Background: Labor pain is a severe pain, and intrathecal opioid injection is one of the analgesia methods to reduce it. Objectives: We assessed the effects of intrathecal Fentanyl and Sufentanil on the onset, duration, and quality of analgesia for labor analgesia. Methods: In this double-blind, randomized clinical trial, 54 healthy nulliparous women 18 - 45 years in the active phase of labor who were requesting labor analgesia were enrolled in two groups fentanyl (F) and sufentanil (S). Patients received 75 µg fentanyl or 7.5 µg sufentanil intrathecally in the fentanyl group (n = 27) and the sufentanil group (n = 27), respectively. Pain relief, onset, duration of analgesia, hemodynamic parameters, patients' satisfaction, and neonatal Apgar score were assessed in this study. Data were analyzed by using SPSS16. Results: There were no significant differences between the groups in terms of demographic and hemodynamic parameters. The onset time of analgesia was 5.6 ± 4.3 and 3.6 ± 2.1 minutes, in the sufentanil and fentanyl groups, respectively (P = 0.037). The duration of analgesia was higher in patients who received sufentanil than those who received fentanyl (113 ± 45 vs. 103 ± 22 minutes (P = 0.629)). The pain score in the Fentanyl group was significantly lower at 5, 10, and 15 minutes after spinal analgesia (P < 0.05). The sedation score at 1 and 5 minutes was significantly higher in the fentanyl group than the sufentanil group (P < 0.05). The frequency and severity of pruritus and satisfaction rate in the fentanyl group were significantly higher than the sufentanil group. Conclusions: Intrathecal fentanyl and sufentanil have a similar analgesic effect on labor. Fentanyl is associated with a faster onset of analgesia and more satisfaction, while sufentanil has longer analgesia.
Introduction: Missed abortion is one type of abortions in which the product of a pregnancy is dead and does not leave the cervix, despite a long period of time. Missed abortion requires urgent action due to serious maternal complications. The purpose of this study was to investigate and compare the effects of using misoprostol on the treatment of missed abortions by two different methods. Methods: In this retrospective study, 100 women with missed abortions at the pregnancy age of 4-6 weeks, who had been referred to Fatemieh Hospital of Hamadan and were candidates for termination of pregnancy, were randomly allocated into two equal groups. In the first group, 600 µg of misoprostol was administered sublingually, and in the second group, 600 µg of misoprostol was given vaginally. The treatment was repeated for both groups at intervals of 6 hours (3 times). Then, the patients were assessed at the 3 rd , 6 th and 12 th hours after treatment for onset of bleeding and success of treatment (as well as abortion, with sonography). Data were analyzed by SPSS software version 16 with 95% confidence interval. Results: In this study, the percentage of complete abortion in women receiving vaginal and sublingual misoprostol was 90% and 96%, respectively (p>0.05). The mean (±SD) of misoprostol use was 1164 (±467.02) and 924 (±367.87) µg, respectively (P=0.004). The mean (±SD) time interval between the use of the first tablet and the incidence of bleeding in women receiving misoprostol by sublingual and vaginal methods were 5.64 (±1.85) and 7.47 (±2.72) hours, respectively. Also, the time until the complete abortion for those receiving the sublingual and vaginal method was 7.10 (±1.90) and 9.38 (±2.53) hours, respectively (P<0.001). Conclusion: In women with a missed abortion, prescribing 600 µg of misoprostol by sublingual method caused a bleeding event of shorter duration than the vaginal method, and complete abortion was achieved with a higher success rate.
