The effect of complementary medicine on maternal health promotion: An experimental study.

BACKGROUND: During the immediate post delivery period, women are particularly susceptible to distension of the bladder. Complementary and alternative medicine is becoming an established intervention modality within the contemporary health care system. However, very little is known about the impact of foot reflexology on the urinary system. The aim of this study was to evaluate the effect of the most popular type of complementary therapy (the foot reflexology) on first voiding time following elective cesarean section without urinary catheter. METHODS: This experimental study was performed on 61 pregnant women in Pastor Hospital, Mashhad, Iran, who met the inclusion criteria. Accordingly, participants were randomly allotted to either treatment or control groups. The intervention group received a single 20-min foot re?exology session at 2-3 h after the surgery. The time taken for first void was recorded by research assistant that blinded to the allocation of groups. The findings were recorded and analyzed with the SPSS software by using of Chi-square, independent t-test, Mann-Whitney, and Fisher exact methods P < 0.05 was considered as statistically significant. RESULTS: Using General Linear Model (GLM) for controlling of confounding variables, the results of t-test showed significant differences between two groups in terms of first voiding time (P = 0.001) following surgery. CONCLUSION: It seems that the use of foot reflexology as a nursing care plan to prevent urinary retention after cesarean section without urinary catheter does shorten first voiding time and increase maternal satisfaction.

Abdominal Wall Leiomyoma: A Case Report.

BACKGROUND: Fibroma or leiomyoma is the most common benign tumor of the female reproductive system, which is usually found in the uterus, but may also occur in other places, such as the ovary, the broad ligament, and in rare cases in the abdominal wall. The formation of the abdominal wall leiomyoma may result from the implantation of myometrium tissue following surgical removal of the uterine leiomyoma, but sometimes these masses occur in a person who has no history of myomectomy. CASE PRESENTATION: This case was a patient who became a candidate for laparoscopy due to abnormal uterine bleeding and pain in the right upper quadrant of the abdomen and ovarian mass. The patient underwent laparotomy due to the inability of surgeons to insert the veress needle because of the presence of mass in the abdominal wall. The pathologic report of the abdominal mass was leiomyoma. This article has been approved by the Ethics Committee of the University (6562276). CONCLUSION: The formation of myoma on the abdominal wall is rare but given the fact that leiomyoma can be created at each part of the body with smooth muscles, including the anterior abdominal wall, this diagnosis should be considered for the differential diagnosis of abdominal masses.

Enhanced delivery of melatonin loaded nanostructured lipid carriers during in vitro fertilization: NLC formulation, optimization and IVF efficacy.

In this study, the potential of melatonin hormone loaded in nanostructured lipid carriers (Mel-NLCs) in the in vitro fertilization (IVF) environment is investigated by measuring the oocyte maturation, the two-pre-nucleus embryo development, the two-cell stage embryo development, and blastocyst production on the oocytes of mice. Mel-NLCs are prepared using the hot homogenization-ultrasonication method. A response surface method is utilized to determine the best independent variables to obtain nanoparticles with a small particle size and high hormone entrapment efficiency. The optimized nanoparticles have a particle size of 119 nm with a polydispersity index of 0.09 and hormone entrapment efficiency of 94%. Characterization results such as TEM and AFM analysis confirm the spherical and relatively uniform structure of the optimal sample. FTIR and XRD analyses indicate that the hormone is properly loaded within the amorphous nanostructure. Drug release from NLC under the in vitro environment exhibits a biphasic domain including burst release in the first 2 hours and the controlled release in 48 h 92% of the drug is released from nanoparticles in 48 hours, but the same amount of hormone is released from the marketed drug suspension during 2 hours. Results of IVF experiments reveal that the nanostructured form has a positive effect on all IVF parameters compared to the free form of the hormone. In addition, using the hormone nanostructured form can reduce the dosage of the melatonin free form with the same efficacy in the IVF environment. Finally, the nanostructured form of melatonin based on NLC nanostructure can be a good candidate for application in IVF media.

