مجله زنان مامائی و نازائی ایران
سال بیست و هفتم شماره 11 (بهمن 1403)

Hypothyroidism is a common disease in pregnant women, which may affect their cesarean section process. Since spinal anesthesia is a more suitable option for pregnant women with hypothyroidism, the present study was conducted with aim to investigate the complications of spinal anesthesia in patients with hypothyroidism undergoing cesarean section with spinal anesthesia.

This case-control study was conducted in 2021-2022 on 83 patients who referred to Motahari Hospital in Jahrom, Iran for cesarean section. The patients were divided into two groups: hypothyroidism (n=42) and control (n=41). The incidence of headache, shivering, nausea, vomiting, pain, and back pain were measured and recorded at different times during and after the operation. Data were analyzed using SPSS software (version 21) and t-test, chi-square and Mann-Whitney tests. P<0.05 was considered significant.

At 15, 30, 45, and 60 minutes after the start of the operation and at the time of entering and leaving the recovery room, the frequency of headache was lower in the control group than the case group, but the difference was not significant (p>0.05). At 15 minutes after the operation and at the time of entering the recovery room, the frequency of shivering was significantly lower in the control group than the case group (p<0.05). At 30 minutes after the start of the operation, the frequency of nausea and vomiting was significantly higher in the control group than the case group (p<0.05).

Since in the case group, only at some moments during surgery, there was an increase in shivering and nausea-vomiting compared to the control group, and at most moments, there was no significant difference in complications between the two groups, it seems that spinal anesthesia can be used without concern for more complications in patients with hypothyroidism.

Type 2 diabetes is a chronic metabolic disease associated with increased inflammation, which plays a significant role in disease progression. IL-1β, SFRP4, and TLR4 proteins are recognized as key components in the inflammatory pathways involved in diabetes. This study was conducted with aim to examine the effect of aerobic exercise and yoga on inflammatory and metabolic markers in overweight women with type 2 diabetes.

This research was applied, multi-group, and comparative study conducted using a quasi-experimental method with a pre-test, post-test design. Thirty overweight women with type 2 diabetes were assigned to three groups: control, yoga, and aerobic exercise. The interventions were performed over 12 weeks, with three 60-minute sessions per week. The aerobic exercise group engaged in treadmill running and light weight exercises at 60-70% of maximum heart rate, while the yoga group participated in breathing exercises, asanas, meditation, and prayers. Data were analyzed using SPSS software (version 21) and covariance analysis and t-correlation test. P<0.05 was considered significant.

Neither of the interventions showed a significant effect on the inflammatory markers IL-1β, TLR4, and SFRP4 (P>0.05). However, both interventions led to a significant reduction in metabolic markers FBS, HbA1c, and HOMA-IR (P<0.05). No significant difference was observed between the effects of the two interventions on metabolic markers (P>0.05).

Aerobic exercise and yoga as non-pharmacological interventions can be effective to improve blood glucose control and quality of life in individuals with type 2 diabetes.

Swimming can help improve symptoms of endometriosis by reducing inflammation and oxidative stress. Also, vitamins C and E may be involved in scavenging free radicals in women with endometriosis. In addition, vitamins B both increase estrogen metabolism in a passive form and support the conversion of linoleic acid to gamma-linolenic acid. The present study was conducted with aim to investigate the effect of regular aerobic exercise and antioxidant vitamins on the expression of NR5A1 and CYP19A1 genes in ovarian tissue of endometriosis model rats.

In this experimental study, 50 female rats were divided into 10 groups: 1-healthy control, 2-endometriosis, 3-sham, 4-endometriosis+exercise, 5-endometriosis+vitamin B, 6-endometriosis+omega3, 7-endometriosis+vitaminE, 8-exercise+endometriosis+vitaminB, 9-exercise+endometriosis+vitaminE, 10-exercise+endometriosis+omega3. The training program consisted of swimming 5 days a week for 8 weeks. Vitamin E was administered at a dose of 200mg/kg, omega3 supplement at a dose of 2ml/kg, and vitamin B (a combination of vitamins B6, B2, B1) at a dose of 60 mg/kg per day by gavage. CYP19A1 and NR5A1 gene expression was measured by real-time PCR. Data were analyzed using SPSS software (version 23) and ANOVA test. P<0.05 was considered significant.

