مجله زنان مامائی و نازائی ایران
سال سیزدهم شماره 1 (فروردین و اردیبهشت 1389)

Spontaneous abortion is the most common complication of pregnancy. However, the effects of abortion on mental health remain controversial. The purpose of this study is to assess the relationship between spontaneous abortion and general health outcomes. In this cohort study, the General health questionnaire 28 (GHQ-28) were administered for 500 women in early stage of pregnancy referring to state clinics of Semnan city between 2007-2008. These women were fallowed afterwards on a monthly schedule. 98 abortions have occurred among these women who were once more fulfilling the GHQ-28 one month after abortion. Another 98 women were randomly selected from those who experienced no abortion until 20th week of gestational age to answer the GHQ-28 as control group. Statistical analyses were performed using t-test, Chi Square, Fisher exact tests and Logistic regression. Mean (±SD) age in abortion group was 26.3±6.1, whereas in control group was 25.4±5.8 years, which were not statistically significant. There was no significant difference between two groups in their number of previous pregnancies, living children, previous abortions and education levels. Abortion has significant effect on incidence of somatic disorder (OR=34.7, P=0.027), anxiety and sleep disorder (OR=5.0, P=0.043), depression (OR=11.5, P=0.027) and general health condition after-abortion (OR=10.2, P<0.001). While on the contrary, abortion did not have any significant effect on social function. GHQ-28 mean score in the case group before abortion and after abortion was 22.6 and 29.4 respectively. However, mean score in the control group was 22.5 and 21.5, respectively before and after 20th weeks of gestational age. Changes in mean health scores of two group were significant (P<0.001). Psychological support of women with abortion for improve their quality of life is a necessity.

Elevated β-hCG and testosterone levels are found in maternal serum among pregnancies complicated by preeclampsia. The aim of present study is to evaluate the effect of fetal gender on serum human chorionic gonadotropin (β-hCG) and testosterone in normotensive and preeclamptic pregnancies. Through a cross-sectional study, 139 women with singleton pregnancies in their third trimester were enrolled by convenient classified sampling. They were selected from whom referred to affiliated clinic of Khorram Abad Women’s Hospital for prenatal care between November 2006 and June 2007. Subjects were divided into two groups of normotensive and preeclamptic pregnancies, based on their blood pressure and proteinuria. 71 pregnancies were uncomplicated (35 male and 36 female). 68 pregnancies were complicated by preeclampsia (35 male and 33 female). Human chorionic gonadotropin (β-hCG) and total testosterone were measured in maternal serum. Data were analyzed by SPSS 11.5 software and statistical tests. In male-bearing pregnancies, maternal β-hCG and testosterone serum levels were significantly higher in preeclamptic mothers when compared to normotensive ones (P<0.001 and P<0.001, respectively). In female-bearing pregnancies testosterone level was significantly higher in preeclamptic than normotensive mothers (P<0.001), whereas the β-hCG levels were same. Male-bearing preeclamptic women had significantly higher testosterone level than that of their female-bearing counterparts (P<0.001), whereas their β-hCG levels showed no statistically significantly difference. In uncomplicated pregnancies the β-hCG levels were significantly higher among female-bearing mothers compared to male bearings (P<0.001). However, the testosterone levels were not statistically different. In preeclamptic pregnancies (with both male and female fetus), total testosterone level was higher than that of normotensive ones. Moreover, it was higher in male-bearing women than female-bearing ones. It was just in preeclamptic pregnancies with male fetus, where the maternal serum β-hCG level was higher than that of uncomplicated pregnancies. Our findings, therefore, would implicate an androgenic-mediated mechanism in the development of preeclampsia.

Early diagnosis and termination of the pregnancies with abnormal fetuses in early stages of pregnancy can prevent from giving birth to disabled infants who will impose burden to their family and community. The aim of this study was to determine the median of serum markers in order to identify the congenital anomalies in the first trimester through performing triple tests screening. In this prospective study, 127 pregnant women referring in their first trimester to obstetric clinic of Omul-Banin Hospital (Mashhad, Iran, Feb 2009-May 2010) were enrolled whose gestational age ranged between 11 weeks and 13 weeks + 6 days. All patients were evaluated with a single sonologist. In each case, fetal nuchal translucency (NT) thickness and CRL were measured and recorded in specific questionnaire designed for triple test results. Maternal serum free beta-human chorionic gonadotropin (Freeβ-HCG) and pregnancy- associated plasma protein-A (PAPP-A) were afterwards measured and recorded in the questionnaire. Our measurements showed that NTs ranged from 1.1 to 2.7mm (Mean=1.62mm). In older mothers (³35 years) the rate of NT was higher than those of other ages. The serum free β-HCG and PAPP-A had no relation with the maternal age. Based on laboratory results of serum markers, median index was determined for free β-HCG and PAPP-A. This index was 127.30 ng/mL for free β-HCG and 24.688 mg/L for PAPP-A, respectively. According to the results of present study, the basic risk for developing fetal anomalies can be achieved by having determined medians (for free b-hCG and PAPP-A), NT, MoM, maternal age, gestational age and other relevant variables. Using specified softwares, these anomalies would be, thus, diagnosed in the first trimester of pregnancy.

