سمیرا ابراهیم زاده ذگمی

In recent years, outpatient cervical ripening and induction of labor has been considered because of reduced costs and increased patient satisfaction. Moreover, due to the side effects of chemical drugs, the tendency of patients for use of herbal medicines has increased. The aim of this study was to evaluate and summarize the results of clinical trials about outpatient herbal medicines in cervical ripening and onset of labor.

Clinical trials related to outpatient use of herbs in cervical ripening and onset of labor, were searched without time and language restrictions in Scopus, Pubmed, Cochrane library, Science direct, Scientific Information Database (SID), Magiran, and Google Scholar search engines until March 30, 2021. Data analysis was performed using STATA software.

16 articles that met the inclusion criteria were reviewed. Meta-analysis was only possible on castor oil and date fruit. The chance of spontaneous onset of labor in was 5.760 and 2.205 times the castor oil and date groups, respectively. Moreover, the increase in bishop score in castor oil group was 2 times higher than the control group. The results of funnel plot and Egger test found no evidence of publication bias (P = 0.710). Peganum, Sisymbrium, chamomile, and saffron were effective in cervical ripening and onset of labor. Evening primrose was effective on Bishop score, but had no effect on spontaneous onset of labor. Red raspberry leaves were not effective in spontaneous onset of labor.

Among the mentioned plants, castor oil and date fruit have more evidence in cervical ripening and onset of labor. Further studies with stronger methodologies are needed.

Sedentary lifestyle is the fourth leading cause of death worldwide. More than %80 of adolescents and young people, especially young girls, worldwide do not have enough physical activity. The present study was designed to determine the effect of education based on health belief model on high-risk sedentary physical activity in female students.

 In this randomized controlled clinical trial, 62 female students of Mashhad University of Medical Sciences in 2020-2021 were selected by convenience sampling method and randomly divided into experimental and control groups based on the dormitory. The educational intervention was performed in two training sessions of 60 to 90 minutes in the form of a webinar, based on the structures of the health belief model. Data collection tools include demographic information form, a researcher-made questionnaire including health belief model constructs, knowledge and subscale of physical activity questionnaire, and Persian version of Youth Risk Behavior Assessment Questionnaire (YRBS 2019) (YRBS 2019), which were used after assessing validity and reliability. The collected data were analyzed using descriptive and inferential statistical tests with SPSS software version 21.

Two groups were homogeneous based on age. Before the intervention, there were not statistically significant differences between both groups in the mean scores in the field of Knowledge, high-risk physical mobility behavior, and all the health belief model constructs, , but after the intervention, the differences between two groups in the mentioned criteria were statistically significant (P <0.001).

Education based on the health belief model is effective in reducing the high-risk behavior of physical inactivity, so the educational program of the present study can be used in order to reduce physical inactivity behavior in female students.

Constipation is one of the most common digestive problems in pregnant women which is commonly associated with hemorrhoids. Patients' non-compliance with lifestyle modification recommendations leads to failure of treatment with this method. Although therapeutic properties of coconut oil on constipation are discussed, but its scientific documentation has not been reported; therefore, this study was performed with aim to determine the effect of coconut oil ointment on the symptoms of constipation in pregnant women with hemorrhoids.

This randomized clinical trial study was performed on 60 pregnant women who referred to Mashhad Comprehensive Health Service Centers in 2018-2019. Eligible individuals were divided into two groups. The control group received only lifestyle modification recommendations, while the intervention group in addition to these recommendations used an applicator of coconut oil ointment twice a day for two weeks. The improvement of constipation symptoms including need for straining during defecation, hard stools and defecation less than 2 to 3 times a week was assessed using the Constipation Questionnaire in Pregnancy. Data were analyzed using SPSS software (version 16) and Chi-square, Fisher exact and Cochran tests. P< 0.05 was considered statistically significant.

The frequency of need for straining during defecation on the fourteenth day after the intervention in pregnant women in the coconut oil ointment group was significantly lower than the control group (p <0.05). In the intragroup comparison, it was found that in the group of coconut oil ointment, the difference in the need for straining during defecation and hard stools according to the day of measurement was significantly different (P <0.001), while in the control group, the difference in the need for straining during defecation and hard stools according to the day of measurement was not significant (p <0.05). In the intragroup comparison, defecation less than 2 to 3 times a week, although clinically was associated with a decrease in the coconut oil ointment group, but this decrease was not statistically significant (p=0.050).

