مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 1 (فروردین 1398)

In human, the growth of the cerebellum may be less affected by Intrauterine Growth Restriction (IUGR). Then, measurement of transverse cerebellar diameter can be used as an appropriate measurement for determining the gestational age of fetus with IUGR. This study was performed with aim to evaluate the agreement of different biometric parameters such as transverse cerebellar diameter, femur length and biparietal diameter in sonographic determining of gestational age of fetuses with IUGR and comparing them. This cross sectional study was performed on 35 pregnant women with small abdomen suspected to IUGR fetuses who referred to sonography ward of Kermanshah Imam Reza Hospital in 2016. Gestational age was determined based on the LMP of patient. Ultrasound was performed for patients; gestational age was measured by Transverse Cerebellar Diameter (TCD) and other sonographic routine parameters, and then the results were compared. Data were analyzed by SPSS software (version 22) and paired t-test, Wilcoxon, Pearson and Spearman correlation coefficient. P There was no significant difference between gestational age predicted by TCD parameter and LMP (P>0.05). But, gestational age determined by the parameters of BPD and Femur Length was significantly lower than gestational age based on LMP (P<0.05). Also, gestational age determined by TCD was significantly more than gestational age based on BPD and FL (P<0.05). Using Transverse cerebellar diameter parameters (TCD) to estimate the accurate gestational age of fetuses with intrauterine growth restriction can be safe and reliable.

For many years, electrocardiogram have been used to diagnose fetal distress around childbirth. If the heart cells are damaged, troponin T is released. Few studies have been performed about the relationship between abnormality of fetal heart rate and troponin T. So, this study was performed with aim to determine the relationship between fetal distress and umbilical venous troponin T level (utTl). This case-control study was conducted on 80 neonates in Zanjan Ayatolah Mousavi hospital in 2016. The neonates were compared in two groups of 40 cases with Fetal heart rate abnormalities and control group. utTl was measured using a kit (Bioassay Technology biology) and Elisa technique with sensitivity of 2.54 ng / L. The demographic and obstetric information were recorded. Data were analyzed by SPSS software (version 22), and independent and paired t-test. P<0.05 was considered statistically significant. utTl of fetal distress group was 531.04 ± 499.55 ng/l and was significantly higher than control group (187.47 ± 59.66 ng/l) (p<0.001). utTl in the early deceleration was the lowest and in the variable deceleration was the highest, but it was not significantly different (p= 0.195). In neonates with abnormal fetal ECG, the troponin level of the umbilical cord blood was significantly higher, indicating that abnormalities of fetal heart rate during labor may cause neonatal heart damage.

Uterine leiomyoma is the most prevalent benign uterine tumor in women which develop in nearly 20-40% of women of reproductive age. Pregnancy in women with uterine leiomyoma is considered as a high-risk pregnancy that lead to many complications. This study was performed with aim to investigate the relationship of uterine leiomyoma with premature rupture of membranes in pregnant women. This descriptive-analytical study was conducted on 500 pregnant women referred to Ali-ibn Abi Talib Hospital in Zahedan from April 2015 to March2017. The qualified pregnant women were divided into two groups of leiomyoma and non-leiomyoma, based on the presence of uterine lymphoma diagnosed in early pregnancy ultrasound. Two groups were examined for number, size and location of leiomyoma. Data were analyzed using SPSS software (version 21), descriptive and Chi-square tests. P<0.05 was considered statistically significant. Among 500 pregnant women who were included in the study, 18.6% (N=93) had uterine lymphoma and 81.4% (N=407) were without uterine leiomyoma. The prevalence of premature rupture of the membrane in the uterine leiomyoma group was 25.85% (N=24) and 9.33% (N=38) in without uterine leiomyoma group. There was significant relationship between premature rupture of membranes with the number and location of uterine lymphoma in pregnant women (p <0.001). There was significant relationship between premature rupture of membranes with uterine leiomyoma (number, size and location). Premature rupture of membranes was more prevalent in intramural mayoma and in mayoma with diameter more than 5 cm.

