Dietary acid load and risk of diminished ovarian reserve: a case-control study.

BACKGROUND: The epidemiologic evidence on the association between acid load potential of diet and the risk of diminished ovarian reserve (DOR) is scarce. We aim to explore the possible relationship between dietary acid load (DAL), markers of ovarian reserve and DOR risk in a case-control study. METHODS: 370 women (120 women with DOR and 250 women with normal ovarian reserve as controls), matched by age and BMI, were recruited. Dietary intake was obtained using a validated 80-item semi-quantitative food frequency questionnaire (FFQ). The DAL scores including the potential renal acid load (PRAL) and net endogenous acid production (NEAP) were calculated based on nutrients intake. NEAP and PRAL scores were categorized by quartiles based on the distribution of controls. Antral follicle count (AFC), serum antimullerian hormone (AMH) and anthropometric indices were measured. Logistic regression models were used to estimate multivariable odds ratio (OR) of DOR across quartiles of NEAP and PRAL scores. RESULTS: Following increase in PRAL and NEAP scores, serum AMH significantly decreased in women with DOR. Also, AFC count had a significant decrease following increase in PRAL score (P = 0.045). After adjustment for multiple confounding variables, participants in the top quartile of PRAL had increased OR for DOR (OR: 1.26; 95%CI: 1.08-1.42, P = 0.254). CONCLUSION: Diets with high acid-forming potential may negatively affect ovarian reserve in women with DOR. Also, high DAL may increase the risk of DOR. The association between DAL and markers of ovarian reserve should be explored in prospective studies and clinical trials.

The uterocervical angle-cervical length ratio: A promising predictor of preterm birth?

OBJECTIVE: To predict spontaneous preterm birth (sPTB) (labor before 37 weeks of pregnancy) in low-risk singleton pregnancies during the second trimester, using ultrasound markers: uterocervical angle (UCA) and cervical length (CL). METHODS: In a prospective observational cohort study, we followed primigravid women with singleton pregnancies without known risk factors for sPTB from 16+0-23+6 weeks of pregnancy until birth. Transvaginal ultrasonography on admission revealed the UCA and CL, and maternal history was obtained from submitted patient profiles. Logistic regression models disclosed significant predictive variables, and receiver operating curves (ROCs) demonstrated optimal cut-offs and test accuracy indices. Predictive functions of variables were compared using positive and negative likelihood ratios. RESULTS: In a sample of 357 participants, 41 (11.5%) experienced sPTB. UCA and CL were significantly associated with sPTB when adjusting for other variables (adjusted odds ratio: UCA 1.05, 95% confidence interval [CI] 1.02-1.07 and CL 0.82, 95% CI 0.75-0.90). Optimal cut-offs were estimated to be 106° and 33 mm for UCA and CL, respectively. We devised the novel index UCA/CL with an area under the ROC of 0.781 (95% CI 0.734-0.823), cut-off = 3.09°/mm, and improved likelihood ratios (positive: 3.18, 2.47, and 4.22; negative: 0.63, 0.52, and 0.51 for UCA, CL, and UCA/CL, respectively). CONCLUSION: The second-trimester UCA/CL was found to be a promising index to predict sPTB in low-risk singleton pregnancies. Further multicenter studies may generalize this conclusion to other gestational ages or risk groups and make it more comprehensive by considering other risk factors.

The association between Diet Quality Index-International score and risk of diminished ovarian reserve: a case-control study.

Introduction: Although limited evidence exists on the beneficial reproductive effects of diet quality indices, the association is still largely unknown. We aimed to investigate the association between Diet Quality Index-International (DQI-I) and antral follicle count (AFC) and serum antimullerian hormone (AMH) as precise and sensitive markers of ovarian reserve and to assess the risk of diminished ovarian reserve (DOR) in women seeking fertility treatments. Methods: In a case-control study, 370 women (120 women with DOR and 250 women with normal ovarian reserve as controls), matched by age and body mass index (BMI), were recruited. Dietary intake was obtained using a validated 80-item semi-quantitative food frequency questionnaire (FFQ). The quality of diets was assessed using DQI-I, which included four major dietary components: variety (0-20 points), adequacy (0-40 points), moderation (0-30 points), and overall balance (0-10 points). DQI-I score was categorized by quartiles based on the distribution of controls. AFC, serum AMH and anthropometric indices were measured. Logistic regression models were used to estimate multivariable odds ratio (OR) of DOR across quartiles of DQI-I score. Results: Increased adherence to DQI-I was associated with higher AFC in women with DOR. After adjusting for potential confounders, the odds of DOR decreased with increasing DQI-I score (0.39; 95% CI: 0.18-0.86). Conclusion: Greater adherence to DQI-I, as a food and nutrient-based quality index, may decrease the risk of DOR and improve the ovarian reserve in women already diagnosed with DOR. Our findings, though, need to be verified through prospective studies and clinical trials.

