مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 3 (خرداد 1402)

Although the benefits of egg donation are clear in helping women who are unable to produce eggs to reproduce, but couples who are candidates for egg donation face many challenges and complications in treatment. Therefore, this study was conducted with aim to investigate the clinical characteristics and complications of pregnancy in couples who are candidates for egg donation.

This cross-sectional descriptive study was conducted in 2015-2020 on 53 couples of egg donor candidates referred to Motazadi Infertility Medical Center and University Jahad Center of Kermanshah city. The required information was collected from couples who were candidates for egg donation through file review and completion of the checklist. Data were analyzed by SPSS statistical software (version 20) and Chi-square, t-test and Fisher test. P<0.05 was considered statistically significant.

According to the results, the most common outcomes of pregnancy resulting from egg donation in the present study were five cases of abortion (9.43%), four cases of preterm birth (7.5%), three cases of preeclampsia (5.7%), two cases of intrauterine growth restriction (3.8%) and one case of fetal malformations (1.87%). Finally, 18 cases (33.97%) of the couples got pregnant with egg donation method and 14 cases (26.4%) had a live birth Also, there was no statistically significant relationship between live birth and BMI, age of the couple, and age of the egg donor (P>0.05).

Based on the results, it seems that pregnancy complications in pregnancies resulting from donated eggs are not as expected as pregnancies resulting from the individual's own eggs. Therefore, they can be controlled by suitable preconception and prenatal care, but there is still a need for more research and investigation of all the variables and factors affecting egg donation process.

One of the major problems of the fetus is the excretion of the contents of the fetal intestine in the amniotic fluid sac or the amniotic fluid stained with meconium. If the time of stained with meconium is long or if the meconium is thick, it leads to serious risks for the mother and the fetus. The present study was conducted with aim to investigate the prevalence of babies born with meconial stained amniotic fluid and the associated maternal and fetal complications.

This cross-sectional study was conducted in a period of 6 months (Dec 2014 to June 2015) on 1383 women with a singleton pregnancy and a gestational age of more than 28 weeks who had referred to Omolbanian Hospital in Mashhad due to the onset of labor pains. The investigated information included: mother's age, gestational age, number of pregnancies, mode of delivery, amniotic fluid condition, baby's gender, baby's Apgar, ABG (arterial blood gas), birth weight and the need for baby resuscitation. Data analysis was done using SPSS statistical software (version 22) and t-test and chi-square statistical tests. P< 0.05 was considered statistically significant.

In the present study, out of 1383 cases of normal delivery, 114 cases had meconium-stained amniotic fluid (prevalence of 8.2%). The number of cesarean section was higher in the thick meconial group (26 cases (%43.3)) compared to thin meconial group (9 cases (16.7%)) (p=0.002). The amount of abnormal ABG was 10 cases (8.7%) in the meconial group, of which 6 cases (5.2%) were in the fetal distress group. The amount of abnormal ABG was 8%, which was significantly higher in the thick meconial group (p=0.002). First minute Apgar less than 7 was more in the thick meconial group (p=0.01) and 5th minute Apgar had no difference between the two groups. There were no cases of convulsions or death of infant in the two groups.

In this study, the prevalence of amniotic fluid stained with meconium was 8.2%. Although the rate of cesarean delivery was higher in the thick meconial group, there was no significant difference in fetal distress in the thick and thin meconial groups. Considering the complications of cesarean section for the mother, natural delivery can be a choice method in these mothers and cesarean section is limited to cases of fetal distress or thick meconium far from delivery.

Recurrent pregnancy loss refers to the occurrence of two or more consecutive abortions before the 20th week of pregnancy, which has a high prevalence and it is necessary to identify the factors affecting it. Therefore, this study was performed with aim to investigate the frequency of various factors affecting pregnancy loss in patients with history of recurrent pregnancy loss.

This cross-sectional study was performed on 280 women with at least two abortions less than 20 weeks who had referred to the only infertility treatment center in Sistan and Balouchestan province in 2017-2018. Data related to abortion was collected based on the patients' file. Data were analyzed using SPSS software (version 20) and Kolmogorov-Smirnov test with lilliefors correction, Student t, Mann-Whitney and Fisher's exact tests. P<0.05 was considered statistically significant.

