pISSN: 1735-8949
eISSN: 1735-9392
Editor–in–Chief:
Fatemeh Davari Tanha, MD.
Vol 8, No 3 (September 2014)
Original Articles
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Objective: To detect whether the preoperative combined administration of rectal diclofenac and paracetamol is superior to placebo or rectal diclofenac alone for pain after abdominal hysterectomy.
Materials and methods: Ninety female patients (American Society of Anesthesiologists (ASA) physical status I-II), scheduled for abdominal hysterectomy were recruited to this double blind trial and were randomized to receive one of three modalities before surgery: rectal combination of diclofenac and paracetamol, rectal diclofenac alone or rectal placebo alone which were given as a suppository one hour prior to surgery. The primary outcomes were visual analogue pain scores measured at 0, 0.5, 2, 4, 8, 16 and 24 hours after surgery and the time of first administration and also total amount of morphine used in the first 24 hour after surgery. A 10 cm visual analog scale (VAS ) was used to assess pain intensity at rest.
Results: In patients receiving the combination of diclofenac and paracetamol total dose of morphine used in the first 24 hour after surgery was significantly lower (13.9 ± 2.7 mg) compared to diclofenac group (16.8± 2.8 mg) and placebo group (20.1 ± 3.6 mg) (p < 0.05). VAS pain score was significantly lower in combination group compared to other groups all time during first 24 hours (p < 0.05). There had been a significant difference between combination group and the two other groups in terms of the first request of morphine (p < 0.05).
Conclusion: According to our study Patients who receive the rectal diclofenac-paracetamol combination experience significantly a lower pain scale in the first 24 hour after surgery compared with patients receiving diclofenac or placebo alone. Their need to supplementary analgesic is significantly later and lower compared to placebo and diclofenac alone. -
Objective:To determine the impact of a national intervention program on some pregnancy complications in Iran.
Materials and methods: this multicenter study was conducted in governmental sector in 14 provinces in Iran between 2003 and 2005. Intervention included education of all maternal health care providers including gynecologists, general physicians, and midwifes in the governmental sector. Time interval between the pre- (of 3,978 and 3,958 pregnancies) and post- (3,958 pregnancies) measurements were 18 months. Self reported data on pregnancy complications were registered. Interviews were conducted by trained personnel. Participants were interviewed when admitted for delivery or at the time attending for vaccination of their 2 month infants.
Results:The following pregnancy complications were reduced significantly as compared to before intervention: 1) bleeding or spotting, 2) urinary tract complications, 3) blurred vision and severe headache, 4) premature labor pain, 5) anemia, 6) severe vomiting, 7) inappropriate weight gain, 8) endometritis, 9) urinary incontinence, 10) breast abscess or mastitis, 11) wound infection, and 12) bleeding was significantly reduced after intervention, compared to before intervention. Premature rupture of membrane showed a significant increase. These complications did not show a significant change: 1) hypertension, 2) fever and chills, 3) convulsion, shock, and loss of consciousness, and 4) obstetric fistula.
Conclusion:National programs may be proved to be largely effective by decreasing some of the pregnancy complications in developing countries. -
Objective:In view of the effect of hard labor on pregnancy outcomes and to determine risk factors, in this study, the effect of spacing between pregnancies was evaluated for probable effect on the incidence of dystocia in labor.
Materials and methods:This is a cross - sectional study used the records of 210 pregnant women referred to Azad University hospitals between January 2000 and December 2012. Dystocia was diagnosed according to ICD-9-CM. Data were analyzed using statistical software Spss17.
Results:It was found that in pregnancies with 2-4 years spacing between births normal delivery was more prevalent while in the group with 8-10 years spacing labor dystocia was more prevalent.
Conclusion:Based on the findings of this study the interval between pregnancies has a significant effect on labor dystocia. Increasing the spacing between pregnancies more than 8 years is a risk factor for dystocia. -
Objective:Despite the benefits of mother-newborn skin-to-skin contact (SSC) immediately after birth, the process has not been universally implemented as routine care for healthy term neonates. The purpose of this study was to determine opinions of the midwives about enabling factors of SSC immediately after birth in Tehran hospitals in 2012- 2013.
Materials and methods:This study has been conducted in a descriptive method based on PRCEDE-PROCEED model. The samples were 292 midwives from 18 hospitals. We used stratified and then simple random sampling. In this study midwives were working at delivery room; deliveries were conducted by midwives or they were in charge of the newborn immediately after birth. Data collection instrument was a self developed questionnaire concerning the enabling factors in the SSC. We applied face and content validity ratio (CVR), content validity index (CVI) and item impact method for the instrument's validity and Cronbach's Alpha for reliability. Finally, data were analyzed and interpreted using spss-18 through descriptive statistics.
Results:The results show that 90.4% of the midwives believed in necessity of a plan, 96.2% believed that good services should be provided to mothers, and 97.9%, 85.3% and 93.8% of them believed there is a need for private space, essential facilities and essential equipment for skin contact process; with Cronbach's Alpha of 0.731, 0.551, 0.501, and 0.600 respectively.
Conclusion:Most of the midwives believed that enabling factors concerning the successful SSC are effective. We suggest further studies on other enabling factors effective in SSC from the view point of midwives, gynaecologists and caregivers. -
Objective: To compare self-confidence in woman with and without PCOS according to their ages.
