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Objective Obstructive sleep apnea (OSA) is a risk factor for adverse pregnancy outcomes. The aim of this study was to evaluate the association between OSA and preeclampsia. Methods Between 30 and 39 weeks gestation, objective sleep apnea were evaluated in 38 normal pregnant and 40 preeclamptic women. Preeclampsia was defined by having a blood pressure (BP) > 140/90 mmHg on two occasions after the 20th week of pregnancy with excess protein in the urine (> 300 mg in 24 h) or 30 mg persistent proteinuria (+ 1 in dipsticks) in random samples. Objective sleep apnea was evaluated using an overnight in-hospital sleep evaluation using the SOMNOwatch plus Respiratory Screener. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5, and further grouped into severity categories: mild (5-14.9), moderate (15-29.9), and severe (≥ 30). Results Mean AHI was 33.3 ± 12.1 in preeclamptic women and was 23.8 ± 15.8 in normal pregnant women (p = 0.008). There was significant difference in prevalence of OSA severity (none, mild, moderate, or severe) between groups. Out of 33 preeclamptic women, 11 women had moderate and 22 women had severe OSA. Whereas, among 33 normal pregnant women, 8, 13, and10 women had mild, moderate, and severe OSA, respectively. Two normal pregnant women had no OSA (AHI Conclusion Our study suggests women are susceptible to developing OSA during pregnancy that is associated with an increased risk of preeclampsia.

Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015), 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups as follows: oral misoprostol (n=28), vaginal misoprostol (n=30), and sublingual misoprostol (n=27). Misoprostol was administered orally (oral misoprostol group), vaginally (vaginal misoprostol group), or sublingually (sublingual misoprostol group). The dosage was similar in three groups (400 micrograms every four hours up to a maximum of five doses). The mothers were followed and induction-abortion interval time, number of dosages required, and misoprostol side effects were documented. The data were analyzed by SPSS version 20.0 software. Results: The mean (standard deviation) age of the sample was 28.27 (±4.97) years. Mean gestational age was 16.58 weeks and mean gravidity was 1.99. Mean number of administered misoprostol doses was 3.89 and most patients responded to three doses of misoprostol. Mean abortion time was 20.08 hours. No side effects were reported in 60% of the subjects. Others experienced side effects such as nausea (16.5%), fever and chills (12.9%), and vaginal bleeding (9.4%). The abortion duration in 35.3% of the subjects was within 18 hours. The most successful method was oral route (82.1%), followed by vaginal route (80%), and sublingual route (70.4%). The abortion duration was statistically different between the three groups (P= 0.001). Conclusion: Finding of the presented study showed that misoprostol is a safe medication to be used for medical abortion in the second trimester of pregnancy. Oral route of administration was superior to vaginal or rectal use of misoprostol.

Up to 25% of ovulating women suffer from primary dysmenorrhea, a condition associated with pain and transient-reduced quality of life, along with greater irritability and impaired sleep. In the present study, we asked whether and if so to what extent melatonin and meloxicam can improve subjective and objective sleep and reduce pain among women with primary dysmenorrhea (PD). To this end, we conducted a double-blind cross-over clinical trial lasting for three menstrual cycles. A total of 14 women (mean age M = 27.5 years) with primary dysmenorrhea took part in the study. At baseline, that is, during the first menstruation, they completed a visual analogue scale to rate pain; sleep continuity was assessed via actigraphs, and overall sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Next, participants were randomly assigned to one of two conditions, either melatonin during the second, and meloxicam during the third menstruation, or meloxicam during the second, and melatonin during the third menstruation. Neither participants nor investigators were aware of participants' study assignment. During the second and third menstruations, the assessments described above were repeated. At baseline, sleep assessed both objectively and subjectively was impaired, and pain was high. Subjective sleep improved and pain decreased during the second and third menstruations irrespective of whether melatonin or meloxicam was administered first or second. Likewise, objective sleep efficiency increased and objective sleep latency shortened. The efficacy of melatonin was superior to that of meloxicam. The present pattern of results suggests that both melatonin and meloxicam are suitable to treat pain and PD-related sleep complaints among women with primary dysmenorrhea.