Coconut oil ointment is effective in improving the symptoms of constipation in pregnant women with hemorrhoids, so its use is recommended in these people.

Due to the side effects and risks of chemical drugs, women are willing to use complementary and herbal medicine during pregnancy and after childbirth. Because of this, researchers have focused significantly on medicinal plants. The aim of this study was to review the effects of evening primrose in pregnancy and postpartum. In this systematic review study, all articles in Persian and English available in SID, Magiran, Google Scholar, Science Direct, Scopus, PubMed databases using Persian keywords Maghrib, pregnancy, and postpartum and English keywords evening primrose, obstetrics, onagraceae, postpartum until 2021 were retrieved. The quality of the articles included in this systematic review was evaluated using the Jadad scale and 8 articles were evaluated.  In this study, 5 studies related to cervical readiness, 1 study related to diabetes, and 2 studies related to postpartum grief scored 3 and more and other studies were excluded. The results showed that the use of evening primrose had a significant effect on improving the lipid profile of gestational diabetes and the duration of postpartum grief and in relation to cervical readiness, contradictory results were obtained. Due to the small number of studies and conflicting results related to the effect of evening primrose in pregnancy and postpartum, further studies in this area are necessary.

High-risk behaviors are of the most important health and psychological and social challenges that most countries in the world are involved with in some way. The purpose of this study was to evaluate the psychometric properties of the Youth Risk Behavior Assessment Questionnaire (YRBS 2019) for the Iranian youth population.

This was a descriptive-analytical cross-sectional study in which the statistical population consisted of university students in Mashhad City, Iran, in the academic year of 2020-2021. Participants were 400 eligible students who were selected using stratified random sampling method. After translating the questionnaire using translation-retranslation method, content validity was assessed using relative content validity coefficient (CVR) and content validity index (CVI), construct validity using factor analysis, reliability using intra-cluster correlation coefficient, and internal consistency was assessed using Cronbach's alpha.

The mean age of students was 23.54 ± 2.36 years. Indices related to content and face validity of 40 items were confirmed. Confirmatory factor analysis confirmed the structure of 6 factors, and the total of 25 questions. Cronbach's alpha value was confirmed in all domains and in total, more than 0.7 for all. The intra-cluster correlation coefficient (ICC) was 0.735 (P = 0.007) which indicated the reliability of the questionnaire. 

The YRBS short form questionnaire had the necessary psychometric properties for assessing high-risk behaviors of young people. In this study, 6 factors extracted in YRBS questionnaire were consistent with the factors extracted in the original version; therefore, it is suggested to use this tool to detect high-risk behaviors in young people. 

Gestational diabetes is the most common medical condition in pregnancy. Since probiotics are viable microorganisms which have beneficial effects on microbial flora of the intestine, they affect glucose metabolism. Therefore, this study was performed with aim to determine the effect of probiotic capsule on the prevention of gestational diabetes in high risk pre-diabetes pregnant women.

This double-blind clinical trial study was performed on 255 high risk pre-diabetic pregnant women in health centers covered by health center No.2 of Mashhad in 2018. In the probiotic group and the placebo group, in addition to routine care, one probiotic capsule and placebo were daily prescribed respectively from 14-16 weeks of gestation for 12 weeks. Then, glucose tolerance test (OGTT) was performed at week 26-28. The research tools included demographic and midwifery information form, checklist of pregnancy diabetes screening tests, drug use checklist, examination form and satisfaction form. Data were analyzed using SPSS software (version 22), and Chi-square, One-way ANOVA, Kruskal – Wallis and Mann-Whitney tests. P<0.05 was considered statistically significant.

21 patients (26.3%) in the probiotic group, 49 (59.8%) in the placebo group, and 55 (67.1%) in the control group had gestational diabetes (P<0.001). Gestational diabetes in the intervention group was significantly less than the placebo and control group. The results of the Chi-square Pearson test for two by two comparison of the groups showed significant difference in gestational diabetes mellitus between probiotic group with placebo (P <0.001) and probiotic group with control (P <0.001). Gestational diabetes in the intervention group in significance level of lower than 5% was lower than the placebo and control group.

The use of probiotic capsules can be recommended to high risk pregnant women in preventing gestational diabetes.

