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فهرست مطالب نویسنده:

mehrnaz valadan

  • Mehrnaz Valadan, Zohre Raisian, Elham Feizabad, Nafiseh Saedi *
    Background

     Cervical ripening is the process of initiating labor in women with an unripe cervix. Vaginally administered prostaglandin E1 analog (misoprostol) has been promising in cervical ripening and labor induction. However, optimal dosage and dose-dependent adverse effects in this administration route need further clarification.

    Objectives

     This trial aimed to compare the efficacy and adverse effects of 50 mcg vs. 25 mcg of vaginal misoprostol in low-risk term pregnant women.

    Methods

     This double-blind, single-center, randomized clinical trial included 200 low-risk term pregnancies undergoing labor induction with a Bishop score of 2 or less. Patients were assigned randomly to receive 25 mcg or 50 mcg of vaginal misoprostol every six hours up to four times until the active phase of labor was reached. The primary outcome included time to vaginal delivery (latent and active phase of labor), and secondary outcomes included the total dosage of prescribed misoprostol, the need for oxytocin for labor augmentation, and the cesarean section rate.

    Results

     Misoprostol 50 micrograms resulted in a significantly shorter time in the first phase of labor (P-value = 0.002), the second phase of labor (P-value = 0.030), and the third phase of labor (P-value = 0.020). The number of administered misoprostol, the need for additional oxytocin, uterine hyperstimulation, cesarean delivery rate, Apgar score, umbilical artery pH, and neonatal intensive care unit (NICU) administration were statistically similar between the two groups.

    Conclusions

     This study showed that 50 mcg of vaginal misoprostol (vs. 25 mcg) for cervical ripening could reduce labor phase duration without significantly increasing adverse maternal and neonatal outcomes.

    Keywords: Misoprostol, Labor, Induced Delivery, Obstetric, Drug-Related Side Effects, Adverse Reactions
  • Nafiseh Saedi, Sedigheh Pourmahdigholi, sara saeedi, Nasim Shokouhi, mehrnaz valadan, elham feizabad, mona mohseni
    Background

    This study aimed to evaluate the ABO blood group characteristics in women with Gestational Diabetes Mellitus (GDM).

    Methods

    This cross-sectional research was conducted on pregnant women with GDM in Yas Hospital, Tehran, Iran, from April 2018 to March 2019. 

    Results

    Totally, 449 pregnant women enrolled in the study. The average age of the participants was 32.26±5.08 years with a range between 18 and 45 years. 46% of the participants were treated with insulin. In this study, 35% were typed as group O, 34.3% as group A, 24.3% as group B, and 6.5% as group AB. The Rh+ blood antigen was present in 92% of the pregnant women. Blood group A (35.7%) was the highest in pregnant women with insulin therapy and the frequency of blood group O was the highest in pregnant women with diet (39.5%) and metformin therapy (35.7%). 

    Conclusion

    In pregnant women with insulin therapy, the most prevalent blood group was A. This was different from those that are frequent in the Iranian normal population and pregnant women with GDM who underwent diet therapy. It seems that blood group A, as a probable associated factor for GDM, can be beneficial in high-risk pregnancy detection for GDM in the Iranian population.

    Keywords: Blood groups, Gestational diabetes mellitus, Pregnancy
  • Zahra Rezaei, Elham Feizabad, Mehrnaz Valadan, Saeedeh Ebadizare
    Objective

    Intrauterine insemination (IUI) is the first-line treatment in couples suffering from various causes of subfertility and infertility. Considering the relatively low rate of pregnancy achieved with each cycle in this method, optimizing various steps in the process including the time interval from sperm collection to IUI may result in an increased rate of success. The goal of this study was to assess the impact of time intervals from the end of sperm processing to IUI (SP-IUI) on the pregnancy rate in IUI.

    Materials and methods

    This single-center prospective cohort study evaluated couples with normal male partner sperm analysis and idiopathic female infertility undergoing IUI from 2018 to 2021. Cycles were stimulated using subcutaneous recombinant FSH and oral Letrozole. Ovulation was triggered using GnRH antagonist when the leading follicle’s size reached greater than 14mm. The participants were placed in one of the three groups based on SP-IUI: group 1 (0–60 min), group II (60–90 min), and Group III: (>90 min).

