Background: Previous studies have reported contradictory results regarding the effectiveness of metformin and myo-inositol on improving reproductive outcomes in patients with polycystic ovary syndrome (PCOS). Therefore, this study aimed to compare the effectiveness of these two drugs on improving reproductive outcomes of PCOS patients undergoing in vitro fertilization (IVF) treatment. Methods: This double-blind randomized clinical trial study was conducted on 140 infertile women with PCOS who were scheduled to undergo IVF in Yas Hospital, Tehran, Iran in 2020. The patients were randomly divided into two groups, including metformin and combination of myo-inositol and folic acid treatment groups. Reproductive outcomes were compared between the two groups. Results: The mean age of the patients was 30.66 ± 5.7 years (30.51 ± 5.88 in metformin treatment group and 30.9 ± 5.53 in myo-inositol group, P = 0.68). There was no significant difference between the two groups regarding the reproductive outcomes, including pregnancy rate, change in BMI, number and quality of oocytes, number and quality of embryos, follicle number, follicle size, ectopic pregnancy rate, and abortion rate (P > 0.05). Conclusion: There is no significant difference in the effect of metformin and myo-inositol on improving reproductive outcomes. Therefore, due to the lack of significant differences in the effectiveness of these two drugs and considering their availability and cost, one of them can be prescribed for the patients.
Introduction: Postpartum depression is a common mental health problem that is associated with maternal suffering. The aim of this double-blind clinical trial was to compare safety and efficacy of saffron and fluoxetine in treatment of mild to moderate postpartum depression. Methods: This was a 6-week, double-blind, randomized clinical trial. Subjects were women aged 18–45 years with mild to moderate postpartum depression who had Hamilton Depression Rating Scale (HDRS 17-item) score≤18. Eligible participants were randomized to receive either a capsule of saffron (15 mg capsule) or fluoxetine (20 mg capsule) twice daily for 6 weeks. The primary outcome measure was to evaluate efficacy of saffron compared to fluoxetine in improving depressive symptoms (HDRS score). Results: There was no significant effect for time×treatment interaction on HDRS score [F (4.90, 292.50)=1.04, p=0.37] between the 2 groups. 13 (40.60%) patients in the saffron group experienced complete response (≥50% reduction in HDRS score) compared with 16 (50%) in the fluoxetine group and the difference between the 2 groups was not significant in this regard (p=0.61). Frequency of adverse events was not significantly different between the treatment groups. Discussion: The results of this study may suggest that saffron is a safe alternative medication for improving depressive symptoms of postpartum depression. Nevertheless, it should be mentioned that the trial is not well powered and should be considered a preliminary study. Therefore, large clinical trials with longer treatment periods and comparison with placebo group would be appropriate for future studies.
Abstract Multiple placental cysts are a common finding in obstetric ultrasound imaging. Although it has benign differential diagnoses such as hydropic degeneration of the placenta or placental mesenchymal dysplasia, its important pathologies such as benign gestational trophoblastic disease or hydatiform mole should always be considered. A challenging issue in obstetrics is pregnancies with a placenta that has a bipartite texture. This means that one side of the placenta is normal, but the other side is full of cystic formation and just one fetus is visualized. The main critical concern is the presence of molar pregnancy because of its catastrophic consequences. Here we report a rare case in which the gravid uterus had a normal diploid fetus but had a bipartite placenta which was triploid in the hydropic part, revealing a unique genetic pattern.
Background: Several studies have been conducted on the relationship between sleep disorders and gestational diabetes. In this study, the relationship between the quality and quantity of sleep and the incidence of gestational diabetes in pregnant women was assessed.Methods: In this case-control study, the quality and quantity of sleep in pregnant women attended to the Perinatology clinic at Yas Hospital, Tehran, Iran between June 2016 to September 2017 and its relationship with gestational diabetes mellitus was assessed. In this research, 3000 pregnant women at 24 to 28 weeks of pregnancy were enrolled. Gestational diabetes screening test was initially performed on Glucose Challenge Test (GCT) with administration of 50 gr of glucose. For abnormal cases, Oral Glucose Tolerance Test (OGTT) with administration of 100 gr of glucose after an overnight fasting (8-10 hours) was requested. According to the Gestational Diabetes Mellitus (GDM) diagnosis criteria based on the American Diabetes Association (ADA), women were divided into two groups of case and control (290 diabetic cases and 2710 non-diabetic cases). The Pittsburgh Sleep Quality Index (PSQI) and the participants’ demographic information were collected.Results: Ultimately, 290 of 3,000 women in the study, based on the ADA criteria were diabetic and non-diabetic patients were 2710 women. Sleep quality in the diabetic mothers was significantly worse than non-diabetic mothers and the duration of sleep of them was higher than non-diabetic mothers (p <0.05).Conclusion: Quality and quantity of sleep can be associated with the incidence of gestational diabetes and diabetic mothers have worse sleep quality and longer sleep times than non-diabetic mothers.
