The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery.

BACKGROUND: Selection and acceptance of appropriate sexual behavior and sexual function are made difficult by low sexual self-efficacy in the postpartum period. The general purpose of this research is to define the effects of an 8-week pelvic floor muscle exercise program on sexual self-efficacy in primiparous women after childbirth. MATERIALS AND METHODS: This clinical trial was performed on 79 primiparous women who referred to health care centers, Mashhad, Iran in 2013, 8 weeks after delivery, to receive health care services. They were selected by easy sampling. The samples were randomly assigned to either intervention or control group. The intervention group was trained in Kegel exercises for 8 weeks. Both groups were evaluated at 4 and 8 weeks. Data collection tools included: Demographic information, sexual self-efficacy, and Brink scale. Data were analyzed using repeated measures, Friedman test, t-test, and Mann-Whitney test. RESULTS: The results showed significant increase in pelvic floor muscle strength in the intervention group at 4 and 8 weeks after exercises (P < 0.0001), but no significant difference was observed in the control group (P = 0.368). There was a significant increase in sexual self-efficacy in the intervention (P < 0.0001) and control groups (P = 0.001) at 4 and 8 weeks after the start of the study. Comparison of the two groups showed a significant difference in sexual self-efficacy after they performed these exercises (P = 0.001). CONCLUSIONS: The findings showed that 8-week pelvic muscle exercises increase the sexual self-efficacy in women after delivery.

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.

Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial.

OBJECTIVE: To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence. METHODS: In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire. RESULTS: Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King's Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention. CONCLUSION: Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.

Comparison of serum levels of Tri-iodothyronine (T3), Thyroxine (T4), and Thyroid-Stimulating Hormone (TSH) in preeclampsia and normal pregnancy.

BACKGROUND: The physiological changes in thyroid gland during pregnancy have been suggested as one of the pathophysiologic causes of preeclampsia. OBJECTIVE: The aim of this study was comparison of serum levels of Tri-iodothyronine (T3), Thyroxine (T4), and Thyroid-Stimulating Hormone (TSH) in preeclampsia and normal pregnancy. MATERIALS AND METHODS: In this case-control study, 40 normal pregnant women and 40 cases of preeclampsia in third trimester of pregnancy were evaluated. They were compared for serum levels of Free T3 (FT3), Free T4 (FT4) and TSH. The data was analyzed by SPSS software with the use of t-student, Chi-square, Independent sample T-test and Bivariate correlation test. p≤0.05 was considered statistically significant. RESULTS: The mean age was not statistically different between two groups (p=0.297). No significant difference was observed in terms of parity between two groups (p=0.206). Normal pregnant women were not significantly different from preeclampsia cases in the view of FT3 level (1.38 pg/ml vs. 1.41 pg/ml, p=0.803), FT4 level (0.95 pg/ml vs. 0.96 pg/ml, p=0.834) and TSH level (3.51 µIU/ml vs. 3.10 µIU/ml, p=0.386). CONCLUSION: The findings of the present study do not support the hypothesis that changes in FT3, FT4 and TSH levels could be possible etiology of preeclampsia.

Efficacy of 17α-hydroxyprogesterone caproate in prevention of preterm delivery.

AIM: Preterm delivery is defined as a birth before 37 weeks' gestation and is the cause of two-thirds of perinatal mortality and thus one of the major problems in obstetrics. Its etiology is unknown, but hormonal factors have been reported to play a part. Progesterone is a placental hormone and effective in maintaining pregnancy. The aim of this study is to evaluate the efficacy of 17α-hydroxyprogesterone caproate in the prevention of preterm delivery. METHODS: This interventional study was performed with 100 pregnant women who had been referred to the Obstetrics Clinic of Ghaem Hospital (related to Mashhad University of Medical Sciences) during 2007 to 2008. They were randomly divided into two groups of 50 cases and 50 controls. The case group received 250 mg of intramuscular 17α-hydroxyprogesterone caproate weekly from 16 weeks' gestation up to a maximum of 37 weeks' gestation. In the control group, routine perinatal care was performed and the pregnancy outcomes were compared in both groups. RESULTS: The mean gestational age was 36 weeks in the case group and 34 weeks in the control group. The mean birth weight was 2695 g in the case group and 2399 g in the control group. A significant difference was observed between the two groups in terms of gestational age and birth weight (P < 0.05). CONCLUSION: Weekly administration of 17α-hydroxyprogesterone caproate to pregnant women with a history of preterm delivery was associated with a decrease in preterm delivery and improvement in birth weight.

The intelligence quotient of school aged children delivered by cesarean section and vaginal delivery.

BACKGROUND: There has always been an asking question with physicians and health staff whether delivery mode can effect on child intelligence. This study was conducted to compare the intelligence quotient (IQ) of school aged children delivered by cesarean section and vaginal delivery in Mashhad, Iran. METHODS: This study conducted in two stages; a cross-sectional section in which 5000 randomly selected children, who were 6-7 years old, attended at 10 Cognitive Examination Posts in Mashhad. The examination was performed by the Exceptional Education and Training Institute affiliated to Ministry of Education for all 6-7 years old children at the entry to the primary school. At the second stage, we selected two matched groups of 189 children who delivered by cesarean section or spontaneous vaginal delivery and then compared their IQ scores. RESULTS: The cesarean delivery group had significantly higher IQ test scores. Maternal and paternal educational levels were related to children's IQ scores. After adjusting of maternal and paternal education, maternal age and parity, there was not any significant difference between IQ scores of cesarean delivery and natural vaginal delivery groups 101(3.67) vs. 100.7(4.28). CONCLUSIONS: Based on our findings, the association between cesarean deliveries with better cognitive development in children cannot be supported.

The relation between short-term oral contraceptive consumption and cerebrovascular, cardiovascular disorders in Iranian women attending Hajj.

OBJECTIVE: To evaluate the spectrum of probable vascular complications due to short-term oral contraceptives OC consumption. METHODS: In this cohort study, selected Iranian female pilgrims from Razavi-Khorasan, Iran province <50 years old, attending Hajj in 2005 were evaluated. We reviewed their physical examinations, vascular risk factors and OC consumption before Hajj. Pilgrims were followed-up in terms of developing possible vascular complications during Hajj and the following year. RESULTS: This study included 896 individuals and completed follow-up was performed for 642. The results showed that 782 (87.3%) of pilgrims used OC. One person developed cerebral vein thrombosis, one myocardial infarction, and one deep vein thrombosis. Eighteen patients (2.8%) experienced transient hypertension. Ten patients (1.5%) had migraine exacerbations. The relationship between developed definite vascular complications and OC consumption was not statistically significant in this study p=0.365. CONCLUSION: Although vascular complications of long-term OC consumption have been analyzed and proved in several studies, few studies have determined short-term OC consumption effects on the vascular system. It seems that even short-term usage of OC may result in vascular complications, thus further studies with more samples is recommended to determine its safety and complications.