Comparative Analgesic Effects of Intradermal and Subdermal Injection of Sterile Water on Active Labor Pain.

BACKGROUND: The labor pain is one of the factors encouraging pregnant women for cesarean section delivery. Recently, intradermal and subdermal injection of distilled water has shown to be effective in improving this pain. OBJECTIVES: The present study aimed to determine which method has a greater impact on labor pain reduction. METHODS: In this double-blind, randomized clinical trial, 121 nulliparous women with a gestational age of ≥ 37 weeks were randomly divided into three groups: (1) 0.5 cc sterile water injection subdermally at four sacral points with insulin needles (n = 40); (2) 0.5 cc sterile water injection intradermally (n = 39); and (3) needle contact with the mentioned points as the placebo (n = 42). Before the intervention, the VAS score was measured for labor pain, and it was repeated 10, 30, 60, and 90 min after the intervention. The results were compared between the three groups. RESULTS: Before the intervention, the mean VAS pain score had no significant difference between the three groups. However, 30, 60, and 90 min after the intervention, the mean pain score was significantly lower in the intradermal and subdermal injection groups than in the control group (P = 0.001); however, the difference between the intradermal and subdermal injection groups was not significant. CONCLUSIONS: The injection of distilled water by either intradermal or subdermal method was associated with a significant reduction in the pain score during labor, but there was no difference between these two methods in terms of decreasing labor pain. As sterile water injection is a safe, effective, and low-cost method, it is proposed to increase the knowledge of midwives and obstetricians about this method.

Beneficial Effects of Oral Lactobacillus on Pain Severity in Women Suffering from Endometriosis: A Pilot Placebo-Controlled Randomized Clinical Trial.

BACKGROUND: This study assessed the effects of a lactobacillus-based medication on pain intensity scores in women with endometriosis. MATERIALS AND METHODS: The present randomized pilot placebo-controlled trial was done on eligible women who were surgically and pathologically diagnosed with endometriosis. Thirty-seven participants who had not received hormonal treatment in the last three months, were enrolled and randomized into LactoFem® and placebo groups. Lactobacillus capsules or placebo were administrated orally once a day for 8 weeks. Patients were assessed for pain severity using Visual Analogue Scale (VAS) scores for dysmenorrhea, dyspareunia and chronic pelvic pain at baseline and after 8 and 12 weeks post-intervention. RESULTS: Mean age of participants and mean body mass index (BMI) for the LactoFem® and control groups were comparable. All patients had stage 3 and 4 of the disease based on revised American fertility society (AFS) classification of endometriosis. Mean initial pain scores for dysmenorrhea, dyspareunia and chronic pelvic pain were 6.53 ± 2.88, 4.82 ± 3.76 and 4.19 ± 3.53, respectively in the LactoFem® group and 5.60 ± 2.06, 3.67 ± 2.64 and 2.88 ± 2.80, respectively for the control group; the two groups had comparable scores in this regard. There was more decrease in pain scores for both dysmenorrhea and the overall pain after 8 weeks of treatment in LactoFem® group compared to the control group. The scores for dysmenorrhea were 6.53 ± 2.88 and 5.60 ± 2.06 in the LactoFem® and control groups, respectively, before intervention but, after 8-week treatment, these values were 3.07 ± 2.49 and 4.47 ± 2.13 (P=0.018), respectively. The changes in overall pain score in the LactoFem® and control group during this period were 7.33 ± 7.00 and 4.11 ± 1.68, respectively (P=0.017). CONCLUSION: This study showed some beneficial effects of lactobacillus administration on endometriosis-related pain (Registration number: IRCT20150819023684N5).

A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP).

