مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 7 (مهر 1401)

Pelvic organ prolapse (POP) is the descent of pelvic organs beyond the vaginal walls which is associated with bothersome urinary, defecatory, sexual and vaginal mass protrusion symptoms. The present study was performed aimed to investigate the correlation of the symptoms and POP-Q stage.

This cross-sectional study was performed on 335 women with pop symptoms referred to the pelvic floor clinic of Tehran Imam Khomeini hospital in 2018-2019. A checklist of detailed medical history which contains urinary, defecatory, sexual and bulging symptoms due to pelvic organ prolapse was completed by a gynecologist (fellowship of pelvic floor disorders) and the stage of POP was evaluated according to pelvic organ prolapse quantification (POPQ) system. The relationship between clinical symptoms and the stage of POP was assessed. Data were analyzed by SPSS software (version 23) and Chi-square, Fisher's exact test and multivariate regression. P<0.05 was considered statistically significant.

Among women with pelvic organ prolapse symptoms, there was significant correlation between stress and urgency urinary incontinence and lower stage of anterior compartment prolapse (p=0.002, p=0.043, respectively). Also, significant correlation was observed between urgency urinary incontinence and lower stage of posterior compartment prolapse (P=0.04), but there was no correlation between defecatory symptoms and stage of anterior, posterior or apical compartment prolapse (P>0.05). There was significant correlation between vaginal noise and sexual dissatisfaction with lower stage of anterior compartment prolapse (p=0.014, p=0.025, respectively).

Urinary symptoms especially stress and urgency urinary incontinence and sexual dissatisfaction were correlated with lower stage of POP. Also, due to the lack of relationship between defecation symptoms and prolapse stage, complaints of pelvic organ prolapse symptoms may not be related to the severity and stage of prolapse in clinical examination.

Mycoplasma is one of the most important bacterial causes of genital infections in women and men, followed by premature birth and even abortion in pregnant women. The present study was performed aimed to detect and isolate Mycoplasma genitallium in some pregnant women in first trimester of pregnancy.

In this cross-sectional (descriptive-analytical) study which was performed in 2020-2021, evaporated urine sampling was collected from 66 pregnant women who were referred to the health center for screening tests on first trimester of pregnancy (between 11-14 weeks). In this way, these women did not urinate for at least 2 hours and then urine samples were collected in sterile containers. Urine sediment DNA was extracted and the genome of Mycoplasma was detected by PCR method. Data were analyzed by SPSS software (version 20) and Independent T-test. P<0.05 was considered statistically significant.

Mycoplasma genitallium genome was isolated from 17.65 % of evaporated urine sediment samples by PCR method.

For isolation and detection of Mycoplasma in pregnant women, sampling of vaginal or cervix discharge have some dangers, thus evaporated urine sampling is a safer and more reliable method.

Ischemia-reperfusion injury is an important problem for ovarian torsion. It is generally caused by the damage of reactive oxygen species. Antioxidant agents such as curcumin may protect the ovaries from damage caused by oxygen free radicals. The present study was performed aimed to evaluate the effects of curcumin on ischemic-reperfusion (I / R) injury by evaluating biochemical and histopathological parameters.

Thirty-six female Wistar rats (200-250g) were divided into six experimental groups: control, sham, torsion (3 hours of ischemia), torsion and detour (3 hours of ischemia and 3 hours of reperfusion) and treatment groups 1 and 2 (Ischemia was divided into 3 hours, reperfusion for 3 hours and then intraperitoneal injection of 100 mg / kg curcumin half hour before detorsion and half hours after detorsion). Malondialdehyde (MDA) test was performed by taking blood samples from rats and special kits. After ovarian resection, hematoxylin and eosin (H&E) staining was performed for histopathological evaluation of the ovary. Data were analyzed by SPSS statistical software (version 18) and one-way variance and Kruskal-Willis statistical tests. P< 0.05 was considered statistically significant.

The amount of malondialdehyde (MDA) showed a significant difference in the torsion and detour groups compared to other groups (P <0.001). In histopathological evaluation, the number of ovarian follicles at different stages of development showed a significant decrease in torsion and detour groups compared to control, sham and treatment groups (P <0.001), but no significant difference was observed between the treatment groups. The number of corpus luteum was significantly reduced in the treatment, torsion and detour groups compared to the control and sham groups (P <0.001).

Curcumin probably maintains ovarian function through its antioxidant and anti-inflammatory properties following ischemic-reperfusion injury.

Since spinal anesthesia is a suitable method for terminating pregnancy in hospitalized pregnant women with Covid-19 and this method is associated with complications that Corona virus and Covid 19 may increase their severity, this study was performed aimed to evaluate the complications of spinal anesthesia after cesarean section in hospitalized women with COVID-19.

