مجله زنان مامائی و نازائی ایران
سال سیزدهم شماره 2 (خرداد و تیر 1389)

Recurrent abortion is a serious problem of obstetrics due to many different causes. Since homocysteine has important role in the embryonal implantation and growth, We did a comparative study of serum levels of homocysteine in patients with recurrent abortion and healthy fertile women. This descriptive and prospective study enrolled 60 nonpregnant women in 15-40 years of age who referred to obstetric clinic of Imam Hossein hospital in Tehran in 2007-2008 periods. Reproductive age was enrolled in this study. 30 women had history of recurrent abortion. Genetic, anatomical. Hormonal and immunological factors as the cause of abortion resulted in exclusion of the patients. 30 women with normal fertility history were selected as control group. The two groups were the same in other variables. The fasting serum homocysteine level was obtained in the patients with recurrent abortions (study group) and women in the control group. Data analysis was done by SPSS (13 version) and P value<0.05 was considered meaningful. The mean age was 29.9±7.5 and 30.1±5.3 in the study and control group respectively and there was no significant difference. The parity was 2.8±1.3 in the control group and 4.6±1.2 in the study group while the number of abortion in the study group was 4.13±1.02 and none in the control group. Although only higher than normal levels of homocysteine was seen in 3 patients of the recurrent abortion group, the mean level of serum homocysteine was significantly higher in the study group than the normal fertile women 10.05±3.8 µmol/L versus 8.2±2.3 µmol/L respectively). The vascular effects of hyperhomocysteinemia results in impaired implantation and growth of embryo ending in recurrent abortions. So checking the level of serum homocysteine is recommended in the evaluation of recurrent abortions and in case of increase prophylactic measures could be implemented.

Premature delivery is the leading cause of perinatal morbidity and mortality. The early treatment and delaying of premature labor results in the increase in the survival of infant, improved quality of life and decrease in the cost of care of the premature neonate. In this study we have compared the safety, efficacy, side-effects and the cost of nifedipine and magnesium sulfate in treatment of preterm labor. In this clinical-trial study, 80 pregnant women experiencing preterm labor at 26-34 weeks of gestation who referred to obstetric clinic of Imam Reza and Ghaem hospitals were enrolled from 2007 to 2008.(regular uterine contractions with periods less than 10 minutes with effacement and dilatation that did not respond to bed rest, fluid therapy and pethidine)The patients received either oral nifedipine or intravenous magnesium sulfate. The efficacy and side effects related to nifedipine and magnesium sulfate were recorded. All data were analyzed by SPSS software, using t student, chi-squire and Fischer exact tests. The response to tocolytic effects of the two drugs showed no significant difference within 48 hours and seven days of treatment (P=0.494), but the maternal side effects of nifedipine were significantly lower than the magnesium sulfate group (P=0.003).The mean cost of treatment was 13 times higher in the magnesium sulfate group than the nifedipine group and the difference was significant (P=0.001). According to our study, we can conclude that the oral nifedipine may be a suitable alternative to magnesium sulfate as a tocolytic due to its good efficacy, minimal side effects, low cost and easy route of administration in the prevention of progress of premature labor.

Some physicians believe that sexual intercourse at term will hasten the onset of labor. This study is done to determine whether coital activity hastens the onset of labor and prevents postdate pregnancy. This prospective and cross-sectional study enrolled 215 pregnant women (>36wks) of low risk group who referred to obstetric clinic of university hospital of Shahid Sadoughi in Yazd in 2007-2008.In each weekly prenatal visit, the participants were asked about coital activity in previous week. The data of the labor were compared in the women with coital activity (study group) and those who had not (control group).Statistical analysis was done by SPSS (11.5 version), t-test and Chi-square test. In 105 women, intercourse was done in the last weeks of pregnancy (mean=2.3±0.6 times) and in 110 participants, there was no sexual activity. Coitus at term was accompanied by hastening of labor; less postdate pregnancy and less need for induction of labor. Spontaneous labor occurred in 66.7% of study group and 48.2% of control group. (P<0.05) Postdate delivery beyond 40 week was 7.6% in the study group and 17.3% in the control group that showed a significant decrease. (P<0.05)The incidence of cesarean section, postpartum fever and healthy neonate showed no significant difference in both groups. Coitus at term can be associated with earlier onset of labor, reduction of postdate pregnancy and reduced requirement for labor induction.

Hysteroscopy is used increasingly for assessment and treatment of uterine disorders. However, the application of new technology mandates the study of the related complications of the procedure. The aim of this study is evaluation of Na and Hgb changes due to hypotonic disturbance and bleeding following hysteroscopy and their correlation with duration of procedure. This cross-sectional study enrolled 100 women in ASA 1 and ASA 2 class (American Society of Anesthesiologists) in the age range of 17-50 years old who were candidate of hysteroscopy in Imam Khomeini hospital of Ahwaz in a one year period.(from September2007 to September 2008). Random sampling was done. After primary clinical evaluation that included serum Na and Hgb, patients were anesthetized by a classic method and hysteroscopy was done by a single expert surgeon. Glycin 1.5% was used for uterine dilatation. Serum Na soon after surgery and Hgb 4-6 hours after surgery were rechecked. Duration of surgery, vital signs and the presence of nausea and vomiting were recorded in recovery room. Then data were analyzed by Spss software (13 versions) and analyzed by t test and chi- square test. P value of 0.05 was considered significant. Abnormal uterine bleeding and infertility were the most common causes of admission of patients. No patient had allergy to glycin as uterine dilator. The mean serum sodium before surgery was 137. 48±7.2 meq/dl and it was 137±6.2 meq/dl (p>0.05) after operation. The average of Hgb before surgery was 11.007±1.2 gr/dl and mean Hgb was 10.97±1.1gr/dl after operation. There was no relationship between duration of the operation and change in the level of sodium and Hemoglobin. The procedure lasted 45±5.5 minutes on average. No nausea and vomiting was observed in the recovery room Hysteroscopy doesn’t cause any problems due to the decreased serum sodium and hemoglobin concentration within 45 minutes of the procedure. It can be regarded as a safe and effective procedure in diagnosis and treatment of common uterine diseases especially uterine bleedings and symptomatic benign uterine diseases.