Comparison of Laparoscopic Ovarian Drilling Success between Two Standard and Dose-Adjusted Methods in Polycystic Ovary Syndrome: A Randomized Clinical Trial.

BACKGROUND: One of the treatment methods for increasing the ovarian response to ovulation induction in polycystic ovary syndrome (PCOS) is laparoscopic ovarian drilling (LOD). The optimal amount of the electrosurgical energy discharged in the ovaries to achieve maximum treatment response with minimal follicle injury is unknown. This study was performed to compare the success level of LOD by means of standard and dose-adjusted treatment methods among infertile clomiphene-resistant PCOS women. MATERIALS AND METHODS: This randomized clinical trial was conducted on infertile clomiphene citrate-resistant PCOS women in the Gynaecology Department of Imam Reza Hospital between 2016 and 2017. The patients were randomly divided into two groups based on the ovarian cautery method. The two groups were examined and compared regarding the antral follicles, the serum levels of anti-Müllerian hormone (AMH), androgens, and mid-luteal progesterone one month after surgery. The regularity of cycles, ovulation, and pregnancy were examined monthly up to six months after surgery. RESULTS: In total, 60 women received bilateral LOD (n=30 per group). The level of AMH (P=0.73), testosterone (P=0.91), and dehydroepiandrosterone sulphate (DHEAS, P=0.16) did not differ at study entrance and one month after ovarian cautery [P=0.94 (AMH), P=0.46 (testosterone), and P=0.12 (DHEAS)] and for postoperative mid-luteal progesterone (P=0.31). Intragroup comparisons showed a statistically significant difference in the decrease in the number of antral follicles and testosterone in the standard group (P=0.02) and AMH level in the cautionary dose-adjusted group (P=0.04). We observed no difference in cycle regularity (P=0.22), ovulation (P=0.11), and pregnancy (P=0.40) between the two groups after six months. CONCLUSION: The results indicated that there was no difference between the two methods of ovarian cautery with regards to establishing cycle regularity and ovulation. The standard treatment was effective in decreasing the numbers of antral follicles and testosterone levels, whereas the dose-adjusted method significantly affected the decrease in AMH levels (Registration Number: IRCT20171210037820N1).

Twin pregnancy in the unicornuate uterus and non-communicating rudimentary horn: A case report.

Background: A unicornuate uterus is present in 0.1% of the general population. This müllerian anomaly carries significant obstetrical risk including abortion, preterm delivery, and rudimentary horn ruptures. Case: The patient is a 24-yr-old primigravida with 12-wk gestational age and a twin pregnancy in the unicornuate uterus and non-communicating rudimentary horn. One fetus in the unicornuate uterus and other in the rudimentary horn that was ruptured. In urgent laparotomy rudimentary horn and fallopian tube excised. Pregnancy in the unicornuate uterus was continued and at 38-wk gestational age, cesarean section due to premature rupture of the membrane was performed and then normal fetus was delivered. Conclusion: Twin pregnancy in a unicornuate uterus and rudimentary horn is a rare condition that carries a considerable risk to the mother. There is a need for increased awareness of this rare condition to prevent maternal morbidity and mortality.

Successful Management of Spontaneous Quadruplet Pregnancy: A Case Report.

Objective: Triplet or higher-order multiple pregnancies are often caused due to ovulation induction. Spontaneous quadruplet pregnancy is a rare phenomenon which is associated with maternal and fetal complications. Here in, we report a spontaneous quadruplet pregnancy with no family history and as a result of an unwanted pregnancy. Case report: The patient was a 34-year-old, G4 L2 Ab1. She noticed being pregnant during breastfeeding, a spontaneous quadruplet pregnancy. There was no case of multiple pregnancies in her or her husband's family. In week 29 she was hospitalized due to the diagnosis of preterm labour. At 32 weeks and 4 days of gestation, because of the restart of labour contractions and dilatation development, she underwent a cesarean section. The outcome was the birth of 4 healthy neonates weighing between 1800 to 2100 gram and normal Apgar score. Conclusion: Quadruplet pregnancy can rarely occur spontaneously even unintentionally, and can reach the third trimester without prophylactic cerclage.

