مجله زنان مامائی و نازائی ایران
سال چهاردهم شماره 8 (اسفند 1390)

Pelvic inflammatory disease is one of the most important complications of upper genital tract infections and common cause of infertility and chronic pelvic pain in women. One of the most common causes of PID is Chlamydia trachomatis. Azithromycin، have important role in treatment of genital Chlamydia infection and use of two doses of this drug is comparable with 14-days of Doxycycline. In this study، we compared the effect of these two drugs.

This clinical trial is carried out on 144 women with mild PID from April 2009 to May 2010 who were referred to Women''s clinic of Imam Reza hospital and they are randomly divided into two groups (72 Cases in each group). One group was treated by Doxycycline 100mg/BID/14d and other group treated by oral Azithromycin 1g single dose that was repeated a week later. Both groups received single-dose of Ceftriaxone 250mg/IM. The partners of both groups took Ceftriaxone and Doxycycline. Pain and tenderness were evaluated in the MCPS & VAS system in the first، 7th and 14th day and were collected with personal details (age، parity، method of contraception، history of PID، employment status) in questionnaires. In this survey we used customary methods of descriptive statistic for introduction of research’s data، independent statistical T test and if abnormal، Man Whitney test for quantitative variants and x2 test for qualitative variants to compare two groups and analyze the results. Statistical analyses were done with SPSS version 13.

Response to treatment occurred in 66 patients (91. 7%) of the Azithromycin group and 64 patients (88. 9%) in the Doxycycline group (p>0. 05). Discontinuation of treatment was seen in 12 patients (14. 3%) in Doxycycline group and no patient (0%) in the Azithromycin group (p<0. 05).

Azithromycin regimen is better than Doxycycline regimen because of same response and only 2 doses instead of 28 doses.

Dysmenorrhea or painful menstruation is seen in about 50% of women in reproductive age which is the most common gynecologic complaint of young women and is one of the most common causes of absence from school or work. Therefore، finding a treatment without side-effects for its control has always been a concern. The purpose of the present study is to evaluate the effect of vitamin E on the reduction of pelvic pain in women suffering of primary dysmenorrhea. This double blind randomized clinical trial was performed on 94 women suffering of primary dysmenorrhea. The women were randomly assigned into two groups. For case group (n=42)، vitamin E was prescribed as a dose of 400 IU daily starting 2 days before the beginning of menstruation and continuing for 3 days (total duration of 5 days)، for two consecutive cycles. For control group (n=52)، a Placebo was prescribed which was completely similar to vitamin E pearls in shape، color، taste and smell. Pain severity was evaluated using Visual Analogue Scale (VAS) for one month before the study and during 2 months of the study. Data was analyzed by SPSS version 15 and using T-test، Chi-square and pair t test. There was no statistically significant difference between two groups in terms of blood group، age، family history of dysmenorrhea، educational status، and Body Mass Index. The mean pain severity before treatment was not significantly different between two groups (7. 15± 1. 75 in case group and 7. 47±1. 82 in control group، p=0. 3). Pain severity during the first (p=0. 001) and second (p=0. 001) months of treatment with vitamin E and placebo was lower than the pain severity before treatment. Pain severity after the first month of treatment with vitamin E was 5. 41 ±2. 4 and with placebo was 5. 76±2. 08 (p=0. 1) and after the second month of the study was 4. 73±1. 89 in case group and 5. 35±2. 05 in control group (p=0. 6). The mean reduction of pain during the second month of the study in the case group was (-2. 7±2. 1) and in control group (-1. 8±2. 4)، the difference was statistically significant (p=0. 04). Both vitamin E and placebo reduced the pelvic pain of dysmenorrhea، but vitamin E caused more significant reduction that regarding to its safety، can be a simple treatment of dysmenorrhea without side-effects.