The most common causes of recurrent pregnancy loss included: uterus anatomical abnormalities (44.64%) and then spontaneous abortion with unexplained causes (38.93%). Endocrine causes (35%), male causes (6.43%), chronic endometritis (8.21%), genetic causes (3.57%), inherited thrombophilia (2.86%), and immunological causes (1.43%) were in the next ranks..

The most common disorders leading to recurrent abortions in Moloud Infertility Center of Zahedan were uterus anatomical disorders (44.46%) and then spontaneous abortions with unknown causes (38.93%) but endocrine disorders (35%) was the next most common cause. In case of timely diagnosis and treatment, it may be possible to reduce the rate of recurrent abortion.

Currently, there is disagreement regarding the duration of treatment with estradiol in the cycle of frozen embryo transfer and its effect on pregnancy outcomes. The present study was performed with aim to compare the duration of treatment with estradiol in the endometrial preparation in the freezing embryo transfer cycle and its effect on pregnancy outcomes in infertile women.

This randomized controlled clinical trial study was performed in 2021 on 140 infertile women candidate for assisted reproductive technology by frozen embryo transfer. The subjects were randomly allocated into two groups: intervention (estradiol recipient, for 8 days) and control (recipient of estradiol as usual, 13 days). In the intervention group, progesterone was started from the eighth day of estradiol intake and in the control group from the thirteenth day of estradiol intake. In both groups, estradiol and progesterone levels were measured the day before progesterone onset and then the embryos were transferred in the morula or blastocyst stage. Data analysis was done using SPSS statistical software (version 26) and chi-square and t-test.  P<0.05 was considered statistically significant.

In the intervention and control groups, the mean serum level of estradiol during embryo transfer was 285.7 ±287.1 and 443.5 ±354.3 (P = 0.028), the mean endometrial thickness at the time of progesterone onset was 9.3 ±1.4 and 8.8 ±0.9 mm (P = 0.008), frequency of chemical pregnancy occurrence was 31.4% and 17.1% (OR = 1.1, P = 0.049) and frequency of clinical pregnancy was 27.1% and 17.1% (OR = 1.4, P = 0.154) respectively.

In infertile women treated with IVF assisted reproductive technology, shorter duration of treatment with estradiol in endometrial preparation and frozen embryo transfer cycle are associated with better pregnancy outcomes.

Vitamin D deficiency in women may play a role in the pathogenesis of infertility and menstrual dysfunction. Due to the high percentage of insufficient vitamin D serum levels in women of reproductive age, recently the role of vitamin D in reproductive physiology has also been considered. The present study was performed with aim to determine the relationship between vitamin D serum level and pregnancy success rate in a cycle of in vitro fertilization (IVF).

In this prospective cohort study conducted in 2022, 116 reproductive-aged women diagnosed with both primary or secondary infertility in their first IVF cycle were studied. Based on the serum level of vitamin D in the blood sample measured by the Elisa method 7 days before embryo transfer, the participants were divided into two groups: deficiency or insufficient and sufficient and were evaluated at the gestational age of 7 weeks in terms of the presence of intrauterine gestational sac and the presence of heartbeat. Data collection tools included socio-demographic, infertility, and nutrition questionnaires, and checklists for recording test results and pregnancy outcomes. Data were analyzed by SPSS statistical software (version 24) and chi-square, independent t-test, and multivariate logistic regression. P<0.05 was considered statistically significant.

The mean of vitamin D serum level in people with successful pregnancy and unsuccessful pregnancy was 60.3±26.8 and 66.5±37.4, respectively (p=0.361) and the frequency of pregnancy success in vitamin D sufficient and insufficient group was 23.3% and 13.6%, respectively (p=0.247). Based on multivariate logistic regression and adjusting for confounding variables, there was no statistically significant difference between the groups in terms of pregnancy success rate (odds ratio: 2.08; 95% (CI): 0.45 to 9.5; (p=0.346).

Although vitamin D serum level in infertile women with successful pregnancies was more than in women with unsuccessful pregnancies, however, this difference was not significant.

One of the possible causes of post-term pregnancies is the unripe cervix. The present study was performed with aim to compare the effect of misoprostol and evening primrose oil on labor progress and neonatal Apgar score in post-term pregnancies.