Intrauterine synechiae after myomectomy; laparotomy versus laparoscopy: Non-randomized interventional trial.

BACKGROUND: Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae). OBJECTIVE: To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy. MATERIALS AND METHODS: In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran's Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups. RESULTS: Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma's size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02). CONCLUSION: With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae.

Evaluating success of curettage in the surgical treatment of endometrial polyps.

OBJECTIVES: To determine treatment efficacy of curettage on endometrial polyp. METHODS: The quasi-experimental pre-and-post study was conducted in 2011-12 at the gynaecology department of Imam Reza Hospital, Mashhad, Iran, and comprised patients who underwent hysteroscopy for endometrial polyp. Location, size, number and base condition of the polyps were recorded before the patient underwent curettage. Hysteroscopy was then performed and the condition of the remaining polyps was compared with initial findings. Also, the remaining polyps were resected. SPSS 13 was used for statistical analysis. RESULTS: There were 51 patients in the study with a mean age of 33.14 ± 8.19 years (range: 23-59 years)Besides, there were 82 polyps; 38(46.3%) having a narrow base, and 44(53.7%) having a wide base. The mean polyp size was 2.39 ± 2.63cm.After performing curettage, 23 (28.0%) polyps were removed completely, 39(47.6%) had size reduction, and 20(24.4%) had no change in size. Curettage could not significantly remove polyps (p < 0.001). Polyps smaller than 2cm were more likely to have been removed compared to the bigger ones (p = 0.003).Polyps with wide base were more significantly removed than those with narrow base (p < 0.001).Further, those with wide base and also smaller than 2 cm were removed more significantly than others (p < 0.001).The location of polyps had no effect on removal probability by curettage (p = 0.114). CONCLUSION: Curettage was not found to be a reliable method for endometrial polyp removal. If hysteroscopy is not accessible, the size of the polyp should be determined by vaginal sonograghy to estimate the probability of its removal by curettage.

Effects of magnetized water on ovary, pre-implantation stage endometrial and fallopian tube epithelial cells in mice.

BACKGROUND: Magnetized water has made many improvements in industry, agriculture and medicine. However its utilization in medicine still remains controversial. OBJECTIVE: In this study we aimed to investigate the effects of magnetized water on height of epithelial cells in pre-implantation stage endometrium and fallopian tube and number of corpus lutea in female mice. MATERIALS AND METHODS: Eighty female NRMI mice were recruited to this experimental study and randomly divided into two groups: the control group which drank normal water and the experimental (case) group which drank magnetized water for 2 weeks. Super-ovulation was induced in these mice and then they were mated with male mice as well. Samples of ovary, uterus and fallopian tube were obtained at the pre-implantation stage. Then, after preparation, the number of corpus lutea in each ovary was counted and the height of fallopian and endometrial epithelial cells was measured by light microscopy. RESULTS: Data analysis showed a significant increase in the mean number of corpus lutea and the height of epithelial cells in fallopian tube comparing the case with the control group (p=0.01, p=0.002 respectively) whereas uterus epithelial cells of the case group showed insignificant increase in height, in compare with the control group (p=0.052). CONCLUSION: Our results suggest that magnetized water intake increases the number of corpus lutea and the height of fallopian tube epithelial cells. Further research is needed to determine whether this will increase in the success rate of fertility.

The effect of extremely low frequency pulsed electromagnetic field on in vitro fertilization success rate in N MRI mice.

