فهرست مطالب نسرین صوفی زاده

Gestational trophoblastic disease consists of a wide range of tumors related to the uterus, including complete and incomplete hydatidiform mole, placental trophoblastic tumor, and choriocarcinoma, which have different tendencies to local invasion and metastasis. In this study, we report a case of twin pregnancy with one fetus and a concomitant mole in a 40-year-old woman.

Case report: 

A 40-year-old woman at 17-week of pregnancy referred with complaints of shortness of breath, headache and high blood pressure. Fetal heart rate was 110. According to the ultrasound of the fetus, the size of the placenta was much larger than normal and had cystic areas. The patient was diagnosed as a case of twin pregnancy with one fetus and a concomitant mole. Emergency hysterotomy was performed. The patient was discharged from the hospital after one week in good general condition and recommended to check weekly βHCG titer test and control blood pressure.

Molar pregnancy is diagnosed by abdominal ultrasound and serum βHCG measurement. Considering pregnancy complications such as gestational hypertension and metabolic disorders such as hyperthyroidism and bleeding which can increase after such pregnancies, early diagnosis and treatment are essential to reducing maternal mortality. In addition, after termination of such pregnancies, examination of the patients for early detection of trophoblastic tumors is very important.

Polycystic ovary syndrome (PCOS) is a common disorder in women of childbearing age that can be associated with adverse pregnancy complications. The aim of this study was to compare the adverse pregnancy consequences between pregnant women with PCOS and control group in Qazvin.

In this study, 150 pregnant women with PCOS aged 18-35 years with gestational age of more than 20 weeks were selected as our case group based on Rotterdam criteria and our control group included 150 pregnant women without PCOS. The groups were compared in terms of pregnancy complications including gestational diabetes, preeclampsia, preterm delivery, low birth weight, and neonatal admission to the neonatal intensive care unit (NICU).

There were no significant differences between the two groups in terms of demographic data including age, weight, height and BMI. In the case group (PCOS) we found gestational diabetes in 33 cases (64.7%) (P=0.021), preeclampsia in 44 cases (67.7%) (P=0.002), and preterm delivery 70 in cases (75.3%) which indicated a significant difference between the case and control groups (P<0.0001). The case group had higher neonatal complications than control group in regard to low birth weight (40 cases, 64.5%, P=0.008) and NICU admission (30 cases, 66.7%, P=0.015).

The results of this study showed that PCOS, due to its metabolic effects, may increase the incidence of gestational diabetes, preeclampsia, preterm delivery, low birth weight or macrosomia and long term NICU admission

Preeclampsia is one of the pregnancy complications and is a multiple organ disorder that occurs in 3 to 5 percent of all pregnancies in western countries. Regarding to the involvement of the autonomic and sympathetic systems in pathophysiology of preeclampsia, the role of stress is highlighted in exacerbating the condition. Since the role of factors such as domestic violence is raised in the incidence or exacerbation of preeclampsia, and with regard to the growth and prevalence of domestic violence in the country, this study was performed with aim to determine the association between domestic violence and preeclampsia.

This case-control study was performed on110 post-partum women in two groups of 55 subjects (preeclampsia and non-preeclampsia) in Beasat hospital of Sanandaj in 2017. Demographic data were collected using researcher-made Demographic-Midwifery questionnaire, and then data related to domestic violence using World Health Organization domestic violence questionnaire. Data were analyzed using SPSS software (version 22) and t-test, Mann-Whitney and Chi-square tests. P <0.05 was considered statistically significant.

There was no significant relationship between domestic violence by husband and preeclampsia (P = 0.203). The risk of preeclampsia in the case of domestic violence and physical violence was 1.5 times than control group, sexual violence was 1.6 times than control group, and psychological violence was 1.2 times than control group. There was no significant association between physical, sexual and mental violence with preeclampsia (P=0.328, P=0.473 and P=0.606, respectively).

No significant relationship was found between the incidence of preeclampsia and the types of violence.

Thrombotic thrombocytopenic purpura is a rare and life-threatening disease with a relatively high prevalence of 5% in pregnancy that causes thrombocytopenia. Due to the high prevalence and mortality of fetal and maternal mortality, which resolves rapidly with the onset of plasmapheresis, the diagnosis of this disease is clinically important. The aim of this study was to successfully manage thrombotic thrombocytopenic purpura syndrome (TTP) with plasmapheresis in pregnant women.

