مجله زنان مامائی و نازائی ایران
سال سیزدهم شماره 5 (آذر و دی 1389)

Prematurity is one of the most common causes of neonatal mortality in many countries. Recent studies show that bacterial vaginosis during pregnancy can lead to some complication such as premature rupture of membrane and preterm labor. The aim of this study was evaluation of bacterial vaginosis and its prophylactic effect on premature rupture of membrane and preterm labor. 500 singlton pregnant women who were referred to Hafez Prenatal Clinic affiliated to Shiraz University of Medical Sciences from October 2006 till October 2007 took part in a double blind clinical trial. Gram stain was prepared from their vaginal discharge and those with positive results were divided into two groups. One group received vaginal metronidazole and the other received placebo for 5 days. Reassessment by Gram stain was done two weeks after termination of treatment and also in weeks 32 and 37 of pregnancy. Premature rupture of membrane and preterm labor rate were assessed in both groups. Data were analyzed by SPSS 15 and using Fisher’s exact test and chi-square test. Bacterial vaginosis occurred in 22.4% of pregnant women. Gram stain of vaginal smear changed to negative in 52 women (91.2%) in treatment group. Premature rupture of membrane was less frequent among metronidazole group (p=0.007).Vaginal metronidazole is effective in treatment of bacterial vaginosis in pregnancy and can reduce premature rupture of membrane in these patients. Screening and treatment of bacterial vaginosis in pregnancy is highly suggested.

Assessment of fetal lung maturity by a simple and rapid test has a pivotal role in obstetric managements. Considering lack of modern laboratory techniques in Iran This study was designed to investigate lamellar body count as an efficient method in evaluation of fetal lung maturity. Lamellar body count was assessed in 104 unspun amniotic fluid samples taken from pregnant women who referred to Akbarabadi hospital in year 2004 whose fetuses were at risk for respiratory distress syndrome. Sysmex K.800 was used to count lamellar bodies. Cut-off points for Lamellar body count were determined to evaluate the risk of respiratory distress syndrome. Standard clinical and radiographic criteria were used to diagnose respiratory distress syndrome. Sensitivity, specificity, positive and negative predictive values were calculated using SPSS11. Lamellar body count of less than 10,000 was 99.1% specific for lung immaturity (positive predictive value = 99.1%, negative predictive value = 83.5%). Lamellar body count of greater than 45,000 eliminated respiratory distress syndrome (negative predictive value = 98.9%). Lamellar body count is an easy, rapid and cost-effective test to assess fetal lung maturity in high-risk fetuses. Using the cut-off points of 10,000 and 45,000, lamellar body count can serve as the first screening test of fetal lung maturity.

Cervical intraepithelial neoplasia and cancerous lesions are spectrum of morphologic changes without having definite boundaries. Immunohystochemical methods and proliferative markers are among the reliable ways in classifying the various lesions of cervical dysplasia. In related literature ki67 proliferative marker is known as a prognostic factor in the progression of cervical cancerous lesions. This research was performed to propound a more detailed classification of CIN using expression of Ki67 proliferative marker.

In this cross-sectional descriptive-analytical study 42 cervical biopsies (mild dysplasia N=16, moderate dysplasia N=8, severe dysplasia N=10 cervical normal tissue N=8) were selected from Pathology archive of Ghaem Hospital in Mashhad in year 2007, and the expression of Ki67 proliferative marker was analyzed hystochemically in paraffinized slides. Then the relationship between the severity of dysplasia, the location of expression of Ki67, and the reactivity of the cervical dysplasia was examined. Data was analyzed by SPSS11 and using ANOVA tests.

The direct relationship between the severity of dysplasia changes and the site and reactivity of cervical intraepithelial lesions was observed by using the expression of KI67 marker

Evaluating intraepithelial cervical lesions by Immunohistochemistry methods and Ki67 marker is a reliable method for diagnosis and classification of various dysplastic lesions.

Post partum perineal pain is one of the disturbing problems in women who have recently given birth. It causes limitation in movement, urination, defecation and also restricts taking care of infant and breast feeding. The purpose of this study was to compare the efficacy of two analgesics; suppository Diclofenac sodium and acetaminophen codeine tablet in the management of post episiotomy perineal pain, while sitting, walking and passing urine. In this interventional study which was performed on women who had vaginal delivery and episiotomy in Imam Reza Hospital in Mashhad in year 2008 a total number of 70 women were randomly assigned to receive either suppository Diclofenac (100 mg every 12 hr) or acetaminophen codeine tablet (320 mg every 6 hr) up to 12 hours after episiotomy. The inclusion criteria were vaginal birth with episiotomy. Pain ratings were recorded before the administration of the drugs and 3 hours after last dose by visual-analog scale. Effect of the two drugs on perineal pain relief was compared. Data was analyzed by using of SPSS11.5 and Chi square and Mann-Whitney tests. Suppository Diclofenac sodium is significantly more effective than acetaminophen codeine in pain relief while sitting, walking and urination after episiotomy (p<0.001). Using rectal Diclofenac sodium is a simple, effective method of reducing pain after episiotomy.

