مجله زنان مامائی و نازائی ایران
سال بیست و سوم شماره 4 (تیر 1399)

Placenta accreta has very dangerous effects for mother and baby; timely diagnosis of this complication can decrease the maternal and neonatal health. Due to the lack of MRI use for timely diagnosis of placenta accreta in Iran, this study was performed with aim to evaluate the accuracy of MRI and ultrasound in the diagnosis of placenta accreta in susceptible women referred to gynecology hospitals in Tabriz.

This cross-sectional descriptive study was conducted in Tabriz gynecology hospitals during 2015-2016 with the participation of 38 susceptible women to placenta accreta. After examination, the patients were referred to the imaging center (ultrasound and MRI) and the results of imaging were compared with the results of after cesarean. Data were analyzed using SPSS software (version 20) and McNemar test. P< 0.05 was considered statistically significant.

MRI examinations showed that 17 patients (89.47%) had placenta accreta, while ultrasound examination showed that 12 (63.15%) had placenta accreta. Comparison of the specificity and sensitivity showed that Ultrasound sensitivity (70%) and specificity (93%) were significantly lower than MRI sensitivity (79%) (p=0.048) and specificity (100%) (p=0.039).

The accuracy, sensitivity, and predictive power of MRI technique in timely detection of this dangerous complication were very good compared to ultrasound and can be used in women susceptible to placenta accreta.

Regarding the safety of Ondansetronecompared to other anti-shivering drugs, its lower side effects and the contradictory results of its use in the prevention of postoperative shivering, this study was performed with aim to evaluate the effect of preoperative intravenous administration of Ondansetroneon prevention of anesthesia-induced shivering in gynecological surgeries.

This randomized clinical trial study was conducted in 2019 with the participation of 100 women in Alzahra Hospital-Tabriz. Patients were randomly divided into two groups. The intervention group received 2 ml (8 mg) of ondansetroneand the control group received 2 ml of normal saline. The shivering intensity in each patient was recorded according to the shiver severity criterion (LAS). Data were analyzed by SPSS software (version 22) and Chi-square test. P <0.05 was considered statistically significant.

Comparison of the number of cases with shivering after anesthesia indicated that 6 (12%) of the ondansetronegroup and 21 (42%) of the control group had shivering intensity >3 that two groups had statistically significant difference (p= 0.001)

Ondansetrone, as one of the 5-HT3 antagonists, can be effective in preventing shivering after general anesthesia in gynecological surgeries, but it cannot completely inhibit shivering.

World Health Organization (WHO) has reported that the exact impacts of cesarean section on maternal and neonatal health are uncertain. This study was performed with aim to compare maternal and neonatal outcomes after vaginal delivery, cesarean section with general anesthesia or spinal anesthesia.

In this retrospective study, 122 medical records of women who underwent vaginal delivery and non-emergency cesarean section at Ghadir Mother and Child Hospital affiliated to Shiraz University of Medical Sciences in 2015-2016 were divided into three groups of 36 subjects (vaginal delivery, cesarean section with general anesthesia and spinal anesthesia) were evaluated. Maternal heart rate and blood pressure, Apgar score, and fetal blood gas of umbilical cord were assessed. Data were analyzed by SPSS software (version 19) and One-way ANOVA test was used for parametric data between groups and repeated measure for evaluating the effect of time in the groups.

Exact Apgar scores at 1 and 5 min showed no significant difference between the groups (P = 0.39 and P = 0.91, respectively). Fetal pH was higher in cesarean group with spinal anesthesia (P = 0.05) while PO2 and HCo3 were higher in cesarean group with general anesthesia (P = 0.04). Postpartum systolic blood pressure in women under spinal anesthesia and diastolic blood pressure in women under general anesthesia were significantly different with other two groups (P <0.05).

Postpartum systolic blood pressure was higher in women under spinal anesthesia and diastolic blood pressure was higher in women under general anesthesia than other groups. pH of the infant's blood was higher in the cesarean group with spinal anesthesia, and the oxygen and bicarbonate pressure in the umbilical cord blood of the infants was higher in the cesarean group with general anesthesia, but the Apgar score and carbon dioxide pressure did not differ between the groups.