Hemorrhoid is one of the most common problems in pregnancy, especially in the second and third trimesters. In the absence of timely treatment and proper follow-up, the problem leads to a chronic disease that can impose harmful effects on the individual, the family and the society. Considering the high prevalence of this problem among pregnant women and failure to review the new advocacy, especially pharmacological and aggressive methods over the past 12 years, this study was performed with to review a variety of non-pharmacological and pharmacological treatments of hemorrhoids in pregnancy and their effectiveness.

To achieve the aim of the study, databases of PubMed, Scopus, ProQuest, Google Scholar, Science Direct, SID and Magiran were searched using English keywords of Hemorrhoid, Haemorrhoid, pregnancy, Pregnant, Medical Treatment, Conservative, Life style, Diet, Nutrition, Surgery, Hemorrhoidectomy and their Persian keywords were searched individually and in combination, from the timeframe covered until October 2019.

There are several methods to treat hemorrhoids during pregnancy, but many of these methods are based on the results of clinical trials on the general population of patients with this condition, so, due to the lack of sufficient and powerful clinical studies on the application of some methods and the prohibition or caution of using some other methods during pregnancy, deciding about the choice of treatment depends on the condition of each patient and considering the criteria such as: gestational age, the severity and degree of sustainability of symptoms as well observing the hierarchy of treatment from conservative and non-invasive approach toward aggressive methods.

There are various methods for the treatment of hemorrhoids, but sufficient and robust studies to confirm the efficacy and safety of these methods to the specific population of pregnant women are limited.

Hemorrhoids is one of the most common problems during pregnancy. Lifestyle modification recommendations are associated with patients' noncompliance. The potential therapeutic properties of coconut oil on hemorrhoids have been suggested, but its scientific evidence has not been reported, therefore this study was performed with aim to determine the effect of coconut oil ointment on hemorrhoids symptoms in pregnant women.

This randomized clinical trial was performed on 60 pregnant women referred to comprehensive health services centers in Mashhad in 2018-2019. The subjects were randomly divided into intervention and control groups. In the intervention group, one applicator of coconut oil ointment was applied twice a day for two weeks; they also received lifestyle modification recommendations. The control group only received lifestyle modification recommendations based on national guidelines. The improvement of hemorrhoids symptoms was measured on the first, seventh and fourteenth days using Visual Analog Scale (pain, prolapse, itching and overall score of hemorrhoid symptom). Data were analyzed using SPSS software (version 16) and Mann-Whitney, Independent T and Friedman tests. P<0.05 was considered statistically significant.

The mean score of pain, prolapse, itching and overall score of hemorrhoid symptoms in coconut oil ointment group significantly decreased compared to the control group (p<0.05). In the intra-group evaluation, in the coconut oil ointment group, the pain score measured by day was significantly different (p<0.001) but in control group this difference was not significant (p=0.050).

Coconut oil ointment is effective in improving the hemorrhoids symptoms, therefore it is recommended for pregnant women with hemorrhoids grade 1 and 2.

About 75% of women experience at least one vulvovaginal candidiasis during their life. Clotrimazole is an antifungal drug that has side effects along with its therapeutic properties. For this reason, a large percentage of women tend to use natural herbal treatments. Artemisia is an anti-fungal activity.

The aim of this study was to compare the effect of Artemisia vulgaris and Clotrimazole on vaginal candida infection on non pregnant women in fertility ages.

This study is a triple blind clinical trial performed on 72 non-pregnant women in Mashhad in 2016-2017 years. The research units were divided into two groups (receiving Artemisia Vaginal Cream and receiving Clotrimazole Vaginal Cream). After confirmation of candidacy and having consent for participation, by random allocation and treated for seven nights. After the treatment, the data was analyzed using SPSS software (version 24).

After treatment, the score for candidate vaginal symptoms was not significant in Artemisia and Clotrimazole group based on Mann-Whitney test (P = 0.518). The Wilcoxon test showed a significant reduction in the symptoms of vaginal candida infection before and after treatment in both groups of Artemisia (P <0.001) and clotrimazole (P <0.001).

Due to the similar effects of Artemisia and Cholitrimazole, Artemisia can be used as an alternative treatment for vaginal candidiasis due to less side effects.

Infertility is recognized as one of the major medical problems in the world. Infertility treatment is a complex, long, and stressful process, and may lead to unsuccessful treatment. It seems necessary to follow up the patients after unsuccessful treatment, to identify their needs and desires, and to provide health services for their health promotion. Therefore, this systematic review was conducted to investigate the needs and preferences of infertile couples after unsuccessful treatment with assisted reproductive technologies (ARTs).

