مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 5 (امرداد 1402)

Although pregnancy is a pleasant period for most women, it is often a stressful period with physiological and psychological changes. Physical health and mental health are two general dimensions of quality of life. It seems that the quality of life has an effect on the sexual function of pregnant women. Therefore, this study was conducted with aim to compare the relationship between sexual function and the quality of life of pregnant women in different trimesters of pregnancy.

This cross-sectional study was conducted in 2019 on 360 pregnant women (120 pregnant women in each trimester) referring to the pregnancy care clinic of Rasht public Hospitals. The tools were questionnaires of demographic characteristics, FSFI sexual function, and quality of life SF-36. Data analysis was done using SPSS statistical software (version 23) and t-test, Chi-square, ANOVA and Pearson's correlation coefficient. P<0.05 was considered statistically significant.

The mean score of the total sexual function of the studied subjects was 18.64 ± 10.05. Sexual dysfunction was seen in 86.4% of the samples. The scores of sexual functions in the first to third trimester of pregnancy were 23.92 ± 7.79, 18.84 ± 8.84, and 13.17 ± 10.37, respectively. It showed a statistically significant difference between the total score and the scores of the dimensions of sexual function with trimesters of pregnancy (p<0.001). The quality of life of the groups with and without sexual dysfunction had statistically significant differences in the two main dimensions of physical health and mental health (p<0.001). The mean scores of physical health and mental health were 54.82 ± 18.73 and 60.18 ± 17.59, respectively. Also, satisfaction (r=0.162, p=0.002) and pain (r=0.108, p=0.041) had a positive correlation with physical health. The total score of sexual function (r=0.158 and p=0.003) had a positive correlation with mental health. Lubrication (r=0.126, p=0.017), orgasm (r=0.146, p=0.006), satisfaction (r=0.247, p=0.0001), pain (r=0.165, p=0.002) and the total score of sexual function (r=0.158, p=0.003) were positively correlated with mental health.

The rate of sexual dysfunction increases with increasing gestational age. Also, quality of life with the highest mean score of mental health was related to the first trimester and the highest mean score of physical health was in the third trimester of pregnancy. Sexual function had a positive correlation with the mental health dimension of quality of life.

Premature ejaculation is one of the problems which men are facing. This disorder can affect the quality of life and in many cases, the fertility of couples. Recent studies have shown that the dapoxetine mechanism affects the spermatogenesis. However, so far, no study has been conducted on the impact of dapoxetine on sexual hormones and spermatogenesis. Therefore, the present study was performed with aim to examine the effects of dapoxetine on sexual hormones and spermatogenesis.

In this study, 32 male albino desert rats weighing 200 to 250 gr were used. The rats were randomly divided into four groups. The first group received saline solution (1mg/kg) via gavage. Groups 2 to 4 were subjected to intervention with dapoxetine at doses of 1, 2, and 4 ml/kg, respectively, administered through gavage. Pathological changes in the testicular, levels of luteinizing hormones, follicle-stimulating hormone, and testosterone were investigated in this study. Data analysis was done using SPSS software (version 22) and ANOVA, Fisher and post hoc tests. P<0.05 was considered statistically significant.

Regarding the results of sexual hormones such as testosterone (p<0.001), luteinizing hormones (p=0.007), and follicle-stimulating hormone (p<0.001), there were significant differences between the mentioned four groups. The results showed that there was no evidence of hyperplasia, necrosis, edema, or maturation arrest in any of the testicular cells from the rat groups. However, spermatogenesis was observed in all rats from each of the four groups.

In general, the use of dapoxetine changes the level of sexual hormones; however, it had no effect on the pathology of testicular cells.

Women with high-risk pregnancies, including women with gestational diabetes, are much more prone to COVID-19 than other pregnant women, so the use of telemedicine programs is very necessary for these women in self-care of their disease during the Covid-19 pandemic; Therefore, the present study was performed with aim to determine the effectiveness of using telemedicine on blood sugar control and maternal complications and neonatal outcomes of women with gestational diabetes during covid-19.

