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.

Effects of Vitamin D on Endometriosis-Related Pain: A Double-Blind Clinical Trial.

BACKGROUND Endometriosis is a disabling disease of reproductive-age women. Dysmenorrhea, dyspareunia, and pelvic pain are the main symptoms of endometriosis. Its etiology is not clear. Endometriosis may have various causes, including vitamin D deficiency, but its effect is controversial. MATERIAL AND METHODS In this double-blind clinical trial, we enrolled patients with endometriosis diagnosed and treated by laparoscopy, with scores of at least 3 for of dysmenorrhea and/or pelvic pain at 8 weeks after surgical treatment. They were randomly prescribed vitamin D (50 000 IU weekly for 12 weeks) or placebo. Severity of pain in the 2 groups (placebo and treatment) was compared by VAS test at 24 weeks after surgical treatment. RESULTS There were 19 patients in the vitamin D group and 20 in the placebo group. Baseline characteristics in the 2 groups were similar. Following the treatment with vitamin D or placebo, we did not find significant differences in severity of pelvic pain (p=0.24) and dysmenorrhea (p=0.45) between the 2 groups. Mean pelvic pain at 24 weeks after laparoscopy in the vitamin D group was 0.84±1.74 and in placebo group it was 0.68±1.70 (p=0.513). Mean dysmenorrhea was 2.10±2.33 in the vitamin D group and 2.73±2.84 in the placebo group (p=0.45). CONCLUSIONS After ablative surgery for endometriosis, vitamin D treatment did not have a significant effect in reducing dysmenorrhea and/or pelvic pain.

Folic acid supplementation reduces plasma homocysteine in postmenopausal women.

Plasma homocysteine, which is increased after menopause, can be a risk factor for cardiovascular disease and osteoporosis. The purpose of the present study was to determine the effect of folic acid supplementation on plasma homocysteine in postmenopausal women. The study was performed as a randomized placebo controlled trial on 48 healthy postmenopausal women (aged 50-70 years) and plasma homocysteine of all women was measured. In the case group, folic acid, and in the control group, placebo was prescribed. The second plasma homocysteine was measured 16-17 weeks later and was compared in the two groups. There was no significant difference between the two groups according to age, BMI, parity, duration of menopause and the first plasma homocysteine level. Plasma homocysteine level was significantly lower in the case group than control group 16 weeks after folic acid administration (10.33 ± 3.51 µmol/l vs 13.21 ± 3.11 µmol/l, p=0.004). There was no significant correlation between plasma homocysteine level and BMI and parity. However, there was a weak-moderate positive correlation between plasma homocysteine and age (p<0.05, r=0.33), and there was a significant but weak correlation between plasma homocysteine and duration of menopause (p=0.05, r=0.28).

Frequency of molar pregnancies in health care centers of tehran, iran.

BACKGROUND: Hydatidiform mole is an important obstetric problem which can result in harmful and serious outcomes. In this study, an attempt was made to determine the proportion of hydatidiform mole in prenatal clinics of Iran University of Medical Sciences (IUMS) to find the precise frequency of this disease. METHODS: Between January 2012 and January 2013, all women who immediately after positive pregnancy test or after retarded menstruation came to prenatal clinics in health care centers of IUMS were included in the study. The women were followed until 8-10 weeks of pregnancy and at this time abdominal sonography was used for confirmation or exclusion of molar pregnancy. RESULTS: In this descriptive study between January 2012 and January 2013, 8614 pregnant women with mentioned criteria were included and 61 cases of hydatidiform mole were diagnosed (0.7% or 7 per 1000 pregnancy). Ten cases (16.4%) were patients with partial moles. There was no significant difference in blood types in molar and non-molar pregnancies, but molar group differed significantly from non-molar group in terms of history of molar pregnancy, abortion, OCP use and ovulation induction. DISCUSSION: Proportion of hydatidiform mole in this study was more than the reported European and American statistics.

Prediction of neonates' macrosomia with maternal lipid profile of healthy mothers.