It is possible that zinc levels in cancer patients are lower than normal people and this may prolong the treatment process of these patients. Therefore, the present study was performed with aim to compare the role of zinc in scar recovery after abdominal hysterectomy in women with and without cancer and its relation to anthropometric indices of women referring to Tabriz hospitals.

This case-control study was conducted in Tabriz hospitals with the participation of 84 women )after abdominal hysterectomy( in 2018. Demographic data, anthropometric indices, serum zinc level and scar recovery status (based on researcher-made questionnaire) of each patient were recorded after abdominal hysterectomy. Data were analyzed by SPSS software (version 20) and Pearson correlation coefficient, Chi-square and independent t-test. P<0.05 was considered statistically significant.

Mean serum zinc level in cancer patients was 43.13±4.93 μg / dl and in those without cancer was 118.73 ± 11.42 μg / dl (P=0.009). The majority of patients with cancer (71.42% ) had a better-than-average period of wound healing, while the majority of patients without cancer (80.95%) were associated with normal healing (P=0.003). Significant positive correlation was found between zinc level only in weight index in cancer patients (r=0.112 , P=0.005) and positive relationships were seen in other indicators of cancer patients and non-cancer patients, but were not statistically significant.

Low levels of zinc lead to undesirable effects on timely recovery in cancer patients after abdominal hysterectomy compared to non-cancer ones.

Molar pregnancy is a type of abnormal pregnancy which is divided into complete and partial hydatiform mole. Its incidence varies in different countries and in different regions in every country. Its incidence is higher in Asia than elsewhere in the world, whereas occasionally its risk factors and clinical symptoms are different in various regions. Therefore, this study was performed with aim to evaluate the risk factors and clinical symptoms of hydatiform-mole in pregnant women referred to Ayatollah Rouhani hospital in Babol.

This retrospective descriptive study was performed on all pregnant women of hydatiforme mole with histopathologic definite diagnosis referred to the educational-therapeutic center of Ayatollah Rouhani Hospital in Babol from 2011-2017. Patients' information including demographic and clinical profiles was provided in a checklist format. Data were analyzed by SPSS software (version 18) and Chi-square and one-way ANOVA tests. P<0.05 was considered statistically significant.

In this study during 2011-2017, there were 19145 pregnancies in Babol Rouhani hospital. According to the pathology report, 70 cases of molar pregnancy were recorded. There were 41 (58.6%) of partial hydatidiform mole and 28 (40%) of complete hydatidiform mole. Most patients with molar pregnancy were in the age range of 20-35 years. 31 patients (44.3%) had O blood group. The most common symptom of the patients was bleeding 43 (61.4%).

The incidence of molar pregnancy was high compared with other parts of the world and the prevalence of partial hydatidiform mol was higher than other studies. The risk factors for molar pregnancy were: history of molar pregnancy, and O positive blood group. The most common clinical manifestation of molar pregnancy was bleeding.

Thrombophilia genes are frequently reported to be major risk factors in the development of cardiovascular disease, thromboembolism and more importantly of pregnancy abortion. The study was conducted to investigate the prevalence rate of thrombophilia polymorphisms in Iranian women.

591 women had miscarriage and infertility disorders who were referred to a private pathobiology laboratory in Tehran, Iran. The subjects were evaluated for single nucleotide polymorphisms using PCR-RFLP procedure during February 2013 to May 2016. Current method was validated and verified for specificity, sensitivity and accuracy by approved and known mutations controls and bioinformatics software’s.

At present study, homozygosity of  prothrombin (AA), leiden (AA) and HPA-1 (TT) were not diagnosed. Among these genotypes, occurrence of FII (Wild type-GG and heterozygous-GA) was highest and lowest rate as 96.3% and 3.7%, respectively. The MTHFR 1298 A>C (AC and CC) had the highest frequency (296 subjects) comparison with the other ones. Outcomes frequency rates (%) of heterozygosity PAI-1, MTHFR1298, MTHFR677, Factor XIII, HPA-1, β-Fibrinogen, Factor V Leiden and Prothrombin were 72.6 %, 70%, 40.5%, 29.4%, 25.5%, 20%, 4.4% and 3.7%,  respectively.