Prevalence of polycystic ovarian syndrome (PCOS) in reproductive age women is about 10 %. There is a lot of morbidity due to this syndrome. Vitamin D deficiency is a common problem in the world and especially in Iran. Because of probable role of activated vitamin D on induction of insulin secretion and reduction in insulin resistance and the effect of hyperinsulinemia on elevation of free androgens; we designed to evaluate the effect of active form of vitamin D on control of PCOS clinical and metabolic complications. This clinical trial study was carried out in Ghaem hospital. 51 untreated PCOS patients randomly were divided into three groups. Treatment with calcitriol (0. 5mg)، metformin (1000 mg) and placebo were started for each group for three month. After three month assessment for improvement in clinical (improvement of ovulation) and metabolic status (fasting blood glucose، glucose tolerance test، insulin resistance and androgen levels) were performed. Only 22. 9% of patients had sufficient vitamin D levels (>30 ng/ml). Treatment with metformin significantly decreased weight (p=0. 027)، insulin level (p=0. 043)، insulin resistance (p=0. 048) and BMI (p=0. 019). Systolic blood pressure and PTH significantly decreased after calcitriol therapy (p=0. 029، 0. 009 respectively). An improvement in ovulation was detected after calcitriol treatment and 7 patients without ovulation demonstrated ovulation features after treatment with calcitriol. Resumption of ovulation was observed in treatment with metformin and placebo but this changes were significantly more evident in calcitriol group (p=0. 02). It seems that treatment with calcitriol may be effective in management of PCOS and it may be better in ovulation induction than metformin therapy.

Obesity is a risk factor for pregnant women and fetus، undoubtedly. Maternal obesity is one of the important risk factors related to maternal and fetal mortality followed with extensive range of medical complications. The purpose of this study was the evaluation of maternal، fetal and neonatal complications according to BMI in women referred to Shiraz health choice centers. This descriptive study was done on 860 delivered women admitted in post partum ward of Hafez and Zeinabieh hospitals in Shiraz. Women were divided in 2 groups according to preconception of BMI: Group 1 with normal weight (19. 8< BMI≤25)، and group 2 with abnormal weight (BMI>25). Participants were studied for age، parity، pregnancy complications، parturition and neonatal complications. Mean age was 26. 9±5. 39 yrs. 68. 3% (608) of women had normal BMI and 31. 7% (282) had abnormal BMI. The most common complication during pregnancy was back pain 25. 4% (226). The prevalence of back pain، high blood sugar، hypertension، induced labor، post partum hemorrhage، post partum infection، duration of hospitalization، cesarean section and neonatal apnea were higher in abnormal weight group than normal weight group which the difference of variables was significant between two groups (p<0. 05). The most odds ratio was post partum infection which the possibility of post partum infection in abnormal weight group was 179. 8 times in compare to the normal weight group (95% CI: 85. 5-378). Obesity is an important risk factor in pregnant women followed with adverse maternal، neonatal and fetal outcomes.

Labor pain is one of the most difficult pains and the main cause of fear of labor among pregnant women. Using aid and non invasive methods for reduction of labor pain is effective in decreasing the rate of elective cesarean section. This study was performed to evaluate the effect of reflexology on relieving labor pain. This randomized clinical trial was performed on nulliparous women referring to Hamedan Tamin Ejtemaee Hospital to determine the effect of massage of uterus pain place in relief of labor pain. 35 women were in case group and 35 in control group. In intervention group، massage of uterus pain place was performed for 30 minutes at foot (between interior malleolus and foot heel) and in control group، massage was performed for 30 minutes but on other area. The questionnaires were completed before and after massage. Severity of labor pain was measured by Visual Analog Scale. Data analyzing was performed by SPSS software (version 16) and Chi-square and Wilcoxon tests were used to compare the effect of reflexology on relieving the labor pain in two groups. Massage of uterus pain (intervention group) with decreasing of labor pain had significant relation (p=0. 001)، but there was no significant relation between massage of uterus pain place and duration of labor (p=0. 59). Massage of uterus pain place is effective in relief of labor pain but it doesn’t affect in decrease of labor duration.