This quasi-experimental study was conducted with the participation of 88 women with gestational diabetes in Taleghani Hospital, Tabriz in 2020-2021. The participants were randomly assigned to two groups of intervention (use of telemedicine technology) and control (conventional method). Weight control, blood sugar, maternal complications and neonatal outcomes were compared between the two groups. Data analysis was done using SPSS statistical software (version 25) and t-test and chi-square test. P<0.05 was considered statistically significant.

The mean fasting blood sugar during the study (P=0.045) and HA1C level before delivery (P=0.034) were significantly lower in the intervention group than the control group. In the control group, the number of instrumental deliveries (P=0.045) and cesarean section (P=0.041) was significantly higher than the intervention group. Also, infant hypoglycemia (P=0.033) and high infant weight (P=0.044) were significantly higher in the control group than the intervention group.

Telemedicine was able to control blood sugar, reduce HA1C before delivery, reduce the number of non-physiological births, reduce hypoglycemia and reduce high birth weight in women with gestational diabetes during the covid-19 pandemic.

Neuraxial analgesia is the most efficient way to relieve pain during delivery. Hypotension is commonly occurred in cesarean surgery. The vasopressors are used as one of the most important methods of prevention and treatment of hypotension. So the present study was performed with aim to determine the effect of bolus norepinephrine and phenylephrine to prevent hypotension in spinal anesthesia in patients undergoing elective caesarean section.

This clinical trial study was conducted in 2022 on 90 pregnant women of 36-41 weeks who were candidates for elective cesarean section without anesthesia restrictions. Immediately after spinal anesthesia, phenylephrine (50 μg/ml) was injected for the first group and norepinephrine (5 μg/ml) for the second group. Vital signs were non-invasively monitored and recorded. Data analysis was done using SPSS statistical software (version 19) and t-test, Man-Whitney U, Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.

The mean systolic blood pressure (p=0.001), diastolic blood pressure (p=0.001) and mean arterial blood pressure (p=0.003) in the norepinephrine group in the first 6 minutes were significantly lower than the phenylephrine group. The heart rate (p=0.001) in the first 6 minutes was significantly higher in the norepinephrine group than the phenylephrine group.

Hemodynamic changes following the administration of bolus epinephrine are less compared to phenylephrine. It causes better control of blood pressure and heart rate.

Pregnancy, as one of the most important periods in a woman's life, has many effects on the physical, psychological and functional condition of women. These changes can affect the quality of life and sleep in pregnant women. Exercising during pregnancy can have positive effects on pregnant women. Therefore, the present study was performed with aim to examine the effect of Pilates exercise on the quality of life and sleep in pregnant women.

This double-blind randomized clinical trial study was performed in 2020 on 60 pregnant women who referred to health centers in Shahrekord. The participants were randomly divided into the intervention and control groups. The pregnant women in the intervention group were required to participate in two Pilates sessions per week for 12 weeks from 20th weeks of pregnancy. At the end of the study (week 38), pregnant women completed the SF-36 quality of life and Petersburg sleep quality questionnaires. Data were analyzed using SPSS software (version 23) and t-test and Mann-Whitney test. P<0.05 was considered statistically significant.

In this study, Pilates had a positive effect on the quality of sleep (P<0.08) and life of pregnant women (P<001).

Considering the positive effects of Pilates exercises on the quality of life and sleep and the lack of negative effects reported in this study, Pilates during pregnancy can be suggested to pregnant women.

Despite the high prevalence of abortion and ectopic pregnancy, there are limited studies on psychological complications following early pregnancy loss, so the present study was conducted with aim to compare the relative risk of stress, anxiety and depression in women with a history of ectopic pregnancy and miscarriage and normal pregnancy.

This cross-sectional study was conducted on 312 women referred to Torbat Heydarieh hospitals from September to February 2021. One and three months after the diagnosis of miscarriage and ectopic pregnancy and proof of viable pregnancy, the data of psychological outcomes was collected through Cohen's stress, Beck depression and Spielberg anxiety questionnaires in three groups. Data were analyzed using SPSS software (version 16) and one-way ANOVA and Chi-square tests. P<0.05 was considered statistically significant.

