مجله زنان مامائی و نازائی ایران
سال بیستم شماره 4 (تیر 1396)

Gestational diabetes is the most common medical problem in pregnancy. According to several differences in the prevalence of gestational diabetes mellitus and its risk factors and performing a study in this regard by two-step method in Kermanshah in 2008, this study was done with aim to determine the prevalence of gestational diabetes mellitus and its related risk factors by one-step method.
This cross-sectional study was performed on 1272 pregnant women at 24 to 28 weeks of gestational age referred to Kermanshah health centers in 2016. The gestational diabetes screening test (OGTT) was carried out by new one-step method for all the women. Information on risk factors in pregnant women with gestational diabetes included: history of stillbirth, miscarriage, fetal macrosomia and others and were collected in diabetes research center. Data analysis was performed using Stata software (version 11) and using t-test and logistic regression. P The mean age of subjects was 27.97±5.73 years. The prevalence of gestational diabetes mellitus was obtained 8.81%. The prevalence of GDM in people without risk factors was 6.49%, in patients with one risk factor was 17.43% and those with more than one risk factor was 21.62%. With one year increase of age, the odds of gestational diabetes increased 6% and with one unit increase of BMI, the odds increased 9%. The risk of gestational diabetes in those who had history of gestational diabetes was 7.25 times and in those who had abortion was 2.44 times than those who had no history of abortion.
Due to the involvement of variables such as age, BMI, history of gestational diabetes and history of abortion in gestational diabetes, training in people with overweight and obesity, old age and people with history of morbidity can be effective to reduce the incidence of gestational diabetes.

Pregnancy is an important period during which the pregnant mother should receive needed oral health education and related examinations. Researches have shown the association between oral health complications and unwanted outcomes of pregnancy such as preterm birth or low birth weight. Therefore, this study was performed with aim to assess the attitude, knowledge and practice of gynecologists and midwifes regarding pregnancy oral health care.
This descriptive-analytic study was performed on 204 gynecologists and midwifes in Kerman in 2016. They were assessed using a validated self-administered questionnaire including demographic information and questions about knowledge, attitude and practice. Data analysis was conducted using SPSS software (version 21) and Chi-square, Mann Whitney and Pearson tests.
Mean score of knowledge among participants was 6.55±2.1 that no statistically significant difference was found between gynecologists and midwifes (P=0.903). About 165 of them (81%) stated that they referred their patients to the dentist and 174 (85.7%) referred those who needed to dental care to the dentist. There was no statistically significant difference between gynecologists’ and midwifes’ attitude (p>0/05).
The findings showed that considering gynecologist's and midwife's knowledge about importance of oral health during pregnancy, they had proper attitude and practice, but it still presents discrepancies with standard guidelines that indicates the need to upgrade their skill and knowledge in order to reach the best care for this period.

Sleep quality will decline in postmenopausal women. So it is necessary to take steps to improve sleep quality. This study was performed with aim to investigate the effects of physical activity and exercise on sleep quality in postmenopausal women.
This descriptive-analytic study was performed on 80 active and inactive postmenopausal women in Shiraz in 2016. The activeness criteria was having at least three one-hour sessions of physical activity per week. Data was collected by demographic characteristics questionnaire and standard questionnaire of Pittsburgh Sleep Quality Index (PSQI). Data was analyzed by SPSS software (version 18) and Mann-Whitney U test. P The active postmenopausal women compared to inactive postmenopausal women were in better position in terms of sleep mental quality (p=0.001), delay in falling asleep (p=0.001), the efficiency and effectiveness of sleep (p=0.005), sleep disorders (p=0.004), the hypnotic drug consumption (p=0.03), the overall quality of sleep (p=0.001). But, no significant difference was observed in the scale of the duration of falling asleep (p=0.42) and morning dysfunction (p=0.44).
Postmenopausal women with regular physical activity can improve their sleep quality which is one of the basic needs of every human.