Introduction Prenatal exposure to maternal anxiety and inappropriate levels of glucocorticoids may influence intrauterine growth and affect later health outcomes. We examined the relationship between maternal anxiety, maternal serum, and fetal cord blood cortisol. Methods Eighty-four pregnant women with gestational age above 37 weeks admitted for elective caesarian section were studied. The Spielberger State–Trait Anxiety Inventory was used to assess maternal anxiety. Maternal blood was sampled immediately before caesarean section. Cord blood sample was taken immediately after birth. Multiple regression analysis was performed. Results Maternal trait anxiety score, maternal serum cortisol, and neonatal weight were associated with the fetal cord blood cortisol (r = 0.21, P = 0.04). Bivariate correlation analysis revealed a positive correlation between maternal trait anxiety and fetal cord blood cortisol (r = 0.21, P = 0.03). Conclusions These data suggested that high maternal trait anxiety increases fetus cord blood cortisol and may regulate fetal growth.

Background: Placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to evaluate the relationship between repeated cesarean deliveries and sub- sequent development of placenta previa. Methods & Materials: This cross-sectional study was held in Imam Reza Hospital Kermanshah-Iran during 2008-2011. This study included all pregnant women with repeated cesarean sections while nullipara and patients with placenta previa without previous surgery were excluded. Diagnosis was made on ultrasound and at surgery. Results: among 2696 Women, 98 cases had P.P (3.63%). The mean age was 30 years, 76.5% (75 cases) had gravidity 2 and 3 and 87.8% (86 cases) had parity 1 - 3. Anterior location of placenta was 44.9% while posterior was 55.1%. 48% were complete P.P, 32.7% low lying P.P, 13.3% marginal P.P, and 6% Partial P.P. 26.5% of patients had history of abortion. 55.1% of patients had male fetus. There was an increase in frequency of placenta previa with just one previous C-section (74.5%). Fre- quency of accreta P.P 32% (n = 7), increta (14.3%, n = 3) and percreta 28% (n = 6). Among those who underwent emergency hysterectomy (21 cases) 23.8% cases had no abnormal placentation. 30.6% of newborns had birth weight < 2500 g. Conclusion: we concluded that patients with history of one pervious cesarean delivery had more Placenta previa and need to hysterectomy were more than those with history of 2 and 3 previous cesarean delivery. The most common type of abnormal placentation was accreta, percreta and increta respectively. *

Introduction: Critical Thinking Disposition indicates individual’s inclination to Critical Thinking, which is one of the domains of personality. Individual characteristics are important and influential factors in the growth and development of students’ Critical Thinking. One of these influential characteristics might be self-esteem, thus this study was to determine the correlation between Critical Thinking Disposition and self-esteem in medical students. Methods: In an analytical cross-sectional study, 289 medical students were selected through stratified random sampling method in Kermanshah University of Medical Sciences in 2011. The instrument for data collection was a questionnaire containing 3 parts: demographic data, California Critical Thinking Disposition Inventory, and Cooper-Smith Self-Esteem Inventory. The results were analyzed by SPSS-16 using descriptive statistics, Pearson and Spearman Correlation Coefficient, ANOVA, Chi-Square and Fisher exact test. Results: Results showed that 98.6% (285) of students had deficiency, 1.4% (4) ambivalence and nobody had positive critical thinking disposition. There was a significantly negative correlation between Critical Thinking Disposition and self-esteem (r=-0.462, P

Objective: Manual removal of placenta is performed in 1–3% of cases, and although it is a well-established and relatively safe procedure, it is not without complications. We carried out this study to determine whether intraumbilical vein oxytocin injection reduces the need for manual removal of placenta and shortens the third stage of labor, in comparison with placebo. Materials and Methods: In this randomized clinical trial, 178 women with singleton pregnancy and normal delivery were studied in 1 year. Immediately after fetus delivery, oxytocin infusion (20 IU/L) was started in both groups. Moreover, 10 IU oxytocin and 1 mL normal saline were injected into the umbilical vein of women in the experimental and control groups, respectively. The duration of third-stage labor, need for manual delivery of placenta, and drug side effects were evaluated in both groups. With regard to the mean level of hemoglobin before and after delivery, the two groups were compared using the Levene test and independent t test, and other qualitative variables of the two groups were compared using the χ2 test. Results: The women who received intraumbilical vein oxytocin had a shorter third stage of labor as compared with the placebo group (4.24 ± 3.27 min vs. 10.66 ± 7.41) (p