This case-control study was performed in 2020-2021 with participation of 150 pregnant women (with and without Covid-19) who are candidates for cesarean section by spinal anesthesia in the teaching hospitals of Tabriz University of Medical Sciences. The complications such as shivering, pruritus, hypotension, decreased heart rate, increased need for hypoxemia requiring oxygen therapy, urinary retention, headache during anesthesia, recovery and up to 12 hours after discharge from recovery was compared between the subjects. Data were analyzed by SPSS software (version 25) and Chi-square and t-test. P<0.05 was considered statistically significant.

During anesthesia, two complications of bradycardia (P=0.041) and hypotension (P=0.036) and after anesthesia, two complications of shivering (P=0.044) and vomiting (P=0.039) 12 hours after recovery were significantly higher in women with Covid-19 than in non-Covid women.

The complications during and after spinal anesthesia are higher in women with Covid-19 than in non-infected women, which may be related to the disease; it requires further investigation.

Hypovitaminosis D and thyroid disorders are associated with negative consequences during pregnancy. Regarding to the importance and prevalence of these two and the limited and contradictory information on their relationship, the present study was performed aimed to investigate the relationship between the level of 25-hydroxyvitamin D and thyroid function tests in the first trimester of pregnancy.

This cross-sectional study was conducted in 2019 on 200 women in the first trimester of pregnancy.  Serum levels of 25 hydroxyvitamin D (to check vitamin D), total thyroxine (TT4), and thyroid-stimulating hormone (TSH) (to check thyroid function) and thyroid peroxidase (TPO) antibodies (to check autoimmunity) were measured.  Data were analyzed by SPSS statistical software (version 25) and Spearman's correlation coefficient and Kruskal-Wallis and Mann-Whitney tests. P<0.05 was considered statistically significant.

There was no statistically significant difference in the mean level of TSH and T4 for different levels of vitamin D (p=0.272 and p=0.538, respectively), although in the group that were in the euthyroid range based on TSH (0.2 to  3.9 mg international units per liter), vitamin D level was significantly higher (p=0.013). A significant inverse relationship was found between deficient and insufficient levels of vitamin D with positive TPO antibody titer (p=0.034 and p=0.019, respectively).

It seems that there is a relationship between vitamin D deficiency and thyroid autoimmunity, as well as between sufficient vitamin D levels and being in a euthyroid state, so it is suggested to correct vitamin D deficiency in women before attempting to pregnancy.

Diabetes is the most common endocrine disease in pregnancy and identifying the risk factors for gestational diabetes helps to identify women who are at risk for type 2 diabetes in the future. The present study was performed aimed to determine the relationship between maternal hemoglobin concentration in the first trimester of pregnancy and gestational diabetes in pregnant women.

This retrospective study was performed on 300 cases of pregnant women who referred to medical centers of Zahedan in 2017-2019. The information checklist was used to collect demographic characteristics of research samples such as age, height, weight and number of pregnancies and deliveries, maternal hemoglobin and FBS concentrations at the first visit to the relevant centers and GCT levels in 24 to 28 weeks of pregnancy. Data were analyzed by SPSS statistical software (version 25) and Independent t-test and ANOVA tests. P<0.05 was considered statistically significant.

Out of 300 women in the statistical population, 113 (37.7%) had gestational diabetes and 187 (62.3%) were healthy in terms of diabetes. Of the subjects, 103 (34.3%) had hemoglobin concentrations greater than 13, 42 (14%) had hemoglobin concentrations 12.4 to 13, 79 (26.3%) had hemoglobin concentrations between 11.6 to 12.3, and 76 (25.3%) had hemoglobin concentrations less than 11.5. The mean hemoglobin level in diabetic pregnant women was 13.71 ± 0.61 g/dl and in healthy women was 11.80 ± 0.52 g/dl, and the difference was statistically significant (P <0.001). There was also a positive and significant correlation between hemoglobin and fasting blood sugar levels (P <0.001).

High hemoglobin level (more than 13 g/dl) in the first trimester of pregnancy is significantly and directly related to gestational diabetes, therefore it can be considered as a risk factor for gestational diabetes.

Postponed childbearing is a social phenomenon in Iranian families. There is a controversy about its effect on mental health. Therefore, this study was conducted aimed to determine the role of childbearing in the rate of depression, stress, and anxiety in Iranian women of childbearing age.

