مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 12 (اسفند 1401)

Neisseria and ureaplasma are considered to be the most important bacteria causing genital infection and infertility. The present study was conducted with the aim of searching for these two pathogens in the cervical secretions of infertile women, emphasizing molecular methods and determining drug resistance genes related to azithromycin and ciprofloxacin.

In this descriptive study, endocervical samples obtained from cervical secretions of 135 infertile women and 135 healthy women referred to Shohada Tajrish Hospital from October 2018 to September 2019 were examined. Data were analyzed by SPSS statistical software (version 21). Chi-square test was used to investigate the relationship between infection and infertility in individuals. P<0.05 was considered statistically significant.

The prevalence of Neisseria gonorrhoea and Ureaplasma urealyticum was significant in the case group compared to the control group (P≤0.05). According to chi-square test, a significant relationship was observed between infection and infertility (P≤0.05). The prevalence of azithromycin resistance in Ureplasma urealyticum and Neisseria gonorrhoeae was 35 cases (48.6%) and 7 cases (58.3%), respectively. Ciprofloxacin resistance was reported in 3 cases (25%) of Neisseria gonorrhoeae and 64 cases (68.8%) of Ureaplasma urealyticum. The highest prevalence of resistance genes in both bacteria was related to mtrR and gyrA.

Antibiotic resistance in the studied bacteria indicates the indiscriminate use of antibiotics, the spread of antibiotic resistance gene structures, and genetic transmission among populations. In order to definitively treat and prevent the occurrence of resistance in pathogen strains, it is necessary to determine the resistance pattern to follow the resistance trend.

Studies have shown that conventional sperm analysis does not represent fertility status completely. About 15% of infertile men have normal clinical and laboratory investigation. DNA fragmentation index (DFI) measures the DNA damage. Also, 20% of men with unexplained infertility have increased DFI level compared to the normal level. The present study was performed with aim to evaluate the clinical utility of DFI as an indicator for varicocelectomy.

This longitude observational study was performed in 2020-2021 on 60 patients who underwent varicocelectomy due to infertility in Imam Reza Hospital of Mashhad. The patients were divided into three groups based on DFI levels (DFI ≤15%, 15-30%, and >30%) considered as excellent, moderate, and poor fertility, respectively. Then, pre- and post-operational semen analysis was performed. Data were analyzed by SPSS software (version 24) and paired-t, Wilcoxon, and analysis of variance tests. P<0.05 was considered statistically significant.

The mean DFI in the excellent fertility group was 10.83 ± 2.92, in the moderate 21.10 ± 6.05, and in the poor fertility 46.56 ± 10.73. The moderate and poor fertility participants experienced statistically significant improvement in sperm count, motility, and morphology. On average, the number of 8.92±16.91 million per cc, the motility of 13.93±19.73% and the morphology of 3.17±3.57% improved after the operation.

The higher the pre-operative DFI, the more significant increase in sperm analysis factors is expected. DFI has a prognostic value for varicocele patients, especially those with higher DFI.People who have a higher pre operative DFI score will improve more after operation.

Breast cancer is the most common type of cancer and the second leading cause of cancer death in women. The severity and importance of risk factors and predisposing behaviors are different in each region. Analysis of the relationship between prognostic factors in women with breast cancer can affect the treatment process of patients. The present study was performed with aim to investigate the relationship between age of disease onset and the prognosis of breast cancer in women.

This cross-sectional descriptive study was performed on 160 patients referred to Khatam Al-Anbia Cancer Clinic in Jahrom in 2021 and their cancer was confirmed based on pathology report. The information in the questionnaire was analyzed using patients' files. Data were analyzed by SPSS software (version 21) and Spearman's correlation coefficient test and survival analysis and Kaplan-Meier curve (survival). P<0.05 was considered statistically significant.

There was no statistically significant relationship between age of disease onset and stage of breast cancer (r = 0.018, P = 0.891) and the size of lesions at the time of breast cancer diagnosis (r = 0.031, P = 0.721). Spearman correlation coefficient showed that there was a statistically significant relationship between the age of disease onset and lymph node involvement (r = -0.190, P = 0.016) and the prognostic factor Her2 at the time of breast cancer diagnosis (r = -0.167, P = 0.045); as the age of onset increases, Her2 decreases at the time of breast cancer diagnosis.