OBJECTIVE: The effects of exposure to electromagnetic fields (EMF) on reproduction systems have been widely debated. In this study, we aimed to investigate whether low frequency EMF could ameliorate the in vitro fertilization success rate in Naval medical research institute (NMRI) Mice. MATERIALS AND METHODS: In this randomized comparative animal study, ten NMRI mice were randomly divided into 2 equal groups (control and experimental). 10 IU of human chorionic gonadotropin (hCG) was injected intraperitoneally to both groups in order to stimulate ovulating, and ovums were then aspirated and kept in KSOM (modified version of sequential simplex optimization medium with a higher K(+) concentration) culture medium. Metaphase II ovums were separated, and sperms obtained by "swim out" method were added to metaphase II ovums in the culture medium. The experimental group was exposed to 1.3 millitesla pulsed electromagnetic field at 4 kilohertz frequency for 5 hours. To assess the efficacy, we considered the identification of two-pronuclear zygote (2PN) under microscope as fertilizing criterion. RESULTS: Total number of collected ovums in the control and experimental groups was 191 and 173, respectively, from which 58 (30.05%) and 52 (30.36%) ovums were collected from metaphase II, respectively. In vitro fertilization (IVF) success rate was 77% in extremely low frequency- pulsed electromagnetic field (ELFPEMF) for exposed group (experimental), whereas the rate was 68% for control group. CONCLUSION: Despite increased percentile of IVF success rate in exposed group, there was no statistically significant difference between 2 groups, but this hypothesis has still been stated as a question. Further studies with larger sample sizes and different EMF designs are suggested.

Frequency and the type of chromosomal abnormalities in patients with primary amenorrhea in northeast of iran.

OBJECTIVE(S): Primary and secondary amenorrhea are different from each other in that the former refers to a physiological failure in the onset of spontaneous menarche during the time when it is expected. whereas the latter involves the cessation of normal menstruation any time prior to menopause. In this study we aimed to investigate chromosomal abnormalities in patients with Primary Amenorrhea in Northeast of Iran by employing GTG banding. MATERIALS AND METHODS: Chromosomal analysis was carried out on 180 cases that were referred from different clinics in eastern cities of Iran to our laboratory from 2004 to 2009. We implemented the suggested protocol regarding peripheral blood lymphocyte culture for metaphase chromosome preparation as well as conventional analysis for G-banded chromosome. RESULTS: The karyotype results revealed that 75.55% (n=136) had normal chromosome composition and 24.45% (n=44) showed chromosomal abnormalities. Among the patients with abnormal chromosome constituents 86.36% exhibit numerical aberration and 13.63% showed structural abnormalities. The most frequent abnormality detected was X chromosome monosomy, homogeneous (21 cases -11.66%) or mosaic (8 cases - 4.44%). The other 6 cases (3.33%) had X chromosome structural imbalanced abnormalities (homogeneous or in mosaic). DISCUSSION: As expected, this study confirmed previously reported cytogentic abnormalities in patients with amenorrhea. Although there are percentage differences between these studies and also verities in chromosomal abnormalities, they have still demonstrated the importance of cytogenetic investigations in the etiological diagnosis of amenorrhea.

Frequency and the type of chromosomal abnormalities in patients with primary amenorrhea in northeast of iran.

OBJECTIVE(S): Primary and secondary amenorrhea are different from each other in that the former refers to a physiological failure in the onset of spontaneous menarche during the time when it is expected. whereas the latter involves the cessation of normal menstruation any time prior to menopause. In this study we aimed to investigate chromosomal abnormalities in patients with Primary Amenorrhea in Northeast of Iran by employing GTG banding. MATERIALS AND METHODS: Chromosomal analysis was carried out on 180 cases that were referred from different clinics in eastern cities of Iran to our laboratory from 2004 to 2009. We implemented the suggested protocol regarding peripheral blood lymphocyte culture for metaphase chromosome preparation as well as conventional analysis for G-banded chromosome. RESULTS: The karyotype results revealed that 75.55% (n=136) had normal chromosome composition and 24.45% (n=44) showed chromosomal abnormalities. Among the patients with abnormal chromosome constituents 86.36% exhibit numerical aberration and 13.63% showed structural abnormalities. The most frequent abnormality detected was X chromosome monosomy, homogeneous (21 cases -11.66%) or mosaic (8 cases - 4.44%). The other 6 cases (3.33%) had X chromosome structural imbalanced abnormalities (homogeneous or in mosaic). DISCUSSION: As expected, this study confirmed previously reported cytogentic abnormalities in patients with amenorrhea. Although there are percentage differences between these studies and also verities in chromosomal abnormalities, they have still demonstrated the importance of cytogenetic investigations in the etiological diagnosis of amenorrhea.