Identifying and prioritizing the stressors of obstetrics and gynecology residents.

BACKGROUND: Studies have shown that the obstetrics and gynecology residents face severe burnout and a large number of stressors, and excessive stress could adversely affect performance and quality of patient care. Thus, the current study attempts to identify and prioritize the stressors of obstetrics and gynecology residents at Isfahan University of Medical Sciences. MATERIALS AND METHODS: A cross-sectional descriptive-analytical study was conducted on 62 residents and faculty members in the department of obstetrics and gynecology at Isfahan University of Medical Sciences in 2022. Respondents were selected by census method. The stressors of obstetrics and gynecology residents were investigated using a researcher-made, 37-item questionnaire. The questionnaire was prepared based on a literature review and respondents' opinions, then its validity and reliability were confirmed. Collected data were analyzed using the SPSS 20, non-parametric Friedman's test, and descriptive statistics methods. RESULT: This study included 46 respondents (74%), 16 faculty members, and 30 residents, who were asked to rate each stressor of the given questionnaire. The residents and their teachers believed that the main stressors were heavy workloads, lack of personal time, long shifts, financial problems, sleep deprivation, and compassion fatigue. Insufficient study time, study workload, and inappropriate assessment systems for residents were among the high-priority stressors, according to the residents. However, the faculty members reported medical errors, unreasonable expectations from residents, and residents' multiple responsibilities as high-priority stressors. According to the Friedman's test, there was a significant difference in rates received from both the faculty members and medical residents (P value <0/001). CONCLUSION: The stressors due to the nature of obstetrics and gynecology, medical care, residency training, and medical resident assessment are the highest priority. The findings of this study could be beneficial to the officials in residency training programs to take the necessary corrective actions.

Evaluation and Comparison of Sensitivity and Specificity of Ultrasonography in Placenta Accreta Diagnosis in the Second and Third Trimesters.

Background: Ultrasound is the selected technique for the detection of placenta accreta spectrum (PAS). This method can detect PAS in 80%-50% of cases. This study aimed to assess and compare the sensitivity and specificity of ultrasonography in the diagnosis of PAS after the first trimester. Materials and Methods: In this prospective study that was performed in 2020-2021 on 79 patients at high risk of PAS, all cases underwent ultrasonography in both 18-22 weeks of gestational age (GA) and 32-34 weeks of GA for evaluation of accreta. As per the risk factors, the delivery plan for all mothers was cesarean section. During the cesarean section, the placenta was examined for accreta, and if it was attached to the uterus, a diagnosis of placenta accreta was ascertained and a total abdominal hysterectomy was performed if the patient's bleeding was not controlled during the operation. The final diagnosis of PAS was made based on the pathology report. Results: Ultrasound evaluation for PAS in 18-22 weeks of GA had 79.17% specificity, 51.61% sensitivity, 61.54% positive predictive value, and 71.70% negative predictive value. Ultrasound imaging for PAS in 32-34 weeks of GA had 60.8% specificity, 90% sensitivity, 62.52% positive predictive value, and 90.33% negative predictive value. Conclusion: It should be concluded that PAS is a critical condition and if the patient is diagnosed in the second or third trimester, special strategies should be applied.

Comparison of High Uterosacral and Sacrospinous Ligament Suspension Surgeries for the Treatment of Pelvic Organ Prolapse in Women.

