مجله زنان مامائی و نازائی ایران
سال یازدهم شماره 4 (زمستان 1387)

Approximately, 10-15% of couples suffer from infertility. Various therapeutic approaches have been used to treat infertility; however for those who do not response to treatment using some methods to assist fertility are inevitable. Swim up is one of these methods that enhance the sperm quality. This aim of study was to determine the effects of swim up method on motility, density and morphology of sperms. Methods and Material: In this experimental-analytical study the semen specimens of 30 individuals with normal parameters (for selection of sperm with better quality) referred to Fateme-Alzahra Infertility Center affiliated to Babol University of Medical Sciences for performing in-vitro fertilization were used. The men with cigarette smoking or addiction excluded. Pre-and post swim-up data including the count, motility, morphology, and grading of sperms were recorded. The data were analyzed using SPSS version 10. Paired t test was used for analysis. The mean sperm count after swim up (64.1×106) was significantly (p<0.001) lower than before the swim up (87.3×106). Mean sperm motility was 60.3% before swim up and 85.8% after swim up (p<0.001). By using swim up method 2.5% (p=0.083), 12.6% (p<0.001) and 21.6٪ (p=0.003) improvement was seen in sperm grade I, II and III respectively. The mean percentage of sperms with normal morphology before and after the swim-up was 11.2% and 16.3%, respectively (p<0.001). Preparation of sperms by swim-up method improves the normal sperm morphology, motility, and grading

Testicular feminization is a rare X linked syndrome with 46 XY karyotype. The aim of this report was to present the role of laparoscopy in the diagnosis and treatment of this syndrome.Materials & Patients: Two women referred to us with a history of amenorrhea. They were 23 and 19 years olds. Physical examination showed normal pubic hair and normal development of external genitalia and breasts. Ultrasonography of abdomen showed; agenesis of the uterus and existence of two gonads near the internal inguinal rings. Hormonal assays were done and karyotype study showed 46XY. In order to confirm the diagnosis by laparoscopy, under general anesthesia and by using Hasson technique, a 10Fr trocar was inserted and totally the four Testes were seen in the abdomen of two patients. Because of the risk of gonadoblastoma, two 5F trocars were introduced in midclavicular lines (below the umbilicus), the gonads were released from the surrounding tissues, and after ligating the vascular attachments the gonads were excised and removed through the trocar incision sites. Post laparoscopy course was uneventful and both patients discharged home after two days. Histopathologic study of the removed gonads confirmed testicular features. Having considered the minimal morbidity and complications in this two cases and report the experience of other authors, it seems that, laparoscopic gonadectomy might be a suitable option in managing patients with testicular feminization.Key Words:

Accurate estimating of the gestational age is one of the most important assesments during pregnancy. Various strategies for management of pregnancy depend on the estimation of accurate gestational age. In addition to the clinical methods, sonographic measurements are important to estimate the gestational age. The aim of this study was to compare the fetal foot length diameter as a non-traditional sonographic measurement with the biparietal diameter (BPD) and femur length (FL) to determine the gestational age in the second and third trimesters. Methods and Material: This study was carried out on 150 pregnant women in second and third trimesters that referred to 22nd Bahman hospital affiliated to Islamic Azad University of Medical Sciences, in Mashad during 2006-2007 for sonographic evaluation. They had all regular menstruations. Non-random sampling was done until enough cases were collected to meet the desired sample size. Ultrasonography of pelvis and abdomen was performed by a single radiologist and the gestational age was reported based on the foot length, BPD, and FL separately. The history of the last menstrual period (LMP) was obtained as well. The protocol of the study was approved by the ethical board of the university and written informed consents were obtained from the patients. All collected data were analyzed by using SPSS software (14th version) and Fischer test. In the second trimester the accuracy of measuring fetal foot length was a little higher than fetal BPD and FL for estimation of gestational age (p=0.945). In the third trimester the measurement of fetal foot length and FL was a little more precise than BPD but there was no significant difference (p=0.961). Estimation of the gestational age in the second and third trimester by measuring the fetal foot length was almost equivalent with the fetal BPD and FL.

