International Journal of Women’s Health and Reproduction Sciences
Volume:8 Issue: 2, Apr 2020

Early menopause is shown to correlate with an increased rate of cardiovascular diseases with age advancement. Smoking, physical activity, body mass index (BMI), and the socio-economic level are consistently linked with the onset of menopause though there is no consensus on the residential factor. Considering the undesirable relation of menopause with women’s health, the present review sought to identify the correlation between the rural-urban factor and natural menopausal age.

A comprehensive literature search, covering publications from 1984 to 2017, was done using several databases such as MEDLINE, PubMed, and Google scholar. Evidence from 13 research articles was analyzed for a rural-urban difference in natural menopausal age. The search was later expanded to explore correctable confounding factors such as smoking habits, physical activities, and BMI.

Rural women in the Asian region appeared to reach their natural menopausal age earlier than their urban counterparts. This was in contrast with the majority of findings in the non-Asian regions, suggesting a regional variation in the rural-urban difference in natural menopausal age. Based on the findings, earlier menopausal age was related to smoking prevalence and this relationship was consistent in both Asian and non-Asian regions. Similarly, higher physical activity was linked to the early age of natural menopause in both Asian and non-Asian regions. Finally, the results revealed the association between higher BMI and higher menopausal age in the Asian region although this association was not observed in the non-Asian regions.

The rural-urban difference in menopausal age has regional variations with rural Asian women reaching menopause earlier than their urban counterparts, but this association was not replicated in the non-Asian regions. Eventually, this difference was affected by factors such as tobacco smoking, high physical activity, and BMI.

Obesity is considered a worldwide important health problem with continuously increasing prevalence, particularly among postmenopausal women. Weight gain is one of the major concerns of menopause. Understanding the contributing factors to postmenopausal obesity helps to reduce its incidence and thus its associated health complications. The present study aimed to review the role of ghrelin in mediating postmenopausal obesity.

A literature review was done to understand the possible association between ghrelin levels and obesity in postmenopausal women.

It was found that the lack of estrogen during menopause increases the serum ghrelin level. In addition, the results revealed that ghrelin stimulates appetite, changes food preference, and causes an accumulation of visceral fat resulting in weight gain. On the other hand, ghrelin was found to have many protective effects as an anti-inflammatory and a neuroprotective agent.

In general, the ghrelin hormone is a double-edged sword as it mediates the increase of body weight in postmenopausal women. More importantly, it plays a considerable role in protecting postmenopausal women from cardiovascular and neurodegenerative diseases. The selective blockage of appetite-stimulating and metabolic effects of ghrelin may be of a potential prophylactic or therapeutic effect for postmenopausal overweight and obesity

The present systematic review focused on the prevention or treatment of three main types of pelvic floor dysfunctions (PFDs) specifically pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) using physiotherapy and pelvic floor muscle exercises (PFMEs). With regard to the breadth of the problem, there is not much evidence grounded on the best management. The main purpose of this systematic review was to evaluate the effects of physiotherapy and PFMEs on the prevention and treatment of pregnancy-related PFDs; namely, POP, FI, and UI. Therefore, this review incorporated studies comparing the use of physiotherapy and PFMEs with every other existing interventions.

This systematic review and meta-analysis was conducted on randomized-controlled-trial (RCT) articles and quasi-RCT designs through a search in the studies published with no time limits until December 2017 in the databases of PubMed (Medline), Web of Science, Scopus, Embase, Cochrane Library, and ProQuest. The meta-analysis was also applied for data synthesis. Moreover, heterogeneity was assessed using Cochran’s Q test and I2 index.