Background: Pelvic floor disorders include urinary incontinence, fecal incontinence, and pelvic floor prolapse, which are common complaints in women. Patients that suffer from uterine prolapse could benefit from surgical procedures that stabilize pelvic ligaments. Here, we aimed to compare the high uterosacral and sacrospinous ligament suspension surgeries. Materials and Methods: This clinical trial was performed in 2019-2021 on 64 women with uterine prolapse. Demographic data of the patients, including age, body mass index (BMI), past medical diseases, history of delivery, type of delivery, and duration of hospitalization, were collected. We assessed their urinary symptoms, prolapse degree, and sexual symptoms using the Female Sexual Function Index (FSFI) and Pelvic Floor Disability Index (PFDI-20) questionnaires before surgical interventions. Patients were divided into two groups undergoing high uterosacral and sacrospinous ligament suspension. They were followed up 6 and 12 months after surgeries. Results: Patients treated with sacrospinous ligament suspension had higher frequencies of surgical complications (P = 0.039), and the most common complication was low back pain (15.6%). The uterine prolapse andC point degree improved significantly in all cases after 6 and 12 months (P < 0.001). The Pelvic Organ Prolapse Quantifications System (POP-Q) scores improved significantly in both groups 6 and 12 months after surgery (P < 0.001), and patients who underwent sacrospinous ligament suspension had significantly lower pain intensity compared to the other group (P = 0.003). FSFI scores improved significantly in patients treated in both groups (P < 0.001). Conclusion: Both high uterosacral and sacrospinous ligament suspension techniques significantly improved pain, uterine prolapse, and C point degree.

Evaluation of Maternal and Fetal Outcomes in Pregnant Women with COVID-19 based on Different Trimesters.

Background: COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters. Materials and Methods: This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection. Results: The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester (P = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women (P = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester (P = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%). Conclusion: We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.

Evaluation of Fetal and Maternal Outcomes in Chorion Villus Sampling (CVS).

Background: Chorionic villus sampling (CVS) is one of the invasive diagnostic methods used to diagnose chromosomal, genetic, and metabolic diseases in the embryonic period. The use of this method is associated with maternal and fetal consequences, the most serious of which is abortion. Therefore, the present study was conducted to investigate the incidence of these consequences and the factors affecting the incidence of abortion. Materials and Methods: A cross-sectional study was performed on 98 pregnant women with CVS indications. Maternal and fetal outcomes including abortion, vaginal bleeding, subchorionic hematoma, premature rupture of membrane (PROM), chorioamnionitis, preterm delivery, limb abnormality, fetal growth retardation, and preeclampsia were recorded. Results: The results of the present study showed that the incidence of fetal outcomes including fetal growth failure, premature rupture of membranes, abortion, and limb abnormalities was 4.1%, 7.1%, 3.1%, and 1%, and the incidence of maternal outcomes including preterm delivery, subchorionic hematoma, preeclampsia, and hemorrhage was 14.3%, 3.1%, 6.1%, and 10.2%, respectively. In addition, a decrease in free BHCG and an increase in NT were significantly associated with the occurrence of abortion (OR: 0.11 and 4.25, respectively, P value < 0.05). Conclusion: It should be noted that due to a long time between placental sampling and the occurrence of vaginal bleeding, premature rupture of membrane, and preterm delivery, it seems that placental sampling has no effect. In addition, only a decrease in free BHCG or an increase in NT significantly increased the chance of miscarriage.

Evaluation of Episiotomy Characteristics of EPISCISSORS-60 Scissors Compared with Mayo Scissors: A Single-Blind Randomized Clinical Trial.

