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Objective: To evaluate the effect of pelvic floor muscle training (PFMT) or Kegel exercise with and without assistance by a resistance device (Kegelmaster device) on the urinary incontinence in women., Study Design: A randomized clinical trial was performed on 91 women with the complaint of urinary incontinence. In the assisted pelvic floor muscle training (APFMT) group (n=41), after complete training, Kegelmaster device were used twice daily for 15 min each session, for a total duration of 12 weeks. In the pelvic floor muscle training (PFMT) group (n=50) after complete training, kegel exercises were done (including perineal muscle contractions for 6-8s with 6s rest in between), twice daily for 15 min each session and for a total duration of 12 weeks. These two groups were then compared according to the scores of special questionnaires for quality of life, strength of pelvic floor muscles, capability to participate in social activities, severity of urinary incontinence, and the number of involuntary urine passage, taken before, and after 1 and 3 months after finishing interventions., Results: 85 women out of 91 women finished the study (46 in the PFMT group and 39 in the APFMT group). Strength of pelvic floor muscles, capability to participate in social activities, score of quality of life according to three world questionnaires of IQOL (incontinence Quality Of Life), IIQ (Incontinence Impact Questionnaire), UDI (Urogenital Distress Inventory), showed no difference between the two groups 1 and 3 months after interventions. Pair t test showed a significant improvement in both groups 1 and 3 months after intervention, according to IQOL score (P=0.000), UDI score (P=0.000), IIQ score (P=0.000), strength of pelvic floor muscles, (P=0.000), capability to participate in social activities (P=0.000), severity of urinary incontinence (P=0.000) and the number of involuntary urine passage (P=0.000)., Conclusion: Pelvic floor muscle training with or without Kegelmaster show no apparent difference to each other, however, these two methods are effective for improvement of urinary incontinence in women., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate the rate of poor pregnancy outcome among nulliparas who had microalbuminuria at the end of the second trimester of their pregnancy., Methods: A prospective cohort study was performed on 490 nulliparous women who were at the end of the second trimester of pregnancy. Urine tests for albuminuria and creatinine measurements were performed in all women and the albumin to creatinine ratio (ACR) was calculated. The women with microalbuminuria (exposed group) and those without microalbuminuria (nonexposed group) were monitored until the end of their pregnancy and compared for pregnancy outcome., Results: Preterm labor (57.9% versus 13.5%), preeclampsia (50.0% versus 8.6%), intrauterine growth restriction (42.1% versus 6.4%), and preterm premature rupture of membranes (31.6% versus 10.2%) were significantly more common in the exposed group. The rates of gestational diabetes did not differ significantly between the 2 groups. In multivariate logistic regression analyses, microalbuminuria increased the risks for preterm labor (adjusted OR 2.4; 95% CI 1.1-5.5, P=0.03) and preeclampsia (adjusted OR 9.5; 95% CI 4.6-19.3, P<0.001)., Conclusion: Microalbuminuria at the end of the second trimester of pregnancy might increase the risks of preterm labor, preeclampsia, intrauterine growth restriction, and preterm premature rupture of membranes., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To compare the effectiveness and adverse effects of nifedipine versus indomethacin in the treatment of preterm labor., Methods: In a randomized clinical trial, 79 women with labor pain at 26-33 weeks of gestation were treated with either oral nifedipine (n=40) or rectal indomethacin (n=39)., Results: Twenty-three (59%) women in the indomethacin group, and 10 (25%) in the nifedipine group did not respond to treatment (P=0.002). None of the 16 and 30 women remaining in the indomethacin and nifedipine groups, respectively, delivered during the subsequent 48 hours. Of these remaining women, 1 (6.25%) in the indomethacin group and 4 (13.3%) in the nifedipine group delivered between 48 hours and 7 days (P=0.162). For the women who responded to treatment, the mean gestational age at time of delivery was 238.5±19.4 days and 246.4±15.4 days in the nifedipine and indomethacin groups, respectively (P=0.182). Seventeen (42.5%) women in the nifedipine group, and 11 (28.2%) in the indomethacin