مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 7 (مهر 1400)

Pulmonary embolism, as a relatively common non-obstetrics complication, is an important cause of maternal mortality during pregnancy. Due to some physiological and hormonal changes, the risk of pulmonary embolism increases during pregnancy and postpartum. This review article was performed with aim to explore the last articles related to diagnostic methods and treatment of this disease.  

In this review article, databases of Google scholar, PubMed, Embase, Medline, Iranmedex and IranDoc were systematically searched using the keywords of pulmonary embolism, thromboembolism, pregnancy, anticoagulant, thrombolytic and thrombectomy during 1990 to 2021.

In this review article, finally 62 studies regarding pathophysiology, clinical feature, diagnostic strategies and treatment of pulmonary embolism during pregnancy were investigated.

The diagnosis of pulmonary embolism during pregnancy needs a high clinical suspicious. Due to the dangers of ionizing radiation to the fetus, correct using of diagnostic algorithms can reduce diminish radiation exposure to mother and fetus. Use of injectable anticoagulants such as enoxaparin is the main treatment method of pulmonary embolism during pregnancy. Oral anticoagulants are not recommended in pregnant women. Also, thrombolytic therapy and surgical thrombectomy can be used in the case of massive and life threatening pulmonary embolism.

Varicocele is one of the most important causes of male infertility that is affected by various factors including anthropometric indices. Body mass index can change the prevalence of varicocele in men and although there are many studies on the relationship between BMI and the prevalence of varicocele, but no study has reviewed these results, so this review study was performed with aim to evaluate the relationship between body mass index and varicocele in various studies.

In this review study, international databases of Web of Science, Scopous, Proquest and Pubmed and Iranian databases such as Irondoc, Magiran, and SID were searched for findings the studies published between 2000 and 2020 using the related keywords. The full text of selected articles was reviewed by two browsers.

A total of 10 studies were reviewed. These studies examined the body mass index of men and examined the prevalence of varicocele in these individuals. Most studies have shown that obese men and people who reported a higher body mass index had a lower prevalence of varicocele and a high body mass index could be a protective and preventive factor in men.

According to the results of this study, body mass index is associated with the incidence of varicocele and people with low body mass index have higher incidence of varicocele than people with normal body mass index.

Sexual violence can occur at any time in women's life and cause much physical, psychological and emotional harm for them. Sexual violence against perimenopausal women has more adverse consequences for middle-aged women, their families and society. The present review study was conducted with aim to investigate prevalence and consequences related to sexual violence in perimenopausal women and beyond.

In this systematic review study, to find the related studies, scientific databases such as PubMed, Scopus, Web of Science, ProQuest, SID, and Magiran were searched using the related keywords. All Persian and English articles from January 31, 2010 to January 31, 2020 that studied sexual violence in perimenopausal women were included in this study. All observational studies including descriptive, descriptive-analytical, case-control and cohort studies entered in this study. Articles were evaluated according to Strobe criteria. Good quality articles were included in this systematic review.

In this study, 482 articles were reviewed, of which 7 articles met the inclusion criteria. The results of this study showed that the prevalence of sexual violence in women varied between different races and was associated with education, economic status, smoking and alcohol consumption. There was a risk of hypertension, elevated neuroendocrines, and proinflammatory cytokines in perimenopausal women with sexual violence. Also, increased menopausal symptoms such as urinary symptoms, sleep disorders and symptoms of depression and anxiety, vaginal problems and sexual dysfunction were associated with sexual violence.

Sexual violence has harmful physical and psychological consequences for middle-aged women. Therefore, the results of this study can be a guide for health planners to reduce this health-social problem and solve the related problems by providing the necessary counseling programs in middle-aged women.

Due to the lack of systematic studies which can add new information on the relationship between pelvic floor muscle fatigue and stress urinary incontinence, this systematic study was performed with aim to investigate the effect of pelvic floor muscle fatigue on stress urinary incontinence. The results of this study will be useful for planning strategies for the prevention and treatment of evidence-based stress urinary incontinence.

In this systematic review study which was performed based on the PRIZMA statement, the observational and clinical trial studies published in PubMed, Scopus, EMBASE, PEDro, LILACS, SciELO, Cochrane Library, Google Scholar databases. CINAHL, SID and Iran Doc published until 2020 were evaluated. Good quality articles (scoring≥ 70) based on the Downs and Black scale were included in this study.

In the initial search, 2301 articles were found and in the later stages, 2296 articles were deleted and 5 articles were included in this systematic review. The results of one study did not show an association between muscle fatigue and stress urinary incontinence, and three articles showed a strong association between muscle fatigue and stress urinary incontinence. One article also showed that pelvic floor muscle fatigue cannot cause stress urinary incontinence.