Endometrial cancer is the most common gynecologic malignancy in the world. The most important factor in managing of this malignancy is early detection of the disease and the proper management either by surgery or radiation therapy. This study was performed with aim to evaluate the epidemiology and risk factors of patients with endometrial cancer.  In this cross-sectional study, 53 endometrial cancer patients (endometrioed typing) referred to the gynecology oncology clinic of an academic hospital in Mashhad University of Medical Sciences within 18 months from 2017-2018 were assessed. The standard questionnaire of risk factors for endometrial cancer was completed for all the patients. Data were analyzed by SPSS software (version 25) and kapa test. P In family history of most patients (92.45%), there were no endometrial-related cancers. Blood pressure was the most commonly associated illness in this study. There was no significant difference between mean endometrial thickness in postmenopausal and non-menopausal women (p= 0.134). In terms of risk factors, menopause, weight gain and increased number of pregnancies, there was more increase in these patients. Emphasizing on preventive measures which are available for endometrial cancer and minimizing the risk factors associated with this malignancy are effective in reducing the mortality resulting from this cancer.

Postpartum depression is a common public health problem in the first year after birth. Low mood, feeling guilty, loss of appetite, difficulty in falling asleep are some symptoms of this condition. Depression can cause serious problems for the child, mother and family. This study was performed with aim to determine the effect of Citrus aurantium on postpartum depression in women. This randomized clinical trial was conducted on 49 mothers referred to the Sabzevar health and treatment centers in 2017. Participants had the score of 14-28 on the Beck Depression Inventory-Second Edition (BDI-II), and their depression was confirmed by a psychiatrist through interview. They were randomly (with random blocking method) assigned to the treatment group (orange blossom 500 mg/Bid+ fluoxetine 20 mg) and control group (fluoxetine 20 mg plus placebo). Treatment was started on week 8 after delivery and continued for 8 weeks. Data were analyzed using SPSS software (version 16) and Kolmogrov-Smirnov, Chi-square, Independent and paired t‑test and Mann–Whitney test. P<0.05 was considered statistically significant. The mean score of depression after the intervention in Citrus aurantium group was 9.2±4.02 and in control group was 17.12±3.56; there was a significant difference between two groups (p>0,001). Also, after the intervention, 15 women (62.5%) in Citrus aurantium group and 1(4%) in control group were without postpartum depression. The use of Citrus aurantium along with fluoxetine in the treatment of mild to moderate postpartum depression is more effective than fluoxetine alone. So, it can be used as an alternative in treatment of postpartum depression.

The hemorrhoid is referred to dilated parts of the anal canal veins, which help to control fecal excretion and is one of the most common digestive diseases. Since postpartum problems such as hemorrhoid have significant effect on physical health and psychological well-being, lactation, baby care, and communication with family and society and affect the health of mothers and children, and considering the importance of postpartum quality of life, and due to the limited studies in this field, this study was performed with aim to determine the association between the severity of hemorrhoid symptoms and quality of life in women with grade I and II internal hemorrhoids during postpartum period. This cross-sectional study was performed in 2017 on 131 women in postpartum period in Tehran. Clinical Therapeutic Clinical Evaluation Questionnaire and World Health Organization Quality of Life were used to collect data on hemorrhoid symptoms and quality of life. Data were analyzed using SPSS software (version 21) and Pearson and Spearman tests. P<0.05 was considered statistically significant. The highest and lowest mean score of quality of life was obtained in the sub-domains of environmental health and physical health, respectively. The lowest and the highest mean score for hemorrhoid symptoms was related to the symptoms of itching and the negative effect of hemorrhoids on the health of women. There was a significant negative correlation between the overall quality of life score with all the symptoms of hemorrhoids except pruritus (r = -0.2 to r = -0.28, p <0.05). There was also significant negative correlation between the symptoms of swelling in the anus and dimensions of social health (r = 0.24, p = 0.006) and environmental health (r = 0.20, p = 0.02) with the quality of life. There was also a negative and significant correlation between the symptom of discomfort in the anus and the subtype of physical health of the quality of life (p = 0.04, p = 0.18). None of the socio-demographic characteristics had a significant relationship with quality of life (p >0.05). The symptoms of hemorrhoids have negative effect on the quality of life in postpartum period.