Pregnancy affects on women’s sleep physiologically and psychologically. Poor sleep quality in late pregnancy seems to be a predictive of depressive symptoms at first few weeks of post birth. The purpose of this study was to investigate the relationship between quality of sleep in late pregnancy and postpartum depressive symptoms.

This prospective longitudinal study was performed on 156 women with gestational age of 28-30 weeks from 10 prenatal care clinics of Qom، Iran. Subjects completed a questionnaire including the Pittsburgh Sleep Quality Index (PSQI)، State-Trait Anxiety Inventory (STAI) and Childbirth Attitudes Questionnaire (CAQ) at 28 and again at 38 weeks of gestation. Three months after delivery، depressive symptoms were assessed using the Edinburgh Postpartum Depression Scale (EPDS). Data was analyzed by Chi-square test، Mantel Haenszel and logistic regression and Two-Way ANOVA Analysis of Variance using SPSS softwareversion16.

Significant relationship was found between quality sleep scores at 28 and 38 weeks of gestation and postpartum depressive symptoms (p>0. 05). Inappropriate sleep quality at 28 weeks (OR=3. 9) and 38 weeks (OR=3. 4) increases the risk of postpartum depressive symptoms nearly four times (p=0. 03).

Quality of sleep is a predisposing factor of postpartum depression. Therefore، assessing the sleep quality of pregnant women and providing proper interventions during pregnancy is suggested to reduce the rate of postpartum depression.

Vulvovaginal candidiasis (VVC) is the most common vaginitis among women. The purpose of this study was comparing the efficacy of honey and clotrimazol 100 mg on vaginitis candidiasis. To evaluate the efficacy and tolerability of clotrimazol and honey or both، they were used for 7 days in the treatment of vaginitis candidiasis.

This double-blind clinical trial was conducted on 77 non-pregnant women aged 18 to 49 years with vaginitis candidiasis. Fifteen patients were in the honey group (Group 1)، 30 in the honey and clotrimazole group (Group 2)، and 32 in the clotrimazole group (Group 3). Participation in the study using vaginal clotrimazole and vaginal honey or both daily for 7 days. Baseline diagnosis consisted candidiasis culture together with clinical diagnosis and declaration of signs by the patients. Gynecological and microbiological tests confirmed the diagnosis، and patients were followed up for 7 and 21 days after the onset of treatment. Student t-test and chi-square statistical tests were used for data analysis.

Alleviations occurred in symptoms and signs of vaginitis after treatment with honey and clotrimazole. The success rate for the treatment of vaginitis candidiasis was 100% in groups 1 and 2; seven and 30 days after intervention، the success was well observed in comparison with group 3، and the difference was significant (p<0. 001). The medication was well tolerated.

Use of honey alone represents a novel and effective formulation for the treatment of vaginitis. Also، a combination of 100 mg of clotrimazole and 5ml of honey application was found to be effective in the treatment of the most common vaginitis.

One of the issues which counterpart medicine and ethics is abortion. Since the fetus passes two stages from arise till final development which at first level has not any spirit and at second level gains spirit، a group of jurists based on the evidence believe that in moral view، abortion of fetus with spirit is not allowed at all. But in scientist and medical view، abortion is allowed for the fetus that leads to death of mother and causes severe body harms in a manner that causes hard continuation of life; also the fetus that has a lot of abnormalities which his/her birth actually is the animal life without any understanding and spending heavy money for his/her is useless. In challenge of ethics and the resulted loss، what is the best way to solve the problem? Does the abortion in any condition opposite to ethics and is forbidden? Really، what kind of abortion is not allowed? What should do in argument task between life of mother and fetus? Whether abortion which is prescribed by a doctor is considered homicide? In this article، in addition to the reasonable answer to these questions، we have proved that abortion in any level of its life is not absolutely forbidden but in some conditions is necessary and even obligation