Iranian Journal of Obstetrics, Gynecology and Infertility
Year:2003 | Volume:6 | Issue:2|Papers Count:19

Objective: Evaluation of frequency of complications of hysteroscopy in patients admitted in Hazrat Rasoul Hospital during 2001 Materials and Methods: In a prospective cross-sectional study all patients admitted in Hazrat Rasoul hospital for hysteroscopy were evaluated for complications one month after hysteroscopy. Results: 253 cases were included during study time. 64 cases of hysteroscopy were operative and the remaining 189 cases were diagnostic. There were 4 cases of complications. Three of these cases had perforation of the uterus. All of them had operative hysteroscopy (p<0.001), and all complications occurred in non menopause patients (p<0.001). One of these was operated for AUB (Abnormal Uterus Bleeding) and two cases for secondary infertility. Another complication was a case of hematuria after submucosal myomectomy with hysteroscopy. There were no electrolyte imbalances or severe hemorrhages. Conclusion: According to findings of this and some studies occurring with complications of hysteroscopy success depends highly upon the type of hysteroscopy (diagnostic or operative), duration of hysteroscopy, and the surgeon’s technique.

Objective: This study was carried out to compare the effect of HCG and magnesium sulfate (mgso4) in prevention of preterm labor. Materials & Methods: The study group included 101 woman at 22-35 weeks of gestation with intact membranes and cervical dilatation less than 4cm in preterm labor in referrals of Obstetric- Clinic in the city of Khoram Abad during the year 2001-2003. The cases and control groups were treated with HCG protocol of the dosage consisting of one single dose of HCG 5000 1v and 10000 units of HCG in 500 dextrose as a drio of 20 drops per minute, and magnesium sulfute (Rotin dose) respectively and treated until preterm labor (PTL) arrested. Complication were. Recorded: On condition of successful cease of labor, the patients were discharged and followed up to the time of delivery. Results: Both groups were similar to each other regarding maternal age, pariety, and gestational age. Mean delay of labor was 22.68 days after administranion of HCG and 24.27 days for (mgso4) that was non-significant. The number of newborns that were admitted to NICU was 9 (18%) for HCG and mgso4. In addition, mean weight at labor was 2334gr and 2287gr for HCG and mgso4. The complaint rate was 100% and 0% for magnesium sulfate and HCG groups respectively (P<0.0001). Conclusion: Since both drugs are alike regarding their effects on birth time weight and delay of labor and in addition HCG exhibits without fetal side effects. So it is recommended to be used in prevention of preterm labor replacome of magso4.

Objective: DVT is a common vascular disease among females due to more prevalence of risk factors such as obesity, immobility and specifically pregnancy and administration of oral contraceptives. Because of its complications such as pulmonary emboli with potential high risk condition and post thrombotic syndrome, leading to prolonged relative disability and recurrence of disease and some other personal and social problems for treatment, it necessitates study of risk factors and clinical features of these patients. Materials and methods: Present study was perfomed cross-sectionally on 133 female patients with clinical and paraclinically approved DVT admitted from March 2001 to Aug of 2003 in Imam-Reza Hospital. The information gathered by a check list was analyzed with SPSS and MINITAB softwares. Result and conclusions: Among 133 patients with DVT, from 11 to 88 years old, long lasting immobility and then OC administration were the top two risk factors, There were two dominant age groups of less than 40 and more than 65 years old that in the first group, using OC and then immobility; and in second one immobility and then malignancy were the most common risk factors of DVT. Remarkablv all patients using OC had DVT in their left foot.

Objective: Gestational trophoblastic disease (GTD) is a rare disorder which affects the human placenta. GTD includes a wide kind of histological features such as hydatiform mole, invasive mole, choriocarcinoma and placental site tumor. Evaluation of BhCG is a sensitive and accessible method in the treatment and follow up of these patients. Most of these cases are treated with suction curettage. The disease may be progressive or persistent in some cases (persistent mole) even though there is no metastasis. These paitents may be affected to choriocarcinoma if any treatment is done. Proliferation neoplasic of trophoblasts will be supressed with suitable chemotherapy in these cases, so they may have normal and natural fertility, and be healty after the treatment. This study aims to evalute the persistent mole prevalence in GTD cases in the Gynecologic Tumor Clinic of Ghaem Hospital from 1991 to 2003. Materials & Methods: This is a descriptive cross sectional study on 250 GTD cases in Tumor Clinic of Ghaem Hospital from 1991 to 2003. Some information, blood group, gestational age, GTD, type, surgical treatment, chemotherapy regime and rate of cure of the patients were acquired from patients files, and they were analysed and processed with SPSS software after coding by the researcher. Results: 197 patients among 250 GTD cases had Hydatid form moles while 37.5% of them (75 patients) underwent chemotherapy because of persistent mole. Average age was 25.6 years in persistent mole cases 59.5% of them were 21-30 years old, their blood group was ORh+ in 44.6%, and GTD diagnosis was obtained in 9-12 weeks of gestational age in 43.9%. Management of persistent mole cases included: MTX in 63 cases (86.3%), ACT-D in 2 cases (2.7%), BEP in one case (1.4%) and EMA CO in 5 cases (6.8%). Hysterectomy was done in only 4 cases (6.3%) because of resistance to MTX. In the follow-up of 56 cases the cure rate was 100% Conclusion: We can prevent mole progression to choriocarcinoma with early diagnosis and suitable treatment.

