this study, 9 clinical trials were evaluated to improve sleep disorders in postmenopausal women by herbal remedies. The evaluated plants included Valerian (three studies), Lemon balm (two studies), Chamomile (one study), herbaceous (one study), Melis (one study), and Lavender (one study). The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disorders. The data suggest improved sleep disturbances in postmenopausal women caused by medicinal plants.

Medicinal herbs can be effective in menopausal sleep disorders, and due to the side effects of hormone therapies, these herbs can be used as a hormone therapy replacement in menopausal women, especially those who are contraindicated in hormone therapy.

Female sexual dysfunction is a global common problem. Tribulus terrestris has long been used to treat infertility, impotence and low sexual desire. Studies assessing the effect of Tribulus terrestris on female sexual dysfunction have reported contradictory findings. Thus, the present study was performed with the aim of systematically reviewing articles on the effect of Tribulus terrestris on female sexual dysfunction to facilitate decisions regarding the use of Tribulus terrestris in this regard.

In this review article, to find the related studies, PubMed, Scopus, Web of Science, Magiran, SID and Google Scholar databases were searched using the keywords "Tribulus" or "Zygophyllaceae" without limitations on language, time and location until December 2021. Two authors extracted articles'' information independently. Eligible studies were evaluated using the Cochrane collaboration quality assessment instrument.

A total of 1367 papers were retrieved using the search strategy. Six papers were eligible to enter the study. The data showed that Tribulus terrestris improved some of the factors associated with sexual dysfunction in childbearing and menopausal women. In three studies, testosterone levels were evaluated, and the findings indicated an increase in free testosterone levels in postmenopausal women.

Consumption of Tribulus terrestris is effective on improving sexual dysfunction in women. Although, due to the limited number of studies, the final decision on the use of this plant in the treatment of female sexual dysfunction requires more accurate and careful investigations.