Dysmenorrhea is painful cramps which happen just before or at the start point of menstruation without organic reason, which is occasionally accompanied by gastro-intestinal problems. This study was performed in order to examine therapeutic effect of vitamin B6 on gastro-intestinal symptoms such as nausea and vomiting due to primary dysmenorrhea.Present study is a double blind case-control randomized study on girls aged between 11-17 years with primary dysmenorrhea who referred to gynecologic clinics of Shahid Sadoughi Yazd in years 2006-2008. 180 girls who had gastrointestinal symptoms accompanying dysmenorrhea selected and were divided into 2 groups: Vitamin B6 group (N: 90) who received 100mg vitamin B6 (two 50 mg capsules) daily in luteal phase for 3 months and placebo group (N: 90) who received two placebo capsules similar to vitamin B6 for 3 months. Data was analyzed by SPSS 11 using T-test and Chi-square test.Vitamin B6 reduced nausea of dysmenorrhea 82.2% and placebo effect was 40% (P= 0.001). Vomiting was reduced 64.4% in vitamin B6 group and 26.6% in placebo respectively (P=0.001). No drug side effect was seen in any of groups. Vitamin B6 can be use as an effective drug on gastro-intestinal symptoms of primary Dysmenorrhea.

Sexual dysfunction is highly prevalent in men and women. Pregnancy is one of the factors which can contribute to sexual dysfunction, and is associated with a wide variety of organic and psychological causes. This study was designed to compare sexual dysfunction in women before and during pregnancy. Current study is a descriptive-analyzing study and study units were chosen randomly from different districts of Semnan in year 2006. 100 women who were pregnant or had recent history of labor took part in the study. Data were collected through a questionnaire designed by authors, in order to compare sexual dysfunction before and during pregnancy. Data were analyzed by SPSS11 and descriptive analytic methods. Results showed that 78% of women had minimum one of the sexual dysfunction before pregnancy and 80% of them during gestational period. Altered sex drive, inability to reach orgasm, pain, sexual dissatisfaction, anxiety, fatigue and masturbation were the most prevalent sexual dysfunctions before and during pregnancy. In addition results showed significant relation between all kinds of sexual dysfunction before and during pregnancy. Because of increasing sexual dysfunctions during pregnancy, we suggest to increase public knowledge about sexual dysfunction for increasing sexual health in society through proper management is suggested.

Postpartum depression is a serious disorder that has serious and long - lasting effects on mother and her family. Identifying the risk factors is essential in order to provide proper prevention. Considering little information in this regard in Iran, this research was conducted to determine the relationship between marital satisfaction during pregnancy and postpartum depression. In this longitudinal co relational study, 100 pregnant women between 37-42 weeks of pregnancy without depression who referred to health center in Astara city in 2006, were sampled. Information about marital satisfaction was gathered during pregnancy using marital satisfaction Questionnaire. Postpartum depression was assessed by Edinburgh Postnatal Depression scale at 15th and 30th days postpartum. Data was analyzed using Chi-square, Man-Whitney, T-student test and General linear model, using SPSS11.5 software. Marital satisfaction during the last month of pregnancy was in a negative correlation with postpartum. Mean of marital satisfaction score demonstrated significant statistical difference in depressed and not depressed groups. Marital satisfaction is a predisposing factor of postpartum depression. Assessing pregnant women’s marital satisfaction and providing proper interventions during pregnancy is suggested to reduce the rate of postpartum depression.

Estimation of delivery date based on last menstrual period and ultrasound is common in prenatal care. The aim of this study was to compare the accuracy of Naegel’s rule, Naegel’s revised rule and ultrasound in estimation of delivery date. This cross-sectional study was done on 540 pregnant women hospitalized in Mobayyeni Hospital in Sabzevar (2007-2008) due sign of to labor. Estimated delivery date was calculated based on three methods and difference between these and ture date of labor calculated. Data was analyzed by descriptive statistical indices, Pearson correlation and T-test using Spss15. Results showed that delivery happened in 6.3, 6.3 and 6.7 percent of women just on the stimated date by Naegel’s rule, Naegel’s revised rule and ultrasound respectively and delivery happened in 51.9, 67.2 and 60.7 percent of them until the estimated date. The difference between true date and the estimated date by Naegel’s rule and ultrasound were correlated significantly with fundal height and birth weight (p<0.001). Post term delivery rates were 0.4, 1.9 and 0.6 percent respectively, based on ultrasound reports, Naegel’s rule and Naegel’s revised rule. Naegel’s rule is more accurate in prediction f delivery date, compared to other similar studies. Using ultrasound prolongs the period preceding the beginning of labor. Using Naegel’s revised rule strongly brings better results.