مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 2 (اردیبهشت 1402)

Hysterectomy means removing the uterus from the body, which requires reducing spasticity and abdominal muscle tone during this long-term surgery. The present study was conducted with aim to investigate the effect of remifentanil on hemodynamic changes and muscle spasticity in patients undergoing total abdominal hysterectomy.

This double-blind randomized clinical trial study was conducted in 2022 on 24 patients referred to the operating room of Motahari Hospital in Jahrom city who underwent hysterectomy surgery. Patients were divided into two groups of remifentanil and control. Hemodynamic symptoms, bleeding rate, surgeon's satisfaction with abdominal muscle spasticity and the time of re-injection of muscle relaxant were evaluated. Data analysis was done using SPSS software (version 21) and ANOVA with repeated measures, Mann-Whitney and chi-square tests. P<0.05 was considered statistically significant.

The mean systolic, diastolic, mean arterial blood pressure and heart rate were not significantly different between the two groups during most of the examined times (P>0.05). There was no significant difference between the two remifentanil and control groups in the mean amount of bleeding at different times (P>0.05), surgeon's satisfaction with abdominal muscle spasticity at different times (P>0.05). The time needed to re-inject the muscle relaxant in the first and second injections was significantly longer in the remifentanil group than the control group (P<0.05); However, there was no significant difference between the two remifentanil and control groups in the third injection (P>0.05).

The use of remifentanil during anesthesia did not have a significant effect on improving hemodynamic changes, bleeding rate and surgeon satisfaction, but delayed the need for additional doses of muscle relaxants. However, it is necessary to further investigate this drug in combination with inhalation gases in larger communities.

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory disease of the breast tissue with unknown etiology. Due to the appearance of most cases of the disease in reproductive age and in women with a history of pregnancy and breastfeeding, the present study was performed with aim to investigate fertility indicators in IGM.

This retrospective study was conducted in 2018-2019 on 240 women, including 80 patients with idiopathic granulomatous mastitis and 160 healthy individuals, referred to the breast clinic of Kurdistan University of Medical Sciences-Iran. Data related to the variables of age, BMI, number of pregnancies, duration of breastfeeding, age of first pregnancy, age of first menstrual period and history of taking contraceptive pills were collected by referring to patients' records in order to determine the relationship of each of these variables with the disease. Data analysis was done using SPSS software (version 25) and independent t-test and Fisher test. P<0.05 was considered statistically significant.

There was a significant relationship between variables of BMI, number of pregnancies, and duration of breastfeeding in the case and control groups (p<0.05); While there was no significant relationship between variables of age, age of first pregnancy, age of first menstruation and history of taking OCP in the case and control groups (p>0.05).

The present study showed that patients with IGM had a higher BMI, more number of pregnancies, and a longer duration of breastfeeding compared to non-affected people; Age, age of first pregnancy, age of first menstruation, and history of OCP use had no significant relationship with IGM.

Pregnancy has a significant effect on the thyroid gland and its function. Hypothyroidism in pregnancy is defined as an increase in serum TSH levels. The present study was conducted with aim to investigate the amount of hemodynamic changes and the level of spinal anesthesia in hypothyroid patients undergoing caesarean section with spinal anesthesia and comparing it with the control group.

In this case-control study, 83 patients aged 18-42 years who referred to Motahari Hospital in Jahrom city for caesarean section were studied in two hypothyroid (n=42) and control (n=41) groups. The level of spinal anesthesia, systolic, diastolic and mean arterial blood pressure and heart rate were measured and recorded before the administration of anesthetic, 1, 15, 30, 45 and 60 minutes after anesthesia and at the time of entry and exit from recovery. Data analysis was done by SPSS software (version 21) and repeated measurement, Cochran, analysis of variance and chi square tests. P<0.05 was considered statistically significant.

There was a significant difference in the frequency of spinal anesthesia between hypothyroid patients undergoing caesarean section with spinal anesthesia and the control group (p<0.001). There was no significant difference between the groups of patients with hypothyroidism and the control group in terms of mean systolic and diastolic blood pressure before and 1 minute after anesthesia, 15, 30, 45 and 60 minutes after anesthesia and at the time of entry and exit from recovery (P<0.05).

Although the use of spinal anesthesia in pregnant mothers with hypothyroidism reported a higher level of anesthesia during the operation compared to the control group, the difference in mean arterial pressure and heart rate was not clinically significant between the groups. Based on the present study, it seems that there is no need to change the spinal anesthesia protocol for patients with hypothyroidism.

Adhering to the daily intake of folic acid-iron during pregnancy reduces maternal complications such as premature birth, low birth weight and fetal defects. It seems necessary to identify factors related to iron/ folic acid adherence. This study was conducted with aim to determine the adherence to iron- folic acid supplementation and its related factors among pregnant women.

This descriptive-analytical study was conducted in 2022 on 178 pregnant women in Mazandaran province/ Iran. Data were collected via questionnaires (Demographic, self-report adherence, Morisky questionnaire and Iron/ folic acid knowledge). Analysis was done using SPSS software (version 21) and chi-square test and logistic regression analysis. P<0.05 was considered statistically significant.