A total number of 26 RCTs were examined in this review in which the outcome variables were related to POP, UI, and FI prevalence; POP, UI, and FI severity, as well as pelvic floor muscle (PFM) strength and endurance. In most articles, UI prevalence or severity in intervention groups had significantly improved compared with those in controls. The number of studies examining POP and FI was also relatively low. In two studies, FI severity or prevalence in intervention groups had significantly enhanced in comparison with those in control groups; however, FI prevalence in two articles had been reported lower in intervention groups than that in control groups although no significant difference had been observed. There was also no significant improvement in intervention groups in two other studies in this respect. Besides, three articles had not reported traces of improvement in POP, as well as a significant difference between intervention and control groups. Nevertheless, two studies had found a significant improvement in POP in this regard. Based on meta-analysis results for the variable of PFM strength, Cochran’s Q test (P<0.001) and I2 index (90.02) indicated heterogeneity between studies; so, a random-effect meta-analysis was applied to estimate overall effect sizes. The overall mean differences following intervention between the study groups were also equal to 6.94, with a 95% CI (1.36 to 12.52).

It was concluded that physiotherapy and PFMEs might have effects on pregnancy-related UI, but they had not consistently reduced FI severity or prevalence and failed to constantly improve POP

Over the past twenty years, the role of inflammatory, immunologic, and stress oxidative factors in the pathogenesis of endometriosis has been emphasized in the literature. Endometrial induced lesions in the surgical endometriosis model of mice are similar to those observed in women. Therefore, the present study evaluated the effects of vitamin C treatment on the endometriosis mice model. More precisely, it aimed to induce an optimum model of endometriosis using both peritoneal and ovarian approaches and to compare the histological and fertility changes in the first-generation infants of endometriosis induced, sham, and control groups. Finally, the study assessed the influence of vitamin C administration treatment on the induced endometriosis mice model and its first-generation infants.

This experimental study was done in three phases. In the first phase, 32 mice were randomly divided into four groups receiving induced endometriosis through peritoneal approach, induced endometriosis through an ovarian approach, as well as sham and control groups. The histological and fertility characteristics of the first generation of ovarian endometriosis, sham, and control groups were compared in the second phase. Then, the histological and fertility characteristics of those endometriosis induced models receiving vitamin C were compared with the controls, and the first generation of these groups was compared as well.

This experimental study began in April 2017 and will be finished in 2020.

The results of this study improve our knowledge about the mechanisms involved in endometriosis progressions. The results further provide a comprehensive animal model for further research and assess the therapeutic role of antioxidants

Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG. In addition, it has a different oligosaccharide structure compared to the regular hCG and promotes the invasion and differentiation of peripheral cytotrophoblast. This study aimed to measure hyperglycosylated hCG as a predictor in the diagnosis of placenta accreta.

In general, 90 pregnant women were involved in this case-control study among which, 30 ladies (control group) were pregnant within the gestational age of ≥36 weeks with at least one previous caesarean section and a normal sited placenta in transabdominal ultrasound (TAU). The other 60 pregnant women (case group) were within a gestational age of ≥36 weeks at least, one previous caesarean section and placenta previa with or without signs of placenta accreta in TAU. Hyperglycosylated hCG and total hCG were measured in each group and the results of the surgery were followed up.

Hyperglycosylated hCG showed higher serum levels in patients with placenta accreta compared to those with placenta previa and control women. Hyperglycosylated hCG with an optimal cut point of (3) IU/L predicted placenta accreta in pregnant women with 90% specificity, 76.7% sensitivity, and 81.1% accuracy.

The high specificity of the above approach makes it a good diagnostic tool (as a single test) for confirming placenta accreta in clinical settings. When this test is added to our established workup, its high positive predictive value makes it a suitable method within the algorithm of accreta confirmation when there is a high suspicion or insufficient evidence to the diagnosis of placenta accreta.

To compare the effectiveness and outcomes of pregnancy accomplished by in vitro fertilization between micro-dose and standard flare-up, along with antagonist protocols in the treatment of poor responders using POSEIDON (Patient-Oriented Strategies Encompassing Individualized Oocyte Number) criteria for diagnosis.