The highest frequency of age of women participating in the study was in the range of 41 to 50 years, but according to survival analysis based on age group, survival was higher in people over 70 years than other age groups (4.71±0.54 years). However, the Kaplan Mir chart did not show a difference between the different age groups, but as age increases, Her2 and lymph node involvement decreases at the time of breast cancer diagnosis.

There are mechanical and pharmacologic methods of cervical ripening that combination of these methods had better results. This study was performed aimed to investigate the effect of extra-amniotic dexamethasone infusion on cervical ripening and Bishop score, labor duration and maternal and neonatal complications.

This randomized clinical trial study was performed on 60 term pregnant women with unripe cervix who were candidates for induction of labor in Amiralmomenin hospital of Semnan in 2019-2020. The subjects were randomly assigned into intervention (extra-amniotic dexamethasone infusion through the intracervical catheter) and control groups (extra-amniotic normal saline infusion). Both groups underwent labor induction and the information about the delivery process including latent and active phase duration, time needed for catheter removal, bishop score after catheter removal, cesarean rate and first and fifth minutes Apgar score of neonates entered in a checklist. Data were analyzed by SPSS (version 23) and T-test, U-Man-Whitney and Chi-square tests. P<0.05 was considered statistically significant.

  After the intervention, there was significant difference between the two groups in terms of initial Bishop score and the Bishop score after catheter removal (P=0.028), but duration of catheter removal (P=0.45), mean time of induction onset to delivery (P=0.14), duration of active phase (P=0.84) and latent phase (P=0.83), first and fifth minutes Apgar score (P=0.19) and cesarean rate (P=0.76) were not significantly different between the two groups. 

Extra-amniotic Dexamethasone infusion improves the Bishop score more than the control group, and facilitates cervical ripening for induction of labor.

Designing valid and reliable tool to measure the sexual self-care status of reproductive age women in order to identify the strengths and weaknesses and design appropriate interventions to improve the sexual health status of reproductive age women is considered a necessity for the society. Therefore, this study was conducted with aim of designing and psychometrically evaluating sexual self-care questionnaire in women of reproductive age.

This was a methodological study with a cross-sectional design conducted in 2021. A questionnaire was designed using a comparative approach based on the Waltz model. Then, to check the psychometric characteristics of the tool, quantitative and qualitative face validity and quantitative and qualitative content validity were investigated. Finally, the reliability of the tool was assessed by the internal consistency assessment and determining the Cronbach's alpha coefficient, and the stability assessment by the test-retest method and determining the intra-cluster correlation coefficient (ICC).

The final version of this questionnaire was designed with 40 items in four areas including prevention of sexually transmitted diseases and genital infections, prevention of gynecology cancers, prevention of unwanted pregnancy and promotion of sexual health. The psychometric characteristics of this questionnaire showed that the validity index of the total tool was 0.93 and the validity ratio of the total tool was 0.96. The relative reliability of the total tool was also shown with Cronbach's alpha of 0.94. The stability of the tool was also shown by the ICC in the total tool of 0.97 with a confidence interval of 0.94-0.98.

The Female Sexual Health Self-care (FSHS) questionnaire has acceptable validity and reliability in the Iranian population, which can measure the broad concept of sexual self-care. The results of this study can be available to experts and planners to review the current situation and design suitable interventions.

Mother's physical and mental health and ability are the key factors in the breastfeeding process. In traditional medicine, grape juice is called Debs or Doshab. It has also been said that its properties are similar to mother's milk. Molasses syrup consisting of concentrated grape juice, Omani lemon and saffron is a source of strengthening the mother after childbirth in Iranian medicine. The present study was performed with aim to investigate the effect of molasses syrup on the breastfeeding pattern in the first three months after childbirth.

This three-blind randomized clinical trial study was conducted on 92 mothers who gave birth in Hafez and Shushtri hospitals in Shiraz in 2020-2021. In the intervention group, molasses syrup and in the control group, placebo was received for six weeks. Data were collected with demographic and midwifery questionnaire and breastfeeding pattern questionnaire. The breastfeeding pattern was examined on the first, tenth, one month and three months after delivery. Data were analyzed by SPSS software (version 26) and independent t, Mann-Whitney, Chi-square and Fisher's exact tests. P< 0.05 was considered statistically significant.

The pattern of breastfeeding on the first day of birth, exclusive breastfeeding (EBF) in both intervention (97.82%) and control (95.70%) groups had no statistically significant difference (p=0.500). The pattern of exclusive breastfeeding with breast milk showed a significant difference on the 10th day in the intervention (71.7%) and control (32.6%) groups (p=0.001), on the 30th day in the intervention (82.6%) and control (34.8%) groups (p<0.001), and three months later in the intervention (82.6%) and control (32.6%) groups (p<0.001).