Introduction: Critical thinking as a process of purposeful self-regulatory judgment leads to problem solving and correct decision making in individuals. In the modern world, health care faces rapid change and burgeoning amount of knowledge. Possessing critical thinking is essential for individuals in health care centers, specially when they are forced to solve clinical problems. The aim of this study was to evaluate critical thinking disposition among medical students in various levels of education.Methods: In this descriptive, cross-sectional study, we determined critical thinking disposition among 289 medical students of Kermanshah University of Medical Sciences. The students were studying at different levels of general physician education. In Iran general physician education divided into four levels; basic sciences, physiopathology courses, clerkship and internship. They were selected using stratified sampling. Data were collected using a questionnaire that consisted of two parts; demographic information of the participants and California Critical Thinking Disposition. To analysis the data, both descriptive and inferential statistics (One-way ANOVA) were employed using SPSS-16 software.Results: Our findings indicated that 98.6% of the students lacked critical thinking disposition, 1.4% were ambivalent disposition and no one had positive disposition to critical thinking. The highest acquired score of critical thinking was for truth-seeking (20.4%) and the lowest score acquired for analyticity (4.8%). The results revealed that there was no statistically significant difference between mean score of participants with regards to their critical thinking disposition in various educational levels. Conclusion: The findings of this study indicated that medical students lacked appropriate critical thinking disposition.

Background: Due to increase in pregnancy complications in advanced age, this study was conducted to assess the relationship between advanced maternal age and the pregnancy complications.Methods: Pregnant women who admitted to the Motazedi hospital in Kermanshah were included in this analytic–cross sectional study. The study group was 1178 cases that divided into two sub-groups; 35-40 year-old (914) and over 40 years old (264); and 2038 subjects of 20-25 year-old recruited as control group. Data such as maternal age, maternal and neonatal complications were extracted from hospital recorded profiles and analyzed using Chi-square, Fisher and ANOVA statistical tests. Results: The results showed that in case groups (35-40 and over 40 year-old): eclampsia (3.7%, 2.27%), gestational diabetes (1.8%, 4.2%), placenta previa (1.1%, 1.5%), placenta abruption (1.8%, 4.2%) were higher than the control group (0.28%, 0.5%, 0.2% and 1%) respectively. Fetal and neonatal outcomes such as intrauterine fetal death (9.6%, 14%), macrosomia (4%, 1.9%), Apgar score

This report describes a 74 year old woman with urinary symptoms progressing to complete anuria with dense labial adhesions.This condition is mostly reported in pediatric age group but few reports addressed this condition in postmenopause.

Prenatal exposure to maternal anxiety and inappropriate levels of glucocorticoids may influence intrauterine growth and affect later health outcomes. We examined the relationship between maternal anxiety, maternal serum, and fetal cord blood cortisol.Eighty-four pregnant women with gestational age above 37 weeks admitted for elective caesarian section were studied. The Spielberger State-Trait Anxiety Inventory was used to assess maternal anxiety. Maternal blood was sampled immediately before caesarean section. Cord blood sample was taken immediately after birth. Multiple regression analysis was performed.Maternal trait anxiety score, maternal serum cortisol, and neonatal weight were associated with the fetal cord blood cortisol (r = 0.21, P = 0.04). Bivariate correlation analysis revealed a positive correlation between maternal trait anxiety and fetal cord blood cortisol (r = 0.21, P = 0.03).These data suggested that high maternal trait anxiety increases fetus cord blood cortisol and may regulate fetal growth.

Introduction Thyroid function is known to be affected during pregnancy. Risk of depression is particularly high for women during the prenatal period. Objective Various investigators have attempted to establish a link between thyroid function and post partum depression. While the pathogenesis of postpartum mood disturbances remains unclear. Aims This study aimed to investigate whether thyroid function differs in women with postpartum depression compared to a control group. Methods In this case-control study, Forty eight patients suffering from postpartum depression according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition totally revised (DSM-IV-TR), and 65 normal controls underwent diagnostic evaluation using Structured Clinical Interview for DSM-IV-TR. Then the Persian version of Edinburgh Postnatal Depression Scale (EPDS) was completed by the participants. Finally, their thyroid functions were assessed. Data analyses were done using the SPSS program 13. Results No statistically significant differences were observed between thyroid function tests and postpartum depression. According to multiple regression analysis with stepwise method, subjects with lower serum TSH, T3RU and T3 levels tended to have higher EPDS scores (P-value=0.008). Conclusion The present study reports that those women with postpartum depression had a no greater prevalence of thyroid dysfunction than the control subjects. It seems that thyroid dysfunction should be considered in women with postpartum depression individually, but the role of thyroid as an important cause of this condition is not yet established. This suggests that future studies should concentrate on this concept in postpartum depression.