فهرست مطالب somayeh moukhah

Premature ovarian insufficiency (POI) occurs in women before the age of 40. Although the outcomes of POI in women include its adverse effects on general health, sexual-reproductive health, and finally reduced quality of life. One of the first adverse consequences is a threat to female identity of the patients. The purpose of the present study was to investigate the perception and experience of women with POI about female identity.

In this qualitative study, interviews were conducted with 15 women having POI. Data included participants' recorded voices that were analyzed using conventional content analysis.

After content analysis of the interviews with a focus on the perception and experience of women with POI about female identity, four categories emerged; they included the failure in realization of motherhood dream, the importance of menstruation, construction of female identity, and attempts to normalize the situation.

After analyzing the emerged categories obtained by interviewing with POI women, it seems that physicians need to pay special attention to the distortion of the female identity of these patients and educate the medical team about the importance of the effect of treatment on improving their emotional health.

Uterine arteriovenous malformation (UAVM) is a rare vascular condition in reproductive age presented mostly with bleeding. Although this malformation is infrequent, it is potentially life-threatening. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method.

Case:

 The case is a 30-yr-old woman with a history of eight-yr infertility.following intrauterine insemination treatment, she had a molar pregnancy. Despite methotrexate treatment, there was persistent vaginal bleeding. Assessment of this patient was done with transvaginal sonography and color Doppler. According to suspicious appearances, angiography was planned for confirmation of UAVM.

UAVM is one of the molar pregnancy complications. The first step for diagnosis of UAVM is transvaginal ultrasonography and color Doppler assessment. Embolization is the best treatment for women who intend to preserve fertility.

Currently vitamin D deficiency is one of the common health problems. The consequences of the lack of vitamin Don women's reproductive health necessarily lead to extensive studies . Considering that the high prevalence of vitamin D deficiency and its negative effects on women's health and particularly fertile women, the present study aimed to investigate the effect of 25-hydroxyvitamin D on fertility, for the first time.
In current study, 150 papers were achieved through electronic searche in the database Iranmedex, SID, google scholar, ScienceDirect, ResearchGate, PubMed up to 2015. 70 articles were reviewed from 1991 to 2014 and the relationship between vitamin D and women's fertility was investigated .
published articles have only addressed the prevalence of vitamin D deficiency in Iran . The results of other studies showing an association between vitamin D deficiency and women’s reproductive health .Vitamin D deficiency was affected by increasing the levels of FSH, and its influence anti-Mullerian hormone levels leading to premature ovarian failure, and ultimately reduce the fertility of women.
Considering the importance of the role of vitamin D in female reproduction , and the adverse effects of vitamin D deficiency on women’s fertility, especially on ovarian reserves, it is essential to prescribe vitamin D supplementation in women in women.

Intrauterine devices (IUDs) have been used as a commonly convenient, efficient, relatively safe, and inexpensive method of contraception worldwide. Contraceptive efficacy is related to intrauterine location of IUD. Insertion of IUD without prior pelvic evaluation by ultrasound is a predisposing factor for unsuitable placement and may reduce contraception effectiveness.
We present a patient who referred to Royan institute in Tehran (Iran) with IUD displacement due to an inappropriate insertion of the device into her recent cesarean section scar.
IUD displacement into the myometrium could be done in clinics, but advanced laparoscopy is needed for confirmed diagnosis and IUD complication management. Three- dimensional transvaginal ultrasound (3DTVUS) clearly displays the correct position of the IUD in the uterine cavity much better than the two-dimensional transvaginal ultrasound (2DTVUS).

Cervical ripening in labor is one of the most important objects in midwifery. Isosorbide dinitrate (ISDN) is one of the most important agents, which has been proposed for cervical ripening, but there are still controversies regarding its prescription. The present study aimed to assess the effects of vaginal and oral ISDN for preinduction cervical ripening.
In this non-blinded clinical trial, 99 nulliparous women with term or prolonged pregnancy were selected and were randomly divided into two groups by block randomization. The intervention groups included those received vaginal ISDN (n=50, 40 mg, daily) and oral ISDN (n=49, 20 mg, twice daily). Size of ripening was measured by bishop score before treatment and 24 hours after that.
24 hours after treatment, bishop score was significantly increased (P 0.05). Duration of induction to the second phase of delivery was compared in two groups. Although there was not any significant difference between the two groups in terms of shifting time from the active phase to delivery and duration of the second phase (P > 0.05), there was a meaningful difference between two groups in duration from induction to the active phase of delivery (P Prescribing vaginal ISDN for cervical ripening was more effective than oral medication, and it seems to be with minimum side effects.

Cervical ripening for labor induction is one of the most important issues in midwifery. Isosorbide dinitrate (ISDN) is one of the most important choices that have been proposed for cervical ripening, but still there are controversies regarding its prescription. The present study aimed to evaluate the effects of vaginal and oral ISDN compared to the control group for pre-induction cervical ripening.

In this non-blinded clinical trial, 149 nulliparous women with term or prolonged pregnancy were randomly selected and divided into three groups by block randomization. The intervention group included vaginal (50 subjects, 40 mg) and oral (49 subjects, 20 mg) ISDN groups. The third group was the control group (50 subjects) which did not receive any medication. The amount of ripening was given by Bishop score evaluated before taking medication and 24 h after taking it.

