مجله زنان مامائی و نازائی ایران
سال دوازدهم شماره 4 (زمستان 1388)

Third-trimester vaginal bleeding due to placental abruption occurs in 0.5-1% of pregnancies and is associated with 10-15% of maternal and perinatal mortality and morbidity. The etiology is unknown in most cases. Hyperhomocysteinemia is recognized as one of the independent risk factors of placental abruption. The objective of this study is to comparably measure the serum homocysteine in abruption group and normal control subjects. This case-control study is performed on 52 third- trimester pregnant women with clinical findings of abruption confirmed by after-delivery placental observation (case group) and 52 control subjects who had normal pregnancies. Samplings were done following an 8 hours of fasting. Serum homocysteine was measured with Axis R homocystein ELA kits manufactured by IBL company. Data were analyzed by chi-square and t-test. It was revealed that measures like age, number of pregnancies and deliveries did not show a statistically significant difference between two groups. Mean concentration of homocysteine in abruption and control groups were 6.8±2.7 and 5.5±2.2 μmol/L, respectively (p=0.013). Mean serum homocystein of abruption group was higher than that of controls’. This finding may light up brand ideas for future clinical trials about reducing the serum homocysteine level and therefore, reduction of placental abruption.

Labor pain is one of the most severe types of pain women experience during their lives. Due to the negative effects of severe labor pain on mother and fetus, attempt to relieve mother’s pain is of considerable necessity. The purpose of this study was to determine the effects of applying SP6 acupressure on labor pain. In a single-blinded randomized clinical trial study, 102 low- risk pregnant women, with gestational age of 38-42 weeks were enrolled at 17 Shahrivar Hospital in Mashhad between 2005-2006. They were randomly subjected to acupressure, palpation and ordinary care groups. For first group, acupressure was applied at the SP6 acupoint to both sides during each uterine contraction and when cervical dilation reached to 3-4cm. In the palpitation group, the SP6 acupoint was just touched. This technique was applied in both groups for a 30-minute period. In the routine care group, just the ordinary delivery care was given. Using Visual Analog Scale, the intensity of labor pain was measured immediately after intervention. Measurement was followed at 30, 60, 90 and 120 minutes after intervention. Intensity of labor pain was compared within groups using ANOVA, Kruskal-Wallis and Chi-square tests. The mean intensity of total labor pain had statistically significant difference between three groups (p=0.03). Also the mean intensity of labor pain at 90 and 120 minutes of after- intervention period in the SP6 acupressure group was significantly lower than the palpation and routine care groups (p=0.01). There was no statistically significant difference between the palpation and routine care group. The study showed that SP6 acupressure decreases the intensity of first stage labor pain without maternal and fetal injuries of any nature and can be used as feasible, inexpensive, non-invasive method for labor pain relief.

Preclampsia is the most common cause of mortality among pregnant women. Recent researches show homodynamic, coagulation and metabolic abnormalities prior to the onset of preeclampsia. The aim of this research is to evaluate predictive values of increased levels of hemoglobin and hematocrit in second trimester and occurrence of preeclampsia. In this prospective study, 60 pregnant women who referred to Ghaem hospital during 2007 were divided into two groups; 30 pregnant women in peeclampsia group whom were diagnosed as preeclampsia and 30 normal pregnant women who had normal blood pressure. Both answered demographic and pregnancy characteristic questionnaires. Hemoglobin, hematocrit, preeclampsia indicators and delivery characteristics were recorded and data were analyzed by Mann-Whitney U, Chi square and independent t-test using SPSS. There were significant differences between two groups in their hemoglobin and hematocrit concentrations in second trimester (p<0/002). The mean of hemoglobin in preeclampsia group was 13/3±1/1, whereas in normal group it was 12/2±1/3 g/dl. Hemoglobin level of more than 12/5 g/dl represented the 72/4% of sensitivity and 57/1% of specificity in prediction of preeclampsia. Hematocrit of more than 37% had sensitivity of 65/5% and specificity of 61/9% in that prediction. Increased levels of hemoglobin and hematocrit concentration in the second trimester were associated with higher incidence of preeclampsia. Therefore, further comprehensive and precise studies considering other predicting factors along with prospective researches in prenatal clinics are recommended.

Epidural analgesia is a popular technique for pain relief of labor but using local anesthetic agents solitarily may produce motor block or be associated with a prolonged second phase and increased incidence of instrumental delivery. Thus, adding an opioid to local anesthetic solutions may provide effective and perfect analgesia. This study is designed to compare epidural bupivacaine and a combination of epidural fentanyl and bupivacaine in induction of painless delivery among pregnant women who were subjected to normal vaginal delivery at Omul-Banin hospital’s maternity ward between 2007-2008. Our patients in this study divided into two groups. In the group A, anesthesia was induced by 15cc of 0.1% bupivacaine whereas in group B it was induced by 15cc of 0.1% bupivacaine plus 50 μg of fentanyl. Pain was assessed using Visual Analogue Scaling (VAS) every 10 minutes till delivery. Motor function was also assessed by Bromage scoring. Both groups were similar in their demographic characteristics such as age, BMI, gestational age and educational state along with their obstetrical exams and progress of labor. Reviewing measurements demonstrated better painless interval in group B during labor. Verbal pain scores after anesthesia induction were significantly lower in group B. motor power remained intact in both groups. The most common side-effect was itching which was more frequent in group B. Compared to bupivacaine in solitude, combinations of opioid and bupivacaine may improve the analgesia during labor. This may influence the progress of labor and high maternal satisfaction.