Materials and methods: This comparative study was conducted on 400 women (100 with and 300 without PCOS) in clinics of Shahid Akbar-Abadi and Firouzgar Hospitals, from July 2012 to February 2013. SPSS-16 used for statistical analysis (SPSS; SPSS Inc., Chicago, IL, USA).
Results: This study showed 98% of PCOS and 93% in non-PCOS groups had average self-confidence with scores of 15-25. None of women in PCOS group and 6.7% of non-PCOS group had high self-confidence (score > 25). There was a significant difference between two groups in term of self-confidence level (p < 0.001). There was no significant difference in self-confidence between age group ≤ 30 and age group > 30 in both group, but in PCOS group, self-confidence were significantly higher in both age group under 30 (p < 0.0001) and 30 and higher (p < 0.0001).
Conclusion:Impaired self-confidence in PCOS groups (under 30 and 30 and higher age groups) in comparison with related value of non-PCOS group shows that mental health status in women with PCOS requires urgent psychological attention and support. -
Objective:To identify the non-obstetric causes and presentation of acute abdomen among pregnant women.
Materials and methods:This was a cross sectional hospital-based study among 128 pregnant women by face to face interview using a semi-structured questionnaire. This study was conducted at the Gynecology & Obstetric Ward of 250 Bed General Hospital, Noakhali, Bangladesh, from January to August 2013. Data were analyzed by a software package used for statistical analysis (SPSS) version 11.5 (SPSS, Inc., Chicago, IL, USA).Mean age of participants was 25±4 years. Our findings showed that 81% were Muslim, 67% were lower middle income group, as well as 47% completed primary level of education. The results revealed that 28% had biliary ascariasis, 24% had peptic ulcer disease and 10% had lower urinary tract infection. We also found that 6% had acute pyelonephritis, 6% had acute gastroenteritis, 6% had acute cholecystitis, 6% had acute appendicitis, 2% had acute pancreatitis, 3% had choledocolithiasis, 2% had ovarian solid mass, 2% had twisted ovarian cyst, 4% had renal colic, and 1% had renal calculus. In non-obstetrical presentation of acute abdomen, the study found that 84% of respondents complained their pain lasting more than 24 hours. Besides, half of respondents felt pain in epigastrium and right hypochondrium. Cramping, prickling and aching type of pain were more, while 66% suffered from continuous pain. Our results also showed that 73% did not explain any aggravating factor and relieving factor, and the rest said food, fasting state and position change aggravated pain as well as relieved pain.
Conclusion:The study concludes that precise diagnosis of the acute abdomen in pregnant women by continual updating of abdominal assessment knowledge, and clinical skills is necessary in the management of abdominal pain in obstetric settings. -
Objective:To determine the association between serum 25 - hydroxy vitamin D concentration and anthropometric indices in patients with polycystic ovarian syndrome (PCOS).
Materials and methods:This is a descriptive cross - sectional study which was carried out on women with PCOS aged 19-39 years old referred to an infertility clinic of Alzahra Hospital, Rasht, Iran during September2011- March2012. The study was conducted based on the Rotterdam criteria. Exclusion criteria were hyperandrogeniema and thyroid dysfunction. The data were gathered through an interview with focus on demographic characteristics and history of infertility. The height, weight and waist and hip circumferences were measured and BMI had been calculated. Also, blood sample had been checked to indicate the level of hydroxy vitamin D. While all statistical analyses were carried out using software package used for statistical analysis (SPSS) version 16 (SPCC Inc., Chicago, IL, USA).
Results: Over 68% of patients had vitamin D deficiency (Vit D < 15). Level of vitamin D had a significant correlation with waist circumference (p < 0.02), height (p < 0.001) and waist-to-hip ratio (WHR) (p < 0.007).
Conclusion: Based on the anthropometric indices, it seems that we can predict the level of 25-hydroxyvitamin D in women with PCOS. -
Objective: To find shortest and reliable time period of urine collection for determination of proteinuria.
Materials and methods: It is a prospective study carried out on 125 pregnant women with preeclampsia after 20 weeks of gestation having urine albumin >1 using dipstick test. Urine was collected in five different time intervals in colors labeled containers with the assistance of nursing staff; the total collection time was 24 hours. Total urine protein of two-hour, four-hour, eight-hour, 12-hour and 24-hour urine was measured and compared with 24-hour collection. Data was analyzed using the Pearson correlation coefficient.
Results: There was significant correlation (p value < 0.01) in two, four, eight and 12-hour urine protein with 24-urine protein, with correlation coefficient of 0.97, 0.97, 0.96 and 0.97, respectively. When a cut off value of 25 mg, 50 mg. 100 mg, and 150 mg for urine protein were used for 2-hour, 4-hours, 8-hour and 12-hour urine collection, a sensitivity of 92.45%, 95.28%, 91.51%, and 96.23% and a specificity of 68.42%, 94.74%, 84.21% and 84.21% were obtained, respectively.
Conclusion: Two-hour urine proteins can be used for assessment of proteinuria in preeclampsia instead of gold standard 24-hour urine collection for early diagnosis and better patient compliance.
