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: 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.
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.
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