Background: It seems that angled scissors may be able to minimize the occurrence of obstetric anal sphincter injuries (OASIS) during vaginal delivery by correcting the angle of the episiotomy incision.For this purpose, this study aimed to evaluate the episiotomy characteristics of EPISCISSORS-60 scissors compared with Mayo scissors. Methods: In this single-blind clinical trial study, 64 pregnant women candidates for natural childbirth were included; 32 women underwent episiotomy with Mayo scissors and 32 underwent episiotomy with the EPISCISSORS-60 instrument. Then, post-suturing angle, incision length, episiotomy, postpartum pain, bleeding volume, and the incidence of OASIS and dyspareunia were assessed. The collected data were analyzed by independent sample t test, chi-square test, and the Fisher exact test. Results: Episiotomy incision length in the EPISCISSORS-60 group with a mean of 4.75 ± 0.72 cm was significantly longer than the Mayo group with a mean of 3.91 ± 0.52cm (P < 0.001). In addition, the incidence of dyspareunia was not significantly different between the 2 groups (6.3% vs 15.6%; P = 0.426). Sphincter damage did not occur at all in the EPISCISSORS-60 group and only 2 cases of grade 3 sphincter rupture occurred in the Mayo group (P = 0.238). The mean of post suturing angle in the EPISCISSORS-60 group (59.09° ± 3.47°) was significantly higher than the Mayo group, with a mean of 31.06° ± 7.21° (P < 0.001). Conclusion: According to the results of the present study, the use of EPISCISSORS-60 can be associated with a higher post-suture episiotomy angle compared with Mayo scissors. As a result, both the incidence of OASIS and its long-term side effects, like dyspareunia, were decreased. However, in our study, the incidence of these complications was very rare and not different between the 2 groups.

Evaluation of the Relationship between Pregnancy-Associated Plasma Protein A (PAPP-A) and Pregnancy Outcomes.

Background: In the current study, we aimed to evaluate the association between pregnancy-related plasma protein-A (PAPP-A) levels measured in the first trimester and pregnancy outcomes. Materials and Methods: This is a descriptive-analytical study that was performed in 2019--2021 on 1061 pregnant women in their first trimester. Demographic and basic information of all women were collected. These data included age, weight, parity, and date of delivery. Then the quantity of PAPP-A was recorded in three groups including less than 0.5 MOM, 0.5 to 2.5 MOM, and more than 2.5 MOM. Results: Data of 1061 women were analyzed. 900 women (84.8%) had term delivery and 155 women (14.6%) had pre-term deliveries. PAPP-A levels were normal in 83.4% of women. BMI and number of pregnancies had significant relationships with PAPP-A (p < 0.001, P = 0.03 respectively). The mean BMI in mothers with PAPP-A higher than 2.5 was significantly more than mothers with normal or lower PAPP-A levels (26.2 ± 31, P = 0.04). The frequency of term labor in mothers with normal PAPP-A was higher than other mothers (86.3%, P = 0.04). The frequency of preeclampsia in recent pregnancies in mothers with normal PAPP-A was significantly lower than other mothers (p < 0.001) and the frequency of abortions in recent pregnancies in mothers with PAPP-A less than 0.5 was significantly higher than mothers with normal or elevated PAPP-A (p < 0.001). Conclusion: Mothers with low PAPP-A levels are more likely to have poor pregnancy outcomes such as abortion, pre-term labor, and preeclampsia.

Comparative Study of the Effect of Vaginal use of Primrose Oil with Misoprostol on Cervical Preparation of Prim Gravid Women: A Double-blind Clinical Trial.

Background: This study compares the effect of vaginal administration of evening primrose oil with misoprostol on cervical preparation in prim gravid women at ≥40 weeks gestation. Materials and Methods: This was a double-blind randomized clinical trial conducted in Isfahan, Iran during 2019-2020 on 110 prim gravid pregnant women with a gestational age of 40 weeks and more and cephalic presentation of the fetus with the obstetrical indication for pregnancy termination. After obstetric examinations to rule out cephalo pelvic disproportion and calculation of the Bishop score by the researcher, patients were randomized to receive 25 µg misoprostol tablets (n = 55) or 1000 mg evening primrose oil Pearls (n = 55) administrated vaginally by a midwife. We compared Bishop's score before and after the intervention, time of cervical ripening, a dose of intervention for cervical ripening, need to induce labor, the interval between cervical preparation and induction of labor, duration of oxytocin use, need for cesarean section, and its cause, Apgar score at 5 and 10 minutes, neonatal birth weight. Results: Mean baseline Bishop Score was not significant between the groups (P = 0.45); after the intervention, it was significantly higher in the primrose oil group (P < .001). Significantly fewer patients required cesarean sections in the primrose oil group (P = 0.03). The other outcomes were. not significant between the groups (P > 0.05). Conclusion: Misoprostol and primrose oil administration appear to positively affect cervical readiness. Primrose oil resulted in significantly better Bishop Scores and fewer cesarean sections compared to misoprostol in pregnancy 40 weeks and more.