This double-blind randomized clinical trial study was conducted in 2018 on 130 pregnant women with post-term pregnancy. The samples were selected by convenience sampling method and randomly assigned to two groups: (evening primrose and misoprostol) and (placebo and misoprostol). To collect the data, a checklist of demographic and clinical information was used along with questions related to bishop score, duration of labor and neonatal Apgar score. Data analysis was done using SPSS statistical software (version 21) and chi-square test, Fisher exact test and independent t-test. P< 0.05 was considered statistically significant.

The mean bishop score in the evening primrose and misoprostol group significantly increased compared to the placebo and misoprostol group (p=0.0001). Also, the length of the latent phase of labor was shorter in the evening primrose and misoprostol group compared to the placebo and misoprostol group. However, based on the results of the chi-square test, there was no significant difference between the two groups in terms of first and fifth minutes Apgar scores (p>0.05).

The use of evening primrose oil vaginal capsule along with misoprostol, compared to misoprostol alone, while helping to prepare the cervix, will be effective in reducing the duration of the latent phase of labor and has no adverse effect on the neonatal Apgar score.

Postpartum home visits have yielded conflicting results. One of the challenges in this field is the implementation of effective training to support mothers after giving birth to investigate the problems of exclusive breastfeeding. The present study was performed with aim to investigate the impact of home visits by midwives on the amount of breastfeeding problems after delivery.

This clinical trial study was conducted on 100 mothers who gave birth in Flowerjan Imam Khomeini Hospital in 2018. The subjects were randomly divided into two groups of intervention and control (n=50 in each group). The control group received routine postpartum care through health centers and the intervention group received training in 4 sessions (in the early postpartum period up to 42 days after birth) at home. The data collection tool was a demographic and breast problems questionnaire which was completed in mothers' homes. Data was analyzed by SPSS statistical software (version 22) and independent t-test and paired t-test. P<0.05 was considered statistically significant.

The frequency of engorgement on the third and seventh days was significantly lower in the intervention group than the control group (P<0.05), and there was no significant difference between the two groups on the fourteenth and forty-second days (P>0.05). The frequency of fissure on the third day was significantly lower in the intervention group than the control group (P<0.05), and there was no significant difference between the two groups on the seventh and fourteenth days (P>0.05). There was no fissure in any of the two groups on the forty-second day.

Practical advice and support on breastfeeding techniques by trained midwives may result in greater transfer of skills and reduced fissure and engorgement.

Early symptoms of menopause are very common and often very bothersome. Considering the increasing number of women experiencing these symptoms in the world and Iran, there is a growing need to use methods to reduce these symptoms. Therefore, this study was performed with aim to determine the effect of the combined herbal capsules (Menohelp) on reducing the early symptoms of menopause, number and intensity of hot flashes (primary outcomes), and improving sleep quality and quality of life (secondary outcomes) in menopausal women.

In this double-blind trial in Tabriz, 100 women aged 50 to 59 years suffering from early symptoms of menopause were randomly assigned into two groups of receiving capsules of either Menohelp or placebo. The randomization was done using blocked randomization stratifying by duration of menopause with allocation ratio of 1:1. The outcomes were assessed using the Green Climacteric Scale, a checklist including the number and severity of hot flashes, Pittsburgh sleep quality and the Menopause-Specific Quality of Life (MENQOL). Data were analyzed by SPSS statistical software (version 21) and repeated measures ANOVA, ANCOVA and Mann-Whitney U. P<0.05 was considered statistically significant.

There were no statistically significant differences between the two groups in terms of mean score of Green at 4 and 12 weeks of intervention (adjusted mean difference 0.60, 95% CI -2.9 to 4.0), but, mean rank number (p = 0.003 and p = 0.008, respectively) and mean intensity (0.59, 0.3 to 0.9) of hot flashes were higher in the Menohelp group than the placebo group. The mean rank score of Pittsburgh (p = 0.29) at 4 weeks and mean score of MENQOL (p = 0.64) at 12 weeks of intervention were not significantly different between the two groups.

The results of the present study could show the positive effects of Menohelp herbal capsule on improving the early symptoms of menopause.

According to the population youth regulation, the number of adolescent pregnancies increased in Iran. Considering the importance of knowing the consequences of pregnancy at this age for planning and caring for these people, the present study was conducted with aim to compare the outcomes of pregnancy and childbirth in adolescents and young women.