As many countries, abortion has always been a sensitive issue in terms of cultural, social, political and religion in Iran. This study was performed with aim to investigate the distribution and causes of fetal congenital abnormalities leading to the licensing of therapeutic abortion in Legal Medicine of Isfahan province.
This retrospective study with forensic epidemiology approach was performed on the records of therapeutic abortions certificates with fetal causes in Legal Medicine of Isfahan province from 2012 to 2014. During the study period, a total of 629 therapeutic abortions certificates with fetal causes were recorded which after evaluation of the mentioned abortions, data related to age, education and residence of the mother and the age of the fetus and the fetal causes of abortion were extracted and were recorded in data collection form. Data were analyzed by SPSS software (version 18) in descriptive statistics and analytic method of multinomial regression. P In terms of frequency distribution of fetal abnormalities, 233 (37.4%) cases of legal abortions certificates were due to cephalic disorders. The second most commonly fetal disorder is hydrops fetalis with 113(18%) cases. The third disorder is chromosomal or trisomy problems, which contains 85(13.5%) of the cases. Skeletal dysplasia with 69 (11%) cases, the fourth most common disorder, followed by thalassemia major with 46 (7.3%) cases.
The distribution of abortion is not the same in different cities of Isfahan. Considering the fact that a significant portion of abortions don’t refer to Legal Medicine and also the mothers who refer to Legal Medicine, but cant receive legal permission, so it is not possible to determine the true feature of abortion in Isfahan province.

Cesarean section is a common surgical surgery in women, and post-cesarean pain and stress are the problems which are faced by young women keen to care of their newborns. Post-operative pain management reduces patient's discomfort, enables quicker walking, reduces hospital stay, and increases patient's satisfaction. This study was performed with aim to determine the effect of massage on post-cesarean pain.
This single-blind clinical trial was conducted on 156 primiparous women referred to Amol Emam Ali hospital for elective cesarean section from 2014 to 2015. The samples were randomly divided into three groups including hands and foot massage, foot massage, and control groups (n=52 in each group). The, four hours after receiving analgesics, patient's pain intensity and vital signs were measured before, immediately after, and 90 minutes after the massage. Data were analyzed using SPSS software (version 22) and STATA software (version 12). P A significant reduction was observed in pain intensity immediately and 90 minutes after massage in intervention groups (P Massage of hands and feet as an effective intervention with no nursing side-effect can be helpful in care and control of postoperative pain in patients.

Dysmenorrhea is one of the common problem among women which is associated with negative impact on social, academic, and sports activities of young women. Different chemical and herbal drugs are used for treatment that they have different effectiveness. Mefenemic acid is of common chemical drugs for dysmenorrhea. This study was performed with aim to compare the effectiveness of fennel with mefenamic acid on severity of dysmenorrhea in young girls.
This double-blind clinical trial was performed on 120 female students with severe and moderate dysmenorrhea. The students were randomly divided into two groups which received the fennel and mefenamic acid. The groups received 30 mg soft capsules of fennel and 250 mg capsules of mefenamic acid every six hours for two consecutive periods, from two days before menstruation until three days after menstruation. Two groups were homogenous in terms of pain severity and individual characteristics before the interventions. Severity of pain was measured by the verbal multidimensional scoring. Data were analyzed by SPSS software (version 16) and variance analysis and Compare couple Bonferroni. P Based on the results of variance analysis, significant reduction in dysmenorrhea severity was observed in two groups of fennel and mefenamic acid one month after the intervention (P0.001).
Fennel and mefenamic acid were effective on severity of dysmenorrhea, but considering less complications of fennel on gastrointestinal tract, it can be used as a suitable drug for dysmenorrhea.

Vulvovaginal candidiasis (VVC) is one of the most common vaginal infection in women of childbearing age. In some cases, due to the intervention of resistant strains of Candida albicans and non-albicans species, recurrent vulvovaginal candidiasis (RVVC) occurs. This study was performed with aim to identify the Candida isolated from patients with vulvovaginal candidiasis by PCR-RFLP method.
This descriptive study was performed on 189 vaginal discharge obtained from women with clinical presentation of VVC referred to Ghaem Hospital, Mashhad University of Medical Sciences during 2015-2016. The vaginal discharge was examined by direct examination and culture on Sabouraud's dextrose agar medium for definitive diagnosis. The genomic DNA of Candida colonies have grown in culture were extracted by boiling lysis method. The Candida isolates were identified by PCR-RFLP technique. The results were analyzed by SPSS software (version 16) and using Pearson and Chi-square test. P
Among 189 sampled patients, 108 positive Candida cultures were acceptable. The Candida species which were identified included C. albicans 84 (77.8%), C. glabrata 10 (9.3%), C. kefyr 4 (3.7%), C. parapsilosis 1 (0.9%) and C. tropicalis 1 (0.9%). About 8 (7.4%) of the specimens contained two species of Candida. RVVC form was observed in 5 (4.6%) of the patients.
The most common cause of VVC was C. albicans; and C. glabrata had the highest frequency among the non-albicans species. Most of patients had non- RVVC.