Objective: To compare the prenatal outcome in women with preeclampsia in previous pregnancy to those in women who developed preeclampsia as nulliparas. Materials & methods: In this study we evaluated the adverse perinatal outcome in women with preeclampsia in a previous pregnancy (n=39) and nulliparous women (n=310). Evaluation variable parameter was as follows: preterm delivery, placenta abruption, IUGR and perinatal death. Results: We found that preeclampsia is more severe in nulliparous group and has more complications compared with women with recurrent preeclampsia. In summary the results that we found are as follow: fetal growth restriction was 30.6% in nulliparous group versus 20.5% in recurrent group. (P=0.22). Preterm labor was 54.1% in nulliparous group versus 30.8% in recurrent group. (P=0.012). abruption placenta was 13.5% in nulliparous group versus 5.1% in recurrent group. (P=0.15). Fetal death was 24% in nulliparous group versus 10% in recurrent group (P= 0.012). Conclusion: Compared to preeclampsia in previous pregnancy, nulliparous women with preeclampsia had siginificantly higher rates of adverse perinatal outcome.

Objective: In various conditions laparotomy is replaced by laparoscopy and for it primitive pneumoperitoneum is necessary. It is possible to use verse needle or tracer for primary arrival. Multiple blind stages is needed for arrival by verse needle but for direct tracer these stages are deleted. In attention to recent reports arriving by tracer could not increase the major complications but could increase the minor complications in comparison to verse needle arriving. This study tries to compare complications of traccer and verse needle pathways. Methods & Materials: This prospective interventional study is performed by a randomized concurrent control clinical trial. Sample size is estimated by Altman’s monogram. That is equal to 240 cases of the patients admitted to Rasool Hospital who were going to have laparoscopic procedure. Results: In our two groups age had no statistical significance difference. In these groups major complications did not occur. Minor complications that occur include intestinal serial injury, uterus serial injury, proportional insufflations and inability to arrive. There was no significant difference between two groups in occurrence of each of the minor complications. But of all the minor complications together, there is a significant difference between two groups (P value=0.003). In our two groups there are no statistically significant difference between prevalence of complications by history of laparoscopy and BMI. Discussion: It was noted in this study that attention to principles of surgery and anatomy can prevent us from major complications. About minor complications: In tracer laparoscopy there are more complications than laparoscopy by verse needle. Age did not have a role in the occurrence of complications.

Objective: Determination of Symphysio-Fundal height according to gestational age in 18-34 week pregnant women in the city of Hamadan. Materials & Methods: Three rural and 9 urban health-care centers and 3 private obstetrics and gynecology offices in the city of Hamadan were randomly selected for sampling. Thirty women for each week of pregnancy (2 samples from each center) were included in the study. Gestational age was determined by last menstrual period. Symphysio- Fundal height measurement was similarly done in all cases. Gathered data was summarized and presented as percentiles. Results: Fifty-percentile Symphysio-Fundal height size in cm was nearly the same as gestational age in weeks. Means of weekly increase of median Symphysio-Fundal height was one centimeter. It was not significantly different in women according to parity or body mass index. 2.5 percentile uterine height size in 18-27 weeks of pregnancy was 5.5 cm and 28-34 weeks, 10 cm less than gestational age. Conclusion: Pregnant women with Symphysio – Fundal height difference was more than 5.5 centimeters in comparison to gestational  age in 18-27 weeks and more than 10 cetimeters in 28-34 weeks should be evaluated regarding intrauterine growth retardation.