The number of participants in the ectopic pregnancy group was 97, in the miscarriage group was 104, and in the normal pregnancy group was 111. One month after the diagnosis of the type of pregnancy, the prevalence of psychological complications including stress (7.6%), anxiety (47.6%) and depression (29.2%) was higher in the case group. Psychological complications three months later were higher in the case group and were 24.4%, 41.5%, and 24.3%, respectively. The relative risk of stress 3.32 and anxiety 1.75 was higher in the ectopic pregnancy group compared to miscarriage group, and the relative risk of depression was 2.86 higher in the miscarriage group.

Considering the greater psychological outcomes of early pregnancy loss compared to normal pregnancy, using effective medical and counseling measures is recommended in order to prevent the adverse effects of psychological distress.

The reactivity time of the non-stress test (NST) has been less investigated in the studies. The present study was performed with aim to investigate the effect of lavender aromatherapy with and without music on the reactivity time of NST and basal fetal heart rate in primiparous women.

 This three-group randomized clinical trial study was conducted between 2020-2021 on 195 primiparous women who referred to the prenatal clinic of Shahid Akbar Abadi educational and medical center in Tehran. The participants were randomly allocated into three groups: lavender aromatherapy, lavender aromatherapy-music, and control (n=65 in each group). In the lavender aromatherapy group, four drops of 10% lavender essence was inhaled. In the lavender aromatherapy-music group, participants also listened to music (nature sounds). After the intervention, NST was performed in all three groups for 20 minutes. The reactivity time of the NST and the number of basal fetal heart rate were considered as primary outcomes. The data were analyzed by statistical software (version 16), and one-way analysis of variance, Tukey's post hoc, paired t-test, chi-square, and Fisher's exact tests. P<0.05 was considered statistically significant.

The mean reactivity time of the NST in the two intervention groups: lavender aromatherapy (7.05±4.11 minutes) and the combination of lavender aromatherapy and music therapy (6.04±3.59 minutes) was lower than the control group (10.43±5.32 minutes). The NST results were reactive in 64 (98.5%) of the cases in each of the intervention groups and 52 (80%) in the control group (P<0.001). There was no significant statistical difference between the two intervention groups in reactivity time of the NST (p= 0.144). During the NST, the three groups did not have a statistically significant difference in the mean basal fetal heart (p= 0.729).

The combination of lavender aromatherapy and music did not have a more effect on shortening the reactivity time of the NST when compared to lavender oil use alone. Therefore, the use of lavender aromatherapy is suggested to reduce the reactivity time of the NST.

Inadequate pain control after caesarean can have adverse effects on various body systems, cause the mother not pay attention to the baby and problems in the breastfeeding process. Therefore, the present study was performed with aim to compare Apotel and diclofenac suppository on pain relief after cesarean section.

This double-blind clinical trial study was performed in 2018 on 120 qualified primiparous women referred to Imam Reza and Pastor Hospitals in Mashhad. The subjects were randomly divided into two groups A and B (Apotel and diclofenac suppository). After cesarean delivery, if the mother requested for pain medication, group A received Apotel and group B diclofenac suppository. The severity of pain was assessed by McGill Pain Questionnaire before intervention, 6, 12 and 24 hours after cesarean section. Data were analyzed by SPSS software (version 16), and Mann-Whitney, t-test, Chi-square and Fisher exact tests. P<0.05 was considered statistically significant.

The two groups had no significant difference in the cesarean pain score before intervention (p=0.214), 6 hours (p=0.318), 12 hours (p=0.305) and 24 hours (p=0.117) after cesarean section. The mean of diclofenac suppository used in group A was 3.21±1.06 and the mean of Apotel used in group B was 1.02±1.22; the two groups were significantly different in the number of Apotel and Diclofenac used (p=0.048).

Although there was no significant difference in the pain scores of the mothers in the Apotel and diclofenac suppository groups, the mean number of diclofenac suppository used was 3 times of Apotel used. Therefore, due to the longer effectiveness of intravenous acetaminophen and its safety compared to diclofenac, Apotel is recommended for cesarean section pain relief.

