مجله زنان مامائی و نازائی ایران
سال بیستم شماره 12 (اسفند 1396)

Placenta previa is a common cause of third-trimester hemorrhage. This complication is associated with feto-maternal complications and requires special care since it results in high-risk pregnancy. The site of placental implantation can affect the feto-maternal outcomes, such as postpartum hemorrhage, need for blood transfusion, and cesarean hysterectomy, in the females with placenta previa. Regarding this, the aim of the present study was to compare the feto-maternal outcomes of placenta previa between the pregnant women with anterior placenta previa and those with posterior placenta previa.
This descriptive-analytic study was conducted on 54 patients undergoing pregnancy termination due to placenta previa diagnosed based on ultrasound evidence at Imam Reza Hospital affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran, within 2008-2014. The maternal and fetal variables were extracted from the patient's medical records by means of a checklist. Data analysis was performed in SPSS (version 20) using Chi-square test, and independent t-test, Mann Whitney U test, and Fisher's exact test. P-value less than 0.05 was considered statistically significant.
The abnormal adherence of placenta was more frequent in the females with anterior placenta previa than in those with posterior placenta previa. Furthermore, 12 (44.4%) and 5 (18.5%) out of 27 cases required hysterectomy in the anterior and posterior groups, respectively. Therefore, the two groups showed a significant difference in this regard (P=0.04). In addition, there was a significant difference between the two groups in terms of the need for blood transfusion (P=0.021). Accordingly, 13 (48.1%) and 5 (18.5%) patients needed blood transfusion in the anterior and posterior groups, respectively. However, no significant difference was observed between the two study groups considering the birth weight (P=0.949) and Apgar score (P=0.623).
As the findings of this study indicated, there was a significant difference between the women with anterior placenta previa and those with posterior placenta previa in terms of the need for hysterectomy and blood transfusion. Consequently, it is recommended to consider the location of placenta prior to the adoption of preoperative strategies for the patients with placenta previa.

Hemorrhage and drop in hemoglobin (Hb) and hematocrit (Hct) levels are the major complications of hysterectomy. This study was conducted to compare the effect of different anesthetic techniques on post-operative Hb and Hct levels following abdominal hysterectomy.
This randomized clinical trial was performed on 100 women aged between 35 and 70 years old in 2013. They were classified as classes I and II according to the American Society of Anesthesiology physical status classification and were candidates for abdominal hysterectomy due to benign causes. The patients were assigned into two groups of spinal and general anesthesia (50 patients per group). The pre- and 24 h post-operative levels of Hb and Hct and systolic and diastolic blood pressure during surgery were recorded 5, 10, 15, 20, 25, 30, 40, 50, and 60 min after the onset of general and spinal anesthesia. Data analysis was performed using t-test, Mann-Whitney U and Chi-squared tests by SPSS software, version 22. P-value less than 0.05 was considered statistically significant.
There was no significant different regarding age, the duration of anesthesia and surgery, mean pre-operative levels of Hb and Hct (P>0.05). The mean post-operative levels of Hb were 9.64±1.12 mg/dl and 10.24±1.11 mg/dl with general and spinal anesthesia, respectively. Moreover, the post-operative levels of Hct were 29.83±3.21% and 32.45±3.05% with the spinal and general anesthesia, respectively (P=0.009 and P The decrease in the post-operative levels of Hb and Hct in the patients who underwent general anesthesia was greater than those who underwent spinal anesthesia.

Hypocalcemia is a common condition in pregnancy. Approximately 20-30 g maternal calcium is actively transferred to the fetus during pregnancy for fetal skeletal mineralization. The aim of this study was to determine the association of pregnancy hypocalcemia with neonatal growth indices.
This cohort study was conducted on 112 pregnant women with the gestational age of 22-26 weeks in 2016. Calcium, albumin, 25(OH)D, and urinary calcium/creatinine ratio were measured for all participants. Hypocalcemia was defined as corrected serum calcium level of Out of the 112 subjects, 35 (31.2%) cases had hypocalcemia. The mean 25(OH)D, calcium/creatinine ratio, and neonatal growth indices were not significantly different between the normocalcemic and hypocalcemic groups (P>0.05). Furthermore, neonatal growth indices were not significantly different in the maternal calcium quartiles. The two groups showed no significant difference in terms of the adjusted mean of neonatal growth indices (P>0.05).
According to the findings of the present study, hypocalcemia was a prevalent condition in pregnancy; however, this condition exerted no adverse effects on neonatal growth indices.