In this systematic review, searching was performed without time restrictions in PubMed, Scopus, the Cochrane Library, PsycINFO, Web of Science databeses, as well as Google Scholar search engine, and Iranian databases including Magiran, Scientific Information Database (SID), Iranpsych, Clinical key, and Iranmedex. Keywords included infertility treatment, assisted reproductive techniques, needs, expectations, unsuccessful treatmen,t and their equivalent words. The relevant articles were retrieved from English and Persian databases. The articles were independently evaluated by two researchers, and disagreements were discussed with the third author.

24 eligible studies (16 cross-sectional and 8 cohort studies), published between the years 1980 and 2019, were included in the study. The needs expressed by infertile patients in these studies includes educational-informational needs, the need to psychological counseling, supportive needs, men's special needs, the need to strategies for stress management, the need for couples counseling, and the need for receiving respect and empathy from health care staff.

Infertile couples' needs included a wide spectrum of needs including educational, psychological, supportive, and counseling needs as well as men's special needs. Recognition of this vulnerable group’s needs can help policymakers and programmers to plan and implement counseling services in fertility clinics. In such a way, the quality of health services in these clinics would be improved and infertile couples' needs would be met.

The success of assisted reproductive techniques plays a very important role in the quality of life of infertile couples and decreases the negative behavior states of infertility. This study aimed at determining the relationship between psychological coping and adjustment strategies with the success of assisted   reproductive technology (ART). This correlational study was conducted on 204 women visiting Milad Infertility Center in Mashhad during 2015-2016. The research instruments included Fertility Adjustment Scale and Infertility Coping Strategies Scale. The positive result of two pregnancy tests within 48 hours was considered as the success of ART. The mean and standard division score of adjustment in the group achieved treatment success (34.3±8.2) exceeded the group failed (33.6±8.8), the difference was not statistically significant (p= 0.381). Also, there was no significant difference between groups in the median and interquartile range of total coping strategies 81 (13) vs. 79.5 (12.25), (p= 0.369). Based on the logistic regression model for one increased transferred embryo, the chance of getting pregnant is 1.3 times, and for each unit increase in FSH level, the chance of ART success decreases 18%. The results of this study showed that there is no relationship between psychological coping and adjustment strategies with ART success. However, the number of transferred fetus and tirthday FSH are introduced as factors that are related to the success of ART.

Labor progress assessment is one of the key factors of maternal care during labor. Anthropometry is one of the branches of anthropology which includes the measurement of different parts of human body. Many studies have assessed the relationship between anthropometric indices and labor disorders. One of these common indices is Cormic Index which defines as: "(sitting height/standing height) × 100". This study was performed with aim to determine the relationship between Cormic Index and labor progress. This correlation study was performed on 151 nulliparous G2 pregnant women referred to Mashhad Omolbanin hospital during 2014-2015. Standing and sitting heights were measured at cervical dilatation of 3-5 cm. Then, vaginal examinations were done hourly to assess cervical dilatation and fetal head descent up to delivery time. Data were analyzed using SPSS software (version 16), and Independent t-test, Spearman correlation coefficient test, repeated measures analysis, and Chi-square test. P The mean Cormic Index was 51.84±2.62 and mean duration of the active phase of labor first stage was 268.83±192.62 min and mean duration of labor second stage was 35.54±34.88 min. There was no significant difference between Cormic Index in two groups of normal and abnormal labor progress in the active phase of labor first stage (P = 0.65). However, there was a positive correlation between Cormic Index and the duration of labor second stage (rs=0.19, P= 0.02). Moreover, the relationship between Cormic Index and fetal head status untill sixth hour was statistically significant (P<0.05). There is no relationship between Cormic Index and labor progress in the active phase of labor first stage. However, there is a relationship between Cormic Index and duration of labor second stage and fetal head descent, so that whatever the trunk is taller (the higher Cormic Index), labor second stage will be longer. Therefore, the labor progress in the latent phase or at the beginning of active phase of labor can be assessed based on Cormic Index.