Nearly 70% of pregnant women adhered to iron-folic acid intake. The most observed side effects were gastrointestinal complications, and the most common reason for non-adherence to use was forgetfulness. Age over 30 years old (OR=2.49; p=0.027), prenatal care more than 4 times (OR=2.33; p=0.042), and the absence of drug side effects (OR=2.42; p=0.033) increased the chances of adhering to iron-folic acid. The chance of adhering decreased in working mothers (OR=0.33; p=0.025).

In this study, adherence to iron and folic acid intake in pregnant women was high. Regular prenatal care and appropriate consultation will improve adherence to iron/folic acid intake in pregnant women.

Episiotomy is one of the most common surgeries in midwifery. Episiotomy wound healing can lead to perineal infection and pain, and affects mothers' satisfaction with childbirth. Tea herb with analgesic and anti-inflammatory properties can be effective on mothers' satisfaction with wound healing process. Therefore, the present study was conducted with aim to investigate the effect of tea herb cream on wound healing satisfaction and episiotomy pain intensity in primiparous women.

This double blind randomized clinical trial study was conducted in 2014 on 100 eligible primiparous women referred to Noorani hospital of Talesh. The participants were randomly allocated into two groups: A (drug) and B (placebo). After delivery, the subjects used the creams on episiotomy site twice a day for 10 days. They completed the researcher's questionnaires about satisfaction with treatment on the 10th day after delivery. Data were analyzed by SPSS software (version 19) and Mann-Whitney, independent t test and fisher exact test. P< 0.05 was considered statistically significant.

 The level of satisfaction in the intervention group with mean rating of 73.93 was higher than the control group with mean rating of 25.07. According to the Mann-Whitney test, the relationship between the two groups in terms of the level of satisfaction was significant (P<0.001)

Tea herb cream is effective on the satisfaction of pain improvement and wound healing.

Dysmenorrhea is usually cramped in nature and focuses on the lower abdomen and is a common disorder that manifests during the menstrual cycle and interferes with a person's daily activities. The present study was performed with aim to compare the effect of the medicinal plant of marigold and mefenamic acid on the pain of patients with primary dysmenorrhea.

This randomized clinical trial study with a control group was conducted in 2018 on 80 girls aged 18-25 years who referred to Khomein health centers. The subjects were divided into two groups: intervention (recipient of amaranth drops) and control (recipient of mefenamic acid capsule) (n=40 in each group) and drugs were taken for 2 months. Before the intervention and during 2 months, the primary dysmenorrhea pain score was evaluated by a visual pain measure including a pain ruler and a pain descriptive form and then were compared. Data were analyzed using SPSS software (version 19) and independent t, paired t and Wilcoxon tests. P<0.05 was considered statistically significant.

Based on the results of Wilcoxon test, the pain intensity score before the intervention and after 1 and 2 months of consumption was significant in both groups (p≤0.001). Based on the results of independent t-tests and paired t-tests, there was a significant difference in the mean number of pain days (pain duration) before and after the intervention in the two groups (p≤0.001), and the duration of pain had decreased in the test group during the first and second month after the intervention.

Marigold medicinal plant and mefenamic acid reduced the duration of dysmenorrhea pain compared to before treatment, therefore, the use of marigold along with mefenamic acid is recommended in the treatment of dysmenorrhea.

Nausea and vomiting are the most common complications of pregnancy. In order to minimize the consumption of chemical drugs and prevent their side effects in pregnant women, this study was conducted with aim to compare the effect of Ondansetron versus Ginger on nausea and vomiting in pregnancy.        

This double-blind clinical trial study was conducted in 2018 on 110 pregnant women with nausea and vomiting in 10-15 weeks of pregnancy who referred to health family clinics of Bandar Mahshahr. Women were randomly assigned to two groups of ginger (n=55) and ondansetron (n=55). The ginger group used 9 tablets of 500 mg consisting of dry ginger powder for three days (once every 8 hours) and the ondansetron group used 9 tablets of 4 mg ondansetron for three days (once every 8 hours). Data collection tool included a demographic questionnaire and a Rhodes index questionnaire which assessed the severity and frequency of nausea and vomiting before entering the intervention and twice a day during the study. Data were analyzed by SPSS software (version 22(, using Mann-Whitney, Wilcoxon, and independent t tests. P<0.05 was considered statistically significant.

The mean score of the Rhodes index in the ginger group decreased from 12.61 ± 3.7 to 5.43 ± 6.23 and in the ondansetron group from 14.5 ± 4.73 to 3.89 ± 3.86 (p<0.001). Therefore, ginger was as effective as ondansetron in reducing the frequency and severity of nausea and vomiting during pregnancy.

Both ginger and ondansetron are effective in treating nausea and vomiting of pregnancy and the effect of ginger and ondansetron is the same with a very small difference.