This cross-sectional study was performed in 2021 on 581 eligible non-pregnant married women from 31 provinces of Iran. Non-random available sampling was performed as electronic form in virtual space. Data were analyzed by Demographic and Medical History Questionnaire, Sleep Quality (adapted from LSQ), Marital Satisfaction (EMS), Perceived Social Support (MSMPSS), Socioeconomic Status (Ghodratnama Questionnaire), and Stress-Anxiety-Depression (DASS-21). Data were analyzed by SPSS software (version 22) and Independent t-test, Chi-square, and binary logistic regression. P<0.05 was considered statistically significant.

Female and spouse education (P <0.001), female employment (P = 0.004), and higher socioeconomic status (P = 0.04) were significantly higher in women without children. The marital satisfaction (P = 0.061), social support (P = 0.13), sleep quality (P = 0.58), history of chronic disease (P = 0.64), and place of residence (P = 0.058) were not significantly different between the two groups. After adjusting the data, the rate of depression in childless women is twice that of women with children (AOR=2.06 95% CI: 1.11-3.82). Stress (P = 0.38) and anxiety (P = 0.9) were not significantly different between the two groups.

Having children not only does not increase the rate of stress and anxiety, but also protects women against depression. Therefore, encouraging childbearing seems to promote the mental health of women in Iranian society.

Regarding to the pandemic of coronavirus and the existence of limited studies on the outcome of this disease in pregnant women, the present study was performed aimed to determine the clinical signs and outcomes of pregnant women with coronavirus.

This descriptive study was performed on 100 pregnant women living in Golestan province who were infected with Covid-19 virus and were admitted to one of the hospitals in the Golestan province in 2020. All pregnant women who were hospitalized due to Covid-19 were followed up for two months after delivery. A researcher-made data collection form was used to evaluate the clinical signs and consequences of coronavirus. Data were analyzed by SPSS software (version 18).

The most common clinical sign in pregnant women was fever on the first day, and most women became asymptomatic from 4th day. Among the maternal consequences, 2 cases (2%) of maternal death was observed in the infected mothers. Preterm delivery (16%) and then oligohydramnios (8%) were more common. Most of the pregnant women did not have fetal complications. Among neonatal outcomes, neonatal hospitalization in the intensive care unit (30%) was the most common, and then neonatal jaundice (24%) and preterm infants (11%) were the most common reported cases. Also, 67% of women with Covid-19 had cesarean section delivery and the birth weight of 77% of infants was in the normal range.

Covid-19 infection in pregnant women significantly increased adverse maternal and neonatal outcomes; therefore, better planning should be done to prevent this disease in pregnant women so that less pregnant women are affected.

Dyspareunia is the most common sexual problem in the postpartum period. Considering the composition and properties of fennel (Foeniculum vulgare), there is a probability of its effectiveness in the prevention and treatment of postpartum dyspareunia. The present study was performed aimed to evaluate the effect of fennel on the prevention of postpartum dyspareunia in primiparous women.

This randomized clinical trial study was conducted on 76 primiparous women referred to Rafsanjan Comprehensive Health Service Centers from January 2017 to May 2018. They were randomly selected as available two weeks after delivery and divided into two groups (n=38 in each group) of receiving 500 mg fennel capsules twice a day for 8 weeks and placebo group. Four and eight weeks after the intervention, both groups were examined in terms of dyspareunia by the Marinoff scale. Data were analyzed by SPSS (version 21) and paired-T and Independent t-test and Chi-square test. P<0.05 was considered statistically significant.

The mean dyspareunia score 4 weeks after the intervention in fennel and placebo groups was 0.69 ± 0.61, 0.83 ± 0.69, respectively (p= 0.430) and 8 weeks after the intervention was 0.50 ± 0.57 and 0.70 ± 0.65, respectively (p=0.211). The difference between the mean dyspareunia scores 4 and 8 weeks after delivery was statistically significant in the intervention group (p=0.011). This difference was not significant between the two groups.

Taking 500 mg fennel capsules twice a day from the second week after delivery has no effect on the prevention of postpartum dyspareunia. Further studies are suggested in this area.

Sleep disorder is one of the common disorders during pregnancy and it is important to identify effective interventions to improve the health of pregnant women. The present study was conducted aimed to determine the effect of acupressure on the sleep quality of pregnant women in the third trimester of pregnancy.

This clinical trial study was conducted in 2018 on 60 pregnant women in the third trimester of pregnancy referring to the health centers in Hamedan city. The study tools were Pittsburgh Sleep Quality Index Questionnaire and Visual Linear Pain Scale Questionnaire. The subjects were placed in two groups of test and control. In the test group, acupressure was applied to real points for 3 weeks, and in the control group, acupressure was applied to false points for 3 weeks. Both groups completed the visual linear pain scale questionnaire before and after the intervention. Data were analyzed by SPSS statistical software (version 18) and Mann-Whitney, Fisher's exact and repeated measurement analysis. P<0.05 was considered as a significant level.

