مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 9 (آذر 1402)

The relationship between endometriosis and thyroid disorders and the subsequent impact on fertility outcomes is still controversial. The present study was performed with aim to evaluate the effect of impaired thyroid-stimulating hormone (TSH) levels on fertilization rate of infertile women with endometriosis.

In this secondary analysis of cohort data, 179 infertile women with endometriosis were selected as the case group and 200 women with diagnosis of tubal factor or unexplained infertility were selected as the control group. Two subgroups of TSH levels above 2.5 mlU/L (with or without levothyroxine use) and TSH levels less than 2.5 mlU/L with levothyroxine use as patients with thyroid dysfunction and women with TSH levels less than 2.5 mlU/L without use of Levothyroxine were considered as thyroid-healthy subjects. Antral follicle count and fertilization rate were compared between the two groups. Data analysis was done using SPSS statistical software (version 24) and ANOVA test. P<0.05 was considered significant.

The mean of TSH in women with endometriosis was significantly higher than the control group (P=0.02, Cohen d=0.77, 95% CI: 0.02-0.43). When women were classified based on the presence or absence of endometriosis and serum TSH levels above 2.5 mlU/L, serum levels of FSH (P=0.76), LH (P=0.91), and fertilization rate (P=0.51) did not significantly differ between the two groups.

It seems that thyroid disorders are more common in women with endometriosis. However, there was no significant effect on the results of assisted reproductive procedures related to the coexistence of endometriosis and higher TSH levels.

Granulomatous inflammatory lesions of the breast can be considered as primary or idiopathic inflammation of the breast; therefore, investigating the relationship between inflammatory parameters including neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio can be useful in the prognosis of idiopathic granulomatous mastitis. The present study was conducted with aim to investigate the relationship between blood parameters related to lymphocytes in response to the treatment of idiopathic granulomatous mastitis (IGM).

This prospective cohort study was conducted in 2020 on 34 patients with IGM referred to the breast clinic of Kurdistan University of Medical Sciences. The course of lymphocyte parameters with disease symptoms, diagnostic and treatment process were measured. For patients with a definite diagnosis of IGM, if there was a mass, aspiration was performed under ultrasound guidance, and needle sampling and routine tests, including complete blood count were performed. The evaluation time was at the beginning of the diagnosis, one month and 6 months after the complete blood count. Data analysis was done using SPSS statistical software (version 24) and variance analysis and Tukey tests. P<0.05 was considered significant.

There was no significant difference between the demographic variables of age and body mass index with the treatment outcome in the examined patients (P>0.05). Also, no significant relationship was observed between the variables of mass number, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with the treatment outcome in the examined patients (P>0.05).

According to the results, it can be said that referring to the mean ratio of neutrophil to lymphocyte and platelet to lymphocyte is not a reliable indicator to evaluate the response to the treatment of IGM.

Abdominal ultrasound (TAUS) and transvaginal ultrasound (TVUS) are used in IVF/ICSI methods to transfer the embryo into the uterine cavity. Since these methods have limitations, the present study was conducted with aim to compare them and their effect on pregnancy outcome.

This retrospective cohort study was conducted in 2018-2022 on 522 intracytoplasmic sperm injection cycles in the Fertility Unit of Mahdieh Hospital in Tehran. After reviewing the files, the patients were divided into two groups of embryo transfer with transvaginal and abdominal ultrasound. After collecting demographic information, pregnancy outcomes including chemical pregnancy and clinical pregnancy, abortion under 10 weeks, ectopic pregnancy and the duration of embryo transfer were compared in the two groups. Data analysis was done using SPSS statistical software (version 26) and Mann-Whitney and Pearson Chi-square tests. P<0.05 was considered significant.

The frequency of chemical and clinical pregnancy and abortion was higher in the TAUS group, however, the incidence of EP was higher in the TVUS group (p>0.05). Also, the duration of embryo transfer using TAUS was longer compared to TVUS, but it was not statistically significant (p>0.05). The number of transferred embryos was equal in both groups, but the number of 5-day embryos was higher in the TAUS group, which was statistically significant (p<0.05).

There was no difference between abdominal ultrasound and transvaginal ultrasound in terms of pregnancy outcomes.

Primary dysmenorrhea is one of the most common menstrual disorders among women that have a negative impact on their social activities. However, regular exercise training and consumption of medicinal plants is common among women in order to treat primary dysmenorrhea. Therefore, the present study was conducted with aim to investigate the effect of combination exercise training along with ginger supplementation on PGE2 levels and primary dysmenorrhea symptoms (intensity and duration) in sedentary girls.

