مجله زنان مامائی و نازائی ایران
سال چهاردهم شماره 1 (فروردین و اردیبهشت 1390)

Toxoplasma gondii, a member of the Apicomplexa,is an obligatory intracellular parasite. Toxoplasma gondii infection during pregnancy can result in abortion, stillbirth and fetal malformation. Due to the geographic variation in the prevalence of the infection and in order to assess the role of Toxoplasma gondii in abortion in Kerman the present study was carried out. In a case-control design, 57 women whose pregnancy was spontaneously terminated prior to 20th week of gestation and 112 women with their pregnancy beyond 20 weeks, matched for age and were studied in Afzalipour Maternity Center. Blood samples were taken after obtaining informed consent and then sera were tested for anti-Toxoplasma IgG and IgM using ELISA technique. Data analysis performed by t-test and Chi square using SPSS 17. The seroprevalence of anti-toxoplasma IgG and IgM antibodies were 30.8% and 3.6%, respectivelyin the whole population studied. The seroprevalence of anti-toxoplasma IgM was not significantly different between the two groups (p=0.40). However, the seroprevalence of anti-toxoplasma IgG was significantly different between abortion and normal pregnancy groups (43.9% and 24.1%, respectively). No significant relationship was observed between anti-Toxoplasma IgG antibodies and education level, consumption of undercooked meat, unwashed vegetables, and contact with cats. Based on the above results we can conclude that chronic infection of toxoplasmosis implicates in abortion, while acute infection has no role in this regard. However, more investigation is needed.

Polycystic ovarian syndrome (PCOS) is the most important cause of oligoovulation and anovulation in women of reproductive age and in infertile women. Several approaches have been proposed to induce ovulation in PCOS patients. Gonadotropins are the classical and effective therapeutic options. The objective of this study was comparing of fertility rate with only FSH protocol, HMG protocol, and combination of FSH and HMG for ovulation induction. 95 infertile women with PCOS diagnosis according to Rotterdam criteria, who were IVF candidate from Montaserieh infertility center in Mashhad were selected. 25 patients underwent induction ovulation by recombinant FSH, 35 patients by HMG, and 35 patients by a combination of FSH and HMG. Assessment was done in the ninth day of the menstrual cycle and the day of HCG injection by intravaginal sonography. The mean size and number of follicles in each ovary, and the endometrial thickness was measured and recorded. After retrieval of the oocytes, in vitro incubation with sperms, and embryo development, number of embryos was recorded and embryos were transferred. Two weeks after fertilization, the βHCG test was done and if the test was positive, transvaginal ultrasound was performed for FHR after 6 weeks and if the result was positive fertility would be confirmed. Data were analyzed by t- test, ANOVA, and chi-square test, using SPSS version 16. Statistically significant value was defined as p≤0.05. In the response to treatment, endometrial thickness, mean number and size of follicles were the same in three treatment methods in the ninth day of menstrual cycle, and at the day of HCG injection. Only the mean numbers of follicles in the three groups were significantly different (p=0.032) in the right ovary in the ninth day of menstrual cycle. Other variables in three groups showed no significant differences. In this study, the result of treatment of PCOS patients by induction ovulation methods such as FSH, HMG, or combination of them demonstrated no differences in fertility outcome. Although fertility rate of FSH group was more than other groups, this might be attributed to the increased level of endogenous LH in PCOS patients.

Infertility is a major negative event in life which has deleterious effects on quality of life in infertile women and men. The purpose of this study was to examine the effectiveness of cognitive behavioral stress management (CBSM) therapy on quality of life in infertile women referring to Infertility and Gynecology Clinics in Yazd city. This is a quasi experimental study with a randomized pre-test and post-test group design with control group and a one month follow-up phase. Statistical population was 214 women referred to Infertility and gynecology clinicsin Yazd city in summer 2009. 24 infertile women were selected using available sampling and randomly assigned to experiment and control groups (12 women in each group). The experiment group received CBSM therapy for 10 weekly sessions. Data were gathered by using World Health Organization Quality of Life (WHOQOL)and demographic characteristics questionnaires. Data were analyzed using SPSS-15 in two levels including descriptive statistic and analysis of covariance. The findings showed that mean scores of life quality were increased significantly in post-test and follow-up phases in experiment group compared to control group (p=0.000). Results suggest that CBSM therapyis effective on improvingquality of life in infertile women. Due to reduced quality of life in infertile women and the effectiveness of mental interventions, special attention should be given to psychological treatment in this group of patients. This could cause mental health and improve quality of life in this group.

Hypertensive disorders complicating pregnancy are common and greatly contribute to maternal morbidity and mortality. Oxidative stress has been implicated in the pathophysiology of preeclampsia. The objective of this study was to evaluate the effect of combination of vitamin C and vitamin E on incidence of preeclampsia and some outcomes of pregnancy in Nulliparous women. In this clinical trial study, 424 pregnant Nulliparous women were attended in hospitals and public or private clinics in Semnan city of Iran were investigated. All women were between 14-22 weeks gestation and 15-35 years old. They were randomly assigned to two groups. First group (case group) received vitamin C (1000 mg/day) and vitamin E (400 IU) with iron and folic acid and second group (control) only received iron and folic acid. Both groups followed for evaluation of preeclampsia and pregnancy outcomes (maternal and neonatal) until delivery. Statistical analyses were performed using t-test, Chi Square, Mann-Whitney tests and Relative Risk (RR). The p-value<0.05 was considered statistically significant. The mean age and body mass index (BMI) were not statistically different between two groups. There were no significant difference between incidence of preeclampsia (5.0% and 7.4%, respectively), small for gestational age (SGA) (6.9% and 9.4% respectively), preterm labor due to preeclampsia (3% and 2%, respectively) and severe preeclampsia (2%, 2.5% respectively) between case and control groups. But incidence of low birth weight (LBW) in case group was significantly less than control group (RR=0.58, 95%CI: 0.36-0.95; P=0.027). Combined vitamin C and E supplementation during pregnancy did not reduce the risk of preeclampsia and SGA in Nulliparous women, but it could reduce LBW.

