مجله زنان مامائی و نازائی ایران
سال سیزدهم شماره 3 (امرداد و شهریور 1389)

Preterm labor is one of the main problems in obstetrics and gynecology medicine. Premature newborn may have numerous physical and mental disorders. The aim of this study is to compare the effects of magnesium sulfate with Nifedipine in order to prevent the preterm labor. In this clinical trial, 130 preterm labored women with gestational age of 20-37 weeks were enrolled and divided into two groups regarding their age (±3years), meantime between symptoms and treatment (±2 hours) and gestational age. The exclusion criteria were diabetes mellitus, hypertension, twin pregnancy, cigarette smoking and cervical incompetence. Magnesium sulfate was used with loading dose of 4g/IV and then maintanance of 2g/h and oral Nifedipine was applied by 20 mg as first dose and then 20 mg every six hours up to 24 hours. The duration between initiation of drugs and their therapeutic effects in subsiding the preterm labor pains were evaluated and data were analyzed by Kolmogorov-Smirnov, t and Mann-Whitney U tests and the statistical significance of 0.05 were considered for analysis. The difference of means of intervals between treatment and pain relief in Magnesium Sulfate (15.86±14.72 min) and Nifedipine (14.32±15.39 min) were significant (P=0.01). There were no significant difference between two groups in meantime of initiation of treatment and pregnancy termination (P=0.47). Regarding the findings of current study, it seems that Nifedipine is more effective than magnesium sulfate in prevention of preterm labor.

Preeclampsia is a common complication of pregnancy and one of the most major causes of maternal and perinatal mortality. Therefore, prediction of pre-eclampsia would help achieving strict midwifery care. Several biophysical and biochemical tests have been investigated for early detection of preeclampsia. However, none of them has shown accuracy and simplicity necessary to predict preeclampsia. The purpose of this study is to use a combination of tests for early prediction of preeclampsia. In this prospective study, 400 nulliparous women between 28 and 32 weeks of gestation referred to healthy centers of Tabriz during 2007 were enrolled. At first, weight, height, blood pressure on left position and supine position was measured and their urine samples were collected for calcium and creatinin measurement. These women were followed until delivery time. Data were analyzed by descriptive statistic test (mean, SD and distribution), ROC diagram, t-test and SPSS 13 software.. From the total of 400 women, 23 women developed pre-eclampsia. According to ROC diagram,urinary calcium/creatinin ratio was less than 0.068 and showed sensitivity 35% and 93% specificity in prediction of pre-eclampsia. Sensitivity and specificity of BMI of higher than 28.88 were 61% and 92%, respectively. Roll-over test higher than 20 mmHg had a 52% sensitivity and 95% specificity. 17% sensitivity and 99/5% specificity appeared when all tests were positive. Combination of these three tests shows a high specificity despite a low sensitivity in rule-out of pre-eclampsia. Thus, applying combination of three tests is recommended to midwives and health care providers.

Despite of growing developments in surgical techniques, ureteral injuries are still a potential complication relating to general surgery, urology and gynecology. This study aims to evaluate the symptoms, etiology, diagnosis and management of non-endourologic iatrogenic uretral injuries. This study was retrospectively performed on female patients with of non-endourologic uretal injuries who were referring to Ghaem hospital, Mashhad between 1997 and2007. In this study, the type of their previous operation (which had caused the injury), diagnostic approach, treatment modality and outcomes were evaluated. The total number of 17 patients were studied (including 20 solitary uretral injuries). The age of patients were between 26-67 years old (mean 43.14 yr). Patients’ symptoms included flank pain in 88.23%, true incontinence in 41.17%, fever in 29.41%, anuria in 11.76%, illeus and abdominal distension in 11.76%, prolonged nausea in 5.88% and acute abdomen in 5.88%. Previous surgeries which caused ureteral injuries were gynecologic procedures in 15 patients (88.23%), including hysterectomy in 8 patients (47.05%) and caesarian section in 4 cases (23.52%), Wertheim surgery, resection of ovarian cyst and pelvic endometriosis surgery 1 case in each (5.88%). In 2 cases the injuries were occurred during non-gynecologic surgeries. Modified lich re-implantation was performed in 11 lower injuries of ureter. In one case the anastomosis were performed with Politano-Ledbetter method. Boari flap technique was used for repair of two lower injuries of ureter. Left to right trans-uretro-uretrostomy (TTU) was performed in one case. Also one case with middle uretral injury was treated with uretro-uretrostomy. Auto-transplantation was applied in one case with upper injury. In our cases, the most common cause of iatrogenic ureteral injury was simple hysterectomy and the most common presented symptoms were flank pain and true incontinence. Most of the patients needed relevant surgeries particularly uretroneocystostomy. In upper injuries the minimally invasive techniques instead of nephrectomy or Auto-transplantation should be considered.

Obesity is a wide-spread health problem in the world. Obesity and overweight in gestational period are associated with increased risk of preeclampsia, prolonged gestational age and cesarean section. The purpose of present study is to evaluate the effect obesity and overweight on pregnancy outcomes and delivery. All the pregnant women referring to referring to delivery ward of Hamedan Tamin Ejtemaee hospital were enrolled between May 2007 and March 2008. The total number of studied women was 1272 subjects. After fulfilling a questionnaire (containing demographic characteristics of patients, duration of first and second stage of labor and neonatal weight), their BMI by dividing their weight in kilograms (at the beginning of pregnancy and before the 12th weeks of gestational age) by the square of their height in centimeter were calculated. Then data were analyzed using Chi-square and Wilcoxon test. There was a significant correlation between obesity and overweight with prior parity, neonatal overweight, gestational age, lengthening of active phase of first stage and whole the second stage of labor (P<0.05). By prevention of obesity and overweight, it would be possible to hinder maternal and neonatal harm.