In this quasi-experimental study, 60 sedentary young girls with moderate/severe primary dysmenorrhea were randomly placed into one of the four groups: training along with ginger consumption, training along with placebo consumption, ginger and control placebo groups. The training groups performed combination exercise training in two sections of endurance training and strength training.  The groups consuming supplementation used ginger capsules. The severity of pain dysmenorrhea was measured by the visual analog scale (VAS) and duration of pain by Cox menstrual cycle (CAS). PGE2 of all participants was examined in two stages before and after the research. Data were analyzed by SPSS software (version 23) and ANCOVA, paired t-test and non-parametric tests. P<0.05 was considered significant.

The PGE2 level significantly decreased in the groups of training with ginger, training with placebo and ginger (P<0.05). In addition, a significant reduction in the intensity and duration of dysmenorrhea pain was observed in all the intervention groups compared to the placebo group in the second and third cycle of menstruation. Also, a significant difference was found between the two training groups with the supplement and placebo consumption in the pain intensity values (P<0.05).

Consumption of ginger supplementation and combination exercise training through reducing PGE2 levels can improve the symptoms of primary dysmenorrhea in sedentary girls; it seems that combination of ginger supplement and combination exercise training have the synergistic effect.

Pregnancy and delivery are of nature wonderful phenomenon that should be done with natural process without intervention. This study was performed with aim to evaluate the effects of prenatal preparation classes on labor pain intensity, mother's satisfaction of delivery experience, and some outcomes of normal vaginal delivery in nulliparous women.

This quasi-experimental interventional study was done in 2022-2023 on 100 nulliparous women who were admitted in Sabalan hospital of Ardabil city for prenatal care and delivery from January to April of 2023. The samples were placed in two groups of receiving training and control (n=50 per group). Data collection tool was questionnaire. The group receiving training participated in prenatal preparation classes and the control group received pregnancy usual care. Then labor pain intensity after start of labor pain and at the end of first stage of labor, and at the end of second stage, need for episiotomy and prineal laceration, and need for oxytocin during labor were recorded. Immediately after delivery, first minute Apgar score and mother's satisfaction of delivery, and ultimately one hour after delivery, initiation of breast feeding were investigated and recorded by the researcher. The data were analyzed by SPSS software (version 26), Chi-square, t-test, Mann-Whitney U and Fisher tests. P<0.05 was considered statistically significant.

Prenatal educations significantly reduced labor pain intensity, need for episiotomy, prineal laceration, need for augmentation with oxyto cin (P<0.001) and also increased mother's satisfaction of delivery experience, first minute Apgar score and early onset of breast feeding (P<0.001).

The prenatal preparation classes have many positive outcomes; therefore, it is suggested to be used more seriously and widely in all pregnancy and childbirth care centers.

Episiotomy is one of the common methods used to widen the pelvic outlet, and it is associated with complications such as pain and bleeding. Green tea and Myrtus communis are two medicinal plants with anti-inflammatory and pain-relieving properties. The present study was conducted with aim to investigate the effect of Myrtus communis extract and green tea on pain reduction and episiotomy wound healing.

This three-blind randomized clinical trial study was conducted in 2020-2021 on 90 primiparous women referred to the maternity ward of Shushtar Al-Hadi and Ganjovian Dezful hospitals. The samples were randomly treated in groups receiving green tea, Myrtus communis extract ointment and placebo for 14 days. Evaluation of the wound healing status was done with Rida index and pain intensity by VAS. Data analysis was done with SPSS software (version 23) and Mann-Whitney and Friedman tests. P<0.05 was considered statistically significant.

There was a significant difference among the three investigated groups in the Rida index on the 14th day, and this index was lower in the Myrtus communis group than in the green tea group and the placebo group (P=0.001). VAS index on the 14th day had a significant difference among the three investigated groups, and this index was lower in the Myrtus communis group than in the green tea group and the placebo group (P=0.001).

The use of Myrtus communis ointment and green tea extract can reduce pain intensity and improve heal episiotomy wound, and it seems that the effect of Myrtus communis ointment is more than green tea ointment and placebo.

The first trimester of pregnancy is associated with unpleasant experiences for mothers. One of these unpleasant experiences is breast pain, which leads to a low quality of life in pregnant women, so the present study was conducted with aim to investigate the effect of vitamin B6 as a safe and available supplement on breast pain in the first trimester of pregnancy.

This randomized controlled clinical trial study was conducted in 2019-2020 on women with a gestational age of 6-10 weeks who had breast pain with start of pregnancy for 5 days or more in Gonabad city. Pregnant women were divided into two groups of 42 people, control and intervention. The control group was given a placebo daily and the intervention group was given a 40 mg vitamin B6 pill for 1 month. The visual pain scale questionnaire was given to the research units before and one month after the intervention. The amounts of vitamin B6 received from the diet of the groups were obtained through a 24-hour food reminder questionnaire and N4 software. Data analysis was done using SPSS software (version 20) and independent t-tests, Mann-Whitney, Chi-square, Fisher, Wilcoxon and regression. P<0.05 was considered significant.