About 50% of cesarean sections are performed because of abnormal development of first stage، therefore، delivery and its control is very important nowadays. For induction or augmentation of labor، oxytocin infusion is widely used in modern obstetric. Since the contraction shape varies by cephalo-pelvic disproportion، this study was conducted to evaluate the shape of uterine contractions with oxytocin in the active phase of labor. In this ‍Cohort study 100 nulliparous women with singleton pregnancy and cephalic presentation was monitored in dilation 3-4 cm for 30 minutes. In order to precede labor، oxytocin was prescribed to 53 women. Finally، the pattern of contractions was recorded in 10-8 cm cervical dilation for 30 minutes. The ratio of spending time of contraction from peak to baseline (F: Fall) and vice versa (R: Rise) in two phases of beginning and end of the first stage of labor in two groups (with and without prescription of Oxytocin) was calculated and compared. Data were analyzed by using SPSS statistical software version 11. 5، paired T-test، independent T-test، and chi-square. P value less than 0. 05 was considered statistically significant. The ratio of F and R was 1. 164±0. 203 and 1. 150±0. 223 at the beginning and the end of labor in oxytocin received group. The F: R ratio was 1. 161±0. 203 and 1. 091±1. 161±0. 214 at the beginning and the end of labor in the other group. No statistically significant difference was observed in the ratio of F and R between with and without oxytocin groups. Using Oxytocin for augmentation of uterine contractions does not change the shape of the uterine contractions.

Shortening duration of delivery without endangering mother and fetus is always highly considered by obstetric specialist and mothers. Widely use of Hyoscine N-butyl bromide and Promethazine in hospitals and limited researches with conflicting results in this regard made us investigate the efficiency of Hyoscine N-butyl bromide and Promethazine on length of active phase of the first stage of labor. A provident double-blind clinical trial was done on 188 nulliparous women. They were classified into the Hyoscine N-butyl bromide (48cases), Promethazine (45cases) and control (95 cases) groups. The samples were randomly allocated from cases who were injected 20 mg of Hyoscine N-butyl bromide, 25 mg of Promethazine IM in dilatation 3-5cm, and control group in which no medicine was used. Data analysis was performed using SPSS software version 16, t- test, chi-square and ANOVA tests. p<0.05 was considered significant. The mean duration of active phase of labor in Promethazine (5.69±3.45) was shorter than in control group (7±3.44). This difference was statistically significant (p=0.049). However duration of active phase of labor had no statistically significant difference between Hyoscine N-butyl bromide and control groups (p=0.205). However, the mean duration of active phase of labor was not statistically significant in the three groups of Hyoscine N-butyl bromide, Promethazine and control (p=0.140). It seems that Promethazine can be used as an effective drug to shorten the length of laboring in comparison with Hyoscine N-butyl bromide.

Delivery has an extensive effect in women's health and it is one of the most important indexes in public health. In recent years, interventions in delivery are common, that fundal pressure is one of them. The use of this procedure is poorly described in the medical literature and controversy exists about its safety in the second stage. Therefore, aim of this study is detect and compare the outcome of delivery by fundal pressure in second stage of labor with spontaneous delivery. This was cross-sectional study that women were included. Seventy two deliveries in which fundal pressure was used to expedite birth were matched with 7 deliveries that occurred spontaneously. Delivery outcome was evaluated in two groups. A questionnaire was used for data gathering. Data were analyzed using statistical methods including Chi-square, Independent t-test, Z-Ratio and Fisher Exact test. Spreadind of episiotomy, tear (p<0.05), APGAR scores on the first minute (p<0.00) and median of duration of the second stage of labor (p<0.000) were statistically different. Fundal pressure is associated with an increased rate of maternal and neonatal accidents. Thus, if there is any requirement to such intervention, its benefit should be considered in comparison with operational delivery.

Early diagnose and management of GDM can decrease perinatal, neonatal and long-time infant problems. There is now accumulated evidence in the literature that high maternal Hemoglobin is associated with increased incidence of adverse pregnancy outcomes which include low birth weight and preterm labor. In the no pregnant population, an association between hemoglobin concentrations with Diabetes Mellitus has been reported before. We decided that we study relationship between maternal Hemoglobin concentration at the first trimester and occurrence of GDM. In a retrospective study sample comprised 100 women. Age, weight, parity, Hemoglobin concentration and FBS at the initial antenatal visit and GCT during 24-28 weeks are recorded. In this study 36 women had GDM and the rest were health. Age, parity and Hemoglobin concentration emerged to be significant factors in incidence of GDM. High maternal Hemoglobin (more than 13 g/dl) at the initial pregnant visit (the first 14 week) is an independent risk factor for GDM.