    Results

    269 couples were included in the study. Sperm processing expectedly resulted in an increased concentration of total sperm count and sperm motility (P<0.001). The rate of chemical or clinical pregnancy, abortion, IUFD, multigestation, pregnancy, term birth, and ectopic pregnancy was not significantly different across study groups (P>0.05).

    Conclusion

    The results of this study suggest that SP-IUI intervals evaluated in this study do not vary in terms of pregnancy rate or adverse pregnancy outcomes in IUI with normal male partner semen analysis. Hence, infertile couples can be flexible in the collection of semen specimens without time and site (at home or hospital) limitations.

    Keywords: Intrauterine Insemination, Sperm Collection, Timing, Idiopathic Infertility, Subfertility
  • Zahra Rezaei, Mehrnaz Valadan, Pooneh Shojaee Asl*
    Background & objective

      Insulin resistance can be seen in most overweight women with polycystic ovary syndrome (PCOS). Insulin resistance seems to play a key role in the pathophysiology of PCOS and infertility. This study aimed to evaluate the effects of insulin resistance on pregnancy rate and regulation of the menstrual cycle following laparoscopic ovarian electrocautery (LOE).

    Materials & Methods

      This prospective cohort study was conducted on 54 infertile metformin- and clomiphene citrate-resistant women with PCOS at Yas Hospital in 2007. These patients initially took a glucose tolerance test and then classified into two groups (i.e., insulin-resistant and non-insulin-resistant) based on the obtained results. Both groups, then, underwent LOE. Patients were evaluated for pregnancy rate and regulation of the menstrual cycle up to six months.

    Results

      Out of 54 patients, 37 patients (68.5%) were non-insulin-resistant, and 17 patients (31.5%) were insulin-resistant. In the insulin-resistant group, after six months, menstrual cycles were less regular than those of the non-insulin-resistant group (OR=0.2; 95%CI, 0.07-0.87). Fifteen (40.5%) women in the non-insulin-resistant group became pregnant; in contrast, three (17.6%) women in the insulin-resistant group became pregnant. In the logistic regression analysis, the results demonstrated that age, duration of infertility, body mass index (BMI), and insulin resistance had no significant effects on pregnancy rate.

    Conclusion

      Insulin resistance can be an important marker of the poor outcomes of PCOS infertility treatment, and LOE significantly improves insulin resistance in women with PCOS.

    Keywords: Polycystic ovary syndrome, Insulin resistance, Laparoscopic ovarian electrocautery, Pregnancy
  • Mehrnaz Valadan, Mohadeseh Mojarad, Elham Feizabad*
    Background & Objective

      Hysteroscopy is an impressive  diagnostic and therapeutic procedure for uterine cavity abnormalities. There are several methods for cervical preparation prior to hysteroscopy, among which misoprostol (a prostaglandin E1 analog) is the most common. However, misoprostol has some side effects, including uterine cramps, vaginal hemorrhage, nausea, vomiting, and fever-like feelings, the severity of which escalates by increasing the dosage. Therefore, in this study, we aimed to compare vaginal misoprostol in two different dosages of 200 and 400 μg with a control group to prescribe the lower dosage of misoprostol in case they were equally effective.

    Materials & Methods

      In this randomized clinical trial study, 87 patients, who had hysteroscopy indications at Yas Hospital, were randomly assigned into three groups (i.e., 200 μg vaginal misoprostol, 400 μg vaginal misoprostol, and placebo). Afterward, the dilatation time of the cervical response and side effects associated with medication and surgery were assessed.

    Results

      The mean dilatation time in the 200 μg misoprostol, 400 μg misoprostol, and placebo groups were 46.7±35.8, 36.8±31.1, and 67.6±49.5 seconds, respectively. These differences were significant (P=0.038). 

    Conclusion

      It seems that administering vaginal misoprostol is an easy, effective, and safe procedure  for cervical preparation before the hysteroscopy. Considering that increasing the dosage of misoprostol did not significantly change the dilatation time, it is recommended that 200 μg misoprostol be used to reduce the side effects.

