مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 8 (آبان 1402)

Prolonged labor increases adverse maternal and neonatal outcomes. Very few interventions are known to shorten labor duration. The present study was performed with aim to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion on the duration of the active phase of labor in nulliparous women.

In this double-blind randomized clinical trial (blinding of patients and data analyst), which was performed in 2020-2021, 60 nulliparous women in the active phase of labor who had referred to the teaching hospitals of Mashhad University of Medical Sciences were randomized by block randomization method and allocated to two groups of receiving normal saline at a rate of 150cc per hour and dextrose at 5% saline at the same rate. The primary outcome was evaluating the duration of the active phase of the labor. Secondary outcomes included the duration of second phase of labor and the rate of cesarean section, maternal and neonatal outcomes. Data analysis was performed using SPSS statistical software (version 25) and Chi-square tests and Fisher's exact test. P<0.05 was considered statistically significant.

The basic variables were similar in the two groups. The active phase of labor and the second stage of labor was statistically lower in saline dextrose compared to the normal saline group (P<0.001). There was no significant difference between the two groups in the rate of cesarean section, the need for oxytocin, maternal complications, first and fifth minutes Apgar score, neonatal complications and the need for NICU (P> 0.05).

It seems that the use of dextrose-containing solutions in nulliparous women during labor shortens the duration of labor compared to normal saline.

Taking many antiepileptic drugs such as sodium valproate during pregnancy has harmful and teratogenic effects. Therefore, the present study was performed with aim to compare the effect of sodium valproate and the less dangerous drug citronellol on the level of three variables for the diagnosis of nervous system abnormalities in mother and fetus.

In this experimental study, which was performed in 2019, eighteen adult female Wistar rats (200-220 g, 10 to 12 weeks) were divided into 3 groups of 6 including control, experimental 1 (receiving sodium valproate, 400 mg/kg) and experimental 2 (receiving citronellol, 400 mg/kg). Female rats were mated with male rats. After confirming pregnancy (vaginal plaque and vaginal smear), they intraperitoneally received sodium valproate and citronellol intraperitoneally on days 7, 8, 9 and 10 of pregnancy. On the 18th day of pregnancy, maternal serum, fetal serum, and amniotic fluid were sampled and free estriol, chorionic gonadotropin, and alpha phytoprotein were measured by ELISA method. Data analysis was done using SPSS statistical software (version 21) and ANOVA and Duncan's test. A p value of less than 0.05 was considered significant.

The mean concentration of estriol, chorionic gonadotropin and alpha phytoprotein in maternal serum, fetal serum and amniotic fluid in citronellol group did not show any significant difference compared to the control group (p>0.05). However, in sodium valproate group, a significant decrease in the level of estriol and placental gonadotropin and a significant increase in alpha phytoprotein in maternal serum, fetal serum, and amniotic fluid were observed compared to the control and experimental groups 2 (p<0.05).

Citronellol as an antiepileptic drug with less side effects and greater safety can be used during pregnancy.

Despite the adverse effects of post-caesarean pain relievers, few studies have compared non-pharmacological methods of pain control. The present study was conducted with aim to compare the effects of foot reflexology and Benson's relaxation on pain levels in women candidates for caesarean section.

This randomized controlled clinical trial study was conducted in 2019-2020 on 135 women candidates for caesarean section in Persian Gulf Martyrs hospital, Bushehr. The participants were selected via convenience sampling and divided into three groups using block randomization: reflexology, Benson's relaxation, and control. In the reflexology and Benson's relaxation groups, the intervention was performed two hours post-operation and six hours after the first time. Pain levels were measured using a visual pain scale immediately, 30 and 60 minutes after the procedure. The amount of pain medication was also recorded. Data were analyzed using SPSS (version 19) and chi-square, Fisher's exact, One-way ANOVA, Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon tests. P<0.05 was considered statistically significant.

Before the intervention, the mean pain ranks were not significantly different among the three groups (P>0.05). Immediately, 30 and 60 min after the intervention, the mean pain ranks were significantly lower in the two intervention groups than the control group (P<0.05). There were no significant differences among the three groups in pethidine intake (P=0.193). However, the control group received significantly higher amounts of ketorolac and diclofenac when compared to the two intervention groups (P<0.05).

Reflexology and Benson's relaxation techniques can reduce post-cesarean pain and analgesics. Therefore, nurses can use these two non- pharmacological pain control methods.

Breast cancer is the most common cancer and one of the major causes of cancer deaths in women. The present study was conducted with aim to investigate the relationship between breast cancer and dietary patterns in women with breast cancer in Jahrom city.

This cross-sectional and analytical study was performed in 2021 on 107 women with breast cancer who referred to the Khatam Al-Anbia center in Jahrom city. The required information was collected through interviews and completing the food frequency questionnaire. Data analysis was done using SPSS software (version 21) and descriptive and inferential statistical tests. P<0.05 was considered statistically significant.