Introduction: One of the concerns of painless deliveries is the safety of neonates. This clinical trial study aimed to compare the effects of epidural and spinal anesthesia on the mortality rate of neonates. Methods: This clinical trial was conducted in Hamadan Hospital in Iran. Ninety women, ages 18 to 45, were randomly assigned to receive epidural or subdural anesthesia. Using a checklist, the following were collected: demographic information, midwifery, hemodynamic status, mothers' pain intensity, and analyses of the baby's umbilical cord blood. The data were analyzed by SPSS version 16 for statistical analysis. Twenty-two of the patients with spinal anesthesia and epidural anesthesia were excluded from the study. Results: There was no significant difference between the two groups in terms of age, gestational age, parity, and severity of pain before or after anesthesia. The hemodynamic status of the mothers before and during the first postoperative period was in the normal range, except that in the spinal group, a decrease in systolic blood pressure was observed in normal range compared with the epidural anesthesia group. In blood gas analysis, the mean pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3) did not show significant differences between the two groups (p > 0.05). The only complications were acidosis and epidural anesthesia. Conclusion: Based on the findings of the present study, both spinal and epidural opioids have no adverse effects on the health of neonates. However, both spinal and epidural opioid are preferred due to fewer changes in the hemodynamic changes in mothers and in umbilical cord blood gas.
Background and Objective:Gestational diabetes is a health problem and is one of the most commonly occurring complications of pregnancy worldwide, which has many effects on the mother and the fetus. The present study was conducted to determine the prevalence of gestational diabetes and its risk factors in Hamadan city, Iran. Materials and Methods:In this cross-sectional study, the study population was 534 pregnant women who were referred to control pregnancy to Hamadan health center from April 2014 to December 2016. Results: The study participants were 534 with the age range of 15-42 years old with an average age of 26.8 and a standard deviation of 5.56. The gestational age was 4 to 29 weeks with an average of 8.32 weeks with a standard deviation of 2.68. Of the 534 participants in this study, 211 (39.5%) had gestational diabetes and there was a significant relationship between factors such as macrosomia and history of impaired glucose tolerance with the prevalence of gestational diabetes. Conclusion: Gestational diabetes has a relatively high prevalence in Hamadan, further information is needed in this area as well as studies based on new guidelines in different parts of the country.
Background and Objective: Infertility and its treatment are among the most important challenges in the field of gynecology. This study aimed to compare two methods of administration of GnRH agonists and GnRH antagonists on the occurrence of pregnancy. Materials and Methods: This randomized controlled clinical trial included 84 infertile couples with male factor infertility problems referred to Fatemieh Hospital, Hamadan, Iran. They were randomly assigned into two groups of 42 cases. The first group was treated with GnRH agonist (Bucereline), and GnRH antagonists (Cetrotide) was administered to the second group. The two groups were compared with each other regarding the incidence of pregnancy, number of oocytes obtained, the mean days of induction, the number of fertilized oocytes, the incidence of Ovarian Hyperstimulation Syndrome (OHSS), and treatment costs. Results: The findings showed that the rates of clinical pregnancy were 19 (45.23%) and 7 cases (16.67%) in the agonist and antagonist groups, respectively. Moreover, there was a significant difference between the groups in this regard (P<0.009). Furthermore, the number of fertilized oocytes in the agonist group was significantly higher than that in the antagonist group (P<0.004). In addition, the mean induction days in the antagonist group was significantly lower, compared to another group (P<0.001). There was no significant difference between the two groups regarding the incidence of OHSS syndrome and the overall cost of treatment. Conclusion: According to the results, the efficacy of agonist drugs was much better than that of the antagonist medications in terms of the occurrence of pregnancy. However, no significant difference was observed between the groups regarding the complications.