Heterozygosity prevalence rate of PAI-1, MTHFR1298 and MTHFR677 are the most common in women. It would appear thrombophilia genes should be considered in preventive strategies particularly in coagulopathy and miscarriage disorders.

Providing postpartum services is one of the most important factors in prevention of adverse maternal outcomes. This study was performed with aim to evaluate the effect of postpartum home care on mothers’ health.

This clinical trial study was conducted on 62 mothers in the postpartum stage in Isfahan in 2015. Mothers were randomly assigned to the experimental and control groups. Data were collected using a researcher-made questionnaire in triple visits of the post-partum period. Each intervention session at home, was provided according to the national protocol. Data was analyzed by SPSS software (version 18) and independent t‑test, Fisher's Exact, Chi‑square and Mann-Whitney tests. P<0.05 was considered statistically significant.

After the intervention, there was a statistically significant difference between experimental and control groups in terms of infection (p = 0.029) and pain and swelling at the suture site (p = 0.021) and feeling pain in the abdomen, thighs, breasts, teeth (p = 0.026). Therefore, the conditions were significantly better in the experimental group than the control group. Also, the mean score of knowledge of the correct pattern of breastfeeding (p = 0.02) and satisfaction with the performance of the health care team (p <0.001) was significantly higher in the experimental group than the control group.

Providing postpartum home care services has increased maternal health, such as reducing abdominal, side, leg, thigh, breast and tooth pain, and episiotomy problems. This intervention improved the breastfeeding process and increased maternal satisfaction.

Polycystic ovary syndrome (PCOS) is a common endocrinopathy among women and insulin resistance is one of the clinical features in this syndrome which plays an important role in improvement of lipid disorders. Dietary glycemic index and glycemic load can affect blood lipid disorders. Because of limited studies in this field, this study was performed with aim to evaluate the relationship between dietary glycemic index/glycemic load and serum lipids level in women with PCOS.

This case-control study was conducted on 45 PCOS women and 45 healthy controls in Moheb Yas Women hospital of Tehran in 2016. Dietary intake was assessed using three 24-h recall questionnaires, and glycemic index and glycemic load were calculated by standard methods. Lipid profile was measured and insulin resistance was calculated by the formula. Anthropometric measurements were conducted in all participants. Data were analyzed by SPSS software (version 16), and Independent T-test and correlation test. P< 0.05 was considered statistically significant.

Mean of serum total cholesterol, insulin resistance and mean of glycemic index was significantly higher in the patients group than the control group (P<0.05). There was a significant relationship between glycemic load and insulin resistance, triglyceride and HDL-c in patients (r=0.388, r=0.401, r= -0.371, respectively (P<0.05). No significant relationship was found between glycemic index with biochemical markers in patients and controls (P>0.05).

Lifestyle modification like correct nutritional status and management of carbohydrate intake and reducing the dietary glycemic load may be effective in prevention or reducing the complications of disease such as lipid abnormalities.

It is important to pay attention to the sexual function of women of childbearing age due to long-term conflict with it and its impact on personal health, marital relations and childbearing. The phytoestrogenic effect of the Vitex agnus-castus plant on sexual function of postmenopausal women as well as in limited animal studies has been shown to improve, enhance sexual behavior and hormones, but it has not been studied in women of childbearing age. Therefore, this study was performed with aim to determine the effect of Vitex agnus-castus plant consumption on sexual dysfunction in women of childbearing age.

This double-blind clinical trial study was performed on 102 women referred to Alzahra Women's Clinic of Rasht for doing Pap smears in 2019. Eligible candidates completed the Female Sexual Function Index (FSFI) questionnaire; if they were placed in the group of sexual dysfunction and then randomly assigned to two groups of Vitex agnus-castus tablet or placebo. FSFI questionnaire was again completed after 4 weeks. Data were analyzed by SPSS software (version 21) and Chi-square, Fisher, Mann-Whitney, Independent-t and paired t-test. P<0.05 was considered statistically significant.