The induction of the experimental model of endometriosis caused a significant increase in the NR5A1 gene compared to the healthy control group (p<0.001). Swimming training+vitamin E (p=0.013) and swimming training+omega3 (p=0.012) led to a significant decrease of NR5A1 gene in ovarian tissue in the experimental model of endometriosis rats. The induction of the experimental model of endometriosis also caused a significant increase in the CYP19A1 gene compared to the healthy control group (p=0.003). The combined exercise+omega3 group had a significant decrease in ovarian CYP19A1 gene compared to the endometriosis group (p=0.031).

Endometriosis is associated with increased NR5A1 and CYP19A1 genes in the ovarian tissue and swimming training plus omega3 and vitamin E will help to improve endometriosis by reducing NR5A1 and CYP19A1 gene expression.

Ischemia-perfusion injury is an important problem for ovarian torsion. Antioxidant agents such as Syzygium aromaticum protect the ovaries from damage caused by oxygen free radicals and improve pregnancy. The present study was conducted with aim to investigate the effect of Syzygium aromaticum hydroalcoholic extract on increasing fertility after ovarian ischemia-perfusion injury in Wistar rats.

In this experimental study conducted in 2021, 20 female Wistar rats were divided into 4 experimental groups: sham, ischemia-reperfusion (4 hours of ischemia and 4 hours of reperfusion) and treatment groups 1 and 2 (the same as the previous group but with the injection of 30 and 60 mg/kg of hydroalcoholic extract of Syzygium aromaticum intraperitoneally 30 minutes before tortioned). Then, fertilization was done by intrauterine insemination (IUI). After ovarian resection, hematoxylin and eosin (H&E) staining was performed for histopathological evaluation of the ovary. Data were analyzed by SPSS statistical software (version 18) and one-way variance and Kruskal-Willis tests. P< 0.05 was considered statistically significant.

In the histopathological evaluation, the number of ovarian follicles in different stages of growth in showed a significant decrease the torsion/detorsion groups compared to the sham and treatment groups (p<0.05). The number of embryos formed in the torsion/detorsion uterine horn of the ischemia-reperfusion group was significantly reduced compared to the sham and treatment groups (p<0.01). Also, fertility rate by IUI showed a significant increase in the treated groups compared to the ischemia-reperfusion group (p<0.05).

Syzygium aromaticum hydroalcoholic extract after torsion/detorsion can improve folliculogenesis in the treatment groups compared to the ischemia-reperfusion group and increase the success of pregnancy by IUI.

Postpartum pain or uterine contractions is one of the common problems of the postpartum period, which has a significant impact on the quality of life of mothers. Considering the side effects caused by the use of chemical drugs, as well as mothers' anxiety and worry about the medicinal effects of drugs for themselves and their babies, today mothers' desire to use complementary medicine to relieve postpartum pain has increased. The present study was conducted with aim to compare the effect of Nigella sativa vs. menstrogel and mefenamic acid on postpartum pain.

This triple-blind clinical trial study was conducted in 2021-2022 on 60 multiparous women referring to Walie Asr maternity hospital in Birjand city who gave birth naturally and complained of postpartum pain. The women were randomly assigned to three groups of Nigella sativa, menstrogel, and mefenamic acid capsules and they took capsules every 6 hours for 24 hours. Pain intensity was measured before each dose and one hour later. Data were analyzed by SPSS software (version 22) and ANOVA, chi-square, paired t-test, post hoc Benferroni tests. P<0.05 was considered significant.

The mean score of pain intensity before and after the intervention in the first round did not differ significantly in the three groups (p>0.05), while the results of the analysis of variance showed that the pain intensity has a significant difference in the three groups in the second round after the intervention (p=0.02), the third round after the intervention (p=0.002) and the fourth round after the intervention (p<0.05), and the intensity of pain was less in the Nigella sativa and menstrogel group than the mefenamic acid group, and the consumption of additional painkillers was also lower.

Nigella sativa and menstrogel can be used as an effective herbal medicine to reduce the intensity of postpartum pain.

Urinary incontinence (UI) is a widespread public health issue predominantly affecting adult women. This study was conducted with aim to investigate the impact of urinary incontinence on sexual satisfaction in postmenopausal women.