Case Report: 

The patient was a 29-year-old woman who was admitted at 21 weeks’ gestation and second pregnancy with fever, muscle aches, increased liver enzymes, headache, decreased consciousness and hallucinations. Due to the low pH and high lactic acid dehydrogenase and neurological symptoms and fever, TTP was diagnosed for the patient and started with 15 units of freshly frozen plasma daily plasma milling until normalization of lactic acid dehydrogenase and platelets. He was discharged in good general condition.

TTP should be considered in the differential diagnosis of missed pregnancies in the second trimester of pregnancy and pregnancies with thrombotic microangiopathy and reduced ADAMTS13 activity should be considered. Although TTP is a deadly disease without treatment, most patients recover with plasmapheresis, so it is recommended to start plasmapheresis as soon as there is clinical doubt based on the patientchr('39')s tests and symptoms.

Endometriosis is one of the most common chronic diseases in women that can cause infertility. Surgical removal of endometrioma can reduce pain and improve the quality of life of patients, while its effect on fertility is still controversial. This study was performed with aim to evaluate the effect of endometriosis surgery on fertility rate and outcomes in women with endometrioma.                                               

This randomized controlled clinical trial was performed in 2017 on 64 women with endometrioma ≥ 4 cm. After random allocation, the intervention group received endometrioma surgery and the control group received expectant treatment. The two groups were followed for six months in terms of fertility. Data were collected using a researcher-made checklist. Data were analyzed by SPSS software (version 20) and independent t-test and Chi-square test. p < 0.05 was considered statistically significant                                                                    

Frequency of pregnancy in the intervention group (76.6%) was significantly different from the control group (46.6%) (p =0.023). Also, the frequency of spontaneous pregnancy was significantly different in the intervention and control groups (95.7%, N=22 vs. 42.9%, N=6) (P=0.001).

Surgery of endometrium ≥4 cm is effective in infertile women and increases the chance of spontaneous pregnancy without other infertility treatments.

Pregnancy is associated with many physiological changes that can affect the effectiveness of drugs. Our purpose in this study was to asses the pattern of drug use during pregnancy, self-administration consumption, maternal and fetal complications.

This study was conducted on 1300 pregnant women referred to health centers of Sanandaj and south of Tehran during 2016-17. The information was obtained by interviewing mothers and examining the documentation of the delivery. Finally all data analysis was performed by SPSS software, v.18 and Chi square and T- test. 

The largest age group of participants was 18-35 years old (80.2%). The most of them were housewives )78.5%) and 87.3% of them had at least a diploma. self-administration consumption was significantly more common in mothers with unwanted pregnancies and those who received their prenatal care from unskilled persons (P<0.05).

In women with self-administration consumption, the mean of education was less. It is concluded that education system has a important role in the change of knowledge, attitude and performance. self-administration consumption more happened between they who were advised by unskilled assistance and they who had uwanted pregnancy. Therefore, we should extend Reproductive Health services for development of Iranian women and mothers society.

Pregnancy is often associated with various psychological problems, such as anxiety. However, these problems are often overlooked and not treated. This study aimed to determine the effect of mindfulness-based stress reduction (BMSR) on anxiety in pregnant women in Sanandaj, Iran.

This semi-experimental research had a pretest-posttest design and control group. In total, 500 pregnant mothers referred to clinics and delivery ward of Besat Hospital in Sanandaj were selected by convenience sampling. After completing the Spielberger Anxiety Inventory, 250 individuals with a high anxiety level were detected, 50 of whom were selected and randomly divided into intervention and control groups. The intervention group participated in eight MBSR teaching sessions, whereas the subjects in the control group received no treatment. Data analysis was performed in SPSS version 22 using independent and paired t-tests.

In this study, 35% of the participants had an MSc and 40% had a diploma. In addition, 90% of the subjects were housewives, and the mean age at marriage was 24.4+60.95 years. Moreover, 77.5% had the intention to choose natural delivery. According to the results, obvious and hidden anxiety was reported at a moderate-to-high level in 50% of the cases. Furthermore, the mean obvious anxiety changed from 45.9 to 49.8 (P>0.05) and from 46.9 to 37.8 (P<0.05) in the control and intervention groups, respectively. On the other hand, hidden anxiety changed from 42.9 to 47.8 (P>0.05) and from 44.9 to 38.8 (P>0.05) in the control and intervention groups, respectively. While the intervention was significantly effective in terms of reduced obvious anxiety, there is insignificant reduction in hidden anxiety in the participants.