    Keywords: Misoprostol, Hysteroscopy, Cervical dilatation
  • Zahra Rezaei, Mehrnaz Valadan, Elahe Zabihi Soltani*
    Background & Objective

    Laparoscopic ovarian drilling (LOD) is a method for ovulation induction in polycystic ovary syndrome (PCOS) patients. The aim of this study was to evaluate the serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) before and after LOD in one or two ovaries in women with PCOS.

    Materials & Methods

    This study was a prospective cohort study. The study population included infertile women with PCOS resistant to clomiphene referred to the Infertility Clinic of Yas Hospital. They were candidates for LOD in 2016–2017. The serum levels of AMH and FSH were measured before and after three months in two groups of unilateral and bilateral LOD. Data were analyzed using Stata software.

    Results

    A total of 35 female patients were enrolled in the study, 18 (51.4%) in bilateral and 17 (46%) in unilateral LOD groups; the average age of patients was 27 ± 3.4 years old. AMH levels significantly (P<0.001) decreased in both unilateral and bilateral groups after LOD. FSH levels significantly (P<0.001) increased in both groups after LOD, but this increase was higher in the unilateral group than in the bilateral group, and this difference was statistically significant (P<0.001).

    Conclusion

     It seems women with clomiphene-resistant PCOS when underwent unilateral or bilateral ovarian drilling experienced a significant decrease in AMH and a significant increase in FSH, indicating a decrease in their ovarian reserve.