Regular exercise with suitable intensity is associated with positive effects and several physiological adaptations. Prolonged and high-intensity exercise is reported to cause some menstrual dysfunction. On the other hand, the use of herbal medicine for the treatment of dysmenorrhea pain is on an increasing trend. Regarding this, the aim of the present study was to assess the effects of eight-week high-intensity interval training (HIIT) and ginger supplementation on primary dysmenorrhea in nonathletic girls.
This quasi-experimental study was conducted on 45 nonathletic freshman students of Mahabad Islamic Azad University, Mahabad, Iran, within the academic year of 2016-2017. The study population was randomly assigned into three groups of training舩, trainingꙖ鱹, and control. The training舩 group was daily administered with four capsules (250 mg) of ginger for 3 days initiated from the beginning of menstruation. The trainingꙖ鱹 group received placebo capsules with the same instruction. The training舩 and trainingꙖ鱹 groups participated in HIIT with 85-95% of maximum heart rate intensity, held three sessions a week for eight weeks. The severity and duration of pain dysmenorrhea were estimated in three cycles, namely first, second, and third months of menstruation, using validated tools. Data analysis was performed in SPSS (version 20) using repeated measures ANCOVA, Bonferroni post hoc test, and Levene's test. P-value less than 0.05 was considered statistically significant.
The results of the present study revealed no significant difference between the groups in terms of the severity and duration of dysmenorrhea in different menstrual cycles (P0.05).
As the results indicated, eight weeks of HIIT with ginger supplementation had no significant effect on primary dysmenorrhea in nonathletic girls. Therefore, further empirical studies are needed in order to determine the effect of this training method and herbal supplementation on dysmenorrhea.

Physiological and hormonal changes during pregnancy affect the body and cause low back pain. This pain render pregnant women incapacitated and affect their health. In this study, we determined the frequency of back pain in each trimester of pregnancy and investigated its contributing factors.
This cross-sectional study was carried out in 2015 among 514 pregnant women who attended the prenatal clinic of Shaheed Mostafa Khomeini, Tehran, Iran. The data collection tools consisted of a maternal demographic information checklist and a questionnaire for assessing the status and severity of back pain. To analyze the data, Chi-squared test, independent t-test, and multivariate logistic regression were run in SPSS, version 18. P-value less than 0.05 was considered statistically significant.
Out of the 514 women, 355 (66.9%) had low back pain, 100 (24.09%) of whom had this pain before pregnancy. Back pain was more prevalent in the third trimester and there was a significant difference in the prevalence of low back pain among the trimesters (P=0.03). Based on the multivariate logistic regression analysis, maternal age, gestational age, and duration of standing were significantly linked to low back pain (P0.05).
There is a high risk of low back pain during pregnancy,and among young mothers, those who stand for long durations are more prone to this problem.

Pre-eclampsia is a serious problem of pregnancy that is associated with proteinuria and increased blood pressure in the second half of pregnancy. It is one of the three leading causes of maternal and fetal mortality. Dysregulated expression of miRNAs related to angiogenesis plays a role in pre-eclampsia and can be considered in the diagnosis of this complication. In the current study, we sought to investigate the expression of Drosha, Dicer, and DGCR8 genes in patients with preeclampsia.
This descriptive-analytic study was carried out among 84 healthy non-pregnant and pregnant women who visited the Women’s Clinic of Alavi Hospital during 2014-2015. The subjects were randomly divided into three groups of 28 each, namely pregnant women with pre-eclampsia, healthy pregnant women, and healthy non-pregnant women (control). Demographic, clinical, and anthropometric data such as age, age of pregnancy, weight, height, and body mass index (BMI) were recorded for all the patients. Then, blood samples were taken from the participants and sent to the research center of Faculty of Medical Sciences for the investigation of the expression rates of Dicer, Drosha, and DGCR8 genes. We also collected delivery outcome information, patient data, and blood test results. The data were analyzed by using descriptive statistics and performing ANOVA, t-test, and Fisher’s exact test in SPSS, version 21.
The levels of DGCR8 protein and Dicer and Drosha enzymes in the pre-eclamptic pregnant women and healthy pregnant women were higher than in the non-pregnant healthy women (control group; P≤0.05). Moreover, the levels of DGCR8 protein and Dicer enzyme were higher in the pregnant mothers with pre-eclampsia than the healthy pregnant women, while the level of Drosha enzyme was lower in the pregnant women with pre-eclampsia relative to the healthy pregnant women.
The levels of Dicer and Drosha enzymes and DGCR8 protein were higher in the healthy and pre-eclamptic pregnant women compare to the healthy controls. Thereby, these molecules can be considered in both diagnosis, as potential indicator molecules of pre-eclampsia, and treatment.