group showed adverse effects (P=0.184)., Conclusion: Indomethacin was less effective than nifedipine for the fast treatment of preterm labor. For women who responded to treatment within 2 hours, however, the delaying of delivery by indomethacin was similar to that by nifedipine., (Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: The Endometriosis Health Profile-30 (EHP-30) is a disease-specific questionnaire to measure the health-related quality of life in patients with endometriosis. The aim of this study was to evaluate the validity and reliability of the Persian version of Endometriosis Health Profile (EHP-30) in women with endometriosis referring to three Gynecology Clinics in Tehran, Iran., Methods: One hundred women (20 to 50 years old) with surgically confirmed endometriosis recruited from three outpatient Gynecology Clinics affiliated to the Iran University of Medical Sciences. All 100 patients were asked to complete EHP-30 questionnaire while referring to the Clinics. The findings were analyzed using descriptive statistics, internal reliability consistency, construct validity (using short form-36, which had already been validated in Iran), factor analysis (with principle component analysis method), and item total correlation to assess the validity and reliability of the questionnaire., Results: The internal consistency reliability of the questionnaire was high (Cronbach's α ranged between 0.80 and 0.93 for core, and 0.78 and 0.90 for modular parts). All items were loaded on their own factors except item 17 (feeling aggressive or violent) and item 18 (feeling unwell), which were loaded on pain and social support domains, respectively. Construct validity of EHP-30, established by using SF-36, indicates good correlations in several similar scales of these two questionnaires., Conclusion: The findings of the study demonstrate that Persian version of EHP-30 is a valid and reliable measure to assess the quality of life in women with endometriosis.

Objective: To evaluate the effect of continuous support provided by midwives during labor on the duration of the different stages of labor and the rate of cesarean delivery., Method: A randomized trial of 100 eligible nulliparous women who had not received education classes on childbirth. In the intervention group (n=50), continuous support during labor was provided; the control group (n=50) did not receive continuous support., Results: The two groups did not differ by age, employment, educational level, gestational age, economic status, and neonatal weight. Mean duration of the active phase of labor (167.9+/-76.3 vs 247.7+/-101 min, P<0.001), second stage of labor (34.9+/-25.4 vs 55.3+/-33.7 min, P=0.003), and the number of cesarean deliveries (4 vs 12, P=0.026) were significantly lower in the intervention group compared with the control group. The rates of oxytocin use and Apgar scores of less than 7 at 5 minutes were similar between the two groups., Conclusion: Continuous support provided by midwives during labor may reduce the duration of labor and the number of cesarean deliveries; this model of support should be available to all women., (Copyright 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: Oral contraceptive pills (OCPs) are one of the most effective reversible and accessible contraceptives, and patient acceptance for their use depends partly on the unfavorable adverse effects. The present study compared the two kinds of OCPs (monophasic; levonorgestrel (LNG)-ethinyl estradiol (EE) 150/30 versus triphasic; LNG-EE 50-75-125/30-40-30) for adverse effects and patient satisfaction., Study Design: A randomized clinical trial was performed on 314 women who used OCPs for the first time, as their contraception, for 6 months. Overall, 1884 cycles were studied. In the monophasic group (n=159 who finally finished the study), monophasic pills LNG-EE 150/30mcg, and in the triphasic group (n=155 who finally finished the study), triphasic pills LNG-EE 50-75-125/30-40-30 mcg were used. Statistical analysis was performed using SPSS 10: Chi square test, Fisher exact test and Student's t-test were used., Results: There were no significant differences between the two groups for common side effects, including nausea, headache, nervousness, facial hyperpigmentation (chloasma), and body weight (increase or decrease) but breakthrough bleeding and spotting (BTB/S) were less in the triphasic group, occurring in 30 cycles (18.86%) versus 10 cycles (6.45%), P=0.009*. Patient satisfaction for the two OCPs was similar and high. The rates of side effects were low., Conclusion: It seems that the monophasic