مجله زنان مامائی و نازائی ایران
سال بیست و ششم شماره 12 (اسفند 1402)

Women's cancers such as endometrium, ovary, cervix, and vulva are common and one of the most effective treatments is the use of surgical techniques. Today, the use of injectable anticoagulants (heparin and enoxaparin) before and after women's cancer surgeries is common in treatment protocols. The present study was performed with aim to compare the effect of oral (apixaban) and injectable (enoxaparin) anticoagulant drugs in patients undergoing gynecological oncological surgeries.

This clinical trial study was carried out from 2021 to 2022 on 80 women referred to the hospital of Iran University of Medical Sciences with the complication of women's cancer (ovary, uterus, cervix, vulva and vagina, etc.) whose disease was confirmed by diagnostic laboratory evaluations and specialist physician and were diagnosed for surgery. After discharge, all patients used two treatment protocols of oral anticoagulants or injectable drugs within 28 days. Demographic information and laboratory indices of patients were evaluated. Data analysis was done using SPSS statistical software (version 22) and Mann-Whitney test. P<0.05 was considered significant.

There was no significant difference between the groups receiving oral and injectable anticoagulants in terms of bleeding time and hospitalization duration (p>0.05). Also, the amount of hemoglobin and platelets in both groups decreased after surgery compared to before surgery, which was statistically significant (p<0.05).

The use of oral and injectable anticoagulants has no effect on the amount of bleeding after surgery in patients with gynecological cancers.

Considering the excruciating process of labor as well as anxiety and fear of natural childbirth, it is necessary to find an appropriate substance for expedite progression of labor and shortening labor duration in pregnant women. This study was performed with aim to determine the effect of topical magnesium sulfate on effacement, dilatation, and labor duration in primiparous women.

This randomized controlled clinical trial study was conducted in 2022 on 98 primiparous women with full-term pregnancy that had referred to Qazvin Kosar Hospital for delivery. Patients were randomly divided into intervention and control groups. After diagnosis of active phase, in the intervention group, 10 cc of magnesium sulfate 50% and in the control group, the same amount of distilled water was poured on the cervix during vaginal examination. The amount of effacement and dilatation at the beginning of the active phase and then every 2 hours, as well as mother's age, gestational age, number of pregnancies, BMI, type of delivery, duration of labor, Apgar score, weight of the baby, duration of contractions and intervals of contractions were recorded in the checklist. Data analysis was done using SPSS software (version 16) and Fisher's exact, Chi-square, t-test and Mann-Whitney tests. P<0.05 was considered statistically significant.

Duration and intervals of contractions in first and second examination were not significantly different in the intervention and control groups (P>0.05). Mean effacement in the intervention group at the start of active phase was 55.61±3.80 and after two hours was 70.21±4.19, which was statistically significant (P=0.021(. Mean dilatation in the intervention group at the start of active phase was 4.57±0.57 cm and two hours after was 7.31±0.71 cm, which was statistically significant (p=0.043(. Mean effacement and dilatation in the control group at the start of active phase and two hours later was not statistically significant (P>0.05).

Topical magnesium sulfate is effective on improving dilatation and effacement during labor and help speed up delivery.

Endometritis and wound infection after caesarean section is the most common complication of caesarean section and is associated with many problems and complications. The present study was conducted with aim to determining the effect of vaginal washing with chlorhexidine before cesarean section on endometritis and wound infection after cesarean section.

This randomized clinical trial study with a control group was conducted in 2021-2022 on 320 patients with indications for cesarean section referred to the Kowsar Hospital in Qazvin, Iran. Before cesarean section, the patients were divided into two groups of test (vaginal prep with chlorhexidine) and control (vaginal prep with normal saline serum). During the first 10 days after cesarean section, the patients were examined for symptoms of endometritis and abdominal incision site infection. Data analysis was done using SPSS statistical software (version 25) and independent t-tests, Mann-Whitney, Chi-square and Fisher's exact test. P<0.05 was considered significant.

Vaginal preparation with chlorhexidine has reduced the incidence of infection in the test group (P<0.05). Although the vaginal preparation with chlorhexidine in the case group decreased the incidence of endometritis compared to the control group, this difference was not significant (P>0.05).

The vaginal preparation with chlorhexidine had positive effects in reducing the incidence of infection and endometritis. Therefore, it is recommended to do the vaginal preparation with chlorhexidine in addition to routine abdominal washing to prevent infections after cesarean section.

Breast cancer is one of the most common cancers in the world that its incidence rate has increased over the last decade. Although the causes and risk factors of breast cancer are not fully known, studies have been reported on the relationship between breast cancer and viral agents, including the Epstein-Barr virus (EBV). Therefore, the present study was performed with aim to explore the correlation between EBV and breast cancer.

In this cross-sectional study which was conducted using breast tissue pathology samples collected from Mashhad hospitals between 2017 and 2022, 30 paraffin tissue samples from breast cancer patients and 33 paraffin tissue samples as a control group from benign breast diseases were collected. After the DNA extraction processes, the EBV virus was tested by polymerase chain reaction (PCR). Data analysis was done using SPSS software (version 20) and Chi-square, Fisher's exact and t-test. P<0.05 was considered statistically significant.

According to the PCR results of 63 tissue biopsy samples, none of the malignant and control group samples were EBV-positive.

The presence of the EBV virus gene was not confirmed in a group of women with breast cancer in Mashhad. However, further studies with a larger sample size are needed to validate the results.