A significant inverse correlation was seen between the duration of receiving chemotherapy and the frequency of fast food consumption (r=-0.201, P=0.046). There was no significant difference in terms of disease pathology, disease stage, lymphatic involvement and cancer vascular involvement in food frequency in any of the foods (P>0.05), but people with breast cancer recurrence had a lower mean frequency of chocolate consumption than those who had no recurrence (P=0.025). People with breast cancer metastasis had a lower mean frequency of coffee consumption (P=0.009) and more fast food consumption (P=0.024) than those without cancer metastasis. The frequency of consumption of chocolate and fried foods was significantly higher in deceased people than in surviving persons (P<0.05).

In this study, there was a significant relationship between breast cancer and food patterns, including a positive correlation with tea and soda consumption, a negative correlation with fast food consumption, and a difference in chocolate and coffee consumption in people with cancer in terms of recurrence and metastasis. More studies are needed to compare the dietary patterns of these people with healthy ones in Jahrom city to find the causes between nutritional disorders and breast cancer.

 Postpartum blues is a transient period of increased emotional reactivity that occurs in approximately half of women in the first week after delivery. Due to the high prevalence of postpartum blues and its adverse effects on the mother, baby, and the family, as well as the acceptance of complementary medicine and aromatherapy, especially in women, and the sedative effects of rose essential oil, the present study was performed with aim to determine the effect of aromatherapy with the rose essential oil on postpartum blues in primiparous women.

This randomized clinical trial study with a placebo group was conducted in 2022 on 65 primiparous women admitted to Omolbanin Hospital in Mashhad. The data was completed through demographic-obstetrical information form, Stein postpartum blues questionnaire and Rosenberg's social support and self-esteem scale, Paswald scale, and Rothen fatigue intensity scale. Rose essential oil was used in the intervention group, and in the placebo group, sweet almond oil was used in the same way. The postpartum blues scores were measured on the 4th, 10th, and 14th days. Data analysis was done using SPSS statistical software (version 22) and Independent t-test, Man-Whitney, Chi-square and Fisher's exact tests. P<0.05 was considered statistically significant.

There was no statistically significant difference between the two groups in terms of the postpartum blues score before the intervention (P=0.246). But after intervention, the postpartum blues score in the intervention group was significantly lower than the placebo group on the 4th, 10th, and 14th days after delivery (P<0.001).

Aromatherapy with rose essential oil was effective and safe in reducing postpartum blues in primiparous women.

Cervical cancer is the fourth most common cancer among women worldwide and is a heterogeneous disease. The exosomal miRNAs could be applied as diagnostic biomarkers and therapeutic targets in cervical cancer. The present study was performed with aim to use a bioinformatics analysis to identify key miRNAs and related genes and pathways in exosomes derived from cervical cancer cells.

In this study, the differential expression of exosomal miRNA and RNAs in healthy and HeLa cells was investigated by analyzing the GEO database for miR-seq and RNA-seq in R software. Subsequently, overlapped miRNA target genes and differentially mRNA from exosome were selected and then, GO and KEGG pathway analysis was performed. The overlapped genes were integrated to construct a PPI network and hub genes selection.

In the present study, it was observed that 31 miRNAs were upregulated and 16 miRNAs were downregulated in exosomes. Also, 341 overlapped genes from miRNAs targets and mRNA-seq were selected for future analysis. GO analysis indicated that overlapped genes were significantly enriched in the leucine transport, MAP kinase phosphatase activity, and glutamine transport. KEGG analysis suggested that the genes were enriched in cellular senescence, p53 signaling pathway and cell cycle. The top ten genes including CCNB1, BUB1, KIF20A, MKI67, FOXM1, BIRC5, NCAPH, ZWINT, GINS2, and ASF1B were identified from the PPI network.

The results identified key miRNAs with altered expression and characterizing key genes in exosomes derived cervical cancer cells. This study will provide novel insights to determine the potential mechanisms associated exosomes derived from cancer cells in cervical cancer progression.

Headache after spinal anesthesia is a common problem in pregnant women undergoing cesarean section with spinal anesthesia. Among the regional anesthesia methods, spinal anesthesia is one of the most common methods for cesarean section, which is mainly performed with median and paramedian techniques. Therefore, this systematic review study was conducted with aim to compare two methods of median and paramedian on the incidence of postdural puncture headache (PDPH ) in women under spinal anesthesia.

In this systematic review study, to find the related articles, Scopus, PubMed, Magiran, SID, Medlib, Cochrane, Science Direct databases and Google Scholar search engine were searched using the keywords of median, paramedian, postdural puncture headache, caesarean section, and spinal anesthesia in both Persian and English languages without time limit until 20 May 2023. Jadad checklist was used to evaluate the quality of the articles.