Given the effectiveness of MBSR on anxiety of pregnant mothers, this method can be used to reduce anxiety in these individuals.

Pregnancy and delivering a baby are the most important achievements occurring in a woman`s life and her family. Although it is a physiologic event, there would happen some complications that could mostly be prevented by prenatal care. The objective of this study was to assess the relationship of the first trimester maternal hemoglobin and fetal birth weight.
This descriptive- analytical study was performed on 3000 pregnant women of 18 to 40 years old with less than 12 weeks of gestational age, referred to health centers in Qazvin province. Hemoglobin measurements were performed by routine laboratorial tests and then recorded in the questioners; afterward, the mothers were followed throughout the gestation period up to the delivery term. Then, the fetal birth weights were recorded. Anemia was defined as Hb Findings: This study presented that 11.4% of babies had low birth weights (Discussion & This study demonstrated that lower birth weight babies in anemic mothers were more prevalent. Therefore, pre-gestational screening and anemia treatment is highly recommended in women of reproductive age.

Prolonged pregnancy occurs in approximately 10% of pregnancies which can also have consequences for the mother and fetus. Since there is no statistical evaluation of the outcome of prolonged pregnancy compared with term pregnancies in Sanandaj city, this study was performed with aim to evaluate the risk factors associated with prolong pregnancy and management of them.
This analytic-descriptive study was performed with evaluation of the files of all referring pregnant women and determining the prevalence of prolong pregnancy in Sanandaj Besat hospital during 2013-2014. Then, in this population, the variables of prolonged pregnancy compared to term pregnancy were collected. Finally, these two types of pregnancy were compared in terms of frequency of the number of pregnancy, the number of delivery, maternal BMI, reduction in amniotic fluid, use of misoprostol for cervical ripening, uterine atony, response to induction, mode of delivery, decelerations of fetal heart rate, Liquid Disposal, birth weight, 1 and 5 minute Apgar scores, and NICU admission. Data were analyzed by SPSS software (version 20) and Chi-square and T tests. P Prolonged pregnancy compared with term pregnancy was significantly different in terms of maternal and neonatal complications such as the number of pregnancy, the number of delivery, use of misoprostol for cervical ripening, uterine atony, response to induction, mode of delivery (vaginal or cesarean), decelerations of fetal heart rate, the response rate to induction, decelerations of fetal heart rate, birth weight, and 1 minute Apgar score (P 0.05).
Maternal and fetal risk factors were significantly higher in prolonged pregnancies than in term pregnancies. Therefore, it is essential to use guidelines for dealing with long-term pregnancies to maintain the health of mother and neonate.

Cervical cancer is one of the main causes of women's mortality in many of developing world countries and had a significant increase in recent years. Using appropriate screening methods, this disease can be diagnosed at early stages and the deaths caused by it will be reduced. This study was performed with aim to compare the results of colposcopy and histology in patients with abnormal Pap smear or suspicious clinical findings.
This cross-sectional analytic study was performed on 75 patients who had referred to Besat Hospital in Sanandaj from January 2013 to January 2016 with abnormal Pap smear and suspicious clinical findings in order to perform colposcopy and Pap smear. Colposcopic results and histological findings were extracted from the patient's files. Data were analyzed using SPSS software (version 22) and Chi-square test. The confidence intervals for diagnostic value indices were 0.05.
Histopathology and colposcopy studies were conducted on 36 patients with abnormal Pap smear and 39 patients with suspicious symptoms and clinical findings. Sensitivity and specificity of colposcopy were 69.23% and 73.46%, respectively. The positive and negative predictive values of colposcopy were 58.07% and 81.82%, respectively. There was significant relationship between the results of colposcopy and histology.
In cases of abnormal Pap smear and suspicious clinical findings, colposcopy can be used to validate the findings.