Neonatal Resuscitation training is one of the main trainings for people who are responsible for taking care of newborn, then how to implement and choose the right model for training is very important. Therefore, it is important to use innovative approaches in Resuscitation training that lead to improving and maintaining the knowledge and skills of learners. The present study was performed with aim to determine the effect of Educare training on the level of knowledge and performance of neonatal resuscitation in undergraduate midwifery students.

This semi-experimental study pre-and post-intervention was carried out in 2022 on 30 undergraduate midwifery students of the School of Nursing and Midwifery. The training was done by the Educare method using theory training and holding a 1-day workshop. Examining the level of knowledge and practice of students was done using a checklist and a researcher-made questionnaire after confirming the validity and reliability before/immediately/and two weeks after the practical training. Data analysis was done using STATA software (version 12) and Independent t-test and analysis of variance with repeated measures. P<0.05 was considered statistically significant.

The neonatal resuscitation knowledge score in midwifery students immediately and two weeks after the training significantly increased compared to before the training (p=0.001). The neonatal resuscitation performance score immediately and two weeks after training significantly increased compared to before training. There was a significant difference between knowledge and performance scores in three stages (p=0.001).

The educare method has improved the neonatal resuscitation knowledge and performance of midwifery students, so it is recommended to design and use this method for training other clinical skills in midwifery students.

Infertility is a global health concern and the prevalence of vitamin D deficiency in the infertile population is 27% to 65%. The role of vitamin D is proposed with the expression of receptors in all types of human reproductive tissues in reproductive health and the outcomes of ART. The present study was performed with aim to investigate the effect of vitamin D on ART outcomes.

In this review study, a comprehensive search was conducted in all databases of Web of Science, Scopus, Proquest, Pubmed, SID, Magiran and Google Scholar were conducted from 2015 to 2023 with English keywords of Assisted Reproductive Techniques, Vitamin D, Infertility, Male infertility, Female infertility and their Persian equivalents.

In total, 15 qualified articles were selected from among 1014 articles found for this study. Based on a wide range of studies, vitamin D potentially plays an important role in human fertility, and a positive correlation between high concentration of vitamin D and clinical pregnancy rate, fetal quality, and live birth rate in ART was reported.

The effects of vitamin D on ART outcomes are controversial and its deficiency is related to ART outcomes. Probably, the effect of vitamin D deficiency on fertility is not associated with all forms of infertility and the difference in dose, time of supply and type of vitamin D may play a role in the contradiction of the results. Identifying the role of vitamin D in the pathogenesis of infertility and ART outcomes still requires further studies.

Prolonged labor stages can have serious consequences for both mother and infant. Positive effects and encouraging results of nipple stimulation on the duration of labor have been observed in some studies. This study was performed with aim to determine the effects of breast stimulation on the duration of labor (primary outcome) and Apgar score and method of delivery (secondary outcomes).

This systematic review and meta-analysis was conducted according to the PRISMA guidelines. A search of published Persian and English texts without time restrictions up to July 2023 was performed in reputable databases including Scopus, Web of Science, Google Scholar, PubMed, and the SID Persian database with English keywords of Stimulation, Physical stimulation, Labor progress, Labor stage, Duration of labor, Breast, Nipple, and Labor, as well as their equivalent Persian keywords. Two authors independently assessed the quality of the articles using the Cochrane Risk of Bias tool and ROBINS-I tool, and the meta-analysis was conducted using RevMan software (version 5.3).

Out of 307 identified studies, 10 articles met the inclusion criteria. According to the subgroup analysis based on the control group, nipple stimulation compared to no intervention significantly reduced the duration of the first stage of labor (4 studies, mean difference: -2.66; 95% confidence interval: -1.70 to -3.61; p<0.001) and the second stage of labor (3 studies, mean difference: -8.22; 95% confidence interval: -3.62 to -12.83; p<0.001).

Although breast stimulation compared to no intervention may reduce the duration of labor, due to the limited studies in this area, further high-quality studies are needed before recommending its use.

Adenoid cystic carcinoma (ACC) of the breast belongs to the basal-like subgroup of breast carcinomas. This group of tumors is triple negative and are negative for all three biomarkers, estrogen receptor (ER) and progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her2). However, triple-negative appearance along with pseudo-basal features and positivity for CD117 or CK14 and CK17 expression is considered pathognomonic for ACC. Unlike other types of triple negative breast tumors, ACC has an excellent prognosis. In this report, a description of one of the cases with ACC and its histopathological features is presented.

The patient was a 43-year-old woman who referred to our medical center with complaints of right breast pain radiating to the armpit since three months before visiting. In mammography, in the right breast, a hypoecho-solid mass with irregular borders in the subareolar region was reported with a retracted nipple. In the ultrasound, the presence of a white hypochoic mass with irregular boundaries was confirmed. In histological evaluation, plates of malignant cells with distinct atypia were reported. The sample was evaluated by immunohistochemistry (IHC) and the evaluation was negative for the expression of the three markers ER, PR and Her2, but positive for the expression of the CD117 marker, and accordingly, the diagnosis of ACC was confirmed for the patient.

ACC tumors are characterized by a triple-negative appearance with basal-like features and positivity for CD117 or cytokeratins 14 or 17 expression that according to this patter, it is very important to distinguish ACC from other tumors with worse prognosis.