Comorbidity of Mitral Valve Stenosis with Influenza in Pregnancy, A Case Report.

In this case, a 44-year-old pregnant woman at a gestational age of 28 weeks and 6 days with symptoms of cold, shortness of breath, and cough since a week ago. She had received remdesivir ampoule, Tamiflu tablet, meropenem and linezolid, and dexamethasone. She received oxygen through a 14-liter reservoir bag mask and hydrocortisone, heparin, and ceftriaxone. Nine hours after hospitalization, the patient suffered a cardiorespiratory arrest, resuscitation was performed, and the patient was intubated. Emergency cesarean section was done in the intensive care unit. Finally, the patient suffered a cardiorespiratory arrest, prop was placed for the patient, and evidence of severe Mitral stenosis and right ventricle dilation were observed. The cardiopulmonary resuscitation operation continued for an hour, but unfortunately the patient died. So, it is important to be careful about influenza during pregnancy and in the case of heart failure symptoms, it is necessary to consider the presence of underlying mitral stenosis.

Wolff-Parkinson-White Syndrome and Peripartum Cardiomyopathy.

Wolff-Parkinson-White (WPW) is a rare congenital arrhythmia that could result in peripartum cardiomyopathy. This condition could be managed by medical treatments or ablation treatments. In this report, we presented a 14-year-old pregnant girl with initial signs of syncope and palpitation, who was later diagnosed with WPW-induced peripartum cardiomyopathy. The baby was successfully delivered at 32 weeks gestational age, and the patient received a beta-blocker as the main treatment strategy. We recommend that a proper cardiology and gynecology care is critical in providing the best prognosis.

Prophylactic hypogastric arterial ligation before cesarean hysterectomy for controlling complications in pregnant women with placenta adherent abnormality: A randomized controlled clinical trial.

Background: Placenta adherent abnormality (PAA) is abnormal attachment of the placenta to the myometrium. This abnormal placenta binding has severe clinical consequences for the mother and the fetus. We investigated the outcomes of hypogastric arterial ligation (HAL) before hysterectomy compared to hysterectomy alone in pregnant women with PAA. Materials and Methods: In this randomized controlled clinical trial, 70 patients were randomly allocated to HAL along with hysterectomy and hysterectomy alone groups (35 in each Group). The total amount of intraoperative blood loss, the need for intraoperative blood products transfusion, frequency of deep vein thrombosis, duration of surgery, duration of hospitalization, and visceral trauma were compared between 2 Groups. Results: Finally, 64 patients completed the study protocol with mean age of 33.84 ± 4.25 years. The study groups were comparable in terms of basic baseline demographic and clinical characteristics. Visceral trauma was less frequently occurred in HAL group compared to hysterectomy alone (0% vs. 15.6%; P = 0.02). Intraoperative blood loss (1525 ± 536.41 cc vs. 2075 ± 889.36 cc; P = 0.001) and were significantly lower in HAL group compared to hysterectomy alone. Duration of operation (179.06 ± 36.28 vs. 197.66 ± 39.47; P = 0.05) and hospitalization (4.97 ± 2.20 vs. 6.10 ± 2.39; P = 0.03) also were significantly lower in HAL group. Conclusion: Our findings suggest that prophylactic HAL has a protective effect on the reduction of blood loss and less visceral trauma in pregnant women with PAA.

Identifying and Responding to the Sexual Reproductive Health Needs of Women with Heart Disease: A Qualitative Study.