and triphasic pills are similar according to patient satisfaction and side effects; therefore there is no benefit of one over the other except for BTB/S, for which triphasic is superior., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Postpartum haemorrhage is one of the most important causes of maternal death., Objectives: To evaluate the effect of active management of the third stage of labour on the amount of blood loss in the third and fourth stages of labour, and the duration of the third stage of labour., Methods: A randomised controlled trial was completed on 200 women who gave birth at a maternity unit in Iran. In the intervention group (n=100), 10IU of oxytocin was injected intramuscularly into the mother following birth of the anterior shoulder of the baby. After clamping and cutting the umbilical cord, the uterus was pushed upwards and posterior, while the cord was pulled down with constant and intermittent traction until the placenta was delivered. In the control group (n=100), on observing signs of placental separation, the placenta was expulsed by maternal force. In both groups of women, blood loss was measured at birth using collecting devices, and drapes and sheets were weighed to estimate blood loss., Findings: Mean blood loss during the third stage of labour was 216.93+/-165.16 ml and 232.12+/-150.35 ml in the intervention and control groups, respectively; the difference was not significant (p=0.49). In contrast, mean blood loss during the fourth stage of labour differed significantly (422.62+/-324.7 ml and 327.27+/-255.99 ml in the intervention and control groups, respectively; p=0.02). The mean duration of the third stage of labour was less in the intervention group than in the control group (4.69+/-5.51 mins and 6.34+/-5.03 mins; p=0.028)., Conclusions: Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour., (Copyright 2008 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the pregnancy outcome in pregnancies with threatened abortion (miscarriage)., Material and Method: A prospective cohort study was performed on 1000 pregnant women. 500 women (case group), had a history of vaginal bleeding during the first half of pregnancy and the other 500 women (control group), did not have this history. Both groups of women were monitored from 20 weeks of pregnancy up to delivery., Results: The women of the 2 groups did not have any significant differences according to age, parity or body mass index (BMI). Spontaneous preterm delivery [126 cases (25.2%) vs. 47 cases (9.4%), P=0.001, adj RR=1.4, CI 95%=1.2-1.5], PROM [51 cases (10.2%) vs. 24 cases (4.8%), P=0.02, adj RR=2.1, CI95%=1.2-2.3], placental abruption [20 cases (4%) vs. 7 cases (1.4%) P=0.01, adj RR=1.1, CI 95%=1.01-1.2], were more in the case group. There were no differences between the 2 groups with regard to Preeclampsia, small for gestational age (SGA), and cesarean deliveries. Neonatal weight (in term pregnancies) in the case group was lower than in the control group (3046.4+/-560.8 g vs. 3317.6+/-432 g, P=0.001). There was a significant relationship between the number of bleeding episodes, spontaneous preterm delivery and placental abruption and there was also a significant relationship between the amount of bleeding and placental abruption., Conclusion: Threatened abortion increases the rate of spontaneous preterm delivery, PROM and placental abruption, and decreases the neonatal weight. Therefore threatened abortion indicates a high risk pregnancy and, as such, demands more serious prenatal care., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Objective: To evaluate some of the risk factors of complete molar pregnancy., Study Design: A case-control study was performed on 91 cases of complete molar pregnancy (case group) and 295 cases of normal, term pregnancy with a live neonate (control group). Then the maternal age, parity and gravidity, blood group and Rh, history of molar pregnancy, consanguinity, history of spontaneous abortion, contraception method and nationality (Afghan or Iranian) were compared in the 2 groups., Results: History of molar pregnancy (OR [odds ratio], 95% CI 5.7 [1.2-25.61), spontaneous abortion (OR, 95% CI 2.1 [1.7-2.61), maternal age > 35 years old (OR, 95% CI 2.3 [1.3-3.9]) and < 20 years old (OR, 95% CI 1.6 [1.4-1.9]), consanguinity (OR, 95% CI 1.3 [1.1-1.51) and Iranian nationality (OR, 95% CI 1.9 [(1.5-2.4]) were found to be risk factors for molar pregnancy., Conclusion: History of molar pregnancy and spontaneous abortion, maternal age > 35 and < 20, consanguinity and nationality may be risk factors for molar pregnancy.