This prospective study included 114 poor responder Iraqi women undergoing intracytoplasmic sperm injection (ICSI) cycles, who were randomly allocated to 3 groups according to the treatment protocol. Micro-dose (n=38), standard flare-up (n=38) and antagonist (n=38) protocols. High dose gonadotrophins (300-450 IU/day) from day 2 of the cycle until the day of human chorionic gonadotropin (hCG) administration were used in the three groups. The primary outcome measure was the number of retrieved mature oocytes and the secondary outcomes included fertilization, implantation, and pregnancy rates (PRs).

The estradiol level at the day of hCG trigger was higher in women who received a standard flare-up protocol while there was a higher endometrial thickness in the micro-dose group compared to standard flare-up and antagonist groups (P<0.05). In addition, non-statistically significantly higher fertilization, implantation, and PRs with less cancellation rates were observed in the micro-dose group.

The micro-dose protocol in the poor responder improved pregnancy, fertilization, and implantation rates while reducing the cancellation rate compared to standard flare-up and antagonist protocols although the result represented no statistical significance.

The present study attempted to provide a clear view of gestational trophoblastic neoplasia (GTN) with the focus on resistance to treatment approaches in Iran.

This retrospective cohort study reviewed the medical records of 272 patients with the definitive diagnosis of GTN referring to Imam Khomeini hospital in Tehran during 2007-2017.

The mean age of participants was 29.19 ± 7.46 years. The abnormal uterine bleeding (AUB) was the most common clinical manifestation in 64.3% of patients. Regarding the risk scoring condition according to the World Health Organization criteria, 77.6%, 9.1%, and 13.3% were categorized as low-, intermediate-, and high-risk cases. Single therapy with methotrexate was used in 22.8% of patients and actinomycin-D was planned for 42.3% whereas 11.0% and 1.5% were considered for treatment with the EMA-CO (Etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) and EMA-EP (Etoposide methotrexate and actinomycin-D/ etoposide and cisplatin) regimens, respectively. Good response to methotrexate was 66.7% but it was 83.6% in the ACT group (P = 0.001). The resistance to single-agent chemotherapy in low- and intermediate-risk groups was 16% and 92%, respectively. In addition, 20.2% of patients in stage one had tumor invasion pattern in the uterus in pretreatment Doppler ultrasonography, but 52% and 30% had resistance to chemotherapy treatment in invasive and noninvasive groups, respectively (P = 0.008).

In general, due to the high resistance of the intermediate-risk subgroup to a single therapy, a combination therapy may be more useful to treat this disorder. The close association between tumor invasion pattern in the uterus in Doppler ultrasonography and drug resistance can be considered as a new criterion for tumor risk scoring

Urinary tract infections (UTIs) are the most common type of infection during pregnancy, which cause serious complications for the mother and baby. The present study was conducted to investigate the relationship between sexual and genital hygiene habits and UTIs in pregnant women.

This case-control study was conducted on 187 pregnant women including 97 pregnant women with symptomatic bacteriuria (case) and 90 healthy pregnant women (control). Controls were frequency matched with the cases with respect to the number of pregnancy and trimesters of pregnancy. Both groups were compared for the presence of UTI. Finally, the binary multivariate unconditional logistic regression approach was used to evaluate the association between UTI and the confounding variables.

The results of this study showed a significant association between UTI in pregnancy and sexual and genital hygiene habits (P<0.05). Based on the binary multivariate logistic regression analysis, attributable risks for UTI included having sexual intercourse >3 times/week (adjusted odds ratio [AOR] =3.68, 95% CI = 2.09-5.41, P=0.001), changing the underwear per week (AOR =1.39, 95% CI=1-1.76, P=0.012), not voiding post-coitus (AOR=2.01, 95% CI=1.34-2.69, P=0.01), washing genitalia from back to the front (AOR=1.96, 95% CI=1.06-2.78, P=0.01), and not washing genitals pre-coitus by the husband (AOR=1.20, 95% CI=0.54-1.9, P=0.024) were among the sexual and hygiene habit variables associated with UTI in pregnant women in this model.