After 24 h, Bishop score in vaginal ISDN group significantly increased compared to the oral ISDN and control groups (P < 0.001 for both). Although the increase in Bishop score was lower in the oral ISDN group than in the vaginal group, it had a statistically significant increase in comparison to the control group (P = 0.001). All the three groups were matched regarding pregnancy termination and cesarean causes, and there was no statistically significant difference among the three groups (P > 0.05).

Prescribing vaginal ISDN for cervical ripening was effective, and it can be used with confidence.

Although the risk factors of ectopic pregnancy have been determined in previous studies, the main risk factors of ectopic pregnancy are different in various countries due to different cultural and social characteristics. Determination of main risk factors of ectopic pregnancy leads to a rapid diagnosis and an improvement in strategies for its prevention. The purpose of this study was to determine the main risk factors of ectopic pregnancy in a sample of Iranian women. We designed a case-control study to include 150 cases and 300controls and to compare them by the following factors: socio-demographic characteristics, contraceptive methods, prior tubal surgery, tubal pathology, prior ectopic pregnancy, prior caesarean section, prior abortion, prior infertility, and prior abdominal/pelvic surgery. The case and control groups were significantly similar in term of education and parity. There was an association between ectopic pregnancy and age which was disappeared after controlling for the main risk factors (adjusted OR=2.45, 95% CI: 0.86-6.97). There was no statistically significant relation between ectopic pregnancy and prior tubal surgery, tubal pathology, prior abortion, prior infertility, assisted reproductive technology, and oral contraceptive method (p>0.05). However, there was a significant association between prior ectopic pregnancy, prior tubal ligation, use of intrauterine device, and prior abdominal/pelvic surgery with ectopic pregnancy (p<0.05). The risk of ectopic pregnancy increased with the use of intrauterine device and tubal ligation, whereas decreased with use of oral contraception. This study identified prior ectopic pregnancy, prior tubal ligation, use of intrauterine device, and prior pelvic/abdominal surgery as the main risk factors for ectopic pregnancy in a sample of Iranian women. Our findings can be useful for early diagnosis of ectopic pregnancy and for improvement in strategies of its prevention through medical therapy instead of unnecessarily surgical treatment.

Heavy menstrual bleeding is one of the leading causes of poor quality of life and iron deficiency anemia in women of reproductive age. This study was conducted to investigate the therapeutic effect of tranexamic acid (TA) on menorrhagia.

In this before and after clinical trial, 46 women with menorrhagia were selected and, after a control cycle for evaluation of the volume and duration of primary bleeding, were subjected to tranexamic acid treatment (500mg every 6 hours from day 1 to 5 of bleeding) for 3 consecutive cycles. Data on the duration of bleeding, amount of bleeding (PBAC chart), quality of life (SF-36 and MQ questionnaires), and hemoglobin and ferritin values were checked and compared before and after treatment using SPSS software.

Tranexamic acid reduced mean PBAC score from 242.86 (160.47) in control cycle to 101.50 (72.67) after the third cycle (p<0.001). Hemoglobin increased from 11.85 (0.84) to 13.08 (0.97) g/dl and ferritin increased from 15.9 (20.39) to 22.13 (2.03) ng/dl (p<0.001). Duration of menstrual bleeding decreased from 7.6 (1.23) days to 6.86 (0.84) days (p=0.001). Tranexamic acid reduced mean MQ score from 70.26 (17.64) to 11.64 (6.49) (p<0.0001). Quality of life scores increased in all aspects (except for bodily pain scale) (p<0.001).

TA due to its short course of prescription, fewer side effects, especially on the pattern of bleeding and menstrual cycle, and not having hormonal effects, seems to be an effective drug for menorrhagia in women of reproductive age.

Severe menstrual bleeding is a leading cause of poor quality of life and iron deficiency anemia in reproductive aged women. The aim of this study was to investigate the efficacy and acceptability of long-term use of medroxyprogestrone acetate in menorrhagia management.

In a pre-post trial, 44 eligible women were allocated to long term medroxyprogestrone acetate treatment (for 3 consecutive cycles). Changes in duration and amount of bleeding, quality of life and also hemoglobin and ferritin values were checked out and compared before and after treatment.

Medroxyprogestrone acetate reduced mean PBLAC score from 220.15(±74.99) in control cycle to 108.81(±74.98) in third cycle (p<0.0001). Hemoglobin increased from 12.24(±0.89) to 13.21(±0.88) g/dl and ferritin increased from 13.38(±6.81) to 30.85(±8.51) ng/dl (p<0/0001). Duration of menstrual bleeding decreased from 8.4(±1.47) days to 8.06(±1.53) days (p=0.001). Medroxyprogestrone acetate reduced mean MQ score from 66.46(±13.82) to 14.13(±7.98) (p<0.0001). SF-36 quality of life scores increased in all aspects (except for bodily pain) (p<0.0001).

Our results showed that long term use of MPA is an effective treatment for idiopathic menorrhagia in terms of menstrual blood loss, hematologic indices and quality of life (p<0.05) and observed complications are not significant. This makes long-term MPA a favored drug choice in idiopathic menorrhagia management in premenopausal women.