Dilatation of cervix is essential for dilatation and curettage and hysteroscopy as well. Complications encountered during the procedure are partly related to difficulties in cervical dilatation. Finding the materials which can cause cervical dilatation more easily is important. The purpose of the present study is to evaluate the effect of vaginal Misoprostol on priming the cervix before dilatation in patients who are candidate for this procedure. A randomized clinical trial was performed on 60 women who were candidated for D&C. In 30 patients (case group), 200 mg Misoprostol (one tablet) was administered in posterior fornix of vagina 4 hours before operation, whereas in other 30 patients (control group), placebo was used. Then the two groups were compared according to their need to Hagar dilatator thinner than number 5 for dilatation of cervix and the duration of dilatation and curettage. It was revealed that measures like age, parity and previous delivery methods did not show a statistically significant difference between two groups. 6 patients (20%), in the case group, and 26 (87%) in the control group needed the Hager dilatator number 5 to dilate the cervix (P<0.005) which their difference was statistically significant. The mean duration of D&C in the control group was 19±4 minute versus 12.7±2.8 minute in case group which showed a statistically significant difference (P<0.001). Vaginal misoprostol is a suitable agent for priming the cervix in order to dilate more easily before D&C.

Early life stress (including the ones during fetal development) has been hypothesized to predispose individuals to several illnesses and psychiatric disorders later in adulthood. The aim of this study was to evaluate the synchronous effects of light and noise prenatal stress on birth weight among rat neonates

In this case-control study, pregnant Sprague-Dawley rats were divided into two groups of under-stress and control. Stress was imposed to the under-stress pregnant females from the 15th day of pregnancy until delivery. Pregnant rats were acutely stressed for 45 minutes three times in day with noise and light. Postpartum neonates in under-stress and control groups were weighted. The weight of adrenal gland and ACTH levels were evaluated in the mothers at postpartum to determine the activity of hypothalamic-pituitary-adrenal. Data were analyzed using t-test.

Results showed a significant difference between the weights of neonatal in two groups (p<0.05). Compared to that of control group, prenatal stress led to a reduced birth weight in under-stress group of neonatal. Induced stresses associated with increased hypothalamus- pituitary-adrenal axis activity in mothers, reflected by higher ACTH level and also increase in weight of adrenal glands in under-stress rats compared to control group.

These findings indicate that the noise and light stress during pregnancy can deregulate neuroendocrine system of mothers and can causes the low birth weight of the neonates.

Breast and cervical cancers have high prevalence and mortality among women. The screening tests are the best diagnostic methods that significantly decrease their mortality. This study was performed to determine the rate and causes of women’s participation or nonparticipation in screening programs of breast and cervical cancers among the women referred to clinics over Kerman city in 2007. This study is a descriptive research on 200 married women who referred to five distinct clinics in Kerman for their prenatal and postnatal care, family planning, baby vaccination and gynecologic visits. After a cluster sampling, data gathering was performed through a questionnaire with the reliability of 0.92. Data analysis was carried out using SPSS software (version 14) and ANOVA and chi-square tests. According to the results, 22.5% of women were participated in breast self examination, 21.5% in clinical breast examination and 27% in Pap smear test. The most common cause for participating in breast-cancer screening was awareness of its importance and in cervical- cancer screening was early diagnosis of cancer. Also the most common cause for nonparticipation (in both breast and cervical-cancers screening programs) was none physicians’ recommendation. There was a significant relation between women’s participation in BSE with educational level and occupation (P<0.001), and between women’s participation in CBE and educational level, occupation (P<0.001) and economic level (P=0.04). Also there was a same scenario between participation in pap smear test and occupation (P<0.001), age (P=0/014), and educational level (P=0/016). Women’s participation in breast and cervical-cancers screening programs was not satisfactory. The most common causes for nonparticipation in these programs were both none physician recommendation and awareness. The study suggests the necessity of compiling the educational programs by health centers which aims to introducing women with these programs. It also seems that recommendation of physicians, midwives and health care providers is necessary in increasing the women’s participation in these programs.

During postpartum period there are enormous changes in physical, emotional and social conditions of mothers which impact their quality of life. Although postnatal morbidity has been well documented in recent years, postnatal quality of life and its association with the mode of delivery has not been addressed. Regarding the importance of postpartum quality of life and different influential factors (including the delivery mode), the presented study was conducted to determine the relationship between the mode of delivery and quality of life among women at their second postpartum week.

In this prospective analytic study, a total of 420 women referring to health centers who had the inclusion criteria were recruited from non-probability sampling and filled the questionnaire of Edinburgh postpartum scale (EPDS) during the third trimester of pregnancy. Women who had EPDS score >12 were excluded. Afterwards, 300 cases (155 ones in normal vaginal delivery (NVD) group and 145 ones in Cesarean section (C/S)) were followed in 2nd postpartum week and their quality of life was assessed using WHOQOL BRFF. Data were analyzed using SPSS 14, and Chi-square, t-test, Mann- Whitney and Linear regression.

Therewas no significant difference between two groups in their education, occupation, economic status, and wanted/unwanted pregnancy. At 2nd postpartum week, vaginal delivery group had a significantly higher means of physical domain than those of C/S (P<0.001). At 2nd postpartum week, vaginal delivery group had also a significantly higher means of psychological domain than those of C/S (P<0.02). However, There were no significant differences between these groups in their social, environmental and overall domains.

: Since that the physical and psychological domains of quality of life were better in the NVD group (compared to those of C/S group), consultation of health care provider for selecting the correct mode of delivery can be effective in reducing the rate of elective cesarean section along with their expenses and can improve the postpartum, quality of life.