مجله زنان مامائی و نازائی ایران
سال هفدهم شماره 125 (هفته سوم آذر 1393)

Misoprostol is a potent uterotonic agent which has been reported to be useful in the prevention and treatment of postpartum hemorrhage; but limited studies have been performed about its effect during cesarean section and prevention from postpartum hemorrhage. This study was performed with the aim to assess the effectiveness of sublingual misoprostol in prevention of bleeding during cesarean delivery. This randomized clinical trial was performed on 186 women who were candidate for cesarean delivery in Tajrish Shohada Hospital during 2008. The women were randomly placed in two groups of misoprostol+ oxytocin and placebo+ oxytocin. The women randomly received 400-microg misoprostol subligually or placebo immediately after cord clamp. All patients also recieved a dilute intravenous oxytocin infusion at delivery. final variable was determining intra-operative blood loss by differences of the preoperative and postoperative hemoglobin and hematocrit concentration. Data was analyzed using SPSS statistical software (version 15) and t test، chi-square or Fisher''s exact tests. Two groups were not significantly different in terms of mean age، parity، gestational age، fetus weight، indications for cesarean section، the duration of operation، and other intrapartum variables، and also the preoperative and postoperative hemoglobin and hematocrit values (P>0. 05). But، drop in hemoglobin 1. 01±1. 19 in intervention group vs. 1. 32±1. 74 mg/dl in control group and P= 0. 002; and drop in hematocrit 2. 97%±3. 29% in intervention group vs. 3. 18%±4. 87% in control group، and P=0. 001، it means that in misoprostol group، drop in hemoglobin and hematocrit were significantly lower compared to placebo group. Also، need to additional uterotonic agent was significantly lower in misoprostol group (18. 8% vs 47. 31%; P=0. 001). There was not a significant difference between two groups in terms of need to transfusion or the incidence of drug''s side effects (P>0. 05). Sublingual misoprostol reduces the intra-operative blood loss during cesarean section and also، the need for additional uterotonic agents; however، this reduce in blood loss does not decrease transfusion rate.

Hypertensive disorders in pregnancy lead to serious complications such as bleeding and infection that is associated with increased mortality. This study was performed with the aim of evaluating the association between seasonal patterns and preeclampsia This case-control study was performed on 455 pregnant women (205 with preeclampsia and 250 without preeclampsia) who had referred to the maternity of Amol Imam Ali hospital after 20 weeks of gestation from 2008-2013. Data such as demographic characteristics and history of mothers'' disease were collected from medical records on file available in the hospital. Data analysis was performed with SPSS software (version 20) and Chi-square، Fisher''s exact، Mann–Whitney U tests، simple and multiple logistic regression. P<0. 05 was considered significant. the highest incidence of preeclampsia was in the fall (31. 21%) and then in the winter (28. 78%). Chi-square test results showed that there was significant relationship between preeclampsia and the history of abortion، diabetes، hypertension and twin pregnancy (P<0. 05). Also، Mann–Whitney U results showed that the mean maternal age was 28. 61±6. 00 years، gestational age 35. 75±3. 50، and birth weight 2600. 73±841. 28 in mothers with preeclampsia which were significantly different with healthy women. (p<0/05) Understanding the relationship between different weather patterns and preeclampsia can be useful in identifying triggers of the risk of preeclampsia. Also، the results of this study can help to design the plans to perform preventive and treatment measures in susceptible pregnant women and decrease serious complications which threaten the mother and fetus.

Physiologic and hormonal changes during pregnancy increase risk of occurrence and severity of sleep breathing disorders in pregnant women. This study was performed with the aim to determine the frequency of sleep breathing disorders and some related factors in pregnant women referred to delivery ward of Alborz social security hospital of Karaj. This cross-sectional، descriptive study was performed on 200 pregnant women referred to the delivery ward of Alborz social security hospital of Karaj in 2009. Background information and Stop Bang questionnaire (for sleep breathing disorders screening) were evaluated through interviews، and information related to neonatal weight and Apgar score were evaluatedfrom medical records، and anthropometric indices of pregnant women were measured with balance scale and tap meter. The data was analyzed by SPSS software (version 18) and Chi-square and Fisher''s Exact tests. P< 0. 05 was considered significant. 91 cases (54. 5%) of pregnant women had habitual snoring، 114 (57%) daily sleepiness and fatigue، 43 (21. 5%) sleep apnea، 14 (7%) hypertension، 6 (3%) body mass index > 35 kg/m²، and 20 (10%) neck circumference > 40 cm. 29 cases (14. 5%) were at high risk for sleep breathing disorders. Statistical significant relationship was found between sleep breathing disorders in pregnant women and increased neck circumference، systolic and diastolic blood pressure، increased BMI and higher Apgar score and increased birth weight (P<0. 001). Pregnant women are at risk for sleep breathing disorders and sleep breathing disorders are more common in pregnant women with central and general obesity، and higher blood pressure.