There was a statistically significant difference between the two groups regarding the gestational age (p=0.04), but other pregnancy variables were homogeneous in the two groups (p>0.05). According to Mann-Whitney test results, there was no significant difference between the two groups regarding the mean score of breast pain after the intervention (p=0.2).

The effect of oral vitamin B6 compared to placebo is not effective on reducing breast pain score in the first trimester of pregnancy. Further studies with a larger sample size, different doses of vitamin B6 and measuring the serum level of vitamin B6 are suggested.

Idiopathic granulomatous mastitis is a rare chronic inflammatory disease of the breast with unknown causes. Despite of developed countries, the incidence of this disease is increasing in Middle Eastern countries. The many challenges related to the etiology of this disease make it necessary to have a comprehensive study to investigate the underlying causes and achieve a better treatment; therefore, the present study was conducted with aim to investigate the underlying causes of granulomatous mastitis.

In this systematic review study, in order to find related articles, PubMed, Web of Science, Embase, Google Scholar, Cochrane Library and Scopus databases were searched with suitable keywords including granulomatous mastitis, risk factors, and mastitis. The search was done in English language and continued from March 2021 to June 2022. The screening process of articles was done at the title, abstract and content levels, respectively. The required information of the articles with inclusion criteria was extracted and entered into the SPSS software, and finally the results were interpreted according to the general conditions of the study.

A total of 71 articles with a total sample size of 4735 patients were included in the study. The mean age of the patients was 34.98 ± 8.46 years. In terms of race, 3749 (79.17%) of these patients were Caucasian. Also, 3251 (91.47%) of the patients mentioned a history of pregnancy and 2721 (83.67%) a history of breastfeeding. The history of taking contraceptive pills (22.79%), smoking (13.88%), trauma (5.7%) and high prolactin tests (19.7%) were also measured.

According to the results of this study, Caucasian race, history of pregnancy and breastfeeding, and the use of contraceptive hormones are the most factors related to this disease.

Interventions which improve the body composition and metabolic health of women with breast cancer are essential because they can improve the prognosis of this disease. Ketogenic diets have been suggested as complementary nutritional treatments for cancer patients. This systematic review was conducted with aim to determine the effect of ketogenic diets on the therapeutic and metabolic outcomes of breast cancer.

In this systematic review, in order to find the related articles, Medline, Embase, Google Scholar, ScienceDirect, Magiran, SID, ISC, and Cochrane databases were searched with the keywords of low carbohydrate, carbohydrate restriction, Ketogenic diet, breast cancer, breast tumor, and breast neoplasms in English and Persian languages until November 2022.

Five studies were reviewed. The results showed that breast cancer patients following a ketogenic diet had significant improvements in emotional and social functions, reduced disease symptoms, and improved metabolic health biomarkers (creatinine, triglycerides, insulin and free insulin-like growth factor I).

Long-term adherence to a ketogenic diet can lead to weight loss, tumor size reduction, improved quality of life, improved inflammatory factors, body composition, insulin resistance, and serum lipid profile disorders in breast cancer patients. Clinical trials are suggested to evaluate the effects of ketogenic diets on these metabolic factors, treatment, and quality of life in women with breast cancer.

Scorpion bite is an important health issue that in many cases occurs in Sistan and Baluchistan province. Severe complications of scorpion bite include: decreased renal blood flow, renal failure, severe hemolysis, pancreatitis, hepatitis, DIC, miscarriage, and death. In this study, a case of mother's death due to DIC caused by scorpion bite is reported.

A 19-year-old primigravid woman with the gestational age of 33 weeks, 5 days after being bitten by a scorpion, following a decrease in the level of consciousness with GCS: 3/15, intubation,undergoing blood transfusion was transferred from Rusk Hospital and admitted to the ICU ward. After being sent to Iranshahr, the patient was examined by anesthesiologist and gynecologist. In the examinations, severe lung rales were heard and bruises caused by scorpion bite were observed on the left side. In ultrasound, a fetus without heartbeat, biliary edema and hydronephrosis were evident. Induction and antiserum treatment started for scorpion stings. Four hours later, mother suddenly had bradycardia and asystole, CPR was performed and despite 45 minutes of CPR, the patient died.

In this patient, due to delay in transferring her to the medical center caused the doctors to fail to save her in time. If the patient bitten by scorpion does not come to hospital within the first 6 hours, she will lose the chance of treatment, and if the more time passes, she will face the risk of death due to the infiltration of poison into the bloodstream, so a person bitten by scorpion should refer to the hospital at the first opportunity and special tests should be performed.