Pelvic floor muscle fatigue can affect the progression or worsening of stress urinary incontinence; however, due to the lack of number of studies and the heterogeneity of studies in this field, conclusions should be used with caution.

Premenstrual syndrome (PMS) is a set of physical and psychological symptoms of menstruation in women which is one of the most common disorders of reproductive age. Several early articles have been published on the effect of aromatherapy on the symptoms of premenstrual syndrome. However, a comprehensive study was not found that shows the results of these studies uniformly and clearly, so this study was performed with aim to determine the effect of aromatherapy on the symptoms of premenstrual syndrome using systematic review.

To achieve the studies related to the research objective, databases of SID, Magiran, Pubmed, Google scholar, Scopus and Science direct were searched without time limit until 2021 using the keywords of premenstrual syndrome, aromatherapy in both Persian and English and all possible combinations with the use of operators of OR, AND. Qualitative evaluation of the studies was performed by the consortium checklist.

Seven plant extracts and essential oils were evaluated in 10 clinical trial studies which met the inclusion criteria. Most of the essential oils studied in the articles had antioxidant and flavonoid compounds with anti-inflammatory, analgesic and antidepressant properties and had a beneficial effect on relieving PMS symptoms. The majority of these essential oils had no or minimal side effects. Performing meta-analysis was not possible due to the heterogeneity of the studies' methodology and the difference of effects assessment tools.

Due to the positive effect of using plant extracts and essential oils in reducing the physical and psychological symptoms of premenstrual syndrome, it can be considered as an alternative treatment for women with premenstrual syndrome.

Despite the studies have been published as review or systematic, the effect of ormeloxifene on mastalgia has not been well elucidated. Therefore, this study was performed with aim to determine the effect of ormeloxifene on mastalgia in clinical trial studies.

To perform this review study, the English electronic databases including ISI Web of Science, PubMed, Scopus, and Cochrane Library; also, Magiran and Scientific Information Database (SID) were searched without time limitation until January 1, 2021, by using the keywords of Mastalgia or Mastalgias or Mastodynia, or Mastodynias or Mammalgia or Mammalgias, and Breast Pain, Breast, pain, and Centchroman or Selective Estrogen Receptor Modulators (SERM), and Systematic Review, and Meta-Analysis.  

Twelve studies were included in this systematic review, and the results of nine studies were combined in the meta-analysis. The percentage difference before and after treatment with ormeloxifene was significant (p<0.001), and ormeloxifene resulted in 86% improvement in breast pain relief (87%; CI:0.83-0.90). The result of the Q test showed moderate and insignificant heterogeneity between the studies (P=0.14; I2=33%). Also, the findings of the two studies have indicated significant efficacy of ormeloxifene.

The results of the meta-analysis supported the efficacy of ormeloxifene in relieving breast pain. However, the analysis of the findings in this meta-analysis should be interpreted with caution due to the high heterogeneity between the studies, small sample size, and the limited number of studies.

Prevention and control of maternal shivering during spinal anesthesia for cesarean section is very important in the appropriate outcomes of surgery; however, choosing the appropriate drug for this issue should be associated with few side effects for mother and baby. Therefore, this study was performed with aim to evaluate the drugs used to control shivering in women under spinal anesthesia.

In this narrative review study, to find the related studies, computer search was performed in databases of SID, Magiran and Google Scholar with Persian keywords of spinal anesthesia, shivering and cesarean section. In the initial stage of searching, 364 studies were reviewed and 341 studies were deleted due to not being related to the subject. Finally, 13 studies were used to write this study.

In reviewing the research background, different studies had used different drugs to prevent shivering after cesarean section. Shivering after spinal anesthesia has been the specific goal of many studies with clinical trial design. Performed interventions in this regard included: intrathecal or intravenous injection of drugs such as magnesium sulfate, hydrocortisone, dexamethasone, ondansetron, ketamine, midazolam, ketamine with midazolam. Opioid drugs such as fentanyl, tramadol, and pethidine have also been reviewed in some studies.

Based on various studies, pethidine with unknown and possible mechanism of μ receptors seems to be the best drug in control of Shivering in cesarean section.

Randomize controlled trials (RCTs) are important in evidence-based medicine, and treatment decisions are made based on the results of these studies. Due to the frequency of this type of research on complementary and alternative medicine (CAM) and its effect on infertility, this study was performed with aim of critical appraisal of the effect of CAM on infertile women's pregnancy rate.

In this critical review, searching was made on electronic scientific databases including Scopus, PubMed, Embase, Web of Science, SID and Magiran without time limitation until November 2020 using the keywords of CAM and infertility. Inclusion criteria was Persian or English published RCTs related to the use of CAM in infertile women and exclusion criteria was lack of access to the full text of the article and non-compliance of the study method with the principles of RCTs. In the evaluation of the articles, the 2017 CONSORT checklist was used for non-pharmacological treatments. The scoring range was 0-44.