Anemia is the most prevalent nutritional deficiency in the world, affecting almost 30% of people worldwide, especially the pregnant women. On the other hand preterm birth is responsible for 2/3 of the infant mortality rate; therefore we performed this study to find the relationship between hemoglobin level in the first trimester of pregnancy and preterm delivery.
Material and This descriptive-analytical study was performed in the years 1392 – 1393 in Qazvin Province. 3000 pregnant women (age range:18 - 40 years), with gestational age of less than 12 weeks were selected from 5 medical health centers. 284 participants were excluded because of IUFD, anomalies, abortion, lack of cooperation or referral to other centers for follow up or performance of lab. tests. The first trimester Hb was recorded in a questionaire for every subject and cases were observed for spontaneous preterm delivery (less than 37 weeks).Using SPSS16 software, data were analyzed by chi -square test, T- test and logestic regression.
In this study the prevalence rates of anemia and preterm birth were 22.2% and 19.9% (542 cases) respectively. Mean gestational age was 38.28 ± 3.56 and the rate of preterm birth in the subjects with normal Hb level was 19.3%, and 21.9% in the patients with anemia. which revealed a significant relationship between maternal anemia and preterm birth (p This study demonstrated the relationship between maternal anemia in the first trimester and preterm birth. Therefore, preconception evaluation and anemia treatment in the women of childbearing age is recommended.

Uterine rupture in pregnancy is rare and often could be life threatening and catastrophic. Myomectomy is one of very common surgeries in gynecology, performed as the vaginal, abdominal and laparoscopic surgeries. Pregnancies occured after abdominal and laparoscopic myomectomy are high risk for uterine rapture.

Case: 

Patient was a 28 Years old female, pregnant woman at the 20 wks of gestational age with abdominal pain and a history of abdominal myomectomy 6 yrs ago. Uterus was ruptured and fetus in amniotic sac was found in abdominal cavity.

Early diagnosis of uterine rupture after myomectomy can save patients from death.

Thyroid peroxides antibodies are associated with recognized complications during and after pregnancy like Abortion and postpartum depression، but other complications such as preterm labor، preterm rupture of membrane (PROM) and effect of antibodies on newborns weight and newborns Apgar score not be evaluated. Studies were demonstrated، treatment with levothyroxine in pregnant women with thyroid peroxides antibodies may prevent maternal and fetal complications. This study illustrated the prevalence of thyroid peroxides antibodies and induced pregnancy complications and then evaluates the effects of levothyroxine in reducing pregnancy complications among pregnant women having such antibodies. Methods and materials: we designed single blind RCT study in 300 first trimester pregnant women attending Prenatal Clinic in Sanandaj from September 2009 to January 2011. of 266 pregnant women without clinical hypothyroidism، 32 women were thyroid peroxides antibody positive. This 32 thyroid peroxides antibody positive women were divided in two groups via simple randomized allocation. Intervention group received a daily dose of 50 microgram levothyroxine in the pregnancy period. Control group did not receive any treatment. Participants were observed until the end of pregnancy period and outcome was assessed. Then data was analyzed by SPSS 11. 5 software and Chi square، Fisher and Kruskal-Wallis test. P-values less than 0. 05 were considered statistically significant. of 266 pregnant women، 32 women (12%) were thyroid peroxides antibody positive. There were no significant statistical differences between delivery type and delivery time. (p=0. 37) Though premature delivery and premature rupture of membrane in treated group was lower than non-treated group and the average of newborns weight and newborns Apgar score was higher than non-treated group، this difference was not statistically significant. (p=0. 22، p=0. 34 and p=0. 16) Add tests for thyroid peroxidase antibodies to pregnancy care and treatment with levothyroxine in pregnant women with thyroid peroxides antibodies can reduce premature delivery and premature rupture of membrane and increase the average of newborns weight and newborns Apgar score.

Dysfunctional uterine bleeding (DUB) is one of the common problems in peri-menopausal women that can affect their physical، emotional and social conditions. In addition DUB is one of the main causes of hysterectomy. The aim of this study was to investigate risk factors associated with DUB in peri-menopausal women in Sanandaj. This case–control study included 62 women with DUB (case group) and 124 women without DUB (control group). We used a questionnaire consisted of different items which was completed for every subject after clinical interview. Using SPSS software، data analysis was performed by chi-square، Fisher exact test and logistic regression. DUB showed significant relationships with type of delivery (p=0. 015) and age (p=0. 045). DUB had no significant relationship with diabetes (p=0. 095)، hypertension (p=0. 917) and type of contraceptive methods (p=0. 906). Analysis by logistic regression revealed that women over 50 years of age and women with history of Cesarean section (C/S) had a respective risk of 2. 284 (p=0. 021) and 2. 493 (p=0. 009) times greater to develop DUB than women without these factors. The age over 50 years and C/S was suggested as risk factors which can be related to DUB. Attention to the advantages of vaginal delivery and complications of C/S is necessary and reduction of C/S rate can be effective in decreasing the incidence of DUB.