Objective: Pap smear has been done by health services since 1991 in Iran. Unfortunately detection of abnormal smear is very low although this cancer was the 9th cause of death in four counties in 1999. The goal of this research is determination the cause of low quality Pap smear in Hamadan County. Materials & Methods: We choose 1224 smears from the total smears that had been evaluated by cytologists. All smears were reevaluted with a pathologist and she answered the questions: was smear prepared correctly? Was smear evaluated carefully? Then results were analyzed with SPSS. Results: Problems were classified in 3 groups. The first were related to smear’s collector (11.7%). 43.7% were related to loss of endocervical cells- 34.7% related to low cellularity- 28.8% related to coverage with inflammatory cells and 4.2% related to poor fixation. The second problem were related to preparing smears by cytologist (74.5%), including coloring, sticking lamella to lame. 47.5% of smears were poorly prepared and of no value 30.1% related to unfavorable stick, 14.2% to wrong coloring, 2.7% related to put the lamella over lame. The third problem was related to the quality of evaluation. There was 96.6% agreement between cytologist and pathologist. Conclusion: This research demonstrated that the first cause of low quality was preparation by the cytologist (74.5%), next refers to collector (11.7%). But the high quality of evaluation (96.6%) was questionable because many smears were deleted from analysis with low quality.

Objective: In this study the main goal is evalution of the results of immediate postpartum insertion of intrauterine devices with and without additional filament. Materials & Methods: This study is a prospective experimental study that has been done for evaluation of the complication of immediately postpartum insertion of IUD in Zeynab hospital during 2002- 2003. Regarding to previous similar studies 80 pregnant women who had been admitted at Zeynab Labour Ward, were considered for this study. These women had full-term pregnancies and had tendency to have contraception immediately, The women were excluded from the study if they were involved with prolonged labour, chorioamnionitis, PROM, preterm labor, bleeding before delivery, anemia, multiple gestation or delivery with devices. After acquiring the consent of the patiens, immediate postpartum insertion of IUD was done in 80 patients. Then they were randomly divided into two groups. In 40 cases (group A), IUDs were inserted without additional filaments, and in 40 other cases (group B) IUD were inserted with additional filament. Follow up was done in the first month, third month and sixth month after insertion. The complications were compared in-two groups. Statistical tests such as Chi-square and t- test were used for informational analysis. Results: In the first month after insertion, the incidence of missing string in group A (without additional filament) significantly was more than the group B (with additional filament) (P=0.023). In the first month the incidence of abnormal bleeding, infection, expulsion, pelvic pain, servilities and uterine sub involution did not have significant difference between the two groups (P>0.05). In the third month after IUD insertion the incidence of missing string in group A (without additional filament) was more than the group B (with additional filament). (P=0.014). Besides the incidence of IUD exertion in third month was significantly high in group A (without additional filament). (Because incidence of missing strings was high). In the sixth month incidence of complication did not show significant difference between the two groups. Conclusion: It is concluded that immediate postpartum insertion of IUD with additional filament is an effective method for holding IUD string in the best situation and finally prevention of missing strings of IUD. This method dose not increase complications in comparison to IUD  insertion without additional filament.

Objective: Congenital anomalies are one of the causes of neonatal morality. Tese anomalies are one of important health problems all over the world. This study asscessed the incidence of congenital anomalies and the relationship between these anomalies and personal, family- social factors in newborns were delivered in the maternity Hospital of Golestan province in 2000. Materials & Methods: The population of this descriptive- analytic, retrospective and case- control study is of live newborns.(healty and abnormal) delivered in 6 maternity hospital of Golestan University of Medical Sciences located in 6 different cities of this province 70 neonates with a congenital anomaly aer case group and 140 healtly neonates are control group. All of them were examined by a pediatrician and their examinations reported in their ward sheets/files. The newborns were selected by a random method. Data were collected by face to fase interviewing through questionnaire filled according to mother-newborn ward sheet Then data were analyzed by means of fissure, t-student and x2 tests. Results: Incidence of newborn congenital anomalies was 1.2%. Cardiovascular anomalies (1.4%) were located at the bottom of the list, and musculoskeletal anomalies (38.6%) were located to the top of list. There was significant statistical difference (P<0.01) in newborns. Congenital anomalies with any newborn’s personal factors such as (birth weight, Gestational age, apgar score, type of delivery and fetal presentation) were noted. This study revealed that congenital anomalies were more common in newborns of mothers aged over 35 years old in first pregnancy and mothers with 4th or greater parities. There were significant and direct correlations between congenital anomalies with a prior history of abortion, oligohdroamnios and polyhydroamnios in pregnancy, on ship consanqunity marriage, taking birth control pills along with duration of its and history of any emotional and psychological stresses during pregnancy (P<0.001). There was also a significant relation between age of hausband at the time of mother’s pregnancy, family history of anomaly, occupation and monthly outcome of husband with newborn’s congenital anomalies (P<0.01). Conclusion: Congenital anomalies of newborns have a relation with personal factors of mother and newborn and with familial- socialfactors. There was significant difference between case group and control group (P=0.001). Therefore newborns delivered by high risk mother should be evaluated for anomalies immediately after birth. Pregnant women who are at risk should be visited frequently and have regular prenatal cares.