Unusual increase of multifetal pregnancy is a public health problem. The prevalence of complications during pregnancy, maternal mortality, preterm labor, and fetal and neonatal complications in twin pregnancy is more than single pregnancy. Fetuses’ weight discordance is one of the important complications that may increase the unpleasant consequences of twin pregnancies such as the risk of fetal and neonatal mortality and disability. Methods and Material: In this analytical study all the archived files (667) of twin pregnancies delivered during 1997-2005 in Alzahra and Rasoul Akram hospitals in Rasht city (north of Iran) were studied. Birth weight differences of the twins were stratified into the following groups: discordant twins (birth weight differences ≥20%) and concordant twins (birth weight differences<20%). Then the frequency of risk factors such as maternal age, parity, pre-eclampsia, and the outcomes such as preterm labor, non-cephalic- cephalic presentation, and cesarean delivery were compared in these groups. The data were analyzed by using the SPSS software version 12. X² and t tests were used to compare between groups. Of thetotal 667 twin deliveries, 78.4% were concordant and 21.6% were discordant. There was significant correlation between discordance and preterm labor and non cephalic- cephalic presentation (p<0.05). But there was not significant correlation between discordance and maternal age, parity, preeclampsia, and cesarean delivery. Twin pregnancy with weight discordance is a very high risk pregnancy, which can be accompanied by non cephalic- cephalic presentation and preterm labor. It needs particular attention for detection and monitoring. Regular prenatal visits should be arranged in these pregnancies.

Pain is common after all kinds of operations especially the cesarean section. Cesarean section is the most prevalent obstetric operation causing pain particularly due to flatulence. Various analgesics have been used to relieve pain after cesarean section. This study was performed to evaluate the effect of cumin oil on pain severity after cesarean section.Methods and Material: In this double blind, clinical trial, 124 women (58 controls and 66 cases) were studied. (Randomized based on number patient was performed. we calculate the sample size based on most common sign. Included women had live, singleton fetuses with gestation age 38-42 weeks. All the women received similar intravenous fluid and analgesia. Excluded patients had high body mass index, twin pregnancy, and history of other surgery rather than cesarean section. The cases received 40 drops of Cumin oil (Barij essence, Kashan, Iran), every 20 minutes for three doses just after discontinuing the intravenous fluid. The controls received placebo (Cumin oil solution 0.1%). Visual analog scaling was used to evaluate the effect of cumin oil on pain severity.

The pain severity in the experimental group was significantly reduced after 20 minutes (p<0/007), 40 minutes (p<0/001) and 120 minutes (p<0/001) of the intervention.

Cumin oil can be prescribed to reduce flatulence related abdominal pain after cesarean section.

Episiotomy is a surgical incision of the perineum, which is done during delivery to facilitate and expedite delivery and to prevent perineal tears. Within the midwifery practice, perineal care both during and after the labor has changed during the past 20 years, however, there is little research on the care of this most frequently performed wound. Curcuma longa or turmeric is a tropical plant, which has the capability of healing wounds because of its containing curcuminoids. The aim of this study was to determine the effect of turmeric ointment on healing of episiotomy site in primiparous women. This study was a double blind clinical trial, which was accomplished in Omul Banin hospital affiliated to Mashhad University of Medical Sciences. Eighty four qualified primiparous women aged 17-35 years who were scheduled for normal vaginal delivery were recruited. Inclusion criteria were: Primiparity, gestational age 37-42 weeks, live and singleton pregnancy, and lack of chronic systemic diseases such as diabetes mellitus that can affect the healing process. The included women were alternately divided to the study and control groups. The turmeric ointment contained 5% ethanolic extract of turmeric rhizomes powder in Vaseline basement and placebo contained a few drops of in concentrated hydro alcoholic extract of turmeric rhizomes powder in Vaseline basement. Both the turmeric and placebo ointments were prepared, packed and coded in similar tubes by a pharmacologist who was blind to the study protocol. After delivery, in case of performing episiotomy, the women were advised to apply either the drug or the placebo every 12±2 hours for 10 days. The healing process was assessed at days 7th, 10th, and 14th after the delivery using the REEDA (Redness, Edema, Ecchymosis, Discharge, and Adhesive) scale. The data were analyzed using Student's t, c2, and Mann-Whitney tests. There was not a significant difference in demographic characteristics and other distracted variables between the two groups. Of the 84 recruited women, 17 were excluded. The remaining 63 women consisted of 32 cases and 31 controls. At the 7th day postpartum, the mean REEDA score was 2.84±1.68 for the study group and 4.35±1.45 for the control group (P<0.001). At the 10th day, the mean REEDA score for the women in the study group was about half of their counterparts in the control group (2.09±1.594 v 4.10±1.777, P<0.001). At the 14th day, 4 days after discontinuing the treatment, the mean REEDA score for the study group was still lower than that of the control group (P=0.012). No side effect was seen or reported during the study. The mean REEDA score for the study group at the 10th day was likely the control group at the 14th day. In fact, the turmeric ointment enhances the healing at the episiotomy site and decreases the duration of healing from 14 days to10 days. Therefore, it seems that this ointment can be prescribed for primiparous women with episiotomy incisions.