Vitrification is one of the most important topics in the field of assisted reproductive techniques (ART). Integrins are important factors in implantation. Considering the importance of embryo virtification, the present study was performed with aim to evaluate the effects of vitrification on the expression of integrins of αν & β3 in the implantation process of mice.

In this study, in order to obtain 50 blastocysts from the uterine horn of 6 to 8 week old female mice, after stimulation of their eggs, the mice were placed one night next to 8 to 12 week old male mice of the same race. The next morning, mice with a vaginal plaque were separated. 98 hours after HCG injection, by flushing method, the obtained embryos were divided into two groups of freeze (n=30) and control (n=20). Afterward, the blastocyst embryos were subjected to a freezing process consisting of two stages: dehydration and freezing, using a freezing solution. Following the thawing and dilution stages, the expression level of the obtained embryos was determined using the RT-PCR method. Data were analyzed by SPSS software (version 24) and Paired-t test. P<0.05 was considered statistically significant.

The results showed the amount of αν and β3 integrins after freezing and melting had a significant difference compared to the ACTB reference gene with the control group (p<0.01).

This study showed that the vitrification by cryotype causes damage to the blastocysts by reducing the rate of integrin expression.

One of the common problems of women in reproductive age is abnormal cessation or reduction of menstrual bleeding, which causes many complications and reduces the quality of life. The present study was conducted with aim to provide a treatment protocol of oligoamenorrhea (secondary amenorrhea, oligomenorrhea) within the framework of the basics of evidence-based Persian medicine and conventional medicine.

In this study, information was collected in the form of narrative review by searching the contents related to cessation or reduction of menstrual bleeding from various Persian medical sources and searching in databases of Pubmed, Web of science, Google scholar, Iranmedex, SID, Magiran with related keywords in order to find evidence and documents. In the next stage, 10 sessions of group discussions on the topic of explanation and interpretation of menstrual disorders in Persian medicine and conventional medicine were held with the presence of experts in the field of Persian medicine and obstetrics and gynecology. Finally, consolidated treatment was presented in the form of a treatment protocol with emphasis on clinical evidences.

The principles of oligoamenorrhea treatment in Persian medicine include lifestyle modification, specially nutrition, physical activity, mental and sleep health, use of herbal medicines, and manual operations (which can be integrated with the treatment steps of some causes of this disorder in conventional medicine.

Considering the existence of some problems in olioamenorrhea treatment in conventional medicine, the use of Persian traditional medicine in the treatment of oligoamenorrhea along with the protocols of conventional medicine can be helpful in the control and management of this disorder.

Researchers have always been investigating the non-narcotic medications for obstetrics and gynecology surgeries. The present study was performed with aim to investigate the efficacy and safety of using anesthesia without narcotics compared to conventional anesthesia with narcotics in the treatment of pain and complications after surgery.

In this systematic review study, according to the PRISMA statement, electronic databases of ‎PubMed, Medline, Embase, Scopus and Cochrane library, as well as the Persian databases of SID and Magiran ‎were searched with the help of Google Scholar between 1990 and the end of 2022. The studies which compared anesthesia with narcotic-based and non-narcotic-based drugs in a clinical trial or observational study design were extracted and qualitative evidence was synthesized from the results of the studies.

In this systematic review, 11 studies including anesthesia induction drugs, anesthesia maintenance and postoperative pain management were examined. For post-surgical pain management, non-opioid drugs such as ketorolac, paracetamol, paracetamol + ketorolac, tenoxicam and diclofenac were used, and in the case of insufficient pain management, opioid rescue drugs such as tramadol, morphine and fentanyl were also used. In general, non-opioid drugs such as paracetamol and non-steroid anti-inflammatory medications are safer than opioids and, in some cases, can be as effective or more effective in providing pain relief and anesthesia; however this pain relief and anesthesia varies depending on the type of drug. The quality of extracted evidence was low according to the Cochrane and Newcastle-Ottawa risk of bias scale.

The use of anesthesia induction and maintenance techniques using non-opioid substances in cesarean and other gynecological surgeries can help to reduce the consumption of opioids and related side effects, such as cardiopulmonary arrest, improve pain control and improve recovery after surgery.