Background: Recognizing the needs of women with heart disease in the field of reproductive health and meeting them can reduce the related complications. The aim of this study was to identify the sexual and reproductive health needs of these women. Materials and Methods: The present study was conducted with qualitative approach (Content analysis). Ten married women of reproductive age with heart disease and 20 providers and managers in, Isfahan, Iran, were selected by using purposive and snowball methods (in 2020). The research setting included heart disease clinics, offices of health team, comprehensive health centers, and the Isfahan Maternal Health Department. Data were collected by semi-structured individual face-to-face interviews in the clinic or other appropriate locations. Some interviews were conducted virtually. Analysis was performed by Qualitative contentment analysis / Conventional content analysis. Results: Sexual and reproductive health needs of women with heart disease were emerged in five main categories, "planned childbearing," "ssociocultural support," "Early reproductive health care of girls," "health team attention to sexual health," and "health system revision." Conclusions: Providing comprehensive reproductive health services before and during pregnancy, family planning, and sexual health for women with heart disease is necessary. It seems that using a multidisciplinary team approach could improve their reproductive health.

Outcomes of supra coronary aortic repair technique in patients with acute aortic dissection type A.

BACKGROUND: Acute aortic dissection type A (AADA) is a fatal event that requires an emergent surgical operation. Here, we decided to evaluate the outcome of supra coronary aortic repair technique in patients with type A acute aortic dissection for 16 years in Isfahan Chamran hospital that one surgeon performed. METHODS: This is a retrospective descriptive cross-sectional study performed in 2019 in Isfahan on documents of 54 patients who underwent supra-coronary repair surgery for type A aortic dissection during 2004 to 2019. We collected patient's demographic information, the condition of patient's vital signs at the time of admission to the hospital and before surgery, the cardiopulmonary bypass (CPB) time and other variables. We also collected data regarding patient's mortality and possible surgical complications. RESULTS: Evaluation of surgical complications showed that acute renal failure (ARF) was the most common complication (87%) followed by postoperative bleeding in ICU that required surgical operation (18.5%), neurologic complications (13%), acute respiratory distress syndrome (ARDS) (9.3%) and chronic renal failure (CRF) (1.9%). The mortality rate was 14.8% (8 patients). The most frequent reason for mortality was bleeding (50%), major neurologic complications (37.5%), multiple organ failure (25%), cardiac failure (12.5%) and CRF (12.5%). Patients with mortality had significantly higher age compared to other patients (P = 0.03), significantly higher duration of CPB use (P = 0.03), higher frequency of irregular peripheral pulses (P = 0.01), higher frequency of abnormal carotid pulses (P = 0.04), and higher bleeding volume in the ICU (P = 0.04). CONCLUSION: Age, disturbed preoperative clinical condition, postoperative bleeding, and organ failure could increase the rates of mortality of AADA.

Evaluation of the Efficacy and Complications of Uterine Artery Embolization in Comparison with Laparotomy-Myomectomy in the Treatment of Uterine Myomas: A Randomized Clinical Trial.

Background: Due to the high prevalence of uterine fibroids or leiomyomas in women of reproductive age and the many treatment options for myomas, finding the best treatment is a challenge for surgeons. Therefore, this study aimed at evaluating the efficacy and safety of 2 treatment options surgical interventions and uterine artery embolization (UAE) in patients with uterine myoma. Methods: The present study was a single-blind randomized clinical trial. The study population included all women with uterine myoma. Hence, 80 patients were divided into 2 groups of 40. The first group underwent laparotomy-myomectomy and the second underwent UAE. These patients were evaluated for clinical symptoms, menstrual disorders, estimated blood loss per menstrual cycle, and pain and complication on the 10th day, and at 2, 6, and 12 months after the intervention. The data were analyzed with SPSS software (Version 25) using an independent samples t test, a repeated measure analysis, and a chi-square test. Results: Ten days, 2, 6, and 12 months after the intervention, there was no significant difference between the 2 approaches in terms of their decreasing effects on per menstrual cycle blood loss (p > 0.05), respectively. After 10 days and 2 months, the pain intensity in the embolization group was higher than laparotomy group (p = 0.045, 0.060), respectively. The pain intensity was also not significantly different between the 2 groups after 6 months and 1 year (p > 0.05), respectively. Also, the frequency of fever was higher in the embolization group (p = 0.745). However, the documented post-procedural complications indicated that hemoglobin level declined post-operation (p > 0.050). Conclusion: The results showed no significant difference between the 2 groups in terms of post-procedural mensuration blood loss or pain intensity and the incidence of menstrual disorders within 1 year. It seems that there is no significant difference between the 2 groups and it may be possible to use the UAE depending on the patient's condition.