Primary dysmenorrhea is one of the most common gynecologic problems in women. Aromatherapy is one of the non-pharmacological methods in the treatment of primary dysmenorrhea. This research was performed to study the effects of aromatherapy massage with scented geranium oil on the pain intensity in primary dysmenorrhea.
This randomized clinical trial was conducted in 2017. 90 students of Neyshabour University of Medical Sciences who had primary dysmenorrhea were randomly allocated to three groups. Subjects in the intervention group were massaged with scented geranium oil 5% and in placebo group; the same procedure was performed using sweet almond oil on the symphysis pubis region for 15 minutes. The intervention and placebo groups received the massage on the first day of menstruation in two consecutive cycles. The control group received no intervention and the severity of their pain was recorded in each cycle. The pain intensity was measured before, immediately after and 24 hours after the treatment using visual analogue scale. SPSS software (version 19) was used for data analysis and p value less than 0.05 was considered significant.
Findings: There was no statistically significant difference in pain intensity between three groups in the menstrual cycle before the initiation of study. There was no significant difference in pain intensity before intervention in the first and second menstrual cycle before the intervention. There was a significant difference in pain intensity between three groups immediately after and 24 hours after the intervention in the first and second menstrual cycles ( P Aromatherapy massage with geranium essence can be used as a non-pharmacological method to reduce the pain of primary dysmenorrhea.

The incidence of vaginal candidiasis and the number of treatment resistant cases are high; moreover, chemical medications are associated with serious adverse effects. Therefore, the use of herbal medicines is taken into consideration because they do not affect the normal vaginal flora and have low side effects. In vitro studies confirmed the favorable antifungal effects of coconut oil on various species of Candida, especially on the resistant species such as Candida glabrata and Candida tropicalis. This study was conducted to compare the effect of vaginally administered coconut oil and clotrimazole on Candida species.
This triple-blind clinical trial was conducted on 71 patients, who were assigned into two groups of coconut oil (35 individuals) and clotrimazole (36 individuals) in Mashhad, Iran, 2017. Data were collected using demographic data form and observation record sheets. The patients received the medicines by applicator for a week. Thereafter, physical examination and re-cultivation were carried out; and the success in the treatment included a negative culture and symptom relief. Data analysis was performed using independent samples t-test, Fisher’s exact and Chi-squared tests with the help of SPSS software, version 19. P-value less than 0.05 was considered statistically significant.
In this study, there was no significant difference between the groups in terms of the frequency of Candida albicans, glabrata, and tropicalis at the pre- and post-intervention phases (P=0.98, P=0.34, P=0.73, respectively). Regarding the success in the treatment, no significant difference was observed between the effects of vaginally administered coconut oil and clotrimazole on various species of Candida (P>0.05).
Considering the beneficial effects of vaginally administered coconut oil on candidiasis, it is recommended to use it to treat this disorder.

Continuous labor support by a doula is one of the most important ways to improve the delivery process. Regarding this, the present study aimed to compare delivery outcomes between two groups receiving continuous support delivered by doula and those having no such support.
In this descriptive-analytical study, the outcomes of 220 deliveries were evaluated in two groups of mothers living in Bandar Abbas, Iran, in 2016. In the supportive group, the mothers were provided with emotional, physical, and informational supports in addition to routine care. In the non-supportive group, only routine labor care was delivered. Childbirth outcomes, including the duration of active phase of labor, oxytocin consumption, severity of pain, type of delivery, perineal rupture, Apgar score, skin-to-skin contact, and the beginning of breastfeeding, were recorded using a researcher-made observation checklist. The data were analyzed in SPSS (version 20) using t-test, Chi-square test, Mann-Whitney U test, and two-way logistic regression. P-value less than 0.0 was considered statistically significant.
According to the results, there was a significant difference between the two study groups in terms of the skin-to-skin contact (P As the findings indicated, the provision of mothers with continuous support during labor and delivery by the doula improved skin-to-skin contact and breastfeeding the first hour of birth.

Maternal nipple pain is one of the common complaints on the first few days post birth, which is the second cause of early discontinuation of breastfeeding. Lanolin is the recommended treatment for relieving the nipple pain. In addition, purslane has analgesic and anti-inflammatory effects due to containing flavonoids and saponins. Regarding this, the present study was conducted with the aim of determining the effect of purslane cream and lanolin on nipple pain among the breastfeeding women.
Material and This double-blind, randomized controlled trial was conducted on 86 breastfeeding women suffering from nipple pain in Mashhad, Iran, in 2016. The samples were randomly assigned into two groups of purslane cream and lanolin (n=43 cases in each group). Both groups were trained about the correct method of breastfeeding and using cream. The nipple pain scores were measured and recorded by the researcher before the treatment, as well as 3 and 8 days post-intervention using the numeric pain scale. Data analysis was performed in SPSS software (version 22) using the t-test, Fisher's exact test, Chi-square test, and Wilcoxon test. P-value less than 0.05 was considered statistically significant.
According to the results, the two groups were comparable before the intervention in terms of pain severity. The two groups showed a significant difference in pain severity on days 3 and 8 post-intervention, compared to the pre-intervention stage; accordingly, the severity of pain was decreased in both groups (P As the findings of the present study indicated, purslane cream was more effective in the treatment of nipple pain than lanolin.