Introduction. The reduction of the duration and pain of the active phase of labor is a very important issue and therefore always under serious investigation. Objective. The purpose of the present study is to evaluate the effect of acupressure at the Sanyinjiao point (SP6) on the duration and pain of the active phase of labor in nulliparas women. Method. A single blind randomized clinical trial was performed on 120 eligible nulliparas women who were at the beginning of active phase of labor (3-4 cm dilatation of cervix plus proper uterine contractions). The women were randomly assigned into two groups. The case group (n = 60), received acupressure at Sanyinjiao point (above the ankle), for 30 min during contractions. In the control group (n = 60), simply a touch at this point without massage was performed. Two hours later a second pelvic examination was performed and in the absence of good forceful contractions oxytocin in the classical form was infused. Finally, duration of active phase, severity of pain (using the Visual Analogue Scale), the amount of necessary oxytocin and necessity to administer oxytocin and the route of delivery were compared between the two groups and statistical analyses were performed using SPSS 15. Results. The mean duration of active phase was shorter in the case group (252.37 +/- 108.50 min vs. 441.38 +/- 155.88, p = 0.0001). Six patients (10%) in the case group and 25 patients (41.7%) in the control group delivered via cesarean section (p = 0.0001). The severity of pain in the case group was less than the control group (5.87 +/- 1.77 vs. 6.79 +/- 1.52, p = 0.003). Twenty-five women (41.7%) in the case group and 38 women (63.3%) in the control group needed oxytocin (p = 0.017) The amount of necessary oxytocin in the case group was less than the control group (73.33 +/- 97.19 ml vs. 126.6 +/- 97.19 ml, p = 0.003). Conclusion. Acupressure at Sanyinjiao point (SP6) reduced the duration and severity of pain of the active phase of labor, cesarean section rates, and necessity and amount of oxytocin.

Objectives: To evaluate the relationship between high maternal weight and the duration of different stages of labor, delivery rout, and neonatal weight and Apgar score., Methods: A comparative prospective study was performed on 240 eligible women, who were divided into two groups. The control group (n = 120), whose their pre-pregnancy or first trimester weight were normal with body mass index (BMI) between 19.8 and 26 kg/m(2), and the case group (n = 120), whose pre-pregnancy or first trimester weight were high, with BMI between 26 and 30 kg/m(2). The progress of labor and delivery in these two groups were followed and the duration of different stages of labor, delivery rout, and neonatal weight and Apgar score were compared between these two groups., Results: The mean BMI in the case and control group were 28.34 ± 2.02 and 22.03 ± 3.83, respectively (P = 0.001). There were no statistically significant differences between the two groups according to the duration of first, second, and third stages of labor and delivery rout and neonatal Apgar score, but the neonatal weight was higher in the case group (3670.8 ± 456.4 g vs. 3511.7 ± 452.7 g, P = 0.007, t = 2.71). With maternal weight gain during pregnancy of more than 12 kg, the duration of the first stage of labor was statistically higher in the case group (235.9 ± 105.3 min vs. 167.2 ± 75.6 min, P = 0.011, t = 2.64). Oxytocin was used for augmentation of labor more, in the case group [43 women (64.2%) vs. 36 women (44.4%), P = 0.017, X(2) = 5.74]., Conclusion: High maternal weight does not have impact on the duration of labor and delivery rout, but can increase neonatal weight and necessity for oxytocin, during labor., (© 2008 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.)

Objective: To evaluate the effect of dexamethasone administration on labor duration., Method: In this controlled trial 122 nulliparous women with a full-term pregnancy and a Bishop score of 7 or greater were randomly assigned to receive a single 8-mg dose of dexamethasone or placebo 6 hours before initiation of labor induction., Results: The interval between initiation of labor induction and beginning of the active phase of labor was shorter in the dexamethasone than in the control group (3.09+/-1.5 hours vs. 4.21+/-1.8 hours; P=0.001). The duration of the second stage of labor was also shorter in the dexamethasone group (22.23+/-16.09 minutes vs. 29.01+/-15.32 minutes; P=0.014)., Conclusion: The administration of dexamethasone was found to shorten labor duration.