The consumption of grape juice, saffron and Omani lemon syrup (Debs) by the mother can be effective on the breastfeeding pattern on the 3rd day, 10th day, 30th day and third month and can improve the mother's breastfeeding.

Menopause is one of the most critical phases of women's life. Some women suffer from psychological problems such as anxiety and depression during this period due to the lack of estrogen. The present study was performed with aim to determine the effect of chamomile tea on anxiety and depression in postmenopausal women.

This randomized clinical trial study was performed on 68 postmenopausal women in the form of 2 groups: chamomile tea (intervention group) and control group in Ahvaz city in 2020. Data collection tool included demographic information questionnaire and depression, anxiety and stress scale DASS form with 21 questions. Chamomile tea was consumed in the intervention group and placebo in the control group 3 times a day for 8 weeks. Before the intervention, 4 and 8 weeks after the intervention, the level of anxiety and depression was measured in the two groups. Data were analyzed by SPSS statistical software (version 24) and independent t-tests, repeated measures and chi-square tests. P< 0.05 was considered statistically significant.

The results of the independent t-test showed that before the intervention, the mean anxiety score in the experimental group was 24.47±1.92 and in the control group 20.70±1.46, as well as the mean depression score in the experimental group was 24.29±1.69 and in the control group 19.23±1.28, there was no statistically significant difference in the two groups (P<0.05). The results of the paired t-test indicated that the mean score of anxiety in the experimental group 4 and 8 weeks after the intervention was 10.50±2.36 and 10.82±1.69, respectively and depression was 10.82±2.27 and 10.76±1.34, respectively, which showed a significant decrease compared to the control group that the mean score of anxiety was 21.85±1.37 and 21.73±1.52 and the depression score was 21.94±0.98 and 20.67±1.09, respectively (p>0.001).

Chamomile tea in postmenopausal women improves symptoms of depression and anxiety. In addition to being economical, the use of chamomile tea has fewer side effects compared to chemical treatments.

 Premenstrual syndrome, by affecting different aspects of women's lives, needs to be controlled. Due to the lack of knowledge of the exact cause of this syndrome, several treatments have been proposed for it. One of the treatment methods is the use of aromatherapy, The present study was performed with aim to determine the effect of aromatherapy with geranium essential oil on premenstrual syndrome in students.

This clinical trial study was conducted in 2020 on 80 students with premenstrual syndrome in Gonabad University of Medical Sciences. The subjects were randomly divided into intervention and control groups. For the intervention group (5 days before menstruation), geranium essential oil and in the control group, a placebo (odorless sweet almond oil) was used. After two consecutive menstrual cycles, the post-test questionnaire was completed. Data were analyzed by SPSS statistical software (version 22) and chi-square, Mann-Whitney and Wilcoxon tests. P<0.05 was considered statistically significant.

There was no significant difference between the mean scores of the dimensions and the total score of the premenstrual syndrome questionnaire in the two intervention and control groups before the implementation of aromatherapy (p>0.05), while after the implementation of aromatherapy, there was a significant difference between the mean scores of the dimensions and the total score between the two groups, so that the intensity of the symptoms of premenstrual syndrome significantly decreased in the aromatherapy group (p<0.05).

Aromatherapy with geranium essential oil is effective in reducing the symptoms of premenstrual syndrome and its use is recommended as a complementary, cheap, non-invasive treatment with few side effects.

The present study was performed with aim to compare the safety and efficacy of different forms of phenylephrine to prevent oxytocin-induced hypotension in cesarean section with spinal anesthesia.

In this systematic review and network meta-analysis, databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials.gov, and Scopus and Persian language databases of SID and Elmnet were searched with keywords of "Phenylephrine", "Caesarean section", "blood pressure", "Oxytocin" and their Persian synonyms. The occurrence of hypotension in different groups of clinical trial studies was considered as the effect size. The safety and efficacy of study arms based on different pharmaceutical forms of phenylephrine were investigated with network meta-analysis review techniques.

