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Background&Objective: Using analgesic drugs such as non- steroidal anti-inflammatory drugs can control the pain after cesarean section. This is an experimental study to compare of efficacy of indometacin Suppository and Votaren ampoule on severity of pain, side effect ratio, and need to narcotic analgesic in-patient who had cesarean section delivery under spinal anesthesia. Materials&Methods: In this study, there were 100 pregnant patients that had selected cesarean section and had research conditions. These patients were selected by randomized method and divided in study group (indometacin) and control group (voltaren) that accomplished for 4 months. On the basis of patient's necessity and take of vital analog scale we profile of indometacin suppository in study group and voltaren Amp in control group. Pethedin ampoules were indicated if further necessity were objected. This research was prolonged with 24 hours after operation. Results: In the end after assembling and analyses of information we observed that indomethacin and voltaren both have positive effective on severity of pain after cesarean section (P<0.5), but in comparison with them the voltaren have better effectiveness than indometacin after 4 hours from first dose (p<0.05). There was no difference in two group in necessity by more sedative. But the side effects was lower in study group than control group (P<0.05). Conclusion: It is suggested that indometacin suppository is profile than voltaren in cesarean patients except in 4 hours after surgery.

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Background and Objective: Post dural puncture headache (PDPH) is a relatively common complication in spinal anesthesia. Several regimens had explained for treatment of this problem. The aim of this study was to determine the effect of intravenous single dose of Aminophylline (1.5mg/kg/body weight) on the incidence of PDPH in cesarean section under spinal anesthesia. Materials and Methods: In a double blind randomized trial study, 120 patients undergone spinal anesthesia for the elective cesarean section in Motahhari hospital of Marvdasht in Fars province in south of Iran during 2008. After umbilical cord clamping 1.5mg/kg/body weight of Aminophylline injected slowly and intravenously in 60 patients. In placebo group (n=60) normal saline injected intravenously. At the 1st, 4th, 24th and 48th hour after surgery, PDPH in patients were evaluated. Results: The incidence of PDPH was significantly lower in cases compared with controls during the first 24 hours post operation (5% vs. 31.7%, P<0.001). Incidence of PDPH in case and control groups after 48 hours was 5% and 23.3% respectively (P<0.004). Conclusion: This study revealed that the intravenous single dose of Aminophylline (1.5mg/kg/body weight) significantly reduced PDPH after spinal anesthesia in cesarean section.

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Background and Objective: Placenta previa (PP) is a common cause of pri-partum bleeding leading to high mortality and morbidity in mothers and neonates. This study was conducted to determine risk factors and outcomes of PP in Golestan province of Iran. Materials and Methods: This case-control study was done on pregnant women admitted for deliverly to the Dezyani hospital of Gorgan, Iran during 2002-07. All PP cases were recruited as case group and 251 non-PP ones were entered into the study as control group. Student t-test and Chi-Square test were used to assess the relationship between variables. Results: In this study out of 33473 pregnant cases, 82 women (0.24%) had PP. The mean (±SD) age of mothers with PP was 28.5 (±6.2) years. There was a significant correlation between PP and delivery method (P<0.05). History of cesarean section was significantly higher in cases than controls (P<0.05). The prevalence of hysterectomy due to PP was significantly higher in women with history of cesarean section (24%) than other ones (5%) (P<0.05). Conclusion: We found a significant relationship between history of cesarean section and hysterectomy due to PP. Therefore, PP should be considered in women with a history of cesarean section.