Introduction: Gestational diabetes mellitus (GDM) is the most common metabolic disorder that occurs during pregnancy. Knowing the risk factors for GDM is thus particularly important., Objective: To evaluate the relationship between GDM and a history of polycystic ovarian syndrome (PCOS)., Methods: A case-control study was conducted involving 188 pregnant women. Ninety-four cases had GDM based on an impaired glucose tolerance test (GTT) and the other 94 cases (control group) were pregnant women without GDM. The subjects in each group were questioned regarding a history of PCOS (i.e., a history of oligomenorrhea and hyperandrogenism) and then their health documentation's were reviewed and those women whose documentation's were complete (sonologic and hormonal evidences for PCOS) entered the study. The relationship between GDM and a history of PCOS was then evaluated., Results: The women with GDM had a history of PCOS more often than the control group of women (15 cases of PCOS in GDM group vs. 6 cases of PCOS in the control group, P=0.03), but regarding body mass index, a history of PCOS were not shown to have a significant relationship with GDM. Regarding the number of pregnancies, a history of PCOS had a significant relationship with GDM (P=0.05)., Conclusions: GDM has a relationship with a history of PCOS, therefore in women with a history of PCOS, the risk of GDM should be considered.

Aim: To compare the effect of extra-amniotic normal saline solution infusion on its own, and in combination with dexamethasone on the ripening of the cervix and induction of labor., Methods: A double-blind randomized clinical trial study was performed at Akbar Abadi Teaching Hospital in Tehran, Iran, between March 2002 and March 2003 on 84 pregnant women at a gestational age of 40 weeks or more, and with a Bishop score

Aim: To evaluate the efficacy of sweeping of fetal membranes for induction of labor in uncomplicated term pregnancies., Methods: A randomized controlled trial was performed in 122 pregnant women beyond 39 weeks of gestation with no complications. The women were assigned to have their membranes swept or not (controls) for labor induction. The main outcome measures included duration of pregnancy and possible complications of sweeping of membranes, including rupture of membranes, postpartum infections, and vaginal bleeding., Results: Twenty-one patients did not give birth in our hospital and were, therefore, excluded from the study; 101 women completed the study (51 patients in the control group and 50 women in the study group). There were no statistically significant differences in maternal age, parity, birth weight, and Bishop score in the two groups. The mean interval between sweeping (stripping) and vaginal examination until delivery was 7.7 +/- (SD) 6.9 and 7.1 +/- 5.6 days in the sweeping and in the control group, respectively (p = 0.61). Of the 101 pregnant women, only 6 patients had premature rupture of membranes (2 in the sweeping group and 4 in the control group). There were no statistically significant differences between these individuals (p = 0.68). Significant vaginal bleeding was not observed in the two groups. Meconium-stained amniotic fluid was seen in 13 women: 8 in the sweeping group and 5 in the control group. There were no statistically significant differences among the women who had meconium-stained fluid in case and control groups (p = 0.39). There were no differences between women who had puerperal fever (3 in the sweeping group and 2 in the control group; p = 0.68). 12 of the 101 women (6 in each group) had cesarean section performed, but there was no difference between the two groups., Conclusion: Sweeping of membranes at 39 weeks of gestation has no significant clinical effect on the duration of pregnancy., (2006 S. Karger AG, Basel)

The purpose of this study was to investigate the effect of applied relaxation training on reducing anxiety and perceived stress among pregnant women. A randomized controlled trial with a prospective pretest-posttest experimental design was used. One hundred ten primigravid women (mean age = 23.8 years) in their second trimester (mean of gestational age = 17.8 weeks) were randomly assigned into experimental and control groups. The experimental group received routine prenatal care with applied relaxation training, and the control group received only routine prenatal care. State/trait anxiety was measured with the Spielberger State-Trait Anxiety Inventory, and perceived stress was measured with the Cohen Perceived Stress Scale. There were significant reductions in state/trait anxiety and perceived stress for the experimental group compared with the control group after the intervention. The findings suggest beneficial effects of relaxation on reducing anxiety and perceived stress in pregnant women. Teaching relaxation techniques could serve as a resource for improving maternal psychological health.