Poor progress of labor is the most common leading cause of cesarean section. Oral intake during labor is one of the strategies to prevent dystocia among low-risk nulliparous women. To date, little is known about the influence of oral intake on labor progress and the most appropriate foodstuff during labor. The purpose of this study was to determine the effect of oral honey date syrup during on labor progress in nulliparous women. In a double-blind randomized clinical trial, 90 low-risk nulliparous women aged 18-35, between 37-42 week gestation, singleton fetus, vertex presentation and spontaneous beginning of uterine contractions were enrolled at Sajad hospital in Shahriyar Tehran in 2007. They were randomized to the intervention, placebo or usual care groups. At labor, after a cervical dilatation of 4 cm to delivery, women in the intervention and placebo groups received honey-date syrup and placebo; respectively. The women in the usual care group were restricted to small quantities of water as desired. Labor progress was compared among the groups using ANOVA, Kruskal Wallis and Chi-Square tests. Normal labor progression rate was higher among honey-date group than two other groups (96.7% vs. 66.7% in placebo and 60.0% in usual care group p<0.002). Labor duration was also shorter in the group taking honey date syrup than two other groups (351.0 minutes vs. 484.2 in placebo and 475.7 in usual care groups, p<0.001). In our study oral honey-date syrup induced high rate of normal labor progress. It may be used during labor to prevent prolonged labors but more research is warranted to clarify these associations.

TVT is a minimally invasive procedure for the treatment of stress urinary incontinence. Attempt for correction of the supportive anatomical tissues of the urethra have been agreed by most of the urologists in recent years. In this paper we would like to introduce the long – term results and complications of this procedure. This descriptive study enrolled 33 patients affected by stress urinary incontinence who were referred to Imam Reza hospital from 2001 to 2004.The age of patients ranged 29-62 years old(mean age of 47.09)and TVT procedure was done for all. All of the patients were admitted and after taking the history, physical examination, doing Marchal – Bonie and Q – Tip tests, routine lab tests, urinary analysis, cardio vascular assessment and anesthetic consultation, the procedure of tension-free vaginal tape was done. The operation took 15-45minutes (mean 22.6 min). The hospitalization period was 2 – 2.5 days. (mean 2.3 days) During 6 years follow up, we did not have any mortality. Subjective improvement was seen in 33 patients (100%) and cure happened in 30 patients (90.9 %) after 1 month, in 28 patients (84.8 %) after 6 months, in 27 patients (81.8%) after one year and 26 patients (78.7%) after 6 years follow up. One patient had urinary retention (3.03%) and one patient had residual volume more than 100cc (3.03 %) they were treated by 1 week of CIC One patient had de novo urgency who improved following 3 weeks of anticholinergic treatment. Tention-free vaginal tape operation is an effective, fast and safe minimally invasive procedure for the treatment of pure stress urinary incontinence in women that has attracted the attention of many urologists due to its short duration and minimally invasive nature.

Nausea and Vomiting are the most common disorders of digestive system in the pregnancy. This study was done to evaluate the effects of acupressure in reducing the severity of nausea and the episodes of vomiting in primigravida women (10-16 gestational ages). In this clinical-trial study, 100 primigravida women with nausea and vomiting in gestational age of 10-16 weeks were randomly selected and divided in two groups, 50 women in the acupressure group and 50 women in the placebo group. Age, education, profession, BMI, gestational age, nausea and vomiting were matched in both groups. Treatment lasted for 4 days in both groups. In the acupressure group sea bands were placed on neiguan point on hands but in placebo group sea bands were placed on points other than the neiguan point. Then, daily severity of nausea and vomiting were recorded during treatment period. The data were analyzed by SPSS software (12 versions), Chi-Square, t- test, Mann Whitney and Will Kaksun tests. There was not significant difference in the severity of nausea and frequency of vomiting before treatment in two groups. Severity of nausea and frequency of vomiting decreased significantly after treatment in Acupressure group.(P=0.60 and P=0.55 respectively). This study showed that the acupressure (by sea-bands that is free of side effects and economical) is effective in reducing severity of nausea and frequency of vomiting in pregnancy.

The infertility and the common social reactions to these persons results in serious psychological problems. One of the most important problems is the depression that has significant effects on all aspects of individual’s life. The goal of his study is investigation of the incidence of depression and factors involved in the infertile women who referred to Kosar center. This cross-sectional study was conducted by simple sampling. In the KOSAR infertility center-URMIA in 2009. We studied 100 infertile women by demographic and Beck Depression Inventory. Data were analyzed by SPSS statistical software with ANOVA and Chi-Square test. Depression was not present in 42% of patients, 36% were mildly depressed, 10% were moderately depressed and 11% had severe depression. As a whole, 58 percent of women had some degree of depression of which 21% had clinical depression. The educational level, career, husband education level and depression were significantly correlated (P<0.005) but there was no significant relationship between depression, duration of infertility and incidence of depression. Due to the clinical depression in infertile women, the presence of psychologists and psychologic nursing seems a necessity in the infertility treatment centers to diagnose and educate the best approaches to the emotional incapability and depression.