In general, sexual and genital hygiene habits are vital preventive actions for controlling the UTI in pregnant women. These actions may lead to UTI complications and a preterm birth reduction. Thus, informing spouses about these practices is highly suggested.

To determine the effect of nimodipine on premature luteinizing hormone (LH) surge in women undergoing intrauterine insemination (IUI). Patients and

Fifty-six infertile women participated in this randomized clinical trial after referring to Mahdiyeh hospital, Tehran, Iran and undergoing IUI treatment in 2017. Participants were randomly divided into nimodipine (n=34) and placebo (n=22) groups. The demographic and clinical profile of women were collected using a predesigned checklist. In the nimodipine group, 30 mg tablets were given to patients three times daily for 2 days. Finally, the serum levels of LH and estradiol were measured before and after the intervention.

Based on the results, the LH surge was observed in 8 (34.8%) women in the placebo group (P=0.04) while it was not detected in 29 (78.4%) women in the nimodipine group. There were no statistical differences in the serum levels of estradiol and LH between the 2 groups before the intervention. The serum levels of estradiol in both groups increased after intervention although this increase was not significant. Eventually, no statistical difference was found between the 2 groups in terms of fertility rate.

In general, nimodipine can significantly reduce premature LH surge in patients undergoing IUI compared to the placebo group.

This study was conducted to evaluate the importance of different sonographic findings in the detection of the morbidly adherent placenta (MAP) among pregnant women and then to assess the correlation between delivery complications and ultrasonographic findings.

This analytical and prospective study was conducted on 150 pregnant women with a previous history of a cesarean section from 2015 to 2017. The sonographic findings included the location of the placenta, retroplacental aliasing, bulging toward the bladder, lacuna, and the lack of sonolucent area behind the placenta. Finally, these patients were followed until delivery and their complications were assessed as well.

Of 150 previous cesarean sectioned patients, 101 (67.3%) cases had not sonographic findings of MAP. No morbidity was found in those with no sonographic findings of MAP. Fifty-nine pregnant mothers had the sonographic criteria of MAP prior to delivery, of whom 39 (80%) patients had MAP during the cesarean section. In 39 patients with confirmed MAP, 27 cases underwent a hysterectomy and 12 received special procedures for uterus reservation. In addition, 8 cases had bladder rupture, 25 cases experienced ICU hospitalization, and 33 cases needed a blood transfusion. Of these 39 confirmed MAP, 31 (79.48%) and 8 patients (20.51%) had previa and an anterior placenta without previa, respectively. Finally, no mortality was reported in the current study.

In general, the most important sonographic factors on predicting MAP were the location of placenta, the aliasing and bulging while lacuna and the lack of sonolucent area had less value. The results demonstrated 93%, 100%, 90%, 79.59%, and 100% accuracy, sensitivity, specificity, as well as positive and negative predictive values for the prediction of MAP by ultrasonography, respectively

Trichomonas infection is prevalent in the United States and a metronidazole oral tablet is the medication of choice for treating this infection. Based on various side-effects of oral or vaginal metronidazole and the increase in microbial resistance against chemical antibiotics, the use of herbal medicine with fewer side-effects seems to be essential. Laboratory experiments indicate the strong anti-microbial effects of Prangos ferulacea (PF) medicinal herb. However, no clinical trial has focused on its anti-microbial effects in humans. Thus, the present study aimed to determine the effects of PF vaginal cream on accelerating Trichomonas vaginalis infection (TVI) recovery.

The present randomized clinical trial was conducted on 80 non-pregnant women visiting the healthcare centers affiliated with Lorestan University of Medical Sciences, Iran, in 2018. Trichomonas infection was diagnosed based on patient complaints, clinical observations, as well as wet mount and stained microscopic tests. The women were randomly divided into two groups of 40 each. One group received oral metronidazole plus PF vaginal cream while the other received oral metronidazole plus placebo vaginal cream for 7 days. Clinical observations, along with wet mount and stained microscopic tests were performed during 7 days following the treatment. Finally, data were analyzed using independent-samples t test, as well as chi-square, Fisher exact, Mann-Whitney U, and McNemar tests at the significance level of P<0.05.