Various individual, social, economic factors along with irrational parenthood cognitions may have negative effects on quality of life of infertile women. The aim of this study was to investigate quality of life and related influencing factors among infertile women referring to Vali-e-asr fertility research center, Tehran, Iran. 147 infertile women referred toVali-e-asr fertility research center affiliated to Tehran university of medical sciences, enrolled in such cross-sectional study. Data were gathered by three specific questionnaires of demographic characteristics, infertility-specified quality of life and irrational parenthood cognitions. 48.3% of studied women had good quality of life, whereas 36.1% had moderate and 15.6% had poor conditions in their quality of lives. Mean ± SD of quality of life scores was 1.62 ± 0.83. Data revealed statistically significant correlations between quality of life and perceived pressures (p=0.001), strong desire for having a child (p<0.001), economic burden of treatment (p<0.001), individual-oriented economic assessment (p=0.001) and level of irrational parenthood cognitions (p<0.001). Quality of life of infertile women in this study is influenced by either level of irrational parenthood cognition, economic burden of treatment or perceived pressures. Identifying highly vulnerable sub-groups in the context of their quality of lives will provide more appropriate counseling conditions. Precise consultation with and perpetual support from infertile women aiming to improve their quality of lives, seem of indisputable necessity. We suggest further studies comparing fertile and infertile women within their quality of lives.

HELLP syndrome is one of the severe complications of preeclampsia which is accompanied by serious fetal and maternal effects. The purpose of the present study is to evaluate the maternal and neonatal complications of the HELLP syndrome and its risk factors. A retrospective study was performed on the documentations of 46628 women who were delivered during 5 years in Akbarabadi Hospital. There were 1811 cases (3.88%) of preeclampsia. 1380 cases of preeclampsia had complete documentation records which were evaluated for the study. 1196 patients were Iranian and 184 patients were Afghans. The preeclamptic patients were divided into two groups; patients with HELLP syndrome (case group; 164 cases) and patients without HELLP syndrome (control group; 1216 cases). Characteristic of these two groups were then compared. There were 46628 deliveries and 1811 cases of preeclampsia (3.88%). 164 cases (11.9%) out of 1380 preeclamptic patients who had complete documentation records had HELLP syndrome. The mean platelet count of case and control groups were 81.3 ± 20.4×103/mm3 and 198.1± 55.9×103 /mm3, respectively (p<0.001). The mean proteinuria in case and control group were 3.26± 0.9 and 2.53±1.25 grams, respectively (p<0.001). The mean gestational age at the time of termination were 33.85±4.21 and 35.9±3.43 weeks in case and control group, respectively (p<0.002). There were no significant difference between two groups in their maternal age, parity, systolic and diastolic blood pressure and bilirubin and cesarean deliveries. Neonatal death [72 cases (44%) VS 170 cases (14%), p=0.001], fetal complications [116 cases (71%) VS 389 cases (32%), p=0.003], maternal symptoms [116 cases (71%) VS. 389 cases (32%), p=0.002] were higher in case group. The incidence rate of HELLP syndrome was not different between Iranian (145 cases; 12%) and Afghans (19 cases; 10%). Neonatal death [68 cases (47%) VS 5 cases (25%), p=0.003], fetal complications [106 cases (73%) VS 10 cases (50%), p=0.02] were higher in Iranian women. Also in control group the mentioned complications were more prevalent among Iranian women. Being Iranian or Afghan does not influence the incidence of HELLP syndrome. However, further amount of proteinuria, lower gestational age at the time of onset of preeclampsia symptoms and also maternal risk symptoms like headache, epigastric pain and blurred vision are risk factors for HELLP syndrome.

The postpartum period has been conceptualized in a variety of cultures as a time of vulnerability for women, characterized by dramatic social and personal changes for the mother, who must adjust to several inexperienced difficulties and concerns. In this descriptive cross-sectional study, postpartum stressors from mothers point of view were evaluated. Study population included women referring to state health care centers in Kerman city. Based on the pilot study, sample size was estimated 400 individuals. Sampling was performed through improbability method. After confirming its validity and stability, data were gathered by a two-section questionnaire. Data analysis was carried out through central and distributional indices, Pearson coefficient of correlations, t-test and ANOVA. 47.5% of mothers were in the age group of 21-25. Among maternal stressful factors, the highest mean score (3.11) was found for “postpartum breast enlarging” and “postpartum hemorrhage”. Deeming the neonate-related stressors, “diaper changing” with mean score of 3.30 was found the most important stressor, whereas with regard to stressful factors relating to social support, “variety of opinions among family members about neonate care” had the highest mean scores (3.20). There was no significant difference in total scores of stressful factors and three containing domains, based on demographic features. Since the postpartum stressors found in this study can be feasibly removed, providing ante-partum education for mothers with more effective educational programs guided by health-care personnel, especially at the time of discharge, is highly recommended.

Gestational trophoblastic neoplasia (GTN) usually occurs during women’s reproductiveages and it is very unusual in postmenopausal women. The aim of this study is to present a case of GTN in a postmenopausal woman.Case Report: A 60-year-old woman with history of vaginal bleeding and a mass lesion was admitted to Ghaem hospital affiliated to Mashhad university of medical sciences. She afterwards underwent surgical biopsy of vaginal mass and histological evaluation revealed metastatic choriocharcinoma. Investigation for extention of metastases performed and the final diagnosis was a stage IIIc choricaricnoma. Patient received EMA-CO regimen chemotherapy (Etoposide, Methotrexate, Actinomycine, Cyclophosphamide, Vincristin) and after seven courses of chemotherapy she experienced a complete relief. Physicians should not ignore the possibility of GTN in different ages with a variety of presentations.