Introduction: One of the remaining challenges in assisted reproductive procedures, especially in vitro fertilization (IVF), is proper embryo transfer. The aim of this clinical trial was to compare IVFembryo transfer outcome by two types of soft embryo transfer catheters in Hamadan Endometrics and Endometriosis Research Center (Iran). Methods: In this clinical trial study, 100 patients who were candidates for IVF were evaluated. Patients were randomly assigned into two groups (A=50 and B=50). The IVF was identical for both groups until the embryo transfer stage. For group A, soft catheter CH3 PM TRANS SET MINI was used and in group B, KITAZATO soft catheter was used for embryo transfer. All transfers were performed by one person. Patients were recruited using checklists, demographic information, infertility history, beta-human chorionic gonadotropin (ß-hCG) serum levels at day 14 post-transfer, and pregnancy bag 28 days after transfer. The results were analyzed by SPSS software version 16 and using descriptive statistics, chi-square and t-test. The significance level was < 0.05. Results: The mean age of group A and group B was 30.12 and 29.24 years, respectively (p=0.341). The mean duration of infertility in both groups was not statistically significant, and in groups A and B were 4.89 and 4 years, respectively. Ninety % of group A experienced their first IVF experience, while in group B it was slightly lower than 86%, which was not statistically significant. The mean number of eggs obtained in group A was 9.84 and in the group B was 9.88 (p=0.962). The mean number of embryos formed in group A was 6.24 and in group B was 5.72 (p=0.405). There was no statistically significant difference between the two groups in using of Tenaculum, the quality of transmission, and the contamination of the catheter head into the blood or mucus. Conclusion: According to the findings of the present study, the use of KITAZATO catheter compared to PM TRANS SET MINI CH3 catheter for fetal transfer in IVF patients showed no significant difference in pregnancy success rate. However, patients who received the KITAZATO catheter had a slightly higher chance of pregnancy that could be clinically valuable.
Background and aims: Endometrial thickness (ET) is one of the main parameters in the success of assisted reproductive technology (ART) methods, which is influenced by sex steroids. This study investigated the effect of vaginal estrogen cream on ET in women undergoing embryo transfer. Methods: In this clinical trial, 100 infertile women candidates for embryo-fetal transfusion were enrolled in the study by a simple sampling method and then randomly divided into two treatment groups. For patients in group A, estradiol tablets were administered alone (control) and group B received the estradiol plus vaginal estrogen cream (intervention). The thickness of the endometrium was measured by ultrasound in both groups and recorded in the checklist. The rate of positive bHCG, pregnancy, and canceled cycles was evaluated in both groups as well. Finally, the data were analyzed using SPSS software. Results: Both groups were matched in terms of age (P=0.129). There was no significant difference between the groups regarding ET (P=0.651) and bHCG frequency (P=0.418) and the pregnancy rate was similar in two groups. Based on the results, the frequency of the canceled cycles was 32% and 50% in intervention and control groups (P=0.031).Eventually, no significant relationship was observed between pregnancy outcome (0.637) and the bHCG (0.553) test with ET. Conclusion: Overall, the administration of vaginal estrogen cream has no effect on ET and pregnancy rate in women under embryo transfer by applying the long protocol method in patients who referred to endometrium and endometriosis research center but it significantly reduces the eliminated cycles
Background: The pain of childbirth is the most severe pain that a woman experiences. This study aimed to compare the effect of epidural bolus and epidural continuous infusion of lidocaine %1 on pain and progress of vaginal delivery and motor function in labor epidural analgesia. Methods: This randomized clinical trial was conducted on 50 pregnant women aged between 18-45 years. They were randomly assigned into two groups of bolus injections of lidocaine1% and continuous infusion using an epidural approach. The evaluated variables included systolic and diastolic blood pressures, mean arterial pressure, pain score, heart rate, satisfaction rate, nausea, vomiting, itching, the progress of delivery, and the level of motor and sensory block. The collected data were analyzed in SPSS software (Version 21). P-value less than 0.05 was considered statistically significant. Results: Two groups were similar in age. There were no significant differences between two groups in terms of mean diastolic blood pressure, incidence of hypotension and C/S rate (P> 0.005). Mean arterial pressure, sedation score and neonatal Apgar scores in the first and fifth minutes in the continuous group were significantly lower than the bolus group. Pain score (VAS) in the bolus group) 2.55±1.04 (was significantly lower than infusion group (5.22±2.50). The length of the first and second stages of labor in the bolus group (42.28 and 34.12) was less than continuous infusion (47.04 and 47.00) (P< 0.005). Conclusion: In women undergoing epidural analgesia, epidural bolus injection of lidocaine 1% is associated with greater analgesia and satisfaction than continuous infusion.
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