The studies entered in the systematic review included 11 studies and the studies were conducted in 2009-2021. A total of 1195 patients with anesthesia class 1 and 2 were included in the study. In 4 studies, there was no statistically significant difference between the two groups of median and paramedian approaches. In 6 studies, the paramedian method caused fewer headaches than median method. In one study, median method caused fewer headaches than paramedian method.

The use of the paramedian method compared to the median technique can cause a lower incidence of PDPH after cesarean surgery. It is suggested that anesthesiologists use the paramedian technique for spinal anesthesia for women undergoing cesarean surgery, if possible, in order to prevent or reduce the occurrence of PDPH after surgery in these patients.

Natural disasters are one of the crises which are increasing all around the world. The effect of these disasters is more intense on adult girls and women than other groups of the society. Reproductive health needs of women and adult girls are one of the important issues at the time of natural disasters, which needs special attention. Although more attention has been paid to this issue, the reproductive health needs of this group are still neglected. The present review study was performed with aim to evaluate the effect of natural disasters on the reproductive health needs of women and girls of reproductive age.

In this systematic review, Web of Science, PubMed, Scopus and Cochrane Library databases were searched between 2011 and 2023 using MESH keywords including Natural disaster, Reproductive Health, Women and Girl. The quality of the studies was assessed by the checklists of STROBE and Joanna Briggs Institute (JBI), and finally, ten eligible studies were used for analysis.

Women and girls face many problems related to reproductive health during natural disasters. Reproductive health needs of women and girls during natural disasters include needs related to mother and child health, menstrual and genital health, early puberty and access to reproductive health services.

The occurrence of natural disasters such as floods, flash floods and earthquakes leads to ignorance of reproductive health requirements of women and girls. Therefore, they may face many problems in these conditions. Hence, it is recommended to provide necessary infrastructures and trainings in order to prepare for possible natural disasters.

Women with drug use disorder probably need larger amounts of drugs for analgesia during and after childbirth; however, due to the limited number of studies in this field, the present study was conducted with aim to evaluate drug use disorder and how to manage it in women with history of caesarean section.

In this systematic review study which was conducted during 2000 until the first six months of 2022, in order to find related articles (published in both Persian and English), databases of PubMed, EMBASE, Cochrane Library, Web Of Science, Scopus, Mag-Iran and SID were searched using the keywords of pain, pain intensity, acute pain, chronic opioid pain, cesarean section, cesarean delivery, drug abuse disorder, pain management, prevention and analgesia.

Women with a history of caesarean who had drug use disorders faced unique challenges in accessing appropriate treatment and support. The results focused on the importance of integrated care models that addressed both the physical and psychological aspects of drug use disorder management. Additionally, specialized interventions tailored to the needs of this population, such as trauma-informed care and perinatal substance use programs, were found to be effective in improving outcomes.

Optimal control of post-cesarean pain in women with drug abuse disorder includes a multifaceted strategy using intrathecal or epidural drugs, acetaminophen and non-steroidal anti-inflammatory agents as the first line.

Heterotopic pregnancy means the coexistence of an intrauterine pregnancy and an ectopic pregnancy. Its incidence is 1 in 30,000 pregnancies. In this study, we report a heterotopic pregnancy with ectopic pregnancy and having heart rate in isthmus region of fallopian tube.

The patient was a 31-years-old woman who had referred to Mobini hospital of Sabzevar city in 2/4/2020 with menstruation delay for 2 weeks and abdominal pain in the hypogastric area with a constant and progressive nature that started about 3 days before the visit. Last menstruation period was 6 weeks and 3 days ago. She had no history of underlying disease or special drug use, and vital signs were stable. She had nausea before visiting and 2 episodes of vomiting in the emergency room of the hospital. In abdominal examination, there was optional guarding and suprapubic tenderness and rebound tenderness. Transvaginal ultrasound and beta titration was performed. In the ultrasound, an echo free focus was seen in the left adnexa with a diameter of 7 mm equivalent to 5 weeks and two days, separately from the ovary, along with a 25×35 mm hematoma around it; which contained the heartbeat of the fetus. A gestational sac with a diameter of 15 mm containing the yolk sac and heartbeat was seen in the endometrial cavity. The patient was transferred to the operating room with the diagnosis of heterotopic pregnancy. The left tube contained a mass of 2×4 cm in the isthmus area, which was completely damaged and was actively bleeding. A left salpingectomy was performed. The intrauterine pregnancy was preserved. The patient referred with labor pain on 6/31/2019 and underwent NVD.

Heterotopic pregnancy mostly occurs in the cases of using assisted reproductive methods. Spontaneous cases of heterotopic pregnancy are rare. Rapid and timely diagnosis plays an essential role in the treatment approach.