There was no significant difference between the two groups before the intervention in terms of sleep quality and other investigated variables (p=0.691). The effect of the intervention over time in improving the quality of night and daytime sleep was significant between the two groups (p<0.001), but the mutual effect of the intervention between the two groups did not show a difference in the duration of daytime sleep (p=0.534).

Acupressure can improve the quality of night and day sleep in pregnant women in the third trimester of pregnancy, so this method can be used as an auxiliary method in improving the sleep disorder of pregnant women.

Nowadays, cesarean section is one of the common obstetric surgeries and one of the most common surgeries in women. Many pharmacological and non-pharmacological methods are used in cesarean surgery to control pain. This review study was performed aimed to review the pharmacological and non-pharmacological methods of pain control in women undergoing cesarean surgery.

In this narrative review study, to find the relevant studies, Persian language databases of "SID, Magiran" and "Google Scholar" was searched with the Persian key words of pharmaceutical, non-pharmacological methods, pain control, pain and cesarean section.

In this study, 74 articles in two categories of pharmacological and non-pharmacological methods were examined. Drugs which were studied in pharmaceutical methods include: opiates, non-steroidal anti-inflammatories, local anesthetics, regulators of sleep and wake cycles, intravenous sedatives, benzodiazepines, antifibrinolytics, NMDA antagonists and antidopaminergic. Non-pharmacological methods include: aromatherapy, music therapy, sports exercises, foot reflexology, auriculotherapy, massage, touch therapy, keeping the peritoneum open, kangaroo contact, Benson relaxation and electrical stimulation of the nerve through the skin (TENS).

The present study conducted a general review to collect all the pharmacological and non-pharmacological methods of controlling pain after cesarean section which has been reported in most of the reviewed studies to be effective for pain control; however, it is not possible to determine possible risks or to rank the interventions, and more studies are needed. But the attending physician can choose among the methods based on the condition of patient.

 Every woman during her life may experience life-threatening bleeding such as bleeding during pregnancy, childbirth and after delivery, or bleeding which is less life-threatening but overshadows the woman's life, such as abnormal uterine bleeding (AUB). Regarding to the importance of preventing and controlling the obstetrics bleeding and the need to find an effective and low-complication treatment method, this systematic review was conducted with aim to determine the effect of herbal medicines on gynecological and obstetric hemorrhages.

In this systematic review study, all the related studies (based on PRISMA) were searched in databases of clinical randomized registration center and PubMed, Magiran, Medlib, SID, IranMedex, Scopus, and Google scholar using the key words of ( Plantago major, plantain, Plantago (lanceolate), Punica granatum, Persian gulnar, Ginger, Zingiber officinale, Chamomile, Achillea millefolium, Grape Seed, cumin (cuminum), Anethum graveolens (dill), Foeniculum (Fennel), Vitex (Chasteberry), postpartum hemorrhage, Menstrual bleeding, bleeding, menorrhagia, randomized clinical trial, and traditional medicine without time limitation until Nov 2021. Data were analyzed qualitatively.

Results:

 In this study, 148 articles were extracted. Also, 28 clinical trials which received Jedad score ≥ 3 and met the inclusion criteria entered the study. The articles related to 10 types of medicinal plants with a sample size of 2666 people were studied. According to the results, the studied plants were effective in reducing gynecological and obstetric hemorrhages.

 The medicinal plants studied in this study can be used for preventing and controlling bleeding in women. However, judging the definite effect of these interventions definitely requires more extensive studies.

Polycystic ovary syndrome is a major cause of anovulation and infertility in women that is associated with chronic diseases such as obesity, insulin resistance, diabetes, cardiovascular disease, and fatty liver disease. This systematic review was performed aimed to determine the effects of ketogenic diet on the outcomes of polycystic ovary syndrome.

In this systematic review, the keywords of “polycystic ovary syndrome”, “ketogenic diet”, “low carbohydrate diet”, and “clinical trials” were searched in databases of Medline, PubMed, Science Direct, Magiran, ISD, ISC and Cochrane in English and Persian language without time restrictions. Then, the articles relevant to the study's aim were reviewed.

In this research, 4 studies were examined. The results showed that following a ketogenic diet in patients with polycystic ovary syndrome may reduce the risk of cardiovascular diseases in these patients by lowering weight and body mass index, blood pressure, serum total cholesterol, and triglycerides.

Long-term adherence to a ketogenic diet may result in weight loss, improved insulin resistance, and serum lipid profile disorders in patients with polycystic ovary syndrome. Clinical trials are suggested to evaluate the effects of ketogenic diet on these metabolic and endocrine factors in PCOS women.