مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 7 (مهر 1402)

Despite the widespread use of progesterone in pregnancy, there is limited information on its effect on uterine-placental blood circulation and especially on the fetal blood circulation system in the second half of pregnancy. The present study was conducted with aim to investigate the effect of different dosages of progesterone suppositories on Doppler ultrasound indices of uterine, umbilical, and middle cerebral arteries of the fetus and the incidence of preterm delivery in women at risk of premature delivery.

This double-blind randomized clinical trial study was performed in 2018-2020 on 90 pregnant women with gestational age of 24-33 weeks and diagnosis of preterm labor. The subjects were randomly divided into three groups. All three groups underwent Doppler ultrasound of uterine, umbilical, and middle cerebral arteries of the fetus at admission. Then, in the first group progesterone 400 mg and in the second group progesterone 200 mg were prescribed vaginally and the third group was studied as a control group. All the three groups underwent Doppler ultrasound again 48 hours later. Vascular resistance was measured based on RI (resistance index) and PI (pulsatility index) Doppler parameters. Data analysis was done using SPSS statistical software (version 16) and one-way analysis of variance, Kruskal-Wallis, Chi-square, Fisher's exact, paired t-test, Wilcoxon, Man-Whitney, and logistic regression tests. P<0.05 was considered statistically significant.

There were no significant differences among the three groups in terms of maternal age, parity, gestational age, cervical length, history of preterm delivery, RI and PI of the uterine, umbilical, and middle cerebral arteries of the fetus at admission (P>0.05). In both progesterone groups, RI and PI significantly decreased in all three fetal uterine, umbilical, and middle cerebral arteries (P<0.05) in 48 hours after the intervention compared to the beginning of hospitalization. The reduction of PI and RI indexes of all arteries except PI of uterine artery (P=0.105) was significant in 48 hours after intervention in progesterone groups compared to the control group (P<0.05).

The administration of a single dose of 200 or 400 mg of vaginal progesterone in women with gestational age of 24-33 weeks with diagnosis of preterm labor causes a significant decrease in the resistance of the uterine, umbilical, and fetal vessels after 48 hours.

Due to the increase in the frequency of cesarean section over the past few decades, the Ministry of Health and Medical Education of Iran compiled the guideline to promote natural childbirth within the framework of the health reform plans and communicated it to the country's medical science centers. The present study was conducted with aim to determine the epidemiological characteristics and changes trend of the frequency of cesarean section performed in the three educational hospitals of Mashhad University of Medical Sciences.

In this cross-sectional study, the information of all mothers admitted to the three educational hospitals of Mashhad University of Medical Sciences (Imam Reza, Ghaem and Omol-Banin hospitals) due to pregnancy termination during 12 years period (2007-2018) was extracted from the hospital information system. The analyzed information included age, hospitalization center, type of admission (elective or emergency), number of babies, need to transfer mother to ICU, total hospitalization cost, duration of hospitalization, and mother's insurance coverage status. Data was analyzed by SPSS software (version 26). P<0.05 was considered statistically significant.

Overall, 163070 pregnant women have been admitted for pregnancy termination, of which, 68258 mothers (41.9%) had cesarean section. The median of duration of hospitalization was 1 and 2 days for vaginal and cesarean section, respectively. Also, 150089 (92%) of hospitalized mothers were covered by insurance and median hospitalization cost considering inflation rate (until 2018) was 2.6 and 1.35 million Toman for cesarean section and vaginal delivery, respectively. In elective and emergency admission, the frequency of cesarean delivery was 76% and 365, respectively. In general, the rate of performing cesarean section during this period has been increasing from 36% in 2017 to 44.2% in 2018.

Despite the guidelines for promoting natural childbirth within the framework of the Health reform plans in 2014, cesarean delivery rate is still increasing.

Crimean-Congo hemorrhagic fever (CCHF) is an acute tick-borne infection which is associated with significant mortality (up to 50%) and serious risk in pregnancy. Ribavirin is an antiviral and of course a teratogenic drug that has significant effects in the treatment of CCHF. The present study was performed with aim to examine the level of awareness of people with CCHF about the teratogenicity of the drug in the embryonic period and the outcome of pregnancy during six months after taking ribavirin.

In this retrospective study, the files of all the hospitalized patients with a definite diagnosis of Crimean Congo fever in two hospitals of Mashhad were assessed over 10 years. Telephone calls were made to the patients and their families and the required information was collected. Data were analyzed using SPSS software (version 22) and Chi-square and Exact Fisher tests. P< 0.05 was considered statistically significant.

In this study, 177 CCHF patients were assessed, and their information regarding education or lack of education about pregnancy at discharge was available for 84 patients, only 9 people (5.1% of all patients) were trained about contraception after treatment with Ribavirin. In the follow-up of the patients, 3 pregnancies resulted in abortion and 7 unhealthy children were reported due to lack of attention to the principles of pregnancy prevention at the time of taking ribavirin and 6 months later.

Considering the effects of teratogenicity of ribavirin, it seems necessary to provide adequate training to patients about the risks of pregnancy during the 9-month after receiving ribavirin.