Out of the 25 articles reviewed, the overall quality compliance rate with the CONSORT checklist was estimated about 50%. The greatest weakness in reporting was observed in the title and abstract (0.88 ± 0. 726) and the discussion section (1.16 ± 0.898). The total mean score of the articles was 22.68 ± 6.176 with a minimum of 9 and a maximum of 33.

The appraised articles in the present study had an average quality. It is required that RCTs be conducted and reported in accordance with standard principles and be thoroughly reviewed critically with relevant checklists before publication. Training of researchers helps improving the quality of articles.

Vaginismus is an involuntary contraction of the vaginal muscles that makes sexual intercourse difficult or impossible. Various treatment strategies have been proposed for vaginismus, such as sex therapy and desensitization. There is no sufficient evidence on the efficacy and effectiveness of vaginismus interventions. This review study was performed with aim to evaluate the effects of different interventions for vaginismus.

In this review study, to find the related articles, the databases of SID, Pubmed, Google scholar, and Science direct were searched using the key words of vaginismus, treatment, and clinical trial from 2002 to 2020. Criteria for selecting a controlled clinical trial were comparison of vaginismus treatments with other treatments, placebo treatment, and routine treatment, or waiting list for treatment.

In this study, 15 studies with a total of 655 participants were reviewed. The results of this study showed that cognitive-behavioral therapies, the use of dilators, Botox, sex therapists, and hypnotherapy could successfully treat vaginismus. Regarding the effectiveness of strategies, Cognitive Behavioral Therapy (CBT) with the highest number of trials has been very successful. After that, the use of dilators was very popular.

This study showed that Cognitive Behavioral Therapy (CBT), the use of vaginal dilators, hypnotherapy, Botox and physiotherapy led to successful and satisfactory intercourse.

Spinal anesthesia is the most common method of analgesia for elective cesarean section. Postoperative nausea and vomiting is one of the most common complaints of patients in cesarean section under spinal anesthesia, so this study was performed with aim to investigate the role of drugs in controlling nausea and vomiting in women undergoing cesarean section with spinal anesthesia.

In this narrative review study, to find the related articles, databases of SID, Magiran, and Google Scholar were searched with the keywords of spinal anesthesia, nausea, vomiting, and cesarean section. The time period for searching articles was from 2001 to 2021.

Different studies have used different medications to prevent nausea and vomiting after cesarean section. Nausea and vomiting after spinal anesthesia has been the specific goal of many studies with clinical trial design. The performed interventions in this regard included: use of drugs such as Dexamethasone, Ketamine, Lidocaine, Ondansetron, Metoclopramide, Granistron, Propofol, Gabapentin and Midazolam.

Although the anti-nausea and anti-emetic effect of ketamine has been approved in the studies, it is best not to be the first choice of an anesthesiologist because of the effects of hallucinations and nystagmus and the fact that it may delay breastfeeding. Propofol has also been shown to have anti-nausea and anti-emetic effects, but we must be careful about the effects of the patient's respiratory depression. Dexamethasone has a delaying effect on nausea and vomiting, so it may not be a good choice for an anesthesiologist. 5-HT3 receptor antagonists (ondansetron and granisetron) seem to be the best choice for first-line treatment of nausea and vomiting. Because these drugs do not have the extrapyramidal side effects of metoclopyramide and can be used as appropriate drugs for nausea and vomiting in patients undergoing cesarean section with spinal anesthesia.

Coronavirus has become a worldwide epidemic and can spread rapidly. Pregnant women and infants are more vulnerable due to weak immune systems. This study was performed with aim to review the clinical manifestations, maternal, fetal, and neonatal outcomes in pregnant women with COVID-19.

In this review study, to find the related studies, databases of Pubmed, Scopus, Medrxiv, and Web of Science were searched from the first of 2019 until January 30, 2021 using the keywords of Corona virus, pregnancy outcomes with all possible combinations and their English equivalents. Boolean operators (AND, NOT, OR) were used to search the databases. According to Strobe criteria, the studies which received high and medium quality evaluation were included in the study and reviewed.

Out a total of 3771 studies, 17 were included in this review. 4494 pregnant women were corona positive in 9 different countries. The most common symptoms of corona virus in mothers were fever and cough, and the neonatal complication of the virus included preterm delivery and respiratory distress. Most deliveries were by cesarean section and most patients used antibiotics and antiviral drugs for treatment. There was not much evidence to support the vertical transmission of Covid-19 through vaginal delivery. The most common diagnostic test for Covid-19 disease was PCR.

In most studies, the increase in cesarean delivery was due to fetal distress. However, due to the vulnerability of these two groups, preventive and precautionary measures should be considered and more emphasis should be done on educating people.