Based on the results, the response to treatment with oral metronidazole plus PF vaginal cream was 92.50 based on patient complaints. More precisely, 86.25% was based on clinical criteria (i.e., strawberry cervix, foamy greenish-yellow vaginal discharge, pH ≥4.5, and positive amine test) and 85% was related to the microscopic criteria of wet mount (x40) and polymorphonuclear leukocytes (x100). In addition, the response to treatment with oral metronidazole and placebo vaginal cream was 91.25%, 83.12%, and 80% based on the patient complaint, clinical criteria, and microscopic criteria, respectively. Eventually, the analysis of the patient complaint, clinical criteria, and microscopic criteria in each group revealed a significant difference before and after the treatment (P<0.001)

The results of this study showed that the PF herbal vaginal cream can be used for the treatment of TVI as an effective treatment along with oral metronidazole

Polycystic ovary syndrome (PCOS) is the most common cause of infertility in women. In addition, the risk of type2 diabetes mellitus (T2DM), hyperinsulinemia, and insulin resistance is higher among women with PCOS. Psyllium can reduce the levels of fasting blood sugar (FBS), insulin resistance, and lipid profile. Thus, the present study aimed to evaluate the effect of psyllium supplementation on insulin resistance and the lipid profile in non-diabetic women with PCOS.

In this randomized double-blind placebo-controlled trial, 54 eligible non-diabetic women with PCOS aged 18-45 were recruited from an endocrinology clinic and divided into 2 groups based on their body mass index (BMI) through stratified-block randomization. Participants in intervention and placebo groups received 5 g of psyllium or cellulose microcrystalline twice a day for 8 weeks. Fasting insulin, FBS, and insulin resistance indicators including HOMA1-IR, HOMA2-IR, along with quantitative insulin sensitivity check index (QUICKI) and the lipid profile were evaluated before and after the intervention.

In the psyllium group, the FBS, fasting insulin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), HOMA1-IR, and HOMA2-IR indicators decreased significantly (P<0.05) after 8 weeks, but the changes were not significant in the placebo group. The mean changes in LDL-C (0.28±0.58 and 0.11±0.67 in intervention and placebo groups, respectively, P=0.036) and QUICKI (0.01±0.03 and 0.02±0.06 in intervention and placebo groups, respectively, P=0.044) were significant between the two groups from the baseline.

Psyllium supplementation decreased FBS, fasting insulin, and the lipid profile while improving insulin resistance in non-diabetic women with PCOS.

Preterm birth and admission to the neonatal intensive care unit (NICU) would disrupt mother-infant attachment. Neurodevelopmental care training and support of family programs are essential for the family of such infants. The purpose of this study was to investigate the effect of neurodevelopmental care training program for mothers with preterm infants on mother-infant attachment at one month’s age.

Study population included all the mothers of preterm infants born in the hospitals of Tehran in 2018. The research was designed as a multicenter cluster clinical trial and four hospitals were randomly selected and divided into intervention and control groups. Before the intervention, the mother-infant attachment was measured by the Maternal-Postnatal Attachment Scale (MPAS). The mothers in the intervention group received a 12-session preterm infant neurodevelopmental care training program while the control group only received the routine care in the unit. Finally, the mother-infant attachment was re-measured in both groups at the one month corrected age.

No significant difference was observed in the attachment score before and after the intervention in the control group but the mother-infant attachment score was significantly different in the intervention group (57.75±11.09 vs. 78.27±4.54).

The neurodevelopmental care training program was effective and increased the mother-infant attachment rate

The ectopic pregnancy in the cesarean section (CS) scar (CSP) is one of the potentially dangerous and late complications of CS. The current study aimed to evaluate the therapeutic approaches in managing CS scar ectopic pregnancy.