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Background and Objective: Hemodynamic alteration and hypotension due to spinal anesthesia can reduce tissue perfusion and increase ischemic risk, myocardial infraction, renal failures spinal damages and even deep veins thrombosis. This study was designed to compare pharmaceutical effects of ephedrine, atropine and mucosal phenilephrin on hemodynamic alteration of women during spinal anesthesia in cesarean section. Materials and Methods: This randomized clinical and double blind study was done on 90 singleton pregnant women with ASA I and II class .the subjects gone elective cesarean section and allocated into three groups. subjects were received 500 ml ringer lactate before spinal anesthesia. Subjects in group I, II and III first received 0.1 mg/kg atropine (IV) 0.01mg/kg ephedrine and 100µgr phenilephrin (mucosal) prior spinal anesthesia, respectively. Hemodaynamic indexes including blood pressure, heart Rate, oxygen saturation and drug side effects were determined every 5 minutes interval through the surgery. Data was analyzed by using SPSS-11.5, Chi-Square and ANOVA tests. Results: Hemodaynamic indexes were changed during study, but three medicine showed similar effect on heart Rate, blood pressure and changes of oxygen saturation (P<0.05). There was a significant differences among three groups for dosage of extra ephedrine to control of blood pressure (P<0.05). This increase dosage of extra ephedrine was 56.7%,20% and in ephedrine, phenilephrin and atropine groups,respectively. Nosia rate was 6.7%, 50% and 46.7% in phenilephrin, atropine and ephedrine groups, respectively (P<0.05). Conclusion: This study showed that to prevent of blood pressure drop following spinal anestasia atropine, phenilephrin and ephedrine can be prescribed, but ephedrine is recommended for lowering the rate of nosia.

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Background and Objective: Abdominal operations as gynaecological procedures result in gastrointestinal dysmotility. Early feeding and ambulation are nonpharmacologic interventions which can be useful in re-initiation of bowel function. This study was done to evaluate the effect of early oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women.

Materials and Methods: In this randomized clinical trial, 120 primiparous women undergone elective cesarean section were assigned to control and intervention groups in Hajar hospital, Shahrekord, Iran during 2007. In the interventional group, oral hydration with liquids was started 4 hours after surgery regardless of presence of bowel sounds and solid food was started after bowel sounds appeared. The control group recieved liquid diet 12 hours after the operation if it was tolerated, they were given soft diet and regular food at the next meal. The return of bowel activity, time of ambulating, satisfaction, discharge from the hospital and complications were compared in two groups. The data were analyzed using SPSS-15, Chi-Square, T and one way ANOVA tests.

Results: The mean postoperative time interval to first hearing of normal intestinal sounds in interventional versus control groups were (9.5±1.38 and 12.5±2.5 hours) the first passage of flatus (15.7±3.61 vs.22.4±4.1 hours), time to first sensation of bowel movement (10.8±1.99 versus 15.7±3.4 hours) and defecation (18.9±3.65 versus 23.4±4.85 hours). These differences were significant (P<0.05). Also discharge from the hospital (0.96±0.18 versus 1.1±34 days) were significantly shorter in interventional group (P<0.05). The women in the early feeding group got out of bed (patient mobilisation) earlier than their interventional group (14.1 hours versus 18.8 hours (P<0.05). Maternal satisfaction was significantly higher among the early fed women (P<0.05).

Conclusion: Early oral hydration after elective cesarean section associated with rapid resumption of intestinal motility and increased woman’s satisfaction.

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Background and Objective: The incidence of ectopic pregnancy is increasing due to artificial reproductive technology and increasing rate of sexual transmitted diseases. Ectopic pregnancy is the most common cause of maternal mortality in the first trimester and it reduces the chance of future successful pregnancy. Identifying the risk factors can help to reduce the maternal mortality and morbidity due to early diagnosis and on time treatment. This study was carried out to assess the risk factors in ectopic pregnancy in northern, Iran. Materials and Methods: This case control study was carreid out on 150 patients with ectopic pregnancy as cases and 300 women with normal pregnancy as controls. The subjects were selected from teaching hospital in Babol in northern Iran, during 2005-09. The risk factors include history of tuble surgery, ectopic pregnancy, cesarean section, pregnancy with IUD, infertility, assisted fertility with IUI, multiple partener, pre-eighteen years marriages were recorded for each subject by direct interview and file. Data were analyzed using SPSS-16 and Chi-Square and exat Fisher tests. Results: Theraputic assisted fertility with IUI (95% CI: 3.02-185.09, OR: 23.6, P<0.05), previous ectopic pregnancy (95% CI: 1.90-73.94, OR: 8.19, P<0.05) and cesarean section history (95% CI: 1.1-2.6, OR: 1.7, P<0.05) increased the possibility of ectopic pregnancy. There was not significant differnces between pre- eighteen years marriages, infertility history and multiple partener in cases compared to controls. Conclusion: This study showed that assisted fertility with IUI, previous tubal surgery, pregnancy with IUD, previous ectopic pregnancy and cesarean section are the main risk factors of ectopic pregnancy in northern, Iran.