INTRODUCTION: Nausea and vomiting of pregnancy (NVP) are one of the most common complains of the early pregnancy period and are bothersome for pregnant women. Some prefer to use herbal medicine instead of chemical agents. OBJECTIVE: The purpose of the present study was to compare the effects of ginger, pyridoxine (vitamin B6), and placebo for the treatment of NVP. METHOD: The study was performed as a triple blind clinical trial on pregnant women suffering mild to moderate NVP between 6 and 16 weeks of pregnancy. In these women ginger, 500 mg twice daily, vitamin B6 40 mg twice daily and placebo twice daily were administered for 4 d. Rhodes questionnaire was used for evaluation of the severity of symptoms. The severity of NVP was evaluated 24 h before entering the study and up to 4 d after using medications and results were compared among the three groups. RESULTS: Seventy-seven women finished the study (28 in the Ginger group, 26 in the B6 group, and 23 in the placebo group). The women of the three groups did not have significant differences according to age, gestational age, parity, and severity of each symptom before treatment and educational status. Total score of Rhodes questionnaire for nausea was decreased significantly in three groups after treatment. (p < .001, p = .012, and p = .03 for ginger, vitamin B6, and placebo, respectively.) Also total score of Rhodes questionnaire for vomiting was decreased in three groups (p = .03 for ginger, p = .02 for B6, and p = .04 for placebo). Ginger and vitamin B6 could reduce the severity of all items of Rhodes questionnaire significantly; however, placebo was significantly effective only on the frequency of nausea, intensity of vomiting and frequency of retching. Ginger and vitamin B6 were more effective than placebo (p = .039 and p = .007, respectively); however, total score of Rhodes did not show significant difference between ginger and vitamin B6 (p = .128). Ginger was more effective for nausea (intensity and distress) and distress of vomit. CONCLUSION: Ginger is more effective than placebo for the treatment of mild to moderate NVP and is comparable with vitamin B6. Trial registration number and registry website: IRCT2015020320923N1.

A comparison between the effects of metformin and megestrol on simple endometrial hyperplasia.

INTRODUCTION: Endometrial hyperplasia is one of the most serious causes of severe abnormal bleeding and also can be a precursor of endometrial carcinoma. OBJECTIVE: The purpose of the present study was to compare the effects of metformin and megestrol on the endometrial hyperplasia. METHODS: The study was performed as a randomized clinical trial on 42 cases of histopathologically confirmed simple endometrial hyperplasia without atypia. The eligible women were randomly assigned into two groups. In metformin group, metformin was prescribed, 500 mg twice a day (1000 mg daily), for a duration of 4 weeks, and then, followed by 1500 mg daily, for 8 more weeks. In the megestrol group, megestrol was prescribed 40 mg daily for 12 weeks. At the end of the duration of the treatment, endometrial sampling was performed and the results were compared between the two groups. RESULTS: The women of the two groups did not have significant difference according to age, BMI and gravidity, parity and history of abortion. Overall, 18 women (81.8%) in metformin group and 12 women (60%) in the megestrol group had normal endometrial histology, after 12 weeks of treatment (p = 0.11). CONCLUSION: Metformin is comparable with megestrol for the treatment of simple endometrial hyperplasia.

A comparison of serum androgens in pre-eclamptic and normotensive pregnant women during the third trimester of pregnancy.

OBJECTIVE: To compare the serum androgens level during the third trimester of pregnancy between normotensive and pre-eclamptic women. METHOD: A case-control study was performed on 64 pregnant women with the gestational age of 28-34 weeks. 32 women were pre-eclamptic (case group), and 32 women were normotensive till term gestation (control group). The serum level of androgens including sex hormone binding globulin (SHBG), total and free testosterone, androstenedione (ADD), and dehydroepiandrosterone sulfate (DHEA-S), were compared between the two groups. RESULTS: The women of the two groups had no statistically significant difference according to age, gestational age, BMI (body mass index), parity and fetal sex. Serum level of SHBG (90.86 ± 9.30 vs. 55.86 ± 8.02 nmol/l, p = 0.02), total testosterone (3.70 ± 0.57 vs. 2.06 ± 0.24 ng/ml, p = 0.01), free testosterone (1.28 ± 0. 17 vs. 0. 74 ± 0.07 pg/ml, p = 0.01), and ADD (2.47 ± 0.10 vs. 2.17 ± 0.10 ng/ml, p = 0.04), was higher in the pre-eclamptic women. However, there was no difference between the two groups for DHEA-S (0.75 ± 0.18 vs. 0.51 ± 0.08 µg/ml, p = 0.19). CONCLUSION: Serum androgen levels during third trimester of pregnancy are higher in pre-eclamptic women and this may propose an effect of androgens in the pathogenesis of pre-eclampsia.