A total of 6 interventions including low dose bolus (50 micrograms) or high dose (75 or 100 micrograms), intramuscular injection of 1, 2 and 3 milligrams of drug and no injection of phenylephrine (injection of normal saline) and totally 4 studies with a total of 9 pairwise comparisons with direct data were available. Also, 6 nonrealistic (indirect) comparisons were synthesized with predictions based on the Baysesian model. Based on the random effect model, injection of bolus of 75/100 μg significantly with a risk ratio of 0.07 (95% confidence interval 0.01 to 0.48) less than low dose bolus (50 μg) was associated with the occurrence of blood pressure drops. Risk of the occurrence of hypotension in the group of bolus injection of a high dose of phenylephrine (75 or 100 micrograms) was 0.04 times (95% confidence interval 0.01 to 0.31) of normal saline injection. There was no significant difference in other comparisons.

Bolus injection with a high dose of phenylephrine is associated with the lowest chance of hypotension; while other methods of drug administration are not different. The synthesis of hypothetical studies based on Baysesian statistics helps researchers predict the results of future clinical trials on these subjects.

A better understanding of the mechanism and / or pathophysiology of shoulder pain syndrome after laparoscopic gynecological surgery leads to an increase in the number of clinical trials to prevent this complication. Therefore, the present study was conducted with aim to define the mechanism and prevention methods of shoulder pain syndrome after laparoscopic gynecology surgeries.

In this narrative review study, to find the articles related to shoulder pain syndrome after laparoscopic gynecology surgeries, the published articles from 2000 including observational and clinical trials, descriptive and correlational studies were searched in the electronic databases of PubMed, Scopus, EMBASE, PEDro, Google Scholar, CINAHL , SID and Magiran with the keywords of shoulder pain syndrome, shoulder pain, surgery, laparoscopy, gynecology, postoperative and gynecology laparoscopy.

The main searched mechanisms included the pain mechanism, pain due to surgical incision, causes of shoulder pain syndrome after laparoscopic surgery in women, use of an alternative blowing gas to reduce shoulder pain syndrome, use of low pressure pneumoperitoneum to reduce the shoulder pain syndrome, gas-free laparoscopy and active gas excretion to reduce shoulder pain syndrome, use of heated or heated and humidified CO2 to reduce shoulder pain syndrome, use of sub-diaphragmatic intraperitoneal anesthesia or localized intraperitoneal anesthesia to reduce tip shoulder pain and use of pulmonary recurrence maneuvers in reducing shoulder pain syndrome.

Shoulder pain syndrome in laparoscopic gynecological surgeries can be minimized with preventive measures such as the use of hot and humid gas, intraperitoneal administration of local analgesics and pulmonary recovery maneuver.

The most important factor initiating cervical cancer is human papilloma virus (HPV) infection; although the HPV vaccine can significantly prevent the infection in women, there is contradictory findings about its side effects such as premature ovarian failure (POF). The present systematic review was conducted with aim to determine the association between this vaccine and POF.

This study was conducted by search in the reliable databases of PubMed, Web of Science, Google Scholar, Embase, and Scopus by two researchers independently based on the PICO guidelines and the use of Mesh terms including Papillomavirus vaccine, Human Papillomavirus Recombinant Vaccine Quadrivalent, Primary Ovarian Insufficiency and Premature Ovarian Failure. Newcastle - Ottawa checklist was used to evaluate the quality of articles.

After review and evaluation of the quality of 128 primary articles, finally 7 articles were included in the systematic review. According to the results of population-based studies, there was no significant relationship between the HPV vaccine and POF; but there are case series which support the association between the HPV vaccine and POF. They declared that the cause of this complication was the induction of autoimmune response by the vaccine and the side-effects of the adjuvant used in it.

Considering that the HPV vaccine is currently the most effective approach in preventing cervical cancer, it seems more reasonable to use preventive benefits of this vaccine. Further studies emphasizing the possible side effects of the vaccine can minimize the challenges associated with this vaccine in the future.

Gestational trophoblastic neoplasia (GTN) is a rare disorder, especially in nulliparous women. This study introduced a patient with GTN who underwent successful and uncomplicated treatment of uterine artery embolization and chemotherapy.

The patient was a 29-year-old woman with a history of two pregnancies who referred to Amiralmomeni hospital of Semnan with complaint of severe vaginal bleeding. On ultrasonography, the hypo-echo mass with cystic changes was seen in favor of GTN. Due to the young age of the patient and to preserve the uterus and re-pregnancy, treatment was performed with uterine artery embolization and then chemotherapy, and treatment was successful.

In patients with GTN, uterine artery embolization along with chemotherapy can be considered an effective treatment with minimal complications, especially in young nulliparous women who are interested in preserving the uterus.