مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 11 (بهمن 1402)

Breast cancer is a common malignancy in women and is the second leading cause of cancer-related deaths in the female population after lung cancer, hence its early detection and intervention has a significant effect on changing the clinical course and prognosis of the disease. The present study was performed with aim to compare the cytology results in needle sampling method between two traditional smear techniques and liquid-based cytology to detect palpable breast masses in women.

The cross-sectional and descriptive study was conducted in 2019-2020 on 65 patients with a palpable breast mass referred to the surgical clinic of Shahid Mohammadi Teaching Hospital. Fine needle aspiration was performed for the patients. One portion of the aspirated material was processed in a non-gynecological ThinPrep liquid setting, while the other was prepared conventionally. The smears were compared in terms of cellularity, epithelial structure, nuclear and cytoplasmic details, and background elements using European Commission breast screening pathology criteria. Both smear methods were also compared with histopathology for confirmation. Data analysis was done using SPSS statistical software (version 23). P<0.05 was considered statistically significant.

The liquid-based cytology method exhibited a cellularity rate of 40% contrasting with 57% in the conventional smear, which had a significant difference (p=0.04). The liquid-based method yielded a clear background, while the conventional method displayed protein content. Cell structure comparison showed no significant difference (p=0.08). Notably, liquid-based cytology excelled in nuclear details, with 55.4% graded as excellent, compared to 49.2% in the conventional smear. High-grade cytoplasmic details were observed in liquid-based cytology, while the conventional smear rated as good.

The liquid-based cytology method has evolved as a new method in the field of cytology and has played an effective role in reducing the limitations of conventional smear.

The time of umbilical cord clamping is an important strategy for better prognosis of preterm and full-term infants, and all health care providers should be informed about the components and importance of this approach. The present study was performed with aim to investigate the time and duration of umbilical cord clamping in the delivery or operating room of Khorasan Razavi Hospitals.

This descriptive study was conducted on 1237 babies born in the delivery or operating room of Khorasan Razavi public Hospitals between 2020 and 2022 with available sampling. In each hospital, a researcher assistant midwife who was not involved in the delivery process recorded the time of umbilical cord clamping after birth, and in the next step, she recorded the possible cause of early umbilical cord clamping by asking the obstetrician. Data were analyzed by SPSS software (version 26) and descriptive statistics tests. P<0.05 was considered statistically significant.

In this study, 165 neonates (13.4%) were premature and 1072 neonates (86.6%) were born full term. In addition, 915 neonates (73.96%) were born naturally and other 322 neonates (26.04%) by cesarean section. The mean duration of the umbilical cord clamping of the newborns was 35.25 ± 27.29 second, which was reported as 21.29 ± 14.95 second in cesarean section and 40.22 ± 28.92 second in natural delivery. In 719 neonates (58.1%), the umbilical cord is closed before 30 seconds and in 322 neonates (26%) before 15 seconds. Among the causes of early umbilical cord clamping, hasting by obstetrician (30%), caesarean section (3.7%), doctor's routine (2.1%) and mother's non-cooperation (1.5%) were the most common causes.

Umbilical cord clamping is done quickly or very quickly in the delivery room of Khorasan Razavi public hospitals, and in caesarean section, this urgency is very noticeable, and the most common cause of hasting is obstetrician. Therefore, correcting the thinking of the obstetrician in order to improve the time of umbilical cord clamping seems necessary. Delaying umbilical cord clamping plays an important role in the transition from fetal to newborn blood circulation and improves the health of newborns.

Postpartum hemorrhage (PPH) is one of the main causes of maternal mortality. The present study was conducted with aim to investigate the relationship between low levels of fibrinogen and the severity of PPH and the importance of administering fibrinogen concentrate or cryo to reduce bleeding.

This prospective cohort study was conducted from 2017 to 2019 on 122 mothers with uterine bleeding in the first 24 hours after delivery in Mashhad. In case of persistent bleeding and rejection of traumatic causes, misoprostol was prescribed, and blood samples were taken at this time (time H0). Patients were divided into severe and non-severe groups by considering the severity of bleeding from H0 to 24 hours. Data were analyzed by SPSS software (version 16) and independent t-test and Mann-Whitney, paired t, Chi-square and Fisher's tests. P<0.05 was considered statistically significant.

Of 122 mothers, 38 and 84 were in the severe and non-severe groups, respectively. More than 50% of the mothers had a normal delivery, and there was no significant difference between the two groups in terms of delivery method (p=0.883). Postpartum fibrinogen level in H0 was significantly lower in the severe group compared to the non-severe group (p<0.001). The mean fibrinogen level was 274.8±115.8 mg/dL in the severe and 368.4±78.5 mg/dL in the non-severe groups.

Early administration of products containing fibrinogen can help to reduce the amount of bleeding in case of PPH and thus reduce the number of bleeding complications and possible interventions. In future studies along with increasing the sample volume, sampling 12 and 24 hours after delivery is also suggested to control the level of fibrinogen.

Despite the effect of vitamin D in improving clinical and laboratory symptoms and insulin resistance and hyperandrogenism, there are still doubts about the role of vitamin D in the treatment of PCOS. Therefore, the present study was conducted with aim to investigate the effect of vitamin D on biochemical indices and sexual hormones in PCOS patients.

This clinical trial study was conducted in 2023 on 213 women aged 18-40 with PCOS diagnosis and vitamin D deficiency in Shahid Akbarabadi Hospital. Patients with a serum level greater than or equal to 30 ng/ml of vitamin D were included in the study and were divided into control and intervention groups. The control group was prescribed metformin 500 mg daily and the intervention group metformin 500 mg daily plus vitamin D 50,000 units weekly for 12 weeks and then the above factors were again checked. Data analysis was done using SPSS statistical software (version 22) and Mann-Whitney and Chi-square tests. P<0.05 was considered statistically significant.