Comparative study of transcutaneous electrical nerve stimulation, the aromatherapy of Lavandula and physiologic delivery without medication on the neonatal and maternal outcome of patients.

OBJECTIVES: The complications of normal vaginal delivery (NVD) are one of the issues that researchers have been discussing today and various ways to reduce these outcomes have been presented. In this study, we aimed to compare the effect of Transcutaneous Electrical Nerve Stimulation (TENS), the aromatherapy of Lavandula and physiologic delivery without medication on NVD outcomes. METHODS: This randomized clinical trial was conducted on 150 women that were candidates of NVD. The information related had been registered in the Iranian clinical trial registration system with the code IRCT20210501051151N1 (https://www.irct.ir/trial/56014). Patients were divided into three groups of Lavandula, TENS, and physiologic delivery. Postpartum pain, maternal and neonatal outcomes, and labor duration were compared in groups. RESULTS: Labor pain was significantly less in TENS and Lavandula than in the physiologic group, respectively (P<0.001). There was no significant difference between the groups in terms of labor duration and maternal and fetal outcomes. CONCLUSION: The use of TENS and Lavandula aromatherapy are useful methods for reducing pain in patients undergoing NVD, but using TENS method is better than Lavandula method, and on the other hand, there are no differences between groups as maternal and neonatal complications.

Evaluation of The Effect of Letrozole in the Ovarian Hyperstimulation Syndrome Prevention in Participants at Risk of Treatment with Ovulation-Stimulating Drugs:A Randomized Controlled Trial.

Background: This study aims to evaluate the effect of Letrozole (LE) in reducing ovarian hyperstimulation syndrome (OHSS) in high-risk participants with polycystic ovary syndrome (PCOS) treated with In vitro fertilization (IVF). Methods: This study was a randomized clinical trial in which participants were randomly divided into two groups (n= 25 per group). Based on GnRH-antagonist protocol, recombinant follicle-stimulating hormone 150 units/day subcutaneously and human menopausal gonadotropin 75 units/ day intramuscularly used from day 2 of the menstrual cycle. In the study group, Letrozole 5 mg daily was added simultaneously with gonadotropin during the first five days of the IVF cycle and in the control group placebo was added. Results: There were statistically significant differences among the groups in terms of Estradiol level on Trigger Day (p= 0.04). The total days of stimulation and cumulative Gonadotropin dose were significantly lower in the Letrozole group (p= 0.00). There were no significant differences between the groups in terms of the number of oocytes retrieved, numbers of implanted embryos, and clinical pregnancy rates (p-value> 0.05). There was only one moderate case in the intervention group and 9 moderate symptoms in the control group (p= 0.04). Discussion: Administration of Letrozole with GnRH antagonist protocol, conventional protocol in PCOS cases in IVF cycle, had a significant effect on reducing the incidence of OHSS. So, if the future studies prove LE co-administration may lessen the incidence of OHSS, LE will be a highly potent drug for preventing OHSS in PCOS cases.

A reproductive and sexual health promotion program for women with heart diseases: A protocol for mixed methods study.

BACKGROUND: Nowadays, for various reasons, the prevalence of heart diseases has increased in women during reproductive age. These diseases can lead to serious reproductive and sexual-related complications in the affected women. This study will conduct to develop a reproductive health promotion program for women with heart diseases. MATERIALS AND METHODS: This is an exploratory sequential mixed methods study that will be conducted in four phases. The first phase is a qualitative research that is done using content analysis method and semi-structured individual interviews. The experiences of women with heart disease and health providers' team in educational hospitals, health centers, and private offices of physicians about reproductive health need will be explored. Purposive sampling will be continued until data saturation is reached and the conventional content analysis method will be used. In the second phase, the studies published from 2000 to 2020 will be reviewed by the matrix method and then will be analyzed by using thematic analysis. Integrating the results of these two stages, the draft of the program will be designed. In the third phase, the validation of the program will be checked by using the two-round modified Delphi method. In the fourth phase, the program will be implemented by the health system and its process will be monitored. CONCLUSION: A life cycle reproductive health program for women with heart disease can help improve their preconception health, fertility planning, and sexual health and promote the well-being of these women in the long run.