BACKGROUND: The aim of this study is to identify the association between the lipid profile of healthy nondiabetic, nonobese pregnant women in the first weeks of the third trimester of pregnancy and macrosomia or large-for-gestational-age (LGA) neonates with normal pregnancies. MATERIALS AND METHODS: In this cohort study, 200 pregnant healthy women without gestational diabetes mellitus (GDM), obesity, or hypertension and carrying a single fetus in a prenatal clinic of a referral hospital were included based on a convenience sampling. Then, we took a blood sample to assess fasting blood sugar (FBS), triglyceride (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). GDM was assessed after administering 50 g of oral glucose. All cases were followed until the end of pregnancy. The main outcome measurement was neonatal birth weight. RESULTS: Only 154 mothers met eligibility criteria. There were eight cases (5.2%) with macrosomia (birth weight ≥ 4000 g) and 35 cases (22.7%) with LGA. Linear regression showed that mothers' TG and neonates' gender were independent predictors of the birth weight of the children (R-square = 0.52, p < 0.001). Logistic regression analysis showed that maternal FBS and TG are the most independent variables which can predict the presence of macrosomia (Nagelkerke R-square = 0.53, p < 0.001) and maternal TG and child gender are the most independent variables that can predict the presence of LGA in neonates of a healthy mother (Nagelkerke R-square = 0.49, p < 0.001). CONCLUSION: Maternal triglyceride levels may be a significant predictor of fetal size in late pregnancy but not in early pregnancy. Our study reinforces that this is true not only in the case of macrosomia (birth weight > 4500 g), but also for LGA.

Effect of Letrozole on endometriosis-related pelvic pain.

BACKGROUND: To determine the role of Letrozole, an aromatase inhibitor, in the treatment of endometriotic pain. METHODS: In this prospective, randomized, controlled clinical trial in minimally invasive surgery research center, 51 women with pelvic endometriosis and endometriotic pain (dyspareunia, dysmenorrhea, pelvic pain) score of 5 or more (for at least one of these endometriotic pain), after laparoscopic diagnosis and conservative laparoscopic surgery were treated with either Letrozole plus OCP (n=25) or only OCP (n=26) for 4 months continuously. RESULTS: Using VAS test, the score of dyspareunia, dysmenorrhea and pelvic pain 4 months after the laparoscopic surgery declined significantly in both groups but the difference between results of the two groups was not significant. CONCLUSION: Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis and in comparison with OCP, Letrozole did not affect the outcome.

Effects of simvastatin in prevention of pain recurrences after surgery for endometriosis.

BACKGROUND: To compare efficacy of simvastatin with GnRHa (Decapeptyl 3.75 mg) on endometriosis-related pains following surgery for endometriosis. MATERIAL/METHODS: Sixty women with pelvic endometriosis, after laparoscopic diagnosis and conservative laparoscopic surgery, were treated with either simvastatin (n=30) for 16 weeks or Decapeptyl (n=30) every 4 weeks for 4 doses. RESULTS: Using VAS, the score of dyspareunia, dysmenorrhea, and pelvic pain 6 months after laparoscopic surgery declined significantly in both groups (p=0.001), but the difference between results of the 2 groups was not significant (p>0.05). CONCLUSIONS: Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis.

Prinzmetal's Angina in a Pregnant Woman: a Case Report.

Acute myocardial infarction (MI) during pregnancy is rare and MI due to Prinzmetal's angina is much rarer. We present a 35-year-old, obese, multigravida, and pre-eclamptic woman, who developed acute anterior wall MI at the 30th week of gestation. On coronary angiography, the second obtuse marginal branch was totally occluded and the right coronary artery (RCA) was normal. Three days later, she had chest pain and ST elevation in the inferior leads. On second angiography, there was narrowing in the RCA, while the obtuse marginal branch was patent. We presume that this discrepancy between the first and second electrocardiograms and angiographic findings was due to Prinzmetal's angina.