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Pulmonary aspiration of gastric contents during the peri-operative period is rare but with significant morbidity and mortality. A 21 years old pregnant woman with preeclampsia was scheduled for an emergency cesarean section under spinal anesthesia. After 18 hours of operation, epilepticus status was occurred. One day after control of seizure, aspiration pneumonitis was diagnosed and treated with mechanical ventilation and positive end-expiratory pressure (PEEP). In patients with the history of loss, consciousness, complication of aspiration, aspiration pneumonia and pneumonitis particularly should be considerated. In case of onset of pneumonitis, PEEP treated procedure with other mechanical ventilation is recommaded.

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Background and Objective: Overweight, obesity and ethnicity are effective factors on pregnancy complications. This study was conducted to determine the relationship between third tri-mester body mass index (BMI) with maternal and neonatal complications. Methods: This descriptive analytic study was conducted on 551 pregnant women in third tri-mester with Fars, Sistani and Turkman ethnicities in Sayad Shirazi teaching hospital in Gorgan, north of Iran during 2012. BMI calculated at the time of labor admission and the subjects categorized into three groups of normal / underweight, overweight and obese. Results: The mean of maternal age among Fars, Sistani and Turkman ethnic groups were 26.5±5.5, 24.6±5.3 and 26.2±5.2 years, respectively. The mean of gestational age among Fars, Sistani and Turkman ethnic groups were 38.4±2.3, 38.6±2.3 and 37.4±3.2 weeks, respectively. A significant relationship was found between BMI and cesarean section and labor dystocia in Fars and Sistani ethnic groups, respectively (P<0.05), while no relationship was found between BMI and neonatal complications. Conclusion: Overweight and obesity in Fars ethnicity are at risk of cesarean section and those with Sistani ethnicity are at risk of labor dystocia.

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Background and Objective: Modification of life style, nutrional regiment and insulin therapy is used for improvement of pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). This study was done to evaluate the effect of the dietary approaches to stop hypertension (DASH) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus. Methods: In this clinical trial study, 52 women with GDM were randomly divided into DASH and control groups for 4 weeks. The control diet contained 45-55% carbohydrates, 15-20% protein and 25-30% total fat. The DASH was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg/day sodium. The numbers of women whom commenced insulin therapy after dietary intervention, the mode of delivery and prevalence of polyhydramnios were assessed. The length, weight and head circumference of infants were measured during the first 24 h after birth. Results: 46.2% of women in the DASH group needed to have a cesarean section, this rate for the control group was 80.8% (P<0.05). The percentage of those who needed to commence insulin therapy after intervention was 23% for DASH group vs 73% for controls (P<0.05). Infants born to mothers on the DASH group had significantly lower body weight (3222.7 vs 3818.8 g, P<0.05), head circumference (34.2 vs 35.1 cm, P<0.05) and ponderal index (2.50 vs 2.87 kg/m3, P<0.05) compared to those born to mothers on the control diet. Conclusion: Consumption of dietary approaches to stop hypertension for 4 weeks among pregnant women with GDM resulted in improved pregnancy outcomes.

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Background and Objective: Breast milk has significant benefits for both mothers and babies. Counseling is a beneficial method for the continuity of exclusive breastfeeding. Remote counseling methods are currently being developed. This study was conducted to determine the effects of telephone counseling on the continuity and duration of exclusive breastfeeding among mothers who have had a cesarean section.
Methods: In this clinical trial, 154 mothers who have had cesarean section delivery were randomly divided into an experimental and a control group. The intervention group received seven sessions of telephone counseling for 1-3 months postpartum in addition to the routine breastfeeding training program. The control group only received the routine breastfeeding training program.
Results: After 4 months postpartum, the average duration of exclusive breastfeeding in the intervention group (15.51±0.88 weeks) was longer than that in the control group (10.74±5.33 weeks) (P<0.05). At 3 months postpartum, exclusive breastfeeding in the intervention group was 10.45 times longer than in the control group (OR=10.455, CI=2.547-42.912, P<0.001).
Conclusion: Telephone counseling is effective in increasing the continuity and duration of exclusive breastfeeding in mothers who undergo a cesarean section.