Introduction: Postpartum hemorrhage is one of the maternal mortality and morbidity etiologies. Recognizing predisposing factors, forecasting the risk of hemorrhage, preparing for that and using perfect medical and surgical interventions on appropriate time can decrease in mortality and morbidity of pregnant women. This study was done aimed to investigate the causes of hemorrhage and treatments of postpartum hemorrhage. Methods: This descriptive analytical and retrospective study was conducted on all women who have had delivery in two governmental hospitals of Mashhad, Iran, 2010-2011. Women who needed to transfusion or reservation of two units of packed cells were included in this study. The predisposing factor, delivery method, therapeutic methods of controlling hemorrhage and maternal complications were evaluated. Data were analyzed using SPSS software version 14. P value less than 0.05 was considered significant. Results: 21181 deliveries have performed during 2010-2011 and only 248 cases (11.8) needed to transfusion or reservation of packed cells. Cause of hemorrhage were atony in 138 cases (55.6), residue in 66 cases (26.6), genital rupture in 42 cases (16.9) and myoma in 2 cases (0.08). Pregnancy termination techniques were cesarean in 66 cases (48) and normal vaginal delivery in 71 cases (52). Medical interventions that used to control hemorrhage were administration of oxytocin, methergine, misoprostol, bimanual massage and revision, and only one patient needed ten medical and surgical procedures to control hemorrhage. No case of maternal death was observed due to hemorrhage. Conclusion: There are various medical and surgical procedures to control postpartum hemorrhage, and if the intervention was done correctly and timely, the need for invasive procedures, complications and mortality is reduced.
Introduction: Gestational diabetes mellitus (GDM) refers to diagnosing of carbohydrate intolerance during pregnancy which may cause some serious fetal and maternal complications. GCT (fifty-gram glucose tolerance test) is the first test for GDM screening which is done without regarding of fasting condition. While prevalence of GDM is 2-5, the result of this test is positive in 14-18 of pregnant women. Thus, those with positive results are screened by a three-hour hundred-gram glucose tolerance test (GTT). Execution of this test requires 8-14 hours fasting and four-times blood sampling in which the patient incurs a lot of time, cost and stresses. If GDM cases are reduced by execution of GTT after ten-hour fasting, a hundred-gram GTT is prevented in many patients. The aim of this survey is evaluation effects of fasting on results of fifty-gram oral glucose challenge test in GDM screening Methods: A total of 130 pregnant women who met the inclusion criteria with gestational age of 24 to 32 weeks and were hospitalized in Imam Reza hospital from 2008 to 2009 participated in this study. They were randomly entered into fasting group (80 cases) or non-fasting group (50 cases). After one hour receiving fifty-gram oral glucose, blood sampling was taken from all of them. Then, the level of blood glucose was measured and compared between two groups by T test, Mann Whitney, Chi Square tests and SPSS software version 13. P<0.05 was determined significant. Results: T-test evaluation shows no statistical significant relation between fasting status and the result of screening (P=0.89). But, based on Chi Square test, fasting and non-fasting group were statistically different in terms of mean blood glucose (P=0.03). Conclusion: In GDM screening test, the mean level of blood glucose reduces in fasting status.
Introduction: Hemorrhoids is one of the most common problems during pregnancy. Lifestyle modification recommendations are associated with patients' noncompliance. The potential therapeutic properties of coconut oil on hemorrhoids have been suggested, but its scientific evidence has not been reported, therefore this study was performed with aim to determine the effect of coconut oil ointment on hemorrhoids symptoms in pregnant women. Methods: This randomized clinical trial was performed on 60 pregnant women referred to comprehensive health services centers in Mashhad in 2018-2019. The subjects were randomly divided into intervention and control groups. In the intervention group, one applicator of coconut oil ointment was applied twice a day for two weeks; they also received lifestyle modification recommendations. The control group only received lifestyle modification recommendations based on national guidelines. The improvement of hemorrhoids symptoms was measured on the first, seventh and fourteenth days using Visual Analog Scale (pain, prolapse, itching and overall score of hemorrhoid symptom). Data were analyzed using SPSS software (version 16) and Mann-Whitney, Independent T and Friedman tests. P<0.05 was considered statistically significant. Results: The mean score of pain, prolapse, itching and overall score of hemorrhoid symptoms in coconut oil ointment group significantly decreased compared to the control group (p<0.05). In the intra-group evaluation, in the coconut oil ointment group, the pain score measured by day was significantly different (p<0.001) but in control group this difference was not significant (p=0.050). Conclusion: Coconut oil ointment is effective in improving the hemorrhoids symptoms, therefore it is recommended for pregnant women with hemorrhoids grade 1 and 2.