This cross-sectional study was carried out on 63 CSP patients. The treatment approach was considered based on the shape and nature of the gestational sac (GS) during ultrasound evolutions. Patients’ demographic data, clinical manifestations, and systemic drug treatment (methotrexate, MTX), as well as the type of surgery, hospitalization times, and treatment-related complications were evaluated, followed by comparing the treatment efficacy in different approaches based on the human chorionic gonadotropin (hCG) resolution time.

The mean age of the subjects was 34.2±5.1 years (within the range of 22-44 years) and the median of B-hCG serum levels at diagnosis was 2319 IU. The vaginal bleeding and abdominal pain (27 [42.9%]) were the most common complaints, followed by a delayed menstrual cycle (8 [12.7%]). The majority of patients were subjected to surgical treatment and 29 cases (46%) were treated by medical approaches. The median time to B-hCG resolution was 42 days. The Cox proportional hazards model showed the significant effect of the treatment approach on time to B-hCG resolution (χ2 =37.78, df=4, P<0.0001). Finally, the MTX plus surgery was the most effective treatment approach (OR=10.56, P<0.0001) in managing CSP patients.

Our findings in line with previous studies showed the superiority of the surgical approach alone or in combination with medical treatments compared to medical approaches alone.

Foeniculum vulgare due to phytoestrogens is important in the treatment of female sexual dysfunction including infertility. Accordingly, this study was conducted to investigate the effect of the F. vulgare seed extract on the fertility results of assisted reproductive technology (ART) in women with a poor ovarian response (POR).

In this before-after intervention, 19 infertile women with POR were enrolled by a convenience sampling method. T h e amounts of luteinizing hormone ( LH) and follicle-stimulating hormone (FSH), ovarian ultrasound volume, the number of preantral follicles, and the size of the prominent ovary were measured before treatment with F. vulgare. Then, patients were treated with F. vulgare for two months, followed by initiating the in vitro fertilization (IVF) cycle. The number of embryos transferred in previous and current cycles was investigated after IVF. Finally, the data were analyzed in SPSS 16.

There was a significant difference in the serum LH level (P=0.002), LH/FSH (P=0.049), the number of follicles and ovules (P=0.003), endometrial thickness (P=0.04), and ovarian volume (P=0.03) between before and after treatment with F. vulgare. Moreover, a significant difference regarding the decreased number of required days for induction was observed between before and after treatment with F. vulgare (P=0.022).

In general, the use of F. vulgare had positive effects on improving t h e quality of oocytes and female fertility indices in women with POR

The fear of childbirth (FOC) is a common problem in women’s lives. Several interventions were carried out to reduce the fear of delivery during pregnancy. Despite these interventions, the increase in cesarean statistics indicates that routine interventions are not effective in controlling the FOC. Accordingly, the present study investigated the effect of peer education on the degree of FOC in pregnant women.

This clinical trial was performed on 108 low-risk pregnant women aged 18-35 years old referring to community health centers of Gonabad University of Medical Sciences. The participants were randomly assigned to peer education, discussion, and control groups using block randomization (36 in each group). The peer education and discussion groups included four 2-hour sessions for 4 weeks and a training booklet. In peer education and discussion groups, the training was done by trained counterparts and a specialist, respectively. Finally, the data were analyzed using SPSS software through ANOVA and chi-square tests.

The results showed a significant difference between mean scores of the FOC in the 3 groups after the intervention (P=0.007). In addition, the Scheffe test showed a significant difference between peer education and the discussion groups (P=0.013). However, after 4 weeks of intervention, no significant difference was observed in the choice of delivery type in the 3 groups (P=0.122).