To evaluate menstrual disorders in adolescents, we should be aware of menstrual cycles range. Therefore, current study was performed to determine menarcheal age, menstrual cycle patterns and its disorders. Correlation between menarche age and menstrual disorders have been investigated. This is a descriptive analytical study which was undertaken in 1000 high school. Girls randomly selected from 20 high schools in Hamedan city of Iran in 2007. Data were collected by questionnaire and data analysis was performed using SPSS 16, descriptive and inferential statistics. p<0/05 was considered significant. The mean age at menarche was 13.7 year. The menstruation disturbances were: hypermenorrhea (clot) 73.9%, intermenstrual bleeding (18.4%), hypermenorhea(long bleeding) 15.2%, polymenorrhea 9.1%, oligomenorrhea 5.9% and hypomenorrhea 1.7%. The prevalence of dysmenorrhea was 78% (primary 54.3 and secondary 25.2 percent). There was significant correlation between menarche age and menstruation interval (and its regularity), intermenstrual bleeding (IMB), and dysmenorrhea (p<0/05). Menometrorrhagia was the most common manifestation of menstruation disorders in the students studied. Therefore, it is recommended to evaluate hormonal and gynecological causes of these disorders to prevent heavy bleeding complications in adolescent girls.

Vasomotor flashes are one of the most common complaints in climacteric women. Currently, Hormone therapy is the gold standard for treatment of it but various studies have reported serious risks even in short-term use. Interest in plants source for treatment of hot flash has grown recently. Flaxseed is a rich source of lignans and many women are more inclined to use it, but literature on effect of flaxseed is rather limited. Objective of this study was to evaluate effect of 6-weeks consumption of flaxseed on vasomotor flashes in climacteric women.

In this double-blind randomized cross-over study 62 women aged at least 41 years with five moderate to severe flashes and other eligibility, were randomly assigned in two groups (n=31). Intervention was two 6-week periods (washout: 2 weeks) and consumption 40 (g) flaxseed powder or placebo twice daily. Participants filled out daily hot flash diary and night sweat diary during the study. Weekly mean of each variable, separately were measured by adding the points during a week and was divided on days that diary had been filled in same week. Outcomes were measured changes from baseline to the average for all follow-up regarding mean of each variable. Data were analyzed by, paired t-test, Wilcoxon and RANOVA using SPSS software.

Data analyzing (n=46) showed statically significant reduction in the mean changes of severity and duration of flashes, night sweat severity and sleep disturbances with flaxseed comparing placebo (p<0.009, p= 0.045, p=0/005, p=0/028 respectively).There were no significant reduction in frequency of hot flashes and night sweats but repeated measurement of ANOVA showed statistically significant reduction in mean of frequency of hot flashes and night sweats during 6 week intervention with flaxseed compared to placebo in women with 5-7 daily flushes and ≤ 2 night sweats, respectively (p<0.001).

Regarding the result of this study, 6-week consumption of flaxseed powder may be effective in reduction of vasomotor symptoms, especially for women with moderate vasomotor symptoms compared to women with more and sever symptoms.

This study was designed to Evaluate the diagnostic value of pyuria and bacteriuria in asymptomatic bacteriuria in pregnant women.A cross sectional study was performed on 1246 pregnant women who were visited in a prenatal clinic without any urinary symptoms. For all of these women’s urinalysis (leukocyte count, bacteriuria) and urine culture, were performed. Then the patients were divided into the three groups: 1) the patients who had just pyuria in their urinalysis (≥5 WBC in HPF),2)The patients who had just bacteriuria in their urinalysis, 3). The patients who had both bacteriuria and pyuria. The positive urine culture was considered as gold standard. Positive urine culture was defined as growth of more than 105 of one kind of bacteria. Then the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined for the three groups using SPSS 16.There were 113 (9%) cases of positive culture and 222 cases of pyuria, bacteriuria or both. In patients with pyuria (78 cases), there were 34 (43.5%) cases of positive culture with the sensitivity of 86.9%, Specificity of 94.5%, PPV=57.7% and NPV=99.3%. In Patients with bacteriuria (73 cases), there were 27 cases of positive culture, with the sensitivity of 91.8%, specificity of 99.3%, PPV=54.8% and NPV=99.3%. In the third group (pyuria plus bacteriuria), (71 cases), 52 (73.2%) patients had positive culture. The sensitivity, specificity, PPV and NPV of test were 88.1%, 98.3%, 73.2% and 99.3%, respectively. There were 7 cases (0.5%) of positive culture without pyuria and bacteriuria.The combination of pyuria and bacteriuria in urinalysis or pyuria with more than 10 WBC in HPF or many bacteriuria, have high sensitivity, specificity, NPV and PPV for the diagnosis of asymptomatic bacteriuria and can be a good substitute for urine culture and only 7.7% of patients need urine culture.

This report describes the management of delayed delivery in a triplet pregnancy after spontaneous abortion of the first fetus.Case report:A 21-year-old woman with induction ovulation pregnancy aborted the presenting fetus at 17th gestational week. As she decided to carry on, cervical cerclage, tocolysis and antimicrobial prophylaxis were performed. The remaining fetuses survived until 28th gestational week. Prolongation of triplet pregnancies after the abortion of presenting fetuses is a possible approach, which is especially justified in women with a history of infertility.