This desctiptive analytical study was performed in 2021 on 865 hospitalized women in postpartum care unit of two government and semi-government hospitals of Gorgan. Pregnancy outcomes were compared in two groups of adolescent (105 women aged 13-19 years) and young women (760 women aged 20-34 years). The data related to the background information was collected through the data collection form and the outcomes of pregnancy and childbirth by a researcher-made checklist through face-to-face interview, review of hospital records and accompanying documents. Data were analyzed using SPSS statistical software (version 16) and Chi-square, Fisher exact test and logistic regression. P<0.05 was considered statistically significant.

Mean gestational age was not significantly different between the two groups. Among the studied outcomes, anemia and abortion was more common in the adolescent group and the other outcomes were not different in the two groups. The chance of having iron deficiency anemia in women under 20 years old compared to women aged 20-34 years was more than 60% (OR=1.64), also the chance of abortion in women under 20 years old was almost 8 times that of women over 20 years old (OR=8.12). The chance of cesarean delivery (OR=3.31) and birth weigh less than 2500 gr (OR = 2.72) in women aged 20-34 was almost 3 times compared to women under 20 years.

Given that the teenagers in this study got pregnant under the support of family and spouse within the framework of legal marriage and had no history of substance abuse, pregnancy in this age group has no other adverse consequences other than iron deficiency anemia and abortion.

 Infertility and efforts to treat it are associated with tensions for couples. In Iran, infertility is a problem associated with many challenges, and women are more affected by these problems than men. The present study was conducted with aim to explain and analyze the lived experiences of infertile women based on the studies conducted in Iran during the last two decades.

This study is a systematic review. The search strategy of this study is based on searching in databases of PubMed, Web of Science, Google Scholar and SID with Persian terms of qualitative studies or interview or lived experience or phenomenology and infertility or infertile women or infertile couples and the English equivalents of these words. became. Articles were evaluated using the CASP checklist; Finally, 21 articles that qualitatively and phenomenologically explained the lived experiences of infertile women from different perspectives entered into the study and evaluation of the composition and meta-analysis.

 By putting together the main codes of the articles as primary codes and removing duplicates, 102 non-repeated codes were obtained, which were categorized in the form of 8 main themes including: general challenges of infertile women, reactions of infertile women, social and cultural aspects, cognitive aspects, psychological consequences of infertility, methods of dealing with psychological and social problems of infertility, factors affecting sexual behaviors, factors increasing and decreasing hope in infertile women with experience of failure in infertility treatment.

 The lived experiences of infertile women show that they face problems and sufferings in Iranian society. It seems that many aspects of the life of infertile women have not yet been explained and analyzed. At the same time, the role of demographic characteristics, cultures, ethnicities and family background in the analyzes has not been noticed by the researchers, that the need for more studies to design effective support programs according to the population policies of the country is more felt.

 When designing an evidence-based treatment program to help patients with pelvic floor disorders through conservative methods, it is necessary to select studies that, in addition to focusing on the desired subject, also have a suitable quality. Therefore, the present study was performed with aim to assess the quality of published clinical trials regarding the effect of conservative methods in women with pelvic floor disorders using CONSORT tool.

 In this critical review, published RCTs which are indexed in PubMed, Scopus, Medline, Cochrane، Web of Science as well as Persian databases such as SID and Magiran from 2001 to 2021 were searched using Persian and English keywords. Out of 416 articles, 64 RCTs were assessed using CONSORT 2017 checklist. Data were analyzed using SPSS (version 16) and descriptive statistical tests.

 In the complete assessment of the articles, the mean overall score of articles quality based om CONSORT criteria was 28.85 ± 7.5 (minimum and maximum range of 12-41). Title, introduction, objectives and discussion had the highest mean score; whereas method and results section had the lowest mean score. Also, 33.9% of the articles had not point out the type of the article in the title. In the abstract section, 75% of the articles did not report the study type, 87.5% did not describe the method of randomization, and more than 73.2% did not report blinding.

 The appraised articles in the present study had a moderate quality. Improving the quality of clinical trials, especially in the method section, is essential for more use at the bedside and providing better care. Getting help from experts in the statistics and methodology as well as using standard tools for critical appraisal, the quality of articles could be improved.