Objective: Abnormal uterine bleeding is one of the major complaints in women. This study was performed to compare the results of endometrial biopsy by dilatation and curettage versus curettage by Novak curette. Methods and materials: A comparative study was conducted in the Obstetrics & Gynecology Ward of the Taleghani Hospital in the year of 2000 to 2001. We performed endometrial biopsy by Novak curette versus dilation and curettage in 105 cases of abnormal uterine bleeding including 75 cases in reproductive years and 30 postmenopausal women. Result: Accuracy and sensitivity of endometrial biopsy by Novak curette is 97% and 97% respectively. Conclusion: We can ascertain that ambulatory technique can be replaced by D&C; and it dose not need anesthesia and it has less cost.

Objective: Many different plants produce compounds that may mimic or interact with estrogen hormones in animals which are referred to as phytoestrogens. Materials and Methods: The two groups of phytoestrogens are the lignans and the isoflavones. Phytoestrogens differ remarkably from synthetic estrogens in that they are easily broken down, are not stored in tissue, and spend very little time in the body. All in all, there are differing opinions about phytoestrogens role in health. When consumed as part of an ordinary diet, phytoestrogens are probably safe and beneficial. Phytoestrogens through their effects on endocrine system could be a theraputic option for menopause and osteoporosis. Studies on cancer incidences in different countries suggest that phytoestrogens have antioxidant activity and can influence intracellular enzymes, protein synthesis, growth factor action, and cell proliferation which help protect against certain cancers (breast, uterus and prostate) in humans, in a way that makes them strong candidates for a role as natural cancer-protective compounds. More extensive studies are needed to confirm the phytoestrogens safety in different fields and determinig the kind and dose of related phytoestrogenic substance in each case. Besides the type and dose of phytoestrogen used, other factors such as duration of use, age, gender, genetic difference and general medical condition of the individual are determinants of positive effect of phytoestrogens.

Objective: Hepatitis B virus (HBV) infection is a global public health problem; HBV infects 1.5 to 2.5 percent of the general population in Iran. Current therapies do not cause sustained response in all patients, so prevention is the most effective strategy for the disease control. Perinatal infection is one of the predominant modes of transmission in developing countries including Iran, and also associated with high chronicity rate of infection in neonates. Maternal-infant transmission occurs mostly at birth, but it occurs transplacentally during pregnancy in 5 to 10 percent of cases. The risk of maternal-fetal transmission is related to gestational age, HBV replication status and viral load of the mother. Although at present maternal screening and neonatal passive-active immunization was proved to be the most effective method for prevention of vertical transmission, it is not effective in 5 to 10 percent of cases. Recently, viral load lowering and early immunity modulation of fetus methods were described. In the present article, we will point to some of these modalities such as third trimesrter Lamivudine therapy, HBIG administration and in-utero DNA vaccination.

Introduction: Nipple soreness is one reason that mothers wean their infants from breast milk. In this study we examined the effectiveness of lanolin on alleviating sore nipples. Materials and Methods: One hundred forty seven breastfeeding women were randomly assigned to one of two groups, application of lanolin on nipple (Lanolin group n=74) and no treatment (control group n=73). All women received education about breastfeeding technique. Patients were seen for a maximum of 3 follows up visits within 7 days for resolution of symptoms. The data were analyzed by SPSS version 11.5, Statistical was done by chi-square, Fisher exact, Mann Whitny tests and Mean Rank. P value <0.05 was considered statistically significant. Results: Although both groups received instruction in breastfeeding technique, longer improvement was seen in the group using lanolin for resolution of soreness and repair of wound (p=0.023, and p=0.028 respectively). Conclusion: Because of cost effective, side effect, nipple trauma second to frequent spreading of lanolin on each breast and the use of cream on nipple may introduce pathogens that cause mastitis, and it is not advised for sore nipples.