Mammography has diagnostic value as a tool for the early detection of intangible breast cancers, both in screening and in the detection of disease. The present study was performed with aim to evaluate the findings related to focal asymmetry density of breast and their relationship with malignancy rate.

This descriptive analytical study was performed in 2019 on 150 patients with focal asymmetric density mammography referred to Khatam Al-Anbia Clinic of Jahrom city. Variables such as the appearance of the lesion on ultrasound, the presence or absence of a mass, the type of mass and the location of the lesion on ultrasound were examined and then hormonal and pathological evaluation was performed if necessary. Data analysis was done using SPSS software (version 19) and Chi-square and t-test. P<0.05 was considered statistically significant.

Out of 150 patients, 134 cases of focal asymmetry density (FAD) were observed on mammography. The age distribution of people whose mammographic findings showed the presence of FAD did not show a significant difference compared to patients without FAD (P=0.728). The outer upper quadrant or UOQ with 84 cases (56%) is the most common site of FAD involvement. Mammographic findings including normal, benign, suspected, borderline and malignant were significantly associated with the presence or absence of FAD (P=0.001). BI-RADS score was also significantly associated with the presence or absence of FAD in mammography (P=0.0001). The pathology was performed only for 21 cases. Based on this test, the sensitivity and specificity of focal asymmetry density for malignancy were determined as 63.64% and 20.00%.

Considering to the sensitivity and specificity of positive focal asymmetric density in mammography, for additional studies and to increase the diagnostic value, it is necessary to use other screening methods along with mammography for patients prone to focal asymmetric density.

Pain is a common phenomenon and an inevitable part of the childbirth process, and the effective control of this pain, like other acute pains, is an important issue for society and health. Many studies show that one of the main reasons for not choosing natural childbirth by mothers is the fear of natural labor and childbirth pain. The present study was performed with aim to compare the effect of effleurage massage and hot water bag in reducing the pain of the first stage of labor for primiparous women.

This randomized clinical trial study with a control group was performed in 2015-2016 on 90 primiparous pregnant women admitted to the gynecology hospital of Tehran. The samples were randomly assigned to two intervention groups and one control group. The intervention group 1 received 15 minutes of massage, and in the intervention group 2, a hot water bag was placed in the back area in three times at dilatation 4, 6 and 8 cm for 15 minutes and the control group received routine care in the delivery room. In all three groups, pain intensity was measured using the VAS scale until the end of labor. Data were analyzed using SPSS software (version 24) and T-test, Chi-square, Fisher and analysis of variance with repeated measures. P<0.05 was considered statistically significant.

After the intervention, the pain intensity significantly reduced in the intervention groups at the beginning of the active and transition phase of childbirth compared to the control group (p<0.001). However, there was no significant difference between the two intervention groups in the amount of pain reduction (p>0.001).

In this study, both the use of hot water bag and massage therapy were effective in reducing pain during labor. Therefore, these interventions can be performed by midwives in care and treatment centers to make childbirth pleasant and improve the quality of mother and baby care.

Pregnant women due to hormonal and physical changes in pregnancy face many problems, such as sleep disorders, which creates stress, tension and anxiety. Due to limitation of drug consumption during pregnancy, it is possible to use non-pharmacological methods to improve this situation, which can point to Benson's relaxation and mindfulness. Therefore, the present study was conducted with aim to determine and compare the effect of Benson's relaxation and mindfulness on the sleep quality of pregnant women.

: In this single-blind randomized clinical trial study which was conducted in 2022, 102 pregnant women from Shiraz city with low sleep quality were allocated to one of the three groups of Benson relaxation, mindfulness and control by using the random block allocation method. The data related to the quality of sleep was checked through the Pittsburgh questionnaire before and one month after the intervention. The interventions were carried out in 8 weeks. Data were analyzed using SPSS software (version 21) and Chi-square, ANOVA, Tukey's post hoc test and paired t-test. P<0.05 was considered statistically significant.

Before the intervention, there was no statistically significant difference among the three groups in the mean score of sleep quality (P >0.05). The mean total scores of sleep quality before the intervention in the three groups of Benson's relaxation, mindfulness and control were 7.08±1.83, 7.52±2.77 and 6.76±2.27, respectively, and after the intervention were 3.52±3.23, 2.73±2.24 and 6.91±2.19, respectively; there was a significant difference between the two intervention groups and the control group after the intervention (p<0.05) and both two intervention groups had the same effect compared to the control group.

Both methods of Benson relaxation technique and mindfulness are effective on the sleep quality of pregnant women; therefore both methods can be used as the care intervention.

In the past decades, umbilical cord blood has been recognized as a valuable source of stem cells, which is used in the treatment of many diseases. The present study was performed with aim to investigate the level of knowledge and attitudes about cord blood storage and donation in pregnant women referring to Amiralmomenin Hospital of Zabol.