In general, the interventional therapy program of peer education is effective in decreasing the FOC in pregnant women

Attachment can be described as a powerful bond between two individuals, in this case, between the mother and child. This process is started during pregnancy and completed after childbearing. Thus, delivery time, as a turning point between two stages of attachment is very important. Accordingly, the present study aimed to investigate the probable relations between the mother to child attachment and the mode of delivery.

In this descriptive-analytical study, 260 pregnant women were included based on specific inclusion criteria, who were in the age range of 15-45 years old and the gestational age between 37 to 42 weeks and were the candidate for physiological delivery or cesarean section. After obtaining the constant written form, the demographic information questionnaire was handed to the participants. One hour after delivery, the attachment questionnaire was completed by the researcher in the postpartum ward. Finally, the Spielberg anxiety inventory for each of the samples was completed up to one hour after delivery.

Based on the findings, the participants of the physiological delivery group showed more positive attachment behaviors in comparison with the other group. Further, some domains of attachment such as looking, caressing and rocking the cradle in the subtypes of emotional behaviors, as well as contiguous behaviors and caring behaviors significantly differed among the participants (P<0.05). Eventually, the participants experienced higher levels of anxiety in the cesarean delivery group, but the differences between the groups were not significant (P>0.005)

In sum, the results of the current study indicated that mothers who engaged in physiological delivery had higher scores regarding mother to child attachment behaviors. In other words, they are more successful to attach their babies compared to the cesarean group. These results are important because various children are born by a cesarean section and an insecure attachment can have many negative effects for the child.

Intrauterine growth retardation (IUGR) is a major problem in midwifery medicine for which no effective treatment has been established. This problem has been associated with significant morbidity and mortality, as well as perinatal mortality. IUGR could be prevented when the treatment is administered before the occurance of irreversible changes. Hence appropriate methods for early detection and successful treatment deem necessary. The purpose of this study was to investigate the relationship of vitamin D serum level with IUGR in pregnant women.

This nested case-control study was conducted on pregnant women who had referred to Fatemieh hospital during 2016. Each of case and control groups included 130 pregnant women. Serum levels of vitamin D were tested in the blood samples obtained from the participants. At the end of the study, all data were analyzed in SPSS software version 16, and χ2 , Fisher exact and t tests were utilized for data analyses. Level of 0.05 was considered statistically significant.

Our results showed that the average age, body mass index at the beginning of the pregnancy, blood group, employment status, and education level were not significantly different between the two groups. Moreover, average serum levels of vitamin D were about 14.74 ng/L and 25.34 ng/L in the case and control groups, respectively. In those with vitamin D deficiency, the chance of IUGR was higher compared to those who had sufficient levels of vitamin D (6.27 times). Therefore, women who had vitamin D deficiency, had almost 6 times more chance of IUGR incidence compared to the women with adequate levels of vitamin D (P<0.05).

The results verified that serum levels of vitamin D can affect the risk of IUGR; therefore, the incidence of IUGR in babies whose mothers have enough vitamin D level during pregnancy is lower than that in other babies.

Controlling acute pains requires proper diagnosis and prescription of appropriate drugs. Hence, it is quite necessary to develop a systematic checklist containing all factors affecting the acute postoperative pain or any acute pain associated with breast cancer in order to determine the type and dosage of analgesics administered to the patients. The aim of the present study was the design, and psychometric and pilot execution of a checklist for determining the severity of pain, as well as the type and dosage of analgesics administered to patients who underwent breast surgeries.

The present methodological study was conducted in Tabriz from 2018 to 2019. The participants consisted of 340 patients who were selected based on the inclusion and exclusion criteria. The study was carried out in four stages including interviews with patients and the elicitation of experts’ views and opinions, checklist validity assessment, the finalization of the items, and finally, questionnaire reliability assessment. Eventually, the data were statistically analyzed using the inter-cluster correlation test and the Kuder-Richardson Formula 20 (KR-20) in SPSS-19.

