مجله زنان مامائی و نازائی ایران
سال شانزدهم شماره 80 (هفته دوم دی 1392)

Cesarean section is one of the most common women surgeries. Post surgical pain leads to delay in successful initiation of breastfeeding and pain relief accelerates the communication between mother and newborn. The aim of this study was to evaluate the analgesic effect of rectal indomethacin suppository on pain relief after cesarean section. This prospective double blind randomized clinical trial was conducted on 65 term pregnant women who referred to Omolbanin hospital، Mashhad، Iran in 2011 for elective cesarean section. Rectal indomethacin suppository and placebo were described before anesthesia for 35 and 30 cases، respectively. Pain score was measured in both groups، 3 and 24 hours after cesarean using visual analogue scale. Data were analyzed using SPSS software (version 16)، chi-square and t-student tests. P value less than 0. 05 was considered significant. Demographic characteristics were same in two groups. Mean duration of surgery was 108±45 minutes. Gas passing in first 24 hours was significantly higher in indomethacin group (p=0. 035). The mean of post operative pain did not show significant differences between two groups. (p>0. 05) Indomethacin might reduce post operative pain at 3 and 24 hour after cesarean section but this is not significant. Therefore، the use of rectal indomethacin suppository before cesarean section was not effective for pain relief in this study.

Systemic opioids and massage therapy are widely used for pain relief during labor. The aim of this study was to compare between massage and intramuscular pethidine (meperidine) for pain relief in the stages of labor and the length of labor. This clinical trial was conducted on 120 pregnant women referred to valiasr hospital in Broojen، Iran in 2012. Subjects were randomly allocated into three groups of massage، intramuscular pethidine and standard care. Data were collected using interview forms، observation and examination. Pain intensity was measured using visual analogue scale. Data were analyzed using SPSS software version 20 and descriptive statistics، paired t-test، chi-square، ANOVA، Spearman and Pearson correlation coefficient tests. P value less than 0. 05 was considered significant. Pain intensity showed significant differences between the three groups، 30 minutes after the intervention and pain intensity was lower in the massage group than other groups (p=0. 001). Intensity of uterine contractions showed significant differences between the three groups and it was lower in massage group than other groups (p<0. 0001). There was no significant differences in duration of the first (p=0. 086) and the second stages (p=0. 295) of labor in all groups. Massage and intramuscular pethidine reduced pain during labor، but massage therapy provided more persistent pain relief and without any side effects. Massage therapy is a safe، effective and inexpensive intervention and it can be used for pain relief during labor.

Pemphigus vulgaris is a kind of autoimmune and fatal disease which is treated with high dose of corticosteroids and antibiotics. Patients treated with immunosuppressive drugs and are prone to infection. Case report: This report is about a 27 years pregnant woman with pemphigus vulgaris who lived in a Caspian littoral city that treating with corticosteroids caused severe infection syndrome and finally died due to failure in diagnosis. Immunocompromised patients who live in tropical regions that infectious agents like Strongyloides Stercoralis are prevalent should be tested for this worm before corticosteroids therapy or increasing the dose of corticosteroids to prevent severe infection.