Nausea and vomiting are common complaints of women in the first half of the pregnancy. Nausea and vomiting of pregnancy significantly affect the quality of life of pregnant women. This study was performed with aim to evaluate the effect of lemon aromatherapy on nausea and vomiting of pregnancy. This double-blind clinical trial was performed on 88 pregnant women with nausea and vomiting referred to the health centers of Hamadan in 2017. The research tools was demographic questionnaire and pregnancy-unique quantification of emesis and nausea -24 questionnaire. The subjects were randomly divided into two groups of 44 women (lemon and placebo) and received lemon essence and placebo (distilled water) for four days. The severity of nausea and vomiting before and after the study were assessed. Data were analyzed by SPSS software (version 21) and Chi-square, independent t-test and Repeated Measures analysis. P The groups were homogeneous for demographic information and pregnancy characteristics. After the aromatherapy intervention, the mean total score of nausea and vomiting decreased in the two groups of test and control, but in the experimental group, the mean score of nausea and vomiting significantly decreased over time compared to the control group (P = 0.007). The lemon essence is effective in reducing the nausea and vomiting of pregnant women, and it can be used as an effective and safe intervention in reducing nausea and vomiting in pregnant women.

Sleep disorders in addition to physical and psychological consequences for pregnant women may affect their labor duration and mode of delivery. This study was performed with aim to determine the relationship between sleep disorders in the last month of pregnancy with labor duration and mode of delivery. This descriptive study was performed on 147 pregnant women referred to the maternity of Abadan Ayatollah Taleghani Hospital in 2017. Data collecting tools included two section of demographic and pregnancy information, and Pittsburgh sleep quality (PSQI). The variables of this study were labor length, mode of delivery and quality of sleep. Data were collected during 3 months. Data were analyzed using SPSS software (version 18) and Chi-square, Independent T-test and ANOVA tests. P<0.05 was considered statistically significant. The mean score of sleep quality in pregnant women was 8.86 ± 4.2 and mean length of labor was 3.53±2.1 h. Also, 74 women (50.3%) had vaginal delivery and 73 (49.7%) had cesarean delivery. Moreover, 47 (64.5%) of women with cesarean section had sleep disorder, while sleep disorders were observed only in 35.5% (26) of women with vaginal delivery. Mean duration of labor in women who have had sleep disorder was significantly higher than those without sleep disorder (p= 0.04). Also, vaginal delivery was significantly higher in women without sleep disorder (p <0.0001). There was statistically significant relationship between sleep disorders in pregnancy and duration of labor, also the prevalence of cesarean delivery was higher in women with sleep disorders.

Due to the prevalence of melasma pregnancy (chloasma) and tendency to complementary medicine, this review study was performed with aim to introduce the medicinal herbs affecting the prevention and treatment of chloasma. This review study was performed by searching in 10 authentic books of Persian medicine with the “Introducing a model for prioritization of drugs, based on Iranian Traditional Medicine references” model and also 32 valuable articles with searching in ISI, Scopus, PubMed, Magiran & SID by using the inclusion criteria of available books and articles with the keywords of Kalaf (melasma and chloasma) in Persian medicine and also chloasma and herbal drug in conventional medicine from 1978-2018. The results were compared. Based on the findings of this study, chloasma has been discussed in detail in Persian and conventional medicine. Persian scholars considered oligomenorrhea as the cause of chloasma. They had recommended treatments such as lifestyle and nutrition modifications, the use of herbal drugs and the use of manual therapies. Accordingly, the use of Crocus sativus, Allium ampeloprasum, Fumaria officinalis, Vitis vinifera, Ficus carica, Trigonella foenum graceum, Apium graveolens and Cicer arietinum was prescribed for treatment of chloasma. Nowadays, conventional medicine has proved the its various mechanisms such as having antioxidants and multivitamins and confirmed its effectiveness for treatment of melasma. Based on the proven mechanism of the plants affecting chloasma, the use of these foods in the diet of patients along with conventional medicine will help to improve the disease faster.

 Hemangioma is the most common benign liver tumor which is usually asymptomatic. There is no consensus on how to deal with symptomatic hemangiomas during pregnancy. In this report, a case of a symptomatic giant Cavernous Hemangioma in a 39-year-old woman at four month of pregnancy is introduced.
Case report:  A 39-year-old woman (Gravida4, para3) with a 4-month pregnancy was referred to the hospital due to pain in the epigastria and right hypochondria and nausea and vomiting. In clinical examination, a massive lesion which covered the entire upper abdominal region was palpable. Since it was symptomatic, it was successfully removed by surgery during pregnancy and Hemangioma with size of 23.5 x 16.5 cm was removed. Successful surgical removal of such a giant hemangioma is rare during pregnancy.