    Keywords: Drilling, Polycystic ovary syndrome, Laparoscopy, Infertility
  • Mehrnaz Valadan, Sakineh Banifatemi, Fardin Yousefshahi *
    Background
    Patients undergoing gynecology laparoscopy frequently experience shoulder pain as a common postoperative complication. Considering diaphragm stimulation in its pathophysiology, there are some advice to prevent or control this special form of referral pain..
    Objectives
    The current study aimed to assess the prophylactic effect of preoperative administration of oral gabapentin to prevent Post Laparoscopic Shoulder Pain (PLSP) after laparoscopic ovarian cystectomy..Patients and
    Methods
    In a randomized, double blind, placebo controlled trial 40 female patients who were candidates to have elective laparoscopic ovarian cystectomy, received uniformed capsules containing gabapentin 600 mg or placebo 30 minutes before anesthesia induction. All patients had the American Society of Anesthesiologists (ASA) Physical Status of I-II and none had pervious abdominal surgery. Thereafter, the presence of side effects and PLSP and its severity was assessed by Visual Analog Scale (VAS) in the beginning of surgery and 2, 6, 12 hours after the surgery..
    Results
    Comparing the gabapentin (n = 20) and placebo (n = 20) groups, basic characteristics including age (P = 0.446), Body Mass Index (BMI) (P = 0.876), pregnancy history (P = 0.660), and surgery time (P = 0.232) were statistically similar. PLSP occurrence was less frequent in the gabapentin group (45%) compared with the placebo group (75%) (P = 0.053), while In gabapentin group the VAS scores were lower in 2(P = 0.004), 6 (P = 0.132), and 12 (P = 0.036) hours, post operatively..
    Conclusions
    Prophylactic gabapentin administration could be considered as an effective and safe intervention to reduce occurrence and severity of PLSP after gynecologic laparoscopic cystectomy..
    Keywords: Gabapentin, Shoulder Pain, Visual Analog Scale, Laparoscopy
  • Zahra Rezaee, Mamak Shariat, Mehrnaz Valadan, Bita Ebrahim, Bahareh Sedighi, Mehrnoush Kiumarsi, Pouya Bandegi
    Objectives
    Considering the rarity of umbilical cord prolapse (UCP) and lack of accurate data about the risk factors and health outcomes, we aimed to evaluate cases of cesarean section (CS) due to UCP in order to reduce treatment costs and provide information about the mortality and morbidity associated with this condition. Patients &
    Methods
    Of 35,259 cases of CS performed in four hospitals during 2004-2012, 103 cases of UCP were selected as the case group; on the other hand, 318 cases without UCP were classified as the control group. Information was extracted from patients'' records and analyzed by SPSS version 18.
    Results
    Prevalence of UCP was estimated at 0.2%. In the case group, the active phase of labor was reported 1.4 times (81% vs 57%-P<0.00), engagement 8 times (14% vs 2% -P<0.001), transverse presentation 8 times (6% vs 2%-P<0.002), grand multiparity 3.9 times (4% vs 0-P<0.001), oligohydramnios 4.7 times (5% vs. 0-P<0.0001, and polyhydramnios 5.9 times (6% vs 0 - P<0.001). UCP was more prevalent in post-term deliveries (P<0.043). One-minute Apgar score < 7 was 3 times more prevalent in neonates of the case group (P<0.00). Prepartum vaginal bleeding was 4 times more common in the case group, compared to the control group; also, decreased fetal movement and heart rate drop were more prevalent in the case group. Mortality rate was 5.2% in the case group and 1.7% in the control group. Overall, the control group had a better general health at discharge, compared to the case group.
    Conclusion
    A statistically significant correlation was detected between UCP and gestational age, active phase of labor, fetal presentation, engagement, parity, and amniotic fluid volume.
    Keywords: Umbilical cord Prolapse, CS, Risk factors, complications of Umbilical cord prolapsed
  • Mehrnaz Valadan, Mamak Shariat, Zahra Rezaei, Fedyeh Hagholahi, Golnaz Sheikholeslami, Pooya Bandegi
    Background and Aim
    Many changes occur during and after pregnancy which affect physical, psychological and social health and generally women''s quality of life. This study aims to explore the relationship between quality of life and sexual dysfunction after delivery.Methods & Materials: This cohort study was designed to compare the relation of mode of delivery to quality of life and sexual satisfaction in 330 pregnant women referred to hospitals of Tehran University of Medical Sciences. Sexual function questionnaire including 20 questions and quality of life questionnaire including 26 questions were developed based on Female Sexual Function Index (FSFI) and World Health Organization life quality (WHOQOL- BREF) questionnaire, respectively. Data were analyzed through SPSS version 15 software using descriptive and analytical methods (t-test, X2 test, Fisher''s exact test and analysis of variance).
    Results
    The mean sexual function score in the vaginal delivery and Cesarean section groups were 45.25±5.59 and 45.50±6.03, respectively, which shows no significant difference. No significant difference was seen regarding the mean score of quality of life between vaginal delivery group (87.8±10.70) and Cesarean section group (88.25±11.29). Also no significant difference was seen between two groups of study, considering different aspects of life (physical, psychological, environmental and social).
    Conclusion
    Quality of life was similar in both groups of vaginal delivery and Cesarean section. Therefore, authorities in charge of health programs can have a leading role in changing people''s concept of delivery and developing a positive attitude towards vaginal delivery. This could be achieved through effective public training schedules.
  • Saghar Samimi Sede, Fateme Davari Tanha, Mehrnaz Valadan, Zeinab Modaressi
    Objective
    To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy.
    Materials And Methods
    Ninety female patients (American Society of Anesthesiologists (ASA) physical status I-II), scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS) was used to assess pain intensity at rest.
    Results
    In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg) compared to diclofenac group (16.8± 2.8 mg) and placebo group (20.1± 3.6 mg) (p<0.05). VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p<0.05). There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p<0.05).
    Conclusion
    According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone.
    Keywords: Postoperative Pain, Rectal Diclofenac, Paracetamol
  • Mehrnaz Valadan, Fatemeh Davari Tanha, Azam Sepahi
    Objective
    The aim of this study was to investigate prenatal and obstetrical outcome in mothers aged 40 years or older.
    Materials And Methods
    A prospective comparative study was conducted for the women aged 40 years and over who delivered at 20 week''s gestation or beyond from January 2004 to December 2005 at four Hospitals of Tehran University of Medical Sciences. For comparison, a control group of patients who were 20-29 years of age was considered.
    Results
    There were statistically significant increases in the rates of gestational diabetes, preeclampsia, caesarean section, breech presentation and stillbirth in women 40 years of age or older.
    Conclusion
    There is a need to offer older women special counseling both before and after conception so that they become informed of the increased risks involved.
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