This systematic review study was conducted based on the PRISMA checklist. A comprehensive search was carried out in various national and international databases using standard keywords, including MESH terms and their Persian equivalents. The keywords included Urinary Incontinence, Urge, Incontinence, Stress Incontinence, Orgasm, Sexual Arousal, Sexual Function, Sexual Satisfaction, Menopause, and Postmenopause. All relevant descriptive-cross-sectional studies were selected for this research.

Out of a total of 754 studies, 12 articles involving 4132 postmenopausal women were included in the investigation. The studies were predominantly descriptive-cross-sectional, with only one study classified as a clinical trial. The mean age of the participants was 56.48 ± 4.73 years. The studies examined three types of urinary incontinence: stress, urge, and mixed incontinence. All studies emphasized that postmenopausal women with urinary incontinence experienced lower sexual function and satisfaction. Some studies indicated that the type of urinary incontinence could have a greater impact on sexual function and satisfaction. Three studies stated that stress incontinence reduced sexual desire, while four studies linked mixed incontinence to the most significant impact on sexual dysfunction. One study found that only stress incontinence had a significant relationship with sexual function.

The most prevalent types of incontinence were urge, stress, and mixed incontinence, respectively. Most articles (four studies) indicated that mixed incontinence has a more significant effect on sexual dysfunction. However, one study found no correlation between mixed incontinence and sexual dysfunction. Further research in this area is recommended.

Toxoplasma gondii parasite is an obligate intracellular protozoan shared between humans and animals and has many effects on pregnant women. The present systematic review and meta-analysis was conducted with aim to determine the prevalence of toxoplasma gondii in pregnant women in Iran.

This systematic review and meta-analysis study was conducted by checking Scientific Information Database (SID), Medline (PubMed), ScienceDirect and Google Scholar without time limit and until November 2023. The keywords used in this study were in English and Persian included toxoplasma gondii, pregnant women, and parasitic infection. The information extracted from the studies was entered into the Comprehensive Meta-analysis (CMA, Version 2) software. The heterogeneity of the studies was analyzed by the I2 test and the distribution bias in the studies was also analyzed by the correlation test at a significance level of 0.1 and funnel plot. Also, the effective factors in creating heterogeneity were investigated by meta-regression test.

In a review of 37 studies with a sample size of 19,784 pregnant women, the prevalence of toxoplasma gondii in Iranian pregnant women was reported as 41.1% (95% CI 34.6-47.9). In the review of the factors affecting the heterogeneity of the studies and the review of the effect of the sample size on this heterogeneity, it was reported that with the increase of sample size, the prevalence of toxoplasma gondii in Iranian pregnant women increases (p<0.05); also with the increase of the year of conducting studies, the prevalence of toxoplasma gondii in Iranian pregnant women decreases (p<0.05).

The prevalence of toxoplasma gondii in pregnant women in Iran is at a high level and it is necessary to increase the awareness of women before pregnancy as well as pregnant women during pregnancy, and carry out the necessary health education in health centers and specific and targeted screening measures for determination of infected pregnant women and reduction of its effects on infants.

Embryonic rhabdomyosarcoma (ERMS) of the cervix is ​​a type of soft tissue sarcoma that usually occurs in young women and is very rare in adulthood. In this study, a case of embryonal rhabdomyosarcoma of the cervix in a 57-year-old woman was reported.

The patient was a 57-year-old woman with symptoms of a palpable mass at the external cervical os and postmenopausal bleeding who was admitted to Omid Hospital, and the lesion was excised. Histopathological examination showed proliferation of small round cells in some cases with a rhabdoid appearance. Accordingly, the initial diagnosis of embryonal rhabdomyosarcoma was made. This diagnosis was confirmed by immunohistochemistry and myogenin positivity, and the patient underwent total hysterectomy and bilateral salpingo-oophorectomy. The tumor was confined to the cervix and there was no evidence of metastasis in additional examinations. In the 26-month follow-up of the patient, there was no sign of recurrence or symptoms related to embryonal rhabdomyosarcoma.

Given the rarity of embryonal rhabdomyosarcoma in postmenopausal women, this tumor may not be diagnosed by histopathology alone and immunohistochemical examination is required for relevant markers. Therefore, when observing a polypoid lesion in the cervix at any age, diagnosing embryonal rhabdomyosarcoma should also be considered. Timely diagnosis and treatment of the disease can prevent tumor recurrence in patient.