Background: Overactive bladder (OAB) syndrome, a condition with urgency, is often characterized by increased daytime frequency and nocturia. Overactive bladder is a highly prevalent condition that drastically impacts the quality of patients’ life. Objectives: This study was conducted to investigate sleep disturbance and fatigue in women with OAB by reliance on two validated questionnaires. Methods: This case-control study was performed among 70 patients recognized with OAB and 70 women in a control group. We employed validated questionnaires, namely Pittsburgh sleep quality index (PSQI) and Fatigue Severity Scale (FSS), to comparatively assess sleep disturbance and fatigue symptoms, respectively. Results: The participants’ mean age was 44.50 ± 12.64 years old. The mean PSQI score was 13.24 ± 3.67 (range: 6 to 22), and the mean FSS score was 39.05 ± 15.12 (range: 9 to 63). Furthermore, the mean scores of PSQI (P < 0.001) and FSS (P < 0.001) were significantly higher in OAB women compared to the control group. In women with OAB, there was a significant positive correlation (P = 0.007) between PSQI and FSS scores. Furthermore, this correlation was observed between urgency urinary incontinence at night and PSQI (P = 0.047) and sleep disturbance (P = 0.023) and between nocturia and sleep efficiency (P = 0.012), sleep disturbance (P = 0.001), sleep latency (P = 0.007), and FSS score (P = 0.032). In addition, a significant direct correlation (P = 0.022) was found between urgency urinary incontinence during the day and daytime dysfunction. Conclusions: The study shows that sleep disorder is common in patients with OAB, and it seems that urinary problem assessment is a prerequisite for any sleep medication prescription.
The use of transcutaneous electrical nerve stimulation (TENS) to relieve labor pain remains controversial and existing evidence is neither strong nor consistent. This research was designed to compare TENS' effect with the injection of pethidine and promethazine in labor pain reduction.In this trial, for 45 pregnant women in the active phase of labor, TENS electrodes were placed (two on both arms, and two over the participants' low back) continuously for 120 minutes; and for another group 45 pregnant women, 100 milligrams of pethidine and 250 micrograms of promethazine were injected intramuscularly which could be repeated once at least one hour later. Labor pain and duration, need for labor induction/augmentation/other pain control methods/ instrumental delivery, delivery type, and maternal and newborn complications were measured in both groups.The baseline mean visual analog scale (VAS) score, in the TENS group was 8.51±0.62 and in the pethidine and promethazine groups was 8.37±0.61 (P=0.31). While in a 120min post-intervention, it was 6.29±1.50 and 5.73±1.46 in the TENS group and the pethidine and promethazine group, respectively with no statistically significant difference (P=0.07). The labor duration in the TENS group was 6.61±1.71 hours and in the pethidine and promethazine group was 6.17±2.07 hours, with no statistically significant difference (P=0.33). In addition, no complication was recorded neither in the mothers nor newborns.This study showed that applying TENS in the active labor phase can reduce at least two scores in patient labor pain with no significant complications.
Multiple placental cysts are a common finding in obstetric ultrasound imaging. Although they have benign differential diagnoses, such as hydropic degeneration of the placenta or placental mesenchymal dysplasia, it's important to consider significant pathologies, such as benign gestational trophoblastic disease or hydatidiform mole. A challenging issue in obstetrics is pregnancies with a placenta that has a bipartite texture. This means that one side of the placenta is normal, but the other side is full of cystic formations, and only one fetus is visualized. The main critical concern is the presence of a molar pregnancy because of its catastrophic consequences. Here, we report a rare case in which the gravid uterus had a normal diploid fetus but had a bipartite placenta, which was triploid in the hydropic part, revealing a unique genetic pattern.
Background: Twin pregnancies have a higher risk of preterm labor than singletons. Otherwise, progesterone using to reduce the risk of preterm labor in twin pregnancies remains controversial. Therefore, this study evaluated the effect of intramuscular progesterone to prevent preterm labor in complicated monochorionic diamniotic twin pregnancies after Radiofrequency Ablation (RFA) of one fetus. Methods: Pregnant women with monochorionic diamniotic twin pregnancies of 16 to 26 weeks of gestational age in an academic center were randomly assigned to receive intramuscular 17-hydroxy progesterone caproate weekly until 36 weeks of gestational age after RFA of one fetus and a control group who did not receive intervention after RFA. Demographic and obstetrical characteristics, as well as maternal, fetal and neonatal outcomes were compared between groups. Results: In total, 79 participants were recruited in the study. The mean±SD of gestational age at delivery in case and control groups were 34.6±3.8 and 34.6±5.1 with no significant difference (p=0.967). Neonatal outcomes including birth weight (p=0.870), intensive care unit admission (p=0.415), premature preterm rupture of membrane (p=0.115) and pregnancy outcome (live birth, fetal demise or neonatal death) (p=0.524) were not different either. Indeed, gestational age at delivery was inversely related to cervical length at the time of procedure and maternal body mass index, but these differences were not statistically significant. Also, there was no significant difference in terms of gestational diabetes, which was a worrying complication of 17-hydroxy progesterone caproate. Conclusion: Although 17-hydroxy progesterone caproate seems to be safe with no apparent maternal and neonatal side effects, it does not prolong pregnancy after RFA. Further studies with longer follow up and larger sample size are suggested.
Background: Cervical insufficiency occurs in the second trimester. Herein, we report a successful term pregnancy in a woman with glucose intolerance and a history of cervical insufficiency after two consecutive preterm deliveries in the second trimester. Case Presentation: We present a 35-year-old woman, G3P2L0, with a history of two preterm deliveries in the second trimester. In the second pregnancy, vaginal cerclage at the 18th gestational week did not prevent premature delivery. Following two pregnancies with borderline fasting blood sugar (FBS) results, we decided to further evaluate the gestational diabetes mellitus (GDM) state with a two-hour postprandial (2 hpp) glucose test and glucose tolerance test (GTT). By impaired 2 hpp and GTT results, an insulin regimen was started with subsequent vaginal cerclage in the third pregnancy. She delivered a healthy 2,750-g girl at 38 weeks of gestation by tight blood sugar control. Conclusions: More attention should be paid to evaluating glucose intolerance in pregnancy, especially in patients with cervical insufficiency. Blood glucose control in these patients can probably improve pregnancy outcomes.
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