Introduction: Preeclampsia is one of the most common complications of pregnancy and oneof the main causes of maternal and neonatal mortality and morbidity. Excretion of protein in urine is the most important diagnostic sign of diagnosis of the patients with preeclampsia. Current gold standard test for quantitative evaluation of proteinuria is 24 hours urine collection, but, this is a time-consuming and cumbersome method, and using a method which can show urine protein as soon as possible could be effective in proceeding the treatment process. This study was performed with the aim to predict the proteinuria in patients suspected to preeclampsia with using the protein to creatinine ratio in random urine sample and determining the best cut off point. Methods: This cross-sectional, analytical study was performed on 103 pregnant women with gestational age >20 weeks referred to Emam Reza hospital complaining of BP≥140/90 mmHg or severe edema from 2013-2014. To measure the protein/creatinine ratio, a random urine sample was taken and then 24 hours urine collection was performed for determination of protein excretion. Data analysis was performed by SPSS software (version 16), and Chi-square, T-test, Man-Whitney and logistic regression PResults: Among 103 pregnant women, protein excretion in 24-h urine was > 300mg in 53 cases and ≤ 300mg in 50 cases. The best cut off point for protein/creatinine ratio of random urine sample was obtained 0.27 with 96 sensitivity and 54 specificity and 70 positive predictive value and 96 negative predictive value (P<0.0001). Conclusion: Protein/creatinine ratio of random urine sample could be used as a simple and rapid test to rule out proteinuria in 93 of patients suspected to preeclampsia.
Introduction: Thyroid disorders are common in young women. Hypothyroidism has a broad clinical range of subclinical to severe disease along with various complications. Hypothyroidism in pregnancy causes many complications on pregnancy. Considering the contradictory results in this regard, this study was performed with aim to evaluate the prevalence of subclinical hypothyroidism and compare the complications of this disease in patients treated with or without levothyroxine. Methods: This cross-sectional and interventional study was conducted on 1,000 pregnant women who referred to Prenatal Clinic of Imam Reza Hospital and the clinics of two gynecologist colleagues in Mashhad in 2012-2013. 212 women with TSH > 3 in the first trimester of pregnancy were selected and randomly divided into intervention (n=112) and control (n = 100) groups. Individuals in the intervention group received 0.5 to 1.5 pills of levothyroxine from diagnosis until delivery. Patients were monitored until the end of pregnancy and complications of pregnancy were evaluated between the two groups. Data were analyzed using SPSS software (version 11.5), Chi-square and independent t-test. P 0.05). However, there was a significant difference between the two groups in terms of abruption, (P=0.015) and abruption was higher in untreated group. Based on the independent t-test, the weight of newborns was higher in the treated group and the two groups were significantly different (P=0.025). Conclusion: Hypothyroidism is a common disease in pregnancy and TSH is a prerequisite for pregnancy testing in order to prevent its complications when diagnosed.
Introduction:Fetus skeleton is formed during pregnancy and calcium and phosphorous for this mineralization is provided by mother, so significant changes may occur in the mother’s skeleton. This study was conducted to evaluate the changes of serum and urinary markers of ossification and bone absorption during pregnancy. Material and Methods: In this cross-sectional study, from Oct. 2005 to Jul. 2006, 307 pregnant women, at Imam Reza Hospital in Mashhad, were randomly assessed. Serum calcium, phosphorous, ALP, 24 hours urinary excretion of calcium and phosphorus were determined. Data were analyzed by SPSS 9.5 software, ANOVA and Tukey HSD tests. Results: ANOVA test indicated that, there was no significant difference between dependent variables (calcium, phosphorous, alkaline phosphatase), 24 hours urinary excretion of calcium, phosphorous and the age of mother (P=0.057), but there was meaningful relationship between serum ALP level, 24 hours urinary excretion of phosphorous and different trimesters of pregnancy (P=0.007). Serum ALP level in the third trimester was varied, compared to the first and second trimesters. However there was no difference in these amounts in the first and the second trimesters. Conclusion: There was no significant alteration in the mean ratio of serum calcium, phosphorus level and 24 hours urinary excretion of calcium in different trimesters of pregnancy (P= 0.070). Noticeable correlation observed between mean serum ALP, 24 hours urinary excretion of phosphorous and different trimesters of pregnancy (P= 0.007, P= 0.025 respectively). Also, differences in the mean serum calcium level, 24 hours urinary excretion of phosphorous in multiparous and nulliparous patients was very clear.