Labor pain is one of the most severe human pains, which has mental and physical side-effects on pregnant women and their fetuses. One of the most ancient complementary methods used to relieve labor pain is massage. The purpose of this study was to investigate the effects of back massage on labor pain in women attending Bentolhoda maternity hospital in Bojnord city (northeast Iran) in 2005. In this single blind clinical trial, that only assessor was blind 62 primiparous pregnant women with gestational age 37-42 weeks, who had singleton pregnancy with vertex presentation and were candidate for normal vaginal delivery were recruited. Number of cases was defined on other trials.Then the women were randomized every other day and were divided in two groups. Back massage in the experimental group (n=32) was continuous, firm, and steady for 30 minutes and the women in the control group (n=30) received 30 minutes routine nursing care in any three phases of labor. By using the visual analogue scale (VAS), the intensity of pain before and after the massage or routine care was compared between the two groups in the latent phase (cervical dilation 3-4 cm), active phase (cervical dilation 5-7 cm), and transitional phase (cervical dilation 8-10 cm) of the labor. In order to collect data an interview and observation sheet were filled out. The data were analyzed using statically tests such as X2, and Student’s t tests by using SPSS soft ware. The women in the experimental group had significantly lower pain in the latent (p<0/001), active (p<0/001), and transitional phases (p<0.001).The mean pain score before and after back massage was significantly different in the experimental group (p<0/001 for each phase). There was significant difference between longevity of contraction and numerous of vaginal examination and mean scores of group on mean score pain before and after intervention in the latent phase (p<0/001). This study indicated that back massage reduce pain intensity in the first stage of labor.

At any time many women are pregnant or lactating worldwide. The medication use by these women is accompanied by significant risks. In addition to normal physiologic changes that alter the pharmacokinetics of drugs, there is concern for the possible teratogenicity and toxic effects of the drugs on the developing fetus and newborn. This article reviews the risks and pharmacokinetic considerations for 10 broad-spectrum antibiotics that can be used to treat various infections during pregnancy and lactation. Information from the Pub Med was reviewed concerning the use of 10 antibiotics (amoxicillin, penicillin G and V, doxycycline, chloramphenicol, ciprofloxacin, rifampin, clindamycin, gentamicin, vancomycin) in pregnant and lactating women. The PubMed search engine was used with the search terms [antibiotic name] and teratogen or tratogenic “[antibiotic name] and pregnancy,” “[antibiotic name] and lactation,” and “[antibiotic name] and breast-feeding” from 1966 to November 2007. Standard reference tracing was done as well. The Scientific Information Database was searched with the similar keywords for Persian articles. One hundred and one references had sufficient information regarding the number of subjects, and the methods. So their findings were included in the study. The teratogenic potential of the drugs in humans ranged from “none” for penicillin G and penicillin V to “unlikely” for amoxicillin, chloramphenicol, ciprofloxacin, doxycycline, and rifampin and to “undetermined” for clindamycin, gentamicin, and vancomycin. Significant pharmacokinetic changes occur during pregnancy for penicillins, fluoroquinolones, and gentamicin, which indicate that dosage of these drugs should be adjusted in the pregnancy period. All of these antibiotics but chloramphenicol can be prescribed during breast-feeding period. Having considered the possible teratogenicity and side effects of these drugs, penicillin and amoxicillin can be prescribed safely but tetracycline should be avoided during pregnancy and lactation.