Regional anesthesia techniques present the most flexible and effective yet least depressant choice for patients. Since their relative risk of mortality is 16 times less than general anesthesia، thus they are mostly desirable in obstetrical anesthesia. Cerebral Subdural hematoma is a very rare but severe and dangerous complication of spinal anesthesia. Despite surgical decompression and aggressive rehabilitation، it causes the majority of neurological complication، if not treated on time. One case is reported in this paper. Case Report: This report introduces a 28 year-old woman who had a compliant of postpartum headache (four days) after she received spinal anesthesia for cesarean section. Post dural puncture headache was diagnosed for her. She was treated with analgesic agents and hydration therapy on days 4 and 11 after cesarean. But on day 22 after surgery، severe headache and frequent vomiting and numbness of right side of body in patient appeared. Brain CT scan was performed on the patient and she was undergone a bleeding drain and surgery because of the right lateral frontoparietal subdural hematoma. Four days later without any neurological complications، she was discharged healthy. Cerebral Subdural hematoma after spinal anesthesia is a rare but dangerous complication that must be considered as a differential diagnosis of headache after spinal anesthesia.

Urinary tract infection and anemia are the important risk factors during pregnancy that can lead to serious complications such as preterm labor, low birth weight, increase in maternal and fetal mortality and hypertension in pregnancy. The aim of this study was evaluating the prevalence of asymptomatic urinary tract infection and anemia in pregnant women in first trimester. This was a cross sectional study was done in 5 health centers of Sanandaj in 2009. The inclusion criteria was pregnant women in first trimester and the exclusion criteria were symptomatic UTI, history of renal stone, abnormality in urinary tract and antibiotic consumption in 14 days ago and multiple pregnancy. Urine culture and hemoglobin were checked. Data were analyzed by T test, chi square test and SPSS software version 11.5. P-value less than 0.05 was considered significant. In this study 1500 pregnant women were evaluated. The mean of age was 28.4±6.1 year and mean of hemoglobin was 12.43±0.89 mg/dl. 107 subjects (7.1%) had hemoglobin less than 11 mg/dl. No significant relationship were seen between anemia and gravidity (p=0.905) and number of parity (p=0.432). 114 subjects (7.6%) had positive urine culture. There was seen a significant relationship between urinary tract infection and anemia (p<0.001). No significant relationship was seen between results of urine culture and parity and gravidity. Also no relationship was seen between anemia and gravidity and parity (p>0.05). There is asignificant relationship between anemia and urinary tract infection in first trimester of pregnancybut not between anemia and gravidity and parity.

Uterine rupture in pregnancy is rare and often catastrophic with high incidence of fetal and maternal morbidity and mortality. The most common cause of uterine rupture is separation of previous cesarean hysterotomy scar. Other common predisposing factors to uterine rupture are previous traumatizing operations or manipulations such as curettage, perforation, myomectomy and excessive or inappropriate uterine stimulation with oxytocin.Case Report: In this case, spontaneous rupture of uterine at 25-26 weeks gestation (twin pregnancy) in a 36 year old woman has been reported(G5P2A2L1). She was hospitalized so that preeclampsia can be rule out for her. She underwent laparoscopic removal of myoma and 3 months later IVF was done for her because of secondary infertility. During hospitalization, suddenly she had mild vaginal bleeding and decreased fetal movement. Emergency sonography reported that the two fetuses died and severe oligohydramnius and myomatosis uterine with the biggest size was 90mm. Try of labor was done for her but she didnt respond to induction and the patient was qualified for cesarean section. During the operation, the rupture of the uterine wall was seen in the site of the previous myomectomy and the two dead fetuses were observed in the abdomen without myoma in the uterin. The myoma that was reported by the sonologist was hematoma and omentoma. Uterine wall was repaired.