مقدمه: هموروئید، از شایعترین مشکلات دوران بارداری میباشد. توصیههای اصلاح سبک زندگی با عدم تبعیت بیماران همراه است. خواص درمانی احتمالی روغن نارگیل بر هموروئید مطرح شده، اما شواهد علمی آن گزارش نشده است، لذا مطالعه حاضر با هدف تعیین تأثیر پماد روغن نارگیل بر علائم هموروئید در زنان باردار انجام شد.
روشکار: این مطالعه کارآزمایی بالینی در سال 98-1397 بر روی 60 زن باردار مراجعهکننده به مراکز خدمات جامع سلامت مشهد انجام شد. واحدهای پژوهش بهطور تصادفی به دو گروه مداخله و کنترل تقسیم شدند. در گروه مداخله پماد روغن نارگیل 2 هفته و روزی 2 بار، یک اپلیکاتور استفاده گردید، ضمن اینکه به این گروه توصیههای اصلاح سبک زندگی داده شد. گروه کنترل فقط توصیههای اصلاح سبک زندگی را بر اساس دستورالعمل کشوری دریافت کردند. سنجش بهبود علائم هموروئید در روزهای اول، هفتم و چهاردهم با استفاده از مقیاس دیداری (درد، بیرونزدگی، خارش و نمره کل علائم هموروئید) صورت گرفت. تجزیه و تحلیل دادهها با استفاده از نرمافزار آماری SPSS (نسخه 16) و آزمونهای منویتنی، تی مستقل و فریدمن انجام شد. میزان p کمتر از 05/0 معنیدار در نظر گرفته شد.
یافتهها: میانگین نمره درد، بیرونزدگی، خارش و نمره کلی علائم هموروئید در گروه پماد روغن نارگیل با کاهش قابل توجهی در مقایسه با گروه کنترل همراه بود (05/0>p). در بررسی درونگروهی، در گروه پماد روغن نارگیل، نمره درد بر حسب روز سنجش، تفاوت معنیداری داشت (001/0>p)، اما در گروه کنترل این تفاوت معنیدار نبود (050/0=p).
نتیجهگیری: پماد روغن نارگیل بر بهبود علائم هموروئید مؤثر است، لذااستفاده از آن در زنان باردار مبتلا به هموروئید درجه 1 و 2 پیشنهاد میگردد.
Introduction: Placenta increta is an uncommon and life-threatening pregnancy complication. This disorder usually is presented with vaginal bleeding during difficult placental removal in the third trimester of pregnancy. However, the disorder may cause some other complications such as abortion at the first or second trimesters of pregnancy too, which make its diagnosis more difficult. This report discusses a case of hysterectomy due to placenta increta at the first trimester of pregnancy. Case Presentation: A 34-years old woman was admitted to Imam Reza Hospital in Mashad, with a history of severe vaginal bleeding. Evacuation curettage had been done due to incomplete abortion at her first admission in another hospital 18 days ago. She had a history of two previous cesarean sections too. Curettage was done to control the severe hemorrhage with a probable diagnosis of incomplete uterine evacuation. Since hemorrhage was not controllable, the patient was consulted for hysterectomy. Afterwards, the pathology report confined the diagnosis, reading “Lower uterine segment with placenta increta”. Conclusion: Women with a history of previous caesarean sections are at risk for abnormal placentation. The condition is prone to complications such as uncontrollable vaginal bleeding in the first trimester which might necessitate immediate hysterectomy because of the complications due to abnormal nature of placenta increta.
Background: Vulvovaginal candidiasis is one of the most common infections in gynecologic filed, and non–albicans Candida species are emerging causative microorganisms. This species shows resistance to routine treatments. One of the suggested treatments is administration of vaginal suppositories of boric acid. The aim of the present study was to compare boric acid with clotrimazole in the treatment of recurrent or resistant vulvovaginitis. Methods: In a double-blind, randomized clinical trial, 90 nonpregnant women were enrolled. The patients were divided into two groups to receive; boric acid (300 mg twice a day for 2 weeks) or clotrimazole (100 mg once a day for 2 weeks) intravaginally. Treatment responses were monitored by laboratory and clinical data. Results: Treatment responses were significantly different in laboratory results for boric acid and clotrimazole groups (86.7% v 60%, P= 0.004). Clinical responses (improved signs and symptoms) showed no significant differences (8.2. v 6.5, P= 0.02). Drug side effects were not different in boric acid and clotrimazole groups (13.3% v 11.1%, P= 0.75).
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