Anxiety is a common problem among pregnant women, which has a negative impact on mother and neonate. Midwives are responsible for providing advice and giving care to mothers during pregnancy, delivery, and postpartum. This study was conducted to evaluate the effect of individual counseling program by a midwife on anxiety during pregnancy in nulliparous women.
This clinical trial was conducted among 90 primiparous women with the gestational ages of 28 to 30 weeks referred to healthcare centers of Mashhad, Iran, during 2015-2016. The participants were randomly assigned into two groups of intervention and control (45 individuals per group). The subjects in the intervention group received three sessions (once every two weeks) of the individual counseling program based on the content of the consultation model in the Gamble's study, and the control group got routine care. Data were collected using the Beck Anxiety Inventory and demographic characteristics form. The level of anxiety was measured at pre-intervention phase during the gestational ages of 34 to 36 weeks. Data analysis was performed using Chi-squared test and t-test with the help of SPSS software, version 16. P-value less than 0.05 was considered statistically significant.
The mean scores of anxiety in the intervention and control groups were 6.355±3.960 and 9.822±5.420 during the gestational ages of 34-36 weeks, respectively, which represented a significant difference between the groups (P The individual counseling program provided by midwife during pregnancy resulted in reduced level of anxiety in the nulliparous women.

Introduction and Trichomonas vaginitis is the most common non-viral disease transmitted through sexual contact. Metronidazole is the most effective medication that has the same adverse effects as other synthetic drugs. Since medicinal plants have less side effects and more popularity among most people, this study was conducted to review the effects of anti-trichomonas vaginalis plants and their therapeutic effects.
Persian and English databases, including PubMed, Medline, Scopus, Google Scholar, SID, IranMedex, and Magiran were searched for articles published between 1976 and 2017 using keywords such as ‘Trichomonas vaginalis’, ‘complementary therapies’ and ‘medicinal plants’ and their Persian equivalents. All the relevant in vivo and in vitro trials were included in the study. Overall, 120 papers were retrieved, 25 of which were critically reviewed.
The articles reviewed in this study showed that some herbal compounds (e.g., Zataria multiflora Boiss, Allium staivum, Lavandula stoechas, Eucalyptus, and Myrtus communis)are effective in inhibiting the growth of Trichomonas vaginalis, but further human studies are needed to apply them to the treatment of Trichomonas vaginitis.
In spite of the beneficial effects of medicinal herbs on the treatment of Trichomonas vaginitis, since most of the studies were in vitro, the application of these plants requires more in vivo studies to take an effective step towards recognizing natural, low-cost, low-risk, and more accessible treatments.Therefore, the results of this study should be used with caution.

Puerperium infections are the most common types of infection in the post-partum period. Endometritis is 10-20 times more common after cesarean section than vaginal delivery. Symptoms such as fever, vaginal discharge, and abdominal pain are common, but signs and symptoms like vaginal discharge associated with uterine decidual cast and its protrusion into the vaginal canal are rare that can be misdiagnosed as intestinal tissue and omentum. In this article, we report two cases of endometritis following cesarean section with unusual manifestations including mass in the uterine cavity and mass protrusion from the vaginal area due to puerpurial endometritis and decidual casts.
Case report: In this article, we report two cases of puerperium infection with uncommon signs including uterine mass and mass protrusion from the cervix with vaginal discharge. In the first case, because of delayed diagnosis and treatment, the patient underwent abdominal hysterectomy due to uterine rupture and omentum protrusion. However, in the second case, because of correct diagnosis and extensive antibiotic therapy and curettage, the uterus was preserved.
After vaginal delivery or cesarean section, patients with signs and symptoms of endometritis should undergo antibiotic therapy. In case endometritis persists, sonography should be performed, and if mass in the uterine cavity is observed, curettage should be used. This is because correct and appropriate diagnosis and treatment prevent disease progression and emergency conditions like sepsis, and on rare occasions, vaginal mass protrusion, and thereby, invasive procedures. In addition, in cases of mass in the uterine cavity or mass protrusion from the vaginal area after vaginal delivery or cesarean section, decidual cast should be considered as a differential diagnosis.