In the first stage, a 100-item checklist was designed, which included 4 subscales (i.e., severe, relatively severe pain, moderate, and mild pain). Then, 66 items were eliminated due to the low content validity ratio and content validity index (CVI). The final checklist contained 34 items with an S-CVI/Ave of 0.941, as well as an inter-cluster correlation test (P=0.001) and internal consistency of 0.921.

The final checklist entitled “Pain Diagnosis and Drug Prescription for Breast Cancer Patients” was an appropriate tool for the precise determination of the severity of pain in addition to the type and dosage of postoperative analgesics.

Human papillomaviruses (HPVs) are a group of non-enveloped viruses which contain double-stranded DNA, and have widespread prevalence in human populations. The aim of this study was to evaluate the prevalence of HPV in asymptomatic patients at the Women’s Clinic in Hamadan and compare the two techniques of Pap smear and Polymerase chain reaction (PCR) in detecting the virus.

This epidemiologic study was carried out on 1770 asymptomatic patients at the Women’s Clinic in Hamadan. After collecting the cell samples from the cervical areas, they were placed in a pre-prepared medium by a physician and divided into two sections after being sent to the laboratory; the first part was for Pap smear and the second for PCR. If there was a viral genome, it could be determined by PCR. People who were HPV + were candidates for typing.

The results of the present study showed that out of 1770 patients aged between 14 and 60 years, referred to Hamadan health centers, 271 patients (15.31%) had HPV. Among them, the highest number of HPV+ cases belonged to the age group of 31-40 years, with the lowest number belonging to the age group of 15-20 years old. Furthermore, out of 271 HPV + patients, 111 (40.09%) had abnormal Pap smear and more than 90% had HPV infection, while less than 10% had low risk (LR) HPV.

The results of this study showed that the prevalence of HPV in Hamadan health centers was relatively high. According to the results of this study, it can be concluded that the use of PCR along with Pap smear can help the patients with diagnosis and better treatment

Arrhythmias can take place in any period of pregnancy. In addition, the incidence of life-threatening ventricular arrhythmias in a pregnant woman without the organic pathology of the heart is rare. Interventional treatment should be carried out in cases of severe arrhythmias and drug resistance. The radiation exposure during ablation carries a potentially harmful effect on the mother and fetus although data on the zero-fluoroscopy ablation of arrhythmias in pregnant women is limited.

A 26-year-old female without structural heart disease at the gestation period of 26-28 weeks was admitted to a hospital due to severe symptoms of ventricular tachycardia (VT) and premature ventricular contractions. In this regard, the conservative therapy of β-blockers was ineffective and accompanied by a decrease in blood pressure to 60/40 mm Hg.

An intracardiac electrophysiological study and non-fluoroscopic catheter ablation were carried out considering the drug refractory and severe symptoms of VT. The ablation of the arrhythmia substrate was successfully performed using the Carto 3 System without fluoroscopy. Based on the results, the procedure was not associated with any maternal or fetal complications.

In general, the non-fluoroscopic catheter ablation guided by electro-anatomical mapping and navigation systems is safe and applicable in the treatment of pregnant women with severe types of arrhythmias.

Major maternal depression is well known as a morbid and common disorder with a prevalence of 12% in the third trimester of pregnancy. Psychotropic medications might not be quite safe in these cases. In addition, pharmacological resistance and any life-threatening conditions can appear with the acute need for an instant therapeutic response. In these cases, electroconvulsive therapy (ECT) might be the only effective option. However, both clinicians and patients often feel hesitant to utilize ECT throughout pregnancy due to the lack of reliable literature.

The challenging case of a 26-year-old pregnant woman at the 37 weeks of gestation was presented with major depression, who achieved full symptomatic remission after ECT. The critical status of this case was well managed by ECT treatment. Through the follow-ups, it was found that she is under medical therapy and has a normal life now. She is taking care of her baby and her symptoms are controlled as well.

Overall, ECT could be a safe and effective treatment at late pregnancy. Obviously, a multidisciplinary team approach is crucial for achieving the desired goals.