Episiotomy is the most common surgical intervention in delivery. Alpha ointment exerts its restorative effects by angiogenesis of the injured area, reducing inflammation and preventing the spread of infection. Therefore, this study was performed with aim to evaluate the effect of Alpha ointment on episiotomy wound healing.
This double-blind clinical trial was performed on 70 primiparous women in Mashhad Omolbanin Hospital during 2015-2016. The research units (35 in the intervention group and 35 in the control group), 48 hours after delivery once a day for ten days, used a knuckle of the prescribed ointment (Alpha or placebo) after washing and drying the wound with normal saline. Wound healing was evaluated using the REEDA scale on the first, fifth and tenth days after delivery. Data analysis was carried out by SPSS statistical software (version 16), and using Mann-Whitney, T-test, Chi-square and Fisher tests. P There was no significant difference between two groups in terms of wound healing on the first day (P = 0.976), fifth day (P=0.9), and tenth day (P=0.931).
Using Alpha ointment has no effect on episiotomy wound healing.

Nowadays, the use of medicinal herbs is fairly common,whilemedicinal herbs don’t have specific doses and can have more threatening consequences for the mother and the fetus, so this study was performed with aim to evaluate the frequency, causes and how to use medicinal herbs during pregnancy.
This descriptive-analytical study was performed on143 women giving birth in the gynecology ward of Yazd ShahidSadoughi hospital in 2016. Data were collected using a self-designed questionnaires consisted 2 sections. The first part was related to the demographic information and the second part was about the performance of women regarding the use of medicinal herbs during pregnancy (13 items) . Data were analyzed by SPSS software (version 19) and using Chi-square, independent-t, and logistic regression tests. P 129 (90.2%) of participants had used medicinalherbs during pregnancy, 78 women (60.46%) had simultaneously used 1-2 medicinal plants, 95 (73.64%) had used as herbal tea, 53 (41.08%) used Ginger (mostly to control nausea and vomiting) and 39 (30.23%) used Peppermint (mostly to control heartburn). The information sources of 122 (94.57%) was family and friends.
Since most samples had used herbs for various reasons during pregnancy and stated family and friends is their source for information; therefore, it is necessary to inform mothers about the risks and benefits of common consumed herbs and to evaluate the safety of these plants on the health of mother and fetus.

Pregnant women and newborns are at risk of vitamin D deficiency (VDD). VDD during pregnancy can lead to several maternal and fetal complications. This study was performed with aim to determine the mean concentration of 25-hydroxyvitamin D [25(OH)D] in pregnant women and newborns in Iran.
This meta-analysis study was performed without time limitation up to August 2016 based on the protocol of systematic review and meta-analysis studies (PRISMA). To access relevant studies, databases of Magiran, Iranmedex, SID, Medlib, IranDoc, Scopus, PubMed, Science Direct, Cochrane, Web of Science, CINAHL and Google Scholar were independently searched by two researchers. Search was performed using MeSH keywords. Pooled estimator was calculated according to significant I2 index based on the random effects model. Data were analyzed using Review Manager software version 5.3.5.
Among 19 studies, 4,829 pregnant women and 1,195 newborns were enrolled. The mean age of pregnant women was 27.01±0.31 years. Mean concentration of vitamin D in pregnant women was 15.02 ng/ml (95% CI: 13.68-16.35). This rate in newborns of 6 studies was calculated 14.59 ng/ml (95% CI: 9.94-19.23). The standardized mean difference (SMD) of 25(OH)D concentration was significant in pregnant women at third-trimester and their newborns (P=0.001).
Mean concentration of vitamin D in pregnant women and newborns in Iran is very low and there is a direct relationship between maternal concentrations of vitamin D at third-trimester and newborn. Therefore, addressing VDD in Iranian pregnant women and newborns should be considered as a health priority.

The intrauterine device (IUD) has been used for years for contraception and is used so far in more than 100 million women. IUD migration into adjacent viscera has been reported, but rarely migrates to the bladder. IUD migration into the bladder can cause stone formation. Many patients are asymptomatic and may have only irritative and obstructive urinary complaints. In this study, a patient is introduced that 10 years after insertion of IUD referred with hematuria and a stone on IUD migrated to bladder was found and improved with endoscopic treatment.
Case Report: A 45-year-old woman with recurrent urinary tract infections and a history of gross hematuria referred to the clinic. Patients had a history of IUD insertion about 10 years ago. Abdominal and pelvic sonography revealed a 2×4 cm stone in urinary bladder. The patient undergone cystoscopy and a large stone was observed in the bladder that was quite nearby IUD. Endoscopic lithoclast broke stone and IUD was removed.
Presence of irritative urinary symptoms and recurrent urinary tract infections in the women who have a history of IUD insertion, migration of the device to the urinary bladder should be considered. In these cases, Ultrasonography and cystoscopy can help to the diagnosis.