Two groups were homogeneous in terms of demographic, social and midwifery characteristics, and mean scores of total sexual function and domains were similar between the two groups before the (p≥0.05). After one month of the intervention, mean score of total sexual function and domains was not statistically significant between two groups (p≥0.05). In comparison of the scores within-group, only the score of orgasm domain was improved (p=0.02).

There was no change in sexual function of women before and after the intervention; so it is recommended that given the mechanism of the effects of phytoestrogens and similar studies in postmenopausal women, this study be conducted over a long period of time.

Adiponectin and nesfatin are the hormones which secret from adipose tissue in response to extracellular stimuli. Lipid metabolism and insulin sensitivity have role in regulating energy balance. This review study was performed with aim to investigate the effect of adiponectin and nesfatin-1 in polycystic ovary syndrome (PCOS).

In this review article, to find the articles, search was performed in databases of pubmed, google scholar, Scopus, SID with the keywords of Adiponectin, Nesfatin, and polycystic ovary syndrome from 2003 to 2017. This study was written based on PRISMA checklist. The quality of the extracted articles was evaluated based on the STORBE, CONSORT and CASP checklist of contents, and ultimately 21 articles were assessed.

In most studies, adiponectin levels have been shown to decrease in patients with PCOS. Also, the studies have shown contradictory results about nesfatin levels and PCOS.

Studies have shown that adiponectin and nesfatin may play a role in PCOS and likely control and regulate this hormone in the body and can help to treat people with PCOS or prevent it and reduce the economic burden on the family and society.

Although vaginal birth after cesarean is a more appropriate alternative comparing to repeat cesarean for eligible individuals, making decision between these two choices is a challenging process and depends on the decision of care providers and mothers. The studies about shared decision making showed different results about mode of birth after cesarean; therefore, this study was performed with aim to review shared decision making about knowledge, decisional conflict and choosing mode of delivery after cesarean.

In this study, for access to the related articles, search was done on PubMed, Scopus, up to date, google scholar, Cochrane and web of science using the MESH-related keywords including "Vaginal birth after cesarean", "Shared decision making", "decision Aid" and "Counseling", as well as Persian databases off SID, magiran and IranMed from October 2018 to July 2019. The quality of the articles was assessed using the Consort Checklist 2017.

From the total of 120 articles found in the databases, 4 articles entered the study according to inclusion criteria. In various studies, Shared decision making methods had a contradictory effect on choosing vaginal birth after cesarean, but had a significant effect on knowledge and decisional conflict.

The use of Shared decision making methods increases the knowledge of women with previous cesarean about choosing the mode of delivery and decreases the decisional conflict. Since the results about choosing birth after cesarean are inconsistent, further studies are needed.

Although spontaneous and traumatic tracheal rupture after intubation is rare, it is life-threatening. Common findings in the tracheal rupture after intubation are emphysema and respiratory distress. In this article, a patient with tracheal rupture due to intubation after cesarean section is introduced.  

A 37-year-old woman with 39-week gestational age underwent general anesthesia for cesarean section with tracheal tube No. 7. During the surgery, the patient was normal for hemodynamic status and respiration. At the end of the surgery after extubation of the tracheal tube, the patient experienced severe coughing. After transferring the patient to the recovery and reducing cough, the patient was transferred to the ward with an oxygen saturation of 96%. After about 30 hours of intubation, the patient suffered face swelling and mild respiratory distress, emphysema from the face to xiphoid. The amount of oxygen saturation with room air was 95% and respiratory distress was not evident. Hemodynamic status was stable. Computed tomography of the lungs showed pneumomediastin, pneumothorax, and subcutaneous emphysema of anterior chest wall and evidence of tracheal rupture. The patient was transferred to the Surgical Intensive Care Unit, and underwent conservative treatment. After 96 hours, emphysema was completely resolved and the patient was discharged from the hospital after 7 days with a good general condition.

Conservative treatment is recommended in tracheal rupture after intubation, when hemodynamic and respiratory conditions are stable.