The role of vitamin C in prevention of preterm premature rupture of membranes.

BACKGROUND: Preterm premature rupture of membranes (PPROM) is one of the most important complications of the pregnancy and cause perinatal morbidity and mortality. History of PPROM is a risk factor of recurrent PPROM. Vitamin C plays an important role in collagen metabolism and increases resistance maintenance of the chorioamniotic membranes. OBJECTIVES: The aim of this study is to evaluate the role of vitamin C supplementation in prevention of PPROM in women with a positive history of PPROM. PATIENTS AND METHODS: This clinical trial study was performed on 170 pregnant women with the history of PPROM, with singleton pregnancy and gestational age 14 weeks in Imam-Reza Hospital, Mashhad University of Medical Sciences during 2008 to 2010. They were randomly divided into two groups. The case patients received 100 mg vitamin C daily from 14th weeks of gestation. PPROM occurrence was compared between two groups as an indicator of the protective effect of vitamin C supplements. RESULTS: PPROM occurred in 44.7% of controls and 31.8% of cases (P < 0.05). PROM occurred in 34.1% of controls and 18.8% of cases (P < 0.05). Pregnancy was terminated at term gestation in 21.2% of controls and 49.4% of cases (P < 0.05). Rupture of membranes was significantly decreased in the case group. CONCLUSIONS: Vitamin C supplementations after 14th weeks of gestation can prevent from PPROM in women with the history of PPROM.

The association between women's pelvic organ prolapse and joint hypermobility.

OBJECTIVE: To determine whether joint hypermobility is associated with pelvic organ prolapse. METHODS: The case-control study was conducted from January to April 2011 and comprised 30 women with pelvic organ prolapse, stage > or = II and 30 controls with stages 0 and I with similar age and parity. They were recruited from the gynaecology clinic at Imam Reza Hospital in Mashhad, Iran. The condition was evaluated by a quantification system and, for the purposes of this study, pelvic organ prolapse was defined as stage > or = II. All the subjects were examined in the dorsal lithotomic position with an empty bladder. A separate investigator evaluated each subject for joint hypermobility by using Beighton score which was calculated by doing five simple manoeuvres. SPSS 11.5 was used for data analysis. RESULTS: The mean age of the 30 cases was 35.40 +/- 6.39 years, while for the controls it was 35.36 +/- 5.9 years. Overall clinical joint hypermobility was found in 24 of the 60 (40%) subjects. There were no significant difference in the prevalence of joint hypermobility between the two groups. The prevalence of hypermobility in the cases was 36.7% (n = 11) versus 43.3% (n=13) in the controls (p = 0.59). The prevalence of cystocele in subjects with joint hypermobility was 41.7% (n = 10) versus 38.9% (n=14), (p < 0.83); rectocele 33.3% (n = 8) versus 41.7% ( n =15), (p < 0.73) women with normal joint mobility. No Significant differences were found between the groups with regard to other markers of connective tissue weakness such as the presence of varicose veins (p < 0.37), easy bruising ( p < 0.43) and observed striae ( p < 0.42). CONCLUSION: Joint hypermobility was not associated with pelvic organ prolapse in the study population. Further studies involving more patients with pelvic organ prolapse are recommended.