: The mean of FSH, TG, HDL, and vitamin D factors after the intervention significantly increased compared to before the intervention (p<0.05). However, the mean of FBS and HOMA IR factors reduced after the intervention compared to before the intervention, and a statistically significant relationship was observed (p<0.05).

The use of vitamin D in PCOS patients can have an effect on laboratory indices such as FBS, HOMA IR, FSH, TG and HDL.

Gestational diabetes (GDM) is one of the most important causes of complications during pregnancy and has a high prevalence, so it is essential to identify the factors affecting its physiopathology as a way to prevent and treat it. Therefore, the present study was performed with aim to investigate the serum level of vitamin D in healthy and diabetic pregnant women.

This case-control study was conducted in 2022-2023 on 198 pregnant women (99 with gestational diabetes and 99 without gestational diabetes in the control group) referred to the treatment centers of Abadan University of Medical Sciences. After obtaining consent from the subjects and recording demographic information, serum vitamin D levels were also recorded. Data were analyzed by SPSS software (version 24) and Independent T and Pearson correlation tests. P<0.05 was considered statistically significant.

The mean serum level of vitamin D in women with GDM was significantly lower than pregnant women in the control group (16.97 vs. 26.76 ng/ml). By grouping pregnant women based on age, gestational age, gravid and BMI, women with GDM had lower mean vitamin D levels than pregnant women in the control group (P<0.05). In the correlation analysis of women with GDM, vitamin D level had an inverse and significant relationship with 1-hour sugar (r=-0.212 and P=0.035) and 2-hour sugar (r=-0.223 and P=0.026), but no significant relationship with FBS level was observed. The sensitivity and specificity of vitamin D in the diagnosis of GDM at the cut-off point of 18.05 were 69.7% and 74.7%, and the positive and negative predictive value were 73.4% and 71.2%, and the overall accuracy was 72.2% and the level of agreement was moderate.

Women with GDM had significantly less vitamin D, which can be considered a risk factor for GDM during pregnancy.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and diet can affect it. Considering the high prevalence of polycystic ovary syndrome in women and its negative consequences on fertility, this review study was conducted with aim to investigate the role of micronutrients on the fertility of women with polycystic ovary syndrome. In this systematic review study, to find the related articles, international databases (ScienceDirect, Embase, Scopus, PubMed) and Persian language databases (Magiran, SID and IranMedex) were searched with different combinations of keywords related to "polycystic ovary syndrome" and " "micronutrients" and "fertility" without time limit until February 2023 using the Verhagen scale. Out of 1080 reviewed articles, finally 13 articles were included in the study. Five studies investigated the indirect mechanisms of micronutrients on factors affecting fertility; in two studies, no statistically significant difference was observed, and in three studies, beneficial effects on insulin metabolism and lipid parameters, regulation of menstruation, regulation of LH/FSH ratio were reported. Of the eight studies that investigated ovarian function, seven studies found improved ovarian function. Most of the studies showed the positive effects of micronutrients on the fertility of women with polycystic ovary syndrome. Micronutrients seem to be associated with improved fertility in women with polycystic ovary syndrome.

Infertility is a common global problem, approximately 40-50% of which is related to male infertility. Since complementary medications and alternative medicine are recently considered for the treatment of infertility, the current study was conducted with aim to assess the effect of carob on semen parameters and male infertility in human and animal experimental studies.
This systematic review study was performed based on PRISMA guidelines using Persian and English keywords and their possible combinations and search in the following databases: PubMed, Web of Science, Science Direct, Scopus, Medlib, Persian SID and Magiran databases, and Google Scholar search engine with keywords based on MeSh, including siliqua (carob), sperm, testis, male infertility, and semen without time limit until April 2023. The inclusion criteria were human and animal interventional studies conducted on men and male animals.
Out of a total of 176 studies, 14 animal studies and three human studies entered the study. The experimental animals included rats, roosters, rams, and dogs. The results of most studies indicated that carob improves sperm parameters such as concentration, progressive motility, morphology, viability, quality, and semen volume. However, the results are contradictory regarding its effect on antioxidant activity, oxidative stress index, and increasing fertility.
Carob plant is effective on some parameters of sperm and male fertility, although due to the insufficient number of articles in some cases and the existence of contradictions in the results of some other articles, it is not possible to give a definite opinion about this plant, therefore, to determine its definite effectiveness, it is recommended to design and perform more studies with a larger sample size and a more accurate method.

Pediatric patients rarely develop ovarian tumors, but mainly develop ovarian germ cell tumors. Malignant germ cell tumors are generally rare and dysgerminoma is the most frequent malignant ovarian neoplasm in young and adolescent girls. In this study, a case of ovarian malignant mixed germ cell tumor with combination of dysgerminoma and embryonal carcinoma component is reported.

A 13-year-old girl referred to Omid educational, research and treatment center of Mashhad with abdominal pain and swelling from five months ago and was gradually worsened. In the ultrasound examination, a mass with a cystic nature was reported in the pelvis with dimensions of 269×185mm. The patient underwent salpingo-oophorectomy surgery and tumor removal for pathological study. In the microscopic examination, 95% of malignant germ cell tumor was reported as dysgerminoma and 5% as embryonal carcinoma (CD 30 positive). The patient was discharged in good general condition to continue the treatment and receive chemotherapy.

Any adolescent girl who develops a rapidly growing pelvic mass should be evaluated for malignant mixed germ cell tumors of the ovary, which are highly aggressive. In these patients, prompt surgical intervention with fertility preservation is crucial.