Stillbirth is one of the adverse outcomes of birth in both developing and developed countries. Worldwide, more than a million pregnancies end in stillbirth, most of which occur in low- and middle-income countries. This study was conducted with aim to determine maternal and fetal risk factors for stillbirth in Qaenat city.

This case-control study was conducted from 2016-2021 on 104 stillbirths and 208 live births (controls) in urban and rural health centers of Qaenat city. Data related to stillbirths were collected using a researcher-made checklist. Data analysis was done using SPSS software (version 26) and chi-square and logistic tests. P< 0.05 was considered statistically significant.

The total stillbirth rate was 9.88 per 1000 live births. In univariate analysis, mother's age (P=0.04), husband's age (P=0.009), history of twin birth (P=0.006), history of underlying disease (P=0.04), gestational age (P=0.001), birth weight (P=0.001), history of abortion (P=0.02) and history of stillbirth (P=0.03) showed a significant relationship with stillbirth. In the multivariate logistic regression analysis, the birth of a baby under 37 weeks (aOR=17.77, CI:7.20-43.83, P<0.001), birth weight less than 2500 gr (aOR=5.36, CI:2.22-12.96, P<0.001) and history of abortion (aOR=2.38, CI:1.07-5.27, P=0.03) showed a significant relationship with stillbirth.

The prevalence of stillbirth in Qaenat city was relatively high. In this study, several maternal and fetal risk factors such as birth less than 37 weeks gestational age, birth weight less than 2500 gr and history of abortion were identified for stillbirth. Early identification of at-risk pregnancies and appropriate intervention may help reduce the occurrence of stillbirths. Therefore, it is necessary to identify high-risk people and provide them with necessary training and counseling.

The quality of puberty can affect the sexual health and fertility of children. There is limited evidence about the risks associated with the use of assisted reproductive methods (ART) on the process of puberty. This review study was conducted with aim to investigate the puberty process in ART children.

In this review study, to find the related articles regarding the puberty process in ART children, the databases of Web of Science, Scopous, Proquest and Pubmed and Persian databases of SID and Magiran and Google Scholar search engine were searched to find published studies using English keywords: Assisted Reproductive Technology, In vitro fertilization, Intracytoplasmic sperm injection, puberty, Tanner and adolescent and their Persian equivalents.

In total, among 1438 articles found, 10 articles were eligible for the research and were selected for this study. The prevalence of puberty disorders in ART children was not different compared to children resulting from spontaneous pregnancy. Tanner's stages, bone growth, hormonal status among adolescents resulting from ART were similar to the normal population, although in girls resulting from ART were exposed to earlier puberty and boys were exposed to small differences in sex hormones compared to children resulting from spontaneous pregnancy.

Although many studies did not show a significant difference in the puberty process of ART adolescents compared to other adolescents, information on long-term follow-up is limited. Therefore, it is necessary to long-term follow-up of ART-born children until completion of puberty by child's sex and ART types.

Childbearing is an important phenomenon in demographic movements and the basis of sustainable development in countries with low replacement fertility rates. The present study was performed with aim to summarize the existing knowledge about the effectiveness of structural factors of social determinants of health on childbearing of Iranian women.

In this systematic review, observational Persian and English studies published from 1/1/2010 to 23/1/2022 were included in the study. Studies were searched in Magiran, SID, Embase, google scholar, Scopus, web of science, and PubMed databases using related keywords including: Reproductive Behavior, Childbearing, Socioeconomic Factors, Ethnic Groups, Culture, Structural Determinants of Health and Iran. The Newcastle-Ottawa tool was used to evaluate the quality of the articles.

In this review study, 36 studies which met the inclusion criteria were included in the study, and health structural factors (education, income, occupation, ethnicity, and culture) on women's childbearing were examined. Women's childbearing is related to these structural factors of health. In this review study, the highest frequency was related to women's education; so that 18 articles showed the negative effect of education on childbearing.

The results of the present systematic review showed the effect of structural social determinants of health (education, income, occupation, ethnicity, and culture) including women's education on childbearing. This confirms that if population policies can implement programs that make the mother's role compatible with the continuation of women's education after marriage, they can be much more effective.

Mitotically active cellular fibroma (MACF) with Minor Sex Cord Elements is a extremely rare disease. Although imaging helps in the diagnosis to some extent, the final and definitive diagnosis is based on evaluation and histological studies. The main differential diagnosis of this tumor is ovarian fibrosarcoma, which has moderate to severe atypia and a poorer prognosis. In this study, a case of mitotically active ovarian cellular fibroma with minor sex cord elements is reported.

A 41-year-old woman referred to gynecologic clinic with abdominal pain and abnormal uterine bleeding in the form of spotting. Clinical findings had no signs for diagnosis. Serum Tumor markers including CA125 were within normal limit. Ultrasound and computed tomography (CT) were supportive of sex cord stromal tumors. After surgical procedures and pathologic evaluation, the patient was finally diagnosed as MACF with less than 10% sex cord elements.

Differentiating mitotically active cellular fibroma from fibrosarcoma which may have similar histological findings is important to prevent overtreatment of patient with cellular fibroma.