This cross-sectional descriptive study was performed in 2022 on 500 pregnant women referred to Amiralmomenin Hospital in Zabol city. The data collection tool was a researcher-made questionnaire consisting of three parts: demographic characteristics, awareness and attitude towards cord blood storage and donation, which was completed by individuals. The score of the awareness section was divided into 3 groups: poor, average and good knowledge and the score of the attitude section was divided into three groups: negative, neutral and positive. Data were analyzed using SPSS software (version 16) and Spearman correlation coefficient. P<0.05 was considered statistically significant.

The mean knowledge score was 24.18±5.11 and 463 (92.6%) of the participants did not have enough information about cord blood storage and donation. The mean attitude score was 28.36±4.54 and the majority of the participants (98.8%, N=494) had a neutral attitude towards cord blood storage and donation. There was no statistically significant correlation between the two variables of awareness and attitude towards cord blood storage and donation (r= -0.03, p= 0.507).

Considering the use of umbilical cord blood stem cells in the treatment of various diseases, it seems necessary to provide information and appropriate educational planning in order to improve the awareness and attitude in pregnant women.

 ectopic pregnancy (EP) refers to implanting a fertilized egg outside the uterine cavity. A ruptured ectopic pregnancy is the main cause of maternal mortality in the first trimester of pregnancy. The present study was performed with aim to systematically review the factors related to ruptured ectopic pregnancy.

 This systematic review study was conducted based on the PRISMA checklist. An extensive search was performed in the internal and external databases, including PubMed, Magiran, Web of Science, Scopus, SID, and Google Scholar search engine using the keywords extracted from Mesh, including Extrauterine Pregnancy, Ectopic Pregnancies, Abdominal Pregnancy, Heterotopic Pregnancy, Ovarian Pregnancy, Tubal Pregnancy, Interstitial Pregnancy, Perforation, Rupture, Factors, Related Factors and also their Persian equivalent with all possible and main combinations from the beginning to March 12, 2023.

 A total of 10 articles out of 624 studies, including 3475 pregnant women were included in the study. Of these, about 1351 people (38%) had a ruptured ectopic pregnancy with mean age of 30.1±5.62 years. Factors such as β-hCG hormone level (5 cases), gestational age weeks (2 cases), and history of ectopic pregnancy (2 cases) were among the factors related to ectopic pregnancy.

 The present study showed that factors such as β-hCG level, age, history of EP, gestational age, history of pelvic infectious diseases (PID) and use of contraceptives are related to ruptured ectopic pregnancy (REP).

Cervical cancer has been recognized as an important health problem in women. Infection with some genotypes of human papillomavirus (HPV) is the most important risk factor associated with cervical cancer. The present study was conducted with aim to estimate the prevalence of genital HPV in suburban women.

In this systematic and meta-analysis study from February 20 to March 20, 2023, databases of Web of Science, Scopus, PubMed and Embase and Google scholar search engine were searched without time restrictions using the keywords such as "papillomavirus", "genital wart" and "suburban population" and relevant synonyms. In the selection criteria, observational studies on the prevalence of genital papillomavirus in suburban women were included. Heterogeneity of the studies was evaluated with I2 and Cochran's Q test. Funnel plot and Egger & Begg tests were used to assess the publication bias of the studies.

Finally, 10 studies with a sample size of 65,813 remained in accordance with the purpose of our study. The results of the meta-analysis showed that the overall prevalence of HPV in suburban women was 17% (95% CI: 13-21%) and HPV/16 genotype with a prevalence of 18% (95% CI: 13-23%) was the most common genotype in the affected people.

In general, the prevalence of genital papilloma virus infection was relatively high in suburban women. This result can be useful for policy makers in planning preventive strategies for cervical cancer in poor and low-income environments.

Painful bladder syndrome is known as a chronic and progressive bladder disorder. The present systematic review was performed with aim to investigate the method of posterior tibial nerve stimulation (PTNS) in the treatment of painful bladder syndrome.

This systematic review study was conducted using Persian and English keywords and all their possible combinations in PubMed, Scopus, ProQuest, Google scholar, Web of science, The Cochrane Library, EMBASE, Cinhal, SID, Magiran, IranMedex and IranDoc databases without time and language limitation until April 2022. Two authors independently identified, screened and qualitatively reviewed the articles and extracted data.

Using the search strategy, 317 studies were retrieved. Seven studies with 174 samples were included in the present systematic review and among them 5 articles were eligible for meta-analysis. The findings showed that needle stimulation of the posterior tibial nerve caused a significant improvement and reduction in the mean frequency of nocturnal urination (mean difference: -0.78, 95% confidence interval: -0.15 to -1.41) and daily urination frequency (mean difference: -3.94, 95% confidence interval: -1.43 to -6.44) compared to the values before treatment. Also, although the values related to interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) also decreased after the intervention compared to the values before treatment, based on the random effects model, this mean difference was not statistically significant.

The results of the present study showed the effect of needle stimulation of the posterior tibial nerve on the mean frequency of daily urination and nighttime urination, however, due to the heterogeneity of the studies and the absence of a control arm, it is not possible to definitely determine a standard method for stimulation of the posterior tibial nerve. Therefore, it is recommended to conduct randomized clinical trials with a larger sample size.