One of the problems that occupy pregnant women`s mind is the labor pain. Owing to considerable rate of Caesarean sections in our community (due to fear of labor pain) it is our duty to try to increase the rate of normal vaginal deliveries instead. The aim of this study is to investigate the effect of reflexology on the severity of labor pain and labor duration in nulliparous women. This clinical trial study was carried out on 70 nulliparous women (39 intervention and 31 controls) who referring to labor room of Afzalipour Hospital (Kerman city) with gestational age of 37 weeks and above, and cervical dilatation of 3-4 cm. They had no significant diseases according to their medical records, nor had used any medications during labor. The intervention group received reflexology for 20 minutes (10 minutes each foot) during their uterus contraction in active phase of labor (acceleration). The control group underwent massage for 20 minutes at the same time but on other areas of their feet. Severity of labor pain was shown by Visual Analogue Scale (VAS), before and after the intervention. Moreover, the duration of labor was determined for both two groups. Severity of labor pain before foot reflexology did not vary between case and control groups (p = 0.14) but after it, severity of labor pain in the intervention group was lower than the control group (p < 0.001). The severity of labor pain reduced after the intervention in the intervention group (p < 0.001), whereas, labor pain increased in the control group (p < 0.001). However, the labor durations were same in both groups (p<0.063). Reflexology have an indisputable effect on decreasing labor pain in the first phase, whereas, it does not affect the total duration of labor.

Vaginitis is the most prevalent gynecological complaint for which women seek medical treatment. Amongst different methods of diagnosis of bacterial vaginosis Amsel`s clinical criteria and Nugent scoring is of the most preferentiality. The aim of this study is to evaluate the diagnostic values of whole Amsel`s clinical criteria, each of Amsel`s criterion solitarily and combination of two criteria, respectively, for diagnosis of bacterial vaginosis. This study is carried out on 105 women referring to gynecologic clinic of 17-Shahrivar Hospital (Mashhad, Iran, 2006-2007) who underwent speculum examination and were qualified to enroll in study. The Nugent scoring system was used as the gold standard method for diagnosis of bacterial vaginosis. Sensitivity, specificity, positive predictive value and negative predictive value of whole Amsel`s clinical criteria, each of Amsel`s criterion solitarily and combination of two criteria for the diagnosis of bacterial vaginosis were determined according to the aimed standard. Among Amsel’s clinical criteria, the most sensitive individual criterion was clue cells (96.9%) and the criterion with the highest specificity was Whiff test (80.8%). PH plus clue cells and clue cells plus vaginal discharge were the most sensitive coupled combinations (84.4%), whereas the combination of clue cells and Whiff test was of the highest specificity (89%). The clinical criteria for the diagnosis of bacterial vaginosis can be simplified into two clinical criteria with no considerable decline in their sensitivity and specificity.

Primary dysmenorrhea is a common disorder occurs in 60-93% of women in menstrual age. It is characterized by pain in the lower abdomen region which may radiate to thighs, despite no dysfunction in the genital system. The onset is in early stages of menstruation that may last by 2 to 3 days. Tranquilizers, herbal drugs and massaging are being applied as treatmentmodalities. Chamomile tea may alleviate the pain, but scientific studies have yet to be conducted. The purpose of this study was to investigate the effects of applying chamomile tea on dysmenorrhea. 80 students of Toyserkan Azad University in western Iran were enrolled in such semi-experimental study. They were randomly divided into two equal groups of study and control. Participants in the study group were asked to drink two cups of Chamomile tea a day, 1 week prior to menstruation and first five days of their menstruation cycle for a 3 month period. Data were gathered by four separate questionnaires (McGill Pain Questionnaire, Visual Analogue Scales for Anxiety, Perceived Stress Scale and The Psycho physiologic Life Adaptation Scale). They were applied before the commencement of intervention, on 1st month and 3rd month, respectively. Data analysis was carried out using Wilcoxon and Chi-square tests. After 1 month of usingChamomile tea, study group had a statistically significant difference in experiencing menstrual pain, distress and anxiety compared to those of control one.There were statistically significant difference between two groups in summation of means of four questionnaires, on 1st and 3rd months of usingChamomile tea (p<0.001). The study finds chamomile tea an effective therapy in relieving the pain originated from primary dysmenorrhea and its consequent psycho-social problems.

Considering the importance of breast cancer, identifying the factors that may either directly or indirectly determine the final prognosis of afflicted patients is helpful in clinical decision making, clinical approach and treatment of disease. Determination, expression and evaluation of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor (Her-2/neu) and p53 gene are somehow effective in prognoses and treatment of the disease. The purpose of this study is to recognize if any relationship exists between Her-2/neu gene amplification and estrogen receptor (ER), progesterone receptor (PR) and p53 gene among female with breast cancer. This descriptive cross-sectional study is performed on 67 women with primary breast cancer whom were hospitalized at oncology ward in Emam Sajjad Hospital (Ramsar, Iran, 2001-2005). Data were gathered from participants medical records, based on Her2/neu gene amplification, estrogen receptor (ER), progesterone receptor (PR) and p53 gene. Samples were evaluated by semi-quantitative immunohistochemistry method using Her-2/neu gene amplification kit, along with ER, PR and p53 gene amplification kits. Data were analyzed by descriptive and analytic statistic tests. It was revealed that 50.7% of studied cases had positive ER, whereas 43.3% were PR positive, 31.3% were p53-positive and 31.3% had positive Her-2/neu. Her-2/neu gene was amplified in 14.2% of ER/PR positive cases andin 66.7% of ER/PR negative subjects. Uusing Chi-square test it was revealed that there is statistically significant correlations between Her-2/neu expression and positive ER (p<0.030), positive PR (p<0.014), simultaneous expression of ER and PR (p<0.001), negative PR and ER expression(p<0.004) and positive family history for cancer (p<0.003), respectively. In addition, no correlation was found between Her-2/neu expression and p53 gene, age, menopause and marital age of patients. Regarding the significant correlation between Her-2/neu amplification and state of estrogen/progesterone receptors, and more significant correlation between Her-2/neu amplification and estrogen/progesterone receptor-negative tumors we can apply exclusive treatment modalities.